Find the state-wise list of network hospitals for APOLLO MUNICH.
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About Apollo Munich Health Insurance:
Apollo has always been associated with quality healthcare in the country, approved by international accreditation bodies and global healthcare experts. Apollo Hospitals in collaboration with Munich Health has grown to be a world leader in the health insurance sector. The company, previously referred to as Apollo DKV Insurance Company Limited was renamed as Apollo Munich Health Insurance Company Limited. Initially, it started off as a joint venture between Apollo Group of Hospitals and Europe’s largest private health insurer, Deutsche Krankenversicherung AG or DKV, formed on 8th August, 2007. In December, 2009 Apollo DKV was renamed, however, it continued to offer innovative health insurance products. Interested customers can avail a health insurance from Apollo Munich either through their website, over a call, or by visiting any of their sales offices. The company has over 50 offices making in-house sales of health insurance plans.
Apollo Munich offers the following health insurance plans:
Apollo Munich Optima Restore Individual: It is a unique health insurance plan that reinstates the basic sum insured in case it is exhausted in a policy year, automatically. This simply means that if your coverage is used up in an individual policy and then fall ill again with another illness, the entire sum assured is restored by Apollo Munich, without any charge. It also comes with a multiplier benefit if there is no claim made under the policy.
Apollo Munich Optima Plus: The Optima Plus offered by Apollo Munich is a top-up plan that offers cover for higher hospitalisation costs at an affordable premium. It is the only plan available in the country offering an option that allows the plan to convert into a fully-fledged nil deductible health insurance plan post retirement.
Apollo Munich Optima Restore Family Floater: This plan is similar to the individual Optima Restore where the basic sum assured is automatically reinstated once exhausted in a policy year. In case of the family floater plan, if any family member finishes up the floater sum insured within a policy year and another family member falls ill during the insured period, the entire amount is restored, free of cost. The plan comes with a multiplier benefit in case the policy is not claimed and the basic sum insured gets doubled.
Apollo Munich Easy Health Family Floater: Under the Easy Health Family Floater plan, your family is protected from unexpected emergencies as well as given a comprehensive cover for accidents needing in-patient hospitalisation and medical treatment for illnesses. This plan offers you a cover on floater sum insured as well as add-on optional covers for certain critical illnesses. The exclusive plan also provides coverage for maternity expenses and recovery benefit, entitling you to a health check-up benefit at every fourth renewal, whether a claim is made or not.
Apollo Munich Optima Vital: The Optima Vital insurance plan is a unique critical illness insurance policy offered by Apollo Munich that offers protection in case of any of the listed critical illnesses. The plan pays you a lump sum amount for any medical expenses or surgical procedures under the critical illness identified. This amount is paid upon confirmed diagnosis of the illness and its severity.
Apollo Munich Optima Cash: The Apollo Munich Optima Cash is a top-up plan that offers cover for daily cash benefit required in hospitalisation for accidents or illness. The plan also provides cover for parent’s hospitalisation, day care procedures, and convalescence benefit, etc.
Apollo Munich Optima Super Family Floater: It is a top-up health insurance plan that provides total health insurance cover on cost-sharing basis. Under this plan, the policyholder is entitled to the benefit of high deductible, where all the medical bills for the whole year are taken into consideration. In case, the total amount crosses the limit, the policyholder can claim the amount above the threshold. In the family plan, a maximum of two adults and two children can be a part of a single policy.
Apollo Munich Optima Senior: For individuals who are 61 years old or more, Apollo Munich offers the Optima Senior. Under this plan, you can avail the benefit of lifelong renewal along with a cover of up to Rs.5 lakhs. Insured individuals under this plan are never denied coverage even if a claim is made after taking the policy.
Apollo Munich Health Insurance Cashless Network Hospitals:
Cashless network hospitals offers an insured individual the benefit of availing medical treatment at its best network of high quality hospitals, without having to pay anything from his or her pocket. The bills incurred for hospitalisation, up to the sum insured are settled by the insurance company directly. However, in these cases prior approval of the Third-Party Administrator (TPA) is necessary. If you are covered under the Apollo Munich Cashless facility, you do not have to run around to arrange for last-minute funds in case of medical emergencies. This facility can be availed at any of the cashless hospitals listed under the Apollo Munich network. Apollo Munich offers cashless mediclaim service with all of its health insurance products. The company boasts of a nationwide network of over 4,000 renowned hospitals where policyholders can benefit from quality health care.
Types of claims at Apollo Munich Health Insurance network hospitals:
The following types of claims can be made at Apollo Munich network hospitals:
Cashless claims: In these type of claims, the insured must inform the TPA in order to avail the cashless benefit. Once authorised, the TPA makes a direct settlement with the network hospital listed under Apollo Munich cashless network. The insured does not have make any payments except for the non-medical expenses and other miscellaneous costs not covered under the policy.
Reimbursement claims: In case of reimbursement claim, the insured is required to make the payment for medical treatments upfront to the hospital. The insured can then seek reimbursement from the insurer for the services covered under the policy.
How do you file claims at Apollo Munich Health Insurance cashless hospitals?
Claim process for a cashless hospitalisation is as follows:
In case of emergency hospitalisation, Apollo Munich should be informed within 24 hours of hospitalisation.
In case of planned hospitalisation, the insured must inform Apollo Munich at least 48 hours before the start of the hospitalisation.
The insurance company will then check your coverage as per your chosen plan and eligibility. The company then sends an authorisation letter to the provider. In case of any discrepancies in the documents, the same should be intimated to the hospital within six hours of receiving the documents.
You are required to pay the non-medical and other miscellaneous expenses not covered under the policy, before getting discharged from the hospital.
A rejection letter is sent to the provided within a duration of six hours, in case the treatment is not covered under the policy.
However, it is important to note that rejection of a cashless claim does not mean the claim is rejected.
Claim process for reimbursement hospitalisation is as follows:
In case of reimbursement claim, you are required to send the claim form signed, with all the required information and documents to Apollo Munich within a span of 15 days after the treatment is completed.
In case of any discrepancies in the documents or the information provided by you, Apollo Munich will send you a letter within seven days of making the claim to rectify the errors.
Once the insurer receives the complete set of documents, the payment is made as well as a settlement statement is provided within 30 days.
The payment is made in the proposer’s name.
Procedures offered/covered in Apollo Munich Health Insurance network hospitals across India:
Some of the common procedures covered under the Apollo Munich Health Insurance are in-patient treatments, day-care procedures, pre- and post-hospitalisation procedures, ambulance cover, domiciliary treatments, e-opinion, etc. However, the specific coverage is based on the policy chosen, and this information will be available under the terms and conditions of the policy documentation.
Exclusions under Apollo Munich Health Insurance network hospital services:
Some of the basic exclusions under the policies offered by Apollo Munich Health Insurance network hospitals are as follows:
Hospitalisation as a result of war or any act of war caused by a chemical, biological, or nuclear weapon or radiation of any kind.
Non-allopathic treatment, mental disorders, congenital diseases, etc.
Any attempt to committing a suicide, or self-inflicted injury, or a criminal or illegal act, while sane or insane is not covered.
Any medical condition caused by substance abuse such as intoxicants or hallucinogenic substances.
All treatments within the first 30 days of cover except any injury caused by accident.
Expenses related to sexually transmitted diseases.
Pregnancy, external aids, or dental treatment, unless covered under the plan.
Unproven treatment procedures, experimental, or investigative procedures.
Treatments such as hernia, cataract, and joint replacement surgeries have a waiting period of two years.
FAQs – Frequently Asked Questions:
What does pre-authorisation mean under the Apollo Munich Health Insurance?
Under the pre-authorisation process, the service provider or the insured requires an approval as well as a guarantee from the insurer or its TPA for the list of services covered before hospitalisation, both during planned as well as emergency treatments.
How should I inform the insurer or service provider in case of any hospitalisation?
Intimation claim can be made by informing Apollo Munich or the TPA’s toll-free number over the phone or by writing into any of the offices. A 60-day benefit for pre-hospitalisation and 90 days for post-hospitalisation is provided to you, in case you inform Apollo Munich or the TPA five days in advance of the treatment and produce all medical documents with all details of the illness and date and place of the hospitalisation.
Are cosmetic treatments or medical expenses incurred for cosmetic purposes covered under the Apollo Munich Health Insurance plans?
No, cosmetic treatments or procedures such as plastic or cosmetic surgeries are excluded unless they are a part of necessary medical treatment as authorised by your medical practitioner for reconstruction after an accident, or illnesses such as cancer.
How will I receive my claim payment?
You will receive your payments in Indian Rupees by either bank transfer or through cheque or DD from Apollo Munich.
Why is it so important to carry the Apollo Munich health card at the time of admission to the hospital?
It is important to carry the health card provided by Apollo Munich as you are required to display it upon admission to any of the hospitals in the network. It carries information such as contact details and number of the TPA as well as the policy details. Also, in case of medical emergencies, the numbers provided on the card can be contacted for any kind of assistance, queries, or clarifications.
Can I undergo a health check-up under the Apollo Munich policy?
Yes, Apollo Munich allows you a health check-up after the end of a block of every continuous two or three or four years, as per chosen variant.
What is the possibility of a premium increase at renewal of an Apollo Munich policy?
The policy premium under Apollo Munich can increase at renewal under the following conditions:
Change in age-band – With the increased age of the insured, if he or she moves to a higher age-band, the renewal premium will be calculated as per the new band. Renewal premium is charged on the basis of the insured’s age on the renewal date.
Change in product’s price – If there is a premium revision of your chosen product resulting from an increase in medical inflation, you may be required to pay an increased premium post renewal.
Change in government taxes, cess, or duties – Any change in government taxes, duties, or cess that may result in change in premium may lead to a higher premium at renewal.
How can I find out the list of hospitals under the given insurance network?
The Apollo Munich website enlists all the empanelled hospitals under the insurance network. The same list is also provided on the welcome kit of the insurance policy or its guidebook. You can also reach the customer care at the toll-free number provided on the website or send an email to the customer service. Alternatively, you can also call the respective TPA for any queries.
What are the charges that are not reimbursable under the cashless facility of Apollo Munich insurance policies?
The following charges are not reimbursable and therefore, are required to be paid by you:
Attendant or visitor pass charges
Special nurse charges not authorised by doctor
Extra bed charges
TV or laundry charges
Telephone or fax charges
Food or beverages for visitors, attendants, etc.
Additional service charges on the room
There are some more charges based on the situation and hospital you are admitted in.
Which is a better option – to submit the claim with the insurance company or the TPA?
Preferably, the claim should be submitted with the TPA.