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Apollo Munich Health Insurance Claims Procedure

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Cashless Treatment

Customer Service

Medical Coverage

Claim Experience

Apollo Munich health insurance policies not only offer comprehensive healthcare packages for their customers but also provide a hassle free claim process in order to get the competitive edge in the market. There are two main types of claims that are provided by Apollo Munich - Cashless claims for either planned or emergency visits, and reimbursement claims where policyholders claim for refund of cash already spent towards hospitalization and other charges. Apollo Munich also boasts a large list of network hospitals where one can claim cashless hospitalization benefits . Whenever a policyholder applies for a claim it is advisable that they keep a copy of the documents they have submitted towards the claim.

Incurred Claim ratio of Apollo Munich Health Insurance:

ICR or Incurred claim ratio is the overall amount or value of claims paid by the company divided by the total sum of premiums collected by that company for a specified period. This data is published by the IRDA and the below table showcases the Incurred Claim ratio of Apollo Munich for the year 2014-15

Net earned premium (in lakhs) Net claims paid (in lakhs) Incurred claims ratio
65,558 41,343 63.03%

The ICR of Apollo Munich is in good stead and shows that they have made a quality high selling product.

Claim Procedure:

With Apollo Munich Insurance, the claims procedure by far and large remains the same for almost all policies with slight differences for each policy. Policyholders can avail cashless claims or claim for expenses already incurred. The following claim procedure highlights the necessary steps required to file the claim.

  1. Cashless Claim:

    In cashless claim, one need not settle the bill themselves. They needn’t even pay cash the insurance company will be represented by a TPA who will settle the bill with the hospital directly. The procedure for cashless emergency claims and cashless planned claims vary

    • Cashless Claims Procedure for Emergency Admission:

      Emergency hospital visits are a cause of worry itself and to worry about insurance claims and money spent out of pocket will only add to it. Upon admission, one will have to check with Apollo Munich if cashless claims can be made. If the hospital of admission falls in the network of cashless hospitals supported by Apollo Munich then the following procedure needs to be followed.

      Intimate Apollo Munich of the emergency hospital admission within 24 hours. Reach out to the hospital insurance help desk and have them fill in the details of the cashless claim and send it over to Apollo Munich for a cashless claim. This claim needs to be certified by the attending doctor. The hospital insurance helpdesk will either send over the insurance claim themselves or one can fax it to Apollo Munich. The fax number can be availed by calling the toll free number and requesting for it. The toll free number is 1800-102-0333.

      • The TPA will then review the documents submitted. If additional documents are required, the TPA will request for their submission. If the TPA approves the claim, then the hospital bills and all expenses covered under the policy will be settled by the TPA and other expenses not covered by the policy will need to be settled by the patient/policyholder
      • For some reason if the claim is not supported, then the bills need to be settled by patient or policyholder and a request for reimbursement can be made. Decisions for rejection will be provided through a rejection letter. Rejection of a cashless claim does not signify rejection of the reimbursement
    • Cashless Claims Procedure for Planned Admission:

      If the patient or policyholder plans on getting a particular treatment at a hospital on the network panel and intends to avail the cashless claim then they need to follow the planned cashless claim procedure which is as follows:

      • Select the hospital from the network hospital list.
      • Then you must intimate Apollo Munich at least a minimum of 48 hours prior to admission. The patient or policyholder will be required to provide certain details such as policy number. Intimation can be done by calling the toll free number 1800-102-0333
      • The cashless request form must then be filled in by the patient or policyholder and faxed to Apollo Munich. The form needs to be submitted with a certification from the attending doctor along with the required medical records.
      • Apollo Munich will review the submitted documents and request and convey their decision to the hospital. In certain cases Apollo Munich may also request for additional documents. In case it is approved the hospital bill will directly be settled by Apollo Munich. In case of rejection, the bills need to be paid by the patient and then a claim for reimbursement can be made.
  2. Reimbursement of Treatment Expenses:

    When cashless claims are rejected, the bills paid by the patient or policyholder can be reimbursed by claiming for reimbursement of expenses. Cashless claims may be rejected for lack of supporting documents or because the hospital may not be on the network of cashless claim hospitals covered by Apollo Munich. The following procedure needs to be followed to make reimbursement claims:

    • You will have to intimate Apollo Munich on admission or treatment within a stipulated time frame. More often than not the sooner one intimates the insurance provider, the better the chances are of the claim being approved. The toll free number can be called to intimate claims for reimbursement. The toll free number is 1800-102-0333
    • Patients or policyholders must provide key information such as policy numbers while making intimations
    • You must quote the policy number while intimating.
    • The claim form can be downloaded from the website or be availed through the agents at the office locations. The claim documents may vary depending upon the policy held by the patient. These claim forms need to be submitted to the Apollo Munich office address. Mailing address can also be availed from the toll free number.
  • Documents Required:

    Documents required while applying for reimbursement claims are as follows:

    • The fully filled claim form along with the attending doctor’s certificate
    • Discharge summary along with other related documents such as hospital bills, pre and post hospitalization reports and their corresponding receipts, prescriptions notes along with their receipts and other documents as mentioned in the claim form
  • Claims Process:

    • The claim processing team will check the above documents and ask for additional documents if required. Additional documents if requested will be given a period of 7 days to be submitted
    • If the claim is admissible, the cheque will be dispatched within 30 days
    • If the claim is not admissible you will get a rejection letter stating the reasons for rejection.

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GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

Apollo Munich Health Insurance Claims Procedure Reviews

Page 1 of 17 1 2 3 4 5
  • Apollo Munich Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    My organization has given me a health insurance from Apollo Munich. I have not gone through about the documents and hospital list. My entire family has been covered in this policy. They have given me a satisfied coverage value. I have not contact the customer care so far.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Very Good Policy"
    0.5 5.0/5 "Blown Away!"
    I have a corporate covered health insurance policy from Apollo Munich. They have given me a coverage value of Rs. 4 lakhs. My entire family has been covered in this policy. This policy covers all the major hospitals in all over India. I have not made any claim so far.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    I had taken this insurance policy a while back and i had been paying the premium amount on an annual basis. The premium method has been convenient and the premium amount has not been high. There has been many hospitals covered in my locality and their customer support has also been helpful.
    Was this review helpful? 2
    , pune
    Reviewed on Jan 09, 2019
  • Apollo Munich Health Insurance
    "Good medical cover with Apollo"
    0.5 5.0/5 "Blown Away!"
    I got the medical cover of Rs. 3 lakhs its covers for my four persons, they got tie up with major hospital. I don't have any medical card but if I want to go for claim. There is a person who coordinate for Tata employee. They do have cash less treatment.
    Was this review helpful? 1
    , mumbai
    Reviewed on Jan 09, 2019
  • Apollo Munich Health Insurance
    "Yet to experience the policy"
    0.5 4.0/5 "Great!"
    I'm having a health insurance with Apollo Munich. I just bought the policy 2 years back. Because one of my friend was working with Apollo munich, hence i have purchased the policy. I pay the premium amount of Rs. 15000 for the coverage value of Rs. 5 lakhs. Me, my wife and child has been covered in this card. All the nearby hospitals has been covered. To renewing the policy is really easy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 07, 2019
  • Apollo Munich Health Insurance
    "Worst Policy"
    0.5 2.0/5 "Expected more"
    The pre-existing disease is not covered in this policy. They are asking the previous 5 years prescription. I have purchased a health insurance policy with Apollo Munich. OPD charges not included in this policy. I never claimed the policy. When my wife admitted in the hospital they have asked me 5 years prescription and i have been renewing the policy for last 5 years.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 07, 2019
  • Apollo Munich Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with Apollo Munich, this policy cover accident claim and there customer support team have explain me about this policy and the premium per year it nominal, it use to get auto debited from my account itself,, till now there service was good.
    Was this review helpful? 1
    , gurgaon
    Reviewed on Dec 26, 2018
  • Apollo Munich Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Appolo munish recently, they have charged me premium on annual basis and they have charged me premium nominal,and it use to get auto debited from my account and they have tie up with many hospital and they have given me list of that with location in excel,overall service is good.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 16, 2018
  • Apollo Munich Health Insurance
    "Good one to go with"
    0.5 4.0/5 "Great!"
    My health insurance policy was taken from Apollo Munich. There has been gap in the documentations. The documentation process was quite hectic. I have submitted the documents twice. Total coverage of the policy is 5 years and the entire family has been covered by this policy. I pay the premium amount of Rs. 9000.
    Was this review helpful? 0
    , kolkata
    Reviewed on Dec 15, 2018
  • Apollo Munich Health Insurance
    "Its best insurance for the health"
    0.5 5.0/5 "Blown Away!"
    The claim is easy they approve everything I heard lots of customer using it, the customer support is good they gave me the policy document on time. They gave me Rs. 10 lakhs of medical cover, they have tie up with all the major hospitals like fortis, apollo. They have cash less treatment.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 14, 2018
  • Apollo Munich Health Insurance
    "Good for health "
    0.5 5.0/5 "Blown Away!"
    I have medical policy for the coverage around Rs. 5 lakhs, they do have pre existing disease cover. The process generation is quick, they send the insurance card with the list of hospitals details. I am very fine with Apollo Munich health benefits.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 14, 2018
  • Apollo Munich Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken health insurance from Apollo munich . Am satisfied with the premium amount which am making the payment . This policy covers cashless hospitalization . They have given the network list of hospital . Overall am satisfied with the policy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Dec 12, 2018
  • Apollo Munich Health Insurance
    "Best policy"
    0.5 5.0/5 "Blown Away!"
    I am having a health insurance policy with Apollo Munich from last 3 years, i am not aware of the premium amount as my company pays it. There was no claim experience so far with this insurance policy. This policy has a coverage value of Rs 5 lacs.
    Was this review helpful? 0
    , kolkata
    Reviewed on Dec 11, 2018
  • Apollo Munich Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with Apollo Munich, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me up to 11,000, i use to pay through on line.
    Was this review helpful? 1
    , bhubaneshwar
    Reviewed on Dec 07, 2018
  • Apollo Munich Health Insurance
    "Stay healthy and Apollo munich gives lots of options. "
    0.5 5.0/5 "Blown Away!"
    I had a health insurance policy with Apollo Munich. This policy supports all my family members. For the approval, they have taken almost an hour. This is one of the best health insurance. The charges are bit higher than other health insurance policy. If i pay Rs. 3000 more, the services are much better. The customer care service is good and they understand all my concern and there is a good follow up also from them. They have huge tie up with many hospitals.
    Was this review helpful? 0
    , new delhi
    Reviewed on Dec 02, 2018
  • Apollo Munich Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using my health insurance with Appolo munish recently, they have charged me premium on annual basis and they have charged me premium nominal up to 6500, and it use to get auto debited from my account and they have tie up with many hospital and they have given me list of that with location in excel,overall service is good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Nov 26, 2018
  • Apollo Munich Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    My spouse had account with Canara bank, they got tie up with Apollo Munich. Hence we got the medical cover around Rs. 5 lakhs, they have many hospitals in my location. In fact I got the medical card even the health insurance premium amount is reasonable.
    Was this review helpful? 1
    , new delhi
    Reviewed on Nov 26, 2018
  • Apollo Munich Health Insurance
    "Best medical policy with best customer service"
    0.5 5.0/5 "Blown Away!"
    I have taken a health insurance policy with Apollo Munich and it was recommended by Friend. I can get cashless facility in all over the city. They have chain of authorized hospitals. On every renewal they are providing additional 50% on the coverage. The customer service is excellent.
    Was this review helpful? 0
    , navi mumbai
    Reviewed on Nov 24, 2018
  • Apollo Munich Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with Apollo Munich, this policy cover accident claim and there customer support team have explain me about this policy and the premium i pay 25,000-30,000 per year it nominal, i pay through on line, till now there service was good.
    Was this review helpful? 0
    , noida
    Reviewed on Nov 16, 2018
  • Apollo Munich Health Insurance
    "Excellent"
    0.5 5.0/5 "Blown Away!"
    I had a health insurance for my family with Apollo Munich. My experience is good. Due to some reason, I was unable to pay the premium. The policy has been lapsed. I have paid 12K for a year. The payment mode is net banking. The policy coverage was 5L. It was covering almost all diseases, If I use even 5L at one time again they will provide 5L which was very good.
    Was this review helpful? 0
    , new delhi
    Reviewed on Nov 15, 2018
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