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  • Apollo Munich Health Insurance Claims Procedure

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    Cashless Treatment

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    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.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    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 16 1 2 3 4 5
    • 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
    • Apollo Munich Health Insurance
      "Very Good services"
      0.5 5.0/5 "Blown Away!"
      I have been renewing the health insurance policy with Apollo Munich for last 5 years. I pay the premium amount of Rs. 11000 and my entire family has been covered in this policy. They are providing the coverage value of Rs. 3 lakhs. When i met an accident, they have given me a claim amount of Rs. 1.45 lakhs. I have availed the cashless treatment for claim. Very Good hospitals are covered in this policy
      Was this review helpful? 0
      , mumbai
      Reviewed on Nov 01, 2018
    • Apollo Munich Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have been using the Health Insurance policy from the Apollo Munich. I pay a premium of 22000 per year. Full family cover . It offers an annual coverage for 5 lacs for the entire family. Overall I never had any issues with their services so far.
      Was this review helpful? 2
      , new delhi
      Reviewed on Oct 30, 2018
    • Apollo Munich Health Insurance
      "Best policy"
      0.5 4.0/5 "Great!"
      My health is insured with Apollo Munich from last 1 year and it is a best policy to use. There was no claim experience so far with this insurance policy. A premium of Rs 16000 has to be paid for this insurance and the coverage value is Rs 10 lakhs...
      Was this review helpful? 1
      , hyderabad
      Reviewed on Oct 19, 2018
    • Apollo Munich Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have taken my health insurance from apollo munich . it had been just 2-3 months only i have been applied this insurance. i am satisfied with the premium which they charge me . they mail me all benefits and use to update me on mail.even customer support team is very good.
      Was this review helpful? 2
      , kolkata
      Reviewed on Oct 15, 2018
    • Apollo Munich Health Insurance
      "Good policy"
      0.5 4.0/5 "Great!"
      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? 1
      , surat
      Reviewed on Oct 02, 2018
    • Apollo Munich Health Insurance
      "Satisfactory"
      0.5 4.0/5 "Great!"
      I have a corporate health insurance policy with Apollo Munich. There is a coverage of three lakhs for the entire family. There are cashless facilities and also OPD facilities too. For the cashless option I need to use the medical card at any listed hospital and if I get hospitalized in a non listed hospital I need to pay the bill upfront and I would get 90% of the bill. Like wise for the OPD option where I can get all my medical bills like scans or other tests reimbursed, the process is done in 15 days and I would get 50%.
      Was this review helpful? 2
      , hyderabad
      Reviewed on Sep 22, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 7-8 years, i have no claim experience so far with this insurance policy. I pay a premium of Rs 12000 for this insurance policy and the coverage value is Rs 5 lacs for this policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 12, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 3 months, i am happy with the coverage value of this insurance. I am not aware of the premium amount as my company pays it. The coverage value is Rs 10 lacs for accidental policy and Rs 10 lacs for death policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 08, 2018
    • Apollo Munich Health Insurance
      "Average Policy"
      0.5 3.5/5 "Pretty good"
      I have a health insurance policy with Apollo Munich from last 1 year, i am happy with the coverage value of this insurance policy. A premium of Rs 7000 has to be paid for this insurance policy and it covers only individual. The coverage value for this insurance is Rs 2 lacs.
      Was this review helpful? 0
      , chennai
      Reviewed on Sep 05, 2018
    • Apollo Munich Health Insurance
      "Normal Service"
      0.5 3.0/5 "Satisfactory"
      I have a health insurance policy with the Appollo Munich, I make the premium payments online. So far there hasn't been any claim experience with the policy. I'll have to wait and see how the respond to my claim request If I'll have any in future.
      Was this review helpful? 0
      , guntur
      Reviewed on Aug 31, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Apollo Munich from last 2 years and it is a good policy. I have not claimed anything so far from this insurance policy. Premium amount was nominal when compared to other policies. I have a coverage value of more than Rs 3 lacs for this policy.
      Was this review helpful? 1
      , bangalore
      Reviewed on Aug 29, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insurance policy with Apollo Munich from last 6 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy. A premium of Rs 7500 has to be paid for this insurance policy.
      Was this review helpful? 2
      , chennai
      Reviewed on Aug 11, 2018
    • Apollo Munich Health Insurance
      "Very Good policy"
      0.5 5.0/5 "Blown Away!"
      They are very good in settlement and i have never had any claim experience so far. I can claim the money upto Rs. 4 lakhs. I have taken the policy for me and my family. The hospital list mentioned in the policy is good and the maximum hospitals covered by this policy. Cashless treatment is also available. Premium amount is paid by my company.
      Was this review helpful? 0
      , jaipur
      Reviewed on Aug 02, 2018
    • Apollo Munich Health Insurance
      "Don't take apollo munich policy and its not recommendable"
      0.5 1.0/5 "Really Bad"
      They have given worst service in Apollo munich. They are not giving properly reply on the mails and phone calls. They are not giving the perfect details. I have never experienced of any claim so far. They have given me a claim amount of Rs. 5 lakhs. I have taken this policy for me and my family. I used to pay the premium amount of Rs. 13000 in a year.
      Was this review helpful? 1
      , hyderabad
      Reviewed on Jul 27, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      Got my health insurance from Apollo Munich insurance . It has the best plan with cashless treatment and pre disease coverage . It has medical coverage of one year of 3 lakhs . It has good premium amount with best policy coverage . I annually pay the payment through on-line banking
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jul 25, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Apollo Munich from more than 10 years and it is an individual policy. I am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy and the policy is covered up to Rs 3-4 lakhs.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jul 13, 2018
    • Apollo Munich Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy from the Appollo Munich. I pay a premium of 1500 per year for a coverage of 3 lacs. This policy is only for me. On one occasion they given me 50% amount for a medical test. Overall it has been a good experience with their services.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jul 02, 2018
    • Apollo Munich Health Insurance
      "Good policy"
      0.5 5.0/5 "Blown Away!"
      From APOLLO MUNIC i have a corporate health insurance and they provide a coverage for 10 lakhs. I have not done any claim with this policy. The provide treatment coverage for accident , critical illness. Its a cashless facility.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 27, 2018
    • Apollo Munich Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've been using the Health Insurance policy from the Apollo Munich. I pay a premium of 22000 per year. Full family coverage . It offers an annual coverage of 5 lakhs for the entire family. Overall I never had any issues with their services so far.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 26, 2018
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