Apollo Munich Health insurance has launched its much awaited product for senior people-“Optima Senior”. Although company covers individuals till age 65 in its easy health plan, the higher age group was not able to avail any benefits from the company’s product features.
Most of the senior citizen products available in the market have high limits. Star Health, National Insurance and New India Insurance have sub-limits on the hospitalization costs and certain treatments as well. Even Max Bhupa has co-payment clause for health insurance above age 65.With Apollo Munich, the features are expected to be much more considering the company do not have policy of sub-limits in any of their products.
Here is a brief review of the product.
Who can Buy
The policy is meant for seniors and anyone above age 61 is eligible to buy. The subscriber should have completed this age. There is no maximum age limit which means the policy can be bought at any age above the threshold limit.
Policy Options
The policy is offered to subscriber and his/her spouse only on individual basis. There is no floating option in this policy.
Coverage
The policy has three coverage options to select from-Rs 2 lakh, Rs 3 lakh and Rs 5 lakh.
Benefits in The policy
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Maximum Age
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No maximum Age
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Pre & Post Hospitalization expenses
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30 days & 60 days
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In Patient treatment
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Covered
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Day Care Procedures
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Covered 140 as per list
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Domiciliary Treatment
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Covered
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Organ donor
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Covered
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Emergency Ambulance
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Rs 2000 per hospitalization
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E-Opinion
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One opinion per policy year
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Other benefits
1. No Claim Discount: The policy offers a 5% discount on the renewal premium after every claim free year.
2. Grace Period: Here, unlike other policies, you get a grace period of 30 days for renewing your health insurance policy.
3. No Claim Bases Loading: The company does not levy any loading if claim arises or one fell ill after taking the policy.
4. Discounts: The policy offers a non-cumulative discount of 5% on premium for every claim free year and a 7.5% discount on a 2 year policy.
Co-Payment Clause
Like most other senior citizens plans, Apollo too has introduced a co-payment clause in this policy. This is a diversion from its other products where no sub-limits are imposed.
1. If the room is shared in twin basis or it’s a lower room then 15% co-payment is applicable.
2. But if you avail a single room or a higher rented room a 30% co-payment clause is applicable.
3. There is also a higher co-payment of 30% on specific illness like cataract, Hysterectomy, Arthroscopy etc.,
4. All 140 day care procedures listed in Apollo Munich will have co-payment of 15%.
All these clauses reduces the risk for the company but policyholder has to take into consideration to avoid any disappointment during claim.
Exclusions
The company has not imposed any specific exclusion in the policy and most of these are applicable in other policies too.
1. The 30 days clause from the issuance of policy date applies here also. Only accidental injury is excluded from this.
2. All pre-existing disease are covered after a waiting period of three years. This may be a disappointment for many individuals as most senior citizen product in the industry has lesser waiting period for pre-existing diseases.
3. 2 years waiting period for specific diseases like cataract, hernia, joint replacement etc.
Apart from this there are other exclusions which you can get from policy wordings or company can impose some specific ones during underwriting the proposal if there is any medical history.
Medical Test
Yes, you need to go for a medical test if opting for this policy. Considering the probability of illness at higher age and strong underwriting guidelines in the company, medical test has been made mandatory. The test will generally comprise normal checkups and TMT(Trade Mill test) to assess state of your heart & kidneys respectively. If you are in good health and the company issues a policy, you can even claim for 50% of your expenses on the medical test undergone.
What is Beneficial?
One of the feature of the product is claim settlement. Since the co-payment clause is applicable on total claim amount and not the Sum Assured, there is a probability of claiming the entire SA if hospital expenses are above your policy SA. This example explains the benefit in detail.
Sum Insured – 300,000
Eligible claim amount – 450,000
Accommodation type – Single room
Copay applicable – 30%
Insurer’s liability – 450,000 x 70% ( 100% -30%) = 315,000/-
Claim Settled for – 300,000
Insured persons liability – 150,000/- (450,000 x 30% + 15,000)
Sum insured available post claim settlement – Nil
If your claim is equivalent to SA or below, the co-payment clause will reduce the final settlement amount.
Should You Buy
For Apollo Munich the co-payment clause is first in their long product list. Although company have tried to adhere to the new guidelines by IRDA the product has some features like co-payment clause on bill amount, no maximum age limit, Increased grace periods etc which will be beneficial to policyholders. It is yet to seen how many people will be able to afford the premium at very high age of their elders. In comparison to other senior citizen plans the product do have more benefits to consider.
However, if compare with Apollo Munich other health products then Easy Health, with life- long renewals and no co-payment clause, is a wiser choice if policyholder age is below 65. Since Optima Senior has not given any additional benefits on waiting periods and one has to go for medical test even in Easy Health, Optima Senior will not be attractive below this age group. For people who have exceeded age 65, there are very limited options available and Apollo Munich can be added in their search criteria. But do watch for specific exclusions although premedical test will clear most of the queries related to health of senior people.
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