Apollo Munich Optima Restore – it’s different!

1. Hi Jitendra,
   Thanks for sharing such a detailed analysis of this policy. You have done a wonderful job by simplifing a complex product.
   I will appreciate if you can answer queries of TFL readers.

   • Thanks Hemant.
     It always has been my objective to create awareness among masses which can help them in making their financial decisions.
     Will surely answer queries of readers.

     • Dear Friend,

       Never buy such a worst Health in Apollo Munich Health Insurance.

       I buyed and getting suffered, Apollo Munich is Cheap Health Insurance company.

       Jagoo Grahak Jagoo. Buy STAR or Bajaj But not Apollo.

       I BUYED Apollo Munich Health Insurance FOR MY MOM,

       On( 28th -Sep-2016)due to seasonal diseases she was attached by Cold, because of it she could able to Breath Normally, so on emergency we admitted to St.John Hospital Bangalore.

       Patient( H N Lepakshi – Ph- 9880805215)(cashless id 286508)

       Apollo tells cashless in networking Hospital, But when hospital ppl asked money to admit Patient, I said “ We have Apollo Health Insurance “ They said “ Even then you needed to pay 8K as admission, then we give you documents and records then you can clams” Then I called “ Apollo customers service, they said that’s true “ Then I payed 8K in hospital & Did Admission .

       Next day, 29th –sep-2016, Doctors gave 1.) Doctor certificate telling “ Due to cold & fever she joined “

       Proof: we sent to apollo “Doctor certificate, Medical Records, Pharma Recors, ” and apollo said in 2-hours we conform it, I called 10+ time to customer service, but no proper-response,

       Next day apollo sent we needed Clarification on:-

       1st you asked:- Needed Clarification for BP.( for that we tested and said no BP) on 30th-Sep.

       2nd You asked:- Needed Diabetic Present .( We needed blood-test and said No-Sugar) on 1st-Oct.

       3rd You are asking:- Steroid why its used needed doctor certification on it.( on 1st-Oct @ 6PM)

       4th:- we gave Doctor Certificated telling due to Breathing difficulty we gave 125mg dose in morning(30th –Sep)@10AM once.

       5th You asked:- Why Hyperglycaemia Steroid is given.(2nd –Oct you asked)

       :-We said Its not Steroid, Hyperglycaemia is glucose level more in blood:

       As Apollo-Munich did not get and room to reject clam,

       they said “we needed still 5th -Oct-2016 to Analysis .” Doctor working in @Apollo Munich have fake doctor certificate, Because on 30th I got a msg from Apollo Doctor team why Dolo-650 Steroid given.

       And Why Hyperglycaemia Steroid given. In future they might tell Glucose is steroid.( Never believe apollo Munich Doctors, Then all are Ass-Hole and Fu-ckers.

       Then, Doctors in hospital said, they are just playing to reject Clams: – Even after asking or calling daily 10+ time to customer care, no response etc.

       Then we meet Heath-Minister they speak to Apollo Munich, Then they started calling me telling,

       “ sorry sir, fault from our side, Your Documents is perfect within 12-Hours we proceed “for clam. On 4th –Oct -2016 they release 15k for stating Treatment “.

       This means, A person admitted in emergency and he don’t have money, so took Apollo-Munich policy trusting they will support:” But see when Patient admitted on 28th –Sep, after so much fight Apollo accepted and said you clam accepted and you can admit patient on 4th-Oct-2016 “

       If apollo is playing for just fever & Cold clam, Can anybody Trust for something Higher in FUTURE.

       You are doing to find pin-point mistake where you can reject telling .” Sorry we cant proceed “ .

       NOTE:

       Doctors in Apollo are telling Hyperglycaemia is a Steroid . They are fake doctors, Keeping Fake Doctors Marks Cards, they joined there job, They cant do job outside as they have Fake-Marks card.

       So, on 3rd –Oct-2016, We payed Hospitalization fee of 20K approx and Discharge Patient,

       Next Day, When Heath-Minister Called, They Accepted Clam and release 15K, We said, we have Discharge Patients, Then they said, then apply for Re-Embrace,

       If Apollo-Munich Had Accepted clam on 1st or 2nd Oct, we have happy made treatment,

       Because of Apollo Health insurance, Not Accepting clam took 5+ Days to accept Clam, Before Taking Insurance, they said in 2+ hours we accept-Clam.

       Now, We needed to Ask Orginal-Documents in Hospital, Then we needed to Make courier to Apollo-Munich, Then they take 1-Month to Re-Embrace, In that also They tell for this test-we can’t do clam,

       For this Medicine, we can clam, like this they tell and 50-60% money, they will give,

       Cheaters, Never buy Apollo Munich.

       As long as they settle my money, I shall be on writing, my problems in All blogs from, Facebook, twitter to Whats up, and almost 20+ Blogs from Mouthshut.com to all.

   • Dear Friend,

     Never buy such a worst Health in Apollo Munich Health Insurance.

     I buyed and getting suffered, Apollo Munich is Cheap Health Insurance company.

     Jagoo Grahak Jagoo. Buy STAR or Bajaj But not Apollo.

     I BUYED Apollo Munich Health Insurance FOR MY MOM,

     On( 28th -Sep-2016)due to seasonal diseases she was attached by Cold, because of it she could able to Breath Normally, so on emergency we admitted to St.John Hospital Bangalore.

     Patient( H N Lepakshi – Ph- 9880805215)(cashless id 286508)

     Apollo tells cashless in networking Hospital, But when hospital ppl asked money to admit Patient, I said “ We have Apollo Health Insurance “ They said “ Even then you needed to pay 8K as admission, then we give you documents and records then you can clams” Then I called “ Apollo customers service, they said that’s true “ Then I payed 8K in hospital & Did Admission .

     Next day, 29th –sep-2016, Doctors gave 1.) Doctor certificate telling “ Due to cold & fever she joined “

     Proof: we sent to apollo “Doctor certificate, Medical Records, Pharma Recors, ” and apollo said in 2-hours we conform it, I called 10+ time to customer service, but no proper-response,

     Next day apollo sent we needed Clarification on:-

     1st you asked:- Needed Clarification for BP.( for that we tested and said no BP) on 30th-Sep.

     2nd You asked:- Needed Diabetic Present .( We needed blood-test and said No-Sugar) on 1st-Oct.

     3rd You are asking:- Steroid why its used needed doctor certification on it.( on 1st-Oct @ 6PM)

     4th:- we gave Doctor Certificated telling due to Breathing difficulty we gave 125mg dose in morning(30th –Sep)@10AM once.

     5th You asked:- Why Hyperglycaemia Steroid is given.(2nd –Oct you asked)

     :-We said Its not Steroid, Hyperglycaemia is glucose level more in blood:

     As Apollo-Munich did not get and room to reject clam,

     they said “we needed still 5th -Oct-2016 to Analysis .” Doctor working in @Apollo Munich have fake doctor certificate, Because on 30th I got a msg from Apollo Doctor team why Dolo-650 Steroid given.

     And Why Hyperglycaemia Steroid given. In future they might tell Glucose is steroid.( Never believe apollo Munich Doctors, Then all are Ass-Hole and Fu-ckers.

     Then, Doctors in hospital said, they are just playing to reject Clams: – Even after asking or calling daily 10+ time to customer care, no response etc.

     Then we meet Heath-Minister they speak to Apollo Munich, Then they started calling me telling,

     “ sorry sir, fault from our side, Your Documents is perfect within 12-Hours we proceed “for clam. On 4th –Oct -2016 they release 15k for stating Treatment “.

     This means, A person admitted in emergency and he don’t have money, so took Apollo-Munich policy trusting they will support:” But see when Patient admitted on 28th –Sep, after so much fight Apollo accepted and said you clam accepted and you can admit patient on 4th-Oct-2016 “

     If apollo is playing for just fever & Cold clam, Can anybody Trust for something Higher in FUTURE.

     You are doing to find pin-point mistake where you can reject telling .” Sorry we cant proceed “ .

     NOTE:

     Doctors in Apollo are telling Hyperglycaemia is a Steroid . They are fake doctors, Keeping Fake Doctors Marks Cards, they joined there job, They cant do job outside as they have Fake-Marks card.

     So, on 3rd –Oct-2016, We payed Hospitalization fee of 20K approx and Discharge Patient,

     Next Day, When Heath-Minister Called, They Accepted Clam and release 15K, We said, we have Discharge Patients, Then they said, then apply for Re-Embrace,

     If Apollo-Munich Had Accepted clam on 1st or 2nd Oct, we have happy made treatment,

     Because of Apollo Health insurance, Not Accepting clam took 5+ Days to accept Clam, Before Taking Insurance, they said in 2+ hours we accept-Clam.

     Now, We needed to Ask Orginal-Documents in Hospital, Then we needed to Make courier to Apollo-Munich, Then they take 1-Month to Re-Embrace, In that also They tell for this test-we can’t do clam,

     For this Medicine, we can clam, like this they tell and 50-60% money, they will give,

     Cheaters, Never buy Apollo Munich.

     As long as they settle my money, I shall be on writing, my problems in All blogs from, Facebook, twitter to Whats up, and almost 20+ Blogs from Mouthshut.com to all.

2. Hi,
   Please give your opinion on Reliance Health wise policy( silver plan). Please consider the policy exclusions also. Please compare Apollo Munich and Reliance Health wise policy.

   • Dear Bharat,

     Reliance health wise is a mediclaim policy which cover hospitalization expenses like Apollo Munich Easy Health plans.Like Apollo Munich, it too has three variants with some additional features provided at each level.

     Apollo Munich has maintained very competitive rates in the past and has been on good service standard since their entry in the health insurance market. Also experience of hospital industry is one of their advantage in rolling out such products.On other hand Reliance has been beaten down by their strategy of giving health insurance at a very cheap rates and then increasing it due to losses.

     Since Apollo Munich is entirely into health insurance I expect it to maintain its competitive edge.

   • Dear Sir,
     Health Policy of Reliance General has a very bad reputation in the market. It has been seen that the premium of the reliance Gold/Silver plan has increased even 500% after 3rd renewal without any claim or any preor notification.

     Dear Hemant,
     I am interested to konw how they have justified to the clients the huge increment of the premium? Is it approved from IRDA?

3. Hi,
   Thanks for such a detailed analysis…my query is- I am a 31 yr old doctor recently married , living with my parents and hunting for an ideal health insurance. Should i opt for a Family floater or an individual health plan??
   Should i go for a Critical illness policy as i feel with the health care expenses going up day by day , only a health insurance may not be enough??
   I would really appreciate your valuable inputs & also any suggestions on any specific company you recomend. Thanks a lot…

   ….& Hemant, you are doing a great job for pple like us…thanks a million & keep up the good work..

   • Dear Sameer,

     Individual policies are always advisable as it covers you for a higher amount. The only concern is the premium rates and because of that we opt for family floater.However, you can work out by having combination of an individual and a family floater.For e.g. if you have a child, you can buy an individual for yourself and cover your spouse and child in a Family Floater plan. Through this, by paying some extra premium, you will be able to cover your family for a higher amount.

     Although critical illness policies are advisable at higher age but then premium is also high.In health insurance policies it is given as rider and renewable even if you claim for it , with some conditions. However, in family floater plans the rider has to be on each family member.Thus if there are three members then you will have to take CI rider on all three.Hence, as suggested above, taking different policies for you and rest of family will serve the purpose as you will be able to add a CI rider in your policy.

     You can select from Apollo Munich or Max Bhupa for meeting your specific requirements.

     I hope this answer your queries.

4. Dear jitender, i would like to apperciate your effords through such exercises-indeed appolo has come out with innovative product & features-but in some cases i have observed that MAX-BUPA scores more in family-first with better coverage & competative rates. let me illustrate my case .i am 50 with wife & 1 kid aged 13.
   the premium in easy health of appollo works out 34993 for 10 lakhs +S.T,& in optima it is 25927 for 10 lakhs whereas i had paid app.26000 including service tax in family first of MAX-BUPA for indiual S.A of 5 lakhs & 15 lakhs floater S.A.,precisely means effective S.A OF 20 lakhs to any member.
   however i have to keep provision of 20% co-payment after 65 in max but then i had preferred it to 10 lakhs of easy health.
   also i have observed that for younger people up 50 to 55 max-bupa family first is better & for people of higher age group apollo scores more- since no co-payment is applicable in appollo-however i need to analyize optima v/s family first for indepth analysis-since it had been launched on 19th dec-11 only.
   i would like to apperciate you & hemant for effords through financial literates for
   benifit of masses.

5. Thanks Mr.Anil.

   The premium rates for all health insurance companies vary across different age groups. There can be instances where one company rate is cheaper at younger age while more at higher age.However, the rates are in allign with their experience and analysis on various parameters.

   The product has to be selected based on ones specific requirements.Max Bhupa may be good at younger age considering some of the features but may not find favour if premium is high. On other hand Apollo or some other company one will prefer if it meets his/her requirements and within his budget constraints.

   Thus one has to look benefits in detail before making any decision and i can see you made yours after a good analysis of your requirements. 🙂

6. Hi Jitendra,
   Nice article! How does Apollo Munich score in claim settlement ratio and customer care w.r.t its peer?
   Kannan

   • Dear Kannan,

     Apollo Munich is good in both the aspects and have been very proactive in launching services for benefits of its customers.

7. Hi Jitender,
   A very timely article. I have a query for which I hope you will provide reply to.

   I have HDFC Ergo family floater plan which I have for the last two years and I am paying Rs. 8300 (me+wife+1 kid) and I am 35 years old now, by March I would be 36 and they have increased my premium amount to Rs. 10150. This policy covers for 3,00,000 with accidental cover as well as education cover for kids (5,00,000) on insurer’s death with upper limit NCB of Rs. 30,000. I have not claimed anything till now and NCB is also exhausted. Now, I would like to make use of the health portability act (because of the higher premium) and switch to any other company. I was till now thinking on government insurance companies like Oriental, United, etc. Kindly advise me whether I should go for the one of the government companies or Apollo Munich Restore or stay with the same HDFC Ergo.

   I hope I have provided you with all the details necessary to answer my query.

   Thank you very much for the article and for your reply in advance.

   • Dear Mr.Rao,

     Firstly, its very difficult to meet so many different needs with a single product.Health insurance emergencies, children’s planning are different goals which should be planned accordingly.Any product which will provide so many combinations will be slightly costlier.

     Health Insurance is bought for meeting medical emergencies in the future. The product should be selected based on certain parameters like hospital network, cost in your preferred hospitals, sub-limits & exclusions. Premium consideration should be there but do not make it the only criteria.

     Apollo Munich Optima Restore has some good features which enhances your SA, especially in floater.The premium may be higher then your existing plan.

     However, do note that in portability the decision rest with the company. Education & accidental cover will not be there as Apollo Munich do not have these features.Rest you should check with the company.

     Its advisable that you plan for your children future seperately and avoid any combo products.Even accidental insurance you should look at a comprehensive policy. Apollo Munich has been good on service standards and has maintained product competitiveness then PSUs.One major difference is sub-limits within features which is there in major PSU policies.

     Look at your requirements and then take a decision.

     I hope this answer your queries.

8. It is different! do you know what else is different – the Apollo Munich Contest. Play it !

   • Hi Sanjay,
     I think you are new to TFL – else you would not have added this comment. I would like to clarify that I don’t have agency of any Life or General Insurance company.
     If you have any doubts regarding Apollo Munich Optima Restore or any other health insurnace policy – feel free to add here.

9. Hi Jitendra & Hemant

   It is really good initiative. You are the social workers of 21st century.

   My doubt: – I am 32 yrs old working in IT. I have ICICI Health Assurance 5Lakh for myself. Also I have opted for Group insurance provided by my employer. It covers my Wife, daughter (3.5 yrs) and mother (62 yrs)

   But I think my wife and daughter needs to be covered under separate Health insurance.

   So for both of them is “Optima Restore Family Floater” advisable?

   Thanking you in anticipation.

   Regards,
   Shailesh

   • Dear Shailesh,

     Thanks for the appreciation.

     You have bought a good coverage for yourself.Although your wife,kid & mother are covered from group insurance,its still advisable that you buy a seperate policy for your mother & Your family.Reason, Group policies benefits are being revised and if your company finds that parents have been the main claimant in group insurance, they might exclude them going forward.Although portability is available now, where if you leave the company you can convert your health insurance into a standalone policy with same company and after one year switch to other, the decision of accetance lies solely on the insurance company which can exclude some of the benefits.

     Hence review your policy for spouse and kid and continue their coverage through group insurance if the standalone policy has benefits as per your requirements.But cover your mother through a separate policy.

     Yes, Optima restore you can consider as Apollo has life long renewals which will benefit you.

     • Dear Shailesh Bhuskute,

       Reading your comment, I had a slight feeling that the Health Assure plan that you are having needs to be reviewed!
       If that’s from a Life Insurance Company, I am sure somebody met their target by you! And if its from a General Insurance Company, the “probability” of having the right product can be as high as 100%. I am sure you know probability is not surety! However, its recommended to review once.

       Optima Restore is a very good option- Never heard any bad report thus far.

       Thank you.

10. Dear Mr. Solanki,

    Does the Multiplier Benefit in Apollo Optima Restore work very year?
    Does the SA increase in the 3rd claim free year? (or 4th say after 1 claim etc.)
    If yes then it will like the magic of compounding! If no in the long run (several claim free years) discount offered in the premium is better isn’t?
    (Also I presume the doubling works only for two consecutive claim-free years.)

    • Dear Pattu,

      NCB benefit in any mode has a maximum limit. Beyond that teh SA does not increase.Also its not an investment product and hence you cannot have a compounding increase in SA for life long.

      The difference I highlighted is that in a general health insurance policy NCB increase by 5-10% every year and has maximum limit of 50%.Hence the SA of Rs 5 lakh reaches 7.5 lakh in few years.Contrary to this in Restore it is 100% which reaches in third year and the increase in SA benefit any health seekers.Also add the restore benefit in third year your SA actually triples and is surely a compounding increase or you can say a multiplier benefit which has not been available till now.

      Good or bad is an individual choice based on his/her requirements.

      I hope this clear your doubts.

      • Got it thanks. The main limitation then is “If a claim is made after the bonus has applied then in the following policy year the multiplier bonus is decreased by 50% of basic SA.”

        So say I have 7.5 lakh cover from the 3rd year on. 3/4 years later when I make a claim the next year there will be decrease in the bonus. To take care of inflation I will have to increase the cover. This is an unappealing limitation to me.

        • Dear Pattu,

          Yes, with time the insurance coverage might have to be increased.Although there are cheaper options like Top up Policies but then all companies have different features.In fact Apollo also have a top up policy which you can consider for increasing the coverage.

          My take is that they are good option for enhancing your coverage at a low premium rates which most Indian consumer are not aware of.

11. Gr8 article.. I was planning to get this optima restore family floater, but cudn’t get any info if they provide critical illness rider along with this??

    • Dear docanoop,

      Right what Mr.Anil said, you cannot add a CI rider. However do note that in any health insurance policies all the illnessess covered in CI are covered for hospitalization expenses.

      For CI rider you will have to look at Easy Health product from Apollo Munich or others.

      • Thanx Jitendra.. 🙂

12. mr.docanoop, no you can”t get critical illness cover rider with optima restore policy -but you can get it with easy health of appolo munich -but critical illness are covered to the extend of sum-assured in all health insurance policies.

    • Thanx anil.. 🙂

13. hi,
    i have a maxbupa family floater policy SILVER HEALTH FOR A COVER OF 2 LACS. MY AGE 32 , WIFE 29 AND KID 1 YR ALL INCLUDED. PREMIUM OF AROUND 7000 P/A. SHOULD I SWITCH OVER TO OPTIMA RESTORE. IS PORTABILITY ALLOWED FROM MAXBUPA TO APOLLO MUNICH

    • Dear Sandeep,

      Yes, portability is applicable to all insurance companies and you can switch from Max Bhupa to Apollo Munich.However, the benefits continuation will be decided by the company.

      So check with the company and then decide if it matches your requirements.

14. Dear Jitendra,

    My family including parents (aged above 70 years) am covered under group mediclaim policy given by Oriental. Can I shift to Appolo Optima with parents ? If yes, where can I find the premium rates ?

    Thanks

    • Dear TCB,

      Portability in Group insurance works differently.

      First you will have to convert your group insurance to a standalone policy with the company you are availing the benefits currently. After continuation of one year you will be able to transfer your policy to another insurance company.

      However, do not that terms of standalone policies are different from group insurance. There might be exclusion of some benefits like your parents inclusion or any other and the standalone policy may have sub-limits which are not there in most group policies. Since the decision of acceptance rest with the company , first check the benefits you will be able to avail and then make your decision.

15. Jitendra,

    Thanks for this wonderful article. I’m looking for an insurance policy for my parents. They have diabetics. And am looking for a policy which has less no.of yrs exlusion for pre-existing diseases?

    I generally see 4yrs for covering pre-existing diseases. I see this “optima restore” has only 3yrs. Could you suggest any policy which has less than 3/4yrs?

    • Dear Mr.Ram,

      For diabetic patients there are specific policies from start health and ICICI Lombard.You can check the scope of coverage for your parents. However, do note that these policies do not cover any other illnesses.
      Apollo Munich do not cover diabities and hence you will not be able to cover your parents.Also, all companies cover preexisting policies only after a waiting period of 3-4 years.

      You should check with these specific policies.

16. mr ramprasad, the underwritting of apollo is not so flexiable-if u infact you should mention diabities in propasal form-apollo will not accept it-but silver lining is that max-bupa is lot flexiable in this regard-they probably will issue the policy after undergoing prescribed tests & exclusions depends on the outcome of tests & normally it is for 2 years.
    other co. for diabitic patents to look for is from star health -which has a policy
    diabitic care but offers limited cover not an mediclaim in real sense.
    pl. never try to hide medical facts while applying for medi-claim & every co. has a right to reject the claim under grounds of “non-disclosure”

17. Thanks very much, this article just came when I was looking to increase my existing mediclaim and was shopping around for a suitable one.
    I m 47 and my wife is 40 with a 13 years old son, the mediclaim policy that we have is of 3 lakhs with National Insurance India, Can I buy an additional policy just for me ?
    will both of the policy apply if needed? Or should I get another policy like Apollo Munich Restore for my family?
    Keep up the good work of educating people like us.
    All the best to the whole team of TFL and specially Hemant ji for the hard work and dedication.

    • Dear Tonyg,

      You have both the options of buying a policy for yourself and the family.Since your family is covered only for Rs 3 lakh, it might not be adequate to meet the emergencies in future. It will be advisable if you enhance cover for your spouse & kid too.
      You can either look at top up policies which are cheaper or buy a comprehensive policy like Apollo Munich Restore. However, do remember that features in all policies are different and you should compare it before taking a decision.

18. Thank you very much for your advice I will compare the features from Max Bupa, Apollo Munich restore and National Insurance India, Do you think it would be sufficient to top it up for another 5 lakhs with critically illness rider.
    Your advice will be very useful when I discuss it with the representative.
    Thanks again.
    Regards

    • Dear Tony,

      Apollo Munich Restore does not have critical illness rider option.
      You can check with other insurance companies for details.Yes, it will be a good option to have a CI rider along with base policy.

19. Thanks for the advice, and keep up the good work

20. Dear Jitendra Solanki,

    Thanks for the nice article and clear explanations. It seems Health Insurance industry still need to long way and in future there is going to be many more policies with new features and innovations. Also year by year the portability of the policy also not possible / feasible. So selecting the correct policy in the first itself seems to be very critical and also a daunting task. So my question is there is way to select or evaluate a health insurance policy using ratings / methodoligies ? For MF we have value reasearch, similarly do we have a any other renowned organizations / company providing this ? If Yes please share the details and how to select the effective health insurance policies ?

    Cheers
    Sowmi

    • Dear Sowmi,

      I-Seva was doing comparison of health insurance products and rating them.However, IRDA has put some restrictions on such kind of comparisons due to which many companies who were offering this service have been affected.

      To evaluate a health insurance scheme identify your requirements which should include any specific illness, cost of hospitalization in your preferred hospital network and members to be covered . This will let you know the features you are searching in a product and the total coverage required to cover all members. Identify the product by going through policy wordings in detail and select which best suits your requirement.

21. Dear Jitendra,

    Thank you for the detailed analysis. Need one clarification – If we pay two year premium at one instance what happened to NCB fo first year. Is it that we loss 50% NCB to save 7.5% if there is no claim in the first year?

    Another question is I am having a Reliance Heathwise Gold – Family Floater policy and no clims been made since I took this policy (4 Years now). Suppose I transfer this policy to Apollo under portabilty sceme, will I get all the benefits which I am suppossed to get after completion of three years of policy.

    Thanks & Best Regards.
    Subodh Padhya

    • Dear Subodh,

      If you pay two year premium then first year NCB is counted during your renewal and it works similar to one year policy.Hence if there is no claim for two years your SA gets doubled during renewal after two years and vice versa.

      As far as portability is concerned the decision rest with the company.In most cases the all features will be continued, however the company may restrict some of them on basis of their evaluation on various parameters.

      You can check with the company for more clarification.

22. Dear Hemant
    Star health has launched new policy w. e. f. 16th jan, 2012. It has similar features as in apolo munich.
    I request you if you can write on this policy, since I am planning to buy one.
    with regards
    Indrajeet Singh

    • Dear Indrajeet,

      Apollo Munich Restore has been discuss in detail here.You can compare the two and select one which best matches your requirement.

      Haven’t gone through Star Health yet but will be evaluating the product soon.

      • Thanks. I will wait for your evaluation of star health new policy.
        can u give a link to the claim rejection ratios of all mediclaim companies.
        with regards
        Indrajeet singh

        • Dear Indrajeet,

          Star health has also revised its base product like Apollo. They are restoring the SA in their new policy.However one major difference between these two companies is the sub-limits. Star Health, although have added features like restoring of SA, Higher bonus etc it still has sub-limits in all their features.For e.g Restoring of SA is 50% up to Rs 3 lakh and 100% above Rs 4 lakh. Similarly the NCB is higher but increase by only 10-25% in first renewal and 5-10% afterwards. The major sub-limits in room rent,doctor fees, nursing expenses remains but with higher limits.

          Within Star Health products its new policy is certainly providing good features but when compared to Apollo it has high sub-limits which may not find favour with many health insurance seekers.

          You can look at the product after analyzing the hospitalization costs in your preferred hospital network. If the sub-limits does not pose any major problems you can go ahead with the policy..

          For claim settlement data you can check IRDA website.

23. If I buy a optima restore family package of 3lakhs and pay a premium for 2 years at the very beginning will I get a discount?If so,what will be the rate and how much will I have to pay in total?

    • Dear Anausa,

      Apollo Munich gives 7.5% additional discount if you pay premium for two years.The discount is applicable on the premium rates. For e.g if Premium is Rs 7000 then you pay Rs 6475 (add 10.3% Service tax) effectively.

    • Hi

      you will get … but be ware of taking apollo munich insurance..

      worst service

24. mr.das,appollo offers 7.5% discount on base premium -if 2 yrs premium is paid instead of 1 year but should be in same age slab,the calculation is simply multiply basic premium by 2 & deduct 7.5% of amount & add S.T @ 10.3% -result will be premium for 2 years.pl. check rates on website for your age group .

25. in this competitive era, we all illlterates , the gullible – public are taken for a ride at our own risk, besides costs…
    fortunately,Of course, here we got these esteemed financial Ad visors, not to err- with financial agents- who solely have their own transient targets…

    well, we get all information and advises from these Experts….
    all accolades to this site – Founder ,Mr. hemanth, and all Expert members.

    final call, follow the pioneers, not the leaders of the day..

26. Hi Jitendra,

    Great to see a person having such a vast knowledge on health policies which is very important for life. kudos to U 🙂 I need a help from you, i need to which health product covers the doctor consultation expenses (Out-Patients). Because i take my mom frequently doctor for consultation, we do not get admitted to hospital as most health products require 24 hrs to be in bed for the claims. Please suggest me a health product which i can take for my parents. It should cover Out-Patient (OP) expenses which i can claim from the insurance companies producing bills.

    • Dear Prabhu,

      Very thanks for the appreciation.

      There are very few specific OPD policies at present and they are slightly costlier when it comes to premium.Even Apollo Munich has one with name of Apollo Maxima. You can check it and see if it matches your requirement.

      Star Health and Max Bhupa also have these specific policies which you can compare.

      However there are some health insurance companies which cover OPD benefits in their basic plans.You can check with them as per your requirements.

27. Hi Jitendra,

    i have talk to executive about Apollo Munich Optima Restore, i have done this policy, is this right which i choose ? please give me your’s opinion on this.

    please suggests

    Rajesh Malik

    • Rajesh,

      Yes this policy has some good features which are considerable.You can simultaneouly create some liquid funds for meeting any shortfall.

      Review your insurance needs at appropriate intervals to cover adequately.

28. Hi Jitendra,

    A very informative article & very precise answer to all the questions. Great work! 🙂

    I’m looking for a health insurance. Confused between the top players – Apollo munich & Max bupa. Need your suggestion.

    I’m 26 years old; no dependents so far; good health condition i.e. no prior/present illness. So an Individual plan would be fine for now or should go for Family Floater plan (considering that I may get married in 1-2 years)? What needs to be a fair sum assured; and also the premium? Which features I need to check at this moment like room sub-limit, pregnancy/maternity expenses (for later)-waiting period, daily cash benefit etc. in order to make a choice?

    So considering these Easy Health or Optima Restore or any Max bupa plans-which one would be suitable for me?

    Eagerly waiting for your reply.

    Thanks,
    Sudip

    • Dear Sudip,

      Thanks for the appreciation.

      Individual policies are always better then floater as you get a higher coverage.Also since you are single you will not be able to get any floater plan as minimum member requirement is two.

      Your SA should be able to cover hospitalization cost in your preferred network comfortably.However, isn’t always advisable that you also create an emergency fund as the high premiums sometimes becomes a constraint for getting required coverage.Generally policies without any sub-limits are good as you do not have to shell out funds from your pocket. Also if company have sub-limits you have to buy a very high cover to meet the cost during hospitalization in good hospitals.Apollo and Max Bhupa have good products with this feature.
      You will be getting married and will have to bear maternity expenses few years down the line.You should look at this as one of the factor.However the coverage will have to be on your spouse to claim the benefit.You can buy an individual cover for her once you get married.

      For you Optima Restore will be a good option. You can can check other policies from Apollo or Max Bhupa to cover your other family members. Also start saving for an emergency fund which will help in meeting expenses if the health insurance coverage falls short.

      • Jitendra, THANKS A LOT for your detailed reply & enlightening about the various deciding factors of choosing a health insurance. 🙂

        I’ll go through the policies of these companines over again & hope to make a decision soon. Will ask you if there’s any other query.

        And yes, I’m working on my emergency fund. And planning other investments too.

        Thanks once again! 🙂

        • Dear Sudip,

          I am pleased that my replies are helping individuals in their financial decisions.

          I will be happy to answer your queries.

29. Dear Mr. Solanki,

    Please let me know if Critical Illness is covered by default in Optima Restore because they don’t tell about it even in policy wordings. And what is claim settlement ratio of Apollo Munich?

    Thanks,
    Atul
    9871800000

    • Dear Atul,

      Optima Restore does not have any exclusive CI rider to attach.However, hospitalization expenses pertaining to illnesses covered under CI are covered under basic heath insurance policy.

      For settlement claim ratio of Apollo Munich you can check at IRDA Website

30. Dear Jitendra Sir,

    I sincerely thank you for your superb reviews. It only because of these reviews I understood my foolishness. Currently I have
    1. Jeevan Saathi Double Cover Joint Life Plan for 1 Lakh (Premium : Rs. 4009) starting on 5-01-09
    2. Health Plus (HCB = 2500) (MSB = 500000) (Premium : Rs. 15000) starting on 20-10-09
    3. Jeevan Anand for 3 lakh (Premium : Rs. 15429.00) starting on 27-03-10
    4. Wealth Plus (Premium : Rs. 2000 monthly through ECS) starting on 4-05-10
    5. Jeevan Saral (Premium : Rs. 766 monthly) starting on 25-05-11

    Wife
    1. Jeevan Astha (Single Premiun : Rs. 1,03,290) starting on 28-12-08
    2. Health Protection Plus (HCB = 1000) (MSB = 200000) (Premium : Rs. 6000) starting on 29-03-10

    All of the above policies were forced to me buy my relations (LIC Agents). Please guide me whether I should continue or not. My age is 29 years & my monthly savings is Rs. 10,000

    • Hi Vishesh,

      You will get analysis on your portfolio as discussed yesterday.

      Regards
      Jitendra solanki

31. Hello TFL team,

    Nice article on medical insurance. It is an eye opener.
    I am 30 years old with kid and covering with Group insurance of 3 Lacs from our Employer. After reading this article, I got to know the need of another Family floater for my family (2 adults + 1 child). Comapred so many policies and short listed Apollo munich family floater standard & Max bhupa Family floater silver. Please suggest me the suitable plan among the 2 and how much SI should I take 3 or 4 Lac?

    • Dear Suresh,

      Its good to see that readers of our articles are gaining awareness.

      Both companies are good.Apollo Munich will be slightly cheaper then Max Bhupa. I have been discussing in this forum that sometimes combination of an individual and a floater (covering your spouse and child) can work well as the premium increase is not very high.The benefit you get is higher coverage.
      Look for at least a cover of Rs 5 lakh for your entire family. You can check with the combination i have discussed.
      As far as Apollo Munich Easy Health Standard is concerned, Restore is enhanced version.You can consider it for your family if standard is your choice.

      • Dear Jitendra,

        Going through the discussion it seem that appollo munich restor is one of the best health insurance policy though marginally expensive. i am look for an health insurance for my parents aged 55 and 49. They are medically fit. What would you advise individual or floater. Also advise if i can look at other policies for my parents.

        • Dear Ajay,

          Optima Restore has some good features which enhances one’s health insurance needs.You can look at this product for your parents too.
          An individual plan is better as you can get a higher coverage.However at your parents age the premium will be high.If the premium cost goes beyond your means in Individual then opt for floater policy.
          Other policies which you can consider are Apollo Easy Health and Max Bhupa.

          • Thanks for your reply Jitendra, Checked the premium comparison for Appollo Easy & Optima + Max Bupa, the premiums are expensive. What abt oriental family floater silver plan with myself as the main proposer plus parents and other members the premium works out to Rs. 11, 360 vis-a-vis Rs. 29171 for optima restore for parents, Easy health @ 23000/- and might be higher for Max Bupa. Do you think this will work or are there any demerits in the above. The surplus can be invested to cover up for co-pay in future under oriental.

            • Dear Ajay,

              The plan from Oriental Insurance has sublimits.For e.g. room rent is payable up to 1% of SA.If your expenses goes beyond this you have to bear it.Similar sub-limits are there in other expenses. Even if you go for higher cover the sub-limits will restrict your claim.Sometimes these pose problems if the hospital cost i s too high like in Metros. Hence you will have to analyze the cost in your preferred network and then decide.If sub-limits are ok then Star Health is also a good option as they have come out with a policy with restore features.

              • Dear Sir,
                I have the same query as of Ajay. I am also looking to buy health insurance for my parents aged 59 and 58. I am interested in oriental insurance happy family floater plan(Gold), SI-6lacs. Premium will be around 20,000; if PA of 10,00,000 each is also taken.
                Kindly compare it with star health plan as suggeted by you. or provide me the link.

                – Also, I need your precious advice regarding the buying process. Should I buy online from the company website or through agents-like medimanage.com, or insuringIndia.com? Kindly highlight the differences in the various buying process.

                –Is TPA is helpful or I should not avail its services and get 5% discount in policy premium of oriental.
                I am waitng for your valuable response and will buy policy immediately.
                Many thanks in advance.

                • Dear Inder,

                  You can check policy details at http://www.starhealth.in

                  Buying through company websites is a good option and the premium may be bit lower than buying through any intermediary.The company reduces the intermediary cost when any customer buy directly through their websites.

                  TPAs have been the cause of some problems in the past and hence most companies like Apollo,Max Bhupa, ICICI and even Star Health have their in house processes. But that doesn’t means TPA services are not considerable everywhere. I haven’t experience services of Oriental and so cannot comment. Now portability is there you can always switch your insurer if you find any deficiency in existing insurer services.

32. Hi Jitendra,

    I need an insurance for my parents aged 64 & 58. I have been researching on Appolo Munich Optima Restore an MAX BUPA Family Floater – silver Plan. A few notable difference between them is – In MAX BUPA – Heart beat – Family First -provides this option – 10lakh insurance cover (5 lakh each) + 15 lakh Floater- premium – ( so the total amount wil be 40 Lakh) – the premium comes to – 40 K .
    The drawback in MAX BUPA is co-pay (80%-20%) after 65 yrs of age. Whereas in Apollo Munich Optima Restore there is no copay. But then there is no floater coverage. I am a bit confused which one i should go for . Request your help !!.

    • DrInfo,

      You should go for individual policies for your parents if the premium is within your budgeted expense.

      In restore you have floater policies also. The benefit of this policy is applicable to floater too.You can check the premium for details.However, the maximum coverage is upto Rs 10 lakh.In Max Bhupa you get higher coverage.

      Restore is good when you consider the features.You can plan for building an emergency fund along with the policy.This will help in reducing cost for you.There are certain exclusions which are applicable to co-pay policies.You should check policy wording for knowing your exact payout if situation arises.

      Do remember that at higher age there will always be restrictions in health policies either through maximum limit or co-payment.Opt which cover illnesses comprehensively and create emergency fund to deal with any shortfall.

33. Dear info, congrats for the research & it is beleived you are looking for policy for 5 members including ur parents.
    i would like to suggest that we should give priority to adequate cover-considering present medical inflation of more than 15% & down the line say after 5 to 8 years will the chosen cover will be sufficient or not ?
    since ur parents are in sixtees -indeed it will be diffucult to choose higher sum assured after some years-so my personnel opinion will be to opt for max-bupa & try to built medical fund for provisions of co-pay.

34. Thanks Jitendra and Anil for the advise. You are right we should take the medical inflation into consideration , hence MAX Bupa with greater coverage makes sense also I need to check policy wordings before taking the policies. One more information I would like to give to the readers is , I checked in the IRDA website for Claim settlement ratio. Max BUPA has just 54% whereas Apollo Munich has 93% , on of the best in the industry.
    .So in this regards does it makes sense to go with Apollo considering the track record.?

    • DrInfo,

      Claim ratio does give you information on the good settlement processes of the company.In Apollo Munich underwriting is very strong and they sometimes do not accept cases where probability of claim is very high like they do not give policies to diabetic. One good thing with this process is that the problems during claims are very less. The underwriting during application may not be so strong in other companies . There are other cases also like agent misselling, misrepresentation of facts by insured etc, although the numbers may be small.

      Apollo Munich does have good claim history among all companies and hence is preferable because of its strong underwriting process.However, if you have notified all the facts to the company during the application you should not face problems during the claim even in other companies.

35. Dr. info, thks for putting up a such a beautiful debate ney apphersion of masses -i would like to throw some light on the question asked for.
    if the proposer mention all the correct information at the time of taking the policy-no insurance co. can deny the claim & there are many forums available for redressal.
    All Health insurance co’s are bound to pay genuine claim if & when arises -But then they have the right to reject the claim on the grounds of non-disclosure & dishonesty from proposer end.
    i personally will never go for such an data as the only creteria for choosing the plan-we should instead go for features & needs of the plan.
    my brother is the agent of star health ( one of the cheapest health insurer in mkt.)-but then no claim has been rejected till date. only mantra being to disclose all correct information at the time of proposal & the word to client that if something is not disclosed-he will never get the claim instead will loose the premium.

36. Who can i conatct at my local city Belgaum (Karnataka) or if a rep can contct me on 9739100000

    Rgds…
    Jones samuel

37. Hi Jitendra,
    I’m 32 yrs old, with my wife 26 yrs & a daughter of 2.5 yrs. What kind of medical insurance should I opt ? I recently read about Apollo Munich Optima Restore. Will it be helpful for my family ? What kind of option should I opt; floater or any other else ? Now what is Floater ? What is the difference of it from others ?

    • Dear Samrat,

      You have two kind of mediclaim policies -Individual and Floater. In an Individual mediclaim the insurance is on a single person like yourself while in a floater policy more than one are insured. The benefit of a floater policy is that any of the members can utilize the Sum Assured. However, the drawback is that if entire amount is utilized by one member, the others have to purchase a new policy to cover themselves.For e.g in a floater policy of Rs 1 lakh for a Person,spouse and child the amount can be utilized for medical benefits on any of them.But suppose the spouse gets hospitalized and entire Rs 1 lakh is used, the person and the child will have to buy a second policy for coverage in the remaining period.

      In your case a floater will be a good option.However sometime a combination of an Individual and a floater works well for getting a higher coverage.Compare the two and take the best option.You can consider Apollo Munich Restore as it has some good features.

      • Hi Jitendra,
        What is the difference between a health insurance and medical insurance ? If I want to get coverage of treatment cost, what should I opt between health insurance and medical insurance ?

        • Samrat,

          Health and Medical Insurance are one and the same thing. The words are used interchangeably for this type of insurance.

38. Thanks Jitendra for your kind advice. So I would like to opt for Apollo Munich Optima Restore; one individual for myself and another floater for my wife and daughter. So please comment on my selection.

    • Samrat,

      You can go ahead with the policy. Do make sure you have identified your requirements in detail.

39. Hi,

    My company at present covers me for all medical related issues moreover employees are covered through corporate insurance a cover for 2.5lakh.

    What i need to know is i need an insurance for which i can pay the premium now and avail the facilities later after my retirement. Somewhat which appeals me is Apollo Munich restore & multiplier. Can you please advice what policy is better for me. I am married and have 02 kids. I will like to cover only 01 kid.
    Regards/

    • Kaushal,

      Although corporate policies benefits are reducing, you have portability available to change your corporate policy to a standalone policy when you leave the job.However, you can only do it with the same company for an year and then have flexibility to switch to any other company. With this benefit you can count your group insurance policy.But do check the features with the existing company to match your requirements and have adequate coverage.
      All health insurance policies are one year policies.Also the real beenfit you avail after continuation of 4-5 years with the company.You can purchase the right insurance and continue for long term.But do remember if you miss any renewal the next policy will be counted as new and you loose all the benefits accrued in the past.Hence renew your policy timely so that by retirement you will be reaping all the benefits available in the policy.

      Simultaneously, you can also look at creating an emergency fund to deal with any shortfall as health insurance policies has certain limitations which you can get from policy wordings.With small saving regularly you can very create this corpus.

40. mr Abrolji, i would like to suggest you to consider either a deductable or surplus policy which can provide u cover after first 2 or 3 lakhs which ever option you choose & which is very cheap-it works after first exhausting the choosen option either from ur pocket or another mediclaim policy.since you are already covered through empolyeer to the extend of 2.5 lakhs-you can take such a policy at nominial premium.There are many co’s which offer top-up type of policy but to certain decided age & with some conditions-however Max-bupa deductable policy can give you cover life-long but will provide cover after say first 3 lakhs in a year -the available policy can be taken up to max. 3 lakhs on floater basis.so you can have effective cover up to 5.5 lakhs & that too at low cost.

41. Dear Mr Jitendra Solanki
    what a Great Service You All are doing to the general public !
    kindly advise which health insurance policy one {my Closest friend} should take – his age is 44yrs,her spouse 32yrs,both working couple & no children,they r planning for child/pregnancy in 1 or 2 year . please advise which should be the Best policy for him – Individual or Floater , of which company Apollo Munich or Max-bupa or star health or some else & their which plan ? please advise at the earliest its urgent for them to decide.
    looking forward for your right guidance at the earliest possible
    regards
    sanjiva

    • Sanjiva,

      Any health insurance policy covers maternity expense after a certain waiting period.In most policies it is 4-6 years.However there some specific policies launched by companies where waiting period for maternity expense is less.
      Following are products you can look for covering this feature:

      1. Max Bupa Heartbeat Health Insurance – waiting period of 24 months
      2. Star Health Wedding Gift Insurance – waiting period of 24 months
      3. Apollo Munich Easy Health Plan – waiting period of 48 month

42. Dear Mr Jitendra Solanki
    Thank You for ur reply mail & very important valuable suggestions !
    Please further advise keeping in mind long term future which policy they should opt/take if they are not considering pregnancy to be covered immediately by the health policy.
    Should critical illnesses be covered by the policy or not – what is Better in their case { they are quite healthy & medically Fit } ?
    Please advise which should be the Best policy for him – Individual or Floater , of which company Apollo Munich or Max-bupa or star health or some else & their which plan ? please advise at the earliest its urgent for them to decide.
    I am myself a cancer surgeon in govt hospital covered by for medical expenses, but lots of patients attendants & social contacts ask me which is the overall BEST health insurance one should be recommended for, then it becomes difficult for me as I have no Informed Expert Advise available. That is the reason i m asking you the required information for my friend as i m amazed by ur in depth knowledge & free service advices to the masses. Please keep up these GOOD ACTIVITIES as society needs these GOOD PEOPLE LIKE YOU in this world of materialism ! You are silently serving the society in your own way, so please do keep doing this, GOD will be Kind to You !

    looking forward for your right guidance at the earliest possible

    regards
    sanjiva

    • Dear Sanjiva,

      There are two different policies in the market-One with sublimits and other without sublimits.In sublimits expenses incurred on room rent,doctors & nursing fees, particular illness and pre & post hospitalization have a maximum capping for claim.Companies like Star Health & National Insurance have capping on all expenses you claim during hospitalization. For e.g. Star Health cover room rent expense max up to Rs 4000 per day. If your rent goes beyond this you have to bear additional expense from your pocket.Hence, you will always have a maximum limit within your Sum Assured for claim.Contrary to this companies like Apollo Munich or Max Bhupa does not have any sublimits and so you can get claim up to your policy SA irrespective of expenses you bear on a single category. Hence the policies from Apollo Munich or Max Bhupa will be costlier as compared to Star or National Due to higher features.

      Which policy will be best depends on the cost of hospitalization in the preferred hospital network and the city you live in.In metros sublimits do create a problem as the cost is way above these.However, if you hail from a very small city policies of Star Health can be considered. On features and services standard I found Apollo Munich to be very competitive and primary reason can be long experience of parent company (Apollo Hospitals) in Health care. If premium is not a constraint then your friend can go for Apollo Munich or Max bhupa.Even Restore policy is a good one considering the features.But you do not have CI which i feel one should go for if in 40’s.Your friend can look at Apollo Easy Health products after comparing with Max Bhupa.Go for policy which closely matches your requirements.

      Although Individual policies are better then floater sometimes premium becomes a constraint.In that case your friend will not have any choice but to go for a floater policy.If so he can look at Top up policies which gives higher cover at very low premium.These are additional policies applicable only when you bear a minimum threshold expense yourself. Otherwise he shoudl go for individual policies.

      For me there is no overall best health plan. Always look for creating some emergency health fund as every health plan will have some constraint.

43. Hi,

    I am 28 year old guy. I have purchased Apollo Munich Health Insurance for myself of 5 lakhs coverage. My policy is due for renewal.. I just want to know should i continue with the exisiting policy or should i move to some psu’s policy. I am really concerned bout the ability of the private cos to pay when the claim arrives. And it can b real financial burden during the time of emergency. your thoughts?? also which is the best policy available in the market??

    My Sister suffered with cancer few years ago. She has recovered and fine now. Which policy should I buy for her? And will cancer be covered in the policy?? & also the side effects which 1 gets while undergoing cancer treatment? pls advice.

    • Dear Yogesh,

      There is no reason for a company whether pvt or public to reject your claim if valid. Private companies are more process oriented and hence claim settlement is faster.Apollo Munich has in house claim settlement and due to stringent underwriting for issuing policies, their claim settlement is one of the best in industry.Hence, you should continue with your policy. Also, the features of their products and services has been very competitive.

      With regard to your sister illness, you can approach any health insurance company for the coverage.However, some may exclude cancer permanently in the policy or you might have to shell out a higher premium. You can consider Apollo Munich, Max Bhupa or Star Health for your sister coverage.

44. Dear Sir,

    Thank you very much for your brilliant article..Kindly resolve my querries.

    I am 30 yrs, wife 28 yrs, no kids, dependent mother 50 yrs all are healthy
    my income 8 lakhs per annum and wife 2.5 lakhs per annum, mother housewife

    I have got HOSPITALIZATION BENEFIT POLICY from National Insurance (Me-75000, mothe 1.5 lakhs). married after taking policy.

    1. Can i take another policy in addition to this one? If i take 2 policies do i have to inform the respective companies?

    2. We are planning to have kids in 2014. Which plan will be better?

    3. Should I take individual plans for all 3 of us or a family floater of higher sum, considering the age of my mother?

    4. If I take a family floater, will i be able to get lifetime renewal for each member?

    Thanks in advance

45. Dear Sir,

    I am planning to take the Apollo Optima restore policy for my parents (aged 61 and 55). My father keeps very good health and my mother has had slight sugar, but not on insulin. I am not sure if this can be called out as diabetes. The last time she had to take insulin was during a brief hospitalization 4 years back. Since then she never has taken insulin and the sugar has been within limits.
    Kindly advise on the following
    a) Would Apollo Munich Optima plan accept this? How should I be disclosing this?
    b) Would they be conducting their medical tests and deducing this or should I call it out?
    c) How would this be affecting the claim settlement in future? I have heard of instances wherein insurance companies label other medical conditions as diabetes, Such as delay in recovering from a surgery is attributed to diabetes.
    Would this condition be affected on similar grounds?

    Kindly advise. Would you suggest any other policy?
    Regards
    Aparna

    • Aparna,

      Apollo Munich do not give health insurance to diabetic patients. Hence you will not be able to cover your mother in their products.You can consider Apollo Munich for your father.

      For diabetic patients there are specific policies from Star Health & ICICI Lombard.You can check with the company for scope of coverage within these policies.You might be able to get a general policy with some waiting period if the treatment is not through insulin.

      Medical Test will be conducted for both the parents.

46. Aparnaji, we should always mention all known information in proposal form before taking health-cover otherwise the chances of rejection of claim are high.
    Now apollo will straight-away reject your proposal if you mention the same or least after taking medical test if suger level is beyond the range.
    So the choice narrows down to max-bupa-which will probably issue the policy with nill exclusion clause -if other tests or normal.
    pl. note non-disclosure of medical history in proposal form makes a fit case for rejection if claim arises within 4 policy years & afterwards it is nullified.
    so better to take informed dicision.

47. Dear Sir,
    I am 53 years and at present healthy. except for minor illness. I would like to take individual health policy. I am staying in Visakhapatnam, Andhra Pradesh. which comapany health policy will be good? pl.reply

    • Dear Murli,

      You can consider Apollo Munich Restore or Max Bhupa policies.Both are good and provide comprehensive coverage.You might have to shell out a higher premium as your age is high.

48. I am 32 yr old and planing to take health insurance of 400,000 for me+my wife+mydaughter.
    I am considering two options
    1) Apollo Munich Optima Restore
    2) Star health Fammily health Optima

    as both of this policy have restore and multiplier facility which one is better?

    • Amit,

      Apollo Munich will surely score above star health because of certain features.
      Apollo Munich do not have any sublimits while Star Health has which restricts the claim you can avail.The restore facility in Star Health has also some limitations. If premium is not a constraint Apollo Munich will be better choice.

49. Dear amit, my sugestion is to go for apollo munich optima restore-if u can efford it or if budget is the restraint then only u may consider star.indeed the facilities in apollo are better to be precise.

50. I am 51, wife 47 and boy 6 yrs. currently having 5 lakhs family floater with Star Health and recently had a hospitalization for one of my family members, unfortunately the hospital did not have Star with them. So I had to pay and then get reimbursed the claim amount. Then I came to know Star’s true colours that they almost deducted more than 50% of my claim amount due to various reasons.
    I am interested in either Apollo Munich or Max Bupa. I would like to have the best benefits at a cheaper price. Kindly advice ASAP since I have to renew my policy by 24th Mar 2012 night.
    Thanks,
    Kumar

    • Kumar,

      Star health has various sublimits within their policies due to which you must not have been able to claim the full amount.
      If you are looking for switching to other insurer then Apollo Munich is a good option. Infact Restore is a good choice since you won’t be having specific requirement like maternity expenses which are excluded.Also you will be bale to get higher coverage with no sublimits.However, the premium may be on higher side due to your age and whether all features will be portable, the decision rest on the company.
      Still, you should check with both the companies and port your policy to the company which best matches your requirement.

51. Dear Jitendra

    Some very useful information above. I needed advise on the health insurance cover for my family – details below:
    Self: 42 years in service
    Wife: 36 years, housewife
    Daughter & Son: 5 year old twins
    Resident: Mumbai
    My employer cover: A total of 2.5 lacs for hospitalisation per year for family

    Please advise which health insurance plan and for what amount I should go for. I was thinking of a family floater or approx 3 or 4 lacs. Also, what is critical illness cover and should I opt for the same and do I get this as an option in Apollo Munich’s Standard plan or is it available onlt in the exclusive plan. If possible I would like to avoid plans that cover maternity and new borns as this will not apply to us.

    Many thanks

    Vivek

    • Vivek,

      Ideally when you have 4 family members you should take a cover of at least Rs 7-10 lakhs in metro cities a semployer coverage will cease when you leave the company.Although you can port your group insurance to a stanadalone policy now, much depends on the benefits that will be continued.

      Critical Illness gives you a lumpsum amount in case of certain critical illnesses like heart attack, cancer etc. At your age you should go for it.Apollo Munich Easy Health Exclusive and Premium variant gives you CI rider along with base policy.You can compare these two and take the preferred one.

      However instead of a floater for four you can go for two floaters covering two members each provided the premium difference is not too large.Compare this option also and then take the best decisions.

52. Good Samaritan’s Jitendra/Hemant/Anil,
    By reading all the posts above i have opted for Apollo Munich Restore optima family floater, premium quoted for 5 lakhs coverage was approx. 29K for myself 29 years old, mother’s age 44 and father’s age 58. Again my parents & myself are covered under my employer’s policy for 2 lakhs coverage.

    My question is if my claim is 7 lakhs, can i get 5 lakhs from Apollo and 2 lakhs from my employer’s policy?

    while having both the policies if all my claims are claimed under my employer’s policy for first two years keeping my Apollo munich claim free and then reaping the benefits of Apollo munich after two years is right or wrong.

    If all three of us fall ill in the same year will the family floater can cover how can one be tackling this situation?

    Excepting your valuable comments. And thanks to all of you for your valuable time and being so generous to humanity.

    • Barath,

      Firstly you should have kept your parents policy separate as the premiums in floater are always calculated on eldest member age. Also, tomorrow when you get married you will like to include your spouse and children’s in the policy.Then with your parents your premiums will be way to high.If you go for standalone policy for your parents at that time it will be counted as fresh and the benefits will be according to your parents health situation at that age.Hence it is always wiser to have separate policy for parents.

      You can always claim from your employer policy while your standalone policy is running. However, when you go for claim from two policies the company check the genuineness of claim and then proceed.The problem will arise when you have to submit bills for the claim as all companies demand original bills if you go for reimbursement.Hence look into these aspects and then continue.There is no harm in running your standalone policy along with group insurance.

      In a family floater the insurance amount can be utilized in case of either or all member hospitalization expenses. The case you have mentioned is something rare and to deal with any of your family relative should be aware about your policy.

53. Dear Barath, Thks a lot for mentioning my name along with hemantji & jitender-i am excited & feeling encourged.Pl. do recheck the premium calculations of optima-restore-actually 29K should be premium for ur parents only-since apollo gives cover upto age 21 only in floater policy along with 2 adults.
    Since you along with your parents are having 2 L cover from your employeer-pl. note you should mention previous policy details in new proposal-you wish to go for.
    all insurance works on the principal of intimidity means insurer should not profit from the insurance & yes you can get full 7 lakhs claim from two different policies & insurance co”s will themselves share as per their ratio of claim.
    regarding trying to keep apollo from claims-if arised in first two years-Yes that will be most sensible to do-since your basic sum assured will be increased by 100% by then.
    to your last question that if claim will arise for all 3 members in floter policy in same year- firstly apollo will not issue floater policy for 3 members mentioned in ur mail -because of ur age i.e more than 21-but then in case such a thing happens-the co. is liable to pay up-to sum-assured only.

    • Thanks Jitendra & Anil for your valuable comments as always.

      Sorry for the confusion it was Optima Restore Individual, wherein myself & my parents premium were quoted @ 29K for 5 lakhs coverage.

      Jitendra & Anil I would be the proposer to get tax benefits under 80D for the time being till i get married. Once i get married i would exclude myself from the above policy and take a family floater which will be the ideal option at that point in time.

      Will the above approach can help me?

      Thanks once again Jitendra & Anil for your precious comments.

54. Dear barath,indeed you are going to manage your & ur parents health insurance Risk & getting divedent too in the form of tax rebate u/s 80D-nice decision

55. Dear Jithendar /amit .
    Lots of insights and help, from you people. Thanks
    1) can i be the proposer to my father and mother in law’s health and have the benefits of income tax.
    2) Is it wise to have eg 3 lacs from max bupa and 3 lacs from apollo , instead of 1 company ! was just thinking. Pl. advise.
    3) could you advise on premium increase over age slabs, from 35 years and above, to arrive at a decision of cost in the long run , which is having lower premium hikes ? , maxbupa heartbeat or apollo restore schemes.
    thanks for your time and answers.

    • Ravi,

      1. You can become proposer to your parents but not in-laws.

      2.It is advisable only if one company is not covering a specific illness while other is.Rest you should keep one policy to save yourself from any future hazzle as sometimes claiming from two companies becomes cumbersome.

      3. You can download brochure from these companies website which will give you premium rates and compare accordingly.

56. Hi Jitendra,

    Can you please confirm that Apollo Munich Optima Restore covers “Multiple Sclerosis” as well?
    Is there any waiting period for this disease?
    FYI- patient age is 32 years,diagnosed with MS 3 years ago.

    Thanks & Regards,
    Sandeep

    • Sandeep,

      No info on this.Policy wordings do not speak of this injury.

      In any case this will be counted as preexisting illness which will be covered only after 3 years of waiting period.Any specific exclusion on this can be confirmed only after submitting your proposal.

57. Hi Hemant,

    Impressed by your precise and desired info 🙂

    I am 30 yrs married, want to cover Me+Spouse+6 month child for SA 3 Lac.
    Kindly advise newly launched Tata AIG Medi Prime.
    Is this better than Apollo/Max/Royal in terms of features ?

    Policy Bazar Agent is suggesting Bharti Axa due to coverage of max critical diseases.

58. Hi Jitendra,

    I m looking out for a health insurance for my mother & sister.
    My father is already suffering from Hepatitis C and cirrhosis of liver.
    I am afraid that the HCV infection should not happen with other family members, which is why I m planning to have health insurance for mom & sister.
    Can you suggest me which policy can surely cover hepatitis virus treatment as well.
    I have gone through almost all policies on the net. Out of which Apollo Munich optima restore / Max bupa heartbeat / star optima family scores the highest.

    My primary needs are:
    1. Less initial waiting period.
    2. No loaders on renewal
    3. Coverage for Hepatitis infections.

    Thanks 🙂

59. Dear navdeep, all mediclaim policies provides cover to the extend of sum-assured per year basis for all types of hospitalisation including critical diseases.
    now i failed to understand what does “coverage of max critical diseases” mean in mediclaim policy.i guess you may be referring to critical diseases rider which even life insurance co”s are providing against premium load-which pays lumpsum amt. in case any of the specified disease is dignosed.
    Going-through all the products of all co”s is Good efford before buying-But selecting the right policy for your needs is the wisdom-take help from financial planner near to you for right selection.

60. Please guide me about the best health insurance for my mother and sister.
    My primary needs are:
    1. less initial waiting period
    2. No loadings at renewals in case of claims made

    Max bupa heartbeat has 90 days waiting period while its Health@companion has 30 days period.
    I want to know the truth.

    • Amit,

      All policies have min 30 days waiting period in the first year.Hence you cannot avoid it.

      For no loading at renewals you can also consider Apollo Munich plans.From these two choose one which best matches your requirement.

61. Hi Jitendra,

    I am 38 yrs female unmarried, I wish to take a Health policy for me and my mother who is 63 years. Can you please suggest which would be the ideal policy for us.

    Thanks,

62. Carol,

    For both of you Apollo Munich will be a good option as it gives coverage to people upto age of 65 and then you can renew lifelong.If premium is not a constraint then optima restore is also a good buy.Otherwise you can opt for Easy Health Product from Apollo.The other companies which you can consider are Max Bhupa & Star Health.

63. Max Bupa Heartbeat has 90 days waiting period, whereas it Health companion plan has 30 days waiting period (according to brochure) with no additional loadings.
    Is that true???
    How well is the settlement ratio of Max bupa and Apollo Munich.??

    How is TATA AIG welsurance??? is it good?

64. Hello
    Jitendra,
    I need suggestion for health insurance for my family.
    My Father -59 yrs healthy , Mother -50 yrs hypertensive on medication
    Father in law- 62 yrs healthy ,Mother in law -Diabetic type-2
    My self age -27 yrs healthy ,

    considering diabetic h/o for in laws, i would like to go for individual policy .
    for my parents i may like to choose in between individual or family floater one .

    Please suggest me in detail for same ..

    thanks
    archana .

    • Archana,

      For yoru parents you can select from Apollo Munich or Max Bhupa.However, you might face problems in your mother case as some companies do not cover hypertension at all. It will be counted as a preexisting illness and if company is ready to cover they might increase the premium by loading.Hence, your father will easily avail the policy but in your mother case there might be some difficulties due to the nature of existing illness.
      Similarly, for your mother in law you might have to go for specific diabetic policies available from Star Health or ICICI Lombard as Type 2 is mostly not covered in general health policies. For your father in law you can opt for the companies same as your father.

      For yourself Apollo Munich and Max Bhupa comes very closer to meeting your requirements.You can look at Easy Health product from Apollo if covering pregnancy at later stage is one of your requirement.

      In all cases you will not be able to avail a floater as there are specific illnesses. Hence you will have to go for individual for all including yourself.

65. Dear archanaji, i would like to suggest you that you can cover all above mentioned relatives in single policy in max-bupa family first-where we can get cover for all members in extended family & if you will be proposar -you will be entilted for tax rebate of Rs.35000= under sec 80/D,ie,15k for ur family & 20k for parents.max-bupa may probably issue the policy after undertaking tests & waiting period exclusions depends on outcome of tests.besides there is a 20% co-payment clauses after age 65 in max.

66. Hi
    Jitendra/Anil,

    Very happy to see your reply here.
    As per our both of suggestions, i will search for right product for each of us .
    Thanks a lot guys for directing me in right direction.
    Good job ppl, keep it up & best wishes to u all .
    Tell me what is your an opinion about medimange. Are they worth for contact or not ?

    thanks & regards
    archana

    • Archana,

      Compare product features yourself and then buy it from anywhere it doesn’t matter.

67. Hi Jitendra / Hemant, i have gone thru the above feedback and did some online research and have a query. In case premium is not a constraint, which policy is better – apollo munich optima restore or max bupa heartbeat (for family floater). Especially keen that the policy includes pregnancy. Thanks !

    • Dear Arvind,

      Optima restore does notcover pregnancy expenses hence you will have to go for Max Bhupa Heartbeat.

68. Hi Jitendra,

    I (31 yrs old) am looking to buy the Health Insurance (2 adults + 1 child). I have personally browsed almost all the companies on the internet but not sure on which I should conclude.

    Many of people told me that you need to opt only PSU like New India Assurance / Oriental etc, since they at least settle the claim, however they said its very difficult to know about the private companies.

    Overall I am impressed with the Apollo Restore plan. But confused as to how their claim settlement would be in future and should i go with them or should i go to PSU?

    Also I read that many companies hike the premium over and above their age slab, so in such a case if tomorrow company raise the premium with 50% then we can be in trouble, is there any control from IRDA on that…

    Also if you can suggest with which company should I go ahead… Hope you understood where my confusion is…

    Appreciate your quick revert, thanks…

    Regds,
    Niyat Anjaria

    • Niyata,

      There is no reason why any private company will not pay you claim if it is genuine.This is a misconception as private companies have been better in comparison to PSUs in many respects including claim settlement.Moreover many private companies have a very long experience in health care which is itself a positive factor for policy buyers.

      With regard to product, Apollo Munich restore is a good one which you should consider if it meets your requirement.The premiums are constant for a defined age group like 35-40 or 40-45.Once you cross this your premium gets increased and remain constant for the age group.In between insurance companies review their premium rates and revise it if required.Since this is a standard practice across the industry everyone faces this situation.

      Do not stretch yourself by paying higher premiums now.Instead buy a lower cover now and enhance it as your savings increases.You can consider top up plans for increasing your coverage as they are very cheap.

69. Dear Jitendra/Hemant/Anil,

    I am 40 Yrs old, hypertensive and on medication for the last 3 yrs ; wife 34 yrs and have undergone surgery for pregnancy, gall-stone & Appendix removal ; Son 4.5 Yrs and Daughter 3 Yrs.

    My employer’s have own Hospital facilities and also has tie-up with other Hospitals for referral treatment for its employee and their dependents and when provided, it is free of cost with no upper limit. But the treatment, whether local or referral is solely depends upon the decision of the Doctors of the Local Company’s Hospital.

    1) Should I go for any additional Health Insurance Policy to cover myself and my family members specially to cover critical illness and accidental / traumatic treatment cost to a preferred super specialty hospital of my own ? if yes, please suggest the best way / Policy for the same.

    2) Also mention, whether it is possible or not to claim medical benefits from the insurer even if the treatment is done at Employer’s cost ?

    • Dear Jubaraj,

      Standalone health insurance is always advisable even if you are covered under any employer scheme.One of the reason is that the wide hospital network which companies have.
      Wrt. your illness i.e. hypertension, most companies do not cover it and so you might face difficulty in availing plan for yourself.Even if any company is covering, it might have a long waiting period 3-6 years to start coverage for this specific problem. In your spouse case she has recently undergone surgery and either the company may exclude some permanently or you may have to shell a higher premium.

      For your children you can cover them with any health insurance company.Apollo or Max Bhupa are considerable.

      If your treatment is done at employer cost then you cannot claim it from insurer .

70. Dear Jubaraj,

    Standalone health insurance is always advisable even if you are covered under any employer scheme.One of the reason is that the wide hospital network which companies have.
    Wrt. your illness i.e. hypertension, most companies do not cover it and so you might face difficulty in availing plan for yourself.Even if any company is covering, it might have a long waiting period 3-6 years to start coverage for this specific problem. In your spouse case she has recently undergone surgery and either the company may exclude some permanently or you may have to shell a higher premium.

    For your children you can cover them with any health insurance company.Apollo or Max Bhupa are considerable.

    If your treatment is done at employer cost then you cannot claim it from insurer .

71. Hi sir

    Recently i got to know that My company is not providing medical cover to my parents since then Iam thinking to buy a medical insurance plan to my parents.Kindly suggest me the best plan in the market,my parents age are 54 and 44.

    Regards
    Ashok

    • Ashok,

      You can consider Appollo Munich Easy Health & Max Bhupa for your parents.Both have good features.Premium will be higher in Max.

    • You may contact medimanage . com. I availed their services and found them quite professional and they provide unbiased advise. They do not charge anything extra to the customers.

72. Hi Solanki ji,

    I am new to buying health policy as we had stayed abroad and have recently come back. I am 35 years old and my husband is 33 years old who has his own business and we have 62 year old mother in law. I am looking for a policy where we three can be covered better way or least we both husband wife have a health policy.

    I am confused between max bhupa and apollo munich optima restore. Though I had selected optima restore but recently I had been reading its poor service suffered by consumers in places like mouthshut etc. websites.

    Kindly suggest us a health insurance policy in India which has good premuim rates as well as good service later. I would be grateful to you. Also, is individual policy better or family one?

    thanks

    • Neha,

      Cases of lapse in policy services are there in all companies. Still, companies like Apollo, Max Bhupa fare better then other players.One good point with Apollo is that they have a g history in Hospitality sector and that’s why they are able to improve upon their services.Product features and premium are also very competitive.So i will advise for these companies.

      With regard to the policy, i will advise you to keep mother policy seperate as in floater premium is calculated on eldest member age which can be costly if you cover all three in a single premium.Also you and your spouse will have requirement of features different than your mother .Hence buy an individual policy for your mother as risk of illness are higher in her case and any claim will affect the policy.

      For you and your spouse you can go for indiviudal if premium is not constraint.Later you can include a member in either policies which is a feature in Apollo Munich.

      Feature wise Apollo products are most competitive and premiums rates are also competitive.If you have any premium constraint then go for Easy Health from Apollo Munich instead of restore. Check policy wordings and see if it matches all your requirement.Look especially waiting periods. e.g. in Apollo Policies the maternity expense is given after six years while in Max Bhupa it is after two years.Once you are convinced on all paramaters which matches your requirements buy the product.You can compare with Max Bhupa.

      For your mother you can consider Restore.Although the premium will be high.The other option will be Easy Health.Senior citizen policies are there but they have high sublimits and maximum SA limit which restricts the amount of claim you can receive.Star Health and Bajaj Allianz have these product.

      Hence, identify your requirements and then select a product.

73. Thanks for the quick response. I liked apollo munich policies but the consumers complaints regarding the company’s response time and efficiency when the individual actually requires it , is the only deterrent.

    Also, for me and my spouse, an individual policy of 5 lakh each is better that than the family floater of 10 lakh?

    • Neha,

      As i said there are issues with each company and hence its difficult to judge only on one parameter.But overall, Apollo has fared well including claim process.The reason being their strong underwriting which I feel is good for consumers during claim.

      In case you are not satisfied then you can consider Max Bhupa.

      Yes, an individual of Rs 5 lakh each will be better.

74. Hello
    I am 39 ,single…
    I am having a Mediclaim of Rs 3 lakhs from Apollo Munich Health. I have already completed 2 yrs and have renewed it for the 3rd yr…It is Easy Health Individual Exlcusive…So far I have not claimed the cover as I have not been hospitalized…
    Can I switch this policy to OPTIMA RESTORE from EASY HEALTH INDIVIDUAL EXLUSIVE…
    Would it be advisable to switch to Optima Restore seeing the benefits or Easy Health is ok for me…
    If I switch…do I have to start from zero(as pre existing diseases etc are not covered for 3 to 4 yrs and 1 month is a wating period )….

    Pls advise…
    Have a Nice Day
    Regards

    • Reveal,

      Easy health individual exclusive is a good product and you should continue with it.You do have an option of switching from Apollo Easy Health to Optima Restore but since you are already reaping the benefits now continue with your existing plan.

      • Dear Jitendra
        Thanks for reply and suggestion
        But I query is Suppose I switch to Optima Restore from Easy Health Exlusive…what do I stand to loose…
        And Will this Optima Restore start from zero and I will have to go all the formalites like waiting period,pre existing diseases etc…or it will be continued .

        Pls Clarify
        Regards

75. Dear Jitendra
    Thanks for reply and suggestion
    If someone decides to switch…does he or she has to again go thru all these formalities a new insured goes thru..or can he reap the benefits by changing his plan
    Pls Clarify
    Regards

    • Reveal,

      Yes, you can switch from Apollo Easy Health to Restore and your benefits will also gets continue.However, if restore has some exclusion of benefits which is present in easy like like maternity expenses, you will not be able to avail.This you should take notice.

76. Hi,

    I have taken a Happy family Floater policy from The Oriental Insurance Co. Ltd from last two years for myself and family (wife, son, mother and father) and it is being continued in third years also.
    I have to operate my father for Cataracts operation, is it payable under this policy.
    Further can i switch my existing policy into Apollo Munich Policy and how it work, what will be the benefits and exclusion if it switches.

    Thanks,
    Manish Gera
    9654500000

    • Manish,

      Cataract is generally covered after two years across various health insurance policies.You can check in policy wordings of the product to know what is the waiting period.
      Yes you can switch to Apollo Munich but continuation of benefits will be decided by the company which you will be able to know during portability process.Still you can show your policy documents to Apollo Munich to know what general features they will continue.Benefits on any specific illness you will come to know only after your application is processed.

77. Firstly, thanks for such a nice article!

    I have quick doubts regarding Optima Restore
    * Is it possible to claim multiple times till you exhaust your SA for an year? It can be basic SA or SA after Multiply benefit.
    * What is the meaning of Restore can not be carry FWD? i.e. If I do not use Restore feature in particular year (say using 5L through basic and 5L through restore), next year SA will remain 5L and restore 5L; and basic won’t be 10L. Is my understanding right?
    * Am new to Health Insurance. Would like to know what is exactly Top-Ups are? I have 5L family floater for myself, wife and kid (2.5 years). Now planning to buy additional individual Optima Restore for wife and myself. (I have 3L family cover from Employer as well). Should this Top-up be bought right now or later?
    * I heard (in one of the CNBC programme) that the policy will elapse if you take citizen of other country (or something on similar line). What is it exactly? If you go on business opportunity for few years (say 5) and come back to India. Will the Policy continue (with assumption that all required Premiums are paid towards renewal).

    Kindly request you to please guide.
    Thanks in advance 🙂

    • Ajit,

      1. In any health insurance policy you can claim multiple times up to the eligible sum assured.

      2.Restore cannot be carry forward means the benefit is available for only one year.If you do not utilized it the amount is not added to your insurance next year.What you have calculated is right.

      3.TopUps are health policies which give coverage over and above athreshold limit which are called as deductibles.So if there is a 10 L policy with R 3 l deductible, th epolicy claim will start only when you have exhausted the R 3 lakh limit either from health insurance from any company or through cash.The major benefit of these policies are that their premiums are very low.

      4.If your paying premiums on time the policy benefits will continue but the claims are applicable only in India.Even NRIs cal also take health policies for claiming any hospitalization expenses in India.

      I hope this answer your queries.

      • Dear Jitendra,

        Thank you for clarifications. Just in continuation –

        (3) Is Optima Restore falls under TopUps? Or do they provide similar mechanism? Currently, I have Family Floater 5L; but plans to buy 5L each for myself and wife. Should I just by Individual Optima Restore or TopUps? What you suggest?

        (4) I was referring Optima Restore Policy. Does it has any clause/condition on Foreign Travel or Citizenship. I could not find anything of that sort in Policy Wordings. Will this Policy be continue if I had to be in another country for 5 years. I know that Claims will be applicable only in India; but other than that, is there any other restriction by which Optima Restore policy will get ELAPSE? As I mentioned, I heard somewhere that in these situation Optima Restore policy will no more valid for Proposer 🙁

        Have almost finalized on Optima Restore. These final doubts will make my decision concrete.
        Thank you again for your support!

        • Ajit,

          1. Top up are surely cheaper but companies which have come out these products have very high sub limits which are applicable to these also.Hence, if premium is not a constraint then Restore will be a good option.

          2.Even if you stay abroad, you can keep renewing your policy. Since Health policies are issued to NRIs also the continuation shouldn’t be a problem for making claim in India.However, different companies may have rules regarding this which you need to check with respective company.Apollo issue policies to NRI.

          • Thanks, Jitendra.

            What about this case –
            * Policy (Optima Restore) is taken as Indian
            * One goes out of country and get Citizenship there.
            * One returns back to India
            * One gets ill and hospitalized
            * He claims for this (assumption: All premiums are paid on time and Policy is renewed periodically)

            In case of Optima Restore, will s/he be in a position to settle the claim?
            Can you please throw some light on this aspect.

            Thank you as always 🙂

            • Dear Jitendra,

              Another thing, if I have family floater for 5L from ICICI, and individual 5L from Optima Restore, and I have to claim 8L. How does it work? Can I seamlessly claim 5L from Optima Restore and 3L from ICICI for same hospitalization case.

              Your guidance will be important as always.
              Thank you so much for everything!

              • Ajit,

                In this case the companies will pay you the total claim but proportionately.How much will each company pays will be decided once you have submitted your claim with them.

            • Ajit,

              There is no boundation on continuation of policy even if you become an NRI.If you have renewed your policy every year you will be able to avail benefits when you come to India.

78. Dear Mr. Jitender,

    Thanks for the update!.

    kindly let me know any advisor/agent no. for further portability processing.

    Regards,
    Manish

    • Manish,

      Which location you are from?

79. Dear Hemant,

    Really liked your article. Just need your opinion. I am in Metro, Age 29 Year, Spouce: 28 Year & Child : <1 year, looking for a Medical cover. I am looking at the option in Apollo Optima Restore.

    Option I (3 lacs)
    Indiviual cover for One Adult +
    Family Floater for One Adult & One Child

    Option II (5 lacs)
    Family Floater Cover for Two Adult & One Child.
    Which one will be better as per you in my case.

    Also, want to know, in case of Family Floater, if the elder member in the policy dies, that what will happen to the policy ?

    • Kanhaiya,

      The first option will be more suitable as it gives you more coverage for the entire family.

      Generally, if the eldest member dies then policy can be renewed by transferring to the next eldest member.This is in Apollo.But still there may be different rules in respective companies which you will have to confirm with them.Especially in PSU where policy ceases in such cases.Hence, whichever company you ave bought health insurance confirm from them.

80. Hi, I want to take health policy for my parents, Age 64 and 62 for 3 lac SA each.
    Please suggest the best policy.

81. Hi! I would like some info to help me choose health insurance products. My mother is 65 years old. Should I go for individual covers for both or should I opt for a floater cover. I am looking at a cover of Rs. 15Lacs each. I am considering Apollo Munich Optimum Restore and Max Bupa. Which one should I go with?

82. Suneela,

    It s advisable to go for individual covers as your mother age is high. In floater policies the premium si decided on the age of eldest member which is disadvantageous to others if the age is too high.

    Max Bhupa has co-payment clause after age 65 which means part of every claim you will have to bear yourself.This is not the case of Apollo Munich. Hence, you will have to compare both products and look at your requirement.Good to read the policy wordings which will give you the exclusions in details. Go for the product which best matches your needs.

    • Thanks Jitendra

83. Mr Jitendra ,

    Appreciate your good work. I am working in IT and have company provided insuarance for me and my family including my parents. But tomorrow if i leave this company , how can i continue with the same company. Also after paying the premuium i have left my earlier company .

    I am also planning to opt for Appollo Munic restore policy after going through most of your comments.

    Thanks Again and Wish you all the Best !! Keep up the good Work .

    • Atif,

      You can port your group insurance policy to a standalone policy with same company now.After a year you can change the company also.However, do note that the features of a standalone policy will vary from a group policy and you may get reduced benefits.Check with the company and then make a decision.

84. Hi, thanks for all the valuable information and also replying to each query. The Apollo Munich website mentions the possibility of loading of up to 150% at the time of renewal of policy in case any illness is detected during the term of policy. As far as I have seen, Max Bupa does not have such a policy of introducing loading at a later stage. What is your view of this type of loading? Should it be a major factor while deciding on health insurance?

    • Sushmita,

      Although Apollo Munich do not put a loading in most of its policies, this is only a feature.If a company finds that claims are very high and frequent or some illness will result in very high claims in future, it can have a loading during renewal. It is one of the factor but not a criteria for selecting/rejecting any company. Has to be looked with other benefits and your family medical history.

85. Hi Jitendra,

    Am quite impressed with the right advices you have been sharing on health insurance. I am on lookout of buying a health policy for myself and my sister. the more i go into all the different company offers, more confused i am. Please let me know

    1. Are the permanent exclusions same in all insurance companies?

    2. i find apollo munichs optima restore quite suitable (am 42 yrs).

    3. Parkinsons and alzhmier is an exclusion in optima restore, is it the same with other companies? (is it addressed as mental or nervous conditions in other policy ? they have used that terminology whereas apollo has specifically mentioned in their policy wordings.

    its urgent

    yhx

    • Bina,

      1. Mostly the exclusions are same across same category of products..Some may differ in very specific products like if any product is launched with less waiting period for preexisting illness or maternity expense.

      2.Apollo Munich restore is a good product with its unique features.However, you need to consider some exclusions like you cannot add a critical illness rider here or you do not get a free medical check up facility every third year unlike you have in Exclusion variant of Apollo Easy Health. If you are ok with these exclusions then go for the product.Overall, Restore is an enhanced version of Apollo Munich Easy Health-Standard variant.Good if you compare features with Exclusive variant and then take a decision.

      3.Health insurance companies generally exclude mental disorders.Any illness related to this is not covered. Although companies do not name specific illness like Apollo did one should get clear from company what is specifically excluded to avoid any dissatisfaction during the claim.

      I hope this answers your queries.

86. ok

87. Thank you so much Mr.Jitendra,

    I want to know if in optima restore i make a claim in 3yr , (with a SI of 5lakh, and multiplier benefit my SI will be 10 lakh in 3yr)assuming i make a claim for 2.5 lakh for heart attack, i will be left with si of 7.5 lakh for any other illness for that particular year. my question is:

    1. will there be any loading on premium because of claim of 2.5 lakh?
    2. Again in the subsequent year ie, 4th yr i get 2nd heart attack, what SI i would be left with

    I was told by a max bupa rep that on the face of it optima restore sounds very good, but there are lot of complications as this restore benefit twists certain issues of SI and there is a indirect load on the insured.

    please guide

    thx
    would also be nice if you can suggest any policy for individual of 42yrs with cheaper premium, but without room rent limits ( no shared hospital accomodation)

    awaiting reply

    • Bina,

      1.If any claim arises then ther is no extra loading of yoru premium but No claim bonus you have recieved is reduced by 50%.For e.g. if your Basic SA is Rs 5 lakh and it goes upto Rs 10 lakh due to 100% bonus in 2 claim free year (Not due to restore benefit), after the claim your SA will reduced to 7.5 lakh.There is no effect on your premium amount.However, Your SA will not be below Rs 5 lakh if two claim arises in continous two years.But if there are any further claims then company may take a decision to increase the premium considering the high no of claims which i feel is justified.

      2.Every terms are mentioned in policy wordings and i feel any agent who is making such a claim should be able to tell you where the flaw is.Still if any doubts persists then you have such forums or can call up the company call centre to verify.Apollo does have good service in that regards.

      I hope this answer your queries.

88. Thank you so much. certainly appreciate the prompt response from your side.

    thx

    bina

89. Dear Jitendra,

    Thank you for a very lucid description of the product.

    A question – I was reviewing the IRDA annual report and found the net profit of Apollo Munich for past years 2010-11, 2009-10 to be in the red. This may be because of the focus of Apollo Munich on health insurance only and incurred claims ratio. Should this be a factor in the decision made for buying health insurance from a company?

    Thanks.

    • Gaurav,

      There can be many reasons for company incurring losses.Look at PSU general insurers where group insurance business is creating losses for them.Any company which si new to the insurance industry takes time to be in profits.Life insurance took almost 10 years.Similarly Health insurance will also take.Hence, it can be a criteria but you need to llok more into reason for losses then only this factor will help you in judging.

90. i have taken health insurance apllo munich on 13 feb 2012 i didnt told all ready i am having pre existing disease, now i want to change in apllo restore .can i change , they are giving 3 years continous reneval after that they cover pre existing disease ,upto feb 2013 my first reneval overs can i continoe with this insurance please give me sugestions

    • Rajkumar,

      Firstly if you haven’t disclose your preexisting disease then company has a right to reject your claim if arises. This is treated as suppression of facts.

      Portability withing appollo policies is available.

91. Iam planning to buy a LIC Policy kindly suggest me which is the best policy for me.
    My Details are
    Age: 31 Yrs
    Martial Status: Married
    Child: 1
    Children Age: 1.5 Years
    Annual Salary: 3,00,000/-

92. Hi! I am evaluating health insurance policy for my mother aged 65. Pls suggest a good health insurance policy for her. Though she is covered under my company’s health insurance policy I would like to take an additional one for her. Also kindly suggest a good policy for a 39 years single woman. Thanks

    • Suneela,

      You can go for Apollo Munich Easy Health which gives coverage to people upto age 65.Then you will have life long renewal.Although Max Bhupa has also similar criteria, it has a co-payment clause after age 65.
      The premium will surely be high in case of Apollo Munich.The second best option you have is Senior Citizen Policies from companies like Star Health.

      • Hi Suneela,

        would you please share what you have finalized as i am also in same situation.
        many thanks in advance.

        Viv

93. Hi! Jitendra,

    What is your view on United India Insurance or New India Assurance compared to Apollo Munich or Max Bupa or Star Health. I have noticed that most of our organisations opt for United India or New India. Are they recommended for an individual or they give better terms to organisations. Thanks

    • Suneela,

      PSUs have a very strong presence in group insurance and so they maintain a good relationship with corporates. Group policies generally have higher benefits then individual policies.Many companies like the two you have mentioned remove all sub-limits in issuing policy to corporates.Hence policies from your employer will always be attractive.

      This is not the case with individual policies where all sublimits are applicable.The exclusions are also high.

      But group policies have their disadvantages too and i always recommend to have a standalone policy.You can compare the features and then make a decision.

94. Hi Mr.Jitendra,

    I would like to know: if there has been a Cyst surgery, in the year 2000, and in 1997. Both times it had been benign. As per apollo optima, policy wordings and proposal form, we have to mention any such previous health conditions 4years prior to the commencement of the policy. These surgeries have been done more than 12yrs and 15yrs. right now there is no problem. My question is:

    1. do we need to mention this though this does not fall under 4years period?

    2. By mentioning this will they exclude the particular surgery, along with corealted dieases?

    other than the above there is no negative health condition / fit in all aspects.
    Please guide it s really urgent.

    thx

    Bina

    • Bina,

      Its always advisable that you mention your medical history.In one such case one of my client has an accident 15 years back due to which he had a problem in spinal cord.Although he recovered fully, Apollo Munich excluded any claim arising due to the spinal cord problem.

      Apollo Munich has very strong underwriting and permanent exclusion can be there.But you should mention it in the proposal form.

95. Does Max Bupa Family Floater covers Critical Illness…

96. Dear ashishjee, Every health insurance co. covers critical illness to the extend of sum-assured per annum-besides the CI rider can also be taken separately which even life insurance co”s are also providing which pays lump-sum fixed amount on detection of specified Discease.

97. Hi, I have observed that in the earlier years, the premium between Apollo and PSE insurance companies are similar, but in later years, such as 46 years onwards, the premium for Apollo is far higher. The premium is 25% to 30% higher in the later years. For a family of 2 (floater policy) and with Rs 3 lakh cover, Oriental’s premium is Rs 6011 for a 35 year old. This goes up to Rs 9483 at the age of 55. With Apollo Easy Health Standard, the premium goes up from Rs 5267 (35 years) to Rs 12448 (55 years). Will appreciate your comments on this. Thanks.

    • Sushmita,

      If you look at the features all major PSE has sublimits in their products.Which means you can claim up to a certain amount only which falls within the limits imposed by the company.Apollo does not have any such limits and you get the full claim in most cases. At younger age risk if illness is less and so Apollo charges a lesser premium.Now as the age increases the probability of illness increases which mean the risk for the company of getting higher no of claims will increase.For PSEs due to sub-limits the chances of higher payouts are less. Contrary to this Apollo charges a higher premium because it does not impose any sub-limits due to which the claim payouts will always be higher.As a company this may become a loss making proposition after a certain period if higher features are provided within same premium as PSEs.

98. Hi Jintendra,

    Thats a quite a insight you have provided.. I have the same question here as many people have already asked.

    I m 35yrs and my wife is 31.. married for year and half now… till date i was working for a channel so the medi claim was provided by the company.. now i m on my own and i m planning to take a medi claim for which i need your expert advise.. i had a chat with a agent who presented me both Apollo Munich Optima and Max Bhupa, my question is very straight which is better as i have to pay premium of Rs. 8500/- for 3 lakhs @ max bhupa where as in Apollo munich i have to pay Rs. 6700/- for 5 laksh.. which has left me confused that which one is better.. secondly we are planning to have child now.. can you advise which one we should we go for. Also suggest if there is something better or similar.

    Thanks & Regards

    Naveen

99. I am sandeep, i have taken the Mediclaim policy from GHPL(Good Health plan) of United india insurance co.Ltd. in feb 2010, but now they started one clause that patient have to give upto 30% of claim amount to company. so i want to switch to another company. i wanted that my parent will also get the benefit(their age is <60), if any case they will not include my parent in my policy than any policy who will include pregnancy.

    Please guide me for this.

    Sandeep
    Faridabad

    • Sandeep,

      If your parents are below age 60 then Apollo Munich Easy Health is a good choice as it do not have co-payment clause even at higher age.Once you have taken the policy you can renew it for lifetime.

      For covering pregnancy, apart from Max Bhupa most policies have a waiting period of 3-4 years.Only Max Bhupa has less waiting period of 2 year i.e. you can claim for this after continuing your policy for 2 years with them.

      • Can any one come to my residence on sunday for further discussion, clearing my doubts and for finalizing the potablity of my policy.

        Sandeep Katyal

        9811486831

100. Dear sandeep, you better switch to max-bupa for your-self & apollo-munich for ur parents ( if having no complications) -maxbupa can offer pregency claim after just 2 years of waiting period & Apollo will pay all claim amount upto sum-assured.
     for further details you can drop in our office which incidentally is in faridabad .

     • My parents age is above 60, and have complications, so tell me which is the best policy in cash less, post claim(who will give the 100% reimbursement of expenses occurred in next2month after the discharge of the patient), who will not take any extra charges at the time of treatment.

       Please suggest.

       • Sandeep,

         Its difficult to get a policy which can give 100% reimbursement at higher age.If your parents were not covered at all then apollo Munich or Max bhupa have policies which give coverage till age 65.Max Bhupa has co-payment clause after age 65.However, if your parents have complications then there will be a possbility that certain illness will be counted as preexisting and will be covered after a waiting period of 4-5 years or might be permanently excluded.It all depends on how company perceives the risk.Also the premium of general health plan will be very high at your parents age.

         The other options you have is senior citizens plans which start at age 60.Apollo has launched it today which start at age 61.however there will always be certain limitation sin these plans.

         It will not be wise to depend on health plans entirely for medical eppenses at your parents age.Buy a plan with sufficient coverage and have some emergency fund for meeting any.

101. Please tell me what is the plan of senior citizen, and if i will not include my parent in my policy than how much premium i have to pay in both apollo M & Max bupa,
     and what is premium of senior citizen policy.

102. Hi Jintendra,

     Thats a quite a insight you have provided.. I have the same question here as many people have already asked.

     I m 35yrs and my wife is 31.. married for year and half now… till date i was working for a channel so the medi claim was provided by the company.. now i m on my own and i m planning to take a medi claim for which i need your expert advise.. i had a chat with a agent who presented me both Apollo Munich Optima and Max Bhupa, my question is very straight which is better as i have to pay premium of Rs. 8500/- for 3 lakhs @ max bhupa where as in Apollo munich i have to pay Rs. 6700/- for 5 laksh.. which has left me confused that which one is better.. secondly we are planning to have child now.. can you advise which one we should we go for. Also suggest if there is something better or similar.

     Thanks & Regards

     Naveen

     • Naveen,

       wrt product features both companies are good.They both do not have any limits.However, there are differences in relation to certain features.for e.g in Apollo maternity expenses is covered after 6 years while in max Bhupa it is after 2 years.Also after age 65 in Max Bhupa co-payment clause gets applicable while in appollo it is not so.If you are looking for claiming maternity expenses through an insurance policy then Max Bhupa is the choice.But its in third year only and upto a certain limit which you have to take in consideration. for other features Apollo looks more beneficial especially at higher age.

       I hope this answer your query.

103. I am 41 yrs , my wife 39 years and son 15 years. I had met with an accident aprox . 16 years back when my Thigh bone got compound fracture. I had taken ICICI LOMBARD family Protect in 2006 i.e 6 years back as that time only this policy had the clause of covering pre existing diseases after 4 years. But it did not have other provisions like lifetime renewability, Donar expense, Domicilliary expences etc. It has a loading provision which is claim amount based for non chronic illnessi.e upto 25000-Nil, 25 to 50000-10%, 50 to 100000-20%, 1 to 2 lakhs – 50% & abve 2 lacs – 75% and there will not be any loading for subsequent premiums.
     But for Chronic Illness loading of 75 % of base premium will continue for all subsequent premiums. and if bfirther claims arise in subsequent renewals a furter loading of 75% will be applied and the maximum limit for such loading is 200%.
     I have not taken any claim under my policy and my sum assured of 300000 has increased by 750000 ( due to 5% cumulative Bonus per year) In view of i want to port my present policy . Kindly advice me the most suitable policy from appolo munich, max Bupa or even from ICICI Lombard, where I could Get a most updated policy with essential provisions without losing the acquired benefit of 6 years covered life in the previous policy. My due date of renewal( It is a 2 year policy) in the previous policy is 4rth September so kindly reply me urgently so that i can apply for portability. I Shall be highly thankfull and obliged for a timely & neutral advice from such experts as have posted comments above like Jtendraji, Anilji and many others.

     • Gautam,

       You can port your policy to any other company.However, there are certain factors which you need to take into consideration.Firstly, the decision to continue with benefits of your existing policy rest with the company you will be porting your policy.The company may give you all benefits of your preexisting diseases or may impose waiting periods.Any preexisting illness company perceives to be higher risk it may have permanent exclusion.It all depends on the underwriting which varies within companies.

       Hence, first confirm from the companies to what extent they will cover your benefits. You will get certain idea.Apollo Munich is very strong on underwriting and may impose restrictions.Also it has waiting period of one year in case of portability for all preexisting illnesses.Since IRDA came out with new norms in health insurance industry you might see new products rolling out with these features.Star Health has done it and all renewals are now in new policies.Similarly ICICI will have to adher to the new norms and you will see new products from it also.

       So my take would be to renew it now and wait for sometime. Do not make a decision in hurry.Also you need to apply for portability at least 30-45 days before your renewal date.

104. Gautamjee, it will be diffcult to Get same premium for 7.5 lakhs cover you are presently enjoying from max or apollo-But yes it will be little competitive if you opt for family first of max-Bupa but for higher sum-assured ,i.e, (5+15) lakhs sum assured ,effective cover for any insured -5 lakhs & 15 lakhs on floater basis.Also there will be no exclusions except first 90 days of waiting period for planned hospitalisation-which can be nullified -if you port.i will covey premium shortly-pl. compare & decide on merits & effordibillity.also 20% of co-payment is there after age 65 in max-bupa.

105. Gautamjee, in continuation to above reply-the premium of max-bupa works out to be RS 19895= (5+15) & RS.17913 ( 2+5) & maxbupa increases premium every-year unlike others who increases it in slab of 5 years. you need to do little home-work for deciding the same.

106. Hi Jitendra,

     Planning to take a Health insurance for family Myself 41 spouse 35 kid 4 yrs
     also would like to know what type of illness are generally covered like Heart ..etc
     Found this site after lot of googling.
     Kindly advise

     • Ramakrishnan,

       You can select a family floater policy from Apollo Munich.Optima Restore is a good policy.

       Any health insurance policy covers hospitalization expenses for most of the illnesses.however, it will have some waiting period i.e. the coverage for a particular illness will start after the waiting period is over.The details of waiting period and any exclusion you can get from policy wordings which you can download from the company website.

107. Dear Jitendra,

     Thank you for a very lucid description of the product.

     Really liked your article. Just need your opinion. I am in Delhi, Age 32 Year, Spouce: 30 Year looking for a Medical cover. I am looking at the option in Apollo Optima Restore& Religare Care Plan.

     Option – (5 lacs)

     Family Floater for tow Adults.

     so i want to know what will be teh good option for me.

     and i am also in tuch one of the policy bazaar adviser.so can i buy from policy bazaar .com

     what u think about policy bazaar.com services.

     i am waiting your response.

     Your guidance will be important as always.
     Thank you so much.

     • Dear Ankit,

       Both policies are good with some differences. Religare care plan has some sub-limits with so-payment clause after age 61. On other hand it gives you medical check up facility every year which is beneficial. Apollo Optima Restore does not cover maternity expense.This may be a drawback if you are looking into it.

       Hence, look at your requirement and see which is more beneficial. Choose the product which best matches your requirement. Go through policywordings of both policy for details and then compare.

       Policybazaar.com is ok for online buying.Alternatively you can buy the product from respective company website.

       • Dear Jitendra,
         Thank u so much for your quick response. i appreciate your effort . i appreciate your effort .

108. Dear Jitendra,

     I am planning to take family floater policy of Apollo Optima Restore for 5 lacs, which doesn’t ask for any medical check-up. I am 41 yrs, my wife 37 yrs and son 10 yrs. My wife has Hypothyroidism and is on medication (eltroxin) for last 8 years. She had also undergone successful gall stone surgery last year. No Diabetes and her health is perfectly alright.
     Though thyroid and gall stone are very common these days, if I mention all these facts in the Proposal form, will that affect my premium Or exclusions? How will Apollo consider this? Also suggest any other suitable Insurance policy for the given condition.
     Thank you in advance for providing your valuable guidance.

     • Ashish,

       Apollo Munich has a very strong underwriting. There have been cases where company has permanently excluded the illness which has occured previously even if the insured has recovered fully. Alternatively, the company may ask for a higher premium if it perceives the risk to be high.

       Thus its very difficult to say at this moment what will happen in your case.You will only come to know after the underwriting. Apply for the policy.the company will sent you a consent for whatever may be the case.You will have an option to reject it or accept it.

       Alternatively you can look at other companies like Max Bhupa and Religare Care.

109. Dear Jitendra,

     I appreciate your quick response. I’ll apply for Optima Restore with all the correct disclosures and wait for their response.

     Shall I also try the following combination in Optima Restore — family floater of 5 lacs for mysellf (41 yrs) and my son (10 yrs) and take an Individual policy of 5 lacs for my wife (37 yrs)? Will this be a better proposition? In this combination, premium will be slightly higher than the 2A + 1C combination in Optima Restore. Can I change this combination later on without losing any continuity benefit?

     Currently I have 4 lacs of group mediclaim cover from United India provided by my employer. How abt taking a separate individual policy from them, if they are lenient in their underwriting approach and perhaps accept my wife’s case? However, I’ve noticed so many cappings in their policy, which are not there in Apollo Munich.
     Thanks & Regards

     • Ashish,

       United India Nusrance do have high sublimit sin their policies which may not favor your requirements as compared to Apollo Munich.Hence, stick to Apollo Munich if it suits your needs.

       Yes you can work on combination which will actually help you in keeping benefits higher. A seperate policy for your wife will ensure if claim arises the other members do not have a disadvantage which happens in floater policy.You can change combination but will loose continuity benefits in some cases where adding new member in a policy.So take your decision carefully.In my view the combination you have chosen is considerable.

110. Hello Sir,

     Would like your kind suggestion :

     Planning to buy Apollo Optima Restore for my self & family.
     My age – 35 , wife 32, children – 2 (below 7 years)

     Should I go for individual policy for myself (5 lkh) & a joint for rest of familly?
     or
     Should I get two policies in which 1 adult & 1 child can be included.
     or should i opt for a floater of 5 lkh for wife & two kids & individual (5 lkh ) for me.

     Budget not a constraint.

     Need right advise.

     • Parekh,

       Going for two policies will surely benefit with higher coverage for entirely family. A combination of 1+1 you can consider.Individual policy will be advisable when you are suffering from any illness.Otherwise going for the combination is beneficial.

       • done.

         thanks a lot.

111. Hi Jitendra,

     Just wanted to check if any member in family floater policy has pre-existing disease such as thyroid then what loading or condition any insurance company applies in such cases? If they apply any exclusion, then will that apply to all the members of floater policy or it’ll apply only for that particular member?
     Is it sensible to take separate policy for that member though it’ll be little expensive? Which insurance company you advise in such a case which provides max coverage.
     Pls advise.
     Thanks & Regards

     • Raj,

       Its always advisable to have an individual policy for members who is suffering from any illness.In case of any preexisting illness, company may impose limitations or loading on premiums. This is a disadvantage to other members who are healthy and can get a health policy at lower premium.

       So buy a separate policy for member who is suffering from Thyroid and a floater for rest of the members.

     • mr.raj sinha , as far my knowledge goes Religare Care Plan can give u maximum coverage upto 60 lakhs & that too on floater basis with 100% of S.I automatic policy recharge if claim amount exhausts your coverage, at no extra cost. and without any co pay like max bupa (Co-pay
       POLICY DOCUMENT
       Page 6 of 30
       If any Insured Person is 65 years of age or over on the date of commencement of the current Policy Year, then it is agreed that We will only pay 80% of any amount We assess for payment or reimbursement in respect of any claim made by that Insured Person and the balance will be borne by the Insured Person.)
       Regard
       Ankit Shukla

112. mr.raj sinha , as far my knowledge goes Max-bupa can give u maximum coverage upto 50 lakhs & that too on floater basis without any exclusion except first 90 days planned hospitalisation for thyroid & having other tests normal.

113. Thanks a lot for your valuable advice….

114. Hello,
     Please guide me rgd the policy I should go in for. I am 39,female,single, no pre-existing medical condition. Which policy would benefit me the most as regards future illnesses and emergencies? I want to get the best benefit as regards the policy so that future medical expenses do not cause me much financial strain. I am self-employed so have no medical insurance, as of now. I have a brother who is 36 and single as well. Can we go in for some policy jointly or would individual policies be more beneficial? please provide policy name as well as the company providing it.
     Many thanks in advance.

     • Dear Anju,

       Its advisable to go for seperate policies.Optima Restore is a good policy to go for.But d check the exclusions in detail.For your brother too you can go for the same policy.If you find premium to be on higher side Easy Health is agood option.The other company to consider are Max Bhupa and Religare Health.

115. Dear Jithendra

     Really a good work you doing , i am 33 yr , and looking for a good Health insurance policy for myself and my wife (25Yr) and my Mother (56yr) and she has diagnosed diabetes( not D II) please suggest me whether i should go for entire 3 members or separate for myself and my wife . and my mother since she is a diabetic , i am planning for Apollo Optima restore (My friend suggested ) and for my mother STAR health insurance since they have diabetic insurance also , still i want advise from you about whether i should go one policy for all or separate and also which company you suggest for us.

     i am also interested a policy that covers a day care procedure well. Thanks in advance.

     regards

     Dr.Kishor

     • Dr. Kishor,

       Its advisable to go for a seperate policy for your mother since most companies do not cover diabetic patient.You can either look at start health which will cover diabetes related hospitalization expenses or PSUs like National which may cover diabetic patients in their basic plans but with extra premium.Apollo do not cover diabetic patients.
       For you, your spouse you can look at Apollo Munich,Max Bhupa or Religare health insurance schemes.

116. anju mam, you should opt for apollo-munich optima restore for 15 lakhs( max sum-assured) if prm is not an constraint & should advise ur brother too for same .
     mam major brother or sister can not be proposer of each other neither u can opt for joint policy under floater basis.managing ur risks should be top priority-so act fast.

     • Hello,
       Many thanks for the guidance. But, I guess 15 lakhs coverage is a bit out of my reach. If I go in for 3 lakhs minimum coverage, and as it is a multiplier and restore policy, my sum may get doubled in a couple of years, if no claim is made for 2 consecutive years. So, do you feel that this works to my benefit as the sum covered will be 6 lakhs?
       Do excuse my ignorance, as I have just now started to look around at these policies and it is difficult to compare them and zero in on which is the best option for me. Also, can one upgrade to another level in this policy down the line? Thanks again.

       • anju mam,
         you should opt for Religare care Plan for 5 lac self and same for your your brother . your prm will be 5,385 only for each of you. & apollo optima restore 3 lac 5369 for each of you,
         or you have many option you should campare all the plan witch in the market and for that policybazaar , easypolicy etc, where you can get good comparison for health insurance

         Regard
         ankit shukla

         • Thank you very much for your time and guidance. Really appreciate it.

117. Hello,
     One more concern of mine needs to be answered. Whether to buy health insurance policy directly through the company website or through sites like medimange? which way is better and why?
     Thanks

118. mam-purchasing policy from known Broker/Agent will always score more than direct. since you will have somebody to assist you at the time of claim/service.

119. Thanks for your prompt and expert guidance, Sir. Please alsol help me with regard to choosing ‘medimanage’ or not. I have no idea about whom to go thru, and want to know if medimanage is really good from the point of view of the customer? Will it be better to buy thru them and if not, then who?
     What a bt policybazaar?. Please guide.
     Thanks

120. mam purchasing through direct or Broker on-line is one & same thing
     -once you have identified co. & policy to be purchased-look for agent
     or Broker near to you-so that servicing becomes easy & assistance
     in post hospitalization for reimbursement perusal is not tiresome.

121. Hello Jitender,

     I wants only one clarification of u r side Apollo Munich optima restore plan coverd Critical illness & How Many Critical illness covered under the policy. i am plannig to take optima restore plan shortly.

     • Dear Harish,

       Illnesses which are covered in critical illness are covered in basic health policy for hospitalization expenses. Hence, Critical illness cover should be looked as specialized product rather then add on.

122. hi dear mam,

     I am planning take Apollo Munich Exclusive Plan he wil Covered medical test Every Insured Persone or only policy holder.

     • Harish,

       If all persons are above the age limit then they will have to go for medical test.

123. Hello,
     Sir, you are rendering a great service to all of us. I really wish to express my gratitude for your advise, guidance and time.
     Please help me choose appropriate critical illness plan. Please specify name of policy and company . I wish to have CI policy separate from the health policy as I have read that it is much better this way. Please suggest one that you feel is a good one.
     My details-39, single, female, no health issues.
     Thanks

124. anju mam
     yo should go for bharti axa CI policy coz in that plan bharti axa covering 20 crt illness.
     regard
     ankit shukla

125. plz tell me which health insurance policy is better for me
     apollo optima restore
     religare care recharge
     my age is 28 yrs wife 26yrs and my child is 3yrs

126. comparision searched by me for 3 members of my family age 28 , 36, 3yrs
     religare care apollo optima restore
     1) service poor as per market review good as per market
     2)sum insured min 2lakh 3lakh
     3)discount for 3yrs payment 10% for 2yrs payment 7.5%
     4)amount rs 17825 rs 15650
     5)recharge /restore starts automatically for b illness only after exhausting ncb and sum insured
     6)n c b inc/dec 10%/20% 50%/50%
     7) sum insured after 2yrs 2.4lakh 6lakh
     8)room icu rent 1% & 2% of suminsured no limit

     plz tell which one is better for me

127. Hello,
     Please guide me rgd the policy I should go in for,I am 43 yrs,wife 40 and 2 daughters aged 14 and 6, it will be the first time going for a health insurance in India as was living abroad from 9 years and as we have a different health plans here.
     can you please advice me which policy should i go for and should i go for individual or for a family floater till now we are all healthy by grace of god but you never know whats in store for, would like to go for a 10 lakh policy if its family floater if individual no idea how much should i go for as said will be doing it for the first time so PLEASE ADVICE
     Thank You

     • Dear Atul,

       I would advise you to go for two floater policies one covering you and a child and other covering your wife and a child. Individual policies are advisable if premium outgo is not a constrain since you will have to shell out more.
       Sometimes by availing two floater policies you are able to get a higher coverage with less premium difference then a single floater policy.You can choose the coverage based on your premium payment limit.

128. I am sandeep katyal already discuss for switching from my current medical policy to another so i want to meet & discuss on the same, i am staying at faridabad.

     Sandeep Katyal
     9811486831

129. Hello,

     Thanks for the informative article. I am an NRI living in Australia with my mother in India. She was diagnosed with breast cancer last year and was treated. She did not have any medical insurance and we had to shell out the expenses out of pocket. Given in future that she may be diagnosed for any more health issues, I was wondering to take a health insurance plan. She is 60years old.

     Much appreciate if you can suggest a good health fund and a life insurance fund clubbed together if any giving the waiting period and also an approximate premium per year

     Many thanks
     Ram cheruku

     • Dear Ram,

       If there is any preexisting illness, it get covered after 4-6 years in most health insurance plans. Also, with some companies, the illness you have specified may not be covered at all considering your mother age.
       Since medical insurance will always have some limitations, it is advisable that you create a health fund of at least Rs 6-7 lakh which you can utilize in case of any shortfall.For health insurance, you can consider Apollo Munich, Max Bhupa or newly launched Religare Health.But do remember that premiums will be higher at your mother age and there may be loading (Extra Premium) from the insurance company, if underwriter perceives the risk to be high.

130. Hi Jitendra,

     Good to see ur responses. Thanks for sharing ur knowledge.

     I also need a support from ur end as i am planning to go for a health insurance for me as well as for my wife. we both are in the same age group (31), i think family floater would be a better option. Now my dilemma is wether to go for private player or the Govt one. The options, i have explored is Apollo Munich and United India Insurance.

     Please suggest me the better option (govt or private). My criteria would be the claim process, better response service, No hidden cost or condition and Reasonable premium load.
     Awaiting for ur response…

     Regards

     • Monu,

       Thanks.

       For health insurance plan you need to understand the basic features and exclusions in the product. Private players have some level of competency better then public sector companies and so there should not be a confusion.
       Apollo have higher features then United India Insurance but also have strong underwriting procedures. The biggest feature is that there are no sub-limits in Apollo which makes it a good choice. There are also value added services you get from this company along with better services during policy purchase or claim process. Understand that higher the sublimits the lower will be the premium.Hence Apollo premium will be higher then United India.

       The best way will be to look at your requirement and compare products on basis of that.Choose one which best matches these.

131. Hey Jitendra.

     Just did a “google search” on something, and I came across “TFL”.

     Do allow me to congratulate you on all the information that you are sharing on the website and the way you are managing this website.It’s truly commendable.

     I’m 35 yrs of age, and am looking for separate mediclaim policies for me and my wife. I’ve short listed Optima Restore and New India Assurance.My query is-
     How instrumental is an agent in getting the claims settled( especially for the public sector players)

     • Dear Shreeraj,

       Thanks for your appreciation.

       Most PSUs are agent driven. Which means for any kind of services you need to contact your agent. Even if you walk into a branch then you will find a good enough time is spent on availing services including issuing your policy as these companies relied on agent to drive their business in past and didn’t focused on services using tech. In that respect an agent is a very important mediator between you and a Health Insurance Company.

       For claims an agent helps you immensely in contacting the right person or department to speed up the process. He also keeps a track and inform you of any requirement which may be lacuna sometimes dealing with a PSU. Although most of them are gearing to keep pace with private players, still you will find such absence in some of them.

       This is not the case with private sector companies where the claim process without an agent will be much simpler.

132. I am a 33 year old male and I’m looking to get insurance for the first time and need some help. I am thinking of 4L Apollo Easy Health with Critical Illness and 3L Apollo Optima Restore. Basically, I like features of both – CI in Easy Health and Restore+Multiplier benefit in Optima restore. Also, it will help me achieve total coverage of 7-10 lakhs. I want to start now to build long history with the insurance companies. Do you think splitting like this between Easy Health and Apollo Optima is a good idea? From a claim processing standpoint, it shouldn’t be a problem, since its the same company?

     Also, is there any good plan for longer term dental coverage?

     • Dear Vivek,

       Yes you can choose insurance in this manner. Both these are good products.

       For dental coverage you have only two options-Features in basic health plan like in Apollo which gives you a limited claim after a certain period. The other is OPD policies.Unfortunately, they are costly and we do not have many.

       Hence, its better to take the basic health plan option and simultaneously create a health fund to meet any emergency.

       • Hi Jitendra, Many Thanks!

         I was going through Critical Illness in the Apollo Easy Health Premium plan and it seems like it is only a one time policy. If it is claimed once, it does not renew after that (even with higher premium, etc). That is strange… many critical illnesses like cancer require long term care over many years, isn’t it? How does one cover for such scenarios… if people have to take a new CI after a CI has occurred, that would be very difficult in that situation, is it not?

         Thanks again!

         • Dear Vivek,

           Most Critical illness policies are once in life time scheme. That means once you have taken the claim for any illness, your policy ceases without any renewal in the future. But in Apollo you can renew the policy twice i.e. you can claim three times in your life.However, the illness once claimed is excluded in the next renewal.

           Yes, you are right. That’s why its advisable to create a health fund and do not rely entirely on CI policies.

           • Oh, I missed the twice renewal option in the Apollo product literature. That’s good. Max Bupa covers more illnesses but might be limited to one claim. Apollo does not allow renewal after 70, but Max Bupa allows lifetime. Oh well…

           • Hi Jitendra,

             I have taken Apollo Munich Easy health Individual Exclusive policy for my mother of 51 yrs for 4L with 100% CI rider. Policy started on march 2010. Finishing 3 years in coming March 2013. If I renew now 4th year starts from March 2013.

             I understood CI as follows:
             Let’s take cancer. Hospitalization is covered till 4L for normal diseases. If cancer is discovered first time then a lumpsum of 100% CI (ie 4L) is given and treatment for cancer is done under the 4L policy. Next year also any treatement related to the same disease cancer is covered upto 4L and next year and next year etc.. Is this not correct ?

             If cancer is discovered first time a lupmsum of 4L is given to me and that’s it ? All expenses related to treatment of cancer has to be taken care by myself for entire life ?

             Please clarify my doubts.
             Thank you.

             • Hi Uday,

               CI for a specific illness clan be claimed once in lifetime. So if you have taken a claim for cancer, the CI rider will get renewed but cancer will be excluded from it.In total you can claim a CI rider in Apollo thrice in lifetime.

133. Hi,

     In Optima Restore, after 2 claim free years, the basic insurance becomes double at no extra cost. but then in 3rd year do i need to pay for the full basic sum insured + bonus??

     say i got a poliyu of 500000. after 2 years it becomes 1000000. in the 3rd year will i have to pay premium for 10,00,000 or 500,000??

     • Dear Yogesh,

       You do not have to pay any extra premium for no claim bonus.

134. hi ,
     i wnts to now what r the differents between icici lombard and apollo munich optima ,and wnts to take the policy for my self and indivial policy .and for my hubby indivial policy my age is 28 and my hubby is 30 so pllll tell me all the ants are the differents ,in two.if i feel ur policy is good then i buy the policy online.
     i be watng for ur reply

     • Dear Ranata,

       ICICI Lombard is a basic health plan where once you exhaust the available Sum Insured in any policy year you have do not have an option but to purchase a new policy to keep your health insurance running. Its only during renewal your initial SI is retained.In Apollo Optima Restore if you exhaust the SI, teh company restore the initial SI fro their side which is availabe to you for claim.So in ICICI if you have a Rs 3 lakh cover and you fully exhaust you have to purchase additional cover. But in Apollo the company restore additional Rs 3 lakh for you which means in effective you have Rs 6 lakh coverage.This is the basic difference.

       Rest you can go through the policy wordings of both to know in detail.

135. Hello Jitendra,

     I’m confused about loading. Both the Optima Restore and Easy Health policy documents have the following language in them. How come they say that there will be no claim based loading? Thanks, Vivek

     “We may apply a risk loading on the premium payable (based upon the
     declarations made in the proposal form and the health status of the persons
     proposed for insurance). The maximum risk loading applicable for an
     individual will not exceed above 100% per diagnosis / medical condition and
     an overall risk loading of over 150% per person. These loadings are applied
     from Commencement Date of the Policy including subsequent renewal(s)
     with Us or on the receipt of the request of increase in Sum Insured (for the
     increased Sum Insured).”

     • Dear Vivek,

       If you read the lines, it says for the proposal and not for claim.What this statement says is that during purchase of health insurance, the company may charge extra premium if they perceive the risk to be higher as identified during underwriting.This loading is either during purchase of fresh policy or in renewal if you have applied for increase of health cover.

       When you take a claim, the company do not charge any loading as per their policy.

       • oh ok, thanks for the clarification. I’ve just taken insurance for the first time (Apollo Easy Health Exclusive) and I wasn’t sure how renewal works – if every renewal is considered a new proposal (and a new policy) or not.
         Further, Apollo advertises no loading for Optima but not for Easy Health in their brochure, even though they use the same language in the policy docs available online so I was trying to make sure I understood the language. Looks like both don’t have claim based loading once the policy has been taken. That’s good to know. Thanks again!

         It does mean that it is better to take a higher cover if going with Apollo, as they may increase premium more than usual if there is some claim or change in health status down the line, and if a higher cover is being requested.

         • Vivek,

           Apollo will not increase premiums due to claim but can do so if you are increasing your coverage.Also do note that health insurance premiums increase at a specific age interval across all companies.

136. Hello Sir,
     Please guide me regarding which Critical illness plan to go in for ? I am 38, single, self-employed, no health issues as of now. What amount would you consider to be the minimum, as an ideal, keeping in mind that such a claim may rise, say 20-30 years down the line. Thanks.

     • Hi Anju,

       There are not many standalone critical illness policies in the industry.Most of the companies offer it as a rider or in combination with basic health Plans. If you do not have any basic health plan you should first consider it. You can avail a CI rider along with it.Apollo Munich Easy Health product also have it and you have an option to renew it for three time sin lifetime, with exclusion of illness for which claim has been taken.

137. Apollo Munich Health Insurance is the only company in indian health industry. which is having health background. its a joint venture between apollo hospitals and Munich RE which is a german base reinsurace company. apollo hospitals is the largest hospital group in Asia. and Munich RE is world second largest company. and the OPTIMA RESTORE plan of apollo munich is rated best product of health insurace for this year. the multiplier benefit of OPTIMA RESTORE plan of apollo munich health insurance is rated best benefit in any of the health plan in all over world. thankyou. for more details feel free to write me.

138. Hi.
     I am 35 yrs old and I have taken Apollo Munich Optima Restore on 12-12-2012, In proposal form I have not mentioned my previous insurance details, which is Bajaj Allianz Unit Gain Policy with 2 riders (Critical Illness & Hospital Cash), please suggest me it is compulsory or not?? please help.

     • Hi Khadir,

       Most people make this mistake. It is important to give existing insurance details when you are applying for another as it affects your claim. If you have missed it you should talk to your agent or inform the company through their call centre.

139. Dear sir,
     My family live in Mira road mumbai for health insurance purpose please guide me any best company which give cover of all critical care and hospital facility vailid in Mira bhayendar area

     Best regards and thanks in advance for your kind reply

     • Hi Shabbir,

       Most companies have list of hospital network on their website.You can check it from there or from the call centre of respective company you wish to avail health insurance.

140. Dear Sir,

     I am planning to go for two health insurance
     a> For my parents aged 63 and 50.
     b> My Wife and me . Both under 32 years of age.

     Please suggest some suitable options

     Thanks,
     Gokul

     • Hi Gokul,

       For both you and your parents, you can opt for Apollo Easy Health which has good features and no co-payment. The maximum entry age is 65 years.But do check policy wording for any specific requirements you are looking for.The other alternative is Max Bupa but it has co-payment above age 65.

141. hi. I want to buy a health insurance for my parents who both r diabetic patients . My father is 55 nd mothr is 50 yrs old. Mother have been taken insuline from 3 yrs. Mother was hospitalised for heart diesese but surgery not required. In this case what should be appropte policy for 2 to 3 lac s.i.

     • Hi Moydul,

       For diabetic patients there is specific policy from star health if it is at stage 2.You can consider that or even some PSUs like National insurance cover diabetic patient with extra premium. You can enquire with them.

142. Hi…

     I am looking fro medical insurance for self and wife.Kindly suggest which medical policy I have to take from market…Apollo or Max Bhupa. Please suggest.

     • Hi Dhiraj,

       Look at your requirements i.e. coverage, premium, specific features, exclusions etc and match with the company. Choose the product which is very near to your requirements. Both these companies have good features but there will be difference in premiums.

143. Dear Sir,
     i have taken Appolo munich s standard health insurancr policy by online .and it was 2 years passed and still i m renewing it but one thing sir the critical illness is not included in the policy .Plz guide me what to do .

     rgds
     gopal

     • Dear Gopal,

       Critical illness in Apollo Munich is available as a rider. You can add it during next renewal of your policy.

144. Hi Jitendra,

     My age is 31.My wife having hyperthyorid condition. Aged 26. We are planning of child within one-two years. I am looking for maximum protection. Premium is not constraint.Will Apollo Munich Optima restore plan be good for us? or we should take individul plans? if yes, please suggest which one?

     Regards,
     Sarbjit

     • Dear Sarabjit,

       Apollo Munich has strong underwriting and i have seen in many cases that they exclude permanently many preexisting illnesses.Also, even in other company the premium may be increased in case of your wife illness gets covered.Considering this it will be wiser to take individual policies.

145. DEAR SIR,
     I M 35+ AGED HAVING LIC JEEVAN AROGYA FOR THE LAST TWO YEARS. AFTER READING UR ARTICLE ON OPTIMA RESTORE I M THINKING TO INCLUDE THIS POLICY INSTEAD OF COTINUING MY EARLIER POLICY. PLZ SUGGEST ME IS IT GOOD FOR ME TO CHANGE MY OLDER POLICY TO OPTIMA RESTORE FAMILY FLOTER. AND PLZ GUIDE IF THERE ANY OTHER INSURENCE COMPANY GIVING THIS TYPE OF FACILITIES LIKE APOLO IN PRESENT SITUATION AS THE ARTICLE WIRTTEN BY U IS QUITE OLD AND MANY POLICIES MUST BE CAME BY THIS TIME.
     PLZ SUGGEST………..THANKING YOU

     • Hi Anshuman,

       LIC Jeevan Arogya is not a comprehensive health policy but a fixed benefit policy which can be considered for additional expenses which you bear apart from hospitalization.

       You should read this to know-

       https://www.retirewise.in/2011/06/lic-jeevan-arogya.html

       For basic health plan you can consider Apollo Munich or Max Bhupa. Retsore benefit is also provided by Star Health but product features vary from Apollo Munich.

146. hello sir,
     as i want to know few days ago what should be appropriate health policy for my parents who both r diabetic patients . My father is 55 and mother is 50 yrs old. i know from some where , there are launched a new policy by hdfc life named ” health assure plan” that is covered also diabetic patients . please give some more information about this policy and is it a suitable health policy for me?

     • Moydul,

       Some companies cover diabetic patients in their basic health plan but with additional premiums.You can check with PSUs like National and New India for covering your parents. Star Health has a specific policy for diabetic patients which you can also look at.

147. Hello.
     Is it true that apollo munich charges extra due to weight being more than the ideal acc to age and height?! So, what is the break down accordingly? Do other companies also charge such overloads? Please suggest health insurance other than Apollo so that extra charges are not to be paid, due to weight issues.
     Thanks.

     • Hi Anju,

       All companies have certain criteria on weight wherein after a specified limit the person is put in overweight category. The company may consider giving health insurance to overweight but with additional premium. The extra premium charged may vary with companies as per their underwriting norms.

148. Dear Sir,
     I have taken GHPL Health insurance (Self +Spouse)in Feb 2010 from Andhra Bank, now i want to switch to any other insurance company but i afford only Approx Rs 4000 Premium a year, so please tell me which is the best policy with no caping and best result,
     For your information i have talk to Tata AIG, Max Bupa-Health Companian, Apollo Munich- easy Health, HDFC ERGO- Health Suraksha, Bharti Axxa.
     So i please suggest and tell any agent where i can buy the policy, because i do not want to buy directly because they will not help at the time of claim.

     Sandeep Katyal

     Faridabad
     Age 34
     M 9811486831

149. Sandeep Katyal
     Dear Sir,
     I have taken GHPL Health insurance (Self +Spouse)in Feb 2010 from Andhra Bank, now i want to switch to any other insurance company but i afford only Approx Rs 4000-5000 Premium a year, so please tell me which is the best policy with no caping and best result,
     For your information i have talk to Tata AIG, Max Bupa-Health Companian, Apollo Munich- easy Health, HDFC ERGO- Health Suraksha, Bharti Axxa.
     So i please suggest and tell any agent where i can buy the policy, because i do not want to buy directly because they will not help at the time of claim.

     Sandeep Katyal

     Faridabad
     Age 34

150. Thanks a lot. Jitendra!
     We will take individual policies.

151. Hi Jitendra,

     Thanks for a very comprehensive review. I have decided on getting an Optima Restore Family Floater.
     I just have a query on Out-patient treatment. I notice that most regular policies, including Optima Restore don’t cover the same. Is it a good idea to get a policy that covers Out-patient expenses as well?

     Thanks in advance!
     Maheima.

     • Hi Maheima,

       Yes outpatient treatment are not covered by these basic health plans. Although specific policies are available in the market but they are very expensive due to which they are not considered by most individuals.But even these basic health plans give some benefits on these after every specific period. Check in the policy what you can avail.
       All said, creating a health fund will be more appropriate.

152. MYSELF-DOB-29-11-1974 WIFE-DOB-27-9-1977 SON- DOB-08-04-2005 .WHICH MEDICAL INSURANCE TO TAKE? LOT OF CONFUSION.APOLLO OPTIMA IS GOOD?INDIVIDUAL OR FLOATER?
     OR MYSELF INDIVIDUAL AND MY WIFE AND SON IN FLOATER?

     • Hi Vimal,

       You can consider Optima from Apollo.But look at whether features matches your requirements.

       If the premium payment is within your range you can consider the option.Breaking it into two is advisable if it lowers down your premium.

153. Hi Jitendraji,

     I have oriental floater policy that includes me (50yrs) spouse(44yrs) & child (17yrs). Now i want to switch over to Apollo Munich floater.
     what is ur advice for changing to Apollo? pls discuss comparison benefits between two? or should i go for other mediclaim company? also suggest floater or individual???…..thanks in advance

     awaiting for ur guidance & valuable suggestion……………….

     • Hi Hemant,

       Although portability is available if you are not satisfied with the company there are certain rules which need to be taken into consideration. First and foremost the final decision of porting your policy rest with the company. Secondly what benefits are to be continued and where to have a limitations is also decided by the company. Sometimes the company may exclude some benefits which you were enjoying or may impose some waiting periods even if you have completed the term in the previous company if it is found to be on a higher risk.
       Apollo has a strong underwriting and so you should first confirm from the company on continuation of your benefits. You can visit their office and talk to the officials. But if you take a decision do it well before your renewal so that you are not dissapointed later and have time to think if you are not satisfied.

154. Hi Jitendra,

     I would like to buy a medical insurance that would cover my wife and my self ( both 28 yrs old). We are yet to have a child so we would prefer a policy that would cover pregnancy coverage. But my main concern is that I am into a transferable government service with service cities including many small cities like Dhibrugarh, Assam etc.

     I need to choose a company that has greater number of network hospital.

     I need your suggestion.

     Thank you

     • Hi Mr. Chattopadhyay,

       Most Private companies are having a large number of hospital network today. In case of PSUs the network is limited now. The list of these network hospitals you can get from the companies website or even from the officials before you decide on the policy. There you can check for any preferred city.
       Recently IRDA made some change sin health insurance where they have enhanced the definition of network hospitals which have actually increases the hospital network. Also, the network is more for cashless benefit. If the hospital is not there in the list but meets the IRDA definition, you can always claim reimbursements.

       With regard to pregnancy cover companies offer it but with some waiting period ranging from 2 years to 6 years.

155. Hi Jitendra

     I am 31 yrs old and i want to cover my spouse (29 yrs)+ my child(3 yrs) + my parents (61 yrs father & 58 yrs mother) under floater cashless health insurance. I want SA of 3-5 Lac with annual premium between 10-15 k

     Need your suggestion for best policy for this combination

     • Hi Chirag,

       Covering your parents in the same policy as you and your family (spouse & child) will not be a wise decision. This is because firstly the premium are calculated on the highest age member which will prove to be costly and secondly the probability of illness at higher age which will affect the entire family cover.

       It is ideal to cover your parents in a seperate policy and rest in other. You can consider Apollo Munich or Max Bhupa for both the requirement. The premium for your parents will be higher due to their age.

156. Hi Jitendra,

     I am looking for a good health insurance for my family.And, I want to cover following members in my family:

     Self : Age – 37 yrs
     Spouse: Age 37 yrs
     Son: Age 2 Years
     Father: Age 70 Years
     Mother: Age 65 years

     So, can you please advise me best options for the same. Can Optima restore fulfill my requirement?

     Thanks
     Dipali

     • Hi Dipali,

       Ideally, you should buy two policies – One covering your parents and other rest of the family members. The reason is the high age of your parente where probability of illness is higher and so companies impose lot of conditions.

       Among your parents, your father has reached 70 and so there will be very less option for him. The premium from the available options will be very high and may not be in your budget. As such, the more viable option will be to create a health fund for him.For your mother you an consider a health pan as companies generally have the basic health plan till age 65. Post this the options are only senior citizen plans where the options are limited.

       For yourself and rest of family optima store is a good option but understand the terms carefully. If not within your parameters, you can also consider easy health from Apollo Munich or product from other companies such as Max Bhupa. But do a comparsion and match with your requirement to take the final decisions.

157. Lets say a person has taken policy for 5L SI,

     1) In the first year, if there are no claims, the NCB would be 50% of SI. So for second year the SI will be 7.5L

     2) Now if in second year there is a claim, the bonus will reduce by 50% of SI.
     So now the SI for 3rd year will be 5L again.

     3) In the third year, if there is a claim again, will there be any loading since there is no balance bonus to deduct? Also, reduction in bonus has been mentioned as 50% if there is claim.
     Is 50% a constant number irrespective of the claim amount?

     Also, every where NCB accumulation is shown in examples upto 2 years only, what happens if there is no claim on a policy for lets say 4 or 5 years?

     • Hi Sindgu102,

       1. The NCB increase or decrease apply to NCB only. The sum assured one has opted for will not get reduced. Apollo does not apply loading on premium or SA so after two claims in third year also you have a claim then there is no NCB benefit but you will not have any loading either as Apollo do not have loadings. However, do remember that a company can always take a decision if claims continues for a long period every year.
       2. There is always a maximum capping on the NCB in any health insurance policy. It do not continously increases. Generally once the NCB reaches equivalent to your SA, there is no further increase in it.

       I hope this clarifies your doubt.

158. Dear Mr. Hemant,
     I am thankful to you for giving this information on health insurance. But is it useful for central govt. employee having CGHS facility?

     with warm regards
     Anil

     • Dear Mr. Anil,

       CGHS generally provides you a comprehensive health cover with higher limits. However, you can analyse what limitations are there in CGHS and then consider the additional health insurance if it fulfills those.

159. I have a group mediclaim from my employer of rs 4 lack.I am with co. from last seven year.recently I have undergone kidney transplant.if I leave the company can I get the same policy benifit as I have no policy other than co group policy.pls guide

     • Hi Sanjay,

       Group Insurance benefit are applicable till you are with your employer. although portability has made it possible to port your group policy to an individual/floater policy, it does have some restrictions. Firstly, for first year it has to be with same company from which you are having your group health policy. from second year you can port it to your choice of company. But which benefits company will be continued will be decided by the company after underwriting. Also the company may have sublimits in its policy which will apply when you port. So it may be a probability that you get less benefit then what you are enjoying in your group insurance. Hence, its wiser to have a standalone policy along with group so that you do not miss out on health insurance when you leave the company.

160. how can I convert group mediclaim policy to individual policy in case I leave company.as I have under gone kidney transplant 20 days back and I have no mediclaim policy other then group mediclaim policy.I am with co from last 7 year.
     please guide

161. Hi,
     Can you please compare Optima Restore with Religare Care policy?? It has similar benefits and less premium. Which is better??Also would like to know how both these comapanies stand on claim settlement??

     Thanks,
     Ashutosh

     • Hi Ashutosh,

       The details of claim settlement you can get form IRDA website. As far as products are considered both have features which are good enough. Religare is fairly new and so they have tried to compete on some additional feature and premium. Apollo has more number of products in its basket and a longer experience then Religare.
       Look at your requirement and then choose which matches yours best.

162. Hi
     Thank you for your sterling services, I’ve recommended your website to friends.

     Now, my situation is
     I’m a 45 year old IT worker, my wife is 39 years old. My parents and I, as well as my parents are covered by my employer’s health Insurance Plan, which happens to be under Apollo Munich.

     Now, given the uncertain economy and state of the IT services business, I’ve decided to take another health insurance plan, along with critical illness cover (which may be a rider, or a separate plan from the same or a different insurer) for my wife and myself. Please note that we’re trying to have a baby so coverage for possible pregnancy would be required, should that happen. I also wish to have coverage for any critical illness (about Rs 5L, min). This may come as a rider to a general health insurance policy that I’ll buy, or as a separate policy from the general health insurer or a different insurer. I hope I’ve explained adequately.

     Now in this scenario, which Insurance plan would you recommend? I’ve heard of Apollo’s Optima Restore Policy, but this doesn’t cover pregnancy or doesn’t have a critical illness cover. What If I buy this policy for us (my wife and I) as well as a separate Critical Illness Policy (say from Max Bupa) for additional cover? Or would you suggest a different policy / combination?

     I’m sure there are many other people in the same situation as I and your suggestion would be greatly helpful.

     • Hi Gaurav,

       Pregnancy cover in most health insurance policies get covered after a waiting period. This waiting period is generally from 3-6 years. In Apollo Munich policies other tan Optima, it is 6 years while Max Bhupa has 2-3 years. If pregnancy cover and critical illness is what you are seeking then you may have to buy different policies. You can look at Max Bhupa for your spouse and Apollo Easy Health which has critical illness rider for yourself.

163. i am 40 yr old.gone through kidney transplant on 22may2013.through employer my family cover in group mediclaim policy.last year i have paid premium for enhance sum assured from my pocket.i am in complany from last 9 year and having a same mediclaim policy now i want to if i change my job how i can convert this policy on my name.i am ready to pay premium as i have paid last year.
     please guide how i can take this policy on my name if i quit from this job.
     pls reply on my mail id.
     Regards
     sanjay
     sanjay

164. Dear Sir,

     Thank you for your suggestion. Can you please suggest me few good term insurance policies. I am NRI. Am I eligible for this policy?

     • Hi Prasad,

       Yes Apollo Munich issue policies to NRIs also.But do remember that they are applicable only for treatment in India. With regards to Term Insurance, you can check with Kotak, HDFC or ICICI.

165. Dear Jitendra ji/Hemant ji
     After reading your valuable article and all comments,i thought that Apollo Munich Optima Restore plan is best family floater plan for me although it lags behind Max Bupa Heartbeat plan in Health check up,Maternity benefit,Nursing allowance,New born baby cover and covering Pre-existing diseases coverage(Max covers after 4 yrs continuous RENEWAL but Apollo covers after 4 yrs continuous CLAIM FREE RENEWAL).On the other hand OPTIMA RESTORE plans has special features like RESTORE & MULTIPLIER benefits.Finally i checked premium rate after 45 yrs age(as after this age premium rate changes alarmingly and it will be deciding to know company’s real color) and it was a rude shock to me.Whereas at my present age 34 yrs PREMIUM FOR MAX IS Rs 16633 AND FOR OPTIMA it is Rs 11149 but at 46 yrs PREMIUM FOR MAX IS Rs 21856 and FOR OPTIMA it is Rs 24230!!!(More than 100 % increase)..it means when this plan needs most then the premium becomes too high.

     • Hi Rupar,

       The premiums are decided on the based of the probability of illnesses. At higher age the probability is higher and so the premium will increase. Apollo Optima Restore would have increased much higher considering the restore benefit they are providing.
       In my view you should compare Apollo Easy Health with Max Bhupa.

166. Hi Jitendra,
     Thank you for your review on Apollo Munich and all your suggestions to everyone.
     I am also in a slight dilemma whether to go for MaxBupa Heartbeat Family Floater with 20 lacs SA premium around 16k or go for Apollo Munich. Just to give you my background, I am 34 yrs old, married and wife is 35 yrs old, no kids.

     Please advise.
     Thanks in advance.

     • Hi Kaushik,

       In my view IRDA has made it simpler for you. With new norms if you have multiple policies you can claim from any one entirely. Previously it was not so due to contribution clause i.e. companies use to give claims only upto their share in your total coverage.
       So if there is some specific coverage which you need and available in each of these products you can consider dividing your insurance between the two. Else go with the product which best matches your requirement and make premium a secondary consideration.

167. sir my age is 34 years. I am diabetic (traced before 6 months). I have wife and 2 kids. Please suggest some policy i.e. apollo munich optima will be a good option or some other policy

     • Hi Rahul,

       Apollo munch do not cover diabetic patients so it will be out of your choice. You should look at buying two policies -one for yourself where diabetic cover is available and second your spouse and child for which you can consider Apollo Munich. For yourself you can consider PSUs like National India Insurance who covers diabities with some additional premium. For coverage specific to diabities, you have even Star Health Diabetic Care.

168. Rahuljee, Apollo-munich will not entertain your proposal-since diabeties is decline in apollo- however you can get cover from max-bupa ( except silver plans) , icici -lombard & religare provided you have type-2 diabeties only.

169. respected jitendra ji
     please guide me in choosing appropriate health insurance policy for me(43yrs) my parents who r 68yrs n 64yrs ,my brother 38yrs his wife 34yrs child 8yrs .

     • Hi Virendra,

       You can consider Apollo Munich Easy Health or Max Bhupa for yourself. For your parents, health insurance at this age will be costly. You can consider Apolly Easy Health for age below 65 and a senior citizen policy for age above 65. But in my view you should create a health insurance fund too as premiums will increase substantially at a very high age.

170. Hi,

     How would you compare Bajaj Allianz Health Guard with the Apollo Munich Optima Restore and easy health policies – we are a family of 3, my wife is 32, I am 33 and my child is 1.

     Look forward to hearing from you.

     Vishal

     • Hi Viashal,

       Compare Bajaj Health Guard with Apollo Munich Easy Health and then see which best matches your requirement. Apollo Munch easy Health has a specific Restore feature which makes it a different category where only few companies like Star Health & Religare have a product.

171. Hello Sir,

     Is disease like Cancer is treated under normal health plan or we have to go for Critical Illness rider. If so, then please suggest the best health plan with Critical Illness.

     Regards,
     Nitin

     • Hi Nitin,

       Any general health insurance policy covers hospitalization expenses due to illnesses they cover. Cancer is very well covered. But since the treatment cost are higher and it may not be t feasible to take such a high coverage amount due to premium cost, a critical illness rider aims to fill that gap.

172. Hi,

     I have following queries, please answer

     1. Can I have Medical policy with 2 different Insurance co.? Is this legal & valid?

     2. How any claim can be settled in above circumstances, if it is crosses limit of 1st policy? because every company needs documents in Original?

     For e.g.

     1st policy SA = 2L
     2nd policy SA=3L

     If claim comes for 4L, then how the claim would process?

     Thanks!!

     • Hi Vikas,

       Yes you can have multiple policies and after October 1st 2013, IRDA has made changes wherein you can claim from any of your policy for entire expenses. The example you have stated, you can claim Rs 2 lakh from first and then Rs 2 lakh from second.

173. Hi,

     I have following queries, please answer

     1. Can I have Medical policy with 2 different Insurance co.? Is this legal & valid?

     2. How any claim can be settled in above circumstances, if it is crosses limit of 1st policy? because every company needs documents in Original?

     For e.g.

     1st policy SA = 2L
     2nd policy SA=3L

     If claim comes for 4L, then how the claim would process?

     Thanks!!

174. Hi Jitendra,

     That would really nice, if your reply on below queries

     1. Can anyone have Medical policy with 2 different Insurance co.? Is this legal & valid?

     2. How any claim can be settled in above circumstances, if it is crosses limit of 1st policy? because every company needs documents in Original?

     For e.g.

     1st policy SA = 2L
     2nd policy SA=3L

     If claim comes for 4L, then how the claim would process?

     Thanks in Advance!!

175. Hi,

     That would be really nice, if you anserw query#323.

     Thank you so much!!

     • Hi Vikas,

       That query is already answered.

176. Hi,

     Please advise a good health insurance family floater with me 38 years + wife + 2 sons 13 & 9. SA shud be 3 or 5 lakhs…thanx…Rakesh Khurana

     • Hi Rakesh,

       The decision of SA has to be on the basis of your living city and your preferred network of hospitals. Also the larger is the family group size the higher has to be the coverage. In general while you are in a metro city like Delhi or Mumbai a Min Rs 3 lakh cover should there per member. So if you are group of four it should be at least a Rs 12 lakh cover should be there. But practically this may not be feasible considering you might have a premium constraint. In that case you can go for a family floater of Rs 5-6 lakh and add a top up or a super top up policy later which are cheaper and help you in enhancing your coverage. Not many companies have these policies some of them i know are Star Health &United India. There are other too so check out on them.
       For general health insurance, Max Bhupa and Appollo Munich have products to consider if you do not want to have any sub-limits but you need to match them with your requirements and then decide. Even the new company Religare has a fairly competitive product. Others like Star Health or PSUs have sublimits in their policies which you should take note of if making a choice. My advise is to set some parameters on the scope of coverage you
       need and then take the help of few web aggregators to check which companies have those features. This will help in refining your choice.

177. Hi Dear Jitendera & Hemant,

     Very nice analysis of the policy which makes it much clearer then the other health care products in the market with respect to Health Insurance. the Only thing i want to ask is
     1. let’s say if Lipid and Liver profile of a person is not well due to any reason Do they later on Deny to pay for the treatment? (Generally all the Companies say that it might be due to excessive intake of Intoxicants).

     2 What kind of Maternity benefits are there?(If we are planning to conceive a bay in a month, two or Three whether all the expenses would be covered under it or not in the family floater plan).

     3. Lets say you are going for the treatment of or surgery of any thing included in the package and later on Doctor’s would suggest something else whether it would be covered under it or not? (If Doctors are operating for a included disease later on they found some chronic or excluded disease inside, can they Deny to pay the Hospital).

     Please Guide.
     Mannu

     • Hi Mannu,

       1. If during the policy issuance company is well informed of the illness through policyholder declaration or medical test then there is no reason that they will not give any claim. But in case it happens later then company do have limitations on when the claim will not be given which is well illustrated in the policy wordings.

       2. Maternity expenses are generally covered after a certain waiting periods. The limitations on coverage you can get from the policy wordings which is freely available at companies websites.

       3. Any kind of exclusions is stated in the wordings. You should read it once where you will get most of the clarity.

178. sir,
     if we suffer from some illness/disease for which no hospitalization is required, just got treated with medicines staying at home. then i want to ask that if one can claim the expenses incurred for the disease or illness from the insurance company or not ???

     • Hi Param,

       Health insurance policies, in general, do cover domiciliary treatment in cases where hospitalization was required but due to certain reason the patient cannot be transferred to hospital and on advice of medical practitioner has to be treated at home. But there are many conditions attached to it for e.g. a minimum 3 day treatment etc. In case of illnesses where 24 hospitalization is not required will be termed as day care and there too companies have a list and terms.

       You need to check your company policy wordings to see what are the terms in your policy and it will also state when and under which illness the company will not give a claim.

179. Hi

     never take apollo munich health insurance. their policy terms will be attractive.. but their customer service , agents, are completely irresponsible and service is worst.

     Remember, THEIR SALES SERVICE is excellent.. but after that.. its completely worse.

     BE WARE

     • Very much agree with you .

180. Hi,
     I am pretty much confused regarding choosing a health policy between Appolo Munich and ICICIlombard, I have a good experience with icicilombard with regards to my motor insurance. I am buying health insurance for the first time. pls could you suggest if i should go ahead with icici or appolo.
     I am looking for 3lac cover for me and my spouse.

     • Hi Shalem,

       If you are satisfied with your current insurer than there should not be a worry n buying a health insurance from it. But before you purchase do a comprehensive review of features by matching with your requirements and go through the policy wordings to know exactly where you won’t receive a claim.

181. Hi
     I am 29 yrs of age and my wife is 25 yrs . I am looking for a health insurance policy for both of us. We got married 1 year back. Am confused between Max Bupa Family floater and Apollo munich Optima restore. Actually I have an elder brother who is married and has a 3 yr old son. We were told by max bupa agent that if we take familu first plan with my father as the policy proposer then all 5 of us (me, wife, brother, bhabhi and nephew) will be covered with sum assured as well as we can create a pool of max’m 15 lakh ….What I wish to ask you is that although it appears a nice idea to me and brother, but he lives in mumbai while I am settled in Jodhpur (rajasthan)… and here in jodhpur there is no office of max bupa…while there is an office of apollo munich…..also the list of tied up hospitals is also an issue as the list does not include all the top hospitals in jodhpur…..My priorities are simple- low premium, max’m cover, no claim bonus, no capping, total cashless facility, good and effective service and quick claim settlement. Kindly help me and suggest which policy we should go for. Would highly appreciate your suggestion

     • Himanshu,

       Covering all family members in a single policy is not a good idea. One other drawback is that the premium will be calculated on the eldest member, which in this case will be your father. So other family members will be paying a higher cost. And as you have mentioned that it does not cover major hospital in Jodhpur, the policy might not be a viable option.

       Ideally you and your brother should cover their families through different policies since you both reside in different cities. Even for your parents you should buy a seperate policy since premiums are on higher side for higher age group. You can check with PSUs companies for hospital network. If most of insurance companies do not cover those hospitals then you will have to rely on claiming through Reimbursement. In that case you can consider any company which have features you desire. But to deal with the situation you will have to build a health emergency fund.

182. Dear All, My insurance claim was rejected with no reasons given. When i questioned them, they gave me an explanation that was not applicable to me, only since i know my rights I was able to question their intentions. I received one call back and no other ever since my complaint. They only sent me my renewal policy promptly as usual. Let me update all about their intention to cheat clients. I have been insuring me and my wife regularly year after year. We were with hdfc and switched to apollo munich paying the highest premiums for the best possible plan. My claim was reject saying that there was a waiting period for the condition stipulated. I have been cheated by the insurance agent, why else would they not give me a portability plan, its a facility stipulated by the govt of india to safe gaurd the common man. Why should I wait another 2 years, am I stupid. The claim was small, Rs 40,000/- thank god. I am going to safegaurd myself and others from making them aware of the cheats these people are. Their insurance agents are cheating people, filling out bogus details, what do they think they will get away with such cheating. They wish! I will be switching shortly!!
     Policy No: 600001845201
     Claim id: 170494

     • Somanna,

       Sorry to hear about your claim rejection.

       Portability is a feature available to every one and you can switch to any insurer. However, there is a limitation here. When you port your current health insurance to a new one, what benefits are going to be continued in your new policy is decided by the company only. So if company where you are porting your insurance feels that few of the conditions cannot be ported then it will be treated as fresh. This simply means that in portability its not necessary that all the benefits of your previous policy will be ported. This decision rest with the company.

       This is how portability works. We are not at 100% portability since features among products vary at companies. Whatever benefits company has continued or discontinued will be stated in your policy wordings. So in my view before making so many switches, take this factor into consideration.

183. Dear Mr.Jitendra,

     I am Living in hyderabad with my wife and a newborn. i am looking at health insurance policy and have studied few companies and came to a conclusion on the following, MaxBupa, Religare & ApolloMunich. I have already taken a 2 lakh individual policy for myself and 2 lakh policy for my mother from ApolloMunich for the last 2 years. Also i have CI from AVIVA for 3 lakhs which i have taken as part of some investment policy. Now i am thinking of taking one health insurance covering myself, wife and baby or take one comprehensive family floater policy for 4 of us. i am looking for a premium of Rs.20000-30000, i dont want to compare health insurance companies for the premium amount variation but want to compare them for the service and their products. i dont want any sub-limits or any cap in the policy. kindly suggest…….Thanking you in advance

     • Sriram,

       Keep your mother policy seperate since the premiums are calculated at the eldest member age. You can choose from Apollo or max Bhupa if you do not want any sub-limits. For your mother, if she is a senior citizen, then there will be limits on the claims.
       Compare the products with your requirement and then choose one which best matches them.

184. Hi, I m single parent of 37 yrs with son who is 6 yrs old.. should I take cover of 3 la c or 5”’ pls suggest.

     • Vandana,

       You should avail a Rs 5 lakh cover for covering both.

185. Hi Jitendra, I am going to buy a family floater plan for self for 15 lacs. Have decided to choose between Religare Care Super NCB & Apollo Muncih Optima Restore, however am confused on ” Restore” benefit of Apollo versus “Recharge” benefit of Religare..

     Do they work similarly or is there a difference. If some one takes a cover of say 5 lacs and member A uses 4 lacs and then member B runs 3 lacs bill in the same year then what would be the payout in such a case for both the policies

     Please guide
     Regards

     • Dheeraj,

       Yes there is a difference in Recharge and Restore option.In recharge the additional sum insured will be reinstated even if you have not exhausted the basic sum insured completely. Also recharge can be used multiple times in a year. But in restore the Sum Insured and NCB has to be completely exhausted and it can be claim only once in a year.

186. Dear Mr. Jitendra,
     I am 30 year old married man, living with family. I am looking for a health insurance policy for me and family. I visited policy bazaar for the same and there I found Apollo Munich Optima restore policy better in comparison with other policies w.r.t. sum assured, multiplier and restore benefit. so, shall I buy this policy or is there any other better options. also shall I buy the individual plan or a floater plan for my family (spouse).

     i had gone through the website and by guiding people like us your are doing very good job. Thanks a lot for your kind cooperation.

     • Pankaj,

       Firstly thanks for the appreciation.

       As far as health policy is concerned much depends on your requirement. Any specific feature in a policy should not be your decision. Rather look at comprehensive coverage it is providing and to what extent it will benefits you. Read the policy wordings to see what is not covered so that you have a clear idea. Also do understand that features like these comes with their conditions on which you need to have a clear understanding. For e.g. restore is applicable only when you utilized the entire Sun Insured and NCB amount.

       So do a comparison on based of certain parameters and then see how a health policy meet those. Once you are convinced then take a decision.

187. Dear Mr. Jitendra,

     On the web site the success rate is of 88% for Apollo Munich Optima restore policy. Please let me know this in actual practice?

     • Hi Pankaj,

       The more authentic figures on claim settlement are illustrated by IRDA. But unfortunately, the data is not available for health insurance companies. IRDA publishes only Life insurance claim settlement.

       What is illustrated on company website cannot be taken as a decisive factor. In my view company history and experience in health care sector is one important factor which you can look at apart from product features.

188. Hello Mr Solanki, its nice to see you responding to so many queries and its very nice. I too have a query. I am 39 years old with 35 year old wife & two kids of ages 5 & 3 respectively. I want a family floater of 20 lacs considering future inflation in medical costs. We are other wise fit family

     What would be better option
     1 ) Optima Restore of Apollo with basic policy of 10 lacs & top up of 10 lacs over it
     2 ) Max Bupa Gold plan with 5 lacs of individual cover & 15 Lacs of floater

     Option 1 seems to be cheaper but option 2 may give more flexibility in terms of any exigency where high hospitalization costs are invovlved

     Please advise. I am looking at clean settlement , transparency & optimum cost

     • Niraj,

       Both companies have enough experience in health care sector and so its difficult to make the best choice. In my view you should select the company which best matches your requirement in the product.

189. I Have Royal Sundaram Medical Policy. I Pay premium of Rs 8000/ app for 2 lac cover. Also I have top up policy of Apollo Munich of Rs 5 lacs.

     I want ask u whether Apollo Munich has its own inhouse settlement or TPA ? Also if I think of portability to Apollo Munich How much premium will be ? My Age is 44, Wife is 43, Son 16 ,Daughter 9.

     Rgds

     Shahid

     • Shahid,

       1. Apollo Munich has inhouse claim settlement.

       2. You can port your policy but there are some key points which you should take in consideration. The continuation of benefits in new policy will be decided by the company. This means after underwriting company will take a decision which benefits they will continue in their policy and which one they will have a waiting period. So it may happen that any existing illness might be fully covered in Royal Sundaram but Apollo Munich gives a waiting period of 1-2 year. All these you will come to know only when your policy goes for underwriting in Apollo Munich. Moreover you have to apply 46 days before renewal date of your existing policy. The premium in the new company will be based on their product.

       In my view you should first apply so that you get to know about the scope of coverage and only then discontinue your existing insurance.

190. notify me

191. I’ve reliance silver health-wise plan family floater. I am planning to go for additional policy. I checked on Mouthshut about Apollo munic and all review comments are below average. After reading it I’m not able to decide whether to go with optima health restore or not.
     -aniruddha

192. I’m a family of 4 members. myself-42, wife-39, daughter-10, son-4.
     I have family floater for 5L from reliance health-wise since last 6 year. No claim history.
     My agent advised me not to switch since its six years of no claim history, due to which the claim will be settled without any problem.
     I am looking form more cover. and hesitating to go with reliance again. they have increased the premium of my gold policy from 5000 to much higher, and i had to settle down with silver at that time. as well as they are not the best in health insurance. So i plan to go for a new health insurance of 5 L floater and continue both (reliance and the new one).
     I zeroed on optima health restore and happened to see reviews on Mouthshut about optima health restore. all review comments are below average. After reading it I’m not able to decide whether to go with optima health restore or not.
     Please advise. – Aniruddha

     • Aniruddha,

       There will be some limitations in any health insurance product and any new product will arrive with some additional features to existing one. When Apollo Munich came with Optima Restore there were very few such products which surely have increased by now.
       Your decision should rest on your requirement which should match with features you want to avail. So go through the coverage in detail. You can compare Optima Restore and Religare Health to see which one matches yours as they both have restore option.

193. Hi,

     I am new to health insurance and looking for a good policy. Here is my case:
     1. Myself – 39 years, wife – 34 yrs, Son – 9 yrs (US citizen), Daughter – 4 yrs . We are staying at Bangalore
     2. Company provided policy – 3L and I have taken 2L (as topup).
     3. Now I have couple of questions: Is it good to take external policy? Should I not topup this year with my company?
     4. Looking for 5L policy

     • Krishna,

       Group health insurance do have many benefits which are good. But the major issue is that the moment you leave the employment its not available. Or if you are changing your job then also it starts as a new policy. So whenever you leave employment the group insurance will cease. The problem arise at higher age when you need it the most. Hence its wiser to have a standalone policy which you can continue for your lifetime. Starting early will help you in reaping the benefit in later years of life.

       You can consider Apollo, Max or even Religare health for your need.

194. Dear Jiendra and Hemant,

     Thanks for parting your time advising individuals in effecient insurance planning.

     I also seek your kind guidance.

     I work as a Company Secretary at a Limited Company but neither I nor my family (Parents, I am single) are covered by my company. Hence, I am planning to buy Appollo Munich policy (As per advise of my financial planner).

     – Restore policy for me (SA 3 Lacs) and Easy Health Stadard/Exclusive policy for my parents (SA 3 Lacs). Is it a good decision?

     – I can see that if one buys individual policies there is a lesser amount of premium one needs to pay against family floater policy. So, shall I take two individual policies for my parents or shall I go with family floater only?

     – Your inputs are welcome.

     Thanks.
     Viral.

     • Viral,

       What you have thought is good enough for you and your parents.

       In Individual policies the premium will be less as you are the only person to be covered. But within the family floater policy premium you may get higher coverage in individual. So ideally an individual policy gives you more coverage. Family floater we consider since premium for all members may be beyond our budget. There are no differences in the features. If you can afford the premium for both your parents then individual policy will do good.

195. Apollo Munich Health insurance is 3rd class insurance company not cashless facility available in network hospital every time demand one by one document and reply delay. after last tell settle all bill your pocket and send all document for reimbursement and not inform one time what’s proper document required my cashless claim not approved in 4 days all document submit every time when apollo demand me.

196. I have taken optima restore last year, this is my 2nd year, i took 5 lac policy, I am planning to take lic jeevan arogya plan. I heard apollo munich claim percentage is good.
     Should i continue with apollo munich?

     • Anand,

       You can continue with Optima restore policy. LIC Jeevan Arogya is structured as a policy for claiming additional expenses.

       Read a review here:
       https://www.retirewise.in/2011/06/lic-jeevan-arogya.html

197. I need your guidance to choose a health insurance policy for my parents.
     My father is 59 and mother is 51. My father has no specific disease except old age related pains and mother has ortho problem for couple of years. Could you recommend a policy that suits them. Thanks Vinay

198. I read this excellent article, although after 2 years. I plan to take medical policy for self and family (age : mine 58, spouse:51, sons – 21 & 19). Till date I was fully covered by Company and hence did not bother to take any policy (my mistake!). I plan to take policy coverage of Rs.10 Lakhs each for myself & my spouse and Rs.5 lakhs each for kids. Considering that total premium touches almost Rs.65,000/- can I take policy of lower value (and lower premium) with Super Top Plans for individual or family? In such a case which plan will you advice? If not, which is the best policy for my family?

199. Hi Jitendra… thanks for the informative article and the responses to many comments. I have one more question on restore feature.
     The policy says that the amount would be restored only when the entire amount is exhausted and the restored amount can not be claimed for same treatment. I doubt if this would be useful in most of the cases. Let me give you an example:
     Say Mr. Ram take a cover of 5L. Ram gets a hospitalization claim of 4L for treatment of X ailment. His left over coverage is of 1L now for that year. Now, again if he gets hospitalized for another ailment Y in the same year and the claim amount for the same is now 3L. Will he have coverage for the entire amount or only 1L as he had not exhausted his main coverage earlier?

200. Hello Jitendra PS Solanki,

     how many commission found.

     because you not share apollo munich claim settlement Ratio for your information I am facing problem with Apollo Munich and you can check Irda complaint one time again suggest any company plan for your information my Apollo Claim number is

     For claim id 211683: 1) The member was hospitalized for loss of appetite and Vitamin D deficiency which could had been managed on OPD(outpatient department) basis.
     2) The member is a lactating mother, laboratory tests were done which are related to Lactation and deficiency which is also not payable under policy.
     3) The member was diagnosed with hypothyroidism and admitted for 4 days, treated on tablet & syrup and no active line of treatment given.

     In view of the above, the need of hospitalization is not established and claim stands repudiated.

     For claim id 217137 which was filed with us on 05 Sep 2014, we observe that the same is a Pre Post hospitalization expenses reimbursement claim. As the main claim (211683) stands repudiated, we regret to inform you that the pre and post claim also stands repudiated as per policy terms and conditions.

     We trust we have addressed your grievance in a fair and equitable manner in due accordance with regulatory guidelines in a customer friendly manner.

     However ,in case you are not satisfied with our decision, you may approach the nearest Insurance Ombudsman for resolution of your grievance. The contact details of Ombudsman offices are available in the “Policy Wording” document.

     For any further assistance, please feel free to write back to us or reach us on our Helpline number: 1800-102-0333.

     Thanks & Regards,

     Vivek Manchanda
     Senior Executive (Grievance Redressal Cell)

     Apollo Munich Health Insurance Company Limited
     iLABS Centre, 2nd & 3rd Floor, Plot No 404 – 405, Udyog Vihar, Phase – III,
     Gurgaon -122016, HARYANA

     and for your information above claim settlement done by ICICI LOMBARD

     I share you details
     CLAIM NO AL NO Employee/Member Id EMPLOYEE NAME MEMBER NAME UHID DOA CLAIM

     220200892636 161 Satyapal Yadav Guddi Devi ILGIC/EQW/00/000000294/W 04-JUL-2014

     Hospital Name -SANJEEVANI SURGICAL GENERAL HOSPITAL

     REQUESTED AMOUNT -28728

     NET SANCTIONED AMOUNT- 22566

     Rs.4000/- Deducted proportionately as per Room rent

     CO-PAYMENT -0

     DISALLOWED AMOUNT – 6162

     Rs.4000/- Deducted proportionately as per Room rent

     capping/Rs.62/- Deducted proportionately as per Room rent

     capping/Rs. 150/- deducted as Registration charges not

     payable./Rs.1800/- Deducted proportionately as per Room rent

     capping/Rs. 150/- Deducted as examination gloves charges not

     payable.

     I apply for 6162 amount the apollo team reply me above region

     My question If Icici pay this claim why not pay me Apollo this claim balance amount give me region and next time if you suggest any Apollo any plan remember this case and Apollo claim ratio for your information apollo claim ratio is 40% below
     And Icici Lombard Claim Ratio is 78% so Friend you decide who is best company for you health insurance I suggest you if you buy Apollo Munich you defiantly face many problem the time of claim.
     you can call me more information 9867446071
     and my apollo policy number is – 1000417293

     And already apollo policy holder i request to you please port your policy before your renewal 45 days any health company you choose like Icici lombard future ganrali (future ganrali is a best health insurance low premium)

     and share this issue more and more people

201. Hi,
     I would like you to suggest a decent health insurance plan for me (30), my mother (56), and my father (62). Should i go for a floater or should i have a different policy for my parents, considering i will get married in a year or two. Also can you suggest a policy/policies; (if possible with CI coverage)? my father had a hernia operation about 5 yrs back, and my mother had uterus removal operation about 20 yrs back; does that affect the premium?

202. hi jitendra

     i m interested buy a apollo munich optima restore policy for me & my wife, my age is 30yrs & my wife 33yrs.

     can u pls suggest what should i buy individual / family policy?

     & can Hepatits B illness will be covered in this policy or not.

     thanks
     Aman

     • Aman,

       If any of you have health issues then its wiser to buy individual policies cause it affects the premium and policy features. Apollo does have stringent underwriting process and so any pre-existing illness, if any, is looked at in detail.Also pre-existing ilnesses are covered after 3-4 years of policy continuation.
       You can go through the policy wordings of the policy where if its excluded will be mentioned.

203. Hi
     I want to buy appolo munic Optima restore or Tata AIG optima restore. Kindly suggest which one is better for our family. And also suggest individual or family floter.
     My age : 36, wife: 29,kid:3.5

     • Hemant,

       You are comparing Apollo with Tata Aig Life or General Insurance product. Can you reveal the exact name of the product from Tata AIG? They do not have any similar name product.

204. hello sir,
     I am 28 yrs old single n mother is 52. She is hypertensive. I would like to take a health insurance plan for both of us. I want a plan which will cover both small illness (Day care procedures) to critical illness.I hv seen Apollo Munich Optima Restore and Maxima plans. Kindly suggest me which one should I take? I can afford 15-18k premium/p.a. On both of us. Also suggest me which one should I take individual of family floater plan? Is there any EMI option to pay the premium on monthly basis? (I also hv Baja Allianz 3 lac health insurance from my employer for immediate family which vl cover the maternity expenses in the coming days). Thanks in advance……

     • A.Manikanth,

       Firstly an individual policies will be more advisable as your mother age is high. Also since she has hypertensive the company may charge a higher premium to cover it. Secondly there is no EMI option to pay the premiums. You can pay only as a lumpsum. Lastly, Maxima Plans are mostly for covering additional benefits than basic health plan. So first cover yourself adequately for basic coverage for which optima restore is a considerable option.

       • Jiterder ji,
         I am 40yrs age. I am diabetic from the past 10 yrs. I would like to take a health Insurance policy for my self. I am single. There are policies for diabetic people from Apollo and Star. But the premiums are quite high. Instead I would like to take normal policy and would like to wait till waiting period 3-4 yrs. I would like to go for Apollo optima restore option. My question is does company give me a policy keeping in mind waiting period of 3-4 yrs. Do you suggest any other policy for me?

205. You can suggest me any other best plans which meets my requirements other than Apollo Munich Optima Restore n Maxima Plans.

     • A.Manaknath,

       You can also look at products from Religare and Max Bhupa.

206. I am surprised as to why there are no posts after 2013, why queries of investors is not there?

207. Hi Jitendra,

     Planning to take a Health insurance for self. (Age 26). hopefully will get married in a year or two. Kindly advise accordingly. Thanks!!!!

     Murli

208. What are the mandatory medical tests for easy health standard and optima restore policies?
     Thank you

209. My mother is 65 years old.I have not taken any insurance for her until today.She has catract.is it okay to take now before the surgery?When the coverage will start?

     Sorry if i sound vague.it is becoz i hav zero knowledge on health insurance

210. Apollo munich is big cheater co. And also its cheaf griveance officer not attend phone, i request to IRDA do not give telephone no.to custmer. Our complaint against excutive mr. SACHIN VISHWAKARMA and MR.JHA both carry a chart for insurance premium but after recieving cheque co. demand loading . Why co. collect premium collect only health check up fee but our case transfer insurance co. Our family insurd since 2004 without any loading.big froud with me. also co. cheating in refund premium co. return amount in 1moth but say 1 week.so i puzzeld for cash to paid premium to other insurance co. So very very bed expierence

     • Hi Rakesh,

       Thanks for sharing this. Personally I have never faced any problems with Apollo – at least in claim settlement.

211. Never ever go for such a worst Health policy, I am telling you for God sake Never take policy. They was worst in service.
     Its True , 4-Month back I took Insurance for my MoM who is 52Years old, And at time of giving policy they said ours is superb ( we won award , In 2-Hours we release support etc etc ) But on 29Th sep-2016 due to Feverfollowed by cold and due to cold she could not Breath so we joined to St.John hospital Bangalore and Intimated Apollo ( ID-286508 ) , And we send List of Doc. like Pharma bills, Test-Reports , Doctor Reports and Test-Bills all things , For all this I payed 10K, Even if Apollo says Its Cashless , we needed to pay our money at time of Admission , Then after submitting all Bills , After 4-5 Hours Apollo send , We needed Clarification Telling is Patient suffering from BP get Doctor Certification , ( Then We gave it ) Then after 4-5 Hours Apollo asked I needed a clarification ( is patient having Previously and BP ) , then Doc replayed NO,, Then after 5-6 Hours They asked one more Clarification Telling Do patient having Sugar ( Diabetic ) Then for Give that report we conducted Test and we gave NO Sugar ( Diabetic ) ,
     Again after 5-6 Hours they asked , we needed to know Previous History of Patient , That also we gave and its was fine or Normal , So even in that they did not get Loop-Hole to reject policy , So again after 5-6 Hours later they again asked we needed some clarification – what all medicine you used and for what , again doctor gave Full explanation , Again after 4-5 Hours , They asked why This medicine used, we needed Clarification etc etc,,
     So finally we needed to DISCHARGE my MoM in 2-Days because of all this Apollo Clarification we stayed for 5-Days in Hospital ,, After that we couldn’t able to Clarify Apollo , because of just Couf & Cold , Then asked so much Clarification so that if they find loop-hole they can reject it.. But we mom said I cant be in hospital for such a long time so, by paying our own money we DISCHARGE my MoM…

     So frinds Never buy Apollo Health Insurance or policy , Above & below People are brokers so they telling its good good Things ( In apollo Blog Only agents can post we can’t tell our reviews ., Its shows error ),
     If You can whats up me @ 9880805215 , I shall send all Doc, what apollo ppl asked and send recorded talk of customers care of Apollo ..

     Apollo is worst , Cheaters , A ss holes..

212. Dear Sir
     Health Insurance Policy from Apollo Munich or XYZ may be good in their Policy Documents. But in Real life….. God knows…Read Some review In Mouthshut.com Before taking Policy of any xyz health insurance company…

213. Dear Friend,

     Never buy such a worst Health in Apollo Munich Health Insurance.

     I buyed and getting suffered, Apollo Munich is Cheap Health Insurance company.

     Jagoo Grahak Jagoo. Buy STAR or Bajaj But not Apollo.

     I BUYED Apollo Munich Health Insurance FOR MY MOM,

     On( 28th -Sep-2016)due to seasonal diseases she was attached by Cold, because of it she could able to Breath Normally, so on emergency we admitted to St.John Hospital Bangalore.

     Patient( H N Lepakshi – Ph- 9880805215)(cashless id 286508)

     Apollo tells cashless in networking Hospital, But when hospital ppl asked money to admit Patient, I said “ We have Apollo Health Insurance “ They said “ Even then you needed to pay 8K as admission, then we give you documents and records then you can clams” Then I called “ Apollo customers service, they said that’s true “ Then I payed 8K in hospital & Did Admission .

     Next day, 29th –sep-2016, Doctors gave 1.) Doctor certificate telling “ Due to cold & fever she joined “

     Proof: we sent to apollo “Doctor certificate, Medical Records, Pharma Recors, ” and apollo said in 2-hours we conform it, I called 10+ time to customer service, but no proper-response,

     Next day apollo sent we needed Clarification on:-

     1st you asked:- Needed Clarification for BP.( for that we tested and said no BP) on 30th-Sep.

     2nd You asked:- Needed Diabetic Present .( We needed blood-test and said No-Sugar) on 1st-Oct.

     3rd You are asking:- Steroid why its used needed doctor certification on it.( on 1st-Oct @ 6PM)

     4th:- we gave Doctor Certificated telling due to Breathing difficulty we gave 125mg dose in morning(30th –Sep)@10AM once.

     5th You asked:- Why Hyperglycaemia Steroid is given.(2nd –Oct you asked)

     :-We said Its not Steroid, Hyperglycaemia is glucose level more in blood:

     As Apollo-Munich did not get and room to reject clam,

     they said “we needed still 5th -Oct-2016 to Analysis .” Doctor working in @Apollo Munich have fake doctor certificate, Because on 30th I got a msg from Apollo Doctor team why Dolo-650 Steroid given.

     And Why Hyperglycaemia Steroid given. In future they might tell Glucose is steroid.( Never believe apollo Munich Doctors, Then all are Ass-Hole and Fu-ckers.

     Then, Doctors in hospital said, they are just playing to reject Clams: – Even after asking or calling daily 10+ time to customer care, no response etc.

     Then we meet Heath-Minister they speak to Apollo Munich, Then they started calling me telling,

     “ sorry sir, fault from our side, Your Documents is perfect within 12-Hours we proceed “for clam. On 4th –Oct -2016 they release 15k for stating Treatment “.

     This means, A person admitted in emergency and he don’t have money, so took Apollo-Munich policy trusting they will support:” But see when Patient admitted on 28th –Sep, after so much fight Apollo accepted and said you clam accepted and you can admit patient on 4th-Oct-2016 “

     If apollo is playing for just fever & Cold clam, Can anybody Trust for something Higher in FUTURE.

     You are doing to find pin-point mistake where you can reject telling .” Sorry we cant proceed “ .

     NOTE:

     Doctors in Apollo are telling Hyperglycaemia is a Steroid . They are fake doctors, Keeping Fake Doctors Marks Cards, they joined there job, They cant do job outside as they have Fake-Marks card.

     So, on 3rd –Oct-2016, We payed Hospitalization fee of 20K approx and Discharge Patient,

     Next Day, When Heath-Minister Called, They Accepted Clam and release 15K, We said, we have Discharge Patients, Then they said, then apply for Re-Embrace,

     If Apollo-Munich Had Accepted clam on 1st or 2nd Oct, we have happy made treatment,

     Because of Apollo Health insurance, Not Accepting clam took 5+ Days to accept Clam, Before Taking Insurance, they said in 2+ hours we accept-Clam.

     Now, We needed to Ask Orginal-Documents in Hospital, Then we needed to Make courier to Apollo-Munich, Then they take 1-Month to Re-Embrace, In that also They tell for this test-we can’t do clam,

     For this Medicine, we can clam, like this they tell and 50-60% money, they will give,

     Cheaters, Never buy Apollo Munich.

     As long as they settle my money, I shall be on writing, my problems in All blogs from, Facebook, twitter to Whats up, and almost 20+ Blogs from Mouthshut.com to all.

214. Dear Sir,
     I am planning to buy Medical Insurance for me and my wife ( 29 Yrs). I was thinking of Apollo Munich because of good number of hospital coverage in Delhi. Please confirm it is true, that in Optima Restore policy the premium would change with age, whereas in Easy Health policy the premium would remain the same through out life or marginal increase. Also in long run which policy would you suggest out of both, because in future the hospital expenses would increase and opting the right policy today is very important to secure the future. Thanks in advance.

     • Dear Rishi,

       Your premium amount will change with your age in both easy health & optima restore plan.You can go with optima restore plan.

215. Dear sir,
     I have Mediclaim policy from Oriental insurance.1.5 Lac for me ,1.5 Lac for spouse ,1+1 for 2 children.
     My age is 43

     I have to plan for purchase new policy/To up around 5 Lac for my family. i had selected apolo munich Optima Family floater..is it ok or i go for others or go for to up.??

     Please guide us.

     Bhavesh

216. Hi,
     My friend recently had a kidney transplant and is looking for a health insurance policy. Pls let me know if any company can cover a transplant patient.

     Rgds

     • Hi Shweta,
       Critical illness policy covers such kind of diseases. You can check apollo munich or max bupa company for such plan.

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