Apollo Optima Senior Brochure


OptimaSENIOR

A health plan designed just for senior citizens

 

So if you are 61 or above and have often worried about your health in future. It’s time to lay those worries to rest. This wonderful plan, offers you and your spouse a life-long hassle free cover so that you can have the best healthcare during trying times, while making sure that you are not faced with any additional loadings in case you fall ill.

What makes OptimaSENIOR Unique

Lifelong renewal

Once covered you can renew the plan forever.

No claim based loading or claim based underwriting

We will never load your renewal premium or deny you coverage just because you claimed or fell ill after taking our policy.

E-opinion

We shall arrange and pay for a second opinion, on your request, from our medical panel for listed ‘Critical Illness’ suffered during the policy year.

No maximum entry age

You can enter the plan any time after the age of 61 years.

Cover up to 5 lakhs

You have an option to select a higher insurance cover up to Rs. 5 lakhs.

Cashless transactions

OptimaSENIOR enables you to get treated on a cashless basis across 4000 network hospitals across 800 cities.

No claim discount

Get a 5% non cumulative discount on the renewal premium payable under the policy after every claim free year, provided that the policy is renewed with us without a break.

Portability

If you are insured with some other company’s health insurance and you want to shift to us on renewal, you can. Our Portability Policy is customer friendly, aims to achieve the transfer of most of the accrued benefits and makes due allowances for waiting periods. 

 

 

 

 

       

 

The premium for the policy will remain the same for the policy period as mentioned in the policy schedule.Your renewal premium may change due to change in your age or applicable tax rate.

Please note that your premium at renewal may change due to a change in your age or changes in the applicable tax rate.

 

Co-Pay Options:

 

1. In case of hospitalisation a co-pay of: 

a) 15% will apply in case of accommodation in a twin sharing room or lower room type

b) 30% will apply in case of accommodation in a single room or higher room type

2. Co-payment of 30% applicable on specified illness/surgeries like Cataract (each eye), Hysterectomy, Arthoscopy etc. No additional co-pay will apply, for this condition

3. Co-payment of 15% shall be applicable to all Day Care Procedures; no additional copay’s shall apply.

 

Major Exclusions:

• All treatments within the first 30 days of cover, except any accidental injury

• Any pre-existing condition will be covered after a waiting period of 3 years.

• Expenses arising from HIV or AIDS and related diseases

• Non-allopathic treatments, congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments

• Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol

• Hospitalisation due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind

• Pregnancy, dental treatment, external aids and appliances

• 2 years waiting period for specific diseases like cataract, hernia, hysterectomy, joint replacement, hydrocele etc.

• Items of personal comfort and convenience

• Experimental, investigative and unproven treatment devices and pharmacological regimens

 

Terms of Renewal:

• We offer life-long renewal unless the Insured Person or any one acting on behalf of an Insured Person has acted in an improper, dishonest or fraudulent manner or any misrepresentation under or in relation to this policy or the policy poses a moral hazard.

• Grace Period - Grace period of 30 days for renewing the policy is provided under this policy.

• Maximum Age - There is no maximum cover ceasing age in this policy.

• Waiting Period - The waiting periods mentioned in the policy wording will get reduced by 1year on every continuous renewal of your OptimaSENIOR policy.

• Renewal premium are subject to change with prior approval from IRDA. Any change in benefits or premium (other than due to change in Age) will be done with the approval of the Insurance Regulatory and Development Authority and will be intimated atleast 3 months in advance.

In the likelihood of this policy being withdrawn in future, intimation will be sent to insured person about the same 3 months prior to expiry of the policy. Insured Person will have the option to migrate to similar indemnity health insurance policy available with us at the time of renewal with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period etc. provided the policy has been maintained without a break as per portability guidelines issued by IRDA.

• Sum Insured Enhancement - Sum insured can be enhanced only at the time of renewal subject to no claim has been lodged/paid under the policy. If the insured enhances the basic sum insured one grid up, no fresh medicals shall be required. In cases where the basic sum insured/enhanced is more than one grid up, the case shall be subject to medicals. In case of enhancement in the basic sum insured waiting period will apply afresh in relation to the amount by which the basic sum insured has been enhanced. However the quantum of enhancement shall be at our sole discretion.

• Any Insured Person in the policy has the option to migrate to similar indemnity health insurance policy available with us at the time of renewal subject to underwriting with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period etc. provided the policy has been maintained without a break as per portability guidelines issued by IRDA.

 

 



Comments
Name
Email Id
Your Comments

Did you know?
Medimanage is the only Dedicated Health Insurance Broker in India.
Medimanage has managed more than 25000 claims end-to-end.
Medimanage insures more than 2 Lakh lives every year.
Testimonials
I am very impressed with your staff specially Somen and Amit. Whenever I have approached them with a query I have always got a positive reply, infact I have recommended medimanage to many friends and colleagues
Sadik Khan


>