Apollo's Optima Restore Health Insurance - Review

We as an organization are always very excited (to an extent overwhelmed sometimes) with any new innovation in the Health Insurance Industry in India. This could be reasoned to very very rare innovations and more of cut-copy-paste or unnecessary frills, we witness in our Insurance industry in India. 

Since its launch, Apollo Munich Health Insurance Company (earlier Apollo DKV) has created quite a flurry in the market, with its innovative marketing and cost-effective health insurance products; Apollo Munich very recently, introduced a new Health Insurance product in its basket called Optima Restore, with some fresh and more importantly, meaningful benefits making this product worth your attention, time and money too.

Notable Awesome Features in Apollo Optima Restore:

The product is an indemnity based, hospitalization policy similar to its existing Health Insurance product Apollo Munich Easy Health, with great additional benefits.
2 major benefits, which make this product awesomely different from all other products in the market are:

1. Automatic Restore Benefit: Claim 1 Get another 1 Free!

   This is a super benefit. One big drawback faced, when one buys a floater plan, is the consumption of the entire sum insured for one major hospitalization, resulting in shortage of sum insured in the same year, in case of another unfortunate hospitalization, for the same or another member. The Restore Benefit aims at solving this problem.  In case of this plan, if the sum insured including bonus has been consumed in a particular year for an ailment or condition, and there is another claim from another member or from the same member, for a dissimilar condition, the entire sum insured would be restored automatically, ensuring these subsequent claims are payable. L&T Insurance's Health Insurance Product recently introduced also provides such a restoration benefit, but this is applicable only in case of accidental claims. Restore is more comprehensive, as it covers every unrelated claim.
   

   Here's an important point, contributed by one of our readers  , which brings more clarity on the Let's consider following cases with a family floater policy of 5L SA. All cases are for same policy year. AM stands for Apollo Munich.

   1) I get an illness A, cost 3L, get claim. I get an illness B, and cost is 4L. I get 2L from AM and rest 2L from my pocket. No restore, as I had not exhausted my 5L after illness A.
   

   2) I get an illness A, cost 3L, get claim. Other family member get an illness A/B, and cost is 4L. I get 2L from AM and rest 2L from my pocket. No restore, as I had not exhausted my 5L after illness A.

   Could you please tell me if my understanding is correct. If yes, it's not that outstanding, as it has been made out.
   
   Yes, the understanding is right. The restore option will trigger for the subsequent claim, only after the entire sum insured is exhausted completely.
   

   With rising healthcare inflation, it is still a good benefit, in the long term for sum insured upto Rs. 5 Lakhs. Note, such benefit would be restored only once in a year. This is explained further in detail with example in the graphic below .

1. Multiplier Benefit: 10X No Claim Bonus  

   This again is a killer feature. The medical insurance policy offers a whopping 50% No Claim Bonus (yes, you read it right: 50%) on the basic sum insured. This means, if you have an Optima Restore policy, with a sum insured of Rs. 5 Lakhs, if you don’t claim in the first year, your sum insured will grow by 50% next year to Rs. 7.5 Lakhs.  What’s more there is no loading for claims, only your bonus will reduce by 50% of basic sum insured (Read more about this below). 

Bottomline, unlike frilly "plus" benefits provided with many products, these benefits are great and immediate value to Health Insurance seekers..

Some other Good Benefits:

• No Loading on Claims: 

  There will be no additional premium charged on renewal, due to any claim in the previous year. However, if there is a Multiplier Benefit accrued, this will be deducted at 50% of the Basic Sum Insured per year of claims. So in the same example, if you go another year without claim, your sum insured will be Rs. 10 Lakhs. Say, you claim in the third year, your sum insured will be reduced by 50% of basic sum insured, which is 2.5 Lakhs to Rs. 7.50 Lakhs. In short, at any stage, there will be no loading on your premium, niether any effect on your core cover, due to a claim. 

• Pre-and Post Hospitalization of 60 and 180 Days

  Generally Mediclaim plans in India cover around 30 days of related medical expenses prior to Hospitalization (Doctor Visits, Laboratory Reports etc.) , and 60 Days of related medical expenses after discharge from the hospital (Follow up visits with Doctor, Physiotheraphy etc.). There are many treatments (including treatment for accidents) which require more than 60 days post discharge from the hospitalization, such expenses were earlier not paid by Health Insurance products in India. The Optima Restore product provides an extended benefit of covering 60 days pre and 180 days post hospitalization, and hence could be beneficial for treatments which require more time to heal/cure.  

• Parents Coverage:

  Yes, this product can be bought for parents too. In fact, you can include one of your parents in a floater too, provided there are only 2 Adults you want to cover. Ofcourse, the product requires a medical test to be carried out for underwriting, and goes without saying, that if there is an ailment, it could result in additional premium loading, waiting periods or even a denial for coverage, as per their underwriting guidelines. 

  A word of caution here, experiencing Apollo Munich's underwriting earlier, note that, if your parent has Diabetes, High Cholesterol, History of a Critical Illness, or any major organ related disease, there are almost no chances of getting through a cover in this policy.  

Price Point:

Since, the product has a restoration benefit and a 50% No claim cumulative bonus, this product is not strictly comparable with other products in the market. The comparison created below is to just give you an idea of the price point, at which the product is available.

Here's a simple comparison for a family, Husband 30 years, Wife 29 years, Kid 2 years for a Rs. 3 Lakh Cover.

Looking at the above premium chart, the price of Apollo Munich Optima Restore, at the median of expensive and cheap mediclaim policies, with the 2 bonus features is very attractive. 

Option of Migration from Apollo Easy Health:

Yes, many of you who already have Apollo’s Health Insurance plan, Easy Health – can be ported to this new plan, provided there are no claims. Depending on the sum insured and the age of the members, there could be requirement of a Medical Test.

Final Take

All in all, at this price point, Apollo Optima Restore Health Insurance is an excellent product if you can afford the premium. Recommended Buy!

Does this product suit you? Know More:

In case you want to speak to a health insurance expert, and understand whether this product suits you, request you to post an inquiry here. You can also call us on Toll Free : 18001028666