Optima Restore

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

Apollo Munich Health Insurance Company Limited will provide the insurance cover

detailed in the Policy to the Insured Person up to the Sum Insured subject to the

terms and conditions of this Policy, Your payment of premium, and Your statements

in the Proposal, which is incorporated into the Policy and is the basis of it.

Section 1. Basic Beneﬁts

Claims made in respect of any of the beneﬁts below will be subject to the Basic

Sum Insured and will affect entitlement to Multiplier beneﬁt.

If any Insured Person suffers an Illness or Accident during the Policy Period that

requires that Insured Person’s Hospitalisation as an in-patient, then We will pay:

a) In-patient Treatment

The Medical Expenses for:

i. Room rent, boarding expenses,

ii. Nursing,

iii. Intensive care unit,

iv. Medical Practitioner(s),

v. Anaesthesia, blood, oxygen, operation theatre charges, surgical

appliances,

vi. Medicines, drugs and consumables,

vii. Diagnostic procedures,

viii. The Cost of prosthetic and other devices or equipment if implanted

internally during a Surgical Procedure.

b) Pre-Hospitalisation

The Medical Expenses incurred in the 60 days immediately before the

Insured Person was Hospitalised, provided that:

i. Such Medical Expenses were in fact incurred for the same condition

for which the Insured Person’s subsequent Hospitalisation was

required, and

ii. We have accepted an in-patient Hospitalisation claim under Beneﬁt 1a).

c) Post-Hospitalisation

The Medical Expenses incurred in the 180 days immediately after the

Insured Person was discharged post Hospitalisation provided that:

i. Such costs are incurred in respect of the same condition for which the

Insured Person’s earlier Hospitalisation was required, and

ii. We have accepted an in-patient Hospitalisation claim under Beneﬁt 1a).

d) Day Care Procedures

The Medical Expenses for a day care procedure mentioned in the list of Day

Care Procedures in this Policy where the procedure or surgery is taken by

the Insured Person as an in-patient for less than 24 hours in a Hospital or

standalone day care centre but not the out-patient department of a Hospital

or standalone day care centre.

e) Domiciliary Treatment

The Medical Expenses incurred by an Insured Person for medical treatment

taken at his home which would otherwise have required Hospitalisation

because, on the advice of the attending Medical Practitioner, the Insured

Person could not be transferred to a Hospital or a Hospital bed was

unavailable, and provided that:

i. The condition for which the medical treatment is required continues

for at least 3 days, in which case We will pay the reasonable charge of

any necessary medical treatment for the entire period, and

ii. If We accept a claim under this Beneﬁt We will not make any

payment for Post-Hospitalisation expenses but We will pay for Pre-

Hospitalisation expenses up to 60 days in accordance with b) above,

and

iii. No payment will be made if the condition for which the Insured Person

requires medical treatment is:

1) Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract

infection including Laryngitis and Pharyngitis, Cough and Cold,

Inﬂuenza,

2) Arthritis, Gout and Rheumatism,

3) Chronic Nephritis and Nephritic Syndrome,

4) Diarrhoea and all type of Dysenteries including Gastroenteritis,

5) Diabetes Mellitus and Insipidus,

6) Epilepsy,

7) Hypertension,

8) Psychiatric or Psychosomatic Disorders of all kinds,

9) Pyrexia of unknown Origin.

f) Organ Donor

The Medical Expenses for an organ donor’s treatment for the harvesting of

the organ donated, provided that:

i. The organ donor is any person whose organ has been made available

in accordance and in compliance with the Transplantation of Human

Organs Act 1994 and the organ donated is for the use of the Insured

Person, and

ii. We will not pay the donor’s pre- and post-Hospitalisation expenses

or any other medical treatment for the donor consequent on the

harvesting, and

iii. We have accepted an in-patient Hospitalisation claim under Beneﬁt 1a).

g) Emergency Ambulance

We will reimburse the expenses incurred on an ambulance offered by a

healthcare or ambulance service provider used to transfer the Insured

Person to the nearest Hospital with adequate emergency facilities for the

provision of health services following an Emergency, provided that:

i. Our maximum liability will be restricted to the amount mentioned in

the Schedule of Beneﬁts, and

ii. We have accepted an in-patient Hospitalisation claim under Beneﬁt 1a).

iii. The coverage includes the cost of the transportation of the Insured

Person from a Hospital to the nearest Hospital which is prepared to

admit the Insured Person and provide the necessary medical services

if such medical services cannot satisfactorily be provided at a Hospital

where the Insured Person is situated, provided that transportation has

been prescribed by a Medical Practitioner and is medically necessary.

Section 2. Restore Beneﬁt

If the Basic Sum Insured and multiplier beneﬁt (if any) is exhausted due to

claims made and paid during the Policy Year or made during the Policy Year

and accepted as payable, then it is agreed that a Restore Sum Insured (equal to

100% of the Basic Sum Insured) will be automatically available for the particular

policy year, provided that:

a) The Restore Sum Insured will be enforceable only after the Basic Sum

Insured inclusive of the Multiplier Bonus under Section 3 have been

completely exhausted in that year; and

b) The Restore Sum Insured can be used for claims made by the Insured

Person in respect of the beneﬁts stated in Section 1;

c) The Restore Sum Insured can be used for only future claims made by

the Insured Person and not against any claim for an illness/disease

(including its complications) for which a claim has been paid in the

current policy year under Section 1;

d) No Multiplier Bonus under Section 3 will apply to the Restore Sum

Insured;

e) The Restore Sum Insured will only be applied once for the Insured

Person during a Policy Year;

f) If the Restore Sum Insured is not utilised in a Policy Year, it shall not be

carried forward to any subsequent Policy Year.

If the Policy is a Family Floater, then the Restore Sum Insured will only be

available in respect of claims made by those Insured Persons who were Insured

Persons under the Policy before the Sum Insured was exhausted.

Section 3. Multiplier Beneﬁt

a) If no claim has been made in respect of Section 1 under this Policy

and the Policy is renewed with Us without any break, We will apply a

bonus to the next Policy Year by automatically increasing the Basic

Sum Insured for the next Policy Year by 50% of the Basic Sum Insured

for this Policy Year. The maximum bonus will not exceed 100% of the

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

Basic Sum Insured in any Policy Year.

b) In relation to a Family Floater, the bonus so applied will only be

available in respect of claims made by those Insured Persons who

were Insured Persons in the claim free Policy Year and continue to be

Insured Persons in the subsequent Policy Year.

c) If a bonus has been applied and a claim is made, then in the

subsequent Policy Year We will automatically decrease the multiplier

bonus by 50% of the Basic Sum Insured in the following Policy Year.

However this reduction will not reduce the Sum Insured below the

basic Sum Insured of the policy.

d) Portability beneﬁt will be offered to the extent of sum of previous sum

insured and accrued cumulative bonus, portability beneﬁt shall not

apply to any other additional increased Sum Insured.

Section 4. Exclusions

Waiting Periods

a) We are not liable for any treatment which begins during waiting periods

except if any Insured Person suffers an Accident.

30 days Waiting Period

b) A waiting period of 30 days (or longer if speciﬁed in any beneﬁt) will apply

to all claims unless:

i. The Insured Person has been insured under an Optima Restore Policy

continuously and without any break in the previous Policy Year, or

ii. The Insured Person was insured continuously and without interruption

for at least 1 year under any Indian insurer’s individual health

insurance policy for the reimbursement of medical costs for in-patient

treatment in a Hospital, and We have issued an endorsement for the

same.

iii. If the Insured person renews with Us or transfers from any other

insurer and increases the Sum Insured (other than as a result of the

application of Beneﬁt 3a) upon renewal with Us), then this exclusion

will only apply in relation to the amount by which the Sum Insured has

been increased.

Speciﬁc Waiting Periods

c) The Illnesses and treatments listed below will be covered subject to a

waiting period of 2 years as long as in the third Policy Year the Insured

Person has been insured under an Optima Restore Policy continuously and

without any break:

Organ / Organ

System

Illness Treatment

ENT • Any Benign ear, nose

and throat (ENT)

disorder

Example: Sinusitis,

Rhinitis etc

• All ear, nose and throat

(ENT) surgery

Example:

Adenoidectomy,

Mastoidectomy,

Tonsillectomy,

Tympanoplasty,

Septoplasty, Functional

endoscopic sinus

surgery (FESS)

Gynaecological • Internal tumors,

cysts, nodules, polyps

including breast lumps

(each of any kind

unless malignant)

• Polycystic ovarian

diseases

• Dilatation and

curettage (D&C)

• Hysterectomy for

menorrhagia or

ﬁbromyoma or

prolapse of uterus

unless necessitated by

malignancy

• Myomectomy for

ﬁbroids

Orthopaedic • Non infective arthritis

• Gout and Rheumatism

• Age related

Osteoporosis

• Joint replacement

• Surgery for prolapsed

inter vertebral disk

Organ / Organ

System

Illness Treatment

Gastrointestinal • Calculus diseases of

gall bladder

• Fissure/ﬁstula in anus,

hemorrhoids, pilonidal

sinus

• Gastric and duodenal

ulcers

• All forms of cirrhosis

• Surgery of gallbladder

and bile duct unless

necessitated by

malignancy

• Surgery of hernia

Urogenital • Calculus diseases of

Urogenital system

Example: Kidney stone,

Urinary Bladder stone

etc.

• Any surgery of

Urogenital system

unless necessitated by

malignancy

• Surgery on prostate

• Surgery for Hydrocele

Others • Cataract

• Internal tumors, cysts,

nodules, polyps, skin

tumors (each of any

kind unless malignant)

• Surgery of varicose

veins and varicose

ulcers

i. However, a waiting period of 2 years will not apply if the Insured

Person was insured continuously and without interruption for at least

2 years under any Indian insurer’s individual health insurance policy

for the reimbursement of medical costs for in-patient treatment in a

Hospital, and We have issued an endorsement for the same.

ii. If the Insured person renews with Us or transfers from any other

insurer and increases the Sum Insured (other than as a result of the

application of Beneﬁt 3a) upon renewal with Us), then this exclusion

will only apply in relation to the amount by which the Sum Insured has

been increased.

d) Pre-existing Conditions will not be covered until 36 months of continuous

coverage have elapsed, since inception of the ﬁrst Optima Restore policy

with us, but

1) If the Insured Person is presently covered and has been continuously

covered without any lapses under:

i) an individual health insurance plan with an Indian insurer for the

reimbursement of medical costs for inpatient treatment in a Hospital ,

ii) any other similar health insurance plan from Us,

then Section 4 d) of the Policy stands deleted and shall be replaced entirely with

the following:

i) The waiting period for all Pre-existing Conditions shall be reduced by

the number of continuous preceding years of coverage of the Insured

Person under the previous health insurance policy.

ii) If the proposed Sum Insured for a proposed Insured Person is more

than the Sum Insured applicable under the previous health insurance

policy (other than as a result of the application of Beneﬁt 3a), then

the reduced waiting period shall only apply to the extent of the Sum

Insured under the previous health insurance policy.

2) The reduction in the waiting period speciﬁed above shall be applied subject

to the following:

i) We will only apply the reduction of the waiting period if We have

received the database and claim history from the previous Indian

insurance company (if applicable)

ii) We are under no obligation to insure all Insured Persons or to insure

all Insured Persons on the proposed terms, or on the same terms as

the previous health insurance policy even if You have submitted to Us

all documentation

We shall consider only completed years of coverage for waiver of waiting

periods. Policy Extensions if any sought during or for the purpose of porting

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

insurance policy shall not be considered for waiting period waiver.

e) We will not make any payment for any claim in respect of any Insured Person

directly or indirectly for, caused by, arising from or in any way attributable to

any of the following unless expressly stated to the contrary in this Policy:

i. War or any act of war, invasion, act of foreign enemy, war like

operations (whether war be declared or not or caused during service

in the armed forces of any country), civil war, public defence, rebellion,

revolution, insurrection, military or usurped acts, nuclear weapons/

materials, chemical and biological weapons, radiation of any kind.

ii. Any Insured Person committing or attempting to commit a breach of

law with criminal intent, or intentional self injury or attempted suicide

while sane or insane.

iii. Any Insured Person’s participation or involvement in naval, military or

air force operation, racing, diving, aviation, scuba diving, parachuting,

hang-gliding, rock or mountain climbing.

iv. The abuse or the consequences of the abuse of intoxicants or

hallucinogenic substances such as intoxicating drugs and alcohol,

including smoking cessation programs and the treatment of nicotine

addiction or any other substance abuse treatment or services, or

supplies.

v. Sleep-apnoea, Treatment of Obesity and any weight control program.

vi. Psychiatric, mental disorders (including mental health treatments),

Parkinson and Alzheimer’s disease, congenital internal or external

diseases, defects or anomalies, genetic disorders, stem cell

implantation or surgery, or growth hormone therapy.

vii. Venereal disease, sexually transmitted disease or illness, “AIDS”

(Acquired Immune Deﬁciency Syndrome) and/or infection with HIV

(Human immunodeﬁciency virus) including but not limited to conditions

related to or arising out of HIV/AIDS such as ARC (AIDS related

complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.

viii. Pregnancy (including voluntary termination), miscarriage (except as a

result of an Accident or Illness), maternity or birth (including caesarean

section) except in the case of ectopic pregnancy in relation to 1a) only.

ix. Sterility, treatment whether to effect or to treat infertility, any fertility,

sub-fertility or assisted conception procedure, surrogate or vicarious

pregnancy, birth control, contraceptive supplies or services including

complications arising due to supplying services.

x. Dental treatment and surgery of any kind, unless requiring

Hospitalisation.

xi. Expenses for donor screening, or, save as and to the extent provided

for in 1f), the treatment of the donor (including surgery to remove

organs from a donor in the case of transplant surgery).

xii. Treatment and supplies for analysis and adjustments of spinal

subluxation, diagnosis and treatment by manipulation of the skeletal

structure, muscle stimulation by any means except for treatment

of fractures (excluding hairline fractures) and dislocations of the

mandible and extremities.

xiii. Treatment of nasal concha resection, circumcisions (unless

necessitated by illness or injury and forming part of treatment),

treatment for correction of refractive error, aesthetic or change-of-life

treatments of any description such as sex transformation operations,

treatments to do or undo changes in appearance or carried out in

childhood or at any other times driven by cultural habits, fashion or

the like or any procedures which improve physical appearance.

xiv. Plastic surgery or cosmetic surgery unless necessary as a part of

medically necessary treatment certiﬁed by the attending Medical

Practitioner for reconstruction following an Accident, Cancer or Burns.

xv. Experimental, investigational or unproven treatment, devices and

pharmacological regimens, Medical Expenses relating to any

hospitalisation primarily and speciﬁcally for diagnostic, X-ray or

laboratory examinations and investigations.

xvi. Convalescence, cure, rest cure, sanatorium treatment, rehabilitation

measures, private duty nursing, respite care, long-term nursing care or

custodial care, general debility or exhaustion (“run-down condition”)

xvii. Any non allopathic treatment.

xviii. All preventive care, vaccination including inoculation and

immunisations (except in case of post-bite treatment), any physical,

psychiatric or psychological examinations or testing, enteral feedings

(infusion formulae via a tube into the upper gastrointestinal tract) and

other nutritional and electrolyte supplements, unless certiﬁed to be

required by the attending Medical Practitioner as a direct consequence

of an otherwise covered claim.

xix. Charges related to a Hospital stay not expressly mentioned as being

covered, including but not limited to charges for admission, discharge,

administration, registration, documentation and ﬁling.

xx. Items of personal comfort and convenience including but not limited

to television (wherever speciﬁcally charged for), charges for access to

telephone and telephone calls, internet, foodstuffs (except patient’s

diet), cosmetics, hygiene articles, body care products and bath

additive, barber or beauty service, guest service as well as similar

incidental services and supplies, and vitamins and tonics unless

vitamins and tonics are certiﬁed to be required by the attending

Medical Practitioner as a direct consequence of an otherwise covered

claim.

xxi. Treatment rendered by a Medical Practitioner which is outside

his discipline or the discipline for which he is licensed, treatments

rendered by a Medical Practitioner who shares the same residence

as an Insured Person or who is a member of an Insured Person’s

family, however proven material costs are eligible for reimbursement

in accordance with the applicable cover.

xxii. The provision or ﬁtting of hearing aids, spectacles or contact lenses

including optometric therapy, any treatment and associated expenses

for alopecia, baldness, wigs, or toupees, medical supplies including

elastic stockings, diabetic test strips, and similar products.

xxiii. Any treatment or part of a treatment that is not of a reasonable charge,

not medically necessary, drugs or treatments which are not supported

by a prescription.

xxiv. Artiﬁcial limbs, crutches or any other external appliance and/or device

used for diagnosis or treatment (except when used intra-operatively).

xxv. Any exclusion mentioned in the Schedule or the breach of any speciﬁc

condition mentioned in the Schedule.

Section 5. General Condition

Condition precedent

a) The fulﬁlment of the terms and conditions of this Policy (including the

payment of premium by the due dates mentioned in the Schedule) in so far

as they relate to anything to be done or complied with by You or any Insured

Person will be conditions precedent to Our liability.

Insured Person

b) Only those persons named as an Insured Person in the Schedule will be

covered under this Policy. Any person may be added during the Policy Period

after his application has been accepted by Us, additional premium has been

paid and We have issued an endorsement conﬁrming the addition of such

person as an Insured Person.

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).

We will inform You about the applicable risk loading through a counter offer

letter. You need to revert to Us with consent and additional premium (if any),

within 15 days of the issuance of such counter offer letter. In case, You

neither accept the counter offer nor revert to Us within 15 days, We will

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

cancel Your application and refund the premium paid within next 7 days.

Please note that We will issue Policy only after getting Your consent.

c) Notiﬁcation of Claim

Treatment, Consultation or

Procedure:

We or Our TPA must be notiﬁed :

1. If any treatment for which

a claim may be made is to

be taken and that treatment

requires Hospitalisation:

Immediately and in any event

at least 48 hours prior to the

Insured Person’s admission.

2. If any treatment for which

a claim may be made is to

be taken and that treatment

requires Hospitalisation in an

Emergency:

Within 24 hours of the Insured

Person’s admission to Hospital.

Please note that if any time period is speciﬁcally mentioned in Section 1-4, then

this will supersede the time periods mentioned above.

Cashless Service:

Treatment,

Consultation

Procedure:

Treatment,

Consultation

or Procedure

Taken at:

Cashless

Service is

Available:

We must be given

notice that the

Insured Person

wishes to take

advantage of the

cashless service

accompanied by full

particulars:

I. If any

planned

treatment,

consultation

or procedure

for which a

claim may

be made:

Network

Hospital

We will provide

cashless

service by

making

payment to the

extent of Our

liability directly

to the Network

Hospital.

At least 48 hours

before the planned

treatment or

Hospitalisation.

2. If any

treatment,

consultation

or procedure

for which

a claim

may be

made to be

taken in an

Emergency:

Network

Hospital

We will provide

cashless

service by

making

payment to the

extent of Our

liability directly

to the Network

Hospital.

Within 24 hours

after the treatment

or Hospitalisation.

Supporting Documentation & Examination

d) The Insured Person or someone claiming on Your behalf will provide Us with

any documentation, medical records and information We or Our TPA may

request to establish the circumstances of the claim, its quantum or Our

liability for the claim within 15 days of the earlier of Our request or the

Insured Person’s discharge from Hospitalisation or completion of treatment.

The Company may accept claims where documents have been provided

after a delayed interval only in special circumstances and for the reasons

beyond the control of the insured.Such documentation will include but is not

limited to the following:

i. Our claim form, duly completed and signed for on behalf of the Insured

Person.

ii. Original Bills (including but not limited to pharmacy purchase bill,

consultation bill, diagnostic bill) and any attachments thereto like

receipts or prescriptions in support of any amount claimed which will

then become Our property.

iii. All reports, including but not limited to all medical reports, case histories,

investigation reports, treatment papers, discharge summaries.

iv. A precise diagnosis of the treatment for which a claim is made.

v. A detailed list of the individual medical services and treatments provided

and a unit price for each.

vi. Prescriptions that name the Insured Person and in the case of drugs: the

drugs prescribed, their price and a receipt for payment. Prescriptions

must be submitted with the corresponding Doctor’s invoice.

e) The Insured Person will have to undergo medical examination by Our

authorised Medical Practitioner, as and when We may reasonably require,

to obtain an independent opinion for the purpose of processing any claim.

We will bear the cost towards performing such medical examination (at the

speciﬁed location) of the Insured Person.

Claims Payment

f) We will be under no obligation to make any payment under this Policy unless

We have received all premium payments in full in time and all payments

have been realised and We have been provided with the documentation and

information We or Our TPA has requested to establish the circumstances of

the claim, its quantum or Our liability for it, and unless the Insured Person

has complied with his obligations under this Policy.

g) We will only make payment to or at Your direction. If an Insured Person

submits the requisite claim documents and information along with a

declaration in a format acceptable to Us of having incurred the expenses,

this person will be deemed to be authorised by You to receive the concerned

payment. In the event of the death of You or an Insured Person, We will

make payment to the Nominee (as named in the Schedule).

h) Cashless service: If any treatment, consultation or procedure for which a

claim may be made is to be taken at a Network Hospital, then We will provide

a cashless service by making payment to the extent of Our liability direct

to the Network Hospital as long as We are given notice that the Insured

Person wishes to take advantage of a cashless service accompanied by full

particulars at least 48 hours before any planned treatment or Hospitalisation

or within 24 hours after the treatment or Hospitalisation in the case of an

emergency.

i) This Policy only covers medical treatment taken within India, and payments

under this Policy will only be made in Indian Rupees within India.

j) We are not obliged to make payment for any claim or that part of any claim

that could have been avoided or reduced if the Insured Person had taken

reasonable care, or that is brought about or contributed to by the Insured

Person failing to follow the directions, advice or guidance provided by a

Medical Practitioner.

Fraud

k) If any claim is in any manner dishonest or fraudulent, or is supported by any

dishonest or fraudulent means or devices, whether by You or any Insured

Person or anyone acting on behalf of You or an Insured Person, then this

Policy will be void and all beneﬁts paid under it will be forfeited.

Other Insurance

l) If at the time when any claim arises under this Policy, there is in existence

any other Policy effected by any Insured Person or on behalf of any Insured

Person which covers any claim in whole or in part made under this Policy

(or which would cover any claim made under this Policy if this Policy did not

exist) then We will not be liable to pay or contribute more than Our rateable

proportion of the claim. If the other insurance is a Cancer Insurance Policy

issued in collaboration with Indian Cancer Society then Our liability under

this Policy will be in excess of such Cancer Insurance Policy. This Clause is

only applicable to indemnity sections.

Subrogation

m) You and/or any Insured Persons will do or concur in doing or permit to be

done all such acts and things that may be necessary or reasonably required

by Us for the purpose of enforcing and/or securing any civil or criminal

rights and remedies or obtaining relief or indemnity from any other party

to which We are or would become entitled upon Us making reimbursement

under this Policy, whether such acts or things will be or become necessary

or required before or after Our payment. Neither You nor any Insured Person

will prejudice these subrogation rights in any manner and will provide Us

with whatever assistance or cooperation is required to enforce such rights.

Any recovery We make pursuant to this clause will ﬁrst be applied to the

amounts paid or payable by Us under this Policy and Our costs and expenses

of effecting a recovery, whereafter We will pay any balance remaining to

You. This Clause is only applicable to indemnity sections.

Alterations to the Policy

n) This Policy constitutes the complete contract of insurance. This Policy

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

cannot be changed or varied by anyone (including an insurance agent or

broker) except Us, and any change We make will be evidenced by a written

endorsement signed and stamped by Us.

Renewal

o) All applications for renewal must be received by Us before the end of the

Policy Period. If the application for renewal and the renewal premium has

been received by Us before the expiry of the Policy Period We will ordinarily

offer renewal terms unless We believe that You or any Insured Person or

anyone acting on Your behalf or 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 renewal of the Policy poses a moral

hazard. Grace Period of 30 days for renewing the policy is provided under

this Policy. Any disease/ condition contracted in the break in period will not

be covered and will be treated as Pre-existing condition.

p) We may vary the renewal premium payable with prior approval of the IRDA.

Change of Policyholder

q) The change of Policyholder (except clause v) is permitted only at the time

of renewal. If You do not renew the Policy, the other Insured Persons may

apply to renew the Policy subject to condition o) above. However, in case the

Insured Person is minor, the Policy will be renewed only through any one of

his/her natural guardian or guardian appointed by Court subject to condition

o) above.

Notices

r) Any notice, direction or instruction under this Policy will be in writing and if

it is to:

i. Any Insured Person, then it will be sent to You at Your address speciﬁed

in the Schedule and You will act for all Insured Persons for these

purposes.

ii. Us, it will be delivered to Our address speciﬁed in the Schedule. No

insurance agents, brokers or other person or entity is authorised to

receive any notice, direction or instruction on Our behalf unless We

have expressly stated to the contrary in writing.

Dispute Resolution Clause

s) Any and all disputes or differences under or in relation to this Policy will be

determined by the Indian Courts and subject to Indian law.

Termination

t) You may terminate this Policy at any time by giving Us written notice, and

the Policy will terminate when such written notice is received. If no claim

has been made under the Policy, then We will refund premium in accordance

with the table below:

1 Year Policy 2 Year Policy

Length of time

Policy in force

Refund of

premium

Length of time Policy

in force

Refund of

premium

Upto 1 Month 75.00% Upto 1 Month 87.50%

Upto 3 Months 50.00% Upto 3 Months 75.00%

Upto 6 Months 25.00% Upto 6 Months 62.50%

Exceeding 6

Months

Nil Upto 12 Months 50.00%

Upto 15 Months 37.50%

Upto 18 Months 25.00%

Exceeding 18 Months Nil

u) We may at any time terminate this Policy on grounds of misrepresentation,

fraud, non-disclosure of material facts or non-cooperation by You or any

Insured Person or anyone acting on Your behalf or on behalf of an Insured

Person upon 30 days notice by sending an endorsement to Your address

shown in the Schedule without refund of premium.

v) The coverage for the Insured Person will automatically terminate if:

i. You no longer reside in India, or in the case of Your demise. However

the cover will continue for the remaining Insured Persons till the

end of Policy period. The other Insured Persons may also apply to

renew the Policy subject to condition o) above. In case, the Insured

Person is minor, the Policy will be renewed only through any one of

his/her natural guardian or guardian appointed by Court. All relevant

particulars in respect of such person (including his/her relationship

with You) must be given to Us along with the Application.

ii. In relation to an Insured Person, if that Insured Person dies or no

longer resides in India.

Free Look Period

w) You have a period of 15 days from the date of receipt of the Policy document

to review the terms and conditions of this Policy. If You have any objections

to any of the terms and conditions, You have the option of cancelling the

Policy stating the reasons for cancellation and You will be refunded the

premium paid by You after adjusting the amounts spent on any medical

check-up, stamp duty charges and proportionate risk premium. You can

cancel Your Policy only if You have not made any claims under the Policy.

All Your rights under this Policy will immediately stand extinguished on the

free look cancellation of the Policy. Free look provision is not applicable and

available at the time of renewal of the Policy.

Section. 6 Interpretations & Deﬁnitions

The terms deﬁned below have the meanings ascribed to them wherever

they appear in this Policy and, where appropriate, references to the singular

include references to the plural, references to the male include the female and

references to any statutory enactment include subsequent changes to the same:

Def. 1. Accident or Accidental means a sudden, unforeseen and

involuntary event caused by external and visible means (but does

not include any Illness) which results in physical bodily injury.

Def. 2. Age or Aged means completed years as at the Commencement

Date.

Def. 3. Commencement Date means the commencement date of this

Policy as speciﬁed in the Schedule.

Def. 4. Day care treatment means enlisted medical treatment, and/or

surgical procedure which is undertaken under General or Local

Anaesthesia in a Hospital/day care centre in less than 24 hrs

because of technological advancement, and which would have

otherwise required a Hospitalization of more than 24 hours, but

treatment normally taken on an Out-patient basis is not included in

the scope of this deﬁnition.

Def. 5. Dependents means only the family members listed below:

i) Your legally married spouse as long as she continues to be married

to You.

ii) Your children Aged between 91 days and 21 years if they are

unmarried

iii) Your natural parents or parents that have legally adopted You,

provided that:

a) The parent was below 65 years at his initial participation in the

Optima Restore Policy, and

b) Parents will not include Your spouse’s parents.

Def. 6. Dependent Child means a child (natural or legally adopted),

who is ﬁnancially dependent on You and does not have his / her

independent sources of income.

Def. 7. Domiciliary Hospitalisation means medical treatment for a

period exceeding 3 days, for an Illness/disease/injury which in the

normal course would require care and treatment at a Hospital but

is actually taken while conﬁned at home under any of the following

circumstances:

• the condition of the Insured Person is such that he is not in a

condition to be removed to a Hospital or,

• the Insured Person takes treatment at home on account of non

availability of room in a Hospital.

Def. 8. Emergency or Emergency Care means management for a severe

Illness or injury which results in symptoms which occur suddenly

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

and unexpectedly, and requires immediate care by a Medical

Practitioner to prevent death or serious long term impairment of

the Insured Person’s health.

Def. 9. Family Floater means a Policy described as such in the Schedule

whereunder You and Your Dependents named in the Schedule are

insured under this Policy as at the Commencement Date. The Sum

Insured for a Family Floater means the sum shown in the Schedule

which represents Our maximum liability for any and all claims

made by You and/or all of Your Dependents during the Policy Period.

Def. 10. Grace Period means the speciﬁed period of time immediately

following the premium due date during which a payment can

be made to renew or continue a policy in force without loss of

continuity beneﬁts such as waiting periods and coverage of pre-

existing diseases. Coverage is not available for the period for which

no premium is received.

Def. 11. Hospital means any institution in India established for In-patient

care and day care treatment of sickness and/or injuries and

which has been registered as a Hospital with the local authorities,

wherever applicable, and is under the supervision of a registered

and qualiﬁed Medical Practitioner AND must comply with all

minimum criteria as under:

• has at least 10 in-patient beds, in those towns having a population

of less than 10,00,000 and 15 inpatient beds in all other places,

• has qualiﬁed nursing staff under its employment round the clock,

• has qualiﬁed Medical Practitioner(s) in charge round the clock,

• has a fully equipped operation theatre of its own where surgical

procedures are carried out,

• maintains daily records of patients and will make these accessible

to the insurance company’s authorized personnel.

Def. 12. Hospitalisation or Hospitalised means the Insured Person’s

admission into a Hospital for Medically necessary Treatment as an

in-patient for a continuous period of at least 24 hours following an

Illness or Accident occurring during the Policy Period.

Def. 13. Illness means a sickness (a condition or an ailment affecting

the general soundness and health of the Insured Person’s body)

or a disease (afﬂiction of the bodily organs having a deﬁned and

recognised pattern of symptoms) or pathological condition leading

to the impairment of normal physiological function which manifests

itself during the Policy Period and requires medical Treatment. For

the avoidance of doubt, Illness does not mean and this Policy does

not cover any mental Illness or sickness or disease (including but

not limited to a psychiatric condition, disorganisation of personality

or mind, or emotions or behaviour) even if caused by or aggravated

by or related to an Accident or Illness.

Def. 14. In-patient Care means treatment for which the Insured Person

has to stay in a Hospital for more than 24 hours for a covered event.

Def. 15. Insured Person means You and the persons named in the

Schedule.

Def. 16. Intensive Care Unit means an identiﬁed section, ward or wing of

a Hospital which is under the constant supervision of a dedicated

Medical Practitioner(s), and which is specially equipped for the

continuous monitoring and treatment of patients who are in a

critical condition, or require life support facilities and where the

level of care and supervision is considerably more sophisticated

and intensive than in the ordinary and other wards.

Def. 17. Medical Expenses means those reasonable and medically

necessary expenses that an Insured Person has necessarily and

actually incurred for medical treatment during the Policy Period

on the advice of a Medical Practitioner due to Illness or Accident

occurring during the Policy Period, as long as these are no more

than would have been payable if the Insured Person had not been

insured and no more than other Hospitals or doctors in the same

locality would have charged for the same medical treatment.

Def. 18. Medically Necessary means any treatment, test, medication, or

stay in Hospital or part of stay in Hospital which

• Is required for the medical management of the Illness or injury

suffered by the Insured Person.

• Must not exceed the level of care necessary to provide safe,

adequate and appropriate medical care in scope, duration or

intensity.

• Must have been prescribed by a Medical Practitioner.

• Must conform to the professional standards widely accepted in

international medical practice or by the medical community in

India.

Def. 19. Medical Practitioner means a person who holds a valid

registration from the medical council of any state of India and is

thereby entitled to practice medicine within its jurisdiction, and is

acting within the scope and jurisdiction of his license.

Def. 20. Network means any such hospitals, day care centre or other

provider that We/ TPA have mutually agreed with, to provide

services like cashless access to Policyholders. The list is available

with Us/ TPA and subject to amendment from time to time.

Def. 21. Non Network means any Hospital, day care centre or other

provider that is not part of the network.

Def. 22. Out-patient Treatment means consultation, diagnosis or medical

treatment taken by any Insured Person at an out-patient department

of a Hospital, clinic or associated facility, provided that he is not

Hospitalised.

Def. 23. Policy means Your statements in the proposal form, this policy

wording (including endorsements, if any), Appendix 1 and the

Schedule (as the same may be amended from time to time).

Def. 24. Policy Period means the period between the Commencement

Date and the Expiry Date speciﬁed in the Schedule.

Def. 25. Policy Year means a year following the Commencement Date and

its subsequent annual anniversary.

Def. 26. Pre-existing Condition means any condition, ailment or injury

or related condition(s) for which Insured Person had signs or

symptoms, and / or were diagnosed, and / or received medical

advice/ treatment, within 36 months prior to the commencement of

his ﬁrst being covered under an Optima Restore Policy issued by Us.

Def. 27. Qualiﬁed Nurse is a person who holds a valid registration from the

nursing council of India or the nursing council of any state in India.

Def. 28. Reasonable charges means the charges for services or supplies,

which are the standard charges for a speciﬁc provider and

consistent with the prevailing charges in the geographical area for

identical or similar services by comparable providers, taking into

account the nature of illness/ injury involved.

Def. 29. Shared Accommodation means a Hospital room with two or

more patient beds.

Def. 30. Sum Insured means the sum shown in the Schedule which represents

Our maximum liability for each Insured Person for any and all beneﬁts

claimed for during the Policy Period, and in relation to a Family Floater

represents Our maximum liability for any and all claims made by You

and all of Your Dependents during the Policy Period.

Def. 31. Surgery or Surgical Procedure means manual and/or operative

procedure(s) required for treatment of an Illness or injury, correction

of deformities and defects, diagnosis and cure of diseases, relief of

suffering or prolongation of life, performed in a Hospital or day care

centre by a Medical Practitioner.

Def. 32. TPA means the third party administrator that We appoint from time

to time as speciﬁed in the Schedule.

Def. 33. We/Our/Us means the Apollo Munich Health Insurance Company

Limited.

Def. 34. You/Your/Policyholder means the person named in the Schedule

who has concluded this Policy with Us.

Section. 7 Claim Related Information

For any claim related query, intimation of claim and submission of claim related

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

documents, You can contact Your TPA through:

· Website : www.fhpl.net

· Email : [email protected]

· Toll Free : 1800 - 425 - 4080

· Fax : +91-40-23541400

· Courier : Claims Department,

Family Health Plan Ltd,

Srinilaya - Cyber Spazio,

Suite No. 101, 102, 109 & 110,

Ground Floor,

Road No. 2, Banjara Hills,

Hyderabad-500034

Section. 8 Grievance Redressal Procedure

If you have a grievance that you wish us to redress, you may contact us with the

details of Your grievance through:

· Our website : www.apollomunichinsurance.com

· Email : [email protected]

· Toll Free : 1800-102-0333

· Fax : +91-124-4584111

· Courier : Any of Our Branch ofﬁce or corporate ofﬁce

You may also approach the grievance cell at any of Our branches with the details

of Your grievance during Our working hours from Monday to Friday.

If You are not satisﬁed with Our redressal of Your grievance through one

of the above methods, You may contact Our Head of Customer Service at

The Grievance Cell, Apollo Munich Health Insurance Company Ltd.,

10th Floor, Building No. 10, Tower-B, DLF Cyber City, DLF City Phase

II,Gurgaon, Haryana-122002

If You are not satisﬁed with Our redressal of Your grievance through one of

the above methods, You may approach the nearest Insurance Ombudsman for

resolution of Your grievance. The contact details of Ombudsman ofﬁces are

mentioned below.

Ombudsman Ofﬁces

Jurisdiction Ofﬁce Address

Delhi, Rajasthan 2/2 A, 1st Floor, Universal Insurance Bldg., Asaf Ali

Road, NEW DELHI – 110 002

West Bengal, Bihar 29, N. S. Road, 3rd Flr., North British Bldg.,

KOLKATA - 700 001

Maharashtra 3rd Flr., Jeevan Seva Annexe, S.V. Road, Santa Cruz

(W), MUMBAI - 400 054

Tamil Nadu, Pondicherry Fatima Akhtar Court, 4th Flr., 453 (old 312 ), Anna

Salai, Teynampet, CHENNAI -600 018

Andhra Pradesh 6-2-46, 1st Floor, Moin Court, Lane Opp. Saleem

Function Palace A. C. Guards, Lakdi-Ka-Pool,

HYDERABAD - 500 004

Gujarat 2nd Flr., Ambica House, Nr. C. U. Shah College, 5,

Navyug Colony, Ashram Road, AHMEDABAD - 380 014

Kerala, Karnataka 2nd Flr., CC 27/ 2603, Pulinat Building, Opp. Cochin

Shipyard, M. G. Road, ERNAKULAM - 682 015

North-Eastern States Aquarius, Bhaskar Nagar, R. G. Baruah Road,

GUWAHATI - 781 021

Uttar Pradesh Jeevan Bhawan, Phase 2, 6th Floor, Nawal Kishore

Road, Hazartganj, LUCKNOW - 226 001

Madhya Pradesh 1st Floor, 117, Zone-II, (Above D. M. Motors Pvt.

Ltd.) Maharana Pratap Nagar, BHOPAL - 462 011

Punjab, Haryana,

Himachal Pradesh,

Jammu & Kashmir,

Chandigarh

S. C. O. No. 101, 102 & 103, 2nd Floor, Batra

Building,

Sector 17 - D, CHANDIGARH - 160 017

Orissa 62, Forest Park, BHUBANESWAR - 751 009

IRDA REGULATION NO 5: This policy is subject to regulation 5 of IRDA (Protection

of Policyholder’s Interests) Regulation.

Appendix I: Day Care Procedure

Day Care Procedures will include following Day Care Surgeries & Day Care

Treatments

Microsurgical operations on the middle ear

1. Stapedotomy

2. Stapedectomy

3. Revision of a stapedectomy

4. Other operations on the auditory ossicles

5. Myringoplasty (Type -I Tympanoplasty)

6. Tympanoplasty (closure of an eardrum perforation/reconstruction

of the auditory ossicles)

7. Revision of a tympanoplasty

8. Other microsurgical operations on the middle ear under general /

spinal anesthesia

Other operations on the middle & internal ear

9. Myringotomy

10. Removal of a tympanic drain

11. Incision of the mastoid process and middle ear

12. Mastoidectomy

13. Reconstruction of the middle ear

14. Other excisions of the middle and inner ear

15. Fenestration of the inner ear

16. Revision of a fenestration of the inner ear

17. Incision (opening) and destruction (elimination) of the inner ear

18. Other operations on the middle and inner ear under general /spinal

anesthesia

Operations on the nose & the nasal sinuses

19. Excision and destruction of diseased tissue of the nose

20. Operations on the turbinates (nasal concha)

21. Other operations on the nose

22. Nasal sinus aspiration

Operations on the eyes

23. Incision of tear glands

24. Other operations on the tear ducts

25. Incision of diseased eyelids

26. Excision and destruction of diseased tissue of the eyelid

27. Operations on the canthus and epicanthus

28. Corrective surgery for entropion and ectropion

29. Corrective surgery for blepharoptosis

30. Removal of a foreign body from the conjunctiva

31. Removal of a foreign body from the cornea

32. Incision of the cornea

33. Operations for pterygium

34. Other operations on the cornea

35. Removal of a foreign body from the lens of the eye

36. Removal of a foreign body from the posterior chamber of the eye

37. Removal of a foreign body from the orbit and eyeball

38. Operation of cataract

Operations on the skin & subcutaneous tissues

39. Incision of a pilonidal sinus

40. Other incisions of the skin and subcutaneous tissues

41. Surgical wound toilet (wound debridement) and removal of diseased

tissue of the skin and subcutaneous tissues

42. Local excision of diseased tissue of the skin and subcutaneous

tissues

43. Other excisions of the skin and subcutaneous tissues

44. Simple restoration of surface continuity of the skin and subcutaneous

tissues

45. Free skin transplantation, donor site

46. Free skin transplantation, recipient site

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

Optima Restore

Policy Wording

47. Revision of skin plasty

48. Other restoration and reconstruction of the skin and subcutaneous

tissues

49. Chemosurgery to the skin

50. Destruction of diseased tissue in the skin and subcutaneous tissues

Operations on the tongue

51. Incision, excision and destruction of diseased tissue of the tongue

52. Partial glossectomy

53. Glossectomy

54. Reconstruction of the tongue

55. Other operations on the tongue

Operations on the salivary glands & salivary ducts

56. Incision and lancing of a salivary gland and a salivary duct

57. Excision of diseased tissue of a salivary gland and a salivary duct

58. Resection of a salivary gland

59. Reconstruction of a salivary gland and a salivary duct

60. Other operations on the salivary glands and salivary ducts

Other operations on the mouth & face

61. External incision and drainage in the region of the mouth, jaw and

face

62. Incision of the hard and soft palate

63. Excision and destruction of diseased hard and soft palate

64. Incision, excision and destruction in the mouth

65. Plastic surgery to the ﬂoor of the mouth

66. Palatoplasty

67. Other operations in the mouth under general /spinal anesthesia

Operations on the tonsils & adenoids

68. Transoral incision and drainage of a pharyngeal abscess

69. Tonsillectomy without adenoidectomy

70. Tonsillectomy with adenoidectomy

71. Excision and destruction of a lingual tonsil

72. Other operations on the tonsils and adenoids under general /spinal

anesthesia

Trauma surgery and orthopaedics

73. Incision on bone, septic and aseptic

74. Closed reduction on fracture, luxation or epiphyseolysis

with osteosynthesis

75. Suture and other operations on tendons and tendon sheath

76. Reduction of dislocation under GA

77. Arthroscopic knee aspiration

Operations on the breast

78. Incision of the breast

79. Operations on the nipple

Operations on the digestive tract

80. Incision and excision of tissue in the perianal region

81. Surgical treatment of anal ﬁstulas

82. Surgical treatment of haemorrhoids

83. Division of the anal sphincter (sphincterotomy)

84. Other operations on the anus

85. Ultrasound guided aspirations

86. Sclerotherapy etc.

Operations on the female sexual organs

87. Incision of the ovary

88. Insufﬂation of the Fallopian tubes

89. Other operations on the Fallopian tube

90. Dilatation of the cervical canal

91. Conisation of the uterine cervix

92. Other operations on the uterine cervix

93. Incision of the uterus (hysterotomy)

94. Therapeutic curettage

95. Culdotomy

96. Incision of the vagina

97. Local excision and destruction of diseased tissue of the

vagina and the pouch of Douglas

98. Incision of the vulva

99. Operations on Bartholin’s glands (cyst)

Operations on the prostate & seminal vesicles

100. Incision of the prostate

101. Transurethral excision and destruction of prostate tissue

102. Transurethral and percutaneous destruction of prostate tissue

103. Open surgical excision and destruction of prostate tissue

104. Radical prostatovesiculectomy

105. Other excision and destruction of prostate tissue

106. Operations on the seminal vesicles

107. Incision and excision of periprostatic tissue

108. Other operations on the prostate

Operations on the scrotum & tunica vaginalis testis

109. Incision of the scrotum and tunica vaginalis testis

110. Operation on a testicular hydrocele

111. Excision and destruction of diseased scrotal tissue

112. Plastic reconstruction of the scrotum and tunica vaginalis testis

113. Other operations on the scrotum and tunica vaginalis testis

Operations on the testes

114. Incision of the testes

115. Excision and destruction of diseased tissue of the testes

116. Unilateral orchidectomy

117. Bilateral orchidectomy

118. Orchidopexy

119. Abdominal exploration in cryptorchidism

120. Surgical repositioning of an abdominal testis

121. Reconstruction of the testis

122. Implantation, exchange and removal of a testicular prosthesis

123. Other operations on the testis under general /spinal anesthesia

Operations on the spermatic cord, epididymis and ductus deferens

124. Surgical treatment of a varicocele and a hydrocele of the spermatic cord

125. Excision in the area of the epididymis

126. Epididymectomy

127. Reconstruction of the spermatic cord

128. Reconstruction of the ductus deferens and epididymis

129. Other operations on the spermatic cord, epididymis and ductus

deferens

Operations on the penis

130. Operations on the foreskin

131. Local excision and destruction of diseased tissue of the penis

132. Amputation of the penis

133. Plastic reconstruction of the penis

134. Other operations on the penis

Operations on the urinary system

135.Cystoscopical removal of stones

Other Operations

136. Lithotripsy

137. Coronary angiography

138. Haemodialysis

139. Radiotherapy for Cancer

140. Cancer Chemotherapy

Note: The standard exclusions and waiting periods are applicable to all of the

above Day Care Procedures depending on the medical condition/ disease under

treatment. Only 24 hours hospitalization is not mandatory

•----ApolloMunich

HEALTH

INSURANCE

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002

E-mail : customerservice@apollomunichinsurance.com TOLL FREE : 1800-102-0333 www.apollomunichinsurance.com

Optima Restore

Policy Wording

AMHI/PR/H/0012/0063/102010/P

SCHEDULE OF BENEFITS

Optima Restore Individual

Basic Sum Insured per

Insured Person per Policy

Year (Rs. in Lakh)

3.00, 5.00, 10.00, 15.00

1a) In-patient Treatment Covered

1b) Pre-Hospitalization Covered, upto 60 Days

1c) Post-Hospitalization Covered, upto 180 Days

1d) Day Care Procedures Covered

1e) Domiciliary Treatment Covered

1f) Organ Donor Covered

1g) Emergency Ambulance Upto Rs.2,000 per Hospitalisation

2) Restore Beneﬁt Equal to 100% of Basic Sum Insured

3) Multiplier Beneﬁt Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%. In case of claim bonus will be

reduced by 50% of the Basic Sum Insured at the time of renewal

Optima Restore Family

Basic Sum Insured per

Policy per Policy Year (Rs.

in Lakh)

3.00, 5.00, 10.00, 15.00

1a) In-patient Treatment Covered

1b) Pre-Hospitalization Covered, upto 60 Days

1c) Post-Hospitalization Covered, upto 180 Days

1d) Day Care Procedures Covered

1e) Domiciliary Treatment Covered

1f) Organ Donor Covered

1g) Emergency Ambulance Upto Rs.2,000 per Hospitalisation

2) Restore Beneﬁt Equal to 100% of Basic Sum Insured

3) Multiplier Beneﬁt Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%. In case of claim bonus will be

reduced by 50% of the Basic Sum Insured at the time of renewal

•----ApolloMunich

HEALTH

INSURANCE