Apollo Munich Optima Senior – A Review

Apollo Munich recently launched its much eagerly awaited product for Seniors-Optima Senior. Unlike its other products, the company has moved from its policy of no sub-limits and has introduced capping in the product which demands a wise review.

Here are some of the USP of Apollo Munich products which have been attracting health insurance seekers:

  1. No Sub-Limits – All major products of the company do not have any sub-limits on room rents, nursing fees, treatment wise etc.
  2. Life Long Renewal – Apollo was the first company which came out with Life Long renewals.
  3. No Claim Based Loading – The company do not charge a loading if claim arises in any particular year.
  4. Portability – The company has been providing portability feature even before IRDA made it mandatory for insurance companies.

Apart from this in-house claim settlement, e-opinion, and many other value added features which were not available in any other health insurance scheme made Apollo Munich a considerable choice for many.

Let’s analyze how Optima Senior fairs with company other products and its peers-

Basic Features

  • Minimum Entry age is kept at 61 and there is no maximum cover ceasing age.
  • You can take a SI of Rs 2 lakh, Rs 3 lakh and Rs 5 lakh.
  • The policy is only on individual basis and there is no Floater option.
  • Only Self & Spouse are covered.

Benefits

In Patient TreatmentRoom Rent, Nursing Expenses, Diagnostic procedures etc.  which are covered in other basic health plans
Pre & Post hospitalization Expenses30 & 60 days
Day Care TreatmentFor 140 procedures listed in Apollo Munich
Organ Donor ExpensesCovered
Domiciliary TreatmentMedical treatment taken at home is covered with certain conditions
E-OpinionOne can take a second opinion from the company panel of medical practitioners

Other Features

No Claim Discount

Policyholder can avail a No claim discount of 5% for every claim free year. However, in this product the discount is on the premium and not SI. Thus, the coverage amount, once taken, remains the same.

Family discount

A family discount of 5% is available if two members are covered in the same policy.

What are the limitations?

This is the major change in the company policy as they have brought host of limitations in this plan to counter the high probability of hospitalization at higher age.

Co-Payment

Like in most health insurance plans for seniors, Apollo Munich too has imposed co-payment clause in this plan. However, the company has tried to make it attractive on the basis of claim you can avail within this clause.

  • On Accommodation

The co-payment is applicable on basis of the accommodation insured avail during hospitalization. If it’s a shared accommodation, the insured has to bear 15% of the claim while in a single occupancy the company pays only 70% of the claim. However, on non-availability and some other factors in shared occupancy, 15% co-payment is applicable even on single occupancy.

  • On Specified Illness/Surgeries

The company has also listed certain illnesses where a flat 30% co-payment is applicable irrespective of the accommodation type. The list includes cataract, joint replacement, hysterectomy and others.

Comparison

With Peers

The table below illustrates the comparison of optima senior with other products available in the industry:

 Star HealthNational Varistha Bima YojnaMax BhupaBajaj AllianzReligare HealthApollo Munich
Maximum age of Entry (Yrs)7580No age limit70No age limitNo Age Limit
Maximum Ceasing age (yrs) No age Limit90No age limit75No age limitNo age limit
Special FeatureNo Medical TestBP and diabetic patient covered with a loadingOption of Top Up & Annual Health check upNo sub LimitsAnnual Health Check Up & SA RechargeNo sub limits
Co-payment30% on all claims & 50% on pre-existing from 1st  year10% on all claims20% on claims with pre-existing20% on all claims for age above 6520% on non-network hospital.20% on SI of Rs 5 lakh & above15% and 30%
Sub LimitsYesYesNoNoYesNo
Limit on specific illnessesYesYesNoNoYesYes
Pre-existing Coverage1st year & 2nd year with  preconditions1st claim free yearAfter 4 years From 2nd year  for 50% of SAAfter 4 yearsFrom 4th year
Premium (Rs)*14495618719272140041597916421

*For Rs 3 lakh SI at age 61

With Apollo Easy Health Scheme

Easy Health which has far superior benefits is the flagship product of the company. With entry age till 65, the plan does not have any capping’s/limitations even at very high age. Also, unlike Senior, the no claim bonus feature is on SI and one can take a floater option. So, If you are within the age group of 61-65 Easy health is going to be the preferred choice, undoubtedly.

Claim Settlement

The co-payment clause is applicable on the billed amount, which means you stand to gain when the claim exceeds your coverage amount. For e.g. if SA is Rs 3 lakh and claim is Rs 4.5 lakh the co-payment of 30% is applicable on Rs 4.5 lakh which means you will be able to claim the full amount even after co-payment clause.

 Should you Consider

One of the major drawbacks in Senior Citizen Plans is the high limitations and hefty increase in premiums at higher age. In some instances, creating a health fund might be a wiser choice. Alternatively, health insurance plans taken at younger age proves to be more beneficial. A considerable product if you have already exceeded age 65 and there are no pre-existing illnesses as underwriting of the company has been very strong. But do weigh your options before making a decision.