Optima Restore

A unique health plan with auto refreshing sum insured benefit
A unique health plan with auto refreshing sum insured benefit

Apollo Munich Health Insurance Co. Ltd. (AMHI) introduces a Restore benefit that automatically re-instates the basic sum insured in case you exhaust it in a policy year.

For further information on this product please contact your Relationship Manager.

Optima Restore

Optima Restore

Apollo Munich Health Insurance Co. Ltd. (AMHI) introduces a Restore benefit that automatically re-instates the basic sum insured in case you exhaust it in a policy year.

For further information on this product please contact your Relationship Manager.

BENEFITS AND FEATURES

Automatic re-instatement of the basic sum insured, if the basic sum insured and multiplier benefit has been exhausted during the policy year.

A never before renewal incentive that doubles your sum insured in 2 years! If you've had a claim free year, AMHI will increase your basic sum insured by 50% as a no claim bonus. If you don't claim even in the second year, AMHI double your basic sum insured as a no claim bonus i.e. 100% of the basic sum insured.

Related medical expenses incurred 60 days prior to the hospitalization and 180 days post discharge from the hospital will be covered.

Basic sum insured Options per policy year ( In Rs.)3 Lac, 5 Lac, 10 Lac, 15 Lac, 20 Lac, 25 Lac, 50 Lac
Inpatient TreatmentCovered up to sum insured
Pre HospitalisationCovered up to 60 days
Post-HospitalizationCovered up to 180 Days
Day Care ProceduresAll Day Care Treatments Covered
Domiciliary TreatmentCovered up to sum insured
Emergency AmbulanceUp to Rs. 2,000 per hospitalization
Restore BenefitEqual to 100% of basic sum insured
Multiplier BenefitBonus of 50% of the basic sum insured for every claim free year, maximum up to 100%. In case of claim, bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic sum insured of the policy.
Tenure DiscountAn additional 7.5% discount is offered on the premium if you choose a 2 year policy.
Family DiscountFamily Discount of 10% if 2 or more family members are covered under Optima Restore Individual Sum Insured Plan.
Additional coverageParents In law can also be covered under this plan.
Dependent children age limitDependent children under up to 25 years of age can be covered under this plan.

Up to 8% discount on renewal premium subject to insured member achieving the average number of steps in each time interval prescribed in the grid by either walking or running regularly to keep fit. The discount will be accrued by the customer at defined time intervals and cumulated at the end of the policy period and offered as a discount on renewal premium.

Ambulance service in an airplane or helicopter, for emergency life threatening health conditions which require immediate and rapid ambulance transportation to the nearest hospital/medical Centre which ground transportation cannot provide.

AMHI may suggest alternate Network Provider in specific cases of surgical or medical treatment, should the Insured member accept and utilize one of the alternatives suggested he would be eligible for a lump sum benefit of Rs 5000.

Renew your cover lifelong and stay covered forever.

Allows you to select your level of care with no unpleasant surprises at the time of claim

In case of a claim during the policy period, the renewal premium would not be loaded

This health plan also comes with an easy upgrade option. You can upgrade your cover to the next slab at the time of your policy renewal.

You can avail tax benefits for the premium amount under Section 80 D of the Income Tax Act (Tax benefits are subject to changes in tax laws).

FAQs

Restore Benefit automatically re-instates the basic sum insured, if the basic sum insured and multiplier benefit has been exhausted during the policy year. Basic sum insured will be re-instated only once in a policy year. 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. If the restore sum insured is not utilised in a policy year, it shall not be carried forward to any subsequent policy year.

Let us consider an individual who has an Optima Restore policy of 3 lacs.

Event 1: In case insured member suffers from a heart condition and has to undergo an angioplasty (PTCA) incurring an expense of greater than 3 lacs towards the surgery.

Policy action: The payout would be made by the policy upto the eligible amount in this case 3 lacs. Post payment of Rs. 3 lacs, (assuming the basic sum insured and multiplier benefit has been exhausted), Restore Benefit would be triggered reinstating the sum insured.

Event 2: In case an insured member now suffers from a heart attack and had to undergo a Coronary Artery Bypass Surgery (CABG), and exhausts 3 lacs.

Policy action: No payout will be made to the insured person as the Restore benefit cannot be utilized for a similar illness/disease or any complication arising out of the same. In this case the CABG was conducted to treat the heart disease for which the earlier treatment was availed.

Event 3: Incase insured member suffers from an accident/ any other illness for e.g. Typhoid which requires hospitalisation.

Policy action: The claim payout will be made as per eligible medical expenses from the restored Sum Insured.

We will pay for the treatment of heart disease in case it occurs for Insured member 2, as the Restore Sum Insured can be used for all future eligible claims made by the Insured Person or his family except claims for an illness/disease (including its complications) for which a claim has been paid in the current policy year for that particular insured member.

We will automatically re-instate the basic sum insured once exhausted. An endorsement highlighting the same will be automatically dispatched to the customer.

Basic sum insured will be re-instated only once in a policy year. The Restore benefit can be reinstated once every year and there would be no policy lifetime limit.

No additional premium would be required incase the Restore Benefit is triggered.

Multiplier Benefit is a no claim benefit and will be offered as renewal incentive. Under Multiplier benefit, a Bonus of 50% of the basic sum insured will be provided for every claim free year accumulating up to 100%. In the event of a claim, the bonus will be reduced by 50% of the Basic Sum Insured at the time of renewal. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy.

Minimum entry age is 91 days and maximum entry age is 65 years. Child between 91 days to 5 years can be insured only when either parents are getting insured under this Policy.

We offer lifelong renewal under this Policy. There is no maximum cover ceasing age under Optima Restore policy.

Yes, Optima Restore policy is offered only on individual & family floater sum insured basis.

Proposer can opt for either 1 or 2 years policy period.

Yes, a family discount of 10% would apply if 2 or more family members are covered under same Policy.

A discount of 7.5% can be availed if insured person is paying 2 year premium in advance.

Yes, cashless hospitalization can be availed in our network hospitals.

Yes, premium paid under Optima Restore policy (Except mode of payment as Cash) is eligible for deduction under Section 80 D of Income Tax (Amendment) Act 1986.

  • A waiting period of 30 days will apply to all claims (except due to accident) unless the Insured Person has been insured under this policy continuously and without any break in the previous Policy Year.
  • 2 Year Specific Waiting Periods – Specific illnesses and treatments listed in the policy wording will not be covered unless the Insured Person has been insured under this policy continuously and without any break in the previous 2 Policy Years.
  • Any pre existing condition would be excluded for 36 months.

If client opts for Optima Restore Policy with 5 Lacs Sum Insured & does not make a claim during policy duration. Multiplier Benefit will be functional as follows-:

Year 1 Year 2 Year 3 Year 4
Base Sum Insured 5,00,000 5,00,000 5,00,000 5,00,000
Claim Status No claim No Claim No Claim No Claim
Multiplier Benefit NA 2,50,000 5,00,000 5,00,000
Total Amount
(At beginning of the year)
7,50,000 10,00,000 10,00,000

If client opts for Optima Restore Policy with 5 Lacs Sum Insured & claimed in 3th year. Multiplier Benefit will be functional as follows-:

Year 1 Year 2 Year 3 Year 4 Year 5
Base Sum Insured 500,000 500,000 500,000 500,000 500,000
Claim Status No claim No Claim Claim No Claim No Claim
Multiplier Benefit NA 250,000 500,000 250,000 500,000
Total Amount
(At beginning of the year)
500,000 750,000 10,00,000 750,000 10,00,000

In this policy Pre- and Post-hospitalization expenses cover all medical expenses incurred within 60 days prior to hospitalization and expenses incurred within 180 days post hospitalization provided the expenses were incurred for the same condition for which the Insured Person’s hospitalisation was required. For Example: A person may be required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses for tests and medicines 60 days prior to hospitalization for that particular disease are covered. Medical expenses for 180 days post-hospitalization after being discharged from the hospital, e.g. the subsequent follow-up consultations with specialists, medicines and test expenses are covered.

At the time of renewing an Individual Policy or Floater Policy you can add dependants to your existing policy subject to necessary procedure and approval from us.
You cannot add dependants in the middle of a policy except in the case of a new born baby, a newly married spouse and child > 91 days not covered earlier. For product specific conditions kindly refer to the product brochures.

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

Yes, you can cancel the policy anytime during the policy term.
If you cancel the policy within 30 days from the date of payment debit, you shall be refunded the premium paid after adjusting the amounts spent on any medical check-up and stamp duty charges and no claim has been made under the policy.
If you cancel the policy after 30 days from the date of payment debit, Apollo Munich will refund part of the premium paid after retaining premiums as applicable short period rates in accordance to the policy document and no claims has been made under the policy

You can cancel the policy by given a written notice to Apollo Munich or Citibank Branch, or by given the consent to 24 x 7 CitiPhone through TPIN verification

You can contact Apollo Munich Health Insurance at toll free number 1800-3000-1401 or write to citicare@apollomunichinsurance.com or visit www.apollimunichinsurance.com

For claim related to the policy request you to contact Apollo Munich Health Insurance at toll free number 1800-3000-1401 or 1800-102-0333 or write to citicare@apollomunichinsurance.com

For view the updated list of hospital available in Apollo Munich Network, we request you to visit Apollo Munich website at www.apollomunichinsurance.com or contact at toll free number 1800-3000-1401 or write to citicare@apollomunichinsurance.com

ELIGIBILITY CRITERIA
  • This policy covers persons in the age group 91 days to 65 years. with lifelong renewal faciltiy.The maximum entry age is restricted to 65 years.
  • Child between 91 days and 5 years can be insured provided either of the parents is getting insured under this Policy.
  • The policy will be issued for a period 1 or 2 years.
  • This policy can be issued to an individual and/or family.
  • The family includes spouse, dependant children and dependant parents as well as parents in law.
  • The policy provides coverage options on individual sum insured basis as well as on family floater basis.
  • Dependent child in the age group of 5 years to 25 years can be insured under this policy.
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Disclaimer:

Insurance products are obligations only of the Insurance company. They are not bank deposits or obligations of or guaranteed by Citibank N.A, Citigroup Inc or any of its affiliates or subsidiaries or any Governmental agency. All claims under the policy will be solely decided upon by the Insurance Company. Citibank, Citigroup or any of their affiliates and group entities hold no warranty and do not make any representation about the insurance, the quality of claims processing and shall not be responsible for claims, recovery of claims, or for processing of or clearing of claims, in any manner whatsoever. This document does not constitute the distribution of any information or the making of any offer or solicitation by anyone in any jurisdiction in which such distribution or offer is not authorized or to any person to whom it is unlawful to distribute such a document or make such an offer or solicitation. Investment products are not available to US persons and may not be available in all jurisdictions.

Participation by the bank's customers in an insurance product is purely on a voluntary basis.

*IRS Circular 230 Disclosure: Citigroup, Inc., its affiliates, and its employees are not in the business of providing tax or legal advice to any taxpayer outside of Citigroup, Inc. and its affiliates. This document is not intended or written to be used, and cannot be used or relied upon, by any such taxpayer for the purpose of avoiding tax penalties. Tax benefits are subject to changes in the tax laws. Any such taxpayer should seek advice based on the taxpayer's particular circumstances from an independent tax advisor.

Citibank N.A. is a registered Corporate Agent of Tata AIA Life Insurance Company Limited, New India Assurance Company Limited, Royal Sundaram General Insurance Company Limited and Apollo Munich Health Insurance Company Limited under the composite license number CA0086 issued by IRDAI.

Life Insurance Policies: These policies are underwritten by Tata AIA Life Insurance Co. Limited (IRDAI Registration No. 110)
CIN: U66010MH2000PLC128403 with its registered office at 14th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg,
Lower Parel, Mumbai 400013.

All guaranteed benefits are payable only when all premiums are paid when due.

Investment risk in the investment portfolio is borne by the Policy Holder. The premium paid in Unit Linked Life Insurance policies are subject to investment risks associate with capital markets and the NAVs of the units may go up or down based on the performance of the fund and factors influencing the capital market and the insured is responsible for his or her decision. Tata AIA Life is only the name of the Insurance Company and the funds offered are only the names of the funds and does not in any way indicate the quality of the contract, its future prospects or returns.

Non-life Insurance Policies:

Policies are underwritten by New India Assurance Company Limited (IRDAI Registration No. 190) CIN: U99999MH1919GOI000526 with its registered office at No.87, Mahatma Gandhi Road, Fort, Mumbai – 400 001 or by Royal Sundaram General Insurance Company Limited (IRDAI Registration No. 102) CIN:U67200TN2000PLC045611 with its registered office at No. 21, Patullos Road,
Chennai 600 002.

Specialist Health Insurance Policies: These policies are underwritten by Apollo Munich Health Insurance Co. Limited
(IRDAI Registration No. 131) CIN: U66030AP2006PLC051760 with its registered office at Apollo Hospitals Complex, Jubilee Hills, Hyderabad - 33.

For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding the sale.

For any queries with respect to your Insurance Policies bought through Citibank N.A., kindly contact 24 x 7 CitiPhone, The updated numbers are available on www.citibank.co.in

SECTION 41 OF THE INSURANCE ACT 1938 PROHIBITION OF REBATES
  1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an Insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy nor shall any person taking out or renewing or continuing a Policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the Insurer.
  2. Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to
    ten lakh rupees.