Easy Health Insurance Plan

Individual Health Insurance : purchased on an individual basis. Family Floater Health Insurance: one single policy takes care of the hospitalization expenses of your entire family under one Sum Insured. Name RelationshipD. O. BSum Insured Mr. Shyam SharmaSelf Lac Mrs. Rani SharmaSpouse Lac Rahul SharmaSon Lac Richa SharmaDaughter Lac Name RelationshipD. O. BSum Insured Mr. Shyam SharmaSelf Lacs Mrs. Rani SharmaSpouse Rahul SharmaSon Richa SharmaDaughter

Types of Plans/ Variants Standard (Rs. Lacs) Exclusive (Rs. Lacs) Premium (Rs. Lacs) Individual Family Floater Sum Insured

 Self, Spouse, Dependent Children and Dependent Parents  Maximum 6 members can be Insured under one policy  Only 2 adults can be Insured in one family floater plan Entry Age Self  Minimum 18 years and Maximum 60 years Adult Dependent  Minimum 18 years and Maximum 60 years Child Dependent  Minimum 5 years and Maximum 21 years, Child dependent can be covered from 91 st day onwards if either of the parents are covered under this policy Cover Ceasing Age  There is no maximum cover ceasing age in this policy Who can be insured

Inpatient Treatment Pre – hospitalization Post hospitalization Day care Procedures Domiciliary Treatment Daily cash for Shared accommodation Organ Donor Emergency Ambulance Health check – up Daily cash for Accompanying an insured child New Born Baby Maternity Expenses Critical Illness Rider (Optional) Out Patient Dental Treatment Spectacles, Contact lenses, Hearing Aid E- opinion in respect of critical illness Standard Exclusive Premium Easy Health Individual / Floater

( Available in Standard, Exclusive and Premium Variant)  In-patient treatment  Pre-hospitalisation  Post-hospitalisation  Domiciliary hospitalisation  Day Care Treatment  Daily Cash – Shared Accommodation  Organ Donor  Emergency Ambulance  Health Check-up Basic Features

 Room rent, boarding expenses,  Nursing,  Intensive care unit,  Medical Practitioner,  Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances,  Medicines, drugs and consumables,  Diagnostic procedures,  Cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure. In-patient Treatment

 The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged from Hospital, provided that We have accepted an inpatient Hospitalisation claim  For 90 days, if we were intimated at least 5 days before the Hospitalisation Pre-hospitalisation  The Medical Expenses incurred due to an Illness in the 30 days immediately before the Insured Person was Hospitalised, provided that We have accepted an inpatient Hospitalisation claim  For 60 days, if we are intimated at least 5 days before the Hospitalisation Post-hospitalisation

 The Medical Expenses incurred by an Insured Person for medical treatment taken at home, which requires Hospitalisation  Could not be transferred to a Hospital, or  Hospital bed was unavailable  The condition continues for at least 3 days  No payment for Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza, Arthritis, Gout and Rheumatism, Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all type of Dysenteries including Gastroenteritis, Diabetes Mellitus and Insupidus, Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders of all kinds, Pyrexia of unknown Origin. Domiciliary Treatment

 The Medical Expenses for a day care procedure or surgery mentioned in the list of Day care procedures where the procedure or surgery is taken by the Insured Person as an inpatient for less than 24 hours. Day Care Procedures List of Day Care Procedures

Standard ( S.I In lacs) Exclusive ( S.I In lacs) Premium ( S.I In lacs) 1.00,2.00,3.00, 4.00, ,4.00, , , Rs. 500 per day, maximum Rs. 3,000 Rs. 800 per day, maximum Rs Rs. 500 per day, maximum Rs. 3,000 Rs. 800 per day, maximum Rs Daily Cash - Shared Accommodation  A daily cash amount will be payable if the Insured person is Hospitalized in Shared Accommodation in a Network Hospital for each continuous and completed period of 24 hours if the Hospitalisation exceeds 48 hours

Organ Donor  The Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated provided the donor is a blood relative of Insured Person  Pre and Post hospitalization expenses for Donor is not covered Emergency Ambulance  Expenses incurred up to Rs on ambulance offered by a healthcare or ambulance service provider used to transfer the Insured Person to the nearest Hospital following an emergency

Health Check-up  We will pay for Expenses incurred on medical check up subject to continuous Claim Free year(s) without any break in the previous policy year(s) PlanStandardExclusivePremium Individual Up to 1% of sum Insured per person at the end of every continuous 4 claim free years Up to 1% of Sum Insured subject to a maximum of Rs per person at the end of every continuous 3 claim free years Up to 1% of Sum Insured subject to a maximum of Rs per person at the end of every continuous 2 claim free years Floater Up to 1% of sum Insured per policy at the end of every continuous 4 claim free years Up to 1% of Sum Insured per policy subject to a maximum of Rs per person at the end of every continuous 3 claim free years Up to 1% of Sum Insured per policy subject to a maximum of Rs per person at the end of every continuous 2 claim free years

( Available in Exclusive and Premium Variant)  Daily Cash – For accompanying an Insured Child  Maternity Expenses  Coverage for New Born Baby Optional Rider  Critical Illness Rider Additional Features

Daily Cash – For accompanying an Insured child  If the Insured Person Hospitalized is a child Aged 12 years or less, We will pay a daily cash amount for 1 accompanying adult for each complete period of 24 hours if Hospitalisation exceeds 72 hours Exclusive ( In lacs) Premium ( In lacs) 3.00, 4.00, , , Rs. 300 per day, maximum Rs. 9,000 Rs. 500 per day, maximum Rs. 15,000 Rs. 300 per day, maximum Rs. 9,000 Rs. 500 per day, maximum Rs

 It will not be subject to the Sum Insured  Will not affect the entitlement to a CB and free Health Check up  Waiting period of 4 years in Floater and 6 years in Individual plan  Medical Expenses for a delivery while Hospitalised or the lawful medical termination of pregnancy during the Policy Period limited to 2 deliveries or terminations. Maternity Expenses Exclusive ( S.I In lacs)Premium ( S.I In lacs) 3.00, 4.00, , , Normal Delivery Rs Caesarean Delivery Rs (*Including pre and post natal limit of Rs and New Born limit of Rs. 2,000) Normal Delivery Rs Caesarean Delivery Rs (*Including pre and post natal limit of Rs and New Born limit of Rs. 3500) Normal Delivery Rs Caesarean Delivery Rs (*Including pre and post natal limit of Rs and New Born limit of Rs. 2,000) Normal Delivery Rs Caesarean Delivery Rs (*Including pre and post natal limit of Rs and New Born limit of Rs. 3500)

Newborn baby  If we have accepted a claim under Maternity expenses we will cover the new born baby under Inpatient Treatment from Day 1  Note: New born baby means those babies born to Proposer and spouse of the proposer during the policy period aged between 1 day and 90 days.

Critical Illness Rider  Additional premium for opting Critical illness rider  If critical Illness Rider benefit has been opted by customer then we will pay the Critical illness Sum Insured as a lump sum in addition to the Payment under “In Patient Treatment”  Critical Illness means Cancer, Coronary Artery (Bypass) Surgery, Heart Attack (Myocardial Infarction), Kidney Failure, Major Organ Transplantation, Multiple Sclerosis, Paralysis, Stroke  The Insured Person is first diagnosed as suffering from a Critical Illness during the Policy Period and he survives for at least 30 days following such diagnosis.  Claims made in respect of Critical Illness will not be subject to the Sum Insured and will not affect either the entitlement to a cumulative bonus or a health check- up.  Maximum three claims in lifetime  Cover ceasing age – 70 years

Critical Illness Rider Insured Name / Age Sum Insured ( Individual) Critical Illness Rider ( 100% ) Critical Illness Rider ( 50%) Self ( 38 ) Spouse ( 35 ) Son ( 9 ) Daughter ( 7 )  Optional Rider – 50% or 100% of basic Sum Insured  The percentage opted should be same for every member in Individual plan. e.g. Insured Name / Age Sum Insured ( Family Floater) Critical Illness Rider ( 100% ) Critical Illness Rider (50%) Self ( 38 ) Spouse ( 35 ) Son ( 9 ) Daughter ( 7 )

( Available only in Premium Variant)  Out-patient Dental Treatment  Spectacles, Contact Lenses, Hearing Aid  E-opinion for Critical Illness Few More Additional Features

Outpatient Dental Treatment  It will not be subject to the Sum Insured  Will not affect the entitlement to a CB and free Health Check up  From the fourth year onwards We will pay 50% of the expenses for dental treatment taken from a Network dentist  We will only pay for Consultation, X-rays, extractions, amalgam or composite fillings, root canal treatments and prescribed drugs for the same  Up to 1 % of Sum insured subject to a maximum of Rs. 5000

Spectacles, Contact Lenses, Hearing Aid  It will not be subject to the Sum Insured  Will not affect the entitlement to a CB and free Health Check up  Every third year, We will pay up to 50% of the actual cost of One pair of spectacles or contact lenses, and/or a hearing aid  These items must be prescribed by a Network EYE/ENT specialised Medical Practitioner  Under a family floater, We will pay for One pair of spectacles or hearing aid per family.  Up to Rs. 5000

 It will not be subject to the Sum Insured  Will not affect the entitlement to a CB and free Health Check up  If an Insured Person suffers a Critical Illness  At the Insured Person’s request We will arrange a second opinion from Our panel doctor. E-Opinion in respect of a Critical Illness

Member Applies for E-Opinion E – Opinion taken from the Specialist E – Opinion sent to the Member E - Opinion Query No Query Query Replied Query Not Replied Closure

 30 days waiting period  2 year specific disease waiting period like cataract, hernia, hysterectomy, joint replacement and hydrocele  Pre-existing disease covered from 4th year  HIV, AIDS and related disease  Internal & external congenital disease  Non-allopathic treatment  Artificial limb and external devices  Cosmetic treatment  Items of personal comfort and convenience  Maternity (if not opted and within waiting period) Major Exclusions

Portability  Comparable Individual Health Insurance Plans  30 days exclusion waiver  2 year exclusion waiver  Pre-existing Exclusion waiver(Minimum waiting period of 1 year)  Transfer of Cumulative 5% every year max. 20%  No reduction in waiting period for other benefits Cumulative Bonus  Available for every claim free year  Sum Insured increased by 10%  Maximum up to 50% of SI  In the event of Claim, CB reduced by 20% of Sum Insured

As per Section 80D – An assessee is entitled to a deduction of Rs in respect of medical premia paid on the health of himself, his spouse and children. If any of them is a senior citizen, then he shall be entitled to a maximum deduction of Rs /- as a whole. In addition thereto, if he pays insurance premia on the health of his parents, whether dependant or not, he will be entitled to additional deduction of Rs /- (senior citizen - Rs /-) Section 80D

Pre Policy Check Up  PPC will be arranged by ApolloMunich only, customers should not go on their own for Pre Policy check up.  In case a proposal is accepted after PPC, Apollo Munich will reimburse up to Rs. 300/- or actual costs of tests ( whichever is lower) on filling a reimbursement request along with the receipt of payment made at DC at the time of PPC.  DCs forward all PCC reports directly to Apollo Munich and confidentiality of the same is maintained. DCs will not provide any copy of reports or duplicate set to customers/agents or any third party.  However on Customer request, AMH may provide photocopy of the same post issuance of policy. (Originals in case, insurance cover is declined).

PPC Process Flow TPA calls the customer, briefs on PPC requirement, process and provides Option of 2-3 DCs to choose from. TPA calls the customer, briefs on PPC requirement, process and provides Option of 2-3 DCs to choose from. Customer confirms the preferred DC, date and time of visit to caller. Customer confirms the preferred DC, date and time of visit to caller. Applicant undertakes the tests and makes The payment upfront to the DC. Gets the Receipt of the payment Applicant undertakes the tests and makes The payment upfront to the DC. Gets the Receipt of the payment DC forwards all the reports to TPA. TPA does the QC and forwards to Apollo DKV DC forwards all the reports to TPA. TPA does the QC and forwards to Apollo DKV Apollo DKV does the medical underwriting and confirms for issuance of the policy. Apollo DKV does the medical underwriting and confirms for issuance of the policy. Member forwards the PPC payment receipt post issuance of Policy to Apollo DKV office for re-imbursement Member forwards the PPC payment receipt post issuance of Policy to Apollo DKV office for re-imbursement

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