January 16

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.


In Patient Treatment Room Rent, Nursing Expenses, Diagnostic procedures etc.  which are covered in other basic health plans
Pre & Post hospitalization Expenses 30 & 60 days
Day Care Treatment For 140 procedures listed in Apollo Munich
Organ Donor Expenses Covered
Domiciliary Treatment Medical treatment taken at home is covered with certain conditions
E-Opinion One 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.


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.


With Peers

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

  Star Health National Varistha Bima Yojna Max Bhupa Bajaj Allianz Religare Health Apollo Munich
Maximum age of Entry (Yrs) 75 80 No age limit 70 No age limit No Age Limit
Maximum Ceasing age (yrs) No age Limit 90 No age limit 75 No age limit No age limit
Special Feature No Medical Test BP and diabetic patient covered with a loading Option of Top Up & Annual Health check up No sub Limits Annual Health Check Up & SA Recharge No sub limits
Co-payment 30% on all claims & 50% on pre-existing from 1st  year 10% on all claims20% on claims with pre-existing 20% on all claims for age above 65 20% on non-network hospital. 20% on SI of Rs 5 lakh & above 15% and 30%
Sub Limits Yes Yes No No Yes No
Limit on specific illnesses Yes Yes No No Yes Yes
Pre-existing Coverage 1st year & 2nd year with  preconditions 1st claim free year After 4 years  From 2nd year  for 50% of SA After 4 years From 4th year
Premium (Rs)* 14495 6187 19272 14004 15979 16421

*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.


Health Insurance, Senior Citizen

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  1. HI,

  2. But if the Sum insured is 4 Lakhs and if the claim is 2 Lakhs, we can claim only 70% of 2 Lakhs (1.4 Lakhs)with the Co pay clause. How can you say that Copay on billed amount is attractive? I am not getting it. I feel all companies are having this way only?

    1. Hi Melly,

      The feature is quoted wrt the comparison within it. Yes you are right that the claim amount will be lower when the bill amount is lower then SI. The reference here is not what makes it unique but what is there to consider.

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