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FAQs (Frequently Asked Questions)
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Pre- and Post-hospitalization expenses cover all medical expenses incurred within X days prior to hospitalization and expenses incurred within Y days post hospitalization (X & Y may depend on the Health Policy) 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 30 days prior to hospitalization for that particular disease are covered. Medical expenses for 60 days post-hospitalization after being discharged from the hospital, e.g. the subsequent follow-up consultations with specialists, medicines and test expenses are covered.
Medical expenses, means all 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.
Pre-existing Condition mean any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 36/48 months(depending on the Health Policy) prior to the first policy issued by the insurer.
The expenses or benefits can be claimed or indemnified by reimbursement or by availing cashless services at the hospitals.
The cashless facilities are available only at the hospitals that are in insurance company’s network.
You can check the network hospital list from the Download section.
No, this facility does not extend to government hospitals.
When you are admitted to the network hospital, you need to show your Health Card to the treating doctor. The Network Hospital would contact the responsible TPA (Third Party Administrator, mentioned on the card) and fill up the pre-authorization form. Then it would send the same to TPA with estimation of expenses. The TPA checks the policy conditions and the sum insured and approves the estimate.
Yes, the insurance company shall pay the entire admissible amount for the medical expenses incurred subject to the sum insured. You might have to pay for the non-medical and expenses not covered to the hospital prior to your discharge from hospital.
The cheques are sent to the hospital to whom approvals for cashless are given.
Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured.
The claim documents should be submitted to the responsible TPA, mentioned on the ID card and the User Guide.
A waiting period is the length of time the insured have to wait before being eligible for Health Policy benefits.
Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Health Insurance policy will come to your rescue.
Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.
An individual policy is purchased by you directly from us. In a Group Health Insurance Policy, the employer or legally constituted group is the policyholder and the insurance company contracts with the employer or legally constituted group. Insurance certificates, issued to a participating member, acts as your policy.

In addition, group health insurance often contains special coverage's that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible.

Coverage under group ends once you cease to be a part of that group, moreover since the insurance contract is between insurer and employer or legally constituted policyholder there is no guarantee that policy would be renewed further.
In some instances Overseas Travel Insurance is required to get a visa to travel to certain countries. Schengen country (many countries of Western Europe constitute the Schengen countries) consulates insist on having Travel Insurance with a minimum of $37,500 coverage. However even if insurance is not required for visa purposes, it is still prudent to purchase health insurance for the following reason:
Health care costs in India are much less when compared to developed countries like the USA, Japan and European countries. In most of these countries medical care is not subsidized by the government, and medical bills can easily exceed thousands of dollars which patients have to pay by themselves. Most people in these countries have some form of Health Insurance; however these insurance policies are not available to visitors. Given this scenario, purchasing Travel Insurance can be viewed as a necessity.
With rapidly changing demographics and lifestyles prevalence of critical illness is on the rise in India. With rise in life expectancy and chronic nature of critical illness there is a requirement of additional funds to afford high medical costs for treating such critical illnesses. Apollo’s policy covers 8 most common critical illnesses were an insured member is compensated by a lumpsum payment.
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Risk Factor : All investments in mutual funds are subject to market risks and the NAV of the schemes may go up or down depending upon the factors and forces affecting the securities market and there can be no assurance that the fund's objectives will be achieved. Past performance of the Fund does not indicate the future performance of the Schemes of the Fund.
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