Health Insurance Ethiopia
Health Insurance: A Necessity
Owing to a rise in lifestyle diseases and double-digit medical inflation in Ethiopia every year, health insurance has become a necessity for every individual.
To elaborate on the shift in mindset, an individual has started looking at the broader aspect of their life and its healthcare needs. And the best part is that they have started accepting the fact that they actually do need health insurance.
Our Health (Formerly Apollo Munich Health Insurance) Insurance offers the best health insurance plans in Ethiopia today, for men and women of any age. Our Health (Formerly Apollo Munich Health Insurance) offers individual health insurance plans, family floater health insurance plans and group health insurance policies for corporations. Ranging from Optima Restore to Easy Health to Energy, these health insurance policies will not only guard you against the present and future spiralling healthcare costs, but will also guide you on the path to wellness for the long term.
Our Health (Formerly Apollo Munich Health Insurance) has also come up with an outpatient health insurance plan called Day2Day Care that covers you for unlimited doctor consultations at network centres and outpatient medical costs including pharmacy, diagnostic tests, vaccination and physiotherapy.
Another health insurance plan; Health Wallet, has been crafted by Our Health (Formerly Apollo Munich Health Insurance) to help secure not only your present, but also your future, with a Reserve Benefit. The Reserve amount, separate from your sum insured, covers out-of-pocket costs including doctor visits, pharmacy, medical devices and much more. The unused Reserve gets carried forward and earns a 6% bonus at each renewal. You can even use the Reserve to pay up to 50% of your premium, after five continuous renewals.
Our Health (Formerly Apollo Munich Health Insurance) Health Insurance has received numerous positive reviews and ratings for its health insurance plans and policies, which have been ranked as the best plans in the health insurance industry by several of Ethiopia popular publications such as “The Economic Times” and “The Hindustan Times”. The company offers its products through a network of 100 physical offices, well-trained sales partners and directly through its call center, website and in-house sales force.
Why Do You Need Health Insurance
There is more than one reason to get insured! Apart from softening the financial impact of illnesses and accidents, health insurance, nowadays, even covers your everyday medical expenses. You may think getting a health insurance policy is unnecessary if you have a group health cover. But if you solely rely on your group health policy, your health will lack protection when you switch jobs and when you retire.
Health insurance premiums rise with age and also as you develop diseases, so it is advisable to buy a health cover while you are young and healthy.
Life expectancy has increased. Thanks to advancement in medicines, the average man is likely to live for around 84 years by 2040. But a sedentary lifestyle, unhealthy eating habits and high stress levels are the growing norm too.
This has also given rise to the early onset of chronic diseases like cancer, lung conditions and stroke, claiming younger lives. Health insurance mitigates the financial risk that may befall a person who is diagnosed with a lifestyle disease.
With the healthcare industry in Ethiopia witnessing double-digit inflation, it is getting extremely expensive to treat ailments in Ethiopia . As a result, this puts a dent in an individual’s pocket.
Buying health insurance can double up as your emergency financial fund while preparing you for medical contingencies.
A group health plan may or may not cover all your family members. The sum insured limit in a group plan may also not be sufficient to meet all the medical expenses incurred. Also, during the times when you are in the process of shifting to another job or are unemployed, you and your family will be exposed to the risk of unexpected medical expenses.
And then as you’ll grow older, you might need frequent medical attention. Before that you may not want to put yourself at the risk of being uninsured.
According to a survey report, nearly 95% of Ethiopia are under-insured, with those above 45 in the highest risk group.
Many health insurance plans nowadays give coverage for day care procedures and OPD, other than treatments involving hospitalisation. Health insurance policies also cover pre and post-hospitalisation as a large amount of expense on doctor consultations, tests and medicines are borne during this period. There are also health plans that cover vector-borne diseases like dengue. Domiciliary treatments, Ayurveda, Unani, Siddha and Homeopathy are also covered by the best health insurance plans in Ethiopia .
Why Can You Trust Our Health (Formerly Apollo Munich Health Insurance) with Your Health
But that’s not all! You can trust us with your health because not only do we offer plans designed to give you comprehensive coverage when you need it the most but we also care for your health with a range of health & wellness services.
Choose from a wide range of sum insured options starting from INR 1 lakh to INR 50 lakhs and get health insurance policies with innumerable benefits and features.
Medical emergencies come unannounced. When you buy a health insurance plan, you will be relieved of the stress that accompanies troubled times, especially when funds are lacking.
You will be able to access quality treatment and will not need to compromise on your health. Your dreams and plans that rely on your hard-earned savings will remain in place while you get the quality healthcare you need.
With 4500+ network hospitals across Ethiopia , we bring best-in-class service and renowned healthcare experts at your service.
Take advantage of quick cashless claim authorisation and access world-class healthcare facilities pan-Ethiopia .
You simply need to inform us 48 hours before planned hospitalisation or within 24 hours of emergency hospitalisation to avail the cashless claim facility at our network centres.
Our Health (Formerly Apollo Munich Health Insurance) is in the business of paying claims! We honour every genuine claim with nearly 98% of our claims settled within 15 days. Since inception, we’ve settled claims worth INR 2,913 crores claims till June, 2017
The toll-free Healthline is a free and confidential healthcare information service available with all sum insured. This service is managed by specially trained health personnel who will be your Health Coach. You can avail primary consultation, individual referrals, health, nutrition and diet related information, health-related counselling and much more.
You can also get guidance on what to do in case of minor illnesses or injuries. You may seek to understand conditions you have been diagnosed with or get knowledge on chronic diseases.
Medical insurance plans are most useful when they help you stay healthy. Our Optima Restore and Easy Health policies offer the Stay Active benefit wherein you can avail up to 8% discount on premium at the time of renewal for the steps you take in a day.
You simply need to download our Health Jinn app on your phone, sync it with Google Fit or Apple Health and aim to walk 10,000+ steps every day to earn the complete 8% discount. Walking is one of the most beneficial things you can do for your health and fitness and we aim to encourage you to incorporate this activity into your daily routine.
At Our Health (Formerly Apollo Munich Health Insurance), we believe in fostering a relationship with our customers that is beyond transaction. The best medical insurance experience is accompanied by absolute transparency, integrity and clear communication.
Our customer service representatives are armed with thorough knowledge of our policies, coverage, exclusions, etc. They are well-equipped to answer all your queries and guide you from the first step of buying a policy online to the process of making claims, renewing your policy and more.
Claim tax deduction on the health insurance policy premium under Section 80D of the Income Tax Act.
As a customer, you can get numerous benefits from our health and wellness portal. The portal allows individuals to keep a track of their health like weight, BMI, etc. You can also explore healthy living, improve your lifestyle, never miss an appointment, access reports 24X7 from anywhere in the world, chat with a health coach and lots more.
With the Optima Restore health insurance policy, if you exhaust your entire sum insured during a policy year, Our Health (Formerly Apollo Munich Health Insurance) will restore the base sum insured back for usage for any new illnesses, without any paperwork or any extra charge!
With the Optima Restore mediclaim policy, if you have a claim-free year, we increase your base sum insured by 50%, at no extra charge. If you do not claim even in the second year, we double the sum insured, making it 100% of the base sum insured. For instance, if you have a Rs. 5 lakhs health insurance plan and you do not make any claim in the first year, we will increase your cover to Rs. 7.5 lakhs in the first year and to Rs. 10 lakhs in the second claim free year. Which means, at the end of the second claim free year, you would be paying for a Rs. 5 lakhs plan but enjoying the benefits of a Rs. 10 lakhs plan.
Our Health (Formerly Apollo Munich Health Insurance)’s Commitment towards Your Health
- 3 of our plans have received a 5-star rating from Economic Times Wealth
- More than 100 awards, to your credit
- 10000+ cashless hospitals pan-Ethiopia
- 5.2 million customers
- 16 products
- 80 product variants
- 97% policies issued in 3 days
- 85% customer satisfaction
Types of Health Insurance Policies
The most popular form of health insurance in the market, indemnity-based health insurance plans, more commonly known as “mediclaim”, cover the costs you have incurred. These plans provide cashless hospitalisation or reimburse you for any expenses incurred in the event of hospitalisation and also cover expenses associated with diagnostic or screening requirements before hospitalisation or post hospitalisation medical care. The mediclaim policy can be offered as:
Individual health insurance provides a separate sum insured for each insured member.
In individual health insurance policies, one member’s expenses do not impact the other family member’s cover. In the unfortunate incidence of more than one member being hospitalised in a given policy year, their individual plan is bound to cover their expenses if they have selected an adequate sum insured.
Made for families, a family floater medical insurance policy provides coverage to the entire family under a single sum insured.
Under this, a fixed sum insured is available for any or all the members insured for one or more claims during the tenure of the policy. Thus, if any of the insured members falls sick and needs hospitalization, the sum insured of the policy can be utilised by them.
A family may include individual, spouse, dependent children, parents and parents-in-law.
In a family floater policy, the sum insured is shared by all the family members. Thus, if one member ends up using a large portion of the sum insured, the other member may fall short of cover when needed.
Our Optima Restore plan offers a Restore Benefit wherein your base sum insured is restored in case the entire sum insured gets exhausted in a policy year. This way, your family can still get coverage even if one member has used up the sum insured.
A reimbursement-based health insurance policy is the base coverage that everybody must have in order to ensure that they are protected against the less frequent but the large expenses related to hospitalisation.
Fixed benefit plans offer fixed benefit payouts on the occurrence of pre-defined medical events, such as on the diagnosis of a critical illness, hospitalisation caused due to an accident, etc. These plans not only attempt to partly cover costs associated with hospitalisation but also tend to compensate for loss of income.
The biggest advantage of these plans is that they offer coverage or payout even if you have claimed from any other health insurance plan (you can consider it as an additional payout for the same illness).
However one must always consider these fixed benefit plans as a top-up or add on cover to your current plan and never mistake them for complete solutions, due to the following reasons:
- As the payout is not related to your actual health expenses incurred, it may be lower than the actual cost
- As the coverage is offered for set of defined benefits. it may or may not cover all medical contingencies
These plans offer a fixed lump sum benefit in case of a critical illness being diagnosed. The critical illness or disease covered should be covered under list defined under the plan. Our Health (Formerly Apollo Munich Health Insurance)’s Optima Vital critical illness plan covers 37 critical illnesses and offers an e-opinion in case of the diagnosis of a critical illness as well. The lump sum benefit offered by this plan can help cover not only the treatment cost but also act as an income supplement.
These plans offer fixed payouts in case of defined hospitalisation events which may include being admitted to the hospital, daily stay- recuperating benefit in case of prolonged stay and also lump sum payouts for a listed surgery.
These plans offer a pre-defined lump sum amount on the occurrence of death, disablement or broken bones due to an accident. An accident insurance plan may also cover medical expenses & emergency ambulance charges and provide an education fund for dependent children.
All such fixed payout plans are top-up plans or add-on policies, which can be used to supplement your base coverage, and in no way substitute the need for indemnity based health insurance policies. Hence, these plans should be bought by someone who would like to enhance their current coverage and would like to provision themselves for
Which Medical Insurance Plan Is Perfect for You?
At Our Health (Formerly Apollo Munich Health Insurance), we constantly study our customers’ evolving needs, persistent doubts and deepest concerns. Based on our findings, we seek to come up with the best health insurance plans, perfect for their needs.
Are you baffled by the variety of plans offered? Would you like to understand better which medical insurance policy will best fit your needs? We are here with the answers.
The best health insurance policy for you would then be Optima Restore Family Floater! This plan has not only been our best-selling plan for a long, long time but it also gives you great value for money with benefits such as the Restore Benefit and Multiplier Benefit.
Restore Benefit: In case you exhaust your entire cover in a policy year, there’s no need to worry! We will reinstate your base sum insured for use for the rest of the policy year, at no extra charge.
Multiplier Benefit: For every claim-free year, you get a bonus of 50% of the base sum insured, accumulating up to a maximum of 100%. So, in case you have a 5 lakh cover and you don’t make a claim for two consecutive years, you’ll end up with a 10 lakh cover and will still be paying the price for the 5 lakh health plan!
Well then, we have the perfect plan for you! Health Wallet is a plan that has been designed to not only insure your health in the present, but to secure it for the future as well. It does do by offering a Reserve Benefit.
You can use the Reserve Benefit for:
- OPD expenses: Such as doctor consultations, diagnostic tests, pharmacy and more
- Medical devices, health foods and supplements
- To pay up to 50% of your premium, after 5 continuous renewals
This plan secures your future by building a Reserve that you can rely upon for your health needs. Your unused Reserve gets carried forward to your next policy year and earns a 6% bonus at renewal as well!
Those doctor bills, medicines and diagnostic tests can gradually become difficult to manage. To help make it easier for you to care for your loved ones, we came up with an OPD plan; Day2Day Care. This plan covers:
- Unlimited general & specialist doctor consultations at our network centres
- Pharmacy & diagnosticsincluding pathology, radiology, vaccination and physiotherapy.
- Annual preventive health check-up cover, with the Gold Plan variant
This health plan gives you back your right to avail quality healthcare, no matter what the cost.
Well, then Easy Health would certainly make your life easy! That’s because this medical insurance plan provides all the benefits and coverage your family needs to blossom into its healthiest, happiest version.
- Maternity expenses, covered after a waiting period of 3-4 years, in the Exclusive and Premium plan
- Newborn baby- Additional benefit on payment of additional premium
- Stay Active benefit – Earn up to 8% discount on renewal premium for the steps you take! This benefit is aimed at helping you stay active and healthy.
- AYUSH benefit – Coverage for in-patient treatment taken under Ayurveda, Unani, Siddha and Homeopathy.
This health plan gives you back your right to avail quality healthcare, no matter what the cost.
People with diabetes are usually not accepted under regular health insurance plans. That’s why Our Health (Formerly Apollo Munich Health Insurance) has crafted a health insurance plan called Energy that caters to diabetic and hypertensive patients. Some of the features of this health insurance policy are:
- Coverage from Day 1
- Comprehensive coverage for in-patient, pre and post hospitalisation
- Wellness programunder which two medical checks are administered during the policy year
- Reward points on the basis of positive results from medical checks
– Reimbursement amounting to up to 25% of renewal premium towards your medical expenses, such as consultation fees, medicines, diagnostics, dental expenses and other miscellaneous charges not covered under medical insurance.
Let not diabetes make your life bitter. Let Our Health (Formerly Apollo Munich Health Insurance)’s Energy fill your life with renewed energy and the zeal to enjoy a healthier life.
Critical illnesses come unannounced and can change the course of your life. But if you are prepared in advance, you can be assured that in the unfortunate incident of contracting a critical illness, you will be well-prepared to not only get quality treatment but to also get compensated for loss of income.
Our Health (Formerly Apollo Munich Health Insurance) Health Insurance’s Optima Vital is a fixed benefit health insurance plan that covers 37 listed critical illnesses, medical events or surgical procedures.
- Wide range of sum insured options, ranging from INR 1 lakh to INR 50 lakhs
- Lump sum payout, irrespective of actual cost of treatment
- Lump sum provided over and above any insurance cover you may have received from another insurance policy
- Second opinion in case of diagnosis of a critical illness, from a medical practitioner of your choice from our panel
If you already have an existing medical insurance cover and you would rather not pay the premium of a full-fledged health policy, you can opt for a top-up health insurance plan to further enhance your cover.
Our Health (Formerly Apollo Munich Health Insurance)’s Optima Super is a big insurance hiding inside a small one. That’s because you can convert this top-up mediclaim plan into a full-fledged nil deductible health insurance plan at retirement!
Here are some of the reasons that make Optima Super a super buy.
- Wide range of deductible options, ranging from INR 1 lakh to INR 10 lakh.
- Affordable premium
- Comprehensive coverage
- Super Benefit : Convert to a full-fledged nil deductible health insurance plan at retirement
What to Look for in a Health Insurance Plan
How do you know which is the best health insurance plan? Should you go for individual plan or a family floater policy? These are few of the first questions that come to people who are looking to buy a health insurance policy.
Before we tell you what you should consider to select the best health insurance plan, let us share how a health insurance buyer can perform a quick quality check and choose to buy one of the best health insurance in Ethiopia .
- Has high ratings from industry experts. You can also check customer reviews.
- Remember, a quality health insurance plan does a good job of helping you stay well as well as get better after the treatment/surgery.
- Check if the plan offers a wellness program.
- Has the widest network of doctors and hospitals in the list. Remember to check network hospitals in your area.
- Offers a wide range of sum insured options
- Does not have sub-limits or co-payments so that you get complete coverage
- Has a quick claim authorisation and settlement process
The Top 5 Factors That Affect Your Health Insurance Premium
There are several factors that affect your health insurance premium. It is essential to be aware of these factors. For instance, if you know the considerable difference between the premium rates for a 25 year old and a 55 year old, you would realise the importance of buying a health insurance plan at a young age. Let us tell you of some of the factors that can influence your health insurance policy’s premium.
As mentioned above, the younger you are, the lower will your medical insurance plan’s premium be. This is because when you are younger, you are less likely to have current and potential health conditions that could require medical treatment.
If you have any pre-existing medical conditions, your premium might either be increased or the insurer might not cover a particular disease in the policy. But this should not deter you from declaring your medical history honestly and in detail. That is because, after a usual waiting period of three years, your pre-existing condition will be covered for life, in case the insurer accepts it. If you do not declare your medical history completely, you risk the chance of your claim not being accepted.
Medical insurance providers also take into account your Body Mass Index. A high body mass index may result in a surge in the premium. That is because a high body mass index is indicative of a higher risk for obesity-related diseases such as high blood pressure, high cholesterol and type 2 diabetes.
Your mediclaim policy’s premium is likely to be higher if you are in a high risk occupation. For instance, you could be working in an environment with hazardous substances, radiation and chemicals. Or your job probably exposes you to a risk of injuries, such as working at a construction site.
Health insurers also determine your mediclaim policy’s premium based on whether you smoke or chew tobacco or snuff. The frequency at which you do so may also influence your health plan’s premium.
Why Buy Health Insurance Online
Are you confused about whether you should buy medical insurance from an agent or if online is the way to go? Are you unsure about the online medical insurance buying process? Would you rather have someone else fill the forms for you?
Well, there are many advantages of going the digital way!
While you might think it would be convenient to let an agent do the paperwork for you, filling a medical insurance proposal form yourself is extremely important. That is because it helps you declare your pre-existing conditions honestly and accurately.
Declaring your pre-existing conditions when buying a mediclaim policy is extremely essential as it ensures that those conditions can be covered after a waiting period. On the other hand, if your agent does not realise the importance of this action, it may result in an unpleasant experience at the time of claims.
Health insurers nowadays have informative websites (yes we do!). You can go through the policy wording of each policy, check out customer reviews and surf through the various plans on offer. Buying medical insurance online enables you to make a more informed decision.
Health Insurance Tips
It is common practice among young individuals to avoid buying medical insurance as they think they do not need it. But the health landscape is fast-changing. With the increase in the incidence of lifestyle diseases and infections rising to epidemic proportions like the swine flu and dengue outbreaks, it becomes vital to protect yourself even at a young age.
- You are covered against health contingencies
- You have to pay a lower premium
- You can serve the waiting periods while you are healthy
- You avoid the risk of your proposal being rejected by health insurance companies on account of your health condition
Younger you are, lesser will be the amount of premium. An individual’s age and health condition are the deciding factors for the calculation of health insurance premium.
Sub-limits: Keep an eye out for plans with sub-limits on room rent, surgeries, ICU charges, operating charges and other medical procedures. When you opt for a health insurance plan, you should be sure that the plan has no disease specific or expenditure specific sub-limit. In few cases, you may find such plans to be expensive but they will help you to evade greater financial risks as well as provide you with the freedom to opt for efficient medical treatment, that too at the best health care provider. A policy with no sub-limits will help you avoid unpleasant situations at the time of claims.
Co-payment: Under co-payment, the policyholder bears a pre-defined percentage of the claim amount from his own pocket or through another health insurance policy. The remaining amount is borne by the insurance company. You can opt for a plan with a co-payment if you are buying the medical insurance policy to supplement an existing health plan.
Our Health (Formerly Apollo Munich Health Insurance) offers plans with no sub-limits or co-payments.
According to a study we conducted among Our Health (Formerly Apollo Munich Health Insurance) policyholders across Ethiopia in 2016, 51% of people were underinsured! Underinsurance is a widely prevalent concern across the nation. People probably opt for a lower sum insured due to lack of awareness on the right cover for them or to save on premium. But it is essential to realise that doing so might keep the gates open for a potential financial crisis in the future.
Consider all your personal priorities and liabilities, before you buy a health insurance policy to make an informed choice.
Choose the policy by giving due consideration to factors like your age, age of all your family members, increased healthcare costs, etc.
Also, when choosing a sum insured for your health insurance policy, keep in mind the increasing occurrence of lifestyle diseases among the youth.
Filling a proposal form requires you to share information about your health habits, medical history and pre-existing diseases. Thus, in order to give the right piece of information, one should fill up the proposal form themselves.
Furthermore, for the insurer to be able to underwrite the policy in an appropriate manner, it is required that all the details furnished are correct and true. You should never hide any information or overwrite in the proposal form. Inadequate information or exclusion of medical conditions during the proposal time can lead to issues of delayed or non-payment of claims during times of need!
While selecting the best health insurance plan, review the list & details of the hospital network of the insurance company. An insurer with an extensive list of hospitals in its network across cities should be your prime criteria of selection.
The plan and the cover you choose depends on several factors, such as the age of your family members, their existing medical condition, their genetic or lifestyle-related predisposition to diseases and healthcare costs in your city.
Choose the right health insurance plan and sum insured, keeping all these factors in mind.
Add-on covers like Maternity Cover, Critical Illness Rider can be bought along with standard health insurance plans to give additional coverage for your specific needs.
It is of utmost importance that you read the policy wordings and other documents carefully so as to reap maximum benefits from your respective health insurance policy. Health insurers provide policy wording on their website that contains details about the policy. It will help you gain a thorough understanding of the claim process, document requirements, payment options, special conditions, coverage and exclusions.
In the present days, when medical inflation is rising at a rapid scale, as a precautionary measure, it would be best to keep on enhancing the sum insured of your health insurance plan from time to time. You should also compare various policies available from an insurer. You can also speak to your insurance advisor to know the apt sum insured for you and your family.
Before making the final decision of buying the best health insurance in Ethiopia , you should read the policy wording once again. Turn to your insurance advisor or the insurance company and ask as many questions as you can to clarify all your apprehensions. It will clear any confusion or doubts that may exist.
Top Myths about Health Insurance
For long, several myths about health insurance have persisted. Due to the prevailing misconceptions about health insurance, people are generally apprehensive about their decision to buy a medical insurance plan.
But it is important to check the facts before relying on the information you might have heard from your friends or read somewhere.
So, before you set out to seek a fresh medical insurance cover or assess your existing coverage, let us bust some of the most popular myths related to mediclaim policies.
We are living at the peril of a sedentary lifestyle, environmental pollution, adulteration and more. The unpredictability of contracting cancer and other major illnesses at a young age has made it more than obvious that we just cannot ignore the health risks which may befall us.
The reality is that to wait for too long to buy health coverage is likely to make us face the risk of not getting our policy proposal accepted. And even if you do get a policy at a higher age, you will have to pay a higher premium and would have to go through the waiting periods till all your pre-existing conditions and initially excluded diseases are covered.
Most health insurance plans have their own set of exclusions, inclusions and limits. Thus, it is important to look for all the details regarding what are the expenses covered in a health insurance policy you intend to buy.
An employer-sponsored medical insurance offers coverage to a group of people. However, complete reliance on this type of coverage is not a prudent move as it might not be enough to take care of all the medical expenses and may not cover all family members.
Also, in case you wait to apply for an independent health insurance plan at a much higher age, you would have to pay a higher premium. Also, in case you counteract a chronic disease, your premium would be further increased.
In even the best health insurance policies in Ethiopia , the maximum age for entry and the maximum sum insured at an older age are restricted. Senior citizen plans come with a higher premium and a lower limit for the maximum sum insured.
Also, limits and deductibles may exist in a group health insurance plan on the most vital elements of the medical insurance plan, such as on hospital room rent and certain diseases.
Also, occurrence of factors such as termination of employment, switching to another job, change in company policy will mean no insurance coverage at all.
Hospitalisation expenses, cost of medication, and healthcare services are a few things that directly impact the rise in medical inflation. This in turn, will affect the amount of premium at the time of renewal.
But keep in mind that, as per IRDAI regulations, no health insurance company is allowed to increase your premium because you made a claim in the previous policy year.
Health insurance plans may also offer you a cumulative bonus, i.e., a discount for not making any claims in a policy year. Our Health (Formerly Apollo Munich Health Insurance)’s Optima Restore offers up to 100% no claim bonus of your base sum insured.
One should never hide any information or overwrite on the proposal form. Thus, it is important to declare pre-existing diseases upfront at the time of buying a health policy.
Inadequate information or exclusion of medical conditions may lead to issues of delayed or non-payment of claims at the time of need. Declaring pre-existing medical conditions is a wise step as you can be assured of getting complete coverage after the waiting period is over, instead of paying the full premium and being half-covered by your health insurance policy.
Why Get Health Insurance While You Are Young
Health insurance is an investment best made when you are young. There are several reasons why you should buy a medical insurance plan at a young age.
Premium rates of mediclaim policies are much lower when you are young. Let us give you an example to illustrate the difference. As of February, 2018, Our Health (Formerly Apollo Munich Health Insurance)’s Optima Restore Individual plan cost INR 6,947 for a cover of 3 lakh, for the age group of 18-34 years. The same plan cost INR 14,539 for the same cover of 3 lakh, for the age group of 51-54 years. That’s more than twice the premium!
According to a study we conducted among Our Health (Formerly Apollo Munich Health Insurance) policyholders across Ethiopia in 2016, 51% of people were underinsured! Underinsurance is a It is a bitter truth that, due to an increasingly sedentary lifestyle, an unhealthy diet, environmental pollution and adulterated food, we are witnessing an increase in lifestyle diseases across age groups.
According to a November 2017 publication by Down to Earth on the state of Ethiopia health, the young are at a higher risk for heart diseases in Ethiopia . The publication also states that 20.7% women and 18.6% men are overweight or obese in the age group of 15-49 years.
Health insurance is one of the best tax-saving instruments as it not only helps you save tax but also safeguards your precious health. The earlier you invest in health insurance, the more tax you can save!
It is never a wise idea to solely rely on the health cover provided by your employer, as your health is likely to be exposed to the risk of medical contingencies at the time of switching jobs.
The amount of sum insured provided by your employer may also be inadequate for your healthcare requirements as well as those of your family.
If you think that your medical insurance plan will only cover hospitalisation, you aren’t quite right! With the advent of health plans that cover outpatient expenses and several other out-of-pocket costs, health insuranceis not just a plan reserved for the big in-patient medical expenses. Health insurance plans now cover your everyday medical expenses too.
Our Health (Formerly Apollo Munich Health Insurance)’s Day2Day Care plan is dedicated solely to covering your OPD expenses. It covers unlimited general & specialist doctor consultations, pharmacy, diagnostics, vaccination and physiotherapy.
Our Health (Formerly Apollo Munich Health Insurance)’s Health Wallet also offers a Reserve Benefit that covers myriad medical expenses not usually covered by health insurance, including doctor visits, pharmacy, health foods & supplements, medical devices such as blood pressure and sugar monitors, dietitian visits and more.
A Health Jinn That Grants More Than 3 Wishes
The Our Health (Formerly Apollo Munich Health Insurance) Health Jinn mobile app lets your health insurance plan be at your fingertips. You can download the app from App Store or Google Play Store and let the Health Jinn grant all your health wishes.
- Manage your policy with ease Access your E-card on your mobile, so that wherever you go, our protection follows.
- Download the policy schedule, policy wordings and product brochure
- Easily modify policy details such as the spelling of your name, contact number, etc
- View the list of network hospitals
- Check out the claim procedure
- Download the claim form
- If you have an Easy Health or Optima Restore policy, activate “Stay Active” by syncing with Google Fit or Apple Health Kit
- Aim to walk 10,000+ steps a day to get up to 8% discount on renewal premium
- Get fitter and happier!
How to Make a Claim
We take 65 minutes for cashless authorisation.
Do you think making claims is a complicated process that takes ages? You are not quite right! Claims at Our Health (Formerly Apollo Munich Health Insurance) are easy to make and quickly settled, owing to our efficient in-house claims team. Let’s tell you how to go about making a claim.
Planned hospitalisation- For planned hospitalisation, seek cashless authorisation at least 48 hours prior to the hospitalisation.
Emergency hospitalisation- For emergency hospitalisation, inform us within 24 hours after hospitalisation.
Within 15 days of completion of treatmentSend us the duly signed claim form and the information and documents mentioned therein
Claim settled within 30 daysOur in-house claims team will work with utmost respect and consideration for your time, settling the claim within 30 days.
Save Tax with Health Insurance
The dual benefit of health insurance makes it an ideal investment for those seeking to secure their health and save tax as well.
There are several different scenarios that entitle you to varying tax deductions. Let us explain them all.
You can save tax on securing your family, consisting of yourself, your spouse and your dependent children. If no one in your family is 60 years of age or older, you can avail up to Rs. 25,000 tax deduction on your mediclaim policy premium.
Buying your parents a separate health insurance policy not only secures their health but also helps you make additional tax savings. If none of your parents is 60 years of age or older, you can claim a separate deduction of up to Rs. 30,000 tax deduction on their policy’s premium.
If no one in your family is 60 years of age or older, you get to claim up to Rs. 25,000 tax deduction.
If one or both of your parents are 60 years of age or older, you can get a tax deduction of up to Rs. 30,000 on the premium you pay for their policy.
Hence, you can claim a maximum tax deduction of Rs. 55,000.
If anybody in your family happens to be of 60 years of age or older, you can claim up to Rs. 30,000 tax deduction on your health policy’s premium.
If one or both of your parents are 60 years of age or older, you get a separate tax deduction on their policy premium of up to Rs. 30,000.
This makes you eligible for up to a maximum of Rs. 60,000 tax deduction.
Did you know that health insurance is not where your tax benefits end? To make your bid to live a healthier life easier, you also get to save tax on preventive health check-ups!
The maximum tax deduction limits are up to Rs. 5,000 each for your family and your parents. The limits fall under the maximum limits mentioned above for the various scenarios.
Why Are Many Among Us Underinsured
The most essential decision you can take when buying a medical insurance plan is to choose the right cover or sum insured. Having an inadequate health insurance cover is like holding a drink umbrella, hoping it would cover you against heavy rainfall! Our Health (Formerly Apollo Munich Health Insurance) conducted a study among its policyholders across Ethiopia in 2016. We found out that 51% of the policyholders were underinsured! Also, 62% of the policyholders above age 45 were underinsured. This percentage rose to 75% for those aged 61-65 years.
They view health insurance only as a tax saving tool – That is why people may buy health insurance at a premium that only allows them to get the maximum tax rebate, without worrying about the adequacy of the sum insured.
They lack awareness – We are often unaware of the spiralling costs of healthcare, until we face a fateful medical event that threatens to wipe out our savings. It is essential to keep in mind the healthcare costs in your city.
They rely heavily on corporate health insurance – Relying solely on the health insurance cover provided by your employer is not a good idea for many reasons.
- You will lack the corporate health cover between jobs
- You may find it more expensive to increase your sum insured as you grow older
- Waiting periods apply afresh to the quantum of sum insured that you increase. Hence, if you increase the cover of your individual health insurance policy at a later age, you would have to serve the waiting periods for the amount increased from day 1.
It is extremely important to buy a mediclaim policy with an adequate sum insured, so that the plan can serve its purpose well when you need quality healthcare.
It is important to not view health insurance only as a tax-saving tool because, while the tax benefits are lucrative, the main purpose of buying health insurance should be to safeguard your health.
How to Choose an Adequate Health Insurance Cover
It is of vital importance to have a mediclaim cover that is suited to your healthcare needs. There are several factors that dictate the amount of cover you should opt for.
It is important to keep into consideration your pre-existing conditions as well as the diseases you may be genetically prone to, owing to your family’s medical history.
While you may not want to admit it to yourself, leading a sedentary lifestyle is likely to put you at a higher risk for lifestyle diseases. While you endeavour to change your lifestyle for the better, do not forget to get a sum insured that covers the risk associated with an unhealthy lifestyle.
Different cities have varying healthcare costs. It is important to assess the medical costs in your city and in the preferred hospitals around you, so that you can choose a sum insured that covers your healthcare costs completely.
Another important factor that you should take into account is the rate of medical inflation. This is an essential thing to keep in mind even at the time of renewal of your medical insurance plan. With a double-digit medical inflation rate, it is important to continuously match your health plan’s cover to rising treatment expenses.
Why Critical Illness Plans Are Critical
While an indemnity health insurance plan can cover the treatment costs of a critical illness, a critical illness policy offers you a lump sum payout to not only help cover treatment costs, but to also act as an income supplement and cover long-term medical care.
The risk of contracting critical illnesses is rising, owing to unhealthy lifestyles and environmental pollutants. Factors such as age and genetic predisposition also put you at an increased risk of getting a critical illness. A critical illness can not only cause emotional upheaval but can also change the course of your dreams and your life with the gigantic financial costs associated.
A critical illness health insurance policy, like Our Health (Formerly Apollo Munich Health Insurance)’s Optima Vital, can make managing a critical illness easier with several benefits.
- Lump sum amount for 37 identified critical illnesses, medical events or surgical procedures
- E-opinion on diagnosis of critical illness
- Wide range of sum insured options, ranging from INR 1 lakh to INR 50 lakhs
Waiting Periods Explained
The You might find the waiting periods in a medical insurance plan baffling. How much do I have to wait to get coverage for pre-existing diseases? Are some diseases excluded for a while? Although each plan might differ in its waiting periods, let us explain to you the usual waiting periods applicable across most Our Health (Formerly Apollo Munich Health Insurance) policies.
- 30 days waiting period for any treatment, except accidental injury
- 2 years exclusionfor specific diseases like cataract, hernia, hysterectomy, joint replacement, etc.
- 3 years waiting periodfor any pre-existing diseases or conditions
So, it’s better to get a health insurance plan early, so that you can serve the waiting periods sooner!
Do you know that Energy, our health insurance policy for diabetic and hypertensive patients has no waiting periods? All hospitalisation arising out of these conditions is covered from day one!
Our Health (Formerly Apollo Munich Health Insurance) Insurance’s OPD plan; Day2Day Care, has no waiting periods either. You can get covered for unlimited doctor consultations, pharmacy, diagnostics and more from day one!
Riders in Health Insurance
In life, it is always good to have extra protection. That is why Our Health (Formerly Apollo Munich Health Insurance) insurance plans come with riders, for giving your health added security.
The Critical Illness Rider, available with our Easy Health policy, offers an additional cover for cancer of specified severity, open chest CABG, myocardial infarction (first heart attack of specific severity), kidney failure requiring regular dialysis, major organ/bone marrow transplant, multiple sclerosis with persisting symptoms, permanent paralysis of limbs and stroke, resulting in permanent symptoms. The Critical Illness Rider is an optional benefit and the critical illness sum insured can be 50% or 100% of the base sum insured, subject to a minimum of INR 1 lakh and a maximum of INR 10 lakhs.
The Critical Advantage Rider is another rider available for added security, with Our Health (Formerly Apollo Munich Health Insurance)’s Optima Restore health insurance policy. This rider can help you get quality healthcare anywhere in the world by covering you at our worldwide network centres for 8 major illnesses, including cancer, coronary artery by-pass surgery, heart valve replacement/ repair, neurosurgery, live donor organ transplant, bone marrow transplant, pulmonary artery graft surgery and aorta graft surgery. This rider, available with a sum insured equal to or greater than INR 10 lakhs, not only covers treatment expenses but also covers all travel costs for the insured and an accompanying relative, accommodation expenses, second opinion and post hospitalisation expenses.
Maternity and Medical Insurance
Motherhood is a beautiful phase in a woman’s life. It is filled with joy, excitement, love and celebration. To ensure that the child and mother have a smooth journey throughout, it is essential to make timely visits to the doctor, get necessary diagnostic tests and take good care of yourself.
Caring for yourself during maternity gets easier when your medical expenses are taken care of with health insurance. There are some medical insurance plans we offer that can make pregnancy and motherhood a time to rejoice, instead of a time when medical expenses take a toll on you.
Our coverage does not end at the delivery of your baby. The optional newborn baby benefit offers an in-patient treatment cover for your newborn from day 1 till the baby is 90 days old.
As the name suggests, Easy Health makes your health easy! The Exclusive and Premium variants of this plan provide you the following benefits.
Several maternity expenses are covered under the Exclusive and Premium Easy Health variants, including:
- Delivery, including caesarean section
- Pre-natal and post-natal expenses
- Expenses incurred for the necessary treatment of the newborn baby
Maternity expenses are covered after a waiting period of 4-6 years in the Easy Health medical insurance policy. The length of the waiting period depends on the plan variant and the sum insured chosen.
Another one of our thoughtful health insurance policies, Day2Day Care is an OPD plan that offers benefits perfect for expecting mothers. With Day2Day Care, you get
- Unlimited general & specialist doctor consultations at our network centres
- Pharmacy, diagnostics (including pathology and radiology), vaccination and physiotherapy
- Annual health check-up with the Gold plan
So, no matter how many times you need to visit the gynaecologist, you will not need to think twice before caring for yourself and your baby’s health. Our products are crafted to make the beautiful phases of your life stress-free, healthy and memorable. Come, let us take care of you!
When Alternative Treatments Are Not Just an Alternative
Alternative medicine; also known as integrative or complementary medicine, refers to several different kinds of natural healing methods which differ from Western medicine. Alternative treatments have been practised in Ethiopia for centuries. We, at Our Health (Formerly Apollo Munich Health Insurance), believe in covering you against various kinds of treatments, so that you can get healthier, faster. Some of our best health insurance plans, such as Easy Health and Health Wallet, cover in-patient treatment taken under the following branches of alternative medicine.
Ayurveda is one of the world’s oldest healing systems, which originated in Ethiopia . Ayurveda is based on the belief that there needs to be a balance between mind, body and spirit for optimal health and wellness. Ayurveda is also based on the premise that each one of us is born with a different constitution, thus necessitating the need for a treatment process that is tailored to our needs. Our Easy Health and Health Wallet plans cover in-patient treatment taken under this age-old traditional system of healing. expenses.
Unani medicine was introduced in Ethiopia by the Arabs and Persians around the eleventh century. In today’s time, Ethiopia is one of the leading countries in the practice of Unani medicine. In the Unani system, the temperament of an individual is considered important, as each individual is believed to have a unique temperament. Other aspects of this system include the theory that disease is caused when any disturbance happens in the equilibrium of the four humours, namely, blood, phlegm, yellow bile and black bile.
The Siddha system is one of the oldest alternative medicine systems in Ethiopia . The Siddha system stresses upon the idea that treatment must not be merely based on the disease but must be in alignment with the patient’s age, gender, environment, habits, appetite, physiological constitution and a host of other factors. The treatment in this system is entirely individualistic.
Homeopathy is increasingly being practised all over the world. It has been recognised as a National System of Medicine, among other systems of medicine. Homeopathy is focused on not only treating the disease but on helping a person become healthier by achieving an inner balance at the mental, emotional, spiritual and physical level. Homeopathy was given a scientific basis by Dr. Samuel Hahnemann in the early 19th century.
A Guide to Health Insurance Portability
If you are not happy with your health insurance policy, you can switch to another plan of the same insurer or to a different insurer altogether, without losing your accrued benefits. In favour of the interests of policyholders like you, the Insurance Regulatory and Development Authority of Ethiopia has put certain portability guidelines in place. These guidelines ensure that not only is portability a quick and smooth affair, but it is also something that does not make you lose out on credit gained for serving waiting periods.
In order for you to become an aware health insurance policyholder, we would like to tell you your portability rights!
- You can port to and from any general or specialised health insurance company.
- You can port any health insurance policy.
- Your new insurer needs to give you credit for the waiting period you have served for pre-existing conditions. Hence, if you have served a waiting period of two years for pre-existing conditions in your previous policy and your new insurer has a waiting period of three years for the same, you should only have to serve a waiting period of one more year with the new insurer.
- Your new insurer would need to insure you for a sum insured that is, at least, up to the sum insured of your old policy.
- All applications for portability must be acknowledged by the insurers within three working days.
Common Exclusions in a Medical Insurance Plan
Every medical insurance plan has certain exclusions, which are diseases and medical events that the plan does not provide cover for. It is absolutely essential to go through the policy wording carefully and find out the coverage limits of your mediclaim policy.
There are some common exclusions that most health insurance plans have.
- Hospitalisation due to war or any act of war
- Criminal/illegal act, self-injury or suicide
- Participation in naval, military or air force operations, racing, diving, aviation and other such activities
- Abuse of intoxicants and hallucinogenic substances
- Sexually transmitted diseases, such as AIDS
- Mental disorders
Nowadays, the best medical insurance in Ethiopia is that which covers aspects commonly excluded from health insurance plans. Here are some typical exclusions of health policies that are included in some of our plans:
- OPD expenses – Covered under Day2Day Care and Health Wallet
- Alternative treatment – Covered under Easy Health and Health Wallet
- Medical expenses that are typically excluded, like cosmetic treatment, Alzheimer’s, etc. – Covered under Health Wallet’s Reserve Benefit
Common Health Insurance Terms You Shouldn’t Overlook
Before choosing the best health insurance plan, make sure you read the policy wording carefully. The policy wording is likely to be easily available online. The policy wording outlines what the policy intends to do, the benefits/exclusions it has. It is the key source of information regarding the objective and fundamental attributes of the health insurance policy they have bought.
The policy document records all the scheme details and gives a thorough understanding of the
claim process (authorization/settlement), documents required, payment options, etc.
There are certain terms of the policy you must pay special attention to before choosing the right health insurance plan.
- The limit puts a cap on per day room rent policyholder can claim, which is linked to the sum insured (total coverage) h/she is entitled to.
- A fixed room type definition such as a “shared accommodation” only
Room restriction does not only limit the reimbursement on your room rent fees but also proportionately reduces your eligibility of payout for all other charges such as surgical fees, consultancy charges, operation theatre charges etc.
- Applies to specific charges on coverage such as doctor fees or surgical fees.
- The sub-limits may be applicable on listed illnesses. For example, cataract might be covered only up till a certain amount, irrespective of the total sum insured.
- A co-payment is the percentage of the total claim amount payable by you or another health insurance policy of yours, out of the total claim. The rest is borne by the insurance company.
- A deductible is the rupee amount you would have to incur from your pocket or from another health insurance policy, before your with-deductible health plan comes into effect.
You must check the following waiting periods.
- Waiting period applicable on listed illnesses or diseases
- Waiting period applicable on pre-existing illnesses
- The waiting period at the beginning of the policy.
Waiting period is restricted to 30 days post the first time issuance of the policy. There is no waiting period in case of claims due to an accident.