To assist insured people with uncomplicated health insurance services, Apollo Munich explains claim procedure in simple language and clear guidelines. The form provides information in uncomplicated guidelines. The policyholder can read all about the claim procedure to be followed while seeking outpatient and inpatient benefits. The procedure for reimbursement of medical expenses incurred, procedure to avail cashless facility and intimation details must be understood before paying for any plan. It is advised to be clear about the process of claim as it will affect the kind of services offered. To enjoy hassle free and uncomplicated claim process, it is advised to keep copies of documents submitted to the Third Party Administrator and also don’t forget to quote your policy number or member ID.

1. Maxima
Claim Procedure 10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002
Thank You for choosing MAXIMA, India’s first comprehensive Health Plan, Please take a few minutes and familiarize yourself with the details of your policy as given in your
MAXIMA kit on:
1. The coverage details and claims eligibility under MAXIMA policy.
2. The exclusions under MAXIMA policy.
Claim Procedure for Out-patient Benefits [Part A]
What do I do in case of a claim or any assistance?
Assistance How to avail cashless facility for Can I avail OPD benefits in Non- Where do I submit a claim?
benefits under part A [Out-patient] of network providers? (Reimbursement
the policy? Procedure)
• Please call us on our toll free line • Please select a provider from the • Reimbursement of expenses for • Please submit all claims to the local
at 1800-102-0333 for any doubts/ list provided to you for the service OPD consultation, Diagnostic Tests, office of the TPA. Our TPA can be
clarifications /information. required by you. The updated list of Pharmacy, Out-patient Dental contacted through:
providers is also available at www. Treatment, and Spectacles/Contact
• You can also log on to our website apollomunichinsurance.com Lenses would be done in cases where - 24 x 7 Toll free line at:
www.apollomunichinsurance.com the member visits a non-network 1-800-425-4033
or email us at customerservice@ • Please visit the provider along with provider. Annual Health Check-Up
apollomunichinsurance.com your Entitlement Certificates and benefit can be availed only at network
provider. - E-mail at: info@fhpl.com
Membership card. In case of non-photo
ID card please carry a valid photo ID
proof like driving license/PAN card etc. • Please submit the duly signed Original - Fax at: 040-2354140
Entitlement Certificate along with the
• Declare the type of Entitlement original payment receipt, prescription - Post/ Courier to
Certificates available with you to the and ID card to your designated TPA on Claims Department,
administration/billing counter. completion of service. Family Health Plan Ltd,
Srinilaya – Cyber Spazio,
• Handover the required Entitlement • Only original copies of the Entitlement Suite # 101,102,109 & 110,
Certificates to the concerned person Certificate shall be valid. Ground Floor,
at the administration/billing counter Road No. 2, Banjara Hills,
and avail the service mentioned in the • The Entitlement Certificate may be Hyderabad, 500 034.
entitlement certificate. Please sign at used by the Insured Person(s) whose
the back of the entitlement certificate name is mentioned on the entitlement
before handing them over. certificate.
• In case you avail of services more than • You will be reimbursed the fixed
the eligibility, kindly pay the difference amount as mentioned in Entitlement
directly to the provider. Certificate or actual payment made,
whichever is lower.
• In case any service is availed that is
less than the denomination of the
entitlement certificate, the difference
cannot be reimbursed from Apollo
Munich Health or the provider. For
example, if you buy medicines worth
Rs. 80 and use a Rs. 100 entitlement
certificate, the difference of Rs. 20 is
not reimbursable.
• This Entitlement Certificate cannot be
combined with any other schemes
offered by the provider.
1

2. Maxima
Claim Procedure 10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002
Claim Procedure for In-patient Benefits [Part B]
Please review your Maxima policy and familiarize yourself with the benefits available and the exclusions.
To help us to provide you with fast and efficient service, We kindly ask you to note the following.
1. We recommend that you keep copies of all documents submitted to the TPA or Apollo Munich Health
2. Quote your member ID/policy number in all your correspondences.
What do I do in case of a claim or any assistance?
Intimation & Assistance Procedure for Reimbursement of Medical Expenses Procedure to avail Cashless facility
• Please contact our designated TPA atleast 7 days prior • Please send the duly signed Claim Form and all the • For any emergency Hospitalisation, your designated
to an event which might give rise to a claim. information/documents mentioned* therein to your TPA must be informed no later than 24 hours after
• For any emergency situations, kindly contact our TPA designated TPA within 15 days of earlier of our request hospitalization.
within 24 hours of the event. or the Insured person’s discharge from the hospital or
Our TPA can be contacted through: completion of treatment. • For any planned hospitalization, kindly seek cashless
*Please refer to Claim Form for complete documentation. authorization from your designated TPA atleast 48
- 24 x 7 Toll free line at: 1-800-425-4033
hours prior to the hospitalization.
- E-mail at: info@fhpl.com • If there is any deficiency in the documents/information
submitted by you, the TPA will send the deficiency • TPA will check your coverage as per the eligibility and
letter within 7 days of receipt of the claim documents. send an authorization letter to the provider. In case
- Fax at: 040-2354140
there is any deficiency in the documents sent, the
• On receipt of the complete set of claim documents, same shall be communicated to the hospital within 6
- Post/ Courier to your designated TPA will send the cheque for the hours of receipt of documents.
Claims Department, admissible amount, along with a settlement statement
Family Health Plan Ltd, within 15 days. • Please pay the non-medical and expenses not covered
Srinilaya – Cyber Spazio, to the hospital prior to the discharge.
Suite No. 101, 102, 109 & 110, • The cheque will be sent in the name of the proposer.
Ground Floor, • In case the ailment /treatment is not covered under the
Road No. 2, Banjara Hills, policy a rejection letter would be sent to the provider
Hyderabad - 500 034. within 6 hours.
Note: Note: Note:
Please use a Claim Intimation Form for intimation Payment will only be made for items covered under • Insured person is entitled for cashless only in our
of a claim. your policy and upto the limits therein. empanelled hospitals.
• Please refer to the list of empanelled hospitals on
our website Or the list provided in the enclosed CD
or call us on our toll free number at 1800-102-0333.
• Rejection of cashless in no way indicates rejection of
the claim.
For any doubt or clarifications and/or information, call our Toll Free Line at 1800-102-0333 or log on to our website www.apollomunichinsurance.com or email us
at customerservice@apollomunichinsurance.com
AMHI/PR/H/0022/0045/102010/P
E-mail : customerservice@apollomunichinsurance.com toll free 1800-102-0333 www.apollomunichinsurance.com