Group Out-patient Insurance

for Docprime.com Customers

Customer Information Sheet

What is covered?
1. Outpatient Consultations
You are eligible for unlimited outpatient consultations by a general Medical Practitioner(s) or a specialist Medical Practitioner(s) in a policy year, Up to a
maximum of Rs. 1500 MRP per consultation-
a. Only 5 Gynaecology consultations are available in a policy year
b. Only 5 Oncology consultations are available in a policy year
Above mentioned limits will be applicable at policy level (for all members) and not for every individual member covered under the policy.
Consultation is procedure whereby a medical physician/specialist reviews a patient’s medical history, examines the patient, and makes
recommendations as to care and treatment. This does not include any additional cost towards any procedure (invasive or non-invasive) done during the
course of consultation. Also, planned treatment where the insured visits a doctor/therapist / specialist for medical / consultation sessions is not covered
(e.g. therapy, counselling).
2. Diagnostics
You are eligible for unlimited outpatient diagnostic tests in a policy year, up to a maximum of Rs. 1500 MRP per test.
What is not covered?
1. Cost of each outpatient consultation or diagnostic test is limited to INR 1500/-. Rs.1500 limit is on the MRP and not the discounted prices.
2. This policy is purely on cashless basis. There is no reimbursement available under this policy.
3. Any claim resulted due to involvement in illegal activities
4. Any claim resulted due to substance abuse
5. Inpatient treatment, day care procedures and naturopathy treatments.
General Conditions
1. There are no waiting periods in this policy. You are covered from day 1.
2. Benefits of this policy can be availed through docprime.com (website or mobile app) only.
3. We shall be under no obligation to make any payment under this Policy unless We have been provided with the documentation and information
(including but not limited to prescription) We have requested to establish the circumstances of the claim, its quantum or Our liability for it.
4. Only those persons named as Insured Persons in the certificate of insurance shall be covered under this Policy.
5. You have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy. If You have any
objections to any of the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation and You will be
refunded the premium paid by You after adjusting the amounts spent on any medical check-up, stamp duty charges and proportionate risk
premium. You can cancel Your Policy only if You have not made any claims under the Policy.
6. This policy would be cancelled on grounds of misrepresentation, fraud, non-disclosure of material facts or noncooperation by any Insured Person,
upon giving 30-days’ notice.
7. This Policy is ordinarily renewable for life unless
a. the Insured Person or anyone acting on behalf of an Insured Person has acted in a dishonest or fraudulent manner or
b. there has been any misrepresentation in relation to this Policy or
c. the renewal of the Policy poses a moral hazard.
7. All Pre-existing diseases are covered in policy from day1
8. Entry age for adults in policy is 18 to 65 years and 91 days to 25 years for child dependent.
How to Claim
1. LOGON to www.docprime.com
2. SEARCH for the Doctor (by specialisation/condition) or Diagnostic Centre (by medical investigations/ common conditions)
3. APPLY available filters or SORT as your preference to narrow down your search on the results page
4. REVIEW the profile of doctor or diagnostic centre to finalize your pick

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Group Out-patient Insurance
for Docprime.com Customers
Customer Information Sheet

5. On booking summary, PROVIDE AND REVIEW details of the patient (covered under insurance), tests to be conducted, time and date of the
appointment. You will receive the details of the appointment booked on your email and SMS as well.
6. VISIT the Doctor/Clinic to avail the services booked and SHOW the confirmation card received through email to the provider (Doctor/Diagnostic Centre)

Please use the following link for the detailed policy wording: https://cdn.docprime.com/documents/insurance/Group_Out_Patient_Policy_Wordings.pdf

We would be happy to assist you. Contact us at: Email: customercare@docprime.com Call Toll Free No.: Toll free 1800 123 9419
Apollo Munich Health Insurance Co. Ltd. • Central Processing Center, 2nd & 3rd Floor, iLABS Centre, Plot No. 404-405, Udyog Vihar, Phase-III, Gurgaon-122016, Haryana
• Corp. Off. 1st Floor, SCF-19, Sector-14, Gurgaon-122001, Haryana • Reg. Off. Apollo Hospitals Complex, 8-2-293/82/J III DH/900 Jubilee Hills, Hyderabad, Telangana - 500033
• Toll Free : 1800 102 0333 • Email : customerservice@apollomunichinsurance.com • For more details on risk factors, terms and conditions, please read sales brochure carefully
before concluding a sale • IRDAI Reg. No. - 131 • CIN: U66030TG2006PLC051760 • UIN: APOHLGP19064V011819