Apollo Smart Health Insurance- December 2025

Q: How do I file a claim under Apollo Smart Health Insurance?

Apollo follows a simple four-step cashless claim process that includes pre-authorization at the hospital, insurer approval, document verification, and cashless treatment with bill settlement. Final approval depends on policy terms, eligibility, submitted documents, and network hospital rules.

Q: How can I file a claim at Niva Bupa?

You can raise a claim or complaint with Niva Bupa through customer care, email, the official website, or by visiting your nearest Niva Bupa branch.

Q: How can I locate a Niva Bupa branch?

You can locate a Niva Bupa branch by using the branch locator available on the official Niva Bupa website.

Q: Who is the insurer for the Apollo Smart Health policy?

The insurer for the Apollo Smart Health policy is Niva Bupa Health Insurance Co. Ltd. (IRDAI Registration No. 145). The policy is issued under the product Smart Health with UIN MAXHLGP21223V012021.

Quick Overview

Apollo Smart is a health insurance plan available on the Apollo 24|7 platform. While it carries the Apollo name, the insurer behind the policy is Niva Bupa Health Insurance. The plan itself is Niva Bupa’s popular Smart Health policy, distributed through Apollo’s digital healthcare ecosystem.

Apollo 24|7 Insurance Services Limited is an IRDAI-licensed Corporate Agent (Composite) (listed as CA1004 on IRDAI’s Corporate Agent list).

Apollo Smart Health Insurance is not Apollo’s own insurance product. Apollo 24|7 acts only as the distribution and healthcare partner, while Niva Bupa underwrites the policy, handles claims, and sets terms.

Apollo’s website clarifies that this is a Group Health Insurance policy issued by Niva Bupa for Apollo-registered users. Apollo’s role is to enhance access, hospitals, and digital care. At Ditto, our experts go through policy details and break down complex concepts into simple, clear insights. This guide helps you understand whether the Apollo Smart Health Insurance fits your needs.

About the Insurer: Niva Bupa Health Insurance

Established in 2008 as a joint venture between Max India and the UK-based Bupa, the company commenced operations in 2010. Niva Bupa is a well-known private health insurer in India. It operates as a standalone health insurance company and focuses primarily on medical coverage.

The insurer has a strong hospital network, high claim settlement performance, and experience with retail health policies.

Performance Metrics of Niva Bupa Health Insurance

Metrics/Values	FY 22-23	FY 23-24	FY 24-25	Avg FY 22-25
Claim Settlement Ratio	90.53%	91.93%	92.39%	91.62%
Incurred Claim Ratio	54.05%	59.02%	NA	58.40% (Avg 21-24)
Annual Business Volumes (Crores)	₹4,073	₹5,608	₹6,762	₹5,481
Volume of Complaints per 10,000 claims	42.74	46.36	38.76	42.85

Eligibility Criteria of Apollo Smart Health Insurance

Aspect	Criteria
Entry Age	Minimum is 18, and maximum is 65 years
Entry Age for Kids	Minimum is 91 days, and maximum is 18 years
Sum Assured	₹5 lakh, ₹10 lakh, ₹15 lakh, and ₹20 lakh
Policy Tenure	1 year
Relationship	Self, Spouse, Daughter, Son, Mother, and Father

Does Apollo Smart Health Insurance offer a Top-up Option?

Yes, the plan also offers a top-up structure with coverage up to ₹1 crore. You must choose a deductible (₹25,000 to ₹20 lakh, based on the option selected).

When you opt for a Top-up, you need to pay a deductible. It is the amount you must pay first, or that your existing health cover must exhaust, before the top-up policy begins to pay.

Example: With a ₹10 lakh top-up and a ₹5 lakh deductible, the top-up applies only after total eligible hospital bills in a policy year cross ₹5 lakh, as per policy terms.

Note

The age eligibility for the option remains the same, with the sole exception that the maximum age for adults can be 70. Your final benefits, premiums, and eligibility depend on your certificate of insurance and policy wording.

What Are the Key Features of Apollo Smart Health Insurance?

Room Rent & Co-pay: Coverage includes a Single Private Room. If you choose a Deluxe Suite or higher category, a 30% co-pay will apply to related hospital expenses.
Waiting Periods: The initial waiting period is 30 days. Pre-existing diseases and specific listed conditions have a waiting period of 12 months.
Emergency Ambulance Cover: Emergency ground ambulance services within India are covered up to ₹2,000 per hospitalization, limited to one transfer per hospital stay.
Wide Hospital Network: Access to 10,000+ cashless hospitals across India, which adds confidence and ease during treatment.
Critical Illness Multiplier: If diagnosed with a listed critical illness, the plan increases your cover to 2 times the base sum insured, helping manage high treatment costs.
Re-Assure Benefit: Offers unlimited reinstatement of the sum insured up to the base cover for the same illness, ensuring continued protection even after multiple claims.

Note

Choosing a higher room can inflate your hospital bill and personal costs. Restoration benefits depend on strict clauses. For the critical illness multiplier, confirm eligible illnesses and the exact payout method in your policy document.

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Annual Premiums with Different Sum Assured

Sum Assured	Premium
₹5 lakh	₹6,543
₹10 lakh	₹8,020
₹15 lakh	₹9,534
₹20 lakh	₹10,056

Note: The listed premiums are for a 25-year-old, exclusive of tax.

Benefits of Buying Through Apollo 24|7

One Platform for Care and Insurance

Apollo 24|7 combines insurance with access to doctors, diagnostics, pharmacies, and hospitals. This creates a smoother health journey, especially for families.

Easier Discovery and Purchase

Buying through Apollo’s app or website feels simple for first-time buyers. The journey feels familiar for users who already use Apollo services.

Online Consultations

If you purchase an Apollo Smart Health Insurance, you get unlimited online doctor consultations across 20 specialities through Apollo 24|7. Doctors connect within 15 minutes, with flexible appointment slots for quick and convenient medical advice.

Exclusive Memberships

You get to enjoy one year of free Apollo 24|7 Circle membership with benefits like faster free medicine deliveries, cashbacks on orders and lab tests, emergency doctor access, consultation discounts, priority support, and secure health record storage.

Inclusions and Exclusions of Apollo Smart Health Insurance

Inclusions	Exclusions
Hospitalization due to illness or accident, including ₹1 lakh accidental cover	Cosmetic or plastic surgery procedures, unless medically needed
Day care procedures	Non-prescribed treatments
Pre-hospitalization expenses up to 90 days and post-hospitalization expenses up to 180 days	Self-inflicted injuries
Emergency ambulance charges	Expenses related to sterility and infertility.
Domiciliary hospitalization, organ transplant, modern treatments, and alternative treatments (AYUSH) as per policy t&c	Expenses related to treatment necessitated due to participation in hazardous or adventure sports

Learn more about what the policy covers and what not.

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Ditto’s Take on Apollo Smart Health Insurance

This plan suits people who want solid hospital coverage along with easy access to Apollo hospitals, doctors, and digital health services in one place. Having said that, we do not recommend group policies as the coverage is tied to the group.

If you leave the association or if the partnership between Apollo and niva bupa ends, the policy usually ends, unless the insurer allows conversion to an individual plan. If you buy insurance through Apollo, understand that some plans are group policies linked to partnerships, and terms may change over time. This reflects how group plans work, not a flaw.

Ditto, too, is an IRDAI-licensed Corporate Agent (Licence No. CA0738, valid until December 9, 2026). Insurance advisory is our core business. We focus on suitability checks, documentation, renewals, and claim support.

While we strive for objectivity, some bias may exist. We encourage readers to compare options and choose what best suits their long-term needs. If you are looking for an individual health plan, we recommend comprehensive plans, which align with your long-term goals.

Note: Ditto has no affiliation with Apollo Healthcare. All information in this article is based on details available on Apollo’s official website and policy brochure.

Frequently Asked Questions

What type of insurance policy is offered on Apollo 24|7?

Apollo 24|7 offers a Group Health Insurance policy. It is created and underwritten by Niva Bupa specifically for registered Apollo users, with Apollo acting as the distribution and healthcare partner.

How do I file a claim under Apollo Smart Health Insurance?

Apollo follows a simple four-step cashless process: pre-authorization at the hospital, insurer approval, document verification, and cashless treatment with bill settlement. Final approval depends on policy terms, eligibility, documents, and network hospital rules.

How can I file a claim at Niva Bupa?

You can raise a complaint through customer care, email, the official website, or by visiting your nearest branch.

How can I locate a Niva Bupa branch?

You can find a Niva Bupa branch by using the branch locator on their official website.

Who is the insurer for the Apollo Smart Health policy?

The insurer is Niva Bupa Health Insurance Co. Ltd. (IRDAI Registration No. 145). The policy is issued under the product Smart Health with UIN MAXHLGP21223V012021.

Last updated on: 28 Dec, 2025