ICICI Lombard Complete Health Insurance

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ABOUT ICICI LOMBARD

  • ICICI Lombard general insurance company ltd is a joint venture between ICICI Bank and Fairfax financial holding limited , a Canadian based USD 37 billion diversified financial services company .
  • ICICI Lombard was established in 2001 .
  • ICICI Bank has 64% stake and Fairfax has 35% .
  • ICICI Lombard general insurance is the largest general insurance company is India.

SUM INSURED OPTIONS(IN LACS )




PLAN COMBINATION

                                           

AGE LIMIT

NOTE : Entry age for individual policy is 6 years

PRODUCT DESIGN

         

IN PATIENT CARE

In ICICI Lombard the Inpatient Treatment covers hospitalization expenses up to Sum Insured .

Medical expenses for in-patient treatment :
  • Doctors’ fees .
  • Professional charges. 
  • Blood, oxygen , Operation Theater Charges. 
  • Surgeons Fees.
  • Diagnostics procedures .
  • Medicines, drugs .
  • Operation Theater charges .
  • Intensive Care Unit charges.
  • Other medical charges.

PRE AND POST HOSPITALIZATION

Medical expenses incurred  immediately 30 days before  and  60 days after hospitalization will be covered.

Example : -  Someone gets fever and visits the doctor a few times ,  and then is advised hospitalization as it turns out to be Typhoid . The expenses he incurred initially in diagnosis and  his visits to the doctor and medical expenses he incurred before hospitalization will be reimbursed . However it should be related to the same reason he is hospitalized .

Same condition is applicable up till 60 days after discharge for all the medical expenses the insured might incur on the road to recovery from the very same illness .

DAY CARE SURGERIES /TREATMENT COVERAGE

All medical expenses incurred while undergoing specific day care procedures /treatment , as mentioned on the link below , which require less than 24 hours of hospitalization are covered .

Some of the day care procedures are :- 
  • Incision of the cornea 
  • Removal of fracture pins and nails .
  • Hemodialysis.


ROAD EMERGENCY AMBULANCE

Reimbursement  up to Rs 1500 /hospitalization  for reasonable expenses incurred on availing an Ambulance service offered by a hospital /ambulance service provided in an emergency condition.

REFILL BENEFIT FOR NEW ILLNESS

If the base sum insured and No Claim Bonus is partially or completely exhausted  once in  a year: 
We will provide Refill Sum Insured up to 100% of Base Sum Insured, for a subsequent/future claim of an
 un-related illness only for the same member or any subsequent claim of a different member.

For Example:  
Fever due to Malaria and Fever due to Typhoid are un-related although both are fever; Refill can get triggered however, refill would not trigger for a customer who has already been paid a claim for angioplasty and then we get a second claim for Bypass surgery.

 REFILL BENEFIT - ILLUSTRATION


AYUSH BENEFIT

Reimbursement of medical expenses for alternative treatment taken under AYUSH provided the treatment has been undergone in:
A Government hospital or 
In Any Institute recognized by Government and/or accredited by Quality Council of India/National Accreditation Board on Health
Does not include pre and post hospitalization expenses

WELLNESS PROGRAM

Get rewards for your healthy behavior by earning points through various wellness activities.

HOSPITAL DAILY CASH

A certain Amount (as per the Sum Insured chosen) will be paid once during the policy period for each and every completed day of hospitalization subject to maximum of 10 consecutive days with 3 days deductible.

CONVALESCENCE BENEFIT

A benefit Amount of 10,000 per insured once during the Policy Period will be paid in case of hospitalization arising out of any Injury or Illness as covered under the Policy, for a period of consecutive 10 days or more.

MATERNITY BENEFIT

  • Reimbursement of medical expenses incurred for delivery , including a cesarean section during hospitalization or lawful  medical termination of pregnancy during the policy period .
  • The waiting period for maternity cover is 3 years .The cover shall be limited to 2 deliveries /terminations during the period of insurance.  
  • Pre-natal and Post Natal expenses shall be covered under this benefit (such waiting periods shall be reduced if the insured has been covered under a similar policy before opting for this policy subject however to portability regulations).


NEW BORN BABY COVER

The new born child can be covered under this policy during hospitalization for a maximum period up to 91 days from the date of birth of child .This cover will be provided only if maternity cover is opted.


OUTPATIENT TREATMENT (OPD)& WELLNESS AND PREVENTIVE HEALTHCARE

An outpatient is someone who visits hospitals for a specific type of illness and doesn’t stay back at the hospital for more than 24 hours , due to technological advancements .

MEDICAL EVACUATION COVER

Reimbursement of necessary and reasonable travel expenses , incurred as a result of evacuation to the nearest hospital under a medical emergency condition.

NURSING AT HOME

An amount of Rs.3000 per day for a maximum of up to 15 days post hospitalization for the medical services of a nurse at your residence.

COMPASSIONATE VISIT

In the event of hospitalization exceeding 5 days, the cost of economy class air ticket up to Rs. 20000 incurred by the customer’s “immediate family members” while traveling to place of hospitalization from the place of origin /residence and back will be reimbursed .” “immediate family members”  would mean spouse , children and dependent parents.

           

CRITICAL ILLNESS

The customer can opt for critical illness cover , covering specified critical illness / medical procedures  :- 
  • Heart attack  of specific severity.
  • Open chest CABG .
  • Stroke resulting in permanent symptoms. 
  • Permanent Paralysis of Limbs.
  • Kidney Failure Requiring Regular Dialysis. 
  • Major Organ /Bone Marrow Transplant.
  • Multiple Sclerosis with Persisting Symptoms.
  • Open heart Replacement or Repair of Heart Valves.
  • Coma of Specific Severity.
      

DONOR EXPENSES

Reimbursement up to Rs 50000 for such medical expenses as incurred by the organ donor for undergoing any organ transplant surgery for your use.

PERSONAL ACCIDENT

The customer can also opt for personal accident cover where the fixed sum is paid upon unfortunate event of accidental death or permanent total disablement resulting from an accident .

This cover can be availed only once during a life time.

        

WAITING PERIODS

  • 30d Waiting Period except accidents
  • 24month Pre-Existing Disease (PED) in i-Health  , Health protect Plus, Health Smart Plus  and Health Smart
  • *24 month  Specific Waiting Period
SPECIFIC ILLNESS COVERED 
  1. Cataract *
  2. Beningn Prostatic Hypertrophy 
  3. Myomectomy ,Hysterectomy unless because of malignancy
  4. All types of hernia , Hydrocele 
  5. Fissures &/or  Fistula in anus ,Hemorrhoids /piles 
  6. Arthritis ,gout , rheumantism and spinal disorders
  7. Joint replacements unless due to accident 
  8. Sinusitis and related disorders 
  9. Stones in the urinary and billiary systems 
  10. Dilatation and curettage , Endometriosis 
  11. All types of skin and internal tumors/cysts/nodules/polyps of any kind including breast lumps unless malignant 
  12. Dialysis required for chronic renal failure 
  13. Surgery on tonsils , adenoids and sinuses
  14. Gastrtic and Duodenal erosions and ulcers 
  15. Deviatied nasal Septum
  16. Varicose Veins /Varicose ulcers

NOTE :- In case of cataract surgery , if the sum insured is till 5 lakh , then Rs.20,000/eye will be covered and for sum insured greater than 5 lakh Rs 100000/eye will be covered .

PERMANENT EXCLUSIONS

  1. Addictive conditions and disorders
  2. Ageing and puberty
  3. Artificial life maintenance
  4. Circumcision
  5.  Dental /oral treatment
  6.  Conflict and disaster
  7. Congenital conditions
  8.  Convalescence and Rehabilitation
  9.  Cosmetic surgery
  10.  Drugs and dressings for OPD Treatment or take-home use
  11.  Eyesight
  12.  Unproven/ Experimental treatment
  13.  Health hydros, nature cure, wellness clinics etc.
  14.  HIV and AIDS
  15.  Obesity
  16.  Hereditary conditions (specified)
  17.  Items of personal comfort and convenience
  18.  Alternative treatment
  19.  Psychiatric and Psychosomatic Conditions
  20.  OPD Treatment
  21.  Stem cell implantation, Ancillary Hospital Charges
  22.  Preventive care; Treatment for Alopecia
  23.  Unrelated diagnostic, x-ray or laboratory examinations
  24.  Charges for medical papers
  25.  Reproductive medicine
  26.  Self-inflicted injuries 
  27.  Sexual problems and gender issues
  28.  Sexually transmitted diseases
  29.  Unrecognized physician or Hospital
  30.  Sleep disorders
  31.  Speech disorders
  32.  Treatment for developmental problems
  33.  Treatment received outside India
  34.  Hospitalization undertaken for observation or for investigations only and where no medical  treatment  is provided
  35.  Active participation in adventure or hazardous sports including but not limited to para-jumping, rock climbing, mountaineering, motor racing, horse racing or deep-sea diving.
  36.  Unlawful Activity
  37.  Any costs or expenses specified in the List of Expenses Generally Excluded at Annexure I .

*PRE-EXISTING DISEASE


Any regular medication, past surgery, or any medical condition or past accidental injury will qualify as pre existing disease or condition and the same will have a waiting period of 2 years in ICICI Lombard. 





ADVANTAGES

1)ROOM RENT ,ICU CHARGES :-   There is NO CAPPING on Room rent and ICU Charges in ICICI.
2)PRE-POST HOSPITALIZATION :- 30 days before and  60 days after the hospitalization expenditure are covered for same illness.
3)EMERGENCY AMBULANCE :-Emergency ambulance up to Rs 1500 /hospitalization  (network/out of network)
4)SUB LIMITS:- No disease wise sub limit is applicable in case of cataract surgery , if the sum insured is till 5 lakh , then Rs.20,000/eye will be covered and for sum insured greater than 5 lakh Rs 100000/eye will be covered .
5)PRE-EXISTING WAITING PERIOD:-  2 years waiting period for  Pre Existing Diseases .
6)CO-PAYMENT:- No Co-pay in case of ICICI
7)SPECIFIC DISEASES WAITING PERIOD:- 2 years of waiting period for specific diseases.
8)DAY CARE PROCEDURES:-  151  day care procedures are covered.
9)PREMIUM LOADING :- There is a NO Loading on Premium.

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