What is ICICI Health Insurance | ICICI Lombard Health Insurance

What is Health Insurance?

A medical insurance policy, also called health insurance, covers medical expenses for illnesses or injuries. It reimburses your bills or pays the medical care provider directly on your behalf. Comprehensive medical insurance covers the cost of hospitalization, daycare procedures, medical care at home (domiciliary hospitalization), ambulance charges, amongst others.

A health insurance plan helps you stay covered against various diseases. Additionally, it helps you boost tax savings. Under section 80D of the Income Tax Act, 1961, you can claim tax benefits against your health insurance premium.

ICICI Lombard Health Insurance


Some points you should understand about health insurance are

Health insurance is essential for people of all age groups. It has the power to fulfill your financial requirement, during contingency times. When combined with a tax-saving instrument, it serves an even greater purpose.

When buying a health insurance policy, you should check out the complete details regarding coverage, risks involved, and exclusions. Read more on health insurance to gain knowledge and make sensible decisions. This will help you stay protected and reap maximum benefits from your policy.


Risk of Incurring Losses 

Insurance is a means of risk management, not a source of profit. Insurance companies are for-profit businesses and must invest the premiums that their customers pay into investments that will generate a return. Otherwise, they would not be able to pay their policyholders when claims occur. This return must be adequate to compensate for the risk that the company assumes by paying claims and still have funds available to meet its obligations to its investors and policyholders over the long term.


The process of estimating risk and determining appropriate rates is called underwriting, which is the largest expense of an insurance company. The underwriting cycle, from the time an individual applies for insurance until the policy expires, involves an initial assessment of the risk presented by that individual. The insurer buys a part of the risk of the insured by paying a premium. The insurer then sets aside a policy amount for each insured. The insurer pays a claim if one occurs. If not, the claim is paid in full when the policy expires at the end of its term.


Whether an individual or business, any choice involves some uncertainty, which may be significant in some cases or small in others and will bear an impact on an individual's level of risk if they choose to opt-out and take no benefit from their coverage.

ICICI Lombard Health Insurance


Health Policy Online from ICICI Lombard

We know that your busy schedule may leave you with very little time to find a reliable health policy for your family. So, digital can become your go-to solution for choosing one of the preferred health policies in India.

We have hence put together a super easy and customizable online experience. It can help you zero down on a health insurance policy for the family from the comfort of your home. You can select, edit the number of family members you wish to cover under the family health plan. You can also have your pick from our smart set of add-on covers basis your healthcare needs.


Here's what you can do

Add family members. Edit family members and their respective health issues. Add your preferred add-on covers based on the healthcare needs of your family. Buy a policy instantly once you are done with all the steps above. You will be able to view the number of hospital cover, outpatient cover, and life cover you have selected for your loved ones.

The coverage is designed to keep your loved ones as comfortable as possible during critical times like illness as well as treatment, surgery, etc. You can check how much money is being spent on each plan every month through our expenses tracker and find out which plan fits in best with your budget that month! Enjoy! 

ICICI Lombard Health Insurance


Covered by ICICI Lombard Complete Health Insurance Policy

Inclusions

Hospitalization

Medical expenses incurred during a stay of more than 24 hours in the hospital, such as hotel charges, doctor/surgeon fees, prescription bills, and so on.

Pre and post hospitalization

Medical expenses incurred 30 days previous to and 60 days after admission to the hospital, assuming the in-patient claim has been accepted.

Daycare treatments

The costs of modern, technology medical procedures and surgeries that require less than 24 hours in the hospital (including dialysis, radiotherapy, and chemotherapy).

AYUSH treatment

Expenses for Ayurveda, Unani, Siddha, and Homeopathy (AYUSH) in-patient treatment only when it is received in a government hospital or any other institute recognized by the government and/or accredited by the Quality Council of India/National Accreditation Board on Health.

Wellness program

Redeeming wellness points gained through various wellness and fitness activities as a result of good behavior. The wellness points can be redeemed on OPD bills for doctor's consultations, medicine and pharmaceuticals, diagnostic and dental expenditures, and so on.

Super no claim bonus

For each claim-free year, you will be awarded a 50% increase in your base sum covered. In the event of a claim, the additional sum covered will be reduced by 50%.

Claim protector

Coverage for things that are not otherwise covered by your claim with us. If your claim for in-patient hospitalization has been approved, you can make use of this benefit.

Additional sum insured protector

If you make claims up to $50,000 in the prior insurance year, it does not affect the additional money insured you have earned over the years.

Reset benefit

If the sum insured, including accrued additional sum insured (if any), is insufficient as a result of earlier claims in that policy year, you can restore your balance sum insured up to 100% of the base sum insured once per policy year. This benefit can be used for a different disease or the same condition if the insured is different.

Cashless hospitalization

Any of our network providers or hospitals provide a cashless hospitalization option. The most recent list of these hospitals and providers can be found here.

Pre-existing diseases

For a total insured of 3 lakh and more, pre-existing diseases stated at the time of proposal and accepted by us will be covered immediately after a 2-year waiting period.

Pre-policy medical check-up

For health coverage under the age of 46 and a sum insured of up to ten lakh, no medical exams will be necessary.

Emergency ambulance

Reimbursement of up to $1500 per hospitalization for reasonable expenses incurred when using an ambulance service provided by a hospital or ambulance service provider during an emergency.

Free health check-up

Every policy year, each insured receives a complementary health check-up coupon, with floater policies receiving two coupons per year.

Domiciliary hospitalization

This should either be due to a hospital's lack of beds or the inability to transfer the insured to a hospital.

Air ambulance cover

The cost of an air ambulance rides to the nearest hospital for emergency treatment.

Worldwide cover

Medical expenses incurred abroad for hospitalization and daycare procedures.

Donor expenses

Medical expenses for organ donors up to ten lakh rupees are reimbursed (as per plans opted). Only if the hospitalization claim for organ donation operation is accepted is this benefit offered.

Emergency services

Expenses for emergency care on the road, as well as telephonic or virtual consultations with a physician for normal health conditions. The consultation can be delivered via voice, video, web portal, chat, or mobile app. This service is available 365 days a year, 24 hours a day.

Unlimited reset benefit

You can restore your balance sum insured up to 100% of the base sum insured an unlimited number of times during the policy year. To be eligible for this, the total insured, including any accrued additional sum insured (if any), must be insufficient due to previous claims in the policy year. This benefit can be used for a different disease or the same condition if the insured is different.

Lifelong renewability

Provision to renew the health policy every year without any restriction on age.

Floater benefit

Floater coverage allows you to cover your entire family (self, spouse, dependent parents, dependent children, siblings, and sisters) under a single policy for the same amount insured by paying a single premium. Any person from 3 months to 6 years can be insured under the family insurance plan as long as at least one adult is also covered under the same policy.

Freelook period

You can cancel the policy by giving written notice within 15 days of receiving the policy.

Additional sum insured

For each claim-free year, you may be eligible for a bonus of up to 10% of your existing total covered. The total additional sum insured that you can earn is limited to 50%. In the event of a claim under the policy, the accrued additional sum insured for the next year will be decreased by 10%.


Exclusions


  • Any disease contracted within 30 days of the policy's start date, excluding those caused by an accident. This clause does not apply to renewals after the first.
  • Some ailments, such as cataracts, hernias, urinary stones, and others, will not be covered for the first 2 years.
  • Any illness, disease, or accident that occurred before the start of the coverage. However, if you renew your insurance with us for two years in a row for an amount insured of $3 lakh or more, these pre-existing disorders will be covered. If the insurance is renewed for four years in a row, the sum insured of Rs. 2 lakh is covered.


Permanent exclusions

  • Treatment for difficulties associated with pregnancy and childbirth, as well as cosmetic, aesthetic, and obesity-related issues.
  • Conflict, civil war, or a violation of the law are all examples of violations of the law.
  • Treatments such as naturopathy, acupressure, acupuncture, magnetic therapy, and others are available.
  • Treatment that was received outside of the country.
  • Expenses incurred as a result of domiciliary therapy.


Exclusions valid for the first 2 years

  • Treatment of the following diseases/illness/ailments
  • Benign prostatic hypertrophy (BPH) is a type of benign prostatic hypertrophy.
  • Unless there is cancer, myomectomy, and hysterectomy are recommended.
  • Hydrocele and hernias of all kinds
  • Unless it's due to an accident, joint replacement is the only option.
  • Sinusitis and its complications
  • The urinary and biliary systems are also prone to stone formation.
  • Endometriosis, dilatation and curettage
  • Unless malignant, all sorts of cutaneous and internal tumors/cysts/nodules/polyps of any kind, including breast lumps
  • Chronic renal failure necessitates dialysis.
  • Tonsils, adenoids, and sinus surgery
  • Ulcers and erosions in the stomach and duodenum
  • Nasal septum deviated
  • Varicose veins and varicose ulcers are two types of varicose veins.
  • Internal congenital abnormalities, illnesses, and deformities of any kind

If you renew your coverage with us for 2 years in a row, we will cover the diseases, illnesses, or afflictions listed above beginning in the third year.

#Any claim for cataract treatment after 2 years from the policy start date shall not exceed 20,000 per eye per policy year for sum insured up to 5 lakh, and shall not exceed 1 lakh per eye for sum insured 7 lakh and above.


ICICI Lombard Complete Health Insurance plan Covered More and Important Health issues.

ICICI Lombard Health Insurance


COVID-19 hospitalization is covered

Our health insurance covers COVID-19-related hospitalization costs. We understand that the best health plan right now is one that protects your family against the pandemic. As a result, if you get our health insurance for parents or family, you and your loved ones will be protected against the pandemic 15 days after your policy begins*. The waiting period for COVID-19 will not apply if you have renewed your insurance with us without interruption or if it has been moved to ICICI Lombard.

No co-payment required

When you have a health plan with a co-pay provision, you must pay a portion of the covered hospitalization expenditures at the time of claim. However, there is no co-pay with our individual and family health insurance. Up to your sum insured, we will cover the total amount due under your policy terms and conditions.

Pre-existing diseases are covered

Pre-existing diseases are covered immediately after 2 years from the policy start date if you choose a plan with a sum insured of 3 lakh or more, which is one of the reasons why our insurance is one of the most popular health policies.

You can avail of unlimited reset benefit

If the balance sum covered under your family health plan is insufficient for future claims by you or a family member, we will increase it to 100% of the base sum insured. As a result, you'll have us on your side to preserve your money for the remainder of the policy year. Your sum covered can be reset for a new disease or the same illness but with a different insurer. Under our iHealth plan, you can use this benefit once every policy year, and under our Health Shield, Health Shield Plus, Health Elite, and Health Elite Plus plans, you can use it an unlimited number of times.

No capping on room rent

When it comes to your recovery, we realize you don't want to make any compromises. As a result, even a private ward is covered by our family insurance. So, if you require privacy to recuperate quickly, our family floater health policy will cover you.

You can enjoy an additional sum insured

If you have had no claims in the preceding policy year with us, we will give you a bonus. Your family's medical insurance policy's sum covered is increased by 10% for each year without a claim, up to a maximum of 50%. In the event of a claim, the amount will be reduced by 10%. Under the base plan, your benefits are unaffected.

Fast, convenient cashless claims

If you need treatment at one of our network hospitals, we may give cashless authorization and discharge authorization in as little as 60 minutes. You may concentrate completely on getting better, without having to wait or be concerned.