ICICI Lombard Complete Health Insurance: Coverage, Claim & Renewal

Updated: 01-09-2023 09:22:22 AM

About ICICI Lombard Complete Health Insurance Policy

ICICI Lombard Complete Health Insurance plan is a comprehensive health policy that offers a range of benefits along with several good options of coverage and add-ons. With this complete health insurance plan, the policyholder is assured cashless approval in just 4 hours. This plan allows the policy owners to avail on-time medical attention without worrying about the money. The insurance company has more than 3600 partnered/ network hospital across the nation, so it is easy to avail top medical facilities in no time.

Who Can Buy this Policy?

Just like any other insurance policy, this plan is also designed for a specific group of individuals. Look at the following to know about the eligibility for this plan:

• Anyone who is 18 years and above can buy this plan for themselves and their family members including parents and dependent children.
• If anyone wants to provide cover to their children under the family floater option, then their child must be above 3 months old. In case, a person is individually buying this plan for their child, then the age should be more than 6 years.
• A plan purchased to cover the children between the age group of 3 months and 5 years, must cover at least 1 adult also.
• 91 days is the entry age for children.
• Medical test and examination are mandatory is an individual is buying this plan for someone who is above 46 years of age.

Features and Benefits of Complete Health Insurance

The health insurance policy by ICICI Lombard comes with a range of key features and provides the benefits listed below:

• Floater Benefit: The insurance plan offers floater options to provide coverage to the entire family (self, spouse, dependent children, parents and siblings). In this option, all the members will be covered for the similar sum insured amount under a single plan by paying only one premium. Anyone above 3 months can also be covered under this plan provided one adult coverage under the same insurance policy.
• Additional Sum Assured/ Insured: An additional amount which is 10% of the annualised sum insured is provided on every renewal for each claim-free year. This benefit can be up to 50% of the sum insured. The accumulated benefit will be reduced by 10% in case there is a claim under the plan.
• Flexible Policy Term: The insurance policy provides the customers with the flexibility to choose their policy term between 1 and 2 years.
• Cashless Hospitalisation: One can avail cash-free hospitalisation facility at any of ICICI Lombard’s partnered/ network hospitals. The list of the hospitals is available on the official website of ICICI Lombard.
• Free Medical Check-Up: The policy also offers the benefit of free health check-up at the designated centres of ICICI Lombard. One can collect the coupons and avail the benefits. For floater policy, maximum 2 coupons can be availed per year.
• Pre-Policy Check-Up: No health check-up and medical examination will be needed for the plan below 45 years customers and sum insured amount up to Rs. 10 lakh.
• Alternate Treatment: The policy also covers the expenses of alternate treatment i.e. Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). However, the treatment should be taken in a government hospital or government recognised institution or accredited by the National Accreditation Board on Health (NABH) or Quality Council of India.
• Ambulance Expenses: The policyholder can also reimburse the expenses or ambulance changes up to Rs. 1,500 per hospitalisation.
• Free-Look Period: The health insurance plan comes with the free-look period of 15 days. During this period, the customer can thoroughly read and review the policy document. They can return the policy by stating the reason within the given period.
• Income Tax Benefits: A policyholder can avail tax benefits on premium paid under this health plan as per the provisions of section 80D, Income Tax Act, 1961. However, these benefits are subject to changes from time to time, it is advisable to consult your tax advisor for more details. Section 80C benefits are not provided.

Also Read: ICICI Lombard Personal Protect Insurance Policy

Exclusions of Complete Health Insurance Plan

The health insurance plan offers two types of exclusions – exclusions that are valid of 2 years and permanent exclusions. Both the exclusions have been tabulated below:

 

Temporary Exclusions (Valid for the initial 2 Years of the Policy)

Permanent Exclusions

·         Benign prostatic hypertrophy ·         Cataract ·         Hernia and hydrocele ·         Haemorrhoids/piles, fissure or fistula ·         Myomectomy and hysterectomy because of malignancy ·         Sinusitis and related health issues ·         Joint replacement (only accidental) ·         Stone in the biliary and urinary systems ·         All types of skin (external) and internal cysts/ tumours/ polyps (all types)/ nodules including breast lumps (unless malignant) ·         Endometriosis, dilatation and curettage ·         Deviated nasal septum ·         Gastric and duodenal ulcers and erosions ·         Dialysis needed for chronic renal failure ·         Varicose ulcers/ varicose veins ·         Surgery on adenoids, sinuses and tonsils

·         Any sort of pre-existing injury/ disease/ illness before the policy’s inception. However, this exclusion can be ceased if the plan is renewed with ICICI Lombard for 2 consecutive years for the sum insured amount of Rs. 3, 4, 5, 7 and 10 lakh. Rs. 2 lakh will be the sum insured amount if renewal is made after 4 consecutive years. ·         Pregnancy and childbirth-related issues, non-allopathic treatment, aesthetic and obesity-related issues and cosmetic treatment ·         Expenses occurred due to the treatment of HIV/AIDS and related issues ·         Misuse or use of drugs and alcohol ·         Intentional self-injury ·         Civil war, war or law breaching ·         Acupressure, acupuncture, naturopathy treatment and other types of therapies ·         Any sort of treatment taken outside India

Claims Offered by ICICI Lombard for this Policy

The insurance company offers the following claims under this health insurance plan:

• Cashless Claims
• Reimbursement Claims
• Other Third-Party Administrator Claims – Cashless
• Other Third-Party Administrator Claims – Reimbursement

Steps for the process have been given here:

#Cashless Claims

• Step 1: Get admitted only in the ICICI Lombard’s network hospitals
• Step 2: Send the insurer a fax of the pre-authorisation form along with relevant documents
• Step 3: Team of ICICI Lombard Health Care will review the claim and accept, reject or raise a query accordingly
• Step 4: Claim will be settled by ICICI Lombard within the given duration.

#Reimbursement Claims

• Step 1: After getting discharged, pay all the bills and collect original documents related to treatments and expenses
• Step 2: Email the duly filled and signed claim form along with documents required to ICICI Lombard
• Step 3: A team will check and reviewthe claim request and approve it accordingly, query or reject the same (as per policy terms and conditions)
• Step 4: After this, the claim will be settled as per policy’s terms and conditions.

#Other Third-Party Administrator Claims – Cashless

• Step 1: Get admitted only in the ICICI Lombard’s network hospitals
• Step 2: Send the insurer a fax of the pre-authorisation form along with relevant documents i.e. ​previous consultation papers, investigation reports, photo ID, ​cashless ID, etc.
• Step 3: Team of ICICI Lombard Health Care will review the claim and accept, reject or raise a query accordingly
• Step 4: Claims will be settled by the insurer with the hospital after completing several formalities.

#Other Third-Party Administrator Claims – Reimbursement

• Step 1: After getting discharged, pay all the bills and collect original documents relatedto treatments and expenses
• Step 2: Email the duly filled and signed claim form along with documents required to ICICI Lombard
• Step 3: A team will check and reviewthe claim request and approve it accordingly, query or reject the same (as per policy terms and conditions)
• Step 4: After this, the team will settle the as per policy’s terms and conditions and reimburse the amount approved.

Frequently Asked Questions 

Q1-How to contact ICICI Lombard Health Insurance?

The company provides a toll-free number 1800 2666. Customers can call on this number and avail information on top-up, NAV, premium paying term and breakup of premium, etc. For NRI customers, the helpline number is +91 40 6627 3505 (chargeable).

Q2-What is annual sum insured?

The basic sum insured amount is the maximum limit that the insurer will pay the customer, as per the rules listed in the insurance contract at the time of claim.

Q3-What is waiting period?

Waiting period is the duration only after which a customer can make the claim.

Q4-What are the parameters considered by the insurer for calculating the premium amount?

The following are the factors considered by the insurer:

• Cover option opted (individual or floater)
• Senior most members’ age
• Sum insured chosen
• Sum limit (if any)
• Optional add-ons