ICICI Lombard Health Booster: Coverage, Claim & Renewal

Updated: 02-04-2019 10:25:08 AM

ICICI Lombard Health Booster is super top-up health insurance cover that helps take care of the excess payment that needs to be paid for illness over and above the amount covered by your existing health insurance plan. It is available in one, two or three year policy period with lifetime renewability option. Even if you do not have any other Health Insurance policy, you can choose the Super top-up cover and get Sum Insured beyond the deductible chosen.

Eligibility

• Anyone who is 18 years of age or above can buy this plan for themselves and their family members
• Insurance coverage is available for children above the age of 3 months under the family floater option. For an individual policy, the child should be 6 years or older
• Medical underwriting is mandatory for individuals above the age of 45 years or opting for Sum Insured more than Rs. 10,00,000 or both

Features and Benefits

The ICICI Lombard health booster comes with a range of features and benefits listed here:

• Floater Option for the Family: The insurance plan offers floater option to provide coverage to the entire family since up to 2 adults and 3 children can be covered under a single policy. In this option, all the members will be covered for the similar sum insured amount under a single plan by paying only one premium. The relationships covered include self, spouse, dependent children, dependent parents, brother, sister, grandparents, grandchildren, mother-in-law, father-in-law, son-in-law, daughter-in-law, dependent brother-in-law and dependent sister-in-law.
• Wide Range of Annual Sum Insured and Flexible Deductibles: Since different people have different needs, ICICI Lombard has provided a wide range of Annual Sum Insured option for the Health Booster plan.The policyholder can choose the Sum Insured as low as Rs. 5 lakh and as high as Rs. 50 lakh. The flexible deductibles option help you avail the benefits of this health insurance plan based on your needs and budget.
• Cashless Hospitalisation: One of the main reasons why the ICICI Lombard Health Booster plan is popular among the masses is because of its cashless hospitalisation feature. The policyholder can visit the ICICI Lombard network providers or hospitals (details available on the company’s website) and get treatment without the need to spend anything since the company will directly pay for hospitalisation and treatment expenses subject to the policy terms.
• Reset Your Sum Assured up to 100%: The policyholder can request the company to reset the up to 100% of the Sum Insured once in a policy year for plans with deductible of Rs. 3,00,000 and above if the Sum Insured in addition to accrued Additional Sum Insured is insufficient due to previous insurance claims in the samepolicy year.
• Domestic Road Emergency Ambulance Cover: Expenses up to 1% of Sum Insured up to Rs. 5,000 incurred by you on availing ambulance services in the case of an emergency will be covered under this plan.
• Access to Wellness Program: This health insurance plan rewards you for your healthy behaviour through its wellness services. Depending on the activity under this Wellness Program, you will earn reward points tracked by the company and rewarded accordingly.
• Ayush Benefit to Cover Alternate Treatment: The ICICI Lombard Health Booster plan also covers the expenses of undergoing an alternate treatment i.e. Ayurveda, Unani, Siddha and Homoeopathy (AYUSH) up to the Sum Insured when it is taken in a government hospital or government recognised institution or accredited by the National Accreditation Board on Health (NABH) or Quality Council of India.
• Enjoy Income Tax Benefits: You can avail tax benefits on premium paid towards this health plan as per the provisions of Section 80D, Income Tax Act, 1961 subject to the terms prescribed therein. Consult your tax advisor for more details. Section 80C benefits are not provided.

For any queries regarding the Premium Paying Term (PPT), top-up premium, Net Asset Value (NAV), breakup of premium, insurance coverage, etc. of any one of the ICICI Lombard products, you can contact the company by dialing 1800 2666 (within India)/ +91 40 6627 3505 (outside India) or emailing customersupport@icicilombard.com.

Exclusions

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

Permanent Exclusions

·         Cataract ·         ENT issues such as Sinusitis, Deviated Nasal Septum and related health issues ·         Gynaecological issues such as Fibroids, Endometriosis, PCOD, Prolapsed Uterus, etc. ·         Orthopaedic issues such as Arthritis, Spinal and Vertebral Disorders, Osteoporosis, Rheumatism, Gout, etc. ·         Gastrointestinal issues such as Cholecystitis, Pancreatitis, Haemorrhoids, Piles, ulcers, etc. ·         Tumours, cysts, nodules, lumps, polyps and all types of internal congenital anomalies, illnesses or defects

·         Pre-existing injury, disease or illness before the inception of the policy for the first two years ·         Medical expenses incurred during the first 30 days of the policy term except for accidental expenses ·         Expenses arising because of self-inflicted injuries such as suicide, attempted suicide, etc. ·         Expenses attributable to the use of drugs, alcohol, etc. ·         Pregnancy and childbirth-related issues including miscarriage, abortion, etc. except ectopic pregnancy proved by diagnostic and certified to be life-threatening by the Medical Practitioner ·         Tests and treatments related to fertility-related treatments including IVF ·         Cost of spectacles, contact lenses, hearing aids and dental treatment ·         Expenses incurred on the treatment of AIDS ·         Injuries or diseases directly or indirectly related to war, invasion, etc.

 

How to Make Claims for ICICI Lombard Health Booster?

Cashless Claims

Step 1: Get admitted to one of the ICICI Lombard’s  network hospitals. 

Step 2: Contact the insurer’s in-house claim processing team and send the details such as policy number, name, relationship with the policyholder, nature of illness or injury, etc. at least 48 hours before a planned treatment or hospitalization. For an emergency treatment or hospitalization, contact the claim processing team within 24 hours of the treatment or hospitalization.

 Step 3: The claim processing team will review the claim and accept, reject or raise a query accordingly. You have to submit documents to support the claim.

Reimbursement Claims

Step 1: Get admitted to one of the ICICI Lombard’s empanelled network hospitals.

Step 2: Contact the insurer’s in-house claim processing team and send the details such as policy number, name, relationship with the policyholder, nature of illness or injury, etc. at least 48 hours before a planned treatment/hospitalization, within 24 hours of the treatment or hospitalization for an emergency treatment/hospitalization or within 7 days of the completion of the treatment /procedure in all other cases. 

Step 3: After getting discharged, pay all the bills and collect original documents related to treatments and expenses. Email the original documents along with the duly filled and signed claim form to ICICI Lombard.

Step 4: The in-house claim processing team will check and review the claim request and approve, reject or raise a query for the same as per the terms and conditions of the policy.

FAQs

Q1-What is Reset Benefit offered under the ICICI Lombard Health Booster?

If you have already availed claims during a policy year, you may find yourself in a situation in which the funds are insufficient to clear the future medical claims. The company offers Reset Benefit for the ICICI Lombard Health Booster plan with deductible of Rs. 3,00,000 and above so that you can easily make future claims during the policy year. The Sum Insured can be reset by up to 100% once every policy year if you are eligible for the Reset Benefit. It is important to note here that Reset will not trigger for the first claim.

Here are the conditions in which the insured can claim the Reset Benefit:

• Plan with deductible Rs. 3 lakh and above
• Sum Insured and accrued Additional Sum Insured are insufficient for future claims during the policy year
• It is not the first claim during the policy year
• The future claim is not related to the illness, disease or injury of the same person for whom a claim has already been paid within the same policy year

Q2-What are the documents required for the ICICI Lombard Health Booster?

Documents required to make the claim:

• Duly completed and signed Claim form also signed by the Medical Practitioner
• Original bill, receipts, discharge certificate from the hospital or Medical Practitioner
• Original bills from the chemist with a proper prescription
• Original reports and payment receipts
• Medical Practitioner’s referral latter for advising hospitalization except in the case of accidents or other emergencies

Q3-What if I do not utilise my Reset Sum Insured in a policy year?

The Reset Benefit offered by ICICI Lombard company for the Health Booster plan helps policyholders to make future claims and make full use of their insurance plan even if they have already availed a considerable portion of their Sum Insured. However, any un utilized Reset Sum Insured is not carried forward to the next policy year.