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  • ICICI Lombard Health Insurance

    ICICI Lombard Health Insurance
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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    ICICI Lombard GIC Ltd. is a joint venture between ICICI Bank Limited, India's second largest bank with total assets of over USD 99 billion at March 31, 2014 and Fairfax Financial Holdings Limited, a Canada based USD 37 billion diversified financial services company engaged in general insurance, reinsurance, insurance claims management and investment management. ICICI Lombard GIC Ltd. is one of the largest private sector general insurance company in India with a Gross Written Premium (GWP) of Rs 71.34 billion for the year ended March 31, 2014.


    ICICI Lombard Health Insurance at a Glance

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    Coverage for your most loved ones

    Total members covered

    Coverage for a maximum of 4 family members with up to 2 adults and 2 children

    You get a choice of coverage tenure

    Pre and Post Hospitalization cover

    Medical expenses covered for 30 days before your hospitalization and 60 days for post hospitalization for related medical expenses

    The next best thing to having a doc in the family

    Health Check-ups

    Free health check-up 2 times a year

    * For a family health cover product.

    Critical Factors of the Plan

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    Not a paisa goes from your own pocket!

    Co-Pay

    No Co-pay

    You?re covered for any future medical expenses

    Life long renewable

    Plans are lifelong renewable and covers you for your entire lifetime.

    Get essential cover for existing ailments

    Pre-existing Diseases

    Any pre-existing condition will be covered after a waiting period of 4 year

    Hospital room rent determines your treatment bill

    Room Rent

    No sub-limits on room rent

    *These Features may be included as part of different products and are subject to the insurer's terms & conditions.

    Additional Features of ICICI Lombard Health Insurance

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    Good health offers multiple rewards

    Hospital Daily Cash and Convalescence Benefit

    The world is your healthcare oyster

    Get cashless medical treatment across India in 4,000+ network hospitals

    *These add-ons may be included as part of different products and are subject to the insurer's terms & conditions.

    Overview

    ICICI Lombard GIC Ltd. was formed as a result of a union between India’s ICICI Bank and Lombard Canada Ltd. of Canada’s Fairfax Financial Holdings Ltd., both mega players in their respective industries.


    ICICI Bank is one of India’s top private banks, outranking a number of its peers in terms of profitability, operational efficiency and customer service among other aspects. It has established a far-reaching network of branches which services an impressive customer-base, in both the urban and rural sectors. It services corporate and retail clients alike through its many innovative and personalised products, developed to suit diverse banking needs, economically and efficiently.

    Lombard Canada Ltd. is a leading financial services provider in Canada, specialising in non-life insurance i.e. general insurance, reinsurance, claims management etc. Headquartered in Toronto, it has a strong credit-rating and a sound reputation for servicing claims efficiently and successfully.


    ICICI Lombard General Insurance Co. Ltd. brings to the Indian market the combined expertise of these two individual enterprises, making it a formidable force in the general insurance industry. It offers insurance solutions to individuals as well as companies in the form of personal and business financial protection solutions respectively. Some of their retail insurance solutions include auto insurance, travel insurance, personal accident and health insurance to name a few.


    Among the company’s health insurance offerings are the following plans:

    1. ICICI Complete Health Insurance
    2. Health Care Plus
    3. Personal Protect
    4. ICICI Lombard Health Advantage Plus
    5. ICICI Lombard Critical Care

    ICICI Complete Health Insurance

    This is a total health insurance solution that aims to provide coverage to not just the proposer but also his/her family. It is made affordable through its two coverage options i.e. Cover on an Individual Basis (which is taken for each person separately, premiums being payable for each insured member) or on a Floater Basis (wherein the entire family is covered for a particular amount). Coverage options are also flexible. Customers can choose to make their cover more comprehensive by opting to to cover critical illnesses in addition to the basic plan.


    Entry Age 3 months for children if at least one adult is also covered
    Policy Period 1 yr. or 2 yrs
    Renewability Lifetime
    Medical Screening Required for entrants over 46 yrs.
    Basis Individual or Floater
    Sum Assured Rs.1, 2, 3, 4, 5, 7 or 10 lakhs.
    (chosen amount can be enhanced at renewal)

    No-claim Bonus: 10% increase in sum assured for every claim-free year; max. 50%; awarded at renewal
    Premium Discount if voluntary deductible is opted for
    Coverage iHealth Plan - Inpatient hospitalisation expenses: Boarding, Nurse Care, ICU, Doctor/Surgeon, Anesthesia, Blood, Oxygen, OT
    - Specified Day care treatment
    - Pre/Post-hospitalisation expenses: Up to 30 / 60 days respectively
    - Ambulance Costs: Up to Rs.1,500 per hospitalisation
    - Pre-existing diseases: 2 or 4 yr. waiting period depending on chosen coverage
    - Yearly Health-checks: Limited to 2 per yr. on floater basis
    Add-on Covers Option 1
    - Daily Cash Allowance: Per day of hospitalisation; max. 10 days; deductible: 3 days
    Rs.500 for coverage options Rs.1 lakh or 2 lakhs
    Rs.1,000 for coverage options Rs.3, 4 or 5 lakhs
    Rs.2,000 for coverage options Rs.7 or 10 lakhs
    - Convalescence Benefit: Hospital stay of10 days or more; Rs.10,000 per insured member; one-time per policy period
    Option 2 - For coverage options above Rs.2 lakhs
    - Critical Illness: One-time, Lump sum payment on diagnosis for -
    Cancer, CABG, Heart Attack, Major Organ Transplant, Stroke, Paralysis, Heart Valve Replacement,
    Terminal Liver Failure
    - Organ Donor Expenses: Up to Rs.50,000; reimbursed

    Health Care Plus

    This plan is offered on an individual basis covering health care expenses related to admissible injuries/illnesses.


    Entry Age 18 yrs. to 65 yrs.; 5 yrs. for children
    Policy Period 1 yr. or 2 yrs.
    Renewability Lifetime
    Medical Screening Required for entrants over 56 yrs.
    Basis Individual
    Coverage - Inpatient hospitalisation expenses: Up to chosen sum assured (no sub-limits): Room, Doctors,
    Surgeons, Medicines, Equipment, Diagnostic Tests etc.
    - Health-checks: On renewal; limited to one insured member
    - Pre-existing diseases: After a 4 yr. waiting period

    Personal Protect

    This plan can be taken in addition to a basic health plan held by a customer. It covers financial loss due to death or Permanent Disablement arising from an accident.


    Entry Age 18 yrs. to 80 yrs.
    Policy Period 1, 3 or 5 yrs.
    Sum Assured Rs.3, 5, 10, 15, 20 or 25 lakhs
    Coverage - Death or Total Permanent Disablement (TPD) resulting from an accident
    - TPD: Loss of sight in both eyes; loss of / loss of use of both hands or both feet or one hand and one foot
    Add-on Covers - Hospitalisation expenses for injuries resulting from the accident, up to 7 days from the accident:
    Coverage options - Rs.10,000, 25,000, 50,000 or Rs. 1 lakh, depending on chosen basic sum assured.
    - Daily Cash Allowance for hospital stay (max. 30 days per yr.) Rs.1,000 or Rs.2,000 depending on
    chosen basic sum assured; 1 day deductible per hospitalisation applies

    ICICI Lombard Health Advantage Plus

    The ICICI Lombard Health Advantage Plus is a health insurance scheme meant specifically for individuals for covering their inpatient and outpatient treatments. The maximum cover amount is limited to Rs.3 Lakhs and hence the policy suits an individual the best instead of two or more people. Medical procedures that are just a day-care affair are also covered under this policy. The outpatient cover, however is limited and varies with age and sum assured. The Health Advantage Plus policy can be availed as a stand-alone policy or as a floater policy which is additional to another base plan.


    Entry Age 5 years to 65 years
    Policy Period 1 year or 2 years
    Renewability Till the age of 75 years
    Medical Screening Required for people over 45 years of age
    Basis Individual or Two people with Floater Benefit
    Sum Assured Rs.2 Lakhs minimum or Rs.3 Lakhs maximum
    Renewal Premium Renewal premium is subject to change as per IRDA guidelines. This premium can be paid to ICICI before the policy expiration date and in no case later than 15 days from the expiry of policy.
    Coverage
    • Covers all inpatient expenses during hospitalization for more than 24 hours
    • 30-days pre-hospitalization expenses
    • 60-days post-hospitalization
    • Pre-existing diseases are eligible for cover in case of two consecutive years of renewal with the company
    • Cover against Swine Flu/ H1N1 Influenza
    • More than 10 technologically advanced treatments that do not need more than 24 hours of hospitalization are covered
    • Outpatient Treatment covered, like dental, maternity, pharmacy and so on. OPD expenses like room, boarding expense, nursing expenses, Dental Treatment, dialysis, Operation Theater Charges etc. are also covered
    Tax Benefits Income Tax benefit on premium paid, under section 80D of the Income Tax Act 1961
    Claim Process Both, Cashless as well as Reimbursement options are available for claim settlement
    Exclusions in the Policy Pre-existing diseases – Can be changed if the policy is availed continuously for two straight years Permanent Exclusions – Non-Allopathic Treatment, HIV and AIDS related expenses, Medical expenses to treat drug and alcohol abuse symptoms, War and nuclear-weapon induced illnesses, Suicide or self-inflicted injury, experimental treatment

    While choosing an appropriate plan, it is advisable to be aware of those items which the plan, specifically, does not cover (i.e. exclusions). There may also be some terms and conditions attached to the policy which should also be studied.


    *Service tax and other charges should be factored in where applicable.

    ICICI Lombard Critical Care

    The critical care plan offered by ICICI Lombard is a scheme that has been designed for working professionals, which gives them a measure of protection from critical illness. The policy is offered to professionals up to the age of 65 years with those below the age of 45 years, not requiring any medical tests. The policy offers to pay a sum assured on the diagnosis of any one of 9 critical illness. The aim of providing such an amount being to help policyholders cope with the expense of treatment and to stave off any possible loss of income or savings.

    Claims Process

    The ICICI Lombard health insurance claims process is straightforward and can be completed with minimum hassles. The claims process is divided into three distinct treatment categories namely:

    1. Reimbursement process
    2. Cashless Emergency process
    3. Cashless Planned process

    Reimbursement Process

    The reimbursement process pertains to the process of receiving compensation for your treatment costs accrued within the policy tenure.

    • Patient gets treated at a hospital and pays all the bills.
    • All the documents related to the treatment are collected by the patient including duly-filled application form, payment slips, final hospital bill, discharge summary, reports, pharmacy bills with doctor’s prescription, copy of health card and so on.
    • All the documents are submitted to an ICICI Lombard Health Care outlet, or are mailed to the mailing address in Hyderabad for processing.
    • Received documents are reviewed by the company, and the final decision is meted out as Approved, Query, and Rejected. Approved and Rejected statuses are self-explanatory, while Query refers to the scenario where patients may have to submit documents as requested by ICICI Lombard. Also, all the statuses will be notified through SMS.

    Cashless Emergency Process

    The Cashless Emergency process is applicable on network hospitals of ICICI Lombard, which can be found in the policy documents as well as the official website. Essentially, the treatment costs arising out of hospitalization are directly settled by the insurer and the hospital in this process.

    • Patient receives treatment in a network hospital of ICICI Lombard and requests for cashless settlements with the company.
    • ICICI Lombard reviews the request and informs the hospital about the authorization status.
    • Patient signs all the documents once the request has been approved, and before leaving the hospital. Cashless approval is provided only for medical-related expenses.
    • On approval, bills are paid by the insurer directly to the hospital, and an SMS notification will be forwarded to the customer.
    • If more information is needed, the status is converted to Query, and notified accordingly. Rejections will also be notified through SMS.

    Cashless Planned Process

    This is mostly similar to the Cashless Emergency process, with the difference being that the insurer should be informed about the planned hospitalization not more than 2 days before actual hospitalization.

    • Patient talks with a doctor and charts out the future course of diagnosis.
    • Cashless Planned hospitalization request is sent at least 2 days before hospitalization.
    • ICICI Lombard reviews the request and informs the hospital about the authorization status.
    • If approved, all related documents are to be signed by the patient before getting discharged, and the bills are settled between the hospital and ICICI Lombard.
    • SMS notifications will be forwarded for approval status such as Approved, Rejected, and Query. Query means ICICI Lombard has requested for more documents pertaining to the customer’s hospitalization.

    ICICI Lombard Health Insurance FAQs

    1. What is the meaning of date of inception of a health insurance policy?
    2. The date of inception of a policy refers to the date when your policy becomes effective.


    3. What is optional coverage? Does ICICI Lombard provide it?
    4. Optional coverage means the add-on benefits in the insurance plan. Yes, the customers can include these add-ons in their policy.


    5. What is mandatory coverage?
    6. It means the original coverage that comes with the policy. You cannot remove it from the policy.


    7. What is a premium?
    8. A premium refers to the amount paid to the insurance company.


    9. What is the meaning of entry age and exist age?
    10. Entry age means the age of eligibility to buy a health insurance policy. Exit age refers to that age on reaching which a person cannot buy or renew his/her policy.


    11. What is the meaning of permanent exclusion?
    12. It means that the disease that falls under this category of permanent exclusion will not be covered under your health insurance plan.


    13. How is the claim procedure at ICICI Lombard?
    14. The claim procedure involves the following three steps -- intimation of claim, process of claim, and claim closure by making the payment.


    15. Whom should I contact to make a claim?
    16. In order to make a claim, you can either approach ICICI Lombard claim management team or the customer service department.


    17. Do I need to pay premium for the second year, if I have to renew my policy?
    18. Yes, you need to pay the premium for the second year, if you intend to renew it.


    19. What is the difference between an individual plan and a floater plan?
    20. An Individual plan refers to the separate plans for each individual. But a floater plan covers your family members as well.


    21. What are the expenses included under the sub limit amount at ICICI Lombard?
    22. The expenses spent in pre-hospitalization, room rent and other expenses related to the treatment process are covered in amount stated in the sub limit bracket.


    23. How does a higher health insurance coverage with ICICI Lombard help me?
    24. A higher health insurance coverage with ICICI Lombard helps you to get advanced and high quality treatment at its network hospitals.


    Examples of Network Hospitals in Major Cities

    CITY NAME OF HOSPITAL
    Kolkata Columbia Asia Hospital
    DELHI National Heart Institute
    BANGALORE Manipal Hospital
    CHENNAI Fortis Malar Hospital
    Mumbai Hinduja Hospital

    *Disclaimer - This is not an exhaustive list but an indicative representation of hospitals that form a part of the company's wider network.


    News About ICICI Lombard Health Insurance

    • Health insurance plans have not been availed by most smokers: ICICI Lombard Report

      Reports from a survey done by ICICI Lombard General Insurance Co. Ltd showed that 57% of the survey participants do not carry health insurance policies, despite being smokers. A total 1011 individuals responded to the survey via Facebook. The age of the respondents was between 22 years and 45 years. Out of this figure, 54% of the respondents were regular smokers. The types of policies held by the respondents owning health plans varied from regular health insurance policies, policies for critical illnesses and policies with high deductibles. Around 20% of the respondents were unsure whether they actually held any policy.

      1st June 2016

    • Health Advisor Platform launched by ICICI Lombard

      Keeping in mind customer satisfaction, ICICI Lombard has launched a health advisor platform which will help policyholders make informed decisions about the choice of hospitals. This platform will have customer reviews and ratings for hospital feedback.

      Through this platform consumers can get actual experience stories and more from other customers who have been through a similar course. The idea is to help policyholders plan their medical processes more effectively through exchange of information and reviews. The portal currently has over 750 hospital listing from around 10 cities in the country and covering over 30 medical procedure reviews.

      30th March 2016

    • ICICI Lombard predicts positive trends for 2016

      ICICI Lombard, the largest private sector general insurance company in India recently conducted a survey, the results of which promise a positive outlook for 2016. An increased level of alertness and facts about general healthcare and insurance during 2015 have resulted in informed customers who are checking facts and figures before opting for insurance policies. The current year also saw changing trends in the motor insurance category, with customers opting for vehicles with enhanced features and design, but still apprehensive about adding additional cover like Engine protection and RTI to their existing plans.

      17th December 2015

    • ICICI’s sale of 9% of General Insurance

      ICICI Bank will be selling 9% stake in ICICI Lombard General Insurance to Fairfax Financial Holdings for an amount of INR 1550 crore. The move comes directly after the decision by IRDAI allowing foreign investors to have increased stake in insurance companies born out of a joint venture.

      Finalisation of the deal will allow Fairfax Holdings to gain a 35% stake in the insurance venture from the earlier 26%. This stake increase is still within the acceptable limits of 49% as decreed by the government. An increased stake in the venture goes on to say that Fairfax undoubtedly has faith in the growth of insurance sector in India in general and the growth of the venture, in particular. The benefit of this increased stake could mean a wider spectrum of fund allocation for the purpose of insurance, allowing people to have options for larger sums of insurance.

      12th November 2015

    • ICICI Lombard Survey reveals the Need for Awareness on Health Insurance

      A recent survey by ICICI Lombard, a popular Indian general insurance company has shed some light on the mentality of earning Indians in the age limits of 25-35 years, particularly pertaining to health insurance. It was found that almost 86% of the sample set believed that they were healthy and didn’t have the need for a health insurance scheme. This survey was conducted across the cities of Mumbai, Delhi, Kolkata, Bangalore, Chandigarh, Lucknow, Hyderabad and Ahmedabad.

      While a majority of spend is done on household items, family, EMIs and premiums, only 5% of the overall expenditure is done on health and medicals. The trend has depicted that the uninsured ones tend to save less and spend more compared to the insured portion of the sample set. While a larger chunk of the sample set purchased insurance at the age of 30, they opined that they should have done the same at 25 or at least before 30.

      Awareness about health insurance needs to improve and the mentality about it being more than a tax saving option needs to change. This survey has explored some crucial corners of the Indian mentality with regards to health insurance.

      12th October 2015

    • Indian Women Neglect Health, Remain Uncovered by Health Insurance

      A recent survey conducted by ICICI Lombard Health Insurance reveals that a majority of women are not covered by health insurance. Only 39% women were covered by health insurance. Among the uncovered group of women, 53% women had not given any serious thought to it.


      ICICI Lombard General Insurance Company conducted this survey in February 2015. The main reason for conducting this survey was to find out women’s awareness towards their health. The survey received responses from 1009 women respondents. According to the survey, Indian women prioritize their family over their health, which is an accepted norm among 40% of the respondents. They have the tendency to neglect their health and health check-ups which is revealed by the responses coming from 79% of the women respondents who didn’t go for any tests or health check-ups, except when they are unwell.


      Although they suffer from various health disorders once or twice in a year, they neglect regular health check-ups. Indian women are more prone to diseases such as anaemia, metabolic disorders, cancer and arthritis compared to men as stated by ICICI Lombard’s claims data analysis for 2013 and 2014.

      11th March 2015

    • ICICI Lombard Reveals Dengue Treatment Tops Health Insurance Claims

      ICICI Lombard has brought to light that treatment of dengue is the main driver of insurance claims in Mumbai although the Municipal Corporation of Mumbai doesn’t agree.


      Dengue rose a whopping 96% in 2013. In 2011, 5% of the total claims from treatment of infectious diseases was dengue-related and gradually climbed to 8% in 2012 . It went up further by 1% to 13% in 2013.


      ICICI Lombard says that 50% of dengue problems occur in the last three months of the year. There was a jump of 91% in men and 103% in women in 2013. Most of the victims are in the age -group 26 to 35 years while the 16 to 25 years age-group is the next most infected. In most cases dengue leads to secondary infections like fever and other common infections of the respiratory tract and gastroenteritis.

      24th November 2014

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