ICICI Lombard Health Insurance Claims Procedure

Founded in the year 2001, ICICI Lombard was the result of a partnership between the India-based ICICI Bank Limited with the Canada-based Fairfax Financial Holdings Limited, a financial services organization. ICICI Lombard is one of India’s most prominent insurance player in the private segment which offers its services and products via its 221 branches that are located across India. In the health insurance segment, ICICI offers a number of health insurance policies, each of which is designed to fulfill all your . Along with their health insurance policies, ICICI also boasts of a robust claim filing and settlement process which is hassle-free and simple.

Types of Health Insurance Claims:

Health insurance claims can be filed as one of two types - cashless claims or reimbursement claims. A Cashless/Cashless Hospitalization/Cashless Treatment Claim will arise when the insured wishes to seek medical treatment at an ICICI Lombard network hospital. Under cashless treatment, the insured will not be required to pay the treatment/hospitalization bill, which will be footed by the insurance company upon successful verification of the claim. Cashless hospitalization can be availed for planned or emergency hospitalization. The other type of claim that can be made on a health insurance policy is a Reimbursement Claim. Under this claim, the insured must bear the costs of hospitalization/medical treatment, and later ask the insurance company to reimburse these costs.

Incurred Claims Ratio of ICICI Lombard for the Year 2016-17:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
1335.34 crore 1204.70 crore 90.22%

Incurred Claims Ratio of ICICI Lombard for the Year 2017-18:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
1349.32 crore 921.00 crore 68.26%

Process for Cashless Claims:

Cashless claims can be filed for planned and emergency hospitalization. In case of planned hospitalization, the insurance company must be informed at least 48 hours in advance while for emergency hospitalization, the insurer must be informed not later than 24 hours after hospitalization has taken place. Following are the steps to be followed to make a cashless claim.

  • You would first need to get in touch with the network hospital that provides cashless facility for ICICI Lombard health insurance. You need to ensure that you have your health card with you which would be issued by ICICI Lombard and seek admission for your treatment..
  • You need to intimate the cashless facility. Simply call the number mentioned on the card or the health insurance helpline number mentioned on the company website. For planned hospitalization make sure you reach out to the company 2 days prior to admission.
  • Submit the health card along with a proof of ID to the network hospital who in turn will conduct the verification of your credentials.
  • A pre-authorization form will be required to be filled in, from the hospital, where the attending doctor will have to sign it. This can be downloaded from the ICICI Lombard website but needs to be faxed to the insurance company along with relevant information.
  • The health insurance company will then communicate with the relevant bank to update the status of the claim made, which could be either be acceptance or rejection or possibly the request for additional information or documentation. You can check out the claim status on the website itself.
  • Once accepted, the medical bills and costs covered under the policy are settled by ICICI Lombard. But the things or expenses not covered under the health insurance have to be paid by you.
  • As a policy owner you need to verify and sign the original bills and at the same time keep a photocopy of the entire hospitalization record.

Process for Reimbursement Claims:

For filing a Reimbursement claim, here are the steps to be followed.

  • Inform ICICI Lombard when you are hospitalized.
  • Once your hospitalization/treatment is complete and you have paid the bills for the same, you must retain all bills and documents related to the treatment/hospitalization with you to file for the claim.
  • Submit the aforementioned bills and documents to ICICI Lombard for processing of the claim. If the treatment is covered under the scope of the terms of your policy and you have provided all the necessary documents, the insurer will process your claim and reimburse you for the amount of the bills, in accordance with the coverage of the policy.

Documents Required for Claim Processing:

  • Claim Form: The claim form which needs to be filled with relevant details, signatures and finally be submitted.
  • Hospital Bills and Summary: All the original hospital bills, with stamps and signatures from the hospital have to be submitted.
  • The original discharge report has to be submitted as well.
  • All other originals reports related to the treatment (including medicine bills and investigation reports) has to be submitted.
  • The future line of treatment as well as follow-up check-ups by the relevant doctor should be sent as well.
  • If seeking treatment in a non-network or unregistered hospital, you need to get the details of the hospital on the official letterhead that includes the number of doctors, nurses and beds available.

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