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About ICICI Lombard Health Insurance

One of India's top private general insurance companies, ICICI Lombard, offers a wide array of insurance products.ICICI Lombard Health Insurance is one of its leading products that is in high demand among customers. Some of the other insurance products offered by the insurer include motor insurance, crop insurance, personal accident insurance, engineering insurance, fire insurance, liability insurance, and marine insurance.

The inclusion of benefits such as extensive coverage for hospitalization expenses, pre and post-hospitalization expenses, day-care procedures, and more contributes positively to an ICICI Lombard health insurance review.

ICICI Lombard has been in operation for more than 21 years. Over 32.7 million policies have been issued by the company to date. For the FY ending March 31, 2023, the company’s Gross Written Premium (GWP) totalled INR 217.72 billion. A total of 3.6 million claims have been settled by ICICI Lombard. The company’s team comprises nearly 12,865 employees (as of March 31, 2023) and it has around 305 branches across India.

ICICI Lombard Claim Settlement Ratio

99.7%

ICICI Lombard

94.21%

Industry Average

Health claim settlement ratio is the percentage of claims settled against the total claims received by the insurance company in a given fiscal year. ICICI Lombard has a claim settlement ratio of 99.7%, as compared to the industry average of 94.21%.

ICICI Lombard Health Insurance Plans Overview

ICICI Lombard health insurance offers 4 health insurance plans. The premium of these plans starts from Rs. 83.29/yr. The sum insured ranges from Rs. 3 Lakh - 1 Cr. Details of the comprehensive coverage provided by the following 4 ICICI Lombard health insurance plans are listed below:

ICICI Lombard Complete Health Insurance Plan

Starting Premium- ₹ 6,265/yr

This is an indemnity health insurance plan which covers the actual medical costs that you incur in case of hospitalisation.The salient features of the plan are as follows

  1. The sum insured is refilled by 100% if it is exhausted in a year on a previous claim
  2. The sum insured is increased by 10% every year if you don’t make a claim in that year
  3. The plan also has a wellness program which rewards you for maintaining good health
  4. Free health check-ups are allowed every policy year
  5. There are optional coverage benefits too which help you in customising your policy and increasing its coverage
  6. There are four coverage options under the plan. They are I Health, Health Protect Plus, Health Smart and Health Smart Plus
  7. There is no maximum entry age. Individuals of all ages can buy the plan Coverage benefits of ICICI Lombard Complete Health Insurance Plan
  8. Here are the benefits which are covered under the plan *Inpatient hospitalisation *Daycare treatments*Post and pre hospitalisation*AYUSH treatments*Ambulance cover
  9. There are optional coverage benefits too which can be taken at an additional premium.These benefits include the following
    • Hospital daily cash
    • Convalescence benefit
    • Maternity benefit
    • Newborn baby cover
    • Nursing at home
    • Compassionate visit by a family member
    • Outpatient treatment cover
    • Wellness and preventive healthcare
    • Critical illness cover
    • Donor expenses
    • Personal accident cover
    • Medical evacuation

Eligible Age

91 days onwards

PED Waiting Period

2 years

Coverage

3 Lakh - 50 Lakh

NCB

5% increase in cover;max upto 50%

ICICI Lombard Health Booster

Starting Premium- ₹ 1,584/yr

This is a top-up health insurance plan which acts as a supplemental coverage if you have an existing health insurance plan. If you want to enhance the sum insured of your existing health insurance plan at lower premiums, you can opt for this top-up policy. The policy is also an indemnity oriented health insurance plan which covers the medical costs incurred on actuals basis. The plan has a sum insured and a deductible. If your claims exceed the chosen deductible limit, then only the Health Booster policy would cover the costs and pay the excess claim. Since this is a super top-up plan, the claims incurred in a policy year would be considered in aggregate when considering the deductible limit

Let’s say that you buy a Health Booster policy where the sum insured is INR 10 lakhs and the deductible is INR 2 lakhs. Now, if you suffer a claim of INR 2.5 lakhs, the Health Booster policy would pay the excess claim of INR 50,000 which exceeds the deductible. If the claim is for INR 1.5 lakhs, the claim would not be met by the policy. However, if, in the same year, you incur another claim of INR 1 lakh, the aggregate claims become INR 2.5 lakhs. In this case, this ICICI Lombard health insurance policy would pay the excess claim of INR 50,000

Here are some of the salient features of the policy

  1. The policy is issued on an individual or family floater coverage basis
  2. You can renew the policy lifelong
  3. You can avail cashless treatments under the plan
  4. The coverage can be taken for up to 3 continuous years
  5. There is a range of sum insured and deductible options to choose from
  6. There is no maximum entry age making the plan suitable for individuals of all age
  7. The sum insured is reinstated if it is exhausted in a policy year
  8. An increase of 10% is allowed in the sum insured every year if you do not make claims
  9. You also get a free health check-up every year so that you can monitor your health regularly
  10. The company has designed various wellness-oriented programs.These programs reward you if you maintain a healthy lifestyle Coverage benefits of ICICI Lombard Health Booster Here are the coverage features which are available under the policy
    • Costs incurred on an inpatient basis if you are hospitalised for 24 hours or more
    • Costs incurred on 150-day care treatments which do not require hospitalisation of 24 hours or more
    • Costs incurred within 60 days before you are actually hospitalised
    • Costs incurred for up to 90 days after you are discharged from the hospital
    • Costs incurred on AYUSH treatments which are taken on an inpatient basis
    • Costs incurred on domiciliary treatments which are taken at your own home
    • Costs incurred in harvesting the organ for organ donor treatments
    • Costs incurred on an ambulance for taking you to the hospital for treatments Besides these inbuilt coverage benefits
  11. the plan also has a range of optional coverage features. These features include the following
    • Optional Cover I - This cover has a combination of two coverage benefits which are as follows
      • Hospital daily cash benefit wherein a fixed amount of benefit is paid daily if you are hospitalised for 24 hours or more
      • Convalescence benefit wherein a lump sum benefit is paid if you are hospitalised for a continuous period of 10 days
    • Optional Cover II- Under this cover option, there are three coverage benefits which are as follows
      • Personal accident cover wherein accidental deaths and permanent total disablements are covered. If any of these instances occur, the plan pays a lump sum benefit of INR 10 or 15 lakhs depending on the coverage selected
      • Temporary total disablement rehabilitation cover which covers temporary total disablements which render you unable to work. In such cases, you get a weekly payment of INR 5000 or INR 10,000 for up to 10 weeks
      • Repatriation of remains wherein coverage is allowed for transporting the mortal remains of the insured to his/her residence. This cover is available for INR 50,000 or INR 1 lakh
    • Optional Cover III - This is a critical illness optional cover where a specified list of critical illnesses is covered. If you are diagnosed with any of the covered illness, a lump sum amount would be paid.The amount would be INR 5 lakhs or 10 lakhs as selected by you.

Eligible Age

91 days onwards

PED Waiting Period

2 years

Coverage

5 Lakh - 50 Lakh

NCB

10% increase in cover;max upto 50%

ICICI Lombard Personal Protect Policy

Starting Premium- ₹ 384/yr

This is a comprehensive personal accident policy which covers accidental deaths and disablements. The policy is a fixed benefit health insurance plan which pays a lump sum benefit in case of claims irrespective of the actual costs incurred. The salient features of the plan are as follow

  1. All types of accidents are covered under the plan whether they are rail accidents, road accidents, air accidents or even due to terrorist activities
  2. Accidents due to natural calamities are also covered
  3. No medical check-ups are required to buy this policy
  4. The policy extends coverage not only in India but worldwide
  5. The premiums of the policy can be paid in instalments if you buy the plan online
  6. Your family members can also be covered under the policy

Coverage benefits under ICICI Lombard Personal Protect Policy This ICICI Lombard health insurance plan provides the following coverage benefits

  • Coverage against accidental death
  • Coverage against permanent total disability suffered in an accident
  • Coverage against permanent partial disability suffered in an accident
  • Coverage against temporary total disability suffered in an accident
  • Coverage for accidental hospital confinement. If the insured is admitted to a hospital after an accident, this cover pays a daily allowance for each day of hospital stay
  • Coverage for accidental hospitalisation expenses wherein the medical expenses incurred on hospitalisation due to an accident are covered
  • Convalescence benefit wherein the company pays a lump sum benefit if the insured is hospitalised due to an accident and the hospitalisation exceeds a specified number of days
  • Coverage for a lump sum benefit which would be payable if two or more insured members are injured in an accident and are hospitalised for a specified number of days Moreover,there are different optional coverage features which can be selected if you want to enhance the coverage of the plan

These optional coverage benefits come at an additional premium and include the following

  • Carriage of a dead body : Under this cover, the costs incurred in carrying the dead body back to the residence are covered
  • Medical benefits extension: If the insured suffers an accidental injury which is covered under the plan and is hospitalised, this extension would cover the hospitalisation costs incurred
  • Hospital daily allowance extension : In case the insured suffers from an accidental disablement and is hospitalised, the extension would give cash benefit for each day of hospitalisation
  • Permanent total disablement improvement extension : If the insured suffers from a permanent total disablement due to an accident, this add-on would pay an additional benefit apart from the claim payable under the policy
  • Permanent partial disablement improvement extension : If the insured suffers from a permanent partial disablement in an accident, the add-on pays an additional benefit along with the disability claim paid under the plan
  • Children’s education grant extension : If the insured dies or becomes permanently disabled in an accident, this extension would pay a lump sum amount which can be used to fund the insured’s children’s education
  • Ambulance charges extension : The expenses incurred in taking the insured individual to the hospital after an accident in an ambulance would be covered under this extension
  • Funeral expenses extension : This extension pays the cost incurred on making funeral arrangements for the insured who died in an accident
  • Repatriation of remains extension: Under this extension, coverage is available for the costs incurred in transporting the dead body from the accident spot to the residence

Eligible Age

18 years - 80 years

PED Waiting Period

NA

Coverage

3 Lakh - 25 Lakh

NCB

NA

Top Features From ICICI Lombard Health Plans

  1. Complete Coverage for Hospitalisation: ICICI Lombard Health Insurance Plans offer comprehensive coverage to the insured,including for pre- and post-hospitalisation expenses.
  2. Cashless Hospitalisation: Policyholders can avail of cashless hospitalisation benefits under ICICI Lombard Health Insurance.In case of any medical emergency and the need for urgent hospitalisation,you can opt for treatment at one of our several network hospitals, completely cashless.
  3. Top-Up Plans: A top-up plan offers extra coverage for any additional payment that you may need to incur over and above your existing health insurance plan by ICICI Lombard.
  4. Critical Illnesses: ICICI Lombard provides health insurance coverage for all critical and life-threatening diseases that generally require longer and costlier treatment.
  5. Pre-existing Diseases: Coverage for pre-existing diseases is also provided; however, it is subject to the survival and waiting period under ICICI Lombard Health Insurance policy.

Exclusions Across ICICI Lombard Health Plans

  1. Pre-existing Health Conditions: Pre-existing diseases such as asthma, cardiac conditions, diabetes, and hypertension will not be covered before 24-48 months of continuous coverage.
  2. Intentional Self-Injury: Suicide attempts or injuries owing to illegal acts are not covered.
  3. Lifestyle Conditions: Illnesses owing to poor lifestyle habits such as tobacco chewing, smoking, alcohol, drugs, and more will be excluded from coverage under ICICI Lombard Health Insurance.
  4. Maternity Complications: Any problems or complexities arising during pregnancy, abortion, childbirth, or miscarriage are excluded from health insurance.
  5. War or Nuclear Injuries: Harm caused by war injuries or those suffered during nuclear attacks, exposure to harmful radiations, biological, or chemical warfare are not covered.
  6. Dental/Eye Treatments: These are generally not covered under health insurance coverage by ICICI Lombard.
  7. HIV/AIDS: Treatment for these conditions is excluded from the health plans.
  8. Alternative Treatments: Therapies such as Naturopathy, Ayurveda, and Homeopathy are not covered.
  9. Cosmetic Surgery: Specific cosmetic treatments for the improvement or enhancement of a body part do not fall under medical insurance coverage of ICICI Lombard Health Insurance.

ICICI Lombard Premium Calculator

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ICICI Lombard Customer Care

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ICICI Lombard Claim Process

ICICI Lombard supports both cashless claims and reimbursement claims. This section covers the information on how to check ICICI Lombard health insurance claim status, fill ICICI Lombard health insurance claim form, and the claim settlement process.

Step 1: Choose a Network Hospital
In times of medical emergencies, go to the nearest network hospital of ICICI Lombard Health Insurance. You may need to get admitted for treatment at the hospital.

Step 2: Contact the Hospital Insurance Desk
Once admitted, a family member or any other contact of the insured must get in touch with the insurance desk at the network hospital. It would provide complete details on the claim-settlement procedure followed at the hospital.

Step 3: Contact the TPA
Third-Party Administrator or TPA is present at the insurance desk of every hospital. Request for a claim form from the TPA to duly fill in for filing a claim request.

Step 4: Submit the Form
After filling out all the required details on the form, submit it to the TPA desk along with the pre-authorisation letter or TPA declaration.

Step 5: Receipt of Email
You will receive an email confirming insurance coverage and the maximum amount sanctioned under the ICICI Lombard Health Insurance Plan.

Step 6: Settlement of Bill
Upon completion of your treatment, you can be dischargd from the hospital without having to pay any money to the hospital desk. If the final bill is within the limit of your sanctioned amount by ICICI Lombard Health Insurance, it will be settled directly with the hospital by the insurer.

Step 1: Inform the Insurer
You must inform ICICI Lombard Health Insurance regarding your hospitalisation before making a reimbursement claim.

Step 2: Make Sure your Documents are in Order
A
fter completing your treatment at the hospital, you would be required to pay the final bill at the time of discharge, unlike cashless hospitalisation. Once you have made the payment, you can file for a reimbursement claim with the insurer. Make sure that all your documents for hospitalisation are in order before making the claim. These include original prescription by the doctor, pharmacy and other medical expenses, diagnostic test expenses, hospital bills, and medical reports.

Step 3: Fill Out and Submit the Claim Form
Download the claim form from the official website of ICICI Lombard Health Insurance. Fill out the required details on the form and get it certified by your treating doctor at the hospital. Mail the form along with the complete set of documents to the insurer.

Step 4: Claim Request Processing
After submission of all the documents, ICICI Lombard Health Insurance will go through your claim request and may approve or reject it based on your policy coverage. In case approved, your claim amount will be transferred to your bank account.

ICICI Lombard Health Insurance Renewal Process

ICICI Lombard Health Insurance plans offer lifetime renewability. This means that you can easily renew your policy year after year upon lapse and continue enjoying its coverage benefits for a lifetime.

You can conveniently apply for ICICI Lombard Health Insurance renewal online on the company’s website. Alternatively, you may call the customer care number to initiate the process or connect with one of the team representatives at a branch near you for more assistance. Listed below is the simple step-by-step procedure to renew your ICICI Lombard Health Insurance policy online:
Step 1: Enter the required details on the ICICI Lombard Health Insurance website - https://www.icicilombard.com/. These would include the age group, number of insured people in the policy, and contact details.
Step 2: Now, choose the amount of coverage for your health insurance. Note that you are entitled to a 10% discount on a health cover chosen for 2 years.
Step 3: New users may need to register to sign up, while existing users can use their login credentials to sign in to their account on the website.
Step 4: You will be asked to enter the details of the insured, such as the name of the applicant, your relationship with the insured, and date of birth. Also, enter the contact details of the insured as well as the details of the nominee.
Step 5: Before making the payment, review the complete details entered and make any changes at this stage, if required.
Step 6: Now, choose your preferred payment option and enter your payment details to complete the payment.
Step 7: Once paid successfully, your ICICI Lombard health policy renewal process is complete. You may download and save a copy for your reference.

In case you are unable to follow the online renewal process, you may do the procedure offline by visiting the nearest branch of ICICI Lombard Health Insurance. Additionally, a Turtlemint expert insurance advisor would love to help you through the process. Visit www.turtlemint.com or download our app here.

Reference Links
https://www.icicilombard.com/about-us/who-we-are
https://www.probusinsurance.com/health-insurance/icici-lombard-health-insurance/
https://www.insurancedekho.com/health-insurance/icici-lombard/top-up
https://www.icicilombard.com/insurancevideos/Complete-Health-Insurance.html

FAQs

Permanent partial disablement includes loss of one hand, loss of one foot, loss of sight in one eye, loss of hearing in one or both ears, loss of fingers and thumbs of hands and/or feet, loss of individual fingers or toes, etc.

Yes, ICICI Lombard health insurance plans allow coverage for senior citizens too. Both health insurance plans offered by the company, Complete Health Insurance and Health Booster, have no maximum entry age making them suitable for individuals of all ages.

You would need to submit your identity proof, age proof, residence proof and photographs with the application form to buy the policy.

Free health check-ups provided under ICICI Lombard health insurance plans are allowed only for adult members. Under both health insurance plans, free health check-ups are allowed for up to two insured members only.

Yes, your health card would be mandatory if you want to make a cashless claim. Health cards contain your policy details and unique identification number. They allow the hospitals to identify the insured members so that cashless treatments can be provided. So, if you are taking treatments at a networked hospital, carry your health card with you for claim purposes.
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