ICICI Lombard Health Insurance

ICICI Lombard General Insurance Company is a leading private sector general insurance company in the insurance market. The company offers a range of general insurance products both for retail customers as well as for corporate ones. The policies offered by the company have a comprehensive scope of coverage and the premiums are also low. Even in the health insurance segment, ICICI Lombard offers some of the best policies which provide extensive coverage to policyholders.

Why choose ICICI Lombard health insurance?

ICICI Lombard has a very good track record which makes the company reputed. Here are some reasons which make ICICI Lombard health insurance plans popular –

1. As on the financial year ending 31st March 2019, the company’s Gross Written Premium crossed INR 147 billion. This shows that the company has a good financial standing
2. The company also settled more than 1.6 million claims as on the financial year ending 31st March 2019
3. ICICI Lombard has received various awards and recognitions over the years. Some of these include the Most Broker Friendly Insurer Award in the year 2019, ET Aspire 2 Good Award in 2016-17 and 2017-18 for all-round excellence and activities in CSR, etc.
4. The company is tied-up with more than 5020 hospitals across India enabling you to avail easy cashless claim settlements
5. The claims are also approved within 4 hours making them quick and hassle-free

List of ICICI Lombard health insurance plans

ICICI Lombard offers three types of health insurance plans to its customers. One is an indemnity oriented health insurance plan which provides comprehensive coverage and pays for the actual medical costs. The second plan is a top-up health insurance plan which helps you in increasing your coverage level at very affordable premium levels. The third one is a personal accident plan which pays a fixed amount of benefit in case of accidental deaths and disablements.

Let’s analyse the plans in details –

1. ICICI Lombard Saral Suraksha Bima

Unexpected events and accidents can turn your life into pathos. Although diseases may still seem to be avoidable at times, it can be hard to avoid an accident. So, all you can do is make yourself financially strong with ICICI Lombard Saral Suraksha Bima. An affordable personal accident insurance plan, in case of permanent disability or death of the insured member in an accident.

Salient features:

The key characteristic features of this policy are given below:

1. ICICI Lombard Saral Suraksha Bima covers accidental disablement and death

2. The policy offers two kinds of coverages:

1. Base cover: It consists of in-built benefits and is available to all insured persons.

2. Optional cover: This provides some optional benefits that are available to the insured persons according to the terms and conditions in their policy.

3. A sum insured of up to Rs. 1 crore can help you beat the rising medical inflation.

4. Benefits of cumulative bonuses from 5% to 50% are also available.

5. On getting admitted and treated in the hospital for at least 24 hours, you will get the hospitalization coverage benefits.

6. The benefits of this plan, except for the optional coverage of “hospitalization expenses caused due to an accident,” are applicable globally.

7. This plan doesn’t have a family floater option. You need to buy separate policies for each of your family members.

8. The plan also offers add-on covers:
1. Temporary Total Disablement
2. Hospitalisation Expenses
3. Education Grant

Coverage benefits:

Let us now take a look at the coverage benefits of this policy:

Death Benefit
Saral Suraksha Bima pays you 100% of the sum of the policy insured in case of permanent disability or accidental death of the insured person just within 12 months after the accident

Benefit for permanent partial disablement
In case the policyholder suffers a permanent partial disablement because of the accident, he or she will receive a particular percentage of the sum insured according to the terms and conditions mentioned in the policy. For example, if the policyholder loses one hand, he will get 50% of the sum insured, but in case he or she has only lost a thumb, the policyholder will receive 25% of the sum insured

Benefit for temporary total disablement
If the policyholder encounters an accident and gets injured that prevents him or her from working temporarily, the scheme will provide temporary compensation quarterly or at the termination period of disablement.

Educational funding
In case a policyholder meets death or permanent total disablement, a one-time educational grant of 10% of the base sum insured is paid to the dependent children who are pursuing an educational course in an educational institution as a full-time student, provided that they are not more than 25 years.

Benefits for hospitalization expenses
When a policyholder meets an accident and gets admitted to the hospital, his or her medical expenses, up to 10% of the insured sum, are covered by this policy. Hospital expenses include room rent, ICU fees, surgeon’s charges, medicinal costing, diagnostic expenses, etc.

Exclusions:

The exclusions of the ICICI Lombard Saral Suraksha Bima scheme are described below:

• Violation of law or illegal activity

• Drug abuse or abuse

• Intentional self-injury (except in cases of self-defence)

• Participation in civil war, war, law breach, or hazardous sports.

Eligibility Criteria:

2. ICICI Lombard Complete Health Insurance Plan

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

Here are the benefits which are covered under the plan –

• Inpatient hospitalisation
• Daycare treatments
• Post and pre hospitalisation
• AYUSH treatments
• Ambulance cover

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

Exclusions under ICICI Lombard Complete Health Insurance Plan

The following instances of claims are not covered by the plan –

• Medical expenses due to illnesses suffered within the first 30 days of coverage
• Suicide attempted suicide or self-inflicted injuries
• Expenses due to alcohol or substance abuse
• Dental treatments and cost of lenses or spectacles
• HIV/AIDS or any other sexually transmitted illness
• Pregnancy-related expenses unless the maternity coverage rider is added to the policy

Eligibility parameters of ICICI Lombard Complete Health Insurance

Entry age	6 years onwards Dependent children can be covered from 3 months to 5 years
Sum insured	INR 3 lakhs to INR 50 lakhs
Basis of coverage	Individual or family floater Under family floater, self, spouse, dependent parents, dependent children and siblings can be covered
Pre-existing waiting period	2 years
Policy term	1 or 2 years
Pre-entrance medical check-up	Not required if age is below 46 years and sum insured is up to INR 10 lakhs

3. ICICI Lombard Health Booster

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 ages
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, 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.

Exclusions under ICICI Lombard Health Booster plan

This ICICI Lombard health insurance plan does not cover the following –

1. Pre-existing illnesses in the first 24 months of buying the plan
2. Any illness or disease occurring in the first 30 days of buying the policy
3. Specific illnesses occurring within the first 2 years of buying the policy
4. Injuries or illnesses suffered due to self-inflicted injuries, war, nuclear radiation, etc.
5. Cosmetic treatments or congenital illnesses
6. Dental treatments or LASIK eye treatments

Eligibility parameters of ICICI Lombard Health Booster Plan

Entry age	6 years onwards Dependent children can be covered from 3 months to 5 years
Sum insured	INR 5 lakhs to INR 50 lakhs
Deductible limit	INR 3 lakhs to INR 5 lakhs
Basis of coverage	Individual or family floater Under family floater, self, spouse, dependent parents, dependent children and siblings can be covered
Pre-existing waiting period	2 years
Policy term	1, 2 or 3 years
Pre-entrance medical check-up	Not required if age is below 46 years and sum insured is up to INR 10 lakhs

4. ICICI Lombard Personal Protect Policy

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 follows –

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 –

1. Carriage of a dead body

   Under this cover, the costs incurred in carrying the dead body back to the residence are covered.

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. Funeral expenses extension

   This extension pays the cost incurred on making funeral arrangements for the insured who died in an accident.

9. 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.

Exclusions under ICICI Lombard Personal Protect Plan

Under this ICICI Lombard health insurance plan, different types of accidental contingencies are covered. However, there are some contingencies which are excluded from the scope of coverage. These contingencies include the following –

• Self-inflicted injuries or attempted suicides
• Accidents suffered when committing an act of criminal nature or when under the influence of alcohol and/or drugs
• Any accidental injuries caused due to insanity, mental illness, participation in hazardous events or sports, etc.
• Accidents suffered due to war, nuclear threats, related perils, etc.
• Disablements or accidental deaths suffered after 7 days of the accident
• Pregnancy and maternity-related complications

Eligibility parameters of ICICI Lombard Personal Protect Plan

Entry age	18 years to 65 years
Sum insured	INR 3 lakhs to INR 25 lakhs
Members covered	Coverage can be taken for self, spouse, dependent children and dependent parents
Policy term	1 year
Pre-entrance medical check-up	Not required

How to buy ICICI Lombard health insurance plans?

You can buy ICICI Lombard health insurance plans online or offline. Offline plans are sold at the company’s branches or by the insurance agents of ICICI Lombard. You would, therefore, either have to visit the nearest branch of ICICI Lombard to buy the policy offline or contact one of the company’s insurance agents. In both the modes, an application form would have to be filled physically and you should submit the form with your relevant documents. The premium should also be paid by cash or cheque and the policy would be issued after the company underwrites it.

An easier alternative is to buy ICICI Lombard health insurance plans online. The online medium is quick and hassle-free. ICICI Lombard allows online purchases of its health insurance plans. To buy the plan online, visit https://www.icicilombard.com/ and choose the health insurance policy that you want to buy. You can, then, fill up an online form stating your coverage details. Once the details are entered, you would be able to check the premium of the plan that you intend to buy. Pay the premium through any online mode and the policy would be issued at the earliest by the insurance company.

Things to consider before buying ICICI Lombard health insurance plans

Before you buy any ICICI Lombard health insurance plan, here are some things which you should consider –

1. The sum insured of the policy should be sufficient enough to meet the medical costs which you would incur. If affording a high sum insured is a problem, you can opt for Health Booster along with a basic health insurance plan. The Health Booster plan would enhance the coverage but keep the premiums low
2. Ensure that all the members of the family, who are dependent on you, are covered under the policy
3. Opt for a longer tenure coverage so that you don’t have to renew annually and you can also enjoy lower premiums
4. Also, include optional coverage benefits under the policy if they suit your coverage requirements. This would help in making your coverage more comprehensive

Renewing ICICI Lombard health insurance plans

Renewal of ICICI Lombard health insurance plans is also simple and can be done online. Just visit https://www.icicilombard.com/, choose ‘Renewals’ and choose ‘Health Policy’. You would then have to enter in your policy number and the date of birth of the eldest member who is insured under the plan. When the details are provided, your policy details will be displayed. You can then renew the policy online by paying the premiums through any online mode.

When renewing your health insurance plan, it is always advised to compare the plan with other health insurance plans available in the market. Health insurance plans allow porting and if you find a better policy offered by another company, you can port your ICICI Lombard health insurance policy at the time of renewal. To compare you can choose Turtlemint which is an online platform tied up with leading health insurance companies. You can visit https://www.turtlemint.com/health-insurance, fill in your coverage details and you will be shown some of the best health insurance plans available in the market. You can then compare the available plans and choose the best policy which offers the widest coverage at the lowest premium rates.

Making a claim in your ICICI Lombard health insurance policy

In your ICICI Lombard health insurance policy, claims happen when you are hospitalised and incur medical costs. In ICICI Lombard’s Personal Protect Policy, claims occur when you suffer from an accidental disablement or death. For making health insurance claims, the process is as follows –

1. Inform the insurance company immediately of your claim
2. If you are admitted in a networked hospital, a pre-authorization form needs to be filled and submitted to the insurance company for approval of cashless claims. You should fill and submit the form 3-4 days before a planned hospitalisation or within 24 hours of an emergency one.
3. Once the form is submitted, ICICI Lombard would assess the claim and approve the cashless settlement
4. Thereafter, you can take cashless treatments at the hospital and your medical bills would be settled by the insurance company
5. After being discharged from the hospital, you should submit a claim form and all the relevant documents so that claim is settled quickly by the insurance company
6. If you are admitted to a non-networked hospital, you should bear the medical costs yourself. Thereafter, the claim form and the hospital bills should be submitted to ICICI Lombard for reimbursement of the medical costs that you have incurred

Documents for health insurance claims

1. Claim form
2. Copy of the policy document
3. Proof of identity of the insured
4. Medical bills
5. Hospital bills
6. Medical reports
7. Doctor’s prescriptions advising hospitalisation
8. Any other medical report or bill associated with the claim
9. Any other document as required by the insurance company

In case of personal accident claims, you should inform the company immediately by sending a mail at customersupport@icicilombard.com or by calling the company’s toll-free number at 1800 2666. Once informed, the company would guide you with the claim process. To get a settlement of your claims, you are required to submit a set of documents. These include the following –

Documents for accidental claims

1. Claim form
2. Copy of the policy document
3. Police FIR
4. Post-mortem report and death certificate in case of accidental deaths
5. Medical reports
6. Discharge summary
7. Proof of disability
8. Any other documents required by the company

Review of ICICI Lombard health insurance plans

ICICI Lombard offers a range of varied health insurance plans which fulfil all types of coverage needs. While the Complete Health Insurance plan provides comprehensive coverage for hospitalisation expenses, Health Booster helps you in enhancing your coverage at a lower premium and Personal Protect guards against accidental contingencies. The plans, therefore, provide all-round coverage. The premiums are also low and you also get a choice of optional add-ons to make the plan more comprehensive as per your coverage requirements.