ICICI Lombard Health Care Plus Policy

Brief Overview

One of the leading insurance companies in India, ICICI Lombard General Insurance has been recognised for offering customer-centric solutions to all kinds of insurance needs. The company’s Gross Written Premium, GWM crossed a massive INR 147 billion in the 2018-19 financial year. 

When it comes to health insurance, the company provides very comprehensive covers, that too at an affordable premium.  With a collaboration of  over 6,500 hospitals all over the country, you can avail the benefits of cashless hospitalisation in almost every corner of the country.

There are many health insurance policies offered by ICICI Lombard. In this article, we are going to discuss the ICICI Lombard Health Care Plus Policy. An ideal plan, Health Care Plus offers wide cover to you and your family. The plan will not only cover you for COVID-19 but also other treatments. Let us look at the plan in detail.

ICICI Lombard Health Care Plus Policy - Highlights

• For 4 members of your family members (including the policyholder), you will receive an individual cover for all
• Special features have been introduced for health insurance against COVID-19
• You have different options when it comes to selecting the Sum Insured
• There is an option for you to ascertain the amount of deductible
• You can choose a policy tenure of 1 or 2 years
• There are no sub-limits on room charges, hospitalisation charges, doctors’ fee and diagnostic tests etc
• Save taxes under Section 80D, Income Tax Act

ICICI Lombard Health Care Plus Policy - Benefits

• High Priority for COVID-19
  In case you get hospitalised because of COVID-19, the policy will have the following feature:
  • There would be no effect on the additional sum insured, which is 10% of Annual Sum Insured, provided on renewal for every claim-free year. This facility is available till 31 March 2021
  • Home healthcare treatment is covered on a cashless basis
  • A dedicated helpline has been set up for COVID-19 queries. You can call on 04066274205
  • The company is settling COVID-19 claims digitally on high priority
  • The initial waiting period for COVID-19 claims will be 15 days. For all other hospitalisations, except accidents, the waiting period is 30 days
• Options to Choose Sum Insured
  With a wide range of sum insured from INR 5 lakhs to INR 10 lakhs, you have many options to select a premium that suits your budget.
• In-patient Treatment Expenses
  When you are admitted to a hospital for treatment of an injury/illness and you need to be admitted for more than 24 hours, the expenses will be covered. The policy overs:
  • Room charges, Boarding and nursing
  • Consultation Charges
  • Medicines and consumables
  • Diagnostic procedures
  • ICU charges
  • Consultation fees
• Cashless Claims
  With a hospital network of over 6,500 , you can make cashless health insurance claims almost anywhere in the country.
• Pre and Post Hospitalisation
  Expenditure on treatment is not limited to hospitalisation. The expenses that you incur 30 days before and 60 days after the hospitalisation will be covered. Note that the expenditure is for the same injury/illness.
• Day Care Treatment
  Day-Care treatments require in-patient hospitalisation for less than 24 hours. Around 150 surgeries or treatments are covered under this policy.
• Ambulance Cover
  If in an emergency, an insured is transferred to the nearest hospital in an ambulance, the road ambulance cost will be covered. You can claim INR 1,500 per hospitalisation as a reimbursement.
• Reset Benefit
  If you exhaust your Sum Insured during the policy period, it will be reset back to 100% of the SI amount. However, keep in mind that you cannot make claim for the same illness during the policy year
• Wellness Programme
  By participating in the List of wellness activities, you earn reward points
• Alternative Treatments
  If you get admitted to a government hospital, the expenses on the alternate treatment will be covered. The following treatments are covered:
  • Ayurvedic
  • Unani
  • Siddha
  • Homoeopathy

ICICI Lombard Health Care Plus Policy - Other Details 

• Value-added Services
  • Free health check-up can be availed by the insured, which is subject to a maximum of 2 coupons/year for floater policies
  • You can chat online with medical practitioners
  • e-Consultation Follow-Up session with a specialist
  • e-Consultation for Diet and Nutrition
• Cancellation of Policy
  The cancellation is possible when:
  • There is misdescription or non-disclosure of any fact from your side. The policy shall be terminated and the premium paid would be forfeited
  • You can send a written request to cancel the policy. The health insurance premium shall be refunded, in case no claim has been made, and deducting the pre-declared
• Other Details at a Glance

ICICI Lombard Health Care Plus Policy - What is not Covered?

• Illnesses or injuries that existed even before the policy is bought is not covered for initial 4 years
• Treatments undertaken during the first 30 days of policy purchase are not covered, except accidental injuries
• Certain diseases are not covered for treatment during the first 2 years, a few of them are given below:
  • Cataract
  • Hernia and its types
  • Joint replacements due to arthritis
  • Stones in urinary and biliary systems
  • Gastric and duodenal ulcers

Permanent Exclusions

• Regular eye, ear examinations, cost of spectacles
• Self-inflicted injuries
• Dental treatments, unless it is an accidental injury
• Birth defects
• Congenital diseases
• Mental Illness, psychological disorders
• Cosmetic/Plastic Surgery, unless it is required after an accidental injury
• Alcohol or drug abuse
• Birth control procedures and hormone replacement therapy

For a more detailed list, you may visit the official website: https://www.icicibank.com/Personal-Banking/insurance/general-insurance/health-insurance/health-advantage-plus/benefits.page  

ICICI Lombard Health Care Plus Policy - Renewal Health Plan

When the term of your health insurance policy ends, you can renew it for another year or two. Renewal refers to the terms on which the contract is renewed, and on mutual consent. If you do not renew your policy once it expires, it will be terminated and you would not be able to draw any benefits. To renew the policy you can get in touch with your insurance agent if any. Or you can do it online. When renewing the health insurance policy online, you can either visit the company website or go to an insurance aggregator website.

Let us take a look at the terms of Renewal:

• In most cases, except for fraud and misinterpretation, a policy is renewed
• The premium that is to be paid at the time of renewal is IRDAI approved
• If you wish to increase the sum insured, you can do it at the time of renewal. However, a fresh waiting period will apply to this new limit, from the date of enhancement.

ICICI Lombard Health Care Plus Policy - Eligibility

ICICI Lombard Health Care Plus Policy - Claim Process

Cashless Claims
You can avail the benefits of cashless hospitalisation if you are admitted to a network hospital. A network hospital has a collaboration with the Insurance Company /TPA. When you produce your Health Card at the time of admission, it entitles you to cashless treatment that you are authorised.

When and How to Make a Cashless Claim?

• Notification - You must inform the insurance company as soon as possible. At least 48 hours in case of planned treatment or within 24 hours in case of emergency hospitalisation.
• Authorisation - Only when you inform the company on time, you will receive prior-authorisation.
• Claim Processing - The Insurance Company or TPA will settle the bills directly with the hospital. Along with the claim form, certain documents will also be submitted. The list of documents is given below.
• Payment of Claims - You will pay your share of the claim amount based on the deductible selected by you.
• Settlement/Rejection of Claim - The claims would be settled within 30 days from the date of submission of documents. If your claim has been rejected for some reason, you will be notified with proper reasons of rejection.

Documents Required for Cashless Claims

Filled and assigned pre-authorisation form

• Copy of Health card
• Photo ID of Insured member
• Doctor’s Consultation
• Investigation Reports

Reimbursement
When you get admission to a non-network hospital, you wouldn’t be able to get the benefits of a cashless facility. You would have to pay for the treatment up front and then request for reimbursement. This way the expenses made can be compensated by the insurance company.

When and How to Make a Reimbursement Claim?

• Hospitalisation - Get admitted to a hospital and get the treatment done
• Collection of Documents - When the treatment is over, collect all treatment-related documents from the hospital. If taking photocopies, make sure they are verified true copies
• Intimation of Claim - You must intimate the insurance company before hospitalisation in case of a planned hospitalisation and within 24 hours of hospitalisation in an emergency. You would then send filled and signed Claim form along with all the documents and mail them to ICICI Lombard Health Care, ICICI Bank Tower, Plot no. 12, Financial District, NanakramGuda, Gachibowli, Hyderabad – 500032
• Review by the Company - The documents will be scrutinised and reviewed by the TPA/ insurance company
• Status of the Claim - Whether your claim is accepted or rejected or more documentation is required, you will be intimated within a few days.

Documents Required for Reimbursement Claims

• Filled and signed pre-authorisation form
• PAN Card
• Health Card
• Police FIR, in case of an accidental injury
• NEFT Details, along with a cancelled cheque
• Doctor’s Consultation
• Investigation Reports
• All diagnostic and pathological Reports
• Original discharge summary, with the date of admission and discharge, history
• All bills and receipts
• Invoice of transplants, if applicable
• Nature of Illness and the Treatment required
• Detail of Individual Medical services
• Doctor’s prescriptions - medicines or/and diagnostic tests

ICICI Lombard Health Insurance - Customer Care Details 

ICICI Lombard Health Care Plus Policy - Review

A wide range of health insurance plans is offered by ICICI Lombard and like most of them, Health Care Plus Policy also offers comprehensive coverage for hospitalisation. The plan offers various sum insured options to choose from, along with a flexible deductible. These features make the Health Care Plus Policy a very affordable plan. There are no sub-limits on room charges, investigative tests and doctor’s fee. Thus, when in hospital, you can concentrate on getting treated rather than worrying about the lengthy hospital bills. So, if you are above 18 years of age and are looking for a health insurance plan that covers your medical bills and also offers wide coverage, this might be the right option for you.