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Hospitalization can be a strain on a person’s health and finance. Hence we
bring you ICICI Prudential Hospital Care Health policy, a complete and
all-inclusive cover which ensures that your hospitalization becomes
pain free for you
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After logging into ICICIBank.com, visit Investments >>Buy Life Insurance |
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 Payout  in addition to other plans |
You can claim benefit amount from this policy as well as other medical insurance policies, since you need to submit only photocopies or duplicates of bills and certificates. The benefit amount paid to you will be irrespective of your actual medical expenses. |
| Cashless hospitalisation |
You can avail of cashless hospitalisation facility in more than 5000 network hospitals. In case you have availed treatment at any of the network hospitals we shall settle the billed amount directly to the hospital. |
| Multiple claims |
You can claim multiple times during the policy term, so long as the total claimed amount does not exceed the benefit limit. |
| Transparent coverage norms |
This policy is transparent and informs you upfront about benefit payouts, coverage and exclusions to help you plan better. |
| Guaranteed coverage |
This policy guarantees you coverage for the entire policy term, so that you enjoy the benefit of the cover, irrespective of any claims made or a change in your health status during the policy term. |
| Tax benefit* |
Avail tax benefits on premium paid up to Rs. 15,000/- u/s 80D of the Income Tax Act, 1961*, subject to amendments from time to time. |
*Tax benefits are as per the Income Tax Act, 1961, and are subject to any
amendments made thereto from time to time. |
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| Daily Hospitalization Cash Benefit |
Payment of daily fixed benefit amount (Rs 1000/-) to take care of your hospitalisation expenses |
| Daily ICU Cash Benefit |
Additional Rs 500/- benefit paid on a daily basis for admission in the Intensive Care Unit (ICU). |
| Surgery Benefit |
A fixed lump-sum benefit amount is paid in addition for more than 900 surgical procedures. The amount paid depends on the type and severity of the surgery. |
| Recuperating benefit |
Additional recuperating benefit of Rs 3000/- paid on being hospitalised continuously for 5 or more days. |
*Tax benefits are as per the Income Tax Act, 1961, and are subject to any
amendments made thereto from time to time. |
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| Benefit |
Plan A (Rs.) |
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| Daily Hospitalisation Cash Benefit (per day) |
1,000 |
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| ICU (Intensive Care Unit) Benefit per day) |
500 |
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| Recuperating Benefit |
3,000 |
| Surgery Benefit |
| Surgery grade 1: Tennis elbow release, bladder stone removal |
15,000 |
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| Surgery grade 2: Hernia, Removal of uterus |
50,000 |
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| Surgery grade 3: Removal of kidney, removal of thyroid gland |
75,000 |
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| Surgery grade 4: Open heart surgery, removal of brain tumor |
1,00,000 |
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| Hospital Care policy offers you high benefit limits. For instance, under plan A, you can claim up to Rs.4 lacs for multiple claims, including surgical benefit up to Rs.3 lacs annually. However, for the entire policy term, you can make multiple claims up to Rs.20 lacs. |
| Benefit Limits |
Plan A (Rs.) |
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| Yearly Limit |
4,00,000 |
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| Surgical benefit |
3,00,000 |
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| Policy Term Limit (upto 20 years) |
20,00,000 |
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You can claim benefit amount from this policy as well as other medical insurance policies, since you need to submit only photocopies or duplicates of bills and certificates. The benefit amount paid to you will be irrespective of your actual medical expenses. |
You can avail of cashless hospitalisation facility in more than 5000 network hospitals. In case you have availed treatment at any of the network hospitals we shall settle the billed amount directly to the hospital. |
You can claim multiple times during the policy term, so long as the total claimed amount does not exceed the benefit limit. |
This policy is transparent and informs you upfront about benefit payouts, coverage and exclusions to help you plan better. |
This policy guarantees you coverage for the entire policy term, so that you enjoy the benefit of the cover, irrespective of any claims made or a change in your health status during the policy term. |
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| In case you opt for plan A, then for an 8-day hospitalisation, your benefit amount is |
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| 8 days * Rs. 1,000 per day = Rs. 8,000 |
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| Recuperating Benefit = Rs. 3,000 |
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| Total benefit amount = Rs. 11,000 |
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On issuance of the policy, as part of the Welcome Kit, you will receive the following:
1) Health Card (a card which has your policy number and contact info rmation of ICICI
Prudential and it can be utilized only in Network Hospitals)
2) Claims and Pre-Authorization Forms |
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When there is a need for hospitalization, you can inform ICICI Prudential about hospitalization by calling on the contact number provided on your health card.
You need to provide following information. |
 Your Policy Number (as mentioned on the health card) |
| Name of insured person who is hospitalized. |
| Nature & Details (location, date of accident or commencement of sickness) |
| Name & Address of Hospital, where life insured is admitted |
Payment of daily fixed benefit amount (Rs 1000/-) to take care of your hospitalisation expenses |
Additional Rs 500/- benefit paid on a daily basis for admission in the Intensive Care Unit (ICU). |
A fixed lump-sum benefit amount is paid in addition for more than 900 surgical procedures. The amount paid depends on the type and severity of the surgery. |
Additional recuperating benefit of Rs 3000/- paid on being hospitalised continuously for 5 or more days. |
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Photocopies or duplicates of the following documents will be needed
to process the claim |
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| If I get a claim from two companies, will my payout from hospital care become taxable? |
Hospital care is a benefit based health insurance plan which qualifies for the tax exemption under section 80D and the payout is not taxable |
| If death occurs during the course of Hospitalization, will the benefit amount be paid to the Nominee? |
In case of death during hospitalization all the applicable benefits will be paid except for the recuperating benefit which is a living benefit |
| Can a customer switch from one Plan to another during the tenure of the policy? |
A customer can’t switch from one plan to another during the tenure of the policy however he can always buy another plan subject to underwriting guidelines of ICICI Prudential Life Insurance Company. |
| Can a surgery claim be made even if the procedure does not require Hospitalization? |
Yes. The applicable surgery benefit will be paid as per the Grade. As long as the surgery is in the list of covered procedures, the payout is not dependent on Hospitalization. The DHCB however will not be paid. |
| Is the recuperating benefit dependent on any documents/prescription? |
No. The recuperating benefit is payable after continuous hospitalization of more than 5 days. The proof of such duration of hospitalization is the only document required. |
| Can I make a claim if I get treated overseas? |
You are entitled for a claim made overseas, provided the diagnosis and treatment occurs from the specified list of countries mentioned in policy Document |
| Are the listed Surgeries according to any standardized definition? |
Yes. The surgical procedures are described as per the International classification of Diseases (ICD) prescribed by World Health Organization |
| If I already have a pre-existing illness, can I get covered under Hospital Care? What are the exclusions for this? |
Yes. For pre-existing illness the company may add extra premiums (rating) or may exclude the pre-existing disease from the scope of the policy, but the coverage can be provided for all other medical conditions |
| Can this policy be proposed to family? Which family members are eligible? |
This policy can be proposed to spouse & dependent children only and not to parents, siblings or non blood relations. |
| With which hospitals is the cashless facility available and how can I get the list? |
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| What is the duration within which a claim has to be reported to ICICI Prudential? |
If the claim is from a network hospital then 4 days prior to the planned hospitalization by forwarding the pre-authorization form. In case of emergency, within 24 hours of getting admitted
If the claim is from a non-network hospital then within 60 days of getting discharged from the hospital, the claim request should be given to the insurer.
All claims will be settled in 7 working days after receiving request.
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| Is the policy holder’s signature mandatory in the pre-auth / claims form? |
Yes. The policy holder’s signatures are required in the pre-auth and claims form. However, only in exceptional case of emergency hospitalization, the signature of attendee can be put in the pre-auth form. But, claims form will require only policy holder signatures or even thumb impression to process the claim request. |
| Can I buy another health or life policy from ICICI Prudential in case my ICICI Pru Hospital Care plan is lapsed? |
Yes, you can buy another life plan even if ICICI Pru Hospital Care is lapsed. However, in case you are buying another health plan within 12 months of lapsing ICICI Pru Hospital Care, all the arrear in premium will have to be cleared first. There is no such condition if you buy another plan after 12 months. |
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Notes: |
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- Only ICICI Prudential policy can be purchased through this facility. This facility is not applicable for existing ICICI Prudential policy holders.
- The issuance of policy is subject to completion of KYC documentation.
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Disclaimer:
ICICI Bank is acting merely as the Corporate Agent with ICICI Life and there is no direct or indirect linkage between the provision of the banking services offered by the Bank to its customers and their usage of the product or participation in the scheme. The participation to this product is purely on a voluntary basis. ICICI Bank has not sponsored any of the products displayed or listed or it does not take any responsibility for any information or content displayed on the website owned by ICICI Prudential Life Insurance. For more details on risk factors and terms and conditions please read the policy document before conducting a sale. Insurance is a subject matter of solicitation.
For more details on the risk factors, term and conditions please read sales brochure carefully before concluding the sale. Unlike traditional products, Unit linked insurance products are subject to market risk, which affect the Net Asset Values and the customer shall be responsible for his/her decision. The names of the Company, Product names or fund options do not indicate their quality or future guidance on returns. Funds apart from return guarantee fund do not offer guaranteed or assured returns. Investments are subject to market risk. In this policy, the investment risk in the investment portfolio is borne by the policy holder. Tax benefits are as per the Income Tax Act, 1961, and are subject to any amendments made thereto from time to time. Service tax & education cess will be charged extra as per applicable rates. Tax laws are subject to amendments from time to time. Advt number: W/II/125/2008-09 Hospital Care: Form No T12: UIN 105N068V01, Lifestage Pension: Form No U49: UIN 105L075V01, Lifetime Gold: Form No. – U53, UIN: 105L077VO1; Lifetime Super Pension: No. – U40, UIN: 105A019V01; Lifestage RP: No. – U48, UIN: 105L073V01 |
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