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The rising levels of stress and increasing cost of healthcare means that a major illness is always on the cards and so is the financial burden. Alleviate this burden by going in for our ICICI Lombard Group Health Insurance plan.
• Exclusive offering for ICICI Bank customers. Customer needs to be an Insured member.
• Adults from 21 to 60 years, children from 91 days to 20 years; child will be covered under floater plan only
Tenure
• 1 Year
Family definition
• Self, spouse and max. 2 dependent children upto 20 years of age
• 30 days for all diseases except hospitalisation due to accident
Specific exclusions
• Standard list of diseases & procedures will be covered after 30 days of initial waiting period.
Pre-existing disease(s) (PED)
• Declared & accepted PED will be covered after 30 days of initial waiting period and needs to be declared by insured for all insured members in policy.
• Any non-declaration of PED will lead to rejection of claims and cancellation of policy.
| Features | |
| Room Rent | No Capping, covered up to SI |
| Pre - Post Hospitalisation | Pre Hospitalisation and Post Hospitalisation for 60 days & 90 days respectively are covered. |
| In-patient Hospitalisation | Covered up to SI |
| Day Care Procedures
|
All Day Care Procedures are covered
|
Domiciliary Hospitalisation |
Covered upto Sum Insured for Medical expenses for treatment taken when confined within one's home subject to completion of minimum 3 continuous days of such hospitalisation |
Domestic Road Ambulance Service |
Covers road ambulance expenses, incurred to transfer the Insured following an emergency to the nearest hospital per event of emergency hospitalisation, provided we have accepted the in-patient claim up to a maximum limit as below |
Donor Expense |
Covered upto Sum Insured as per definition, provided organ used is for Insured person |
Unlimited Reset Benefit |
Reset will be available unlimited times in a policy year in case the annual Sum Insured including accrued Additional Sum Insured (if any) and Super No Claim Bonus (if any), Sum Insured Protector (if any) is insufficient as a result of previous claims in that policy year will be applicable only within the geographical boundaries of India. |
Claim Protector |
The items which are not payable under the claim as per the list of excluded items released by IRDAI that is related to the particular claim will become payable. This cover will be applicable only within the geographical boundaries of India. |
ASI Protector |
Additional Sum Insured (ASI) accrued by you will not be impacted or reduced at renewal if any one claim or multiple claims admissible in the previous policy year under the policy does not exceed the overall amount of Rs.50,000. This cover will be applicable only within the geographical boundaries of India. |
Sum Insured Protector |
The SI will be increased on cumulative basis at each renewal on the basis of Inflation rate in previous year. |
Pre policy Medicals |
Tele UW incase of declared PED |
Pre-Existing Diseases |
Pre-Existing Diseases that have been declared at the time of proposal and accepted by us will be covered with 30 days waiting period. |
Home Healthcare |
We will cover the medical expenses incurred by you on availing treatment at home. This cover will be applicable only within the geographical boundaries of India. |
Health Check Up |
Not Applicable |
Health Assistance Services |
Not Applicable |
30 Days waiting period |
Cataract |
Benign Prostatic Hypertrophy |
|
Myomectomy, Hysterectomy unless because of malignancy |
|
All types of Hernia, Hydrocele |
|
Fissures &/or Fistula in anus, hemorrhoids/piles |
|
Arthritis, gout, rheumatism and spinal disorders |
|
Joint replacements unless due to accident |
|
Sinusitis and related disorders |
|
Stones in the urinary and billiary systems |
|
Dilatation and curettage, Endometriosis |
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All types of Skin and internal tumors/ cysts/ nodules/ polyps of any kind including breast lumps unless malignant |
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Dialysis required for chronic renal failure |
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Surgery on tonsils, adenoids and sinuses |
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Gastric and Duodenal erosions & ulcers |
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Deviated Nasal Septum |
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Varicose Veins/ Varicose Ulcers |
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All types of internal congenital anomalies/illness/defects |
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| Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded. |
| Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes: i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons. ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs. |
| Obesity/ Weight Control: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: 1) Surgery to be conducted is upon the advice of the Doctor 2) The surgery/Procedure conducted should be supported by clinical protocols 3) The member has to be 18 years of age or older and 4) Body Mass Index (BMI); a) Greater than or equal to 40 or b) Greater than or equal to 35 in conjunction with any of the following severe co- morbidities following failure of less invasive methods of weight loss: i.Obesity-related cardiomyopathy ii.Coronary heart disease iii.Severe Sleep Apnea iv.Uncontrolled Type2 Diabetes |
| Gender treatments: Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex. |
| Hazardous or Adventure sports: Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving. |
| Breach of law: Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent. |
| Excluded Providers: Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim. |
| Circumcision whether or not necessitated by vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery unless necessary for treatment of a disease not excluded by the terms of the policy or as may be necessitated due to treatment of an accident. |
| Cosmetic or plastic Surgery: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, It must be certified by the attending Medical Practitioner. |
| Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. |
| Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons |
| Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure. |
| Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. |
| Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness |
| Sterility and Infertility: Expenses related to sterility and infertility. This includes: (i) Any type of contraception, sterilization (ii) Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI (iii) Gestational Surrogacy (iv) Reversal of sterilization |
| The cost of spectacles and contact lenses, hearing aids. |
| Dental treatment or surgery of any kind unless requiring hospitalisation. |
| Convalescence, general debility, run-down condition or rest cure, congenital external disease or defects or anomalies, , intentional self-injury (whether arising from an attempt to suicide or otherwise) and use of intoxicating drugs and/or alcohol. |
| Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any diseases, illness or injury whether or not requiring Hospitalisation/ Domiciliary Hospitalisation. |
| Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Medical Practitioner. |
| Diseases, illness, accident or injuries directly or indirectly caused by or contributed to by nuclear weapons/materials or contributed to by or arising from ionising radiation or contamination by radioactivity by any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel. |
| Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception. |
| Maternity: i.Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period |
| Naturopathy treatment |
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