ICICI Lombard Health Insurance - Health Advantage Plus Policy

ICICI Lombard Medical Health Insurance - Benefits

• Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental treatment, medical bills, ambulance charges etc
• Avail Cashless Claim facility at 3,500 network hospitals across India
• A maximum of 2 adults can be covered under a single policy.
• Now get additional Sum Insured for every claim free year.
• Avail tax benefit under Section 80 D of the Indian Income Tax Act, 1961 *
• Pre-existing illness covered after two years, subject to continuous renewal of the policy.
• Maternity expenses can be covered under OPD expenses of this plan up to the OPD sum insured
• ICICI Lombard Health Advantage Plus insurance policy has no sub-limits on room rent, doctor fees, and hospital charges or for any disease except Cataract (INR 20,000 per eye applicable)
• ICICI Lombard Health Advantage Plus insurance policy has no co-payments for any disease or any Hospital usage
• Insurance against Terrorist activities.
• Buy Online through ICICI Bank, HDFC Bank and Citibank Credit card and pay in EMIs without any extra charges**

ICICI Lombard Health Insurance - Coverage

Basic Hospitalisation Cover

Covers medical expenses incurred: As an inpatient during hospitalisation for more than 24 hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic tests, etc.

• 30 days prior to hospitalisation
• 60 days post hospitalisation
• Pre-existing diseases shall be covered after 2 years
• This policy also covers you for hospitalization# in case of Swine Flu / H1N1 influenza

Following technologically advanced treatments do not need 24-hour hospitalisation but are covered under this policy are:-

• 30 days prior to hospitalisation
• 60 days post hospitalisation
• Pre-existing diseases shall be covered after 24 months of continuous coverage since inception of first individual health policy with the company.
• Technologically advanced treatment that do not need 24-hour hospitalisation but are covered under this policy are:-
  
  
  1. Cataract
  2. Lithotripsy (Kidney Stone Removal)
  3. Tonsillectomy
  4. Eye Surgery
  5. Dialysis
  6. Dilatation & Curettage
  7. Chemotherapy
  8. Radiotherapy
  9. Coronary Angiography
  10. Cardiac Catheterization
  
  
  

ICICI Lombard Health Medical Insurance - Eligibility

• The enrollment age (of senior most member) can be between 5 to 65 years of age .
• Maximum two adults can be covered under a single policy.
• The Proposer needs to be above 18 years of age.
• No health check-up up to the age of 55 years (age as on last birthday).
• Individual(s) proposed for Insurance whose age is 56 years & above have to undergo medical tests at ICICI Lombard designated diagnostic centers.
• The policy cover is renewable till the age of 70 years.
• Income Tax benefit u/s Section 80D of the Income Tax Act, 1961 can only be availed for policies bought for self, spouse, dependent children or parents.

ICICI Lombard Mediclaim Insurance - Exclusions

Exclusions for Basic Hospitalization Benefit Cover:

Exclusions valid for the firs 30 Days

-Any illness contracted within 30 days of the inception date of the policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals of this policy.

Exclusions valid for the first 2 Years

Treatment of the following diseases -

• Cataract **
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation & Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
• Dialysis required for chronic renal failure
• Surgery on tonsils and sinuses
• Gastric and duodenal ulcers
• Deviated Nasal Septum

** Sub limit of Rs. 20,000 per eye is applicable.

If the policy is renewed with us for 2 consecutive years, the above diseases/illness/ailments will be covered from the 3rd year. If these are pre-existing diseases at the time of inception of the policy, the same will be covered from the second consecutive renewal.

Permanent Exclusions

• Any illness/ disease/ injury/ pre-existing disease before the inception of the policy. However, this exclusion ceases to apply if the policy is renewed with the Company for 2 consecutive years.
• Non-allopathic treatment, pregnancy and childbirth related diseases, cosmetic, aesthetic and obesity related treatment.
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self injury
• War, riots, strike, nuclear weapon induced treatment.

Exclusions for OPD (Outpatient Department Expenses):

• Suicide or self-inflicted injury
• Alcohol or drug abuse
• War, riots, nuclear related hospitalization
• Non-allopathic treatment, experimental and unproven treatment
• Expenses arising from treatment of HIV/ AIDS or related disease, use or misuse of alcohol and other intoxicating substances and intentional self-injury

ICICI Lombard Medical Insurance - Claims

Claim Process

Cashless Hospitalisation Inform ICICI Lombard Health Care helpline and register claim Validation & Authorisation TPA/ICICI Lombard Health Care settles bills directly with hospital/provides financial assistance Reimbursement Medical Expenses & other claims Inform TPA/ICICI Lombard Health Care Helpline and register claim Validation & Authorisation Mail the required documents to claim department at mailing address TPA/ICICI Lombard Health Care to check and reimburse payment