 |
|||||||
Insurance - Health Insurance - FAQs - |
|||||||
|
| General | | | Cover | | | Premium | | | Claims |
- What
is the Family Floater Plan?
- Why
do I need health insurance?
- What
is a Health Card?
- What
are the benefits of a health card?
- Are
all policyholders eligible for a Health Card?
- How
does a Health Card function in case of a 2-year policy?
- Why
should I take Family Floater health plan if I already have health
insurance from my employer?
- Which
medical tests does an adult above 46 years needs to go through?
- What
if I want to renew my health insurance policy after one year?
- Would
I have to fill the form again?
- When
do I have to take a medical check up? What is the period for the
medical check up i.e., from the start date of the policy?
- In
the event of claim being already made, If I want to renew my policy
for the second year, do I have to undergo medical check up again?
- What
if I also have or intend to buy a medical policy of any other
insurance company?
- Would I be able to avail of my medical & premium reimbursements in case my policy is rejected?
- What
is Health Advantage Plus Insurance?
- Which
medical tests does an adult above 56 years need to go through?
- What
if I want to renew my health insurance policy after one year?
- When do I have to take a medical check up?
What is the Family Floater Plan?
For the first time in India, one single policy takes care of the hospitalisation expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents.
e.g.: The Prakash Family is covered under a traditional health
insurance plan - Mr. Prakash Rs. 2 lac, his wife Rs. 1
lac, their son and daughter Rs.50,000 each and they have paid premium
for all these 4 policies. In an unforeseen situation, wherein surgery
and post hospitalisation bill of their son amounts to Rs. 1.30 lakh
The existing policy will cover only Rs. 50,000, while Mr. Prakash
will have to bear the balance Rs. 80,000 from his pocket.
With Family Health Floater Insurance plan, each member of Prakash
family is covered up to Rs. 4 lac. Thus, Family Floater would have
covered entire Rs. 1.30 lakh medical expenses of Mr. Prakash's son.
Why do I need health insurance?
Health insurance will protect you and your family against any financial contingency arising due to a medical emergency.
A health card is a card that comes along with the Policy.
It is similar to an Identity card. This card would entitle you to avail cashless hospitalisation facility at any of our network hospitals.
What are the benefits of a health card?
A health card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance.
Moreover, you need to display your health card at the time of admission into the hospital.
Are all policyholders eligible for a Health Card?
Yes, all the policyholders are eligible for the Health Card as it is an important component of the policy.
How does a Health Card function in case of a 2-year policy?
In case of a 2-year policy, you will be issued a single card, which would be valid for the entire policy period. The health card need to be renewed or re-issued during the policy tenure.
Why should I take Family Floater health plan if I already have health insurance from my employer ?
- Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Family Floater Health Insurance policy will come to your rescue.
- Family Floater Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.
Which medical tests does an adult above 46 years needs to go through?
An adult above 46 years of age has to undergo the following medical tests:
- Complete Blood count
- Fasting Blood Sugar
- ESR
- .Serum Creatinine
- .SGPT
- Urine Routine
- .ECG
- Medical Exmaination with BP recordings – By a physician
Our representative will call the proposd insured (s) for prior appointment for the medical tests (mentioned above) within 2 days of receipt of full premium.
What if I want to renew my health insurance policy after one year?
We would be sending you a renewal notice informing you of the expiry of your health policy via courier.
Would I have to fill the form again?
No, you would not have to do so again.
When do I have to take a medical check up? What is the period for the medical check up i.e., from the start date of the policy?
On purchase of the policy, we would inform you on the medical check up routine. Ideally, the check-ups are conducted within 5 days of paying the first premium.
In the event of claim being already made, If I want to renew my policy for the second year, do I have to undergo medical check up again?
No, the medical check up has to be taken only once, during the start of taking a policy and only if you are 46 years of age or above in case of Family Floater Insurance and 56 years in case of Health Advantage Plus Insurance.
What if I also have or intend to buy a medical policy of any other insurance company?
It's as per your choice, but you would have to intimate us of the same and the concerned insurance company.
Would I be able to avail of my medical & premium reimbursements in case my policy is rejected?
In the event that your policy is rejected, you can definitely avail of premium reimbursements within 7 working days. However,.we would not be able to reimburse your medical expenses.
What is Health Advantage Plus Insurance?
The Health Advantage Plus Health Insurance Policy has a fixed premium and enables you to save up to Rs. 5099* under Section 80 D of the Income Tax Act.
*Click here to know how the plan works
Which medical tests does an adult above 56 years need to go through?
An adult above 56 years of age has to undergo the following medical tests to buy Health Advantage Plus Insurance:
1. Complete
Blood count
2. Fasting Blood Sugar
3. ESR
4. Serum Creatinine
5. SGPT
6. Urine Routine
7. ECG
8. Medical Examination with BP recordings – By a physician
Our representative will call the proposed insured (s) for prior appointment for the medical tests (mentioned above) within 2 days of receipt of full premium.
What if I want to renew my health insurance policy after one year?
We would be sending you a renewal notice informing you of the expiry of your health policy via courier.
When do I have to take a medical check up?
In case of Health Advantage Plus Insurance, everyone aged 56 years & above would have to undergo medical check up.
- Do you cover Pre-existing diseases?
- Can I have an Insurance cover higher than Rs 3 lakh for individual or Rs 4 lakh for others?
- How do I select the appropriate cover amount?
- Does a higher cover mean preferential treatment in case of hospitalisation & claim?
- Can I have a health insurance cover of less than Rs 2 lakh?
- Does a higher cover guarantee better protection?
- Which diseases are not covered and till what term from the start date of the policy?
- Am I entitled for cover immediately after I take my policy?
- Do you cover Pre-existing diseases (Health Advantage Plus)?
- Does it cover Senior Citizens?
- How many members are covered under Tax Gain Health Advantage Plus Insurance?
Do you cover Pre-existing diseases?
Pre-existing diseases are covered subject to sub-limits and waiting period. These diseases are covered after 4 years provided the policy is renewed with us for the said period. Health Advantage Plus Insurance has a shorter waiting period of 2 years, i.e. pre-existing diseases are covered from the 3rd year onwards.
Can I have an Insurance cover higher than Rs 3 lakh for individual or Rs 5 lakh for others?
We currently do not provide an Insurance cover higher than Rs 3 lakh for individual or Rs 5 lakh for others.
How do I select the appropriate cover amount?
The appropriate cover amount ought to be determined on the basis of the following factors:
- Your age : Age is a critical factor for determining the cover since health risk increases with age.
- Pre-existing / hereditary diseases : Pre-existing diseases are covered subject to sub-limits and waiting period.
For example: A person whose parents suffer from Diabetes is more prone to the disease, so we recommend a higher cover at an early age so that the pre-existing also gets covered. - Moreover, also consider your financial status and lifestyle before selcting the coverage amount.
Does a higher cover mean preferential treatment in case of hospitalisation & claim?
No, a higher cover does not entitle you to preferential treatment. Irrespective of the insurance cover you buy -- either a Rs. 2 lakh cover or a 4 lakh cover -- you would get high quality service and treatment at our network hospitals.
Can I have a health insurance cover of less than Rs 2 lakh?
We currently do not provide a health insurance cover of less than Rs 2 lakh.
Does a higher cover guarantee better protection?
A higher cover protects you from a medical emergency which can burn a hole in your procket. Today, people are more prone to various ailments and health problems due to fast-paced lifestyle and erratic schedules. Rising medical cost is a major deterrent, and thus, a higher cover would guarantee you a better protection.
Which diseases are not covered and till what term from the start date of the policy?
Pre-existing diseases are covered subject to sub-limits and waiting period. These diseases are covered after 4 years provided the policy is renewed with us for the said period. Health Advantage Plus Insurance has a shorter waiting period of 2 years, i.e. pre-existing diseases are covered from the 3rd year onwards
Am I entitled for cover immediately after I take my policy?
For the first 30 days after your policy is activated, you would avail of accidental cover immediately. However, you would not be entitled for any cover for sickness.
Do you cover Pre-existing diseases? (Health Advantage Plus)
Pre-existing diseases are covered subject to sub-limits and waiting period. These diseases are covered after 2 years provided the policy is renewed with us us for 2 consecutive years.
Does it cover Senior Citizens?
Senior Citizens are covered up to the entry age of 65 and the policy can be renewed up to 70 years of age.
How many members are covered under Tax Gain Health Advantage Plus Insurance?
One policy covers the individual or 2 family members - defined as 2 Adults or 1 Adult or 1 Kid. If kid is more than 1, you need to buy an additional policy for each of the additional member.
- In the event of claim being already made, If I want to renew my policy for the second year, do I have to pay premium again?
- How do I get the maximum tax saving benefit on the premium payable under the Tax Gain Health Advantage Plan?
In the event of claim being already made, If I want to renew my policy for the second year, do I have to pay premium again?
Yes, you would be required to pay premium again.
How do I get the maximum tax saving benefit on the premium payable under the Tax Gain Health Advantage Plan?
The premium payable under this plan is fixed at Rs.15,000 (which is the new limit for tax deduction available under section 80 D) and the amount of coverage changes depending on the age and the number of members covered. This amount is fully deducted while computing your taxable income. Hence, you save Rs.5099* on your health insurance and the effective cost is Rs.9901* only.
* For highest income tax slab of 33.66% (including 10% surcharge for income above Rs. 8.50 Lakh and education cess @ 2%).
Click here to view sum insured table.
- What do I do in case of a claim?
- What is the claim procedure?
- What are the documents required for filing a claim?
- What is a TPA? Who is the TPA for ICICI Lombard?
- How much time does it take to settle the bills?
- When do I have to take a medical check up?
- Do I need to pay for hospitalisation?
- How to prevent rejection of claims?
- In the event of no claims during the first year, what if I want to discontinue my policy?
- What exactly is the role of TPA i.e. Third Party Administrator. Would I have to approach the TPA during times of crisis?
- If I renew policy with ICICI Lombard, will I get benefits on renewal?
- What is the maximum amount that can be reimbursed?
- Are Dental Treatment charges covered?
- Can I lodge a claim just after buying this plan?
What do I do in case of a claim?
In case of a planned hospitalisation or emergency services, use your Health ID Card at any of our network hospitals and avail cashless service. Contact our call centre number 1800 425 8885/ 7878 for assistanceIn case of a Cashless hospitalisation, claim can be of two types:
Planned:
Where the member of the covered family is aware of the hospitalisation 2-3 days in advance.
Emergency:
Where the customer or a member of the covered family meets with sudden accident or suffers from bout of illness that requires immediate admission to the hospital.
The claims are serviced at both -- network and non-network hospitals.
Network Hospitals:
These are the hospitals that form part of the company's network
(part of the company's tie-up list). More than 4500+ hospitals form
part of the network. For a complete list of network hospitals, log
on to our website www.icicilombard.com.
Non-network Hospitals:
These hospitals do not form part of the company's tie-up list. The bills are settled by patient & the relevant documents and bills are subsequently submitted to the TPA. The amount, consequently, is reimbursed to the patient.
In case of planned hospitalisation:-
- Please contact our TPA help-line at 1800 42 57878/ 58885. The same is mentioned in the Health Identity Card.
- Fax / submit the required documents. E.g. Doctor’s certificate, medical bills etc.
- Obtain approval from the TPA
- Post authorisation approval, customer avails treatment
In case of emergency hospitalisation
- The patient is to be rushed to the hospital
- Patient can avail treatment
- Family to contact TPA help-line as mentioned in the policy
Health Card
- Family to submit required documents. E.g. Doctor’s certificate, medical bills etc.
- Family to obtain approval from the TPA
- Authorisation for network/ non-network hospitals has to be obtained
- Bills settled by the TPA
What are the documents required for filing a claim?
The following documents are required for filing a claim:-
- Duly completed claim form
- Original bills, receipts and discharge certificate/ card from the hospital
- Original bills from chemists supported by proper prescription
- Receipt and pathological test reports from a pathologist supported by the note from attending Medical practitioner / surgeon prescribing the test. Nature of operation performed and surgeon’s bill and receipt.
What is a TPA? Who is the TPA for ICICI Lombard?
TPA stands for Third Party Administrator. In our case, TTK Health Service Pvt. Ltd is the TPA. A TPA is a specialised health service provider rendering a variety of services like networking with hospitals, arranging for hospitalisation, claim processing and documentation.
How much time does it take to settle the bills?
Normally, the bills are settled within 15 days of receiving the relevant documents.
When do I have to take a medical check up?
On purchase of the policy, we would inform you on the medical check up routine. Ideally, the check-ups are conducted within 5 days of paying the first premium.
Do I need to pay for hospitalisation?
If you are admitted in any of our network hospitals, you can avail cashless facility. We would directly reimburse all the admissible expenses to the hospital. However, in case of non-network hospitals, you will have to settle hospital bills at the time of discharge, and consequently, the same will be reimbursed to you by us.
How to prevent rejection of claims?
- Carefully read the list of exclusions in policy wordings
(which comes to you with the policy). - Make sure that you have declared all the pre-existing diseases at the time of enrolment.
- Do not claim for any hospitalisation and diagnostic studies/ investigation charges which do not confirm existence of an illness or injury that requires hospitalisation.
In the event of no claims during the first year, what if I want to discontinue my policy?
Once you stop paying the premiums, the policy would be discontinued.
What exactly is the role of TPA i.e. Third Party Administrator. Would I have to approach the TPA during times of crisis?
Yes, all insurance claims throughout the world are settled by third party administrator. In our case, it is TTK Health Services Pvt. Ltd.
In case of hospitalization, the charges would be directly paid to the hospital, for that you would need to call on a help line number of our third party administrator (it's the agency who will settle your claims abroad on our behalf ) and they will arrange for a cash less facility. If it is a case of emergency, the TPA would help you provide the cashless facility in the nearest hospital, or else they will inform you on the hospital where you can avail the treatment.
If I renew policy with ICICI Lombard, will I get benefits on renewal?
You can avail of the NCB i.e., No Claim Bonus, at the time of renewal, provided no claims are made on your previous policy.
If I renew policy with ICICI Lombard, will I get benefits on renewal?
OPD (Outpatient Department) claims depend on the sum insured chosen and the age of the insured. The maximum amount that can be reimbursed under OPD claims is up to Rs. 10,000/- Click here to view sum insured table.
Are Dental Treatment charges covered?
Yes, Dental Treatment Expenses are covered under Outpatient Treatment but should be on medical prescription.
Can I lodge a claim just after buying this plan?
No, OPD Claims may be lodged only once during the policy period and after 90 days prior to policy start date, and 30 days after policy expiry.
Insurance is the subject matter of solicitation.
Insurance brought to you from ICICI Lombard General Insurance Co Limited Misc 1, 13, 29, 30, 34B, 46, 50. ICICI Bank Limited has a referral arrangement with ICICI General. The contract of insurance is between ICICI General and the Insured, and not between ICICI Bank Limited and the Insured. Nothing contained on the Website shall constitute or be deemed to constitute an advice, an offer to purchase or an invitation or solicitation to undertake any activity or enter into any transaction relating to the Insurance Products. Participation by ICICI Bank's customers is on a purely voluntary basis 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. For more details on coverage, terms and conditions, please read the policy document carefully before conducting a sale.
