Policy Coverage

This is a comprehensive Tax-Saving health plan and shall cover the insured for:

• Basic Hospitalisation Cover
• Outpatient Department (OPD)

Basic Hospitalisation Cover
This covers inpatient hospitalisation expenses up to sum insured of Rs. 2 or Rs. 3 Lakhs (depending on the plan chosen). You can avail the cashless claim facility in any of the 4,500+ network hospitals across India.

Basic Hospitalisation cover includes: 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.
• Declared pre-existing diseases can be covered after the 2nd year provided the policy is renewed with us for two consecutive years.
• Technologically advanced treatment that do not need 24-hour hospitalisation but are covered under this policy are:-
  • Cataract
  • Lithotripsy (Kidney Stone Removal)
  • Tonsillectomy
  • Eye Surgery
  • Dialysis
  • Dilatation & Curettage
  • Chemotherapy
  • Radiotherapy
  • Coronary Angiography
  • Cardiac Catheterization

Coverage limit for specific ailments / conditions:
Certain specific ailment(s) / surgery(s)/ procedure(s) are covered up to pre-defined limits under this policy (subject to the total sum insured).
Click here for the details.

All others ailment(s) / surgery(s)/ procedure(s) are covered up to the sum insured under the policy.

*- Pre-hospitalisation period, the period of Hospitalisation and the Post-hospitalisation period, should fall within the Period of Insurance.

Outpatient Department (OPD)
This covers outpatient treatment expenses. In case of an OPD treatment (Outpatient Department), the claims will be settled later after furnishing the medical prescription documents/bills.

Outpatient Department Covers:

• Room, Boarding Expenses as charged by the Hospital
• Nursing Expenses
• Expenses related to Dental Treatment
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees
• Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids, ambulance charges
• OPD claims can be lodged only once during the Period of Insurance, within a period of 90 days from start of cover and 30 days of end of cover.

Sum Insured for Plans covering 2 individuals comes under the Floater benefit.

For more details, kindly refer to thePolicy Wordings.

• Floater benefit – The floater benefit would mean that one policy covers 2 family members with one sum insured and one premium. This takes care of hospitalisation expenses as well as Outpatient Treatment expenses in case of a sudden illness, accident or planned surgery of either of the family members.
• Optimum income tax benefit under section 80 D*. Save up to Rs. 5,099/- on your Policy premium.Click here to know more about Tax Benefit.
• Fixed premium of Rs 15,000 for all plans. For Senior Citizens aged 65 and above, the premium is Rs. 20,000.
• Reimbursement of OPD expenses up to Rs. 10,000 This includes diagnostics tests, dental treatment, etc. (OPD Benefit depends on age of senior most insured member and the plan chosen).
• Declared pre-existing illness covered after 2 years, i.e. from the 3rd year.
  
• Cashless claim facility available at over4,500 network hospitals across India.
• No health check up required upto the age of 55 years (as on last birthday).
• Free health check-up coupon for any one insured family member.
  Click here to know more.
• Medical checkup mandatory for insured of age 56 years and above. Click here for Medical Test Details.

*Optimum Tax Benefit of Rs 5099 subject to the provisions of Section 80D of the Income Tax Act, 1961 and amendments made thereafter. (assuming highest tax bracket and premium of Rs. 15,000)

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• The enrollment age (of the senior most family member) should be between 5 years to 65 years.
• The policy cover is renewable till the age of 70 years.
• The customer can buy the policy only for his two family members - defined as self, spouse or dependent children or dependent parents for the purpose of income tax exemption u/s Sec. 80D.

Click here to view our Policy Exclusions.

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• Save Tax up to Rs. 5,099 u/s 80 D of the Income Tax Act.
• Supplements employer-based health plans with higher sum insured and medical benefits.
• Individuals require to have an insurance that caters solely to their health needs, apart from life insurance and investments, that provides cover against expenses incurred during hospitalisation, as well as before and after.
• Avail cashless hospitalisation through ICICI Lombard's network of 4,500+ hospitals across India.

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Know all about making a claim

• Cashless claim settlement process
• Reimbursement claim settlement process
• All India Cashless Hospital Network
• Documents Required
• Download Pre Authorisation Form
• Download Claim Form

Why buy online at www.icicilombard.com? We give you a few of many reasons why -

• Highest Levels of Security: The website has been given the following security certifications:
  TRUSTe Privacy Seal Program
  VeriSign Certification
• Digitally signed policy is available 24X7 online, customer can take prints instantly. The hard copy of the policy is couriered the same day (or next day if customer buys after 6 PM) and will reach him/her within 2-3 working days.
• No Paperwork
• Multiple payment options – credit card, net banking (direct debit), and cheque / demand draft.
  You can pay through your ICICI Bank or Citibank Credit Card and avail of Interest-Free equal monthly installments (EMI) for your premium.

  (subject to the discretion of ICICI Bank)

Health Advantage Plus Product Code: Misc 63

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