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CLAIM PROCESSING

1) What is the claim process?

At ICICI Prudential Life, every claim is a fulfilment of a promise that we have made to our policyholders and we do our best to process the claim in the most transparent and quick manner.

We follow the 3 step claims process

Step 1: Intimation

Step 2: Claims Processing

Step 3: Decision & Payout

2) How can a claim be reported?

  • All ICICI Prudential Life branches

  • Central claims team at Mumbai

  • Online claim intimation through company’s website

  • SMS ‘ICLAIM Policy No’ to 56767

  • Claim care cell 1860-266- 7766

The Company has always made it a point that the claimant is at ease at a critical milestone like claims, thereby not only offering him/ her a physical touch point via branches spread geographically which provides ‘priority service’ with ‘no queue’ facility, but also through the digital platform of intimating claims online at www.iciciprulife.com thereby providing alternate means from the traditional processes.

The call center of the Company has a dedicated 24X7 helpline for claims which assists in resolving customer queries and are able to connect to the claims team directly via a conference call to the claims manager. Thus, ‘hand holding’ and providing customer satisfaction at the earliest. Also, the customer can send an SMS and receive call back for quick assistance.

All required documents has to be submitted along with intimation for speedy processing. One can refer to our website, claim form, policy document or even contact our Branch / Customer Care to know the exact requirements.

3) How much time does it take to settle a claim?

Turnaround Time as mandated by Insurance Regulation and Development Authority of India (IRDAI) Health Claims
Raising Claim Requirements Within 15 days of receipt of claim
Settlement or Rejection or Repudiation of claims wherein investigation is not required Within 30 days from the date of receipt of last necessary document
Settlement or Rejection or Repudiation of claims wherein investigation is required Investigation should be completed not later than 30 days from the date of receipt of last necessary document and the claim shall be settled within 45 days from the date of receipt of last necessary document

 

4) How will the claim payout happen?

On receipt of all required documents and completion of field investigation as the case may be, ICICI Prudential Life settles and communicates claims decision within the defined TAT as mentioned above.

To expedite transfer of claims, proceeds to claimants, we aim to process most of our payouts through electronic modes like ECS and NEFT.

Heart and Cancer

#Doctors document confirming diagnosis need to be submitted

*The premium has been calculated for a 31 year old healthy male for a ₹20 lakh cancer cover and a ₹10 lakh heart cover for a policy term of 5 years and is exclusive of all taxes. The annual premium is ₹2,174 (exclusive of all taxes)

~ Up to ₹25 lakhs for heart cover + up to ₹50 lakhs for cancer cover. Cash Payout depends on the severity of the condition. Please refer the sales brochure carefully for the payouts at different level of conditions.

**You will get daily hospital cash benefit of Rs. 5,000 if you get hospitalised for a continuous stay of 24 hours, due to any of the listed conditions under your chosen cover. The benefit amount is fixed and will be paid irrespective of actual hospitalisation expenses. This benefit will be payable subject to a maximum limit of ten (10) days per policy year and thirty (30) days over the policy term. The yearly limit of number of days of hospitalisation cannot be carried forward to next year.

##The Sum Assured chosen at inception increases by 10% simple interest on each policy anniversary, for every claim free year. The maximum Sum Assured under the cover will be capped at 200% of the Sum Assured chosen at inception. This increase in Sum Assured will stop on occurrence of first claim under the cover. Where Cancer cover and Heart cover are chosen together, the Sums Assured for both the covers increase by 10% simple interest on each policy anniversary, for every claim free year. The maximum sum assured will be capped at 200% of the Sum Assured chosen at inception for each type of cover. In case of occurrence of first claim under any one type of cover, the increase in Sum Assured will stop for that cover type and Increasing Cover Benefit will continue for the other type of cover, for which no claim has occurred.

^^A discount of 5% on the first year’s premium will be offered on purchase of ICICI Pru Heart / Cancer Protect when life assured and his/ her spouse is covered under the same policy. The policy benefits of both the Lives Assured shall be independent of each other. The Sums Assured of both the lives could be different. A claim made by one Life Assured under the policy does not affect benefits of other Life Assured. This Family benefit has to be chosen at the inception of the policy only, spouse cannot be added once the policy is issued. This discount is not applicable on Single Pay Policy. With one policy, you can avail either Family Benefit or Loyalty Benefit.

***Tax benefits under the policy are subject to conditions u/s 80D of the Income Tax Act, 1961. Goods and Services Tax and Cesses will be charged extra over the premium amount as per the applicable rates. Tax laws are subject to amendments from time to time.

`This premium has been calculated for a 35 year old healthy male for a heart cover of ₹25 lakh and a cancer cover of ₹25 lakh for a policy term of 20 years and for all benefits chosen (i.e. hospital, income & increasing cover) and is exclusive of taxes. The annual premium is `18,263 (exclusive of all taxes)

~~Cancer cover provides protection against pre-cancerous (Carcinoma-in-Situ), early stage of cancer and severe stages of cancer. Zero stage cancer refers to Carcinoma in situ as per standard medical classification. Refer - http://www.cancer.gov/cancertopics/factsheet/Detection/staging. Heart cover provides protection against the most common listed heart problems. However Pre-Existing Diseases are not covered. Please refer the sales brochure carefully to know more about the illnesses covered

``To know more about the inclusions and exclusions on the listed minor and major conditions please read the sales brochure carefully

ICICI Prudential Life Insurance Company Limited. IRDAI Regn No. 105. CIN: L66010MH2000PLC127837

© 2016, ICICI Prudential Life Insurance Company Limited. Registered Address:- ICICI PruLife Towers, 1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai-400025. Insurance is the subject matter of the solicitation. For more details on the risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale. Call us on 1-860-266-7766 (10am-7pm, Monday to Saturday, except national holidays and valid only for calls made from India) and on 91-22-6193-0777 (Valid for calls made from outside India) (10am-7pm (IST), Monday to Saturday, except national holidays). Tax benefits under the policy are subject to conditions u/s 80D of the Income Tax Act, 1961. Goods and Services Tax and Cesses will be charged extra over the premium amount as per the applicable rates. Tax laws are subject to amendments from time to time. ICICI Pru Heart/Cancer Protect. UIN: 105N154V01.

Advt. No.: W/II/1615/2017-18

ICICI Bank Limited ("ICICI Bank") with registered office at ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, 390 007, Gujarat (CIN: L65190GJ1994PLC021012) is a corporate agent (Composite, IRDAI Reg No.: CA0112 valid till 31/03/2019) of ICICI Prudential Life Insurance Company Limited ("ICICI Prulife"). Insurance is underwritten by ICICI Prulife.

The products, services and benefits referred to herein are subject to terms and conditions governing them as specified by ICICI Prulife from time to time. ICICI Bank is acting merely as a corporate agent of ICICI Prulife. Purchase by ICICI Bank’s customer of any insurance products is purely voluntary, and is not linked to availment of any other facility from ICICI Bank. ICICI Bank shall not be liable or responsible for any loss resulting from insurance company's products/ services.

BEWARE OF SPURIOUS PHONE/ FRAUD PHONE CALLS !

• IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums.

• Public receiving such phone calls are requested to lodge a police complaint.


 

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