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Group Health Insurance - Top up Terms and conditions

Product Name – Group Health Insurance & Group TakeCare Insurance

UIN: ICIHLGP02001V030102 (Group top up cover) & ICIHLGP18120V011718 (OPD cover)

Insurer Name - ICICI Lombard General Insurance Company Limited (IRDA Reg. No. 115)

 

ParameterCover 1Cover 2Cover 3
Family size Self 2 member >2 member Self 2 member >2 member Self 2 member >2 member
Group health insurance cover IPD SI options ₹10 lacs ₹25 lacs ₹50 lacs
Deductible options ₹3 lacs / ₹4 lacs / ₹5 lacs
Group TakeCare cover OPD benefit SI ₹2500 ₹5000 ₹7500 ₹3000 ₹6000 ₹9000 ₹5000 ₹10000 ₹15000

 

  1. The type of customer for whom the product is intended
    • “Customer” applying shall mean all ICICI Bank customers over 21 years. The child to be insured should be above 91 days and less than 21 years and individual should be above 21 years and less than 55 years.
  1. Main characteristics of the product, Options and coverage provided by the product, as applicable

Key Benefits & Exclusions

OPD Cover benefits: (Under Group TakeCare Insurance)

Consultation Cover We will pay for the Medical Expenses incurred during the Period of Cover for any of the following consultations with or second opinions from a Medical Practitioner or Healthcare Professional in relation to any Illness contracted or Injury suffered by the Insured Person during the Period of Cover as per Policy terms and Conditions.
Pharmacy & Diagnostic Cover We will pay the Medical Expenses incurred on purchase during the Period of Cover of medicines (including over the counter medicines), drugs etc prescribed by a Medical Practitioner for any Illness contracted or Injury suffered by the Insured Person during the Period of Cover. We will pay the Medical Expenses incurred on Outpatient diagnostics tests including but not limited to, biochemistry, hematology, immunology, microbiology, serology, pathology, x-ray, ultrasound and TMT for the Insured Person from a Network Provider/Health Service Provider the Period of Cover as per Policy Terms and Conditions.
Health Assistance Benefit: Health assistance will be provided through Our dedicated helpline. The health assistance team is dedicated to assist the Insured Person in:
    1. Identifying specialist/ Hospital
    2. Fixing an appointment with Medical Practitioners wherever applicable on best effort basis
    3. Providing options on suitable Network Providers.
    4. Providing information on ailments and possible lines of treatment
    5. The facilitation for assistance would be free for the Insured Person. Any service availed by the Insured Person would be on a paid basis and to payment will be borne by the Insured Person and paid directly to the Medical Practitioner or Hospital.

 

EXCLUSIONS AND LIMITATIONS APPLICABLE TO SECTION B (Please refer to the Policy Wordings for more details Section B of Group TakeCare Insurance)

HEALTH TOP UP BENEFITS – (UNDER GROUP HEALTH INSURANCE)

S.NoTitleDescriptionRefer To Policy Wordings
1. Product Name Group Health Insurance (UIN: ICIHLGP02001V030102)
Sum Insured 10Lacs/25lacs/50Lacs

Part II of the Schedule Clause

2. Scope of the Cover

Deductible Amount 3Lacs/4Lacs/5Lacs
Covers Medical expenses in excess of Deductible amount that will be applicable on aggregate for the following covers
In Patient treatment Covers Hospitalization expenses for a duration of more than 24 consecutive hours for an insured event
Pre & Post Hospitalization Medical Expenses incurred due to Illness up to 30 days period immediately before and 60 days immediately after an Insured Person's admission to a Hospital
Day Care Procedure Medical expenses for All day care procedures and surgeries where such procedures or surgeries are undertaken by an Insured Person as an In-patient in a Hospital for continuous period of less than 24 hours
Domiciliary Cover Covers Medical expenses incurred for Domiciliary Hospitalization up to Sum Insured
Cover for alternate methods of treatment Reimbursement of expenses for Alternative treatment up to Sum Insured
Organ Donor Expense Covers Medical Expenses incurred for an organ donor’s Hospitalization for an organ donated to the Insured Person.
Domestic Road Emergency Ambulance Ambulance expenses incurred to transfer the Insured Person following an emergency to the nearest Hospital. Maximum amount payable is Rs.3000 per event of emergency hospitalization
Air Ambulance Covers expenses incurred on air ambulance services to transfer the Insured Person to the nearest Hospital in case of an emergency. Maximum amount payable under this cover is 10% of Sum Insured as stated in the Policy Schedule.
3 What are the major Exclusions in the Policy Note: Following is an indicative list of the policy exclusions. Please refer to the policy clause for the complete list.
  • Naturopathy treatment, acupressure, acupuncture, magnetic and such other therapies
  • Unproven experimental treatment
  • Any expenses arising out of Domiciliary Treatment
  • Treatment taken outside the country
  • Cosmetic surgery
  • Lasik Surgery
  • Septoplasty
  • Infertility & Related Ailments
  • Admin/Registration/Service/Misc. Charges
  • Expenses on fitting of Prosthesis
  • Any device/instrument/machine contributing/replacing the function of an organ
  • Holter Monitoring are outside the scope of the policy
  • Sterility, venereal diseases or any sexually transmitted diseases
  • Dental treatment unless due to accident
  • Any case directly or indirectly related to criminal acts
  • Refractive error correction, hearing impairment correction
  • Substance abuse, self-inflicted injuries, STDs and HIV/ AIDS
Part II of the schedule Clause 3.4 Permanent Exclusions
4 Sub Limit Cataract will be capped at Rs. 1 Lakh per eye per Policy year Part II of the schedule Clause 3
5 Payout Basis
  • Cashless or Reimbursement of covered medical expenses up to specified Sum Insured as per the scope of cover
  • Cashless Facility available at over 4000+ network hospitals.
Part II oftheschedule4. Claim Administration
6 Waiting Period
  1. Pre-existing diseases: No waiting period for declared and accepted PED.
  2. Initial waiting period: 30 days for all illnesses (except Hospitalization due to injury).
  3. Specific waiting period: First 12 months, for specific Illness and treatment. (Please refer to the policy clauses for the full listing)
Part II of the schedule Clause3.1 Clause3.2
7 Renewal Condition
  1. The Policy can be renewed as a separate contract under the then prevailing ICICI Lombard Group Health Insurance product or its nearest substitute (in case the product ICICI Lombard Group Health Insurance is withdrawn by the Company) approved by IRDA.
  2. The policy shall ordinarily be renewable except on grounds of fraud, moral hazard or misrepresentation or non- cooperation by the insured.
  3. The policy could be subject to certain changes in terms and conditions including change in premium rate.
  4. Premium rates may change at the time of renewal subject to change in plan &/or age band of senior most insured
Part III of the schedule 18. Renewal notice
8 Cancellation
  1. Disclosure to information norm: The policy shall be void and all premium paid hereon shall be forfeited to the company, in the event of misinterpretation, mis-description or non-disclosure of any material fact.
  2. You may cancel this Policy by giving Us 15 days written notice for the cancellation of the Policy by registered post, and then We shall refund premium on short term rates for the unexpired Policy Period.
Part III of the schedule 13. Cancellation/ Termination

Please refer to the Policy Wordings of Group Health Insurance for more details.

Company shall not be liable for the deductible amount as specified against the plan opted. The Company are not liable for any payment unless the hospitalization medical expenses exceed the deductible. No deductible shall be applicable for optional cover.

For details, kindly refer to Policy Wordings of Group Health insurance.

  1. Total premium and other charges including taxes, applicable

One-time payment of premium as per selected plan.

  1. Freelook Period

Offer can be cancelled during free look period (15 days from the date, the policy is received) by giving a written notice to Company or by calling on 1800 2666. In this case, Company will refund the premium paid subject to deduction of the expenses incurred by Company on medical examination of the Insured Person(s) and the stamp duty charges.

  1. Cancellation
  1. Disclosure to information norm: The policy shall be void and all premium paid hereon shall be forfeited to the company, in the event of misinterpretation, mis-description or non-disclosure of any material fact.
  2. You may cancel this Policy by giving Us 15 days written notice for the cancellation of the Policy by registered post, and then We shall refund premium on short term rates for the unexpired Policy Period.
  1. Renewal
  1. The Policy can be renewed as a separate contract under the then prevailing ICICI Lombard Group Health Insurance product or its nearest substitute (in case the product ICICI Lombard Group Health Insurance is withdrawn by the Company) approved by IRDA.
  2. The policy shall ordinarily be renewable except on grounds of fraud, moral hazard or misrepresentation or non- cooperation by the insured.
  3. The policy could be subject to certain changes in terms and conditions including change in premium rate.
  4. Premium rates may change at the time of renewal subject to change in plan &/or age band of senior most insured
  1. Waiting period
  1. Pre-existing diseases: No waiting period for declared and accepted PED.
  2. Initial waiting period: 30 days for all illnesses (except Hospitalization due to injury).
  3. Specific waiting period: First 12 months, for specific Illness and treatment. (Please refer to the policy clauses for the full listing)

(Part II of the schedule Clause3.1, Clause3.2)

Validity of master policy mentioned is till 14th Sept 2022.

Group Health Insurance Policy No: (4015i/MSTR/204935516/00/000) & Group TakeCare Insurance policy no. (4149/GTC/204941318/00/000) underwritten by ICICI Lombard GIC Ltd has been issued to ICICI Bank Ltd for its customers

Only for the customers of ICICI Bank Limited who intend to enrol under Group Health Insurance (Misc 11), ICIHLGP02001V030102, policy underwritten by ICICI Lombard GIC Ltd. IRDAI Reg No. 115. ICICI Bank is acting in the capacity of the group master policy holder _ This is just for information purpose and should not in any way be construed as any kind of promotion or endorsement of any insurance product by 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 registered as a corporate agent (Composite, IRDAI Regn No. : CA0112 valid till March 31, 2022) of ICICI Lombard General Insurance Company Limited. Insurance is underwritten by ICICI Lombard. 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.

This is only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before enrollment in the policy. ICICI Lombard General Insurance Company Limited. Registered Office: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhivinayak Temple, Prabhadevi, Mumbai - 400 025. IRDA Reg. No. 115. Toll Free No. 1800 2666. Fax No 02261961323. CIN L67200MH2000PLC129408. Website: www.icicilombard.com. Email: customersupport@icicilombard.com. BEWARE OF SPURIOUS PHONE CALLS AND FICTIOUS/FRADULENT OFFERS

  • 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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