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Health Top up - Terms and conditions


Product Name – Group Health Insurance
Product UIN: ICIHLGP02001V030102
Insurer Name - ICICI Lombard General Insurance Company Limited (IRDA Reg. No. 115)

a. The type of consumer for whom the product is intended

“Customer” applying shall mean all ICICI Bank customers over the age of 18 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.

b. Main characteristics of the product, Options and coverage provided by the product, as applicable

Key Benefits & Exclusions

S.No Title Description Refer To Policy Wordings
1. Product Name Group Health Insurance (UIN: ICIHLGP02001V030102)  
2 What are the major Exclusions in the Policy Sum Insured 10Lacs/15Lacs/20Lacs/25lacs/50Lacs Part II of the Schedule Clause2. 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 continuousperiod of less than 24 hours
Domiciliary Cover Covers Medical expenses incurred for Domiciliary Hospitalizationup 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 SumInsured as stated in the Policy Schedule.
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 Clause3.4 Permanent Exclusions
3 Sub Limit Cataract will be capped at Rs. 1 Lakh per eye per Policy year Part II of the schedule Clause 3
4 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
5 Waiting Period a) Pre-existing diseases: No waiting period for declared and accepted PED.
(b) Initial waiting period: 30 days for all illnesses (except Hospitalization due to injury).
(c) 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 Clause3.1Clause3.2
6 Renewal Condition a) 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.
(b) The policy shall ordinarily be renewable except on grounds of fraud, moral hazard or misrepresentation or non- cooperation by the insured.
(c) The policy could be subject to certain changes in terms and conditions including change in premium rate.
(d) 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
7 Cancellation a) 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.
b) 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 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.

  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)'Group Health Insurance Policy No: 4015i/MSTR/202389551/00/000 (master policy no.)underwritten by ICICI Lombard GIC Ltd has been issued to ICICI Bank Ltd for its customers

Only for the customers of ICICI Bank Limited (“ICICI Bank” or “Bank”) who intend to enroll under Group Health Insurance. (UIN - ICIHLGP02001V030102), (Master policy - 4015i/MSTR/190538709/00/000) policy underwritten by ICICI Lombard General Insurance Company Limited (“ICICI Lombard”). IRDAI Regn 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. Insurance is being provided to all customers of ICICI Bank. For more details, please refer the policy wordings or you may contact us on 18002666. T & C apply.

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 Regn No.: CA0112 valid till 31/03/2022) of ICICI Lombard. Insurance is underwritten by ICICI Lombard. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. 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.

GROUP HEALTH INSURANCE. (UIN - ICIHLGP02001V030102)

Email - customersupport@icicilombard.com, Website - www.icicilombard.com. T&C apply.

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.