ICICI Lombard Group Health Insurance - Terms and conditions

ICICI Lombard Group Health Insurance - Terms and conditions

Key Benefits, Exclusions, Disclaimers & Policy Coverage

    1. Pre & Post Hospitalisation- 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
    2. Day Care Procedure - Medical expenses for day care procedures where such procedures are undertaken by an Insured person as an In-patient in a hospital for continuous period of less than 24(twenty four) hours
    3. Domiciliary hospitalization- Medical expenses for treatment taken when confined within one’s home for a minimum of 3(three) consecutive days
    4. Donor expense- Medical expenses incurred in respect of the donor for any of the organ transplant surgery, provided the organ donated is for Insured persons, subject to a maximum of 2(two) adults covered in the policy
    5. Alternative methods of treatment- Covered up to Sum insured provided inpatient treatment under this cover is in a government hospital located in India or in any Institute recognized by the Government of India and/or accredited by Quality Council of India/National Accreditation Board of Health. The treatment rendered should be from a registered medical practitioner who holds a valid practicing license.
    6. Road ambulance services- 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 for sum insured of 10(ten) lacs and Rs. 1500(one thousand and five hundered) for sum insured of 5(five) & 7(seven) lacs
    7. Air ambulance Services- Ambulance expenses incurred to transfer the insured person following an emergency to the nearest hospital by air ambulance is covered up to 10% of annual sum insured
    8. Cashless hospitalization at 4500+ network hospitals- As on 1st January 2018.
    9. Enjoy tax benefits- Avail tax deduction on premium paid under health insurance policy as per applicable provisions of Section 80D of Income Tax Act, 1961 and amendments made there to.
    10. Declared and accepted pre-existing diseases will be covered from day one
    11. Plan options
FeaturesWith OPD & MaternityWithout OPD & Maternity
Outpatient department expenses (OPD) Reimbursement of medical expenses incurred on outpatient care such as doctor consultations, pharmacy and diagnostics. Maximum amount payable is as per grid below NA
Sum insured 5 lacs Sum insured 7 lacs Sum insured 10 lacs Sum insured 15 lacs Sum insured 20 lacs Sum insured 25 lacs Sum insured NA
Amount Payable (`) 6000
(six thousand)
7000
(seven thousand)
12000
(twelve thousand)
15000
(fifteen thousand)
20000
(twenty thousand)
25000
(twenty five thousand)
NA
Maternity Benefit Medical expenses for the delivery of a child, where Insured Person and spouse, both are covered after 12 months of continuous policy period. Maximum amount payable under this cover is as per grid below NA
Sum insured 5 lacs Sum insured 7 lacs Sum insured 10 lacs Sum insured 15 lacs Sum insured 20 lacs Sum insured 25 lacs Sum insured NA
Amount Payable (`) 25000
(twenty five thousand)
50000
(fifty thousand)
75000
(seventy five thousand)
100000
(one lakh)
NA

* Conditions Apply

For details, kindly refer to Master Policy Wordings in line with cover that you wish to purchase.Master Policy Wordings for Sum Insured – Rs. 5 and 7 lakh

Master Policy Wordings for Sum Insured – Rs. 10, 15, 20 and 25 lakh

Policy Exclusions –Exclusions/ Waiting periods

  • Any illness contracted within 30(thirty) days of the inception date of the Policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals
  • Maternity would be covered after 12(twelve) months if both self & spouse are covered under the same policy (if plan opt)
  • OPD to be claimed after a 90(ninety) day waiting period (if plan opt)
  • Covid-19 cooling period is 15 days

Exclusions valid for the first Year

  • Treatment of the following diseases/illness/ailments:
  • Cataract*
  • Benign Prostatic Hypertrophy
  • Myomectomy, Hysterectomy unless because of malignancy
  • Hernia, Hydrocele
  • Fissures & / or Fistula in Anus, hemorrhoids/Piles
  • Arthritis, Gout, Rheumatism and spinal disorders
  • Joint replacement, unless due to accident
  • Sinusitis and related disorders
  • Stone in the urinary and biliary systems
  • Dilatation & Curettage, Endometriosis
  • All types of Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant
  • Dialysis required for chronic renal failure
  • Surgery on tonsils, adenoids and sinuses
  • Gastric and duodenal erosions & ulcers
  • Deviated Nasal Septum
  • Varicose Veins/Varicose Ulcers

If the Policy is renewed with us for one consecutive year, the above diseases / illness / ailments will be covered from the second year. If these are pre-existing diseases at the time of inception of the policy, the same will be covered after the one year** onwards, subject to continuous renewal of the policy with us.
*Any claim for Cataract treatment shall not exceed Rs 35,000 per eye, during each Policy Year after one year from the Policy start date for SI of Rs 5 lacs & 7 lacs and Rs. 1 Lakh for SI Rs. 10 lacs

Permanent exclusions

  • Any illness/ disease/ injury/ pre-existing disease before the inception of the policy. However, this exclusion ceases to apply if the policy is renewed with the Company for 1 consecutive year
  • Non-allopathic treatment, pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related treatment
  • Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self-injury
  • War, civil war or breach of law
  • Naturopathy treatment, acupressure, acupuncture, magnetic and other such therapies
  • Treatment taken outside the country
  • Any expenses arising out of Domiciliary Treatment

For details, kindly refer to Master Policy Wordings in line with cover that you wish to purchase.Master Policy Wordings for Sum Insured – Rs. 5 and 7 lakh

Master Policy Wordings for Sum Insured – Rs. 10, 15, 20 and 25 lakh

Eligibility

  • The customer can buy the policy for any family member(s) children and / or parents The insured should be above 3 (three) months in case of floater and 21(twenty one) years in case of individual. To cover children aged between 3 months to 20 years, the policy must also cover at least 1 adult
  • The Proposer needs to be aged above 21(twenty one) years
  • Individual(s) proposed for Insurance whose age is 55 years & above have to undergo medical tests at designated diagnostic centers
  • Customer has to be an ICICI Bank customer at time of purchase/renewal
  • Income Tax benefits u/s 80D can only be availed for policies bought for Self, Spouse, Parents and Dependent children.
  • Maximum family size allowed is 2A+2C

For details, kindly refer to Master Policy Wordings in line with cover that you wish to purchase.Master Policy Wordings for Sum Insured – Rs. 5 and 7 lakh

Master Policy Wordings for Sum Insured – Rs. 10, 15, 20 and 25 lakh

Freelook Period

  • Policy can be cancelled during free look period 15(fifteen) days from the date, the policy is received). In this case, ICICI Lombard will refund the premium paid subject to deduction of the expenses incurred by ICICI Lombard on medical examination of the Insured Person(s) and the stamp duty charges.

Disclaimers

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 (policy no.) 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 applyICICI 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. Enrollment 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 Lombard Group Health Insurance. Misc. 11. UIN - ICIHLGP02001V030102)Email - customersupport@icicilombard.com, Website - www.icicilombard.com. T&C apply.ICICI Lombard Group Health Insurance Misc 11 ICIHLGP02001V030102,Master policy number - 4015i/MSTR/202390316/00/000
customersupport@icicilombard.com, www.icicilombard.com T&C apply