ICICI LOMBARD IHEALTH INSURANCE

iHealth is one of the four complete health insurance plans from ICICI Lombard. It not only offers extensive coverage during medical emergencies but also provides you with access to a large number of cashless hospitals across India.

ICICI Lombard iHealth Details

• ICICI Lombard iHealth plan is available with sum-insured options ranging from 2 to 50 lakh rupees.
• The minimum entry age is 6 years with no restriction on maximum entry age.
• 3 months to 5 years old children can be insured under a floater plan only.
• Floater cover takes care of yourself, spouse, dependent parents, dependent children, brothers and sisters under a single policy by paying one premium amount.
• Individuals above 3 months of age can be covered provided 1 adult is also covered under the same policy.
• Initial waiting period for hospitalisation: 30 days (except for accidental injuries).
• Pre-existing diseases/illnesses are covered only after 24/48 months of continuous coverage, depending on the sum-insured, and specified illnesses after 24 months.
• The waiting period for hypertension/diabetes/cardiac conditions is 90 days unless disclosed as pre-existing.
• Lifelong renewal facility.
• 15 days of Free-look period.

ICICI Lombard i Health: Major Benefits

• Policy term: 1 to 2 years.
• Cashless hospitalisation, wherever possible or reimbursement of covered medical expenses.
• 6,500+ strong network of hospitals across India.
• Pre-hospitalisation expenses for up to 30 days and post-hospitalisation up to 60 days.
• Takes care of in-patient treatment and hospital expenses for admission longer than 24 hours.

The critical illness cover addresses specified procedures such as:

• Cancer of specified severity.
• Open chest CABG.
• First heart attack.
• Major organ/bone marrow transplant.
• Permanent paralysis of limbs.
• Kidney failure requiring regular dialysis.
• End-stage liver disease; subject to a maximum of 2 adults.

Specific diseases covered include:

• Cataract.
• Benign Prostatic Hypertrophy.
• Myomectomy.
• Hysterectomy unless because of malignancy.
• All types of Hernia, Hydrocele, Fissures and/or Fistula in the anus, haemorrhoids/piles, Arthritis, gout, rheumatism and spinal disorders, Joint replacements unless due to accident.
• Sinusitis/related diseases.
• Stones in the urinary/biliary systems.
• Dilatation and curettage.
• Endometriosis.
• All types of Skin and internal tumours/cysts/nodules/polyps of any kind, dialysis required for chronic renal failure.
• Surgery on tonsils, adenoids and sinuses.
• Gastric and Duodenal erosions & ulcers.
• Deviated Nasal Septum, Varicose Veins/Varicose Ulcers.
• All types of internal congenital anomalies/illnesses/defects.
• Daycare procedures.
• In-patient AYUSH hospitalisation.
• Newborn baby cover.
• A domestic road-emergency ambulance with 1,500 rupees as the maximum amount payable/emergency hospitalisation.
• Wellness program.
• Reset benefit - applicable based on the sum-insured.
• Hospital daily cash allowance for minimum 3 andmaximum 10 consecutive days: 500 to 3,000 rupees/day.
• Convalescence benefit.
• Donor expenses.
• Value-added services: Free health check-up coupon to the insured for every policy year, a maximum of 2 coupons/year for floater policies, online chat with medical practitioners, specialist e-consultation with one follow-up session, diet and nutrition e-consultation.
• Cumulative bonus or additional sum-insured: 10% of annual sum-insured provided on every renewal for each claim-free year, maximum of 50%.
• 30 days grace period for renewal after the date of expiry of your policy.
• Tax benefit and relief under Section 80D of the Income Tax Act.

ICICI Health Insurance: General Exclusions

• Expenses related to the treatment ofpre-existing diseases and their direct complications until the expiry of 24 months (48 months for plans with sum-insured up to 2 lakh rupees) of continuous coverage.
• Treatment of the listed conditions, surgeries or treatments until the expiry of 24 months of continuous coverage.
• The following illnesses within 90 days from the first policy commencement (unless they are pre-existing and disclosed at the time of underwriting): Hypertension, Diabetes and Cardiac conditions.
• Any admission primarily for diagnostics/evaluation purposes.
• Diagnostic expenses not related/not incidental to the current diagnosis.
• Admission primarily for enforced bed rest and not for receiving treatment.
• Obesity/Weight Control (barring specific conditions) and Cosmetic/Plastic surgeries.
• Dietary supplements/substances purchased without prescriptions.
• Hazardous/Adventure sports.
• Treatment directly arising from/consequent upon any insured individual committing/attempting to commit a breach of law with criminal intent.
• Alcoholism/drug/substance abuse.
• Unproven treatments/services and supplies for or in connection with any treatment.
• Birth control/Sterility/Infertility expenses.
• Medical treatment expenses traceable to childbirth, including complicated deliveries and caesarean sections incurred during hospitalisation, except ectopic pregnancy.
• Expenses on dental treatment, unless necessitated due to an accident.
• Circumcision, unless required for treatment of an illness/necessitated due to an accident.
• Treatments for birth defects and external congenital illnesses/defects/anomalies.
• Expenses arising out of any condition caused by or associated with AIDS, whether or not arising out of HIV.
• Intentional self-injuries (whether arising from an attempt to commit suicide or otherwise).
• Expenses related to donor screening/treatment, including surgery to remove organs from a donor in the case of transplant surgery.
• Injury or illnesses caused by/arising from/attributed to war, invasion, acts of foreign enemies, hostilities, civil war, commotion, unrest, rebellion, revolution, military or usurped power or confiscation or nationalisation or requisition of or damage by or under the order of any government or local public authority.
• Illnesses/injuries caused by/contributed to by nuclear weapons/materials or contributed to by/arising from ionising radiation/contamination by radioactivity by any nuclear fuel or from any nuclear waste or the combustion of nuclear fuel.
• Treatment outside the country.

ICICI Lombard Health Care Claims, Insurance Portability & Cancellation

• Cashless hospitalisation and settlement: Only available at a network provider and the health card must be presented.
• Pre-authorisation is required before taking treatment or incurring medical expenses at a network provider. At least 48 hours before a planned hospitalisation and within 24 hours of hospitalisation in case of emergency.
• Must contact the in-house claim processing team with policy number, name, your relationship with the policyholder, nature of illness/injury, name and address of the medical practitioner/hospital.
• Reimbursement settlement: Give notice to ICICI Lombard or the in-house claim processing team by calling 1800 2666 and also in writing with all the details within 10 days.

The following documents should be provided in support of a claim:

• Duly completed claim form signed by you and the medical practitioner. It can be downloaded from www.icicilombard.com.
• Original bills, receipts and discharge certificate/card from the hospital/medical practitioner.
• Actual bills from chemists supported by proper prescription.
• Original investigation test reports/payment receipts.
• Indoor case papers.
• Medical practitioner's referral letter advising hospitalisation in non-accident cases.
• Any document as required by ICICI Lombard or the TPA to investigate the claim/obligation to make payment for it.

• All documents must be forwarded to ICICI Lombard Health Care, ICICI Bank Tower, Plot No. 12, Financial District, Nanakramguda, Gachibowli, Hyderabad - 500 032.
• The insured can port the policy by submitting an appropriate application form to the insurance company at least 45 days before the renewal date. All applicable benefits will be passed on to insured individuals who were holding similar retail health insurance policies of other non-life insurers.
• ICICI Lombard Health insurance plans can be cancelled by the insurance company on the grounds of misrepresentation/fraud, moral hazard or non-disclosure of material facts (as stated in the proposal/claim form) at the time of claim and non-co-operation of the insured individual by serving a 15-days notice.
• A policyholder can also cancel it at any time by giving15 days written notice, and the company allows refund after retaining premium at a short Period-rate, provided no claim has occurred up to the cancellation date.

ICICI Lombard Health Insurance Policy: FAQs

Q: What are the sum-insured differences between ICICI insurance iHealth plan and the Health Protect Plus plan?

The ICICI Lombard health insurance iHealth plan brings sum-insured choices from 2 to 50 lakh rupees; however, the Health Protect Plus only offers 3, 4 and 5 lakh rupees options.

Q: Is the sub-limit available with iHealth plan?

Yes, up to sum-insured of 5 lakh rupees.

Q: What is the maximum amount once every policy year that can be utilised as a Convalescence benefit?

10,000 rupees.

Q: Is there any duration-restriction on the floater benefit under this policy?

No, it is available up to a lifetime.

ICICI iHealth Insurance

• ICICI Lombard GIC Ltd. is the country's leading general insurance company with over 4 crore satisfied customers and an admirable claim-settlement ratio of 98%. It holds the record for settling 99.9% health insurance claims during FY2020.
• Registered Office: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025.
• IRDAI Registration No: 115, CIN- L67200MH2000PLC129408 | 1800 2666 | Fax: 02261961323 |customersupport@icicilombard.com | www.icicilombard.com.

Disclaimer:The information shared is only indicative. Please go through the actualICICI Health insurance policywordings for details on risk factors, terms and conditions Or explore www.icicilombard.com before finalising the purchase.