14 min read
Updated on Jul 26, 2022
ICICI Lombard General Insurance is amongst India’s leading insurance providers in the private sector. It was established as a joint venture company of ICICI Bank, the largest private sector bank of India and Fairfax Financial Holdings, a Canadian based holding company. It was incorporated as a public limited company on October 30th, 2020.
The company offers a well-diversified and comprehensive range of insurance products including health insurance, motor insurance, crop insurance, personal accident insurance, marine insurance, fire insurance, engineering and liability insurance.
Bharti AXA General Insurance has been merged with ICICI Lombard General Insurance Company with effect from 8th September 2021 resulting in an enhanced distribution channel supported by 1,00,000+ partners and a multitude of digital platforms.
|Gross Written Premium||INR 135.92 billion for 19-20.|
|Total policies issued||26.2 million policies|
|Claims settled||1.86 million claims|
|Networked Hospitals||9300+ network hospitals|
|Branches||273 branches across India|
ICICI Lombard General Insurance Company has been recognised consistently for its innovative products and customer-centric approach. The awards received by the insurance company are a testimony to the trust of its customers reposed in the company. Some of the recent awards and achievements of ICICI Lombard General Insurance Company are as follows:
Some of the most common coverage benefits found in most of the ICICI Lombard health insurance plans are as follows –
|Type of coverage benefit||Meaning|
|Inpatient hospitalisation||This feature covers the expenses that incur when you are hospitalised for 24 hours or more. Whether you are hospitalised for an injury or an illness, you get covered for the room rent, ICU room rent, nurse’s fee, doctor’s fee and other medical charges|
|Pre and post hospitalisation||The expenses that you incur before you are hospitalised are called pre-hospitalisation expenses. Such expenses are covered up to a specific number of days.
Post-hospitalisation expenses, on the other hand, mean the expenses that you incur after you are discharged from the hospital. These expenses are covered for up to a specific number of days after discharge
|Daycare treatments||Daycare treatments are those which do not require hospitalisation for 24 hours. Such treatments are covered under the policy up to the sum insured|
|Emergency medical assistance||Under this coverage, you get 24*7 medical assistance from ICICI Lombard in a medical emergency. You can hire an ambulance, get ambulance assistance or opt for teleconsultations under this coverage benefit|
|Organ donor cover||If you are undergoing an organ transplant surgery, the plan covers the cost of the donor’s organ hospitalisation and organ harvesting|
|AYUSH cover||Coverage for non-allopathic alternative modes is also offered by ICICI Lombard’s health insurance plans|
|Free health check-ups||You can avail of free health check-ups every year for up to 2 insured members|
|Domiciliary treatments||If you are treated at your own home due to a lack of hospital beds or because you are in no condition to be hospitalised, the underlying medical costs would be covered by the policy|
Despite the comprehensive coverage, there are some instances where coverage under ICICI Lombard health insurance plans is not available. These instances are called policy exclusions. The complete list of exclusions can be found in the policy wordings. However, some of the common instances include the following –
ICICI Lombard offers a range of health insurance policies that provide comprehensive coverage at unbeatable premium rates. At PayBima, we offer the most comprehensive health plan, Complete Health Insurance or iHealth, offered by ICICI Lombard. Have a look –
iHealth Shield is one of the variants of the iHealth policy which allows sum insured up to Rs.50 lakhs. You can buy the policy for yourself and your family with the option of customising the coverage as per your needs. Some of the salient features of iHealth Shield are as follows –
If you use up your sum insured during the policy year, the plan allows a free reinstatement of the sum insured back to its original level. This restoration benefit is allowed an unlimited number of times within the same policy year.
In the case of medical emergencies, you can avail of teleconsultations and ambulance services under the plan.
If you suffer any illness or injury, you don’t have to step out of your home to avail of doctor’s consultations. iHealth Shield offers the benefit of online chats with the doctor right from your home, and that too is free of cost.
You can also avail of an online second opinion from the company’s panel of medical experts in the case of severe illnesses.
iHealth Shield offers a choice of 10 optional add-ons that you can add to your policy by paying a small additional premium. These add-ons help in enhancing the scope of the policy for complete protection.
A step up from the Shield variant, the Shield Plus variant offers additional coverage benefits, both inbuilt as well as optional. Here are the salient features of this plan option –
The plan allows coverage for the expenses incurred in hiring an air ambulance in an emergency if you need to be hospitalised in another city for your treatment.
The sum insured in the plan starts from Rs.10 lakhs and goes up to Rs.50 lakhs. So, if you are looking to avail of a policy that offers high sum insured levels with a comprehensive scope of coverage, Shield Plus can be the suitable choice.
If you don’t claim in the policy year you earn a 10% ASI (Additional Sum Insured). You can keep on earning the 10% ASI after every successive claim-free year up to a maximum of 50%. In the case of a claim, the ASI reduces by 10%.
However, the plan allows an ASI protector wherein, if your claim in the last year is up to Rs.50,000, the ASI would not be reduced.
There are different types of add-ons available with the policy. These add-ons help in enhancing the coverage at an additional premium. You can choose any number of add-ons that you want and enhance your cover as per your needs.
In the case of planned treatments that you avail internationally, the plan would extend coverage for the hospitalisation costs with a co-payment of 10%.
iHealth Elite is another variant that you can find in the iHealth plan offered by the company. The policy offers comprehensive coverage features and high sum insured options. The features of the policy are as follows –
If you undergo organ donor treatments, the plan would allow coverage for up to Rs.10 lakhs so that you can pay for the associated medical costs.
Upon hospitalisation, which continues for 24 hours or more, you get a daily allowance over and above the claim for your medical expenses. The allowance is fixed and ranges from Rs.1000 to Rs.3000 per day depending on the sum insured that you have selected.
The plan allows coverage for the medical expenses incurred on pregnancy and childbirth. You can avail of coverage for up to Rs.25,000 for normal deliveries and Rs.50,000 for C-Section. There is also a cover for pre and post-natal expenses of Rs.2000 each and a newborn baby cover up to Rs.1 lakh. Maternity cover, however, is available after a waiting period of 3 years.
If you incur medical expenses on an outpatient basis, i.e. without being hospitalised, the same would be covered under the policy. This is an inbuilt coverage feature wherein you can enjoy coverage from Rs.5000 to Rs.20,000 depending on the sum insured that you choose.
Long hospitalisations are unfortunate and so this plan pays a lump sum convalescence benefit of Rs.10,000 if you are hospitalised for 10 days or more. This benefit is paid in addition to the claim that you incur.
The last variant of the iHealth plan, Elite Plus is suitable for individuals looking for high sum insured levels for themselves and their families. The salient features of the plan are as follows –
This cover enhances the claim payable under the policy by including the cost of consumables. The policy covers the cost of consumables which is otherwise excluded in normal plans.
Under this cover, the sum insured is increased, automatically, at every renewal at the last year’s inflation rate. This ensures that your coverage keeps pace with the inflated medical expenses and covers you optimally.
If you don’t claim in the first policy year, you would be rewarded with a super no claim bonus of 50%. The sum insured would increase by 50%, free of cost. Thus, you can double up the sum insured within 2 claim-free years. The super no claim bonus allows a maximum increase of up to 100% of the sum insured if the sum insured is Rs.10 lakhs. For higher levels, the maximum limit enhances to 200%.
With this feature, you can avail of coverage for your hospital bills incurred in a foreign country. The coverage comes with a co-payment of 10% and is available if you choose a sum insured of Rs.10 lakhs and above.
If you are hospitalised for 5 days or more and your immediate family lives in another city, the policy would cover the cost of return airfare for one immediate family member, i.e. your spouse, child, or dependent parent.
This feature covers the cost of hiring a nurse at home to help you with your recovery post hospitalisation. Coverage under this benefit is available for up to 15 days after your hospitalisation.
The plan allows a daily cash allowance if you are hospitalised for 24 hours or more. The allowance paid is Rs.3000/day for each day of hospitalisation. Moreover, if your hospitalisation equals 10 days or more, you also get a lump sum convalescence benefit of Rs.10,000.
The plan offers two optional coverage features of critical illness add-on and personal accident add-on. Under the former, specified critical illnesses are covered. If you are diagnosed with any covered illness, a lump sum benefit is paid. The personal accident add-on, on the other hand, covers accidental death and permanent disability and pays a lump sum benefit in either case.
Here’s a schedule showing the comparative analysis of each of these plans offered by the company –
|Features||Shield||Shield Plus||Elite||Elite Plus|
|Pre and post hospitalisation||30 and 60 days||30 and 60 days||30 and 60 days||30 and 60 days|
|Donor expenses||Covered, up to the sum insured or Rs.10 lakhs, whichever is lower||Up to Rs.10 lakhs||Covered, up to the sum insured or Rs.10 lakhs, whichever is lower||Up to Rs.10 lakhs|
|Unlimited Reset Benefit||Available||Available||Available||Available|
|Air ambulance cover||Covered||Covered||Covered||Covered|
|ASI||10% of the sum insured up to 50%||10% of the sum insured up to 50%||10% of the sum insured up to 50%||10% of the sum insured up to 50%|
|Ambulance cover||1% of the sum insured or Rs.10,000||Rs.10,000||1% of the sum insured or Rs.10,000||Rs.10,000|
|Claim protector||Optional benefit||Available||Optional benefit||Available|
|Sum insured protector||Optional benefit||Available||Optional benefit||Available|
|Worldwide cover||Optional benefit for sum insured Rs.10 lakhs and above||Available||Optional benefit for sum insured Rs.10 lakhs and above||Available|
|Super no claim bonus||Optional benefit||Optional benefit||Optional benefit||Inbuilt|
|Hospital cash allowance||Optional benefit
Rs.1000-Rs.3000 per day
Rs.3000 per day
Rs.1000 to Rs.3000 per day
Rs.3000 per day
|Convalescence benefit||Optional benefit
|Nursing at home||Optional benefit
Rs.2000 or Rs.3000 per day
Rs.3000 per day
Rs.2000 or Rs.3000 per day
Rs.3000 per day
|Compassionate visit||Optional benefit
Rs.10,000 or Rs.20,000
Rs.10,000 or Rs.20,000
|Maternity cover||Not available||Not available||Inbuilt benefit
Normal – Rs.15,000 or Rs.25,000
Caesarean – Rs.25,000 or Rs.50,000
Pre and post-natal cover – Rs.2000 each
Newborn cover – Rs.10,000 or Rs.1 lakh
Pre and post-natal cover – Rs.2000 each
Newborn cover –Rs.1 lakh
|Outpatient cover||Not available||Not available||Inbuilt benefit
Rs.5000 to Rs.20,000
|Critical illness cover||Optional benefit
Up to sum insured or 50% of sum insured
Up to 50% of the sum insured
Up to sum insured or 50% of sum insured
Up to sum insured or 50% of sum insured
|Personal accident cover||Optional benefit||Optional benefit||Optional benefit||Optional benefit|
|Entry age||Minimum – 6 years onwards
Dependent children – 3 months to 5 years on a floater basis
|Sum insured||Rs.5 lakhs, Rs.7 lakhs, Rs.10 lakhs, Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs or Rs.50 lakhs||Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs or Rs.50 lakhs||Rs.5 lakhs, Rs.7 lakhs, Rs.10 lakhs, Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs or Rs.50 lakhs||Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs or Rs.50 lakhs|
|Term of the plan||1, 2 or 3 years|
|Premium payment frequency||In one lump sum
|Pre-existing waiting period||2 years|
ICICI Lombard health insurance policies can be brought online through www.PayBima.com easily in the following steps:
1. Select your health plan
Click on the above link to visit PayBima’s official website and click on health insurance to find the most suitable policy for you.
2. Fill relevant details
A form will appear in which you are required to fill in the requested medical and personal details to enable PayBima to calculate the premium based on your eligibility and your coverage requirements. Fill in your name, the number of dependents, sum assured, age, gender, Pincode of your location and your contact details. PayBima also provides personalized consultation for buying the policy easily.
3. Compare the plans
After providing all the details, PayBima will display the plans which best suits your coverage requirements and eligibility. ICICI Lombard’s health insurance plans will also be shown. You can easily compare the coverage of the plans with their premium and choose the policy which best suits you.
4. Fill the proposal form online
After you have finalized your policy, you just have to fill out a proposal form by correctly providing your details. Ensure to provide correct details at the time of filling the proposal form so that you do not face any problem at the time of making a claim
5. Pay the premium
Payment of premium is the last step for buying the health insurance policy. Pay the premium online and the insurance company will instantly issue the policy provided there are no adverse declarations made by you about lifestyle habits and medical history in the proposal form
6. Medical screening
You may be required to undergo a pre-entrance health check-up based on certain factors such as your age, lifestyle habit, medical history and the coverage opted. Medical screening is required in case of high health risks. You can avail of the medical screening at any of the network hospitals of the insurance company.
PayBima not only provides a facility to buy a health insurance policy but also allows you to renew it by visiting its official website. ICICI Lombard health insurance policies allow lifelong renewals and you can enjoy uninterrupted coverage if you renew within the due date.
Health insurance renewal can be done online by providing your policy number and other policy details. At the time of renewal, you can check your plan details and also make changes to your plan if required. Any changes made to the plan may be separately charged thereby increasing your premium. You can contact PayBima through email at firstname.lastname@example.org or at 1800 267 67 67 to get assistance for renewing your ICICI Lombard complete health insurance policy.
PayBima offers a very simple and easy process to file a claim for an ICICI Lombard health insurance plan. The process is discussed as follows:
1. Locating network hospital
ICICI Lombard General Insurance offers both reimbursement and cashless claim facility. To avail cashless claim facility, the first thing you need to do is locate the nearest network hospital of the insurance company by visiting the website of the insurance company. You can locate your nearest hospital from the list of hospitals with which the insurance company has a tie-up.
After locating the nearest networked hospital, you can get admitted to it by showing your Identity proof and health card.
3. Pre-authorization Claim form
A pre-authorization claim form is required to be submitted to the insurance company for cashless settlement of the health claims. You can download the form online from the company’s website or visit the nearest branch of the insurance company to get the form. The form should be submitted at least three to four days before hospitalization. You can also submit the form within 24 hours of hospitalization in case of emergency.
4. Cashless approval
The insurance company will approve a cashless facility based on pre-authorized claim form submitted. After receiving approval from the insurer, the networked hospital will proceed with the treatment. All the bills for the treatment will be handled and paid by the insurance company.
5. Reimbursement Claim Facility
If you do not opt for a cashless claim and get admitted to a non-networked hospital, your claim would be settled on a reimbursement basis. In such cases, you are required to inform the insurance company before planned admission to a non-network hospital. You can inform the insurance company even after admission but before discharge in case of emergency admissions. After discharge from the hospital, you will have to settle all the bills which you can get reimbursed by filling up the claim form and attaching all the original receipts, bills and medical documents. The company will reimburse your amount after assessing your claim and validating your documents and proof.
PayBima provides hassle-free and smooth claim settlement assistance to its customers. You can contact PayBima at 1800 267 67 67 or email at email@example.com to get help with your claim settlement.
Certain documents are required to be submitted to get a successful settlement of the claim. The documents include the following:
ICICI Lombard General Insurance is a celebrated brand name in the insurance sector for its customer-centric approach and comprehensive benefits. Other highlights of the company are as follows:
ICICI Lombard health insurance plans allow coverage for you, your spouse, dependent children, dependent parents and siblings on a floater basis.
Pre-entrance health check-ups are not required if you are below 46 years of age and you opt for a sum insured up to Rs.10 lakhs. However, in these cases too, if you declare an adverse medical history, pre-entrance health check-ups might be required.
ICICI Lombard’s health insurance plans allow a free look period of 15 days from the date of policy issuance. You can cancel the policy during this period and avail of a refund of your premium.
Yes, a range of value-added benefits is offered under ICICI Lombard health insurance plans. These benefits include online doctor chats, free health check-ups, e-consultation with dieticians and nutritionists, e-consultation with specialists, etc.
The reset benefit is available only for unrelated claims. So, if you suffer multiple claims but are for the same illness or injury, reset benefit would not be allowed.
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