Health Advantage ICICI Lombard

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In this age when medical costs are skyrocketing in every city, health insurance has become a necessity. Finding a plan that caters to all your needs without asking for an unreasonable premium seems overwhelming, right? Enters ICICI Lombard Health AdvantEdge offering wholesome coverage and all-around wellness benefits.

The ICICI Lombard Health AdvantEdge plan is designed to provide a shield against rising medical costs and extend a helping hand in times of emergencies. Let’s explore the plan in detail to understand how it works in offering coverage.

To learn more about Family Floater Plans, click here.

Highlights of Health Advantage by ICICI Lombard

Sum insured starting from ₹5 lakhs to ₹3 crores.

Access to worldwide coverage.

Multiple value-added services.

Loyalty benefits through exciting discounts.

Get all your insurance related queries answered

ICICI Lombard Health AdvantEdge: Highlights

Here’s a detailed table highlighting the main features of the ICICI Lombard Health AdvantEdge plan:

Particulars	Details
Policy Name	ICICI Lombard Health AdvantEdge
Insurance Company	ICICI Lombard General Insurance Company Ltd
Policy Type	Individual, Multi-Individual and Family Floater
Sum Insured Options	Starting from ₹5 lakhs to ₹3 Crore
Add-Ons	Available Options: Maternity Benefits Claim Protector Cover Teleconsultations Benefits Co-Payment Benefits Personal Accident Cover
Waiting period	PED Waiting Period: 24 Months Initial Waiting Period: 30 Days Specific Condition Waiting Period: 24 Months Initial Waiting Period for Critical Illness: 60 or 90 Days
Network Hospitals	Over 10,300
Claim Settlement Ratio	99.7% as of FY 2023-2024

Wish to Enhance Your Coverage? Take a Look at the Riders Available

If you wish to enhance coverage on your existing health insurance plan, then you can simply opt for the following riders for a hassle-free coverage expansion:

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Riders	Benefits
Maternity Benefit	The rider offers the following: Medical expenses related to pregnancy (childbirth/termination). Reimbursement upto 10% of the annual sum insured.Women between the ages of 18 to 45 years are eligible for claims. Maximum number of times claims can be raised: Three.
Claim Protector	Under this rider, you can get coverage for non-payable items if your policy has a sum insured amount of less than ₹15 lakhs. Note: Non-Payable items include those items that are listed by the Insurance Regulatory and Development Authority.
Co-Payment Option	Through this rider, you can opt for a 10% or 20% co-payment for your medical expenses. This means that you will pay a specific amount from your pocket, and the remaining medical bill amount is settled by the insurance company.
Teleconsultation Benefits	Through this rider, you can get: Teleconsultations with healthcare professionals. Unlimited access. 24*7 access. Telecommunication includes phone calls, texts, video calls, etc, for all your medical needs (routine or emergency).
Personal Accident Cover	Under this rider, if the insured faces permanent total disability, permanent partial disability or death, then: A lump sum payment equal to the sum insured amount for such conditions is provided. The maximum payment provided under this rider is ₹50 lakhs.
Critical Illness Rider	Under this rider, if the insured is diagnosed with any of the listed critical illnesses, then: A lump sum payment equal to the base sum insured is provided. The maximum payment under this rider is ₹50 lakhs.

ICICI Lombard Health AdvantEdge: Eligibility Criteria

To purchase the ICICI Lombard Health AdvantEdge plan, you first need to meet the following eligibility criteria:

The minimum entry age for adults is 18 years and for children is 91 days to 25 years.
The maximum entry age for adults is 65 years and for dependent children, it is 25 years.
The exit age for dependent children is 25 years and for adults it is lifelong.

Note: Children between the ages of 91 days to 5 years can be covered if their parents are insured under the policy.

Features and Benefits of ICICI Lombard Health AdvantEdge

The ICICI Lombard Health AdvantEdge is a plan that caters to all your medical needs, so you no longer have to worry about medical bills. In addition to medical coverage, the plan has a lot more to offer. Let’s take a look at the features and benefits of ICICI Lombard Health AdvantEdge

Coverage for Your Medical Needs

When medical costs are skyrocketing, it is a policy like this that steps in to offer coverage for unreasonably high medical bills. Whether it is hospitalisation expenses or ambulance services, the ICICI Lombard Health AdvantEdge takes care of the bills while you can focus on getting healthier.

Additional Coverage for Enhanced Protection

If you feel that the base coverage under your health insurance is not enough for all your medical needs, then worry not, because you can now simply opt for riders to enhance the protection. The plan offers a wide list of additional coverage that you can add to your existing policy in exchange for a minimal extra premium.

Loyalty Benefits

In addition to building medical coverage each policy year, now you can also enjoy an increased sum insured for continuously renewing your policy every year. The insurance company provides a 20% increase in the expiry or renewed annual sum insured every time you renew your policy without any additional premium.

Easy Application and Approval

In today’s time, when you are preoccupied every day of the week, the last thing you want to do is stand in a long line to purchase medical insurance. ICICI Lombard brings to you an easy online application and approval process that can be completed within minutes. Fill in the form, wait for approval, and you have secured your medical needs with just a few clicks.

Quick Claim Settlement

Imagine paying premiums for years only to realise that your claims can not be settled in times of emergencies due to documentation or technical errors. This is why a plan like ICICI Lombard Health AdvantEdge is a reliable choice, as the insurance company has an impressive claim settlement ratio. The promise to settle your claims in times of need is something that the insurance company has excelled at.

ICICI Lombard Health AdvantEdge: What is Covered?

The ICICI Lombard Health AdvantEdge plan has a long list of coverages that take care of all your medical needs. Here’s what you get under the policy:

Pre and Post Hospitalisation Expenses

The expenses incurred on pre- and post-hospitalisation care might not seem a huge burden initially, but can eventually pile up into a shocking medical bill. Therefore, the plan offers coverage for pre and post-hospitalisation expenses.

60 days before hospitalisation expenses are covered.
180 days post-hospitalisation expenses are covered.

In-Patient Treatment

Expenses incurred on inpatient treatment are covered up to the sum insured amount.

Hospital Accommodation

Getting treated at a reliable medical facility is an integral part of any hospitalisation and the policy ensures that you can easily choose any room category without having to worry about the expenses. Under Hospital accommodation, the policy offers coverage up to the sum insured.

Day Care Procedures

Daycare procedures are those procedures that require hospitalisation for less than 24 hours. The policy offers coverage for all types of daycare procedures.

AYUSH Treatment

If the insured undergoes any AYUSH treatment, the policy offers coverage up to the sum insured.

Organ Donor Expenses

The policy also takes care of the expenses incurred in finding an organ donor and related expenses.

Ambulance Service Cover

In times of medical emergencies, if the insured needs ambulance service, the policy promises to cover the expenses incurred on taking surface ambulance service.

Note: These expenses are covered up to 1% of the sum insured for every hospitalisation, and the maximum amount allowed under this coverage is ₹10,000.

Domiciliary Hospitalisation

If the insured opts for domiciliary hospitalisation after an authorisation from a medical professional, the expenses incurred on such hospitalisation are taken care of by the policy.

Health Check-Ups

The insured can easily get an annual health checkup done without having to worry about the expenses. The policy offers an annual health checkup coverage that starts from the first year, and the maximum amount under this coverage is ₹10,000.

ICICI Lombard Health AdvantEdge: What is Not Covered?

When you are purchasing medical insurance, it is important that you are aware of the exclusions. Here’s what the ICICI Lombard Health AdvantEdge plan does not cover:

Permanent Exclusion

The following medical treatments and checkups are not covered under the policy.

A routine ear or eye examination.
Dental treatments
Birth control procedures
Fertility related treatments
Any sex change procedures

Exclusion for Pre-Existing Diseases

The policy does not offer coverage for pre-existing diseases in the first 24 months of the policy.

Note: Please check the policy document for a detailed understanding of the exclusion.

Specific Exclusions

For the first two years of the policy, hospitalisation expenses incurred on specific listed diseases or illnesses are not covered.

Pros & Cons of Health Advantage by ICICI Lombard

Sum insured benefit restored

Coverage for newborns and vaccination

24/7 tele/video consultation

Coverage for Bariatric surgery

Cumulative bonus guaranteed

Coverage for maternity expenses

Convalescence benefit assured

Coverage for pre-existing diseases

Saving of 10% on premium if you buy the plan for a term of 2 years

No coverage is provided for hernia, cataract, and urinary system stones for the first 2 years under the plan

The policy does not cover any disease/illness occurring within 1 month from the date of the start of the policy.

No disease/illness/injury/pre-existing diseases are covered before the start of the policy term.

Any treatment received outside India is not covered under the plan.

Injury arising out of law violation with criminal intent is excluded.

The cost of domiciliary treatment is not covered under the policy.

The cost of cosmetic surgeries is excluded.

Any miscellaneous expenses such as admission fees, registration charges, and service charges are excluded from claim payouts.

Our verdict

The ICICI Lombard Health AdvantEdge is a comprehensive and reliable health insurance plan that is curated to cater to the needs of every individual. The credibility of the health insurance company makes the plan 10 times better. If you are purchasing the plan, you are not only getting medical coverage but at a promise of 24×7 assistance, access to a wide range of network hospitals and a lot more.

If you are looking for a reliable health insurance plan that allows you personalisation for wholesome coverage, then head to Paybima to explore plans.

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ICICI Lombard
Insurance Company

ICICI Lombard Health Insurance Company Ltd is a leading private general insurance company that offers a range of comprehensive and well-diversified products through multiple channels of distribution. This customer-centric company has a legacy of over 2 decades and is committed to its loyal customers. ICICI Lombard has over 312 branches with over 13,670 employees as of March 31, 2024. The insurer has issued over 36.2 million policies, honored over 2.9 million claims, and has a Gross Written Premium (GWP) of ₹255.94 billion for the year ended March 31, 2024.

Founded in

2001

Number of Claims

2.9 million claims paid

Number of Policies

36.2 million policies issued

Turnover (GWP)

INR 255.94 billion

JV Partners

ICICI Bank & Fairfax Financial Holdings Limited

Claims Experience

Claims Experience Rating 4.7

% of claims settled in less than 30 days
Reflects on the speed of settling valid claims

99.74%

% of Complaints received on overall claims
% customers unhappy with claims experience

0.13%

Claim Settlement Ratio (No. of claims)
What % of the claims received were paid?

99.7%

No. of Cashless Hospitals

24800+

Benefits of Health Advantage by ICICI Lombard

In-patient Hospitalization
ICU Rent Limit	Up to single private AC room
Room Rent Limit	Covered
Pre & Post Hospitalization
Post-hospitalization expenses are covered	Up to the Sum Insured
Post-hospitalization expenses are covered for up to	180 days after the date of discharge
Pre-hospitalization expenses covered	Up to the Sum Insured
Pre-hospitalization expenses covered up to	90 days before hospitalization
Day Care Treatment
Financial Limit	Up to sum insured
No. of treatments covered	Basic and modern treatments

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The plan covers all costs related to hospitalisation (both pre- and post-treatment), daycare surgeries, AYUSH treatment costs, emergency services, critical illness, and personal accident cover.

The insured is entitled to receive 1 free health checkup coupon and 2 in case of a floater plan.

Claims under health insurance can only be made if the policyholder has been admitted to the hospital for at least 24 hours.

Cashless claims can be made at any of the network hospitals that have a tie-up with the insurance company.

The 3 major risks involved in health insurance are speculative risk, pure risk, and financial risk.

Any individual between the ages of 18 years to 65 years can explore the plan as it offers comprehensive coverage, loyalty benefits and exciting value-added benefits that take care of all the medical needs of the insured.

No, base coverages and riders are not the same. Base coverages are inbuilt coverages that a policy offers to the insured, whereas riders are optional benefits that the insured can add to the existing policy in exchange for an additional premium.

Yes, you can switch your existing policy to ICICI Lombard. To make the switch, you need to apply along with a portability form and existing policy documents at least 45 days before your existing policy lapses.