ICICI BANK HEALTH INSURANCE

Health advantage plus insurance:

BENEFITS:

Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental

treatment, medical bills, ambulance charges etc
Avail Cashless Claim facility at 3,500 network hospitals across India

A maximum of 2 adults can be covered under a single policy.

Now get additional Sum Insured for every claim free year.
Avail tax benefit under Section 80 D of the Indian Income Tax Act, 1961 *
Pre-existing illness covered after two years, subject to continuous renewal of the policy.
Maternity expenses can be covered under OPD expenses of this plan up to the OPD sum
insured
ICICI Lombard Health Advantage Plus insurance policy has no sub-limits on room rent,
doctor fees, and hospital charges or for any disease except Cataract (INR 20,000 per eye
applicable)
ICICI Lombard Health Advantage Plus insurance policy has no co-payments for any
disease or any Hospital usage
Insurance against Terrorist activities.
Buy Online through ICICI Bank, HDFC Bank and Citibank Credit card and pay in
EMIs without any extra charges**
* Tax benefits are subject to changes in tax laws
** EMI facility available only for ICICI Bank, Citibank, HDFC Bank (upto 6 months) credit card customers at the sole discretion of the Banks.
Note: EMI option subject to minimum annual premium of Rs. 1500. Click here to know more.

COVERAGE:

Basic Hospitalisation Cover

Covers medical expenses incurred:

As an inpatient during hospitalisation for more than 24 hours, including room charges,
doctor’s / surgeon’s fee, medicines, diagnostic tests, etc.

30 days prior to hospitalisation

60 days post hospitalisation
Pre-existing diseases shall be covered after 2 years
This policy also covers you for hospitalization# in case of Swine Flu / H1N1 influenza

Following technologically advanced treatments do not need 24-hour hospitalisation but

are covered under this policy are:-

- Cataract (limited to Rs. 20,000 per eye)

- Lithotripsy (Kidney Stone Removal)
- Tonsillectomy
- Eye Surgery
 - Dialysis
- Dilatation & Curettage
- Chemotherapy
- Radiotherapy
- Coronary Angiography
- Cardiac Catheterization

Outpatient Department (OPD)

The following OPD expenses are covered:

Room, Boarding Expenses as charged by the Hospital
Nursing Expenses
Expenses related to Dental Treatment
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables,
Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy,
Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids,
Dental treatment charges, Ambulance charges

Note The OPD claims can be made only on a reimbursement basis. You can lodge a
claim only once during the Period of Insurance, i.e. 90 days after commencement of
policy and 30 days after expiry of the Period of Insurance.

HEALTH ADVANTAGE PLUS INSURANCE POLICY PREMIUM TABLE

Age of Senior
Most Member (as
Individual 2 Adults
on his last
birthday)
(with floater benefit)
SI under SI under SI under SI under Hospitalisation
Hospitalisation Hospitalisation Hospitalisation Benefit = Rs. 3 Lakhs
Benefit = Rs. 2 Benefit = Rs. 3 Benefit = Rs.2
Lakhs Lakhs Lakhs

SI under OPD Benefit as below SI under OPD Benefit as below

Fixed Premium Rs. 15,000
5 yrs. - 18 yrs. Rs. 10,000 Rs. 9,500 -
19 yrs. - 35 yrs. Rs. 9,000 Rs. 8,800 Rs. 8,000 Rs. 7,500
36 yrs. - 45 yrs. Rs. 8,500 Rs. 8,000 Rs. 7,000 Rs. 6,500
46 yrs. - 55 yrs. Rs. 6,000 Rs. 5,500 Rs. 3,000 Rs. 2,000
56 yrs. - 60 yrs.* Rs. 4,500 Rs. 3,500 -
Fixed Premium Rs. 20,000
61 yrs. - 65 yrs. Rs. 7,000 Rs. 5,500 -
66 yrs. - 70 yrs. Rs. 4,000 Rs. 2,000 -
(for renewal
only)**
*Medical Tests mandatory for insured aged 56 and above
**Age at entry: max. upto 65 years; renewable upto 70 years

ELIGIBILITY:

The enrollment age (of senior most member) can be between 5 to 65 years of age .
Maximum two adults can be covered under a single policy.
The Proposer needs to be above 18 years of age.
No health check-up up to the age of 55 years (age as on last birthday).
Individual(s) proposed for Insurance whose age is 56 years & above have to undergo
medical tests at ICICI Lombard designated diagnostic centers.
The policy cover is renewable till the age of 70 years.
Income Tax benefit u/s Section 80D of the Income Tax Act, 1961 can only be availed
for policies bought for self, spouse, dependent children or parents.

Exclusions for Basic Hospitalization Benefit Cover:

Exclusions valid for the firs 30 Days

-Any illness contracted within 30 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 of this policy.

Exclusions valid for the first 2 Years

Treatment of the following diseases -

- Cataract **
- Benign Prostatic Hypertrophy
- Myomectomy, Hysterectomy unless because of malignancy
- Hernia, Hydrocele
- Fistula in Anus, Piles
- Arthritis, Gout, Rheumatism
- Joint replacement, unless due to accident
- Sinusitis and related disorders
- Stone in the urinary and biliary systems
- Dilatation & Curettage
- Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
- Dialysis required for chronic renal failure
- Surgery on tonsils and sinuses
- Gastric and duodenal ulcers
- Deviated Nasal Septum

** Sub limit of Rs. 20,000 per eye is applicable

If the policy is renewed with us for 2 consecutive years, the above diseases/illness/ailments will be covered from the 3rd year. If these are pre-
existing diseases at the time of inception of the policy, the same will be covered from the second consecutive renewal.

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 2 consecutive years.
- Non-allopathic treatment, pregnancy and childbirth related diseases, 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, riots, strike, nuclear weapon induced treatment.

Exclusions for OPD (Outpatient Department Expenses):

- Suicide or self-inflicted injury
- Alcohol or drug abuse
- War, riots, nuclear related hospitalization
- Non-allopathic treatment, experimental and unproven treatment
- Expenses arising from treatment of HIV/ AIDS or related disease, use or misuse of alcohol and other intoxicating substances and intentional
self-injury
For more details, kindly refer to the Policy Wordings.

FAMILY FLOATER HEALTH INSURANCE:

Family Floater Health Insurance
A comprehensive Health Insurance policy that ensures... Poorey parivaar ki poori
suraksha. Secure your family against financial emergencies during sudden illness, surgery
and accidents as well as against terrorist activities.

Family Floater Health Insurance plan lets you share the entire sum insured among the
family members covered under the policy, without any individual upper limits.
Understand the Floater Concept
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Example

The Prakash Family is covered under a traditional health insurance plan with individual policies, of which Mr. Prakash
is separately covered for Rs. 2 Lakhs, his wife for Rs. 1 Lakh, their son and daughter for Rs. 50,000 each. They have
paid premium for all these four policies separately. In an unforeseen situation, wherein surgery and post hospitalisation
bill of their son amounts to Rs. 1.30 Lakhs, the existing policy will cover only Rs. 50,000, while Mr. Prakash will have
to bear the balance Rs. 80,000 from his pocket. However, with Family Floater Health Insurance plan, each member of
the Prakash family can utilize the entire sum insured of Rs. 4 Lakhs. Thus in the above situation, Family Floater would
have covered the entire amount of Rs. 1.30 Lakhs of medical expenses of his son.

Policy Details

Key Benefits

• Comprehensive coverage for your family with floater benefit

• Cashless claims facility at over 3,500+ network hospitals across India
• Continue to enjoy quality service even during claim settlements with - ICICI
Lombard Health Care - our own in-house health claim processing and wellness
team
• No sub-limits on room rent, doctor fees, and hospital charges or for
any disease (except Cataract where Rs. 20,000 per eye is applicable).
• No co-payments for any disease or any hospitalisation expenses

Know more about key benefits

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Key Benefits

• Comprehensive coverage for your family with floater benefit

• Cashless claims facility at over 3,500+ network hospitals across India
 • Continue to enjoy quality service even during claim settlements with - ICICI
Lombard Health Care - our own in-house health claim processing and wellness
team
• No sub-limits on room rent, doctor fees, and hospital charges or for any disease*
• No co-payments for any disease or any hospitalisation expenses
• No health check-up up to the age of 55 years (age as on last birthday)
• Avail tax benefits under Section 80D of the Indian Income Tax Act 1961**
• Now get a Free health check-up coupon for any one insured family member, valid
for the policy period
• Buy Online and pay in EMIs without any extra charges***
• Options for one or two year covers (auto renewal) available
• Get additional Sum Insured for every claim free year
• Keep your family secured even against expenses for hospitalisation due to
terrorist
activities

* Except Cataract where Rs. 20,000 per eye is applicable

** Tax benefits are subject to tax laws. Click here to calculate your tax saving
*** EMI facility available only for ICICI Bank, Citibank and HDFC Bank (up to 6
months) credit card
customers at the sole discretion of the Banks.

Note: EMI option subject to minimum annual premium of Rs. 1500. Click here to know
more.

What is covered

• Medical expenses incurred as an inpatient during hospitalisation for more than

24 hours, including room charges, doctor/ surgeon's fee, medicines bills, etc
• Medical expenses incurred 30 days prior and 60 days post hospitalisation
• Day Care expenses incurred on named advanced technological surgeries and
procedures requiring less than 24 hours of hospitalisation. (Including Dialysis,
Radiotherapy and Chemotherapy)

Know more about what is covered

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What is covered

• Medical expenses incurred as an inpatient during hospitalisation for more than

24 hours, including room charges, doctor/ surgeon's fee, medicines bills, etc
• Medical expenses incurred 30 days prior and 60 days post hospitalisation
 • Day Care expenses incurred on named advanced technological surgeries and
procedures requiring less than 24 hours of hospitalisation. (Including Dialysis,
Radiotherapy and Chemotherapy)
• Pre-existing diseases can be covered after four continuous years of coverage with
the Company*
• This policy also covers you for hospitalisation in case of Swine Flu / H1N1
influenza**

* Conditions Apply
** If it's not a pre-existing illness

Terms of Renewability

Your Family Floater Health Plan can be renewed instantly. Click here to know more.

View Premium Table

For complete details, refer to the Policy Wordings.

What is not covered

Exclusions valid for the first 30 Days

• Any illness contracted within 30 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

Know more about what is not covered

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What is not covered

Exclusions valid for the first 30 Days

• Any illness contracted within 30 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

Exclusions valid for the first 2 Years

• Treatment of the following diseases/illness/ailments:

• Cataract
 • Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation & Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast

lumps, unless malignant / adenoids and hemorrhoids

• Dialysis required for chronic renal failure
• Surgery on tonsils, adenoids and sinuses
• Gastric and duodenal ulcers

If the Policy is renewed with us for two consecutive years, the above diseases / illness /
ailments will be covered from the third year. If these are pre-existing diseases at the
time of inception of the policy, the same will be covered after the fourth year onwards,
subject to continuous renewal of the policy with us.

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 4 consecutive years
• 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, riots, strike, nuclear weapon, induced treatment

For details, kindly refer to Policy Wordings.

Eligibility

• The customer can buy the policy for any family member(s) children and / or
parents
• The senior most person to be insured should be between 5 to 60 years of age.
(Persons aged 60 and above can consider our Health Advantage Plus plan, in
which the age of the senior most person is up to 65 years)
 • The Proposer needs to be aged above 18 years

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Eligibility

• The customer can buy the policy for any family member(s) children and / or
parents
• The senior most person to be insured should be between 5 to 60 years of age
• The Proposer needs to be aged above 18 years
• To cover children aged between 91 days to 5 years, the policy must also cover at
least 1 adult under the same policy
• Children under less than 91 days old cannot be covered
• Individual(s) proposed for Insurance whose age is 56 years & above have to
undergo medical tests at ICICI Lombard designated diagnostic centers
• The policy cover is renewable till the age of 70 years
• Income Tax benefits u/s 80D can only be availed for policies bought for Self,
Spouse,
Children or Parents
• Floater benefit under the policy is available up to the age of 60 years. All floater
policies thereafter will be renewed under individual plan up to the age of 70 years

For details, kindly refer to Policy Wordings.

Claims

Identify your Service Provider

Refer to your cashless claim card and check the logo displayed to determine
your service provider

Click to view the various service providers

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Claims

Identify your Service Provider

Refer to your cashless claim card and check the logo displayed to determine your service
provider
 • ICICI Lombard Health Care
• TTK Healthcare TPA Private Limited
• Parekh Health Management (Pvt.) Ltd.
• Medi Assist India Pvt. Ltd.
• MD India Healthcare Services (TPA) (Pvt.) Ltd.
• Paramount Health Services Pvt. Ltd.
• E Meditek Solutions Ltd.
• Family Health Plan Ltd.
• Raksha TPA Pvt. Ltd.
• Health India TPA Services Private Limited
• Dedicated Healthcare Services (India) Private Limited
• Alankit Health Care Limited
• Vipul Med Corp TPA. Pvt. Ltd.
• Park Mediclaim Consultants Private Ltd.
• Safeway Mediclaim Services
• Anmol Medicare Ltd.

Health Insurance and You

What is Health Insurance?
The commonest form of health insurance policies in India cover the expenses
incurred on hospitalisation, though a variety of products are now available which
offer a range of health covers, depending on the need and choice of the insured.
The health insurer usually provides either direct payment to hospital (cashless
facility) or reimburses the expenses associated with illnesses and injuries or
disburses a fixed benefit on occurrence of an illness. The type and amount of
health care costs that will be covered by the health plan are specified in advance
in the form of policy wordings and documents.

Personal Accident Insurance - Introduction

ICICI Lombard Personal Accident Insurance policy covers you not only against
Accidental Death and Permanent Total Disablement (PTD), but also against terrorism
and acts of terrorism. You can choose from 4 options of Rs. 3 Lakhs, 5 Lakhs, 10 Lakhs
or 20 Lakhs with a choice of cover period (annual auto renewal) - 3, 4 or 5 years.

Policy Details
Policy Coverage | Key Benefits | Eligibility | Need for PA | Claim Process | Why buy
online
Policy Coverage
Personal Accident policy covers you for

Terrorism and Acts of Terrorism: In case of the death of the insured arising out of
terrorism or acts of terrorism within the policy period, the nominee (mentioned in the
policy) is compensated with the sum Insured. The Company shall also pay
compensation against permanent and total loss of limbs, sight etc. (of the insured)
arising out of terrorism or acts of terrorism.
Accidental Death : In case of death of the insured due to an accident within the policy
period, the nominee (mentioned in the policy) is compensated with the Sum Insured.
Permanent Total Disablement (PTD) : Personal Accident pays compensation against
the permanent and total loss of limbs, sight etc. due to an accident.
Click here for details

Note: If any such injury as mentioned above shall result in the inability to remain
gainfully employed, then the Capital Sum Insured payable will be 100%.

Click here to view our Policy Exclusions.

For more details, kindly refer to the Policy Wordings.

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Key Benefits
Covers claims arising out of Terrorism or acts of Terrorism
Covers against Accidental Death or Permanent Total Disablement (PTD)
Choose among Sum insured options of Rs. 3, 5, 10 and 20 Lakhs
Choice of cover period: 3, 4 or 5 years
No health check-up required
Easy Claim Process with minimal documentation

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Eligibility
Age criteria at entry: Minimum 18 years, Maximum 70 years.
The applicant can buy the policy for his spouse aged between 18-70 years.

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Need for PA
Terrorist activities are no longer limited to the sensitive border areas of India. The
recent terror attacks in Mumbai at prominent areas including CST railway station, Hotel
Taj and Hotel Oberoi Trident, has shook the entire nation. The bomb blasts at major
Indian cities like Delhi, Jaipur, Bangalore and Ahmedabad have put the entire nation
under threat. It has become imperative to have a terrorism cover. Our Personal Accident
Policy covers you against terrorism related accidental losses and death.
According to a report by IIT Delhi on Traffic Injuries and Fatalities in India, road traffic
accidents take a toll of almost 1.2 million people a year and additionally injure or
disable between 20 million and 50 million annually
Personal Accident Insurance protects the insured against Accidental Death & Permanent
Total Disablement (PTD)

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Claim Process
Know all about making a claim

Claim Process
Documents Required
Download Claim Form

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Why buy online

Here are some reasons why you should buy your policy on www.icicilombard.com -

Instant Policy - Your Policy is issued instantly, on completion of your online

transaction. It is emailed immediately to the Email ID provided by you.
You can also print/download the policy from your account on
www.icicilombard.com using your User ID & Password. It’s a Digitally Signed valid
document just like a hard copy of your policy, which you can access online.
Moreover, if you select to the “Send me the Policy through courier” option while
buying the policy, it will be couriered to your correspondence address, and will reach
you within 15 days.
No Paperwork – There is no need of any paperwork. Save time & paper- Buy Online.
EMI without any extra charges: You can pay online through ICICI Bank, HDFC
Bank and Citibank Credit Cards through EMIs without any extra charges . (Conditions
Apply)
Highest Levels of Security: All your details are secured with us. Click to view our
security certification:
Entrust Certification

Personal Accident Product Code: Misc 15

A major illness or accident can adversely affect your plans for the future, since it keeps
you away from work and eats into your savings. ICICI Lombard’s Critical Care Insurance
policy helps protect your savings by taking care of your medical expenses during those
trying times, so that your savings can be utilised in the way you had initially planned. It
also offers financial support to help you cope with the lifestyle changes that you need to
make post a critical illness or major accident, by offering you a lump-sum benefit of the
entire sum insured on first diagnosis / undergoing of any of the nine listed medical
illnesses and procedures.

Benefits

Coverage

Eligibility

Exclusions

Claims

FAQs
 Comprehensive cover and pure benefit policy offering lump-sum amount
equivalent to sum insured just on first diagnosis / undergoing of any of 9 Major
Medical Illnesses & Procedures, Accidental Death /Permanent Total Disablement
(PTD) due to accident.
No health check-up required for policy issuance.
No survival period, benefit paid immediately on first diagnosis of the covered
disease.
Claim settled within 21 days of receipt of all required documents.
Only a proposal form and medical declaration from needs to be filled for policy
issuance.
Choose between a cover of Rs. 3 Lakh, Rs. 6 Lakh or Rs. 12 Lakh sum insured and
policy duration between 1 year, 3 years or 5 years.
Avail oftax benefit under section 80D of Income Tax Act on the premium
applicable for Major Medical Illnesses & Procedures cover.*

* Tax benefits are subject to tax laws.