General Insurance from ICICI Lombard General Insurance

Health Insurance :

Avail of health policies that covers your entire family under one umbrella, thereby enabling you to pay only one premium and covering each member to the full extent of the sum insured. Save maximum tax under our 10K Tax Saving Plan.

The Health Plans are as follows -

10K Tax Saver Insurance - A fixed premium plan enabling highest tax saving u/s 80D with comprehensive health benefits.

Family Floater Insurance - A single policy that secures the hospitalization expenses of your entire family.

10K Tax Saver Health Insurance.

ICICI Lombard General Insurance presents to you `10K Tax Saver Health Insurance Policy’. The first of its kind, this policy has a fixed premium and enables you to save up to Rs. 3,366* under Section 80 D of the Income Tax Act.

How does it work:

Under this policy, the insurance premium remains the same at Rs. 10,000. What changes is the Sum Insured (amount of coverage) depending on the age and the number of members covered. The amount of the premium (Rs. 10,000) is fully deductible under Section 80D of the Income Tax Act. Thus, you save Rs. 3366 on your tax payable.

* For highest income tax slab of 33.66% (including 10% surcharge for income above Rs. 10 Lakh and education cess @ 2%).

Family Floater Health Insurance.

For the first time in India, one single policy takes care of the hospitalization expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents.

How does it work?

The Prakash Family is covered under a traditional health insurance plan - Mr. Prakash Rs. 2 lac, his wife Rs. 1 lac, their son and daughter Rs.50,000 each and they have paid premium for all these 4 policies. In an unforeseen situation, wherein surgery and post hospitalisation bill of their son amounts to Rs. 1.30 lac. The existing policy will cover only Rs. 50,000, while Mr. Prakash will have to bear the balance Rs. 80,000 from his pocket.

With Family Health Floater Insurance plan, each member of Prakash family is covered up to Rs. 4 lac. Thus, Family Floater would have covered entire Rs. 1.30 lac medical expenses of Mr. Prakash's son.

Policy Coverage :

What is Covered : The policy covers medical expenses.

• Incurred as an inpatient during hospitalization for more than 24 hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic tests, etc
• 30 days prior to hospitalization.
• 60 days post hospitalization.
• Pre-existing disease can be covered after the 4th year provided the policy is renewed with us for four consecutive years.
• Technologically advanced treatment that do not need 24-hour hospitalization but are covered under this policy are:-
  - Cataract
  - Lithotripsy (Kidney Stone Removal)
  - Tonsillectomy
  - Eye Surgery
  - Dialysis
  - Dilatation & Curettage
  - Chemotherapy
  - Radiotherapy
  - Coronary Angiography
  - Cardiac Catheterization
  
  
  Coverage limit for specific ailments/ conditions :
  
  Certain specific ailment(s) / surgery(s)/ procedure(s) are covered up to pre-defined limits under this policy (subject to the total sum insured).
  

  All others ailment(s) / surgery(s)/ procedure(s) are covered up to the sum insured under the policy.

Key Benefits :

Avail the following benefits with 10K Tax Saver Health Policy:

• One policy - one sum insured for entire family. All members, either individually or together, can claim up to the total sum insured.
• Maximum income tax benefit under section 80 D.
• Fixed premium of Rs 10,000 for all plans.
• Cashless claim facility available at over 2,900 network hospitals in more than 175 cities across India
• No health check up required
• Digitally signed policy available 24X7 online.
• Multiple payment options – credit card, net banking (direct debit), and cheque / demand draft.

You can pay through your ICICI Bank Credit Card and avail of Interest-Free equal monthly installments (EMI) for your premium.

Additional Benefits:

Double Benefit : A benefit of Rs.10,000 is paid, if more than one member of the family (covered under one policy) are simultaneously hospitalized for a period of 5 consecutive days or more.

Convalescence Benefit : A benefit of Rs.10,000 is paid, if the period of hospitalization is 10 consecutive days or more. This benefit is paid once in a year.

• The enrolment age (of the senior most family member) should be between 19 years to 60 years.
• At least two members must be insured under this policy.
• Other members in the plan can be less than 19 years of age (i.e. up to 91 days).
• The policy cover is renewable till the age of 75 years.
• The customer can buy the policy only for his (two or more) family members - defined as self, spouse, dependent children and dependent parents for the purpose of income tax exemption u/s Sec. 80D.

Policy Exclusions :

What is not covered - Following are the set of temporary and permanent exclusions :

30 days exclusions : Medical charges incurred, except those arising out of accidental injuries, within the first 30 days from the start date of the policy are not covered. This clause does not apply for subsequent renewal (without a break) of this policy with us.

2 years exclusions : Expenses incurred on treatment of following diseases within the first two years from the start date of the policy are not covered:
- 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

Permanent exclusions :
- Any internal congenital illness
- 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, terrorism acts, nuclear weapon induced treatment

These above diseases are covered from third year, if the policy is renewed with us for two consecutive years (4 years, if these are pre-existing diseases at the time of inception of the policy).

Claims :

Cashless Claims -

Under cashless facility, claims can be of two types:

Planned: Where the customer of covered family member is aware of the hospitalisation 2-3 days in advance

Emergency: Where the customer or covered family meets with sudden accident or suffers from bout of illness that requires immediate admission to the hospital.

Non Cashless Claims -

• Patient avails the treatment.
• Settle the hospital bills directly by paying the relevant charges.
• Call the TPA at toll free number 1600 42 58885 / 1600 42 57878 and inform about the hospitalization. You can also fax them at the toll free number 1600 233 4535 and call at their landline number 080 23099900
• Submit the relevant bills / documents for the claimed amount to the TPA.
• The claims will be settled in 7 working days, from the time of submission of bills.

• Duly completed claim form (available with all network hospitals).
• Original bills, receipts and discharge certificate / card from the hospital
• Bills from chemists supported by proper prescription
• Investigation test reports and payment receipts, supported by the note from attending medical practitioner / surgeon prescribing the test.
• Doctor’s referral letter advising hospitalization in non-accidental cases.
• Nature of operation performed and surgeon’s bill and receipt.
• Any other documentation / information as required by the TPA

Hospitals where we have our tie ups to provide cashless facility I.e. the bills are settled directly by us with the hospitals. We have more than 2,900 hospitls spread over more than 175 cities across India.Click here to find the network hospital in your locality.

FAQ'S :

Why do I need health insurance?

We understand the importance of health insurance only when we are hospitalised due to an injury or illness. Health insurance helps to ensure that you and your family are protected against the financial adversity resulting from medical and hospitalisation expenses.

Where can I obtain health insurance?

With online health insurance you can have your policy in your inbox within minutes. Just fill in your personal details and calculate premium. The second option is by contacting an agent.

What is a floater?

The floater is a unique plan wherein the value (sum insured) opted can be used by all the members of the family or by a single-family member. For example: if the policy is bought for 3 lacs, then either all three members of the family can use it for 1 lac each or one member can use the entire cover of 3 lacs.

What is a health card?

The health card is a feature of our product that helps you avail cashless treatment in our 1100 network hospitals. You receive a health card Along with you policy document .

Given a health card, do we have to pay once admitted in a hospital?

In case you are admitted in any of our network hospitals and avail of the cashless facility we would directly reimburse all the admissible expenses. In case of a non- networked hospitals the same will be reimbursed to you.

What are the benefits of the health card?

The benefits of carrying the Health Card is that you get access to the cashless facility from the list of network hospitals. This means you can walk into any of the 1100- networked hospitals across the country and get treated without having to pay for your bills first. Also in the event of any unforeseen accident a third party can identify your Insurance Company and your family can be intimated.

Cashless facility
Health card provides you with access to claim cashless facility treatment from any of the network hospitals. This means that you can walk in to any of the network hospitals across the country and get treated without having to pay for your bills first and then claim from us. This is subject to you getting the required authorization from our TPA.

Claim Reimbursement
it is completely understandable if you want to get treatment done from a hospital of your choice which might not feature in our list of network hospitals. In that case you will have to pay your bills to the hospital and in turn fill a claim form and send in the complete documents. Your expenses will be reimbursed within 15 working days of receipt of complete documents from you.