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Health Shield 360 Top up - Terms and Conditions

 

Product Name: Health Shield 360. UIN: ICIHLGP22083V022122 A

 

HS 360 Top up comes into effect only after hospitalization expenses cross a certain limit, thus providing an added cover to your existing health policy. For example, one has opted for a Top-up policy with a Sum Insured of ₹20 Lakh and a deductible of ₹4 Lakh. In case of an unfortunate circumstance, this policy will cover the hospitalization expenses exceeding ₹4 Lakh upto the Sum Insured.

 

Eligibility

 

  • Exclusive offering for ICICI Bank customers. Customer needs to be an Insured member.

  • Adults from 21 to 60 years, children from 91 days to 20 years; child will be covered under floater plan only

  • Tenure: 1 Year

  • Family definition: Self, spouse and max. 2 dependent children upto 20 years of age

 

 

Specific exclusions

 

  • 30 days waiting period for all diseases except hospitalisation due to accident.

  • Standard list of diseases & procedures will be covered after 30 days of initial waiting period.

 

 

Pre-existing disease(s) (PED)

 

  • Declared & accepted PED will be covered after 30 days of initial waiting period and needs to be declared by insured for all insured members in policy.

  • Any non-declaration of PED will lead to rejection of claims and cancellation of policy.

 

 

Premium Chart

 

HS 360 Top Up Premium Chart

Sum Insured

Deductible Amount

2 Lakhs

3 Lakhs

4 Lakhs

5 Lakhs

15 Lakhs

4649

4099

3699

2949

25 Lakhs

6549

5999

5549

4849

50 Lakhs

-

9199

8749

8049

 

Age agnostic premium for all cohorts such 1A, 2A, 2A + 1K, 2A + 2K, 1A +1K, 1A + 2K

 

(* A → Adult, K → Kid)

 

 

Key features of the product are as below:

 

Features

Room Rent

No Capping, covered up to SI

Pre - Post Hospitalisation

Pre Hospitalisation and Post Hospitalisation for 60 days & 90 days respectively are covered.

In-patient Hospitalisation

Covered up to SI

Day Care Procedures

All Day Care Procedures are covered

Domiciliary Hospitalisation

Covered upto Sum Insured for Medical expenses for treatment taken when confined within one's home subject to completion of minimum 3 continuous days of such hospitalisation

Domestic Road Ambulance Service

Covers road ambulance expenses, incurred to transfer the Insured following an emergency to the nearest hospital per event of emergency hospitalisation, provided we have accepted the in-patient claim up to a maximum limit as below

15 Lakhs - INR 3,000
25 Lakhs , 50 Lakhs - INR 5,000

Donor Expense

Covered upto Sum Insured as per definition, provided organ used is for Insured person

Unlimited Reset Benefit

Reset will be available unlimited times in a policy year in case the annual Sum Insured including accrued Additional Sum Insured (if any) and Super No Claim Bonus (if any), Sum Insured Protector (if any) is insufficient as a result of previous claims in that policy year will be applicable only within the geographical boundaries of India.

Claim Protector

The items which are not payable under the claim as per the list of excluded items released by IRDAI that is related to the particular claim will become payable. This cover will be applicable only within the geographical boundaries of India.

ASI Protector

Additional Sum Insured (ASI) accrued by you will not be impacted or reduced at renewal if any one claim or multiple claims admissible in the previous policy year under the policy does not exceed the overall amount of Rs.50,000. This cover will be applicable only within the geographical boundaries of India.

Sum Insured Protector

The SI will be increased on cumulative basis at each renewal on the basis of Inflation rate in previous year.

Pre policy Medicals

Tele UW incase of declared PED

Pre-Existing Diseases

Pre-Existing Diseases that have been declared at the time of proposal and accepted by us will be covered with 30 days waiting period.

Home Healthcare

We will cover the medical expenses incurred by you on availing treatment at home. This cover will be applicable only within the geographical boundaries of India.

Health Check Up

Not Applicable

Health Assistance Services

Not Applicable

30 Days waiting period

Cataract

Benign Prostatic Hypertrophy

Myomectomy, Hysterectomy unless because of malignancy

All types of Hernia, Hydrocele

Fissures &/or Fistula in anus, hemorrhoids/piles

Arthritis, gout, rheumatism and spinal disorders

Joint replacements unless due to accident

Sinusitis and related disorders

Stones in the urinary and billiary systems

Dilatation and curettage, Endometriosis

All types of Skin and internal tumors/ cysts/ nodules/ polyps of any kind including breast lumps unless malignant

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/illness/defects

 

Exclusions

 

  • Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.

 

  • Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:

 

  • Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.

  • Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.

 

  • Obesity/ Weight Control: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:

     

    • Surgery to be conducted is upon the advice of the Doctor

    • The surgery/Procedure conducted should be supported by clinical protocols

    • The member has to be 18 years of age or older and

  • Body Mass Index (BMI);

  • Greater than or equal to 40 or

  • Greater than or equal to 35 in conjunction with any of the following severe co- morbidities following failure of less invasive methods of weight loss:
    • Obesity-related cardiomyopathy

    • Coronary heart disease

    • Severe Sleep Apnea

    • Uncontrolled Type2 Diabetes

 

  • Gender treatments: Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.

 

  • Hazardous or Adventure sports: Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

 

  • Breach of law: Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.

 

  • Circumcision whether or not necessitated by vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery unless necessary for treatment of a disease not excluded by the terms of the policy or as may be necessitated due to treatment of an accident.

 

  • Cosmetic or plastic Surgery: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, It must be certified by the attending Medical Practitioner.

 

  • Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.

 

  • Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons

 

  • Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.

 

  • Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness

 

  • Sterility and Infertility: Expenses related to sterility and infertility. This includes:

     

    • Any type of contraception, sterilization

    • Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI

    • Gestational Surrogacy

    • Reversal of sterilization

 

  • The cost of spectacles and contact lenses, hearing aids.

 

  • Dental treatment or surgery of any kind unless requiring hospitalisation.

 

  • Convalescence, general debility, run-down condition or rest cure, congenital external disease or defects or anomalies, , intentional self-injury (whether arising from an attempt to suicide or otherwise) and use of intoxicating drugs and/or alcohol.

 

  • Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any diseases, illness or injury whether or not requiring Hospitalisation/ Domiciliary Hospitalisation.

 

  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Medical Practitioner.

 

  • Diseases, illness, accident or injuries directly or indirectly caused by or contributed to by nuclear weapons/materials or contributed to by or arising from ionising radiation or contamination by radioactivity by any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel.

 

  • Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception.

 

  • Maternity:

     

    • Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;

    • Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period

 

  • Naturopathy treatment

 

 

Please refer policy wording for more details

 

Title

Description

Claim submission clause

Claim must be filed within 30 days from the date of completion of treatment. However, the Company may at its absolute discretion consider waiver, of this Condition in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time-limit. The claim would invite additional 10% co-payment over and above payable amount as per policy terms and conditions.

Reasonable and Customary Charges

Reasonable and Customary Charges will be applied on re-imbursement claims from non network hospitals where medical treatment taken by the Insured Person during the Policy Period following an Illness or Injury that occurs during the Policy Period, subject to availability of the Sum Insured and any specific limits specified in the Schedule of Benefits and the terms, conditions and exclusions specified in the Policy document.

Claim Intimation & Network clause

All Reimbursement Claims must be intimated to ILHC within 24 hrs of admission, in case of non intimation/ Delayed intimation 10% Co-pay would be applicable except for Accidental claims. If the member is getting admitted in any network hospital and filing for reimbursement claims such claims will be settled to members with 15% co-pay.

Add-Del of Lives

Premium to be charged as per fixed grid for addition endorsement. Premium to be refunded as per refund grid. No Refund for deletion if claim is under process or paid.

Special Condition

The Account holder (Proposer/ Applicant) to be one of the insured member in the policy

Special Condition

This policy only to be sourced along with the new salary/ savings account opening.

Termination

Policy will cease to be in effect from the date of termination of relationship with the organization.

 

Claim Process:

 

Reach us at:

 

 

 

 

 

Disclaimer:

Prohibition of Rebates – Section 41 of the Insurance Act, 1938 1) No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer. 2) If any person shall fail to comply with sub regulation (1) above, he shall be liable to payment of fine which may extend to rupees ten lakhs.

 

Only for the customers of ICICI Bank Ltd who intend to enroll under Health Shield 360 (Master policy no- 4177i/MSTR/248334901/00/000) underwritten by ICICI Lombard GIC Ltd. ICICI Bank Limited ("ICICI Bank") with registered office at ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, 390 007, Gujarat (CIN - L65190GJ1994PLC021012) is a Corporate Agent (Composite, IRDAI Regn. No.: CA0112 ) of ICICI Lombard General Insurance Company Limited (“ICICI Lombard”). Insurance is underwritten by ICICI Lombard.

 

ICICI Bank Ltd customer participation in the policy is entirely voluntary. This is only an indication of the cover offered for more details on risk factors, terms, conditions and exclusions, please read the sales brochure / policy wordings carefully before concluding a sale. ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025 Toll Free: 1800 2666 Fax No: 022 61961323 IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 Customer Support Email Id: customersupport@icicilombard.com Website Address: www.icicilombard.com Product Name: Health Shield 360. UIN: ICIHLGP22083V022122

 

BEWARE OF SPURIOUS PHONE CALLS AND FICTIOUS/FRADULENT OFFERS

 

IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums. Public receiving such phone calls are requested to lodge a police complaint.

Disclaimer

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