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ICICI Lombard Health Shield 360 - Terms and Conditions

 

Key Benefits, Exclusions, Disclaimers & Policy Coverage

 

  • Hospitalisation Cover: All expenses pertaining to in-patient hospitalisation such as room rent, intensive care unit charges, surgeon’s and doctor’s fee, anaesthesia, blood, oxygen, operation theatre charges  etc. incurred during hospitalisation for a minimum period of 24 consecutive hours are  covered under the basic hospitalisation cover.

  • Day Care Surgeries / Treatments Coverage: All the medical expenses incurred while undergoing Day Care Procedures / Treatment which require less than 24 hours hospitalisation are covered

  • Pre and Post Hospitalisation Expenses: Medical expenses incurred, immediately, 60 days before and 90 days after hospitalisation will be covered

  • In Patient AYUSH Treatment: Expenses for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatment only when it has been undergone in a AYUSH hospital or in AYUSH Day Care Center on Re - imbursement basis

  • Unlimited Reset Benefit: We will reset up to 100% of the base Sum Insured unlimited times in a policy year in case the Sum Insured including accrued additional Sum Insured (if any), Super No Claim Bonus (if any) & Sum Insured Protector (if any) is insufficient as a result of previous claims in that policy year

  • Additional Sum Insured (ASI): An Additional Sum Insured of 10% of Annual Sum Insured provided on each renewal for every claim free year up to a maximum of 100%. In case of a claim under the policy, the accumulated Additional Sum Insured will be reduced by 10% of the Annual Sum Insured in the following year

  • Health Check-up Cover: In this benefit we will cover the medical expenses incurred by you on availing treatment at home as prescribed by a medical practitioner

  • Claim Protector: In case the customer has opted for this cover, the IRDAI list of non-payable items shall become payable in case of a claim

  • Additional Sum Insured (ASI) Protector: ASI accrued by the customer shall not be impacted if any one claim or multiple claims admissible in the previous year does not exceed the overall amount of `50,000

  • Sum Insured Protector: In case the customer has opted for this cover, the SI will be increased at renewal on the basis of inflation rate of previous year

  • 360 Wellbeing program: 360 Wellbeing program aims to empower individuals to manage their lifestyle and prevent complications arising from adverse health conditions. It intends to promote, incentivise and reward individuals for healthy behavior through various health and wellbeing activities

  • Air Ambulance Cover: Air Ambulance expenses incurred to transfer the Insured Person following an emergency to the nearest Hospital up to Sum Insured on cumulative basis

  • Domestic Road Emergency Ambulance Cover: The expenses incurred on road ambulance services which are offered by a healthcare or ambulance service provider to transfer an individual to the nearest Hospital with adequate emergency facilities for the provision of Emergency Care is covered

  • Donor Expenses: Medical Expenses incurred in respect of the donor for any organ transplant surgery, provided the organ donated is for the insured person’s use

  • Domiciliary Hospitalisation: Coverage for medical expenses in a situation where the Insured Person is in such a state that he/she cannot be moved to a hospital or the treatment is taken at home, if there's a non-availability of room in the hospital

  • PED covered after 30 days: Declared and accepted Pre-Existing Diseases will be covered after 30 days initial waiting period. Any non-declaration of PED will lead to rejection of claims and cancellation of policy

  • Cashless hospitalization at 6500+ network hospitals- As on 21st June 2021

  • Tax Deduction u/s 80D: Tax deduction under section 80D is as per the applicable provisions of the Income Tax Act, 1961 (including any amendments thereto) and are subject to changes in the tax laws

  • Out-Patient Treatment Cover*: Outpatient (OPD) medical expenses covered on cashless and reimbursement basis

  • Maternity Benefit*: Reimbursement for medical expenses incurred for delivery, including a cesarean section, during hospitalisation or lawful medical termination of pregnancy during the policy period. The waiting period for maternity cover is 1 year. The cover shall be limited to 2 deliveries / terminations during the period of insurance. Pre - Natal and Post - Natal expenses shall be covered under this benefit. This cover is applicable only for floater plan having Self and Spouse in the same policy

  • Newborn Baby Cover*: The newborn child can be covered under this policy during hospitalisation for a maximum period up to 91 days from the date of birth of the child. This cover will be provided only if maternity cover is opted

  • Super No Claim Bonus*: In case the customer has opted for this cover, there will be a 50% bonus awarded for every claim free year subject to a maximum of 100%

  • Compassionate Visit*: In the event of hospitalisation exceeding 5 days, the cost of economy class air ticket up to a certain amount (as per the plan chosen) incurred by the customer’s “immediate family member” while travelling to place of hospitalisation from the place of origin / residence and back will be reimbursed. “Immediate family member” would mean spouse, children and dependent parents 

  • *These are add-on covers and are available by paying extra premium

  • Cashless hospitalization at 6500+ network hospitals- As on 1st January 2018.      

 

Terms & Conditions

 

  • Eligibility:
    • Exclusive offering to ICICI Bank customers who are insured members

    • 21 to 75 years for Adult, children from 91 days to 20 years; child will be covered under floater plan only

 

  • Tenure: 1 Years

  • Family definition: Self, Spouse, Dependent parents, Dependent siblings and max. 2 dependent children upto 20 years of Age

    •  

  • Room rent restriction: NIL

 

  • Pre-Policy Medicals:

     

    •  Tele underwriting above age 55 years and also incase of declared pre-existing disease

    •  Medical test for above 65 years of age and for Rs. 75 Lakhs and Rs. 1 Cr Sum Insured options

 

 

Waiting Period

 

  • Cooling period: 30 days for all diseases except hospitalisation due to accident

  • Specific exclusion: Standard list of diseases & procedures (kindly refer to 1 year exclusion list) will be covered after 12 months of continuous coverage

 

  • Pre-existing disease(s) (PED):
    • Declared & accepted PED will be covered with NIL waiting period

    • PED 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

 

  • Maternity cover: This cover can be availed only if both the insured & spouse are covered under the same plan for a continuous duration of 12 months

 

Conditional Underwriting

 

  • When an insured member declares an existing illness, a medical underwriting is done for such proposal. On the basis of the medical underwriting the proposal is either accepted with loading on premium or it’s rejected

  • Customer is enrolled in the policy with loading on premium and also becomes part of Be Healthy program of 360 Wellbeing Program 

  • Standard List of Diseases & Procedures Will be Covered After 12 Month of Continuous Coverage

 

 

List of Specific Diseases/Procedure

 

  • 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 biliary 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

  • Dastric and Duodenal erosions & ulcers

  • Deviated Nasal Septum

  • Varicose Veins/ Varicose Ulcers

  • All types of internal congenital anomalies/ illness/ defects

 

 

Major Permanent Exclusions

 

  • Medical expenses incurred during the first 30 days of inception of the policy, except those arising out of accidents. This exclusion doesn’t apply for subsequent renewals without a break

  • Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)

  • Expenses arising out of or attributable to alcohol or drug use / misuse / abuse

  • Cost of spectacles / contact lenses, dental treatment

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

 

For more details, kindly refer the Master Policy Wordings

 

 

Disclaimer:

Only for the customers of ICICI Bank Limited who intend to enrol under ICICI Lombard Health Shield 360 (UIN - ICIHLGP22083V022122 (4177i)), policy underwritten by ICICI Lombard GIC Ltd. IRDAI Reg No. 115. ICICI Bank is acting in the capacity of the group master policy holder (policy no.) This is just for information purpose and should not in any way be construed as any kind of promotion or endorsement of any insurance product by ICICI Bank Limited. Insurance is being provided to all customers of ICICI Bank. For more details, please refer the policy wordings or you may contact us on 18002666. T & C apply. 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 valid till 31/03/2022) of ICICI Lombard. Insurance is underwritten by ICICI Lombard. Enrollment by ICICI Bank’s customer of any insurance products is purely voluntary, and is not linked to availment of any other facility from ICICI Bank. ICICI Lombard Health Shield 360 (UIN - ICIHLGP22083V022122 (4177i)). Email - customersupport@icicilombard.com, Website - www.icicilombard.com. T&C apply. ICICI Lombard Health Shield 360 (UIN - ICIHLGP22083V022122 (4177i)), Master policy number 4177i/MSTR/220856891/00/000 customersupport@icicilombard.com, www.icicilombard.com T&C apply

 

Disclaimer

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