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ICICI Lombard Health Advantage Plus

Product Description:

Health Advantage Plus is an individual health insurance offering from ICICI Lombard which allows coverage of upto 2 adults with floater benefit under 1 plan (the floater benefit is allowed upto the age of 55 yrs post which all policies will be renewed as Individual plan upto 70 yrs). The entry age for the eldest member in the plan can be between 5 and 65 yrs while the policy can be renewed upto 70 yrs of age The policy has been so underwritten that it also provides OPD benefits to its Insured and allows them to choose the spread between the twin benefits of Hospitalization and OPD cover depending on one’s needs. Further, there are no sub-limits on room rent, doctor’s fee, or hospital charges for any disease except cataract. The Insurer allows purchase without any medical tests upto age 45, provided the proposer has a clean proposal form. Those above 56 yrs need to undergo health check up at one of the designated diagnostic centres of the Insurer. This policy also provides 30 days pre-hospitalization and 60 days post-hospitalization cover for all related expenses.

Know more about your Insurance

Key features: Availability, Benefits and Exclusions

Minimum Age at Entry : 5 years
Maximum Age at Entry : 65 years
Maximum Age at Renewal : 70 years
Minimum Sum Assured : Rs 2 lacs
Maximum Sum Assured : Rs 3 lacs
No claim Bonus – Annual : 5%
No claim Bonus – cumulative : upto 50%
Maternity Benefits : N/A
Pre-Existing Disease cover : after 4 years
Waiting Period : 30 Days

Product pricing (Incl. S/Tax)   (Rs)
Age of the Eldest Member (as on last B’Day) Individual 2 Adults (with floater benefit)
  Hospitalization benefit = Rs 2 lacs Hospitalization benefit = Rs 3 lacs Hospitalization benefit = Rs 2 lacs Hospitalization benefit = Rs 3 lacs
Fixed premium = Rs 15,000
  SI under OPD benefits as below SI under OPD benefits as below
5 – 18 yrs 10,000 9500 N/A N/A

Claim procedure

  1. Intimation & Assistance - In case of planned hospitalization, select and approach the service desk of the chosen network hospital, preferably at least 2 days in advance. Use your ICICI Lombard Health card for identification purpose. You can also share your policy no and passport no with the healthcare provider or use your PAN card or voter ID card for the same.

  2. Pre-authorization: Get the pre-authorization form (available at the hospital help desk and/or ICICI Lombard website), filled and signed from the treating doctor and submit the same with the hospital along with other necessary documents. The network hospital checks the identity of the Insured for validation and submits the pre-authorization form to the Insurer. After cross verifying the identity of the Insured and the policy coverage, the Insurer will provide confirmation to the provider by e-mail/fax and also inform the Insured by way of a text message.

  3. Cashless settlement: Get admitted for treatment at the network hospital and sign all forms, invoices and documents on discharge. ICICI Lombard will directly make the payment to the hospital for pre-approved treatment and as per policy terms & conditions. Any non-medical expense and/or expenses towards conditions not authorized under hospitalization need to be paid directly by the beneficiary of treatment. Also, remember signing the ICICI Lombard claims form and hand it over to the hospital along with all the relevant supporting documents.

*Please note in case of emergency, authorization should be taken not later than 24 hrs of admission.

Some key statistics for ICICI Lombard

Claims Pending Ratio : To be Announced soon
Complaints Resolved Ratio : To be Announced soon
Provider Network (cashless) : To be Announced soon

General Health Insurance Tips

Understand the cost of healthcare in your city/area before deciding the total cover (Sum Assured)

If your family includes a young bride, it is important to ensure the coverage of maternity benefits

Ask about the coverage of pre-existing diseases

Look at the waiting period

Satisfy yourself about the specific disease’s coverage under the Critical Illness cover

Inquire about the availability of cashless facility at the Network hospitals

Always compare before buying

Disclaimer: This is only an illustrative document to serve as a quick guide for aide in decision making.

Information Source: ICICI Lombard website www.icicilombard.com as on 10th Oct’2011
IRDAI annual report’2010