medal

Best General Insurance Provider of the Year*

*Best General Insurance Provider of the Year award at Business Today-Money Today Financial Awards

Group Health Insurance

Why ICICI Lombard?

Employees are the backbone of an organization and the most valued asset. Our Group health insurance product is designed to offer health coverage to suit employees of all business types ranging from small & medium enterprises to large organizations. The group health insurance policy gives choice to employees to choose plans, sum insured range starting from 1 lac to 10 lacs.

icon

6500 network hospitals

Employees can get treatment in any of our network hospitals across India. Some of the group hospitals included in our network include Apollo Hospitals, Manipal Hospitals, Fortis Healthcare, Max Healthcare, Narayana Health.

icon

Tele consultations

The insured is eligible to avail unlimited General Physician consultations for routine health issues over the phone by a qualified doctor by calling on the helpline number +91 124 4498757

icon

Health assistance services

Health Assistance is a dedicated medical care service that assists you in all your health related queries for identifying specialist/hospital/fixing an appointment with doctors/nutritionist /facilitating 2nd opinion. know more To avail this facility call our Helpline at 040 – 6627 4205 (9:30 am to 6 pm Mon to Sat, excluding public holidays) or write to healthassistance@icicilombard.com

icon

In house claims processing

Cashless settlement can be availed if treatment has been taken from our network hospitals. List of network hospitals

icon

Wellness programs

Opt for multiple wellness plans offered by ICICI Lombard.

icon

AI enabled mobile app for employees

Download our mobile app for health & wellness needs. know more Some of the key features of this app include - policy information, coverage & health cards, enrolling members, claims submission & tracking, cashless OPD services, emergency ambulance services, steps tracking, health blogs, chat with experts, health check-up, medicine reminders & EMR and individual policy management

What is Group Health Insurance?

Group health insurance cover is offered to the employees of an organization, which can also be extended to cover their family. The policy covers indemnification of medical expenses incurred by the insured during hospitalization & any illness or injury suffered in India. Pre & Post hospitalization medical expenses can be covered upto 30 days and 60 days and covers age from 91 days to 80 years.

Group Health Insurance Policy

Why Group Health Insurance?

The need of health insurance is more than ever before due to the following reasons

1

Sky rocketing medical expenses

2

Need for routine medical check-up and care

3

Expensive trips to specialist doctors

4

Possibility of hospitalization and treatment

Group Medical Insurance

What is covered in Group Health Insurance?

Group health insurance indemnifies your health care needs according to the coverage’s opted. We cover the below

circlecheck Pre & post hospitalization
circlecheck Pre-existing disease
circlecheck Maternity expenses
circlecheck Baby day one
circlecheck Pre post natal expense
circlecheck In-patient department expenses
circlecheck Ambulance charges
circlecheck Day care expenses

Advantages of Group health insurance

The policy covers benefits for the employee and their family

  • No physical health checkup
  • Covers people regardless of their age
  • Customized health care
  • Boosts employee morale
  • Affordable than buying an individual health insurance policy
  • Family is covered in the given sum insured
Group Mediclaim Policy

Claim settlement

Health claim processing is automated and simplified by using AI/ML algorithms

1

Insured requires hospitalization

2

Admitted in network hospital

3

Hospital submits Pre-Auth through web portal

4

System auto adjudicates & gives instant approval

Get answers to common questions about group health insurance policy

Covid 19 is covered subject to minimum 24 hr of in-patient.

Employer can initiate a request for quotation of the Group Health Insurance policy for their employees at any point of time. The employer has to specify the coverage requirement and a quote shall be given to them.

Minimum requirement for an employer to opt for Group Health Insurance is 10 employees or 25 total lives, below which we cannot provide Group health insurance.

Group health insurance is categorized in 2 categories

  • Employer-employee - Employees along with their spouse, children and parents are covered
  • Non employer-employee – The enrolled are covered

Group Health Insurance can be bought through ICICI Lombard's Group health Insurance policy where we cover up to 500 lives. Premium is decided subject to coverage, demography and claim experience

Yes, you can you have corporate health insurance and individual health insurance at the same time.

Group Health Insurance policy is customized and tailor made and the policies are designed as per the client’s requirements. Therefore there are no limitations.

Group Health Insurance is a collective insurance an organization buys for the benefit of its employees and employee’s dependents. The organization may tailor a plan or select a pre-planned insurance policy from an insurance company.

Individual health insurance is one that an individual purchases for himself or their dependents.

While buying the Group Health Insurance, the employer should take in consideration the coverage provided by the insurance company, the services offered and the company's claims process, this will make insurance policy buying more feasible and convenient.

While buying Group Health Insurance, employer should see the coverages provided by insurance company, services offered and the company's claims process, this will make insurance policy buying more feasible and convenient.

Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered

Treatment on trial/experimental basis and any device/instrument/machine contributing/replacing the function of an organ; Holter Monitoring are outside the scope of the policy

BASIC COVERAGE- HOSPITALIZATION

  • Any illness which require minimum 24 hrs of hospitalization will be cover under GHI upto sum insured.
  • Apart from hospitalization, any day care procedure which do not require minimum 24 hours of hospitalization and are included in our standard Daycare list are covered. Refer to ICICI Lombard official website for day care list.
  • We have a sum insured range from 50,000 to 10 lacs.

ADD ON

  • Maternity expense- which include pre-post natal care of 30 and 60 days respectively and delivery expenses for 2 living children. Limit under maternity is customize as per customer requirement
  • Cost of Prescribed External Medical Aid- The Company will reimburse the charges incurred by the insured during the policy period on account of procuring medical prosthetic or artificial devices or any medical equipment including but not limited to hearing aids, spectacles, contact lenses.
  • Baby Day One- This add-on will cover medical expenses incurred on the “new born baby” only as an in-patient in hospital for a maximum period up to 91 days.
  • Critical illness cover-The Company will pay the sum insured for this add-on, in case Insured is diagnosed as suffering from one or more of the Critical Illnesses for the first time in life, during the Policy Period
  • Corporate floater- A floater of fix amount( 1L to 10L depending on customer requirements) will be provided to cover the medical expense over and above the SI
  • Ambulance Cover- Ambulance charges would include transportation cost to the nearest hospital in case of life threatening emergency conditions.
  • Health Check-up- The company by way of this add-on, will cover the cost of health check-up incurred by the Insured for medical examination undergone being a requirement from employer. Such medical examination is generally conducted to understand health status of the employee.
  • Disease sublimit- By way of this add-on, the company can introduce sub-limits on certain diseases based on the claim experience and the requirement of the Insured. The limit is customise with respect to customer requirement
  • Domiciliary Hospitalization- Due to unavailability of bed in nearby hospital or patient is not physically or medically fit to go to a hospital, can avail this add on for treatment at his home.
  • Room Rent, nursing charges, consultation fee, diagnostic fee etc- This add-on restricts the coverage for respective heads upto a specified amount. In cases, where the claim amount exceeds this amount, the entire admissible claim amount which includes various hospital bills etc, will be reduced in the proportion which the eligible room rent limit bears to the actual room rent.
  • Virtual OPD- Include Tele consultation and Video consultation
  • Wellness and Preventive care- By way of this add-on the insured can avail any or all of the below mentioned:
    1. Health Risk Assessment
    2. Health Check-up's (add-on of report evaluation service)
    3. Medical Centre Management
    4. Diet & Nutrition Plans
    5. Online Doctor Chat
    6. Health Camps - on campus
    7. Expert Sessions - on campus
    8. Second Opinions: Domestic and International markets
    9. Discounted offerings - on health and wellness services ( Eg Gyms, Diagnostic)
    10. Disease Management Programs: Eg Diabetes, Healthy Heart
    11. PHR - Personalized Health Records
    12. Health & Wellness Reminder Services
    13. Health Concierge Desk
    14. Others

    The limit under Add on can be customized

Room rent can range from 1% of the sum insured to actuals for normal and ICU. The room rent charge depends on what the employee wants to opt for.

Pre-existing disease is covered under the Group Health Insurance.. The term ‘Pre-existing Disease’ means any condition, ailment or injury or illness or related condition (s) for which the insured had developed signs or symptoms, and/or were diagnosed and/or received medical advice/treatment, within 48 months prior to the first Policy with the company.

Health check-up facility is provided from the vast network hospitals across multiple locations in India.

Maternity Benefit covers the pre and post-natal expenses. It covers for the pre (30 days) and post (60 days) hospitalization and delivery expense. The monetary limit is customized depending on the requirement of the employer.

Abortion is covered, subject to prescription from doctor & under a critical condition during pregnancy. Voluntary abortion is not covered under the policy.

New born baby can be covered under the policy if the addon cover is opted for. This addon cover includes hospitalization expense of new born baby from day 1 upto full sum insured or maternity limit

Internal congenital is covered under the policy. External congenital is covered only in life threatening situation subject to minimum of 24 hours of hospitalization.

Yes, subject to minimum 24 hours of hospitalization on in-patient (IPD) basis and is covered only in government recognized AYUSH hospital.

Medical tests are not required to avail Group Health Insurance.

Employee and spouse are covered upto age of 65 years, Children are covered upto 25 years of age and parents upto age limit of 80 years. Employee and spouse should be minimum 18 yrs.

On admission to the hospital the insured can avail the cashless facility, where the cost of treatment is paid by the insurance company directly to the network hospital.

The treatment undergone is in accordance with the policy terms and conditions.

We have tie up of network hospitals across the country where cashless facility can be availed. Refer list of network hospitals on the website.

Policy coverage will be extended up to expiry date of the policy subjected to availability of sum insured.

There is no limit on number of claim admissibility

Insured to get admitted in network hospital
icon
Hospital to send Cashless Request to ICICI Lombard Health Claims teams
icon
Process is done at ICICI Lombard Health Claims teams
icon
Decision to Approve/Query/Reject is taken
icon
Insured to pay non-payables & get discharge
  • Insured to submit Health Card Copy and Photo ID Proof at Hospital Insurance Desk.
  • Hospital will send the cashless request to ihealthcare through Web/email upon admission recommendation from Hospital Doctor. Insured needs to check the pre-authorization note and duly sign the same.
  • Post receipt of Cashless Request from Hospital, ihealthcare team to check the medical admissibility and accordingly Approve/Query/Reject the request.

Insured will be notified via SMS/email at all events of Cashless Hospitalization. A call will be made if the cashless request has been queried/rejected. (Subject to availability of insured/dependants contact details)

  • In case of planned admission insured/dependents can reach out to hospital for cashless approvals in advance
  • In case of emergency during admission insured/dependents can approach Hospital TPA desk for Cashless request.

You call our customer support number 1800 2666 (Available 24 x 7)

Claim will be paid on reimbursement basis and below is the reimbursement process.

Insured Hospitalized in non-network hospital
icon
Payment to Hospital & collect original documents from hospitals
icon
Submit original document to ICICI Lombard Health Claims
icon
Claim process done by ICICI Lombard Health Claims
icon
Claim settled on reimbursement basis

Documents to be submitted for Reimbursement

  • Duly filled Claim form including NEFT form for Electronic Funds Transfer & Cancelled Cheque Copy
  • Discharge Summary (with details of complaints and treatment availed)
  • Final Hospital Bill (detailed break-up) along with interim bills & payment receipts
  • All investigation reports (Original Blood Reports, X-Ray Reports, Sonography, CT Scan, MRI etc
  • All Pharmacy bills supported by Doctor’s prescriptions
  • Implant Sticker / Invoice, if used (eg: Lens details in Cataract Case, Stent details in angioplasty)
  • Medico Legal Certificate (MLC) and or FIR for all accident cases

Claim Submission Process

  • Insured to collect all the claim documents during discharge.
  • Claim to be submitted within 30 days from date of discharge.
  • Claim form can be downloaded from our website www.icicilombard.com
  • Claim Status can be tracked Online or by sending an SMS to 575758

Insured need to dispatch the reimbursement claim documents to below mentioned address:

CLAIMS TEAM ICICI LOMBARD HEALTH CARE ICICI LOMBARD GIC LTD, ICIC BANK TOWER, PLOT NO:12 FINANCIAL DISTRICT, NANAKRAM GUDA, GACHIBOWLI, HYDERABAD. PIN CODE: 500032

  • In case of any claim related query, insured can write to us at ihealthcare@Icicilombard.com
  • Or can contact @ our Toll Free Number 1800 2 666 (In-house Call Centre)

Original bills for hospitalization, diagnostic, pharmacy, room rent and all the bills related to hospitalization duly signed by the employee and the hospital authority

Premium is calculated based on employee’s demography, claim experience of past 2-3 years and coverage provided to the client

Pre-existing disease (PED) is covered under Group Health Insurance, as compared to a waiting period which is applicable in individual health policies. Other coverages can be customized as per client requirement.

The employees can avail the benefit of the coverage for his/her dependants under the Group Health Insurance. Dependants include spouse, children up to 25 years of age and parents up to 80 years of age.

The coverage of the policy is valid in India and employees, dependents can avail the facility of network hospitals.