What is a waiting period?
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
What is covered in Group Health Insurance by ICICI Lombard?
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:
- Health Risk Assessment
- Health Check-up's (add-on of report evaluation service)
- Medical Centre Management
- Diet & Nutrition Plans
- Online Doctor Chat
- Health Camps - on campus
- Expert Sessions - on campus
- Second Opinions: Domestic and International markets
- Discounted offerings - on health and wellness services ( Eg Gyms, Diagnostic)
- Disease Management Programs: Eg Diabetes, Healthy Heart
- PHR - Personalized Health Records
- Health & Wellness Reminder Services
- Health Concierge Desk
- Others
The limit under Add on can be customized
What is room rent capping in Group Health Insurance (Group Mediclaim)?
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.
What is a pre-existing disease? Are pre-existing diseases covered in a standard health insurance?
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.
What is “health check-up” facility?
Health check-up facility is provided from the vast network hospitals across multiple locations in India.
What is Maternity Benefit coverage under the Group Health Insurance?
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.
Is abortion covered under the Group Health policy?
Abortion is covered, subject to prescription from doctor & under a critical condition during pregnancy. Voluntary abortion is not covered under the policy.
Does the policy provide coverage to a new born baby under maternity coverage?
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
Is congenital disease covered under the Group Health Insurance?
Internal congenital is covered under the policy. External congenital is covered only in life threatening situation subject to minimum of 24 hours of hospitalization.
Is treatment through AYUSH medicine covered under the policy?
Yes, subject to minimum 24 hours of hospitalization on in-patient (IPD) basis and is covered only in government recognized AYUSH hospital.
Do I have to undergo medical tests to avail this health cover?
Medical tests are not required to avail Group Health Insurance.
Is there any age limit?
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.