What is Group Health Insurance?

30 Days

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

Hospital to send Cashless Request to ICICI Lombard Health Claims teams

Process is done at ICICI Lombard Health Claims teams

Decision to Approve/Query/Reject is taken

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

Payment to Hospital & collect original documents from hospitals

Submit original document to ICICI Lombard Health Claims

Claim process done by ICICI Lombard Health Claims

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.