ICICI Lombard Complete Health Insurance Plan

Policy Benefits

• In-patient hospitalization expenses, including Room Rent, Boarding, Nursing Expenses, intensive care unit charges, anesthesia, OT charges and other expenses are covered.
• Pre hospitalization expenses are covered for 30 days before hospitalization and post hospitalization expenses are covered for 60 days after hospitalization.
• 150 Day Care surgeries are covered, for which the insured person requires hospitalization for less than 24 hours.
• In-patient AYUSH treatment (Ayurveda, Unani, Siddha, & Homoeopathy) is covered, provided the treatment is taken in any government Hospital, any institute Accredited by Quality Council of India, National Accreditation Board on Health or other hospital as specified under the policy.
• Medical expenses incurred from routine health check - ups and for other wellness and fitness activities are reimbursed.
• Maternity Benefit is limited to 2 deliveries/terminations. Pre & post natal expenses are also covered. It is applicable for Health Protect Plus, Health Smart, & Health Smart Plus variant.
• New Born Baby Cover can be availed up to 91 days from date of birth of the child. This cover is available when opted for maternity cover. It is applicable for Health Protect Plus, Health Smart, & Health Smart Plus variant.
• Outpatient (OPD) medical expenses are reimbursed. This benefit is applicable for Health Protect Plus, Health Smart, & Health Smart Plus variant.
• Donor transplant expenses are reimbursed, subject to the maximum of Rs 50,000. This benefit is applicable for Health Protect Plus, Health Smart, Health Smart Plus, IHealth variant.
• A specific amount as daily hospital cash is paid up for maximum 10 days of hospitalization, subject to minimum 3 days of consecutive hospitalization. This benefit is applicable for Health Protect & IHealth variant.
• Nursing at home benefit up to Rs 3,000 per day for maximum of 15 days post hospitalization. This benefit is applicable for Health Smart variant. This benefit is applicable for Health Smart variant.
• Convalescence benefit of Rs 10,000 per insured during the policy period, in case of hospitalization due to injury/illness for consecutive 10 days or more. This benefit is applicable for Health Protect & IHealth variant.
• Add-on personal accident cover against Accidental Death or Permanent Total Disablement. This benefit is applicable for Health Protect Plus, Health Smart, & Health Smart Plus variant.
• Opt for critical illness add-on cover that covers specified Critical Illnesses / medical procedures. This benefit is applicable for Health Protect Plus, Health Smart, Health Smart Plus, IHealth variant.

Value Added Benefits

• Get cumulative bonus. Sum Insured is increased by 10% of the annual sum insured on every claim-free policy year, up to a maximum of 50%.
• 100% Sum Insured will be restored, in case of exhaustion of sum insured under the policy.
• Medical expenses incurred in case of evacuation to the nearest hospital under medical emergency are reimbursed.
• Air travel expense of immediate family member is reimbursed. It is applicable on economy class air ticket up to Rs 20,000. This benefit is payable in the event of hospitalization exceeding 5 days. This benefit is applicable for Health Smart variant.
• No pre-policy medical check-up for insured below 46 years of age and sum insured up to 10 lacs.
• Free annual health check-up can be availed by each insured, subject to maximum of 2 coupons per year in floater policies.
• Avail other value added services such as Online Chat with doctor, Specialist Consultation with One Follow-up session, Dietician & Nutritionist e-consultation, information on offers related to healthcare services.
• Tax Benefit under section 80D of Income Tax Act, 1961.

Sub Limits

• Sub-limits are applicable on specified surgeries/medical procedures. The sub-limit is available for Health Protect variant and IHealth variant up to sum insured 5 Lacs.
• Ambulance Charges are paid up to Rs 1500 per hospitalization.
• For Plans with Sum Insured up to 5Lacs Cataract surgery sublimitis 20,000/- per eye per Policy year. Sub limit of 1 lac per eye per policy year applicable for Sum Insured above ` 5Lacs.

Waiting Period Clause

• Initial Waiting Period: Claims arising during first 30 days of the policy start date, except accidental claims.
• Specific Waiting Period: Some treatments such as Cataract, Hydrocele, Arthritis, Joint replacements, etc. is covered after 24 months from the inception date of the policy.
• Pre existing Disease Waiting Period: 4 years waiting period for sum insured 2 lacs and 2 years for sum insured greater than 2 lacs.
• Maternity Cover Waiting Period: Maternity benefit has a waiting period of 3 years.