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Health Insurance

How to download insurance copy using policy number?

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1. For queries or complaints related to ICICI Lombard, you may contact ICICI Lombard on 18002098888 (Toll-Free) or write to customersupport@icicilombard.com. For more details, you may visit the ICICI Lombard website, www.icicilombard.com .

2. For queries or complaints related to ICICI Prulife, you may contact ICICI Prulife on 1800222020 (Toll-Free) or write to lifeline@iciciprulife.com.
For more details, you may visit the ICICI Prulife website, www.iciciprulife.com .

What is Health Insurance portability?

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Health insurance portability means that you have the freedom to switch from one insurer to another without losing any continuity benefit with respect to PEDs, waiting period and other time bound exclusions, earned in the previous health insurance policies, subject to continuous insurance in the previous years

Does Complete Health Insurance Policy cover pre-existing diseases?

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Yes, pre-existing diseases are covered after specified waiting period, provided the policy is renewed continuously for the same period with the Company.

How long will ICICI Lombard take to settle my claim in Health Booster Policy?

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Once all necessary documents have been sent to us and queries have been answered, we will process your claim. If you are availing of the cashless facility, your claim will be settled within 4 hours directly with the hospital. In case of a reimbursement facility, your claim will be settled through NEFT within 14 days of submission of all the required documents. We will provide you the benefit under claim service guarantee if there is a delay beyond these specified timelines as per the T&C stated for this feature. Please refer policy wordings for details.

Is a medical test mandatory for everyone in Complete Health Insurance Policy?

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A medical test is mandatory for any insured member who is more than 45 years age.

What is a non-premium bearing endorsement in Complete Health Insurance Policy?

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A non-premium bearing endorsement is the endorsement for which no additional premium is charged.

Can extended family members be covered under my health policy?

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Your policy is designed to cover your immediate family members, which can include your spouse, dependent children, brother(s), sister(s), dependent parent(s), grandparent(s), grandchildren, mother-in-law, father-in-law, son-in-law, daughter-in-law, dependent brother-in-law and dependent sister-in-law. However, the total number of people covered under the policy cannot exceed more than 2 adults and 3 children.

Do I need to intimate ICICI Lombard in case of any delay in claim settlement in Health Booster Policy?

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Absolutely not, as our systems are designed to pay the claim service guarantee amount directly to customers along with the reimbursement claim amount.

Which diseases come under permanent exclusions of the Health Booster plan?

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Injury or diseases directly or indirectly attributable to war, invasion, act of foreign enemy, war like operations, cosmetics, aesthetics treatment unless arising out of accident. Cost of spectacles, contact lenses, and hearing aids (LASIK), dental treatment, or surgery of any kind unless requiring hospitalisation etc. (Refer policy wordings for details).

If I go for Cashless Hospitalisation how will Claim Service Guarantee work in Health Booster Policy?

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In case of delay in response by ICICI Lombard beyond the time period of 4 hours (3 hours for enhancement, query & final bill), we shall be liable to pay ₹1,000 to the customer. Our maximum liability in respect of a single hospitalisation shall, at no time exceed ₹1,000.

Can I file multiple claims in the year in Health Booster Policy?

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Yes, you may file multiple claims in the year, subject to the total amount of the claims not exceeding the sum insured of your policy, additional sum insured and reset benefit.

What is the procedure to cancel the Health Booster policy?

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The policy can be cancelled by giving a 15 days’ written notice. Premium refund will be on short-term basis for the unexpired policy period as per the rates detailed below, provided no claim has been payable under the policy.

What are the steps for cash settlement in Complete Health Insurance Policy?

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Cash settlement is only available at network hospitals. Pre-authorisation request to be made -
• At least 48 hours before a planned hospitalisation and
• Within 24 hours of emergency hospitalisation

Steps involved-
• Admission in network hospital
• Fax the pre-authorisation form along with relevant documents (Investigation reports, Previous consultation papers if any, Cashless ID, Photo ID)
• Review of claim request by Company(as per policy terms & conditions
• Claim settlement by Company (as per policy terms & conditions) with the hospital after completion of all formalities

Which diseases are covered under First 2 Years Exclusions in Complete Health Insurance Policy?

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Following ailments / treatments would not be covered in the first two years of the Period of Insurance

• Cataract*
• Benign Prostatic Hypertrophy
• Myomectomy, Endometriosis, Hysterectomy unless because of malignancy
• All types of Hernia, Hydrocele
• Fissures &/or Fistula in anus, haemorrhoids/piles
• Arthritis, gout, rheumatism and spinal disorders
• Joint replacements unless due to accident
• Sinusitis and related disorders
• Stones in the urinary and biliary systems
• Dilatation and curettage Endometriosis
• All types of Skin and internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant
• Dialysis required for chronic renal failure
• Surgery on tonsils, adenoids and sinuses
• Gastric and Duodenal erosions & ulcers
• Deviated Nasal Septum
• Varicose Veins / Varicose Ulcers
* After 2 years of continuous coverage with us, a sub-limit of ₹20,000 per eye will be applicable for sum insured less or equal to ₹5 lakh and ₹1 lakh per eye for sum inured greater than ₹5 lakh during each Policy Year.

In Complete Health Insurance Policy does a higher cover mean preferential treatment in case of hospitalisation and claim?

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No, a higher cover does not entitle you to preferential treatment. Irrespective of the insurance cover you buy - either a ₹2 lakh cover or a ₹4 lakh cover - you will get quality service and treatment at our network hospitals.

What do you mean by waiting period in Complete Health Insurance Policy?

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The duration after which a claim can be made is called the waiting period.

Are all policyholders eligible for a Health Card in Health Booster Policy?

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Yes, all the policyholders are eligible for the Health Card as it is an important component of the policy.

What is the difference between individual and Floater options in Health Booster Policy?

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Individual plan covers only one insured in a policy. Floater plan covers more than one insured (maximum 2 Adults and 3 Children) and provides one sum insured to all.

What are the tax benefits that can be availed on this in Complete Health Insurance plan?

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Deduction u/s 80 D of Income Tax Act is available from taxable income for premium paid towards health insurance A) For self, spouse and dependent children - (Maximum ₹25,000) If you are 60 years and above - (Maximum ₹30,000) B) For Parent (s) (Maximum ₹25,000) * In case Parent(s) are resident senior citizen (Maximum ₹30,000)

Can I add or remove family members from Health Booster Policy?

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Yes, you can add family members to your policy at any time by paying additional premium as applicable. However, removal can be done only at the time of renewal. The additions cannot increase the policy limit to more than 2 adults and 3 children. In the case of an individual policy, any other person cannot replace the insured. Please note that fresh waiting period will be applicable to the person added

What is the difference between Top Up & Super Top Up in Health Booster Policy?

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For a Top Up Plan, deductible will apply for every hospitalisation except for claims made for any one illness. In case of an accident where more than one member of a family is hospitalised, deductible will apply on the aggregate claim amount. For Super Top Up Plan, deductible will apply on aggregate basis for all hospitalisation expenses during the policy year. The deductible will apply on individual basis in case of individual policy and on floater basis in case of floater policy

What are the documents required for a claim in Complete Health Insurance Policy?

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• Depending upon the circumstances of the case, additional information or additional documents can be asked for the settlement of the claim
• The documents should be in originals unless otherwise agreed by the Company
• Document in vernacular should be accompanied by the translation of the same in English and duly attested
• Copy of health card

List of Documents required:
• Duly completed Claim form signed by the insured and the Medical Practitioner
• Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner
• Original bills from chemists supported by proper prescription
• Original investigation test reports and payment receipts
• Indoor case papers
• Medical Practitioner's referral letter advising hospitalisation in non-accident cases

In Complete Health Insurance Policy how many times can Convalescence Benefit be claimed? Does it get restored every year in a multi-year policy? Is this amount over and above policy Sum Insured (SI)?

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• Convalescence Benefit can be claimed once per person in a policy year and it gets restored every year in a multi-year policy. It is over & above Basic Policy SI.

What should I do if I want to insure more than 2 adults or 3 children under Complete Health Insurance Policy?

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If the number of adults or number of children are more than 2+3, you need to buy an additional policy for the additional members. There can be a maximum of 2 adults and 3 children in a policy

What do you mean by Premium in Complete Health Insurance Policy?

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The amount paid to avail the covers in the policy is called premium.

How can I create my online account with ICICI Lombard to avail of these services?

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You can avail of these services through your personal login on our website.
a) Log on to www.icicilombard.com and click on the ICICI Lombard Healthcare option, which you will find under 'Claims & Wellness'

b) Go to the customer log in section and sign up to fill in and submit the form

c) You will get a reference number and message informing that your ID will be activated in 24 hours.

d) After you receive an e-mail with your login credentials, login to the system to avail the value added services available to you. With this online account, you can also access your policy certificate, policy information, claim forms, list of empanelled hospitals and more.

If you have any other question(s) or cannot access your account then please call us on our toll-free number 1800 2666 or e-mail us at customersupport@icicilombard.com.

Can ICICI Lombard cancel my Health Booster policy before the expiry date?

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We may cancel your policy in the case of misrepresentation, fraud, non-disclosure of material facts or non-cooperation of the insured/ policyholder. Prior to cancelling the policy, we will send a written notice to this effect through registered post, giving 15 days' notice to the policyholder.

How does a Health Card function in case of a 2 years / 3 years (auto renewal) policy?

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In case of a 2 years / 3 years (auto renewal) policy, you will be issued a single card, which will be valid for the entire policy period. The health card need not be renewed or re-issued during the policy tenure.

If I have made a claim, does that affect the renewal of my Health Booster Policy?

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In case you have made a claim in the current year, you will not be eligible for no-claim bonus. However, if a claim is made in the subsequent years and no claim was made earlier, then 10% of base sum insured will be deducted at the time of next renewal from the additional sum insured accrued. However, at any renewal, your sum insured will not be less than the base sum insured for the policy.

What do you mean by Reimbursement in Complete Health Insurance Policy?

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The amount paid back by the insurer for the expenses incurred by the insured is called reimbursement.