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| What do I do in case of a claim? |
| In case of a planned hospitalisation or emergency services, use your Health ID Card at any of our network hospitals and avail cashless service. Contact our toll free claims helpline 1800 425 8885 for assistance |
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| What is the claim procedure? |
In case of a Cashless hospitalisation, claim can be of two types:
Planned:
Where the member of the covered family is aware of the hospitalisation 2-3 days in advance.
Emergency:
Where the customer or a member of the covered family meets with sudden accident or suffers from bout of illness that requires immediate admission to the hospital.
The claims are serviced at both -- network and non-network hospitals.
Network Hospitals:
These are the hospitals that form part of the company's network (part of the company's tie-up list). More than 4000 hospitals form part of the network. For a complete list of network hospitals, log on to our website www.icicilombard.com.
Non-network Hospitals:
These hospitals do not form part of the company's tie-up list. The bills are settled by patient & the relevant documents and bills are subsequently submitted to the TPA. The amount, consequently, is reimbursed to the patient.
In case of planned hospitalisation:-
 | Please contact our TPA help-line at 1800 425 8885. The same is mentioned in the Health Identity Card. |
| Fax / submit the required documents. E.g. Doctor’s certificate, medical bills etc. |
| Obtain approval from the TPA |
| Post authorisation approval, customer avails treatment |
In case of emergency hospitalisation
| The patient is to be rushed to the hospital |
| Patient can avail treatment |
| Family to contact TPA help-line as mentioned in the policy. |
Health Card
| Family to submit required documents. E.g. Doctor’s certificate, medical bills etc. |
| Family to obtain approval from the TPA |
| Authorisation for network/ non-network hospitals has to be obtained |
| Bills settled by the TPA |
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| What are the documents required for filing a claim? |
The following documents are required for filing a claim:-
| Duly completed claim form |
| Original bills, receipts and discharge certificate/ card from the hospital |
| Original bills from chemists supported by proper prescription |
| Receipt and pathological test reports from a pathologist supported by the note from attending Medical practitioner / surgeon prescribing the test. Nature of operation performed and surgeon’s bill and receipt. |
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| What is a TPA? Who is the TPA for ICICI Lombard? |
| TPA stands for Third Party Administrator. In our case, TTK Health Service Pvt. Ltd is the TPA. A TPA is a specialised health service provider rendering a variety of services like networking with hospitals, arranging for hospitalisation, claim processing and documentation. |
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| How much time does it take to settle the bills? |
| Normally, the bills are settled within 15 days of receiving the relevant documents. |
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| Do I need to pay for hospitalisation? |
If you are admitted in any of our network hospitals, you can avail cashless facility. We would directly reimburse all the admissible expenses to the hospital. However, in case of non-network hospitals, you will have to settle hospital bills at the time of discharge, and consequently, the same will be reimbursed to you by us.
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| How to prevent rejection of claims? |
| Carefully read the list of exclusions in policy wordings
(which comes to you with the policy). |
| Make sure that you have declared all the pre-existing
diseases at the time of enrolment. |
| Do not claim for any hospitalisation and diagnostic studies/ investigation charges which do not confirm existence of an illness or injury that requires hospitalisation. |
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| In the event of no claims during the first year, what if I want to discontinue my policy? |
| Once you stop paying the premiums, the policy would be discontinued. |
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| What exactly is the role of TPA i.e. Third Party Administrator. Would I have to approach the TPA during times of crisis? |
Yes, all insurance claims throughout the world are settled by third party administrator. In our case, it is TTK Health Services Pvt. Ltd.
In case of hospitalization, the charges would be directly paid to the hospital, for that you would need to call on a help line number of our third party administrator (it's the agency who will settle your claims abroad on our behalf ) and they will arrange for a cash less facility. If it is a case of emergency, the TPA would help you provide the cashless facility in the nearest hospital, or else they will inform you on the hospital where you can avail the treatment. |
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| If I renew policy with ICICI Lombard, will I get benefits on renewal? |
You can avail of the NCB i.e., No Claim Bonus, at the time of renewal, provided no claims are made on your previous policy.
The No Claims Bonus (NCB) is a discount allowed off insurance premiums, and is used to 'reward' the insured for a period of claims free policy usage. Every additional No Claims Bonus year you get, the lower your insurance premium should be. An insured becomes entitled to No Claim Bonus (NCB) only at the renewal of a policy after the expiry of the full duration of 12 months.
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FAQs 
