What is Group Health (Floater) Insurance?
Group health (Floater) insurance covers a group of peoples. It's typically offered by employers to their employees.
Which Group Health Insurance is the Best in India?
You need to consider various parameters before buying a group health insurance policy. Consider the insurer's claim settlement ratio, customisation options, sum insured offered, etc., before buying a plan.
Who Can Take Group Health (Floater) Insurance?
A business entity needs at least 10 employees to buy a group health (Floater) insurance plan.
What is the Maximum Age for Group Health (Floater) Insurance?
The maximum age differs across plans. Several health insurance companies offer plans up to the age of 65 years.
Is Covid 19 covered under ICICI Lombard’s Group Health Insurance policy?
Covid 19 is covered subject to minimum 24 hr of in-patient.
When should I get a group health insurance policy for my employees?
Employer can initiate a request for quotation of the Group Health Insurance policy for their employees at any point of time. The employer has to specify the coverage requirement and a quote shall be given to them.
Our workplace has only 10 to 15 members. Can I still buy a Group Health Insurance policy for them?
Minimum requirement for an employer to opt for Group Health Insurance is 10 employees or 25 total lives, below which we cannot provide Group health insurance.
Who all can be covered in a Group Health Insurance policy?
Group health insurance is categorized in 2 categories
- Employer-employee - Employees along with their spouse, children and parents are covered
- Non employer-employee – The enrolled are covered
How to get the Group Health Insurance for my small business?
Group Health Insurance can be bought through ICICI Lombard's Group health Insurance policy where we cover up to 500 lives. Premium is decided subject to coverage, demography and claim experience
Can I have a corporate health insurance and an individual health insurance policy both at same time?
Yes, you can you have corporate health insurance and individual health insurance at the same time.
What are the limitations of a Group Health Insurance?
Group Health Insurance policy is customized and tailor made and the policies are designed as per the client’s requirements. Therefore there are no limitations.
How is a Group Health Insurance different from an Individual Health Insurance?
Group Health Insurance is a collective insurance an organization buys for the benefit of its employees and employee’s dependents. The organization may tailor a plan or select a pre-planned insurance policy from an insurance company.
Individual health insurance is one that an individual purchases for himself or their dependents.
What employers should look for when buying a Group Health Insurance policy in India?
While buying the Group Health Insurance, the employer should take in consideration the coverage provided by the insurance company, the services offered and the company's claims process, this will make insurance policy buying more feasible and convenient.
Why should you take Group Health Insurance for your employees?
While buying Group Health Insurance, employer should see the coverages provided by insurance company, services offered and the company's claims process, this will make insurance policy buying more feasible and convenient.
Will I have to pay penalty if I don’t provide health insurance to my employees?
There is no penalty.
Can the policy be transferred from one insurance provider to another provider without losing the benefits?
Yes, at the time of renewal of the policy for next tenure.
What is the initial waiting period for ICICI Lombard Group Health Insurance?
No waiting period
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’s not covered in Group Health Insurance provided by ICICI Lombard?
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
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.
What is Group Insurance Premium?
Group insurance premium is the money paid to the insurance company offering the group insurance plan.
Who Pays the Premium in a Group Health Plan?
It's the employer who pays the premium for a group health insurance plan.
How is the Group Insurance Premium Calculated?
Premiums aren't fixed and depend on several factors such as age, health conditions of members, number of members, job type, and sum insured, among others.
What happens to the policy coverage after a claim is filed?
Policy coverage will be extended up to expiry date of the policy subjected to availability of sum insured.
What is the maximum number of claims allowed over a year?
There is no limit on number of claim admissibility
How to avail cashless treatment?
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.
Whom do I call at the time of emergency hospitalization?
You call our customer support number 1800 2666 (Available 24 x 7)
What to do if I am admitted to non-network hospitals?
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)
What are the documents required for claiming?
Original bills for hospitalization, diagnostic, pharmacy, room rent and all the bills related to hospitalization duly signed by the employee and the hospital authority