What do you mean by a pre-existing disease?
Any condition, ailment or injury or related condition(s), for which you have had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment, within 48 months prior to the first policy with the insurance company is called a pre-existing disease.
What do you mean by waiting period?
The duration after which you can make a claim is called a waiting period. Our waiting periods for ICICI Lombard Health AdvantEdge and Health Booster policy are as below:
- No waiting period for accidental hospitalisation.
- 30 days for all claims other than accidental hospitalisation.
- 2 years for pre-existing diseases. These diseases should be declared at the time of proposal and accepted by us for policy with sum insured of ₹3 lakh and above.
- 2 years for standard list of diseases and procedures.
What does annual sum insured mean?
Annual (basic) sum insured is the maximum amount that an insurance company will pay you in the event of a claim in a policy year.
If I increase my sum insured at the time of renewal, does a waiting period apply?
Yes, a waiting period will apply only to the added sum insured.
My employer provides me with a health insurance. Do I still need one?
Numerous employers offer group or individual health plans. However, these are not customised as per your needs and may have certain restrictions and limitations. Also, the coverage is dependent on the continuation of the job. Once you quit, you cannot avail the health plan benefits. Therefore, it is important to insure yourself with a comprehensive cover that lets you customise as per your needs. For example, for a family of 4 members, a sum insured of ₹2 lakh-₹3 lakh provided by your employer may be inadequate.
From what age can I include my children in the plan?
You can include your children aged between 90 days to 20 years in your policy. Newborns can be included after 90 days of birth. However, your daughter or son cannot be shown as a ‘dependent’ if they file a joint tax return.
Which health insurance policy is ideal?
If you have a family, you should choose a family floater health insurance over an individual health plan. It not only protects your entire family but also helps you save a lot on premiums.
What is the advantage of health insurance?
Health insurance plans provide cover for unexpected medical expenses. It covers an array of costs incurred on daycare procedures, hospitalisation, ambulance and domiciliary hospitalisation. Apart from this, you can also get tax benefits on your health insurance policy.
Can a person have more than one health insurance policy?
Yes, you can buy multiple health insurance policies to cover your medical costs. If one insurer rejects your claim, there is still a chance that others may accept as per its terms and conditions.
What is the right age to buy a health insurance policy?
It is recommended that you obtain a health insurance policy as soon as possible. Purchasing insurance at a young age allows you to earn an additional sum insured for every claim-free year under your policy. And as you get older, you will be able to accumulate higher and better coverage.
What to do if I am admitted to a non-network hospital?
If you get admitted to a non-network hospital, you have to pay for the medical treatment costs out of your pocket. Post-discharge, you can submit all the relevant documents such as medical bills and ambulance receipts for the reimbursement claim. Post verification, the claim amount will be transferred to your bank account.
Will my existing health insurance policy cover hospitalisation expenses on account of COVID-19?
Yes, hospitalisation expenses on account of COVID-19 will be covered under the policy in accordance with the policy terms and conditions.
How can I intimate my claim after hospitalisation?
You can intimate a claim by calling us on 1800 2666 (toll-free) or using our mobile app, IL Take Care. Scanned copies or photographs of all claim related documents can be uploaded in the app.
Further, the Insured is required to furnish/courier hard copies of all requisite claim documents at his/ her own expense to the below mentioned address:
ICICI Lombard Healthcare,
ICICI Bank Towers,
Plot No. 12, Financial district,
Nanakramguda, Gachibowli,
Hyderabad- 500032
Are any waiting periods applicable to claims under COVID-19?
In case your policy has an outpatient treatment cover, then waiting periods are not applicable. A claim under outpatient treatment cover can be made in accordance with the claims procedure mentioned in the policy wordings.
In case of hospitalisation on account of COVID-19, the hospitalisation expenses incurred will be covered provided the illness is contracted after completion of 15 days in case of a fresh policy. In case of a policy that has been renewed continuously without a break or in case of policies that have been ported in to ICICI Lombard, the 15 day condition will not be applicable.
Will I be allowed to enhance my sum insured?
Sum insured enhancement will be allowed based on medical assessment in accordance with the underwriting guidelines. However, such sum insured enhancement will be done only at the time of renewal.
Are the expenses on medicines and diagnostic tests incurred during medically advised home isolation due to COVID-19 covered?
In case you choose to get treated at home for COVID-19, we will cover the same under the home healthcare facilitated by us through our empaneled service providers.
Will the policy cover expenses due to quarantine?
In case the quarantine is in a hospital on the advice of a medical practitioner, then the medical expenses incurred will be covered in accordance with the policy terms and conditions. However, expenses incurred on account of self-quarantine or quarantine at home will not be covered.
Will the policy cover hospitalisation in a country other than India?
No. The geographical scope of the policy is limited to India.
Will my travel history abroad affect the admissibility of claim under the policy?
So long as the hospitalisation is in India, the travel history will not affect the admissibility of claim under the policy.
Are the consultations with a medical practitioner and diagnostic tests in relation to COVID-19 covered under my health insurance policy?
In case your policy has an outpatient treatment cover, then consultations with a medical practitioner and diagnostic tests as advised by a medical practitioner will be covered up to the sum insured. A claim under outpatient treatment cover can be made in accordance with the claims procedure mentioned in the policy wordings.
Further, in case there is hospitalisation on account of COVID-19 and the same has been paid under the policy, then all expenses related to COVID-19 incurred on account of consultations with a medical practitioner and diagnostic tests as advised by a medical practitioner in the 30 day period prior to date of admission and 60 day period after date of discharge will be covered in accordance with the policy terms and conditions.