Arogya Sanjeevani Policy Lead generation

About Arogya Sanjeevani Policy, ICICI Lombard

Arogya Sanjeevani Policy, ICICI Lombard is an ideal choice if you are looking for a health plan that secures your basic health needs. It is a standard policy that will have your back in times of a medical emergency. You can also extend its benefits to your family (legally wedded spouse, dependent parents, parents-in-law and children). Arogya Sanjeevani Policy, ICICI Lombard covers your pre and post hospitalisation expenses, room charges, doctor’s or special consultant’s fees, medication bills during hospitalisation and more. Picking an Arogya Sanjeevani plan is simple, just choose your sum insured and that’s it. The sum insured for Arogya Sanjeevani Policy, ICICI Lombard begins at just ₹1 lakh, and you can choose a plan up to ₹5 lakh. Thus, it cuts down your confusion and keeps you financially protected against medical emergencies.

Why buy Arogya Sanjeevani Policy, ICICI Lombard?

99.8% health claim
settlement ratio (FY19)*

4250+ network
hospitals#

Speedy claim
approvals

* Source: IRDAI #As on 31st March 2020

What’s covered and not covered under Arogya Sanjeevani Policy, ICICI Lombard?

  • Inclusions
  • Exclusions
  • Inpatient hospitalisation

    Medical costs for minimum 24 hours of hospitalisation, including room rent, doctor’s/surgeon’s fee, ICU charges and medication bills.
  • Pre and post hospitalisation

    Medical expenses incurred 30 days prior and 60 days post hospitalisation.
  • Day care procedures

    Medical bills for all the day care treatments that require hospitalisation for less than 24 hours.
  • Pre-existing diseases

    Specified pre-existing diseases after 4 years waiting period. The waiting period benefit applies to ported policies.
  • Inpatient AYUSH treatment

    Alternative treatments like Ayurveda, Unani, Siddha and Homeopathy (AYUSH) undergone in a government hospital or any institute recognised by the government and or accredited by Quality Council of India/National Accreditation Board.
  • Floater benefit

    Extending the coverage of your single policy to your family (legally wedded spouse, dependent parents and parents-in-law, dependent children) by paying one premium amount on floater basis. You can get any child above 3 months of age covered under the policy provided one adult is also covered under it.
  • Dental treatment

    Dental costs for treating a disease or arising out of an injury.
  • Ambulance cover

    On road ambulance charges up to ₹2000.
  • Cataract treatment

    Expenses incurred during a cataract treatment up to 25% of the sum insured or ₹40,000, whichever is lower.
  • Modern treatments

    New age treatments and advances in technology like balloon Sinuplasty, Immunotherapy and Stem Cell Therapy, amongst many others (refer policy document) up to 50% of the sum insured.
  • Any admission primarily for diagnostic and evaluation expenses
  • Diagnostic expenses that don’t relate to the treatment you are undergoing
  • Costs incurred for nursing at home
  • OPD expenses
  • Costs incurred by non-allopathic treatment, unproven treatment, treatment of pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related treatment
  • Expenses arising out of professional participation in hazardous or adventure sports
  • Costs incurred for the treatment of alcoholism or drug or substance abuse
  • Expenses incurred at spas and nature cure clinics
  • Bills for dietary supplements and substances that are not prescribed
  • Expenses for eyesight correction treatment arising out of refractive error less than 7.5 dioptres
  • Expenses related to fertility and infertility
  • Expenses arising out of war, civil war, nuclear attack, chemical or biological attack or breach of law
  • Costs incurred for treatments out of India

Following treatments, disorders and conditions for the first 2 years:

  • Benign ENT disorders
  • Tonsillectomy
  • Adenoidectomy
  • Mastoidectomy
  • Tympanoplasty
  • Hysterectomy
  • All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps
  • Benign prostate hypertrophy
  • Cataract and age related eye ailments
  • Gastric/ Duodenal Ulcer
  • Gout and Rheumatism
  • Hernia of all types
  • Hydrocele
  • Non Infective Arthritis
  • Piles, Fissures and Fistula in anus
  • Pilonidal sinus, Sinusitis and related disorders
  • Prolapse inter Vertebral Disc and Spinal diseases unless arising from an accident
  • Calculi in the urinary system, Gall bladder and Bile duct, excluding malignancy
  • Varicose Veins and Varicose Ulcers
  • Internal Congenital Anomalies

Following treatments, disorders and conditions for the first 4 years:

  • Treatment for joint replacement unless arising from an accident
  • Age-related Osteoarthritis & Osteoporosis
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What is the claim process for Arogya Sanjeevani Policy, ICICI Lombard?

Cashless Claims

  • Get admitted

    Choose any of our network hospitals
  • Share documents

    Fax your pre-authorisation form with relevant documents
  • We verify

    Allow us to review your claim
  • We settle

    Your claim is settled by the ICICI Lombard Health Care team

Reimbursement claims

  • Collect bills

    You’ll need the original hospital bills and documents
  • Share documents

    Mail the duly filled (and signed by insured and treating doctor) claim form and documents to your service provider (ICICI Lombard Health Care or TPA)
  • We verify

    Allow us to review your claim
  • We settle

    Get your reimbursement after claim approval

Other Third Party Administrator Claims – Cashless

  • Get admitted

    Choose any of our network hospitals
  • Share documents

    Mail the duly filled (and signed by insured and treating doctor) claim form and documents to your service provider (ICICI Lombard Health Care or TPA)
  • They verify

    Allow us to review your claim
  • They settle

    Your claim is settled by the service provider

Other Third Party Administrator Claims – Reimbursement

  • Get admitted

    Choose any of our network hospitals
  • Share documents

    Mail the duly filled (and signed by insured and treating doctor) claim form and documents to your service provider (ICICI Lombard Health Care or TPA)
  • They verify

    Allow service provider to review your claim
  • They settle

    Get your reimbursement after claim approval

NOTE

  1. Cashless facility is only available at our cashless network hospitals
  2. In case of planned hospitalisation, contact your service provider two days prior to admission
  3. In case of emergency hospitalisation, contact your service provider within 24 hours of hospitalisation
  4. For intimating the claim, please call our 24x7 toll free number 1800 2666 or SMS ‘HEALTHCLAIM’ to 575758 (charge – ₹ 3 per SMS) or email us at ihealthcare@icicilombard.com.
  5. Please send the relevant documents to : ICICI Lombard Health Care, ICICI Bank tower, Plot No. 12, Financial District, Nanakramguda, Gachibowli, Hyderabad -500 032

What are the benefits of Arogya Sanjeevani Policy, ICICI Lombard?

Affordable premium

You are covered for pre-existing diseases, day care procedures and you get a floater option to secure your family. All this at an affordable premium.

Tax benefits

Save ₹25,000 in taxes for securing your health and that of your dependent parents and children under section 80D. Senior citizens can avail tax benefit up to ₹50,000.

Lifelong renewability

Flexibility to renew your policy for as long as you want to. We will never refuse you based on age

Cumulative bonus

5% additional sum insured on every claim-free year up to a maximum of 50% of sum insured for the same premium amount.

Free look period

Cancellation of policy by giving a written notice within 15 days of receiving the policy.

Get answers to common queries about Arogya Sanjeevani Policy, ICICI Lombard

  • General
  • Cover
  • Premium
  • Claims
  • Policy
  • Covid-19
Does Arogya Sanjeevani Policy, ICICI Lombard cover COVID-19?

Yes, your hospitalisation expenses for COVID-19 are covered under Arogya Sanjeevani Policy, ICICI Lombard.

What’s the maximum age limit for Arogya Sanjeevani Policy, ICICI Lombard?

The maximum entry age limit is 65 years. The minimum age for children is 91 days (floater option). Applicants who are more than 45 years of age will have to undergo a medical underwriting process.

Why do I need health insurance?

Health insurance protects you from the financial burden of unexpected, high medical costs. It covers medical expenses incurred during hospitalisation. It also provides the benefit of free health check-up and cashless hospitalisation.

How does it help to buy health insurance at a young age?

Buying health insurance at a young age is a prudent decision as it provides some significant benefits like an affordable premium, saving your tax and earning cumulative bonus.

How much health policy coverage do I need?

The amount of coverage needed is based on several deciding factors like current age, health conditions, family medical history, family members and their health conditions, ability to pay the premium and hospital preferences. You can consider these and then decide your coverage, or you can call us on 18002666 for assistance.

Do I need to purchase Arogya Sanjeevani Policy, ICICI Lombard even if my employer is covering me in a Group Health Insurance Plan?

Group Health Insurance Plan provided by an employer isn’t sufficient or effective in covering your health needs. You usually don’t get the needed coverage, tax benefits, cumulative bonus or a flexible coverage. Moreover, the policy ends as soon as you leave the job. Hence, it is advisable to have Arogya Sanjeevani Policy, ICICI Lombard in addition to the group health plan.

What is a Cumulative Bonus?

A cumulative bonus is an additional sum insured given to you by the insurer without charging an additional premium.

What do you mean by annual sum insured?

The annual (basic) sum insured is the maximum and total amount that an insurance company is liable to pay you for all the claims made under a policy.

What do you mean by waiting period?

It is a period from the start date of the policy when specified diseases/treatments are not covered. Once this period is over, and if the policy has been renewed continuously without a break, the specified diseases/treatments shall be covered.

If I increase my policy Sum Insured at the time of renewal, does a waiting period apply?

Yes, the waiting period will be applicable afresh only for the increased Sum Insured.

What happens to my waiting period if my Arogya Sanjeevani Policy, ICICI Lombard expires?

Your waiting period starts from scratch if your policy is not renewed before the grace period is over.

What is a pre-existing disease?

Any condition, ailment or injury or related condition(s), for which you 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 is a free-look period?

It is a period given to you to go through the policy terms and conditions. The free-look period is 15 days for Arogya Sanjeevani Policy, ICICI Lombard. In this period, if you don’t agree to any of the conditions of the policy, you may cancel it. Your premium will be refunded. However, medical examination or stamp duty charges if any, would be deducted from it. If you cancel the policy after 30 days, we will refund you on pro-rata basis.

Can NRIs also buy an Arogya Sanjeevani Policy, ICICI Lombard?

Non-resident Indians can also opt for the policy. However, the premium can be paid only in Indian currency, via an Indian bank account.

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What coverage do I get with the Arogya Sanjeevani Policy, ICICI Lombard?

Hospitalisation, pre-hospitalisation and post-hospitalisation expenses are covered under Arogya Sanjeevani Policy, ICICI Lombard. Other covers include Inpatient AYUSH treatment, cataract treatment, dental treatment and ambulance cover. Read more on them here.

What is a family floater insurance?

Family floater insurance is a single health insurance policy that will cover one or more members of your family. They can be your legally wedded spouse, dependent parents and parents-in-law, and dependent children in the age group of 3 months to 25 years. It doesn’t cover children above 18 years of age who are financially independent.

How many new family members can I add to my current floater?

The floater option easily allows you to add up to 2 adults and 3 children (above 3 months of age) all under one policy. You can get your immediate family members covered (legally wedded spouse, dependent parents, parents-in-law and dependent children) for the same sum insured. If you want to add a new family member, you can do so only at the time of renewal.

Is overseas treatment for an illness covered?

The expenses for overseas treatments are not covered under Arogya Sanjeevani Policy, ICICI Lombard.

Will Arogya Sanjeevani Policy, ICICI Lombard pay for maternity expenses?

Maternity expenses like treatment of pregnancy and childbirth related complications are not covered under Arogya Sanjeevani Policy, ICICI Lombard.

How do I know if Arogya Sanjeevani Policy, ICICI Lombard covers an institute for AYUSH treatment?

AYUSH treatment will be covered by ICICI Lombard only when treatment is undertaken in a government hospital or any institute recognised by the government and or accredited by Quality Council of India/National Accreditation Board of Health. Treatment taken at a healthcare facility which is not a hospital is excluded.

What does Basic Hospitalisation cover?

It covers the inpatient hospitalisation expenses incurred during hospitalisation for a minimum period of 24 consecutive hours. These include boarding and nursing expenses, intensive care unit charges, surgeon’s/doctor’s fee, anaesthesia, blood, oxygen, operation theatre charges etc.

What is covered under Day Care Surgeries/Treatments?

It covers the medical expenses incurred while undergoing Specified Day Care Procedures/Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours hospitalisation.

What expenses are covered under Pre and Post Hospitalisation?

It refers to the payment of medical expenses incurred immediately 30 days before and 60 days after hospitalisation.

What are the sub-limits for various covers under Arogya Sanjeevani Policy, ICICI Lombard?

The table below explains the sub-limits across various covers of Arogya Sanjeevani Policy, ICICI Lombard.

Covers
Sub-limits
Room Rent, Boarding, Nursing Expenses under hospitalisation 2% of the sum insured subject to a maximum of ₹5000 per day
Intensive Care Unit (ICU)/ Intensive Cardiac Care Unit (ICCU) Up to 5% of the sum insured subject to a maximum of ₹10,000 per day
Cataract treatment Up to 25% of sum insured or ₹40,000 whichever is lower
Modern treatments and advances in technology Up to 50% of sum insured
Emergency Ambulance Up to ₹2000 per hospitalisation
Is there a specific geographical jurisdiction for receiving treatment?

You can avail treatment anywhere in India to claim benefits under this product.

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What is the starting premium for an adult under Arogya Sanjeevani Policy, ICICI Lombard?

The premium for Arogya Sanjeevani Policy, ICICI Lombard starts at ₹4025 for 1 Adult with ₹1 lakh sum insured.

How much premium qualifies for tax benefits?

Under section 80D of the Income Tax Act, you can avail tax benefits for premiums paid towards your health insurance policy. The following table shows maximum tax deduction for self, spouse, dependent children and parents (whether dependent or not):

Description
Medical Insurance paid for self, spouse and dependent children (in ₹)
Medical Insurance paid for self, spouse and dependent children (in ₹)
Total deduction under section 80D(in ₹)
All are under the age of 60 years 25,000 25,000 25,000
I. Assessee and family are under the age of 60 years
II. Parents are above the age of 60 years
25,000 25,000 25,000
Assessee and parents have attained or are above the age of 60 years 25,000 25,000 25,000
Is the premium exempted from Income Tax?

Under section 80D of the Income Tax Act, 1961 you’re allowed to claim a deduction of ₹25,000 per year for the premium paid on health insurance of self, spouse, parents or children. The deduction allowed for senior citizens is ₹50,000.

What parameters are considered for calculating the premium?
  • Cover opted (Individual/Floater)
  • Age of senior-most member
  • Sum Insured selected
Is this product priced according to tier/location?

The premium for this product is not affected by the location of the policy holder.

Whom do I call at the time of emergency hospitalisation?

You can contact us on our toll-free number 1800 2666 or SMS "HEALTHCLAIM" to 575758 to receive a call back. To avail cashless service use the health card at any network hospital. For cashless emergency hospitalisation, we need to be contacted within 24 hours of hospitalisation.

Do I have to pay any amount while claiming under Arogya Sanjeevani Policy, ICICI Lombard?

Yes, 5% of the claim amount is to be paid by you as per the co-pay clause under Arogya Sanjeevani Policy, ICICI Lombard.

What do I do if my claim is rejected?

If your claim is rejected, you can ask the reason for such rejection. If you’re not convinced, you can contest the decision. A claim can be rejected for several reasons like an incomplete waiting period, incorrect information provided and delay in making a claim.

What is the Claim Settlement Ratio for ICICI Lombard Health Insurance?

Our claim settlement ratio for health is 99.8% (FY19).

What is the procedure for reimbursement settlement?

All the claimshave to be intimated 48 hours prior to hospitalisation and within 24 hours post admission in case of emergency.

  • To intimate claim SMS 'HEALTHCLAIM' to 575758 (charge – ₹3 per SMS) or call our toll free number 1800 2666 or e-mail us at ihealthcare@icicilombard.com
  • Send your duly filled (and signed by you as well as your treating doctor) claim form and required documents to us
  • We will review your claim request (as per policy terms and conditions)
  • On approval, we will settle your claim (as per policy terms and conditions) and reimburse the approved amount to you
What is the process to make a claim?

The claim process involves 3 steps

  • Claim Intimation
  • Claim Processing
  • Claim Payment/Closure

The claim process involves 3 steps

  • Call Centre
  • Walk-in
  • E-mail
  • Fax
  • Letter
  • SMS
What are the steps for cashless settlement?

It is only available at network hospitals.

Steps involved:

  • Make a pre-authorisation request at least 48 hours before a planned hospitalisation and within 24 hours of emergency hospitalisation.
  • Get admitted in network hospital
  • Fax the pre-authorisation form along with relevant documents (Investigation reports, previous consultation papers if any, Cashless ID, Photo ID)
  • We will review your claim request (as per policy terms and conditions)
  • On approval, we will settle your claim (as per policy terms and conditions) with the hospital after completion of all formalities

 

Whom should I contact to make a claim?

You should contact ICICI Lombard claims management team or customer service.

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What are the sum insured options provided under Arogya Sanjeevani Policy, ICICI Lombard?

The annual sum insured options range between ₹1 lakh to ₹5 lakhs for Arogya Sanjeevani Policy, ICICI Lombard.

Can I get a higher sum insured under Arogya Sanjeevani Policy, ICICI Lombard?

If you need a policy with a sum insured higher than ₹5 lakhs then Arogya Sanjeevani Policy, ICICI Lombard is not the right pick for you. Explore our higher sum insured plans here.

What is the tenure for Arogya Sanjeevani Policy, ICICI Lombard?

Your health is covered for 1 year under Arogya Sanjeevani Policy, ICICI Lombard.

Are all the major corporate hospitals on the network?

ICICI Lombard has tie-ups with over 4250+ leading hospitals across the country. This is to ensure the best service and round-the-clock assistance for our policyholders. Being in the network, these hospitals come with the cashless hospitalisation facility.

What does lifelong renewability mean?

Lifelong renewability is a facility assured to an individual to enjoy the lifelong protection of a health insurance cover without any restrictions on age. This helps the insured to not only meet sudden medical expenses but also enjoy health protection for a longer time.

What is beneficial for me - floater insurance or individual insurance?

For young families, a floater insurance policy is more economical than opting for multiple individual policies. You get a higher coverage at an affordable premium in floater insurance, as compared to individual insurance.

What is a Health Card, and what are its benefits?

A health card contains the details of the health insurance policy and is issued with the policy. It also contains the contact details and numbers of third-party administrators (TPA), whom you can contact during a medical emergency for assistance, queries or clarifications. You can avail the benefit of cashless hospitalisation at the cashless network hospitals on producing the health card.

How do I switch to Arogya Sanjeevani Policy, ICICI Lombard insurance when I have another ongoing insurance cover?

If you wish to switch your current insurance to Arogya Sanjeevani Policy, ICICI Lombard, you need to send us your application with a duly filled Portability form, supported with complete documentation at least 45 days prior to the renewal date of your existing policy.

What should I do if my policy expires?

You need to pay the renewal premium before the due date of the policy, else your health insurance policy will expire. However, we offer a grace period of 30 days from the expiry of the policy.

What if I want to renew my health insurance policy after one year?

We will be sending you a renewal notice informing you of the expiry of your health policy.

What is the grace period for renewal?

From the expiry date of the policy, you get 30 days grace to renew it under the yearly premium payment mode.

What is a Health Card?

It is a card that you get along with your policy. It is similar to an identity card and entitles you to avail cashless hospitalisation at any of our network hospitals.

What are the benefits of a health card?

A health card mentions the contact details and the contact numbers of the Third Party Administrator (TPA). In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital.

How much refund will I receive if I cancel my Arogya Sanjeevani Policy, ICICI Lombard?

To cancel your Arogya Sanjeevani Policy, ICICI Lombard you need to give a 15 days’ written notice, and your premium will be refunded for the unexpired policy period as follows:

Time of cancellation
Percentage of eligible refund
Up to 30 days 75
31 to 90 days 50
3 to 6 months 25
6 to 12 months 0
What plans are available under the Arogya Sanjeevani Policy, ICICI Lombard?

There are no variants of Arogya Sanjeevani Policy, ICICI Lombard.

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Will Arogya Sanjeevani Policy, ICICI Lombard cover hospitalisation expenses for COVID-19?

Yes, hospitalisation expenses for COVID-19 will be covered under Arogya Sanjeevani Policy, ICICI Lombard as per the policy terms and conditions.

How can I intimate my claim for Arogya Sanjeevani Policy, ICICI Lombard after hospitalisation?

Claim intimation can be done online on IL Health Care 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

Is any waiting period applicable under Arogya Sanjeevani Policy, ICICI Lombard for COVID-19 claim?

In case of a fresh policy, the hospitalisation expenses incurred for COVID-19 will be covered provided the illness is contracted after completion of 30 days. 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 30 day condition will not be applicable.

Will the expenses towards COVID-19 vaccination be covered in case such vaccine is manufactured?

The expenses towards vaccination are not be covered under Arogya Sanjeevani Policy, ICICI Lombard.

Are the expenses on medicines and diagnostic tests incurred during medically advised home isolation due to COVID-19 covered?

No, Arogya Sanjeevani Policy, ICICI Lombard does not cover these expenses.

Will Arogya Sanjeevani Policy, ICICI Lombard 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 Arogya Sanjeevani Policy, ICICI Lombard cover hospitalisation in a country other than India?

No. The geographical scope of Arogya Sanjeevani Policy, ICICI Lombard is limited to India.

Will my travel history abroad affect the admissibility of claim under Arogya Sanjeevani Policy, ICICI Lombard?

So long as the hospitalisation is in India, the travel history will not affect the admissibility of claim under Arogya Sanjeevani Policy, ICICI Lombard.

What are the expenses incurred for COVID-19 that will not be covered under my Arogya Sanjeevani Policy, ICICI Lombard?

The non-payable expenses as listed by IRDAI will not be covered under your Arogya Sanjeevani Policy, ICICI Lombard.

Will my family members be covered for COVID-19 expenses?

Yes, provided they are covered under Arogya Sanjeevani Policy, ICICI Lombard.

Are the consultations with a Medical Practitioner and diagnostic tests in relation to COVID-19 covered under my Arogya Sanjeevani Policy, ICICI Lombard?

In case there is hospitalisation on account of COVID-19, then all expenses related to COVID-19 incurred for consultations with a Medical Practitioner and diagnostic tests as advised by a Medical Practitioner in the 30 day period prior to the date of admission and 60 day period after date of discharge will be covered as per policy terms and conditions.

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