Group Insurance 481 views May 15, 2021

ICICI Lombard Group Health Insurance Plan provides financial protection against daycare treatment, hospitalization, domiciliary hospitalization to the employees if they suffer from an illness or injury during the policy period. The employer is the policyholder in ICICI Lombard Group Health Insurance Plan, and it can opt for any of the following add-ons available under this plan –

  1. Cover for Pre-Existing Diseases
  2. Maternity Expenses
  3. Out-patient Expenses
  4. HIV
  5. Cost of Prescribed External Medical Aid
  6. Baby Cover 
  7. Critical Illnesses Cover
  8. Travel Expenses for Medical Treatment
  9. Dental Expenses
  10. Cover for Alternate Methods of Treatment
  11. Donor Expenses
  12. Ambulance Charges
  13. Pre and Post-hospitalization expenses

Read this page carefully and learn more about the benefit, terms and conditions of the ICICI Lombard Group Health Insurance Plan

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ICICI Lombard Group Health Insurance Plan Basic Coverage

The insurer will cover the following medical expenses –

  1. In-patient hospitalization expenses such as boarding and nursing expenses
  2. ICU charges
  3. Surgeon and doctor’s fees
  4. Cost of anesthesia, blood, oxygen, operation theatre charges, etc.

Note – In-patient hospitalization should be a minimum of 24 hours.

The insurer also covers your daycare treatments undertaken under General or Local anesthesia in a Hospital/Daycare center where the hospitalization is for less than 24 hours due to technological advancement.

Note – If the daycare treatment is taken on an outpatient basis, the same shall not be covered.

ICICI Lombard Group Health Insurance Plan Add-on Options

Any of the following additional covers under this can be opted by the policyholder –

  1. Cover for Pre-Existing Diseases: The insured member’s pre-existing diseases shall be covered after 1 year. Only those illnesses shall be covered under this add-on which are diagnosed within 48 months before the effective date of the policy or its reinstatement.
  2. Maternity Expenses: This add-on provides coverage for medical expenses that are incurred for baby delivery and lawful medical termination of pregnancy. The cover also extends and provides childbirth coverage for pre and post-natal expenses. The coverage under this add-on shall be available after 9 months of continuous coverage. Any expenses incurred due to voluntary medical termination of pregnancy during the first 12 weeks from the date of conception will not be covered.
  3. Out-patient Expenses: This add-on cover will cover the out-patient expenses incurred during 24 hours of hospitalization. However, if an insured member undergoes any daycare procedure/treatment, the same shall not be covered under this add-on benefit.
  4. Cost of Prescribed External Medical Aid: The cost of prosthetic or artificial devices or any medical equipment such as hearing aids, spectacles, contact lenses, etc. will be covered under this add-on.
  5. Baby Cover: This add-on will cover the medical expenses of a newborn baby for in-patient hospitalization up to 91 days.
  6. Critical Illnesses Cover: The insurance company pays the sum insured if any of the insured members are diagnosed with one or more of the critical illnesses for the first time.
  7. Travel Expenses for Medical Treatment: Travel expenses incurred due to medical treatment where the treating Medical Practitioner has advised you to receive treatment in another hospital or by a specialist outside your residence city/state.
  8. Dental Expenses: Under this add-on, medical expenses related to dental treatment will be covered
  9. Cover for Alternate Methods of Treatment: This add-on covers medical expenses incurred on homeopathic, Ayurvedic, Siddha, Unani, acupressure, acupuncture, yoga and naturopathy treatment, provided such treatments are administered by a medical practitioner.
  10. Donor Expenses: Any medical expenses incurred in respect of the donor for any of the organ transplant/surgery, provided the organ is donated for the insured’s use.
  11. Ambulance Charges: Ambulance charges shall be covered only in case of emergency hospitalization.
  12. Pre and Post-hospitalization: Any medical expenses incurred 30 days before and 60 days after hospitalization will be covered under this add-on cover.

Exclusions from ICICI Lombard Group Health Insurance Plan

ICICI Lombard Group Health Insurance Plan comes with the following exclusions –

  1. Pre-Existing Diseases Treatment up to 48 months
  2. Treatment of any illness within 30 days from the first date of policy commencement, except the ones arising due to an accident
  3. Investigation & Evaluation
  4. Rest Cure, rehabilitation and respite care
  5. Obesity Treatment and Weight Control Programs
  6. Gender treatments
  7. Treatment due to participation in hazardous or adventure sports
  8. Treatment due to breach of law with criminal intent
  9. Treatment in any hospital or by any medical practitioner which is specifically excluded
  10. Circumcision unless necessary for the treatment of a disease
  11. Cosmetic or plastic surgery unless necessary for the treatment of accident, burns, cancer or any other disease
  12. Treatment of alcoholism, drug or substance abuse
  13. Treatments received in health hydros, nature cure clinics, spas or similar establishments
  14. Treatment for correction of eyesight due to refractive error less than 7.5 dioptres
  15. Cost of dietary supplements and substances that are purchased without doctor’s prescription
  16. Unproven treatments
  17. Sterility and infertility treatment such as – contraception of any type, sterilization, assisted reproduction (artificial insemination and IVF, ZIFT, GIFT, ICSI), Gestational Surrogacy, reversal of sterilization
  18. Cost of spectacles and contact lenses, hearing aids, etc.
  19. Dental treatment or surgery unless requiring hospitalization
  20. Convalescence, general debility, run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease
  21. Intentional self-injury/suicide
  22. Diseases, illness, accident or injuries which are directly or indirectly related to war, nuclear weapons/materials, ionizing radiation of any nuclear waste
  23. Maternity expenses
  24. Naturopathy treatment

Note: If any Add-On is opted by the policyholder, the respective exclusion shall not apply

Free Look Period

A free look period of fifteen days from the date of receipt of the policy document will be provided to the policyholder where they can review the terms and conditions of the policy and return the same if not acceptable. If the insured has not made any claim during the free look period, a refund of paid premium less medical examination expenses and stamp duty charges will be made. If the policy risk has already commenced and the option of return of the policy is exercised, a deduction towards the proportionate risk premium for the period on the cover will be made. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage and a refund will be paid.

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