Group Insurance 843 views May 19, 2021

ICICI Lombard Group Hospi Shield Insurance Plan provides coverage to the employees of an organization against hospitalization expenses. The employer can buy this plan to provide financial safeguard to its employees against medical expenses. Key benefits of the ICICI Lombard Group Hospi Shield Insurance Plan are –

  1. Hospital Daily Cash
  2. Specific Infection Disease Benefit
  3. Accidental Injury Benefits

Let’s read this page and learn more about the benefit of the ICICI Lombard Group Hospi Shield Insurance Plan.

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ICICI Lombard Group Hospi Shield Insurance Plan Hospital Daily Cash

The insured members are eligible for the following benefits under this plan.

Hospital Daily Cash Benefit

If the insured suffers an illness or injury (due to an accident) during the policy term, the insurer will pay a daily amount to him/her as specified in the policy certificate. This benefit shall be payable only for each continuous and completed day of hospitalization.

EMI Benefit

If the insured suffers from an illness or accident during the policy term, the insurer will pay him/her the sum insured. The insured can make multiple claims under this benefit. However, the maximum liability is restricted up to the sum insured as specified against the EMI benefit in the policy certificate.

Day Care Treatment Benefit

During the policy period, if the insured undergoes daycare, the insurer will pay an amount as specified in the policy certificate against this benefit. The daycare treatment benefit is applicable for medically necessary treatment and it commences and continues on the written advice of the treating medical practitioner. The insurer shall not be liable to pay under this benefit more than 5 times for each insured person in a policy year.

Cancer Cash Benefit

If any of the insured members are diagnosed with Cancer of Specified Severity during the policy period, the insurer will pay a daily cash amount as mentioned in the policy certificate. The diagnosis must be supported by histological evidence of malignancy. The following shall be excluded under this benefit –

  1. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant, borderline malignant, low malignant potential, neoplasm of unknown behavior, or non-invasive
  2. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond
  3. Malignant melanoma that has not caused invasion beyond the epidermis
  4. All tumors of the prostate unless histologically classified as having a Gleason score > 6 or having progressed to at least clinical TNM classification T2N0M0
  5. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below
  6. Chronic lymphocytic leukaemia < RAI stage 3
  7. Non-invasive papillary cancer of the bladder is histologically described as TaN0M0 or of a lesser classification
  8. All Gastro-Intestinal Stromal Tumors are histologically classified as T1N0M0 (TNM Classification) or below and with a mitotic count of less than or equal to 5/50 HPFs
  9. All tumors in the presence of HIV infection.

The employer can opt for any of the extension under Hospital Daily Cash

  1. ICU Cash Benefit
  2. Brain & Stroke Hospitalization Cash Benefit
  3. Organ Transplant Hospitalization Cash Benefit
  4. Heart Ailment Hospitalization Cash Benefit
  5. Fracture & Burns Cash Benefit
  6. Ambulance Cover Benefit
  7. Child Care Cash Benefit
  8. Hospital Attendant Cash Benefit
  9. Compassionate Visit Cash Benefit

ICICI Lombard Group Hospi Shield Insurance Plan Specific Infection Disease Benefit

Under this coverage section, the insurer shall cover the following illnesses –

  1. Vector-borne diseases such as Malaria, Dengue, Chikungunya, Kala Azar, Japanese encephalitis, Zika Fever and Filariasis
  2. Rabies and Tetanus-related hospitalization
  3. Gastro Intestinal Infections such as Acute Inflammatory Diarrhoea, Typhoid Fever, Acute onset, caused by invasive or noninvasive pathogens
  4. Specific Viral Infections such as Viral Hepatitis (Hepatitis A, B, C and E), Measles, Mumps, Poliomyelitis, Avian Influenza and Swine Influenza
  5. Specific Nervous System Infections like Meningitis, Encephalitis, Creutzfeldt–Jakob disease, Guillain–Barré syndrome

The insurer shall pay the sum insured in case the insured member is hospitalized due to any of the above-mentioned illnesses during the policy period. Specific Infection Disease Benefit is subject to the following conditions –

  1. The hospitalization should be commenced and continued on the written advice of the treating medical practitioner.
  2. The hospitalization should be continued for a minimum of 48 hours
  3. No benefit shall be payable under this benefit for the illness for which the insured has already got treated before the commencement of the policy.
  4. No benefit shall be payable if the illness occurs during the waiting period
  5. The insurer is not liable to make any payment under this benefit in respect of pre and post-hospitalization medical expenses.
  6. Once the claim is paid under this benefit, all cover in respect of the insured person shall immediately and automatically cease. However, benefits for illnesses other than the above-mentioned ones shall continue.

ICICI Lombard Group Hospi Shield Insurance Plan Accidental Injury Benefits

The insured will receive the following benefits during the policy term in case of death or disablement due to an accident, whichever is earlier –

  1. Death Benefit
  2. Permanent Total Disablement (PTD) Benefit
  3. Permanent Partial Disablement (PPD) Benefit
  4. Temporary Total Disablement (TTD) Benefit
  5. Children’s Education Grant Benefit
  6. Accidental Hospitalization Expenses Reimbursement Benefit
  7. Accidental Hospitalization Daily Cash Benefit
  8. Loss Of Job Benefit
  9. Recovery Benefit

Free Look Period

A free look period of 15 days applies to new individual health insurance policies and not on renewals or at the time of porting/migrating. During the free look period, the insured 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, the insurance company shall refund the paid premium after deducting the medical examination expenses and stamp duty charges. Where the risk has already commenced and the option of return of the policy is exercised by the insured, the insurer will make a deduction towards the proportionate risk premium for the period of cover. If only a part of the insurance coverage has commenced, such proportionate premium commensurates with the insurance coverage during the free look period.

Note: The free look period will be 30 days in case the policy is purchased through distance marketing modes.

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