Group Insurance 234 views May 15, 2021

ICICI Lombard Group Takecare Insurance Plan provides coverage against medical expenses for the incurred illness/injury during the policy term. This policy is a contract of insurance between the policyholder (employer) and ICICI Lombard where the former pays the premium for the benefits received by its employees amid a medical emergency. Continue reading this page below and know more about the benefits, terms & conditions and exclusions of the ICICI Lombard Group Takecare Insurance Plan.

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ICICI Lombard Group Takecare Insurance Plan Benefits

The insured member’s (employees) will be entitled to the following benefits under ICICI Lombard Group Takecare Insurance Plan –

Hospifund Benefit

Under this benefit, hospital cash shall be provided to the insured during his/her hospital stay, provided the insured person suffers from an illness or injury (due to an accident). A daily cash amount as specified in the policy certificate will be paid to the insured for each continuous and completed hospitalization of 24 hours. The following extensions are available under Hospifund Benefit –

  1. Intensive Care Cash Benefit
  2. Cancer Hospitalization Cash Benefit
  3. Brain & Stroke Hospitalization Cash Benefit
  4. Organ Transplant Hospitalization Cash Benefit
  5. Heart Ailment Hospitalization Cash Benefit
  6. Fracture & Burns Cash Benefit
  7. Day Care Treatment Cash Benefit
  8. Convalescence Benefit
  9. Ambulance Cover Benefit
  10. Child Care Cash Benefit
  11. Hospital Attendant Cash Benefit
  12. Compassionate Visit Cash Benefit

 Outpatient Benefit

This base benefit provides the following coverages to the insured –

  1. Consultation Cover
  2. Pharmacy Cover
  3. Diagnostic Cover
  4. Coverage for Minor Procedures
  5. Travel Expenses for Medical Treatment

Wellness Cover

Here, the insurer will cover the following medical expenses –

  1. Routine Physical & Preventive Examinations
  2. Onsite Health Services
  3. Wellness Session
  4. Health Risk Assessment (HRA)
  5. Wellness Events such as vaccination, eye screening, and dental screening
  6. Telephonic or Virtual Consultation
  7. Workplace Wellness Management Program
  8. Emergency Ambulance Service

Exclusions from ICICI Lombard Group Takecare Insurance Plan

The insurer will not provide the above-mentioned benefits if a claim arises due to the following –

Exclusions from Hospifund Benefits

  1. Pre-existing diseases up to 48 months from the date of policy inception
  2. No cash benefit shall be paid if the hospitalization takes place within the first 30 days. However, this exclusion shall not apply to accidental hospitalization. If the insured has continuous coverage for more than 12 months, this exclusion shall not apply. Whereas the 30-day waiting period shall apply to the enhanced sum insured only in case of an increase in the sum insured.
  3. Any dental treatment or surgery unless necessitated due to an accident or specifically covered under the policy
  4. Vaccination and inoculation
  5. Alternative treatments
  6. Any treatment outside India unless specifically covered under the policy
  7. Circumcision unless necessary for the treatment of an illness
  8. Hormone replacement therapy
  9. Alopecia, baldness, wigs, or toupees and hair fall treatment
  10. Routine medical, eye and ear examinations unless specifically covered under the policy
  11. Cosmetic or plastic surgery unless part of the illness or injury treatment
  12. Eyesight correction treatment for refractive error < 7.5 diopter
  13. Any medical examination, diagnostics or hospitalization for employment or travel purpose
  14. Treatment of general debility, sterility, venereal disease
  15. Obesity or weight control treatment
  16. Rest cure, rehabilitation and respite care
  17. Intentional self-injury/suicide
  18. First degree burns where the impact is only the epidermis or outer layer of skin
  19. Any external congenital anomalies unless specifically covered under the policy
  20. Change of gender treatments
  21. Treatment by a family member and self-medication
  22. Breach of law with criminal intent
  23. Treatment for alcoholism, drug or substance abuse
  24. Illness/Injury due to serving in military/police or any other forces of similar nature
  25. Unproven treatments
  26. Expenses related to donor screening
  27. Treatment taken from a non-registered person
  28. Domiciliary hospitalization
  29. Hospitalization due to engagement in professional sports unless specifically covered under the policy
  30. Hospitalization due to war, invasion, an act of foreign enemies, hostilities
  31. Treatment necessitated due to the participation in hazardous or adventure sports
  32. Treatment of impotence, erectile dysfunction, venereal diseases or any sexually transmitted diseases
  33. Sterility and infertility treatments
  34. Hospitalization primarily for evaluative and diagnostic purposes
  35. Treatment with the excluded provider
  36. Maternity-related medical treatment expenses
  37. Treatments received in health hydros, nature cure clinics, spas or similar establishments
  38. Unprescribed dietary supplements and substances

Exclusion from Outpatient Benefit

  1. Medical expenses incurred due to contraction of any Illness necessitating hospitalization.
  2. Personal comfort, cosmetics and convenience expenses
  3. Dietary supplements and substances that are purchased without prescription
  4. Alternative treatment except for AYUSH treatment.
  5. Unproven treatments
  6. 30 day waiting period 
  7. Illness/Injury directly caused due to war, invasion, an act of a foreign enemy, warlike operations
  8. Defects/Anomalies, venereal disease, intentional self-injury
  9. Treatment of alcoholism, drug or substance abuse
  10. Sterility and infertility treatment
  11. Hospitalization arising due to Human T-Cell Lymphotropic Virus Type III (HTLV -III) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any syndrome or condition of a similar kind.
  12. Illness/Injuries directly or indirectly related to nuclear weapons/materials
  13. Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception
  14. Treatment of sleep apnoea syndrome or continuous ambulatory peritoneal dialysis (C.A.P.D.), oxygen concentrator for bronchial asthmatic condition,
  15. Any sexually transmitted disease.
  16. Cosmetic or plastic surgery unless it is forming a part of the illness or injury treatment
  17. Change of gender treatments
  18. Breach of law
  19. Injury/Illness arising due to the participation in hazardous or adventure sports
  20. Treatments received in heath hydros, nature cure clinics, spas or similar establishments
  21. Treatment received outside India

Note: No exclusions shall apply on Wellness Cover.

Free Look Period

The insured person shall be allowed a free look period of 15 days from the date of receipt of the policy document to 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 insurer will refund the paid premium less medical examination expenses and the stamp duty charges. Whereas if the risk has already commenced and the option of return of the policy is exercised by the insured person, a deduction towards the proportionate risk premium for the period on the cover will be made. And if only a part of the insurance coverage has commenced, such proportionate premium will commensurate with the insurance coverage.

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