Health Insurance 609 views May 17, 2021

ICICI Lombard COVID Shield Insurance Plan provides coverage against medical expenses arising due to the diagnosis of COVID-19. This insurance plan covers hospitalization, pre and post-hospitalization costs, as well as medical expenses during quarantine. Know more about the coverage, exclusions and terms and conditions of ICICI Lombard COVID Shield Insurance Plan on this page below.

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ICICI Lombard COVID Shield Insurance Plan Coverage

The insurer will cover the following medical expenses if you are diagnosed with COVID-19 during the policy period –

In-patient Treatment – The insurer will indemnify the medical expenses incurred during your hospital stay, provided the hospitalization is for at least 24 hours. Under in-patient treatment, the following medical expenses shall be covered up to the annual sum insured –

  1. Room Rent, boarding expenses
  2. Nursing expenses
  3. ICU charges
  4. Consultation fees
  5. Anesthesia, blood, oxygen
  6. Medicines, drugs and other prescribed consumables
  7. Relevant laboratory diagnostic tests, X-ray and such similar expenses

In-patient treatment cover shall be subject to the following conditions:

  1. The claim is admissible under this cover after an initial waiting period of 15 days or as specified in the policy certificate.
  2. The laboratory diagnosis for COVID-19 must be done after completion of the initial waiting period of 15 days
  3. Your COVID-19 test of RT PCR must be conducted by the National Institute of Virology, Pune or any other laboratory authorized by ICMR or any other government-designated laboratory in India appointed for testing of COVID-19

Pre and Post-hospitalisation Expenses – Relevant medical expenses incurred 30 days before the hospitalization and 60 days post hospitalization shall be covered under this policy up to the sum insured.

Hospitalization Expenses for Quarantine – If you need to be quarantined in a hospital due to COVID-19 as per your doctor’s advice, the insurer shall cover your hospitalization expenses during the quarantine period.

Health Assistance – You will also get access to ICICI Lombard Health Assistance Team (HAT) who will assist you understand your health condition by providing answers to your queries. The services include –

  1. Identifying a Physician/ Specialist
  2. Scheduling an appointment with any Medical Practitioner empanelled with ICICI Lombard
  3. Scheduling appointments for a second opinion
  4. Providing suitable options concerning Hospitals as well as assisting in cashless facility
  5. Providing preventive information on ailments
  6. Providing guidance on post-hospitalization care, such as physiotherapy, nursing at home, etc.

Note – Services provided under this benefit are solely for assistance and not for a visit/consultation to an independent medical practitioner. Under this benefit, you won’t get coverage for the charges for any independent medical practitioner/nutritionist consulted on HAT’s recommendation. To avail of HAT’s service, dial 040-66274205.

ICICI Lombard COVID Shield Insurance Plan Extensions

You can enhance your ICICI Lombard COVID Shield Insurance Plan by adding any of the following extensions –

Road Ambulance Cover  – You will get healthcare or ambulance service during the policy period for transpiration to the nearest hospital with adequate emergency facilities. The maximum Road Ambulance Cover is INR 5,000 per hospitalization, up to 2% of the annual sum insured per policy year. This benefit includes and is limited to the cost of the transportation of the insured to the nearest hospital and from the hospital to the nearest diagnostic center for advanced diagnostic treatment (during hospitalization).

Domiciliary Hospitalization – If you are diagnosed with COVID-19, the domiciliary hospitalization for the treatment of COVID-19 illness shall be covered under the policy if it is advised by the attending medical practitioner. The medical expenses shall be covered if the domiciliary hospitalization continues for at least 3 consecutive days.

Note – Any medical expenses payable under Domiciliary Hospitalization shall not exceed 50% of the annual sum insured.

If the domiciliary hospitalization arises directly or indirectly from the following, no benefits shall be payable to you:

  1. Asthma, bronchitis, tonsillitis and upper respiratory tract infection including laryngitis and pharyngitis, cough and cold, influenza
  2. Arthritis, gout and rheumatism
  3. Ailments of spine/disc
  4. Chronic nephritis and nephrotic syndrome
  5. Any liver disease
  6. Peptic ulcer
  7. Diarrhea and all type of dysenteries, including gastroenteritis
  8. Diabetes mellitus and insipidus
  9. Epilepsy
  10. Hypertension
  11. Pyrexia of any origin

Tele-Consultation – The insurer will arrange consultations and recommendations for routine health issues offered by a qualified medical practitioner or health care professional. Telephonic/Virtual consultation shall be provided to you by a qualified medical practitioner or health care professional via audio, video, online portal, chat or mobile app. This extension is subject to the following conditions –

  1. The medical practitioner may prescribe counter medications to you based on the information provided, as the case may be.
  2. This service is available to you 24 hours a day and 365 days a year. The insurance company healthcare professional may refer you to a specialist or a general physician if required, and the charges for such a specialist or a general physician will need to be borne by you.
  3. The insurer is not liable for any discrepancy in the information provided under this benefit. Choosing the services under this benefit is purely upon your discretion and at your own risk.
  4. Charges incurred on consultations, medications, diagnostic tests and therapy shall not be payable under this benefit.

Exclusions from ICICI Lombard COVID Shield Insurance Plan

The insurer shall not be liable to make any payment under this policy if the claim arises due to the following:

  1. Hospitalization expenses not related to COVID-19
  2. Any pre-existing disease/condition
  3. Any expenses incurred concerning self-quarantine if you are not diagnosed with COVID-19
  4. COVID-19 claims aren’t admissible if testing is done at a diagnostic center other than the ones authorized by the Union Health Ministry of India
  5. If you are diagnosed positive with COVID-19 or quarantined for the same before the policy start date or within the waiting period of 15 days.
  6. Diagnosis and treatment for COVID-19 outside the geographical scope of India
  7. Expenses incurred due to lockdown or any cluster containment operations carried by the state or central government
  8. Treatment taken for any condition or disease other than COVID-19 is excluded
  9. Inoculations, vaccinations or any other treatment which aims to prevent disease or illness
  10. Expenses incurred towards treatment in any hospital or by any Medical Practitioner which is specifically excluded. However, this exclusion shall not apply in case of life-threatening situations
  11. Unproven Treatments
  12. Personal comfort, cosmetics, convenience and hygiene-related items

Free Look Period

There is a free look period of fifteen days from the date of receipt of the policy document where you can review the terms and conditions and return the same if not acceptable. If you haven’t made any claim during the free look period, you’ll receive a refund of the paid premium less medical examination and stamp duty charges. Where the risk has already commenced and you have returned the policy, a deduction towards the proportionate risk premium for the period of cover will be made by the insurer. If only a part of the insurance coverage has commenced, such proportionate premium will commensurate with the insurance coverage during such period.

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