Health Insurance 218 views May 17, 2021

ICICI Lombard Critical Illness Insurance Plan provides coverage against 18 critical illnesses to the insured. So if you are contracted with any of the mentioned critical illnesses during the policy period and survive for at least 30 days from the date of its diagnosis, the insurer will bear the cost of your treatment. Continue reading this page and know more about the benefits of the ICICI Lombard Critical Illness Insurance Plan.

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List of Critical Illnesses Covered Under ICICI Lombard Critical Illness Insurance Plan

The following critical illnesses shall be covered under the ICICI Lombard Critical Illness Insurance Plan –

  1. Cancer of Specified Severity
  2. Open Chest CABG
  3. Myocardial Infarction (First Heart Attack of Specified Severity)
  4. Kidney Failure Requiring Dialysis
  5. Major Organ/Bone Marrow Transplant
  6. Stroke Resulting in Permanent Symptoms
  7. Permanent Paralysis of Limbs
  8. Open Heart Replacement or Repair of Heart Valves
  9. End-Stage Liver Disease
  10. Loss of Limbs
  11. Loss of Speech
  12. Major Burns
  13. Coma of Specified Severity
  14. Alzheimer’s Disease Before the Age of 50 years
  15. Blindness
  16. Parkinson’s Disease
  17. Deafness
  18. Multiple Sclerosis with Persisting Symptoms

Cancer of Specified Severity – This critical illness subject to the following exclusions –

  1. Carcinoma in situ, Benign tumor, Pre-malignant tumor, Borderline malignant tumor, Low malignant potential tumor, Neoplasm of unknown behavior or Non-invasive tumor such as – Carcinoma in situ of breasts, Cervical dysplasia CIN1, CIN -2 and CIN-3.
  2. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond
  3. Malignant melanoma which is non-invasive beyond the epidermis
  4. All tumors of the prostate, unless it is histologically classified as having a Gleason score > 6 or having progressed to at least clinical TNM classification T2N0M0
  5. All Thyroid cancers which are histologically classified as T1N0M0 (TNM Classification) or below
  6. Chronic lymphocytic leukemia less than RAI stage 3
  7. Non-invasive papillary cancer of the bladder which is histologically described as TaN0M0 or of a lesser classification
  8. All Gastro-Intestinal Stromal Tumors which are histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of <= 5/50 HPFs
  9. All tumors in the presence of HIV infection.

Open Chest CABG – Angioplasty or any other intra-arterial procedures shall not be covered under this critical illness.

Myocardial Infarction (First Heart Attack of Specified Severity) – Myocardial Infarction should be diagnosed as per the following signs/symptoms –

  1. Chest pain
  2. Electrocardiogram changes
  3. Elevation of infarction-specific enzymes, Troponins or other specific biochemical markers.

Other acute Coronary Syndromes, any type of angina pectoris, rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease or intra-arterial cardiac procedure shall be excluded.

Major Organ/Bone Marrow Transplant – Under this critical illness cover, other stem-cell transplants and islets of Langerhans transplant shall not be covered.

Stroke Resulting in Permanent Symptoms – Transient ischemic attacks (TIA), Traumatic injury of the brain, Vascular disease affecting only the eye/optic nerve/vestibular functions shall not be covered under this critical illness.

Permanent Paralysis of Limbs – Coverage for total and irreversible loss of use of two or more limbs due to injury or disease of the brain or spinal cord provided it is present for more than 3 months.

End-Stage Liver Disease – This critical illness shall be covered if it arises due to permanent jaundice, Ascites and Hepatic encephalopathy. Liver failure due to drug or alcohol abuse is excluded.

Loss of Limbs – The physical separation of two or more limbs due to injury or disease where it is medically necessary. Loss of limbs due to self-inflicted injury, alcohol or drug abuse is excluded.

Loss of Speech – Total and irrecoverable loss of the ability to speak due to injury or disease of vocal cords is covered. The inability to speak should be continued for at least12 months from the date of diagnosis and must be confirmed by the medical evidence furnished by an Ear, Nose, Throat (ENT) specialist. If the loss of speech arises due to any psychiatric cause, no benefit shall be payable to you

Major Burns – The insurer will cover this critical illness if third-degree burns cover at least 20% of the body’s surface area.

Coma of Specified Severity – If there is no response to external stimuli continuously for at least 96 hours and the patient is on life support, the insurer will cover this critical illness. Coma resulting directly from alcohol or drug abuse is excluded.

Multiple Sclerosis with Persisting Symptoms – If in the MRI findings multiple sclerosis is confirmed and there are current clinical impairment of motor or sensory function for at least 6 months, the insurer will cover this critical illness. Multiple Sclerosis arising due to neurological damage such as SLE and HIV are excluded.

General Exclusions from ICICI Lombard Critical Illness Insurance Plan

The insurer shall not cover the critical illnesses if they arise due to the following –

  1. Any Critical Illness diagnosed within 90 days of the policy inception. This exclusion shall not apply to the second or subsequent critical illness diagnosed during the policy term
  2. Any Critical Illness diagnosed when the premium is due
  3. Congenital external illness/defects/anomalies
  4. Intentional self-injury
  5. Abuse of intoxication liquor or drugs
  6. Pregnancy and childbirth
  7. Consequential losses of any kind
  8. War or any similar act

Free Look Period

You will have 15 days (Free Look Period) from the date of receipt of the policy where you can review the terms and conditions and return the same if found unacceptable to you. You also need to state the reasons for your objection. On such cancellation, you’ll get a refund of the paid premium less medical examination and the stamp duty charges.

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