ICICI Lombard Complete Health Insurance (Health Elite)

ICICI Lombard Complete Health Insurance (Health Elite) Plan is a health insurance policy provided by the ICICI Lombard General Insurance Company Limited. 

This health insurance policy offers extensive coverage, addressing various healthcare needs. It encompasses a broad range of expenses, such as maternity costs, consumable items, and day-to-day OPD expenses like medicines, tests, consultations, etc. Moreover, the plan provides the option for increasing the sum insured automatically based on the previous year's inflation rate. Despite its comprehensive benefits, it's worth noting that this plan is relatively expensive when compared to other products available in the market. Additionally, it lacks the flexibility of monthly premium payments. When considering the insurer, our research indicates that they have a lower number of claim settlement complaints, but there is a notable volume of complaints related to policy purchase.

What are the benefits offered by the ICICI Lombard Complete Health Insurance (Health Elite) Plan? 

• Inpatient hospitalisation coverage: The ICICI Lombard Complete Health Insurance (Health Elite) Plan offers coverage for hospitalisation expenses. This includes all costs associated with admission that extend beyond 24 hours, encompassing nursing care, medical consultations, prescription medications, intensive care unit (ICU) charges, and any other related expenses.
• Pre-hospitalisation coverage: Pre-hospitalisation expenses refer to costs incurred before hospitalisation, such as consultations, tests, checkups, etc. To qualify for coverage, these expenses must be associated with the medical condition leading to hospitalisation and be approved as part of the inpatient hospitalisation coverage. Under the ICICI Lombard Complete Health Insurance (Health Elite) Plan, pre-hospitalisation expenses are covered for up to 30 days preceding hospitalisation, with coverage extending up to the sum insured.
• Post-hospitalisation coverage: Post-hospitalisation expenses encompass medical costs incurred after hospitalisation, such as follow-up consultations, medical check-ups, rehabilitation sessions, physiotherapy, and other related expenses. To be eligible for coverage, these expenses must be connected to the medical condition necessitating hospitalisation and approved under the inpatient hospitalisation coverage. The ICICI Lombard Complete Health Insurance (Health Elite) Plan provides coverage for post-hospitalisation expenses for up to 60 days after hospitalisation, with coverage extending up to the sum insured.
• Daycare treatment coverage: These are, typically, medical procedures or surgeries that necessitated an extended hospital stay in the past but can now be accomplished within 24 hours due to significant advancements in medical technology. The ICICI Lombard Complete Health Insurance (Health Elite) Plan provides comprehensive coverage for all daycare treatments without any limitations. This means that all associated costs will be covered up to the sum insured, offering financial support for such medical procedures.
• Domiciliary treatment coverage: Domiciliary treatments involve medical interventions for illnesses or injuries requiring immediate attention at a hospital but are administered at home due to the severity of your medical condition or the unavailability of nearby hospital beds. The ICICI Lombard Complete Health Insurance (Health Elite) Plan extends coverage for expenses associated with all domiciliary treatments (with the exception of 17 specified illnesses) up to the sum insured. Additionally, you have the option to avail of additional coverage beyond the sum insured, enhancing the overall protection provided by the plan.
• Organ donor coverage: In the event of organ transplantation where you are the recipient, the ICICI Lombard Complete Health Insurance (Health Elite) Plan includes coverage for expenses related to harvesting the organ from the donor, up to Rs 10 Lakhs. Furthermore, there is an option to obtain additional coverage beyond the sum insured, allowing for enhanced financial protection in such critical medical situations.
• Modern treatment coverage: As healthcare evolves swiftly, modern treatments utilising technological advancements like stem cell therapy, robotic surgery, etc. are revolutionising the approach to diseases once deemed incurable. The ICICI Lombard Complete Health Insurance (Health Elite) Plan provides comprehensive coverage for the expenses associated with these cutting-edge treatments up to the sum insured without any limit.
• Non-medical expenses coverage: Beyond medical expenses, the ICICI Lombard Complete Health Insurance (Health Elite) Plan extends coverage to non-medical expenses, including items like gloves, oxygen masks, nebulization kits, and similar necessities. This coverage is applicable up to the sum insured, provided you choose to include the relevant add-on to your plan. 
• No Claim Bonus: Health insurance providers offer a No Claim Bonus as an incentive if you refrain from making any claims in a policy year. With the ICICI Lombard Complete Health Insurance (Health Elite) Plan, a No Claim Bonus of 10% of the sum insured is provided, regardless of whether any claims are made during the policy year. Opting for an add-on allows you to retain the accumulated bonus even if a claim is filed. Moreover, you have the opportunity to accumulate a maximum bonus of 50% of the sum insured under the policy.
• Super No Claim Bonus: The Super No Claim Bonus, an upgraded version of the No Claim Bonus, operates in a similar fashion. ICICI Lombard Complete Health Insurance (Health Elite) Plan offers you a Super No Claim Bonus, equivalent to 50% of the sum insured if you opt for an add-on. You have the opportunity to accumulate a maximum of up to 100% of the sum insured under the policy. It's crucial to note that in the event of a claim, the accumulated bonus will decrease at the same rate it was earned.
• Restoration benefit: The ICICI Lombard Complete Health Insurance (Health Elite) Plan includes a valuable refill benefit, designed to replenish the sum insured once it has been exhausted within a policy year. This benefit kicks in when the sum insured and No Claim Bonus is partially exhausted. It specifically applies to unrelated illnesses, allowing you to enjoy it unlimited times for subsequent claims throughout the policy year.

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

ICICI Lombard Complete Health Insurance (Health Elite) Plan: Financial Limits

• Room rent limit: The maximum amount your health insurance policy pays for the room you stay in during your hospitalisation is called the room rent limit. If the room you opt for falls within this limit, you won't incur extra expenses. Yet, if your chosen room surpasses this specified limit, a proportional deduction will be applied. Consequently, you'll be accountable for paying a proportionate share of the total bill, rather than just covering the difference in room rent. The ICICI Lombard Complete Health Insurance (Health Elite) Plan provides the freedom to choose any room type without restrictions.
• ICU rent limit: It is the maximum amount covered by your health insurance policy for your ICU stay in the hospital. With the ICICI Lombard Complete Health Insurance (Health Elite) Plan, there is no limit on coverage for ICU rent. This signifies that the plan covers the entire cost up to the sum insured, ensuring comprehensive coverage for ICU expenses.
• Co-payment: A co-payment is a specific percentage of the claim amount that you are required to cover from your own funds. After settling this co-payment, the insurer takes care of the remaining expenses. It's worth noting that the ICICI Lombard Complete Health Insurance (Health Elite) Plan does not entail any co-payment.
• Deductible: A deductible is a specific amount that you are responsible for paying before your insurer starts covering your medical expenses. The ICICI Lombard Complete Health Insurance (Health Elite) Plan, however, does not include any deductible.
• Limits on surgeries/treatments: It denotes the maximum amount that a health insurance policy will provide for specific medical procedures or treatments. Certain insurers set restrictions on the coverage for particular procedures, while others may not impose such limits. With the ICICI Lombard Complete Health Insurance (Health Elite) Plan, critical surgeries/procedures like cataract treatments are covered up to Rs 1 Lakh per eye per policy year, and joint replacement surgeries are covered up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 lakhs. 

ICICI Lombard Complete Health Insurance (Health Elite) Plan: Waiting Periods & Exclusions

👉Waiting period
Following the purchase of a health insurance policy, certain illnesses and conditions may not be covered for a specified duration, known as the waiting period. However, once this waiting period concludes, you become eligible to claim for these specific conditions. Some of the types of waiting periods are listed  below -

• Initial waiting period: There is an initial waiting period of 30 days for all medical conditions, excluding accidents, following the purchase of the policy. During this time frame, you cannot claim for hospitalisation, except in case of an accident.
• Waiting period for pre-existing diseases: In essence, a pre-existing disease is a health condition or illness you have had within the last 36 months before securing a health insurance policy. In the ICICI Lombard Complete Health Insurance (Health Elite) Plan, a waiting period of 24 months is in place for pre-existing diseases. Throughout this duration, you cannot file claims for medical expenses associated with your pre-existing conditions.
• Waiting period for specific diseases: Besides pre-existing conditions, insurance providers may designate a waiting period for certain medical conditions or illnesses, regardless of whether you have a history of these diseases or not. The duration of this waiting period is determined by the insurer and is unrelated to your current health status. Specifically, the ICICI Lombard Complete Health Insurance (Health Elite) Plan enforces a waiting period of 24 months for particular diseases, and a waiting period of 3 months for hypertension, diabetes, and cardiac conditions.

👉Exclusions
Health insurance policies do not cover certain medical conditions. These are known as exclusions. Here are some of the types of exclusions -

• Standard permanent exclusions: Insurance providers in India are obligated to adhere to the 'standard permanent exclusions' set forth by IRDAI.  These include -

1. Investigation and evaluation: Hospital admission for the purpose of observation or monitoring.
2. Rest, rehabilitation, and respite care: Admission to a healthcare facility for resting without active treatment. 
3. Obesity/weight control: Treatment or surgery associated with weight control or obesity.
4. Gender reassignment: Treatments designed to alter the body’s characteristics to match the opposite sex. 
5. Plastic/Cosmetic surgery: Treatment or surgery specifically aimed at modifying body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment for illness or illness arising from participating in adventurous activities such as river rafting, scuba diving, mountaineering, etc. as a professional.  
7. Breach of law: Expenses for treating a person involved in or attempted to indulge in a criminal act.
8. Excluded providers: Treatment received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treatment for addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Treatments taken in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons. 
11. Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses linked to correcting refractive errors of up to a maximum of 7.5 diopters to improve vision.
13. Unproven treatments: Expenses related to surgeries, medical procedures, or treatments that are not proven to be successful.
14. Expenses related to birth control, sterility, infertility: Medical costs incurred for contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, GIFT, ZIFT, gestational surrogacy, ICSI, etc. 
15. Maternity costs: Expenses related to pre/post-natal care, childbirth-related hospitalisation, etc. 

• Additional permanent exclusions: Apart from the list of standard permanent exclusions established by IRDAI, insurance companies have the authority to introduce additional exclusions for specific medical conditions or situations. If you are managing a severe medical condition or a specific disease that is considered too risky to cover, they may permanently exclude it from the policy.  The IRDAI has outlined a specific list of illnesses for which insurance companies are permitted to apply permanent exclusions. It is important to note that insurers are not allowed to impose permanent exclusions on illnesses or diseases that are not on this predefined list.
• Non-standard exclusions (Specific exclusions): These are exclusions that extend beyond the standard permanent exclusions outlined by IRDAI. These exclusions are defined by the insurance company and may vary depending on the terms and conditions of the policy. Some specific exclusions in the ICICI Lombard Complete Health Insurance (Health Elite) Plan are listed below -

1. Costs associated with prosthesis, corrective devices and external equipment of any type utilised for treatment, unless required due to accident.
2. Dental treatment except in case it is needed due to an accident.
3. Expenses related to acupressure, acupuncture, magnetic and other similar therapies.
4. Circumcision unless necessary for treating a disease or injury
5. Treatment expenses related to venereal or any sexually transmitted diseases.
6. Treatment expenses related to external birth defects or anomalies.
7. Expenses related to domiciliary treatment, i.e., treatment taken at home.
8. Treatment expenses for intentional self inflicted Injury or attempted suicide by any means.
9. Expenses associated with screening, treatment, or surgery to remove an organ from a donor.
10. Expenses for treating any illness or injury arising from war, invasion, act of foreign enemy, military, government/public authority orders, etc.
11. Expenses for treating any illness or injury arising from nuclear weapons, radiation, etc.

What to expect in terms of claims experience if you buy from ICICI Lombard General Insurance Company Limited?

• Speed of claims: ICICI Lombard General Insurance Company Limited has demonstrated a commendable track record in promptly and efficiently settling claims. It has successfully resolved 99.78% of claims within a span of less than 30 days. 
• Claim-related complaints: According to our research, ICICI Lombard General Insurance Company Limited has received a lower number of claim complaints, as compared to other insurers, accounting for 0.11%. 
• Claims incurred ratio: It is a measure of an insurer’s financial performance. It represents the number of claims incurred compared to the total premiums collected in a financial year. ICICI Lombard General Insurance Company Limited holds a claims incurred ratio of 78.85%.
• Claim settlement ratio: It represents the percentage of claims successfully settled by the insurance company relative to the total number of claims it received in a given financial year. ICICI Lombard General Insurance Company Limited's claim settlement stands at 80.97%.
• Network hospitals: With an extensive network comprising 9,500+ hospitals, you can enjoy the convenience of cashless treatments at a diverse array of healthcare providers across various locations.

How is the customer service of ICICI Lombard General Insurance Company Limited?

• Policy purchase-related complaints: As per our research, ICICI Lombard General Insurance Company Limited has received a higher number of complaints related to its after-sales service, as compared to other insurance companies, accounting for 0.01%. 
• Response on toll-free: Our research suggests that ICICI Lombard General Insurance Company Limited’s response time on their toll-free number is quick, as compared to other insurers.
• Response on Twitter: According to our research, ICICI Lombard General Insurance Company Limited’s response time on Twitter is average, as compared to other insurers. 

About ICICI Lombard General Insurance Company Limited

ICICI Lombard General Insurance Company Limited, a collaboration between ICICI Bank Limited, a renowned bank, and Fairfax Financial Holdings Limited, a prominent financial services entity, was founded in 2001. It is a private general insurance company in India. It provides a diverse range of insurance products such as motor insurance, health insurance, personal accident insurance, crop insurance, fire insurance, marine insurance, etc. The company is headquartered in Mumbai, Maharashtra and Mr. Bhargav Dasgupta serves as its CEO and MD.