ICICI Lombard Complete Health Insurance (Health Shield)

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

This health insurance plan offers a comprehensive solution for your healthcare needs at a reasonable price compared to other products. It goes beyond covering hospitalisation expenses by including consumable items and day-to-day outpatient costs like medicines, tests, consultations, etc. The plan also provides the flexibility of automatically increasing your coverage in line with the previous year's inflation. However, it's important to note that monthly premium payments are not an option. Our research indicates a lower number of complaints regarding claim settlements but a relatively higher number of concerns related to the policy purchase process.

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

• Inpatient hospitalisation coverage: ICICI Lombard Complete Health Insurance (Health Shield) Plan provides coverage for hospitalisation expenses, which include all costs associated with admission that exceed 24 hours such as nursing care, medical consultations, prescription medication, intensive care unit (ICU), and any other related expenses.
• Pre-hospitalisation coverage: Expenses you incur before hospitalisation, like consultations, tests, checkups, etc. are called pre-hospitalisation expenses. To be eligible for this coverage, these expenses must be related to the medical condition that resulted in hospitalisation and should be approved as part of the inpatient hospitalisation coverage. The ICICI Lombard Complete Health Insurance (Health Shield) Plan provides coverage for pre-hospitalisation expenses for 30 days before hospitalisation, up to the sum insured. 
• Post-hospitalisation coverage: Medical costs incurred after hospitalisation, including follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and other related expenses are called post-hospitalisation expenses. However, these expenses are eligible for coverage only if they are related to the medical condition for which you required hospitalisation and are approved as part of inpatient hospitalisation coverage. ICICI Lombard Complete Health Insurance (Health Shield) Plan covers post-hospitalisation expenses for 60 days after hospitalisation up to the sum insured. 
• Daycare treatment coverage: Daycare treatments are medical procedures or surgeries that required an extended hospital stay in the past but can now be completed within 24 hours because of groundbreaking advances in medical technology. The ICICI Lombard Complete Health Insurance (Health Shield) Plan offers coverage for all daycare treatments without any limit. Meaning, all associated costs will be covered up to the sum insured.   
• Domiciliary treatment coverage: Domiciliary treatments are essentially medical treatments for illnesses or injuries that necessitate immediate attention at the hospital but are given at home due to the severity of the patient’s medical situation or the absence of hospital beds in the vicinity. The ICICI Lombard Complete Health Insurance (Health Shield) Plan covers expenses incurred for all domiciliary treatments(except for 17 illnesses) up to the sum insured. You can also avail of additional cover over the sum insured.
• Organ donor coverage: The ICICI Lombard Complete Health Insurance (Health Shield) Plan covers expenses associated with harvesting the organ from the donor in case of organ transplantation up to Rs 10 Lakhs, where you are the organ recipient. You can also avail of additional cover over the sum insured.
• Modern treatment coverage: Healthcare is rapidly progressing, and modern treatments are emerging with technological advancements. These treatments, including stem cell therapy, robotic surgery, etc., are aimed at treating diseases that were previously considered incurable. The ICICI Lombard Complete Health Insurance (Health Shield) Plan covers the expenses of such modern treatments up to the sum insured without any limit.
• Non-medical expenses coverage: In addition to medical expenses, non-medical expenses, such as gloves, oxygen masks, nebulization kits, and other similar items, are covered by the ICICI Lombard Complete Health Insurance (Health Shield) Plan up to the sum insured if you opt for an add-on.
• No Claim Bonus: Health insurers offer a No Claim Bonus as a reward if no claims are made during a policy year. ICICI Lombard Complete Health Insurance (Health Shield) Plan provides 10% of the sum insured as No Claim Bonus, irrespective of whether any claims are made during a policy year. You can keep the accumulated bonus intact even if a claim is filed if you opt for an add-on. Furthermore, you can accumulate a maximum bonus of 50% of the sum insured under the policy.
• Super No Claim Bonus: The  Super No Claim Bonus is an enhanced version of the No Claim Bonus and works similarly. The ICICI Lombard Complete Health Insurance (Health Shield) provides 50% of the sum insured as Super No Claim Bonus if you opt for an add-on. You can accumulate a maximum bonus of 100% of the sum insured under the policy. However, the accumulated bonus will reduce at the same rate it was earned if a claim is filed. 
• Restoration Benefit: The refill benefit is a feature that restores the sum insured after it has been used up during a policy year. The ICICI Lombard Complete Health Insurance (Health Shield) Plan provides this benefit for unrelated illnesses. This feature is activated when both the sum insured and the No Claim Bonus have been partially used up. Moreover, you can enjoy this benefit unlimited times in a policy year for subsequent claims.

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 Shield) Plan: Financial Limits

• Room rent limit: It is the maximum amount your health insurance policy pays for the room you stay in during your hospitalisation. If the room you choose falls within the limit specified by your health insurance policy, you won’t have to pay any additional costs. However, if the room you select exceeds the eligibility limit, a proportionate deduction applies. And you will be responsible for paying a proportionate share of the total bill, not just the difference in the room rent. ICICI Lombard Complete Health Insurance (Health Shield) Plan offers the flexibility to select any type of room, without any restrictions.
• ICU rent limit: It is the maximum amount covered by your health insurance policy for your ICU stay in the hospital. The ICICI Lombard Complete Health Insurance (Health Shield) Plan provides coverage for the ICU rent without any limit. Meaning, the plan covers the entire cost up to the sum insured.
• Co-payment: A co-payment is a certain percentage of the claim amount that you must pay out of your own pocket. Once this amount is paid, the insurer will cover the remaining expenses. Under the ICICI Lombard Complete Health Insurance (Health Shield) Plan, there is no co-payment.
• Deductible: A deductible refers to a certain amount that you must pay from your end before your coverage kicks in to cover your medical expenses. In the ICICI Lombard Complete Health Insurance (Health Shield) Plan, there is no deductible.
• Limits on surgeries/treatments: It is the maximum amount that a health insurance policy will pay for certain medical procedures or treatments. Some insurers have limits on the amount they will cover for certain procedures, while others may not. Under the ICICI Lombard Complete Health Insurance (Health Shield) Plan, important 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 Shield) Plan: Waiting Periods & Exclusions

👉Waiting period
After you buy a health insurance policy, some illnesses and diseases may not be covered for a certain period of time. This time frame is referred to as the waiting period. But, once the waiting period ends, you can claim for these conditions. Listed below are some of the types of waiting periods -

• Initial waiting period: It is worth noting that an initial waiting period of 30 days applies for all medical conditions except accidents. This means that you will not be able to claim for any hospitalisation, except for accidents, for the initial 30 days of policy purchase.
• Waiting period for pre-existing diseases: Any health condition or illness you have experienced in the past 36 months before securing a health insurance policy is referred to as a pre-existing disease. Under the ICICI Lombard Complete Health Insurance (Health Shield) Plan, there is a waiting period of 24 months for pre-existing diseases. During this period, you cannot claim for medical expenses related to such diseases. 
• Waiting period for specific diseases: Apart from the pre-existing conditions, insurers will have a list of specific medical conditions or illnesses that are subject to a waiting period, irrespective of whether you have had those diseases before or not. The duration of this waiting period is decided by the insurer and is not based on your current health status. The ICICI Lombard Complete Health Insurance (Health Shield) Plan comes with a waiting period of 24 months for specific diseases and 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: All insurance providers are required to stick to the ‘standard permanent exclusions’ established by IRDAI. These include -

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

• Additional permanent exclusions: Insurance companies can impose additional exclusions for certain medical conditions or situations besides the standard permanent exclusions. If you have a severe medical condition or a specific disease that is considered to be too risky to cover, they may choose to permanently exclude it from the policy.  

The IRDAI has established a list of illnesses for which insurance companies can apply permanent exclusions. They cannot impose permanent exclusions on illnesses or diseases that are not on this list. 

• Non-standard exclusions (Specific exclusions): These are specific exclusions that go beyond the standard permanent exclusions listed by the IRDAI. These specific exclusions are determined by the insurance company and can differ based on the policy’s terms and conditions. The specific exclusions under the ICICI Lombard Complete Health Insurance (Health Shield) Plan include - 

1. Costs related to prosthesis, corrective devices and external equipment of any type used for treatment, unless required due to accident.
2. Dental treatment except in cases required due to an accident.
3. Expenses associated with acupressure, acupuncture, magnetic and other similar therapies.
4. Circumcision unless required for treating a disease or injury
5. Treatment expenses for venereal or any sexually transmitted diseases.
6. Treatment expenses for external birth defects or anomalies.
7. Domiciliary treatment, i.e., treatment taken at home.
8. Treatment associated with intentional self inflicted Injury or attempted suicide by any means.
9. Expenses related to screening, treatment, or surgery to remove an organ from a donor.
10. Expenses related to any illness or injury resulting from war, invasion, act of foreign enemy, military, government/public authority orders, etc.
11. Expenses related to any illness or injury resulting 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 a record of settling claims quickly and efficiently. It has settled 99.78% of claims in less than 30 days.  
• Claim-related complaints: As per 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 measures an insurer’s financial performance and 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: This denotes the ratio of claims successfully settled by the insurance company to the total number of claims they received in a financial year. ICICI Lombard General Insurance Company Limited holds a claim settlement ratio of 80.97%. 
• Network hospitals: With a network of over 9,500+ hospitals, ICICI Lombard General Insurance Company Limited enables you to receive cashless treatments from a wide range of healthcare providers across various locations.

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

• Policy purchase-related complaints: Based on our research, ICICI Lombard General Insurance Company Limited has received 0.01% of complaints related to its after-sales service, which is significantly higher than other insurance companies. 
• 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: As per 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, headquartered in Mumbai, Maharashtra, is a general insurance company in India. Established in 2001, it is a collaborative venture between ICICI Bank Limited, a renowned bank, and Fairfax Financial Holdings Limited, a prominent financial holdings company. It provides an extensive array of insurance products, encompassing motor insurance, health insurance, personal accident insurance, crop insurance, fire insurance, marine insurance, and more. Mr. Bhargav Dasgupta is the company's CEO and MD.