ICICI Lombard Complete Health Insurance (iHealth) is a health insurance policy offered by ICICI Lombard General Insurance Company Limited. It provides comprehensive coverage and is fairly priced than other products. It also covers maternity expenses and outpatient expenses, such as medicines, tests, and consultations, in addition to hospitalisation and related expenses. It is important to note, however, that this plan does not allow monthly premium payments. Our research also found that the insurer has received higher complaints regarding policy purchase and lower number of claim settlement complaints. This suggests that the insurer is reliable and provides good customer service.
What are the benefits offered by the ICICI Lombard Complete Health Insurance (iHealth) Plan?
- Inpatient hospitalisation coverage: The expenses you incur when you are admitted to a hospital for more than 24 hours are called inpatient hospitalisation expenses. Some of these expenses include room and boarding expenses, medical practitioner fees, prescription medicine costs, ICU charges, etc. ICICI Lombard Complete Health Insurance (iHealth) Plan covers these inpatient hospitalisation expenses.
- Pre-hospitalisation coverage: Expenses you incur before getting hospitalised are called pre-hospitalisation expenses. These include costs associated with consultations, tests, checkups, lab reports, etc. Your insurer will cover these expenses only if they are related to the medical condition for which you are later hospitalised and the claim is approved under inpatient hospitalisation. Pre-hospitalisation expenses incurred up to 30 days before hospitalisation are covered by the ICICI Lombard Complete Health Insurance (iHealth) Plan - up to the sum insured.
- Post-hospitalisation coverage: Post-hospitalisation expenses are expenses you incur after being discharged from the hospital. These include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more. The policy will provide coverage for such expenses only if they are related to the condition you were hospitalised for and your claim is approved under inpatient hospitalisation. The ICICI Lombard Complete Health Insurance Plan (iHealth) covers post-hospitalisation expenses for up to 60 days post-hospitalisation - up to the sum insured.
- Daycare treatment coverage: Daycare treatments are those that used to require prolonged hospital stays, but technology has made it possible to complete them in less than 24 hours. These treatments make it possible for patients to receive efficient care without having to put their lives on hold. A total of 150 daycare procedures are covered by the ICICI Lombard Complete Health Insurance (iHealth) Plan. It does not place a cap on daycare treatments, so they will be covered up to the sum insured.
- Domiciliary treatment coverage: Medical treatments can be administered at home if you are unable to be moved to the hospital due to the severity of an injury or illness or if there are no hospital beds available in nearby hospitals. This is called domiciliary hospitalisation. ICICI Lombard Complete Health Insurance (iHealth) does not cover such expenses.
- Organ donor coverage: ICICI Lombard Complete Health Insurance (iHealth) offers organ donor coverage as an add-on. You can include this cover in your base plan at a certain extra cost. This add-on covers organ harvesting expenses up to Rs 50,000 - when the insured is the recipient.
- Modern treatment coverage: Technological revolutions in healthcare have created modern treatments once thought to be impossible. Today, these treatments are widely available to many, making healthcare more accessible than ever before. Ailments once considered incurable can now be cured with the help of such treatments like stem cell therapy, robotic surgeries, etc. ICICI Lombard Complete Health Insurance (iHealth) covers modern treatments up to the sum insured.
- Non-medical expenses coverage: Consumables such as gloves, bandages, oxygen masks, syringes, and other items used during treatments fall under non-medical expenses. Such non-medical expenses are not covered by the ICICI Lombard Complete Health Insurance (iHealth) Plan.
- No Claim Bonus: A No-Claim Bonus is a reward provided by an insurance company if you do not make a claim during the policy period. The ICICI Lombard Complete Health Insurance (iHealth) Plan provides a no claim bonus of 10% of the sum insured if you do not make any claims during the previous policy year - up to a maximum of 50% of the base sum insured. However, if you have made a claim during a previous policy period, the accumulated bonus amount will be reduced on renewal.
- Super No Claim Bonus: This is a modified version of the No Claim Bonus. ICICI Lombard Complete Health Insurance (iHealth) Plan does not offer a Super No Claim Bonus.
- Restoration Benefit: A Restoration Benefit reinstates your sum insured if it is used up within the policy year. It ensures continuous protection against unplanned medical expenses all year long, eliminating the need to purchase additional coverage. Under the ICICI Lombard Complete Health Insurance (iHealth) Plan, refill benefits can be used for unrelated illnesses. The restoration benefit will be triggered when the sum insured and any No Claim Bonus have been partially or fully exhausted. You will only be able to receive a refill once per policy year and it will only be valid for subsequent claims.
Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured.
ICICI Lombard Complete Health Insurance (iHealth): Financial Limits
- Room rent limit: The room rent limit is a crucial factor to consider when choosing a health insurance plan. It is the maximum amount that the insurance company will cover for the room you are hospitalised in. If you select a room that is within the room rent limit of your plan, you won’t face any additional costs. There will, however, be a proportionate deduction if you pick a room with a higher rent than your eligibility. So, you will be required to pay a proportionate share of the total bill rather than just the difference in room rent. With the ICICI Lombard Complete Health Insurance Plan, you have all the freedom to choose any type of room you want.
- ICU rent limit: It is the maximum amount that the health insurance policy will pay for your stay in the intensive care unit (ICU) of a hospital. And, the good news is that there is no ICU rent limit in the ICICI Lombard Complete Health Insurance Plan. So, the costs related to ICU stay are covered up to the sum insured.
- Copayment: A copayment is a certain percentage of the claim amount that you must pay out of your own pocket and the insurer will step in to take care of the rest during a claim. ICICI Lombard Complete Health Insurance (iHealth) Plan does not have a copayment limit.
- Deductible: A deductible is the amount you must pay before your health insurer steps in to pay for medical expenses. The ICICI Lombard Complete Health Insurance (iHealth) Plan does not have a deductible limit.
- Limits on surgeries/treatments: It refers to the maximum amount your health insurance policy will cover for a medical procedure or treatment. Some policies may have specific limits on the amount they will cover for certain procedures, while others may not. In case the expenses go beyond this limit, the difference will be your responsibility. Under the ICICI Lombard Complete Health Insurance (iHealth) Plan, important surgeries and treatments are covered, including cataract treatment up to Rs 1 lakh per eye per policy year and joint replacement surgery 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 (iHealth): Waiting Periods & Exclusions
👉Waiting period: Health insurance may not cover certain illnesses and diseases for a certain period of time. This is known as the waiting period. Medical expenses associated with those conditions can be claimed only after the waiting period gets over. Here are some of the types of waiting periods -
- Initial waiting period: There is a 30-day waiting period for all medical conditions except accidents. This means if you are hospitalised for any reason other than an accident, you will not be able to file a claim during the first 30 days of coverage
- Waiting period for pre-existing diseases: A pre-existing disease is any medical condition or illness that you have had in the 48 months before issuance of the health insurance policy. Under ICICI Lombard Complete Health Insurance (iHealth), pre-existing diseases are subject to a 24-month waiting period. There will be no coverage for such diseases during this time frame.
- Waiting period for specific diseases: Some insurers have waiting periods for certain illnesses and conditions, other than pre-existing conditions, regardless of whether you have had them before. Your insurer will determine this waiting period and this decision has no bearing on your current health. The ICICI Lombard Complete Health Insurance (iHealth) Plan has a 24-month waiting period for specific diseases.
👉Exclusions: Health insurance policies do not cover certain situations at any cost. These are called exclusions.
- Standard permanent exclusions: IRDAI defines a set of "standard permanent exclusions" that must be followed by all insurance companies. These standard permanent exclusions are non-negotiable and cannot be modified at any cost. Here are some of them -
- Investigation and evaluation: Admission to the hospital solely for observation monitoring.
- Obesity/weight control: Surgery for obesity or weight loss.
- Change of gender treatment: Treatments to alter the body's characteristics to match the opposite gender.
- Plastic/cosmetic surgery: Surgery or treatment to alter the appearance or characteristics of the body.
- Rest cure, rehabilitation, and respite care: Admission to a bed rest facility without any active treatment.
- Profession in hazardous or adventure sports: Medical expenses incurred while participating in risky activities like paragliding, snorkelling, scuba diving, bungee jumping, etc.
- Narcotics: Treatments for alcohol addiction, drug use, etc.
- Treatments in establishments arranged for domestic purposes: Treatment received in health spas, nursing homes, or similar establishments intended solely or partially for domestic use.
- Refractive error: Correction of refractive errors of up to 7.5 diopters for better vision.
- Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
- Breach of law: Costs associated with treating a person who attempts or commits a breach of law with criminal intent.
- Unproven treatments: A surgical or medical procedure that hasn't been proven effective.
- Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Excluded providers: Treatment administered by a medical practitioner or hospital excluded by the insurance company.
- Substances purchased without prescription: Vitamin supplements, minerals, etc., which are not prescribed by a physician.
- Additional permanent exclusions: Besides the above-mentioned list, certain illnesses or situations may also be excluded from coverage depending on the particular situation or medical condition. Insurers may also exclude coverage for certain conditions or diseases that they consider risky. Insurers, however, are only permitted to apply permanent exclusions to a set of illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI). They cannot deny coverage for illnesses and diseases beyond this list.
- Non-standard exclusions (Specific exclusions): These are specific exclusions other than the standard permanent exclusions specified by the IRDAI. These exclusions may vary across insurers depending on the policy's terms and conditions. Here are some of the top specific exclusions under the ICICI Lombard Complete Health Insurance (iHealth) Plan -
- External equipment or prosthetics used in diagnosis or treatment, unless the need arises as a result of an accident.
- Treatments for dental problems other than those caused by accidents.
- Circumcisions unless they are deemed necessary for treating a disease or injury.
- Treatments related to external birth defects or anomalies.
- Domiciliary treatments, i.e., medical treatment administered at home
- Treatments for self-inflicted injuries or attempted suicide by any means.
- Costs associated with screening, treatment, or surgery to remove an organ from a donor.
- An injury or illness caused directly or indirectly by terrorism, nuclear emissions, war, or civil war.
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 has settled 99.66% of claims in less than 30 days. This indicates that you can expect a speedy resolution to your insurance claims, providing you with the assurance that you need.
- Claim-related complaints: According to our research, ICICI Lombard General Insurance Company receives few claims-related complaints. This suggests that their customer service department is well-equipped to handle any queries or concerns you may have regarding insurance claims.
- Claims incurred ratio: This ratio provides insight into an insurance company's financial performance. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. ICICI Lombard General Insurance Company has a claims incurred ratio of 77.32%.
- Claim settlement ratio: The claim settlement ratio is the percentage of claims settled by an insurer compared to the total number of claims received in a given financial year. ICICI Lombard General Insurance Company has a claim settlement ratio of 85.44%. This low claim settlement ratio is concerning, as it suggests that the insurer may not be able to fulfil their obligations.
- Network hospitals: ICICI Lombard General Insurance Company has over 7,500+ hospitals in its network. With such an expansive network of healthcare providers, it allows you to make informed decisions and get quality healthcare services without worrying about any financial burden.
How is the customer service of ICICI Lombard General Insurance Company Limited?
- Policy purchase-related complaints: ICICI Lombard General Insurance Company received a higher number of complaints related to after-sales service.
- Response on Toll-Free: ICICI Lombard General Insurance Company's response on their toll-free number was average when compared to other insurers.
- Response on Twitter: Based on our research, ICICI Lombard General Insurance Company responds quickly on Twitter. This is an indication that it values customers' feedback and their time.
About ICICI Lombard General Insurance Company Limited
ICICI Lombard General Insurance Company Limited is a joint venture between ICICI Bank Limited and Fairfax Financial Holdings Limited. It offers a wide range of insurance products, such as motor insurance, health insurance, personal accident insurance, crop insurance, fire insurance, marine insurance, etc. Founded in 2001, it has its headquarters in Mumbai, Maharashtra. The CEO and MD of the company is Mr. Bhargav Dasgupta.