ICICI Lombard Elevate

ICICI Lombard Elevate Policy is a health insurance policy offered by ICICI Lombard General Insurance Company Limited.

Are you looking for a health insurance plan that won’t drain your savings but still offers robust coverage? Look no further than the ICICI Lombard Elevate Policy. This policy masterfully balances affordability with an impressive set of features and benefits, making it a standout choice for savvy consumers.

Why is the ICICI Lombard Elevate Policy a smart pick? It’s cost-effective compared to other options on the market and covers a wide range of expenses. From consumables and bariatric surgery to maternity, OPD, and hospitalisation-related expenses, this policy has got you covered. But that’s not all. The Elevate Policy offers flexibility with the option to reduce the pre-existing disease (PED) waiting period to just two years or even one year and the specific disease waiting period to 1 year.

On the downside, keep in mind that this plan does not allow for monthly premium payments. However, our research shows that while ICICI Lombard has fewer complaints about claim settlements, there is a higher number of complaints related to policy purchases.

What are the benefits offered by the ICICI Lombard Elevate policy?

• Inpatient hospitalisation coverage: With the ICICI Lombard Elevate Policy, you get comprehensive financial support for inpatient hospital expenses incurred during hospital stays that last more than 24 hours. Here's what you can expect: it takes care of all the essential expenses, from room charges and nursing care to prescribed medications and medical practitioner fees. And that's not all - ICU expenses and any other related costs are also covered. However, for inpatient or day care treatments, the cost of an automation machine for peritoneal dialysis will not be covered.
• Pre-hospitalisation coverage: Before you are admitted to the hospital, you might face various medical expenses like consultations, tests, check-ups, and lab reports. These costs are known as pre-hospitalisation expenses. The ICICI Lombard Elevate Policy covers all these expenses as long as they are connected to the condition requiring your hospital stay. To get reimbursed, your claim will need to be approved under your inpatient hospitalisation coverage. Here’s a standout feature - with this policy, you are covered for pre-hospitalisation expenses for up to 90 days before your hospital admission, all the way up to the sum insured. So, you can be sure that the ICICI Lombard Elevate Policy has you well-protected from the very start of your medical journey.
• Post-hospitalisation coverage: When you leave the hospital, your journey to recovery often continues with additional medical expenses. These post-hospitalisation expenses can include follow-up consultations, medical check-ups, rehabilitation sessions, physiotherapy, and more. Remember that these expenses will be covered if they are considered medically necessary and have been prescribed in writing by a doctor. The ICICI Lombard Elevate Policy supports you through this stage by covering these costs as long as they relate to the condition that led to your hospital stay. To ensure coverage, your claims will need to be approved under your inpatient hospitalisation benefits. With this policy, you are covered for post-hospitalisation expenses for up to 180 days after your hospital admission, up to the sum insured. 
• Daycare treatment coverage: With the incredible advancements in medicine, many procedures and surgeries that once needed long hospital stays can now be completed in just a day. With the ICICI Lombard Elevate Policy, you don’t have to worry about limits on these treatments. The policy covers only 150 daycare procedures up to the total sum insured. This means you receive the care you need without any extra stress about coverage limits. Under the plan, the coverage includes any day care procedure that requires a period of specialised observation or care afterwards.
• Domiciliary treatment coverage: Sometimes, a medical condition demands immediate attention, but if a hospital stay isn’t feasible, such treatments can be administered at home. This can either be due to the severity of the patient’s condition or a lack of available hospital beds. The ICICI Lombard Elevate Policy does not cover up to 15 domiciliary treatments. This coverage extends up to the total sum insured, ensuring you receive necessary care right at home when you need it most. However, remember that the costs associated with nursing care at home are not included in pre- and post-hospitalization expenses.
• Organ donor coverage: If you are receiving an organ transplant, the ICICI Lombard Elevate Policy has you covered in more ways than one. Not only does it take care of your own inpatient expenses, but it also covers the expenses of the organ donor. This coverage extends up to the total sum insured. Remember that the policy does not cover pre- and post-hospitalization expenses for the organ donor. Also, expenses related to complications that require a redo surgery or ICU admission for the organ donor are not covered.
• Modern treatment coverage: Today’s healthcare landscape is filled with incredible advancements and offers solutions that were once thought impossible. Treatments like radio surgeries and stem cell therapies now bring hope and potential cures for conditions that were previously untreatable. The ICICI Lombard Elevate Policy embraces these innovations, providing coverage for such modern treatments without any limitations. 
• Non-medical expenses coverage: During treatment, you might encounter costs for items like nebulisation kits, gloves, oxygen masks, and other essential consumables. These non-medical expenses are necessary for your care but aren’t always covered by standard policies. With the ICICI Lombard Elevate Policy, you don’t have to worry about these extra costs. The policy includes coverage for non-medical expenses as an add-on. One special condition you should know is that post-hospitalization physiotherapy costs will be covered if your doctor considers it medically necessary and provides a written recommendation.
• No claim bonus: The No Claim Bonus feature is a reward for staying healthy and not filing any claims during the policy year. With the ICICI Lombard Elevate Policy, you can enjoy this bonus with a potential maximum of 100%. Here’s how it works - if you don’t make any claims in a given year, you earn a 20% no claim bonus. What is even better is that if you do end up making a claim, you won’t lose the bonuses you have already accumulated. 
• Super no claim bonus: The Super No Claim Bonus is a step up from the standard No Claim Bonus. With the ICICI Lombard Elevate Policy, this feature takes your rewards to the next level. Here’s how it works - if you avoid making any claims in a year, you earn a 100% Super No Claim Bonus as an add-on. The best part? There is no cap on how much bonus you can accumulate. Even if you do make a claim, you keep all the bonuses you have accumulated. It is a fantastic way to get even more value from your policy!
• Restoration benefit: The restoration benefit is a standout feature of the ICICI Lombard Elevate Policy. This benefit kicks in when you have used up your sum insured during the policy year. It is like having a backup plan that refreshes your coverage, and you can use it unlimited times each year. Once you make a claim and the sum insured gets partially exhausted, the restoration benefit automatically replenishes your coverage. You can even utilise this benefit from the very first paid claim. It applies to related and unrelated illnesses. 

Please note that the limits and conditions mentioned in the above benefits and features are for a sum insured of Rs. 10 Lakhs.

ICICI Lombard Elevate policy: Financial Limits

• Room rent limit: The room rent limit represents the most your insurer will cover for your hospital room. Staying within this limit means you avoid any extra expenses. However, if you opt for a room that exceeds this limit, you will encounter a proportionate deduction. This means you will be responsible for a share of the entire bill, not just the difference in room cost. Fortunately, if you have the ICICI Lombard Elevate policy, you are in luck. This policy offers the benefit of no room rent limit as an add-on, giving you greater flexibility and peace of mind during your stay.
• ICU rent limit: When you find yourself needing to stay in the ICU, understanding the ICU rent limit becomes essential. This limit defines how much your health insurance policy will cover for your ICU stay. With the ICICI Lombard Elevate policy, you get a significant advantage: there is no ICU rent limit. This means that the insurer will cover the entire cost of your ICU stay as long as it falls within the total sum insured. 
• Copayment: This is the portion of an approved claim amount that you’re responsible for while the insurer takes care of the remaining costs. It’s a common feature in many policies. However, the ICICI Lombard Elevate policy includes an optional copayment of 10%, 20%, 30%, 40%, or 50%. 
• Deductible: It is the amount you must pay out of your own pocket before your policy starts covering your medical expenses. The good news with the ICICI Lombard Elevate policy is that you don't have to worry about this. There is no deductible, so you can jump straight to coverage without any upfront costs.
• Limits on surgeries/treatments: When it comes to medical procedures and treatments, some policies set limits on how much they will pay. These limits can vary from one procedure to another, potentially leaving you with extra costs. But with the ICICI Lombard Elevate policy, you get a clear advantage. There is no cap on the coverage for cataract treatments and joint replacement surgeries. The insurer covers these procedures up to the full sum insured, so you can focus on your recovery without worrying about additional expenses.

Please note that the above-mentioned financial limits are considered for a 30-year-old individual opting for a sum insured of Rs. 10 Lakhs.

ICICI Lombard Elevate policy: Waiting Periods & Exclusions

👉Waiting Period

Some diseases and illnesses may not be covered for a specific duration after you purchase health insurance. This is called the waiting period. Any claim can be submitted for coverage only after the waiting period ends. Here are some of the primarily known types of waiting periods –

• Initial waiting period: The ICICI Lombard Elevate policy has an initial waiting period of 30 days for every medical condition, except in the case of accidents. This means that you cannot claim for any hospitalisation unless it is due to an accident.
• Waiting period for pre-existing diseases: If you have a medical condition or illness that you have dealt with in the 36 months before applying for health insurance, that is considered a pre-existing disease. With the ICICI Lombard Elevate policy, there is a 12-month waiting period for such conditions when you opt for an add-on. This means that for the first 12 months (as an add-on), you won't be able to file claims related to pre-existing diseases. After this period, you will be fully covered, allowing you to focus on getting the care you need.
• Waiting period for specific diseases: Insurance policies often include waiting periods for specific diseases beyond just pre-existing conditions. These waiting periods are set by the insurance provider and are not influenced by your current health. With the ICICI Lombard Elevate policy, you will have a 12-month waiting period (as an add-on) for certain conditions. However, there is a shorter, 90-day waiting period for hypertension, diabetes, and cardiac conditions, unless they’re pre-existing. 

👉Exclusions

There are certain situations that your insurer will not cover at any cost, which are referred to as exclusions. These include –

• Standard permanent exclusions: It is essential to understand the standard permanent exclusions set by the Insurance Regulatory and Development Authority of India (IRDAI). These exclusions outline what your policy won’t cover. Here’s a closer look -
  • Hospitalisation for Monitoring: If you are admitted merely for observation or evaluation, this won’t be covered. 
  • Rest Cure and Rehabilitation: Any stay at a facility for bed rest where no active medical treatment is provided falls outside of coverage.
  • Obesity and Weight Control: Treatments or surgeries aimed at controlling weight or addressing obesity are excluded.
  • Change of Gender Treatment: Procedures intended to change your gender characteristics are not covered.
  • Plastic and Cosmetic Surgery: Any surgeries or medical procedures performed to alter your appearance or body characteristics are not included.
  • Hazardous or Adventure Sports: Medical costs related to professional participation in risky activities like skydiving, river rafting, scuba diving, or horse racing are excluded.
  • Breach of Law: Expenses for treating injuries or conditions resulting from criminal activities or attempts are not covered.
  • Excluded Providers: Treatments from hospitals or practitioners that are excluded by your insurance company won’t be reimbursed.
  • Narcotics: Treatments for addiction, including those for alcohol or drug abuse, are not covered.
  • Domestic-Use Establishments: Expenses related to treatments at health spas, nursing homes, or similar facilities meant for domestic use are excluded.
  • Over-the-counter Supplements: Vitamins, minerals, and other dietary supplements bought without a prescription are not covered.
  • Refractive Errors: Expenses for correcting refractive errors up to 7.5 diopters to improve eyesight are not included.
  • Unproven Treatments: Medical procedures or treatments not proven effective are excluded from coverage.
  • Birth Control and Infertility Treatments: Costs related to contraception, artificial insemination, sterilisation, and advanced reproductive technologies like ICSI, IVF, ZIFT, GIFT, and gestational surrogacy are not covered.
  • Maternity Expenses: Pre and post-natal costs, as well as expenses related to childbirth, are excluded from coverage.
• Additional permanent exclusions: Apart from standard permanent exclusions set by the IRDAI, insurance companies may also have their own list of additional exclusions. These are specific to certain medical conditions or situations that the insurer deems too risky to cover. If a particular disease or condition is considered too high-risk, the policy might exclude it permanently. However, it is important to know that insurers can only apply these exclusions to a pre-approved list of illnesses defined by the IRDAI. They cannot exclude any disease or condition beyond this established list. 
• Non-standard exclusions (Specific exclusions): These are basically specific exclusions that extend beyond the standard permanent exclusions set out by the IRDAI and can differ from one insurer to another. These are some of the specific exclusions under the ICICI Lombard Elevate policy –

1. War and Related Activities: Injuries or diseases resulting from war, invasion, acts by foreign enemies, or warlike operations are not covered.
2. Nuclear and Chemical Attacks: Coverage doesn’t extend to injuries or illnesses caused by nuclear, chemical, or biological attacks.
3. Prosthetics and Medical Equipment: Costs for prosthetics, corrective devices, external durable medical equipment like wheelchairs or crutches, sleep apnea treatment instruments, or cochlear implants are not covered unless they’re needed due to an accident or during surgery.
4. Dental Treatments: Expenses for treatment related to natural teeth and gums are excluded, except if the treatment is required while hospitalised due to an accident.
5. Alternative Therapies: Treatments like acupressure, acupuncture, and magnetic therapies are not covered.
6. Circumcision: The policy excludes circumcision unless it's necessary to treat a disease or injury.
7. Sexually Transmitted Diseases: Costs related to venereal and sexually transmitted diseases, other than HIV, are not covered.
8. External Birth Defects: The policy does not cover expenses related to screening, counselling, or treatment of external birth defects.
9. Self-Inflicted Injuries: The policy excludes treatment for intentional self-inflicted injuries or attempted suicide by any means.

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

• Speed of claims: The ICICI Lombard General Insurance Company Limited boasts an impressive record, having settled 99.78% of claims in under 30 days. This efficiency means you are likely to experience a smooth and swift claim process without the hassle of delays.
• Claim-related complaints: Our research reveals that ICICI Lombard General Insurance Company Limited has  0.11% of claims that experience issues. This means that they still have to work towards their commitment to customer satisfaction and efficient claim handling.
• Claims incurred ratio: The claims incurred ratio is a key indicator of an insurance provider’s financial health. It compares the total claims the insurer has paid out to the total premiums collected over a financial year. For ICICI Lombard General Insurance Company Limited, this ratio stands at 78.85%. 
• Claim settlement ratio: This ratio is a vital metric that shows how well an insurer handles claims. For ICICI Lombard General Insurance Company Limited, this ratio is 80.97%. This percentage reflects the proportion of claims they have settled out of all the claims received in a financial year.
• Network hospitals: ICICI Lombard General Insurance Company Limited boasts an extensive network of over 9,500+ hospitals. This broad network guarantees that customers have access to a huge range of healthcare providers across many locations. With this extensive coverage, you can enjoy the convenience of cashless treatment, free from financial worries.

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 their after-sales service, compared to other insurers, accounting for 0.01%.
• Response on toll-free: In our research, we observed that the service response on ICICI Lombard General Insurance Company Limited's 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.

About ICICI Lombard General Insurance Company Limited

ICICI Lombard General Insurance Company Limited is actually a joint venture between Fairfax Financial Holdings Limited and ICICI Bank Limited. It brings a wealth of insurance options to the table. Established in 2001 and headquartered in Mumbai, Maharashtra, this private general insurance company offers a diverse range of products. From motor and health insurance to personal accident, crop, fire, and marine insurance, they cover a broad spectrum of needs. Under the leadership of CEO and MD Mr. Bhargav Dasgupta, ICICI Lombard continues to provide comprehensive and reliable insurance solutions.