ICICI Lombard Health AdvantEdge

ICICI Lombard Health AdvantEdge is a health insurance policy offered by ICICI Lombard General Insurance Company Limited. 

If you're looking for cost-effective yet comprehensive health insurance coverage, this plan is a great option for you.It combines affordability with a diverse array of features and advantages, making it a perfect option. Not only does it offer a more budget-friendly solution, but it also provides coverage for a range of expenses such as consumables, bariatric surgery, maternity costs, OPD expenses, and hospitalisation-related expenses.

One of the drawbacks you may encounter with this product is the inability to choose monthly premium payments. Additionally, our research indicates that while the insurer has received fewer complaints regarding claim settlements, there have been a higher number of complaints related to policy purchases.

What Are The Benefits Offered By ICICI Lombard Health AdvangeEdge?

• Inpatient hospitalisation coverage: Like other health insurance plans, the ICICI Lombard Health AdvantEdge plan provides coverage for expenses incurred during your hospital admission. This includes charges for your accommodation, nursing care, medical consultations, prescribed medications, intensive care unit expenses, and any other relevant costs.
• Pre-hospitalisation coverage: Incurring pre-hospitalisation charges is a possibility for you before getting admitted to the hospital. These charges typically include consultation fees, lab tests, checkups, and medical reports. It's crucial to remember that your insurer will only cover these expenses if they are directly linked to the medical condition that ultimately necessitates hospitalisation. To make sure you have the necessary coverage, it's essential that your claim is approved as part of your inpatient hospitalisation policy. Luckily, with the ICICI Lombard Health AdvantEdge plan, you can have peace of mind knowing that pre-hospitalisation expenses up to the sum insured are covered generously for a period of 60 days before your hospitalisation.
• Post-hospitalisation coverage: Once you have been discharged from the hospital, you may come across additional medical expenses referred to as post-hospitalisation costs. These expenses can encompass various aspects such as consultations with your doctor, medical check-ups, rehabilitation programs, physical therapy, and more. To ensure coverage for these expenses, it is essential that they are directly linked to your initial hospital stay and that your claim is approved under inpatient hospitalisation.The ICICI Lombard Health AdvantEdge plan ensures that you receive comprehensive coverage for post-hospitalisation expenses for up to 180 days after your hospital stay. With this plan, you can rest assured knowing that you will be well taken care of even after leaving the hospital, and the coverage extends up to the sum insured.
• Daycare treatment coverage: Daycare treatment, previously necessitating an extended hospital stay, can now be conveniently accomplished within a mere 24 hours, courtesy of remarkable advancements in medical technology. With the ICICI Lombard Health AdvantEdge plan, you can experience tranquillity, as all expenses associated with daycare procedures are fully covered up to the sum insured, without any restrictions.
• Domiciliary treatment coverage: When it comes to medical treatments for illnesses or injuries that need urgent care in a hospital but can be given at home due to the patient's severe illness or injury, or the unavailability of hospital beds nearby, we call it domiciliary treatments. With the ICICI Lombard Health AdvantEdge plan, all costs associated with domiciliary treatments are completely covered up to the sum insured. The cover is so extensive that even the costs of qualified nurses hired on the attending medical practitioner's recommendation are covered. However there are 17 treatments not covered under this plan. Please Note: When you hire qualified nurses on the recommendation of the attending medical practitioner, the costs are covered.
• Organ donor coverage: In the ICICI Lombard Health AdvantEdge plan, all organ donor expenses are fully covered up to the sum insured. This extensive coverage encompasses all costs associated with organ harvesting for transplantation surgery for the recipient. Under this plan, expenses for screening the organ donor and treating complications in a donor's surgery are also covered. Please Note: Any expenses incurred for treating complications during the donor's surgery are fully covered. Additionally, the screening expenses for the organ donor are also taken care of.
• Modern treatment coverage: As medical technology advances, groundbreaking treatments that were once unimaginable are now becoming a reality. Stem cell therapy, radio surgeries, and other modern treatments are pushing the boundaries of what was once considered incurable. The ICICI Lombard Health AdvantEdge plan is designed to specifically cover expenses associated with these cutting-edge treatments without any limit.
• Non-medical expenses coverage: Non-medical expenses encompass essential items such as gloves, nebulization kits, and oxygen masks. It's important to note that the ICICI Lombard Health AdvantEdge plan offers coverage for these non-medical expenses without any limit as an add-on benefit.
• No Claim Bonus: The No Claim Bonus is a valuable benefit provided by insurance companies as a token of appreciation when no claims are made throughout the policy period. With the ICICI Lombard Health AdvantEdge plan, you can enjoy a 20% No Claim Bonus based on the sum insured, up to a maximum of 100% of your sum insured. Even if you do make a claim during the policy period, the bonus will remain intact.
• Super No Claim Bonus: The Super No Claim Bonus is a faster variant of the regular No Claim Bonus and operates in a similar manner. However, it's important to note that the ICICI Lombard Health AdvantEdge plan does not offer this particular benefit.
• Restoration Benefit: Introducing the remarkable attribute of the ICICI Lombard Health AdvantEdge plan - The Restoration Benefit. This exceptional feature restores the sum insured after it has been utilised throughout the policy year, for both related and unrelated ailments including complications. The replenishment benefit becomes active when both the sum insured and the no claim bonus have been partially utilised. You can conveniently avail of this benefit once during a policy year, starting from subsequent claims.

ICICI Lombard Health AdvantEdge: Financial Limits

• Room rent limit: The room rent limit refers to the highest amount that your insurance provider will cover for the hospital room you occupy during your hospital stay. By adhering to this limit, you can avoid any additional expenses. However, if you opt for a room with a higher rent, a deduction will be applied proportionately. Essentially, this means that you will be accountable for paying a reasonable portion of the overall bill, rather than just covering the difference. Experience the freedom to choose any room type without any restrictions with the ICICI Lombard Health AdvantEdge plan.
• ICU rent limit: The ICICI Lombard Health AdvantEdge plan provides extensive coverage for ICU expenses, ensuring that there is no limit on the amount covered. With this plan, you can access high-quality medical care without any concerns about the financial burden it may bring.
• Copayment: A copayment, also known as a copay, is the amount you are required to pay out of pocket towards an approved claim. In the ICICI Lombard Health AdvantEdge plan, you won't have to worry about copayments. You won't have any such additional expenses as the insurer will cover all the remaining costs once you've made your payment.
• Deductible: A deductible is typically an amount you have to pay before your insurance coverage starts to cover the remaining costs. In the ICICI Lombard Health AdvantEdge plan, you won't have to worry about any deductibles.
• Limits on surgeries/treatments: Limits on surgeries and treatments pertain to the highest level of coverage offered by a health insurance policy for specific medical procedures or treatments. Certain plans may have restrictions on the amount they will reimburse for certain procedures, while others may not. The ICICI Lombard Health AdvantEdge plan provides extensive coverage for essential surgeries and treatments like cataract treatment and joint replacement surgery, up to the chosen 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 Health AdvantEdge : Waiting Periods & Exclusions

👉Waiting period

A waiting period is a designated period of time that occurs after the purchase of a health insurance policy. During this period, certain illnesses and medical conditions are not covered by the policy. These conditions can only be claimed once the waiting period has ended. The duration of the waiting period varies depending on the specific policy you choose. Here are some types of waiting periods for your reference:

• Initial waiting period: There is a mandatory waiting period of 30 days for all medical conditions, excluding accidents. Within this duration, you will not be able to submit a claim for hospitalisation, unless it is due to an accident.
• Waiting period for pre-existing diseases: A pre-existing condition pertains to any medical ailment or illness that you have encountered within the 36 months prior to obtaining a health insurance policy. In the ICICI Lombard Health AdvantEdge plan, there is a waiting period of 24 months for pre-existing conditions. Throughout this waiting period, you will not be able to make any claims for expenses related to your pre-existing disease.
• Waiting period for specific diseases: In addition to any pre-existing conditions, insurers also have a list of specific medical conditions or illnesses that may require waiting periods. These waiting periods apply whether or not you have previously experienced these diseases. It's important to note that the length of the waiting period is determined by the insurer and is not dependent on your current health status. The ICICI Lombard Health AdvantEdge plan has a waiting period of 24 months for certain diseases.

👉Exclusions

Health insurance policies do not offer coverage for certain medical conditions or situations, which are commonly known as exclusions. Let's have a look at some of these exclusions:

• Standard permanent exclusions: Insurance companies operating in India must adhere to a set of 'standard permanent exclusions' mandated by the Insurance Regulatory and Development Authority of India (IRDAI). These exclusions are as following -

1. Investigation and evaluation: Hospitalisation for monitoring or observation purposes alone.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for rest or respite where no active medical treatment is given.
3. Obesity/weight control: Any surgical or medical procedures intended for weight control or obesity.
4. Change of gender treatment: Medical treatment aimed at altering the body's characteristics to that of the opposite gender is excluded.
5. Plastic/cosmetic surgery: Surgical or medical procedures intended for modifying appearance or body characteristics.
6. Profession in hazardous or adventure sports: Any medical expenses incurred while participating as a professional in adventure activities such as mountaineering, river rafting, scuba diving, horse racing, etc.
7. Breach of law: Any expenses related to the treatment of a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged for domestic purposes: Treatment expenses incurred in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances purchased without prescription: Expenses on vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
12. Refractive error: Expenses associated with correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Costs related to pre/post-natal care, childbirth, and other hospitalisation expenses.

• Additional permanent exclusions: Furthermore, alongside the permanent exclusions stipulated by the IRDAI, insurance companies possess the authority to impose 'specific exclusions'. If an illness is deemed to be high-risk, insurers have the option to permanently exclude it from coverage. Nevertheless, it is worth noting that insurers are bound by the pre-approved list of illnesses established by the IRDAI for implementing permanent exclusions.
• Non-standard exclusions (Specific exclusions): These specific exclusions extend beyond the standard permanent exclusions specified by the IRDAI. It's important to note that these exclusions can vary among insurance companies and are subject to the terms and conditions of the policy. Here are a few examples of the specific exclusions mentioned in the ICICI Lombard Health AdvantEdge plan -

1. Injury or disease resulting from war, invasion, acts of foreign enemies, civil unrest, and associated events, such as capture and detainment.
2. Injury or illness caused by a nuclear, chemical, or biological attack or the use of weapons associated with these forms of warfare.

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 settled  99.78% of its claims within 30 days.  This assures you of a smooth and timely claim settlement experience. 
• Claim-related complaints: As per our research, we found that ICICI Lombard General Insurance Company Limited has a complaint rate of  0.11% for claims in comparison to other insurance providers. This indicates that their claim settlement process is average.
• Claims incurred ratio: The claims incurred ratio is a measure of an insurer's financial performance. It shows the total claims paid out in relation to the premiums received in a specific fiscal year. ICICI Lombard General Insurance Company Limited has a claims incurred ratio of 78.85%.
• Claim settlement ratio: ICICI Lombard General Insurance Company Limited 's claim settlement ratio stands at 80.97%. This figure reflects the proportion of total claims received to those successfully settled by the company in a specific fiscal year.
• Network hospitals: ICICI Lombard General Insurance Company Limited provides access to an extensive network of 9,500+ hospitals. This broad network allows customers to receive cashless treatment without any financial worry.

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 lower 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 is quick, as compared to other insurers. 
• Response on Twitter: As per our research, ICICI Lombard General Insurance Company Limited has an average response time on Twitter, as compared to others.

About ICICI Lombard General Insurance Company Limited 

ICICI Lombard General Insurance Company Limited is a collaborative effort between ICICI Bank Limited and Fairfax Financial Holdings Limited. This private general insurance company provides a comprehensive selection of insurance products, including motor insurance, health insurance, personal accident insurance, crop insurance, fire insurance, marine insurance, and more. Established in 2001, the company is based in Mumbai, Maharashtra, with Mr. Bhargav Dasgupta serving as its CEO and MD.