ICICI Lombard MaxProtect (Premium)

ICICI Lombard MaxProtect (Premium) is a health insurance policy provided by the ICICI Lombard General Insurance Company Limited. 

This plan comes with a wide range of features and benefits, such as coverage for global treatment, consumables, weight loss, and more. It also covers hospitalisation and related expenses. One of the standout features is the hassle-free claim settlement, allowing you to enjoy cashless facility at any medical facility in India. However, it's worth noting that this plan does not offer the flexibility to pay premiums on a monthly basis.

Based on our research, it seems that the insurer has a lower number of complaints regarding claim settlements, indicating their strong track record in claims service. However, they have received a higher number of complaints related to policy purchases, suggesting that their purchase experience may not be up to par.

What are the benefits offered by the ICICI Lombard MaxProtect (Premium) Plan? 

• Inpatient hospitalisation coverage: The ICICI Lombard MaxProtect (Premium) plan provides coverage for hospitalisation costs. This covers everything from admission expenses lasting more than 24 hours to nursing care, medical consultations, prescription medications, ICU charges, and other related expenses. However there is a hidden condition, if you need to be admitted to the hospital for inpatient treatment please note that any expenses related to an automation machine for peritoneal dialysis will not be covered.
• Pre-hospitalisation coverage: Pre-hospitalisation expenses are the costs you incur before being admitted to the hospital, including consultations, tests, and check-ups. In order to be eligible for coverage, these expenses must be related to the medical condition that ultimately leads to your hospitalisation. They also need to be approved as part of your inpatient hospitalisation coverage. With the ICICI Lombard MaxProtect (Premium) plan, you can breathe easy knowing that pre-hospitalisation expenses are covered for up to 60 days before your hospitalisation, with coverage extending up to the sum insured. However please note, that nursing care expenses at home are unfortunately not included in the coverage for pre-hospitalisation costs.
• Post-hospitalisation coverage: Post-hospitalisation expenses refer to the medical costs that come up after you are discharged from the hospital. These may include follow-up consultations, medical check-ups, rehabilitation sessions, physiotherapy, and other similar expenses. To qualify for coverage, these expenses must be related to the medical condition that led to the hospitalisation and be approved under the inpatient hospitalisation coverage. The ICICI Lombard MaxProtect (Premium) plan has got you covered when it comes to post-hospitalisation expenses. You can avail of coverage for up to 180 days after being discharged from the hospital, and the coverage extends up to the sum insured. However please note, nursing care expenses at home are unfortunately not included in the coverage for post-hospitalisation costs.
• Daycare treatment coverage: These medical procedures or surgeries used to require a lengthy hospital stay, but thanks to impressive advancements in medical technology, they can now be completed within 24 hours. With the ICICI Lombard MaxProtect (Premium) plan, you'll have comprehensive coverage for all daycare treatments without any restrictions. This means that all the costs associated with these procedures will be covered up to the sum insured. Please note, that any costs related to the purchase of an automation machine for peritoneal dialysis will not be covered under the daycare treatment expenses.
• Domiciliary treatment coverage: Domiciliary treatments are medical interventions for illnesses or injuries that need urgent attention at a hospital. However, these treatments are provided at home instead, either because your medical condition is quite serious or because there are no hospital beds available nearby. The ICICI Lombard MaxProtect (Premium) plan covers all domiciliary treatments (except for 13 specified illnesses) up to the sum insured. 
• Organ donor coverage: If you ever find yourself in need of organ transplantation as the recipient, the ICICI Lombard MaxProtect (Premium) plan has got you covered. They offer coverage for the inpatient hospitalisation expenses up to the sum insured. However, it's important to note that the plan does not cover the donor's pre and post-hospitalisation expenses.
• Modern treatment coverage:  As healthcare continues to progress rapidly, innovative treatments like stem cell therapy and robotic surgery are transforming how we approach previously untreatable diseases. With the ICICI Lombard MaxProtect (Premium) plan, you can rest assured knowing that you'll have comprehensive coverage for the costs of these advanced treatments, up to the sum insured with the maximum limit of 1CR.
• Non-medical expenses coverage: In addition to covering medical expenses, the ICICI Lombard MaxProtect (Premium) plan also includes coverage for non-medical expenses. This means that items such as gloves, oxygen masks, nebulization kits, and other essential supplies are covered under this plan. The coverage for these non-medical expenses is available without any limit.
• No Claim Bonus: Health insurance companies offer a perk called the No Claim Bonus. Basically, if you don't make any claims in a year, they'll reward you with a bonus for being healthy. The ICICI Lombard MaxProtect (Premium) plan gives you a No Claim Bonus worth 20% of the sum insured with a maximum limit of 100%. Even if you make a claim in the policy year, rest assured the bonus amount will remain intact. Please be aware that the accumulated bonus cannot be used for claims made outside of India.
• Super No Claim Bonus: The Super No Claim Bonus is an enhanced version of the No Claim Bonus that works in a similar way. However, the ICICI Lombard MaxProtect (Premium) plan does not offer this feature.
• Restoration benefit: The restoration benefit is a nifty feature that tops up your sum insured after it's been used up during the policy year. With the ICICI Lombard MaxProtect (Premium) plan, you can take advantage of this benefit for unrelated illnesses. It is also available for related illnesses & related complications after a waiting period of 45 days. This handy feature kicks in once both your sum insured and no claim bonus have been partially utilised. You can enjoy this benefit multiple times within a policy year, starting from the subsequent claims you make. Please note that the Restoration Benefit can only be availed for a related illness if hospitalisation takes place within 45 days after a claim has been settled for the same insured person in the current 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 MaxProtect (Premium) Plan: Financial Limits

• Room rent limit: The room rent limit is the maximum amount that your health insurance policy will cover for your hospital room. If you choose a room that falls within this limit, you won't have to pay any additional costs. However, if the room you select exceeds this limit, a proportionate deduction will be applied. As a result, you'll be responsible for paying a share of the total bill that corresponds to the difference in room rent. With the ICICI Lombard MaxProtect (Premium) plan, you have the freedom to choose any room type except suite room without any pesky restrictions
• ICU rent limit: The maximum amount covered by your health insurance policy for your stay in the ICU at the hospital is known as the ICU rent limit. With the ICICI Lombard MaxProtect (Premium) plan, there is no limit on coverage for ICU rent. This means that the plan covers the full cost up to the sum insured, providing extensive coverage for all ICU expenses.
• Copayment:  A copayment is when you have to pay a certain percentage of the claim amount out of your own pocket. Once you've covered this co-payment, the insurer will handle the rest of the expenses. It's important to mention that the ICICI Lombard MaxProtect (Premium) plan doesn't have any co-payment requirements.
• Deductible: A deductible is basically the amount you have to pay out of your own pocket before your insurance kicks in and covers your medical costs. The ICICI Lombard MaxProtect (Premium) plan doesn't come with any deductible. That means you don't have to worry about shelling out any money upfront before your coverage kicks in. 
• Limits on surgeries/treatments: It represents the highest amount that a health insurance policy will pay for specific medical procedures or treatments. Some insurance companies may have limitations on coverage for certain procedures, while others may not have any restrictions. With the ICICI Lombard MaxProtect (Premium) plan, important surgeries/procedures like cataract treatments and joint replacement surgeries are covered up to the total sum insured amount.

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 MaxProtect (Premium) Plan: Waiting Periods & Exclusions

👉Waiting period

After you buy a health insurance policy, there may be a waiting period before certain illnesses and conditions are covered. This means that for a specific duration, known as the waiting period, these conditions may not be eligible for claims. However, once this waiting period is over, you can start claiming for these specific conditions. Here are some types of waiting periods to be aware of:

• Initial waiting period: After purchasing the policy, there is a 30-day waiting period for all medical conditions, except accidents. This means that during this time, you won't be able to make a claim for hospitalisation unless it's due to an accident.
• Waiting period for pre-existing diseases: A pre-existing disease refers to a medical condition or illness that you have had in the past 36 months before getting a health insurance policy. In the ICICI Lombard MaxProtect (Premium) plan, you’ve the flexibility to reduce the applicable PED waiting period to 24 months by paying an extra premium. During this time, you won't be able to make claims for medical expenses related to your pre-existing conditions. 
• Waiting period for specific diseases: In addition to any pre-existing conditions you may have, insurance providers can also impose a waiting period for specific medical conditions or illnesses. It doesn't matter if you've had these diseases before or not, the insurer decides how long this waiting period will be, and it's not based on your current health. The ICICI Lombard MaxProtect (Premium) plan has a waiting period of 24 months for specific diseases.

👉Exclusions
Health insurance policies may not cover certain kinds of medical conditions. These are called 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 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 someone who has committed or attempted to commit 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 received 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 related to correcting refractive errors of up to 7.5 diopters to improve vision.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be successful.
14. Expenses related to birth control, sterility, infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, GIFT, ZIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: In addition to the standard permanent exclusions set by IRDAI, insurance companies can add extra exclusions for certain medical conditions or situations. If you have a serious medical condition or a specific disease that is deemed too risky to cover, they may permanently exclude it from your policy. The IRDAI has provided a specific list of illnesses that insurance companies are allowed to apply permanent exclusions to. It's worth noting that insurers are not permitted to enforce permanent exclusions for illnesses or diseases that are not included in this predefined list.
• Non-standard exclusions (Specific exclusions): These exclusions go beyond the usual permanent exclusions set by IRDAI. They are determined by the insurance company and may differ based on the policy's terms and conditions. Here are some specific exclusions found in the ICICI Lombard MaxProtect (Premium) plan:

1. Prosthesis or external equipment for diagnosis or treatment is not covered except if necessary due to an accident or required intra surgery.
2. Dental treatment is not covered unless it is required due to an accident.
3. Expenses for treatments like acupressure, acupuncture, magnetic therapies, etc. are not covered.
4. Circumcision is not covered except it is necessary for treating a disease or injury, or if it is due to an accident.
5. Treatment expenses related to external birth defects are not covered.
6. Treatment for intentional self-inflicted injury or attempted suicide by any means is not covered.
7. Expenses related to domiciliary hospitalisation are not included in the coverage.
8. Expenses for donor screening, treatment, and organ removal surgery in transplant cases are not covered.
9. Injuries or diseases caused by war, invasion, acts of foreign enemies, and warlike operations are not covered.
10.  Injuries or illnesses resulting from nuclear weapons or materials are also not covered.

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 remarkable track record in promptly and efficiently settling claims. It has successfully resolved 99.78% of claims within a timeframe 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 is the percentage of claims settled by the insurer when compared to the total number of claims they receive in a financial year. ICICI Lombard General Insurance Company Limited's claim settlement ratio of 80.97%. 
• Network hospitals: ICICI Lombard General Insurance Company Limited has an extensive network comprising 9,500+ hospitals. This widespread network enables the convenience of cashless treatments at a range of healthcare providers across different locations.

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

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

About ICICI Lombard General Insurance Company Limited

ICICI Lombard General Insurance Company Limited, established in 2001, is a private general insurance company in India. It is a joint venture between ICICI Bank Limited and Fairfax Financial Holdings Limited. With its headquarters in Mumbai, Maharashtra, the company offers a wide range of insurance products including motor insurance, health insurance, personal accident insurance, crop insurance, fire insurance, marine insurance, and more. Mr. Bhargav Dasgupta serves as the CEO and MD of the company.