Group Health Insurance Policy for Family

Annual sum insured denotes maximum amount of cover available during each policy year of the policy period.

Declared & accepted pre-existing diseases (PED) will be covered.

Any pre existing disease (PED) not declared at the time of policy inception will be considered as non-disclosure of the material facts and will lead to policy cancellation. To avoid this, all material facts related to PEDs should be declared before the policy issuance. However, should you need to declare any PED after policy issuance, please visit our branch office. The acceptance of the PED will be subject to our underwriting guidelines. In case the PED is a declined risk as per Our underwriting guidelines, please note that Your Policy may be subject to cancellation with Zero refund of premium

It will take T+7 days for us to dispatch your policy certificate, T being the date of your savings account activation or amount being deducted from your credit/ debit card

A health care card is given to all the people insured and has all the details of the insured along with the policy number, insured name and policy end date. You will have to produce this when you avail of the cashless hospitalization facility.

The premium you pay for yourself, up to the limit of Rs. 25,000, excluding service tax and education cess, is eligible for deduction under section 80D. This deduction is eligible under the prevailing tax laws, which are subject to change.

No, the claim amount you receive under your health policy is not subject to tax.

Should you find that there are any inaccuracies in your policy certificate it is very important that you contact us to rectify them so as to ensure all material facts relating to your coverage are correct. Changes in the details of your policy can be such as spelling of your name and change of address, change of date of joining or contact details will not have any impact on the premium you have paid. These changes if deemed fit by us will be endorsed in the policy either by contacting ICICI Lombard at our on 18002666 or writing on customersupport@icicilombard.com

Any changes made in the policy during the policy period will be made through an endorsement. All the endorsements will be confirmed with an Endorsement letter which is sent to the customer after the changes are made.

• Free look period: You can place a cancellation request with your ICICI Securities branch within 15 days of receiving the policy certificate by sending us the free look request form available on our website or by submitting written notice to the company either via registered post or from your registered email address. If you avail of this feature, the premium will be returned.
• Should you wish to cancel the policy after the free look period but before the expiry date, you can do so by following the same process as above. We shall refund premium on the short term rates as specified below for the policy period remaining.

We may cancel your policy in the case of misrepresentation, fraud, non-disclosure of material facts or non-cooperation of the insured/ policyholder

Claim Intimation: If you need to make a claim, you must intimate us in any of the following ways:

• Call us at our 24*7 customer care toll free number 1800 2666
• Text message HEALTHCLAIM to 575758 (charged at Rs. 3 per SMS)
• Email us at ihealthcare@icicilombard.com

Do ensure that you intimate us of a planned hospitalization at least 48 hours before admission. In the case of an emergency, we must be informed within 24 hours of admission. You can download claim form from our website - www.icicilombard.com.

Claim Documents: You shall be required to furnish the following documents for or in support of a Claim:

• Duly completed Claim form signed by You and the Medical Practitioner.
• Original bills, receipts and discharge certificate/ card from the Hospital/ Medical Practitioner
• Original bills from chemists supported by proper prescription.
• Original investigation test reports and payment receipts.
• Indoor case papers/ Operation theatre notes
• Medical Practitioner’s referral letter advising Hospitalization in non- Accident cases.
• Any other document as required by Us or Our TPA to investigate the Claim or Our obligation to make payment for it

For Reimbursement of claims you may send complete document set to below mentioned address:

ICICI Lombard GIC Ltd, ICICI Lombard Healthcare, Bank Tower, Plot No. 12, Financial District, Nanakram Guda, Gachibowli, Hyderabad, Andhra Pradesh- 500032

Once a claim is submitted, its status can be tracked on our website. You can log in to our website - www.icicilombard.com and check for the claim status using following path- www.icicilombard.com=>Claim=>Services=>Track your claims.

Alternatively same can be tracked by clicking on https://www.icicilombard.com/IL-Health-Care/Customer/ClaimStatus

There is a waiting period of 30 days from the start of the first time you buy the policy before which a claim cannot be made for any illness, except for hospitalisation due to injury or accident.

An OPD claim is one that is filed for treatment, procedures or services from the out-patient-department of a hospital, clinic, nursing home or diagnostic centre, in which the insured patient has not been admitted. This will exclude procedures covered under Day Care Surgeries. This can include X-rays, MRIs, Doctor Consultations, etc. You can file a claim for this only if the event requiring the service or treatment had occurred 30 days after the policy start date.

Yes, maternity is covered under Your Policy. However, to be eligible to claim this cover, Your legally wed spouse and You must be covered under the same policy and both must have completed 12 months together in the policy. Maximum amount payable under this cover is subject to limit as defined against this extension.

Cashless and reimbursement are two different ways to settle a claim:

• Cashless claim is a claim where we pay the agreed claim amount directly to the hospital. You need not to pay the hospital for the claim amount. You are required to inform us about the procedure or treatment and send us all the related paper work.
• Reimbursement claim is a claim where you settle the bill with the hospital and then send us the relevant documents. We will reimburse you for the agreed claim amount.

Yes, you may file multiple claims in the year, subject to the total amount of the claims not exceeding the sum insured on your policy. For OPD cover, claim can be filed only once a year.

The policy offers claim settlement up to the Sum Insured except for cataract where there is a limit of Rs.35,000 for Sum Insured less than Rs.10 lakhs and Rs.1,00,000 for Sum Insured equal to or more than Rs.10 Lakhs, applicable on per eye per policy Year basis.

ICICI Lombard has an extensive network of hospitals with which it works to offer cashless and reimbursement facilities for your treatment. However, there are some hospitals that are delisted and ICICI Lombard will not cover any medical expenses for treatment taken in these hospitals. The updated list of delisted hospitals is also available on our website www.icicilombard.com. Please call us at our toll free number 1800 2666 should you need more information on this.

Once all necessary documents have been sent to us and queries have been answered, we will process your claim. If you are availing of the cashless facility, your claim will be settled within 4 hours directly with the hospital. In case of a reimbursement facility, your claim will be settled through NEFT within 14 days of submission of all the required documents.