Health Care Plus Insurance Plan

Health Care Plus is designed to provide an adequate and enhanced sum insured. Such type of a policy is extremely beneficial when one is unable to meet the towering medical expenses. Health Care Plus helps when the coverage limit is crossed and the expenses are beyond an individual's affordability limit. It is advisable to enhance your health cover with Health Care Plus to protect your finances and overcome unexpected health issues. It provides individual cover for each member of the family with a flexible sum insured and flexible deductibles. This long-term cover is applicable for two years for people falling in the age group of 5 - 65 years. There are no sub limits on room rent, hospitalization expenses, diagnostic tests and doctor's fees. Free health checkup is also provided on policy renewal. One can also avail income tax benefits using this cover.

A) Key Benefits:

Individual Cover for each member of the family
Flexible Sum Insured
Flexible Deductibles
Long term cover from 1 year to 2 years.
Entry Age: 5 years to 65 years and lifetime renewability
No sub-limits on room rent, hospitalization expenses, diagnostic tests/ doctors fees, etc.
No Co-payment
Free Health Check-up for any one insured member upon policy renewal
Income Tax benefit under section 80D

B) Eligibility and Coverage

What is covered?

The Company will indemnify, subject always to the Limit of Indemnity, the Insured against:

Any illness contracted within 30 days of the inception date of the Policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals
Hospitalization Expenses (without sub limits) covering all your
Bed Charges/ Room Rent
Drs/ Surgeons Fees
Medicines and surgical suppliest
Diagnostic Tests (Blood and radiological)
Pre-existing diseases after 4th consecutive renewal of the Health care plus policy with the company

The Coverage provided under Health Care Plus policy is independent of any other Group/ Individual/ Floater policy held by the insured.

What is not covered?

Any expense incurred prior/ post Hospitalization
Pre-existing Diseases covered only after 4 consecutive renewals with the company
Expenses incurred on treatment of following diseases within the first 2 years from the commencement of the Policy, will not be payable:

Cataract
Benign Prostatic Hyperplasia
Benign tumors
Arthritis and related disorders
Stones Kidney and Gall bladder
Ulcer- Gastric, Peptic, Duodenal
D&C and hysterectomy unless for Malignancy
Tonsillitis, sinusitis and related surgeries
Hernia and Hydrocele

Medical charges incurred within 30 days of inception date of the policy except those that are incurred as a result of bodily injury caused by an accident. This exclusion does not apply for subsequent renewals with the Company without a break.

Permanent Exclusions:

Any Physical, Medical or mental condition or treatment or service which is specifically excluded in the Policy in Part I of the Schedule under Special Conditions
Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, vaccinations, issue of medical certificates and examinations as to suitability for employment or travel
Internal congenital illness
Suicide or self-inflicted injury
Alcohol or Drug Abuse
Illness or Injury whilst performing duties as a serving member of a military or police force
Treatment relating to birth defects and external congenital illnesses
All dental treatment unless due to accident
Treatment traceable to Pregnancy and Childbirth, abortion and its consequences, tests and treatment relating to infertility and invitro fertilization. This will not apply to Ectopic Pregnancy proved by diagnostic means and is certified to be life threatening by the Medical Practitioner
Birth control procedures and hormone replacement therapy
Prosthesis, corrective devices and medical appliances which are not required intra-operatively or for the illness for which the Insured was hospitalized
Treatment of mental illness, stress, psychiatric or psychological disorders, Aesthetic treatment, Cosmetic surgery and Plastic surgery unless necessitated due to accidentor as a part of any illness
Circumcision unless necessary for treatment of a diseases or necessitated due to an accident
Vaccination and inoculation of any kind
Any Sexually transmitted diseases. Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex syndrome (ARCS) and all diseases caused by and/ or related to the HIV
The performance of hazardous sports of any kind
Treatment by a family member and self-medication or any treatment that is not scientifically recognized
Flying other than as a passenger on a scheduled regular carrier
Any criminal act
War invasion, act of foreign enemies, hostilities (whether declared or not), civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, riot, strike, lockout, military or popular uprising, civil commotion martial law, loot, sack and pillage
Nuclear weapons, materials ionizing radiation or contamination by radioactivity from
any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel
Experimental and unproven treatment, diagnostic tests and treatment not consistent with or incidental to the diagnosis and treatment of any illness or injury for which hospitalization is required
Costs of donor screening or treatment including surgery to remove organs from a donor in case of transplant surgery
Non-allopathic treatment
Treatment taken at home or received outside the country
Treatment taken from persons not registered as Medical Practitioners under respective medical councils
Vitamins and Tonics, Treatment of obesity, general debility, convalescence, run-down condition and rest cure
Enrollment age for the members proposed for this insurance is from 5 years to 65 years.
Proposer needs to be aged 18 years or above.
Individual(s) proposed for Insurance whose age is 56 years & above have to undergo medical tests at ICICI Lombard designated diagnostic centers.
The policy is renewable lifetime

C) Claim Process

The claims for Healthcare Plus are serviced by ICICI Lombard Health Care, our very own claims processing portal. It has always been our endeavor to provide the best of the policy and services to our valued customers, ICICI Lombard Health Care is our initiative towards this commitment.

In case of emergency or planned hospitalization, just use your health ID card at ICICI Lombard Health Care network hospitals and avail of cashless services.

Call our 24-hour toll free number 1800 2666 for complete assistance.

For treatment in non-cashless hospitals, the claim form should be filled duly after discharge from hospital and send to ICICI Lombard Health Care office along with following documents in original*

Standard list of documents required:

Claim form duly filled & signed by insured and doctor.
Original discharge card/ summary & final bill.
All investigation reports in originals.
All medicines/ lab/ hospital bills in original.
All payment receipts in original and should be stamped.
Any other required documents depending upon the case.

Disclaimer: Cashless Approval is subject to pre-authorisation by the company.

Only expenses relating to hospitalization will be reimbursed as per the policy coverage. Non-medical expenses will not be reimbursed.

Enhance Health Cover with Health Care Plus

Health insurance has proved to be a lifeline to innumerable people during crisis. A sound health insurance policy safeguards you by preventing a health crisis to transpire in to a financial crisis.

Today, the benefits of health insurance are well acknowledged by all, but what is often asked is, "How much health insurance should I avail?"

One needs to factor in many variables while deciding on the right health insurance cover. Lifestyle, one's medical history, family's medical history and annual income are the main parameters on which an adequate health cover should be selected.

On an average, Indian’s prefer to avail health insurance cover amounting to 50% of their annual salary.

If your family has a history with a particular disease then you are more likely to suffer from it. One needs to look at the nature of major and minor diseases that may probably affect you and your family, along with the approximate costs of dealing with those health issues to ascertain your ideal health cover.

D) Group Health Policy

People often consider the group health policy offered by their employer as a primary health policy. Yes, it acts as a cushion but it is not adequate to be considered as a primary healthcare policy. Irrespective of whether one's employer provides a group healthcare policy, the need for a personal healthcare policy is paramount.

Your employer may opt to back out of the policy by discontinuing with it. Many group health policies do not consider one's parents in the health cover. Moreover, it is not available from a sustainable point of view. What if you leave your present job and your new employer does not provide a group health insurance policy?

Insurance provided by your employer is an added advantage and that is what it should be. It should be in addition to your primary individual health care plan.

Even if you plan to continue with your existing company for a major part of your life, the group insurance policy may not support you after you retire.

E) Tips for Purchasing Adequate Health Cover

Insurance companies go all out to promote their respective insurance policies. Every company has policies that are similar to others and they differ with minor changes. After all, different people have different needs. While choosing an adequate cover, you must ensure that you are availing the policy, which you need, and not what the insurance company is providing. Go through the following tips to ascertain an adequate health cover.

Tip 1 - One must understand and differentiate between necessity and frills. Additional covers to the policy should not be opted for if you do really do not require them.
Tip 2 - Many a times people decide the cover depending upon the premium they will have to pay. Rather than concentrating on the premium, one must focus on the finer aspects of the policy like benefits and terms.
Tip 3 - Noting the renewal age is one of the important factors while deciding your insurance cover. The need for insurance is more profound when one has crossed the age of retirement and the regular source of income is not available any longer.
Tip 4 - The sum insured is not a guarantee for the claim. There are certain limits, which overrule the sum insured. One must consider limits if any, in the policy and then weigh those with the extent of the coverage. Example, there are limits on the insured amount in case of heart related diseases, cataract etc.
Tip 5 - Long term policies overpower plans restricted by days. Think of the sum insured as a long-term investment to safeguard your health. While choosing the sum insured also consider the inflation rate.
Tip 6 - Insurance premiums undergo a drastic change when the person in question crosses the age of 45. Hence, premiums have to be weighed accordingly and an insurance plan must be bought at the earliest.

F) Claims Settlement

With the advent of technology, the claims process has become streamlined. The claims are sorted through dedicated portals of insurance companies. For example, ICICI Lombard's Health ID card facilitates cashless services. All one needs to do is display the card at an affiliated hospital.