ICICI Lombard offers policy named iHealth complete health insurance plan. There are several individuals these days who are opting for ICICI Lombard iHealth Insurance these days compared to other health insurance plans owing to its unique features. What are the features of ICICI Lombard Complete Health Insurance Plan? What are optional add on cover available in ICICI Lombard iHealth Insurance? What is the waiting period for pre-existing disease coverage in ICICI Lombard iHealth Insurance? Should you opt for ICICI Lombard iHealth Insurance Plan or not?
Why do we need health insurance plan?
You can skip this section if you are already clear that health insurance plan is must.
When there is illness to you or to your family members, high hospitalization expenses or medical bills can empty to your pocket and screwup your financial life. Here comes health insurance plan. Health Insurance plan would protect you for high paid hospital expenses.
Overview about ICICI Lombard iHealth Insurance Plan
Many experts believe that ICICI Lombard Complete Health Insurance is one of the best family floater health insurance policies in India. It is a comprehensive plan designed to care of the health expenses you and your family at the time of emergency and planned hospitalization and treatments. It offers health insurance for senior citizens, takes care of maternity expenses, covers new born baby and much more.
Features of ICICI Lombard iHealth Insurance Plan
1) The company offers a wide range of sum insured starting from Rs. 3 lakh to 50 lakh as per one’s needs.
2) Pre-existing diseases will be covered immediately after 2 years of continuous coverage under the policy.
3) The policy provides lifelong renewal.
4) No medical tests are required for insurance cover under the age of 46 years and sum assured up to Rs 10 lakh.
5) The tax deduction u/s 80C is available for the premium paid under a health insurance policy as per provisions of the Income Tax Act 1961.
6) The policy can be cancelled by giving a written notice within 15 days of receiving a policy.
7) The plan covers all the hospitalization expenses like room rent, doctor visit, anesthesia, blood, oxygen, etc. incurred during hospitalization of minimum 24 consecutive hours.
8) All the medical expenses incurred while undergoing surgeries or treatments mentioned in the subscriber list which require hospitalization of less than 24 hours.
9) All medical expenses incurred immediately 30 days before and 60 days after hospitalization will be covered.
10) The benefit of cashless hospitalization can be availed at any of the company’s network of hospitals. The list is provided at the official website of the company.
11) Expenses for yoga, Ayurveda, Unani and homeopathy treatment will only be covered only when they are incurred in a government recognized institute or hospital.
12) An additional sum insured of 10% of the annual sum insured is provided on each renewal for every claim-free year up to a maximum of 50%.
13) Reimbursement up to Rs. 1500 per hospitalization is provided for reasonable expenses incurred on availing an ambulance in an emergency condition.
14) The company provides for a free health check-up at designated center, one free check-up for every insured every year.
15) The company also runs a wellness program which intends to promote and reward you for your healthy behavior. All the activities that earn wellness points are tracked by the company.
What is the eligibility to take ICICI Lombard iHealth Insurance Policy?
Here is the eligibility to apply for this health insurance plan.
1) The minimum entry age to enter the policy is 6 years. Children between 3 months to 6 years can be covered under floater plan only.
2) There is no restriction on maximum entry age.
3) If you are above 18 years of age, you can buy a complete health insurance policy for yourself, your family members, children and parents.
4) If you wish to cover your child to be covered under the family floater, your child needs to be 3 months of age.
5) If you wish to have an individual policy for your child, he/she needs to be more than 6 years of age.
6) A policy bought to cover children aged between 3 months to 5 years should necessarily cover at least one adult too.
What are optional add on cover available in ICICI Lombard iHealth Insurance?
There are few optional add-ons available with the policy like a free health check-up, online chat with doctors, dietician and nutrition e-consultation, specialist e-consultation, consultation on physiotherapy, vaccination care, speech and audiology.
What is the waiting period for pre-existing disease coverage in ICICI Lombard iHealth Insurance?
Pre-existing conditions or diseases will be covered immediately after 2 years of continuous coverage under the policy, if the policy is issued for the first time with ICICI Lombard. If the insured has been covered under a similar policy before opting this policy, the waiting period may reduce subject to portability regulations.
What is ICICI Lombard iHealth Insurance Reset Benefit?
The company will reset up to 100% of the base sum insured once in a policy year in case the sum insured, including the accrued additional sum insured is insufficient as a result of previous claims in that policy year. It is subject to certain conditions-
1) The reset amount can only be used for all future claims within the same policy year, not related to the illness or disease for which the claim has been paid in that policy year for the same person.
2) Reset will trigger for the first claim.
3) For individual policies, reset the sum assured will be available on an individual basis and for floater policies; it will be available on floater basis.
4) Any unutilized reset sum assured will not be carried forward in the subsequent policy year.
How to earn wellness points in this health insurance plan?
This insurance has come up with a unique wellness point program under their health insurance plan.
1) Collect relevant reports, or receipts and bills for specified category of activities under which you want to earn your wellness points.
2) Send the requisite documents along with duly filled submission form to the registered office.
3) There is an entire list of wellness activities and the points associated with them available at the website.
4) An acknowledgment will be sent to you to keep you updated regarding the status of your point accumulation request.
5) To track the earned points, one can call on toll free no. 1800 2666 or send an email to [email protected] or one can even the website www.icicilombard.com and hit claims and wellness management.
6) The total wellness points earned by you will be sent to you through registered email id once in every 3 months.
7) Each wellness point is equivalent to 25 paise.
8) One can redeem the earned wellness points against reimbursement of medical expenses like consultation charges, medicine and drug etc. and any other expenses that are not covered any medical insurance.
Like any other health insurance plan, even this plan comes with list of exclusions.
1) Any pre-existing disease will not be paid for first 24 months of continuous coverage.
2) Any illness detected within 30 days of inception of policy except for those incurred as a result of injury.
3) Any medical expense incurred by you for treatment of the following illnesses within 24 months of continuous coverage-
Cataract subject to certain conditions
Arthritis, gout and spinal disorder
Varicose veins or varicose ulcers
Joint replacements unless due to accident
Stones in the urinary and billiary system
Deviated nasal septum
All types of internal congenital anomalies or illness or defects
Myomectomy, hysterectomy unless because of a malignancy
All types of hernia, hydrocele
Surgery on tonsils, adenoids, and sinuses
Gastric and duodenal erosions and ulcers
Benign Prostatic Hypertrophy
Sinusitis and related disorders
Dialysis required for chronic renal failure
Fissures, fistula in anus, hemorrhoids, piles
All types of skin and internal tumors, cysts, nodules, polyps of any kind including breast lumps unless malignant.
Apart from these exclusions, there are certain permanent exclusions
Expenses attributed to self-inflicted injury like suicide or attempt to suicide
Expenses arising out of drug use or abuse
Cost of spectacles or contact lenses and dental treatment
Medical expenses incurred for treatment of AIDS
Treatment arising from or traceable to pregnancy
How does cashless claim work under ICICI Lombard iHealth Insurance?
The claims of ICICI Lombard iHealth Insurance are serviced by its own claim processing portal named ICICI Lombard Health Care. This portal is an initiative to provide the best of services to the customers. In order to avail cashless services, just use your health card at ICICI Lombard Health Care network hospitals or you call on 24 hour toll free no. 1800 2666.
For treatment in non-cashless hospitals, the claim form should be duly filled after discharge from the hospital along with listed documents and sent to their registered office.
Should you opt for ICICI Lombard iHealth Insurance Plan or not?
ICICI Lombard Complete Health Insurance is a comprehensive insurance plan that provides complete health cover for you and your family. While there are good features in this health insurance plan, premiums are on little higher side based on the basic features and any additional add-ons to be availed. One can compare the features with any other plans based on age and features which you intend to take and decide whether this plan is coming to you at lesser cost or not.
There is nothing better than a health insurance plan you can gift your family. In today’s era where medical emergencies are at the rise and soaring healthcare expenses taking its toll on people’s savings, covering your family against those out of the blue situations. Here comes a health insurance plan like HDFC ERGO Health (formerly known as Apollo Munich) Optima Restore plan comes in handy in covering your family.
This policy is beneficial for those who are explicitly looking for advanced features. This policy comes with 3 basic features- Restoration, Multiplier and Stay Health benefit. The other features such as lifelong renew-ability, no claim bonus up to 50%, critical illness cover with E-opinion option, no co-payment etc. have made it worth your money
HDFC Ergo Health Optima Restore Insurance Plan is a Comprehensive Online Health Insurance Plan that provides comprehensive cover for the entire family.
How it works – This policy can be taken for self, spouse, dependent children and dependent parents. This policy covers all basic hospitalization expenses with the benefit of restoring the initial Basic Sum Assured if it is utilized for claim and upto 100% of Basic Sum Assured as No Claim Bonus is payable in this plan.
The plan can be taken for an Individual or as a Family Floater. In a Family Floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a single policy. You can opt for 1 Adult and 3 children also. The plan offer lifelong renewability. There is no claim-based loading. Also you can upgrade to the next higher slab of cover on renewal. Maternity related expenses are excluded in this plan as is the case with most plans.
There are 2 Unique Benefits in this plan:
Restore Benefit: The Uniqueness in this plan is that in this plan, the Sum Assured is restored if it is exhausted that can be utilized for a future claim for a different illness is made during the same policy year. Thus, if the Initial Sum Assured gets exhausted, the entire amount is restored back into the plan at no extra cost!
Let us explain this with an example. If you have a Sum Assured of Rs 5 lakhs and Claim for Rs 6 lakhs in the first hospitalization, then the entire limit is exhausted and only Rs 5 lakhs would be payable. However, if another claim happens within the same year for a different illness or for a different family member, then the entire Sum Assured of Rs 5 lakhs is available for claim even though the initial Sum Assured has been exhausted.
However, the restore benefit works only if:
The entire Basic Sum Assured is exhausted
The claim is for a completely unrelated illness
Multiplier Benefit: Another Unique Benefit of this plan is that for a claim free year, there is a 50% increase of the Basic Sum Assured as No Claim Bonus and if the consecutive year is also Claim Free then the total No Claim Bonus increases by 100% with a net effect of Double the Basic Sum Assured.
Let us explain this with an example. If you have a 5 lakh policy and don’t claim in the first year, the cover increases to Rs 7.5 lakhs in the second year which rises to Rs 10 lakhs in the third year for another consecutive claim free year while the premium is calculated only for a premium for Rs 5 lakhs of initial Basic Sum Assured.
In case of claim, the No Claim Bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy. This plan provides for regular features like pre-hospitalization, hospitalization and post hospitalization expenses without any cap on charges like doctor’s fees, OT charges, etc. as well as Day Care Treatment, Domiciliary Treatment, Organ Donor costs, etc.
Restoration of the entire Sum Insured if used in the middle of the year at no additional cost
No claim bonus increases the insurance cover by 50% for one claim free year and then 100% for the consecutive claim free year
Lifelong renewal to stay insured forever
No sub-limits on hospital room rent or co-pay required
No loading on renewal premiums if a claim is made
Cashless treatment across 4000 hospitals in more than 800 cities
Wide cover for treatment against illnesses and accident
Additional Features of HDFC Ergo Health Optima Restore Insurance Policy
Policy Term options of 1 or 2 years with a 7.5% Discount on 2 year policy terms
Tax benefit on premiums paid under Section 80D of the Income Tax Act, 1961
Free look period of 15 days from the receipt of policy documents
No caps/limits on doctor/surgery fees, operation theatre, room rent and intensive care unit
7.5% Discount on 2 year policy terms and more
There is No claim based loading in this plan
Quick turnaround time with 90% of pre-authorization is done within 2 hours of intimation or hospitalization
Easy upgrade: This health plan also comes with an easy upgrade option on policy renewal
What is covered in HDFC Ergo Health Optima Restore Insurance Plan?
This plan pays for:
Pre-Hospitalization Coverage up to 60 Days
Post-Hospitalization Coverage up to 180 Days
Day Care Procedures for 140 listed day care procedures
Emergency Ambulance Upto Rs.2,000 per Hospitalisation
Additional Benefits of HDFC Ergo Health Optima Restore Insurance Plan
Restore Benefit where the Sum Assured is restored if it is exhausted that can be utilized for a future claim for a different illness is made during the same policy year. Thus, if the Initial Sum Assured gets exhausted, the entire amount is restored back into the plan at no extra cost!
Multiplier Benefit where there is a 50% increase of the Basic Sum Assured as No Claim Bonus and if the consecutive year is also Claim Free then the total No Claim Bonus increases by 100% with a net effect of Double the Basic Sum Assured
Exclusions – What is not covered in HDFC Ergo Health Optima Restore Insurance Plan?
Any treatment within first 30 days of cover except any accidental injury
Any Pre-existing diseases/conditions will be covered after a waiting period of 3 years
2 years of exclusion for specific diseases like cataract, hernia, hysterectomy, joint replacement etc.
Expenses arising from HIV or AIDS and related diseases
Abuse of intoxicant or hallucinogenic substance like drugs and alcohol
Pregnancy, dental treatment, external aids and appliances
Hospitalization due to war or an act of war or due to nuclear, chemical or biological weapon and radiation of any kind
Non-allopathic treatment, congenital diseases, mental disorder, cosmetic surgery or weight control treatments
Eligibility and Restrictions of HDFC Ergo Health Optima Restore Insurance Plan
Sum Assured (in Rs)
Policy Term (in years)
Entry Age of Life Insured (in years)
Renewable till Age (in years)
2 Years Standard Exclusion
For specific diseases like cataract, hernia, hysterectomy, joint replacement etc.
Waiting Period for Pre-existing Illness
After continuous renewal of 3 years
30 days from the date of expiry to renew the policy
What does HDFC Ergo Health Optima Restore Insurance plan cover?
In-patient care: Hospitalization expenses such as room rent, nursing expenses, ICU charges, surgeon’s fees, doctor’s fees, anaesthesia, blood, oxygen, operation theater charges, etc. with no sub-limits Day care treatment: Medical expenses incurred if hospitalization is less than 24 hours for listed 140 procedures Pre and Post hospitalization: Medical expenses incurred 60 days immediately before hospitalization will be covered. Expenses incurred up to 180 days after being discharged from the hospital such as follow-up visits to medical practitioner, medication, etc will be covered. Ambulance charges: Charges of Ambulance provided by the hospital or any service provider will be reimbursed upto Rs 2000 for each hospitalization Organ Donor Cover: Medical expenses incurred by an organ donor while undergoing the organ transplant surgery if the organ is for the use of the insured person. Domiciliary Hospitalization: Medical expenses incurred by the insurer for treatment at home will be reimbursed. The medical treatment should be for a period exceeding 3 consecutive days and should merit hospitalization. Restore of Sum Assured: If the Sum Assured in the policy is exhausted due to claims made, then the company restores the entire sum assured once in the policy year. This restores Sum Assured amount can be used for future claims, not related to the illness / injury for which the claim has already been made during the same year. Multiplier Benefit: For a Claim Free year, there is a No Claim Bonus of 50% and another 50% of No Claim Bonus for the second consecutive Claim Free year of total 100% of Basic Sum Assured Treatment anywhere in the country: For select diseases / ailments / treatments, the Company will reimburse the cost of medical expenses, whether the insured gets these treatments anywhere in India.
Family Floater Cover of HDFC Ergo Health Optima Restore Insurance Plan Under this plan, any number of members of the immediate family (children, spouse and parents) can be covered in a single policy.
Exclusions of HDFC Ergo Health Optima Restore Insurance Plan
The standard policy exclusions are –
Any pre-existing ailment/injury that was diagnosed/received within 48 months prior to issuance of the first policy
Any diseases contracted during first 30 days of the policy start date except those arising out of accidents
Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)
Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
Cost of spectacles/contact lenses, dental treatment
Medical expenses incurred for treatment of AIDS
Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
Tests and treatment relating to infertility and in vitro fertilization
Some treatments such as non-infective arthritis, joint replacement etc., which are covered only after completion of 2 consecutive policy years
Frequently Asked Questions of HDFC Ergo Health Optima Restore Insurance Plan
What is the difference between a family floater and critical illness or hospital cash insurance? The individual or family floater health insurance works on the principle of indemnity. This means that these insurance policies will pay you only what you have spent for medical treatment in hospital. On the other hand, the critical illness or the hospital cash insurance pays you the amount insured, irrespective of the amount spent for medical treatment. These are a benefit based policies.
Do I need to undergo a medical check-up while buying a health insurance policy?You may be required to undergo a medical check-up after you buy, in case any member to be insured is above 45 age or for sum insured 7 Lakhs or above. What is beneficial for me – floater insurance or an individual insurance?Buying an individual cover or a floater cover is an individual’s perception. However, as a general rule, at younger ages floater cover is advisable. As you grow older, you should go for an individual cover. What are the documents required for portability?You can apply for Apollo Munich Optima Restore Plan under portability with following documents:
Last 3 year’s copy of expiring health insurance policy
Copy of renewal notice
Tax Benefits of HDFC Ergo Health Optima Restore Insurance Plan
There is Tax Benefits under section 80D of the Income Tax under the existing tax laws of the Income Tax, 1961:
Of Rs 25000 on the premium amount paid for Health Insurance Coverage of self, spouse and children
An additional amount of Rs 50,000 for premium amount paid towards Health Insurance Coverage of parents
Another additional Rs 5000 of deduction if either or both of the parents are Senior Citizen
Total Amount available for deduction under section 80D of the Income Tax Act, 1961 is Rs 25000 for Senior Citizen parents and Rs 50000 for self, spouse and children.
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