ICICI Lombard Complete Health Insurance - Health Advantage Plus

Purchase mode: Online

Options available: Individual and Family floater

Recommendation about Mediclaim: YES

Premium: There premium charge are high and but they provide 10% discount if renewal for 2 Years.

Product Features:

Parameter

Value

Entry age

5 to 65

Renewal

Till 70

Policy tenure

1 and 2 Year (Auto Renewal)

Pre existing illness cover

Pre-existing diseases for first 2 yrs not Covered

Cashless Facility

Though in select hospitals, they have wide network

Sum Insured

Minimum- Rs 2 lac and Maximum – Rs 3 lac

Family Combination

Maximum 2 Adults and 1 Child

Hospitalization cover

All in-patient expenses

Pre & post hospitalization medical expenses

Pre-hospitalisation expenses up to 30 days

Post- hospitalisation expenses up to 60 days

Domiciliary treatment

Yes

Sub limits

No sub limit

What does this policy cover :

  • Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor/ surgeon's fee, medicines bills, etc
  • Medical expenses incurred 30 days prior and 60 days post hospitalisation
  • Day Care expenses incurred on named advanced technological surgeries and procedures requiring less than 24 hours of hospitalisation. (Including Dialysis, Radiotherapy and Chemotherapy)

Exclusions :

Exclusions valid for the first 30 Days:

  • 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 of this policy.
Exclusions valid for the first 2 Years:

Treatment of the following diseases:

  • Cataract (limited to Rs 20,000 per eye)
  • Benign Prostatic Hypertrophy
  • Myomectomy, Hysterectomy unless because of malignancy
  • Hernia, Hydrocele
  • Fistula in Anus, Piles
  • Arthritis, Gout, Rheumatism
  • Joint replacement, unless due to accident
  • Sinusitis and related disorders
  • Stone in the urinary and biliary systems
  • Dilatation & Curettage
  • Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast
    lumps, unless malignant / adenoids and hemorrhoids
  • Dialysis required for chronic renal failure
  • Surgery on tonsils and sinuses
  • Gastric and duodenal ulcers
  • Deviated Nasal Septum

Note: The OPD claims can be made only on a reimbursement basis. You can lodge a claim only once during the Period of Insurance, i.e. 90 days after commencement of policy and 30 days after expiry of the Period of Insurance.

Permanent Exclusions:

  • Non-allopathic treatment, pregnancy and childbirth related diseases, cosmetic,
    aesthetic and obesity related treatment.
  • Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor,
    intoxicating substances or drugs as well as intentional self injury.
  • War, riots, strike, nuclear weapon induced treatment.

Exclusions for OPD (Outpatient Department Expenses):

  • Suicide or self-inflicted injury
  • Alcohol or drug abuse
  • War, riots, nuclear related hospitalisation
  • Non-allopathic treatment, experimental and unproven treatment
  • Expenses arising from treatment of HIV/ AIDS or related disease, use or misuse
    of alcohol and other intoxicating substances and intentional self-injury.

Other features of the policy :

  • Out-patient (OPD) expenses includes dental treatment, medical bills, diagnostics tests etc  
  • No Health check-up for people below  45 yrs age
  • Covers Swine Flu / H1N1 influenza
  • No sub-limits on doctor’s fees, room rent, hospital charges
  • No sub-limits on diseases (except cataract where sub-limit is Rs 20,000)
  • No co-payments for any hospitalisation expenses or diseases
  • Provides cover against terrorist activities
  • Maternity expenses can be covered under OPD expenses

Illustration showing premium:

Members

Indicative Annual Premium

(For cover of Rs.3 lakh )

                           

1 Adults (Age 39)

7902

2 Adults

15000

Age of oldest male member between 36-45 years

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