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| OPD Coverage Health Insurance Plans |
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| 3- ICICI Lombard Health Insurance - Health Advantage Plus |
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| Eligibility |
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- The enrolment age (of senior most member) can be between 5 to 65 years of age.
- Maximum two adults can be covered under a single policy.
- The Proposer needs to be aged above 18 years
- No health check-up up to the age of 45 years (age as on last birthday).
- Individual(s) proposed for Insurance whose age is 56 years & above have to >undergo medical tests at ICICI Lombard GIC Ltd designated diagnostic centers
- The policy is renewable till the age of 70 years
- Income Tax benefit u/s Section 80D of the Income Tax Act, 1961 can only be availed for policies bought for self, spouse, dependent children or parents.
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| Sailent Features |
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- Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental treatment, medical bills, ambulance charges, etc.
- Avail Cashless Claim facility at over 4,000+ network hospitals across India(Tip - Simply use your Health ID card at any of our 4,000+ network hospitals and avail cashless service, a boon for those times when you need finance the most.)
- No sub-limits on room rent, doctor fees, and hospital charges or for any disease (Tip - Sub-limit means any limit or restriction put on the Sum Insured available for any treatment/ service/ disease/ covered under the policy. For example, a health policy may have sub-limits of 1% of Sum Insured on the Room rent on a per day basis, or a sub limit of 25% of Sum Insured on Doctor's fees. Sub-limits can be applied on the entire treatment of one illness, like Heart diseases may have a sub-limit of Rs. 50,000, i.e, a maximum of Rs. 50,000 can be claimed for the heart disease treatment)
- No co-payments for any disease or any Hospitalisation expenses (Tip - Co-payment means a certain percentage of every claim amount which has to be borne by the insured person. For example a health policy may have co-pay of 20% on hospitalisation expenses taken in a non network hospital then he will have to bear 20% of such claim amount out of his own pocket.)
- Now get an Additional Sum Insuredfor every claim free year
- Pre-existing illness covered after two years, subject to continuous renewal of the policy with the Company
- Avail Tax Benefitunder Section 80 D of the Indian Income Tax Act, 1961**.
- Maternity expenses can be covered under OPD expenses of this plan up to the OPD sum insured
- Insurance against Terrorist activities
- A maximum of 2 adults can be covered under a single policy
* Except Cataract (Rs. 20,000 per eye applicable)
** Tax benefits are subject to changes in tax laws |
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| What is covered |
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- Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor's / surgeon's fee, medicines, diagnostic tests, etc.
- Medical expenses incurred 30 days prior and 60 days post hospitalisation
- Pre-existing diseases can be covered after two continuous years of coverage with the Company*
- Covers against hospitalisation# in case of Swine Flu / H1N1 influenza
* Conditions Apply # If it's not a pre-existing illness The following technologically advanced treatments that do not need 24-hour hospitalisation but are covered under this policy are: Cataract (limited to 20,000 per eye) Lithotripsy (Kidney Stone Removal) Tonsillectomy Eye Surgery Dialysis Dilatation & Curettage Chemotherapy Radiotherapy Coronary Angiography Cardiac Catheterisation Outpatient Department (OPD) Cover Room, Boarding Expenses as charged by the Hospital Nursing Expenses Expenses related to Dental Treatment Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids, Dental treatment charges, Ambulance charges
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. |
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| What is not covered |
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| Exclusions for Hospitalisation Benefit Cover |
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| Exclusions valid for the first 30 Days: |
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| 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. |
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