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Health and wellness form
an important aspect of the balance in your life.
To ensure that you are taken care of when the need
arises, we present 'Health Advantage
Plus', a unique health policy that covers
you not only for hospitalisation
expenses but also for Out Patient
Treatment expenses (OPD expenses) caused
by, including but not limited to,
accidents arising out of
terrorist activities. Now, get
covered even against Swine Flu / H1N1
influenza in case of hospitalisation, if
it's not a pre-existing illness. You can also
avail of tax benefits~ on
your premium paid subject to the provisions of
Section 80D of the Income Tax Act,1961 and
amendments made thereafter.
Health Advantage Plus
- A comprehensive health insurance policy
that offers you complete protection!
~ Tax benefits are subject
to changes in tax laws.
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Floater is a common cover for
both the members
Anyone out of
the 2 adults insured can avail of either covers
under Health Advantage Plus; Floater provides a
common cover for both
members. |
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Example: Consider that
Mr.& Mrs. Kumar haven taken a Rs. 3 Lakhs
hospitalisation cover. In an foreseen situation
wherein a surgery and post hospitalisation bill
for Mr.Kumar amounts to Rs. 1.9 Lakhs, the
remaining Rs. 1.1 Lakhs can be claimed by Mrs.
Kumar or even by Mr. Kumar later. If Mr. &
Mrs. Kumar had taken two separate policies of
Rs. 1.5 Lakhs each then Mr. Kumar would have to
pay Rs. 0.4 Lakhs from his own pocket. With a
floater the cover of Rs. 3 Lakhs would be shared
among both Mr. & Mrs. Kumar; thus making the
entire amount available to both of
them. |
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No
health check-up up to the age of 55 years (age
as on last
birthday)
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Simply use your 'Health Advantage Plus'
ID card at any of the empanelled
3500+ hospitals and avail of
cashless service, a boon for those times when
you need finance the most. This benefit is only
for hospitalisation
claims.
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You
can avail a full utilisation of tax benefit on
up to Rs. 15,000/- (Rs. 20,000 for Senior
Citizens) as premium paid under Section 80D of
the Income Tax Act,1961. This will save up to
Rs. 4635/- ^ in your tax liability in one
year. |
| ^ Indicative figure. Consult your Tax
Advisor for benefits applicable to
you. Tax benefits are subject
to changes in tax
laws. |
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Pre-existing diseases covered from the
third year onwards upon two consecutive renewals
with the
company
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Basic
Hospitalisation
Cover | |
Covers 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. |
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| Outpatient Treatment
Expenses
Cover | |
For
the first time in India, you can avail of an
insurance cover for orthopedic,
maternity, dental, pharmacy, general
practitioner and other medical expenses
incurred up to the sum insured on OPD
basis. |
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The following OPD expenses are
covered:
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 up to 30
days after expiry of the Period of
Insurance. | |
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Health Advantage Plus
Plan can be renewed instantly*
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a. The policy can be
renewed under the then prevailing Health
Advantage Plus Plan or its nearest substitute
approved by IRDA in the event that the plan has
been discontinued.
b. Renewal
Premium - Premium payable on renewal
and on subsequent continuation of cover are
subject to change with prior approval from
IRDA
c. Maximum Entry
Age – The maximum entry age under this
policy is 65 years.
d. Maximum
Renewal Age – This policy can be
renewed up to a maximum age of 70
years.
e. Floater
Benefit – The floater benefit under
this policy is available up to the age of 55
years. All floater policies thereafter will be
renewed under individual plan up to the age of
70 years.
f. Grace
Period - The Policy may be renewed by
mutual consent and in such event the renewal
premium shall be paid to the Company on or
before the date of expiry of the Policy and in
no case later than 15 days (Grace Period) from
the expiry of the Policy. Insured will be
treated as continuously covered in terms of
continuity of benefit during such Grace Period.
However, the Company shall not be liable for any
claim for the period for which the premium is
not received by the Company.
g.
Cumulative Bonus - An
Additional Sum Insured of 5% would be provided
on cumulative bases on each renewal up to a
maximum of 50% in case there is no claim under
the policy. However, 10% of the Sum Insured will
be reduced from the accumulated Additional Sum
Insured, in case there is a claim under the
policy.
h. Sum Insured
Enhancement – Sum Insured can be
enhanced only upon renewal, subject to
underwriters' approval.
i.
Inclusion / Exclusion of
Insured – This policy allows to include
or exclude a member in the plan only at the time
of renewal.
* Conditions
Apply | |
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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 above 18 years of age.
- No health check-up
up to the age of 55 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
centrers.
- 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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Exclusions for Basic
Hospitalisation Benefit
Cover | |
- 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 with the
company.
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Treatment of the
following diseases -
- Cataract **
-
Benign Prostatic Hypertrophy
- Myomectomy,
Hysterectomy unless because of malignancy
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Hernia, Hydrocele
- Fistula in Anus,
Piles
- Arthritis, Gout, Rheumatism
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Joint replacement, unless due to accident
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Sinusitis and related disorders
- Stone in
the urinary and biliary systems
- Dilatation
& Curettage
- Skin and all internal
tumours / cysts / nodules / polyps of any kind,
including breast lumps, unless malignant /
adenoids and haemorrhoids
- Dialysis required
for chronic renal failure
- Surgery on
tonsils and sinuses
- Gastric and duodenal
ulcers
- Deviated Nasal Septum
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Sub limit of Rs. 20,000 per eye is
applicable
Note: If the policy
is renewed with us for two consecutive years,
then the above mentioned diseases / illness /
ailments will be covered from the third
year.
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Exclusions for OPD
(Outpatient Department
Expenses) | |
-
Suicide or self-inflicted injury
- Alcohol or
drug abuse
- War, riots, nuclear related
hospitalisation
- Non-allopathic,
experimental and unproven treatment
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Expenses arising from treatment of HIV / AIDS or
related disease, use or misuse of alcohol and
other intoxicating substances and intentional
self-injury
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How Do I Claim My
Insurance |
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In
case of emergency or planned hospitalisation,
just use your Health ID Card at
ICICI Lombard Health Care network hospitals and
avail of cashless service. Call our
24x7 Toll-free number 1800-209-8888 for
the complete assistance. For treatment in
non-cashless hospitals, the claim form should be
filled fully after discharge from hospital and
sent to ICICI Lombard Health Care office along
with following documents in
original*
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* Only expenses
relating to hospitalisation will be reimbursed
as per the policy coverage. Non-medical expenses
will not be reimbursed.
Standard
list of documents required:
- Claim
form duly filled & signed by the insured
& doctor.
- Original discharge card/
summary & final bill.
- All investigation
reports in originals.
- All medicines /lab/
hospital bill in original.
- All payments
receipts in original and should be stamped.
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Any other required documents depending upon the
case.
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| Age of Senior Most Member
(as on his last birthday) |
Individual
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| Fixed Premium Rs.
15,000 |
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Sum Insured under Hospitalisation Benefit =
Rs. 2
Lakhs |
Sum Insured under
Hospitalisation Benefit -
Rs. 3 Lakhs |
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Age in
Years |
Sum
Insured under OPD Benefit as
below |
How
much do you save?
Total
Savings = (OPD Benefit + Tax Benefit)
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Effective Premium = (Total Premium -
Total Savings) |
Sum
Insured under OPD Benefit as
below |
How
much do you save?
Total
Savings = (OPD Benefit + Tax Benefit)
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Effective Premium = (Total Premium -
Total Savings)
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5 -
18 |
Rs.
10,000 |
Rs.
14,365 |
Rs.
635 |
Rs.
9,500 |
Rs.
14,135 |
Rs.
865 |
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19 -
35 |
Rs.
9,000 |
Rs.
13,635 |
Rs.
1,365 |
Rs.
8,800 |
Rs.
13,435 |
Rs.
1,565 |
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36 -
45 |
Rs.
8,500 |
Rs.
13,135 |
Rs.
1,865 |
Rs.
8,000 |
Rs.
12,635 |
Rs.
2,365 |
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46 -
55 |
Rs.
6,000 |
Rs.
10,635 |
Rs.
4,365 |
Rs.
5,500 |
Rs.
10,135 |
Rs.
4,865 |
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56 -
60* |
Rs.
4,500 |
Rs.
9,135 |
Rs.
5,865 |
Rs.
3,500 |
Rs.
8,135 |
Rs.
6,865 |
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Fixed Premium Rs.
20,000 |
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61 -
65 |
Rs.
7,000 |
Rs.
11,635 |
Rs.
8,365 |
Rs.
5,500 |
Rs.
10,135 |
Rs.
9,865 |
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66 -
70 (for renewal only)** |
Rs.
4,000 |
Rs.
8,635 |
Rs.
11,365 |
Rs.
2,000 |
Rs.
6,635 |
Rs.
13,365 |
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2 Adults
(Floater
Benefit) |
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Fixed Premium Rs.
15,000 |
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Sum Insured under Hospitalisation Benefit =
Rs. 2
Lakhs |
Sum Insured under
Hospitalisation Benefit -
Rs. 3 Lakhs |
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Age in
Years |
Sum
Insured under OPD Benefit as
below |
How
much do you save?
Total
Savings = (OPD Benefit + Tax Benefit)
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Effective Premium = (Total Premium -
Total Savings)
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Sum
Insured under OPD Benefit as
below |
How
much do you save?
Total
Savings = (OPD Benefit + Tax
Benefit) |
Effective Premium = (Total Premium -
Total Savings)
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5 -
18 |
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19 -
35 |
Rs.
8,000 |
Rs.
12,635 |
Rs.
2,365 |
Rs.
7,500 |
Rs.
12,135 |
Rs.
2,865 |
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36 -
45 |
Rs.
7,000 |
Rs.
11,635 |
Rs.
3,365 |
Rs.
6,500 |
Rs.
11,135 |
Rs.
3,865 |
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46 -
55 |
Rs.
3,000 |
Rs.
7,635 |
Rs.
7,365 |
Rs.
2,000 |
Rs.
6,635 |
Rs.
8,365 |
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56 -
60* |
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1) * Medical Tests mandatory for insured
aged 56 and above
2) Age is in completed
years as on last birthday
3) ** 65 years is
the maximum age of entry for this product,
renewable up to the age of 70 years
4) The
maximum benefit available under each plan shall
be as per the sum insured mentioned against each
section
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