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ICICI Lombard Health Shield 360

At ICICI Lombard, we believe that health insurance is not just a matter of saving tax or getting the protection you need. It can be so much more. It’s about partnering with you to find precisely what works for you based on your needs and then going the extra mile to deliver more than what we promise. We go about finding a policy that truly caters to your needs, based on multiple factors, some of which can be customised as per your needs. Once selected, a single policy will provide a health cover that fits you and your family like a glove.Read More

With countless features and benefits, we’re redefining the way you stay protected.Read Less

FEATURES

PLAN OPTIONS/VARIANTS

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    Health Shield 360 Gold

    • In Patient Treatment: Medical expenses incurred, for hospitalization more than 24 consecutive hours.
    • Pre Hospitalisation: Medical expenses incurred 60 days before hospitalisation will be covered.
    • Post Hospitalisation: Medical expenses incurred 90 days after hospitalisation will be covered.
    • Daycare Procedures and Treatment: All medical expenses incurred while undergoing Day Care Procedures are covered.
    • PED waiting period (Declared & Accepted): Covered immediately after 1 year of continuous coverage under the policy.
    • In Patient AYUSH hospitalisation: Hospitalisation expenses for Ayurveda, Unani, Siddha and Homeopathy (AYUSH) treatment, on reimbursement basis.
    • Donor Expenses: Medical Expenses incurred by organ donor, on organ being donated to the insured.
    • Unlimited Reset benefit4: Reset up to 100% of the cover amount unlimited times in a policy year, if insufficient because of previous claims in that policy year.
    • Domiciliary hospitalisation: Coverage for medical expenses when the Insured cannot be moved to a hospital or if rooms in the hospital are unavailable.
    • Additional Sum Insured (ASI): 10% of Annual Sum Insured provided as ASI upon renewal every claim free year up to a maximum of 100%. In case of a claim, accumulated ASI is reduced by 10% of the Annual Sum Insured in the following year.
    • Domestic Road Ambulance: Cover up to maximum of Rs.3,000 per hospitalisation for domestic ambulance service.
    • Health Check-up:  Free Health Check-up every policy year, up to Rs 1,000 per year.


    Health Shield 360 Platinum

    • Health Shield 360 Platinum = Health Shield 360 Gold + the below Add-ons as inbuilt features
    • Maternity5: Reimbursement for medical expenses incurred for delivery during hospitalisation after 3 year waiting period. For both normal and C section: Maternity limit for SI 5L = Rs 25,000 & SI 10L = Rs 50,000.
    • New Born Baby Cover5: New born child is covered up to 90 days from its date of birth. Maximum limit Rs. 10,000.

Eligibility

Documentation

  • No Documentation Needed
  • Pre Policy Medicals: Tele UW above age 55 years and also in case of declared PED. Compulsory Medicals for age above 65 years.

Exclusions

  • Any Pre-Existing condition(s) until 12 months of Your continuous coverage has elapsed, since Period of Insurance Start Date
  • Any Expenses related to the treatment of Hypertension, Diabetes, cardiac conditions within 90 days from the first policy start date
  • Any illness that you contract within 30 days of the starting date of your policy, except those that are incurred because of an accident. This clause is not applicable on the subsequent renewals
  • Any Medical Expenses incurred by You on treatment of following Illnesses within the first two (2) consecutive years of Period of Insurance Start Date:
  • Cataract
  • All types of Hernia, Hydrocele
  • Arthritis, gout, rheumatism and spinal disorders
  • Surgery on tonsils, adenoids and sinuses • Dilatation and curettage, Endometriosis
  • Gastric and Duodenal erosions and ulcers
  • Varicose Veins / Varicose Ulcers
  • Benign Prostatic Hypertrophy
  • Joint replacements unless due to accident
  • Sinusitis and related disorders
  • Stones in the urinary and billiary systems
  • Dialysis required for chronic renal failure
  • Deviated Nasal Septum
  • Fissures / Fistula in anus, hemorrhoids / piles
  • All types of internal congenital anomalies / illness / defects
  • Myomectomy, Hysterectomy unless because of malignancy
  • All types of Skin and internal tumors / cysts / nodules / polyps of any kind including breast lumps unless malignant

Permanent exclusions

  • Any illness / disease / injury pre-existing before the inception of the policy for the first year. Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations
  • Medical expenses incurred during the first 30 days of inception of the policy, except those arising out of accidents. This exclusion doesn’t apply for subsequent renewals without a break
  • 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 treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalisation) except ectopic pregnancy

Claims

Cashless Claims

  • Get admitted in any one of our network hospital
  • Fax the pre-authorization along with relevant documents (investigation reports, Previous consultation papers if any, Cashless ID, Photo ID)
  • ICICI Lombard Health Care reviews your claim requested and accordingly will approve query or reject the same (as per policy terms and conditions)
  • ICICI Lombard Health Care settles the claim (as per policy terms and conditions) with the hospital after completion of all formalities

Reimbursement Claims

  • Upon discharge, pay all hospital bills and collect all original documents of treatments and expenses underdone
  • Send the duly filled (and signed by insured and treating doctor) claim form and required claim documents
  • ICICI Lombard Health Care reviews your claim requested and accordingly will approve, query or reject the same (as per policy terms and conditions)
  • ICICI Lombard Health Care Settles the claim (as per policy terms and conditions) and reimburses the approved amount

Standard List Of Documents

  • Duly completed claim form signed by you and the medical practitioner
  • Original bills, receipts and discharge certificate / card from the hospital / medical practitioner
  • Original bills from chemists supported by proper prescription.
  • Original investigation test reports and payment receipts
  • Indoor case papers
  • Medical Practitioner’s referral letter advising hospitalisation in non-accident cases
  • Any other document as required by ICICI Lombard Health Care to investigate the claim or our obligation to make payment for the same

ICICI Lombard Health Shield 360

Disclaimer

1Tax deductions under Section 80D is as per applicable provision of the Act (including any amendments thereto) and are subject to changes in the tax laws.
2Factors determining the renewal premium are (i) age slab of the senior most insured member at the time of renewal (ii) any change in the renewing policy.
3Only when it has been undergone in a AYUSH hospital or in AYUSH Day Care Center on Re - imbursement basis.
4Please note that reset will not trigger for first claim and reset cannot be used by same person and/or for same illness for which a claim has been paid in the policy year.
5The waiting period for maternity cover is 3 years. The cover shall be limited to 2 deliveries / terminations during the period of insurance. Pre - natal and Post - natal expenses shall be covered under this benefit. This cover is applicable only for floater plan having Self and Spouse in the same policy.
8Disclaimer: Cashless approval is subject to pre-authorisation by the company. Only expenses relating to hospitalisation will be reimbursed as per the policy coverage. Non-medical expenses will not be reimbursed.
10Following is an indicative list of the policy exclusions. Please refer to the policy clause for the complete list.
#as on 31st July 2020.Read More

IDFC First Bank Limited ("Bank") with registered office at KRM Tower, 8th Floor, No.1, Harrington Road, Chetpet, Chennai- 600031 is licensed as a corporate agent of ICICI Lombard General Insurance Company Limited under license no.CA0106 issued by Insurance Regulatory & Development Authority of India and does not underwrite the risk or acts as an insurer. This policy is issued to you by ICICI Lombard and is subject to the terms and conditions governing such policy. The contract of insurance is between ICICI Lombard and the insured only, and not between IDFC First Bank and the insured. Bank’s customer participation in the policy is entirely voluntary.

This is only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before concluding a sale. ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025. . IRDA Reg.No.115. Toll Free 1800 2666. Fax No – 022 61961323. CIN (L67200MH2000PLC129408). customersupport@iciclombard.com. www.icicilombard.com. Health Shield 360. UIN: ICIHLGP22083V022122.

“Only for the customer of IDFC FIRST Bank Ltd who wish to avail Health Shield 360 insurance (Master policy no : 4177i/MSTR/249333866/00/000) underwritten by ICICI Lombard General Insurance Company Ltd.”Read Less

FREQUENTLY ASKED QUESTIONS

Why do I need Health Insurance?

Healthcare is expensive. Technological advances, new procedures and more effective medicines have driven up the cost of healthcare. This increase has to be borne by the consumer, making treatment unaffordable for too many. Health Insurance overcomes these obstacles so that you remain free of anxiety regarding your health. Think for a moment about the enormous medical costs you would incur if you suffered a major accident tomorrow or were suddenly stricken by an illness. Uninsured people live with such risks everyday. Health insurance seeks to shield you from that risk. It provides the much needed financial relief. You also get tax benefit under section 80D of the Income Tax Act and amendments made thereto.

How will health insurance pay for my emergency medical expenses?

Your health insurance will either pay your hospital bills directly if opted for the cashless facility or it will reimburse any payment made by you towards medical expenses incurred due to an illness or injury as per the policy terms.

What do you mean by Family Floater Policy?

Family Floater is one single policy that takes care of the hospitalization expenses of your entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured, as per policy terms and conditions.

Will my health insurance cover begin from day one?

When you get a new policy, there will be a 30 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurance companies. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal. Furthermore, in the case of a declared & accepted pre-existing disease or specific diseases, you will have to serve the waiting period of 2 years for these diseases / conditions.

What is pre-existing condition in health insurance policy?

It is a medical condition/disease that existed before you obtained health insurance policy.

If my policy is not renewed in time before expiry date, will it be denied for renewal?

The policy will be renewable provided you pay the premium within 30 days (called as Grace Period) of expiry date. However, coverage would not be available for the period for which no premium is received by Us. The policy will lapse if the premium is not paid within the grace period.

What happens to the policy coverage after a claim is filed?

After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement. For Example: In January you start a policy with a coverage of Rs. 5 Lakh for the year. In April, you make a claim of Rs. 2 Lakh. The coverage available to you for the May to December will be the balance of Rs. 3 Lakh.

What is Unlimited Reset Benefit?

It is a benefit that allows an insured to reinstate the entire sum insured in the policy year when it gets exhausted due to incurred claims. In case the entire cover is exhausted, it gets replenished automatically for the next hospitalization that occurs within the policy year. Reset will not trigger on first claim and cannot be used by same person for same illness for which the claim has already been paid in the policy.

More FAQs