ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED

Key Information Sheet

S. No. Title Description Refer To Policy Wordings
1 Product Name iHealth (ICICI Lombard Complete Health Insurance)
2 What am I Benefit as per Sum Insured Opted
covered for Sum Insured 2 lacs 3 lacs/ 7 lacs/ 15Lacs/
(`) 4 lacs / 10 lacs 20Lacs /
5 lacs / 30Lacs
50Lacs
In Patient treatment Covers Hospital expenses for admission longer than 24 hours
Pre & Post Medical Expenses incurred due to Illness up to 30
Hospitalisation days period immediately before nd 60 days immediately after an d. Benefits covered under the
Insured a Person's admission to a Hospital policy
Day Care Procedure Medical expenses for day care procedures where such
procedures are undertaken by an Insured Person as an In-patient
in a Hospital for continuous period of less than 24 hours
In Patient AYUSH Reimbursement of expenses for AYUSH treatment Extension 5 - Domestic Road
Hospitalisation Emergency Ambulance Cover
Domestic Road Ambulance expenses incurred to transfer the Insured Person
Emergency following an emergency to the nearest Hospital. Maximum d. Benefits covered under the
Ambulance amount payable is ` 1,500 per event of emergency policy
hospitalization
Cover for Pre After 4 Years After 2 Years
Existing disease
Wellness Program Wellness program intends to promote, incentivize and reward the
insured person for their healthy behavior. Wellness points
accumulated can be redeemed against out-patient expenses like
consultation charges, medicines/drugs, diagnostic expenses etc.
Additional Sum An additional sum insured of 10% of annual sum insured for each
Insured completed and continuous claim free Policy Year subject to a
(Cumulative bonus) maximum of 50%
Reset Benefit Not Applicable Applicable
3 Optional Add On Hospital Daily Cash Allowance per day for hospital stay of minimum 3 consecutive Extension 1 - Hospital Daily Cash
Covers days or more up to a maximum of 10 consecutive days.

` 500 per Day ` 1,000 per ` 2,000 per ` 3,000 per

day day day
Convalescence ` 10,000 prvided once for each Policy year during Policy Period, in Extension 2 - Convalescence Benefit
Benefit case of Hospitalisation of minimum 10 consecutive days or more
Critical Illness Critical Illness cover for specified critical Illnesses/ medical Extension 7 - Critical Illness Cover
procedures like Cancer of specified severity, open chest CABG,
First heart attack, major organ/bone marrow transplant,
permanent paralysis of limbs, Kidney failure requiring regular
dialysis, end stage liver disease; subject to a maximum of 2 adults.

NA 100% of policy SI 50% of policy SI

 S. No. Title Description Refer To Policy Wordings
Donor Expenses Medica l Expenses incurred in respect of the donor for any of Extension 9 - Donor Expenses
the organ transplant surgery, provided the organ donated is for
Insured persons, subject to a maximum of 2 adults
NA Up to ` 50,000
4 Value Added • Free health check-up coupon to Insured for every Policy Year, d. Benefits covered under the
Services subject to a maximum of 2 coupons per year for floater policies. policy
• Online Chat with Medical Practitioners
• Specialist e-Consultation with One Follow-up session
• Diet & Nutrition e-consultation
5 What are the Note: Following is an indicative list of the policy exclusions. e. exclusions
major Exclusions Please refer to the policy clause for the complete list.
in the Policy • Acupressure, acupuncture, magnetic and such other therapies
• Excl16:Unproven treatments
• Excl08: Cosmetic or plastic surgery
• Dental treatment unless due to accident
• Excl10: Breach of law
6 Waiting Period (a) Pre-existing diseases: Covered after 24 months (48 months, for plans e. Exclusions
with Sum Insured up to 2Lacs) of continuous coverage. e. I. 1
(b) Specific waiting period: First 24 months, for specific Illness and e. i. 3
treatment. (Please refer to the policy clauses for the full listing) e. I. 2
(c) In case of hypertension, diabetes and cardiac conditions, the waiting e. i. 4
period will be 90 days unless disclosed as pre-existing
(d) Initial waiting period: 30 days for all illnesses (except Hospitalisation
due to injury).
(e) Critical illness: waiting period of 90 days will be applicable
7 Payout Basis • Cashless or Reimbursement of covered medical expenses up to specified Sum g. Other Terms and Conditions
Insured as per the scope of cover
• Claim Service Guarantee
• Cashless Facility available at over 6500+ network hospitals.
8 Sub Limit (a) Cataract, where sub-limit of ` 20,000/- is applicable per eye per Policy year for e. i. 2
Plans with Sum Insured up to 5Lacs. Sub limit of ` 1,00,000 per eye per Policy year
will be applicable for cataract treatment for plans with Sum Insured above ` 5Lacs
(b) Sub limit options of A and B available for Sum Insured option 2 lacs and Sub limit C
option is available for 3 lacs /4 lacs/ 5 lacs.
(c) No Sub limits applicable on Sun Insured 7lacs/ 10lacs.
9 Renewal Condition (a) Maximum renewal age - There will be life-long renewable without any age restriction f. General Terms and Clauses
for the cover. However Premium at the time of renewal is subject to change with
change in age band.
(b) Grace Period - The renewal premium shall be paid to Us on or before the date of
expiry of the Policy and in no case later than 30 days (Grace Period) from the expiry
of the Policy.
(c) Floater Benefit - The floater benefit under this policy is available up to Lifetime
10 Renewal Benefits (a) Cumulative Bonus (Additional Sum Insured) - An Additional Sum Insured of 10% of d. Benefits covered under the
Annual Sum Insured provided on each renewal for every claim-free year up to a policy
maximum of 50%. In case of a claim under the policy, the accumulated Additional
Sum Insured will be reduced by 10% of the Annual Sum Insured in the following year.
(b) Complimentary Health Check Up Coupons: One coupon per individual
policy and two coupons per Floater policy will be offered.
11 Cancellation a) Disclosure to information norm: The policy shall be void and all premium paid f. General terms and clauses
hereon shall be forfeited to the company, in the event of misinterpretation,
mis-description or non-disclosure of any material fact.

UIN: ICIHLIP22096V062122
 Policy Wordings
b. Preamble (Explanation: Medical practitioner referred in the definition of “AYUSH
Hospital” and “AYUSH day care center” shall carry the same meaning as
ICICI Lombard General Insurance Company Limited ("We/ Us"), having
defined in the definition of “Medical practitioner” under chapter I of
received a Proposal and the premium from the Policy Holder named in Part a of
Guidelines)
the Policy (hereinafter referred to as the "Policy Schedule") and the said
Proposal and Declaration together with any statement, report or other Cashless Facility means a facility extended by the insurer to the insured
document leading to the issue of this Policy and referred to therein having where the payments, of the costs of treatment undergone by the insured in
been accepted and agreed to by Us and the Policy Holder as the basis of this accordance with the policy terms and conditions, are directly made to the
contract do, by this Policy agree, in consideration of and subject to the due network provider by the insurer to the extent pre-authorization approved.
receipt of the subsequent premiums, as set out in the Policy Schedule, and
Condition Precedent shall mean a policy term or condition upon which the
further, subject to the terms and conditions contained in this Policy that on
Insurer's liability under the policy is conditional upon.
proof to Our satisfaction of the compensation having become payable as set
out in the Policy Schedule to the title of the said person or persons claiming Congenital Anomaly refers to a condition(s) which is present since birth, and
payment or upon the happening of an event upon which one or more benefits which is abnormal with reference to form, structure or position.
become payable under this Policy, the Annual Sum Insured/ appropriate a) Internal Congenital Anomaly - Congenital anomaly which is not in the
benefit amount will be paid by Us. visible and accessible parts of the body
c. DEFINITIONS b) External Congenital Anomaly - Congenital anomaly which is in the
For the purposes of this Policy, the terms specified below shall have the visible and accessible parts of the body
meaning set forth wherever appearing/specified in this Policy or related Co-payment means a cost sharing requirement under a health insurance
Extensions: policy that provides that the policyholder/insured/proposer will bear a
Where the context so requires, references to the singular shall also include specified percentage of the admissible claims amount. A co-payment does
references to the plural and references to any gender shall include references not reduce the Sum Insured.
to all genders. Further any references to statutory enactment include Cumulative Bonus shall mean any increase or addition in the Sum Insured
subsequent changes to the same granted by the insurer without an associated increase in premium.
i. Standard Definitions (Definitions whose wordings are specified by Day care centre means any institution established for day care treatment of
IRDAI) illness and/or injuries or a medical setup with a hospital and which has been
Accident means a sudden, unforeseen and involuntary event caused by registered with the local authorities, wherever applicable, and is under
external, visible and violent means. supervision of a registered and qualified medical practitioner AND must
comply with all minimum criterion as under –
Any one illness means continuous Period of illness and it includes relapse
within 45 days from the date of last consultation with the Hospital/Nursing a) has qualified nursing staff under its employment;
Home where treatment may have been taken. b) has qualified medical practitioner/s in charge
Ayush Hospital is a healthcare facility wherein medical/surgical/para- c) has fully equipped operation theatre of its own where surgical
surgical treatment procedures and interventions are carried out by AYUSH procedures are carried out;
Medical practitioner(s) comprising of any of the following:
d) maintains daily records of patients and will make these accessible to
a) Central or State government AYUSH hospital; or the insurance company’s authorized personnel
b) Teaching hospital attached to AYUSH college recognized by the central Day Care Treatment refers to medical treatment, and/or Surgical Procedure
government/Central council of Indian medicine/ Central council for which is
Homeopathy; or
1.1 undertaken under General or Local Anesthesia in a Hospital/Day care
c) AYUSH Hospital, standalone or co-located with in-patient healthcare centre in less than 24 hrs because of technological advancement, and
facility of any recognized system of medicine, registered with the local
authorities, wherever applicable, and is under the supervision of a 1.2 which would have otherwise required a hospitalisation of more than 24
qualified registered AYUSH medical practitioner and must comply with hours.
the following criterion: Treatment normally taken on an out-patient basis is not included in the scope
i. Having at least 5 in-patient beds of this definition.
ii. Having qualified AYUSH medical practitioner in charge round the Deductible is a cost sharing requirement under a health insurance policy that
clock provides that provides that the insurer will not be liable for specified rupee
amount in case of indemnity policies and for a specified number of days/hours
iii. Having dedicated AYUSH therapy sections as required and/or has in case of hospital cash policy, which will apply before any benefits are
equipped operation theatre where surgical procedures are to be payable by the insurer This is to clarify that a deductible does not reduce the
carried out; sum insured.
iv. Maintaining daily records of the patients and making them Dental treatment means a treatment related to teeth or structures
accessible to the insurance company’s authorized representative supporting teeth including examinations, fillings (where appropriate),
AYUSH Day Care Centre means and includes Community Health Centre crowns, extractions and surgery
(CHC), Primary Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such Disclosure to information Norm means the policy shall be void and all
health centre which is registered with the local authorities, wherever premium paid thereon shall be forfeited to the Company in the event of
applicable and having facilities for carrying out treatment procedures and misrepresentation, mis-description or non-disclosure of any material fact
medical or surgical/para-surgical interventions or both under the supervision
of registered AYUSH Medical Practitioner (s) on day care basis without in- Domiciliary Hospitalisation means medical treatment for an illness/ disease
patient services and must comply with all the following criterion: / injury which in the normal course would require care and treatment at a
hospital but is actually taken while confined at home under any of the
a) Having qualified registered AYUSH Medical Practitioner(s) in charge; following circumstances:
b) Having dedicated AYUSH therapy sections as required and/or has a) the condition of the patient is such that he/she is not in a condition to be
equipped operation theatre where surgical procedures are to be carried removed to a hospital, or
out;
b) the patient takes treatment at home on account of non-availability of
c) Maintaining daily records of the patients and making them accessible room in a hospital.
to the insurance company’s authorized representative.

UIN: ICIHLIP22096V062122
 Emergency Care means management for an illness or injury which results in Medical Advice means any consultation or advice from a Medical
symptoms which occur suddenly and unexpectedly, and requires immediate Practitioner including the issuance of any prescription or repeat prescription.
care by a medical practitioner to prevent death or serious long term
Medical Expenses means those expenses that an Insured Person has
impairment of the insured person’s health
necessarily and actually incurred for medical treatment on account of Illness
Grace Period means the specified period of time immediately following the or Accident on the advice of a Medical Practitioner, as long as these are no
premium due date during which a payment can be made to renew or continue more than would have been payable if the Insured Person had not been
a policy in force without loss of continuity benefits such as waiting periods insured and no more than other hospitals or doctors in the same locality would
and coverage of Pre Existing Diseases. Coverage is not available for the period have charged for the same medical treatment.
for which no premium is received.
Medically Necessary Treatment is defined as any treatment, tests
Hospital means any institution established for in- patient care and day care medication or stay in hospital or part of a stay in Hospital which
treatment of illness and / or injuries and which has been registered as a
a) Is required for the medical management of the illness or Injury suffered
hospital with the local authorities under the Clinical Establishments
by the insured
(Registration and Regulations) Act 2010 or under enactments specified under
the Schedule of Section 56(1) of the said Act Or comply with all minimum b) Must not exceed the level of care necessary to provide safe, adequate
criteria as under: and appropriate medical care in scope, duration or intensity
a) has qualified nursing staff under its employment round the clock; c) Must have been prescribed by a Medical practitioner
b) has at least 10 inpatient beds, in those towns having a population of d) Must conform to the professional standard widely accepted in
less than 10,00,000 and 15 inpatient beds in all other places international medical practice or by the medical community in India
c) has qualified medical practitioner(s) in charge round the clock; Migration means the right accorded to health insurance policy holders
/proposers (including all members under family cover and members of group
d) has a fully equipped operation theatre of its own where surgical
Health insurance policy), to transfer the credit gained for pre-existing
procedures are carried out
conditions and time bound exclusions, with the same insurer.
e) maintains daily records of patients and makes these accessible to the
Network Provider means hospitals or health care providers enlisted by an
Insurance company’s authorized personnel.
insurer, TPA or jointly by an insurer and TPA to provide medical services to an
Hospitalisation means admission in a Hospital for a minimum period of 24 insured by a cashless facility.
consecutive in-patient care hours except for specified
Newborn Baby means baby born during the Policy Period and is aged upto 90
Procedures/Treatments, where such admission could be for a period of less
days.
than 24 consecutive hours.
Non-Network Provider means any Hospital, day care centre or other
Illness means a sickness or disease or pathological condition leading to the
provider that is not part of the Network.
impairment of normal physiological function and requires medical treatment.
Notification of claim means the process of intimating a claim to the insurer
a) Acute condition - Acute condition is a disease, illness or injury that is
or TPA through any of the recognized modes of communication
likely to respond quickly to treatment which aims to return the person to
his or her state of health immediately before suffering the OPD treatment is one in which the Insured visits a clinic / hospital or
disease/illness/injury which leads to full recovery. associated facility like a consultation room for diagnosis and treatment based
on the advice of a Medical Practitioner. The Insured is not admitted as a day
b) Chronic condition - A chronic condition is defined as a disease, illness,
care or in-patient.
or injury that has one or more of the following characteristics:
Portability means the right accorded to an individual health insurance
i. it needs ongoing or long-term monitoring through consultations,
policyholder/proposers (including all members under family cover), to
examinations, check-ups, and / or tests
transfer the credit gained for pre-existing conditions and time bound
ii. it needs ongoing or long-term control or relief of symptoms exclusions, from one insurer to another insurer
iii. it requires your rehabilitation for the patient or for the patient to be Pre-existing Disease means any condition, ailment, injury or disease
specially trained to cope with it
a) That is/ are diagnosed by a physician within 48 months prior to the
iv. it continues indefinitely effective date of the policy issued by the insurer or its reinstatement or
v. It recurs or is likely to recur b) For which medical advice or treatment was recommended by, or
received from, a physician within 48 months prior to the effective date
Injury means any accidental physical bodily harm, excluding illness or
of the policy issued by the insurer or its reinstatement.
disease solely and directly caused by external, violent, visible and evident
means which is verified and certified by a Medical Practitioner. Post-Hospitalisation Medical Expenses means medical expenses incurred
during predefined number of days immediately after the Insured Person is
Inpatient care means treatment for which the insured person has to stay in a
discharged from the hospital, provided that:
Hospital for more than 24 hours for a covered event.
a) Such Medical Expenses are for the same condition for which the
Intensive Care Unit means an identified section, ward or wing of a hospital
Insured Person’s Hospitalisation was required, and
which is under the constant supervision of a dedicated medical
practitioner(s), and which is specially equipped for the continuous monitoring b) The In-patient Hospitalisation claim for such Hospitalisation is
and treatment of patients who are in a critical condition, or require life support admissible by the Insurance Company.
facilities and where the level of care and supervision is considerably more
Pre-Hospitalisation Medical Expenses means medical expenses incurred
sophisticated and intensive than in the ordinary and other wards
during predefined number of days preceding the hospitalization of the insured
ICU (Intensive Care Unit) Charges means the amount charged by a Hospital person, provided that: :
towards ICU expenses which shall include the expenses for ICU bed, general
a) Such Medical Expenses are incurred for the same condition for which
medical support services provided to any ICU patient including monitoring
the Insured Person’s Hospitalisation was required, and
devices, critical care nursing and intensivist charges.
b) The In-patient Hospitalisation claim for such Hospitalisation is
Maternity expenses shall
admissible by the Insurance Company.
a) include medical treatment expenses traceable to childbirth (including
Qualified Nurse is a person who holds a valid registration from the Nursing
complicated deliveries and caesarean sections incurred during
Council of India or the Nursing Council of any state in India.
Hospitalisation);
Reasonable and Customary Charges means the charges for services or
b) expenses towards lawful medical termination of pregnancy during the
supplies, which are the standard charges for the specific provider and
policy period
consistent with the prevailing charges in the geographical area for identical or
similar services, taking into account the nature of Illness/injury involved.

UIN: ICIHLIP22096V062122
 Renewal defines the terms on which the contract of insurance can be who executed the Policy Schedule and is (are) responsible for payment of
renewed on mutual consent with a provision of grace period for treating the premium(s).
renewal continuous for the purpose of gaining credit for pre-existing
Policy Period means the period commencing from the Policy Period Start
diseases, time-bound exclusions and for all waiting periods.
Date, Time and ending at the Policy Period End Date, Time of the Policy and as
Room Rent means the amount charged by a hospital towards Room and specifically appearing in the Policy Schedule.
Boarding expenses and shall include associated medical expenses.
Policy Year means a period of twelve months beginning from the Policy
Subrogation shall mean the right of the insurer to assume the rights of the Period Start Date and ending on the last day of such twelve-month period. For
insured person to recover expenses paid out under the policy that may be the purpose of subsequent years, “Policy Year” shall mean a period of twelve
recovered from any other source. months beginning from the end of the previous Policy Year and lapsing on the
last day of such twelve-month period, till the Policy Period End Date, as
Surgery or Surgical Procedure means manual and/or operative procedure
specified in the Policy Schedule
(s) required for treatment of an illness or injury, correction of deformities and
defects, diagnosis and cure of diseases, relief of suffering or prolongation of Senior Citizen means any person who has completed sixty or more years of
life, performed in a hospital or day care centre by a Medical Practitioner age as on the date of commencement or renewal of a health insurance policy.
Unproven/ Experimental treatment means treatment including drug Service Provider means any person, organization, institution, or company
experimental therapy which is not based on established medical practice in that has been empanelled with Us to provide services specified under the
India, is treatment experimental or unproven. Benefits (including add-ons) to The Insured person. These shall also include
all healthcare providers empanelled to form a part of network other than
ii. Specific definitions (Definitions other than those mentioned under c.i.
hospitals.
above)
The list of the Service Providers is available at our website
Admission means Your admission in a Hospital as an inpatient for the purpose
(https://www.icicilombard.com/content/ilom-en/serviceprovider/search.
of medical treatment of an Injury and/or Illness.
asp) and is subject to amendment from time to time.
AYUSH treatments refers to the medical aid and / or hospitalisation
You/Y our/ Yours/ Yourself means the person(s) that We insure and is/are
treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and
specifically named as Insured / Insured Person(s) in the Policy Schedule.
Homeopathy systems
We/ Our/ Ours/ Us means the ICICI Lombard General Insurance Company
Annual Sum Insured means and denotes the maximum amount of cover
Limited
available to You during each Policy Year of the Policy Period, as stated in the
Policy Schedule or any revisions thereof based on Claim settled under the d. Benefits covered under the policy
Policy.
1. In-patient Treatment
Break in Policy occurs at the end of the existing policy term, when the
We hereby agree subject to terms, conditions and exclusions herein
premium due for renewal on a given policy is not paid on or before the
contained or otherwise expressed here on that, if during the Policy -
premium renewal date or within 30 days thereof.
year, You require Hospitalisation for any Illness or Injury on the written
Contribution is essentially the right of an insurer to call upon other insurers, advice of a Medical Practitioner, then We will indemnify the Medical
liable to the same insured, to share the cost of an indemnity claim on a Expenses so incurred by You.
rateable proportion of Sum Insured. This clause shall not apply to any Benefit
However, Our total liability under this Policy for payment of any and all
offered on fixed benefit basis.
Claims in aggregate during each Policy Year of the Policy Period shall
Claim means a demand made by You or on Your behalf for payment of Medical not exceed the Maximum Limit of Indemnity as stated in the Policy
Expenses or any other expenses or benefits, as covered under the Policy. Schedule.
Immediate Family means spouse, dependent children, brother(s), sister(s) 2. Day Care Procedures/Treatment
and dependent parent(s) of the insured.
We hereby agree subject to terms, conditions and exclusions herein
Insured/ Insured Person(s) means the individual(s) whose name(s) is/are contained or otherwise expressed hereon that, if during the Policy -
specifically appearing as such in the Policy Schedule and is/are hereinafter year, You require Hospitalisation as an inpatient for less than 24 hours in
referred as “You”/“Your”/ “Yours”/ “Yourself” a Hospital (but not in the outpatient department of a Hospital) on the
written advice of a Medical Practitioner, then We will pay You for the
Maximum limit of indemnity means the sum total of annual sum insured,
Medical Expenses incurred for undergoing such Day Care Procedure/
additional sum insured (if any) and super no claim bonus (if opted and accrued
Treatment or surgery, However, Our total liability under this cover for
by the insured)/ Sum Insured Protector (if opted by the insured)
payment of any and all Claims in aggregate during each Policy Year of
Medical Practitioner is a person who holds a valid registration from the the Policy Period shall not exceed the Maximum Limit of Indemnity as
Medical Council of any State or Medical Council of India or Council for Indian stated in the Policy Schedule.
Medicine or for Homeopathy set up by the Government of India or a State
3. Pre-Hospitalisation and Post-Hospitalisation Expenses
Government and is thereby entitled to practice medicine within its
jurisdiction; and is acting within the scope and jurisdiction of his license. We hereby agree subject to the terms, conditions and exclusions
herein contained or otherwise expressed here on that, We will
The term Medical Practitioner would include physician, specialist,
compensate You for the relevant Medical Expenses incurred by You in
anaesthetist and surgeon but would exclude You and Your spouse, Your
relation to:
children, Your brother(s), Your sister(s) and Your parent(s).
i. Pre-hospitalisation Medical Expenses incurred by You for a 30-day
For the purposes of worldwide cover, Medical practitioner would mean a
period immediately prior to Your Hospitalisation; and
person who holds a valid registration from the Medical council of the
respective country where the treatment is being taken by the insured ii. Post-hospitalisation Medical Expenses incurred by You for a 60-day
period immediately post Hospitalisation, provided that Your
Period of Insurance means the period as specifically appearing in the Policy
Hospitalisation falls within the Policy year and We have accepted
Schedule and commencing from the Policy Period Start Date of the first Policy
Your Claim under "In-patient Treatment" or "Day Care Procedures"
taken by You from Us and then, running concurrent to Your current Policy
section of the Policy. However, Our total liability under this Policy for
subject to the Your continuous renewal of such Policy with Us.
payment of any and all Claims in aggregate during each Policy Year
Policy means these Policy wordings, the Policy Schedule and any applicable of the Policy Period shall not exceed the Maximum Limit of
endorsements or extensions attaching to or forming part thereof. The Policy Indemnity as stated in the Policy Schedule.
contains details of the extent of cover available to You, what is excluded from
4. In Patient AYUSH Hospitalisation - We will reimburse expenses for
the cover and the terms & conditions on which the Policy is issued to You.
AYUSHtreatment only when the treatment has been undergone in a
Proposer means the person(s) or the entity named in the Policy Schedule AYUSH Hospital or AYUSH Day Care centre.

UIN: ICIHLIP22096V062122
 We will not cover expenses for hospitalisation done for evaluation or Medical Risk Assessment
investigation only. Treatment taken at a healthcare facility which is not
We will reward You with wellness points on undergoing medical checkup,
a Hospital are also excluded.
using complimentary checkup coupons provided with policy, anytime during
owever, Our total liability under this Policy for payment of any and all the policy period. We will help You in getting the appointment fixed at Our
Claims in aggregate during each Policy Year of the Policy Period shall empanelled centers or We will arrange home visit wherever necessary. You
not exceed the Maximum Limit of Indemnity as stated in the Policy will be awarded 1,000 wellness points per insured, maximum up to 2,000
Schedule. points per floater policy on undergoing these tests.
5. Reset Benefit Second year onwards, if Your medical test results are in normal limits,
additional 1,000 wellness points per insured, maximum up to 2,000 points per
For plans with Sum Insured ` 3lacs and above, We will reset up to
floater policy will be awarded for maintenance of health. We will
100% of the Sum insured once in a policy year in case the Sum insured
communicate the findings of this assessment to You and advice You
including accrued Additional Sum Insured (if any) is insufficient as a
appropriately.
result of previous claims in that policy year, provided that:
Preventive Risk Assessment
• The total amount of reset will not exceed the Sum Insured for that policy
year You can also earn wellness points by undergoing certain other diagnostic
and preventive health check up (Specified in list given below or as suggested
• The reset amount can only be used for all future claims within the same
by Our empanelled medical experts) at any diagnostic centre at Your own
policy year, not related to the illness/ disease/ injury for which a claim
expenses. You shall have to submit medical reports of these tests to Us.
has been paid in that policy year for the same person
List of Additional tests and corresponding wellness points per Policy Year:
• The claim will be admissible under the reset only if the claim is
admissible as per section d. “benefits covered under the policy”
Test For whom Wellness Points
• Reset will not trigger for the first claim
Heart related screening tests
• For individual policies, reset Sum Insured will be available on individual (2D echo/ TMT) Above 45 years 500
basis whereas for floater policies, it will be available on floater basis
HbA1c / Complete lipid profile Any age 500
• Any unutilized reset Sum Insured will not be carried forward to
PAP Smear Females above age 45 500
subsequent policy year
Mammogram Females above age 45 500
• Such reset will be available only once during a Policy year to each
insured in case of individual policy and can be utilized by insured Prostate Specific Antigen (PSA) Males above age 45 500
persons who stand covered under the Policy before the Sum Insured Any other test as suggested by
was exhausted. Our empanelled Medical expert As suggested 500
• For any single claim during a policy year, the maximum claim amount
payable shall not exceed the sum of C. Disease Management Services

1. The Sum Insured, and In case Your medical tests indicate any health irregularities, We will help You
track Your health through Our empanelled medical experts who will guide You
2. Additional Sum Insured in maintaining/ improving Your health condition. We may also provide
• During a Policy Year, the aggregate claim amount payable, shall Dietician and nutritional counseling as per Your health condition.
not exceed the sum of: D. Medical Concierge Services
1. The Sum Insured You can also contact Us to avail the following services:
2. Additional Sum Insured • Emergency assistance information such as nearest ambulance /
3. Reset Sum Insured hospital / blood bank etc.

6. Wellness Program • Second opinion provided through electronic mode: E-opinion (Second
opinion) of an empanelled medical expert and/or agency.
Wellness program intends to promote, incentivize and reward You for
Your healthy behavior through various wellness services. All the • Referral for medical service provider, evacuation/ repatriation
wellness activities as mentioned below make You earn wellness services, home nursing care etc
points which will be tracked by Us. You can redeem these wellness E. Affinity to wellness
points as per Our redemption terms and conditions
We will provide You information on health and wellness training, online fitness
The wellness services and activities are categorized as below: portals, sporting events, various sports and health related applications,
1. Manage and track Your health latest fitness accessories through periodic communications like e-mailers,
blogs, forums etc. and will reward You for undertaking any of the fitness &
• Online Health Risk Assessment (HRA) health related activities as given below.
• Medical Risk Assessment List of Fitness initiatives and wellness points
• Preventive Risk Assessment Initiatives Wellness Points
2. Disease Management Services Gym/ Yoga membership for 1 year 2,500
3. Medical Concierge Services Participation in Professional sporting events like
4. Affinity to Wellness Marathon/ Cyclothon/ Swimathon etc. 2,500
Participation in any other health & fitness activity/
B Manage & Track Your Health: Online event organized by Us 2,500
Health Risk Assessment (HRA)
You have to provide Us relevant receipts/ bills and /or certificates indicating
The Health Risk Assessment (HRA) questionnaire is a tool for evaluation of participation and completion of these activities. These fitness centers, gym,
health and quality of life. It helps You review Your personal lifestyle practices yoga centers etc and the companies organizing these fitness initiatives
which may impact your health status. You can log into Your account on Our should be legally registered entities as per rules, regulations as applicable by
website www.icicilombard.com and take HRA. This can be undertaken once governing law.
per policy year per insured person.
As per the above mentioned activities, You can earn maximum 5,000
On taking online HRA test, You can earn 250 wellness points per insured, wellness points per insured, and maximum 10,000 wellness points per floater
maximum up to 500 points per floater policy. policy.

UIN: ICIHLIP22096V062122
 You can also earn 100 wellness points for each of the following activities: a) Free health check-up coupons to each insured for every Policy Year,
subject to a maximum of 2 coupons per year for floater policies.
• Quit smoking - based on Self declaration
b) Vaccination care cover
• Share Your fitness success story
c) E-opinion (Second opinion) of an expert Medical Practitioner from Our
• On winning any Health quiz organized by Us
designated centers, with respect to critical Illnesses and procedures
Redemption of Wellness Points
d) Other value added services
Each wellness point will be equivalent to ` 0.25. Wellness points not
i. Diet & nutrition e-consultation
redeemed in the given policy year can be carry forwarded maximum up to 3
years from the date of awarding of these points, provided the policy is ii. Online Chat with Medical Practitioners
renewed continuously for subsequent 3 years. You can redeem these
iii. Provide information on offers related to healthcare services like
wellness points against outpatient medical expenses like consultation
consultation, diagnostics, medical equipment and pharmacy
charges, medicine & drugs, diagnostic expenses, dental expenses, wellness
& preventive care and other miscellaneous charges not covered under any e) Health assistance: We also provide Health Assistance as a part of Our
medical insurance, through our Network providers, the list of which will be Value added services, Our Health Assistance Team (HAT) will assist the
updated on our website www.icicilombard.com from time to time. In case Insured Person in understanding his/her health condition better by
cashless facility is not available for wellness points' redemption at these providing answers to any queries related to health and health care
network centres, You can avail reimbursement by submitting relevant providers on Our dedicated helpline. To avail this service, the Insured
documents with Us. Person may call Our helpline on 040-66274205 (please note that this
number is subject to change).
Terms and conditions under wellness services
The services provided under this shall include:
• Any information provided by You in this regard shall be kept
confidential. • Identifying a Physician/ Specialist
• You should notify and submit relevant documents, reports, receipts etc • Scheduling an appointment with any Medical Practitioner empanelled
for various wellness activities within 60 days of undertaking such with Us
activity. • Scheduling appointments for a second opinion
• For services that are provided through empanelled service provider, We • Providing suitable options with respect to Hospitals as well as
are only acting as a facilitator; hence would not be liable for any providing assistance in Cashless facility, wherever applicable.
incremental costs or the services.
• Providing preventive information on ailments
• All medical services are being provided by empanelled health care
service provider. We ensure full due diligence before empanelment. • Providing guidance on post Hospitalization care, such as
However You should consult Your doctor before availing/taking the Physiotherapy/ Nursing at home.
medical advices/services. The decision to utilize these Please note that services provided under this Benefit are solely for
advices/services is solely at Your discretion. assistance, and should not be construed to be a substitute for a visit/
• There will not be any cash redemption against the wellness points. consultation to an independent Medical Practitioner. This Benefit does not
include the charges for any independent Medical Practitioner/nutritionist
• ICICI Lombard, its group entities, or affiliates, their respective directors, consulted on HAT’s recommendation, and such charges are to be borne by
officers, employees, agents, vendors, is not responsible for or liable for, the Insured Person. We do not accept any liability towards quality of the
any actions, claims, demands, losses, damages, costs, charges and services made available by our network providers/ service providers and are
expenses which a Member claims to have suffered, sustained or not liable for any defects or deficiencies on their part
incurred, by way of and / or on account of the Program.
While deciding to obtain such value-added service, You expressly note and
Services offered are subject to guidelines issued by IRDA from time to time agree that it is entirely for You to decide whether to obtain these services and
7. Additional Sum Insured (Cumulative Bonus) - It is hereby declared and also to decide the use (if any) to which these services is to be put for
agreed that notwithstanding anything to the contrary in the Policy, at the time Extensions/ Endorsements available under ICICI
of renewal of this Policy, We will provide an additional sum insured
(Cumulative Bonus) provided that there is no Claim under this Policy Lombard Complete Health Insurance
Mandatory Extensions/ Endorsements under the Plan The Benefits listed
Tenure Additional Sum Insured as a
below shall be available to the Insured Person only if the additional premium
percentage of Annual Sum
has been received by Us and the Benefit is specified to be in force for that
insured
Insured Person in the Policy Schedule.
For all insured persons
Benefits under this Section are subject to the terms, conditions, waiting
For each completed and periods and exclusions of this Policy and in accordance with the applicable
continuous Policy Year subject to Plan as specified in the Policy.
a maximum of 50% 10%
Extension 5: Domestic Road Emergency Ambulance Cover
However, in the event of a Claim under the Policy during any subsequent
Policy year, the accrued Additional Sum Insured will be reduced by 10% of the In consideration of the payment of additional premium to Us, it is hereby
Annual Sum Insured at the time of renewal of this Policy. This extension is also declared and agreed that notwithstanding anything to the contrary in the
subject to the following: Policy and subject always to the Annual Sum Insured for this Extension, We
will reimburse You up to a maximum of `1500/- per
In relation to a Floater Benefit cover, the Additional Sum Insured so accrued
during the Claim-free Policy year(s) will also be on floater basis and will only Hospitalisation, for the reasonable expenses incurred by You on availing
be available to those Insured Person(s) who were insured in such Claim-free ambulance services offered by a Hospital or by an ambulance service
Policy year(s) and continue to be insured in the subsequent Policy years provider for Your necessary transportation to the nearest Hospital in case of a
life threatening emergency condition, provided however that, a Claim under
8. Value-Added Services this extension shall be payable by Us only when:
Notwithstanding anything to the contrary in the Policy, We at your request (i) Such life threatening emergency condition is certified by the Medical
will arrange for You or will facilitate You in availing any of the following Practitioner, and
additional services subject to a limit as specified in the Policy Schedule, on
issuance or upon renewal of the Policy for a continuous period from Period of (ii) We have accepted Your Claim under "In-patient Treatment" or "Day Care
Insurance Start Date, as specified in the Policy Schedule, including but not Procedures" section of the Policy.
limited to:- Subject otherwise to the terms, conditions and exclusions of the Policy

UIN: ICIHLIP22096V062122
 Following extensions are being offered to You as optional covers under v. All Thyroid cancers histologically classified as
this product. These benefits are available w.r.t. the members, for whom
T1N0M0 (TNM Classification) or below vi. Chronic lymphocyctic
these optional covers have been opted by You by paying additional
leukaemia less than RAI stage 3 vii. Non-invasive papillary cancer of the
premium.
bladder histologically described as TaN0M0 or of a lesser classification,
Extension 1: Hospital Daily Cash
viii. All Gastro-Intestinal Stromal Tumors histologically classified as
In consideration of the payment of additional premium to T1N0M0 (TNM Classification) or below and with mitotic count of less
than or equal to 5/50 HPFs;
Us, it is hereby declared and agreed that notwithstanding anything to the
contrary in the Policy and subject always to the Annual Sum Insured for this 2) Open chest CABG
Extension, We will pay You a daily cash amount, as stated against this
The actual undergoing of open chest surgery for the correction of one or more
Extension in the
coronary arteries, which is/are narrowed or blocked, by coronary artery
Policy Schedule, for each and every completed day of bypass graph (CABG). The diagnosis must be supported by a coronary
angiography and the realization of surgery has to be confirmed by a specialist
Hospitalisation up to a maximum of 10 consecutive days, if such
medical practitioner.
Hospitalisation is at least for a minimum of 3 consecutive days and it falls
within the Policy Year. The Claim under this extension will be payable only if The following will be excluded:
We have admitted Our liability under "In-patient Treatment" section of the
I. Angioplasty and/or any other intra-arterial procedures
Policy.
3) First heart attack - of specified severity The first occurrence of
Subject otherwise to the terms, conditions and exclusions of the Policy
myocardial infarction which means the death of a portion of the heart muscle
Extension2: Convalescence Benefit as a result of inadequate blood supply to the relevant area. The diagnosis for
this will be evidenced by all of the following criteria:
In consideration of the payment of additional premium to Us, it is hereby
declared and agreed that notwithstanding anything to the contrary in the 8. a history of typical clinical symptoms consistent with the diagnosis of
Policy, We will pay You an amount of ` 10,000 if You are Hospitalized for a Acute Myocardial Infarction (for e.g. typical chest pain)
minimum period of 10 consecutive days, due to any Injury or Illness as
9. new characteristic electrocardiogram changes iii. elevation of
covered under the Policy. This benefit is payable only once to an Insured
infarction specific enzymes, Troponins or other specific biochemical
Person during each Policy Year of the Policy Period.
markers.
Subject otherwise to the terms, conditions and exclusions of the Policy
The following are excluded:
Extension 9: Donor Expenses
i. Other acute Coronary Syndromes
In consideration of the payment of additional premium to Us, it is hereby
ii. Any type of angina pectoris.
declared and agreed that notwithstanding anything to the contrary in the
Policy, We will indemnify You up to an amount not exceeding ` 50,000 for the iii. A rise in cardiac biomarkers or Troponin T or I in absence of overt
Medical Expenses incurred in respect of the donor for any of the organ ischemic heart disease OR following an intra-arterial cardiac
transplant surgery, provided the organ donated is for Your use and We have procedure.
admitted Your Hospitalisation Claim under the Policy. 4) Kidney failure requiring regular dialysis
Subject otherwise to the terms, conditions and exclusions of the Policy End stage renal disease presenting as chronic irreversible failure of both
Extension 7: Critical Illness Cover kidneys to function, as a result of which either regular renal dialysis
(hemodialysis or peritoneal dialysis) is instituted or renal transplantation is
In consideration of the payment of additional premium to Us, it is hereby
carried out. Diagnosis has to be confirmed by a specialist medical
declared and agreed that notwithstanding anything to the contrary in the
practitioner.
Policy, We will pay You the sum insured as stated against this Extension in the
Policy Schedule, in case You are diagnosed as suffering from one or more of 5) Major organ/ bone marrow transplant
the Critical Illnesses for the first time in your life, during the Policy Period. The actual undergoing of a transplant of:
However, We will not make any payment if You are first diagnosed as I. One of the following human organs: heart, lung, liver, kidney, pancreas,
suffering from a Critical Illness within 90 days of the Period of Insurance Start that
Date. This benefit can be availed by You only once during Your lifetime. No
Claim under this Extension shall be admissible in case any of the Critical II. resulted from irreversible end-stage failure of the relevant organ, or
Illnesses is a consequence of or arises out of any Pre-Existing III. Human bone marrow using haematopoietic stem cells. The undergoing
Condition(s)/Disease. of a
"Critical Illness"for the purpose of this Policy includes the following: IV. transplant has to be confirmed by a specialist medical practitioner. The
1) Cancer of specified severity following are excluded:
A malignant tumour characterized by the uncontrolled growth & spread of I. Other stem-cell transplants
malignant cells with invasion & destruction of normal tissues. This diagnosis ii. Where only islets of langerhans are transplanted
must be supported by histological evidence of malignancy & confirmed by a
pathologist. The term cancer includes leukemia, lymphoma and sarcoma. The 6) Stroke resulting in permanent symptoms
following are excluded - Any cerebrovascular incident producing permanent neurological sequelae.
i. All tumors which are histologically described as carcinoma in situ, This includes infarction of brain tissue, thrombosis in an intracranial vessel,
benign, pre-malignant, borderline malignant, low malignant potential, haemorrhage and embolisation from an extracranial source. Diagnosis has to
neoplasm of unknown behavior, or non-invasive, including but not be confirmed by a specialist medical practitioner and evidenced by typical
limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN 2 clinical symptoms as well as typical findings in CT Scan or MRI of the brain.
and CIN-3 Evidence of permanent neurological deficit lasting for at least 3 months has to
be produced. The following are excluded:
ii. Any non-melanoma skin carcinoma unless there is evidence of
metastases to lymph nodes or beyond; I. Transient ischemic attacks (TIA)
iii. Malignant melanoma that has not caused invasion beyond the ii. Traumatic injury of the brain
epidermis; Vascular disease affecting only the eye or optic nerve or vestibular functions.
iv. All tumours of the prostate unless histologically classified as having a
Gleason score greater than 6 or having progressed to at least clinical
TNM classification T2N0M0........

UIN: ICIHLIP22096V062122
 7) Permanent paralysis of limbs Any complications resulting from or arising out of any surgery or medical
Total and irreversible loss of use of two or more limbs as a result of injury or procedure shall be subject to the overall sub-limit, as applicable
disease of the brain or spinal cord. A specialist medical practitioner must be of No Sub-limits shall be applicable on any Major Medical Illness & Procedures
the opinion that the paralysis will be permanent with no hope of recovery and and Joint Replacement Surgery. Major Medical Illness & Procedures for the
must be present for more than 3 months. purpose of this Policy shall mean and include the following:
8) Open heart replacement or repair of heart valves The actual 1. Cancer of Specified Severity
undergoing of open-heart valve surgery is to replace or repair one or more
2. Kidney Failure Requiring Dialysis
heart valves, as a consequence of defects in, abnormalities of, or disease-
affected cardiac valve(s). The diagnosis of the valve abnormality must be 3. Major Organ /Bone marrow Transplant
supported by an echocardiography and the realization of surgery has to be 4. All cardiac surgeries / conditions including but not limited Open Chest
confirmed by a specialist medical practitioner. Catheter based techniques CABG
including but not limited to, balloon valvotomy/ valvuloplasty are excluded. 5. Multiple Sclerosis
9) End stage liver disease 6. Stroke Resulting in Permanent Symptoms
Permanent and irreversible failure of liver function that has resulted in all three 7. Permanent Paralysis of Limbs
of the following: a) Permanent jaundice; and 8. All brain related surgeries
b) Ascites; and The sub-limits mentioned above shall be applicable for each Hospitalization.
c) Hepatic encephalopathy. For the purpose of applicability of the said sub-limits, multiple
d) Liver failure secondary to drug or alcohol abuse is excluded Hospitalizations pertaining to the same Illness or medical procedure / surgery
occurring within a period of 45 days from the date of discharge of the first
Note: In the event of a Claim arising out of any of the Hospitalization shall be considered as one Hospitalization.
Critical Illness or medical procedures as covered under this Extension, You Subject otherwise to the terms, conditions and exclusions of the Policy
should intimate Us within thirty (30) days from the date of first diagnosis of
such Illness or from the date of surgical procedure or from date of occurrence e. Exclusions
of the medial event as the case may be (irrespective of Your coverage under We will not be liable for any Deductible amount, if applicable and as
any other health insurance policy). specifically defined in the policy schedule under the Policy
Further, You should arrange for submission of the Claim Documents* as
We shall not be liable to make any payment under this Policy in connection
stated in the Policy including the confirmation from the Medical Practitioner
with or in respect of any expenses whatsoever incurred by You in connection
that the Critical Illness or medical procedure or medical event for which a
with or in respect of:
Claim has been lodged under this Extension, does not relate to any Pre-
Existing Condition/Disease(s) or any Illness or Injury which existed within the i. Standard exclusions (Exclusions for which standard wordings are
first 3 months of the Period of Insurance Start Date. specified by IRDAI)
*In case You are covered under any health policy of other insurance company 1.Code- Excl01: Pre-Existing Diseases
and become entitled to a Claim under such policy, then for this Extension, You
a) Expenses related to the treatment of a pre-existing Disease (PED) and
may submit to Us the copies of such Claim Documents provided they are duly
its direct complications shall be excluded until the expiry of 24 months
certified by such insurance company or any hospital where You are getting
(48 months for plans with Sum Insured up to 2Lacs) of continuous
treated, as applicable
coverage after the date of inception of the first policy with insurer.
The cover under this extension shall terminate in the event of Your Claim
b) In case of enhancement of sum insured the exclusion shall apply afresh
becoming admissible hereunder. In consequence thereof no benefit shall be
to the extent of sum insured increase.
payable to You under this extension of the policy thereafter.
c) If the Insured Person is continuously covered without any break as
Extension 15: Sub Limits on Medical Expenses/ Illness/
defined under the portability norms of the extant IRDAI (Health
Surgeries/ Procedures Insurance) Regulations, then waiting period for the same would be
Notwithstanding anything to the contrary in the Policy and subject to the reduced to the extent of prior coverage.
Maximum Limit of Indemnity, Our maximum liability to make payment for the d) Coverage under the policy after the expiry of 24 months (48 months for
Medical Expenses incurred during any Hospitalisation (including its related plans with Sum Insured up to 2Lacs)for any pre-existing disease is
Pre and Post Hospitalization expenses if applicable) due to the below subject to the same being declared at the time of application and
mentioned Surgeries / Medical Procedures or any medical treatment accepted by Insurer.
pertaining to an Illness / Injury shall be limited as per the table below:
2. Code- Excl02: Specified disease/procedure waiting period
S. Surgeries / Medical Sub-limits (Rs.)
a) Expenses related to the treatment of the listed Conditions,
No. Procedures
surgeries/treatments shall be excluded until the expiry of 24 months of
1 Cataract per eye 10,000 15,000 20,000 continuous coverage after the date of inception of the first policy with
2 Other Eye Surgeries 15,000 22,000 35,000 us. This exclusion shall not be applicable for claims arising due to an
accident.
3 ENT 15,000 22,000 35,000
4 Surgeries for - Tumors/ b) In case of enhancement of sum insured the exclusion shall apply afresh
Cysts/Nodule/Polyp 20,000 30,000 60,000 to the extent of sum insured increase.
5 Stone in Urinary System 20,000 30,000 40,000 c) If any of the specified disease/procedure falls under the waiting period
specified for pre-Existing diseases, then the longer of the two waiting
6 Hernia Related 20,000 30,000 60,000 periods shall apply.
7 Appendisectomy 20,000 30,000 40,000 d) The waiting period for listed conditions shall apply even if contracted
8 Knee Ligament after the policy or declared and accepted without a specific exclusion.
Reconstruction Surgery 40,000 60,000 90,000
e) If the Insured Person is continuously covered without any break as
9 Hysterectomy 20,000 30,000 60,000 defined under the applicable norms on portability stipulated by IRDAI,
10 Fissures/Piles/Fistulas 15,000 22,000 35,000 then waiting period for the same would be reduced to the extent of prior
11 Spine & Vertebrae related 40,000 60,000 90,000 coverage.
12 Cellulites/Abscess 15,000 22,000 35,000 List of specific diseases/procedure:
All Medical Expenses for any • Cataract*
treatment not involving • Benign Prostatic Hypertrophy
surgery/medical procedure 10,000 15,000 25,000

UIN: ICIHLIP22096V062122
 • Myomectomy, Hysterectomy unless because of malignancy Expenses related to the surgical treatment of obesity that does not fulfil all the
• All types of Hernia, Hydrocele below conditions:
• Fissures &/or Fistula in anus, hemorrhoids/piles 1) Surgery to be conducted is upon the advice of the Doctor
• Arthritis, gout, rheumatism and spinal disorders 2) The surgery/Procedure conducted should be supported by clinical
• Joint replacements unless due to accident protocols
• Sinusitis and related disorders 3) The member has to be 18 years of age or older and
• Stones in the urinary and billiary systems 4) Body Mass Index (BMI);
• Dilatation and curettage , Endometriosis
a) greater than or equal to 40 or
• All types of Skin and internal tumors/ cysts/nodules/ polyps of any kind
including breast lumps unless malignant b) greater than or equal to 35 in conjunction with any of the following
severe co-morbidities following failure of less invasive methods of
• Dialysis required for chronic renal failure
weight loss:
• Surgery on tonsils, adenoids and sinuses
i. Obesity-related cardiomyopathy
• Gastric and Duodenal erosions & ulcers
• Deviated Nasal Septum ii. Coronary heart disease
• Varicose Veins/ Varicose Ulcers iii. Severe Sleep Apnea
• All types of internal congenital anomalies/ illness/defects iv. Uncontrolled Type2 Diabetes
* After two years from the Period of Insurance Start Date, Our maximum iv Code-Excl07: Change of Gender treatments
liability arising out of any Claim for a cataract treatment shall not exceed Rs.
Expenses related to any treatment, including surgical management, to
20,000 per eye, during each Policy Year of the Policy Period for plans with Sum
change characteristics of the body to those of the opposite sex.
Insured up to ₹5Lacs. Sub limit of ₹1,00,000 per eye per Policy year will be
applicable for Cataract surgery for plans with Sum Insured above ₹5Lacs. v Code-Excl08: Cosmetic or plastic Surgery
In case the above Illnesses are Pre-existing condition(s) at the Expenses for cosmetic or plastic surgery or any treatment to change
commencement of this Policy, then these Illnesses shall be covered after 24 appearance unless for reconstruction following an Accident, Burn(s) or
months (48 months for plans with Sum Insured upto 2Lacs) of continuous Cancer or as part of medically necessary treatment to remove a direct
coverage has elapsed, since Period of Insurance Start Date. and immediate health risk to the insured. For this to be considered a
medical necessity, it must be certified by the attending Medical
3. Expenses related to the treatment of the below mentioned illness within
Practitioner.
90 days from the first policy commencement date shall be excluded unless
they are pre-existing and disclosed at the time of underwriting vi Code-Excl09: Hazardous or Adventure sports
I. Hypertension Expenses related to any treatment necessitated due to participation as
ii. Diabetes a professional in hazardous or adventure sports, including but not
limited to, para-jumping, rock climbing, mountaineering, rafting, motor
iii. Cardiac Conditions
racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea
b) This exclusion shall not, however, apply if the Insured person has diving.
continuous coverage for more than twelve months
vii Code-Excl10: Breach of law
The within referred waiting period is made applicable to the enhances sum
Expenses for treatment directly arising from or consequent upon any
insured in the event of granting higher sum insured subsequently
Insured Person committing or attempting to commit a breach of law
4. Code-Excl03: 30-day waiting period with criminal intent.
a) Expenses related to the treatment of any illness within 30 days from the viii Code-Excl11: Excluded Providers
first policy commencement date shall be excluded except claims
Expenses incurred towards treatment in any hospital or by any Medical
arising due to an accident, provided the same are covered.
Practitioner or any other provider specifically excluded by the Insurer
b) This exclusion shall not, however, apply if the Insured Person has and disclosed in its website / notified to the policyholders are not
Continuous Coverage for more than twelve months. admissible. However, in case of life threatening situations or following
an accident, expenses up to the stage of stabilization are payable but
c) The within referred waiting period is made applicable to the enhanced
not the complete claim.
sum insured in the event of granting higher sum insured subsequently
months (48 months for plans with Sum Insured up to 2Lacs) ix Code-Excl12: Treatment for, Alcoholism, drug or substance abuse or
any addictive condition and consequences thereof.
5. Permanent Exclusions
x Code-Excl13 : Treatments received in heath hydros, nature
i Code- Excl04: Investigation & Evaluation
cure clinics, spas or similar establishments or private beds
a) Expenses related to any admission primarily for diagnostics and registered as a nursing home attached to such establishments or
evaluation purposes only are excluded. where admission is arranged wholly or partly for domestic reasons.
b) Any diagnostic expenses which are not related or not incidental to the xi Code-Excl14: Dietary supplements and substances that can be
current diagnosis and treatment are excluded. purchased without prescription, including but not limited to
Vitamins, minerals and organic substances unless prescribed by a
ii Code- Excl05: Exclusion Name: Rest Cure, rehabilitation and respite
medical practitioner as part of hospitalisation claim or day care
care-
procedure.
Expenses related to any admission primarily for enforced bed rest and not for
xii Code-Excl15: Expenses related to the treatment for correction of eye
receiving treatment. This also includes:
sight due to refractive error less than 7.5 dioptres
i. Custodial care either at home or in a nursing facility for personal care
xiii Code-Excl16: Unproven Treatments: Expenses related to any
such as help with activities of daily living such as bathing, dressing,
unproven treatment, services and supplies for or in connection
moving around either by skilled nurses or assistant or non-skilled
with any treatment. Unproven treatments are treatments, procedures
persons.
or supplies that lack significant medical documentation to support their
ii. Any services for people who are terminally ill to address physical, effectiveness.
social, emotional and spiritual needs.
xiv Code-Excl17: Sterility and Infertility: Expenses related to sterility and
iii Code- Excl06: Obesity/ Weight Control
infertility. This includes:

UIN: ICIHLIP22096V062122
 (i) Any type of contraception, sterilization liable to pay interest to the policyholder from the date of receipt of last
necessary document to the date of payment of claim at a rate 2% above
(ii) Assisted Reproduction services including artificial insemination
the bank rate.
and advanced reproductive technologies such as IVF, ZIFT, GIFT,
ICSI III. However, where the circumstances of a claim warrant an investigation
in the opinion of the Company, it shall initiate and complete such
(iii) Gestational Surrogacy
investigation at the earliest, in any case not later than 30 days from the
(iv) Reversal of sterilization date of receipt of last necessary document- ln such cases, the
xv Code-Excl18: Maternity: Medical treatment expenses tracable to Company shall settle or reject the claim within 45 days from the date of
childbirth (including complicated deliveries and caesarean sections receipt of last necessary document.
incurred during hospitalisation) except ectopic pregnancy. Expenses IV. ln case of delay beyond stipulated 45 days, the Company shall be liable
towards miscarriage (unless due to an accident) and lawful medical to pay interest to the policyholder at a rate 2% above the bank rate from
termination of pregnancy during the policy period) the date of receipt of last necessary document to the date of payment of
ii Specific exclusions (Exclusions other than those mentioned under claim.
e.i above (Explanation: "Bank rate" shall mean the rate fixed by the Reserve Bank
6 Any physical, medical or treatment or service that is specifically of lndia (RBl) at the beginning of the financial year in which claim has
excluded in the Policy Schedule under Special Conditions fallen due)
7 Any expenses incurred on prosthesis, corrective devices, external 4. Complete Discharge
durable medical equipment of any kind, like wheelchairs, crutches, Any payment to the policyholder, insured person or his/ her nominees or
instruments used in treatment of sleep apnoea syndrome or cost of his/ her legal representative or assignee or to the hospital as the case
cochlear implant(s) unless necessitated by an Accident or required may be, for any benefit under the Policy shall be a valid discharge
intra-operatively. towards payment of claim by the Company to the extent of that amount
8 Expenses incurred on dental treatment unless necessitated due to an for the particular claim
Accident
5. Multiple Policies
9 Personal comfort, cosmetics, convenience and hygiene related items
and services i. In case of multiple policies taken by an insured person during a period
from one or more insurers to indemnify treatment costs, the inusred
10 Acupressure, acupuncture, magnetic and other therapies person shall have the right to require a settlement of his/her claim in
11 Circumcision unless necessary for treatment of an Illness or terms of any of his/her policies. In all such cases the insurer chosen by
necessitated due to an Accident. the insured person shall be obliged to settle the claim as long as the
12 Treatment relating to birth defects and external congenital Illnesses or claim is within the limits of and according to the terms of the chosen
defects or anomalies policy.
13 Any expenses arising out of Domiciliary Hospitalisation treatment ii. Insured Person having multiple policies shall also have the right to
14 Treatment taken outside the country prefer claims under this policy for the amounts disallowed under any
15 Intentional self-injury (whether arising from an attempt to commit other policy / policies, even if the sum insured is not exhausted. Then
suicide or otherwise) the Insurer shall independently settle the claim subject to the terms and
conditions of this policy.
16 Expenses related to donor screening, treatment, including surgery to
remove organs from a donor in the case of transplant surgery iii. If the amount to be claimed exceeds the sum insured under a single
policy , the insured person shall have the right to choose insurers from
17 Any injury or illness caused by or arising from or attributed to war,
whom he/she wants to claim the balance amount.
invasion, acts of foreign enemies, hostilities (whether war be declared
or not), civil war, commotion, unrest, rebellion, revolution, military or iv. Where an insured person has policies from more than one insurer to
usurped power or confiscation or nationalisation or requisition of or cover the same risk on indemnity basis, the insured person shall only
damage by or under the order of any government or public local be indemnified the treatment costs in accordance with the terms and
authority conditions of the chosen policy.
18 Any Illness or Injury caused by or contributed to by nuclear 6. Fraud
weapons/materials or contributed to by or arising from ionising
radiation or contamination by radioactivity by any nuclear fuel or from If any claim made by the insured person, is in any respect fraudulent, or
any nuclear waste or from the combustion of nuclear fuel if any false statement, or declaration is made or used in support thereof,
or if any fraudulent means or devices are used by the insured person or
f. General Terms and Clauses anyone acting on his/her behalf to obtain any benefit under this policy,
i. Standard General Terms and Clauses (General Terms and clauses all benefits under this policy and the premium paid shall be forfeited.
whose wordings are specified by IRDAI) Any amount already paid against claims made under this policy but
1. Disclosure of Information which are found fraudulent later shall be repaid by all
recipient(s)/policyholder(s) , who has made that particular claim,, who
The Policy shall be void and all premium paid thereon shall be forfeited shall be jointly and severally liable for such repayment to the insurer
to the Company in the event of misrepresentation, mis-description or
non-disclosure of any material fact by the policyholder For the purpose of this clause, the expression "fraud" means any of the
following acts committed by the Insured Person or by his agent or the
(Explanation: "Material facts" for the purpose of this policy shall mean hospital/doctor/any other party acting on behalf of the insured person,
all relevant information sought by the company in the proposal form and with intent to deceive the insurer or to induce the insurer to issue an
other connected documents to enable it to take informed decision in the insurance Policy:—
context of underwriting the risk)
a) the suggestion, as a fact of that which is not true and which the
2. Condition Precedent to Admission of Liability Insured Person does not believe to be true;
The terms and conditions of the policy must be fulfilled by the insured b) the active concealment of a fact by the Insured Person having
person for the Company to make any payment for claim(s) arising under knowledge or belief of the fact;
the policy.
c) any other act fitted to deceive; and
3. Claim Settlement (provision for Penal lnterest) d) any such act or omission as the law specially declares to be
I. The Company shall settle or reject a claim, as the case may be, within fraudulent
30 days from the date of receipt of last necessary document. The company shall not repudiate the claim and / or forfeit the policy benefits
II. ln the case of delay in the payment of a claim, the Company shall be on the ground of fraud, if the insured person / beneficiary can prove that the
misstatement was true to the best of his knowledge and there was no
UIN: ICIHLIP22096V062122
 deliberate intention to suppress the fact or that such mis-statement of or lapses under any health insurance policy with an lndian General/Health
suppression of material fact are within the knowledge of the insurer. insurer, the proposed insured person will get the accrued continuity benefits
in waiting periods as per IRDAI guidelines on portability.
7. Cancellation
For Detailed Guidelines on portability, kindly refer the link .
a) The policyholder may cancel this Policy by giving 15days' written
notice, and in such an event, the Company shall refund premium for the https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?pag
unexpired Policy Period as detailed below. e=PageNo3987
10. Renewal of Policy
Cancellation Refund % for 1 Refund % for 2 Refund % for 3
Period year tenure years tenure years tenure The policy shall ordinarily be renewable except on grounds of fraud
policy policy policy misrepresentation by the insured person

From 16 days to I. The Company shall endeavor to give notice for renewal. However, the
1 month 80.00% 80.00% 80.00% Company is not under obligation to give any notice for renewal.

From 1 month to II. Renewal shall not be denied on the ground that the insured person had
3 months 60.00% 70.00% 75.00% made a claim or claims in the preceding policy years.

From 3 months to III. Request for renewal along with requisite premium shall be received by
6 months 40.00% 60.00% 67.50% the Company before the end of the policy period.

From 6 months to IV. At the end of the policy period, the policy shall terminate and can be
9 months 20.00% 50.00% 60.00% renewed within the Grace Period of 30 days to maintain continuity of
benefits without break in policy. Coverage is not available during the
From 9 months to grace period
12 months 0.00% 40.00% 52.50%
V. No loading shall apply on renewals based on individual claims
From 12 months experience
to 15 months NA 30.00% 47.50%
11. Withdrawal of Policy
From 15 months
to18 months NA 20.00% 40.00% i. ln the likelihood of this product being withdrawn in future, the Company
will intimate the insured person about the same 90 days prior to expiry
From 18 months of the policy.
to 21 months NA 10.00% 32.50%
ii. lnsured Person will have the option to migrate to similar health
From 21 months insurance product available with the Company at the time of renewal
to 24 months NA 0.00% 25.00% with all the accrued continuity benefits such as cumulative bonus,
From 24 months waiver of waiting period. as per IRDAI guidelines, provided the policy
to 27 months NA NA 20.00% has been maintained without a break.

From 27 months 12. Moratorium Period

to 30 months NA NA 12.50% After completion of eight continuous years under this policy no look back
From 30 months would be applied. This period of eight years is called as moratorium period.
to 33 months NA NA 5.00% The moratorium would be applicable for the sums insured of the first policy
and subsequently completion of 8 continuous years would be applicable from
From 33 months date of enhancement of sum insured only on the enhanced limits. After the
to 36 months NA NA 0.00% expiry of Moratorium Period no health insurance claim shall be contestable
except for proven fraud and permanent exclusions specified in the policy
Notwithstanding anything contained herein or otherwise, no refunds of contract. The policies would however be subject to all limits, sub limits, co-
premium shall be made in respect of Cancellation where, any claim has been payments, deductibles as per the policy contract
admitted or has been lodged or any benefit has been availed by the Insured 13. Premium Payment in lnstalments (Wherever applicable)
person under the Policy.
lf the insured person has opted for Payment of Premium on an instalment
b) The Company may cancel the Policy at any time on grounds of mis- basis i.e. Half Yearly, Quarterly or Monthly, as mentioned in the policy
representation, non-disclosure of material facts, fraud by the Insured Person, Schedule/Certificate of lnsurance, the following Conditions shall apply
by giving 15 days' written notice. There would be no refund of premium on (notwithstanding any terms contrary elsewhere in the policy)
cancellation on grounds of mis-representation, non-disclosure of material
facts or fraud. I. Grace Period of 15 days would be given to pay the instalment premium
due for the policy
8. Migration:
II. During such grace period, coverage will not be available from the due
The insured person will have the option to migrate the policy to other health date of instalment premium till the date of receipt of premium by
insurance products/plans offered by the company by applying for migration of Company.
the policyatleast3O days before the policy renewal date as per IRDAI
guidelines on Migration. lf such person is presently covered and has been III. The insured person will get the accrued continuity benefit in respect of
continuously covered without any lapses under any health insurance the "Waiting Periods", "Specific Waiting Periods" in the event of
producuplan offered by th company, the insured person will get the accrued payment of premium within the stipulated grace Period.
continuity benefits in waiting periods as per IRDAI guidelines on migration. IV. No interest will be charged lf the instalment premium is not paid on due
For Detailed Guidelines on migration, kindly refer the link date.
https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?pag V. ln case of instalment premium due not received within the grace period,
e=PageNo3987 the policy will get cancelled.
9. Portability VI. ln the event of a claim, all subsequent premium instalments shall
The insured person will have the option to port the policy to other insurers by immediately become due and payable.
applying to such insurer to port the entire policy along with all the members of VII. The company has the right to recover and deduct all the pending
the family, if any, at least 45 days before, but not earlier than 60 days from the instalments from the claim amount due under the policy.
policy renewal date as per IRDAI guidelines related to portability. lf such
person is presently covered and has been continuously covered without any

UIN: ICIHLIP22096V062122
 14. Possibility of Revision of Terms of the Policy Including the Premium policyholder, the Company will pay the nominee {as named in the Policy
Rates Schedule/Policy Certificate/Endorsement (if any)} and in case there is no
subsisting nominee, to the legal heirs or legal representatives of the
The Company, with prior approval of IRDAI, may revise or modify the terms of
policyholder whose discharge shall be treated as full and final discharge of its
the policy including the premium rates. The insured person shall be notified
liability under the policy.
three months before the changes are effected.
ii. Specific terms and clauses (terms and clauses other than those
15. Free look period
mentioned above under f.(I) above.
The Free Look Period shall be applicable on new individual health insurance
18. Material Change
policies and not on renewals or at the time of porting/migrating the policy
The Insured shall notify the Company in writing of any material change
The insured person shall be allowed free look period of fifteen days from date
in the risk in relation to the declaration made in the proposal form or
of receipt of the Policy documents to review the terms and conditions of the
medical examination report at each Renewal and the Company may,
Policy, and to return the same if not acceptable.
adjust the scope of cover and/or premium, if necessary, accordingly
If the insured has not made any claim during the Free Look Period, the insured
19. Records to be Maintained
shall be entitled to
The Insured Person shall keep an accurate record containing all relevant
a) a refund of the premium paid less any expenses incurred by the
medical records and shall allow the Company or its representatives to
company on medical examination of the insured person and the stamp
inspect such records. The Proposer or Insured Person shall furnish such
duty charges; or
information as the Company may require for settlement of any claim
b) where the risk has already commenced and the option of return of the under the Policy, within reasonable time limit and within the time limit
Policy is exercised by the insured person, a deduction towards the specified in the Policy.
proportionate risk premium for period of cover or
20. Notice & Communication
c) where only a part of the insurance coverage has commenced, such
i. Any notice, direction, instruction or any other communication related to
proportionate premium commensurate with the insurance coverage
the Policy should be made in writing.
during such period;
ii. Such communication shall be sent to the address of the Company or
16. Redressal of Grievances
through any other electronic modes specified in the Policy Schedule.
ln case of any grievance the insured person may contact the company
iii. The Company shall communicate to the Insured at the address or
through
through any other electronic mode mentioned in the schedule.
Website : www.icicilombard.com
21. Territorial Limit
Toll Free : 1800 2666
All medical treatment for the purpose of this insurance will have to be taken in
E-Mail: [email protected] India only unless worldwide cover has been opted for.
Courier: ICICI Lombard General Insurance Company Ltd. 22. Automatic change in Coverage under the policy
ICICI Lombard House, The coverage for the Insured Person(s) shall automatically terminate:
414, Veer Savarkar Marg, i. In the case of his/ her (Insured Person) demise.
Near Siddhi Vinayak Temple, However the cover shall continue for the remaining Insured Persons till the
Prabhadevi, Mumbai- 400025 end of Policy Period. The other insured persons may also apply to renew
the policy. In case, the other insured person is minor, the policy shall be
lnsured person may also approach the grievance cell at any of the company's renewed only through any one of his/her natural guardian or guardian
branches with the details of grievance appointed by court. All relevant particulars in respect of such person
(including his/her relationship with the insured person) must be
lf lnsured person is not satisfied with the redressal of grievance through one of submitted to the company along with the application. Provided no claim
the above methods, insured person may contact the grievance officer has been made, and termination takes place on account of death of the
at Manager- Service Quality, Corporate Manager- Service Quality, insured person, pro-rata refund of premium of the deceased insured
National Manager- Operations & finally Director-services and Business person for the balance period of the policy will be effective.
development at the following address:
ii. Upon exhaustion of sum insured and additional sum insured (if any), for
ICICI Lombard General Insurance Company Limited, the policy year. However, the policy is subject to renewal on the due
ICICI Lombard House, date as per the applicable terms and conditions.

414, Veer Savarkar Marg, 23. Territorial Jurisdiction

Near Siddhi Vinayak Temple, All disputes or differences under or in relation to the interpretation of the
terms, conditions, validity, construct, limitations and/or exclusions
Prabhadevi, Mumbai 400025 contained in the Policy shall be determined by the Indian court and
For updated details of grievance officer, kindly refer the link.. according to Indian law.
.https://www.icicilombard.com/grievance-redressal... 24. Arbitration
lf lnsured person is not satisfied with the redressal of grievance through above i. If any dispute or difference shall arise as to the quantum to be paid by
methods, the insured person may also approach the office of lnsurance the Policy, (liability being otherwise admitted) such difference shall
Ombudsman of the respective area/region for redressal of grievance as per independently of all other questions, be referred to the decision of a sole
lnsurance Ombudsman Rules 2017. Grievance may also be lodged at IRDAI arbitrator to be appointed in writing by the parties here to or if they
lntegrated Grievance Management System cannot agree upon a single arbitrator within thirty days of any party
https://igms.irda.gov.in/ invoking arbitration, the same shall be referred to a panel of three
arbitrators, comprising two arbitrators, one to be appointed by each of
17. Nomination: the parties to the dispute/difference and the third arbitrator to be
The policyholder is required at the inception of the policy to make a appointed by such two arbitrators and arbitration shall be conducted
nomination for the purpose of payment of claims under the policy in the event under and in accordance with the provisions of the Arbitration and
of death of the policyholder. Any change of nomination shall be Conciliation Act 1996, as amended by Arbitration and Conciliation
communicated to the company in writing and such change shall be effective (Amendment) Act, 2015 (No. 3 of 2016).
only when an endorsement on the policy is made. ln the event of death of the ii. It is clearly agreed and understood that no difference or dispute shall be

UIN: ICIHLIP22096V062122
 preferable to arbitration as herein before provided, if the Company has List of Non Payable Items as per IRDAI
disputed or not accepted liability under or in respect of the policy, iii. It is Sr. No Items
hereby expressly stipulated and declared that it shall be a condition
precedent to any right of action or suit upon the policy that award by 22 Television Charges
such arbitrator/arbitrators of the amount of expenses shall be first 23 SURCHARGES
obtained. 24 ATTENDANT CHARGES
25. Policy alignment 25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART
Policy Alignment option will be available in cases wherein insured(s) with two OF BED
separate health indemnity policies with Us, having different policy end dates 26 BIRTH CERTIFICATE
but want to align the policy start dates. We can align the policies by extending 27 CERTIFICATE CHARGES
the coverage of one policy till the end date of the other policy.
28 COURIER CHARGES
Such policies will be charged with premium on pro rata basis though the sum
29 CONVEYANCE CHARGES
insured under the policy shall remain constant.
30 MEDICAL CERTIFICATE
26. Endorsements (Changes in Policy)
31 MEDICAL RECORDS
i. This policy constitutes the complete contract of insurance. This Policy
32 PHOTOCOPIES CHARGES
cannot be modified by anyone (including an insurance agent or broker)
except the company. Any change made by the company shall be 33 MORTUARY CHARGES
evidenced by a written endorsement signed and stamped. 34 WALKING AIDS CHARGES
ii. The proposer may be changed only at the time of renewal. The new 35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
proposer must be the legal heir/immediate family member. Such 36 SPACER
change would be subject to acceptance by the company and payment
37 SPIROMETRE
of premium (if any). The renewed Policy shall be treated as having been
renewed without break. 38 NEBULIZER KIT
iii. The proposer may be changed during the Policy Period only in case of 39 STEAM INHALER
his/her demise or him/her moving out of India. 40 ARMSLING
iv. Mid- term endorsement of addition of member in the policy shall only be 41 THERMOMETER
allowed for newly wedded spouse by marriage and new born baby with 42 CERVICAL COLLAR
relevant documentation 43 SPLINT
27. Change of Sum Insured 44 DIABETIC FOOT WEAR
Sum insured can be changed (increased/ decreased) only at the time of 45 KNEE BRACES (LONG/ SHORT/ HINGED)
renewal or at any time, subject to underwriting by the Company. For any 46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
increase in SI, the waiting period shall start afresh only for the enhanced
portion of the sum insured. 47 LUMBO SACRAL BELT
48 NIMBUS BED OR WATER OR AIR BED CHARGES
28. Non Payables
49 AMBULANCE COLLAR
Below are the non payable items applicable in the policy. The list may be
updated as per the direction of Authority, For updated list please visit Our 50 AMBULANCE EQUIPMENT
website: www.iciciclombard.com 51 ABDOMINAL BINDER
52 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES
List of Non Payable Items as per IRDAI
53 SUGAR FREE Tablets
Sr. No Items
54 CREAMS POWDERS LOTIONS (Toiletries are not payable, only
1 BABY FOOD prescribed medical pharmaceuticals payable)
2 BABY UTILITIES CHARGES 55 ECG ELECTRODES
3 BEAUTY SERVICES 56 GLOVES
4 BELTS/ BRACES 57 NEBULISATION KIT
5 BUDS 58 RECOVERY KIT, ETC]ANY KIT WITH NO DETAILS MENTIONED
6 COLD PACK/HOT PACK [DELIVERY KIT, ORTHOKIT,
7 CARRY BAGS 59 KIDNEY TRAY
8 EMAIL / INTERNET CHARGES 60 MASK
9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY 61 OUNCE GLASS
HOSPITAL) 62 OXYGEN MASK
10 LEGGINGS 63 PELVIC TRACTION BELT
11 LAUNDRY CHARGES 64 PAN CAN
12 MINERAL WATER 65 TROLLY COVER
13 SANITARY PAD 66 UROMETER, URINE JUG
14 TELEPHONE CHARGES 67 AMBULANCE
15 GUEST SERVICES 68 VASOFIX SAFETY
16 CREPE BANDAGE
g. Other Terms and Conditions
17 DIAPER OF ANY TYPE
18 EYELET COLLAR 1. CLAIM ADMINISTRATION
19 SLINGS The fulfillment of the terms and conditions of this Policy (including payment of
premium by the due dates mentioned in the Policy Schedule) insofar as they
20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES
relate to anything to be done or complied with by each of You shall be
21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED conditions precedent to admission of Our liability. You are requested to go

UIN: ICIHLIP22096V062122
 through our list of de-listed/excluded providers which is available on our taking into consideration the available Sum Insured in the two Policy periods,
website. including the Deductions for each Policy Period. Such eligible claim amount to
be payable to the Insured shall be reduced to the extent of premium to be
Further, upon the discovery or happening of any Illness or Injury that may give
received for the Renewal/due date of premium of health insurance Policy, if
rise to a Claim under this Policy, then as a condition precedent to the
not received earlier.
admission of Our liability, You shall undertake the following:
1.2 CLAIM DOCUMENTS
You shall be required to furnish the following documents for or in support of a
1.1CLAIMS PROCEDURE
Claim:
A) For Cashless Settlement
I. Duly completed Claim form signed by You and the Medical Practitioner.
Cashless treatment is only available at a Network Provider (List of Network The claim form can be downloaded from our website
Providers is available at our website). In order to avail of cashless treatment, www.icicilombard.com
the following procedure must be followed by You:
ii. Original bills, receipts and discharge certificate/ card from the Hospital/
Pre-authorization Medical Practitioner
Prior to taking treatment and/ or incurring Medical Expenses at a Network iii. Original bills from chemists supported by proper prescription.
Provider, You must contact Us or Our in house claim processing team
iv. Original investigation test reports and payment receipts.
accompanied with full particulars namely, Policy Number, Your name, Your
relationship with Policy Holder, nature of Illness or Injury, name and address of v. Indoor case papers
the Medical Practitioner/ Hospital and any other information that may be
vi. Medical Practitioner's referral letter advising Hospitalization in non-
relevant to the Illness/ Injury/ Hospitalisation. You must request
Accident cases.
preauthorization at least 48 hours before a planned Hospitalization and in case
of an emergency situation, within 24 hours of Hospitalization. To avail of vii. Any other document as required by Us or Our TPA to investigate the
Cashless Hospitalization facility, you are required to produce the health card, Claim or Our obligation to make payment for it
as provided to You with this Policy, subject to the terms and conditions for the 1.3 Claim Service Gurantee
usage of the said health card Or You can seek pre authorization by providing
Your Policy number and ID proof to the hospital who can co-ordinate with Our We provide You Claim Service Gurantee as follows
claim team to provide cashless facility. We will consider Your request after a) For Reimbursement Claims: We shall make the payment of admissible
having obtained accurate and complete information for the Illness or Injury for claim (as per terms & conditions of Policy) OR communicate non
which cashless Hospitalization facility is sought by You and We will confirm admissibility of claim within 14 days after You submit complete set of
Your request in writing. documents & information in respect of the claims. In case We fail to
B) For Reimbursement Settlement make the payment of admissible claims or to communicate non
admissibility of claim within the time period, We shall pay 2% interest
i. You shall give notice to Us or Our in house claim processing team by over and above the rate defined as per IRDAI (Protection of
calling the toll free number 1800 2666 or emailing us at Policyholder's interest) Regulation 2017.
[email protected] as specified in the Policy
provided to You and also in writing at Our address with particulars as b) For Cashless Claims: If You notify per authorization request for cashless
below: facility through any of Our empanelled network hospitals along with
complete set of documents & information, We will respond within 4
• Policy number; hours of the actual receipt of such pre authorization request with:
• Your Name; a) Approval, or
• Your relationship with the Policyholder; b) Rejection, or
• Nature of Illness or Injury; c) Query seeking further information
• Name and address of the attending Medical Practitioner and the In case the request is for enhancement, i.e. Request for increase in the
Hospital; amount already authorized, We will respond to it within 3 hours.
• Any other information that may be relevant to the Illness/ Injury/ In case of delay in response by Us beyond the time period as stated above for
Hospitalisation cashless claims, We shall be liable to pay Rs.1,000 to You. Our maximum
i. The above information needs to be provided to Us or Our in house claim liability in respect of a single hospitalization shall, at no time exceed Rs.1,000.
processing team immediately and in any event within 10 days of We will not be liable to make any payments under this Claim Service
Hospitalization, failing which We will have the right to treat the Claim as Guarantee in case of any force majeure, natural event or manmade
inadmissible, as We may deem fit at Our sole discretion. disturbance which impedes Our inability to make a decision or to
communicate such decisions to You.
ii. You must immediately consult a Medical Practitioner and follow the
advice and treatment that he recommends. The service gurantee shall not be applicable for any cases delayed o account
of reasonable apprehension of fraud or fraudulent claims or cases referred
iii. You or someone claiming on Your behalf must promptly and in any event
to/by any adjudicative forum for necessary disposal.
within 30 days of Your discharge from a Hospital (for post-
hospitalization expenses, within 30 days from the completion of post- You may lodge claim separately for the hospitalization claim, Pre-Post
hospitalization period) deliver to Us the documentation (written details hospitalization, optional covers, OPD etc. In such scenario, if delay happens
of the quantum of any Claim along with all original supporting beyond the time period as specified above, the interest amount calculated
documentation) as more particularly listed in Claim documents section will be on the net sanctioned amount of respective transaction and not the
However, in both the above cases i.e. 1..1 total amount paid for the entire claim.
(A) & (B), You must take reasonable steps or measure to minimise the Any amount paid towards interest under Claim Service Guarantee will not
quantum of any Claim that may be covered under the Policy If so affect the Sum Insured as specified in the Schedule.
requested by Us or Our in house claim processing team, You will have to If you are not eligible for 'Claim Service Guarantee' for the reasons stated
undergo a medical examination from Our nominated Medical above, We will inform the same to You, within 14 days in case of a) and within
Practitioner, as and when We or Our in house claim processing team 4 hours in case of b) above
considers reasonable and necessary. The cost of such examination will
be borne by Us
Claim falling in two Policy periods
If the claim event falls within two Policy periods, the claims shall be paid

UIN: ICIHLIP22096V062122
 Details of Insurance Ombudsmen
Jurisdiction of Office Office Details Jurisdiction of Office Office Details
Union Territory, District) Union Territory, District)
Gujarat , UT of Dadra and Nagar AHMEDABAD - Shri Kuldip Singh CHENNAI – 600 018.
Haveli, Daman and Diu Office of the Insurance Tel.: 044 - 24333668 / 24335284
Ombudsman, Jeevan Prakash Fax: 044 - 24333664
Building, 6th floor, TilakMarg, Relief Email:
Road, Ahmedabad – 380 001. [email protected]
Tel.: 079 - 25501201/ 02/ 05/ 06
Email: Delhi & DELHI - Shri Sudhir Krishna
[email protected] Following Districts of Haryana - Office of the Insurance
Gurugram, Faridabad, Sonepat Ombudsman,
& Bahadurgarh. 2/2 A, Universal Insurance
Karnataka BENGALURU - Building, Asaf Ali Road,
Office of the Insurance New Delhi - 110 002.
Ombudsman, Tel.: 011 - 23232481/23213504
Jeevan Soudha Building,PID No. Email:
57-27-N-19. Ground Floor, 19/19, [email protected]
24th Main Road, JP Nagar, 1st
Phase, Bengaluru – 560 078. Assam, Meghalaya, Manipur, GUWAHATI -
Tel.: 080 - 26652048 / 26652049 Mizoram, Arunachal Pradesh, Office of the Insurance
Email: Nagaland and Tripura. Ombudsman,
[email protected] Jeevan Nivesh, 5th Floor,
Nr. Panbazar over bridge, S.S.
Madhya Pradesh and BHOPAL - Road, Guwahati - 781001(ASSAM).
Chhattisgarh Office of the Insurance Tel.: 0361 - 2632204 / 2602205
Ombudsman, Email:
Janak Vihar Complex, 2nd Floor, [email protected]
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Andhra Pradesh, Telangana, HYDERABAD -
Bhopal – 462 003.
Yanam and part of Union Office of the Insurance
Tel.: 0755 - 2769201 / 2769202
Territory of Puducherry. Ombudsman,
Fax: 0755 - 2769203
6-2-46, 1st floor, "Moin Court",
Email:
Lane Opp. Saleem Function Palace,
[email protected]
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Orissa BHUBANESHWAR - Shri Suresh Tel.: 040 - 23312122
Chandra Panda Fax: 040 - 23376599
Office of the Insurance Email:
Ombudsman, [email protected]
62, Forest park,
Bhubneshwar – 751 009. Rajasthan Office of the Insurance
Tel.: 0674 - 2596461 /2596455 Ombudsman,
Fax: 0674 - 2596429 JeevanNidhi – II Bldg., Gr. Floor,
Email: Bhawani Singh Marg,
[email protected] Jaipur - 302 005.
Tel.: 0141 - 2740363
Punjab, Haryana (excluding CHANDIGARH -
Email:
Gurugram, Faridabad, Sonepat Office of the Insurance
[email protected]
and Bahadurgarh) Ombudsman,
Himachal Pradesh, Union S.C.O. No. 101, 102 & 103, 2nd
Rajasthan. JAIPUR -
Territories of Jammu & Kashmir, Floor, Batra Building, Sector 17-D,
Office of the Insurance
Ladakh & Chandigarh. Chandigarh – 160 017.
Ombudsman,
Tel.: 0172 - 2706196 / 2706468
Jeevan Nidhi – II Bldg., Gr. Floor,
Fax: 0172 - 2708274
Bhawani Singh Marg,
Email:
Jaipur - 302 005.
[email protected]
Tel.: 0141 - 2740363
Email:
Tamil Nadu, Tamil Nadu CHENNAI - [email protected]
PuducherryTown and Karaikal Office of the Insurance
(which are part of Puducherry). Ombudsman,
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet,

UIN: ICIHLIP22096V062122
Jurisdiction of Office Office Details Jurisdiction of Office Office Details
Union Territory, District) Union Territory, District)

West Bengal, Sikkim, KOLKATA - Shri P. K. Rath State of Uttaranchal and the NOIDA - Shri Chandra Shekhar
Andaman & Nicobar Islands. Office of the Insurance following Districts of Uttar Prasad
Ombudsman, Pradesh: Office of the Insurance
Hindustan Bldg. Annexe, 4th Floor, Agra, Aligarh, Bagpat, Bareilly, Ombudsman,
4, C.R. Avenue, Bijnor, Budaun, Bulandshehar, Bhagwan Sahai Palace
KOLKATA - 700 072. Etah, Kanooj, Mainpuri, Mathura, 4th Floor, Main Road,
Tel.: 033 - 22124339 / 22124340 Meerut, Moradabad, Naya Bans, Sector 15,
Fax : 033 - 22124341 Muzaffarnagar, Oraiyya, Pilibhit, Distt: Gautam Buddh Nagar,
Email: Etawah, Farrukhabad, Firozbad, U.P-201301.
[email protected] Gautambodhanagar, Ghaziabad, Tel.: 0120-2514252 / 2514253
Hardoi, Shahjahanpur, Hapur, Email:
Districts of Uttar Pradesh : LUCKNOW - Shri Justice Anil Shamli, Rampur, Kashganj, [email protected]
Lalitpur, Jhansi, Mahoba, Kumar Srivastava Sambhal, Amroha, Hathras,
Hamirpur, Banda, Chitrakoot, Office of the Insurance Kanshiramnagar, Saharanpur.
Allahabad, Mirzapur, Sonbhabdra, Ombudsman,
Fatehpur, Pratapgarh, 6th Floor, Jeevan Bhawan, Bihar, Jharkhand. PATNA - Shri N. K. Singh
Jaunpur,Varanasi, Gazipur, Phase-II, Nawal Kishore Road, Office of the Insurance
Jalaun, Kanpur, Lucknow, Unnao, Hazratganj, Lucknow - 226 001. Ombudsman,
Sitapur, Lakhimpur, Bahraich, Tel.: 0522 - 2231330 / 2231331 2nd Floor, Lalit Bhawan, Bailey
Barabanki, Raebareli, Sravasti, Fax: 0522 - 2231310 Road, Patna 800 001.
Gonda, Faizabad, Amethi, Email: Tel.: 0612-2547068
Kaushambi, Balrampur, Basti, [email protected] Email:
Ambedkarnagar, Sultanpur, [email protected]
Maharajgang, Santkabirnagar,
Azamgarh, Kushinagar, Gorkhpur, Maharashtra, Office of the Insurance
Deoria, Mau, Ghazipur, Chandauli, Area of Navi Mumbai and Ombudsman,
Ballia, Sidharathnagar. Thane JeevanDarshan Bldg., 3rd Floor,
excluding Mumbai Metropolitan C.T.S. No.s. 195 to 198,
Goa, Mumbai Metropolitan MUMBAI - Region N.C. Kelkar Road, Narayan Peth,
Region excluding Navi Mumbai Office of the Insurance Pune – 411 030.
& Thane. Ombudsman, Tel.: 020-41312555
3rd Floor, Jeevan Seva Annexe, Email: [email protected]
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28
/28/29/30/31
The updated details of Insurance Ombudsman are also available on IRDA
Fax: 022 - 26106052 website: www.irda.gov.in on the website of General Insurance Council:
Email: www.generalinsurancecouncil.org.in, website of the company
[email protected] www.icicilombard.com or from any of the offices of the Company

ICICI Lombard General Insurance Company Limited

Mailing Address: Interface Building No. 16, 601-602, 6th Floor, New Link Road, Malad (West), Mumbai - 400 064.
Registered Office Address: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025.
Visit us at www.icicilombard.com • Mail us at [email protected] • Toll Free No.: 1800 2666 • Chargable No.: +91 86 55 222 666
Insurance is the subject matter of solicitation. IRDA Reg. No. 115. CIN: L67200MH2000PLC129408. UIN: ICIHLIP22096V062122