Health Top up - Terms and conditions

Product Name – Group Health Insurance
Product UIN: ICIHLGP02001V030102
Insurer Name - ICICI Lombard General Insurance Company Limited (IRDA Reg. No. 115)

a. The type of consumer for whom the product is intended –

  • “Customer” applying shall mean all ICICI Bank customers over the age of 18 years. The child to be insured should be above 91 days and less than 21 years and individual should be above 21 years and less than 55 years.

b. Main characteristics of the product, Options and coverage provided by the product, as applicable –

Key Benefits & Exclusions

S.No Title Description Refer To Policy Wordings
1. Product Name Group Health Insurance (UIN: ICIHLGP02001V030102)  
3 What are the major Exclusions in the Policy Sum Insured 10Lacs/15Lacs/20Lacs/25lacs/50Lacs Part II of the Schedule Clause 2. Scope of the Cover
Deductible Amount 3Lacs/4Lacs/5Lacs
Covers Medical expenses in excess of Deductible amount that will be applicable on aggregate for the following covers
In Patient treatment Covers Hospitalization expenses for a duration of more than 24 consecutive hours for an insured event
Pre & Post Hospitalization Medical Expenses incurred due to Illness up to 30 days period immediately before and 60 days immediately after an Insured Person's admission to a Hospital
Day Care Procedure Medical expenses for All day care procedures and surgeries where such procedures or surgeries are undertaken by an Insured Person as an In-patient in a Hospital for continuous period of less than 24 hours
Domiciliary Cover Covers Medical expenses incurred for Domiciliary Hospitalization up to Sum Insured
Cover for alternate methods of treatment Reimbursement of expenses for Alternative treatment up to Sum Insured
Organ Donor Expense Covers Medical Expenses incurred for an organ donor’s Hospitalization for an organ donated to the Insured Person.
Domestic Road Emergency Ambulance Ambulance expenses incurred to transfer the Insured Person following an emergency to the nearest Hospital. Maximum a m o u n t payable is Rs.3000 per event of emergency hospitalization
Air Ambulance Covers expenses incurred on air ambulance services to transfer the Insured Person to the nearest Hospital in case of an emergency. Maximum amount payable under this cover is 10% of Sum Insured as stated in the Policy Schedule.
Note: Following is an indicative list of the policy exclusions. Please refer to the policy clause for the complete list.
  • Naturopathy treatment, acupressure, acupuncture, magnetic and such other therapies
  • Unproven experimental treatment
  • Any expenses arising out of Domiciliary Treatment
  • Treatment taken outside the country
  • Cosmetic surgery
  • Lasik Surgery
  • Septoplasty
  • Infertility & Related Ailments
  • Admin/Registration/Service/Misc. Charges
  • Expenses on fitting of Prosthesis
  • Any device/instrument/machine contributing/replacing the function of an organ
  • Holter Monitoring are outside the scope of the policy
  • Sterility, venereal diseases or any sexually transmitted diseases
  • Dental treatment unless due to accident
  • Any case directly or indirectly related to criminal acts
  • Refractive error correction, hearing impairment correction
  • Substance abuse, self-inflicted injuries, STDs and HIV/ AIDS
Part II of the schedule Clause
3.4 Permanent Exclusions
4 Sub Limit Cataract will be capped at Rs. 1 Lakh per eye per Policy year Part II of the schedule Clause 3
5 Payout Basis
  • Cashless or Reimbursement of covered medical expenses up to specified Sum Insured as per the scope of cover
  • Cashless Facility available at over 4000+ network hospitals.
Part II oftheschedule4. Claim Administration

This being a Group Insurance Policy, it is noteworthy that in case if the customer closes the Bank account, the benefits under this policy shall cease upon expiry of the policy term and the customer may not be eligible for renewal of this policy. Customer can purchase another retail policy from ICICI Lombard. Further, in line with extant IRDAI regulations, customer shall also have the right to migrate from ICICI Lombard Group Health Insurance to an individual health insurance policy or a family floater policy as may be issued by ICICI Lombard to transfer the credit gained for pre-existing conditions and time bound exclusions. However, the customer shall be required to apply for same to ICICI Lombard at least 45 days before the policy expires.

For more details, please refer to the Policy Wordings.

Company shall not be liable for the deductible amount as specified against the plan opted. The Company are not liable for any payment unless the hospitalization medical expenses exceed the deductible. No deductible shall be applicable for optional cover.

c. Total premium and other charges including taxes, applicable

One-time payment of premium as per selected plan.

d. Freelook Period

Offer can be cancelled during free look period (15 days from the date, the policy is received) by giving a written notice to Company or by calling on 1800 2666. In this case, Company will refund the premium paid subject to deduction of the expenses incurred by Company on medical examination of the Insured Person(s) and the stamp duty charges.

e. Cancellation

  1. Disclosure to information norm: The policy shall be void and all premium paid hereon shall be forfeited to the company, in the event of misinterpretation, mis-description or non-disclosure of any material fact.
  2. You may cancel this Policy by giving Us 15 days written notice for the cancellation of the Policy by registered post, and then We shall refund premium on short term rates for the unexpired Policy Period.

f. Renewal

  1. The Policy can be renewed as a separate contract under the then prevailing ICICI Lombard Group Health Insurance product or its nearest substitute (in case the product ICICI Lombard Group Health Insurance is withdrawn by the Company) approved by IRDA.
  2. The policy shall ordinarily be renewable except on grounds of fraud, moral hazard or misrepresentation or non- cooperation by the insured.
  3. The policy could be subject to certain changes in terms and conditions including change in premium rate.
  4. Premium rates may change at the time of renewal subject to change in plan &/or age band of senior most insured

g. Tenure

Policy tenure for a period of 1 year.

h. Waiting period

  1. Pre-existing diseases: Declared and accepted PED covered after 24 months
  2. Initial waiting period: 30 days for all illnesses (except Hospitalization due to injury).
  3. Specific waiting period: First 24 months, for specific Illness and treatment.

(Please refer to the policy clauses for the full listing)

(Part II of the schedule Clause3.2, Clause3.3, Clause3.4)