This presentation explains about the various features and benefits of availing Individual health insurance policy (for self and family) from ICICI Lombard.
2. Who said I need health Insurance?
I don’t fall sick!! Why
should I take an Health
Insurance??
3. Why Health Insurance?
Health insurance is needed more now than ever
before because of -
Skyrocketing
medical costs
Need for
routine
medical check
ups and care
Expensive
trips to
specialist
doctors
Possibility of
hospitalization
and treatment
4. Benefits of Health Insurance from ICICI Lombard
Day care surgeries
/ treatments
covered
Free yearly medical
checkup coupons for
up to 2 people
Optional Maternity
cover available
Cashless Treatment
at Specialty Hospitals
Pre-existing
disease covered
(after 2 years)
Outpatient
treatment covered
6. Scope of cover
Disease/ Injury
Treated medically/
surgically
By Hospitalisation/
Domiciliary hospitalisation
At Nursing home/ hospital
in India as in-patient
Pre hospitalisation
Post hospitalisation
Age limit
90 days – 80 years
Relevant medical
expenses 30 days prior
to hospitalisation
Relevant medical
expenses 60 days after
hospitalisation
7. Compensation payable
Reasonable and
necessarily incurred
Room expenses in
hospital/ nursing home
Nursing expenses
Medical practitioner fee
Treatment cost
Medicines/ diagnostic cost
Blood/ oxygen
Cost of pacemaker
Operation theatre charges
Surgical appliances
Dialysis, chemotherapy,
radiotherapy
8. Compensation payable contd.…
Pre and post
hospitalisation expenses
Max of SI
Surgical operation
Manual operative
procedure for
Deformity
Defect correction
Diagnosis cure
Prolongation of life
9. Hospitalisation
Min period of 24 hrs
Time limit not applicable for specific treatment
Dialysis
Chemotherapy
Tonsillectomy
Day Care
Cataract
10. Pre & post hospitalisation
Pre hospitalisation
Post hospitalisation
Relevant medical expenses 30 days prior to
hospitalisation
Relevant medical expenses 60 days after
hospitalisation
Any one illness
Continuous Period of Illness
Relapse within 45 days of the earlier treatment
11. Domiciliary hospitalization
Treatment exceeding 3 days at
Residence
Serious condition of patient does
not allow removal to hospital
Lack of accommodation in
nursing home
Pre / post hospitalisation expenses
not covered
Specified diseases excluded Asthma/ Diabetes/ Dysentery/
Hypertension/ Flu/ Epilepsy/ Arthritis
12. My No Service Areas..
Ok.. Lot of things are
covered…Is there
anything left that we don’t
cover???
13. First year exclusions
Cataract
Benign prostratic
hypertrophy
Hysterectomy for
menonhargia or fibromyoma
Hernia/ hydrocele
Congenital internal disease
Fistula in anus/ piles
Sinusitis & related disorder
14. General exclusions
War/ war group
Nuclear perils
Plastic surgery
Spectacles/ contact lens/
hearing aid
Dental treatment
Convalescence/ general debility
Sterility/ venereal disease /
circumcision
Intentional self injury
15. General exclusions contd.…
Use of intoxicating drugs/
alcohol
Aids
Diagnostic/ laboratory
expenses not consistent
with treatment
Vitamins/ tonic inconsistent
with treatment
Pregnancy
Naturopathy
20. Reimbursement – mediclaim
Planned / Emergency treatment in
non-notified hospital
Notice to TPA & approved
Submit
Duly completed claim form
Bills, receipts and discharge
certificate/card from the Hospital
Bills from Chemists supported by
proper prescription.
Test reports and payment
receipts
Settlement within a week on
complete submission