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A health insurance policy will provide a cover to you and your family against

sudden medical contingency or bodily injury.

Why health insurance?


Every human being is exposed to various health hazards.
Medical emergency can strike anyone without pre-warning.
Inadequate facilities in government hospitals
Private hospitals are too expensive
Medicines have become quiet expensive
Diagnostic charges are beyond common man’s reach
Specialists come at a price
Tax benefit under section 80 D of the Income Tax Act
Health risk is a personal risk, which could arise from various factors viz.
a) Physical condition
b) Accident related
c) Environment related
d) Life style related
e) Travel related

Health insurance, like other forms of insurance, is a form of collectivism by means of


which people collectively pool their risk, in this case the risk of incurring medical
expenses. The collective is usually publicly owned or else is organized on a non-profit
basis for the members of the pool, though in some countries health insurance pools may
also be managed by for-profit companies. It is sometimes used more broadly to include
insurance covering disability or long-term nursing or custodial care needs. It may be
provided through a government-sponsored social insurance program, or from private
insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its
employees) or purchased by an individual. In each case, the covered groups or
individuals pay premiums or taxes to help protect themselves from unexpected healthcare
expenses. Similar benefits paying for medical expenses may also be provided through
social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as
a monthly premium or annual tax) can be developed., ensuring that money is available to
pay for the healthcare benefits specified in the insurance agreement. The benefit is
administered by a central organization such as a government agency, private business, or
not-for-profit entity[1]

How it works

A health insurance policy is a contract between an insurance company and an individual


or his sponsor (e.g. an employer). The contract can be renewable annually or monthly.
The type and amount of health care costs that will be covered by the health insurance
company are specified in advance., in the member contract or "Evidence of Coverage"
booklet. The individual insured person's obligations may take several forms:[8]

• Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays
to the health plan each month to purchase health coverage.
• Deductible: The amount that the insured must pay out-of-pocket before the health
insurer pays its share.
• Co-payment: The amount that the insured person must pay out of pocket before
the health insurer pays for a particular visit or service.
• Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-
payment), the co-insurance is a percentage of the total cost that insured person
may also pay.
• Exclusions: Not all services are covered. The insured person is generally
expected to pay the full cost of non-covered services out of their own pocket.
• Coverage limits: Some health insurance policies only pay for health care up to a
certain amount. The insured person may be expected to pay any charges in excess
of the health plan's maximum payment.
• Out-of-pocket maximums: Similar to coverage limits, except that in this case,
the insured person's payment obligation ends when they reach the out-of-pocket
maximum, and the health company pays all further covered costs
• Capitation: An amount paid by an insurer to a health care provider, for which the
provider agrees to treat all members of the insurer.
• In-Network Provider: (U.S. term) A health care provider on a list of providers
pre selected by the insurer. The insurer will offer discounted coinsurance or co-
payments, or additional benefits, to a plan member. Generally, providers in
network are providers who have a contract with the insurer to accept rates further
discounted from the "usual and customary" charges the insurer pays to out-of-
network providers.
• Prior Authorization: A certification or authorization that an insurer provides
prior to medical service occurring. Obtaining an authorization means that the
insurer is obligated to pay for the service, assuming it matches what was
authorized. Many smaller, routine services do not require authorization.[9]
• Explanation of Benefits: A document sent by an insurer to a patient explaining
what was covered for a medical service, and how they arrived at the payment
amount and patient responsibility amount.[10]
• A Third Party Administrator (TPA) is an organization that processes insurance
claims or certain aspects of employee benefit plans for a separate entity.[1] This
can be viewed as "outsourcing" the administration of the claims processing, since
the TPA is performing a task traditionally handled by the company providing the
insurance or the company itself. Often, in the case of insurance claims, a TPA
handles the claims processing for an employer that self-insures its employees.
Thus, the employer is acting as an insurance company and underwrites the risk.
The risk of loss remains with the employer, and not with the TPA. The employer
may also contract with a reinsurer to pay amounts in excess of a certain threshold,
in order to share the risk for potential catastrophic claims. An insurance company
may also use a TPA to manage its claims processing, provider networks,
utilization review, or membership functions. While some third-party
administrators may operate as units of insurance companies, they are often
independent.
• Third party administrators also handle many aspects of other employee benefit
plans such as the processing of retirement plans and flexible spending accounts.
Many employee benefit plans have highly technical aspects and difficult
administration that can make using a specialized entity such as a TPA more cost
effective than doing the same processing in house.

[edit] Health plan vs. health insurance (United States)

In the United States, historically, HMOs tended to use the term "health plan", while
commercial insurance companies used the term "health insurance". A health plan can also
refer to a subscription-based medical care arrangement offered through HMOs, preferred
provider organizations, or point of service plans. These plans are similar to pre-paid
dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a
fixed number of services.The services offered are usually at the discretion of a utilization
review nurse who is often contracted through the managed care entity providing the
subscription health plan. This determination may be made either prior to or after hospital
admission (concurrent utilization review).

Comprehensive vs. scheduled

Comprehensive health insurance pays a percentage of the cost of hospital and physician
charges after a deductible (usually applies to hospital charges) or a co-pay (usually
applies to physician charges, but may apply to some hospital services) is met by the
insured. These plans are generally expensive because of the high potential benefit payout
— $1,000,000 to 5,000,000 is common — and because of the vast array of covered
benefits.[11]

Scheduled health insurance plans are not meant to replace a traditional comprehensive
health insurance plans and are more of a basic policy providing access to day-to-day
health care such as going to the doctor or getting a prescription drug. In recent years,
these plans have taken the name mini-med plans or association plans. The term
"association" is often used to describe them because they require membership in an
association that must exist for some other purpose than to sell insurance. Examples
include the National Association for the Self Employed and the Health Care Credit Union
Association. These plans may provide benefits for hospitalization and surgical, but these
benefits will be limited. Scheduled plans are not meant to be effective for catastrophic
events. These plans cost much less than comprehensive health insurance. They generally
pay limited benefits amounts directly to the service provider, and payments are based
upon the plan's "schedule of benefits". Annual benefits maximums for a typical scheduled
health insurance plan may range from $1,000 to $25,000.[12]
Other factors affecting insurance prices

A recent study by PricewaterhouseCoopers examining the drivers of rising health care


costs in the U.S. pointed to increased utilization created by increased consumer demand,
new treatments, and more intensive diagnostic testing, as the most significant driver.[13]
People in developed countries are living longer. The population of those countries is
aging, and a larger group of senior citizens requires more intensive medical care than a
young healthier population. Advances in medicine and medical technology can also
increase the cost of medical treatment. Lifestyle-related factors can increase utilization
and therefore insurance prices, such as: increases in obesity caused by insufficient
exercise and unhealthy food choices; excessive alcohol use, smoking, and use of street
drugs. Other factors noted by the PWC study included the movement to broader-access
plans, higher-priced technologies, and cost-shifting from Medicaid and the uninsured to
private payers.[13]

Health Plans

Health Advantage Plus Insurance


A unique policy that covers hospitalisation and Outpatient Department Expenses
(including Dental treatment, cost of medicines and drugs) and enables optimum tax
savings of up to Rs. 5099 u/s 80D.
Product Info Buy online Sum Insured Table Email Us

Family Floater Plan


A single policy that secures the hospitalization expenses of your entire family.
Product Info Price Chart Calculate Premium Buy Online Email Us

Personal Accident Insurance


A Policy that covers personal accident, permanent total disablement (PTD) and loss due to
terrorism

A comprehensive Health Insurance policy that not only goes beyond covering just your
hospitalisation expenses, but also offers coverage for Out Patient Treatment expenses
(OPD) and Tax Benefits.

Policy Details

Key Benefits

• Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental


treatment, medical bills, ambulance charges, etc.
• Avail Cashless Claim facility at over 3,500+ network hospitals across India
• No sub-limits on room rent, doctor fees, and hospital charges or for any disease
• No co-payments for any disease or any Hospitalisation expenses
• Now get an Additional Sum Insured for every claim free year
• Pre-existing illness covered after two years, subject to continuous renewal of the
policy with the Company
• Avail Tax Benefit under Section 80 D of the Indian Income Tax Act, 1961**.
• Maternity expenses can be covered under OPD expenses of this plan up to the
OPD sum insured
• Insurance against Terrorist activities
• A maximum of 2 adults can be covered under a single policy
• Buy Online and pay in EMIs without any extra charges***

* Except Cataract (Rs. 20,000 per eye applicable)


** Tax benefits are subject to changes in tax laws
*** EMI facility available only for ICICI Bank, Citibank and HDFC Bank (up to 6
months) credit card customers at the sole discretion of the Banks.

Note: EMI option subject to minimum annual premium of Rs. 1500. Click here to know
more.

What is covered

Hospitalisation Cover

• Medical expenses incurred as an inpatient during hospitalisation for more


than 24
hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic
tests,
etc.
• Medical expenses incurred 30 days prior and 60 days post hospitalisation

Know more about what is covered


Close X

What is covered

Hospitalisation Cover

• Medical expenses incurred as an inpatient during hospitalisation for more than 24


hours, including room charges, doctor’s / surgeon’s fee, medicines, diagnostic
tests, etc.
• Medical expenses incurred 30 days prior and 60 days post hospitalisation
• Pre-existing diseases can be covered after two continuous years of coverage with
the Company*
• Covers against hospitalisation# in case of Swine Flu / H1N1 influenza

* Conditions Apply
# If it's not a pre-existing illness

The following technologically advanced treatments that do not need 24-hour


hospitalisation but are covered under this policy are:

Cataract (limited to Rs. 20,000 per eye)


Lithotripsy (Kidney Stone Removal)
Tonsillectomy
Eye Surgery
Dialysis
Dilatation & Curettage
Chemotherapy
Radiotherapy
Coronary Angiography
Cardiac Catheterisation

Outpatient Department (OPD) Cover

Room, Boarding Expenses as charged by the Hospital


Nursing Expenses
Expenses related to Dental Treatment
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables,
Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy,
Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs External Medical Aids,
Dental treatment charges, Ambulance charges

Note: The OPD claims can be made only on a reimbursement basis. You can lodge a
claim only once during the Period of Insurance, i.e. 90 days after commencement of
policy and 30 days after expiry of the Period of Insurance.

Terms of Renewability
Health Advantage Plus Plan can be renewed instantly. Click here to know more

For more details, kindly refer to the Policy Wordings.

What is not covered

Exclusions for Hospitalisation Benefit Cover


Exclusions valid for the first 30 Days:

Any illness contracted within 30 days of the inception date of the policy, except those
that are incurred as a result of an accident. This clause is not applicable on the subsequent
renewals of this policy.

What is not covered


Exclusions for Hospitalisation Benefit Cover

Exclusions valid for the first 30 Days:

Any illness contracted within 30 days of the inception date of the policy, except those
that are incurred as a result of an accident. This clause is not applicable on the subsequent
renewals of this policy.

Exclusions valid for the first 2 Years:

Treatment of the following diseases:

• Cataract (limited to Rs. 20,000 per eye)


• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation & Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast
lumps, unless malignant / adenoids and hemorrhoids
• Dialysis required for chronic renal failure
• Surgery on tonsils and sinuses
• Gastric and duodenal ulcers
• Deviated Nasal Septum

Note: If the policy is renewed with us for two consecutive years, the above diseases /
illness / ailments will be covered from the third year. If these are pre-existing diseases at
the time of inception of the policy, the same will be covered from the second consecutive
renewal.

Pre-existing Disease Exclusion:

Any illness / disease / injury pre-existing disease before the inception of the policy.
However, this exclusion ceases to apply if the policy is renewed with the Company for 2
consecutive years.

Permanent Exclusions:

• Non-allopathic treatment, pregnancy and childbirth related diseases, cosmetic,


aesthetic and obesity related treatment.
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor,
intoxicating substances or drugs as well as intentional self injury.
• War, riots, strike, nuclear weapon induced treatment.

Exclusions for OPD (Outpatient Department Expenses):

• Suicide or self-inflicted injury


• Alcohol or drug abuse
• War, riots, nuclear related hospitalisation
• Non-allopathic treatment, experimental and unproven treatment
• Expenses arising from treatment of HIV/ AIDS or related disease, use or misuse
of alcohol and other intoxicating substances and intentional self-injury.

For more details, kindly refer to the Policy Wordings.

Eligibility

• The enrolment age (of senior most member) can be between 5 to 65 years of age.
• Maximum two adults can be covered under a single policy.
• The Proposer needs to be aged above 18 years
• No health check-up up to the age of 55 years (age as on last birthday).

Eligibility

• The enrolment age (of senior most member) can be between 5 to 65 years of age.
• Maximum two adults can be covered under a single policy.
• The Proposer needs to be aged above 18 years
• No health check-up up to the age of 55 years (age as on last birthday).
• Individual(s) proposed for Insurance whose age is 56 years & above have to
undergo medical tests at ICICI Lombard GIC Ltd designated diagnostic centers
• The policy is renewable till the age of 70 years
• Income Tax benefit u/s Section 80D of the Income Tax Act, 1961 can only be
availed
for policies bought for self, spouse, dependent children or parents.
Click here to view our Policy Exclusions.

Click here to view our Terms of renewalability.

Claims

Identify your Service Provider

Refer to your cashless claim card and check the logo displayed to determine
your service provider

Claims

Identify your Service Provider

• ICICI Lombard Health Care


• TTK Healthcare TPA Private Limited
• Parekh Health Management (Pvt.) Ltd.
• Medi Assist India Pvt. Ltd.
• MD India Healthcare Services (TPA) (Pvt.) Ltd.
• Paramount Health Services Pvt. Ltd.
• E Meditek Solutions Ltd.
• Family Health Plan Ltd.
• Raksha TPA Pvt. Ltd.
• Health India TPA Services Private Limited
• Dedicated Healthcare Services (India) Private Limited
• Alankit Health Care Limited
• Vipul Med Corp TPA. Pvt. Ltd.
• Park Mediclaim Consultants Private Ltd.
• Safeway Mediclaim Services
• Anmol Medicare Ltd.

General Insurance for Family

We all have family that we care for, those who are close and special to us. They are the
one who makes the world a better place to live in and makes life a lovable journey. You
want to bestow all that you can to ensure their happiness and security. At the same time,
you are busy and sometimes unable to manage all that is necessary. Addressing this
concern, todays financial institutions and insurance providers, both public and private are
striving hard to provide services that shares your responsibility towards your family.
Cashless Claims Overview

Get admitted in any one of our networked


hospitals

Fax the pre-authorisation form along with relevant


documents (Investigation reports, Previous
consultation papers if any, Cashless ID, Photo ID)

ICICI Lombard Health Care reviews your claim


request and accordingly will approve, query or reject
the same (as per policy terms & conditions)

ICICI Lombard Health Care settles the claim


(as per policy terms & conditions) with the hospital
after completion of all formalities.
Claims Do's & Don'ts

• Make sure to fill up the mobile number in pre-authorisation form


• Non-payable items have to be borne by the Insured
• In case of cashless denial, the Insured has to pay the hospitalisation expenses
• In case of planned surgery, send the pre-authorisation form in advance ( but not
before 15 days from the admission date)
• All claims to be submitted within 21 days from the Date of Discharge (DOD)
• Post hospitalisation claims may be submitted within 81 (60 + 21) days from Date
Of
Discharge
• Use the website to access the claims tracker, network hospital list, e-card and
various other information and services
• Do not refer network list of any other service provider
• Do not submit the claim documents at any local ICICI Lombard GIC Ltd office
• Always keep a photocopy of the claim documents submitted to ICICI Lombard
GIC Ltd
• All claim forms should be duly and completely filled

Required Documents

• Duly filled Claim form (signed by the Insured and the treating doctor)
• Discharge summary (with details of complaints & the treatment availed
• Final Hospital Bill (detail breakup) along with interim bills
• Payment Receipts
• Doctor’s consultation papers
• All investigation reports (e.g. Blood report, X-ray, Sonography, MRI, etc.)
• All pharmacy bills supporting with doctor prescriptions
• Implant sticker / invoice, if used (e.g. lens details in cataract case, stent details in
angioplasty)
• Medico Legal Certificate (MLC) and / or FIR for all accident cases

• For miscellaneous charges - detail bills with supporting prescription of the


Treating
doctor
• Copy of Health card
• Any other related documents
Note: All documents should be Original

Standard Payments & Exclusions

Payments include:

• Accommodation Charges - Room Rent (as per eligibility)


• ICU Charges (wherever applicable)
• Treating Doctor fees (e.g. - Surgeon charges, Visit fees, Consultation fees, etc.)
• Nursing Charges
• Anesthesia & Anesthetist charges
• Operation Theatre charges (wherever applicable)
• Investigation charges
• Pharmacy bills
• Consumables
• Implant(s) charges (wherever applicable) – e.g. Stents, Lens, etc.

Exclusions include:

• Ambulance charges (unless specified in policy)


• Administration charges
• Admission / Registration fees, File / Records Management charges
• Service / Surcharges
• Bed booking / Reserving charges
• Food & Beverages
• Soaps , Toiletries & Laundry
• Patients’ Attendant charges
• Special Nurse / Attendant charges
• Telephone / Photocopy / Courier / Insurance Processing Fees, etc
• FIR / MLC charges
• Others (non-insurance, items not related to treatment)
• All Items mentioned as exclusions in the policy

Status Descriptions

Claims may be Approved or Rejected or Queried:


Approved Cases - Settlement letter and the cheque in favour of the proposer is sent at
the mailing address mentioning approved and disallowed amount and reasons.

Queried Cases - Query letter is sent to the insured requesting submission of additional
documents/information. Two query reminders are also sent within a span of 15 days each,
failure to revert within 45 days of initial query leads to closure of the claim. Closure of a
claim is not equivalent to rejection. Closed cases may be reopened if adequate documents
are provided.

Rejected Cases - Rejection letter is sent to the insured mentioning sufficient grounds as
per the terms and conditions of the policy.

Note:

• Cashless Facility is only available at hospitals in our cashless network.


• In case of Planned Hospitalisation contact your service provider two days prior to
admission.
• In case Emergency Hospitalisation contact your service provider within 24 hours
of hospitalisation.
• ICICI Lombard Health Care is an in-house health claim processing and wellness
centreof ICICI Lombard.

HEALTH ADVANTAGE PLUS INSURANCE POLICY PREMIUM TABLE


Age of Senior
Most Member
Individual 2 Adults
(as on his last
birthday)
(with floater benefit)
SI under SI under SI under SI under
Hospitalisation Hospitalisation Hospitalisation Hospitalisation Benefit
Benefit = Rs. 2 Benefit = Rs. 3 Benefit = Rs.2 = Rs. 3 Lakhs
Lakhs Lakhs Lakhs

SI under OPD Benefit as below SI under OPD Benefit as below


Fixed Premium Rs. 15,000
5 yrs. - 18 yrs. Rs. 10,000 Rs. 9,500 -
19 yrs. - 35 yrs. Rs. 9,000 Rs. 8,800 Rs. 8,000 Rs. 7,500
36 yrs. - 45 yrs. Rs. 8,500 Rs. 8,000 Rs. 7,000 Rs. 6,500
46 yrs. - 55 yrs. Rs. 6,000 Rs. 5,500 Rs. 3,000 Rs. 2,000
56 yrs. - 60 yrs.* Rs. 4,500 Rs. 3,500 -
Fixed Premium Rs. 20,000
61 yrs. - 65 yrs. Rs. 7,000 Rs. 5,500 -
66 yrs. - 70 yrs. Rs. 4,000 Rs. 2,000 -
(for renewal
only)**
*Medical Tests mandatory for insured aged 56 and above
**Age at entry: max. upto 65 years; renewable upto 70 years

Advantages of Health Insurance: Helpful Tips for Health Health Insurance


Insurance Policies:
• It relieves you from the rising
Health Insurance Costs • Family Floater Health & Accidental
• Protection of your family Plan Insurance provides you
during Medical Contingency • Basic Health with a sense of security
• Coverage of Critical diseases> Insurance that you and your family
• Cashless cliam facility • Cover Critical are protected against
• evfilaim bonus facility Care Plan sudden medical
• Personal Accidentemergency or during the
• Enjoy tax rebates cover time of accident. With
• Group Medical Health and accident
Insurance cover you need not
worry about your
• Long Term Health Medical Expense in
Plan such contingency. We
help you provide with
the best Insurance
cover.

Comparison of Health Insurance Plans

Illustration based on 30 year old individual looking for Rs. 3 lakh cover

Results Sorted by Premium (cheapest first)


Free of
Sr Premium
Policy Sub-
No (Rs.)
limits?

1 ICICI Lombard - Health Insurance 1 year (Floater) 3,043

2 Future Generali - Health Suraksha Basic (Individual) 3,146

3 Future Generali - Health Suraksha Silver (Individual) 3,540

4 HDFC Ergo - New Healthwise (Floater) 3,599

United India Insurance - Mediclaim Policy Platinum


5 3,609
(Individual)

6 Apollo DKV - Easy Health Individual Standard (Individual) 3,626

7 IFFCO Tokio - Individual Medishield (Individual) 3,637

8 Star Health - Medi Classic (Individual) 3,640

9 National Insurance - Parivar for Family (Floater) 3,799

10 Reliance General - Individual Mediclaim (Individual) 3,799

11 Oriental Insurance - Health Insurance (Individual) 3,799

12 New India Assurance - Mediclaim (Individual) 3,800

Cholamandalam MS General Insurance - Individual Health


13 3,805
(Individual)
14 Future Generali - Health Suraksha Golden (Individual) 3,932

15 National Insurance - Mediclaim Policy (Individual) 3,988

16 Bajaj Allianz - Health Guard (Individual) 4,275

17 Apollo DKV - Easy Health Individual - Exclusive (Individual) 4,302

18 Royal Sundaram - HealthShield Standard (Individual) 4,420

Cholamandalam MS General Insurance - Family Floater


19 4,918
(Floater)

Floater Health Insurance Policy

Did you know that a floater health insurance plan provides cover for all your family
members under the same plan for a single premium? The sum assured available to any
one member or to all members in case of any eventuality during the term of the policy.

The incidence of chronic diseases has been on the rise all over the world in the past few
years. People have been spending large amounts of money treating various kinds of
diseases. The cost of medical treatment too has been ever rising. This is where medical
insurance can come handy. By spending a small sum on a regular basis in a health-care
policy, you can undergo medical treatment assured that your precious savings are not
affected by the cost of treatment. The peace of mind alone could help you to heal
quicker!

As in any booming economy, India's economic growth is being driven largely by the
middle class. Notwithstanding our increased spending capabilities, we are aware of every
rupee that goes out of our pockets. We are constantly on the lookout for the best product
in terms of cost as well as returns. It is no different with insurance, health insurance in
particular.

A relatively new type of health insurance plan called the Floater health insurance plan
helps you get maximum benefit for money spent. This is a health insurance plan where all
members of a family can be covered under the same plan for a single premium, with the
sum assured available to any one member or to all members in case of any eventuality
during the term of the policy.

The policy covers medical expenses incurred as an inpatient during hospitalization for
more than 24 hours, including room charges, doctor/surgeon fee and medicines etc. This
policy also covers expenses 30 days prior to hospitalization and 60 days post
hospitalization.

So...what is the difference between regular health insurance plans and Floater health
insurance plans?

We can study this with the following example. A family of three - husband (34 years),
wife (33) and child (6) - with a regular health insurance policy pays a premium of Rs.
7580. The same family will have to pay only Rs. 6024 if they opt for a Floater policy.

Normal Mediclaim Floater Policy


Individual Claim made
Claim Claim Family Sum
Individual Age sum Premium during the
Settled Settled Insured
insured year
Husband 34 300000 3100 0 0 0 300000
Wife 33 200000 2690 180000 180000 180000
Daughter 6 100000 1790 120000 100000 120000
7580 300000 280000 300000 300000

In case of the regular health policy, you have to specify the sum insured against each
family member. In the event of a claim, if the expenses move beyond that amount, you
have to bear the difference. The Floater policy, on the other hand, provides each family
member the benefit of the entire sum insured under the policy.

In the above-mentioned example, when the claim amount increased in the daughter's
case, only the amount up to her respective sum insured would have been paid in case of
Mediclaim. With the Floater plan, however, the full claim would have been paid out since
the total sum insured of the family was Rs.300000 - the sum assured was available to any
one of these three persons or to all the three persons in case of any eventuality during the
tenure of the policy.
Floater plans have some additional benefits, such as:

• Free health checkup coupon for the senior most member of the insured family
• An option for 2-year cover that offers a continuous 2-year protection with no
increase in premium in the second year. This one time payment of premium for 2
years takes care of your renewal hassles for next year. The 1-year cover is also
available.
• No health check up required up to the age of 45 years (as on last birthday).
• Income tax benefits under Section 80D (which from the current financial year has
increased from Rs. 10,000 to Rs. 15,000) in the form of deduction from total
taxable income. It is Rs 20,000 for senior citizens.

Policy Exclusions

30-day exclusion: Medical charges incurred, except those arising out of accidental
injuries, within the first 30 days from the start date of the policy are not covered. This
clause does not apply for subsequent renewal (without a break) of this policy.

The Floater policy is based on the probability of the number of people in a family falling
ill during the year. A young family has a lower probability of falling ill, therefore the
Floater policy can be an effective cost saver. As age increases, you should start looking to
migrate to individual sum insured policies.

Types of Health Insurance

Health Insurance Types

Health insurance can be broken down into two broad categories:

Traditional and Managed care. Within those categories, there are four basic types of
plans:

• Traditional indemnity plans, which are now often called fee-for-service plans;
• PPO, or Preferred Provider Organizations;
• POS, or Point-Of-Service plans;
• and HMOs, or Health Maintenance Organizations.

No one type of health care plan is better than the other. It really depends on your needs
and preferences. Some people enjoy the autonomy offered by fee-for-service plans, while
others prefer the low costs associated with closed-panel HMOs. Also, as health insurers
compete for business, distinctions among the types of plans may blur.

Traditional Health Insurance

Up until about 30 years ago, most people had traditional indemnity coverage. These days,
it's often known as "fee-for-service." Indemnity plans are a bit like auto insurance: you
pay a certain amount of your medical expenses up front in the form of a deductible and
afterward the insurance company pays the majority of the bill.

Advances in modern medicine increased the cost of providing health care and made it
possible for people to live longer. Those advances caused many insurance companies to
look for ways to reduce their costs of doing business, giving managed care the boost it
enjoys today.

Fee-for-service

For years, indemnity or fee-for-service coverage was the norm. Under this type of health
coverage, you have complete autonomy when it comes to choosing doctors, hospitals and
other health care providers. You can refer yourself to any specialist without getting
permission, and the insurance company doesn't get to decide whether the visit was
necessary. You don't, however, have complete autonomy. Most fee-for-service medicine
is managed to a certain extent. For instance, if you're not already incapacitated, you may
need to get clearance for a visit to the emergency room.

On the down side, fee-for-service plans usually involve more out-of-pocket expenses.
Often there is a deductible, usually of about $200-$2,500 before the insurance company
starts paying. Once you've paid the deductible, the insurer will kick in about 80 percent of
any doctor bills. You may have to pay up front and then submit the bill for
reimbursement, or your provider may bill your insurer directly.

Under fee-for-service plans, insurers will usually only pay for reasonable and customary"
medical expenses, taking into account what other practitioners in the area charge for
similar services. If your doctor happens to charge more than what the insurance company
considers "reasonable and customary," you'll probably have to make up the difference
yourself. Traditionally, preventive care services like annual check-ups and pelvic exams
haven't been covered under fee-for-service plans. But as the evidence mounts that
preventive care can prevent more costly illnesses down the road, some insurers are
including them.

Fee-for-service plans often include a ceiling for out-of-pocket expenses, after which the
insurance company will pay 100 percent of any costs. Needless to say, the ceiling is
usually pretty high.

In a nutshell, fee-for-service coverage offers flexibility in exchange for higher out-of-


pocket expenses, more paperwork and higher premiums.
Managed care

Managed care has been around in one form or another since the 1930s, but it really took
off in the last 10 years. As it grew, it evolved, leaving us with three basic types of
managed care plans. Today, the majority of people with private health insurance have
some type of managed care.

Although there are important differences among the different types of managed care
plans, there are some similarities. All managed care plans involve an arrangement
between the insurer and a selected network of health care providers, and they offer
policyholders significant financial incentives to use the providers in that network. There
are usually explicit standards for selecting providers and a formal procedure to assure
quality care.

Preferred Provider Organizations (PPOs)

One step over the managed care border is the Preferred Provider Organization. PPOs
have made arrangements for lower fees with a network of health care providers. PPOs
give their policyholders a financial incentive to stay within that network.

For example, a visit to an in-network doctor might mean you'd have a $10 co-pay. If you
wanted to see an out-of-network doctor, you'd have to pay the entire bill up front and then
submit the bill to your insurance company for an 80 percent reimbursement. In addition,
you might have to pay a deductible if you choose to go outside the network, or pay the
difference between what the in-network and out-of-network doctors charge.

With a PPO, you can refer yourself to a specialist without getting approval and, as long as
it's an in-network provider, enjoy the same co-pay. Staying within the network means less
money coming out of your pocket and less paperwork. Preventive care services may not
be covered under a PPO.

Exclusive Provider Organizations are PPOs that look like HMOs. EPOs raise the
financial stakes for staying in the network. If you choose a provider outside the network,
you're responsible for the entire cost of the visit.

Point-of-Service (POS)

Point-of-service plans are similar to PPOs, but they introduce the gatekeeper, or Primary
Care Physician. You'll need to choose your PCP from among the plan's network of
doctors.

As with the PPO, you can choose to go out of network and still get some kind of
coverage. In order to get a referral to a specialist, though, you usually must go through
your PCP. You can still choose to refer yourself, but it'll mean more hassles and more
money coming out of your pocket. If your PCP refers you to a doctor who is out of the
network, the plan should pick up most of the cost. But if you refer yourself out, then
you'll probably have to deal with more paperwork and a smaller reimbursement. You
may also have to pay a deductible if you go outside the network.

POS plans may also cover more preventive care services, and may even offer health
improvement programs like workshops on nutrition and smoking cessation, and discounts
at health clubs.

Health Maintenance Organizations (HMOs)

Most of the time, when you talk about HMOs, you're really talking about closed-panel
HMOs -- the least expensive, but least flexible type of health plan. They also tend to be
geared more toward members of group plans than individuals.

In exchange for a low co-payment (or sometimes no co-pay at all), low premiums and
minimal paperwork, an HMO requires that you only see its doctors, and that you get a
referral from your primary care physician before you see a specialist. If you can still pick
up the phone, you'll probably need to get clearance before you can visit the emergency
room.

An HMO may have central medical offices or clinics (such as those used by Kaiser
Permanente), or it may consist of a network of individual practices. In general, you must
see HMO-approved physicians or pay the entire cost of the visit yourself. HMOs have the
best reputation for covering preventive care services and health improvement programs.

Overseas Travel Insurance Policy Features


Eligibility: Insurance policy available for all ages between 1 – 70 years

Policy Duration: Cover trips from as short as 7 days to 180 days. Can be extended
online

Policy Maximum: The Plans offer various coverage options (US $ 50,000 to US $
100,000)

Premium: Premium is payable on a pay per day basis and not slab rates, pay EMI
without any extra charges on ICICI Bank, Citibank and HDFC Bank Credit Cards

Pre-existing diseases: Pre-existing ailments and maternity are excluded except in case
of life-threatening situations i.e. until the insured's heath is stable

A (Excellent) Rating: ICICI Lombard has received an A (Excellent) rating from


General Insurance Company of India and iAAA rating from ICRA signifying highest
claims paying ability
Deductible/Policy Excess : There is a Deductible/Policy Excess of US $ 100. This
implies for any claim the first $100 are to be borne by the insured

Additional Coverage: Coverages include Dental Treatment, Medical Evacuation,


Repatriation, Baggage Loss/Delay, Trip Cancellation and Interruption, etc.

Insurance 24X7: Buy insurance online or Dial-A-Policy at 1800 209 8888 to buy your
policy over the phone

Claim: In order to make a claim, please contact our TPA (Third Party Administrator)
SOS International, which has tie-ups with network hospitals worldwide

Foreign travel, be it for a holiday, business or studies is always exciting and you would
want nothing to come in the way of your trip. To ensure your travel is exciting and worry
free, ICICI Lombard offers Overseas Individual Travel Insurance that covers
unexpected and unplanned medical expenses when you are abroad. Besides medical
expenses we also offer plans that cover a host of non medical expenses.

We have allied with UnitedHealth Group, one of the largest health care companies in the
US to provide our travellers access to UnitedHealthcare's network of hospitals &
physicians.

Key Benefits
• Cashless hospitalisation facility available worldwide
• Avail of quality health care through our tie-up with UnitedHealth Group (UHC is
a leading US based healthcare provider)
• No medical check-up required for policy issuance
• The insurance also covers medical evacuation costs back to India
• Pre-existing diseases are covered under life-threatening situations*
• Coverage available up to 360 days (Original policy for 180 days and extension for

additional 180 days)


• Pay Per day: Slab rate for first 7 days only, then pay on a per day basis
• Extend the policy online in case you extend the trip, pay only for number of days
extended
• This policy also covers you for hospitalisation in case of Swine Flu / H1N1
influenza, if it
is not a pre-existing disease
• Buy Online and pay in EMIs without any extra charges**

* Conditions Apply
** EMI facility available only for ICICI Bank, Citibank and HDFC Bank (up to 6
months) credit card customers at the sole discretion of the Banks.

Note: EMI option subject to minimum annual premium of Rs. 1500. Click here to know
more.

View Details of Policy Coverage


For age : 71 to
For age : 1 year to 70 years
85 years
Platinum Annual
Coverage Gold Senior Citizen
Coverage Details Multi-Trip
amount Plan plan
Plan Plan
US$
50,000, 71 to 75 years -
US$ US$ 50,000 & 76
1) Medical Cover*
100,000, to 85 years - US$
US$ 25,000
250,000
Cashless
2) hospitalisation
worldwide
Daily allowance for US$ 25 (for
3) - - -
hospitalisation$ 5 days)
4) Dental Treatment* US$ 250 -
5) Passport Loss** US$ 200
Checked-in Baggage
6) US$ 500
Loss
Checked-in Baggage
7) US$ 100
Delay+
8) Personal Accident US$ 15,000 US$ 25,000
US$
9) Personal Liability US$ 25,000
100,000
Financial Emergency
10) US$ 300
Assistance
Hijack Distress
US$ 125
11) Allowance*** (7 days
per day
max)
Trip Cancellation &
12) US$ 500 - - -
Interruption*
13) Missed Connection^ US$ 500 - - -
14) Trip Delay*++ US$ 500 - - -
15) Home Insurance # Rs. - - -
- Building 2,000,000
- Content Rs. 500,000
Repatriation of
16) US$ 7,000 -
Remains
Senior Citizens
1 year
180 days Policy Policy can be
policy with
17) extendable up to 360 extended up to a
30/45 days
days maximum of 180
per trip
days.
Scenario 1 : Premium for
Insured for
an individual, aged 35 Rs. Rs. 3,548 +
US$ Rs. 2,455 +
years, travelling to US for 1,714
100,000
30 days
Scenario 2 : Premium for
Insured for
an individual, aged 65 Rs. Rs. 9,512 +
US$ Rs. 3,981 +
years, travelling to 2,690
100,000
Germany for 30 days
Scenario 3 : Premium for
an individual, aged 71 Insured for
- - - Rs. 3,328
years, travelling to US$ 50,000
Singapore for 30 days
Note: Senior Citizens Policy can be extended up to a maximum of 180 days.
* Deductible of US$ 100. This deductible is applicable on per illness (complete
treatment) basis and not on per visit to the doctor / hospital.
Note: For medical Cover the maximum amount that can be claimed per illness or injury
is US$ 100,000. Further sub-limits applicable for persons aged 56 and above.
** Deductible of US$ 50.
*** Beyond 12 hours
# On value - Building insured on reconstruction value, Contents insured on their present
market value
$ 2 days deductible - If hospitalisation is for more than 2 consecutive days. This benefit
can be availed only once during the policy period
^ Delay of more than 3 Hours
+ 12 hours delay - Applicable if baggage is delayed for more than 12 hours from actual
arrival time of common carrier
++ Up to US$ 100 per day, if trip is delayed for more than 6 hours.
For details, kindly refer to Policy Wordings.