Health Insurance

PAN India Cashless Network Hospital

Why do you need ICICI Lombard General Insurance (Bharti AXA General Insurance*) Health Insurance? 

Health insurance is designed to cover your medical expenses and give you the freedom to avail quality healthcare. It enables you to access medical treatment of the covered risks without any hassles. Fast-paced life coupled with high levels of pollution, unhealthy food habits, and job-related stress are some of the major factors that may result in health-related emergencies. In the event that you have not covered yourself and your loved ones under a health insurance plan, a medical emergency can end up becoming a financial emergency in no time. All this can be avoided by simply paying a small amount of premium.
So, why wait for an emergency to happen when you can financially safeguard yourself with a health insurance plan. Furthermore, rising healthcare costs also stress the need for a health insurance plan for every individual. 
ICICI Lombard General Insurance (Bharti AXA General Insurance*) new-age health insurance plans are not just limited to providing coverage before, during, and after hospitalization. Our health insurance plans are intended to provide protection against medical emergencies, in-patient treatments and day care procedures too. This ensures that your pockets do not drain due to any kind of medical emergency. 
Thus, regardless of your financial capability, with a health insurance plan, you can avail treatment at network of hospitals. After you have purchased a health insurance policy, not only will it bring peace of mind but in addition, you can avail tax deductions under Section 80D of the Income Tax Act.
 

Benefits Of Health AdvantEdge

• In-patient treatment
• Pre and post-hospitalization cover
• Organ donor cover
• Day care treatment 
• AYUSH treatment

Other/Optional Benefits Of Health AdvantEdge

• OPD for medical and dental.
• Vaccination for the new born baby in the first year
• Domestic air ambulance
• Guaranteed Cumulative Bonus (GCB)
• Restoration Benefit
• Bariatric surgery charges
• Domiciliary Hospitalization
• Personal accident cover 
• Critical Illness cover

• In-patient  treatment : Up to sum insured
• Organ donor : Up to sum insured
• Day care treatment  : Up to sum insured as per listed provided in policy document
• Domiciliary hospitalization : Up to sum insured
• Domestic  air ambulance : Subject to maximum limit as specified in the schedule to this policy

* Please refer to the policy brochure for detailed summary of product feature and benefits.

• Maternity benefit:
  -Maternity benefit with 9 month waiting period, up to first 2 deliveries/mtp in lifetime ( available only with 3 yr. Policy term) 
  -New born baby for first 90 days
• Vaccination for new born baby: till one year of age during policy period
• Animal bite vaccination : As per specified limit and plan opted

Sum Insured (SI) Rupees

• Waiting Period For Pre Existing Disease: Insured / Insured Person to opt for 24/36/48 months of waiting period
• Waiting Period for Named Ailments:  Insured / Insured Person to opt for 24/12 months of waiting period (refer to the policy wordings for entire list)
• Waiting period for Critical Illness: Insured / Insured Person to opt for 60 / 90 days of waiting period
• Survival period for Critical Illness: Insured / Insured Person to opt for 30 days of survival period.

*Please refer to the policy brochure for detailed summary of product feature and benefits.

• Co-payment: Co payment will be applicable as chosen by the Insured.
• Waiting period for below illnesses: Genetic Disorders and Mental Illness specifically for the following ICD codes: 
  Schizophrenia (ICD - F20; F21; F25) 
  Bipolar A ective Disorders (ICD - F31; F34) 
  Depression (ICD - F32; F33) 
  Obsessive Compulsive Disorders (ICD - F42; F60.5) 
  Psychosis (ICD - F 22; F23; F28; F29) 
• The waiting period chosen for Pre-existing Diseases will by default apply to this section. 

Claim Settlement ratio is the ratio of claims settled against claims reported during thce year. ICICI Lombard General Insurance (Bharti AXA General Insurance*) health insurance claim settlement ratio is 92.37% for FY 2016-17.

• Insured gets admitted to the hospital
• Takes treatment and pays hospital bills.
• Gets back all original documents from the hospital.
• Submits all original and necessary documents to the TPA along with duly filled claim form.
• TPA will review the documents and effect payment within 30 days of receiving the complete documents.
• If the health insurance claim is rejected, a letter will be sent along with the reasons for rejection.
• For any query one can connect us on  1800-103-2292/ or drop us a mail on customer.service@bhartiaxa.com
   

Any number of claims can be made during the health insurance policy period subject to the sum insured mentioned under the policy.

• In case of Emergency Hospitalization in Network Hospitals:
• The patient takes admission in the hospital by showing a Health ID card
• The cashless claim request form to be filled by the hospital & signed by the hospital authority & insured and faxed  or mailed to TPA or submitted to the insurance help desk at the hospita TPA will review the claim
• TPA will inform the insured and the hospital with the status via SMS, email or fax notification usually within 6 hours of submission of the request
• TPA will approve only the medical expenses covered under the policy. 
• These expenses will be settled by ICICI Lombard General Insurance (Bharti AXA General Insurance*) directly.
   

ICICI Lombard General Insurance (Bharti AXA General Insurance*) offers both Cashless services and Non-cashless (reimbursement) facilities for its customers. You can find our impanelled list of cashless hospitals where claims are managed by Third Party Administrators (TPAs) to offer claims service during hospitalization. 

Hospitalization expenses are covered in the health insurance policy. Hospitalization expenses are covered in the plan if you have been hospitalized for a minimum period of 24 hours. However, specific day care treatments, which do not require 24-hour hospitalization, are also covered under our health insurance policy. 

The treatments include: 

• Dialysis
• Chemotherapy
• Radiotherapy
• Eye surgery
• Dental surgery
• Lithotripsy 
• Tonsillectomy
• Dilatation and Curettage
• Cardiac Cauterization
• Hydrocele surgery
• Hernia repair surgery
   

No, the health insurance policy is meant to cover hospitalization only in India

The critical illness cover takes care of expenses incurred for treatment of any of the below specified critical illnesses. The Coverage is available in either of the following options:

Payment of lump sum benefit amount if the Insured Person is being diagnosed as contracting any of specified Critical Illnesses and surviving for more than 30 days post such diagnosis.
Payment /reimbursement of expenses incurred for treatment of such specified Critical Illness in a Hospital / Nursing Home

This benefit is available after a survival period of 30 days from the date of inception of the first year health insurance Policy. The SI available under this benefit is separate and is in addition to the SI available under the hospitalization benefit section of the Policy.

The following critical illnesses are covered under the Smart Super Health Insurance Policy:

• Cancer
• First Heart Attack
• Coronary Artery Disease
• Coronary Artery Bypass surgery
• Heart Valve Surgery
• Surgery to Aorta
• Stroke resulting in permanent symptoms
• Kidney Failure requiring regular dialysis
• Aplastic Anaemia
• End Stage Lung Disease
• End Stage Liver Failure
• Coma of specified severity
• Major Burns
• Major Organ or Bone Marrow Transplantation
• Multiple Sclerosis with persisting symptoms
• Fulminant Hepatitis
• Motor Neurone Disease
• Primary Pulmonary Hypertension
• Terminal Illness
• Bacterial Meningitis
   

Domiciliary hospitalization means treatment done at home in India for a period exceeding three days for disease, illness, or injury, which in the normal course, would require hospitalization. This could happen if either the condition of the patient is such that he or she cannot be moved to hospital or nursing home, or due to lack of accommodation.

We cover the cost of the treatment as well as expenses, if any, on the employment of qualified nurses, employed on the recommendation of the attending medical practitioner. The cover is limited to a maximum of 10% of the sum insured and will be payable if the treatment exceeds three days.
 

Pre and post hospitalization means the medical expenses incurred during a period before and after hospitalization for any disease, illness, or injury sustained, respectively.

The cashless claim is a facility that is available in our network of tied-up hospitals where we settle health insurance claims directly with the hospital or nursing home without you having to pay any amount to the hospital.

In the case of a pre-planned hospitalization, if the chosen hospital is included in our network of cashless hospitals, all that you need to do is request the hospital to send us a claim form along with certification from the doctor about the nature of the illness and treatment.

Once our Third-Party Administrator receives the information, and if the health insurance claim is admissible, the TPA sends you a pre-authorization in a few hours, for the cashless claim. We have an extensive network of more than 4,300+ network hospitals all over India where you can avail this facility.
 

The medical insurance cover provided by your employer is available to you only as long as you are an employee of the company. Moreover, the sum insured under your employer's health insurance plan may not be adequate for your needs. Hence it would be advisable to go for a separate health insurance policy.

Yes, we send you a health card along with the policy schedule and 80D certificate, once you take a health insurance plan with us. Health card is like an identity card issued by the insurer (insurance company) to the insured (individual). It is a useful card providing you the access to the network hospitals. You would need to provide your health card at the time of admission into the hospital. This card will be beneficial for availing cashless facility as well.

We issue health insurance policies for tenure of 1 year, 2 years, and 3 years, which can be renewed subsequently.

Usually, mediclaim policies cover expenses related to treatment and hospitalization but do not offer protection for other non-billable expenses. Our health insurance plans give you 360 degree cover for hospital bills and incidental expenses. 

Our comprehensive health insurance cover provides a cashless facility in over 4300+ hospitals and also provides 11 different value-added benefits. What's more, we help you pick a plan that's suited for your health needs.
 

You can choose from our health insurance plans, designed keeping your needs in mind here. Get your quote online, fill the proposal form, and check out making the payment. You will receive the health insurance policy documents through email instantly.

The Health insurance policy offered by ICICI Lombard General Insurance (Bharti AXA General Insurance*) acts as a support system for you and your family. With this health insurance plan, you can avail the following benefits, which include: 

Hospitalization expenses including: 

• Hospital charges (room & boarding and operation theatre)
• Fees of surgeon, anesthetist, nurses, and specialists 
• The cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs, and organs, etc
• Domiciliary hospitalization expenses including payment of medical treatment for a period exceeding three days for disease, illness or injury, which in a regular course, would require hospitalization, but is taken at home
• Daycare treatment wherein 24 hours hospitalization is not required
• Pre and post hospitalization expenses including related medical fees for a specified period incurred before and after hospitalization for disease, illness, or injury sustained and considered a part of a claim admissible under the health insurance policy
• Pre-existing conditions are covered from the 5th year onwards, after four years of continuous coverage with us
   

In addition to the above, our health insurance policy offers a host of value-added benefits under SHIP and SSHIP 

• Hospital cash allowance
• Home nursing
• Ambulance charges
• In-patient physiotherapy charges
• Accompanying person's expenses
• Parent accommodation as a companion for a child
• Out-patient dental emergency treatment arising out of accidents.
• Out-patient emergency treatment for accidents
   

Health insurance covers you and your family against expenses incurred in a medical emergency. With medical bills on the rise, insurance helps in reducing the financial burden during hospitalization. Also, the cases of critical illnesses and lifestyle-related ailments have increased rapidly. Health insurance allows you to be better prepared for such events. 

The premium that you pay for your health insurance is eligible for tax deduction under Section 80D of the Income Tax Act
 

Kindly call our customer support help desk at 1800-103-2292 (Toll-free) to renew your health insurance policy.

The major exclusions under health insurance policy are:

• Pre-existing diseases, illness, or injury. Health insurance benefits will not be available for any condition(s) as defined in the policy, until 48 months of continuous coverage have elapsed, since the inception of the first policy with the Company
• Any benefit under critical illness within the first 30 days of inception of the policy for the first year. This exclusion doesn't apply for subsequent renewals with the Company without a break.
• Medical expenses incurred for treatment undertaken for disease or illness and/or for critical illness within 30 days of the inception date of health insurance policy. This exclusion doesn't apply for subsequent renewals with the Company without a break.
• Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, vaccinations and inoculation of any kind, issuing of medical certificates and examinations as to suitability for employment or travel.
• Vitamins and tonics unless forming part of treatment for the disease, illness, or injury.
• Any stay in Hospital without undertaking any treatment or where there is no active regular treatment by the Medical Practitioner
• Prostheses, corrective devices, and medical appliances, which are not required intra-operatively or for the disease/ illness/ injury for which the Insured / Insured Person was hospitalized
• Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment.
• Costs of donor screening or treatment, unless specifically covered and specified in the Schedule to this Policy.
• Naturopathy treatment.
• Any treatment received outside India.

And treatment of the following health conditions: 

• Cataract, Benign Prostatic Hypertrophy, Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy, dilation, and curettage
• Hernia, hydrocele, congenital internal disease, fistula in anus, and sinusitis
• 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, Gastric, and Duodenal ulcers
• Joint Replacement surgeries unless necessitated by accident during the first two years of the operation of the Policy. 

We cover self, spouse, and two dependent children under the age of 21 years under one policy.

We cover self, spouse, and two dependent children up to the age of 23 years. Lifelong renewal is offered under our health insurance policies.

If your child is between 3 months and five years of age, he/she can be covered as part of a family floater policy provided at least one parent is covered. If the child is between 5 years and 23 years of age, you can choose between continuing the family floater policy or taking a separate health insurance policy for the child.
 

A family floater health insurance policy covers all family members (insured, his or her spouse, and two dependent children up to the age of 23 years) under one single policy. The sum insured floats over the entire family, and a consolidated premium needs to be paid. You can cover your family member under comprehensive health insurance to get family floater advantage.

Sum insured is the maximum amount paid to the insured by the insurance company in the event of a claim as per the health insurance contract.

You can decide the amount of health insurance on your own. We have a variety of sum insured options for you to choose from. You can decide on the amount based on the number of family members to be covered under the policy, the age of family members, the expected costs of treatment and the amount of premium you are willing to pay.

The premium payable on your health insurance policy is based on the following factors:

• Sum insured option is chosen
• The number of family members to be covered
• The age of the senior most person in the family to be covered
• The type of policy you opt for - Basic, Premium, Optimum,  Smart Super Health Insurance Policy