ICICI Lombard General Health Insurance - iHealth Plan

ICICI Lombard Complete Health Insurance - iHealth Plan

ICICI Lombard Complete Health Insurance, iHealth Plan, makes sure that you and your family is secured against untimely health conditions. It gets you comprehensive coverage and also gives you an option to choose your medical plan, premium and policy according to your budget and requirements.

A) Key Benefits

• Coverage up to Rs. 10 Lakhs. Multiple sum insured options
• Can avail tax benefits on your health plan under Section 80D of the Indian Income Tax Act 1961
• Can get policy renewal facility for life time
• No Maximum Entry Age to avail this policy
• No medical test required for policyholders below 46 years of age
• Can benefit from cashless medical treatment across India in 4,000 plus network hospitals
• No Sub-limit. However you can opt for a sub-limit option.

No Sub-limits shall be applicable on any Major Medical Illness and Procedures and Joint Replacement Surgery. Major Medical Illness and Procedures for the purpose of this Policy shall mean and include the following:

• Cancer
• End Stage Renal Failure
• Major Organ Transplant
• All cardiac surgeries / conditions including but not limited to Heart Valve Replacement, Coronary Artery Bypass Graft (CABG) and Myocardial Infraction
• Multiple Sclerosis
• Stroke
• Paralysis
• All brain related surgeries

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Sub-limit on A & B applicable for 2 lakhs Sum Insured, Sub-limit C applicable for Rs. 3 Lac, Rs. 4 lakhs and Rs. 5 Lac. There is no sub-limit on the annual Sum Insured of Rs 7 Lakhs and Rs. 10 Lakhs.

Surgeries / Medical Procedures	Sub-limits (Rs.)
	A' (*Sub-limit A can only be bought through the call centre *Toll Free (1800 2666)	B' (*Sub-limit B can be purchased online.)	C' (Sub-limit C can be purchased Online.)
Cataract per eye	10,000	15,000	20,000
Other Eye Surgeries	15,000	22,000	35,000
ENT	15,000	22,000	35,000
Surgeries for - Tumors/Cysts/Nodule/Polyp	20,000	30,000	60,000
Stone in Urinary System	20,000	30,000	40,000
Hernia Related	20,000	30,000	60,000
Appendisectomy	20,000	30,000	40,000
Knee Ligament Reconstruction Surgery	40,000	60,000	90,000
Hysterectomy	20,000	30,000	60,000
Fissures/Piles/Fistulas	15,000	22,000	35,000
Spine & Vertebrae related	40,000	60,000	90,000
Cellulites/Abscess	15,000	22,000	35,000
Other Surgeries & Procedures	25,000	37,000	55,000
All Medical Expenses for any treatment not involving surgery/medical procedure	10,000	15,000	25,000

B) Additional Benefit: Design your Own Policy

a) Hospital Daily Cash:

A certain amount (as per the plan chosen) will be paid for each and every completed day of hospitalization, if such hospitalization is at-least for a minimum period of 3 consecutive days and subject to a maximum of 10 consecutive days.

Policy Sum Insured (Rs.)	Benefit per member (Rs.)
2 Lac	500 per day
3 Lac / 4 Lac / 5 Lac	1000 per day
7 Lac /10 Lac	2000 per day

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b) Convalescence Benefit:

A benefit amount of Rs.10,000 will be offered to every insured once for each Policy year and insured will be paid in case of hospitalization arising out of any Injury or Illness as covered under the policy, for a period of 10 consecutive days or more.

c) Donor Expenses and Critical Illness Cover:

• Donor Expenses:
  Reimbursement upto Rs. 50,000 for such medical expenses as incurred by the organ donor for undergoing any organ transplant surgery for your use.
• Critical illness Cover:
  Provides cover on diagnosis of specified Critical Illnesses/ Medical Procedures as per the sum insured of the policy.
• Cancer
• Coronary Artery By-pass Graft Surgery
• Myocardial Infraction
• Kidney Failure
• Major organ transplant
• Stroke
• Paralysis
• Heart valve replacement surgery
• End stage liver failure.

This cover is available on all Sum Insured options.

The benefit amount on the above circumstances will be payable depending on the diagnosis of the illness.

Maximum 2 adults can apply up to 60 years.

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d) Coverage

What is covered?

• Medical expenses incurred as an inpatient during hospitalization for more than 24 hours, including room charges, doctor/ surgeon's fee, medicines bills, etc
• Medical expenses incurred 30 days prior and 60 days post hospitalization
• Day Care expenses incurred on named advanced technological surgeries and procedures requiring less than 24 hours of hospitalisation. Click here to view the list.
• The minimum entry age starts from 6 years under individual policy,and 3 months under a floater policy.
• Pre-existing diseases can be covered after four continuous years of coverage with the Company

What is not covered?

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

Exclusions Valid for the First 2 Years:

Treatment of the following diseases/illness/ailments:

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

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 after the two years onwards, subject to continuous renewal of the policy with us.

Any claim for Cataract treatment shall not exceed Rs 20,000 per eyen, during each Policy Year after 2 years from the Policy start date.

Permanent exclusions:

• 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 for sum insured of Rs. 3 Lac, 4 Lac, 5 Lac, 7 Lac,10 Lac and Rs. 2 Lac sum insured if the policy is renewed for 4 consecutive years.
• Non-allopathic treatment, pregnancy and childbirth related complications, 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, civil war or breach of law
• Naturopathy treatment, acupressure, acupuncture, magnetic and other such therapies
• Treatment taken outside the country
• Any expenses arising out of Domiciliary Treatment

e) Eligibility

The customer can buy the policy for any family member(s) children and / or parents

The minimum entry age for customer to get the policy is 3 months in case of floater and 6 years in case of individual.

The proposer needs to be aged above 18 years:

• The insured should be above 3 months in case of floater and 6 years in case of individual. The proposer needs to be aged above 18 years
• To cover children aged between 3 months to 5 years, the policy must also cover at least 1 adult
• Children under less than 91 days old cannot be covered
• Individual(s) proposed for Insurance whose age is 46 years & above have to undergo medical tests at ICICI Lombard designated diagnostic centers
• This policy offers the option of life-long renewability
• Income Tax benefits u/s 80D can only be availed for policies bought for Self, Spouse, Parents and Dependent children.

f) Tax Benefits

Health Insurance plan is a favorable tax planning tool, when you are considering your tax saving options during year end. It is true that tax saving is important, but investing in a comprehensive health insurance can add a feather to the cap on your investments. ICICI Lombard Complete Health Insurance plan along with being an effective investment tool is also the most comprehensive solution in times of medical and non-medical emergencies. Get extensive coverage for individual or for your entire family with a single policy and save tax easily. There are two kinds of income tax benefits for individuals or family with ICICI Lombard Complete Health Insurance.

Section 80D: With ICICI Lombard Complete Health Insurance you can save tax under various section of the Income Tax Act. These include Sec 80C, Sec 80D, Sec 80E etc. Investments made on medical insurance premium paid are eligible for tax deduction, from your earnings, under section 80D.

How much can you save with ICICI Lombard Complete Health Insurance

As per Section 80D & with ICICI Lombard Complete Health Insurance the premium amount paid is deductible up to Rs. 25,000 from the income per year. In case of 60years and above the deductible limit increases up to Rs. 30,000 per year. In case of parents, if you are paying their medical insurance premium then there could be additional deduction of Rs. 25,000 per year. This amount paid can be claimed for under section 80D. If parents are senior citizen, then the additional amount deductible can be of Rs 30,000.

So, above all every individual is viable to deduct up to Rs. 55,000 from the taxable income as per the medical insurance premiums paid for self, spouse, children (Rs.35000) and parents (If senior citizen Rs.30000/- else Rs.25000/-).

(Note: You can not claim premiums paid for your in-laws / Brother / Sister)

Mode of Payment: Except cash, any mode of payment is acceptable for claiming deduction under Section 80D.

Remember! Do not pay premium from savings or gifts received. The insurance premium has to be paid from the taxable income of that year, if you plan to make a claim deduction in section 80D.