ICICI Lombard Health AdvantEdge
Overview
ICICI Lombard Health AdvantEdge is a premium health insurance plan offered by ICICI Lombard General Insurance. The plan offers a bunch of premium features such as no room restrictions, worldwide coverage, unlimited restorations, air ambulance cover and others, apart from covering the base benefits. You can also opt for maternity coverage, OPD benefits and critical illness cover as add-ons.
Consider this plan if you are looking for premium benefits along with the options of maternity and OPD coverage. However, there is one cause of concern. ICICI Lombard’s claim settlement ratio is below the benchmark we recommend.
Pros and Cons
- No room restrictions – Pick any room if your base sum insured is more than Rs. 20 Lakh.
- Never spills the bill – The plan does not include a mandatory copay or disease-specific limit. In case of in-patient hospitalisation, you are fully covered up to the sum insured.
- Day care procedures covered – Your insurer covers your day care treatment expenses up to the sum insured.
- Pre and Post Hospitalisation expenses covered – The insurer pays for medical expenses up to 90 days before and 180 after the hospitalisation.
- Unlimited restorations available – The insurer automatically restores your base sum insured for future claims unlimited times in case you run out of cover during a policy year.
- Worldwide coverage – Your insurer provides worldwide coverage for planned and emergency hospitalisation for a higher base sum insured.
- PED coverage starts after a short waiting period of 2 years.
- The plan is reasonably priced for the benefits it offers.
- Room coverage is restricted to a single private room up to Rs. 20 Lakh base sum insured.
- The base plan does not include coverage for non-medical items; available at an extra premium.
- Age based pricing – Premium increases every year with age.
- Claim settlement ratio – The insurer showcased a claim settlement ratio of 86.58% in FY24, which is below the benchmark of 90%.
Plan Benefits
Get full cover on hospitalisation expenses
The plan covers hospitalisation expenses at actuals without any disease-specific limits. The room rent cover is restricted to a single private room up to Rs. 20 Lakh base sum insured. Beyond that, you can pick any room you like. ICU charges are covered at actuals.
Day care procedures are fully covered
Many advanced surgeries or procedures done under anesthesia now require less than 24 hour hospitalisation. These are called day care treatments. Your insurer fully covers the cost of such procedures or treatments.
Get cover for pre and post hospitalisation expenses
The plan covers hospitalisation-related medical expenses 90 days before and 180 days after hospitalisation. These include consultations, diagnostic tests, medication and other related expenses.
Alternative medicine covered
Want to take alternative treatment like Ayurveda or Homeopathy? Don’t worry. Your insurer fully covers your hospitalisation and related expenses.
Get worldwide coverage for any illness
Take treatment anywhere in the world. Your insurer covers the hospitalisation expenses for planned treatments as well as emergencies outside India after a waiting period of 2 years. This benefit is available only if your base sum insured is Rs. 25 Lakh or above.
Get cover even if you are forced to be hospitalised at home
Are you forced to be hospitalised at home? Imagine this. No beds are in the hospital or the patient’s medical condition does not allow him to be moved to a hospital. This is called domiciliary hospitalisation. Your insurance policy covers the cost of hospitalisation if it happens for at least 3 consecutive days under the supervision of a medical practitioner.
Guaranteed cumulative bonus available
You get a 20% guaranteed cumulative bonus every year up to a maximum of 100% of the sum insured, irrespective of the claims you make.
Unlimited restorations of sum insured available
Even if you claim a part of your base cover, you don’t have to worry about the coverage for future claims. Your insurer restores your full sum insured for all future claims unlimited times during a policy year. This feature comes in handy if you make multiple claims during a policy year.
Covers organ harvesting cost in case of an organ transplant
If you are an organ recipient, your insurer will cover the hospitalisation expenses of the organ donor for harvesting the donated organ.
Ambulance charges covered
The plan covers road and air ambulance charges up to the sum insured.
Get free health checkup every year
Get a pre-defined free health check-up every year, subject to limits. You can avail of this benefit only at a network provider center on a cashless basis. This benefit has a separate limit over and above the base coverage.
Surrogacy and oocyte cover available
This plan provides coverage for surrogate mother and oocyte donor up to Rs. 5 Lakh. This is an inbuilt cover and does not require you to pay an extra premium.
Get convalescence benefit in case of longer hospitalisation
If your hospitalisation exceeds 10 consecutive days, the insurer provides you a fixed convalescence benefit of Rs. 20,000 for incidental expenses.
Anima Bite vaccination coverage available
Get coverage for expenses related to vaccination for the OPD treatment post an animal bite up to Rs. 10,000. This benefit is only available on a reimbursement basis.
Get cover for weight loss treatment
Want to undergo weight loss treatment? The plan covers hospitalisation expenses for weight loss treatment up to the sum insured if certain conditions are met.
Unlimited teleconsultations are available
You can avail of unlimited general or specialist telephonic consultations to stay healthy.
Wellness benefits available
Stay healthy and earn reward points from your insurer. You can use these reward points to get up to a 5% discount on subsequent premiums if certain conditions are met.
Get non-medical items covered with an add-on
Non-medical items usually constitute 10% to 20% of hospitalisation expenses for each claim. The base variant of ICICI Lombard Health AdvantEdge does not cover this cost. However, with Claim Protector add-on, you can make your insurer cover these costs too.
Get additional critical illness coverage for 20 listed illnesses
If you want extra coverage for life-threatening critical illnesses, opt for Critical Illness add-on. The add-on covers 20 critical illnesses and provides a lump sum benefit upon the diagnosis of a listed critical illness.
Get maternity expenses covered with an additional premium
The plan covers maternity and newborn baby expenses up to Rs. 1 Lakh if you choose this add-on. The coverage starts after a waiting period of 2 years.
Opt for a copay to lower the premium
If you find the plan expensive, choose a small copay to lower the premium. Copay options of 10% and 20% are available. However, choose this option with caution as you pay a fixed percentage of each claim out-of-pocket.
BeFit add-on for OPD benefits
With this add-on, you get cover for an array of OPD benefits such as doctor consultations, minor diagnostic procedures, medication and physiotherapy sessions. You can avail of these benefits on a cashless basis via booking through the insurer’s mobile app.
Policy Conditions
| Sum Insured Range | Rs. 5 Lakh – Rs. 3 Crore |
| Entry Age | 91 Days – 18 Years for dependent children, 18 – 65 Years for adults. |
| Policy Tenure Options | 1, 2, or 3 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage | Up to 2 adults and 3 children under the family floater option |
| Premium Payment | Annual. |
Exclusions
Waiting Periods
- Initial Waiting Period: 30 days (except accidents)
- Specific Illness Waiting Period: 24 months.
- Waiting Period on Pre-Existing Diseases: 24 months.
- Waiting Period for Diabetes, Hypertension, and Cardiac Conditions unless PED: 90 days
- Maternity Benefit Waiting Period: 24 months
- Critical Illness Waiting Period: 90 days
- Bariatric Surgery Waiting Period: 24 months
- Worldwide Cover Waiting Period: 24 months
- BeFit Benefit Waiting Period: 30 days
Medical Exclusions
- Change of gender treatment
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven treatments
- Refractive error correction for less than 7.5 diopters
- Dental OPD treatment
Non-Medical Exclusions
- Investigation and evaluation
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Treatment necessitated by committing breach of law with criminal intent
- Treatment taken by a medical practitioner outside his discipline
- War, terrorism, nuclear events
- Injuries from hazardous sports
About the Insurer
ICICI Lombard General Insurance was founded in 2001 and is a leading general insurance company in India. It is a joint venture between ICICI Bank, India’s second-largest private bank, and Fairfax Financial Holdings, a Canada-based financial services company.
ICICI Lombard is a publicly listed company offering a comprehensive range of insurance products, including health, motor, travel, home, business and property insurance. The insurer has an extensive business track record and showcases a decent performance with a low volume of claim-related complaints and a healthy incurred claim ratio. However, its relatively low claim settlement ratio may be a cause of concern.
Performance Highlights (FY24)
Turnover – Rs. 24,776 Crore
Claim Settlement Ratio – 86.58%
Incurred Claim Ratio – 71%
Volume of Claim Complaints – 10.53 / 10,000 claims
Network Hospitals – 13,600+
Get In Touch
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Frequently Asked Questions
What is the ICICI Lombard Health AdvantEdge plan?
The Health AdvantEdge plan is a comprehensive health insurance policy offering extensive coverage, including in-patient hospitalisation, pre and post-hospitalisation expenses, and various optional benefits.
Who is eligible to purchase ICICI Lombard Health AdvantEdge?
Individuals aged 18 to 65 years can purchase the plan. Dependent children aged 91 days to 18 years can be covered under a family floater policy.
What sum insured options are available ICICI Lombard Health AdvantEdge?
The plan offers various sum insured options from Rs. 5 Lakh to Rs. 3 Crore.
What is the waiting period for pre-existing diseases?
Pre-existing diseases are covered after a waiting period of 2 years from the policy inception.
Does ICICI Lombard Health AdvantEdge cover maternity expenses?
Yes, the plan offers coverage for maternity expenses, including coverage for the newborn baby with an add-on.
What is the 'Reset Benefit' feature under ICICI Lombard Health AdvantEdge?
The insurer automatically restores the sum insured if it gets exhausted during the policy year. Restoration benefit is only available for subsequent claims in a policy year.
Does the plan offer a cumulative bonus?
Yes, you get a 20% guaranteed cumulative bonus every year, up to a maximum of 100% of base sum insured, irrespective of the claims you make.
Are health check-ups included under ICICI Lombard Health AdvantEdge?
The plan provides coverage for preventive health check-ups every year to all insured lives, subject to limit.
Is there coverage for AYUSH treatments?
Yes, in-patient treatments under Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) are covered up to the sum insured.
Does the plan cover organ donor expenses?
Yes, medical expenses incurred for organ donor hospitalisation are covered up to the sum insured in case you are the organ recipient.
Are ambulance charges covered under ICICI Lombard Health AdvantEdge?
The plan covers expenses for both road and air ambulance services during emergencies, subject to policy terms.
What is the 'Claim Protector' feature, and what does it cover?
The ‘Claim Protector’ is an add-on that covers non-medical listed items such as gloves, masks, syringes and other consumables, during hospitalisation.
Does ICICI Lombard Health AdvantEdge offer any benefits for long-term hospitalisation?
Yes, the plan includes a ‘Convalescence Benefit’ that provides a lump sum amount of Rs. 20,000 once a year if you are hospitalised for 10 or more consecutive days. This benefit helps cover incidental expenses during prolonged hospital stays.
What is the policy tenure available?
You can choose a policy tenure of 1, 2, or 3 years, based on your preference.
Are there any discounts available?
Yes, ICICI Lombard Health AdvantEdge offers various discounts, including tenure-based discounts and discounts for certain vaccinations.
Is there a free-look period?
Yes, there is a 15 day free-look period during which you can review the policy terms and cancel if not satisfied.
Are day care procedures covered under ICICI Lombard Health AdvantEdge?
Yes, the plan covers day care procedures that require less than 24 hour hospitalisation, including advanced treatments.
What is the claims process?
You can avail of cashless treatment at network hospitals or opt for reimbursement by submitting necessary documents as per the insurer’s guidelines.
Are there any tax benefits?
Premiums paid towards ICICI Lombard Health AdvantEdge plan are eligible for tax deductions under Section 80D of the Income Tax Act.
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