With ICICI Lombard’s Family Floater Health Insurance, you get one single policy which takes care of the medical expenses incurred by you/ your family during hospitalization for a minimum period of 24 consecutive hours, during medical emergencies
Benefits for your family
- Single sum insured for the family
- Cashless Claim facility in over 4500+ network hospitals
- Hospitalisation cover upto 4 lakhs
- 0% EMI Option*
- No medical check-up required upto the age of 55
- Tax Benefit under Section 80D of Income Tax Act, 1961**
The policy covers medical expenses:
- Incurred as an inpatient during hospitalization for more than 24 hours, including room charges, doctor/ surgeon’s fee, medicines, etc.
- 30 days prior to hospitalization.
- 60 days post hospitalization.
- Day Care expenses incurred on advanced technological surgeries and procedures like Dialysis, Radiotherapy, and Chemotherapy requiring less than 24 hours of hospitalisation.
Key Benefits
- One Policy – One Premium for the entire family.
- Income Tax benefits under Section 80D.
- No health check up required upto the age of 45 years (as on last birthday).
- 5% discount on premium for every claim-free year
- Digitally signed policy available 24×7 online. You can take prints instantly.
- Hassle free claims procedure
- Cashless claim facility at over 3,500 network hospitals in more than 175 cities across India.
Additional Benefits
- FREE Health Checkup coupon - A FREE Health Checkup coupon for the senior most member of the family being insured.
- Up to 2-year Cover - We offer 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 hassels next year. Option for 1 year cover also available.
Policy Exclusion
All health policies have following set of temporary and permanent exclusions:
30 Days 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 with us.
2 Years exclusions
Expenses incurred on treatment of following diseases within the first two years from the start date of the policy are not covered:
- Cataract
- 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
- 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
Claim Process
Cashless claims facility is available only at our network hospitals. This list of network hospitals is enclosed with your policy. Under this facility you just sign the bills at the time of your discharge and we shall settle the amount directly with the hospital.
Under cashless facility, claims can be of two types:
Planned:
Where the insured or covered family member(s) is aware of the hospitalization 2-3 days in advance.
- Contact our Third Party Administrator (TPA) TTK Health Services help-line at 1800 42 58885 / 1800 42 57878 (Toll Free & Accessible only in India). You can also fax them at the toll free number 1800 233 4535 and call at their landline number 080-25026700. The same is mentioned on the Health Identity Card.
- Fax / submit the pre-authorization form to TPA with doctor’s comments. This form is available online and also at all our network hospitals.
- The TPA faxes pre-authorization form with approval within 2-3 hours.
- Avail the health treatment.
- On your discharge, the TPA settles bills with the hospital.
Emergency:
Where the insured or covered family member(s) meets with a sudden accident or suffers from a bout of illness that requires immediate admission to the hospital.
- Rush the patient to the hospital.
- Patient avails the treatment.
- Family contacts TPA help-line at 1800 42 58885 / 1800 42 57878 (Toll Free & Accessible only in India) as mentioned on the health card. You can also fax them at the toll free number 1800 233 4535 and call at their landline number at 080-25026700
- Family submits the pre-authorization form to TPA with doctor’s comments. This form is available online and with all network hospitals.
- The TPA faxes pre-authorization form with approval within 2-3 hours. On discharge, the TPA settles bills with the hospital.
Health - Reimbursement Settlement
Reimbursement claims facility is available at both the network and non-network hospitals. The reimbursement claims process is as follows:
- Patient avails the treatment.
- Settle the hospital bills directly by paying the relevant charges.
- Call our TPA at toll free number 1800 42 58885 / 1800 42 57878 (Toll Free & Accessible only in India) and inform about the hospitalization. You can also fax them at the toll free number 1800 233 4535 and call at their landline number at 080-25026700.
- Submit the relevant bills / documents for the claimed amount to the TPA.
- The claims will be settled in 7 working days, from the time of submission of bills.
- For any assistance before, during or after the claim, call our TPA at the toll free numbers 1800 42 58885 / 1800 42 57878 (Toll Free & Accessible only in India). You can also fax them at 1800 425 2626 and call at their landline number at 080-25026700
Documents Required
- Duly completed claim form (available with all network hospitals).
- Original bills, receipts and discharge certificate / card from the hospital.
- Bills from chemists supported by proper prescription.
- Investigation test reports and payment receipts, supported by the note from attending medical practitioner / surgeon prescribing the test.
- Doctor’s referral letter advising hospitalization in non-accidental cases.
- Nature of operation performed and surgeon’s bill and receipt.
- Any other documentation / information as required by the TPA