ICICI Lombard

Dear Sir,

Life is full of surprises… some bitter, some sweet. Health and wellness form an important aspect of the balance in your life. To ensure that you are taken care of when the need arises, we present 'Health Advantage Plus', a unique innovative health Insurance plan that cover much more than basic hospitalization covers. It covers medical emergencies like surgeries, accidents and sudden illnesses,dental treatment expenses. You can avail a full utilization of tax benefit on up to Rs.15,000/- (Rs.20,000 for Senior Citizens) under Section 80D of the Income Tax Act 1961 & amendments thereof.

Health Advantage Plus -Coverages

Basic Hospitalization
Cover for
Benefit A

Covers all reasonable and necessary medical expenses incurred durins hospitalization for more than 24 hours, subject to sum insured under benefit A.

30days pre-hospitalization
60 days post-hospitalization
Named advanced technological surgeries and procedures that require less than 24 hours of hospitalization ~.
Some of the illnesses that require less than 24 hours hospitalization are:
- Cataract
- Dilatation and curettage
- Cardiac Catheterization
- Lithotripsy (Kidney Stone removal)
- Chemotherapy
- Tonsillectomy
- Radiotherapy
- Eye Surgery
- Coronary Angiography
- Dialysis
~Conditions Apply

Pre-existing Diseases- It will be covered after the 2nd year, on continuous renewal with 'Health Advantage Plus'

Outpatient Treatment Expenses for
Benefit B

For the first time in India, you can avail of an insurance cover for orthopedic, maternity, dental, pharmacy, general practitioner and other medical expenses incurred on OPD basis.

This is an insurance cover to cover expense that you incur for your health,subject to sum insured under benefit B.
The Outpatient Treatment Expenses can be claimed only once a year within a period of 90 days from the start of cover and 30 days from the end of cover.

Floater Cover

Floater is a common cover for both the members

Anyone out of the 2 adults insured can avail of cover under benefit A and B of Health Advantage Plus; Floater provides a common cover for both members.

Suppose Mr.& Mrs. Kumar take a 3 lacs(Benefit A) cover. In an foreseen situation wherein a surgery and post hospitalization bill for Mr.Kumar amounts to Rs.1.9 lacs, the remaining 1.1 lacs can be claimed by Mrs. Kumar or even Mr. Kumar later. If Mr. & Mrs. Kumar had taken two separate policies of 1.5 lacs each then Mr. Kumar would have to pay 0.4 lacs from his own pocket. With floater thecover of3 lacs would be shared among both Mr. & Mrs. Kumar; thus making available to both of them a cover of 3lacs.

No
Medical
Checkup

No medical check- up required upto 55 years for purchase of policy.

Cashless
Hospitalization

Simply use your 'Health Advantage Plus' ID card at any of the 4000+ hospitals and avail of cashless service, a boon for those times when you need finance the most. This benefit is only for hospitalization claims.

Maximum
Tax Benefit

You can avail a full utilization of tax benefit on upto Rs.15,000/- (Rs.20,000 for Senior Citizens) as premium paid under Section 80D of the Income Tax Act,1961. This will save upto Rs.5,099/- ^ in your tax liability in one year.

^ Indicative figure. Please consult your Tax Advisor for Tax benefits, under section 80D, applicable to you.

Pre-existing
Disease

Pre-existing diseases covered from the third year onwards upon two consecutive renewals

Eligibility

The proposer has to be aged above 18 years. The age of entry for the senior most members proposed for insurance is 65 years and the cover is renewable till the insured person reaches 70 years of age.

The proposer can cover any two members. Self, spouse,dependent parents and children, aged between 5 yrs to 65 yrs, to avail of benefit under 'Health advantage Plus'.

Exclusions

Exclusion-Under
Benefit-A

Any illness/disease/injury existing before the inception of the policy for the first 2 years.

Any illness contracted during the first 30 days of inception of the policy ,except accidents.
Congenital disease
Non-allopathic treatment, Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as international self injury!
War, riot, strike, nuclear weapons induced hospitalization!
Certain ailments will be excluded from treatment for 2-years: Cataract; Benign Prostatic Hypertrophy; Myomectomy, Endometriosis, Hysterectomy unless because of malignancy; All types of Hernia, Hydrocele; Fissures &/or Fistula in anus, haemorrhoids/piles; Arthritis, gout, rheumatism and spinal disorders; Joint replacements unless due to accident; Sinusitis and related disorders; Stones in the urinary and biliary systems; Dilatation and curettage; All types of Skin and internal tumours/cysts/nodules/polyps of any kind including breast lumps unless maligant; Dialysis required for chronic renal failure; Surgery on tonsils, adenoids and sinuses; Gastric and Duodenal uclers; Deviated Nasal Septum¹

! Also excluded under benefit B
¹this is only an indicative list. For complete list refer to Policy wording

Exclusion-Under
Benefit-B

The Company shall not receive any claims prior to completion of 90 days of the commencement of the Policy.

How Do I Claim My Insurance

The claims for Health Advantage Plus are serviced by TPA (TTK Healthcare Services Pvt. Ltd.). We constantly measure the TPA on set parameters to ensure the most responsive and best of services to our valued customers.

In case of emergency or planned hospitalisation, just use your Health ID Card at TTKs network hospitals and avail of cashless service. Call TTKs 24-hour-toll-free number 1800-425-8874/1800-425-8854/1800-425-8885 for complete health assistance.

For treatment in non-network hospitals: The claim form must be filled fully after discharge from hospital and sent to TTK office along with the following documents in original >.

Hospital Bill with Receipt for payment, the receipt should be stamped and preferably numbered.
Doctors prescription and medicine bills.
Discharge summary from the hospital.
Pathological reports and other investigation reports along with the doctor's authorization.
All other relevant details and documents connected to hospitalization.

Claim for OPD will also be handled by the TPA (TTK Healthcare Services). For these claims to be processed, medical prescription is a mandatory requirement.

> Expenses relating to hospitalization will be reimbursed under Benefit A & OPD expenses under Benefit B

No claim shall be admissible under this Benefit B, 30days after expiry of the Period of Insurance.

Premium Grid

	5-60 yrs.	61-70 yrs.
Premium (including Taxes and Cess) - Fixed	Rs.15,000/-	Rs.20,000/-

Choose he Plan Option

Age of Senior Most Member	Individual		2 Adults with Floater Benefit
Age of Senior Most Member	SI under Benefit A= 2Lacs	SI under Benefit A= 3Lacs	SI under Benefit A= 2Lacs	SI under Benefit A= 3Lacs
	SI under Benefit B as below		SI under Benefit B as below
5 yrs. - 18 yrs.	10,000	9,500	#	#
19 yrs. - 35 yrs.	9,000	8,800	8,000	7,500
36 yrs. - 45 yrs.	8,500	8,000	7,000	6,500
46 yrs. - 55 yrs.	6,000	5,500	3,000	2,000
56 yrs. - 60 yrs.	4,500	3,500	#	#
61 yrs. - 65 yrs.	7,000	5,500	#	#
66 yrs. - 70 yrs.	4,000	2,000	#	#

Note :

1) *Individual (s) proposed for insurance whose age is 56 years and above have to compulsorily undergo medical tests at ICICI Lombard designated diagnostic centers

2) Age is in completed years as on last birthday

3) 65 years is the maximum age of entry for this product, renewable upto the age of 70 years

4) The maximum benefit available under each plan shall be as per the sum insured mentioned against each section.

5) #-Plan not available