KEY INFORMATION SHEET

S.No. Title Description Refer to Policy Clause in

1 Product Name Health Shield (ICICI Lombard Complete Health Insurance)
Benefit as per Sum Insured Opted: Part II of the Schedule
2 What am I covered for
Sum Insured (Rs.) 3lacs/ 4lacs/ 5lacs 7lacs/ 10lacs 15lacs/ Clause
20lacs/25lacs/50lacs 2. Scope of the Cover
In Patient treatment Covers Hospital expenses for admission longer than 24 hours
Pre & Post Hospitalisation Medical Expenses incurred due to Illness up to 30 days period immediately
before and 60 days immediately after an Insured Person's admission to a
Hospital
In Patient AYUSH Reimbursement of expenses for AYUSH treatment
Hospitalization
Day Care Procedure Medical expenses for day care procedures where such procedures are
undertaken by an Insured Person as an In-patient in a Hospital for continuous
period of less than 24 hours
Donor Expenses Medical Expenses incurred in respect of the donor expenses up to Sum Extension 9
insured for any of the organ transplant surgery, provided the organ donated is
for Insured persons, subject to a limit of Rs.10 Lakhs.
Domiciliary We will cover the Medical Expenses incurred in respect of the Domiciliary Extension 20
hospitalization Hospitalization of the Insured Person during the Policy Period

Air Ambulance Cover expenses incurred on air ambulance services in respect of an Insured Person Extension 21
which are offered by a healthcare or an air ambulance service provider
Emergency Services • Domestic Road Ambulance expenses incurred to transfer the Insured Extension 24
Person following an emergency to the nearest Hospital. Maximum
amount payable is 1% of the Sum insured maximum up to Rs.10,000 per
event of emergency hospitalization.
• Ambulance Assistance: we will arrange ground medical transportation by
a Service provider to transport the Insured Person to the nearest Hospital
• Tele consultation: We will arrange consultations and recommendations for
routine health issues by a qualified Medical Practitioner or health care
professional

Wellness Program Applicable Part II of the Schedule

Clause
Unlimited Reset Applicable Extension 22
Benefit
ASI Protector Available only for the Sum Insured options 5 Lakhs and above. Extension 19
3 Optional Add On Critical Illness Critical Illness cover up to sum insured for Sum insured amount 10lacs and Extension 7
Covers below and 50% of sum insured for basic sum insured amount more than
10lacs. specified
critical Illnesses/ medical procedures like Cancer of specified severity, open
chest CABG, First heart attack, major organ/bone marrow transplant,
permanent paralysis of limbs, Kidney failure requiring regular dialysis, end
stage liver disease; subject to a maximum of 2 adults.
Personal Accident Personal Accident cover up to Sum Insured upon the unfortunate event of Extension 8
accidental death or Permanent Total Disablement resulting from an Accident,
subject to a maximum of 2 adults.
Nursing at Home Medical expenses incurred, up to a maximum of 15 days post Hospitalisation for Extension 3
the medical services of a Qualified Nurse at Your residence maximum up to:
Rs.2,000 per day per member Rs.3,000 per day per member
Compassionate Visit Expenses incurred by Insured's "immediate relative" while travelling to place of Extension 4
Hospitalisation from the place of origin/residence and back in the event of
Insured person's Hospitalisation exceeding 5 days.
Up to Rs.10,000 per Policy Up to Rs.20,000 per Policy Year of
Year of Policy Period Policy Period

Hospital Daily Cash A daily cash amount for each and every completed day of Hospitalization up to Extension 1
a maximum of 10 consecutive days, if such Hospitalization is at least for a
minimum of 3 consecutive days
Rs.1,000 per day Rs.2,000 per day Rs.3,000 per day
UIN: ICIHLIP21383V052021 1 CIN: L67200MH2000PLC129408
 Convalescence Benefit Rs. 10,000 provided once for each Policy year during Policy Period, in case of Extension 2
Hospitalisation of minimum 10 consecutive days or more
Claim Protector Available only for the Sum Insured options 5 Lakhs and above. Extension 18
Sum Insured Protector Available only for the Sum Insured options 5 Lakhs and above. Extension 17
World Wide Cover Available only for the Sum Insured options 10 Lakhs and above. Extension 23
Super No claim Bonus Available only for the Sum Insured options 5 Lakhs and above. Extension 16
4 Value Added Services * Free health check-up coupon to Insured for every Policy Year, subject to a maximum of 2 coupons Part II of the Schedule
per year for floater policies. Clause
* Online Chat with Medical Practitioners 2. Scope of the Cover
* E-opinion (Second opinion)
* Diet & Nutrition e-consultation
* Information on offers related to healthcare services like consultation, diagnostics, medical
equipments and pharmacy
5 What are the major Note: Following is an indicative list of the policy exclusions. Please refer to the policy clause for Part II of the schedule
Exclusions in the the complete list. Clause
Policy * Acupressure, acupuncture, magnetic and such other therapies 3.5 Permanent
* Unproven experimental treatment Exclusions
* Cosmetic surgery
* Dental treatment unless due to accident
* Any case directly or indirectly related to criminal acts
6 Waiting Period (a) Pre-existing diseases: Declared and accepted PED will be covered after 24 months of continuous Part II of the schedule
coverage. Clause3.1
(b) In case of hypertension , diabetes and cardiac conditions, the waiting period will be 90 days unless Clause3.3 Clause3.2
disclosed as pre-existing diseases.
(c) Specific waiting period: First 24 months, for specific Illness and treatment. (Please refer to the
Clause 3.4
policy clauses for the full listing
(d) Initial waiting period: 30 days for all illnesses (except Hospitalisation due to injury).

7 Payout Basis * Cashless or Reimbursement of covered medical expenses up to specified Sum Insured as per the Part II of the schedule
scope of cover 4. Claim Administration
* Claim Service Guarantee
* Cashless Facility available at over 4000+ network hospitals.
8 Sub Limit (a) Cataract, where sub-limit of Rs.20,000/- is applicable per eye per Policy year for Plans with Sum Part II of the schedule
Insured up to 5Lacs. Sub limit of Rs.1,00,000 per eye per Policy year will be applicable for cataract Clause 3.2
treatment for plans with Sum Insured above Rs.5Lacs

9 Renewal Condition (a) Maximum renewal age - There will be life-long renewable without any age restriction for the cover. Part III of the schedule
However Premium at the time of renewal is subject to change with change in age band. 17. Renewal notice
(b) Grace Period - The renewal premium shall be paid to Us on or before the date of expiry of the
Policy and in no case later than 30 days (Grace Period) from the expiry of the Policy.
© Floater Benefit - The floater benefit under this policy is available up to lifetime
10 Renewal Benefits (a) Cumulative Bonus (Additional Sum Insured) - An Additional Sum Insured of 10% of Annual Sum Part II of the schedule
Insured provided on each renewal for every claim-free year up to a maximum of 50%. In case of a 2. Scope of the Cover
claim under the policy, the accumulated Additional Sum Insured will be reduced by 10% of the
Annual Sum Insured in the following year.
(b) Complimentary Health Check Up Coupons: One coupon per individual policy and two coupons per
Floater policy will be offered.

11 Cancellation a) Disclosure to information norm: The policy shall be void and all premium paid hereon shall be Part III of the schedule
forfeited to the company, in the event of misinterpretation, mis-description or non-disclosure of any 11. Cancellation
material fact.
b) You may cancel this Policy by giving Us 15 days written notice for the cancellation of the Policy by
registered post, and then We shall refund premium on short term rates for the unexpired Policy
Period.

UIN: ICIHLIP21383V052021 2 CIN: L67200MH2000PLC129408

Policy Wordings Break in Policy occurs at the end of the existing policy term, when the premium due
ICICI Lombard General Insurance Company Limited ("We/ Us"), having received a for renewal on a given policy is not paid on or before the premium renewal date or
Proposal and the premium from the Policy Holder named in Part I of the Policy within 30 days thereof.
(hereinafter referred to as the "Policy Schedule") and the said Proposal and Contribution is essentially the right of an insurer to call upon other insurers, liable to
Declaration together with any statement, report or other document leading to the the same insured, to share the cost of an indemnity claim on a rateable proportion of
issue of this Policy and referred to therein having been accepted and agreed to by Us Sum Insured. This clause shall not apply to any Benefit offered on fixed benefit
and the Policy Holder as the basis of this contract do, by this Policy agree, in basis.
consideration of and subject to the due receipt of the subsequent premiums, as set Congenital Anomaly refers to a condition(s) which is present since birth, and which
out in the Policy Schedule, and further, subject to the terms and conditions contained is abnormal with reference to form, structure or position.
in this Policy that on proof to Our satisfaction of the compensation having become
payable as set out in the Policy Schedule to the title of the said person or persons a) Internal Congenital Anomaly -Congenital anomaly which is not in the visible
claiming payment or upon the happening of an event upon which one or more and accessible parts of the body
benefits become payable under this Policy, the Annual Sum Insured/ appropriate b) External Congenital Anomaly- Congenital anomaly which is in the visible and
benefit amount will be paid by Us. accessible parts of the body
PART II OF THE POLICY Condition Precedent shall mean a policy term or condition upon which the Insurer's
1. DEFINITIONS liability under the policy is conditional upon.
For the purposes of this Policy, the terms specified below shall have the meaning set Cashless Facility means a facility extended by the insurer to the insured where the
forth wherever appearing/specified in this Policy or related Extensions: payments, of the costs of treatment undergone by the insured in accordance with the
policy terms and conditions, are directly made to the network provider by the insurer
Where the context so requires, references to the singular shall also include
to the extent pre-authorization approved.
references to the plural and references to any gender shall include references to all
genders. Further any references to statutory enactment include subsequent Claim means a demand made by You or on Your behalf for payment of Medical
changes to the same. Expenses or any other expenses or benefits, as covered under the Policy.
Accident means a sudden, unforeseen and involuntary event caused by external, Co-payment means a cost sharing requirement under a health insurance policy that
visible and violent means. provides that the policyholder/insured/proposer will bear a specified percentage of
the admissible claims amount. A co-payment does not reduce the Sum Insured.
Admission means Your admission in a Hospital as an inpatient for the purpose of
medical treatment of an Injury and/or Illness. Cumulative Bonus shall mean any increase or addition in the Sum Insured granted
by the insurer without an associated increase in premium.
AYUSH treatments refers to the medical aid and / or hospitalisation treatments
given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy Day Care Treatment refers to medical treatment, and/or Surgical Procedure which
systems is
Ayush Hospital is a healthcare facility wherein medical/surgical/para-surgical 1.1 undertaken under General or Local Anesthesia in a Hospital/Day care centre in
treatment procedures and interventions are carried out by AYUSH Medical less than 24 hrs because of technological advancement, and
practitioner(s) comprising of any of the following: 1.2 which would have otherwise required a hospitalisation of more than 24 hours.
a) Central or State government AYUSH hospital; or Treatment normally taken on an out-patient basis is not included in the scope of this
b) Teaching hospital attached to AYUSH college recognized by the central definition.
government/Central council of Indian medicine/ Central council for Day care centre means any institution established for day care treatment of illness
Homeopathy; or and/or injuries or a medical setup with a hospital and which has been registered with
c) AYUSH Hospital, standalone or co-located with in-patient healthcare facility of the local authorities, wherever applicable, and is under supervision of a registered
any recognized system of medicine, registered with the local authorities, and qualified medical practitioner AND must comply with all minimum criterion as
wherever applicable, and is under the supervision of a qualified registered under –
AYUSH medical practitioner and must comply with the following criterion: a) has qualified nursing staff under its employment;
i. Having at least 5 in-patient beds b) has qualified medical practitioner/s in charge
ii. Having qualified AYUSH medical practitioner in charge round the clock c) has fully equipped operation theatre of its own where surgical procedures are
iii. Having dedicated AYUSH therapy sections as required and/or has carried out;
equipped operation theatre where surgical procedures are to be carried out; d) maintains daily records of patients and will make these accessible to the
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized personnel
insurance company’s authorized representative Deductible is a cost sharing requirement under a health insurance policy that
AYUSH Day Care Centre means and includes Community Health Centre (CHC), provides that provides that the insurer will not be liable for specified rupee amount in
Primary Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such health centre case of indemnity policies and for a specified number of days/hours in case of
which is registered with the local authorities, wherever applicable and having facilities for hospital cash policy, which will apply before any benefits are payable by the insurer
carrying out treatment procedures and medical or surgical/para-surgical interventions or This is to clarify that a deductible does not reduce the sum insured.
both under the supervision of registered AYUSH Medical Practitioner (s) on day care basis Domiciliary Hospitalisation means medical treatment for an illness/disease/injury
without in- patient services and must comply with all the following criterion: which in the normal course would require care and treatment at a hospital but is
a) Having qualified registered AYUSH Medical Practitioner(s) in charge; actually taken while confined at home under any of the following circumstances:
b) Having dedicated AYUSH therapy sections as required and/or has equipped a) the condition of the patient is such that he/she is not in a condition to be removed
operation theatre where surgical procedures are to be carried out; to a hospital, or
c) Maintaining daily records of the patients and making them accessible to the b) the patient takes treatment at home on account of non-availability of room in a
insurance company’s authorized representative. hospital.
(Explanation: Medical practitioner referred in the definition of “AYUSH Hospital” and Disclosure to information Norm means the policy shall be void and all premium
“AYUSH day care center” shall carry the same meaning as defined in the definition of paid thereon shall be forfeited to the Company in the event of misrepresentation,
“Medical practitioner” under chapter I of Guidelines) mis-description or non-disclosure of any material fact
Annual Sum Insured means and denotes the maximum amount of cover available Dental treatment means a treatment related to teeth or structures supporting teeth
to You during each Policy Year of the Policy Period, as stated in the Policy Schedule including examinations, fillings (where appropriate), crowns, extractions and
or any revisions thereof based on Claim settled under the Policy. surgery
Any one illness means continuous Period of illness and it includes relapse within 45 Emergency Care means management for an illness or injury which results in
days from the date of last consultation with the Hospital/Nursing Home where symptoms which occur suddenly and unexpectedly, and requires immediate care by
treatment may have been taken. a medical practitioner to prevent death or serious long term impairment of the
UIN: ICIHLIP21383V052021 3 CIN: L67200MH2000PLC129408
insured person’s health sum insured (if any) and super no claim bonus (if opted and accrued by the insured)/
Grace Period means the specified period of time immediately following the Sum Insured Protector (if opted by the insured)
premium due date during which a payment can be made to renew or continue a Medical Advice means any consultation or advice from a Medical Practitioner
policy in force without loss of continuity benefits such as waiting periods and including the issuance of any prescription or repeat prescription.
coverage of Pre Existing Diseases. Coverage is not available for the period for which Medical Expenses means those expenses that an Insured Person has necessarily
no premium is received. and actually incurred for medical treatment on account of Illness or Accident on the
Hospital means any institution established for in- patient care and day care advice of a Medical Practitioner, as long as these are no more than would have been
treatment of illness and / or injuries and which has been registered as a hospital with payable if the Insured Person had not been insured and no more than other hospitals
the local authorities under the Clinical Establishments (Registration and or doctors in the same locality would have charged for the same medical treatment.
Regulations) Act 2010 or under enactments specified under the Schedule of Section Medical Practitioner is a person who holds a valid registration from the Medical
56(1) of the said Act Or comply with all minimum criteria as under: Council of any State or Medical Council of India or Council for Indian Medicine or for
a) has qualified nursing staff under its employment round the clock; Homeopathy set up by the Government of India or a State Government and is
b) has at least 10 inpatient beds, in those towns having a population of less than thereby entitled to practice medicine within its jurisdiction; and is acting within the
10,00,000 and 15 inpatient beds in all other places scope and jurisdiction of his license.

c) has qualified medical practitioner(s) in charge round the clock; The term Medical Practitioner would include physician, specialist, anaesthetist and
surgeon but would exclude You and Your spouse, Your children, Your brother(s),
d) has a fully equipped operation theatre of its own where surgical procedures are Your sister(s) and Your parent(s).
carried out
For the purposes of worldwide cover, Medical practitioner would mean a person who
e) maintains daily records of patients and makes these accessible to the Insurance holds a valid registration from the Medical council of the respective country where
company’s authorized personnel. the treatment is being taken by the insured
Hospitalisation means admission in a Hospital for a minimum period of 24 Medically Necessary Treatment is defined as any treatment, tests medication or
consecutive in-patient care hours except for specified Procedures/Treatments, stay in hospital or part of a stay in Hospital which
where such admission could be for a period of less than 24 consecutive hours.
a) Is required for the medical management of the illness or Injury suffered by the
Inpatient care means treatment for which the insured person has to stay in a Hospital insured
for more than 24 hours for a covered event.
b) Must not exceed the level of care necessary to provide safe, adequate and
Illness means a sickness or disease or pathological condition leading to the appropriate medical care in scope, duration or intensity
impairment of normal physiological function and requires medical treatment.
c) Must have been prescribed by a Medical practitioner
a) Acute condition - Acute condition is a disease, illness or injury that is likely to
respond quickly to treatment which aims to return the person to his or her state of d) Must conform to the professional standard widely accepted in international
health immediately before suffering the disease/illness/injury which leads to full medical practice or by the medical community in India
recovery. Migration means the right accorded to health insurance policyholders/proposers
b) Chronic condition - A chronic condition is defined as a disease, illness, or injury (including all members under family cover and members of group Health insurance
that has one or more of the following characteristics: policy), to transfer the credit gained for pre-existing conditions and time bound
exclusions, with the same insurer.
i. it needs ongoing or long-term monitoring through consultations,
examinations, check-ups, and / or tests Newborn Baby means baby born during the Policy Period and is aged upto 90 days.
ii. it needs ongoing or long-term control or relief of symptoms Network Provider means hospitals or health care providers enlisted by an insurer,
TPA or jointly by an insurer and TPA to provide medical services to an insured by a
iii. it requires your rehabilitation for the patient or for the patient to be specially cashless facility.
trained to cope with it
Non- Network Provider means any Hospital, day care centre or other provider that
iv. it continues indefinitely is not part of the Network.
v. It recurs or is likely to recur Notification of claim means the process of intimating a claim to the insurer or TPA
Immediate Family means spouse, dependent children, brother(s), sister(s) and through any of the recognized modes of communication
dependent parent(s) of the insured. OPD treatment is one in which the Insured visits a clinic / hospital or associated
Injury means any accidental physical bodily harm, excluding illness or disease facility like a consultation room for diagnosis and treatment based on the advice of a
solely and directly caused by external, violent, visible and evident means which is Medical Practitioner. The Insured is not admitted as a day care or in-patient.
verified and certified by a Medical Practitioner. Period of Insurance means the period as specifically appearing in the Policy
Intensive Care Unit means an identified section, ward or wing of a hospital which is Schedule and commencing from the Policy Period Start Date of the first Policy taken
under the constant supervision of a dedicated medical practitioner(s), and which is by You from Us and then, running concurrent to Your current Policy subject to the
specially equipped for the continuous monitoring and treatment of patients who are Your continuous renewal of such Policy with Us.
in a critical condition, or require life support facilities and where the level of care and Policy means these Policy wordings, the Policy Schedule and any applicable
supervision is considerably more sophisticated and intensive than in the ordinary endorsements or extensions attaching to or forming part thereof. The Policy
and other wards contains details of the extent of cover available to You, what is excluded from the
ICU (Intensive Care Unit) Charges means the amount charged by a Hospital cover and the terms & conditions on which the Policy is issued to You.
towards ICU expenses which shall include the expenses for ICU bed, general Proposer means the person(s) or the entity named in the Policy Schedule who
medical support services provided to any ICU patient including monitoring devices, executed the Policy Schedule and is (are) responsible for payment of premium(s).
critical care nursing and intensivist charges.
Policy Period means the period commencing from the Policy Period Start Date,
Insured/Insured Person(s) means the individual(s) whose name(s) is/are Time and ending at the Policy Period End Date, Time of the Policy and as specifically
specifically appearing as such in the Policy Schedule and is/are hereinafter referred appearing in the Policy Schedule.
as “You”/“Your”/ “Yours”/ “Yourself”
Policy Year means a period of twelve months beginning from the Policy Period Start
Maternity expenses shall Date and ending on the last day of such twelve-month period. For the purpose of
a) include medical treatment expenses traceable to childbirth (including subsequent years, “Policy Year” shall mean a period of twelve months beginning
complicated deliveries and caesarean sections incurred during from the end of the previous Policy Year and lapsing on the last day of such twelve-
Hospitalisation); month period, till the Policy Period End Date, as specified in the Policy Schedule
b) expenses towards lawful medical termination of pregnancy during the policy Portability means the right accorded to an individual health insurance
period policyholder/proposers (including all members under family cover), to transfer the
credit gained for pre-existing conditions and time bound exclusions, from one
Maximum limit of indemnity means the sum total of annual sum insured, additional
insurer to another insurer
UIN: ICIHLIP21383V052021 4 CIN: L67200MH2000PLC129408
Pre-existing Disease means any condition, ailment, injury or disease B) Day Care Procedures/Treatment
a) That is/ are diagnosed by a physician within 48 months prior to the effective date We hereby agree subject to terms, conditions and exclusions herein
of the policy issued by the insurer or its reinstatement or contained or otherwise expressed hereon that, if during the Policy - year,
b) For which medical advice or treatment was recommended by, or received from, You require Hospitalization as an inpatient for less than 24 hours in a
a physician within 48 months prior to the effective date of the policy issued by the Hospital (but not in the outpatient department of a Hospital) on the written
insurer or its reinstatement. advice of a Medical Practitioner, then We will pay You for the Medical
Expenses incurred for undergoing such Day Care Procedure/ Treatment or
Post-Hospitalisation Medical Expenses means medical expenses incurred surgery.
during predefined number of days immediately after the Insured Person is
discharged from the hospital, provided that: However, Our total liability under this cover for payment of any and all
Claims in aggregate during each Policy Year of the Policy Period shall not
a) Such Medical Expenses are for the same condition for which the Insured exceed the Maximum Limit of Indemnity as stated in the Policy Schedule.
Person’s Hospitalisation was required, and
C) Pre-Hospitalization and Post-Hospitalization Expenses
b) The In-patient Hospitalisation claim for such Hospitalisation is admissible by the
Insurance Company. We hereby agree subject to the terms, conditions and exclusions herein
contained or otherwise expressed here on that, We will compensate You for
Pre-Hospitalisation Medical Expenses means medical expenses incurred during the relevant Medical Expenses incurred by You in relation to:
predefined number of days preceding the hospitalization of the insured person,
provided that: : i. Pre-hospitalization Medical Expenses incurred by You for a 30-day
period immediately prior to Your Hospitalization; and
a) Such Medical Expenses are incurred for the same condition for which the
Insured Person’s Hospitalisation was required, and ii. Post-hospitalization Medical Expenses incurred by You for a 60-day period
immediately post Hospitalization, provided that Your Hospitalization falls
b) The In-patient Hospitalisation claim for such Hospitalisation is admissible by the within the Policy year and We have accepted Your Claim under "In-patient
Insurance Company. Treatment" or "Day Care Procedures" section of the Policy. However, Our
Qualified Nurse is a person who holds a valid registration from the Nursing Council total liability under this Policy for payment of any and all Claims in aggregate
of India or the Nursing Council of any state in India. during each Policy Year of the Policy Period shall not exceed the Maximum
Limit of Indemnity as stated in the Policy Schedule.
Renewal defines the terms on which the contract of insurance can be renewed on
mutual consent with a provision of grace period for treating the renewal continuous D) In Patient AYUSH Hospitalization - We will reimburse expenses for
for the purpose of gaining credit for pre-existing diseases, time-bound exclusions AYUSH treatment only when the treatment has been undergone in a
and for all waiting periods. AYUSH Hospital or AYUSH day care centre.
Reasonable and Customary Charges means the charges for services or supplies, We will not cover expenses for hospitalization done for evaluation or
which are the standard charges for the specific provider and consistent with the investigation only. Treatment taken at a healthcare facility which is not a
prevailing charges in the geographical area for identical or similar services, taking Hospital are also excluded.
into account the nature of Illness/injury involved. However, Our total liability under this Policy for payment of any and all
Room Rent means the amount charged by a hospital towards Room and Boarding Claims in aggregate during each Policy Year of the Policy Period shall not
expenses and shall include associated medical expenses. exceed the Maximum Limit of Indemnity as stated in the Policy Schedule
Senior Citizen means any person who has completed sixty or more years of age as E) Wellness Program
on the date of commencement or renewal of a health insurance policy. Wellness program intends to promote, incentivize and reward You for Your
Service Provider means any person, organization, institution, or company that has healthy behavior through various wellness services. All the wellness
been empanelled with Us to provide services specified under the Benefits (including activities as mentioned below make You earn wellness points which will be
add-ons) to The Insured person. These shall also include all healthcare providers tracked by Us. You can inform us of the various wellness activities
empanelled to form a part of network other than hospitals. undertaken by You via email or calling our toll free number. You can redeem
these wellness points as per Our redemption terms and conditions
The list of the Service Providers is available at our website
(https://www.icicilombard.com/content/ilom-en/serviceprovider/search.asp) and is The wellness services and activities are categorized as below:
subject to amendment from time to time. a) Manage and track Your health
Subrogation shall mean the right of the insurer to assume the rights of the insured o Online Health Risk Assessment (HRA)
person to recover expenses paid out under the policy that may be recovered from
o Medical Risk Assessment
any other source.
o Preventive Risk Assessment
Surgery or Surgical Procedure means manual and/or operative procedure (s)
required for treatment of an illness or injury, correction of deformities and defects, b) Disease Management Services
diagnosis and cure of diseases, relief of suffering or prolongation of life, performed in c) Medical Concierge Services
a hospital or day care centre by a Medical Practitioner
d) Affinity to Wellness
Unproven/Experimental treatment means treatment including drug experimental
therapy which is not based on established medical practice in India, is treatment a) Manage & Track Your Health:
experimental or unproven. o Online Health Risk Assessment (HRA)
You/Your/ Yours/ Yourself means the person(s) that We insure and is/are The Health Risk Assessment (HRA) questionnaire is a tool for
specifically named as Insured / Insured Person(s) in the Policy Schedule. evaluation of health and quality of life. It helps You review Your personal
We/ Our/ Ours/ Us means the ICICI Lombard General Insurance Company Limited lifestyle practices which may impact your health status. You can log into
Your account on Our website www.icicilombard.com and take HRA.
2. WHAT WE WILL PAY (SCOPE OF COVER) This can be undertaken once per policy year per insured person.
A) In-patient Treatment On taking online HRA test, You can earn 250 wellness points per
We hereby agree subject to terms, conditions and exclusions herein insured, maximum up to 500 points per floater policy.
contained or otherwise expressed here on that, if during the Policy - year, o Medical Risk Assessment
You require Hospitalization for any Illness or Injury on the written advice of a
Medical Practitioner, then We will indemnify the Medical Expenses so We will reward You with wellness points on undergoing medical
incurred by You. checkup, using complimentary checkup coupons provided with policy,
anytime during the policy period. We will help You in getting the
However, Our total liability under this Policy for payment of any and all appointment fixed at Our empanelled centers or We will arrange home
Claims in aggregate during each Policy Year of the Policy Period shall not visit wherever necessary. You will be awarded 1,000 wellness points
exceed the Maximum Limit of Indemnity as stated in the Policy Schedule. per insured, maximum up to 2,000 points per floater policy on
undergoing these tests.
UIN: ICIHLIP21383V052021 5 CIN: L67200MH2000PLC129408
 Second year onwards, if Your medical test results are in normal limits, Redemption of Wellness Points
additional 1,000 wellness points per insured, maximum up to 2,000 Each wellness point will be equivalent to 0.25. Wellness points not redeemed in
points per floater policy will be awarded for maintenance of health. We the given policy year can be carry forwarded maximum up to 3 years from the
will communicate the findings of this assessment to You and advice You date of awarding of these points, provided the policy is renewed continuously for
appropriately. subsequent 3 years. You can redeem these wellness points against out patient
o Preventive Risk Assessment medical expenses like consultation charges, medicine & drugs, diagnostic
You can also earn wellness points by undergoing certain other expenses, dental expenses, wellness & preventive care and other
diagnostic and preventive health check up (Specified in list given below miscellaneous charges not covered under any medical insurance, through our
or as suggested by Our empanelled medical experts) at any diagnostic Network providers, the list of which will be updated on our website
centre at Your own expenses. You shall have to submit medical reports www.icicilombard.com from time to time. In case cashless facility is not available
of these tests to Us. for wellness points’ redemption at these network centres, You can avail
reimbursement by submitting relevant documents with Us.
List of Additional tests and corresponding wellness points per Policy
Year: Terms and conditions under wellness services
• Any information provided by You in this regard shall be kept confidential.
Test For whom Wellness Points
• You should notify and submit relevant documents, reports, receipts etc for
Heart related screening various wellness activities within 60 days of undertaking such activity.
tests (2D echo/ TMT) Above 45 years 500
• For services that are provided through empanelled service provider, We are
HbA1c / Complete only acting as a facilitator; hence would not be liable for any incremental
lipid profile Any age 500 costs or the services.
PAP Smear Females above age 45 500 • All medical services are being provided by empanelled health care service
Mammogram Females above age 45 500 provider. We ensure full due diligence before empanelment. However You
should consult Your doctor before availing/taking the medical
Any other test as advices/services. The decision to utilize these advices/services is solely at
suggested by Our Your discretion.
empanelled Medical
expert As suggested 500 • There will not be any cash redemption against the wellness points.

b) Disease Management Services • ICICI Lombard, its group entities, or affiliates, their respective directors,
officers, employees, agents, vendors, is not responsible for or liable for, any
In case Your medical tests indicate any health irregularities, We will help You actions, claims, demands, losses, damages, costs, charges and expenses
track Your health through Our empanelled medical experts who will guide which a Member claims to have suffered, sustained or incurred, by way of
You in maintaining/ improving Your health condition. We may also provide and / or on account of the Program.
Dietician and nutritional counseling as per Your health condition.
• Services offered are subject to guidelines issued by IRDA from time to time.
c) Medical Concierge Services
• In case of expiry of policy, the wellness points may be carried forward for a
You can also contact Us to avail the following services: period not exceeding three months.
o Emergency assistance information such as nearest ambulance / • The wellness points accrued shall be at periodic intervals at rates/amounts
hospital / blood bank etc. declared upfront at the commencement of the policy and shall not be linked
o Second opinion provided through electronic mode: E-opinion (Second to any dynamic factor such as interest rate.
opinion) of an empanelled medical expert and/or agency. F) Additional Sum Insured (Cumulative Bonus)
o Referral for medical service provider, evacuation/ repatriation services, It is hereby declared and agreed that notwithstanding anything to the
home nursing care etc contrary in the Policy, at the time of renewal of this Policy, We will provide an
d) Affinity to wellness additional sum insured (hereinafter referred to as “Additional Sum Insured”)
of 10% of annual sum insured for each completed and continuous Policy
We will provide You information on health and wellness training, online Year subject to a maximum of 50% provided that there is no Claim under this
fitness portals, sporting events, various sports and health related Policy during the Policy Year except as an Out-patient.
applications, latest fitness accessories through periodic communications
like e-mailers, blogs, forums etc. and will reward You for undertaking any of Tenure Additional Sum Insured
the fitness & health related activities as given below. as a percentage of Annual Sum insured
List of Fitness initiatives and wellness points For all insured persons
Initiatives Wellness Points For each
completed and continuous Policy 10%
Gym/ Yoga membership for 1 year 2,500 Year subject to a maximum of 50%
Participation in Professional sporting events like However, in the event of a Claim under the Policy during any subsequent
Marathon/Cyclothon/Swimathon etc. 2,500 Policy Year, the accrued Additional Sum Insured will be reduced by 10% of
the Annual Sum Insured at the time of renewal of this Policy.
Participation in any other health & fitness activity/
event organized by Us 2,500 In relation to a Floater Benefit cover, the Additional Sum Insured so accrued
during the Claim-free Policy Year(s) will also be on floater basis and will only
You have to provide Us relevant receipts/ bills and /or certificates indicating
be available to those Insured Person(s) who were insured in such Claim-free
participation and completion of these activities. These fitness centers, gym, yoga
Policy Year(s) and continue to be insured in the subsequent Policy Year(s).
centers etc and the companies organizing these fitness initiatives should be legally
registered entities as per rules, regulations as applicable by governing law. G) Value-Added Services
As per the above mentioned activities, You can earn maximum 5,000 wellness Notwithstanding anything to the contrary in the Policy, We at your request
points per insured, and maximum 10,000 wellness points per floater policy. will arrange for You or will facilitate You in availing any of the following
You can also earn 100 wellness points for each of the following activities: additional services subject to a limit as specified in the Policy Schedule, on
issuance or upon renewal of the Policy for a continuous period from Period
o Quit smoking- based on Self declaration of Insurance Start Date, as specified in the Policy Schedule, including but
o Share Your fitness success story not limited to:-
o On winning any Health quiz organized by Us a) Free health check-up coupons to each insured for every Policy Year,
subject to a maximum of 2 coupons per year for floater policies.
b) Vaccination care cover

UIN: ICIHLIP21383V052021 6 CIN: L67200MH2000PLC129408

 c) E-opinion (Second opinion) of an expert Medical Practitioner from Our specified for pre-Existing diseases, then the longer of the two waiting
designated centers, with respect to critical Illnesses and procedures periods shall apply.
d) Other value added services d) The waiting period for listed conditions shall apply even if contracted
i. Diet & nutrition e-consultation after the policy or declared and accepted without a specific exclusion.

ii. Online Chat with Medical Practitioners e) If the Insured Person is continuously covered without any break as
defined under the applicable norms on portability stipulated by IRDAI,
iii. Provide information on offers related to healthcare services like then waiting period for the same would be reduced to the extent of prior
consultation, diagnostics, medical equipment and pharmacy coverage.
e) Health assistance: We also provide Health Assistance as a part of Our List of specific diseases/procedure:
Value added services, Our Health Assistance Team (HAT) will assist the
Insured Person in understanding his/her health condition better by • Cataract*
providing answers to any queries related to health and health care • Benign Prostatic Hypertrophy
providers on Our dedicated helpline. To avail this service, the Insured • Myomectomy, Hysterectomy unless because of malignancy
Person may call Our helpline on 040-66274205 (please note that this
number is subject to change). • All types of Hernia, Hydrocele
The services provided under this shall include: • Fissures &/or Fistula in anus, hemorrhoids/piles
• Identifying a Physician/ Specialist • Arthritis, gout, rheumatism and spinal disorders
• Scheduling an appointment with any Medical Practitioner • Joint replacements unless due to accident
empanelled with Us • Sinusitis and related disorders
• Scheduling appointments for a second opinion • Stones in the urinary and billiary systems
• Providing suitable options with respect to Hospitals as well as • Dilatation and curettage , Endometriosis
providing assistance in Cashless facility, wherever applicable.
• All types of Skin and internal tumors/ cysts/nodules/ polyps of any kind
• Providing preventive information on ailments including breast lumps unless malignant
• Providing guidance on post Hospitalization care, such as • Dialysis required for chronic renal failure
Physiotherapy/ Nursing at home.
• Surgery on tonsils, adenoids and sinuses
Please note that services provided under this Benefit are solely for
assistance, and should not be construed to be a substitute for a visit/ • Gastric and Duodenal erosions & ulcers
consultation to an independent Medical Practitioner. This Benefit does not • Deviated Nasal Septum
include the charges for any independent Medical Practitioner/nutritionist • Varicose Veins/ Varicose Ulcers
consulted on HAT’s recommendation, and such charges are to be borne by
the Insured Person. We do not accept any liability towards quality of the • All types of internal congenital anomalies/ illness/defects
services made available by our network providers/ service providers and are * After two years from the Period of Insurance Start Date, Our maximum
not liable for any defects or deficiencies on their part liability arising out of any Claim for a cataract treatment shall not exceed Rs.
While deciding to obtain such value-added service, You expressly note and 20,000 per eye, during each Policy Year of the Policy Period for plans with
agree that it is entirely for You to decide whether to obtain these services and Sum Insured up to 5Lacs. Sub limit of 1,00,000 per eye per Policy year will
also to decide the use (if any) to which these services is to be put for be applicable for Cataract surgery for plans with Sum Insured above 5Lacs.
3. WHAT WE WILL NOT PAY (EXCLUSIONS UNDER THE POLICY) In case the above Illnesses are Pre-existing condition(s) at the
commencement of this Policy, then these Illnesses shall be covered after 24
We will not be liable for any Deductible amount, if applicable and as specifically months of continuous coverage has elapsed, since Period of Insurance
defined in the policy schedule under the Policy Start Date.
We shall not be liable to make any payment under this Policy in connection with 3.3
or in respect of any expenses whatsoever incurred by You in connection with or
in respect of: a) Expenses related to the treatment of the below mentioned illness within 90
days from the first policy commencement date shall be excluded unless they
3.1 Code- Excl01: Pre-Existing Diseases are pre-existing and disclosed at the time of underwriting
a) Expenses related to the treatment of a pre-existing Disease (PED) and I. Hypertension
its direct complications shall be excluded until the expiry of 24 months
of continuous coverage after the date of inception of the first policy with ii. Diabetes
insurer. iii. Cardiac Conditions
b) In case of enhancement of sum insured the exclusion shall apply afresh b) This exclusion shall not, however, apply if the Insured Person has
to the extent of sum insured increase. continuous coverage for more than twelve months.
c) If the Insured Person is continuously covered without any break as c) The within referred waiting period is made applicable to the enhanced sum
defined under the portability norms of the extant IRDAI (Health insured in the event of granting higher sum insured subsequently.
Insurance) Regulations, then waiting period for the same would be
reduced to the extent of prior coverage 3.4 Code- Excl03: 30-day waiting period

d) Coverage under the policy after the expiry of 24 months for any pre- a) Expenses related to the treatment of any illness within 30 days from the first
existing disease is subject to the same being declared at the time of policy commencement date shall be excluded except claims arising due to
application and accepted by Insurer. an accident, provided the same are covered.

3.2 Code- Excl02: Specified disease/procedure waiting period b) This exclusion shall not, however, apply if the Insured Person has
Continuous Coverage for more than twelve months.
a) Expenses related to the treatment of the listed Conditions,
surgeries/treatments shall be excluded until the expiry of 24 months of c) The within referred waiting period is made applicable to the enhanced sum
continuous coverage after the date of inception of the first policy with us. insured in the event of granting higher sum insured subsequently
This exclusion shall not be applicable for claims arising due to an 3.5 Permanent Exclusions
accident. Unless covered by way of an appropriate Extension/optional covers, We
b) In case of enhancement of sum insured the exclusion shall apply afresh shall not be liable to make any payment under this Policy in connection with
to the extent of sum insured increase. or in respect of
c) If any of the specified disease/procedure falls under the waiting period i. Code- Excl04: Investigation & Evaluation

UIN: ICIHLIP21383V052021 7 CIN: L67200MH2000PLC129408

 a) Expenses related to any admission primarily for diagnostics and evaluation xii. Code- Excl15: Expenses related to the treatment for correction of eye sight
purposes only are excluded. due to refractive error less than 7.5 dioptres
b) Any diagnostic expenses which are not related or not incidental to the xiii. Code- Excl16: Unproven Treatments: Expenses related to any unproven
current diagnosis and treatment are excluded. treatment, services and supplies for or in connection with any treatment.
ii. Code- Excl05: Exclusion Name: Rest Cure, rehabilitation and respite care- Unproven treatments are treatments, procedures or supplies that lack
significant medical documentation to support their effectiveness.
a) Expenses related to any admission primarily for enforced bed rest and not
for receiving treatment. This also includes: xiv. Code- Excl17: Sterility and Infertility: Expenses related to sterility and
infertility. This includes:
i. Custodial care either at home or in a nursing facility for personal care
such as help with activities of daily living such as bathing, dressing, (i) Any type of contraception, sterilization
moving around either by skilled nurses or assistant or non-skilled (ii) Assisted Reproduction services including artificial insemination and
persons. advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
ii. Any services for people who are terminally ill to address physical, (iii) Gestational Surrogacy
social, emotional and spiritual needs. (iv) Reversal of sterilization
iii. Code- Excl06: Obesity/ Weight Control xv. Code- Excl18: Maternity: Medical treatment expenses traceable to
Expenses related to the surgical treatment of obesity that does not fulfil all childbirth (including complicated deliveries and caesarean sections incurred
the below conditions: during hospitalization) except ectopic pregnancy. Expenses towards
1) Surgery to be conducted is upon the advice of the Doctor miscarriage (unless due to an accident) and lawful medical termination of
pregnancy during the policy period
2) The surgery/Procedure conducted should be supported by clinical protocols
xvi. Any physical, medical or treatment or service that is specifically excluded in
3) The member has to be 18 years of age or older and the Policy Schedule under Special Conditions
4) Body Mass Index (BMI); xvii. Any expenses incurred on prosthesis, corrective devices, external durable
a) greater than or equal to 40 or medical equipment of any kind, like wheelchairs, crutches, instruments used
in treatment of sleep apnoea syndrome or cost of cochlear implant(s) unless
b) greater than or equal to 35 in conjunction with any of the following necessitated by an Accident or required intra-operatively.
severe co-morbidities following failure of less invasive methods of
weight loss: xviii. Expenses incurred on dental treatment unless necessitated due to an
Accident
i. Obesity-related cardiomyopathy
xix. Personal comfort, cosmetics, convenience and hygiene related items and
ii. Coronary heart disease services
iii. Severe Sleep Apnea xx. Acupressure, acupuncture, magnetic and other therapies
iv. Uncontrolled Type2 Diabetes xxi. Circumcision unless necessary for treatment of an Illness or necessitated
iv. Code- Excl07: Change of Gender treatments due to an Accident. . Expenses for venereal disease or any sexually
Expenses related to any treatment, including surgical management, to transmitted disease
change characteristics of the body to those of the opposite sex. xxii. Treatment relating to birth defects and external congenital Illnesses or
defects or anomalies
v. Code- Excl08: Cosmetic or plastic Surgery
xxiii. Any expenses arising out of Domiciliary Hospitalisation treatment
Expenses for cosmetic or plastic surgery or any treatment to change
appearance unless for reconstruction following an Accident, Burn(s) or xxiv. Treatment taken outside the country
Cancer or as part of medically necessary treatment to remove a direct and xxv. Intentional self-injury (whether arising from an attempt to commit suicide or
immediate health risk to the insured. For this to be considered a medical otherwise)
necessity, it must be certified by the attending Medical Practitioner.
xxvi. Expenses related to donor screening, treatment, including surgery to
vi. Code- Excl09: Hazardous or Adventure sports remove organs from a donor in the case of transplant surgery
Expenses related to any treatment necessitated due to participation as a xxvii. Any injury or illness caused by or arising from or attributed to war, invasion,
professional in hazardous or adventure sports, including but not limited to, acts of foreign enemies, hostilities (whether war be declared or not), civil
para-jumping, rock climbing, mountaineering, rafting, motor racing, horse war, commotion, unrest, rebellion, revolution, military or usurped power or
racing or scuba diving, hand gliding, sky diving, deep-sea diving. confiscation or nationalisation or requisition of or damage by or under the
vii. Code- Excl10: Breach of law order of any government or public local authority
Expenses for treatment directly arising from or consequent upon any xxviii. Any Illness or Injury caused by or contributed to by nuclear
Insured Person committing or attempting to commit a breach of law with weapons/materials or contributed to by or arising from ionising radiation or
criminal intent. contamination by radioactivity by any nuclear fuel or from any nuclear waste
or from the combustion of nuclear fuel
viii. Code- Excl11: Excluded Providers
4. CLAIM ADMINISTRATION
Expenses incurred towards treatment in any hospital or by any Medical
Practitioner or any other provider specifically excluded by the Insurer and The fulfillment of the terms and conditions of this Policy (including payment of
disclosed in its website / notified to the policyholders are not admissible. premium by the due dates mentioned in the Policy Schedule) insofar as they
However, in case of life threatening situations following an accident, relate to anything to be done or complied with by each of You shall be conditions
expenses up to the stage of stabilization are payable but not the complete precedent to admission of Our liability. You are requested to go through our list of
claim. de-listed/excluded providers which is available on our website.
ix. Code- Excl12: Treatment for, Alcoholism, drug or substance abuse or any Further, upon the discovery or happening of any Illness or Injury that may give
addictive condition and consequences thereof. rise to a Claim under this Policy, then as a condition precedent to the admission
of Our liability, You shall undertake the following:
x. Code- Excl13 : Treatments received in heath hydros, nature cure
clinics, spas or similar establishments or private beds registered as a 4.1 CLAIMS PROCEDURE
nursing home attached to such establishments or where admission is A) For Cashless Settlement
arranged wholly or partly for domestic reasons.
Cashless treatment is only available at a Network Provider (List of Network
xi. Code- Excl14: Dietary supplements and substances that can be purchased Providers is available at our website). In order to avail of cashless treatment,
without prescription, including but not limited to Vitamins, minerals and the following procedure must be followed by You:
organic substances unless prescribed by a medical practitioner as part of
hospitalization claim or day care procedure.
UIN: ICIHLIP21383V052021 8 CIN: L67200MH2000PLC129408
 Pre-authorization vi. Medical Practitioner's referral letter advising Hospitalization in non-
Prior to taking treatment and/ or incurring Medical Expenses at a Network Accident cases.
Provider, You must contact Us or Our in house claim processing team vii. Any other document as required by Us or Our TPA to investigate the
accompanied with full particulars namely, Policy Number, Your name, Your Claim or Our obligation to make payment for it
relationship with Policy Holder, nature of Illness or Injury, name and address 4.3 Claim Service Gurantee
of the Medical Practitioner/ Hospital and any other information that may be
relevant to the Illness/ Injury/ Hospitalisation. You must request We provide You Claim Service Gurantee as follows
preauthorization at least 48 hours before a planned Hospitalization and in a) For Reimbursement Claims: We shall make the payment of
case of an emergency situation, within 24 hours of Hospitalization. To avail admissible claim (as per terms & conditions of Policy) OR
of Cashless Hospitalization facility, you are required to produce the health
card, as provided to You with this Policy, subject to the terms and conditions communicate non admissibility of claim within 14 days after You submit
for the usage of the said health card Or You can seek pre authorization by complete set of documents & information in respect of the claims. In
providing Your Policy number and ID proof to the hospital who can co- case We fail to make the payment of admissible claims or to
ordinate with Our claim team to provide cashless facility. We will consider communicate non admissibility of claim within the time period, We shall
Your request after having obtained accurate and complete information for pay 2% interest over and above the rate defined as per IRDA
the Illness or Injury for which cashless Hospitalization facility is sought by (Protection of Policyholder's interest) Regulation 2002.
You and We will confirm Your request in writing. b) For Cashless Claims: If You notify per authorization request for cashless
B) For Reimbursement Settlement facility through any of Our empanelled network hospitals along with
complete set of documents & information, We will respond within 4 hours
i. You shall give notice to Us or Our in house claim processing team by calling of the actual receipt of such pre authorization request with:
the toll free number 1800 2666 or emailing us at
customersupport@icicilombard.com as specified in the Policy provided to a) Approval, or
You and also in writing at Our address with particulars as below: b) Rejection, or
* Policy number; c) Query seeking further information
* Your Name; In case the request is for enhancement, i.e. Request for increase in the
* Your relationship with the Policyholder; amount already authorized, We will respond to it within 3 hours.

* Nature of Illness or Injury; In case of delay in response by Us beyond the time period as stated above
for cashless claims, We shall be liable to pay Rs.1,000 to You. Our maximum
* Name and address of the attending Medical Practitioner and the liability in respect of a single hospitalization shall, at no time exceed
Hospital; Rs.1,000. We will not be liable to make any payments under this Claim
* Any other information that may be relevant to the Illness/ Injury/ Service Guarantee in case of any force majeure, natural event or manmade
Hospitalisation disturbance which impedes Our inability to make a decision or to
communicate such decisions to You.
i. The above information needs to be provided to Us or Our in house
claim processing team immediately and in any event within 10 days The service gurantee shall not be applicable for any cases delayed o
of Hospitalization, failing which We will have the right to treat the account of reasonable apprehension of fraud or fraudulent claims or cases
Claim as inadmissible, as We may deem fit at Our sole discretion. referred to/by any adjudicative forum for necessary disposal.
ii. You must immediately consult a Medical Practitioner and follow the You may lodge claim separately for the hospitalization claim, Pre-Post
advice and treatment that he recommends. hospitalization, optional covers, OPD etc. In such scenario, if delay happens
beyond the time period as specified above, the interest amount calculated
iii. You or someone claiming on Your behalf must promptly and in any will be on the net sanctioned amount of respective transaction and not the
event within 30 days of Your discharge from a Hospital (for post- total amount paid for the entire claim.
hospitalization expenses, within 30 days from the completion of
post-hospitalization period) deliver to Us the documentation Any amount paid towards interest under Claim Service Guarantee will not
(written details of the quantum of any Claim along with all original affect the Sum Insured as specified in the Schedule.
supporting documentation) as more particularly listed in Claim If you are not eligible for 'Claim Service Guarantee' for the reasons stated
documents section However, in both the above cases i.e. 4.1 above, We will inform the same to You, within 14 days in case of a) and within
(A) & (B), You must take reasonable steps or measure to minimise the 4 hours in case of b) above.
quantum of any Claim that may be covered under the Policy If so requested PART III OF THE POLICY
by Us or Our in house claim processing team, You will have to undergo a
medical examination from Our nominated Medical Practitioner, as and when General Terms and Conditions
We or Our in house claim processing team considers reasonable and 1. Disclosure of Information
necessary. The cost of such examination will be borne by Us
The Policy shall be void and all premium paid thereon shall be forfeited to the
Claim falling in two Policy periods Company in the event of misrepresentation, mis-description or non-disclosure
If the claim event falls within two Policy periods, the claims shall be paid of any material fact by the policyholder
taking into consideration the available Sum Insured in the two Policy (Explanation: "Material facts" for the purpose of this policy shall mean all
periods, including the Deductions for each Policy Period. Such eligible claim relevant information sought by the company in the proposal form and other
amount to be payable to the Insured shall be reduced to the extent of connected documents to enable it to take informed decision in the context of
premium to be received for the Renewal/due date of premium of health underwriting the risk)
insurance Policy, if not received earlier.
2. Claim Settlement (provision for Penal lnterest)
4.2 CLAIM DOCUMENTS
I. The Company shall settle or reject a claim, as the case may be, within 30
You shall be required to furnish the following documents for or in support of a days from the date of receipt of last necessary document.
Claim:
II. ln the case of delay in the payment of a claim, the Company shall be liable to
i. Duly completed Claim form signed by You and the Medical Practitioner. pay interest to the policyholder from the date of receipt of last necessary
The claim form can be downloaded from our website document to the date of payment of claim at a rate 2% above the bank rate.
www.icicilombard.com ii.Original bills, receipts and discharge
III. However, where the circumstances of a claim warrant an investigation in the
certificate/ card from the Hospital/ Medical Practitioner
opinion of the Company, it shall initiate and complete such investigation at
iii. Original bills from chemists supported by proper prescription. the earliest, in any case not later than 30 days from the date of receipt of last
iv. Original investigation test reports and payment receipts. necessary document- ln such cases, the Company shall settle or reject the
claim within 45 days from the date of receipt of last necessary document.
v. Indoor case papers

UIN: ICIHLIP21383V052021 9 CIN: L67200MH2000PLC129408

 IV. ln case of delay beyond stipulated 45 days, the Company shall be liable to false statement, or declaration is made or used in support thereof, or if any
pay interest to the policyholder at a rate 2o/o above the bank rate from the fraudulent means or devices are used by the insured person or anyone acting
date of receipt of last necessary document to the date of payment of claim. on his/her behalf to obtain any benefit under this policy, all benefits under this
(Explanation: "Bank rate" shall mean the rate fixed by the Reserve Bank of policy and the premium paid shall be forfeited.
lndia (RBl) at the beginning of the financial year in which claim has fallen due) Any amount already paid against claims made under this policy but which are
3. Moratorium Period found fraudulent later shall be repaid by all recipient(s)/policyholder(s) , who has
made that particular claim,, who shall be jointly and severally liable for such
After completion of eight continuous years under this policy no look back would repayment to the insurer
be applied. This period of eight years is called as moratorium period. The
moratorium would be applicable for the sums insured of the first policy and For the purpose of this clause, the expression "fraud" means any of the following
subsequently completion of 8 continuous years would be applicable from date acts committed by the Insured Person or by his agent or the hospital/doctor/any
of enhancement of sum insured only on the enhanced limits. After the expiry of other party acting on behalf of the insured person, with intent to deceive the
insurer or to induce the insurer to issue an insurance Policy:—
Moratorium Period no health insurance claim shall be contestable except for
proven fraud and permanent exclusions specified in the policy contract. The a) the suggestion, as a fact of that which is not true and which the Insured
policies would however be subject to all limits, sub limits, co-payments as per Person does not believe to be true;
the policy contract b) the active concealment of a fact by the Insured Person
4. Condition Precedent to Admission of Liability having knowledge or belief of the fact;
The terms and conditions of the policy must be fulfilled by the insured person for c) any other act fitted to deceive; and
the Company to make any payment for claim(s) arising under the policy. d) any such act or omission as the law specially declares to be fraudulent
5. Material Change The company shall not repudiate the claim and / or forfeit the policy benefits on
The Insured shall notify the Company in writing of any material change in the risk the ground of fraud, if the insured person / beneficiary can prove that the
in relation to the declaration made in the proposal form or medical examination misstatement was true to the best of his knowledge and there was no deliberate
report at each Renewal and the Company may, adjust the scope of cover and/or intention to suppress the fact or that such mis-statement of or suppression of
premium, if necessary, accordingly material fact are within the knowledge of the insurer.
6. Records to be Maintained 12. Cancellation
The Insured Person shall keep an accurate record containing all relevant a) The policyholder may cancel this Policy by giving 15days' written notice,
medical records and shall allow the Company or its representatives to inspect and in such an event, the Company shall refund premium for the unexpired
such records. The Proposer or Insured Person shall furnish such information as Policy Period as detailed below.
the Company may require for settlement of any claim under the Policy, within Cancellation Period Refund % for Refund % for Refund % for
reasonable time limit and within the time limit specified in the Policy. 1 year tenure 2 years tenure 3 years tenure
7. Complete Discharge policy policy policy
Any payment to the policyholder, or his/ her nominees or his/ her legal From 16 days to 1 month 80.00% 80.00% 80.00%
representative or assignee or to the hospital as the case may be, for any benefit From 1 month to 3 months 60.00% 70.00% 75.00%
under the Policy shall be a valid discharge towards payment of claim by the From 3 months to 6 months 40.00% 60.00% 67.50%
Company to the extent of that amount for the particular claim
From 6 months to 9 months 20.00% 50.00% 60.00%
8. Notice & Communication
From 9 months to 12 months 0.00% 40.00% 52.50%
i. Any notice, direction, instruction or any other communication related to the
From 12 months to 15 months NA 30.00% 47.50%
Policy should be made in writing.
From 15 months to 18 months NA 20.00% 40.00%
ii. Such communication shall be sent to the address of the Company or
through any other electronic modes specified in the Policy Schedule. From 18 months to 21 months NA 10.00% 32.50%
iii. The Company shall communicate to the Insured at the address or through From 21 months to 24 months NA 0.00% 25.00%
any other electronic mode mentioned in the schedule. From 24 months to 27 months NA NA 20.00%
9. Territorial Limit From 27 months to 30 months NA NA 12.50%
All medical treatment for the purpose of this insurance will have to be taken in From 30 months to 33 months NA NA 5.00%
India only unless worldwide cover has been opted for. From 33 months to 36 months NA NA 0.00%
10. Multiple Policies Notwithstanding anything contained herein or otherwise, no refunds of
premium shall be made in respect of Cancellation where, any claim has
i. In case of multiple policies taken by an insured person during a period from
been admitted or has been lodged or any benefit has been availed by the
one or more insurers to indemnify treatment costs, the inusred person shall
Insured person under the Policy.
have the right to require a settlement of his/her claim in terms of any of
his/her policies. In all such cases the insurer chosen by the insured person b) The Company may cancel the Policy at any time on grounds of mis-
shall be obliged to settle the claim as long as the claim is within the limits of representation, non-disclosure of material facts, fraud by the Insured
and according to the terms of the chosen policy. Person, by giving 15 days' written notice. There would be no refund of
premium on cancellation on grounds of mis-representation, non-disclosure
ii. Insured Person having multiple policies shall also have the right to prefer
of material facts or fraud.
claims under this policy for the amounts disallowed under any other policy /
policies, even if the sum insured is not exhausted. Then the Insurer shall 13. Automatic change in Coverage under the policy
independently settle the claim subject to the terms and conditions of this The coverage for the Insured Person(s) shall automatically terminate:
policy.
i. In the case of his/ her (Insured Person) demise.
iii. If the amount to be claimed exceeds the sum insured under a single policy ,
the insured person shall have the right to choose insurers from whom However the cover shall continue for the remaining Insured Persons till the
he/she wants to claim the balance amount. end of Policy Period. The other insured persons may also apply to renew the
policy. In case, the other insured person is minor, the policy shall be
iv. Where an insured person has policies from more than one insurer to cover renewed only through any one of his/her natural guardian or guardian
the same risk on indemnity basis, the insured shall only be indemnified the appointed by court. All relevant particulars in respect of such person
treatment costs in accordance with the terms and conditions of the chosen (including his/her relationship with the insured person) must be submitted to
policy. the company along with the application. Provided no claim has been made,
11. Fraud and termination takes place on account of death of the insured person, pro-
rata refund of premium of the deceased insured person for the balance
If any claim made by the insured person, is in any respect fraudulent, or if any
period of the policy will be effective.
UIN: ICIHLIP21383V052021 10 CIN: L67200MH2000PLC129408
 ii. Upon exhaustion of sum insured and additional sum insured (if any), for the ii. lnsured Person will have the option to migrate to similar health insurance
policy year. However, the policy is subject to renewal on the due date as per product available with the Company at the time of renewal with all the
the applicable terms and conditions. accrued continuity benefits such as cumulative bonus, waiver of waiting
14. Territorial Jurisdiction period. as per IRDAI guidelines, provided the policy has been maintained
without a break.
All disputes or differences under or in relation to the interpretation of the terms,
conditions, validity, construct, limitations and/or exclusions contained in the 20. Policy alignment
Policy shall be determined by the Indian court and according to Indian law. Policy Alignment option will be available in cases wherein insured(s) with two
15. Arbitration separate health indemnity policies with Us, having different policy end dates but
want to align the policy start dates. We can align the policies by extending the
i. If any dispute or difference shall arise as to the quantum to be paid by the coverage of one policy till the end date of the other policy.
Policy, (liability being otherwise admitted) such difference shall
independently of all other questions, be referred to the decision of a sole Such policies will be charged with premium on pro rata basis though the sum
arbitrator to be appointed in writing by the parties here to or if they cannot insured under the policy shall remain constant.
agree upon a single arbitrator within thirty days of any party invoking 21. Premium Payment in lnstalments (Wherever applicable)
arbitration, the same shall be referred to a panel of three arbitrators, lf the insured person has opted for Payment of Premium on an instalment basis
comprising two arbitrators, one to be appointed by each of the parties to the i.e. Half Yearly, Quarterly or Monthly, as mentioned in the policy
dispute/difference and the third arbitrator to be appointed by such two Schedule/Certificate of lnsurance, the following Conditions shall apply
arbitrators and arbitration shall be conducted under and in accordance with (notwithstanding any terms contrary elsewhere in the policy)
the provisions of the Arbitration and Conciliation Act 1996, as amended by
Arbitration and Conciliation (Amendment) Act, 2015 (No. 3 of 2016). I. Grace Period of 15 days would be given to pay the instalment premium due
for the policy
ii. It is clearly agreed and understood that no difference or dispute shall be
preferable to arbitration as herein before provided, if the Company has II. During such grace period, coverage will not be available from the due date
disputed or not accepted liability under or in respect of the policy, iii. It is of instalment premium till the date of receipt of premium by Company.
hereby expressly stipulated and declared that it shall be a condition III. The insured person will get the accrued continuity benefit in respect of the
precedent to any right of action or suit upon the policy that award by such "Waiting Periods", "Specific Waiting Periods" in the event of payment of
arbitrator/arbitrators of the amount of expenses shall be first obtained. premium within the stipulated grace Period.
16. Migration: IV. No interest will be charged lf the instalment premium is not paid on due date.
The insured person will have the option to migrate the policy to other health V. ln case of instalment premium due not received within the grace period, the
insurance products/plans offered by the company by applying for migration of policy will get cancelled.
the policyatleast3O days before the policy renewal date as per IRDAI guidelines
on Migration. lf such person is presently covered and has been continuously VI. ln the event of a claim, all subsequent premium instalments shall
covered without any lapses under any health insurance producuplan offered by immediately become due and payable.
th company, the insured person will get the accrued continuity benefits in VII. The company has the right to recover and deduct all the pending
waiting periods as per IRDAI guidelines on migration. instalments from the claim amount due under the policy.
For Detailed Guidelines on migration, kindly refer the link 22. Possibility of Revision of Terms of the Policy Including the Premium Rates
https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page= The Company, with prior approval of IRDAI, may revise or modify the terms of
PageNo3987 the policy including the premium rates. The insured person shall be notified
I. three months before the changes are effected.
17. Portability 23. Free look period
The insured person will have the option to port the policy to other insurers by The Free Look Period shall be applicable on new individual health insurance
applying to such insurer to port the entire policy along with all the members of policies and not on renewals or at the time of porting/migrating the policy
the family, if any, at least 45 days before, but not earlier than 60 days from the The insured person shall be allowed free look period of fifteen days from date of
policy renewal date as per IRDAI guidelines related to portability. lf such person receipt of the Policy documents to review the terms and conditions of the Policy,
is presently covered and has been continuously covered without any lapses and to return the same if not acceptable.
under any health insurance policy with an lndian General/Health insurer, the
proposed insured person will get the accrued continuity benefits in waiting If the insured has not made any claim during the Free Look Period, the insured
periods as per IRDAI guidelines on portability. shall be entitled to
For Detailed Guidelines on portability, kindly refer the link . a) a refund of the premium paid less any expenses incurred by the company on
medical examination of the insured person and the stamp duty charges; or
https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=
PageNo3987 b) where the risk has already commenced and the option of return of the Policy
is exercised by the insured person, a deduction towards the proportionate
18. Renewal of Policy risk premium for period of cover or
The policy shall ordinarily be renewable except on misrepresentation by the c) where only a part of the insurance coverage has commenced, such
insured person proportionate premium commensurate with the insurance coverage during
I. The Company shall endeavor to give notice for renewal. However, the such period;
Company is not under obligation to give any notice for renewal. 24. Endorsements (Changes in Policy)
II. Renewal shall not be denied on the ground that the insured person had i. This policy constitutes the complete contract of insurance. This Policy
made a claim or claims in the preceding policy years. cannot be modified by anyone (including an insurance agent or broker)
III. Request for renewal along with requisite premium shall be received by the except the company. Any change made by the company shall be evidenced
Company before the end of the policy period. by a written endorsement signed and stamped.
IV. At the end of the policy period, the policy shall terminate and can be ii. The proposer may be changed only at the time of renewal. The new
renewed within the Grace Period of 30 days to maintain continuity of proposer must be the legal heir/immediate family member. Such change
benefits without break in policy. Coverage is not available during the grace would be subject to acceptance by the company and payment of premium (if
period any). The renewed Policy shall be treated as having been renewed without
V. No loading shall apply on renewals based on individual claims experience break.

19. Withdrawal of Policy iii. The proposer may be changed during the Policy Period only in case of
his/her demise or him/her moving out of India.
i. ln the likelihood of this product being withdrawn in future, the Company will
intimate the insured person about the same 90 days prior to expiry of the policy. iv. Mid- term endorsement of addition of member in the policy shall only be

UIN: ICIHLIP21383V052021 11 CIN: L67200MH2000PLC129408

 allowed for newly wedded spouse by marriage and new born baby with relevant 10 LEGGINGS
documentation 11 LAUNDRY CHARGES
25. Change of Sum Insured 12 MINERAL WATER
Sum insured can be changed (increased/ decreased) only at the time of renewal 13 SANITARY PAD
or at any time, subject to underwriting by the Company. For any increase in SI, 14 TELEPHONE CHARGES
the waiting period shall start afresh only for the enhanced portion of the sum 15 GUEST SERVICES
insured. 16 CREPE BANDAGE
26. Nomination: 17 DIAPER OF ANY TYPE
The policyholder is required at the inception of the policy to make a nomination 18 EYELET COLLAR
for the purpose of payment of claims under the policy in the event of death of the 19 SLINGS
policyholder. Any change of nomination shall be communicated to the company 20 BLOOD GROUPING AND CROSS MATCHING OF DONORS
in writing and such change shall be effective only when an endorsement on the SAMPLES
policy is made. ln the event of death of the policyholder, the Company will pay 21 SERVICE CHARGES WHERE NURSING CHARGE ALSO
the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement CHARGED
(if any)} and in case there is no subsisting nominee, to the legal heirs or legal 22 Television Charges
representatives of the policyholder whose discharge shall be treated as full and 23 SURCHARGES
final discharge of its liability under the policy.
24 ATTENDANT CHARGES
27. Redressal of Grievances 25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS
ln case of any grievance the insured person may contact the company through PART OF BED
Website : www.icicilombard.com 26 BIRTH CERTIFICATE
27 CERTIFICATE CHARGES
Toll Free : 1800 2666
28 COURIER CHARGES
E-Mail: customersupport@icicilombard.com 29 CONVEYANCE CHARGES
Courier: ICICI Lombard General Insurance Company Ltd. 30 MEDICAL CERTIFICATE
ICICI Lombard House, 31 MEDICAL RECORDS
32 PHOTOCOPIES CHARGES
414, Veer Savarkar Marg,
33 MORTUARY CHARGES
Near Siddhi Vinayak Temple, 34 WALKING AIDS CHARGES
Prabhadevi, Mumbai- 400025 35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
lnsured person may also approach the grievance cell at any of the company's 36 SPACER
branches with the details of grievance 37 SPIROMETRE
lf lnsured person is not satisfied with the redressal of grievance through one of 38 NEBULIZER KIT
the above methods, insured person may contact the grievance officer at 39 STEAM INHALER
Manager- Service Quality, Corporate Manager- Service Quality, National 40 ARMSLING
Manager- Operations & finally Director-services and Business development at 41 THERMOMETER
the following address: 42 CERVICAL COLLAR
ICICI Lombard General Insurance Company Limited, 43 SPLINT
ICICI Lombard House, 44 DIABETIC FOOT WEAR
414, Veer Savarkar Marg, 45 KNEE BRACES (LONG/ SHORT/ HINGED)
46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
Near Siddhi Vinayak Temple,
47 LUMBO SACRAL BELT
Prabhadevi, Mumbai 400025 48 NIMBUS BED OR WATER OR AIR BED CHARGES
For updated details of grievance officer, kindly refer the link.. 49 AMBULANCE COLLAR
.https://www.icicilombard.com/grievance-redressal... 50 AMBULANCE EQUIPMENT
lf lnsured person is not satisfied with the redressal of grievance through above 51 ABDOMINAL BINDER
methods, the insured person may also approach the office of lnsurance 52 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES
Ombudsman of the respective area/region for redressal of grievance as per 53 SUGAR FREE Tablets
lnsurance Ombudsman Rules 2017. Grievance may also be lodged at IRDAI 54 CREAMS POWDERS LOTIONS (Toiletries are not payable, only
lntegrated Grievance Management System prescribed medical pharmaceuticals payable)
- https:/ligms. irda.qov. in/ 55 ECG ELECTRODES
28. Non Payables 56 GLOVES
Below are the non payable items applicable in the policy. The list may be 57 NEBULISATION KIT
updated as per the direction of Authority, For updated list please visit Our 58 RECOVERY KIT, ETC]ANY KIT WITH NO DETAILS MENTIONED
website: www.iciciclombard.com [DELIVERY KIT, ORTHOKIT,
59 KIDNEY TRAY
List of Non Payable Items as per IRDAI
60 MASK
Sr. No. Items
61 OUNCE GLASS
1 BABY FOOD
62 OXYGEN MASK
2 BABY UTILITIES CHARGES
63 PELVIC TRACTION BELT
3 BEAUTY SERVICES
64 PAN CAN
4 BELTS/ BRACES
65 TROLLY COVER
5 BUDS
66 UROMETER, URINE JUG
6 COLD PACK/HOT PACK
67 AMBULANCE
7 CARRY BAGS
68 VASOFIX SAFETY
8 EMAIL / INTERNET CHARGES
9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED
BY HOSPITAL)
UIN: ICIHLIP21383V052021 12 CIN: L67200MH2000PLC129408
Extensions/ Endorsements available under ICICI Lombard Complete Health j) Hypertension;
Insurance k) Pyrexia of any origin
Mandatory Extensions/ Endorsements under the Plan Extension 21. Air Ambulance Cover
The Benefits listed below shall be available to the Insured Person only if the In consideration of the payment of additional premium to Us, We will cover the
additional premium has been received by Us and the Benefit is specified to be in expenses incurred on air ambulance services in respect of an Insured Person which
force for that Insured Person in the Policy Schedule. are offered by a healthcare or an air ambulance service provider and which have been
Benefits under this Section are subject to the terms, conditions, waiting periods and used during the Policy Period to transfer the Insured Person to the nearest Hospital with
exclusions of this Policy and in accordance with the applicable Plan as specified in adequate emergency facilities for the provision of Emergency Care, provided that:
the Policy. i. Our maximum liability under this Benefit for any and all claims arising during the
Extension 9. Donor Expenses Policy Year will be restricted to the Sum insured as stated in the Policy Schedule;
In consideration of the payment of additional premium to Us, We will indemnify the ii. It is for a life threatening emergency health condition/s of the Insured Person which
Insured person up to the sum insured as specified in the policy schedule for the requires immediate and rapid ambulance transportation from the place where the
Medical Expenses incurred in respect of the donor for any of the organ transplant Insured Person is situated at the time of requiring Emergency Care to a hospital
surgery, provided the organ donated is for the insured person’s use and We have provided that the transportation is for Medically Necessary Treatment, is certified in
admitted the In patient Hospitalization Claim under the base plan. writing by a Medical Practitioner, and road ambulance services cannot be provided.
We shall not be liable to pay for any claim under this Benefit which arises directly or iii. Such air ambulance providing the services, should be duly licensed to operate
indirectly for or in connection with any of the following: as such by a competent government Authority.
i. Pre-hospitalization Medical Expenses or Post-hospitalization Medical iv. This cover is limited to transportation from the area of emergency to the nearest
Expenses of the organ donor. Hospital only;
ii. Screening expenses of the organ donor. v. We will not cover:
iii. Any other Medical Expenses as a result of the harvesting from the organ donor. a) Any transportation from one Hospital to another;
iv. Costs directly or indirectly associated with the acquisition of the donor’s organ. b) Any transportation of the Insured Person from Hospital to the Insured
v. Transplant of any organ/tissue where the transplant is experimental or Person’s residence after he/she has been discharged from the Hospital
investigational. c) Any transportation or air ambulance expenses incurred outside the
vi. Expenses related to organ transportation or preservation. geographical scope of India.

vii. Expenses incurred by an Insured Person as a donor. vi. We have accepted a claim under Section II.A.1 in respect of the Insured Person
for the same Accident/Illness for which air ambulance services were availed.
viii. Any other medical treatment or complication in respect of the donor, consequent
to harvesting. vii. We shall not be liable if Medically Necessary Treatment can be provided at the
Hospital where the Insured Person is situated at the time of requiring
Extension 19. ASI protector Emergency Care.
In consideration of payment of additional premium to Us, the insured can avail the Extension 22. Unlimited Reset Benefit
benefit as mentioned under additional SI protector. Additional sum insured(ASI)
accrued by the Insured person will not be impacted or reduced at renewal if any one In consideration of the payment of additional premium to Us, Reset will be available
claim or multiple claims admissible in the previous policy year under the base policy unlimited times in a policy year in case the Sum insured including accrued Additional
does not exceed the overall amount of Rs. 50,000. Sum Insured (if any) and Super No Claim Bonus (if any), Sum Insured protector (if
any) is insufficient as a result of previous claims in that policy year, provided that:
Extension 20. Domiciliary Hospitalization
• The total amount of reset will not exceed the Annual Sum Insured for that policy year
In consideration of the payment of additional premium to Us, We will cover the
• The reset amount can only be used for all future claims within the same policy year
Medical Expenses incurred in respect of the Domiciliary Hospitalization of the
Insured Person during the Policy Period provided that: • The claim will be admissible under the reset only if the claim is admissible as per
terms and conditions of the base policy
i. The Domiciliary Hospitalization is for Medically Necessary Treatment.
• Reset will not trigger for the first claim
ii. The Domiciliary Hospitalization commences and continues on the written advice
of a Medical Practitioner. • For individual policies, reset Sum Insured will be available on individual basis
whereas for floater policies, it will be available on floater basis
iii. The Medical Expenses incurred are Reasonable and Customary Charges.
• Any unutilized reset Sum Insured will not be carried forward to subsequent policy year
iv. The Domiciliary Hospitalization continues for at least 3 consecutive days in
which case We will make payment under this • The reset amount can only be used for all future claims within the same policy
year, not related to the illness/ disease/ injury for which a claim has been paid in
Benefit in respect of Medical Expenses incurred from the first day of Domiciliary
that policy year for the same person.
Hospitalization.
• For any single claim during a policy year, the maximum claim amount payable
v. Any Medical Expenses payable shall not in aggregate exceed the maximum
shall not exceed the sum of
Sum Insured and cumulative bonus (if any) as specified in the Policy Schedule
against this Benefit. o The Sum Insured,
We shall not be liable to pay for any claim under this Benefit which arises directly or o Additional Sum Insured, and
indirectly from or in connection with any of the following: o Super No claim Bonus
a) Asthma, bronchitis, tonsillitis and upper respiratory tract infection including o Sum insured protector
laryngitis and pharyngitis, cough and cold, influenza;
• During a Policy Year, the aggregate claim amount payable, shall not exceed the sum of:
b) Arthritis, gout and rheumatism;
o The Sum Insured
c) Ailments of spine/disc
o Additional Sum Insured
d) Chronic nephritis and nephritic syndrome;
o Super No claim Bonus
e) Any liver disease;
o Sum insured protector
f) Peptic ulcer
Extension 24. Emergency Services
g) Diarrhea and all type of dysenteries, including gastroenteritis;
i. Domestic Road Ambulance:
h) Diabetes mellitus and insipidus;
We will cover the expenses incurred on road ambulance services which are
I) Epilepsy; offered by a healthcare or ambulance service provider and which have been
UIN: ICIHLIP21383V052021 13 CIN: L67200MH2000PLC129408
 used during the Policy Period to transfer the Insured Person to the nearest iii. Tele Consultation
Hospital with adequate emergency facilities for the provision of Emergency We will arrange consultations and recommendations for routine health issues by
Care, provided that: a qualified Medical Practitioner or health care professional. For the purpose of
• Our maximum liability under this Benefit for every claim arising during the Policy this benefit Telephonic/Virtual consultation shall mean consultation provided by
Year will be restricted to 1% of the Sum insured maximum up to Rs. 10,000; a qualified Medical Practitioner or Health care professional through various
• We have accepted a claim under Section II.A.1 in respect of the Insured Person mode of communication like audio, video, online portal, chat or mobile app. The
for the same Accident/Illness for which road ambulance services were availed. services provided under this Benefit will be made available subject to the terms
and conditions, and in the manner prescribed below:
• This Benefit includes and is limited to the cost of the transportation of the
Insured Person: • The Medical Practitioner may suggest/recommend/prescribe over the
counter medications based on the information provided, if required on a
a) To the nearest Hospital with higher medical facilities which is prepared case to case basis. However, the services under this Benefit should not be
to admit the Insured Person and provide the necessary medical construed to constitute medical advice and/or substitute the Insured
services if such medical services cannot satisfactorily be provided at a Person's visit/ consultation to an independent Medical
Hospital where the Insured Person is situated, and only if that Practitioner/Healthcare professional*.
transportation has been prescribed in writing by a Medical Practitioner
and is for Medically Necessary Treatment. • This service will be available 24 hours a day, and 365 days in a year.

b) From a Hospital to the nearest diagnostic centre during the course of • We/Medical Practitioner/Healthcare professional may refer the Insured
Hospitalization for advanced diagnostic treatment in circumstances Person to a specialist or a general physician, if required**, and the charges
where such facility is not available in the existing Hospital. for such specialist or a general physician will have to be borne by the
Insured Person.
• The ambulance / service provider providing the services be a registered
provider with road traffic authority. • We shall not be liable for any discrepancy in the information provided under
this Benefit.
Any expenses in relation to transportation of the Insured Person from Hospital to
the Insured Person’s residence • Choosing the services under this Benefit is purely upon the customer’s own
discretion and at own risk.
while transferring an Insured Person after he/she has been discharged from the
Hospital are not payable under this Benefit. *The proposer should seek assistance from a health care professional when
interpreting and applying them to the Insured person’s individual
ii. Ambulance Assistance circumstances. If the Insured person has any concerns about His/ her health,
We will arrange ground medical transportation by a Service provider to transport He/ She may consult His/ her general practitioner.
the Insured Person to the nearest Hospital or any clinic or nursing home for **Consultations charges would be applicable.
medically necessary treatment on cashless basis subject to availability of
services in that particular city/location. Kindly visit our website for updated list of Following extensions are being offered to You as optional covers under this
cities/locations where the services are provided. product. These benefits are available w.r.t. the members, for whom these
optional covers have been opted by You by paying additional premium.
1. The services under this Benefit are subject to the following conditions:
Extension 1. Hospital Daily Cash
• The medical transportation is for a life threatening health condition of
the Insured Person which requires immediate and rapid transportation In consideration of the payment of additional premium to Us, it is hereby declared
to the Hospital; as certified in writing by the Medical practitioner and agreed that notwithstanding anything to the contrary in the Policy and subject
always to the Annual Sum Insured for this Extension, We will pay You a daily cash
• The Insured Person is in India and the treatment is in India only; amount, as stated against this Extension in the Policy Schedule, for each and every
• The ambulance service is availed within the same city completed day of Hospitalization up to a maximum of 10 consecutive days, if such
Hospitalization is at least for a minimum of 3 consecutive days and it falls within the
• The services can be availed on cashless basis only; Policy Year. The Claim under this extension will be payable only if We have admitted
2. Process to avail Ambulance Assistance: Our liability under “In-patient Treatment” section of the Policy.
a) On calling Our helpline number provided below, Our trained customer Subject otherwise to the terms, conditions and exclusions of the Policy
service executive (CSE) will ask the Insured person relevant questions Extension 2. Convalescence Benefit
to assess the situation.
In consideration of the payment of additional premium to Us, it is hereby declared
b) The call may be redirected to a qualified Medical Practitioner in order to and agreed that notwithstanding anything to the contrary in the Policy, We will pay
evaluate the requirement for an ambulance with Advanced Life Support You an amount of Rs. 10,000 if You are Hospitalized for a minimum period of 10
based on the Insured Person’s condition. consecutive days, due to any Injury or Illness as covered under the Policy. This
c) The below mentioned details are to be made available for availing the services: benefit is payable only once to an Insured Person during each Policy Year of the
1. UHID of Insured Person, as provided on the Health Card. Policy Period.

2. Contact number of the Insured Person Subject otherwise to the terms, conditions and exclusions of the Policy

3. Location of Insured Person Extension 3. Nursing at Home

How to Call an Ambulance? In consideration of the payment of additional premium to Us, it is hereby declared
and agreed that notwithstanding anything to the contrary in the Policy and subject
always to the Annual Sum Insured for this Extension, We will pay You for the
An IVRS will ask expenses incurred by You, up to Rs. 3,000 for each day up to a maximum of 15 days
you to select option Call will be
Call 18001028136 to 1or 2 depending on answered by an post Hospitalization for the medical services of a Qualified Nurse at Your residence,
reach the requirement. CSE & details like provided that the nurse is employed in a Hospital and the engagement of such
Emergency name, UHID, nature
Dial 1 for Medical of emergency will Qualified Nurse is certified as necessary by a Medical Practitioner and relate directly
Response Centre
Ambulance be asked to any Illness or Injury, covered under the Policy. The payment under this extension
Services is subject to admissibility of Your Hospitalization Claim under the Policy.
For the purpose of this extension, the term “Qualified Nurse” means a person who
holds a valid registration from the Nursing Council of India or the Nursing Council of
any state in India.
Doctor may Patient will be taken Subject otherwise to the terms, conditions and exclusions of the Policy
to the nearest Emergency
accompany patient hospital as per the Ambulance Extension 4. Compassionate Visit
in the ambulance if predefined hospital Transport will arrive
required network chart In consideration of the payment of additional premium to Us, it is hereby declared
and agreed that notwithstanding anything to the contrary in the Policy, in event of

UIN: ICIHLIP21383V052021 14 CIN: L67200MH2000PLC129408

Your Hospitalization, which in the opinion of the Medical Practitioner attending on iii. Elevation of infarction specific enzymes, Troponins or other specific
You, extends beyond a period of 5 consecutive days, We will indemnify the cost of biochemical markers.
the economy class air ticket incurred by Your Immediate Relative from and to the The following are excluded:
place of origin of such relative or the place of residence of the relative.
i. Other acute Coronary Syndromes
Our liability under this benefit, however, in respect of any one event or all events of
Hospitalization during the Policy Year shall not in aggregate exceed Rs. 20,000 per ii. Any type of angina pectoris
Policy Year of Policy Period. iii. A rise in cardiac biomarkers or Troponin T or I in absence of overt
For the purpose of this extension, the term “Immediate Relative” would mean the ischemic heart disease OR following an intra-arterial cardiac
Insured’s Spouse, Children & Parents. procedure.
Subject otherwise to the terms, conditions and exclusions of the Policy d) Kidney failure requiring regular dialysis
Extension 7. Critical Illness Cover End stage renal disease presenting as chronic irreversible failure of both
kidneys to function, as a result of which either regular renal dialysis
In consideration of the payment of additional premium to Us, it is hereby declared (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is
and agreed that notwithstanding anything to the contrary in the Policy, We will pay carried out. Diagnosis has to be confirmed by a specialist medical
You the sum insured as stated against this Extension in the Policy Schedule, in case practitioner.
You are diagnosed as suffering from one or more of the Critical Illnesses for the first
time in your life, during the Policy Period. e) Major organ /bone marrow transplant
However, We will not make any payment if You are first diagnosed as suffering from a The actual undergoing of a transplant of:
Critical Illness within 90 days of the Period of Insurance Start Date. This benefit can i. One of the following human organs: heart, lung, liver, kidney, pancreas,
be availed by You only once during Your lifetime. No Claim under this Extension shall thatresulted from irreversible end-stage failure of the relevant organ, or
be admissible in case any of the Critical Illnesses is a consequence of or arises out of
any Pre-Existing Condition(s)/Disease. ii. Human bone marrow using haematopoietic stem cells. The undergoing
of a transplant has to be confirmed by a specialist medical practitioner.
“Critical Illness” for the purpose of this Policy includes the following:
The following are excluded:
a) Cancer of specified severity
i. Other stem-cell transplants
A malignant tumour characterized by the uncontrolled growth & spread of
malignant cells with invasion & destruction of normal tissues. This diagnosis ii. Where only islets of langerhans are transplanted
must be supported by histological evidence of malignancy. The term cancer f) Stroke resulting in permanent symptoms
includes leukemia, lymphoma and sarcoma. Any cerebrovascular incident producing permanent neurological
The following are excluded – sequelae..This includes infarction of brain tissue, thrombosis in an
i. All tumors which are histologically described as carcinoma in situ, benign, intracranial vessel, haemorrhage and embolisation from an extracranial
pre-malignant, borderline malignant, low malignant potential, neoplasm of source. Diagnosis has to be confirmed by a specialist medical practitioner
unknown behavior, or non-invasive, including but not limited to: Carcinoma and evidenced by typical clinical symptoms as well as typical findings in CT
in situ of breasts, Cervical dysplasia CIN-1, CIN 2 and CIN-3 Scan or MRI of the brain. Evidence of permanent neurological deficit lasting
for at least 3 months has to be produced.
ii. Any non-melanoma skin carcinoma unless there is evidence of metastases
to lymph nodes or beyond; The following are excluded:

iii. Malignant melanoma that has not caused invasion beyond the epidermis; i. Transient ischemic attacks (TIA)

iv. All tumours of the prostate unless histologically classified as having a ii. Traumatic injury of the brain
Gleason score greater than 6 or having progressed to at least clinical TNM iii. Vascular disease affecting only the eye or optic nerve or vestibular
classification T2N0M0 functions.
v. All Thyroid cancers histologically classified as T1N0M0 (TNM g) Permanent paralysis of limbs
Classification) or below Total and irreversible loss of use of two or more limbs as a result of injury or
vi. Chronic lymphocytic leukaemia less than RAI stage 3 disease of the brain or spinal cord. A specialist medical practitioner must be
vii. Non-invasive papillary cancer of the bladder histologically described as of the opinion that the paralysis will be permanent with no hope of recovery
TaN0M0 or of a lesser classification, and must be present for more than 3 months.

viii. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 h) Open heart replacement or repair of heart valves
(TNM Classification) or below and with mitotic count of less than or equal to The actual undergoing of open-heart valve surgery is to replace or repair
5/50 HPFs; one or more heart valves, as a consequence of defects in, abnormalities of,
ix. All tumors in the presence of HIV infection. or disease-affected cardiac valve(s). The diagnosis of the valve abnormality
must be supported by an echocardiography and the realization of surgery
b) Open chest CABG has to be confirmed by a specialist medical practitioner. Catheter based
The actual undergoing of heart surgery to correct blockage or narrowing in one techniques including but not limited to, balloon valvotomy/valvuloplasty are
or more coronary artery(s), by coronary artery bypass grafting done via a excluded.
sternotomy (cutting through the breast bone) or minimally invasive keyhole i) End stage liver failure
coronary artery bypass procedures. The diagnosis must be supported by a
coronary angiography and the realization of surgery has to be confirmed by a i. Permanent and irreversible failure of liver function that has resulted in
cardiologist. all three of the following:

The following are excluded: a) Permanent jaundice; and

a) Angioplasty and/or any other intra-arterial procedures b) Ascites; and

c) First heart attack - of specified severity (Myocardial infarction) c) Hepatic encephalopathy.

The first occurrence of heart attack or myocardial infarction, which means ii. Liver failure secondary to drug or alcohol abuse is excluded
the death of a portion of the heart muscle as a result of inadequate blood Note: In the event of a Claim arising out of any of the Critical Illness or medical
supply to the relevant area. The diagnosis for Myocardial Infarction should procedures as covered under this Extension, You should intimate Us within
be evidenced by all of the following criteria: thirty (30) days from the date of first diagnosis of such Illness or from the date of
i. A history of typical clinical symptoms consistent with the diagnosis of surgical procedure or from date of occurrence of the medial event as the case
acute myocardial infarction (For e.g. typical chest pain) may be (irrespective of Your coverage under any other health insurance policy).

ii. New characteristic electrocardiogram changes Further, You should arrange for submission of the Claim Documents* as stated

UIN: ICIHLIP21383V052021 15 CIN: L67200MH2000PLC129408

 in the Policy including the confirmation from the Medical Practitioner that the electrical installation with high tension supply, or as jockeys or circus
Critical Illness or medical procedure or medical event for which a Claim has personnel, or engaged in activities like racing on wheels or horseback, big
been lodged under this Extension, does not relate to any Pre-Existing game hunting, mountaineering, winter sports, rock climbing, pot holing,
Condition/Disease(s) or any Illness or Injury which existed within the first 3 bungee jumping, skiing, ice hockey, ballooning, hang gliding, river rafting,
months of the Period of Insurance Start Date. polo and persons whilst engaged in occupation / activities of similar hazard
*In case You are covered under any health policy of other insurance company d) serving in any branch of the military or armed forces of any country
and become entitled to a Claim under such policy, then for this Extension, You during war or warlike operations
may submit to Us the copies of such Claim Documents provided they are duly iv. Compensation in respect of death or disablement
certified by such insurance company or any hospital where You are getting
treated, as applicable a) arising or resulting from You committing any breach of law with a
malafide or criminal intent
The cover under this extension shall terminate in the event of Your Claim
becoming admissible hereunder. In consequence thereof no benefit shall be b) caused by venereal disease or insanity or mental, nervous or emotional
payable to You under this extension of the policy thereafter. disorder
Extension 8. Personal Accident cover c) resulting from, or contributed to or aggravated or prolonged by
childbirth or pregnancy or in consequence thereof
In consideration of the payment of additional premium to Us, it is hereby declared
and agreed that notwithstanding anything to the contrary in the Policy, We will pay The cover under this Extension shall be available only once during Your lifetime.
You or Your Nominee / legal heir, as the case may be, the sum insured as specified Claims documents: You or Your Nominee/ legal heir, as the case may be, shall
against this Extension in the Policy Schedule, on occurrence of any Insured Event, be required to furnish the following for or in support of a Claim:
as specifically described hereunder, arising due to an Injury sustained by You during
the Policy Year: i. In case of Death

• Insured Event – Accidental Death a) Policy Copy

We will pay Your Nominee / legal heir, as the case may be, the sum insured as b) Claim form duly filled & signed by Nominee
specified against this Extension in the Policy Schedule, on the unfortunate event c) Post Mortem Report (certified copies) – as applicable and wherever
of Your death, provided such death results solely and directly from an Injury conducted
sustained within a period of twelve months from the date of Accident resulting in d) F.I.R. or Death report or Inquest Panchnama (in original or certified
such Injury. copies)-
Provided that the date of occurrence of the Accident falls within the Policy Year. e) Spot Panchnama (certified copies)- if applicable
• Insured Event – Permanent Total Disablement (PTD) resulting from Accident f) Death certificate (in original or certified copy)
We will pay You the sum insured as specified against this Extension in the Policy g) Any other document as may be required by Us.
Schedule on the occurrence of any of the following losses, provide such losses
are total, permanent and irrecoverable resulting solely and directly from an ii. In case of PTD
Injury sustained within a period of twelve months from the date of Accident a) Policy Copy
resulting in such Injury:
b) Claim form duly filled & signed by You
i. Loss of use of both eyes, or physical separation/ loss of use of two entire
hands or two entire feet, or one entire hand and one entire foot, or of such c) Disability certificate –by an authorized Medical Practitioner of the
loss of use of one eye and such physical separation/ loss of use of one entire district/ units concerned, stating percentage of disablement
hand or one entire foot d) F.I.R. and Panchnama wherever applicable (original or certified copies)
ii. Physical separation/ loss of use of two hands or two feet, or one hand and e) Medical report
one foot, or of Loss of Use of one eye and loss of use of one hand or one foot f) Original bills, receipts and discharge certificate/card from the
If such Injury results in permanently and totally, disabling the Insured Hospital/Medical Practitioner
Person from engaging in any employment or occupation of any description g) Original bills from chemists supported by proper prescription
whatsoever
h) Investigation reports like laboratory test, X-rays and reports essential of
Provided that the date of occurrence of the Accident falls within the Policy confirmation of the type and percentage of disability and payment
Year. receipts
Notwithstanding anything, We shall not be liable to pay You under this Extension i) Photo of Insured Person showing the disability
for:
j) Any other document as may be required by the Us
i. Compensation under more than one of the categories as specified in the
Insured Event, during the Policy Year If You are covered under any health and accident insurance policy of other
insurance company and become entitled to Claim under such policy, then You
ii. Payment of compensation in respect of Death or Permanent Total can submit to Us the copies of the above–
Disablement arising from or resulting from any Illness unless such Illness
arose directly as a consequence of an Accident listed documents / medical records, provided they are duly certified by such
insurance company or any hospital where You are getting treated, as applicable.
iii. Compensation in respect of a death or disablement resulting from, whilst:
Note: The cover under this extension shall terminate in the event of Your Claim
a) engaging in aviation or ballooning, or whilst mounting into, or becoming admissible hereunder. In consequence thereof no benefit shall be
dismounting from or traveling in any balloon or aircraft other than as a payable under this extension of the policy thereafter
passenger (fare-paying or otherwise) in any scheduled airlines in the
world, or engaging in any kind of adventure sports for personal Subject otherwise to the terms, conditions and exclusions of the Policy
gratification Extension 16. Super No Claim Bonus
b) participating in winter sports, skydiving/parachuting, hang gliding, In consideration of payment of additional premium to Us, the insured person can
bungee jumping, scuba diving, mountain climbing (where ropes or avail the benefit under super no claim bonus. All terms and conditions
guides are customarily used), riding or driving in races or rallies using a applicable to the additional sum insured feature will apply to this cover as well,
motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian except for the below mentioned terms and conditions:
activities, skin diving or other underwater activity, rafting or canoeing
involving white water rapids, yachting or boating outside coastal waters • If no claims have been paid in the expiring Policy year and the policy is being
(2 miles), participation in any professional sports, any bodily contact renewed without any break in period the Insured person will be given a Super no
sport or any other hazardous or potentially dangerous sport for which claim bonus viz. 50% increase in the Sum insured for each completed year.
You are untrained • Super no claim bonus will be over and above the accrued additional sum
c) working in underground mines or explosives magazines, or involving insured, if any.

UIN: ICIHLIP21383V052021 16 CIN: L67200MH2000PLC129408

• The Super no claim bonus cannot, at any given Policy year, exceed the below Extension 18. Claim Protector
mentioned % of the annual Sum insured In consideration of payment of additional premium to Us, the insured can avail the
Sum Insured Super no claim bonus as % of Annual SI benefit as mentioned under claim protector. If a claim has been accepted under the
5L to 10L 100% inpatient hospitalization cover, then the items which are not payable under the claim
as per the List of Excluded items released by IRDAI that is related to the particular
15L to 50L 200% claim will become payable. The maximum claim payout under this benefit shall be
• In the event of a claim in the Policy year, the super no claim bonus will reduce by limited to Annual Sum Insured under your policy.
50%. Extension 23. Worldwide Cover
• At the time of renewal if the Insured person opts out of this optional cover, then In consideration of the payment of additional premium to Us, We will indemnify the
the Super no claim bonus accrued up until the expiring policy year will be Insured person for hospitalization expenses including planned hospitalisation
forfeited. incurred outside India and anywhere across the world including USA and Canada,
• In case no claims are made in the Policy year, the super no claim bonus will be upto the amount specified under against this benefit in the policy schedule subject to
credited automatically to the subsequent policy year even in the case of multi- the terms & conditions specified hereunder:
year policies (2 & 3 year policy tenure) i. A co-pay of 10% will be applied to every admissible claim over and above to any
Extension 17. Sum Insured Protector other co-pay charged
In consideration of payment of additional premium to Us, the insured person can ii. The benefit is available for 45 consecutive days from the date of travel in a single
avail the benefit under sum insured protector. The Sum Insured protector is trip and 90 days in a cumulative bases as a whole in a Policy year
designed to protect the Sum Insured against rising inflation by linking the Sum iii. The expenses covered under this benefit will be limited to inpatient
Insured under the base plan to the Consumer Price index (CPI). hospitalization expenses and days care treatment/ procedure expenses.
The Sum Insured will be increased on cumulative basis at each renewal on the basis Expenses incurred for pre and post hospitalization will not be covered under this
of inflation rate in previous\ year. Inflation rate would be computed as the average benefit.
CPI of the entire calendar year published by the Central Statistical Organisation iv. The payment of any claim under this benefit will be based on the rate of
(CSO). exchange as on Date of Loss published by Reserve Bank of India (RBI) and shall
The % increase will be applicable only on Annual Sum Insured under the Policy and be used for conversion of Foreign Currency into Indian rupees for payment of
not on additional sum insured or any other benefit which leads to increase in Sum claims. If on the insured person’s date of loss, if the RBI rates are not published,
Insured. the exchange rates published next shall be considered for conversion

UIN: ICIHLIP21383V052021 17 CIN: L67200MH2000PLC129408

Details of Insurance Ombudsmen

Areas of Jurisdiction Office of the Insurance Ombudsman Areas of Jurisdiction Office of the Insurance Ombudsman
Gujarat , UT of Dadra and Nagar Haveli, Office of the Insurance Ombudsman, Andhra Pradesh, Telangana and UT of Office of the Insurance Ombudsman,
Daman and Diu JeevanPrakash Building, 6th floor, Yanam – a part of the UT of Pondicherry 6-2-46, 1st floor, "Moin Court",
TilakMarg, Relief Road, Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
Ahmedabad – 380 001.
Tel.: 040 - 67504123 / 23312122
Tel.: 079 - 25501201/02/05/06 Fax: 040 - 23376599
Email: bimalokpal.ahmedabad@ecoi.co.in Email: bimalokpal.hyderabad@ecoi.co.in
Rajasthan Office of the Insurance Ombudsman,
Office of the Insurance Ombudsman, JeevanNidhi – II Bldg., Gr. Floor,
JeevanSoudhaBuilding,PID No. 57-27-N-19, Ground Bhawani Singh Marg,
Karnataka Floor, 19/19, 24th Main Road,JP Nagar, Ist Phase, Jaipur - 302 005.
Bengaluru – 560 078. Tel.: 0141 - 2740363
Tel.: 080 - 26652048 / 26652049 Email: Bimalokpal.jaipur@ecoi.co.in
Email: bimalokpal.bengaluru@ecoi.co.in
Kerala , UT of (a) Lakshadweep, (b) Mahe Office of the Insurance Ombudsman,
Madhya Pradesh and Chhattisgarh Office of the Insurance Ombudsman, – a part of UT of Pondicherry 2nd Floor, Pulinat Bldg.,
JanakVihar Complex, 2nd Floor, Opp. Cochin Shipyard, M. G. Road,
6, Malviya Nagar, Opp. Airtel Office, Ernakulam-682015.
Tel.: 0484 - 2358759/2359338
Near New Market, Bhopal – 462 003.
Fax: 0484-2359336
Tel.: 0755 - 2769201 / 2769202 Email: bimalokpal.ernakulam@ecoi.co.in
Fax: 0755 - 2769203
West Bengal, UT of Andaman and Nicobar Office of the Insurance Ombudsman,
Email: bimalokpal.bhopal@ecoi.co.in
Islands, Sikkim Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue,
Odisha Office of the Insurance Ombudsman, KOLKATA - 700 072.
62, Forest park, Tel.: 033 - 22124339 / 22124340
Bhubneshwar – 751 009. Fax : 033 - 22124341
Tel.: 0674 - 2596461 /2596455 Email: bimalokpal.kolkata@ecoi.co.in
Fax: 0674 - 2596429 Districts of Uttar Pradesh : Office of the Insurance Ombudsman,
Email: bimalokpal.bhubaneswar@ecoi.co.in Laitpur, Jhansi, Mahoba, Hamirpur, Banda, 6th Floor, JeevanBhawan, Phase-II,
Chitrakoot, Allahabad, Mirzapur, Sonbhabdra,
Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Nawal Kishore Road, Hazratganj,
Punjab , Haryana, Himachal Pradesh, Office of the Insurance Ombudsman, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lucknow - 226 001.
Jammu and Kashmir, UT of Chandigarh Lakhimpur, Bahraich, Barabanki, Raebareli, Tel.: 0522 - 2231330 / 2231331
S.C.O. No. 101, 102 & 103, 2nd Floor, Sravasti, Gonda, Faizabad, Amethi, Kaushambi,
Batra Building, Sector 17 – D, Balrampur, Basti, Ambedkarnagar, Sultanpur, Fax: 0522 - 2231310
Chandigarh – 160 017. Maharajgang, Santkabirnagar, Azamgarh, Email: bimalokpal.lucknow@ecoi.co.in
Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur,
Tel.: 0172 - 2706196 / 2706468 Chandauli, Ballia, Sidharathnagar.
Fax: 0172 - 2708274 Goa, Office of the Insurance Ombudsman,
Email: bimalokpal.chandigarh@ecoi.co.in Mumbai Metropolitan Region 3rd Floor, JeevanSevaAnnexe,
excluding Navi Mumbai & Thane S. V. Road, Santacruz (W),
Tamil Nadu, UT–Pondicherry Town and Office of the Insurance Ombudsman, Mumbai - 400 054.
Karaikal (which are part of UT of Fatima Akhtar Court, 4th Floor, 453, Tel.: 022 - 26106552 / 26106960
Pondicherry) Fax: 022 - 26106052
Anna Salai, Teynampet,
Email: bimalokpal.mumbai@ecoi.co.in
CHENNAI – 600 018.
State of Uttaranchal and the following Districts of Office of the Insurance Ombudsman,
Tel.: 044 - 24333668 / 24335284 Uttar Pradesh:
BhagwanSahai Palace
Fax: 044 - 24333664 Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun,
Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, 4th Floor, Main Road,
Email: bimalokpal.chennai@ecoi.co.in Meerut, Moradabad, Muzaffarnagar, Oraiyya, Naya Bans, Sector 15,
Pilibhit, Etawah, Farrukhabad, Firozbad, Distt: GautamBuddh Nagar,
Delhi Office of the Insurance Ombudsman, Gautambodhanagar, Ghaziabad, Hardoi,
Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, U.P-201301.
2/2 A, Universal Insurance Building, Sambhal, Amroha, Hathras, Kanshiramnagar, Tel.: 0120-2514250 / 2514252 / 2514253
Saharanpur. Email: bimalokpal.noida@ecoi.co.in
Asaf Ali Road,
New Delhi – 110 002. Bihar, Office of the Insurance Ombudsman,
Tel.: 011 - 23232481/23213504 Jharkhand. 1st Floor,Kalpana Arcade Building,,
Email: bimalokpal.delhi@ecoi.co.in Bazar Samiti Road,
Bahadurpur,
Patna 800 006.
Assam , Meghalaya, Manipur, Mizoram, Office of the Insurance Ombudsman, Tel.: 0612-2680952
Arunachal Pradesh, Nagaland and Tripura JeevanNivesh, 5th Floor, Email: bimalokpal.patna@ecoi.co.in
Nr. Panbazar over bridge, S.S. Road, Maharashtra, Office of the Insurance Ombudsman,
Guwahati – 781001(ASSAM). Area of Navi Mumbai and Thane JeevanDarshan Bldg., 3rd Floor,
Tel.: 0361 - 2632204 / 2602205 excluding Mumbai Metropolitan Region C.T.S. No.s. 195 to 198,
Email: bimalokpal.guwahati@ecoi.co.in N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@ecoi.co.in

ICICI Lombard General Insurance Company Limited

Mailing Address: Interface Building No. 16, 601-602, 6th Floor, New Link Road, Malad (West), Mumbai - 400 064.
Registered Office Address: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025.
Visit us at www.icicilombard.com • Mail us at customersupport@icicilombard.com • Toll Free No.: 1800 2666 • Chargable No.: +91 86 55 222 666
Insurance is the subject matter of solicitation. IRDA Reg. No. 115. CIN: L67200MH2000PLC129408.

UIN: ICIHLIP21383V052021 18 CIN: L67200MH2000PLC129408