ICICI Lombard Health Care

Claims and Wellness Management

Group Health Policy presentation - 2022

Agenda
• Policy Features
• Claim Process
• Digital Capabilities
• Value Added Services
Basic Policy Details
Particulars Description

Corporate Name EPAM Systems India Private Limited

Policy Start & End Date 01-Jan-2022 to 31-Dec-2022

Insurer ICICI Lombard GIC Ltd

TPA In-house claims team - ICICI Lombard Health Care

Geographical Limits India (Covers for treatment availed in India)

Sum Insured 10 Lakhs per family, for policy year

Employee, Spouse, 3 Dependent Children up to age 30 years

Family Definition
and dependent parents or in-laws are covered under the policy.

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Policy Features
Particulars Description
Pre-Existing Diseases Covered

Room rent restricted to 7,000/- of the SI per day for normal and 12,000/-
Room Rent
of the SI per day for ICU. Room rent is inclusive of nursing charges.

Pre Hospitalisation and Post Hospitalisation for 60 days & 90 days

Pre-Post Hospitalization
respectively are covered
Claim must be filed within 30 days from the date of completion of
Claim Submission
treatment.

Mid term inclusion is possible only in case of a) spouse on account of

marriage during policy term b) newborn (child birth during the policy term
Mid Term Inclusion
but after completion of 91 days) subject to not more than 3 children being
covered under the policy.

Others Proportionate clause not applicable.

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Policy Features
Particulars Description
Maternity Benefit 65,000/- for Normal & 75,000/- for C-section for first 2 children only
Baby Day 1 Baby Covered from 1 day up to Family SI

Pre-Post Natal Expenses to the limit of 5,000/- for pre and 5,000/- for
Pre/Post Natal Expenses
Post is covered above Maternity Limit

Ambulance Service Ambulance charges limited to 10,000/- per person.

Eye Related Diseases Restricted to 50,000/-

Psychiatric Ailments – 30,000/-

Additional Coverages 50% Co-Pay for Cyber knife treatment/Stem Cell Transplantation.
Cochlear Implant treatment shall be restricted to 50% of the SI

Ayurvedic treatment will be covered in Government and Private

Ayurvedic Treatment
Hospitals.

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Other Coverages
• Infertility is covered up to 75,000/-
• Lasik Surgery, Refractive Error (+or- 6.5) up to 50,000/-
• Dental Treatment is covered up to 10,000/- for family in policy period.
• Autism & Septoplasty are covered
• Expansion of coverage scope including Modern treatment & advancement in Tech like Below
modern treatment methods and advancement in Technologies can be covered up to 50% FSI
• Uterine Artery Embolization and HIFU
• Balloon Sinuplasty
• Deep Brain stimulation
• Oral chemotherapy
• Immunotherapy- Monoclonal Antibody to be given as injection
• Intra vitreal injections
• Robotic surgeries
• Stereotactic radio surgeries
• Bronchical Thermoplast
Day Care Treatment

Medical treatment or surgical procedure which is undertaken under general or local

anaesthesia and requires admission in a Hospital/Day Care centre for stay less than 24
hours is called as Day Care Treatment.

Treatment normally taken on out-patient basis is not included in the scope of this definition.

Examples of Day Care Procedures are:

• Cataract
• Cancer - Chemotherapy
• Coronary Angiography
• Haemodialysis
• Tonsillectomy
Exclusions

• Treatment on trial/experimental basis

• Admin/Registration/Service/Misc. Charges
• Expenses on fitting of Prosthesis
• Any device/instrument/machine contributing/replacing the
function of an organ
• Holter Monitoring are outside the scope of the policy.
• Claim Process
• Cashless
• Reimbursement
Cashless Process

Insured to get Hospital to send Insured to pay

Process @ Approve/Query/R
Cashless admitted in network Cashless
ILHC eject
non-payables &
hospital Request to ILHC discharge

 Insured to submit Health Card Copy and Photo ID Proof at Hospital Insurance Desk.
 Hospital will send the cashless request to ihealthcare through Web/eMail upon admission recommendation from Hospital
Doctor. Insured needs to check the pre-authorization note and duly sign the same.
 Post receipt of Cashless Request from Hospital, ihealthcare team to check the medical admissibility and accordingly
Approve/Query/Reject the request.
Insured will be notified via SMS/eMail at all events of Cashless Hospitalization. And also a call will be
made if the cashless request has been queried/rejected. (subject to availability of insured/dependants
contact details)

• In case of planned admission insured/dependents can reach out to hospital for cashless approvals in advance
• In case of emergency during admission insured/dependents can approach Hospital TPA desk for Cashless request.

Network Hospital Details are available on our website; www.icicilombard.com

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Reimbursement Process
Insured Payment to
Submit original Claim process Claim
Hospitalized in Hospital &
Reimbursement non-network collect original
document to @ ILHC Settlement
ILHC
hospital documents

Claim Submission Process

Documents to be submitted for Reimbursement  Insured to collect all the claim documents
 Duly filled Claim form including NEFT form for Electronic Funds Transfer & during discharge.
Cancelled Cheque Copy  Claim to be submitted within 30 days from date
 Health Card Copy and copy of ID Proof (Govt. Issued) of discharge.
 Discharge Summary (with details of complaints and treatment availed)  Claim form can be downloaded from our
 Final Hospital Bill (detailed break-up) along with interim bills & payment website www.icicilombard.com
receipts  Claim Status can be tracked Online or by
 All investigation reports (Original Blood Reports, X-Ray Reports, Sonography, sending an SMS to 575758 ex: ILHC CL
CT Scan, MRI etc 220201448322
 All Pharmacy bills supported by Doctor’s prescriptions Insured will be notified via SMS/eMail at all
 Implant Sticker / Invoice, if used (eg: Lens details in Cataract Case, Stent events of Claim process. And also a call
details in angioplasty) will be made if the Claim has been
 Medico Legal Certificate (MLC) and or FIR for all accident cases queried. (subject to availability of
insured/dependants contact details)
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ICICI Lombard Healthcare | Claim Submission Process
Original Documents Mobile App

• Original claim documents to • Initiated submission of reimbursement

claims via IL Take care App (Mobile App)
be dispatched to Hyderabad • Scan now and submit original physical
Office. documents later.
• Address: Claims Team, ICICI • Emboss It - Emboss all documents with a
blue pen on top left side "For ICICI
Lombard Health Care, ICICI Lombard Claim“. Submit It - Click the
Lombard GIC Ltd, ICIC Bank send button and we will receive your
Towers, Plot No.: 12, 9th Floor, claims.
Financial District, • Store It – You are advised to keep the
originals of submitted documents safely
Nanakramguda, Gachibowli, as we may ask for actual documents till
Hyderabad - 500032 180 days of settlement/repudiation of
claim or it may be required during any
processing/field verification of a particular
claim. Customers are required to send
documents once they get query letter.

 In case of any claim related query, insured can write to us at ihealthcare@icicilombard.com

 Or can contact @ our Toll Free Number 1800 2 666 (In-house Call Centre)
Digital Capabilities
The Features Policy
• All health, motor, travel policies; labels for multiple health policies of same corporate
• Policy terms and conditions (As per the HR’s requirement)
• Endorsements
• E-cards
• Dependents’ Logins
• Flexi-plan selection and enrolment
Policies
• Emergency Ambulance Services purchase
Claims Self and
• Claim Intimation with documents upload Dependents’
• Claim Tracking & Deduction details Cards
• Previous claim documents
• Pre-planned hospitalization request Policy Details
• Pre-planned hospitalization history

Wellness
Advisory Panel
• Network hospitals with details
• Tele-consultation Overlay
• Health Assistance of Services
• Chat with an expert

Wellness
• Health Risk Assessment
• Diet and Exercise Tracker
• Health parameters’ tracking and trends
• Sleep, Meditation and Water Reminders
• Health Records upload up to 1GB
• Blogs
IL Take Care App – Registration & Login
Download the IL Take Care app from Play Store/App store App Registration Add policy details

QR codes of IL Take Care

Android iOS

 After installing, Register using your Name, DOB and Mobile

Number
 You will receive a Six digit OTP
 Post entering the same, you can generate a 6 digit M-Pin or a
password for further logins in the app.
 Add your policy – Find Insurance e-card, view details & verify
members
Info available @ Website www.icicilombard.com

Tracking of
claim status

Search Download
Network
Hospitals Health Card

Website

Download Claim
claim forms Process

Online
filling of
claims

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Value Added Services
Services @ Health Assistance
Handhold Feedback on
Understand customer Facilitate with
through the the service
need suitable option
entire process availed

Post
Doctor Second Facilitating
Hospitalization
Appointment Opinion Hospitalization
Care
Health Assistance Team Services

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Connect @ Health Assistance
Reach us @

Helpline - 040 6627 4205 (8 am to 8 pm from Mon to Sat except public holidays)
Toll free - 1800 2 666 – Ask for Doctor Team

healthassistance@icicilombard.com

https://www.icicilombard.com/IL-Health-Care/Home/healthassistance

Online chat (8 am to 8 pm from Monday to Saturday except public holidays)

Home Health Care: Coverage & Exclusions
Eligibility: Prescribed continuous active line of treatment from Doctor / Hospital , subject to
Policy T&C. Medically manageable at home with right set of clinical qualified personnel

What we
Coverages Exclusions
Pay
• Fever – Covid and • Management of • Doctor Consultations
Non Covid *Comorbid Conditions • Nursing Expenses
• Acute Gastroenteritis • Occupational Therapy • Diagnostics
• Respiratory Tract / Speech Therapy / • Pharmacy
Infection Behavioural Therapy
• Urinary Tract Infection • Neuro / Stroke
• Asthma Rehabilitation
• Post Operative Care • Medical Emergency
• Wound Care – Non • Treatment at OPD
• Equipment Cost is
surgical requiring • Other exclusion as
not covered under
hospitalization per Policy T&C
health insurance
Home Health Care: Process

Home Care managed

by hospital

Customer Hospital providing Seamless cashless

prescribed with home care facility service
home care

Home Care
managed by
specialist providers

Customer Approaches Facilitates Efficient

prescribed with ILGIC service via settlement of
home care network partners claims
Connect @ Health Assistance
Reach us @

Helpline - 040 6627 4205 (8 am to 8 pm from Mon to Sat except public holidays)
Toll free - 1800 2 666 – Ask for Doctor Team

homehealth@icicilombard.com

Online chat (8 am to 8 pm from Monday to Saturday except public holidays)

Thank You