ICICI Lombard Group Health Insurance

ICICI Lombard’s Group Health Insurance (ICICI Lombard GHI) is amongst the leading healthcare schemes offered by ICICI Lombard General Insurance (ICICI Lombard). ICICI Lombard provides a comprehensive group health insurance policy to small, medium, and large organizations. In addition, they also offer a wide range of employee health benefits consisting of group personal accident insurance, doctor consultations, health checkups, and more.
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Key Statistics of ICICI Lombard General Insurance Company
GHI Premiums
â‚ą1,903 crores
FY 2021
GHI lives insured
1.08 crores
FY 2020
Health lives insured
1.64 crores 
FY 2020
Health claims Processed
4,33,498
FY 2020
Health claims Settlement Ratio
78.67%
FY 2020
Health claims Settled within 3 months
78.67%
FY 2020
*Source - IRDAI and IBAI annual reports  **GMC - Group Medical Cover
***Claims Settlement Ratio (CSR) is the percentage of claims settled by the insurance company against the no. of claims obtained in a financial year. A high claim settlement ratio indicates the good financial health of the insurance group.
GHI Premiums
â‚ą1,009 crores
FY 2021
GHI lives insured
53 lakhs
FY 2020
Health lives insured
1.72 crores
FY 2020
Claims Processed
1,67,673
FY 2020
Claims Settlement Ratio
86.52%
FY 2020
Claims Settled within 3 months
86.42%
FY 2020
Awards and Recognitions
Gold Shield
ICAI Award FY 2019
20 Best Insurers in the Asia Pacific Region for 2020
India’s Leading General Insurance Company
Dun & Bradstreet BFSI Summit & Awards 2020
Insurance Company of the Year
India Insurance Summit & Awards 2020
Sales Champion Award - Large Category
Economic Times Summit & Awards
Gold
LACP Vision Awards
Most Innovative Insurance Offerings
FICCI Awards
Best General Insurance Provider of the Year
Money Today Financial Awards
Excellence in Financial Reporting
ICAI Awards 2015-16
Top Projects in India
SKOCH Order-of-Merit
Best Customer Experience Award of the Year
Financial Sector
iAAA rating
ICRA
iAAA rating
ICRA
Best Insurance Company in Private Sector
General 2014
Gold Shield
ICAI Awards 2012-13
HR Excellence
Technology award 2012

What is Group Health Insurance?

Group Health Insurance(GHI) is a type of insurance scheme that covers employees and workers of a company. As an employer, it is your responsibility to implement a group coverage policy within the organization. With a group medical plan, employees and their family members can avail superior health care benefits and medical treatment, including accidental and emergency-related incidents. ICICI Lombard has excellent group insurance offerings for companies of all sizes.
Highlights  of HDFC ERGO Group Health Insurance
Dedicated health assistance services
Complete cover for your employees and their families
Extensive network of 6536 hospitals and 273 branches across India
Unlimited general physician consultations 
840 virtual offices
Customised plans for small, medium enterprises and large organisations

Standard Benefits Offered by ICICI Lombard Group Health Insurance

Here is a comprehensive summary of the ICICI Lombard Group Health Insurance Plan:
Feature
Type of cover
Eligibility criteria (Age)
90 days - 80 years
Option to provide cover to the baby from Day 1
Who/What is included?
Employee as well as their spouse, children, and parents
Inpatient hospitalization and accidental emergency
Illness/injury during the policy period
Waiting period
Waived off
Sum insured.
From Rs. 50,000 up to  to Rs. 10 lakhs
Pre and post hospitalization expenses
60 days and 90 days, respectively
Room Rent and ICU
Ability to have uncapped  room rent and ICU expenses
Eye treatment
Lasik surgery is covered if the correction index is +/- 6.5 DCataract surgery is covered
Pre-existing diseases (PEDs)
Option to cover all pre-existing diseases expenses from Day 1
Attendant cover
Yes, covered up to Rs 5,000 per family within Sum Insured if the length of stay for the patient is more than five days on a reimbursement basis.  This covers costs pertaining to boarding and lodging of the attendant in a hospital/location.
Day care treatment
Day care treatments are covered
Mental health
Yes, hospitalisation due to psychiatric conditions for upto Rs. 30,000
General list of exclusions
Infertility and sterility
Septoplasty
Admin and miscellaneous related charges
Holter monitoring
Prosthesis
Experimental treatment
Additional Benefits Offered by ICICI Lombard Group Health Insurance
Ambulance cover
Covered  of up to INR 5,000 per hospitalization
Air Ambulance - Covered up to Rs. 1,00,000 or family sum insured, whichever is less
Home healthcare
Covered only on a cashless basis, the service is presently available in nine cities across India (Bangalore, Chandigarh, Chennai, Delhi (NCR), Hyderabad, Jaipur, Kolkata, Mumbai, and Pune)
Health assistance services
Available on-call for queries regarding:
1. Specialist
2. Hospital
3. Fixing an appointment with Doctors/Nutritionist
4. Facilitating 2nd opinion and more
Specific condition
Terrorism
Lucentis up to Rs. 50,000 per family within SI
Internal congenital diseases, only if it is life-threatening
AYUSH benefit
Covered only in a recognized government hospital along with a valid medical practioner’s prescription
Add-on Benefits Offered by ICICI Lombard Group Health Insurance
General
Outpatient department (OPD Cover - Reimbursement)
Health check-ups
Maternity
Option to have maternity benefit for C-section and Normal Delivery (up to Rs. 75,000) for up to two babies
Pre-and-post natal expenses of up to INR 5,000 covered within the Maternity limit
Newborn baby cover
Please note that Plum has collated and presented this data for informational purposes only and at a particular point in time. Plum does not endorse, rate, or recommend any particular insurer or insurance product offered by an insurer. The final terms, conditions, and premiums may vary depending upon factors including group size, age, location, and applicable taxes.

Here's how ICICI Lombard is better with Plum

Complete digital experience
From cashless claims to digital health IDs, and much more, go digital with Plum.
Cover for businesses of all sizes
Get the best online group health insurance for teams and companies of all sizes.
Scales as you expand your team
Add or remove employees and medical benefits as you scale.
Doctor on call
Get teleconsultations from our expert doctors along with advice on medical and general health.
Plum Wellness
Get access to corporate wellness programmes for your employees.
Insurance on WhatsApp
Start a claim, download your eHealth card, check policy details, and much more on WhatsApp.
Single dashboard
Be it employer or employee, desktop or mobile, check your insurance plan & health benefits dashboard anywhere.
Track your claims
Know how your team is utilizing their employee benefits and medical coverage.
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How Does Plum Work?

Open
app.plumhq.com
to access your insurance
Select
Open WhatsApp
and continue to chat
Click on use
my insurance button
on the dashboard
Open
app.plumhq.com
to access your insurance
Click on use
my insurance button
on the dashboard
Select
Open WhatsApp
and continue to chat

Documents Required for Claims Process

This can be understood better by the type of claims process you have opted for - Cashless or Reimbursement.
Duly filled and signed claim application form (with employee code)
Original hospital bills with a break-up of expenses
Discharge summary and payment receipts
Invoice and sticker for implants
Medical practitioner’s prescription
Pre and post hospitalization bills for medicine and consultation
FIR or legal, medical certificate in case of death or accident-related cases
Bank details of the employee - NEFT and cancelled cheque
In case of an emergency, get yourself admitted to the nearest network hospital
Your health card - you need to show this at the TPA desk in the hospital
Confirm your treatment plan with the doctor/hospital
Discharge certificate and medical bills/invoice
Claims application form
Duly filled and signed claim application form (with employee code)
Original hospital bills with a break-up of expenses
Discharge summary and payment receipts
Invoice and sticker for implants
Medical practitioner’s prescription
Pre and post hospitalization bills for medicine and consultation
FIR or legal, medical certificate in case of death or accident-related cases
Bank details of the employee - NEFT and cancelled cheque
In case of an emergency, get yourself admitted to the nearest network hospital
Your health card - you need to show this at the TPA desk in the hospital
Confirm your treatment plan with the doctor/hospital
Discharge certificate and medical bills/invoice
Claims application form

Here’s why you will love Plum

With Plum, get complete access to your insurance plan on WhatsApp
Check your healthcare benefits
Intimate your claim
Read what’s covered and not covered
Select other health benefits
Download your Digital health ID Card
See daycare treatment list

Frequently asked 
questions

What are the benefits of buying a group health insurance plan?

A group health insurance policy for employees comes with multiple features and benefits. Here are a few:
No more waiting period; get your family and self-covered from day 1, includes covid-19 cover, provides day 1 coverage for pre-existing disease and condition, no restrictions on  room rent limit, cashless and reimbursement options are available, no need for a health checkup, maternity benefits and newborn baby cover is included

Can I get cover for Covid-19 in group health insurance?

Yes, hospitalization and medical treatment for Covid-19 is covered under ICICI Lombard Group Health Insurance.

Are congenital diseases covered in group health insurance?

Internal congenital diseases are covered under this scheme, while external abnormalities are only covered if the case becomes life-threatening in the near future.

Can I avail treatment for Ayush?

Yes, ICICI Lombard GHI provides cover for treatment arising out of AYUSH but only in a government-recognized hospital on an inpatient basis.

Do I have to go for a medical test?

A non-network hospital is a health institution that is not included in the insurers' list of network hospitals for cashless treatment. You can only avail of reimbursement facilities in such hospitals.

When does a claim get rejected?

There are multiple reasons for a claim to be denied by the insurer. Here are a few:
1. Treatment for substance abuse
2. Treatment is out of the scope of cover
3. Non-disclosed pre-existing disease
4. Intentional harm or self-inflicted wounds
5. Sum insured amount is exhausted

How many claims can I make in a year?

There is no such limitation on the number of claims made in a year, provided you have a sufficient amount of sum insured remaining from the total cover.

Can I avail expenses for treatment taken outside India?

No, ICICI Lombard GMC (group medical cover) does not cover medical treatment globally.