ICICI Lombard Golden Shield

Let’s Get To Know More About The Plan!

The ICICI Lombard Golden Shield plan is a specialised health insurance policy for senior citizens offered by ICICI Lombard General Insurance Company Limited. It's intricately designed to address the unique healthcare needs of senior citizens, considering the challenges that come with ageing. Packed with various features and benefits, this plan ensures that you or your ageing parents can access essential medical care without the worry of unexpected financial burdens. Opting for this policy provides a comforting sense of security, knowing that healthcare expenses are covered, allowing you to focus on well-being rather than financial stress.
 

What is The Eligibility Criteria?

• Minimum Age Of Entry: 56 years
• Maximum Age Of Entry: No upper age limit
   

Delving Into The Benefits And Limits Of The ICICI Lombard Golden Shield

In addition to taking care of inpatient hospitalisation costs - like room and boarding charges, medical practitioner fees, prescribed medications, ICU expenses, and related charges - the ICICI Lombard Golden Shield plan extends its coverage to various other expenses. Here's a quick overview of some of the additional costs the plan caters to -

• Pre- & Post-Hospitalisation Expenses
  You can rest easy knowing that the ICICI Lombard Golden Shield plan has you covered even if your doctor orders a bunch of diagnostic tests before or after your hospital stay. The policy offers coverage for these tests for a reasonable duration - 60 days before hospitalisation and 180 days after discharge - up to the sum insured. It's important to note that these expenses will be covered only if they are directly linked to the medical condition for which you were hospitalised, and approval for these claims is part of the overall coverage for inpatient hospitalisation.
   
• Daycare Treatment Coverage
  The ICICI Lombard Golden Shield plan has your back when it comes to daycare treatments. These are medical procedures or surgeries that used to require a longer hospital stay but can now be completed in just 24 hours, thanks to advancements in medical technology. The good news is that all daycare procedures are covered by the plan, and there's no limit on these treatments. That means your expenses will be covered up to the sum insured without any restrictions.
   
• Domiciliary Treatment Coverage
  Domiciliary treatments are urgent medical interventions usually meant for hospital settings but administered at home due to the patient's severe illness or health condition, making hospital transportation unsafe, or due to a lack of nearby hospital beds. With the ICICI Lombard Golden Shield plan, you can rest assured knowing that it covers domiciliary treatment expenses, with a few listed illnesses or health conditions being exceptions. The coverage extends up to the sum insured, providing financial support during such critical situations.
   
• Organ Donor Coverage
  The ICICI Lombard Golden Shield plan goes the extra mile by covering expenses related to organ donation when you are the recipient. The policy takes care of the inpatient costs of the organ donor associated with organ transplantation, providing coverage up to the sum insured you choose under the policy, with a maximum limit of Rs. 10 lakhs.
   
• Modern Treatment Coverage
  The landscape of healthcare is evolving rapidly, propelled by technological breakthroughs that introduce treatments once deemed impossible. The ICICI Lombard Golden Shield plan is meticulously crafted to embrace these advancements, providing coverage for the costs associated with these cutting-edge treatments. It's essential to note that the policy comes with specific sub-limits for various covered treatments, details of which are outlined in the policy document. This ensures that you stay well-informed about the extent of coverage for the latest and most advanced medical interventions.
   
• Claim Protector (Non-Medical Expenses)
  The ICICI Lombard Golden Shield plan goes beyond merely covering medical expenses; it extends coverage for non-medical expenses through an add-on feature. Non-medical expenses include the costs of essential consumables like gloves, nebulization kits, oxygen masks, etc., necessary for treatment. These items can be quite expensive and can accumulate rapidly. The plan steps in to provide coverage for these non-medical expenses up to the sum insured, offering financial relief and easing the burden of these costs.
   
• Cumulative Bonus (No Claim Bonus)
  The plan also includes a rewarding feature - a 10% bonus on the sum insured for each claim-free year. It's a gesture to acknowledge your dedication to maintaining good health and not raising any claims during a policy year. The bonus accumulates over time, reaching a maximum of 100% of the sum insured. What makes it even more enticing is that if you happen to make a claim in the following policy year, your accumulated bonus remains unaffected. Essentially, the bonus you've earned remains intact, providing an additional layer of assurance to your health coverage.
   
• Reset Benefit (Restoration Benefit)
  The reset benefit is a valuable feature that automatically replenishes your sum insured when it's been exhausted within a policy year. This benefit kicks in when you've utilised both the base sum insured and any accumulated bonus, either partially or completely. It remains available for any subsequent claims made within the same policy year. The reset benefit can be availed for unrelated illnesses an unlimited number of times throughout the policy year. Moreover, this benefit extends its coverage to related illnesses, including complications, post 45 days of discharge from the initial claim, once per policy year.
   
• Room Rent Limit
  It is the maximum amount your insurer will pay for the hospital room during your stay. If you pick a room within your plan's specified limit, you won't have any additional expenses to worry about. However, going for a room with a higher rent than your coverage allows will result in a proportional deduction. This means you'll be responsible for paying a share of the total bill, rather than just the difference in room rent. With ICICI Lombard Golden Shield, there are certain limitations on the type of room you can choose during your hospital stay. Depending on the sum insured you choose, you can go for either a twin-sharing room or a single private AC room.

Additional Features Of The ICICI Lombard Golden Shield Plan

• Preventive Health Check-up
  Ensuring a healthy and fulfilling life involves taking proactive steps to maintain well-being and catch potential health concerns before they become major issues. Preventive health check-ups are a key part of this strategy, aiming to identify and address possible health issues early, sometimes even before symptoms show up. With this plan, you get access to preventive care through predefined packages at specific network hospitals approved by the insurer. You can take advantage of this benefit once a year. Making it convenient, you can easily use the insurer's app or redeem coupons provided in the policy kit. Keep in mind that there are terms and conditions associated with this benefit.
   
• Care Management Program
  The Care Management Program is designed to offer support and assistance as you navigate the challenges that may arise in your golden years, ensuring you're well-prepared for the future. Through user-friendly apps, you can easily access a range of benefits and healthcare services provided by the program. Here are some of the services and benefits provided under this program -
• •  
  • Tele consultations.
  • Second e-opinion for critical illness.
  • Diet and nutrition e-consultation.
  • Ambulance assistance.
  • Access to health assistance team which provides guidance and helps you with various services, etc.

Beyond healthcare services, the program adds an extra incentive by allowing you to earn wellness points. Engaging in activities such as yoga, meditation, walking, etc., can accumulate these points, which can later be redeemed for discounts on specific services or products. It's not just about managing health challenges; it's also about encouraging and rewarding a healthy and active lifestyle.

• Home Care Treatment
  Home care treatment is a unique healthcare approach where injuries or illnesses are addressed in the comfort of your own home, instead of in a hospital setting. This innovative method brings medical services and support directly to patients' homes, providing a more personalised and convenient approach to healthcare. This type of coverage can be particularly advantageous for elderly individuals who may find it challenging to travel to hospitals and prefer the comfort of their homes for necessary treatments.
  
  Under this plan, the costs of home-based treatment are typically covered up to 5% of the sum insured on a cashless basis. This not only offers financial relief but also ensures that individuals can receive necessary care in a familiar and comfortable environment. It's important to note that the coverage is subject to terms and conditions.

Understanding Waiting Periods

When you buy a health insurance policy, there's a waiting period – a specific time frame during which coverage for certain illnesses and diseases doesn't apply. Once this waiting period concludes, you're eligible to claim these conditions. Various types of waiting periods exist, each serving specific purposes –

• Initial Waiting Period
  After securing your health insurance policy, there's an initial waiting period of 30 days for all medical conditions. During this period, you won't be able to claim hospitalisation unless it's a result of an accident.
   
• Waiting Period For Pre-Existing Diseases
  If you've had any medical condition in the 48 months leading up to your health insurance policy, it is considered a pre-existing disease. Under the ICICI Lombard Golden Shield plan, there's a 24-month waiting period for these pre-existing conditions. This means that during this time frame, the policy won't cover any expenses related to these pre-existing diseases.
   
• Waiting Period For Specific Diseases
  Insurers maintain a list of medical conditions or illnesses, separate from your pre-existing ones, and these conditions are associated with their own waiting period. This waiting period is determined by the insurer and isn't influenced by your current health state. Under the ICICI Lombard Golden Shield plan, there's a 24-month waiting period for specific diseases, regardless of whether you've had them before or not.
  
  Important Note: If you have health conditions such as diabetes, hypertension, or cardiac-related issues, there's a shorter waiting period of just 90 days unless it's considered a pre-existing disease (PED), and you've disclosed it during the application process.
   

What Is Not Covered?

Your health insurance policy outlines situations that it doesn't cover, and these are termed exclusions. Some types of exclusions include -

• Standard Permanent Exclusions: IRDAI has established standard permanent exclusions that all insurers must follow. They include –
  • Investigation And Evaluation: Hospital admission solely for observation or monitoring.
  • Rest Cure, Rehabilitation, And Respite Care: Admission at a hospital premises for bed rest where no active treatment is given.
  • Obesity/Weight Control: Surgery or medical treatment for weight control or obesity.
  • Change Of Gender Treatment: Treatments for altering body characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Treatments or surgeries for modifying body characteristics or appearance.
  • Profession In Hazardous Or Adventurous Sports: Treatment expenses for injury/illness resulting from engaging in professional adventure activities like skydiving, horse racing, mountaineering, etc.
  • Breach Of Law: Expenses linked to treating a person attempting a criminal act.
  • Excluded Providers: Treatment taken from a practitioner or hospital excluded by the insurer.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
  • Treatments In Establishments For Domestic Purposes: Expenses for treatment taken in health spas, nursing homes, or similar establishments arranged for domestic reasons.
  • Dietary Supplements, Substances Without Prescription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Costs for correcting refractive errors up to 7.5 diopters for improved eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven to be effective.
  • Expenses Related To Birth Control, Sterility, Infertility: Sterilisation, contraception artificial insemination, advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Childbirth-related hospitalisation expenses, pre/post-natal costs, etc.
• Additional Permanent Exclusions: In addition to the above-mentioned standard exclusions, your insurer may impose additional exclusions for specific medical conditions or situations. If you have certain diseases or severe medical conditions considered too risky for coverage, the insurer might permanently exclude them from your policy. It's crucial to note that insurers can only permanently exclude illnesses listed by the IRDAI.
• Non-standard Exclusions (Specific Exclusions): These exclusions are more specific and extend beyond the standard ones outlined by the IRDAI. They can vary among insurance companies and are contingent on the terms and conditions of your policy. Here are some noteworthy specific exclusions under the ICICI Lombard Golden Shield plan –
  • Alternative therapies like acupressure, acupuncture, magnetic therapy, and others.
  • Circumcision unless deemed necessary for the treatment of an illness or due to an accident.
  • Expenses related to venereal diseases or sexually transmitted diseases, except for HIV/AIDS.
  • Intentional self-injury, whether as a result of a suicide attempt or otherwise.
  • Treatment for conditions requiring hormone replacement therapy.
  • Any injury or illness resulting from war, invasion, acts of foreign enemies, hostilities (whether war is declared or not), civil war, commotion, unrest, rebellion, revolution, military or usurped power, confiscation, nationalisation, requisition, or damage caused under the order of any government or public local authority.
  • Artificial life maintenance for an insured person declared brain dead or in a vegetative state as indicated by -
    • Deep coma and unresponsiveness to all forms of stimulation; or
    • Absent pupillary light reaction; or
    • Absent oculo-vestibular and corneal reflexes; or
    • Complete apnea.
  • Expenses related to multifocal lenses and ambulatory devices such as walkers, crutches, splints, stockings of any type and also any medical equipment used at home.
  • Any expenses related to prosthesis, corrective devices, external durable medical equipment of any type, instruments utilised in the treatment of sleep apnoea syndrome or cost of cochlear implant(s) unless required due to an accident or needed intra-operatively.
     

Summary

Links To Access The Brochure And Policy Wording Documents

• Brochure: https://www.icicilombard.com/docs/default-source/default-document-library/golden-shield-brochure.pdf
   
• Policy Wording: https://www.icicilombard.com/docs/default-source/default-document-library/updated-golden-shield_-pw-011223.pdf

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