ICICI Lombard – MaxProtect

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The ICICI Lombard MaxProtect Plan is a health insurance product from ICICI Lombard General Insurance Company Limited. It is an innovative health insurance plan created to give you and your family essential medical care without the worry of high costs. The ICICI Lombard MaxProtect Plan comes with a variety of features, benefits, and add-ons, offering increased coverage options. This ensures that during medical emergencies, you will not face financial strain and allows you to concentrate on your recovery. The plan has two versions – Classic and Premium, each tailored to meet the varied needs of individuals.

What is The Eligibility Criteria?

Minimum Age:
- For adults - 21 years old
- For dependent children - 91 days old
Maximum Age:
- For adults - Up to 65 years old
- For dependent children - Up to 20 years old

Delving Into The Benefits And Limits of The ICICI Lombard MaxProtect Plan

In addition to covering expenses for hospital stays lasting more than 24 hours, which include room, board, nursing charges, medical practitioner fees, prescribed medications, drugs, ICU charges, and related costs, here are some of the other expenses covered under the ICICI Lombard MaxProtect Plan.

Pre & Post Hospitalisation Expenses
Do not stress if the doctor needs to do lots of tests before or after you stay in the hospital as the insurer will take care of such expenses. The plan covers expenses up to the sum insured for a good amount of time - 60 days before you’re admitted to the hospital and 180 days after you leave. Just remember, these expenses are covered by the insurer only if they are related to the medical condition you are hospitalised for, and your claim must be approved as part of inpatient hospitalisation coverage.
Daycare Treatment Coverage
They are medical procedures or surgeries that used to require a long hospital stay but can now be done within a span of 24 hours due to medical advancements. The ICICI Lombard MaxProtect Plan covers all daycare procedures without any limits, under both variants. This means that your expenses will be covered up to the sum insured.
Domiciliary Treatment Coverage
Domiciliary treatments are those medical treatments needed urgently in a hospital but given at home because the patient is too sick or injured to go to a hospital, or because there are no hospital beds nearby. The ICICI Lombard MaxProtect Plan covers domiciliary treatment costs (except for a few listed diseases) up to the sum insured, under both the plan variants.
Organ Donor Coverage
Under both its variants of the ICICI Lombard MaxProtect Plan, the expenses of the organ donor when you are the recipient are covered. It pays for the inpatient costs of the organ donor in case of an organ transplantation, up to the total sum insured you choose for the policy.
Modern Treatment Coverage
Healthcare is advancing fast with new technologies, bringing in treatments that were once thought impossible. The ICICI Lombard MaxProtect Plan keeps up with these changes and covers costs for modern treatments like stem cell therapy, oral chemotherapy, robotic surgeries, etc., with a maximum limit of up to Rs. 1 Crore - under both plan variants.
Non-Medical Expenses
In addition to covering medical costs, the ICICI Lombard MaxProtect Plan also includes coverage for non-medical expenses if you choose the ‘Premium’ variant. Non-medical expenses include the cost of consumables like gloves, nebulization kits, oxygen masks, and other items needed for treatment. These items can be costly and also add up quickly. The ICICI Lombard MaxProtect (Premium) Plan’s Premium variant offers coverage for these expenses up to the total sum insured, easing the financial burden of such costs for you.
Cumulative Bonus
The plan gives you a cumulative bonus of 20% of the sum insured, subject to a maximum of 100% of the expiring or renewed cover amount, whichever is lower. This bonus is to reward you for staying healthy and not making any claims during a policy year. Even if you make a claim, the accumulated bonus will not decrease. This means the bonus you earned before making a claim will stay the same. However, this benefit is not available for those who chose an unlimited sum insured.
Reset Benefit (Restoration Benefit)
The reset benefit is a feature that replenishes your sum insured when it is used up in a policy year. This benefit is triggered when you fully or partially use your annual sum insured, including any cumulative bonus (if any). The reset benefit is applicable for subsequent claims and can be utilised for unrelated illnesses within the same policy year as many times as needed. Additionally, it covers related illnesses and complications, but only after 45 days from discharge.
Room Rent Limit
This is the maximum amount the insurer will pay for the room you stay in during hospitalisation. If the room you choose fits within this limit, you will not have to pay anything extra. But if you go for a room that costs more than what your plan allows, a proportionate deduction will be applied. This means you'll be responsible for a proportionate share of the total bill, not just the extra room cost. With ICICI Lombard MaxProtect Plan, you can choose any room except the suite - under both the variants.

Additional Features Of The ICICI Lombard MaxProtect Plan

Cashless Facility At Any Hospital
One standout feature of the ICICI Lombard MaxProtect Plan is its cashless service available at any hospital. This means you can choose any medical facility in India that suits your preferences or healthcare needs. The claim settlement is hassle-free – whether it's a nearby hospital, a specialised centre known for expertise, or one recommended by your doctor. The insurer directly takes care of all covered medical expenses with the healthcare provider. No need to pay upfront or wait for claim refunds. Just keep in mind that this facility is subject to confirmation from the respective hospital.
Bariatric Surgery
The ICICI Lombard MaxProtect Plan covers expenses for bariatric surgery, a procedure to help you lose weight, if it is recommended by your doctor. It covers associated costs up to the sum insured and can be used as many times as needed in a policy year, as long as the sum insured isn't used up. To qualify, you must be at least 18 years old and have completed the applicable waiting period. You should also keep in mind that there may be other conditions related to this coverage.
Value-Added Services
The ICICI Lombard MaxProtect Plan includes coverage for various appealing extra services. You can access health assistance, book emergency ambulances, and enjoy discounts on various medical expenses like investigations, diagnostic tests, lab tests, health supplements, medical equipment, AYUSH products, and more. To benefit from these assistance services, make sure to follow the terms and conditions mentioned in the policy document.
Teleconsultation
In today's digital age, many industries have shifted towards online services, and the medical field is no exception. Teleconsultation is one such outcome. Recognizing the increasing need for remote healthcare, the ICICI Lombard MaxProtect Plan now includes coverage for medical consultations regarding your routine health concerns. You can consult with generalists or specialists through audio, video, online portal, chat, or mobile app, all from the comfort of your home. This service is available day and night throughout the year, and you can access it as many times as needed without any extra charge. All you have to do is book an appointment through the insurer's app to speak or video call a doctor.

Understanding Waiting Periods!

When you invest in a health insurance policy, there is a specific time during which certain illnesses and diseases are not covered, and this time frame is called the waiting period. After this waiting period is over, you can claim for these conditions. There are different types of waiting periods, including –

Initial Waiting Period
For all medical conditions, there is an initial waiting period of 30 days after you get the policy. During this time, you cannot claim for hospitalisation unless it is due to an accident.
Waiting Period For Pre-Existing Diseases
Any medical condition you have in the 48 months before getting the health insurance policy is called a pre-existing disease. With the ICICI Lombard MaxProtect Plan, you will have to serve a 48-month waiting period for pre-existing diseases. But, you have the choice to shorten this duration to 24 months by paying an extra premium. During this waiting period, the policy will not cover any expenses related to your pre-existing diseases.
Waiting Period For Specific Diseases
Insurers have a list of medical conditions or illnesses, different from your pre-existing ones, and these conditions also come with a waiting period. It does not matter if you had these diseases before or not; the waiting period is set by the insurer, and is not based on your current health conditions. The ICICI Lombard MaxProtect Plan has a 24-month waiting period for specific diseases.

Exclusions

In your health insurance policy, there are certain situations that will not be covered, and these are called exclusions. Some types of exclusions include -

Standard Permanent Exclusions: The standard permanent exclusions are set by IRDAI that all insurers must adhere to, and they include –
- Investigation And Evaluation: Hospital admission only 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 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 Adventure Sports: Treatment expenses incurred for treatments for professional adventure activities like skydiving, horse racing, mountaineering, etc.
- Breach Of Law: Expenses related to treating a person attempting criminal activities.
- Excluded Providers: Treatment 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 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: Contraception, sterilisation, artificial insemination, advanced reproductive technologies (IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.).
- Maternity Expenses: Childbirth-related hospitalisation expenses, pre/post-natal costs, etc.
Additional Permanent Exclusions: Apart from the standard exclusions mentioned earlier, the insurer might add additional exclusions for specific medical conditions or situations. If you have certain diseases or severe medical conditions that the insurer thinks are too risky to provide cover for, they may permanently exclude them from your policy. However, it's essential to know that insurers can only permanently exclude those illnesses that are listed by the IRDAI.
Non-standard Exclusions (Specific Exclusions): These exclusions are specific and go beyond the standard ones listed by the IRDAI. They might differ among insurance companies and depend on your policy's terms and conditions. Here are some notable specific exclusions under the ICICI Lombard MaxProtect Plan –
- Dental treatment expenses, unless it is necessitated by an accident requiring 24 hours of hospitalisation.
- Therapies such as acupressure, acupuncture, magnetic therapy, etc.
- Circumcision, unless it is necessary for treating an illness or is required due to an accident.
- Treatment for external congenital illnesses, defects, or anomalies.
- Intentional self-injury, whether it is an attempt to suicide or otherwise.
- Expenses related to domiciliary hospitalisation.
- Costs associated with donor screening, treatment, and surgery for organ removal in transplant surgeries.
- Injuries or illnesses caused by war, invasion, acts of foreign enemies, hostilities (whether or not war is declared), civil war, commotion, unrest, rebellion, revolution, military or usurped power, confiscation, nationalisation, requisition, or damage by any government or public local authority.
- Illnesses or injuries caused or contributed to by ionising radiation, nuclear weapons/materials, or contamination by radioactivity from nuclear fuel, nuclear waste, or combustion of nuclear fuel.

Summary

Product Benefits	Coverage Limits
Pre-Hospitalisation Expenses	Coverage up to the sum insured for 60 days before hospitalisation.
Post-Hospitalisation Expenses	Coverage up to the sum insured for 180 days after discharge.
Daycare Treatment Coverage	All daycare procedures are covered up to the sum insured.
Domiciliary Treatment Coverage	Coverage up to the sum insured (except for specified diseases).
Organ Donor Coverage	Coverage for inpatient expenses of the organ donor, up to the chosen sum insured.
Modern Treatment Coverage	Coverage up to a maximum of Rs. 1 crore.
Non-Medical Expenses	Coverage up to the sum insured under the Premium variant.
Cumulative Bonus	Cumulative bonus of 20% of sum insured up to a maximum bonus of 100% of expiring or renewed insured amount, whichever is lower. Benefit not applicable for unlimited sum insured option.
Reset Benefit (Restoration Benefit)	Available when the annual sum insured is fully or partially used, including any cumulative bonus. Applicable for unrelated illnesses and can be used multiple times within the same policy year for subsequent claims. Covers related illnesses and complications, but only after 45 days from discharge.
Room Rent Limit	Applicable for any room except suite.
Pre-existing Diseases	Covered after a 48-month waiting period (can be reduced to 24 months with an additional premium)
Specific Diseases	Covered after a 24-month waiting period.

Links To Access The Brochure And Policy Wording Documents

FAQs

Does MaxProtect have room rent restrictions?
Yes, with the ICICI Lombard MaxProtect Plan, you are free to choose any hospital room except suite.
Does the ICICI Lombard MaxProtect Plan cover AYUSH treatments?
Yes, the ICICI Lombard MaxProtect Plan covers inpatient AYUSH treatments, which include Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy up to the sum insured.
Under the ICICI Lombard MaxProtect Plan, what are the sum insured options available?
With the ICICI Lombard MaxProtect Plan, you have various sum insured options to choose from, including Rs. 1 Crore, Rs. 2 Crores, Rs. 3 Crores, Rs. 5 Crores, Rs. 10 Crores, and even an unlimited sum insured option.
Are consumables covered under the ICICI Lombard MaxProtect Plan?
Whether consumables like gloves, masks, nebulization kits, etc., are covered or not, depends on the variant you select. If you opt for the 'Premium' variant of the ICICI Lombard MaxProtect Plan, you can enjoy coverage for these non-medical expenses up to the sum insured.
Does the ICICI Lombard MaxProtect Plan cover domiciliary treatments?
Yes, the ICICI Lombard MaxProtect Plan does cover domiciliary treatments, which are treatments taken at home for specific conditions, up to the sum insured.