ICICI Lombard Health AdvantEdge Plan

Let's Get To The Bottom Of It!

Health AdvantEdge is a health insurance product offered by ICICI Lombard General Insurance Company. With Health AdvantEdge, you can feel secure knowing that you and your loved ones can access quality medical care without worrying about the potential cost. It's a worthwhile choice for those looking for a smart, comprehensive solution to their healthcare worries.

Who's Eligible?

Minimum Entry Age

Adults: 18 years
Children: 91 days. Any child between 91 days and 5 years old can get family floater coverage as long as either parent is insured.

Maximum Entry Age

Adults: 65 years.
Dependent Children: 25 years.

What's In It For You?

It covers inpatient hospitalisation expenses, which include costs incurred during a stay in a hospital longer than 24 hours, such as room boarding, nursing, medical practitioner fees, prescription drug costs, ICU costs, etc.

Here's a quick peek at the other expenses covered by the ICICI Lombard Health AdvantEdge Plan -

Pre & Post Hospitalisation Expenses: Your doctor may run a bunch of diagnostic tests or schedule checkups before or after hospitalisation. But worry not! Health AdvantEdge covers it all up to the sum insured. Pre-hospitalisation expenses are covered up to 60 days before you are hospitalised and post-hospitalisation expenses up to 180 days after discharge. Wait, there's one caveat - you'll only get coverage for these expenses if they're related to the medical condition you're hospitalised for and your claim is approved as part of inpatient hospitalisation coverage.
Daycare Treatment Coverage: Medical advancements have made it possible to perform some medical procedures and surgeries within 24 hours, that once required a prolonged hospital stay. These are called daycare treatments. So, what used to be a slow and arduous journey can now be completed quickly and comfortably. Health AdvantEdge plan keeps up with technological advances and covers such daycare treatments up to the sum insured.
Domiciliary Treatment Coverage: An injury or illness that requires immediate medical attention in a hospital but is treated at home when the patient can't be moved safely to a hospital due to its seriousness or because there are no hospital beds available. This is called domiciliary hospitalisation. The ICICI Lombard Health AdvantEdge Plan will cover such domiciliary treatment costs up to the sum insured.
Organ Donor Coverage: The ICICI Lombard Health AdvantEdge Plan also covers organ donor expenses. It provides coverage for the costs associated with harvesting the organ from the donor for transplantation (when the insured person is the recipient) up to the sum insured.
Modern Treatment Coverage: Technological changes and progress in the field of medicine are transforming healthcare rapidly, leading to some incredible modern treatments that were once believed impossible. Such treatments are now widely available, allowing more people to access the healthcare they need and truly deserve. With the ICICI Lombard Health AdvantEdge Plan, you're covered for modern treatments up to the sum insured.
Non-Medical Expenses: The ICICI Lombard Health AdvantEdge Plan covers non-medical expenses up to the sum insured - if you opt for the add-on. Consumables like gloves, nebulization kits, oxygen masks, and other things are non-medical expenses. This coverage gives you a sense of comfort knowing that you have the necessary protection against the costs of consumables, which tend to add up quickly.
Guaranteed Cumulative Bonus (No Claim Bonus): This plan offers a guaranteed bonus equal to 20% of the sum insured up to a maximum of 100% of the sum insured. Any claim you make will not reduce your accumulated bonus. This means that the bonus earned irrespective of the claim will remain intact, so you can take advantage of this benefit without the fear of losing it.
Restoration Benefit: This feature restores your sum insured once it has been exhausted within the policy year. Under this plan, your base sum insured is restored instantly after the first claim, so you don't have to worry about running out of coverage. The Restoration Benefit kicks in after you use up your base sum insured and cumulative bonus (if applicable) and is available for subsequent claims during the policy year. You can use the restore benefit once every policy year for a lifetime, as long as you keep renewing the policy.
Room Rent Limit: This is the maximum amount your insurance will cover for your hospital room. If you pick a room that fits within your plan's room rent limit, you won't be surprised by out-of-pocket costs. However, if you opt for a room with a higher rent than what you qualify for, you will be subject to a proportionate deduction. In this case, you will be responsible for a proportionate share of the entire bill, not just the difference in room rent.

But, worry not! You can choose any room you like with ICICI Lombard Health AdvantEdge be it shared, single room, deluxe, or any room that’s available. You can enjoy maximum flexibility and convenience in selecting any room as the insurer does not impose any restrictions.

Key Highlights Of The Product

Long Hospital Stays? Health AdvantEdge Has Got Your Back!
Health AdvantEdge also offers a convalescence benefit, giving you peace of mind in case of an extended hospital stay. In case you are hospitalised continuously for 10 days or more for treatment of any accident/disease/illness/injury, you will receive a fixed allowance of Rs 20,000. You can use this benefit once every year.
Get Coverage Anywhere Anytime
The plan doesn’t impose any geographical limits for a sum insured of Rs 25 Lakhs and above. So, you can be assured of worry-free protection wherever you are! Hospitalisation expenses incurred outside India and anywhere in the world will be covered up to the sum insured - subject to policy terms and conditions.
Weight Loss Surgery Covered
The Health AdvantEdge Plan covers bariatric surgery expenses. To qualify for this coverage, you must be at least 18 years of age and have served the waiting period. Other coverage-related conditions may also apply.

Waiting Period - What's That?

You may not be able to claim for some illnesses and diseases right after you purchase a health insurance policy. You will have to wait a certain period of time before the coverage kicks in. This timeframe is known as the waiting period. You can claim for these conditions after serving the waiting period associated with your health insurance plan.

Here are some of the types of waiting periods -

Initial Waiting Period: All medical conditions except accidents entail a 30-day waiting period. In other words, unless there's an accident, you can't claim medical expenses during these 30 days.
Waiting Period For Pre-Existing Diseases: A pre-existing disease is any medical condition or illness that you have had in the 48 months before the issuance of the health insurance policy. ICICI Lombard Health AdvantEdge Plan has a 24-month waiting period for pre-existing diseases. The policy won't cover any pre-existing disease-related expenses you incur during this period.
Waiting Period For Specific Diseases: Insurers specify a list of illnesses or conditions other than PEDs that need you to serve a waiting period for regardless of whether you've had them before. This waiting period is determined by the insurer and isn't based on your health status. ICICI Lombard Health AdvantEdge Plan imposes a waiting period of 24 months for specific diseases.

What's Not Covered By The Plan?

Certain situations will not be covered by your health insurance policy. These are called exclusions. They include -

Standard Permanent Exclusions: The IRDAI has defined a list of 'standard permanent exclusions', that all insurance companies have to abide by. Some of these include -

Investigation and evaluation: Admitted to a healthcare facility only for observation or monitoring purposes.
Change of gender treatment: Treatment that alters the body's characteristics to those of the opposite gender.
Plastic/cosmetic surgery: Treatment or surgery that modifies the appearance of the body.
Rest cure, rehabilitation, and respite care: Hospitalisation for bed rest with no active treatment.
Obesity/weight control: Treatment or surgery administered for weight control or obesity.
Profession in hazardous or adventure sports: Medical expenses you incur while partaking in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc. as a professional.
Narcotics: Addiction treatment for alcoholism, drug abuse, etc.
Treatments in establishments arranged for domestic purposes: Treatment in health spas, nursing homes, and similar establishments intended exclusively for domestic use.
Dietary supplements, substances purchased without prescription: Vitamins, minerals, etc. not prescribed by a physician.
Breach of law: Treatment costs associated with an individual who has committed or attempted to indulge in a criminal act.
Excluded providers: Treatments taken from medical practitioners and hospitals excluded by the insurance company.
Refractive error: The cost of correcting refractive errors of up to 7.5 diopters for better vision.
Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
Unproven treatments: Unproven surgeries, medical procedures, or treatments.
Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.

Additional Permanent Exclusions: Insurance companies may apply additional exclusions for particular situations or medical conditions apart from the standard permanent exclusions. And, if you are found to have certain diseases or severe medical conditions carrying a higher degree of risk, they may permanently exclude them from coverage as well. However, insurers can deny coverage only for a list of illnesses laid down by the Insurance Regulatory and Development Authority of India (IRDAI).
Non-Standard Exclusions (Specific Exclusions): These are specific exclusions besides the standard permanent exclusions listed by the IRDAI. Remember, these exclusions may vary across insurers and depend on the terms and conditions of the policy. Here are the top specific exclusions under the ICICI Lombard Health AdvantEdge Plan-

Treatments for an injury or illness arising out of war, military or usurped power, seizure, etc.
Treatments for an injury or illness resulting from a nuclear, chemical, or biological attack or weapons, etc.
Treatment received outside the geographical limits of India (unless you've opted for worldwide coverage).
OPD treatments, unless you buy the OPD for Medical and Dental add-on.

A Quick Recap

Here is a quick overview of the plan's benefits and coverage –

Product Benefits	Coverage Limits
Pre-Hospitalisation Expenses	60 days up to the sum insured
Post-Hospitalisation Expenses	180 days up to the sum insured
Daycare Treatment Coverage	Up to the sum insured
Domiciliary Treatment Coverage	Up to the sum insured
Organ Donor Coverage	Harvesting expenses up to the sum insured
Non-Medical Expenses	Covered up to the sum insured, if you opt for an add-on
Guaranteed Cumulative Bonus (No Claim Bonus)	20% increase in sum insured every year, maximum up to 100%
Room Rent Limit	No Limit
Modern Treatment Coverage	Up to the sum insured
Restoration Benefit	Up to 100% of the sum insured
Pre-existing Disease	Covered after a 24-month waiting period
Specified Treatment	Covered after a 24-month waiting period

Here's everything you need...

FAQs

Can I receive treatment abroad for an illness under ICICI Lombard Health AdvantEdge?
You can receive coverage for treatments performed abroad if you opt for worldwide coverage under ICICI Lombard Health AdvantEdge. However, keep in mind that some conditions are associated with this coverage.
What is the maximum level of coverage offered by the ICICI Lombard Health AdvantEdge Plan?
The ICICI Lombard Health AdvantEdge Plan covers you for up to Rs 3 crores.
Are vaccinations for newborn babies a part of ICICI Lombard Health AdvantEdge Plan’s coverage?
If you have opted for the maternity benefit under this plan, you can obtain vaccinations for newborns. As per the T&Cs, expenses covered will be up to 1% of the base sum insured per newborn child, subject to a maximum of Rs 10,000.
Does the ICICI Lombard Health AdvantEdge Plan cover hospitalisation expenses related to Covid-19?
This policy covers Covid-19-related expenses as stipulated in the policy terms.
Will ICICI Lombard Health AdvantEdge Plan offer coverage for health check-ups?
Yes, health checkups will be covered on a cashless basis, as per the terms and conditions of the policy. To be eligible for coverage, you must be at least 18 years old.