Does ICICI Lombard Elevate really offer unlimited health insurance?
This article discusses the ICICI Lombard Elevate health insurance plan to understand whether it really offers unlimited claims.
Does ICICI Lombard Elevate really offer unlimited health insurance?
Posted on 25 Sep 2024
Author: Sayan Sircar
17 mins read
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This article discusses the ICICI Lombard Elevate health insurance plan to understand whether it really offers unlimited claims.
📚 Topics covered:
- Why are we talking about ICICI Lombard Elevate policy?
- What are the main features of ICICI Lombard Elevate policy?
- Where does the unlimited coverage of ICICI Lombard Elevate policy come from?
- What are the main things about ICICI Lombard Elevate policy that you must understand before buying this policy?
- Does this policy mean that a Super Top-up plan is not needed due to unlimited restoration?
- Should you buy or port into ICICI Lombard Elevate policy?
- Frequently asked questions (FAQs) about the ICICI Lombard Elevate policy
- What is the ICICI Lombard Elevate Health Insurance Plan?
- What does ‘unlimited claim restoration’ mean for the ICICI Lombard Elevate Health Insurance Plan?
- Does the ICICI Lombard Elevate Health Insurance Plan cover pre-hospitalization and post-hospitalization expenses?
- Is maternity coverage included in the ICICI Lombard Elevate Health Insurance Plan?
- Can I get worldwide coverage under ICICI Lombard Elevate Health Insurance Plan?
- What is the ‘Power Booster’ feature in the ICICI Lombard Elevate Health Insurance Plan?
- What is the waiting period for pre-existing diseases in the ICICI Lombard Elevate Health Insurance Plan?
- Does the ICICI Lombard Elevate Health Insurance Plan cover modern treatments?
- Are ambulance services covered in the ICICI Lombard Elevate Health Insurance Plan?
- What is the ‘Critical Illness’ benefit in the ICICI Lombard Elevate Health Insurance Plan?
- How does the ‘BeFit’ option work in the ICICI Lombard Elevate Health Insurance Plan?
- What are the exclusions under the ICICI Lombard Elevate Health Insurance Plan?
- What is the voluntary co-payment option?
- Does the ICICI Lombard Elevate Health Insurance Plan cover AYUSH treatments?
This article is a part of our detailed health insurance article series. Ensure you have read the other parts here:
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Why are we talking about ICICI Lombard Elevate policy?
ICICI Lombard Elevate policy is a new health insurance policy from ICICI Lombard with some unique features:
- Unlimited Claim Resets: Enjoy unlimited reinstatement of your sum insured with the Reset Benefit, ensuring you’re always covered for new illnesses.
- Lifetime Coverage with Infinite Care: Opt for lifetime protection for one major health event with the Infinite Care add-on, ensuring peace of mind for the unexpected.
- Power Booster: Double your sum insured every year with a 100% cumulative bonus, even if you make a claim.
- Up to 3 crore Global Coverage: Be insured worldwide, including in high-cost medical countries like the USA and Canada, with a coverage limit of up to ₹3 crore.
- Maternity and Newborn Coverage: Get maternity benefits, newborn hospitalization coverage, and vaccinations for your child’s first year.
- Guaranteed Cumulative Bonus: Gain 20% additional sum insured every year, even with claims, ensuring growing coverage year after year.
There is a lot of marketing for this policy regarding the potential for unlimited or infinite coverage. Before going into these details, it is important to cover the main features of ICICI Lombard Elevate policy.
What are the main features of ICICI Lombard Elevate policy?
- Type of Plan: Both Indemnity and Benefit based.
- Sum Insured: Individual Sum Insured or Floater Sum Insured (shared between family members)
- Details: UIN number is ICIHLIP25031V012425, product code is 4225, official website: here
- Tax deductions: Under Section 80D, up to ₹25,000/year for self/family and ₹50,000/year for seniors (age more than 60). There is no tax benefit in the new tax regime: Which is the best tax regime to choose from April?
What are the basic coverages offered by ICICI Lombard Elevate policy?
- In-patient Hospitalization: Covers hospital stays over 24 hours.
- Day Care Procedures: Covers medical expenses for all day-care treatments.
- Modern Treatment: Coverage for specific modern treatments up to the annual sum insured.
- Pre-Hospitalization: Covers medical expenses up to 90 days before hospitalization.
- Post-Hospitalization: Covers medical expenses up to 180 days after discharge.
- AYUSH Treatment: In-patient AYUSH (Ayurveda, Yoga, Naturopathy, etc.) hospitalization covered.
- Road Ambulance: Coverage for domestic road ambulance expenses.
- Organ Donor Expenses: Covers expenses for the organ donor.
- Domiciliary Hospitalization: Covers medical expenses for treatment at home.
- Guaranteed Cumulative Bonus: 20% cumulative bonus for each claim-free year, up to 100%.
- Reset Benefit: Up to 100% reset of the annual sum insured for an illness.
- Bariatric Surgery: Coverage after two years for obesity-related surgery.
- Surrogate Mother Coverage: Covers hospitalization for surrogate mothers (up to ₹ 5 lakhs).
- Oocyte Donor Coverage: Covers hospitalization for oocyte donors (up to ₹ 5 lakhs).
What are the optional coverages/riders offered by ICICI Lombard Elevate policy?
Optional Covers / Riders offered by ICICI Lombard Elevate policy:
- Infinite Care: Lifetime hospitalization cover for one claim.
- Power Booster: 100% cumulative bonus even with a claim.
- Jumpstart: Covers pre-existing conditions like asthma and diabetes with a reduced waiting period.
- Chronic Disease Management: Disease management program for listed chronic diseases.
- Maternity Benefit: Coverage for delivery or legal termination of pregnancy (up to ₹ 1 lakh).
- New Born Baby Cover: Covers newborn hospitalization (up to 2x Maternity Sum Insured).
- BeFit: Benefits on outpatient consultations, diagnostics, pharmacy, physiotherapy, etc.
- Worldwide Coverage: Covers global hospitalization, including the USA and Canada (up to ₹ 3 crore).
- Claim Protector: Pays for items that are otherwise non-payable as per policy limits.
- Inflation Protector: Protects sum insured against inflation based on the Consumer Price Index.
- Air Ambulance: Covers air ambulance services up to the annual sum insured.
- Convalescence Benefit: A lump sum of ₹ 20,000 for hospital stays exceeding ten days.
- Nursing at Home: ₹ 2,000 per day for post-hospitalization nursing, up to 10 days.
- Compassionate Visit: Covers travel costs for immediate family members during hospitalization.
- Critical Illness: Lump sum payment (up to ₹ 50 lakhs) upon diagnosis of listed critical illnesses.
- Personal Accident: Lump sum payment for accidental death or disability (up to ₹ 50 lakhs).
- Dependent Accommodation: ₹ 1,000 per day for the accommodation of a dependent.
- Durable Medical Equipment: Covers costs for renting or purchasing medical equipment (up to ₹ 5 lakhs).
- Tele-Consultations: 24x7 unlimited tele-consultations via mobile app.
- Waiting Period Reduction Options: Option to reduce waiting periods for pre-existing diseases, maternity, and specified illnesses.
- Room Modifier: Options to modify room rent eligibility.
- NRI Advantage: Special coverage and discount for NRIs for accidental emergencies.
Where does the unlimited coverage of ICICI Lombard Elevate policy come from?
Unlimited coverage is available only under the Infinite Care rider, which has to be availed every year once the policy has been taken into account. If you opt out of it, you cannot opt back in.
This feature only applies to one claim during the entire life of the policy. So, while the coverage is unlimited for one health event, the protection isn’t infinite across all events or illnesses. Pre-existing conditions may not be covered under unlimited coverage.
Also, the Reset benefit is only for unrelated diseases and therefore will cap your claims for repeated claims for the same issue. We cover this point below.
What are the main things about ICICI Lombard Elevate policy that you must understand before buying this policy?
20 per cent co-payment outside preferred hospitals
From the company website:
Enjoy a 10% discount by selecting a PPN (Preferred Provider Network) hospital for your treatment. If you choose to receive treatment outside the PPN network, a 20% co-pay for the expenses will apply.
If you are undergoing any planned surgeries, then it will be good to know the nearest or most suitable Network hospitals which have tie-ups with the policy. It will also be good to study this list before taking the policy and also stay updated on any changes.
No room rent capping is not there by default
As per policy wording:
Room category applicable under this cover shall be capped at Single Private AC room unless the Insured Person has opted for Optional Cover 27 Room Modifier
No caps on room rent are possible only with the Room Modifier rider. If you do not have this rider, and your room rent is X while a Single Private AC room is Y (Y < X) then you will only get
Y / X * Total Claim amount
once claimed.
Reset benefit is only for unrelated diseases
The reset benefit can only be utilized for unrelated illnesses or treatments. If you make repeated claims for the same condition, this benefit does not apply. So, claims are only unlimited when they are for different illnesses or injuries.
Each reset is limited to the sum insured. Therefore, while you may reset the amount multiple times, the coverage is essentially capped by the sum insured per illness per policy period.
Immediate coverage of BP or diabetes needs a rider
Asthma, Diabetes, Hypertension, Hyperlipidemia, Obesity and Coronary Artery Disease (with PTCA done before 1 year) can be covered from Day 31 onwards only with the Jumpstart rider.
This rider cannot be removed in future renewals.
Does this policy mean that a Super Top-up plan is not needed due to unlimited restoration?
Whether or not you get the unlimited claim or not, it is important to have a super top-up policy as well just to be on the safe side. This is because the unlimited cover is for any unrelated illness only. If you are incurring claims for the same illness then super top-up will help you then.
Related:
What are top-up and super-top-up health insurance policies? Do you need either?
Should you buy or port into ICICI Lombard Elevate policy?
There are three golden rules that you need to follow regarding purchasing health insurance:
- Declare all medical conditions honestly, as per your knowledge, while filling out the proposal form to reduce chances of claim rejection
- Purchase the policy from an agent with a physical office in your city to help with claims
- Keep self (+spouse and kids) and senior parents covered under two separate floater policies to keep total premiums lowest
Apart from these, you must have a separate super top-up health insurance policy to cover extreme claims: What are top-up and super-top-up health insurance policies? Do you need either?.
The ICICI Lombard Elevate policy on paper is a good option. Whether it is good for your particular case or not depends on:
- how this policy’s terms and features compare vs other similar policies
- your existing policy and why you want to shift out of it
- your understanding of the overall policy terms and conditions
Therefore, it is important to consult with a competent advisor in your city, preferably face to face, and act on their advice. It will help both with claims and choosing the most appropriate policy in the first place.
Frequently asked questions (FAQs) about the ICICI Lombard Elevate policy
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What is the ICICI Lombard Elevate Health Insurance Plan?
It is a health insurance plan that provides coverage for both hospitalization and outpatient treatments, offering features like unlimited reset of the sum insured and worldwide coverage.
What does ‘unlimited claim restoration’ mean for the ICICI Lombard Elevate Health Insurance Plan?
‘Unlimited claim restoration’ allows you to reset the sum insured multiple times in a policy year, but only for unrelated illnesses. This means the coverage is reinstated for each new illness.
Does the ICICI Lombard Elevate Health Insurance Plan cover pre-hospitalization and post-hospitalization expenses?
Yes, the plan covers pre-hospitalization expenses up to 90 days before hospital admission and post-hospitalization expenses up to 180 days after discharge.
Is maternity coverage included in the ICICI Lombard Elevate Health Insurance Plan?
Yes, maternity coverage is included, but it is limited to 10% of the annual sum insured, with a cap of ₹ 1 lakh. It also has a waiting period of 24 months.
Can I get worldwide coverage under ICICI Lombard Elevate Health Insurance Plan?
Yes, with the optional Worldwide Cover, you can receive coverage for hospitalization and day-care treatments globally, including in the USA and Canada, up to ₹ 3 crore.
What is the ‘Power Booster’ feature in the ICICI Lombard Elevate Health Insurance Plan?
The Power Booster feature provides a 100% cumulative bonus of the sum insured each year, even if you make a claim during that year.
What is the waiting period for pre-existing diseases in the ICICI Lombard Elevate Health Insurance Plan?
Pre-existing diseases are covered after a waiting period of 36 months of continuous coverage, unless you opt for the ‘Jumpstart’ cover, which reduces the waiting period to 30 days.
Does the ICICI Lombard Elevate Health Insurance Plan cover modern treatments?
Yes, the plan covers modern treatments such as robotic surgeries, stem cell therapy, and oral chemotherapy, subject to the annual sum insured.
Are ambulance services covered in the ICICI Lombard Elevate Health Insurance Plan?
Yes, both road and air ambulance services are covered under the policy up to the annual sum insured.
What is the ‘Critical Illness’ benefit in the ICICI Lombard Elevate Health Insurance Plan?
The Critical Illness benefit provides a lump sum payout of up to ₹ 50 lakhs if the insured is diagnosed with a critical illness listed in the policy.
How does the ‘BeFit’ option work in the ICICI Lombard Elevate Health Insurance Plan?
The BeFit option allows cashless coverage for outpatient consultations, diagnostic tests, and minor procedures through the insurer’s mobile app.
What are the exclusions under the ICICI Lombard Elevate Health Insurance Plan?
Exclusions include pre-existing diseases during the waiting period, cosmetic surgery, weight control surgeries without a doctor’s recommendation, treatment for substance abuse, and treatment related to hazardous activities.
What is the voluntary co-payment option?
The voluntary co-payment option allows you to bear a percentage of the claim amount (10% to 50%), reducing your premium.
Does the ICICI Lombard Elevate Health Insurance Plan cover AYUSH treatments?
Yes, the policy covers inpatient AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) treatments up to the sum insured.
Related Articles
- Health insurance: what, why, how much to get and from where?
- What are top-up and super-top-up health insurance policies? Do you need either?
- A health insurance premium fund: who needs it and why
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This post titled Does ICICI Lombard Elevate really offer unlimited health insurance? first appeared on 25 Sep 2024 at https://arthgyaan.com
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