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ICICI PRUDENTIAL LIFE INSURANCE

insurance

ICICI PRUDENTIAL

11 L.B. Road

Adyar, Chennai 600020

HOSPITAL CARE

Hospital Care

Today, when you are young and healthy, planning for a contingency is not always a priority but the cost of treating even the smallest of ailments is on the rise. You realize it only when you or your loved ones has to undergo some medical emergency and you are faced with the challenge of organizing funds to meet the hospitalisation related expenses. Hence a medical emergency comes not only with emotional turmoil but also with a huge expense attached to it.

During such an unexpected situation, your only concern should be that the best doctors and medical facilities are available and cost should not be a constraint so that you can take care of things without compromise but to ensure that best in class treatment is provided, the key to that is to be financially prepared for it.

To help you manage this unexpected emergency, ICICI Prudential presents Hospital Care - a comprehensive insurance policy that has:

  • Facility of cashless hospitalisation in an extensive network of hospitals in India
  • Benefit amount will be paid in addition to payment received by you from other medical insurance plans.
  • You will receive lump-sum benefit amount, irrespective of the actual billing.
  • Long term guaranteed coverage up to 20 years.
  • Tax benefits on premium paid up to Rs.15,000 under Section 8
Features of Hospital Care :

1. Hospitalisation Benefits (DHCB)

  • Get a benefit amount if you are hospitalized for more than 24 hours i.e. at least 2 consecutive nights and must be charged for 2 days room expenses.
  • The benefit amount is fixed and will be paid irrespective of actual hospitalisation expenses
  •  DHCB is payable for hospitalisation up to 90 days per policy year, which includes any days spent in Intensive Care Unit.

2. Intensive Care Unit (ICU) benefit

  • An additional 50% of DHCB amount per day is paid to you if you get admitted to an Intensive Care Unit (ICU), and this amount is paid depending on the plan chosen.
  •  The ICU benefit is payable for hospitalisation up to 30 days per policy year, and is paid in addition to D

3. Recuperating benefit

  • A post-hospitalisation benefit amount in addition to all other amounts will be paid out to ensure that follow-up tests, medicines and consultations go ahead as planned .
  • You are eligible for recuperating benefit only on being hospitalized continuously for 5 or more days DHCB.
    4. Surgery benefit

Over and above the hospitalisation expenses, a fixed lump-sum amount is also paid for more than 900 surgical procedures. These surgeries have been classified into four grades, depending on the type and severity. A sample list of surgeries is given below:

Grades

Surgeries

1

Tennis elbow release, bladder stone removal

2

Hernia, Removal of uterus

3

Removal of kidney, removal of thyroid gland

4

Open heart surgery, removal of brain tunour

For the detailed list of surgeries,

5. Benefit amounts at-a-glance

You can choose any one plan, from the following four options Each plan has fixed benefit amounts, as shown below:

Benefit

Plan A (Rs.)

Plan B (Rs.)

Plan C (Rs.)

Plan D (Rs.)

Daily Hospitalistion Cash Benefit (per day) 1,000 2,000 3,000 4,000
ICU (Intensive Care Unit) Benefit per day) 500 1,000 1,500 2,000
Recuperating Benefit 3,000 6,000 9,000 12,000
Surgery Benefit        
Surgery grade 1 15,000 30,000 45,000 60,000
Surgery grade 2 50,000 1,00,000 1,50,000 3,00,000
Surgery grade 3 75,000 1,50,000 2,25,000 4,00,000
Surgery grade 4 1,00,000 2,00,000 3,00,000

4,00,000

Waiting period – 90 days except accidental claims.

Sample Case 1

In case you opt for plan A, then for an 8-day hospitalisation, your benefit amount is 

DHCB = 8 days * Rs. 1,000 per day = Rs. 8,000

+

Recuperating Benefit = Rs. 3,000

(refer to the table below for benefit amounts)

Total benefit amount = Rs. 11,000

Sample Case 2
In case you opt for plan D, then for an 6-day hospitalisation, including 4 days in ICU, with a Grade 2 surgery, your benefit amount is
DHCB = 6 days * Rs. 4,000 per day = Rs. 24,000
+
4-day ICU benefit = 4 days * Rs. 2,000 per day = Rs. 8,000
+
+
Grade 2 Surgery benefit = Rs. 2,00,000
(refer to the table below for benefit amounts)
Total benefit amount = Rs. 2,44,000

6. High benefit limits

Hospital Care policy offers you high benefit limits. For instance,under plan A, you can claim up to Rs.4 lakhs for multiple claims, including surgical benefit up to Rs.3 lakhs annually. However, for the entire policy term, you can make multiple claims up to Rs.20 lakhs.

Benefit Limits Plan A (Rs.) Plan B (Rs.) Plan C (Rs.) Plan D (Rs.)
Yearly Limit 4,00,000 8,00,000 12,00,000 16,00,000
Surgical benefit 3,00,000 6,00,000 9,00,000
Policy Term Limit 20,00,000 40,00,000 60,00,000 80,00,000

Claims intimation and processing

You have to provide complete and accurate information asked by the company at the earliest to ensure faster claim settlement. Please refer to the policy document for details.

Claims Helpline 

Contact our 24*7 ClaimCare Cell at 1800 - 103 - 6363 to know more about the claims process.

The claims can be under two scenarios:

Photocopies or duplicates of the following documents will be needed to process the claim:

  1. Copy of policy certificate
  2. Claimant's Statement form
  3. Duly filled claim form (provided along with the welcome kit or available on our website)
  4. Treating Doctor's Certificate
  5. Copy of Indoor Case Papers
  6. Hospital Discharge Card/Summary
  7. Medical evidence in form of diagnostic reports, prescriptions, bills with breakup, any other document to support hospitalization / surgery.

Besides the above, if required, ICICI Prudential may request for additional documents / information, if any, for processing the claim.

1. CASHLESS Hospitalisation in a NETWORK HOSPITALS a. PLANNED HOSPITALISATION

Step 1: Call and inform ICICI Prudential (on the help line number provided on the reverse of the health card) about the planned hospitalization 4 days prior to the treatment, before admitting into the hospital.

Step 2: Download the pre-authorization form from here or you could even visit any of our branches.

Step 3: To gain access to the network hospitals, just show your health card and also submit a duly filled pre-authorization form at the treating hospital.

Step 4: The forms shall be scrutinized and further processed and the cashless facility will be activated. We will inform you about the cashless facility being activated through SMS. Also the status of the case will be updated on the website.

Step 5: On discharge, you need to sign the required documents at the hospital.
Step 6: ICICI Prudential will pay the amount to hospital.

b. EMERGENCY HOSPITALISATION

Step 1: In case of emergency, first admit the patient in the Hospital and then inform ICICI Prudential, within 24 hours. You can call up on the number provided on the reverse of the health card.

Step 2: As it's an emergency, you have the facility of collecting the pre-authorization form from the treating hospital or you could even download the pdf format from the website.

Step 3: Show your health card to the network hospital and also submit the pre-authorization form to the treating hospital.

Step 4: The forms shall be scrutinized and further processed and the cashless facility will be activated.

Step 5: On discharge, you need to sign the required documents.

Step 6: ICICI Prudential will pay the hospital.

The Cashless Settlement Scenario:

  • Hospital bill amount is more than your eligible amount: ICICI prudential settles the eligible amount with the hospital and balance bill amount is payable by you.
  • Hospital bill is less than eligible amount: ICICI Prudential settles the claim with the hospital and the balance eligible amount is paid to you

2.   HOW TO CLAIM IN CASE OF HOSPITALISATION IN NON-NETWORK HOSPITALS

While it's suggested that you choose a network hospital, you are at liberty to choose a Non-network hospital also. In case you avail treatment in a non-network hospital, ICICI Prudential will pay you the eligible amount as per the plan opted by you.
Step 1: Get admitted to the hospital and take the complete treatment.

Step 2: Settle the relevant bills in full, on discharge.

Step 3: Collect all the treatment papers along with the doctor's prescriptions, investigation reports, Hospital Discharge card, photocopies or duplicates of medical bills and receipt of hospital Bills and copy of FIR (if any, in case of an accident).

Step 4: Lodge your claim by filling in the claim form (you can collect the claims forms your nearest ICICI Prudential branch or the website.) and attach all the required documents, within 60 days from the date of discharge.

The claim will be processed within 7 working days from the date of receiving all the required documents

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