ICICI Health Insurance Scheme

ICICI Lombard Health Insurance Family Shield Review

ICICI Lombard offers health insurance plans for covering individuals and families. These plans cover individuals and families. They also come with some tax benefits which you get. Often people sign up for financial products from companies, without going through the fine print. We take a look at the benefits they give you and demystify the jargon.

The ICICI Lombard Family Shield is a health insurance package for the entire family. They claim cashless service at 3400 hospitals which you can avail of with a Health ID card issued to you. Medical expenses covered for hospitalization of more than 24 hours is covered. In case of an emergency or a planned hospitalization you need to get in touch with their toll free number to get health assistance. The Family Shield Health Insurance scheme is available for single year and two year periods. Everyone from 5 years to 55 years is eligible.

In principal, ICICI Lombard requires you to pay a health insurance premium every year and assures you that they will take care of your hospitalization expenses. Yet there are some exclusions.

Existing illnesses not covered by ICICI Lombard Family Shield

Any illness, disease or injury which existed before the inception of the policy is not covered for the first four years of the policy.

No coverage for the first thirty days after signing up for this policy

Medical expenses are not covered for the first 30 days after taking out this policy. The only exception is in the case of accidents.

Here's a list of ailments which are not covered for the first two years of this policy but are covered thereafter.

Cataract
Benign Prostatic Hypertrophy
Myomectomy, Hysterectomy unless because of malignancy
Hernia, Hydrocele
Fistula in anus, piles
Arthritis, gout, rheumatism
Joint replacements unless due to accident
Sinusitis and related disorders
Stones in the urinary and biliary systems
Dilatation and curettage
Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant/adenoids and hemorrhoids
Dialysis required for chronic renal failure
Surgery on tonsils, adenoids and sinuses
Gastric and Duodenal ulcers
So the first time you opt for this policy, you cannot claim medical expenses for the above ailments. If you are already suffering from any of these ailments, then they will not be covered for four years from the date of taking out the policy. Two years or four years, as applicable refers to consecutive years.

A long list of ailments which are not covered by the Family Shield policy of ICICI Lombard.

AIDS/HIV or any other sexually transmitted diseases - AIDS is a major killer worldwide today. India has millions of people affected with it. HIV/ AIDS and related diseases are not covered by this policy. STDs (Sexually transmitted diseases) such as Gonorrhea, Hepatitis, Herpes, Scabies and Syphilis and all other diseases which can be considered sexually transmitted diseases are not covered.
Use and misuse of liquor. intoxicating substances or drugs are not covered. So if an overdose of some intoxicant or even liquor gets a person to hospital, this policy won't cover the claim.
Routine medical, eye and ear examinations, cost of spectacles, laser surgery, contact lenses or hearing aids, vaccinations, issue of medical certificates and examinations as to suitability for employment or travel are not covered
Internal congenital illness
Suicide or self-inflicted injury. So if someone makes an attempt to kill herself/himself and ends up in hospital, their family has to meet the medical expenses themselves.
Alcohol or Drug Abuse
Illness or Injury whilst performing duties as a serving member of a military or a police force is not covered.
Treatment relating to birth defects and external congenital illnesses is not covered under this policy.
Dental treatment is not covered unless due to accident.
Treatment traceable to Pregnancy and Childbirth, abortion and its consequences, tests and treatment relating to infertility and invitro fertilization. This will not apply to Ectopic Pregnancy proved by diagnostic means and is certified to be life threatening bythe Medical Practitioner.
Birth control procedures and hormone replacement therapy. Many women opt for hormone replacement therapy after menopause. This is not covered by this policy. Vasectomy and Hysterectomy are not covered.
Prosthesis, corrective devices and medical appliances which are not required intra-operatively or for the illness for which the Insured was hospitalized, are not covered.
Treatment of mental illness, stress, psychiatric or psychological disorders, Aesthetic treatment, Cosmetic surgery and Plastic surgery unless necessitated due to accident or as a part of any illness are not covered.
Circumcision unless necessary for treatment of a diseases or necessitated due to an accident.
Vaccination and inoculation of any kind.
The performance of hazardous sports of any kind
Treatment by a family member and self-medication or any treatment that is not scientifically recognized is not covered
Flying other than as a passenger on a scheduled regular carrier is not covered.
Any criminal act is not covered.
War invasion, act of foreign enemies, hostilities (whether declared or not), civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, riot, strike, lockout, military or popular uprising, civil commotion martial law, loot, sack, pillage, terrorism or any terrorist acts. This is a broad section and a lot of injuries may be disallowed under this.
Any losses directly or indirectly due to contamination due to any act of terrorism, regardless of any contributory causes (if the insurer alleges that by reason of these exclusion any loss is not covered by this insurance, the burden of proving the contrary shall be upon the insured.
Nuclear weapons, materials ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.
Experimental and unproven treatment, diagnostic tests and treatment not consistent with or incidental to the diagnosis and treatment of any illness or injury for which hospitalization is required.
Costs of donor screening or treatment including surgery to remove organs from a donor in case of transplant surgery
Non-allopathic treatment is not covered. Non-allopathic treatment, pregnancy, childbirth-retaled diseases, cosmetic aesthetic and obesity related treatment are not covered. So if you opt for homeopathic treatment, naturopathy or any other alternative medicine, expenses related to it are not covered. If you're a female and have complications during child-birth, you will have to fund the medical expenses yourself. Weight loss treatments, face-lifts, liposuctions and other such cosmetic surgery is not covered.
Treatment taken at home or received outside the country,
Treatment taken from persons not registered as Medical Practitioners under respective medical councils.
Vitamins and Tonics, Treatment of obesity, general debility,convalescence, run-down condition and rest cure.
Domiciliary Treatment.
Tax Benefits

You do get a tax benefit under section 80D of the Income Tax (Amendment)Act 1986 if you opt for this policy. All contributions made upto Rs.10,000 per annum can be deducted from your gross income.

With so many exclusions, it's a little difficult to think up situations where this policy could be useful. If you're a heart patient and need coverage for your heart ailment, you'll have to pay the health insurance premium on 'Family Shield' to ICICI Lombard for four years before you can make any claim. If your eyes are healthy but six months after opting for this policy, you need a cataract operation..hard luck! You'll have to bear the expenses yourself.
A policy worth considering if at all, only after taking into account all the riders.

Source: http://www.parinda.com