# ICICI Lombard Group Health Insurance

ICICI Lombard’s Group Health Insurance (ICICI Lombard GHI) is amongst the leading healthcare schemes offered by ICICI Lombard General Insurance (ICICI Lombard). ICICI Lombard provides a comprehensive group health insurance policy to small, medium, and large organizations.

In addition, they also offer a wide range of employee health benefits consisting of group personal accident insurance, doctor consultations, health checkups, and more.

## Key statistics of ICICI Lombard general insurance company

- ₹1,903 cr GHI Premiums FY 2021
- 1.08 cr GHI lives insured FY 2020
- 1.64 cr Health lives insured FY 2020
- 4,33,498 Health claims Processed FY 2020
- 78.67% Health claims settlement ratio FY 2020
- 78.67% Health claims Settled within 3 months FY 2020

*Source - IRDAI and IBAI annual reports*

**GHI - Group Health Insurance**  
**Claims Settlement Ratio (CSR)** is the percentage of claims settled by the insurance company against the number of claims obtained in a financial year.

### Awards and recognitions

Excellence in Financial Reporting, ICAI Awards 2015-16

### What is group health insurance?

Group Health Insurance (GHI) is a type of insurance scheme that covers employees and workers of a company. As an employer, it is your responsibility to implement a group coverage policy within the organization. With a group medical plan, employees and their family members can avail superior health care benefits and medical treatment, including accidental and emergency-related incidents. ICICI Lombard has excellent group insurance offerings for companies of all sizes.

#### Highlights of Group Care Insurance

### Standard benefits offered by ICICI Lombard group health insurance

| Feature | Type of Cover |
|---------|---------------|
| Eligibility criteria (Age) | 90 days - 80 years. Option to provide cover to the baby from Day 1 |
| Included | Employee as well as their spouse, children, and parents. Inpatient hospitalization and accidental emergency. Illness/injury during the policy period. |
| Waiting period | Waived off |
| Attendant cover | Yes, covered up to ₹5,000 per family within Sum Insured if the length of stay for the patient is more than five days on a reimbursement basis. |
| Sum Insured | Ranges from ₹50,000 to ₹10 lakhs |
| Hospitalisation cover | 60 days and 90 days, respectively |
| Room rent and ICU | Ability to have uncapped room rent and ICU expenses |
| Eye treatment | Lasik surgery is covered if the correction index is +/- 6.5 D. Cataract surgery is covered. |
| Pre-existing cover | Option to cover all pre-existing diseases expenses from Day 1 |
| Day care treatments | Included |
| Mental health | Yes, hospitalization due to psychiatric conditions for up to ₹30,000 |
| General list of exclusions | Infertility and sterility, Septoplasty, Admin and miscellaneous related charges, Holter monitoring, Prosthesis, Experimental treatment |

### Additional benefits offered by ICICI Lombard group health insurance

- **Ambulance Cover** - Covered up to ₹5,000 per hospitalization, Air Ambulance - Covered up to ₹1,00,000 or family sum insured, whichever is less.
- **Home Healthcare** - Covered only on a cashless basis, available in nine cities across India.
- **Health Assist Services** - Available on-call for queries regarding specialists, hospitals, fixing appointments with doctors or nutritionists, facilitating second opinions and more.
- **Specific Condition** - Terrorism, Lucentis up to ₹50,000 per family within Sum Insured, internal congenital diseases, only if life-threatening.
- **AYUSH Treatment** - Covered only in a recognized government hospital along with a valid medical practitioner’s prescription.

### Add-on benefits offered by ICICI Lombard group health insurance

- **General** - Outpatient department (OPD Cover - Reimbursement), Health check-ups.
- **Maternity** - Option to have maternity benefit for C-section and Normal Delivery (up to ₹75,000) for up to two babies, pre-and-post natal expenses of up to ₹5,000 covered within the Maternity limit, newborn baby cover.

### Here’s how ICICI Lombard is better with Plum

- Complete digital experience, cashless process, cover for businesses of all sizes, scales as you expand your team, doctor on call, Plum wellness, insurance on WhatsApp, single dashboard for tracking claims.

### Frequently Asked Questions

**Can I add or remove members after the initial setup?**
Super top-up allows the addition of an additional coverage of 20 lakhs to your existing policy.

**How are premiums calculated for additions?**
New employees can be added at the time of marriage or childbirth, and you can remove employees who exit the company.

**Can an employee convert the group plan to an individual plan if they leave the company?**
No, the policy doesn’t cover same-sex or unmarried couples.