ICICI Lombard Complete, as the name suggests, is an all-embracing regular mediclaim product which can be considered as senior citizen mediclaim too due to no restriction on entry and exit age. It does get pricey for elders and for covering maternity and OPD expenses
Raj Pradhan
ICICI Lombard General Insurance has launched “Complete Health Insurance”, a product with no restriction on entry and exit age, no room rent limits and no co-pay. Life-long renewal is certainly welcome; Insurance Regulatory and Development Authority (IRDA) draft regulation on mediclaim does mention about policy continuation during the life time of the insured.
No entry age restriction also means that the new product can be considered as a competitor to the senior citizen mediclaim market segment. Most of the senior citizen specific mediclaim products come with restrictions for room-rent, co-pay or surgery specific limitations.
Premium – ICICI Lombard Complete has much wider cover and with less restrictions, but expectedly at a price in mid to high range. Individual in age group 26-35 years will have a premium of Rs4,775 for sum insured (SI) of Rs3 lakh. The premium for other mediclaim products in the market for the same age group and SI range from approximately Rs3,200 to Rs5,500. Price should not be the sole comparison factor as each product features vary.
ICICI Lombard Complete premium for the age group 61-65 is Rs26,609 for SI of Rs3 lakh. The premium for same age group and SI ranges from approximately Rs17,000 to Rs31,500 for non-senior citizen mediclaim. The premium for senior citizen products like Star Health Red Carpet, Bajaj Allianz Silver Health, etc is lower due to several restrictions. The premium is ranged from Rs11,500 to Rs16,000.
There is no savings for online purchase. While the insurance company’s press release mentions about maternity and OPD (expenses incurred as an outpatient) cover, it is only for the offline product so far and that too with an additional premium.
Moneylife got the following clarification from ICICI Lombard, “The online brochure you are referring to is specific for the online product where we are not offering the maternity and OPD cover as of now. We wanted to start off with a simpler product online and introduce more benefits gradually, as we understand the online customer’s preferences better. On the offline platform, the product with maternity and OPD cover is available for the customer.”
Maternity cover is offered for the offline policy with two adults (with or without children on the policy) after the waiting period of three years. The premium for covering two adults (age 26-35 years) and one child for a SI of Rs3 lakh is Rs9,055 for cover without maternity, OPD and Hospital Daily Cash (HDC) benefits; the premium for same parameters is Rs16,779 (with maternity, OPD, HDC and other benefits).
Entry and exit age – There are no restrictions, of course, subject to underwriting at the time of the proposal. Renewal at the premium at that time will be done unless there is misrepresentation, fraud or moral hazard.
Room rent limits - No restriction.
Co-pay – Not applicable. Co-pay means that the insured is required to bear a certain percentage of expenses if hospitalised.
Pre-existing diseases (PED) waiting period – It is two years for a sum insured (SI) of over Rs2 lakh, while it is four years for SI of Rs1 or Rs2 lakh. Lower PED waiting period is welcome.
Free health check-up – The customer is entitled for a free health check-up at designated centres. The coupons will be provided to each insured for every policy year, subject to a maximum of two coupons per year for floater policies.
Sum Insured - ICICI Lombard Complete is offered for SI of Rs1 to Rs10 lakh. SI over Rs10 lakh and up to Rs50 lakh is offered in specific family floater options.
Claims based loading - There will be claims based loading up to 200% depending on the nature of claims, which is a real drawback. Recently, Apollo Munich launched Optima Senior, a senior citizen mediclaim product, with no claims loading. If a senior citizen mediclaim can come with no claims based loading, it is surprising that regular mediclaim is still keeping such tough clause.
No-claim-bonus - The no-claim-bonus will provide 10% additional SI for every claim-free year (except an out-patient claim), subject to a maximum of 50%. In the event of a claim during any subsequent policy period, the accrued additional SI will be reduced by 20%.
Critical illness - There is an optional cover for specific critical illnesses for couple of adults on the policy up to 60 years of age for SI of above Rs2 lakh.
Donor reimbursement - Expenses up to Rs50,000 incurred by the organ donor for undergoing any organ transplant surgery for you.
Day-care procedures - The product covers 140 day-care procedures which do not need 24 hours of hospitalisation.
Two year waiting – Applicable to certain ailments like cataract, dialysis, tonsils, varicose veins, stone, sinusitis and so on. Cataract will be limited to Rs20,000 per eye after the waiting period.
Major permanent exclusions – Non-allopathic treatment, dental treatment, cost of spectacles/contact lens, treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion and its consequences congenital disease.
Sub-limits for specific procedures – There are no sub-limits in the base policy, however, the customer can get the hospitalisation cover with a reduced premium by limiting the medical expenses pertaining to specified medical and surgical procedures.