Insurance review – A policy for all ages

Most folks would like to buy a single hospitalisation plan with multiple benefits that adequately covers both themselves as well as family members. This policy for all ages fits the bill with good coverage and all the benefits that a health policyholder would seek.

A policy for all ages

ICICI Lombard Complete Health Insurance Plan Health Shield – Policy basics

This policy is available for anyone above 18 years old. It allows both individual and floater options. In the floater plan, you can add up to 2 adults and 3 children. Children above 91 days of age can be added into the policy. If the age of the policyholder is above 46 at the time of purchase, he/she would have to undergo a medical test at a designated diagnostic centre. This is not a minus as most folks perceive, as it enables timely discovery and disclosure of pre-existing conditions, curtailing claim rejections later. 

The policy offers a good range of sum insured, starting from Rs 3 lakh and going up to Rs 50 lakh. In case you don’t want to buy a separate top-up policy to increase coverage, the cover under this policy can be enhanced to provide sufficient coverage. (Read this article to see how much health cover we recommend)

Apart from actual hospitalisation, the policy covers pre-hospitalisation and post-hospitalisation expenses of up to 30 days and 60 days, respectively. All day care treatments – that is, procedures that used to take more than 24 hours hospitalisation in the past, but are now completed in less than a day due to advancements in technology – are covered by this policy.

About the insurer

ICICI Lombard is a leading health insurer, ranking 7th based on premium collected. Among private insurers, it ranks 3rd.  Its claim settlement efficiency ratio is 99.72%, which indicates prompt settlement of claims. Its claim settlement ratio was 67.28% by value and 87.33% by number of claims, in the nine months ended December 2021. 

While claim settlement ratio by number of claims and settlement efficiency ratio are better than the average values for the sector (84.6% and 93.5% respectively), the ratio by value lags the sector average of 77%. 

There are other major insurers with good claim settlement by value, such as United India Insurance from the public sector (83.81%) and Bajaj Allianz from the private sector (89.9%). To better understand these metrics, see this article (all numbers are based on public disclosures for the nine months ended December 2021).

Why buy

We recommend this policy on the following counts.

  • No room rent limit: You don’t have to worry about the room rents as it doesn’t have a cap on how much room rent can be claimed. A room rent limit also tends to proportionately reduce reimbursement of other bills during hospitalisation, so the absence of a limit is a big plus. 
  • Low waiting period: The waiting period for coverage of pre-existing diseases is 2 years, which is better than peer policies which insist on 3 years. 
  • Restore benefits: This policy provides restore benefits, where your sum insured once exhausted will be restored by the insurer. But such restoration will only apply for a different disease. In the case of family floater policy, this is a good feature to have. Even if the full coverage is used for a policyholder, other members of the policy can still enjoy the full coverage restored by the insurer.
  • No co-pay: There is no co-payment clause to this policy, reducing the possibility of out-of-pocket expenses. Some policies limit maximum claim payable for selected modern treatments like robotic surgeries, balloon sinuplasty, immunotherapy etc. This policy does not have such limitations. This ensures that policyholders are eligible to claim the full amount in most situations.
  • No claim bonus: The policy also provides a no-claim bonus that automatically adds to your coverage. The sum insured is increased by 10% for every claim free year, subject to a maximum of 50% of sum insured. This feature could help in meeting an unexpected medical bill, that is beyond the total health cover purchased. 
  • Extras: The policy provides complimentary health check-up coupons for every renewal that can be used in a selected facility. This policy covers in-patient hospitalisation expenses at an AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy) facility, which is not covered by many insurers.

Suitable for seniors

In addition to the above, certain aspects of the policy make it a good option for senior citizens as well. This policy does not have a maximum age of entry. As we explained in when we talked about health insurance for senior citizens, dedicated senior citizen policies come with a lot of restrictions. Compared to these, broader policies like the ICICI Lombard Complete Health Insurance Plan Health Shield offer seniors a more comprehensive health cover with fewer restrictions, for those willing to fork out higher premiums. This policy also provides add-ons (explained below) that could be useful for senior citizens like nursing at home, domiciliary hospitalisation, organ donor expense coverage and air ambulance coverage.

Do note that one policy can have a maximum of two adults; hence you cannot add yourself, your spouse, and your parents to a single policy. In that case, a separate policy will have to be taken.

How premiums compare

ICICI Lombard Complete Health Insurance Plan Health Shield clearly has an edge on product features over competing policies. So how do its premiums compare? On this count, premiums do appear competitive.

For example, consider a family floater policy for a family of four with both adults at 35 years old. The premium for a Rs 10 lakh sum insured is at Rs 22,721. This compares well to the Rs 24,686 for Star Health Comprehensive insurance policy and Rs 32,448 for HDFC Ergo Optima Secure. Refer to this document, page 17 for the premium table.

For senior citizens, this policy is on the expensive side. For a sum insured of Rs 10 lakh and age 61-65; the policy’s premium works out to Rs 45,462 for an individual plan. This is higher than National Insurance’s Senior Citizen Mediclaim Policy at Rs 39,365. But as mentioned above, being a senior citizen-specific policy, the policy from National Insurance is far more restrictive in benefits. Refer to the Senior Citizen section in Prime Health Insurance for more details on benefits.

Optional add-ons

The policy provides a number of features as add-ons. Of course, these will entail additional costs. Here’s our take on whether you need to go for them.

  • Nursing at home: The insurer will pay expenses for nursing at home post hospitalisation. This will be available for only upto 15 days. Maximum payout per day will be Rs 2,000 or Rs 3,000 based on sum insured. This can be a useful feature, particularly for seniors. For Rs 10 lakh sum insured, this add-on will cost Rs 3,528 for a family of 4, with both adults aged 35. For an individual policy for a 60 year old, this add-on will cost Rs 882. 
  • Hospital cash benefit: In the case of hospitalisation, the insurer will pay a daily benefit in addition to any claim amount. The minimum number of days of hospitalisation to qualify for this benefit is 3. This benefit applies to a maximum of 10 days per hospitalisation. The maximum payout per day varies from Rs 1,000 to Rs 3,000 based on the sum insured. The cap on the number of days of hospitalisation reduces the usefulness of this add-on, as cash expenses are likely to hurt on extended hospitalisation. For Rs 10 lakh sum insured, this add-on will cost Rs 5,112 for a family of 4, with both adults aged 35. For an individual policy for a 60 years old, this add-on will cost Rs 1,278 a year. 
  • Sum insured protector: With this add-on, the sum insured will increase at the rate of consumer price inflation. While this may seem useful, healthcare inflation may be greater than consumer price inflation and the probability of making a claim will increase with age. In our view, this extra can be skipped in favour of getting a good initial sum assured. For Rs 10 lakh sum insured, this add-on will cost Rs 521 for a family of 4, with both adults aged 35. For an individual policy for a 60 year old, this add-on will cost Rs 827.
  • Worldwide cover: Usually health insurance coverage is applicable only to treatments undergone within India. With this addon, this policy offers to cover treatments undergone outside India, subject to conditions. A co-pay of 10% will be applicable for every claim. The cover will be applicable for a maximum 45 days from the date of travel from India and up to a maximum of 90 days in a policy year. Hence, this is not a replacement of health coverage for someone moving abroad. At best, it can be a good option for coverage on specific medical treatments that is yet to be available in India. For the vast majority of us, this add-on can be skipped. For Rs 10 lakh sum insured, this add-on will cost Rs 5,802 for a family of 4, with both adults aged 35. For an individual policy for a 60 year old, this add-on will cost Rs 18,557
  • Domiciliary hospitalisation: The medical expenses incurred as part of domiciliary hospitalisation will be covered, subject to conditions. This can be a useful add-on in case you have a health condition that requires prolonged treatment at home instead of as an in-patient. But this benefit has a number of exclusions which you need to be aware of. These include arthritis, bronchitis, liver diseases etc. See prospectus, page 13 for more details on this.
  • Air ambulance cover: Expenses incurred for air ambulance services in respect of an insured person will be covered by the policy. The possibility of availing this is remote, so this can be skipped.

The minuses

  • Treatment sub-limits : This policy has sub-limits on the claims applicable for cataract operation, a common condition among older folks. For sum insured up to Rs 5 lakh, the sub limit applicable is Rs 20,000 per eye, per policy year. This falls short of likely actual expenses. For a sum insured of above Rs 5 lakh, the sub limit applicable is Rs 1 lakh, which is sufficient to cover cataract procedures at today’s prices.
  • Permanent exclusions : The policy comes with a number of permanent exclusions. Treatment of obesity, expenses for investigation and evaluation, sterility and infertility treatments, experimental and unproven treatments etc. These fall in the exclusion list of the majority of the policies. Do note that in the case of senior citizens, the rest cure, respite care, experimental and unproven treatments are more probable, which are excluded. To see the full list of exclusions, see prospectus, page 7.
  • Maternity is not covered : For young couples, who would like an option to claim maternity expenses, this is a deterrent. But given that maternity is a planned event, this shouldn’t put you off from buying this policy.
  • Complicated offering : With many add-ons and separate conditions applicable to each add-on, it becomes difficult to evaluate the policy against applicable premium. 
    For example, the domiciliary hospitalisation benefits are not applicable for a number of diseases like arthritis, bronchitis, liver diseases etc. Nursing at home has limits on maximum daily payments and maximum number of days that can be claimed. Hospital cash benefits have limits, while the worldwide cover has co-payments.

Final take

ICICI Lombard Complete Health Insurance Plan Health Shield can be the go-to policy both for youngsters and seniors looking to cover all their hospitalisation needs with one plan. Go for this policy if there is a good presence of the network hospitals tied up with this insurer, in your area. For senior citizens, if you are looking for a policy with good benefits, do consider this one after checking premiums for the target age group.

More like this

13 thoughts on “Insurance review – A policy for all ages”

  1. sundar.srirammech

    How about list of diseases excluded? Is it good to compared to other health insurance companies

    1. Bipin Ramachandran

      Hello,

      Maternity and related expenses (e.g. treatment for miscarriage) are permanently excluded in this policy. There are other health insurance policies which cover this. Rest of the exclusions are comparable to similar policies from other insurers.

      Thanks

  2. Anandkumar Mehta

    Hi Bipin

    There’s a premium chart on page 16 and another one on page 17. What is the difference?

    1. Bipin Ramachandran

      Hello Sir,

      Page 16 contains premium excluding GST
      Page 17 contains premium including GST

      Thanks

  3. Prasanth Pathiyil

    Is health insurance portable now? I have ABC health assure plan at 17k family floater strated 5 years back. Im now 45 yo

  4. There is major problem with the policy which surprisingly is not covered by Prime investor.
    “They don’t pay for Same Person Same illness in the policy”

    1. Bipin Ramachandran

      Hello,
      If one has exhausted the sum insured for a specific illness, then more claims will not be paid for the same illness until the end of the policy-year. This is because the restoration of sum insured will not be applicable for the same illness.

      For all applicable cases of hospitalization, claim can be raised provided:
      * The sum insured is not exhausted in the policy-year
      * The illness is not specifically excluded in the policy
      * The waiting period is complete if the illness is due to a pre-existing disease

  5. I am 51 years OLD. I have a 15L cover from Office . I have 7 more years to retire. I need a policy to cover me and family ( Wife, Father, Son ) post retirement. What will be the best way forward ?

    1. Bipin Ramachandran

      We recommend buying an additional policy even if you are covered by the company policy. Health insurance policies may have limit on maximum age of entry or limit on features based on age of entry; however once purchased, these policies are renewable for life. Please refer our list of recommended policies https://www.primeinvestor.in/prime-health-insurance/ (Basic and Super Top-up) for yourself, spouse and son)

      Most policies will allow only upto 2 adults in a single policy, hence you will have to look for an additional policy for your father. Please refer the Senior Policies section for our recommended policies.

      Recommended reading:
      How much cover you need: https://www.primeinvestor.in/why-you-dont-need-a-1-crore-health-policy/
      Health insurance for senior citizens: https://www.primeinvestor.in/health-insurance-for-senior-citizens/

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The client may notify us of his/her wish to cancel his/her subscription by sending an email to [email protected]. The client must provide at least 5 business days advance notice for this to be implemented.

Refunds: There can be no cancellation and refund of subscription fee paid once the subscription is active, other than as stated in Clause 8 of these Terms. If the client is entitled to a refund as specified under Clause 8 of these Terms, the RA will credit that refund to the card or other payment method used by the client to submit payment, unless it has expired - in which case the RA will contact the client to proceed with the refund. If we do issue a refund or credit due to circumstances outside the obligations specified under Clause 8, we are under no obligation to issue the same or a similar refund in the future.

General disclaimers: The recommendations made herein in the Research Services are expression of views and/or opinions and should not be deemed or construed to be advice for the purpose of purchase or sale of any security, nor a solicitation or offering on any investment/ trading opportunity on behalf of the company, AMC, insurance company, or issuer of security referred to herein.

The content and research reports generated by the RA does not constitute or is not intended to constitute an offer to buy or sell, or a solicitation to an offer to buy or sell financial products, units or securities.

The information/ opinion/ views mentioned in research reports or by the RA are not meant to serve as a professional guide to the client or recipients of this Report. The research report, recommendation, or any other content published by the RA do not assure or guarantee any minimum or fixed returns to the client or recipients of the reports/ recommendations/ content.

Use of this information is at the client’s own risk. The client must make his/ her own investment decisions based on his/her specific investment objective and financial position and using such independent advisors as he/she believes necessary. The services rendered by the RA are on a best-effort basis. All information in the content or research report of the RA is provided on an as is basis. Information is believed to be reliable but the RA does not warrant its completeness or accuracy and expressly disclaim all warranties and conditions of any kind, whether express or implied.

While due care has been taken to ensure that the disclosures, information, and opinions given are fair and reasonable, PrimeInvestor Financial Research Pvt Ltd and/or none of its officers, directors, partners, employees, agents, subsidiaries, affiliates or business associates shall be liable for any direct, indirect, special, incidental, consequential, punitive or exemplary damages, including lost profits arising in any way whatsoever from the information/ opinions/ views contained in the research report and recommendations that form part of the Research Service, and/or mails, social media or notifications issued by PrimeInvestor Financial Research Pvt Ltd or any other agency appointed/authorised by PrimeInvestor Financial Research Pvt Ltd. Returns and performance figures mentioned in the research report represent past performance and should not be constituted to be future returns or guaranteed returns.

Any agreements, transactions or other arrangements made between the client and any third party named on (or linked to from) the Website are at your own responsibility and entered into at your own risk. Any information that you receive via the Website, whether or not it is classified as “real time”, may have stopped being current by the time it reaches you. Market price information may be rounded up/down and therefore may not be entirely accurate.

The purpose of these disclosures is to provide essential information about the Research Services in a manner to assist and enable the prospective client/client in making an informed decision for engaging in Research Services before onboarding.

History, present business and background: PrimeInvestor Financial Research Private Limited is registered with SEBI as Research Analyst with registration no. INH200008653. The Research Analyst got its registration on August 19, 2021 and is engaged in offering research and recommendation services.

Disciplinary history: There are no pending material litigations or legal proceedings against the Research Analyst. As on date, no penalties / directions have been issued by SEBI under the SEBI Act or Regulations made thereunder against the Research Analyst relating to Research Analyst services.

Details of the RA's associates: No associates.

Usage of Website Content: This Website is controlled and operated by the RA. All material, including research reports, recommendations, portfolios, ratings, lists of financial products, illustrations, statements, opinions, views, photographs, products, images, artwork, designs, text, graphics, logos, button icons, images, audio and video clips and software (collectively, “Content”) are protected by copyrights, trademarks and other intellectual property rights that are owned and controlled by the RA or by other parties that have licensed their material to us.

Except where otherwise agreed in writing with the RA, material on the Website is solely for the client’s personal, non-commercial use. Except as provided below, the client must not copy, reproduce, republish, upload, post, transmit or distribute such material in any way, including by e-mail or other electronic means and whether directly or indirectly and the client must not assist any other person to do so.

Without the prior written consent of the RA, modification of the materials, use of the materials on any other web site or networked computer environment or use of the materials for any purpose other than personal, non-commercial use is a violation of the copyrights, trademarks and other proprietary rights, and is prohibited. Any use for which the client receives any remuneration, whether in money or otherwise, is a commercial use for the purposes of these Terms.

The client may occasionally distribute a copy of a research report, or a portion of the same, from the Website in non-electronic form to a few individuals without charge, provided the client includes all copyright and other proprietary rights notices in the same form in which the notices appear, original source attribution, and the phrase “Used with permission from PrimeInvestor Financial Research Pvt. Ltd.”

While the client may occasionally download and store research reports or information from the Website for his/her personal use, he/she may not otherwise provide others with access to the same. The foregoing does not apply to any sharing functionality we provide through the Website that expressly allows the client to share Content or links to Content with others. In addition, the client may not use Content he/she has downloaded for personal use to develop or operate an automated trading system or for data or text mining.

The client agrees not to rearrange or modify the Content available through the Website. The client agrees not to display, post, frame, or scrape the Content for use on another website, app, blog, product or service, except as otherwise expressly permitted by these Terms. You agree not to create any derivative work based on or containing the research products and Content. The framing or scraping of or in-line linking to the Services or any Content contained thereon and/or the use of webcrawler, spidering or other automated means to access, copy, index, process and/or store any Content made available on or through the Services other than as expressly authorized by us is prohibited.

The client further agrees to abide by exclusionary protocols (e.g., Robots.txt, Automated Content Access Protocol (ACAP), etc.) that may be used in connection with the Research Services. The client may not access parts of the Research Services to which he/she is not authorized, or attempt to circumvent any restrictions imposed on your use or access of the Services.

As a general rule, the client may not use the Content, including without limitation, any Content made available through one of our RSS Feeds, in any commercial product or service, without our express written consent.

The client may not create apps, extensions, or other products and services that use our Content without our permission. The client may not aggregate or otherwise use our Content in a manner that could reasonably serve as a substitute for a subscription to the Website.

The client may not access or view the Services with the use of any scripts, extensions, or programs that alter the way the Services are displayed, rendered, or transmitted to you without our written consent.

The client agrees not to use the Services for any unlawful purpose. We reserve the right to terminate or restrict the client's access to the Website if, in our opinion, the client's use of the Services may violate any laws, regulations or rulings, infringe upon another person's rights or violate these Terms.

Prohibited content: The Website includes comments sections, blogs and other interactive features that allow interaction among clients and between clients and the RA. We call the information posted by or contributed by users “Contributed Content.” In the course of availing of the Research Services or uploading any post or comment on the Website, the client shall not post any Contributed Content that (i) contains nude, semi-nude, sexually suggestive photos, (ii) tends or is likely to abuse, harass, threaten, impersonate or intimidate other users of the Website and/or Research Services, (iii) is lascivious or appeals to the prurient interest or if its effect is such as to tend to deprave and corrupt persons who are likely to use or have access to the Website and/or Services, or (iv) otherwise violates, is prohibited or restricted by applicable law, rule or regulation, is offensive or illegal or violates the rights of, harms or threatens the safety of other users of the Website and/or Services (collectively “Prohibited Content”).

We reserve the right to cease to provide the client with the Research Services or access to the Website, or terminate your subscription, with immediate effect and without notice and liability, for violating these Terms, applicable law, rules or regulations and reserves the right to remove Prohibited Content which is in violation of these Terms, or is otherwise abusive, illegal or disruptive. The determination of whether any content constitutes Prohibited Content, violates these Terms, or is otherwise abusive illegal or disruptive, is subject to the sole determination of the Firm.

Changes to Research Services: We are constantly endeavouring to improve the quality of Research Services provided to our clients. Due to this, the form and nature of the Research Services provided may change from time to time without any prior notice to the client. We reserve the right to introduce and initiate new features, functionalities, components to the Website and/or Research Services and/or change, alter, modify, or discontinue existing ones without any prior notice to the client.

Warranty and liability disclaimer: The Website, Research Services, and all the materials and services, included on or otherwise made available to the client through this Website is provided by the RA on an “as is” and “as available” basis without any representation or warranties, express or implied except otherwise specified in writing. Without prejudice to the foregoing paragraph, the RA does not warrant that:

  • This Website and/or Research Services will be constantly available, or available at all;
  • The information on this Website or provided through the Research Services is complete, true, accurate or not misleading; or
  • The quality of any products, services, information, or other material that you obtain through the Website or Services will meet your expectations.

The RA, to the fullest extent permitted by law, disclaims all warranties, whether express or implied, including the warranty of merchantability, fitness for particular purpose and non-infringement. The RA makes no warranties about the accuracy, reliability, completeness, or timeliness of the Website, Research Services, Content, Contributed Content, Services, software, text, graphics and links.

The RA does not warrant that this Website, Research Services, information, content, materials, or any other material included on or otherwise made available to you through this Website, their servers, or electronic communication sent by the RA are free of viruses or other harmful components.

Nothing on this Website constitutes, or is meant to constitute, advice of any kind.

Indemnification: The client:

  1. Represents, warrants and covenants that no materials of any kind provided by him/her will:
    1. Violate, plagiarise, or infringe upon the rights of any third party, including copyright, trademark, privacy or other personal or proprietary rights; or
    2. Contain libellous, Prohibited Content or other unlawful material;
  2. Hereby agree to indemnify, defend and hold harmless the RA and all of the RA’s officers, directors, owners, agents, customers/clients, information providers, affiliates, licensors and licensees (collectively, the “Indemnified Parties”) from and against any and all liability and costs, including, without limitation, reasonable advocate’s fees, incurred by the Indemnified Parties in connection with any claim arising out of any breach by the client of these Terms or the foregoing representations, warranties and covenants. The client shall cooperate as fully as reasonably required in the defence of any such claim. The RA reserves the right, at its own expense, to assume the exclusive defence and control of any matter subject to indemnification by the client.

Applicable law: This Website, including the Content and Contributed Content and information contained herein, and the provision of Research Services shall be governed by the Securities and Exchange Board of India, laws of the Republic of India and the courts of Chennai, India which shall retain exclusive jurisdiction to entertain any proceedings in relation to any disputes arising out of the same. As such, the laws of India shall govern any transaction completed using this Website.

Information gathered and tracked: Information submitted or collected on the Website or pursuant to the use of the Services is stored in a database. Specifically, we store the username, name, e-mail address, contact number, as submitted or collected on our Website or through the provision of the Research Services. We may use such information to send out occasional promotional materials, including alerts on new Services available, or other promotional and marketing material relating to our clients and customers.

In accordance with the Information Technology Act 2000, the name and the details of the Grievance Officer at PrimeInvestor is provided below:

Mr. Srikanth Meenakshi
PrimeInvestor Financial Research Pvt. Ltd., Registered office: 659, 4th Avenue, D-Sector, Anna Nagar Western Extension, Chennai 600 101.
Email: [email protected]

11. Mandatory notice:

Clients shall be requested to go through Do’s and Don’ts while dealing with RA as specified in SEBI master circular no. SEBI/HO/MIRSD-POD-1/P/CIR/2024/49 dated May 21, 2024 or as may be specified by SEBI from time to time.

12. Optional Centralised Fee Collection Mechanism:

SEBI has operationalized a centralized fee collection mechanism for IA and RA. Under this mechanism, clients shall pay fees to IAs/RAs through a designated platform/portal administered by a recognized Administration and Supervision body. This is an optional mechanism for the registered entities. At this time, PrimeInvestor has opted out of this fee collection mechanism. Therefore, all subscription payments for the Research Services will be through the modes as specified in Clause 5 of these Terms.

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