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.

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.