What is restoration benefit in health insurance?
Restoration benefit in health insurance - Importance, types and points to note before claim.
July 11, 2022
Claim settlement ratio (2019-20)
Total GHI lives insured (2020-21)
Total GHI claims incurred (2020-21)
Rs. 1863 crores
A leading private sector insurance company, ICICI Lombard is a joint venture of ICICI Bank Limited and Canada based Fairfax Financial Holdings Limited. With the mission of creating value in the market by offering general and group health insurance solutions, ICICI Lombard has been consistently recognized with several awards for its innovative products and customer-centric approach. ICICI Lombard is the most preferred by people because it is dependable, approachable, and transparent.
Moreover, ICICI Lombard offers a range of group health insurance plans that aims to provide wide coverage and the best service to their customers. The super top-up plan that ICICI Lombard offers covers policyholders when the sum insured amount of their base health insurance plan gets exhausted. Thus, ICICI Lombard works relentlessly in catering to all the insurance needs of its policyholders.
With the dedicated team with 24*7 service at Pazcare, your insurance journey is made easy. The process of buying your ICICI Lombard group health insurance is made completely tech-enabled, hassle-free, and convenient. The employee dashboard where employers and employees can easily track the policies, claims, inclusions, and exclusions, Pazcare has become the most preferred among HRs. Our consultants at Pazcare will certainly help you get the best group health insurance quotes in the market.
These simple steps will guide you to purchase ICICI Lombard group health insurance online at Pazcare.
For further information, write to us at email@example.com or call our customer care at +91 78291 11300. Alternatively, connect with us on Whatsapp using the number +91 81973 79596.
ICICI Lombard remains the top choice for many when it comes to buying group health insurance. Some of the main reason why you should choose ICICI Lombard as your insurance partner is highlighted below:
6500+ network hospitals
With over 6500+ widespread network hospitals under ICICI Lombard, you can enjoy cashless as well as reimbursement treatment.
Outstanding claim settlement ratio
ICICI Lombard has an impressive claim settlement ratio of 78.57% (2020-21) which makes it the most preferred choice by customers.
Cashless claim settlement facility under 4 hours
ICICI Lombard has an impressive cashless claim settlement facility which is within 4 hours. Completely hassle-free and makes your insurance journey seamless.
Wellness programs and more
ICICI Lombard provides wellness packages where you can enjoy various services. Some of them include online HRA which is a tool to evaluate your health status and quality of life. Also, Disease Management Service (DMS), various free health check-up facilities, and medical concierge services.
Your Claim Settlement Ratio (CSR) is the percentage of claims that your insurance company settles in a year out of the total claims made during the year. To put it in simple words, the higher the ratio, the more reliable the insurer is. Thus, the claim settlement ratio acts as a credibility indicator.
ICICI Lombard has a widespread network with over 6500+ hospitals across India. This allows you to avail cashless medical treatment as per the terms and conditions of your policy. You do not have to pay out of your pocket. Make sure you check if your nearest hospital is under the network hospital list before you get hospitalized.
ICICI Lombard group health insurance cashless claim
The process of availing of a cashless claim at ICICI Lombard is completely smooth and hassle-free. This makes ICICI Lombard the most preferred insurance carrier. Here’s how you can make cashless and reimbursement claims under the ICICI Lombard group health insurance plan.
Follow these steps to avail of cashless treatment under your ICICI Lombard group health insurance plan.
Step 1: Visit the nearest network hospital
Get hospitalized at the nearest network hospital that is under the ICICI Lombard network in order for you to avail of the cashless treatment.
Step 2: Show identity proofs
Show your health insurance ID card, company ID card, and proof of identity.
Step 3: Fill and submit the pre-authorization form
Make sure you fill-up the pre-authorization form, which the hospital will then forward to ICICI Lombard Health Administration Team (HAT).
Step 4: Request review
Now your documentation will be sent for verification purposes to ICICI Lombard. They will cross-check with your policy benefits. ICICI Lombard will then inform the hospital about the decision.
Step 5: Claim settlement
You do not have to do anything, your insurer will settle all your medical bills directly with the hospital. Wait till you claim the request gets approved and once approved, you will be notified within 60 minutes. ICICI Lombard will directly settle at the hospital, you really do not have to worry about anything.
ICICI Lombard group health insurance reimbursement claim process
In order to avail reimbursement claim facility under your ICICI Lombard group health insurance plan, kindly follow these steps:
Step 1: Get admitted to a non-network hospital
Get hospitalized, and get the treatment from a non-network hospital nearest to your place or of your choice.
Step 2: Make the payment at the hospital up-front
Make sure you clear all the bills at the hospital upfront from where you received the medical treatment.
Step 3: Collect all the documents
Collect all the original bills and supporting documents required. Contact us at firstname.lastname@example.org
Documents required for ICICI Lombard group health insurance claim settlement
Make sure you submit all these documents for a group health insurance reimbursement claim settlement with ICICI Lombard.
Step 4: Documents Submission
After you are done collecting all the required documents, submit them to the nearest ICICI Lombard health insurance branch. Do it under 15 days of discharge.
Step 5: Claim processing
Once you submit all the required documents, your insurer will validate the documents. The insurer will either approve or reject the reimbursement claim process. Once it is settled, it will get deposited in your bank account.
You can also contact us at email@example.com. We will guide you through the whole process. We provide 24X7 claim assistance for your employees.
Renew your ICICI group health Insurance before it expires so that you do not lose the benefits. Here are all the steps for your renewal process:
Step 1: Get in touch with the team Pazcare by submitting a form containing your personal details like name, company details, employee strength, number of employees you are looking to insure, etc.
Step 2: Our consultants will reach out to you once you submit the form. Submit the following documents along with the form.
Step 3: You can choose additional add-ons to your existing policy if you feel the need for it. This includes your dental insurance riders, maternity benefits, and more. With Pazcare, you can choose a wide range of additional add-ons like wellness and therapy sessions, unlimited medical consultations, and several other comprehensive packages.
Step 4: Our consultants will get back to you with competitive quotes for ICICI Lombard group health insurance. Consultants will quickly go through your claim report and the add-ons you have selected. Thus, your insurance premium might vary from the previous financial year.
Step 5: Now you are given the terms and conditions, and once you agree to them, the premium should be paid to the ICICI Lombard group health insurance policy.
Step 6: The onboarding process will be done in 24 hours by Pazcare. Our team members will reach out to you if any additional information is required from your end.
We at Pazcare will ensure that you have the best insurance-buying experience and it is made seamless with the help of Pazcare’s dashboard.
Step 7: Now you have to verify all your documents. Your insurance provider will let you know if any additional documents are required from your end.
Step 8: The final step is the claim settlement. Once your documents get verified, and the claim has been made per the policy terms and conditions, the payment will be made within 7 working days.
Here are some of the main factors that play a vital role in deciding the premium of ICICI Lombard group health insurance.
The age of the person is considered when determining your insurance premium. Age is put into consideration because this factor helps in accessing the risk. Generally, it is assumed that younger people have better immunity compared to older people. Hence, the fewer health risks, and the premium would be low.
Nature of the job
Your nature of the job is also considered while calculating the premium. Some jobs are risk-averse while some jobs are highly risky. Thus, high-risk jobs will have higher premiums.
The monetary limit up to which the insurer can cover all his/her health and medical expenses if an employee is referred to as the sum insured of a policy. To put it in simple words, the higher the sum insured, the higher the premium.
Your Claim history
Your claim history is also considered by your insurer while calculating the policy’s premium. The insurer will check all the previous claims and see if there are any chargeable premiums while renewing the policy.
If you want to customize your insurance policy with different add-ons then the premium will increase. However, a standard group health insurance policy is offered to the employee.
In-Patient hospitalization expenses
If you get ill or meet an accident, your ICICI Lombard group health insurance plans cover you against in-patient hospitalization. Some of the expenses include hospital room rent charges, nursing expenses, hospital ICU, surgeon expenses, operation theater expenses, etc.
Pre- hospitalization and post-hospitalization expenses
Under ICICI Lombard group health insurance plans, cover 60 days of pre-hospitalization and 90 days of post-hospitalization expenses.
You can cover all the maternity-related expenses for a normal and c-section delivery. You just have to opt for a maternity insurance rider.
Accidental hospitalizations coverage
Your hospitalization expenses that arose due to accidents are covered under your ICICI Lombard group health insurance policy. However, these hospitalizations must be for a period of more than 24 hours. Mind you, the coverage is only limited to India.
If you get ill and have to take an ambulance facility to rush to the hospital, your ambulance charges are all covered under the ICICI Lombard group health insurance plan.
Nutritional supplements/ tonics
ICICI Lombard group health insurance plans do not cover you for your unprescribed vitamins, tonics, or any nutritional supplements.
Injuries caused by self-harm
ICICI Lombard group health insurance does not cover you against any diseases caused by the intention of self-harm.
Treatment arising from the abuse of substances
ICICI Lombard group health insurance plans do not cover you against the disease or treatment caused due to the abuse of any substances like drugs, alcohol, etc.
ICICI Lombard group health insurance plans do not cover you against any treatment which is not yet proven.
Choosing ICICI Lombard is a smart decision considering the benefits. Here are some of the benefits of ICICI Lombard:
100% sum insured reset feature
You can enjoy this benefit once during a policy term where your ICICI Lombard plan can be reset up to 100% of the base sum insured during a policy term. This is if the sum insured is insufficient due to the claims made in the previous year.
Several rewards for healthy habits
Your ICICI group health insurance plan offers you various rewards in the for of wellness points for your healthy habits. Look at the terms and conditions to redeem this facility.
Absolutely free value-added services
There are several free value-added services provided under your ICICI Lombard group health insurance plan. Some of them include e-consultation, online chats with health experts, health check-ups, audiology, and much more.
Designed for all small & medium enterprises to large organizations
Your ICICI Lombard group health insurance is designed for all enterprises including small, medium, and large enterprises. The group health insurance offers choices to employees to choose plans which are personalized and the sum insured range starts from 1 lakhs to 10 lakhs.
Intimate your insurer
Make sure you inform ICICI Lombard group health insurer about your claim to the insurer. Make sure it is within 48 hours or at least 3 days prior in case of emergency. This is in the case of planned hospitalization.
Have all the necessary documents ready with you. Your proof of identity - policy number/health insurance ID card, company ID, and a valid unique govt. ID card.
Submission of pre-authorization form
Fill up the pre-authorization form and submit it to the hospital
The claim will be settled directly at the network hospital once all your details are verified.
Contact us for any queries
For any queries or help, contact Pazcare at firstname.lastname@example.org or call us at +91 78291 11300.
Intimate your insurer
Inform about your claim to the insurer within 48 hours or at least three days prior in case of emergency. This is in the case of planned hospitalization.
Clear all your bills
Make sure you clear all your bills and collect the original copies of hospital bills, doctor consultation reports, and other essential documents.
Submit all the required documents along with the claim form to the insurer.
The claim will be settled in your bank account directly once all your documents are verified.
Contact us for any queries
For any queries or help, please contact Pazcare at email@example.com or call us at +91 78291 11300. The team will make sure you are given the right solution.
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Why buy a group health insurance
policy online from Pazcare?
For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.
The ICICI Lombard health insurance customer care number is 1800-103-2292. You can also email them at firstname.lastname@example.org.
Your insurance premium is calculated based on the employee's demography, claim experience of the past 2-3 years, and coverage provided to the client.
Yes, an employee can avail of the benefit of covering his/her dependents under the ICICI Lombard group health insurance. Dependents include spouses, children up to 25 years of age, and parents up to 80 years of age.
The initial waiting period for ICICI Lombard group health insurance is 30 Days.
Several treatments on a trial/experimental basis and any device/instrument/machine contributing/replacing the function of an organ or injuries caused by self-harm are not covered under your ICICI Lombard group health insurance.
Abortion is covered, provided it is prescribed by your doctor & under a critical condition during pregnancy. Mind you, voluntary abortion is not covered under the policy.
There is no limit on the number of claims allowed.
The Claim Settlement Ratio of ICICI Lombard group health insurance can be calculated using this formula:
Claim Settlement Ratio = (Total no. of claims approved/Total no. of claims received) x 100
You can claim ICICI Lombard group health insurance in two ways. You can go for a cashless claim at a network hospital and a reimbursement claim at a non-network hospital.