Power of Infinite Personalisation

HEALTH INSURANCE
Golden opportunity for Growth
Macro trends contributing to improve health insurance penetration

~17%
of world diabetes patients

~14% ~50%
medical inflation, Expenses are
2x of overall inflation 17% out of pocket
of world population,
~5%
~₹35k bn Retail health insurance
penetration ~40%
healthcare urbanization
market expected by 2031

Crisil’s India Outlook report, CEBR, WHO 2023, India’s Impending Economic Boom- Morgan Stanley, Frost & Sullivan
Emerging Customer Needs
Curating solutions basis
requirements
 Inadequate
Adequate
Fair
Affordable
pricing
protection
coverage

One size
What are the
Transparency
Customised Trust
in claims
fits all
What does offering
challenges approach
the customer
faced by
want?
customer?

5
 Key information

Entry Age Family Floater Limit Child Considered

• 18 YEARS to no • 2 adults & 3 as Kid Till 30
limit kids • If policy taken with parents

Tenure Options Standard Waiting Periods Sourcing Guidelines

• 1 year • Accidental hospitalization: Day 1 • New:
• 2 years • Initial waiting period: 30 days • Zone A, Pune starts with 7.5L
• 3 years • Pre-existing disease: 3 yrs • Zone B, C starts with 5L
• Specific illness, Maternity, Bariatric • Zone D starts with 10L
surgery: 2 yrs • Rollover:
• CI Add on: 90 days • Starts with 10L
Inbuilt covers
 Inbuilt Covers

In Patient Pre & Post Cover Reset Benefit Loyalty Bonus

Upto Sum Insured Upto Sum Insured Unlimited times 20% upto max.
Single Pvt Room Pre 90 | Post 180 days (Any person any illness) 100% Increase in Sum Insured

Domiciliary
Donor Expenses Bariatric Surgery Hospitalization Modern Treatments
Upto Upto Sum Insured Upto
Sum Insured 2 years waiting period Upto
Sum Insured (SI) Sum Insured
 Inbuilt Covers

Domestic Road Surrogacy & OOCYTE

Ambulance Day Care Surgeries Ayush In Patient
Upto Upto In patient treatment for
Upto Sum Insured
Sum Insured Sum Insured surrogate mother & oocyte
donor upto Max 5L

Wellness Program Health Assistance Team

Ambulance Service Deals & Discount
Arrangement of ambulance Deals & discount through IL 30% renewal discount basis Assistance in queries related
through IL Take Care app Take Care app on the earned wellness to health & health care
points providers
Add – On Covers
 Remove SI limit on any one claim
of your choice with Infinite Care cover

Ankit’s Sum Insured is 10L

10L

with
5L 2L Infinite Care activated
infinite Claim Claim on high value claim
(higher than SI without any limit)

claim
Ankit has bought Elevate with 10L SI along with Infinite Care add-
on. Apart from two claims of 5L & 2L, a surgery is planned which
IN ACTION

will cost 30L

As claim amount exceeds SI 10L, with Infinite Care he is eligible to

avail this claim and get the whole amount covered.
 100% Increase in Base SI every year UNLIMITED
times with Power Booster cover irrespective of claim

with
infinite 20th Year Policy SI ₹2Cr
SI boost Suhana, a 42-year-old from Indore, has opted for a base
10th Year Policy SI ₹1Cr Sum Insured (SI) of 10 lakhs along with the Power

IN ACTION
Booster Cover.

With this, her SI doubles each year irrespective of any

5th Year Policy SI ₹50L claim: 20 lakhs in the 2nd year, 30 lakhs in the 3rd year,
and continues increasing till she stays covered with
Elevate.

1st Year Policy SI ₹10L This is excluding SI increase due to GCB

 Option to choose Unlimited SI cover

3Cr 1Cr
50L
with
infinite
25L
SI option

20L

3Cr 5L
 Reduced Waiting Period for PED customers
with Jump Start cover

30 Days 3 Years

with PED waiting

period
Jump Start Asthma
Obesity Mr. Sharma has Hypertension for past 5
years. He wants a health policy with

IN ACTION
Hyperlipidaemia immediate cover without waiting for years.
Hypertension

With Jumpstart cover in Elevate, PED waiting

Diabetes period for Hypertension will get reduced from
3 years to 30 days

To be availed at the time of fresh sourcing

 Reduced Waiting Period for PED customers
with Jump Start cover

Reduced pricing basis family combination

Before After
with 1A 30.0% 30.0%
Jump Start 1A1K 30.0% 20.0%
1A2K 30.0% 15.0%
1A3K 30.0% 12.5%
2A0K 30.0% 17.5%
2A1K 30.0% 13.5%
2A2K 30.0% 12.0%
2A3K 30.0% 10.0%

More affordable More personalized

 With iinfinite personalization…. Powered by AI

Infinite Care Power Booster

Get one-time infinite claim amount for your Get Cumulative Bonus of 100% every year irrespective
selected claim of claim for indefinite period

Infinite Sum Insured Jump Start

With unlimited SI option , the hassle of limited Get PED waiting period reduced from 3 years
coverage will be a thing of the past to 30days with Jump Start add-on

+ many more features to personalize your cover

 Personalize your cover basis geographical
coverage

Worldwide
NRI Advantage
cover
with
Infinite
Coverage for NRI/ Get coverage across
personalization for OCI the globe
customers seeking
Get complete Planned & emergency
specific features coverage in India cover on cashless basis
only
New
NEW
features NRI Advantage add-on cover
FEATURE

Get comprehensive health insurance coverage in India

35.4 Mn NRI
population • Coverage for Non Resident Indians
(NRI) / Overseas Citizens of India (OCI)
while in India
18% NRIs travel to India
for medical reasons • Get base coverage at 25% discount on
every year premium

India preferred destination for • Discount will continue as long as

affordable advanced medical customer is NRI/OCI
treatments
• Other add-on covers can also be opted
*
NRIs need waiting period
continuity if they return to
India
*except Worldwide cover

For internal circulation only

 NEW NRI Advantage add-on cover
FEATURE

Conditions for Eligibility Documents required Other T&Cs

• NRI/OCI Declaration • Proof of residence in India • Worldwide cover cannot be
• Identity proof for Citizenship of • Proof of residence outside India availed by the NRI/OCI
India • Proof of Employment/Self • Policy issuance will happen post
• Indian bank account for employment/Student document QC (NSTP)
premium/claims payment

Declaration of overseas residence to be submitted on every renewal to avail discount

In case of permanent return to India the policy can be continued without NRI Advantage discount

For internal circulation only

 NEW Worldwide add-on cover
FEATURE

Get coverage for planned & emergency treatments in foreign countries with Worldwide cover

Coverage across all countries in the

Sum insured up to Rs.3Cr
world

Total 90 days cover in a policy Coverage not limited to listed critical

year illnesses but available for any illness

Available on cashless No waiting period in case of

basis only accidental emergencies

Option to reduce waiting period from

2 years to 1 year
For internal circulation only
 NEW Personalize your cover basis age & PED
FEATURE

Disease Management
Senior Care
Program
with
Value added Holistic approach for
Infinite
services disease management
personalization for
customers seeking Expert care and Expert guidance &
specific features support for seniors health check-ups for
aged >55 years customers with PED
 NEW Emerging needs of ageing population in India
FEATURE
A growing segment that requires care & support

Demographic shift Chronic diseases alert

180mn Indian population ~21% of elderly with atleast

aged 55yrs+ 1 chronic illness
1 in 4 suffer from mental
health issues

Family structure shift Time crunch

Rising trend of nuclear 65% of urban families
families unable to provide daily care
to seniors
Young adults settling abroad

For internal circulation only

 NEW Senior Care add-on cover
FEATURE
One stop solution for all your health care & support needs

Consultations Deals &

& diagnostics VAS
discounts

Emergency Engagement

For internal circulation only

 NEW Senior Care add-on cover
FEATURE
Access to host of services for your health & support needs

Consultations & Emergency Engagement Value added

diagnostics services Deals & discounts activities services

• Specialist • 24 X 7 Emergency • Up-to 35% off on • Updates on live events • Online Concierge
Teleconsultations assistance diagnostic services on health, wellbeing & Service
• Second Opinion • Doctor on call • Up-to 20% off on celebrations • Digital health records
• Physiotherapist • Ambulance assistance medicine orders • Offline events and • Home Fumigation
Sessions • Up-to 20% off on activities for • Nursing/Attendant care
• Psychologist Sessions medical equipment entertainment at home
• Doctor Home Visits • Up-to 10% off on • Elder-friendly Tours • Lifestyle management
physiotherapy program

Option to choose from 4 plans available ranging from* Rs. 763 to Rs. 1695

* Premium given above is for 2A plan & is exclusive of GST

The cover descriptions are for reference purposes only. The policy wordings remain sacrosanct
For internal circulation only
 NEW Disease Management Program add-on cover
FEATURE

• Hypertension and diabetes together • Cardiovascular illness alone account for 37%
account for 68% of lifestyle illness cases of lifestyle illnesses

Management of chronic care requires a holistic approach focusing on right medicine, lifestyle changes, physical activities, and
health education.

Disease Management Program* offers

• Expert guidance to maintain/ improve health conditions
Manage & improve existing health
• Dietician and nutritional counseling
conditions effectively

• 2 Health check-ups
Promote overall well-being and a healthier
• Counselling for lifestyle modifications lifestyle

*Applicable for customers with Hyperlipidaemia, Diabetes, Obesity, Asthma or Hypertension or with family history of PED

For internal circulation only

 NEW Disease Management Program add-on cover
FEATURE

Mr. Sharma, aged 42yrs has a family history of diabetes & he suffers from border line diabetes. Mr. Sharma
opts for Disease Management Program

Health assessment Doctor consultation & diet & 2nd Diagnostic test for
call medicine regimen health improvement check

6th Post 6th

Day 1 Day 2 Day 7 Day 10 monthly
month month

Onboarding call to 1st Diagnostic test Follow-up calls & Regular follow-ups until
explain program benefits Doctor consultation the policy term

With guidance from expert doctors under Disease Management Program,

Mr. Sharma manages to improve his health conditions & enjoy healthy lifestyle

For internal circulation only

 Personalize your claims experience

Claim Protector Inflation Protector Air Ambulance

with
Infinite
Non payables SI increase Emergency
personalisation for
Gloves, cotton, At renewal, basis of Covered up to Sum
customers seeking syringe, mask etc. inflation % of insured
specific features are covered previous year
 Personalize maternity benefits

Maternity Newborn Baby Vaccination

Expenses Cover Cover Expenses
with
Infinite Delivery expenses Medical expenses 1st Year for Baby
personalisation for
• 10% of SI, max up • Hospitalisation
customers seeking to 1 lakh expenses up to
• Vaccination
expenses
specific features • 2 years waiting 90 days
• 1% or max. Rs.
period • Coverage twice 10,000 of sum
the maternity insured
coverage
 Personalize accommodation and travel

Dependent
Room Modifier Compassionate Visit
Accommodation
with
Infinite Upgrade- Daily benefit Travel expenses
personalisation for Downgrade
• Upgrade to all • 1,000 per day
customers seeking room category up to 10 days
• Up to INR 20,000
benefit
specific features • Downgrade to • On 3 days of • Conveyance for
twin sharing hospitalisation immediate relatives
 Personalize home care and recovery

Durable Medical Convalescence

Nursing at Home
Equipment Cover Benefit
with
Infinite
Home care Equipments Recovery benefit
personalisation for
customers seeking • Rs.2,000 per • Wheelchair, • Lump sum up to
day, up to 10 ventilator, suction Rs. 20,000
specific features days machine
• =>10 days of
• Up to SI or max. 5 hospitalization
lacs
 Personalize preventive care

Health Check-up BeFit Teleconsultation

with
Infinite Anytime support
Preventive care Cashless OPD
personalisation for
customers seeking • 0.5% of SI, max • Pharmacy, • Unlimited
up to Rs. 5,000; Diagnostics, OPD teleconsultation
specific features • On Cashless basis Consultations etc
available in 7 plans
 Personalize for emergency

Personal Accident 20 Critical Illness

with
Infinite Accidental coverage
Lump sum Benefit
personalisation for
customers seeking • Up to SI, max up to • Up to SI, max up to
specific features 50 lacs 50 lacs
• No survival period
 Discounts for our special customers

with
UP TO
infinite UP TO UP TO

discounts 15% 15% 2.5% 10% 30% 25%

EARLY RENEWAL
LONG TENURE CIBIL SCORE BEFORE 30 DAYS PPN NETWORK WELLNESS NRI Advantage
DISCOUNT

Maximize value with premium-cutting add-ons

* Total discount capped at 30%
 Medical Underwriting
Screening, Process & Pre-tests
 Key inclusions in medical underwriting

Diabetes Type Blood Pressure Reading* HbA1c*

Type 2 (Non-Insulin) Lesser than 150/100 Up to 8% (from 7%)
(150/90)

Obesity (Standalone) Asthma Hyperlipidemia*

BMI up to 39 On occasional usage of inhalers and • Total cholesterol up to 300
absence of history of hospitalization • Triglycerides up to 250
• LDL up to 180

Other Age when first detected* Duration since detection*

Good management of ailment with Greater than 30 years Max up to 15 yrs
medications with no complications or
history of hospitalization (Neuropathy,
Nephropathy, Retinopathy etc) * Relaxed parameters Loading as applicable
 Tele-screening Process

All Pre-existing Age Sum Insured

Zones Disease Criteria Criteria
PED 55 years & above >=25L

• Pre-medical policy check up will be triggered on case to case basis and for PEDs
 Zone Distribution

A B C D
Delhi,
Mumbai (including Thane Rest of India (Punjab, Rajasthan
district, Navi Mumbai), (excl. NCR region), Chandigarh, Rest of NCR (Alwar district,
Himachal Pradesh, Jammu &
Gurugram district, Pune, Kolkata, Telangana Kashmir, Ladakh, Lakshadweep,
Bagpat district, Bharatpur
Karnal district, Sonipat district, (incl. Hyderabad), Madhya Kerala, Tamil Nadu (excl. Chennai, district, Bulandshahr
Rohtak district, Bhiwani district, Pradesh, Goa, Gujarat Pondicherry), Odisha, Arunachal district, Faridabad district,
Chakri Dadri district, (excl. Ahmedabad and Pradesh, Assam, Manipur, Gautam Buddha Nagar
Mahendragarh district, Daman Surat), Bangalore, Chennai, Meghalaya, Mizoram, Nagaland, district excl. Noida, Jhajjar
& Diu, Dadra Nagar, Andhra Pradesh, Tripura, Sikkim, Andaman & Nicobar, district, Jind district, Nuh
Ahmedabad, Surat, Noida City, Chattisgarh, Pondicherry, Rest of Karnataka, West Bengal district, Panipat district,
(excl. Kolkata), Bihar, Jharkhand,
Ghaziabad district, Hapur Uttarakand Rewari district, Mewat
Maharashtra (excl. Mumbai and
district, Meerut district, Pune), UP (excl. NCR Region), district, Palwal district)
Muzaffarnagar district, Shamali Haryana (excl. NCR region)
district

10% discount on 15% discount on 12.5% loading on

Zone A Zone A Zone A
Trivia Time

Which cover gives 100% bonus on

SI every year unlimited times
irrespective of claims?

Answer: Power Booster

Trivia Time

Can a customer claim an amount

exceeding the SI limit?

Answer: Yes, if customer has

already opted for ‘Infinite Care’
add-on
Trivia Time

I have hypertension and I am

diabetic too. How soon can I
get covered?

Answer: Jump Start add-on

cover protects you right from
the 31st day of the policy
Trivia Time

I am a 81-year-old retired person.

Can I buy Elevate health insurance?

Answer: Yes, there is no

upper age limit
Trivia Time

Is reset benefit available for same

person same illness?

Answer: Yes, unlimited reset benefit

is available as inbuilt feature &
covers for same or unrelated
illness for any person
Cancellation Grid
and
Claim Procedure
 Refund % for 1- Refund % for 2- Refund % for 3-
Cancellation period Refund % for 1-year tenure Policy Refund % for 2-year tenure Policy Refund %
for 3-year tenure Policy year tenure year tenure year tenure
Cancellation period Policy Policy Policy
Within 1 month* 80.00% 80.00% 80.00%
From 1 month to 3 months 60.00% 70.00% 75.00%
From 3 months to 6 months 40.00% 60.00% 67.50%
From 6 months to 9 months 20.00% 50.00% 60.00%
From 9 months to 12 months 0 40.00% 52.50%
From 12 months to 15 months NA 30.00% 47.50%
From 15 months to 18 months NA 20.00% 40.00%
From 18 months to 21 months NA 10.00% 32.50%
e
From 21 months to 24 months
From 24 months to 27 months
NA
NA
0
NA
25.00%
20.00%

claim
From 27 months to 30 months
From 30 months to 33 months
From 33 months to 36 months
NA
NA
NA
NA
NA
NA
12.50%
5.00%
0.00%
Not applicable for policies with free look period; Premium refund for cancellations during the free look period will
be provided as per the Free look clause. Free look period of 30 days beginning from the date of receipt of policy
document.
Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of
Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the insured
person under the policy.

b) The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of material facts,
fraud by the insured person by giving 15 days’ written notice. There would be no refund of premium on cancellation
on grounds of misrepresentation, non-disclosure of material facts or fraud.
1. Claims Procedure

A. For Cashless Settlement

Cashless treatment is only available at a Network Provider (List of Network Providers is available at our website). In orderto avail of cashless treatment, the following procedure must be
followed by You:
Pre-authorization
Prior to taking treatment and/ or incurring Medical Expenses at a Network Provider, You must contact Us or Our in house claimprocessing team accompanied with full particulars namely,
Policy Number, Your name, Your relationship with Policy Holder, nature of Illness or Injury, name and address of the Medical Practitioner/ Hospital and any other information that may be
relevant to the Illness/ Injury/ Hospitalisation. You must request preauthorization at least 48 hours before a planned Hospitalization and in case of an emergency situation, within 24 hours
of Hospitalization.
To avail of Cashless Hospitalization facility, you are required to produce the health card, as provided to You with this Policy, subject to the terms and conditions for the usage of the said
health card Or You can seek pre authorization by providing Your Policy number and ID proof to the hospital who can co-ordinate with Our claim team to provide cashless facility. We will
consider Your request after having obtained accurate and complete information for the Illness or Injury for which cashless Hospitalization facility is sought by You and We will confirm Your
request in writing.
B. For Reimbursement Settlement

i. You shall give notice to Us or Our in house claim processing team by calling the toll free number 1800 2666 or emailing us at [email protected] as specified in the
Policy provided to You and also in writing at Our address with particulars as below:
Policy number;
Your Name;
Your relationship with the Policyholder;
Nature of Illness or Injury;
Name and address of the attending Medical Practitioner and the Hospital;
Any other information that may be relevant to the Illness/ Injury/ Hospitalisation

The above information needs to be provided to Us or Our in house claim processing team immediately and in any event within 10 days of Hospitalization, failing which We will have the
right to treat the Claim as inadmissible, as We may deem fit at Our sole discretion.
ii. You must immediately consult a Medical Practitioner and follow the advice and treatment that he recommends.
iii. You or someone claiming on Your behalf must promptly and in any event within 30 days of Your discharge from a Hospital (for post-hospitalization expenses, within 30 days from the
completion of post-hospitalization period) deliver to Us the documentation (written details of the quantum of any Claim along with all original supporting documentation) as more
particularly listed in Claim documents section. In case there is a delay beyond 30 days in submission of claim documents, we may condone the delay provided the insured person submits
a valid reason justifying the delay to us in writing.

However, in both the above cases i.e. g. Claim Administration I. 1. (A) & (B), You must take reasonable steps or measure to minimise the quantum of any Claim that may be covered
under the Policy.
If so requested by Us, You will have to undergo a medical examination from Our nominated Medical Practitioner, as and when Weor Our in house claim processing team considers
reasonable and necessary. The cost of such examination will be borne by Us.
2. Claim Documents
You shall be required to furnish the following documents for or in support of a Claim:

1. Duly completed Claim form signed by You and the Medical Practitioner. The claim form can be downloaded from our
website www.icicilombard.com
2. Original bills, receipts and discharge certificate/ card from the Hospital/ Medical Practitioner
3. Original bills from chemists supported by proper prescription.
4. Original investigation test reports and payment receipts.
5. Indoor case papers
6. Medical Practitioner's referral letter advising Hospitalization in non-Accident cases.
7. Any other document as required by Us or to investigate the Claim or Our obligation to make payment for it
Thank You