Policy of the week: ICICI Lombard’s Health AdvantEdge Apex Plus

What works

Restoration benefits

The plan offers a suite of benefits. The ‘Restore Benefit’ allows policyholders to replenish coverage after a claim, and the absence of room rent limits provides flexibility in choosing accommodation.

The potential ‘Maximum 100 percent’ no-claim-bonus can significantly enhance the sum insured without additional cost. The inclusion of wellness benefits enhances the overall coverage, reflecting a comprehensive approach to healthcare. The policy also covers Ayush (Ayurveda-Unani-Siddha-Homeopathy) treatment up to 100 percent of the sum insured.

Also read: The methodology of Moneycontrol-SecureNow Health Insurance Ratings

More protection

The policy features a Claim Protector benefit, which ensures that any item not covered under the Insurance Regulatory and Development Authority of India (IRDAI) list of non-payable items becomes payable in the event of a claim. This enhancement boosts the overall coverage, offering financial protection beyond the standard exclusions outlined by IRDAI.

Also read: How to use Moneycontrol-SecureNow Health Insurance Ratings 

Better customer service

As per SecureNow’s experience with ICICI Lombard, the insurer has efficient policy issuance and renewal processes, contributing to a hassle-free customer experience. The extensive hospital network is a notable strength and the insurer's willingness to occasionally add hospitals upon request demonstrates flexibility.

What doesn’t work

However, certain aspects warrant careful consideration. Disease-wise waiting periods of up to 24 months – for example, cataracts, endometriosis, haemorrhoids, surgery for skin ailments – and a two-year waiting period for pre-existing conditions emphasise the importance of understanding the coverage timelines. Moreover, coverage for bariatric surgery (considered a modern treatment procedure) is capped at 50 percent of the sum insured.

Rural-urban divide

The policy comes with a geographical restriction. If you have purchased the policy in smaller towns (Zone-2) but undergo treatment in larger cities (Zone-1), a 12.5 percent co-payment is applicable. This adds a layer of complexity, highlighting the need for geographical awareness when selecting this plan.

Co-payment refers to the arrangement where the policyholder is required to bear a certain percentage of the total claim amount, with the insurance company taking care of the balance. Put simply, the policyholder has to share the medical expenses. Co-pay ratio is typically 10 to 20 percent of the approved claim amount. This brings the premiums down but also implies that you will have to shell out more out of your pockets in the case of a claim.

Last word

In summary, ICICI Lombard's A-rated plan offers a balanced mix of strengths and considerations. Its efficiency in claims processing, attractive features, and responsive approach contribute to its appeal.

However, potential limitations such as waiting periods and restrictions on specific diseases’ treatment procedure coverage necessitate careful evaluation based on individual needs and preferences. As with any insurance plan, a thorough understanding of the terms and conditions is crucial for informed decision-making.