Hospital Care FAQs

FAQs - General

 
Q1. If I have a mediclaim as well as a Hospital Care policy, I will not be able to give you the original documents of treatments, surgeries etc. since these papers cannot be issued in duplicate. How will I manage to get both claims in such a case?
Ans: For making a Hospital Care claim, you will be required to show all your original documents at our branch. The originals will immediately be verified and attested and the original documents will be returned to you. You can submit the originals to your mediclaim company.

Q2. When does the cover start? (What is the waiting period under Hospital Care policy?)
Ans: There is a waiting period of 90 days except for accidental claims. Thus your cover starts from 90 days of policy issue date.

Q3. If I already have a pre-existing illness, can I get covered under Hospital Care? What are the exclusions for this?
Ans:To cover pre-existing illness ICICI Prudential may add extra premiums or may exclude the illness and its related complications from the scope of the policy depending upon the underwriting norms.

Q4. Can I switch from one plan A to some other plan during the tenure of the policy?
Ans: No. You cannot switch from one plan to another. You can take a fresh additional policy under any plan subject to a maximum Daily Hospitalization Cash Benefit (cumulative of all policies) equal to plan D.

Q5. Can I buy this policy for my family? For whom all can I buy this policy?
Ans:You can buy this policy for your family, which includes your spouse and children.

Q6. Can a married woman take the policy for her parents?
Ans: No. A married woman cannot take the policy for her parents.

Q7. Do I have to undergo medical tests before enrolling under any Plan type?
Ans: As per underwriting norms, if you choose plan A or plan B, and you happen to be in the age group of 1 - 45 years, you would not required to undergo medical tests.

Q8. Which medical tests does an adult above 46 years need to go through?
Ans:An adult above 46 years of age has to go through the following medical tests, depending on the plan chosen by him

As per the plan

Our representative will call the proposed insured(s) for prior appointment for the medical tests (mentioned above) within 2 days of receipt of full premium.

This leaflet is indicative of terms, conditions, warranties and exceptions contained in the insurance policy. For further details, please refer to the policy document. In the event of conflict, if any, between the terms and conditions contained in this leaflet and those contained in the policy document, the terms and conditions contained in the policy document shall prevail. Insurance is the subject matter of the solicitation © 2007, ICICI Prudential Life insurance Company Limited. Hospital Care: Form No.: T12
 
 
FAQs - Claims

 
Q1. How many claims can be made during the policy term?
Ans:One can make multiple claims during the policy term subject to the yearly limit and Policy Term limits available.

Q2. In case of taking claim from two insurers, will I need to furnish all original documents to ICICI Prudential?
Ans:
- It is always preferred to submit all the documents in original only. However, if you need to retain the originals (for claim to be raised with other company) the photocopies can be provided (the same to be verified against originals by ICICI Prudential official)
- Incase the hospital has submitted the original documents directly to your insurance company; the hospital can issue duplicate copies of the same. These will be accepted only if the hospital issues a certificate stating that the originals are submitted to another insurance company. The certificate must state name of the insurance company / TPA whom the documents are submitted.

Q3. Is recuperation benefit dependent on any documents/prescription?
Ans:Recuperation benefit is payable when the Life assured is continuously hospitalized for a period of 5 or more days and it is not dependent on any documents/ prescription. The benefit shall be maximum 3 times Daily Hospitalisation Cash Benefit (DHCB). This benefit is not payable, if the Life Assured dies in the hospital.

Q4. If I want to claim money from two insurance companies, can my other insurer deny me a payout incase I claim under Hospital Care as well?
Ans:The benefits under Hospital Care policy are independent of any other policy taken by you. However, the benefit whether payable by other company, depends upon the other company's terms and conditions.

Q5. If I want to claim money from two insurance companies, will my payout from Hospital Care policy become taxable?
Ans:The benefits received under Hospital Care policy are Non-Taxable.

Q6. Will a claim be entertained if it's not from the Network Hospital?
Ans:Yes, we will entertain the claim from Non Network Hospital provided the terms and conditions under the policy are met. A Hospital Network is created by the company in order to facilitate the cashless hospitalization and convenience to customer.

Q7. Will I get a pre-authorization form at a network hospital?
Ans:Yes, you will get a pre-authorization form at our network hospitals. However it will not be available at non-network hospitals.

Q8. Can I make a claim if I get treated out side India?
Ans:You are entitled to make claim for the treatment undergone out side India, provided the diagnosis and treatment occurs in the countries which are listed in the policy document.

Q9. What is grading of surgery and are the procedures according to any standardised definition?
Ans:There are 4 surgery grades under this policy, the benefit are payable based on the type of surgery undergone.
The surgical procedures are described as per the International Classification of Diseases (ICD) prescribed by World Health Organization.

Q10. Can a surgery claim be made even if the procedure does not require Hospitalisation?
Ans:Yes. The applicable surgery benefit will be paid as per the surgery grade. As long as the surgery is in the list of covered procedures, the payout is not dependent on Hospitalization. However other benefits (Daily Hospitalisation Cash Benefit, Intensive Care Unit Benefit & Recuperating Benefit) will not be paid.

Q11. If death occurs during the course of hospitalization, will the benefit amount be paid to the nominee?
Ans:The benefit amount shall be payable as per the policy terms. However, recuperating benefit shall not be payable upon the death of the Life Assured in hospital.

Q12. If I make a claim, will my policy be renewed next year?
Ans: Hospital Care is a long term policy. The policy shall continue through the term if the premiums are paid on the due date or within the grace period. The policy gets terminated once the lifetime limit exhausted or upon death of Life Assured or on maturity of the policy.

Q13. Do I have to undergo medical tests before enrolling under any Plan type?
Ans:As per underwriting norms, generally, if you choose Plan A / Plan B and you happen to be in the age group of 1-45, the medicals would be waived off.

Q14. What is a health card and the benefit of carrying a health card?
Ans:A health card is a card that comes along with the policy. It sent to you as part of the Welcome Kit and contains your name and policy number. This card would entitle you to avail cashless hospitalisation facility at any of our network hospitals.
BENEFITS: 

• It serves as a proof of Identity
• Entitles you to avail cashless facility hospitalisation facility at the network hospitals

Q15. Are all policyholders eligible for a health card?
Ans: Yes, all the policyholders are eligible for the health card as it is an important component of the policy.

Q16. What should I do in case I lose my health card?
Ans:Please inform us. We will replace it immediately at additional cost.

Q17. What if I have to get admitted but my Health Card is lost and I am waiting for the new card?
Ans:In case of a hospitalisation you need to quote the Policy number and card number in the authorization form and get the authorization. Carry a photo ID card with you at the time of admission.

Q18. What is the turn around time for receiving the re-imbursements in case of non-network hospitals?
Ans: We will process the claim and dispatch the cheque in 7 working days

Q19. With which hospitals, is the cashless facility available and how can I get the list?
Ans: The extensive list of network hospitals across India is available here. The claims procedure and the health card will be sent along with the policy certificate.