Question 1

What are the facilities covered under hospitalization benefit?

Accepted Answer

Hospitalization benefit pays out ₹5000 per day for maximum 10 days in a policy year of hospitalization irrespective of actual expenses incurred, if the policy holder is hospitalized for a period of 24 hours, due to any of the listed conditions under your chosen cover.

Question 2

Are pre existing conditions covered?

Accepted Answer

Pre existing diseases are not covered. Any heart or cancer condition which was diagnosed or for which medical advice/treatment was received within 48 months prior to the policy issuance, would not be covered.

Question 3

How does the policy pay out?

Accepted Answer

The policy pays out on diagnosis of listed conditions of heart ailments or cancer, irrespective of the stage of the disease (Early or late). If it is a minor condition, the policy pays out 25% of the cover amount and continues it’s cover till the policy term. If unfortunately, the disease affects the policy holder again in a major way (any major condition), it pays out the rest 75% to the policy holder and the policy terminates. In case of a major condition, the policy pays out 100% of the cover amount as lump sum upon diagnosis.

Question 4

How long does it take to get the reimbursement?

Accepted Answer

ICICI Pru Heart/Cancer Protect pays out on diagnosis of the disease, and hence do not require you to show bills to claim. You just have to produce medical records of diagnosis/doctor’s certificate of diagnosis, to our claim care centres. Health claim process - /insurance-claim/documents-required-for-health-claim.html

Question 5

How many network hospitals does the company have tied up with, where I can get treatment?

Accepted Answer

The policy pays out a lump sum amount on diagnosis, and has no bearing on where the treatment is carried out. The policyholder can use the amount to fund his/her treatment at hospital of his/her choice.

Question 6

Can I cover my parents within the same policy?

Accepted Answer

No, but you can cover your spouse under the same policy, availing a 5% discount on the first year’s premium. Also, unlike a family floater, the covers of both people would remain independent of each other, with the option to choose different cover amounts for each.

Question 7

Does the family get any sum assured upon the policyholder’s death?

Accepted Answer

The policy does not have a death benefit, as in no absolute amount is paid upon death of the policy holder. But cover under heart and cancer conditions would be paid out irrespective of if death occurs or not, provided the policyholder has been diagnosed with heart illnesses or cancer. There is no survival period for Cancer. But also note that there is a survival period of 7 days for heart diseases i.e., the policy holder has to survive for a period of 7 days from the date of diagnosis to be eligible to receive the cover amount. If you have availed the income benefit, even in case of a policyholder’s death,an amount of 1% of health cover is paid out for a period of 5 years (To your nominee)

Question 8

What if a cancer gets treated once and then comes back to affect the person in remission, does the policy cover it again?

Accepted Answer

ICICI Pru Heart/Cancer Protect pays out on every stage. If the Cancer was of minor stage to start with, policy pays out 25% of the total cover for treatment and recovery. If, unfortunately, the Cancer comes back from remission to affect the person again at a higher severity (major stage), the policy pays out rest of the cover amount for treatment and recovery.

Question 9

What are the tax benefits applicable on ICICI Pru Heart/Cancer Protect?

Accepted Answer

Claim deduction up to ₹25,000# for health insurance premium paid towards this plan under Section 80D#. Choosing the single pay option (5 years premium) can be used to fulfil your 80D limit of up to ₹25,000 for the relevant financial year.