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ICICI Lombard Health Insurance Claim Settlement

For its health insurance coverage, ICICI Lombard General Insurance Company provides quick and timely claim settlements. The 78.32 per cent health claim settlement percentage appears to be satisfactory. The claim ratio determines the insurer’s ability to settle claims based on the number of claims submitted.

ICICI Lombard Health Insurance

ICICI Lombard General Insurance Company is one of India’s most well-known private general insurance companies. It is a joint venture between ICICI Bank Limited and Fairfax Financial Holdings Limited, based in Canada. ICICI Lombard General Insurance Company has constantly received awards for its customer-centric approach and innovative products over the years. With its comprehensive array of insurance products, ICICI Lombard General Insurance adds value to the market by providing general insurance solutions in sectors such as health, two-wheeler, car, travel, business, rural, home, and marine. 

In addition to normal health insurance policies, ICICI Lombard Health Insurance also offers a super top-up plan that protects policyholders when their base health insurance plan’s sum insured amount is depleted. As a result, the insurer is committed to addressing all of its policyholders’ insurance needs. You can also take advantage of ICICI Lombard General Insurance’s wellness programme, which includes a variety of services. Online HRAs (tools to assess your health and quality of life), Disease Management Services (DMS), Medical Concierge Services, and free health check-ups are just a few examples.

ICICI Lombard Health Insurance Claim Process

ICICI Lombard makes the process of settling claims simple and convenient. To ensure a worry-free claim settlement without the involvement of a third party, the insurer maintains an in-house claim processing and wellness centre. The claim procedure for ICICI Lombard is divided into two scenarios: cashless and reimbursement.

Claim Process for Cashless Treatment

During treatment at a network hospital, you can use the cashless claim process. For cashless treatment, ICICI Lombard has over 3,600 network hospitals across the country. The following are the steps in the cashless claim process:

  • In your area, look for an ICICI Lombard Health Insurance network hospital. 
  • Notify the insurer of the treatment – if it is an emergency, do so within 24 hours, and if it is planned, do so 1-2 days ahead of time. 
  • Carry your ICICI Lombard health ID card and one valid photo ID with you when you go to the hospital. 
  • Show the hospital assistance desk executive your ICICI Lombard health ID card.
  • Fill out and submit the pre-authorization form issued by the hospital. 
  • The hospital submits the pre-authorization request form to ICICI Lombard after verifying your identity. 
  • After reviewing the documentation, ICICI Lombard either approves or disapproves the claim. 
  • Following clearance, you can begin your cashless treatment, with all costs being paid directly by ICICI Lombard.
  • In case of rejection, you can get the treatment at the hospital and pay all hospital bills out of your pocket

Reimbursement Treatment

During treatment at a network or non-network hospital, a reimbursement claim can be filed. The steps for submitting a reimbursement claim are as follows:

  • In case of planned hospitalisation, notify ICICI Lombard Health Insurance within 24 hours (emergency hospitalisation) and 1 or 2 days before admission.
  •  Also, notify the insurer of your hospitalisation. 
  • Visit a hospital for treatment. 
  • Collect all original documentation from the hospital at the time of discharge.
  • Send these documents to your nearest ICICI Lombard Health Insurance branch, together with a completed and signed Reimbursement claim form. 
  • ICICI Lombard would settle the claim amount within 15 days of receiving all of the papers.

Documents Required for Filing a Claim

  • Original investigation reports
  •  Final hospital discharge summary
  •  FIR or post-mortem report if happened
  •  Pharmacy bills along with the prescription
  •  Cancelled cheque or NEFT details for payment
  •  Original bills, receipts, and discharge report
  •  Indoor case papers and duly-filled claim form
  •  Original hospital bills and a valid photo ID proof
  •  Treating doctor’s report, and original consultation notes
  •  Nature of operation performed and surgeon’s bill and receipt
  •  Test reports along with attending doctor’s or surgeon’s report

ICICI Lombard Health Insurance Claim Settlement Ratio

The Claim Settlement Ratio is a percentage of the total number of health insurance claims received by an insurance provider during a financial year divided by the number of claims settled. The Claim Settlement Ratio of ICICI Lombard Health Insurance for the financial year 2019-20 is 78.67%.

Reviews and Ratings

The policy has an impressive rating of 4.2/5 based on 38 reviews from Policy Bazaar. Insurance Dekho has given the policy a rating of 4.5/5 based on 89 reviews. 

Rahul – Very good plan. I suggested this plan to many of my family members. Actually, I bought this a year before because the claim ratio is good. I am happy.

Sanam – Today I got my refund of claim reimbursement and today is the best day of life. All credit goes to ICICI Lombard as they are very nice. 


What is the timeframe for reporting the hospitalisation to ICICI Lombard Health Insurance?

In the event of planned hospitalisation, you must notify ICICI Lombard Health Insurance at least 1 or 2 days ahead of time. In the event of emergency hospitalisation, you must notify your insurance carrier within 24 hours of admission.

What is the Claim Settlement Ratio of ICICI Lombard Health Insurance?

The Claim Settlement Ratio of ICICI Lombard Health Insurance for the financial year 2019-20 is 78.67%.

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