SHIELDING YOUR

FAMILY’S
WELLBEING!
 INDEX

1 Healthy U & Golden Year Benefits 2 Introducing Health Shield 360

3 Health Shield 360 – BASE 44 Basic Coverage

5 Recommended & Premium Covers 6 Key Points to Note

7 IL TakeCare 8 Exclusions
 HEALTHY U & GOLDEN YEARS PLAN
BASE PLAN PRE - CONDITIONS CLAIM PAYMENT
Sum Insured:

FOR
GROUP HEALTH INSURANCE
GOLDEN
HEALTHY U
HEALTH COMPANION FOR YOUR FAMILY
YEARS
EXCLUSIVELY FOR ICICI BANK CUSTOMERS Pre - Existing diseases: Co-pay : Co-pay :
₹ 5 lakhs to ₹ 25 lakhs ₹ 5 lakhs & ₹ 10 lakhs No co-pay for 20% Co pay for
Declared and accepted
Pre - Existing conditions Healthy U Golden Year
/ diseases will be
Hospitalisation with Pre
& Post Hospitalisation: covered after 30 days
Day Care Procedures Domiciliary Hospitalisation
30 / 60 days

Room rent Sub-limit only

capping: Nil on Cataract
Air Ambulance Road Ambulance Cover ADD ON COVER
Health scan :
No Medicals for
up to 55 year
for all Sum IL TakeCare App: Bringing
OPD expenses & Insured option
Alternate treatment Donor Expense Maternity cover cashless OPD to your fingertips
 INTRODUCING

FOR
GROUP HEALTH INSURANCE
GOLDEN
HEALTHY U
HEALTH COMPANION FOR YOUR FAMILY
YEARS
EXCLUSIVELY FOR ICICI BANK CUSTOMERS

Comprehensive Focus on health and wellness

Convenient Health Shield 360:

Domestic covers
Competitive Worldwide cover
Top up + OPD cover
 BASIC FEATURES
Waiting period for 12 months Entry age – up to 75 yrs
1 2
for specific diseases

Sum insured up to ₹ 1 cr 3 4 Nil co-pay for Golden Year

Pre & Post hospitalisation

cover – 60 days & 90 days 5 6 Unlimited Reset Benefit

Additional Sum Insured
Claim Protector
HEALTHY U
7 PLAN 8 Annual Health Check-Up
FEATURES
Additional Sum Insured
9 10 Protector

Sum Insured Protector 11 12 360 Wellbeing program

Tele-underwriting above
Conditional Underwriting 13 55 yrs and 50 lacs SI 14 No room rent capping
Compulsory medical for SI `75
Lakhs and ₹ 1cr
HEALTH SHIELD 360 – BASE

Hospitalisation Expenses
with High SI Limit
• Covers in-patient hospitalisation
expenses, Sum Insured options
available from – ₹ 5 lakhs to ₹ 50 lakhs
In Patient AYUSH
Hospitalisation
• AYUSH treatment taken in AYUSH
hospital or AYUSH Day care
Health Check-up Cover
• Expense incurred towards the cost of
Health Check-up will be covered every
year. Cover changes basis sum insured
For Details On Each Cover, Please Refer Slide No 30 Onwards
BASIC COVERAGE
Day Care Surgeries/Treatment
• All Day Care Treatments & procedures
covered up to SI
Unlimited Reset Benefit
• Sum Insured gets reinstated each time it
gets exhausted for a next claim which is
not related to previous claim
Home Health care
• Covers Home care treatment on advise
by medical practitioner
Pre and Post-Hospitalisation
Expenses
• Medical expenses incurred, immediately,
60 days before and 90 days after
hospitalisation
Additional Sum Insured
(Cumulative Bonus)
• 10% increase in sum insured for every
claim free year
• Max increase in sum insured -100%
Claim Protector
• Pays claim for non-payable items in
claim such as consumables
 BASIC COVERAGE
Cumulative Bonus 360 Wellbeing Program
Sum Insured Protector
Protector (ASI)
• The Sum Insured increases on cumulative • Incentivises and rewards individuals for healthy
• For any claims upto ₹50,000, NCB
basis at each renewal on the basis of behavior through various health and wellbeing
earned is protected
inflation rate in the previous year activities
• Empowers individuals to manage their lifestyle
and be better prepared in preventing adverse
health conditions

Air Ambulance Cover Donor Expense Domiciliary Hospitalisation

• Expneses incurred for Air Ambulance • Covers medical expenses in respect of • Covers medical expenses in respect of
services required for emergency care the donor for organ transplant surgery domiciliary hospitalisation
• SI limit upto Sum Insured

PED covered after 30 days

2A 2A+2K
• Declared and accepted Pre Existing Premium for ` 10 lakhs SI
Diseases will be covered after 30 days of for 36 - 40 age bracket `13,547 `17,233
initial waiting period
Excluding GST Excluding GST

A - Adult, K- Kid
For Details On Each Cover, Please Refer Slide No 30 Onwards
ADD-ON COVERAGE
 ADD-ON COVERAGE OPTION 1
COMPREHENSIVE
HEALTH PROTECTION

Maternity & Newborn

OPD Cover
Baby Cover

• OPD expenses covered for consultancy, • Medical expenses for delivery

RECOMMENDED COVERS diagnostic and pharmacy • Pre-natal and Post-natal expenses
• Sum Insured options up to ₹ 30,000 • Sum Insured options up to ₹1 lakh
• Covers Newborn Baby for hospitalisation
BASIC COVERAGE upto 91 days

| Out-patient Treatment cover* 2A 2A+2K

Premium for ` 10 lakhs SI
for 36 - 40 age bracket `21,609 `25,295
| Maternity benefit*
Excluding GST Excluding GST

| Newborn Baby cover* Health Shield 360 Premium with OPD `21,609 `25,295
OPD SI `12,000 `12,000
Tax (33%) `7,131 `8,347

Effective cost to customer `2,478 `4,948

*These are add-on covers and are available by paying extra premium. A - Adult, K- Kid
 ADD-ON COVERAGE OPTION 2
COMPREHENSIVE
HEALTH PROTECTION

Super No Claim Bonus Compassionate visit

• 50% increase in sum insured for every • Cost of Air travel is covered for an immediate

PREMIUM COVERS claim free year – max increase in sum relative for hospitalisation more than 5 days
insured is 100%

RECOMMENDED COVERS
2A 2A+2K
Premium for ` 10 lakhs SI
for 36 - 40 age bracket `23,487 `28,310
| Super No Claim Bonus*
Excluding GST Excluding GST

| Compassionate Visit*
Health Shield 360 Premium with OPD `23,487 `29,052
OPD `12,000 `12,000
Tax (33%) `7,751 `9,342

Effective cost to customer `3,736 `6,968

*These are add-on covers and are available by paying extra premium.
A - Adult, K- Kid
 HEALTH SHIELD 360 WORLDWIDE COVER
The worldwide cover offers a higher Sum Insured with a
Hospitalisation Expenses Day Care Surgeries/ Treatment
worldwide hospitalisation cover for emergency and planned
hospitalisation requirements.
• Planned and Emergency • All the medical expenses incurred while undergoing
• Sum Insured limit ₹ 75 lakhs & ₹ 1 cr Day Care Procedures/ Treatment which require less
than 24 Hours of hospitalisation are covered
Planned & Emergency
hospitalisation expenses*
International Emergency Road Emergency Ambulance
Worldwide cashless facility Medical Assistance (Worldwide including India)
at network centers*
• `35,000 for Overseas claims
• Air Ambulance
• `10,000 for Domestic claims
Daycare procedures

International emergency medical services Premium for ` 1 Crore Sum Insured

(Air & Roadside ambulance) for 36 - 40 age bracket

*Plan hospitalisation - Prior approval required from ICICI Lombard for International planned 2A 2A+2K
hospitalisation.
*Cashless facility subject to pre-authorisation by our service provider. `88,592 `108,373
*Applicable for resident Indian.
Excluding GST Excluding GST

Note: Worldwide cover benefit is available only when Insured member (Indian resident) is travelling abroad and his single trip is not more than 45 days and multiple trips taken abroad by
customer in a policy year is not more than 90 days.
The scope of this cover extends to worldwide including India, USA and Canada and the Maximum limit of indemnity would be restricted to the Annual Sum insured for claims within and outside
India, in aggregate. A - Adult, K- Kid
KEY POINTS TO NOTE

Eligibility
Tenure
Family definition
Pre-Policy Medicals
Co-payment – World Wide Cover
World Wide Cover
Cooling period
Specific exclusions
Maternity Cover
TERMS & CONDITIONS
Exclusive offering to ICICI Bank customers that are insured members
Adults from 21 to 75 years, children from 91 days to 20 years; child will be covered under floater plan only
1 Year
Self, Spouse, Dependent parents, Dependent siblings and up to 2 dependent children upto 20 yrs. of age
Tele-underwriting above age 55 years, and also in case of declared Pre - Existing diseases; Medicals above 65 yrs. of age and
for `75 lakhs and `1 Cr SI options
A co-pay of 10% will be applied to every admissible claim over and above to any other co-pay levied, if the treatment is taken
outside India
The benefit is available for 45 consecutive days from the date of travel in a single trip and 90 days in a cumulative basis as a
whole in a Policy year
WAITING PERIOD
30 days for all diseases except hospitalisation due to accident
Standard list of diseases & procedures (kindly refer to 1 year exclusion list) will be covered after 12 months of continuous
coverage
This cover can be availed only if both insured & spouse are covered under the same plan for a continuous duration
of 12 months
 PED AND CONDITIONAL UW

• All declared and accepted PED’s will be covered after 30 days of initial waiting period
Pre - Existing
• PED needs to be declared by insured for all insured members in policy
Disease (PED):
• Any non declaration of PED will lead to rejection of claims and cancellation of policy

• On the basis of insured member’s age and declared existing illness, a medical underwriting is done
Conditional for each proposal. As an outcome of this underwriting the proposal is accepted with loading on
Underwriting:
premium or is rejected
 • Any Expenses related to the treatment of Hypertension, Diabetes, cardiac conditions within 90
Specified disease/ days from the first policy start date
procedure waiting
period: • In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum
insured increase

• Medical expenses incurred during the first 30 days of inception of the policy, except those arising
out of accidents. This exclusion doesn’t apply for subsequent renewals without a break
• Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)
Major Permanent
Exclusions: • Expenses arising out of or attributable to alcohol or drug use/ misuse/ abuse
• Cost of spectacles/ contact lenses, dental treatment
• Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during Hospitalisation) except ectopic pregnancy

List of specific diseases/
procedure:
Standard list of diseases & procedures
(kindly refer to 1 year exclusion list)
will be covered after 12 months of
continuous coverage
• Cataract
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• All types of Hernia, Hydrocele
• Fissures &/or Fistula in anus, hemorrhoids/ piles
• Arthritis, gout, rheumatism and spinal disorders
• Joint replacements unless due to accident
• Sinusitis and related disorders
• Stones in the urinary and billiary systems
• Dilatation and curettage, Endometriosis
• All types of Skin and internal tumors/ cysts/ nodules/ polyps of any kind including breast
lumps unless malignant
• Dialysis required for chronic renal failure
• Surgery on tonsils, adenoids and sinuses
• Gastric and Duodenal erosions & ulcers
• Deviated Nasal Septum
• Varicose Veins/ Varicose Ulcers
• All types of internal congenital anomalies/ illness/ defects
IL TakeCare
 IL TAKECARE
CONVENIENCE Mobile
Internet Banking portal
Contact - (Relationship Manager)
DIGITAL POLICY
Visit - ICICI Bank Branch

IL TAKECARE
E CARDS CASHLESS OPD
A one stop solution for all your insurance and wellness needs. Download the
IL TakeCare app to avail the following services and much more, all at the
ease of your fingertips.
Convenient & Easy-To-Use app
Wide range of Emergency & Convenient Medical solutions at your fingertips EMERGENCY
AMBULANCE
24x7 WELLNESS SERVICES
Quick Claims settlement process
Wellness Programs to help keep you fit

Download the IL TakeCare App

TELE
CONSULTATION CLAIMS

https://bit.ly/2n5vkmt https://apple.co/2nNyPya
 CLAIM PROCESS
HOW TO INTIMATE A CLAIM?
Reach us at: 18002666
Monday to Saturday between 8:00 am to 8:00 pm
Cashless Claims
Get admitted in any one of our network hospitals
Reach out to insurance desk in hospital and submit the
pre-authorization claim form along with relevant documents
Hospital insurance desk shares the pre-authorization documents
with IL Health Care
ICICI Lombard Health Care will review your requested claim and
will accordingly approve, query, or reject the same (as per policy
terms and conditions)
customersupport@icicilombard.com IL TakeCare app
Reimbursement Claims
If hospitalisation occurs in a non-network hospital:
Upon discharge, pay all hospital bills and collect all original
documents of treatments and expenses underdone
Send the duly filled (and signed by insured and treating doctor) claim
form and required claim documents
ICICI Lombard Health Care reviews your claim requested and
accordingly will approve, query, or reject the same (as per policy
terms and conditions)
ICICI Lombard Health Care Settles the claim (as per policy terms and
conditions) and reimburses the approved amount
Below are the places from where you can download the claim form.
IL TakeCare App
ICICI Lombard Website
ICICI Lombard customer support helpline – 18002666
 MANAGE YOUR CLAIMS

Intimate a claim and upload

Fill the claim form Upload your documents Track your claim
documents & dispatch them

Home → Click on ‘Claims’ → ‘Claims’ → File a claim ‘Claims’ → File a claim ‘Claims’ → Track your claim
‘File a Claim’
THANK YOU
BASE COVER
 UNLIMITED RESET BENEFIT

Reset will be available unlimited times in a policy year in case the Sum insured including accrued Additional
Definition Sum Insured (if any) and Super No Claim Bonus (if any), Sum Insured protector (if any) is insufficient as a result of
previous claims in that policy year

• Reset will not trigger on the first claim

• Total amount of reset will not exceed the Annual sum insured for that policy year
Terms & • It cannot be used for the same illness/ disease/ injury for which the claim
Condition has already been paid in the policy tenure for the same person
• Any unutilized reset Sum Insured will not be carried forward to subsequent policy year

Sum Insured 10 lakhs

First claim - 6th Month 8 lakhs
Illustration
Second Claim - 8th Month 7 lakhs Sum Insured reinstates to 10 lakhs
Third Claim - 10th Month 6 lakhs Sum Insured reinstates to 10 lakhs
 ADDITIONAL SUM INSURED (CUMULATIVE BONUS)
10% increase in Sum Insured for every claim free renewal in policy, renewed without any break. Maximum increase in
Definition sum insured is 100%

Terms & • In the event of a claim in the Policy year, ASI will reduce by 10%
Condition • At the time of renewal if the Insured person opts out of this optional cover, then the Super no claim bonus accrued up
until the expiring policy year will be forfeited

Sum Insured 10 lakhs

Illustration
Sum Insured in 1st renewal 11 lakhs
Sum Insured in 2nd renewal 12 lakhs

CLAIM PROTECTOR
Definition This cover gets the payment for the items which are not payable under the claim as per the List of Excluded items
released by IRDAI that is related to the particular claim

Terms &
Condition • The maximum claim pay out under this benefit shall be limited to Annual Sum Insured under your policy
• The claim is paid under this section only if base claim is payable under hospitalisation cover

Illustration Examples of non payable items: Consumables, Surgical blades, cotton, cotton bandage, etc.
 CUMULATIVE BONUS PROTECTOR(ASI PROTECTOR)
Additional sum insured(ASI) accrued will not be reduced at renewal if any one claim or multiple claims admissible in
Definition the previous policy year under the policy does not exceed the overall amount of ₹50,000

Sum Insured 10 lakhs

Illustration Sum Insured in 1st renewal 11 lakhs A claim is paid during 2nd year - ₹ 40000
Sum Insured in 2nd Renewal 11 lakhs

SUM INSURED PROTECTOR

The Sum Insured protector is designed to protect the Sum Insured against rising inflation by linking the Sum
Definition Insured under the base plan to the Consumer Price index (CPI)

• The Sum Insured will be increased on cumulative basis at each renewal on the basis of inflation rate in previous year
• Inflation rate would be computed as the average CPI of the entire calendar year published by the Central Statistical
Terms & Organisation (CSO)
Condition • The % increase will be applicable only on Annual Sum Insured under the Policy and not on additional sum insured or any
other benefit which leads to increase in Sum Insured
 HEALTH CHECK-UP
Cost of Health Check-up will be covered as per specified limit mentioned in policy document
Definition

• Health Check-up will be availed only at our empanelled service provider on

cashless basis as per the available medical test packages
Terms & • The policy is renewed with us without any break
Condition • This benefit doesn’t not reduce sum insured or impact the accrued bonus (if any)
• Any unutilized test or amount can’t be carried forward to next policy year

CONDITIONAL UNDERWRITING
On the basis of the proposed insured members age and declared existing illness, a medical
Definition underwriting is done for each proposal. As an outcome of this underwriting the proposal is
accepted with loading on premium or is rejected

Benefit • Customer is enrolled in the policy with loading on premium and is also becomes part of
Be Healthy wellness program
 360 WELLBEING PROGRAM
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CONDITIONAL UNDERWRITING BASED WELLNESS PLANS

Be Healthy Stay Healthy
• Maximum points to be earned – 7000 • Maximum points to be earned – 6000 • Value on Be Healthy points that can be redeemed
• Points earned can be redeemed for Discount on renewal premium • Points earned can redeemed for Payment of non-payable items, is ₹1100 in 1st year to ₹1750 in 5th Year
OPD expenses, Membership fees on IL Platform
ADD ON COVERS
 MATERNITY COVER
Definition It covers expenses for Delivery including cesarean section during policy period. The
expenses include Pre and Post Natal expenses

• The cover shall be limited to 2 deliveries/ terminations during the Period of

Insurance
Terms & • Delivery expense for pre - mature baby less than 32 weeks will be covered
Condition • This cover can be availed only if both insured and spouse are covered under the
same plan for a continuous duration of 12 months. The waiting period for
maternity claim is 12 months

NEWBORN BABY COVER

Definition It will cover Medical Expenses incurred on the “Newborn Baby” during Hospitalisation for a
maximum period up to 91 days from the date of birth of the baby

Terms &
Condition • This cover will be available only if maternity cover has been opted
 OUT PATIENT TREATMENT COVER
Medical Expenses incurred as an outpatient will be covered up to specified limit
Definition
mentioned in policy schedule

• Outpatient consultation by a General Medical Practitioner or Specialist Medical

Practitioner or Super Specialist Medical practitioner or AYUSH medical
practitioner in relation to any Illness contracted or Injury suffered by the Insured
Person during the Policy period
Benefit
• Diagnostics test as recommended/ prescribed by the medical practitioner
• Pharmacy – Medicines purchased by the Insured Person from a pharmacy,
provided that such medicines have been prescribed in writing by a Medical
Practitioner
 SUPER NO CLAIM BONUS
Definition 50% increase in Sum Insured for every claim free renewal in policy without any
break in policy. Maximum increase in sum insured is 100%

• In case no claims are made in the Policy year, the super no claim bonus will
be credited automatically to the subsequent policy year even in the case of
multi-year policies (2 & 3 year policy tenure)
Terms & • In the event of a claim in the Policy year, the super no claim bonus will
Condition reduce by 50%
• At the time of renewal if the Insured person opts out of this optional cover,
then the Super no claim bonus accrued up until the expiring policy year will
be forfeited

Sum Insured 10 lakhs

Sum Insured in 1st renewal 15 lakhs
Illustration
Sum Insured in 2nd renewal 20 lakhs A claim is made in 2nd year of policy
Sum Insured in 3rd Renewal 15 lakhs
 COMPASSIONATE VISIT

In the event of Insured’s Hospitalisation extending beyond a period of 5 consecutive

Definition days then the cost of return fair for economy class air ticket is reimbursed for
immediate family

Terms & The reimbursement limit is restricted to ₹ 20,000 for Premium Plan and ₹ 30,000
Condition & ₹ 50,000 for Worldwide plan
PREMIUM CHART
 HEALTH SHIELD 360 - BASIC COVERAGE

Sum Insured = `5 Lakhs Sum Insured = `10 Lakhs

Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 4,556 5,918 6,987 7,255 9,289 11,763 0-25 5,348 6,753 8,000 8,215 10,573 13,446
26-30 6,077 7,259 8,584 9,338 11,194 14,422 26-30 7,175 8,322 9,868 10,627 12,783 16,562
31-35 6,077 7,259 8,584 9,338 11,194 14,422 31-35 7,175 8,322 9,868 10,627 12,783 16,562
36-40 7,343 8,782 9,773 11,809 13,330 14,963 36-40 8,781 10,131 11,297 13,547 15,324 17,233
41-45 7,424 8,848 9,833 11,940 13,456 15,029 41-45 8,862 10,197 11,357 13,677 15,450 17,299
46-50 10,202 12,560 13,097 17,172 18,775 19,528 46-50 12,357 14,580 15,219 19,842 21,721 22,632
51-55 14,409 15,897 16,673 25,028 25,770 26,145 51-55 17,503 18,447 19,366 28,975 29,837 30,307
56-60 21,067 21,870 22,995 36,787 38,979 39,827 56-60 25,644 25,943 26,620 42,535 45,081 46,124
61-65 28,075 29,214 30,214 50,533 52,850 54,512 61-65 34,193 34,535 35,027 58,466 61,185 63,208
66-70 37,376 40,118 43,205 71,320 73,049 74,778 66-70 45,571 46,548 50,180 82,587 84,611 86,702
71-75 41,389 44,573 47,553 79,099 81,024 82,994 71-75 50,547 51,794 55,302 91,727 93,979 96,352

A - Adult, K- Kid
 HEALTH SHIELD 360 - BASIC COVERAGE

Sum Insured = `15 Lakhs Sum Insured = `20 Lakhs

Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 5,865 7,418 8,796 8,975 11,586 14,768 0-25 6,366 8,086 9,615 9,729 12,603 16,098
26-30 7,893 9,159 10,870 11,652 14,039 18,228 26-30 8,577 9,984 11,876 12,647 15,276 19,869
31-35 7,893 9,159 10,870 11,652 14,039 18,228 31-35 8,577 9,984 11,876 12,647 15,276 19,869
36-40 9,675 11,167 12,455 14,893 16,860 18,972 36-40 10,519 12,173 13,604 16,181 18,352 20,681
41-45 9,765 11,241 12,522 15,038 17,000 19,045 41-45 10,618 12,253 13,676 16,339 18,504 20,761
46-50 13,644 16,106 16,809 21,881 23,960 24,965 46-50 14,846 17,557 18,350 23,798 26,091 27,214
51-55 19,357 20,399 21,412 32,018 32,969 33,485 51-55 21,074 22,236 23,368 34,849 35,912 36,501
56-60 28,392 29,450 30,573 47,070 49,890 53,049 56-60 30,923 32,103 33,354 51,257 54,357 57,828
61-65 37,883 39,011 39,845 67,563 72,806 73,670 61-65 41,269 42,526 43,461 73,596 79,337 80,307
66-70 50,512 54,801 57,832 96,656 99,025 1,00,365 66-70 55,036 59,738 63,069 1,05,309 1,07,919 1,09,406
71-75 56,035 61,004 63,729 1,07,398 1,10,035 1,11,575 71-75 61,056 66,500 69,497 1,17,019 1,19,921 1,21,626

A - Adult, K- Kid
 HEALTH SHIELD 360 - BASIC COVERAGE

Sum Insured = `25 Lakhs Sum Insured = `50 Lakhs

Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 7,131 8,987 10,635 11,011 14,116 17,893 0-25 8,775 11,103 13,168 13,429 17,340 22,104
26-30 9,525 11,041 13,082 14,171 17,010 21,975 26-30 11,807 13,706 16,269 17,433 21,008 27,277
31-35 9,525 11,041 13,082 14,171 17,010 21,975 31-35 11,807 13,706 16,269 17,433 21,008 27,277
36-40 11,628 13,411 14,953 17,996 20,340 22,854 36-40 14,473 16,709 18,640 22,281 25,227 28,390
41-45 11,735 13,498 15,032 18,167 20,504 22,940 41-45 14,608 16,820 18,739 22,497 25,436 28,500
46-50 16,312 19,240 20,091 26,244 28,718 29,927 46-50 20,409 24,095 25,151 32,731 35,844 37,353
51-55 23,054 24,306 25,524 38,207 39,351 39,982 51-55 28,952 30,515 32,035 47,891 49,317 50,094
56-60 33,718 34,988 36,335 55,971 59,320 63,071 56-60 42,465 44,051 45,735 70,402 74,622 79,352
61-65 44,918 46,272 47,278 80,156 86,365 87,407 61-65 56,658 58,350 59,601 1,01,049 1,08,893 1,10,191
66-70 59,823 64,907 68,506 1,14,491 1,17,309 1,18,912 66-70 75,545 81,964 86,501 1,44,556 1,48,104 1,50,112
71-75 66,341 72,228 75,466 1,27,169 1,30,303 1,32,142 71-75 83,804 91,240 95,320 1,60,621 1,64,570 1,66,877

A - Adult, K- Kid
 HEALTH SHIELD 360 - RECOMMENDED COVERS

Sum Insured = `5 Lakhs | OPD = `6000 Sum Insured = `10 Lakhs | OPD = `12,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 6,810 8,172 9,241 12,358 14,392 16,866 0-25 9,553 10,958 12,206 20,365 22,724 25,596
26-30 8,330 9,512 10,838 14,252 16,109 19,336 26-30 11,380 12,527 14,074 22,252 24,408 28,187
31-35 8,330 9,512 10,838 13,715 15,571 18,799 31-35 11,380 12,527 14,074 20,754 22,910 26,689
36-40 9,597 11,035 12,027 15,446 16,967 18,599 36-40 12,986 14,336 15,502 21,609 23,386 25,295
41-45 9,678 11,102 12,087 15,046 16,562 18,135 41-45 13,067 14,402 15,562 20,259 22,032 23,880
46-50 12,456 14,814 15,350 19,903 21,505 22,258 46-50 16,562 18,785 19,424 25,377 27,255 28,166
51-55 16,662 18,151 18,927 27,282 28,024 28,399 51-55 21,708 22,652 23,571 33,180 34,042 34,513
56-60 23,321 24,124 25,249 39,041 41,233 42,081 56-60 29,849 30,148 30,825 46,740 49,286 50,329
61-65 30,328 31,468 32,468 52,787 55,103 56,766 61-65 38,398 38,740 39,232 62,671 65,390 67,413
66-70 39,629 42,372 45,459 73,573 75,303 77,032 66-70 49,776 50,753 54,385 86,792 88,816 90,907
71-75 43,642 46,826 49,807 81,352 83,278 85,248 71-75 54,752 55,999 59,507 95,932 98,184 1,00,557

A - Adult, K- Kid
 HEALTH SHIELD 360 - RECOMMENDED COVERS

Sum Insured = `15 Lakhs | OPD = `15,000 Sum Insured = `20 Lakhs | OPD = `20,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 11,046 12,599 13,977 22,100 24,712 27,894 0-25 13,173 14,893 16,422 26,931 29,805 33,300
26-30 13,073 14,339 16,050 24,253 26,640 30,829 26-30 15,383 16,790 18,682 29,163 31,791 36,384
31-35 13,073 14,339 16,050 22,755 25,142 29,331 31-35 15,383 16,790 18,682 27,203 29,832 34,425
36-40 14,856 16,348 17,636 23,931 25,898 28,010 36-40 17,326 18,980 20,411 28,034 30,205 32,534
41-45 14,946 16,422 17,702 22,595 24,557 26,602 41-45 17,425 19,060 20,483 26,255 28,420 30,677
46-50 18,825 21,287 21,989 28,391 30,469 31,475 46-50 21,653 24,364 25,156 32,344 34,637 35,760
51-55 24,538 25,579 26,593 37,199 38,149 38,666 51-55 27,880 29,043 30,174 41,655 42,718 43,308
56-60 33,573 34,631 35,754 52,251 55,070 58,230 56-60 37,730 38,910 40,161 58,064 61,164 64,635
61-65 43,063 44,192 45,026 72,744 77,986 78,851 61-65 48,075 49,333 50,268 80,403 86,144 87,113
66-70 55,693 59,982 63,013 1,01,837 1,04,205 1,05,545 66-70 61,843 66,545 69,876 1,12,116 1,14,725 1,16,213
71-75 61,216 66,185 68,910 1,12,579 1,15,216 1,16,755 71-75 67,863 73,307 76,304 1,23,826 1,26,728 1,28,433

A - Adult, K- Kid
 HEALTH SHIELD 360 - RECOMMENDED COVERS

Sum Insured = `25 Lakhs | OPD = `25,000 Sum Insured = `50 Lakhs | OPD = `30,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 15,564 17,419 19,068 32,289 35,394 39,171 0-25 18,834 21,162 23,227 36,334 40,244 45,008
26-30 17,957 19,474 21,515 34,600 37,439 42,405 26-30 21,866 23,765 26,328 39,489 43,063 49,332
31-35 17,957 19,474 21,515 32,179 35,018 39,983 31-35 21,866 23,765 26,328 37,067 40,641 46,911
36-40 20,061 21,844 23,386 32,665 35,008 37,522 36-40 24,532 26,768 28,699 38,575 41,521 44,685
41-45 20,168 21,931 23,464 30,442 32,779 35,215 41-45 24,667 26,879 28,798 36,398 39,337 42,401
46-50 24,745 27,673 28,524 36,825 39,300 40,509 46-50 30,468 34,154 35,210 44,939 48,052 49,561
51-55 31,487 32,739 33,957 46,640 47,784 48,415 51-55 39,011 40,574 42,094 57,950 59,376 60,153
56-60 42,151 43,421 44,768 64,404 67,753 71,504 56-60 52,524 54,110 55,794 80,461 84,681 89,411
61-65 53,351 54,705 55,711 88,589 94,798 95,840 61-65 66,717 68,409 69,660 1,11,108 1,18,952 1,20,250
66-70 68,256 73,340 76,939 1,22,924 1,25,742 1,27,345 66-70 85,604 92,023 96,560 1,54,615 1,58,163 1,60,171
71-75 74,774 80,660 83,899 1,35,601 1,38,736 1,40,575 71-75 93,863 1,01,299 1,05,379 1,70,680 1,74,629 1,76,936

A - Adult, K- Kid
 HEALTH SHIELD 360 - PREMIUM COVERS

Sum Insured = `5 Lakhs | OPD `6,000 Sum Insured = `10 Lakhs | OPD = `12,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 7,335 9,222 10,816 13,408 15,967 18,966 0-25 10,122 12,095 13,910 21,501 24,428 27,869
26-30 9,007 10,714 12,565 15,606 17,987 21,740 26-30 12,119 13,833 15,948 23,729 26,453 30,800
31-35 8,979 10,686 12,537 15,013 17,394 21,146 31-35 12,091 13,805 15,920 22,175 24,899 29,247
36-40 10,452 12,416 13,933 17,158 19,204 21,361 36-40 13,925 15,844 17,578 23,487 25,833 28,310
41-45 10,571 12,519 14,029 16,831 18,872 20,970 41-45 14,043 15,947 17,674 22,210 24,552 26,968
46-50 13,818 16,701 17,762 22,625 24,753 26,031 46-50 18,055 20,847 22,054 28,364 30,810 32,290
51-55 18,356 20,370 21,671 30,669 31,936 32,836 51-55 23,563 25,076 26,563 36,890 38,320 39,359
56-60 25,676 27,004 28,654 43,751 46,468 47,842 56-60 32,436 33,303 34,548 51,914 55,028 56,640
61-65 33,689 35,354 36,879 59,509 62,351 64,538 61-65 42,102 43,012 44,072 70,078 73,366 75,957
66-70 44,285 47,553 51,164 82,885 85,139 87,393 66-70 54,914 56,459 60,659 97,067 99,659 1,02,319
71-75 49,018 52,727 56,232 92,103 94,553 97,049 71-75 60,703 62,518 66,594 1,07,833 1,10,654 1,13,595

A - Adult, K- Kid
 HEALTH SHIELD 360 - PREMIUM COVER

Sum Insured = `15 Lakhs | OPD = `15,000 Sum Insured = `20 Lakhs | OPD = `20,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 11,655 13,818 15,806 23,320 26,541 30,333 0-25 13,820 16,188 18,364 28,226 31,747 35,890
26-30 13,871 15,746 18,067 25,847 28,844 33,642 26-30 16,234 18,289 20,828 30,864 34,140 39,381
31-35 13,843 15,718 18,039 24,293 27,290 32,089 31-35 16,206 18,261 20,800 28,849 32,125 37,365
36-40 15,875 17,977 19,875 25,969 28,546 31,267 36-40 18,418 20,719 22,797 30,217 33,035 36,012
41-45 16,002 18,087 19,978 24,706 27,278 29,933 41-45 18,553 20,836 22,906 28,511 31,324 34,228
46-50 20,445 23,517 24,829 31,631 34,319 35,935 46-50 23,388 26,746 28,186 35,814 38,754 40,525
51-55 26,547 28,198 29,822 41,218 42,778 43,904 51-55 30,030 31,840 33,619 45,955 47,665 48,903
56-60 36,382 38,049 39,782 57,869 61,298 65,067 56-60 40,741 42,568 44,466 64,085 67,833 71,951
61-65 47,095 48,834 50,277 80,808 86,660 88,134 61-65 52,405 54,310 55,893 89,063 95,452 97,068
66-70 61,292 66,191 69,832 1,13,035 1,16,013 1,17,963 66-70 67,861 73,211 77,189 1,24,154 1,27,410 1,29,545
71-75 67,717 73,296 76,631 1,25,582 1,28,829 1,30,978 71-75 74,866 80,957 84,601 1,37,831 1,41,380 1,43,733

A - Adult, K- Kid
 HEALTH SHIELD 360 - PREMIUM COVER

Sum Insured = `25 Lakhs | OPD = `25,000 Sum Insured = `50 Lakhs | OPD = `30,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 16,249 18,790 21,123 33,659 37,449 41,911 0-25 19,651 22,795 25,678 37,967 42,695 48,275
26-30 18,862 21,063 23,789 36,409 39,933 45,584 26-30 22,958 25,674 29,054 41,673 46,064 53,150
31-35 18,834 21,035 23,761 33,932 37,456 43,106 31-35 22,930 25,646 29,026 39,195 43,586 50,673
36-40 21,225 23,693 25,920 34,993 38,021 41,221 36-40 25,950 29,003 31,751 41,411 45,175 49,155
41-45 21,368 23,817 26,035 32,844 35,866 38,987 41-45 26,122 29,150 31,887 39,308 43,063 46,944
46-50 26,595 30,208 31,744 40,525 43,685 45,579 46-50 32,720 37,224 39,096 49,444 53,374 55,700
51-55 33,778 35,714 37,617 51,220 53,049 54,365 51-55 41,793 44,172 46,509 63,514 65,757 67,350
56-60 45,364 47,319 49,351 70,830 74,864 79,299 56-60 56,443 58,846 61,347 88,299 93,337 98,883
61-65 57,980 60,019 61,710 97,846 1,04,740 1,06,467 61-65 72,389 74,899 76,967 1,22,453 1,31,114 1,33,229
66-70 74,695 80,463 84,748 1,35,800 1,39,303 1,41,592 66-70 93,511 1,00,746 1,06,101 1,70,429 1,74,794 1,77,619
71-75 82,278 88,849 92,772 1,50,608 1,54,428 1,56,952 71-75 1,03,120 1,11,373 1,16,270 1,89,193 1,93,959 1,97,083

A - Adult, K- Kid
 HEALTH SHIELD 360 - WORLD WIDE COVER
Sum Insured = `75 Lakhs | OPD = `30,000 Sum Insured = `100 Lakhs | OPD = `50,000
Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K Age Individual 1A+1K 1A+2K 2A 2A+1K 2A+2K
0-25 27,316 32,716 37,581 49,474 57,886 67,983 0-25 35,123 41,087 46,480 58,033 67,218 78,205
26-30 30,692 34,790 39,987 52,990 59,855 71,266 26-30 38,731 43,302 49,048 61,855 69,383 81,768
31-35 30,651 34,748 39,946 50,486 57,351 68,761 31-35 38,663 43,233 48,980 59,297 66,825 79,210
36-40 49,795 56,709 62,737 77,547 86,288 95,676 36-40 59,208 66,798 73,438 88,592 98,135 1,08,373
41-45 49,995 56,882 62,898 75,495 84,226 93,509 41-45 59,452 67,013 73,641 86,625 96,159 1,06,283
46-50 69,708 81,318 85,142 1,08,474 1,18,057 1,23,501 46-50 80,631 93,247 97,530 1,22,199 1,32,645 1,38,662
51-55 1,16,621 1,23,320 1,29,637 1,87,135 1,92,630 1,96,668 51-55 1,30,976 1,38,339 1,45,292 2,06,794 2,12,866 2,17,380
56-60 1,30,458 1,35,501 1,41,064 2,10,411 2,22,675 2,37,504 56-60 1,45,822 1,51,409 1,57,552 2,31,797 2,45,111 2,61,173
61-65 2,17,982 2,23,872 2,29,315 3,79,421 4,09,118 4,16,364 61-65 2,39,713 2,46,208 2,52,225 4,13,091 4,45,078 4,53,029
66-70 2,90,312 3,13,659 3,31,241 5,45,236 5,59,074 5,68,949 66-70 3,17,336 3,42,522 3,61,537 5,90,987 6,05,994 6,16,760
71-75 3,09,527 3,35,539 3,50,798 5,83,163 5,97,876 6,08,402 71-75 3,37,881 3,65,919 3,82,446 6,31,541 6,47,483 6,58,945

A - Adult, K- Kid

Only for the customers of ICICI Bank Ltd who intend to enroll under Health Shield 360 (Base Plan- 4177i/MSTR/220856891/00/000)(Top Up Plan - 4177i/MSTR/220905046/00/000) underwritten by ICICI Lombard GIC Ltd. Prohibition of Rebates – Section 41 of the Insurance
Act,1938. 1) No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India any rebate of the whole or part of the commission payable
or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer. 2) If any person shall fail to comply
with sub regulation (1) above, he shall be liable to payment of fine which may extend to rupees ten lakhs. ICICI Bank with registered office at ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, 390 007, Gujarat (CIN:L65190GJ1994PLC021012) is registered as a
corporate agent (Composite, IRDAI Regn No. : CA0112 valid till 31/03/2022) of ICICI Lombard General Insurance Company Limited having its registered office at ICICI Lombard House, 414, Veer Savarkar Marg Near Siddhivinayak Temple, Prabhadevi Mumbai, 400 025, Maharashtra.
Bank’s customer participation in the policy is entirely voluntary .The advertisement contains only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before concluding a sale.
ICICI Lombard General Insurance Company Limited. Registered Office: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhivinayak Temple, Prabhadevi, Mumbai - 400 025. IRDA Reg. No. 115. Toll Free No. 1800 2666. Fax No 02261961323. CIN L67200MH2000PLC129408.
Website: www.icicilombard.com. Email: customersupport@icicilombard.com. Health Shield 360.( 4177i). UIN: ICIHLGP22083V022122. ADV/....