L&T GROUP MEDICAL INSURANCE HOSPITALIZATION POLICY 2023-24

THE FOLLOWING IS APPLICABLE FOR ICICI LOMBARD INSURANCE – (OPTION A)

POLICY NO: 4016 / 71639601 / 11 / 000

IL TAKE CARE APP

 Download IL TAKE CARE APP from the Google Play store or Apple APP Store
 Login with your Mobile number as per your HR Master.
 Click Health Policy Icon on the Main Page, Select the policy 4016/71639601/11/000
and select “Member Details” and download the E-Card/UHID/Insurance Card of the
member.
 Click on Claim’s Icon on the main page to track the Reimbursement/Cashless claim
requests and Raise the Reimbursement Claim Request.
 Main Page -> Claims -> Track Your Claim -> Select UHID/Patient Name
Note: If required, verify the UHID cards by Selecting Health policy from Main Screen (Valid Till
30-MAR-2024), Click in Self Card Details and Select the Verify this card and verify all other
cards.

CASHLESS PROCESS
 The Insurance card and Staff Employee ID card is mandatory to be submitted to the
hospital TPA desk, along with all other required documents.
 Once the hospital has raised the request, it can be tracked on the IL Take Care APP
under the Main Page -> Claims -> Track Your Claim -> Select UHID/Patient Name
Points to be noted in the cashless process:
1. Cashless requests are applicable for network hospitals only.
2. Please use the link https://ilhc.icicilombard.com/Customer/GetHospitalList to check
the network hospitals list.
3. For pre-planned hospitalization, we suggest informing the hospital to raise the
cashless request 4 days in Advance.
4. Please read the Remarks in Initial / Enhancement / Final cashless approvals for
clarification regarding Initial /Final /Enhancement Approval and Payable Amount etc
5. The initial approval may be lesser than the requested amount. However, only at the
final approval stage, the total amount approved will need to be considered.
6. For newborn babies, the first 90 days from the birth the cashless request will get
processed with the mother’s UHID card. Please inform the hospital to raise the
cashless request with the mother’s UHID with the insured name as Baby of “Mothers
Name to mentioned”
7. If the hospital is demanding to pay the Discount / MOU deducted amount in final
cashless approvals, please call the ICICI helpdesk numbers provided below. If the
hospital still insists to pay, please make the payment and collect the original Payment
receipt and apply for Pre and Post Hospitalization claims.

Sensitivity: LNT Internal Use

 ICICI Helpdesk Contact Details are as below:

Customer Care 9052444024 customersup@icicilombard.com

Mr.Raghu 6382428412
Healthicici@icicilombard.com
Mr.Kumar 6382406185

REIMBURSEMENT PROCESS
 The staff has to submit the reimbursement claim request for both Hospitalization
Reimbursement and Pre and Post-Hospitalization claims on IL Take Care App.
Home Page -> Claims -> File a Claim -> Type of Claim.
Alternatively, the documents can be uploaded on below link. In case of any issue while
applying, please use the mentioned link for the claim status & upload the documents.

https://ilhc.icicilombard.com/Customer/ClaimStatus

 Fill in the details and attach the required documents.- Less than 5MB
 Post claim request completed, Mention the claim reference number in ICICI Lombard
Application and submit all original claim documents with SSC Team Chennai.
o Insurance Claims Process Dept – SSC L&T Ltd - Shared Services Centre, TCTC
Building, 2nd Floor, P.B.No 979, Mount Poonamallee Road, Manapakkam,
Chennai – 600089
o The documents should NOT BE sent to the Hyderabad address of ICICI.
 The status of the claim can get tracked through IL Take Care APP
Points to be noted in the Reimbursement process:
1. E-Card/UHID/Insurance Card of the member is mandatory to raise the reimbursement
request.
2. Hard Copies need to be submitted to SSC – Chennai
3. Any expenses incurred or cashless requests in delisted Hospitals towards treatment
are not payable by the Insurer. URL to check the delisted and use the same in Chrome
Browser:
https://www.icicilombard.com/docs/default-
source/apps/healthclaims/assets/files/delisted-hospital-list.pdf

Sub-limits:
1. Maternity Limit – Rs.60,000/- (for normal delivery), Rs. 1,00,000/-(for caesarean)
including Pre 30 days & Post 30 days bills (For first two children only). The sublimit
includes Mother maternity expenses, Wellborn baby expenses, including pre and post-
expenses.
2. Cataract Surgery maximum Limit – Rs. 50,000/- per eye including Pre 30 days & Post
60 days bills.
3. Sinus (Nasal) treatment Limit – Rs. 35,000/-
4. Ambulance Charges are limited to Rs. 1000/- per claim

Sensitivity: LNT Internal Use

 Mid-Term Inclusion:
New Joiners have updated the correct details in MY ZONE including dependent details at
the time of joining, the same will be taken up from MY ZONE only. If the dependent details
are not updated at the time of joining and were updated later, the same will not be
considered in the insurance coverage.
Existing employees cannot add their dependents in the middle of the policy. As per the
policy conditions, only NEWLY BORN BABIES & NEWLY MARRIED COUPLES can be added
in MID TERM INCLUSION.

Mandatory Documents to be submitted for Reimbursement :

A. ICICI Claim form completely filled
B. EFT Form completely filled
C. Cancelled Cheque Leaf with Account Holder's name printed
D. Final Bill with payment Receipts (Original)
E. Discharge Summary (Original)
F. Diagnostics report (Original)
G. Pharmacy Bills (Original)
H. Other Payment Receipts (Original)
I. Break up details required, If package rate mentioned in bills
J. Government KYC Documents*
K. RT-PCR Test Mandatory for Covid Claims
L. Implant Sticker and Invoice for Cataract

Sensitivity: LNT Internal Use

 FREQUENTLY ASKED QUESTIONS (FAQS)
1. I have recently joined L&T. Am I covered from day 1? How can I go about with a
cashless claim?
For newly joined staff the cashless request can be considered after receipt of inputs
(basic details from respective HR). This will be done typically at least a month after
joining. However, reimbursement claims will be considered from the date of joining.

2. What is the max cover for the hospitalization?

Below are the details for cover/Sum insured as per Cadre. Once the Basic Sum insured
is exhausted, the Corporate floater will get enhanced automatically.

Cadre Basic Sum Insured Corporate Floater Total

Trainee 100000 100000 200000
NON - COV 200000 250000 450000
COV and JGM & Above 300000 550000 850000
The Reimbursement /Cashless claim requests will get processed from the base policy
and post exhaustion of the Basic Sum insured and Corporate floater in the base policy.

3. How do I know my Login ID for IL Take Care App?

There is an SMS sent from ICICI to all the employees who have opted for the policy.
Else please refer to the first page to know how to download the app and login.

4. Why are the full limits not showing up in the IL Take Care App?
The display in the APP will show only the base limit.

a. For non-covenanted employees, the breakup of eligibility is Sum Insured (Rs 2

lakhs) plus the Corporate Floater Amount (Rs 2.5 lakhs).
b. For covenanted employees, breakup of eligibility is Sum Insured (Rs 3 lakhs) +
Corporate Floater Amount (Rs 5.5 lakhs).
c. Once the above sum insured is exhausted, the Corporate floater amount will
be triggered automatically by ICICI Lombard for the settlement of claim.

5. What is the room rent applicable for me?

Maximum Room Rent allowed per day: (including Nursing charges)
TRAINEE CADRE – RS. 4000/-
NON - CONVENANTED CADRE – RS. 5000/-
COVENANTED TIER 1 – RS. 6000/-
COVENANTED TIER 2 – RS. 7000/-
COVENANTED TIER 3 – RS. 8000/-
JGM & ABOVE – UPTO RS. 14,000/-

Sensitivity: LNT Internal Use

 6. What is the Special Treatment?
For treatment coverage-related confirmation, Share the treating doctor’s letter about
the diagnosis and recommended treatment. ICICI will check the same with our internal
team and confirm.

7. Is Home Nursing & Physiotherapy covered?

Home Nursing or any care given at home is not covered in the policy. Only
Physiotherapy up to 60 days post-discharge is covered, provided it is clearly
mentioned in the discharge summary.

8. What about an overlap from last year’s claim?

For last year’s claim documents:- Please submit all original claim documents along
with Manual claim form, NEFT form & Cancel Cheque to SSC Insurance department –
Chennai. The manual claim form & NEFT form get it from the concerned HR.

SPECIFIC EXCLUSIONS IN POLICY

Following are a few exclusions, including but not limited to, under the policy
 The expenses incurred for the treatment of certain diseases are not covered
such as convalescence, general debility, "Run down" condition or rest cure.
 Birth defects (Congenital ailments), disease or defects or anomalies.
 Sterility, any fertility or assisted conception procedure, venereal disease,
intentional self-injury, and use of intoxicating drugs/alcohol, all psychiatric and
psychosomatic disorders. Circumcision.
 Genetic Disorders & stem cell implantation/surgery are not covered.
 50% Co-Pay for cyberknife treatment/Stem Cell Transplantation, Cochlear
Implant treatment shall be restricted to 50% of the Base Sum Insured.
 Lasik Surgery, Septoplasty, Infertility & Related Ailments incl.'Male sterility'
Treatment on trial/ experimental basis; Admin/Registration/Service/Misc.
Charges; Expenses on the fitting of Prosthesis; Any
device/instrument/machine contributing/replacing the function of an organ;
Holter Monitoring are outside the scope of the policy.
 All expenses arising out of any condition directly or indirectly caused by or
associated with Human T-cell Lymphotropic Virus Type III (HTLD - III) or
Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or
Variations Deficiency Syndrome or any Syndrome or condition of similar kind
commonly referred to as AIDS, HIV and its complications including sexually
transmitted diseases.
 Expenses incurred for investigation or treatment irrelevant to the diseases
diagnosed during hospitalisation or primary reasons for admission. Private
nursing charges, Referral fee to family doctors, Outstation consultants /
Surgeon's fees etc.

Sensitivity: LNT Internal Use

  External and or durable Medical / Non-medical equipment of any kind used for
diagnosis and or treatment including CPAP, CAPD, Infusion pump etc.,
Ambulatory devices i.e. walker, Crutches, Belts, Collars, Caps, splints, slings,
braces, Stockings etc of any kind, Diabetic footwear, Glucometer /
Thermometer and similar related items etc and any medical equipment which
is subsequently used at home etc. All non-medical expenses including Personal
comfort and convenience items or services such as telephone, duty Doctor
charges, television, Aya / barber or beauty services, diet charges, baby food,
cosmetics, napkins, toiletry items etc, guest services and similar incidental
expenses or services etc.
 Any treatment required arising from Insured’s participation in any hazardous
activity including but not limited to scuba diving, motor racing, rock or
mountain climbing etc unless specifically agreed by the Insurance Company.
 Outpatient Diagnostic, Medical or Surgical procedures or treatments, non-
prescribed drugs and medical supplies, Hormone replacement therapy, Sex
change or treatment which results from or is in any way related to sex change.

COMMUNICATION & ESCALATIONS :

For queries related to Reimbursement, Cashless, e-cards, IL Care app please connect with: -
NAME E-MAIL ID CONTACT NUMBER
Customer Care customersup@icicilombard.com 9052444024
Mr.Raghu raghu.g@ext.icicilombard.com 6382428412
Mr.Kumar kumar.n@ext.icicilombard.com 6382406185

In case there is no/ delayed response from the above, please escalate to L&T SSC
Insurance: -
LEVEL EMAIL CONTACT
1 level Escalation ssc-insurance@lntecc.com 044-6174 8858
2 level Escalation priya.ramachandran@lntecc.com 044-6174 8986

Sensitivity: LNT Internal Use