GROUP HEALTH INSURANCE POLICY FOR PARENTS

The policy number for the GHI policy for Parents and Parent-in-laws, for the period August 1, 2022
to July 31, 2023 is4016/120339706/06/000
What are the policy benefits?

Employee’s parents and parents in-law can be covered under this

Who can be covered? policy. (Parents-in-law are eligible to be covered, subject to both the
parents being enrolled in the policy

All new joinees need to, enroll within 30 days from the date of joining.

For existing Employees: On first time enrollment, the applicable co-pay

will be 35% on each & every claim in the 1st year of enrollment and
20% in subsequent years.
If your parents & parents-in-law are already enrolled in last year's policy,
then they will be auto-enrolled for the next year's policy. Premium shall
When Can I enroll my be deducted from Jul-22 Salary, unless employee leaves the
parents and Parents-in- organization or opts out of the policy.
law in the policy?
If you have any time claimed under the current year's policy, then you
would not be able to opt out of this policy for the next year. The
enrollment will get auto-renewed.

If you opt out of this policy you will not be eligible to enroll your parents
or parents-in-law in subsequent year.

The Co-pay for existing employees who have enrolled their parents in
2021-22 year policy and new joinees (joined before 1st June’22), the
Co-pay applicable will be 20%.
Co-pay
Existing employees who joined before 1st June 2022 and who did not
enroll for this policy last year and wish to enroll now, the applicable
co-pay will be 35% and the maximum sum insured is limited to 4 lacs
only.

Pre-Post Pre Hospitalisation and Post Hospitalisation for 30 days and 60 days
Hospitalisation respectively are covered.

Room Rent is restricted to 1.5% of Sum Insured for Normal Room

Normal Room Rent
(Room rent limit incl. of nursing charges).

ICU Room Rent 2.5% of Sum Insured for ICU (Room rent limit incl. of nursing charges).

What if the room

charges are over and If insured is admitted in a higher category room, then the differential
above the mentioned amount will be borne by the insured.
limits?

Ambulance Service Ambulance Charges covered upto to Rs.4,000 Per Hospitalisation

Day care procedures Day Care Procedures are covered as per standard list

Pre-existing diseases Covered from Day 1 (After Policy Start Date)

Claim must be filed within 60 days from the date of discharge. However,
the Insurance Company may at its absolute discretion consider
Is there any other sub
extension to 90 days in extreme cases of hardship where it is proved to
limit
the satisfaction of the Insurance Company that under the circumstances
in which the insured was placed it was not possible for him or any other
 person to give such notice or file claim within the prescribed time-limit.
Any claim received after 90 days will not be payable.

Is there any co- 50% Co-Pay for Cyber Knife treatment / Stem Cell Transplantation.
payment Cochlear Implant treatment shall be restricted to 50% of the SI.

Special Coverage Sublimit of Rs. 30,000/- for Cataract Surgery per eye.

Liability for Nasal Sinus Surgeries upto Rs. 35,000/-; Hospitalisation

Special Coverage
arising out of Psychiatric ailments upto Rs. 30,000/-

Validity of the Policy It is an annual policy.

At the time of availing cashless facility or lodging of a claim for

Date of Birth Proof of
reimbursement, the enrolled dependent has to compulsory provide a
the enrolled dependent
photo identity proof of the patient.

What makes this policy different from any other retail policy?
Why Group Insurance Program from ICICI Lombard General Insurance?

Group Insurance program for Typical Retail Insurance Plans (as

Insurance Benefits
Parents and Parents-in-law available in market)

Pre Existing Diseases Only from 3rd or 4th year

Coverage from Day 1
covered* onwards

Waiver on 1st year

Yes No
Exclusion*

Waiver on 1st 30 days

Yes No
Exclusion*

Pre-policy Medical test Waived off Yes

Age limit No age limit Typically restricted to 65 years

Medical Tests for Mandatory ( coverage based on

Waived off
approving plan medical reports )

Two year exclusions None 16 ailments

* These ailments would not be covered under the retail policy, but the same would be covered
under the Group Health Insurance Policy for Parents, Cataract, Hysterectomy, Hernia, Fissures,
Arthritis, Joint replacement, Sinus, Stones in Urinary & biliary systems, D&C, Dialysis, Surgery on
tonsils.

Frequently Asked Questions (FAQ’s)

Who are the dependents eligible to enroll under the Group Health Insurance Policy for Parents?
Employees can enroll only their Parents and Parents-in-law in the Group Health Insurance Policy
for Parents.

Can I cover my Parents-In-law in this Policy?

Parents-In-law are eligible for coverage under the Group Health Insurance Policy for Parents.

Is there any condition to enroll my Parents-in-law in Group Health Insurance Policy for Parents?
Yes. Parents-in-law can only be allowed to be covered if both the Parents are enrolled. If any one
of the Parents is not alive, subject to declaration from the employee, then only the Parents-in-law
can be covered.

My Parents and Parents-in-law details are not auto populated?

You may enter the details manually and submit.

Can I cover only my Parents-in-law in Group Health Insurance Policy for Parents?
Yes. Only Parents-in-law can be covered, only if declaration is given by employee stating that
both the Parents are not alive. There is a column for the same “Applicable or Not-Applicable” for
the declaration. You have to select NA if any of your parent or Parents-in-law are not alive.

If one of my Parents is not alive, can I cover both my Parents-in-law?

Yes. You can cover your single parent and both your Parents-in-law subject to declaration from
your side stating one of your parent is deceased, only then the Parents-in-law can be covered.

If both my Parents-in-law are alive, can I enroll only one of them?

No. You have to enroll both your Parents and Parents-in-law.

If I get married during this policy period, can I enroll my Parents in-laws?
Yes, you can enroll your Parents in-laws, subject to your Parents being enrolled at the time of
renewal of this policy i.e. in July every year. If your Parents are not enrolled at the time of
renewal, then you can enroll your parents and in-laws at the time of next renewal.

What is the maximum sum insured limit for Parents-in-law?

The maximum sum insured limit for Parents-in-law can be one step higher than Parents sum
insured limit. If Parents are not alive, the maximum sum insured limit of Parents-in-law is Rs 4 lacs
in first year and employee can opt for one notch higher in subsequent year. Eg. If Father is having
1 lakh single parent coverage, and mother having 2 lakhs single parent coverage. Then Parents-in-
law can be covered for either 1/2/4/6 lakh single/floater coverage.

I have taken sum insured of Rs. 4,00,000/- under last year parental policy. If I need to increase or
decrease what will be the sum insured which I can take?
Please note as per policy you can go for 1 notch higher only. Hence you can increase the same to
Rs. 6,00,000/- only. Sum Insured amount cannot be changed downwards.

Can I change my dependent details post enrollment in the policy?

No, dependent details can’t be changed, only spell correction in name can be changed via SR (I-
Care > Claims – Reimbursement Allowance > Parental Insurance Policy), DOB will not be
changed.

I have just joined the Bank. Am I eligible to enroll my Parents/Parents-in-law under the Group
Health Insurance Policy for Parents?
Yes. You can enroll your Parents and Parents-in-law within 30 days from your date of joining.

My Parents are already covered under the existing group mediclaim policy of the bank, Can I take
an additional coverage under this policy?
Yes you can take an additional top up coverage for your Parents under this policy.

Can I take coverage only for 1 of my dependent Parents?

Yes. You can take single coverage for your mother or father.

What is the premium payable for coverage of my Parents/ Parents-in-law?

The below are the premium for addition of Parents and Parents-in-law Excluding GST

OPTION 1: INR 1,00,000

Premium to be paid by employee (In Rupees)

Sum Insured Rs 1 Lac Upto 45 years 46 to 55 years 56 to 65 years Above 65 years

Coverage for 1 Member 4732 8395 10532 13126

Floater Insurance for 2 Member 8395 15110 17858 22589

OPTION 2: INR 2,00,000

Premium to be paid by employee (In Rupees)

Sum Insured Rs 2 Lac Upto 45 years 46 to 55 years 56 to 65 years Above 65 years

17858
Coverage for 1 Member 5648 11294 14042

Floater Insurance for 2 Member 10379 19841 23504 30068

OPTION 3: INR 4,00,000

Premium to be paid by employee (In Rupees)

Sum Insured Rs 4 Lac Upto 45 years 46 to 55 years 56 to 65 years Above 65 years

Coverage for 1 Member 7937 15721 19841 25031

Floater Insurance for 2 Member 14500 27626 32967 42125

OPTION 4: INR 6,00,000

Premium to be paid by employee (In Rupees)

Sum Insured Rs 6 Lac Upto 45 years 46 to 55 years 56 to 65 years Above 65 years

Coverage for 1 Member 9005 18010 22589 28541

Floater Insurance for 2 Member 16484 31594 37699 48077

Is there any increase in premium amount than the last year?

Yes, there is increase in premium amount. Due to adverse claim ratio in 2021-2022 policy, the
premium amount is increase.

Whom should I call in case of any query?

In case of any queries kindly Call @ ICare 1800-200-1441 or write to Medical Helpdesk at
medical.helpdesk@icicibank.com or Mr Akshay Acharekar at akshay.acharekar@icicibank.com or
Sachin Pednekar at sachin.pednekar@icicibank.com.

What do you mean by floater insurance and what is the premium payable for my Parents if they
fall in different age band?
Floater insurance ensures coverage for both Parents under same sum assured i.e if you want to
cover Father and Mother for a floater cover of INR 200,000 in such scenario the overall coverage
benefit individually or combined cannot exceed INR 2 lacs. The premium for the floater insurance
will charge as per higher age of parent.
 Example A: I want to cover my Father and Mother aged 54 years for a floater cover of INR
200,000/- between them. Then the Premium payable = INR 19841/- +18%GST

Example B: I want to cover my Father aged 59 years and my Mother aged 54 years for a floater
cover of INR 200,000/- between them. Then the Premium payable = INR 23504/- +18%
GST (Higher of the 2 bands).

Example C: I want to cover my Father aged 59 years and my Mother aged 54 years for a floater
cover of INR 400,000/- between them. Then the Premium payable = INR 32967/- +18% GST
(Higher of the 2 bands)

Can I cover my Parents and Parents-in-law in one floater Group Health Insurance Policy for Parents?

No. You have to take separate floater insurance for your Parents and Parents-in-law. Mother and
father will be combined in one single floater and mother-in-law and father-in-law in another floater.
Both parent or Parents-in-law can’t be combined in any single floater.

I would like to take individual sum insured for my Parents and Parents-in-law (single parent
coverage), will I be able to do so?

Yes you can cover your Parents and Parents-in-law for individual sum insured (single parent
coverage) Eg. you can cover Father and Mother and in-law individually for 2 lacs each. In such
overall premium will be calculated as per age and sum insured for each individual separately. Hence
the total premium will be greater than the floater premium. E.g.
Example A: I want to cover my Father aged 54 years for sum insured of 2 lacs and Mother aged
54 years for sum insured of 2 lacs. Then the Premium payable = INR 22588/- +18% GST (i.e
11294/- each) whereas under floater it would be INR 19841/- +18% GST

Example B: I want to cover my Father-in-law aged 59 years and my Mother-in-law aged 54 years
for an individual sum insured of INR 200,000/- each. Hence premium for father-in-law would be
INR 14042/- and for mother-in-law would be INR 11294/- Hence total premium payable = INR
25336/- +18% GST

How do I select floater coverage or single parent coverage?

When you are enrolling your Parents and Parents-in-law enrolled for the policy, there is field
called coverage type in which you can opt for type of coverage required i.e. floater or single
parent coverage.

What is the amount of GST to be paid on the premium?

Currently the GST is 18% on the premium amount. This is over and above premium amount.

What is co-pay policy, can you explain the same?

This Group Health Insurance Policy for Parents which has been taken has a co-pay of 20% on all
claims for the employees who had enrolled their Parents in last year policy and for employees
who newly join the organization and avail this policy within 30 days from the date of joining. For
employees who had not availed this policy last year and are availing the policy in the current year
the co-pay amount would be 35% on all claims.

Why there is co-pay in this policy?

There is co-pay in this policy, so that the claims ratio does not go adverse, on renewals there will
be a huge loading on the premium paid by the employees.
What if I have not enrolled my Parents at the time of renewal of the Group Parental Policy?
In case an employee has not enrolled his Parents at the time of renewal in current policy year
(August 1, 2022 to July 31,2023) then the employee can enroll his Parents only in the next policy
year at the time of renewal. But in that case, the employee will have to pay 35% of the claim
amount incurred and insurance company will pay the balance 65% subject to the insured sum
amount of the dependent. In the subsequent year policy, the co-pay will then reduce to 20%.

Details of Insurer and Third Party Administrator (TPA)

This policy is with ICICI Lombard General Insurance Company Ltd. and TPA name is IHEALTH
CARE.

Whom should I call in Case of Emergency (ICE) situations & Escalations?

In addition to ICICI Bank Emergency helpline 040-23128811 which is available to all employees,
IHealth Care Toll free call centre + fax no: 18002666
E-mail address: ihealthcare@icicilombard.com
Dedicated Mobile No: 09052444024 (only for cashless status)
Medical Helpdesk contact number- 040 61094152 / 040 61094153 / 02262878143
Medical Helpdesk Email Id :- medical.helpdesk@icicibank.com

How do I enroll my dependents under the new Group Health Insurance Policy for parents?
You can enroll your dependents through the link provided on email and following path on HR4U:
HRMS>Main Menu > Self Service > Benefits > Enroll in Parental Policy > Click on “+“ to add
dependents.
Or through UOTM App > My Wellness > Parental Policy Enrollment

How do I de-enroll my dependents under the Group Health Insurance Policy for Parents?
Please note that mid-term de-enrollment is not possible. You can de-enroll your parents or in-law
only at the time of renewal of policy. Kindly send the mail to akshay.acharekar@icicibank.com or
medical.helpdesk@icicibank.com to de-enroll from the parental insurance policy. Please note that
once you de-enroll you can’t enroll your parents in policy for the next year. Also note that, if you
have availed the medical benefits in current year than, you can’t de-enroll from policy for the
subsequent year.

Are both domiciliary and hospitalisation expenses covered under the policy?
No, only hospitalisation expenses are covered under the policy and minimum 24 hours
hospitalisation is required to claim the expenses, subject to the hospitalisation being justified.

How will the premium be paid by the employee and when will the same be payable?
The premium can be paid by the employee, either in one, two, three, four, five or six installments
and the same will be recover from your salary.

Kindly confirm from when the premium will be deducted for the policy commencing from August
01,2022?
1st installment of premium will deducted from July 2022 salary, for the policy commencing from
August 01,2022.

Will I be entitled to income tax rebate for the premium paid by me for my dependents?
As per current Income tax norms, premium paid only towards your Parents upto a sum of Rs.
25,000/- p.a. for the employee or his dependents for hospitalisation coverage will be treated as tax
exempted.
Please note that the medical insurance premium paid for Parents-in-law, cannot be considered for
tax exemption under section 80 D

I have resigned now, I have not lodged any claim, am I entitled for a refund in the premium paid?
The employee is not entitled for any refund, if he has resigned, however if there is any
hospitalisation claim, for the period for which he has paid the premium, he can lodge the claim
with the insurance company.

I have resigned and I would like to continue with this policy by pay the necessary premium?
This Group Health Insurance Policy for Parents is only for the employees of the bank, if you resign
you cannot continue with this policy, however you will be eligible to claim any hospitalisation till
the validity of the existing policy for which you have already paid the premium.
Example: If you have paid premium for policy from 1st August to 31st July, and your LWD was
30th Sep, you can claim for medical benefit till 31st July.

What is the room rent that I am eligible for?

If an insured is admitted to a normal room, then his room entitlement is 1.5% of the sum insured,
and in case the insured is admitted to a ICU then his room entitlement is 2.5% of the sum insured.
Room rent limit is inclusive of nursing charges.

What if I have taken a room which is higher than my eligibility?

In case your room rents exceeds the room rent amount which is specified in the policy, then the
insured will have to pay the amount which is over and above his eligibility, in addition to the 20%
co-pay which is specified in the policy.

Can I discontinue the coverage for my dependents in between the policy and claim refund?
You will not be entitled for any refund of premium in case you would like to discontinue the
coverage of your dependents during the policy for which you have paid the premium. The option
to de-enroll would be available only at the time of the next year renewal of the policy, provided no
claims have been availed in current year’s policy.

Is the premium paid now going to be the same for the next year renewal also?
The premium will vary at the next year renewal depending on claim ratios etc. It may increase or
decrease every year.

What is my policy number?

The policy number for the GHI policy for Parents, for the period August 1, 2022 to July 31, 2023 is
4016/120339706/06/000

What will be the policy period?

The policy will be effective from 1st August to 31st July. All claims where date of admission is
after 1st August will be considered for processing.

How do I claim cashless facility?

If an employee wants to avail of cashless treatment, he has to go to I Healthcare specified hospital
and fill in the admission request form available with the hospital at TPA counter and under e-
forms path is Universe > e-FORMS > HRMG > Cashless Hospitalisation Form (form no 2). The
hospital will fax the same to I Healthcare for approval.

I Healthcare will allow cashless treatment to the employee dependents after verifying the cashless
request sent from the hospital.

The list of I Healthcare specified hospitals is given under Universe-> e-Form > HRMG -> Form No
1 (All India Network Hospitals List).

I Healthcare 24 Hrs Help Line No. 18002666 & 9052444024 (cashless helpline no).

What is the process of claiming medical expenses and what are the documents to be submitted?
Application can be made on completion of treatment or after the discharge from the hospital.
Duly filled in hospitalisation claim form, which is available under e-forms, path is Universe > e-
FORMS > HRMG > Hospitalisation Reimbursement Claim Form (form no 3). All the documents
need to be sent to Medical Helpdesk Dept, ICICI Lombard Health Care, 9th Floor, ICICI Bank
Tower, Plot No. 12, Financial District Nanakram Guda, Gachibowli, Hyderabad, TG :- 500032.
Medical Helpdesk – 040 61094152/53

Following documents are to be submitted along with the claim form:-

· Original discharge card
· Original medical bills
· Original payment receipts from hospital
· Copies of Prescriptions from Doctor
· Copies of Investigation / Pathology reports
· Copies of Date of Birth proof of patient

I have not taken any cashless option; can I claim reimbursement of expenses?
Yes, you can claim the reimbursement of hospitalisation expenses.

I have enrolled my Parents and Parents-in-law for the Group Health Insurance Policy for Parents,
will they get a Health Card?
Health card details is uploaded on Universe > Human Resources > My Wellness > UHID Details
> Parental Insurance Policy.
You can download the health card by clicking the Lombard Link provided in the above path. Post
that you have to select the option “Corporate” > UHID No (Patient UHID No) > Age (Patient Age)
and then submit.

Can I enroll my spouse and children under this policy?

No. This policy is only for Parents and Parents in-law. However, you can enroll your spouse and
children under the ICICI group mediclaim policy for employees.

Can the insurance company reject the claim for misrepresentation of facts while enrollment of
dependent eg. age, relationship etc.?
In case of misrepresentation of facts, the claim will be rejected and appropriate action will be
initiated against the employee.

What happens if I have not lodged the claim for reimbursement with the insurance company
within 60 days from the discharge of hospital?
The employee will have to justify to ICICI Lombard General Insurance Co. Limited (ILGIC) the
reason for not being able to submit the claim within 60 days from the date of discharge. In case
ILGIC is convinced with the reason, they will take up the claim for reimbursement.

I have resigned from the bank and currently serving my notice period, Can I enroll my dependent
Parents and Parents-in-laws?
Yes. You can enroll your dependent Parents and Parents-in-laws only if your last working date is
after Aug 01,2022.

By when should the enrolment be done if I am a new joinee?

You need to enroll your Parents and Parent-in-laws within 30 days from the date of your joining.
Also the enrolment has to be done before the 25th of – the month. For e.g. If the enrolment is
done before the 25th August 2022, then the premium will get deducted in August 2022 salary and
insurance coverage will be effective from 1st September 2022 to 31 July 2023. And, if the
enrolment is done after the 26th August 2022, the premium will get deducted in September 2022
salary and insurance coverage will be effective from1st October 2022 to 31 July 2023.

How will the premium be calculated for enrolment done after 1st August 2023?
The premium will be calculated on prorate basis. E.g. If the enrolment is done before the 25th
September 2022, then the premium will get deducted in September 2022 salary and insurance
coverage will be effective from 1st October 2022 to 31 July 2023. And, if the enrolment is done
after the 26th September 2022, the premium will get deducted in October 2022 salary and
insurance coverage will be effective from 1st November 2022 to 31 July 2023. Please note that
premium will be charged on pro rate basis for the remaining period.

Is there any Free Look Period in this policy?

No. There is no such Free Look Period in this policy. Also note that once the premium is paid, you
can’t cancel the policy in mid-term. Cancelation is possible only at the time of next renewal.

What is cut-off date of auto renewal & can I cancel the policy after auto renewal?
The cut-off date of auto renewal is 20th July of every year and you can can’t cancel the policy
after auto renewal.