HEALTH

SHIELD
360

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HEALTH SHIELD 360

TERMS AND CONDITIONS

Product Name Health Shield 360

Product UIN ICIHLGP22083V022122

Insurer Name ICICI Lombard General Insurance Company Limited (IRDA Reg. No. 115)

A The type of consumer for whom the product is intended –

“Customer” applying shall mean all ICICI Bank customers over the age of 21 years. The child
to be insured should be greater than 91 days and less than 21 years and individual should be
above 21 years and less than 61 years.

Main characteristics of the product, Options and coverage provided by the

B product, as applicable

Features Option

Sum Insured 15L, 25L, 50L

Deductible 2L/ 3L/ 4L/ 5L

In-patient Hospitalisation

Day Care Treatment/Surgeries

Pre - Post Hospitalisation

In Patient AYUSH Hospitalisation

Unlimited Reset Benefit

Additional Sum Insured (Cumulative Bonus)

Donor Expenses

Domiciliary Hospitalization

Domestic Road Emergency Ambulance Cover

Air Ambulance

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 HEALTH SHIELD 360

Features Option

Home Healthcare

Claim Protector

Sum Insured protector

ASI Protector

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HEALTH SHIELD 360

B Key Benefits & Exclusions

Sr.no Title Description Option

1 Product Name Health Shield 360 (UIN : ICIHLGP22083V022122)

2 What am Sum Insured 15 Lakhs/ 25 Lakhs/ 50 Lakhs Clause d. (A)

I covered for
Deductible 2 Lakhs/ 3 Lakhs/ 4 Lakhs/ Clause d.
5 Lakhs C. Extension/Optional
Covers. 23
The Deductible will be
applicable on aggregate
basis for all Hospitalization
expenses during the Policy
year

Hospitalization Covers Hospital expenses Clause d. (A)

Expenses for admission longer than
24 hours
Room Rent No Capping, covered up to
Sum insured
Day Care Medical expenses for day
Procedure care procedures where such
procedures are undertaken
by an Insured Person as an
In-patient in a Hospital for
continuous period of less
than 24 hours
Pre & Post Medical Expenses incurred
Hospitalisation due to Illness up to 60 days
period immediately before
and 90 days immediately
after an Insured Person's
admission to Hospital

In-patient Covered up to sum insured

Hospitalisation

In Patient Medical expenses for AYUSH

AYUSH treatment when the treatment
Hospitalisation has been undergone in an
AYUSH Hospital or AYUSH
day care centre.
Unlimited Reset The Sum Insured, will be reset
Benefit up to 100% unlimited times in
a year. In case the balance sum
insured including accrued,
Additional Sum Insured (if any)

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 HEALTH SHIELD 360

Sr.no Title Description Option

and Super No Claim Bonus (if
any), Sum Insured protector (if
any) is insufficient as a result of
previous claims in that policy
year. This cover will be
applicable only within the
geographical boundaries of
India. Unlimited reset will be
applicable for future claims and it
will not trigger for same person
same illness within policy year.
Additional At the time of renewal of this
Sum Insured Policy, We will provide an
(Cumulative additional sum insured
Bonus) (hereinafter referred to as
“Additional Sum Insured”) of
10% of annual sum insured of
immediately preceding policy
year subject to a maximum of
100% provided that there is no
Claim under this Policy during the
Policy Year. However, in the
event of a Claim under the Policy
during any subsequent Policy
Year, the accrued Additional Sum
Insured will be reduced by 10%
of the Annual Sum Insured at the
time of renewal of this Policy.
This cover will be applicable only
within the geographical
boundaries of India.
Donor expense Medical Expenses incurred in
respect of the donor for any of
the organ transplant surgery,
provided the organ donated is
for Insured persons
Domiciliary Medical expenses for treatment
Hospitalization taken when confined within
one’s home for a minimum of 3
consecutive days
Domestic Road Expenses incurred to transfer Clause d. (C). 6
Emergency the Insured Person following an
Ambulance emergency to the nearest
Cover Hospital through domestic road
ambulance services. Maximum
amount payable is as per the
opted basic sum insured

Basic Sum Road Ambulance

Insured (INR) cover per event (INR)
15 Lakhs Rs.3,000
25 Lakhs/
Rs.5,000
50 Lakhs

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HEALTH SHIELD 360

Sr.no Title Description Option

Air Ambulance Expenses incurred on air Clause d. (C). 7

ambulance services in
respect to you which are
offered by a healthcare or an
air ambulance service provide
to transfer you to the nearest
Hospital with adequate
emergency facilities for the
provision of Emergency Care.
Maximum amount payable is
up to Sum Insured.
ASI Protector Additional sum insured(ASI) Clause d. (C). 08
accrued by you will not be
impacted or reduced at
renewal if any one claim or
multiple claims admissible in
the previous policy year
under the policy does not
exceed the overall amount of
Rs.50,000
Sum Insured The Sum Insured will be Clause d. (C). 09
Protector increased on cumulative
basis at each renewal on the
basis of inflation rate in
previous year
Claim Protector If a claim has been accepted Clause d. (C). 10
under the inpatient
hospitalization cover, then
the items which are not
payable under the claim as
per the List of Excluded items
that is related to the particular
claim will become payable.
The maximum claim payout
under this benefit shall be
limited to Annual Sum
Insured under your policy.

Home Health Medical expenses up to Sum Clause d. (C). 21

Care Insured incurred by you on
availing treatment at home
provided You have been
advised non-emergency
hospitalization by a Medical
practitioner and you out of
your own will, opts to
undergo treatment at home.

Tax Benefits Tax deduction under Section

80D is as per applicable
provisions of the Income Tax
Act, 1961 and amendments
made thereto.

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 HEALTH SHIELD 360

3 What are the Note: Following is an indicative list of the Clause e. Permanent
major Exclusions policy exclusions. Please refer to the policy Exclusions
in the Policy clause for the complete list.

• 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)
• Unproven Treatments
• Obesity/ Weight Control
• Change of Gender treatments
• Cosmetic or plastic Surgery
• Hazardous or Adventure sports, Breach
of law
• Cost of spectacles/ contact lenses, dental
treatment
• Expenses related to, sterility and infertility
• Treatment for, Alcoholism, drug or substance
abuse
• Any expenses incurred on prosthesis,
corrective devices, external durable medical
equipment of any kind
• Medical treatment expenses traceable to
childbirth (including complicated deliveries
and caesarean sections incurred during
Hospitalisation) except ectopic pregnancy

4 Waiting Period Pre-existing diseases: Nil waiting period for Clause e. 3.1
declared and accepted PEDs
Specific waiting period: 30 days for specific Clause e. 3.2
Illness and treatment. (Please refer to the
policy clauses for the full listing)
Expense related to hypertension, diabetes and Clause e. 3.3
cardiac conditions within 90days from the policy
commencement date unless they are PED
Initial waiting period: 30 days for all illnesses Clause e. 3.4
(except Hospitalisation due to injury).

5 Payout Basis •Cashless or Reimbursement of covered Clause g. 4.1

medical expenses up to specified Sum
Insured as per the scope of cover
•Cashless Facility available at over 6500+
health network providers*
*As on 22nd June 2021

Please refer to the Policy Wordings for more details.

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HEALTH SHIELD 360

C Total premium and other charges including taxes, applicable

One-time payment of premium as per selected option.

Sum Insured Deductible Premium (Rs incl GST)

`15 lacs `2 lacs 4,649

`25 lacs `2 lacs 6,549

`15 lacs `3 lacs 4,099

`25 lacs `3 lacs 5,999

`50 lacs `3 lacs 9,199

`15 lacs `4 lacs 3,699

`25 lacs `4 lacs 5,549

`50 lacs `4 lacs 8,749

`15 lacs `5 lacs 2,949

`25 lacs `5 lacs 4,849

`50 lacs `5 lacs 8,049

D Deductible: Means a cost sharing requirement under a health insurance policy that
provides that the insurer will not be liable for a specified rupee amount in case of
indemnity policies and for a specified number of days/hours in case of hospital cash
policies which will apply before any benefits are payable by the insurer. A deductible
does not reduce the Sum Insured.

E Freelook Period: Please refer to the policy wording

F Conditional underwriting: Basis proposed insured members age and declared

existing illness, a proposal may undergo Medical Underwriting. As an outcome of this
underwriting the proposal is accepted with/ without loading on premium or is rejected

G Cancellation: Please refer to the policy wording

H Renewal: Please refer to the policy wording

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Only for the customers of ICICI Bank who wish to avail 'Health Shield 360 Policy No : (4177i/MSTR/245580779/00/000) underwritten by ICICI
Lombard GIC Ltd. ICICI Bank Limited ("ICICI Bank") with registered office at ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, 390
007, Gujarat (CIN - L65190GJ1994PLC021012) is a Corporate Agent (Composite, IRDAI Regn. No.: CA0112 valid till 31/03/2022) of ICICI Lombard
General Insurance Company Limited (“ICICI Lombard”). Insurance is underwritten by ICICI Lombard. 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. The advertisement contains only an indication of
cover offered. For more details on risk factors, terms, conditions and exclusions, please read the sales brochure / policy wordings carefully before
concluding a sale. ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo
belongs to ICICI Lombard GIC Ltd ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi,
Mumbai – 400025 Toll Free : 1800 2666 Fax No : 022 61961323 IRDA Reg. No. 115 CIN : L67200MH2000PLC129408 Customer Support Email Id :
customersupport@icicilombard.com Website Address: www.icicilombard.com. Product Name : Health Shield 360 UIN : ICIHLGP22083V022122
ADV/14945 | 022XXXBO-ST