{"uin":"ICIHLGP26055V072526","name":"Group Health (Floater) Insurance Prospectus","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526","insurer":{"slug":"icici-lombard-general-insurance","name":"ICICI LOMBARD General Insurance Company Limited","url":"https://indiainsurances.com/insurer/icici-lombard-general-insurance"},"line":"health","category":"group-health","category_name":"Group health","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Group Health (Floater) Insurance is a group health policy covering in-patient hospitalisation and day care hospitalisation expenses, with optional covers available. Group members can have cover for a maximum of 1 year, with minimum sum insured 10,000 and no maximum sum insured limit.","analysis":{"state":"machine","analysed_at":"2026-10-20 04:30:57.341119+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"The documents describe base cover and optional covers, but do not name plan variants.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"The coverage for group members is maximum 1 year. A master policy can be issued for more than 1 year.","display":"Group member cover: maximum 1 year; master policy: more than 1 year possible","note":null,"quote":"Cover Period: The coverage for group members will be maximum for 1 year. However, a master policy can be issued for a period more than one year.","sources":[{"clause":null,"heading":"Salient Features","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19772#c-salient-features"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For cashless pre-authorisation, the request should be received at least 48 hours before planned hospitalisation and within 24 hours of hospitalisation in an emergency. For reimbursement, all claims have to be intimated 48 hours prior to hospitalisation or within 24 hours post admission in case of emergency.","display":"Cashless: 48 hours before planned hospitalisation or within 24 hours of emergency hospitalisation; reimbursement: 48 hours prior to hospitalisation or within 24 hours post admission in emergency","note":null,"quote":"Request for pre- authorisation should be received at least 48 hours before a planned Hospitalisation and in case of an emergency situation, within 24 hours of Hospitalisation. ... All claims have to be intimated 48 hours prior to Hospitalisation or within 24 hours post admission in case of emergency for prompt settlement of claims.","sources":[{"clause":null,"heading":"Pre-authorization","page":28,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-pre-authorization"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Duly completed claim form signed by the insured","Original bills, receipts and discharge certificate/card","Original bills from Chemists supported by proper prescription","Original investigation test reports and payment receipts","Indoor case papers","Medical Practitioner’s referral letter advising Hospitalisation in non- Accident cases","Account details for Electronic Fund Transfer (EFT mandate form and cancelled cheque)","Any other document as required by the Company or the TPA to investigate the Claim or the Company’s obligation to make payment for it"],"display":"Claim form, original bills/receipts/discharge card, chemist bills with prescription, investigation reports and receipts, indoor case papers, referral letter for non-accident hospitalisation, EFT mandate/cancelled cheque, and other documents required by the Company or TPA","note":null,"quote":"The Insured shall be required to furnish the following for or in support of a claim:\nI. Duly completed claim form signed by the insured\nII. Original bills, receipts and discharge certificate/card\nIII. Original bills from Chemists supported by proper prescription IV) Original investigation test reports and payment receipts V) Indoor case papers VI) Medical Practitioner’s referral letter advising Hospitalisation in non- Accident cases VII) Account details for Electronic Fund Transfer (EFT mandate form and cancelled cheque) VIII.Any other document as required by the Company or the TPA to investigate the Claim or the Company’s obligation to make payment for it.","sources":[{"clause":null,"heading":"2. Basis of assessment of claims","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-2-basis-of-assessment-of-claims"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The claim will be processed within 15 days of receipt of claim along with claim form and document. Cashless pre-authorisation TAT is within 1 hour from receipt of the last necessary document from hospital, and final cashless final bill authorisation TAT is within 3 hours from receipt of the last necessary document from hospital.","display":"Reimbursement claim: within 15 days of claim form and documents; cashless pre-authorisation: within 1 hour; final cashless bill authorisation: within 3 hours","note":null,"quote":"The claim will be processed within 15 days of receipt of claim along with claim form and document ... Turn Around Time(TAT) for claim settlements- TAT for Pre-Authorization of Cashless Facility is within 1 hours from the receipt of last necessary document from Hospital. TAT for final cashless final bill authorization is within 3 Hours from the receipt of last necessary document from hospital.","sources":[{"clause":null,"heading":"Pre-authorization","page":28,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-pre-authorization"},{"clause":null,"heading":"2. Basis of assessment of claims","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-2-basis-of-assessment-of-claims"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months","Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of specified number of months as mentioned in the policy schedule","Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident","Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.","Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.","Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.","Expenses for cosmetic or plastic surgery or any treatment to change appearance","Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports","Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.","Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","Expenses related to sterility and infertility.","Medical treatment expenses traceable to childbirth","Any expenses incurred on Out Patient treatment","Treatment taken outside the geographical limits of India.","Expenses for non-medical items listed in Annexure II shall not be covered under this Policy."],"display":"PED waiting period, specific waiting period, 30-day waiting period, diagnostics/evaluation, rest cure, gender-change treatment, cosmetic surgery, professional adventure sports, breach of law, substance abuse, infertility, maternity, OPD, treatment outside India, and non-medical items","note":"Some exclusions may not apply to the extent an add-on or special condition specifically covers the risk.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of specified number of months as mentioned in the policy schedule ... Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident ... Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. ... Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. ... Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex. ... Expenses for cosmetic or plastic surgery or any treatment to change appearance ... Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent. ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... Expenses related to sterility and infertility. ... Medical treatment expenses traceable to childbirth ... Any expenses incurred on Out Patient treatment ... Treatment taken outside the geographical limits of India. ... Expenses for non-medical items listed in Annexure II shall not be covered under this Policy.","sources":[{"clause":null,"heading":"Standard Exclusions A. Pre-Existing Diseases - Code- Excl01","page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-standard-exclusions-a-pre-existing-diseases-code"},{"clause":null,"heading":"B. Specific Waiting Period: /Specified Disease/","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-b-specific-waiting-period-specified-disease"},{"clause":null,"heading":"C. 30-day waiting period- Code- Excl03","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-c-30-day-waiting-period-code-excl03"},{"clause":null,"heading":"D. Investigation & Evaluation-Code- Excl04","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-d-investigation-evaluation-code-excl04"},{"clause":"Excl05","heading":null,"page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-excl05"},{"clause":"Excl05(II)(b)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-excl05-ii-b"},{"clause":null,"heading":"H. Cosmetic or plastic Surgery: Code-Excl08","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-h-cosmetic-or-plastic-surgery-code-excl08"},{"clause":null,"heading":"I. Hazardous or Adventure sports: Code- Excl09","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-i-hazardous-or-adventure-sports-code-excl09"},{"clause":null,"heading":"J. Breach of law: Code- Excl10","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-j-breach-of-law-code-excl10"},{"clause":null,"heading":"K. Excluded Providers: Code- Excl11","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-k-excluded-providers-code-excl11"},{"clause":null,"heading":"Q. Sterility and Infertility: Code- Excl17","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-q-sterility-and-infertility-code-excl17"},{"clause":null,"heading":"R. Maternity: Code Excl18","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-r-maternity-code-excl18"},{"clause":"Excl05(II)(c)","heading":"Biological attack or weapons","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-excl05-ii-c"},{"clause":"20","heading":"Expenses for non-medical items listed in","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-20"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"First contact ICICI Lombard through its website, toll-free number, email, address, or branch grievance cell. If not satisfied, contact the grievance officer; then IRDA through Bima Bharosa or IGCC; the Insurance Ombudsman may also be approached subject to jurisdiction.","display":"First ICICI Lombard customer support/grievance cell, then grievance officer, then IRDA/Bima Bharosa or Insurance Ombudsman","note":null,"quote":"ln case of any grievance the insured person may contact the Company through Website: www.icicilombard.com Toll free: 1800 2666 Email: customersupport@icicilombard.com Address: ICICI Lombard General Insurance Co. Ltd. Ground floor- Interface 11, Sixth floor- Interface 16 , Office no 601 & 602, New linking Road, Malad (West), Mumbai – 400064. ... lnsured person may also approach the grievance cell at any of the company’s branches with the details of grievance. lf lnsured person is not satisfied with the redressal of grievance, insured person may contact the grievance officer ... lf lnsured person is not satisfied with the redressal of grievance, the insured person may also approach Insurance Regulatory and Development Authority (IRDA) through the Bima Bharosa Portal ... Insured may also approach Insurance Ombudsman, subject to vested jurisdiction, for the redressal of grievance.","sources":[{"clause":"24","heading":"Redressal of Grievance","page":35,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-24-2"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"Minimum SI is 10,000 and maximum SI has no limit.","display":"Minimum SI: 10,000; Maximum SI: no limit","note":null,"quote":"Minimum SI: 10,000; Maximum SI: no limit","sources":[{"clause":null,"heading":"Salient Features","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19772#c-salient-features"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Accident claims are excepted if covered. Optional Modification of initial waiting period can modify the 30-day waiting period to the number of days specified in the Policy Schedule.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered. ... If this optional cover is in force, as specified in Policy Schedule, the initial waiting period 30- day waiting period- Code- Excl03\n- will stands modified to number of days as specified in Policy Schedule (Part I of Policy).","sources":[{"clause":null,"heading":"C. 30-day waiting period- Code- Excl03","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-c-30-day-waiting-period-code-excl03"},{"clause":"39","heading":"Modification of initial waiting period","page":24,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-39"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":36},"display":"36 months","note":"The optional Cover for Pre-Existing Diseases changes this to 1 year or as stated in Part I of the Policy.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer. ... Cover for Pre-Existing Diseases: By way of this add-on, Pre-existing Diseases shall be covered after 1 year (or as stated in Part I of the Policy.)","sources":[{"clause":null,"heading":"Standard Exclusions A. Pre-Existing Diseases - Code- Excl01","page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-standard-exclusions-a-pre-existing-diseases-code"},{"clause":null,"heading":"II. 3) Add-Ons/ Extensions","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-ii-3-add-ons-extensions"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"quote-verified","value":{"unit":"months","amount":12},"display":"up to 12 months","note":"The exclusion says the actual specified number of months is as mentioned in the policy schedule; accident claims are excepted.","quote":"“Specific waiting period” means a period up to 12 months from the commencement of a health insurance policy during which period specified diseases/treatments (except due to an accident) are not covered. ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of specified number of months as mentioned in the policy schedule of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":null,"heading":"46. Specific Waiting Period: Specified Disease/","page":6,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-46-specific-waiting-period-specified-disease"},{"clause":null,"heading":"B. Specific Waiting Period: /Specified Disease/","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-b-specific-waiting-period-specified-disease"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Cataract","Benign Prostatic Hypertrophy","Hysterectomy for Menorrhagia or Fibromyoma","Hernia","Hydrocele","Fistula in anus","piles","Sinusitis and related disorders"],"display":"Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Fistula in anus, piles, Sinusitis and related disorders","note":null,"quote":"List of specific diseases/procedures Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Fistula in anus, piles, Sinusitis and related disorders","sources":[{"clause":null,"heading":"B. Specific Waiting Period: /Specified Disease/","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-b-specific-waiting-period-specified-disease"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced sums insured, sixty continuous months applies from the date of enhancement only on the enhanced limits.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of sixty continuous months is called as moratorium period.","sources":[{"clause":"19","heading":"Moratorium","page":34,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-19-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The insured can port the policy from one insurer to another by applying to the new insurer at least 30 days before, but not earlier than 60 days from, the renewal due date. Credits are transferable to the extent of the sum insured and benefits available in the previous policy, subject to underwriting; this does not apply to enhanced sum insured.","display":"Portability allowed with waiting-period credit, application 30 to 60 days before renewal","note":null,"quote":"The insured has the choice to port his / her policies from one Insurer to another. An Insured desirous of porting his/her policy to another insurer shall apply to such insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the due date for renewal.\nb) The insured is entitled to transfer the credits gained to the extent of the sum insured and the benefits available in the previous policy, subject to the underwriting policy of the Company ... This benefit is not applicable for enhanced sum insured.","sources":[{"clause":"12","heading":"Portability","page":33,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-12-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"quote-verified","value":true,"display":"Yes, lifetime renewability","note":"From the prospectus.","quote":"Maximum Renewal age – No restriction. Lifetime renewability.","sources":[{"clause":null,"heading":"Salient Features","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19772#c-salient-features"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"No loading applies on renewals based on individual claims experience. However, the total premium at renewal of the group policy can be loaded depending on the incurred claims ratio for the entire group insured, as mutually agreed by the insured and the insurer.","display":"No individual claim loading; group premium may be loaded by group incurred claims ratio","note":null,"quote":"The Total Premium payable at renewal of the Group Policy will be loaded depending upon the incurred claims ratio for the entire group insured under the Group Mediclaim Insurance Policy as mutually agreed by the insured and the insurer. ... No loading shall apply on renewals based on individual claims experience","sources":[{"clause":"58(VII)(f)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-58-vii-f"},{"clause":"21","heading":"Renewal notice","page":34,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-21-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The insured may cancel at any time during the term by giving 7 days’ written notice. For a policy term up to 1 year, the insurer refunds proportionate premium for the unexpired period if no claim has been made; for terms more than 1 year, premium is refunded for unexpired policy years where risk coverage has not commenced. No refund is made if any claim has been admitted or lodged or any benefit availed.","display":"7 days’ notice; proportionate unexpired premium if term up to 1 year and no claim; no refund if claim admitted/lodged or benefit availed","note":null,"quote":"The insured may cancel the policy at any time during the term, by giving 7 days’ notice in writing. ... refund proportionate premium for unexpired policy period, if the term of policy up to one year and there is no claim (s) made during the policy period. ... refund premium for the unexpired policy period, in respect of policies with term more than 1 year and risk coverage for such policy years has not commenced. Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the Insured person under the Policy.","sources":[{"clause":"9","heading":"Cancellation","page":32,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-9-2"},{"clause":"9(a)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-9-a"},{"clause":"9(b)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-9-b"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"Base medical or surgical treatment must be taken in India unless agreed in Part I of the Policy, and claims are payable in India in Indian Rupees. Treatment outside the geographical limits of India is excluded, unless specifically provided.","display":"India only, unless agreed/provided in the policy","note":"Treatment Outside India is available only if the optional cover is in force.","quote":"All medical/surgical treatment under this policy shall have to be taken in India (unless agreed upon in Part I of the Policy) and admissible claims thereof shall be payable in Indian currency. ... No Claims shall be payable under this policy unless the cause of action arises in India, unless otherwise specifically provided in Part II of the Policy to this policy. ... Treatment taken outside the geographical limits of India.","sources":[{"clause":"58(VII)(d)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-58-vii-d"},{"clause":"16","heading":"Cause of Action/ Currency for payment","page":34,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-16-2"},{"clause":"Excl05(II)(c)","heading":"Biological attack or weapons","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-excl05-ii-c"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"not-applicable","value":null,"display":null,"note":"The Customer Information Sheet states free-look cancellation is not applicable for this group policy.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days; 15 days for monthly premium mode","note":"Monthly premium mode has 15 days; all other cases have 30 days. The renewal notice also refers to 30 days.","quote":"The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases. ... At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days to maintain continuity of benefits without break in policy.","sources":[{"clause":"7(b)(ii)","heading":null,"page":3,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-7-b-ii"},{"clause":"21","heading":"Renewal notice","page":34,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-21-2"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Minimum entry age is 3 months. Children below 3 months can be covered if one or both parents are covered concurrently, and there is no maximum entry age limit.","display":"Minimum 3 months; children below 3 months if parent(s) covered; no maximum entry age","note":"From the prospectus.","quote":"Eligibility: Entry age – The policy can be offered to an individual whose age is minimum 3 months. Children below 3 months can be covered provided one or both the parents are covered concurrently. There is no maximum entry age limit.","sources":[{"clause":null,"heading":"Salient Features","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19772#c-salient-features"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The documents refer to monthly mode and all other cases for grace period, but do not list the available premium payment modes.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage during the grace period is offered if the premium is paid in instalments during the policy period. For renewal after the policy period, the policy says coverage is not available during the grace period.","display":"Installment premium grace: coverage offered; renewal grace: coverage not available","note":"The documents distinguish instalment-premium grace during the policy period from renewal grace after the policy period.","quote":"Provided the insurers shall offer coverage during grace period, if the premium is paid in installments during the policy period. ... Coverage is not available during the grace period. ... However, risk coverage shall not be available for such a period.","sources":[{"clause":"11","heading":"Premium Payment in installments","page":33,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-11-2"},{"clause":"21","heading":"Renewal notice","page":34,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-21-2"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"not-stated","value":null,"display":null,"note":"The policy covers room rent and says room category or limits are as specified in the Policy Schedule, but no actual daily room-rent limit is printed in the provided documents.","quote":null,"sources":[],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Childbirth cover and any waiting period.","status":"quote-verified","value":"Maternity is excluded under the base policy. It can be covered through the Maternity Expenses add-on, which covers delivery during hospitalisation or lawful medical termination of pregnancy, with cover available after 9 months or as stated in Part I of the Policy.","display":"Excluded in base; optional maternity add-on after 9 months or as stated in Part I","note":"Voluntary medical termination of pregnancy during the first 12 weeks from conception is not covered under the add-on.","quote":"R. Maternity: Code Excl18\ni. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalisation) except ectopic pregnancy; ... Maternity Expenses: This add-on provides cover for medical expenses incurred for delivery, during Hospitalisation or lawful medical termination of pregnancy during the Policy Period. ... The cover under this add-on shall be available after 9 months (or as stated in Part I of the Policy) of continuous coverage have elapsed since the inception of the first Policy with the Company","sources":[{"clause":null,"heading":"R. Maternity: Code Excl18","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-r-maternity-code-excl18"},{"clause":"22(c)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-22-c"},{"clause":"22(a)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-22-a-2"}],"law":[]},{"key":"ped_cover_group","label":"Pre-existing diseases","section":"Waiting periods","meaning":"Whether pre-existing diseases are covered from day one for the group.","status":"quote-verified","value":"Pre-existing diseases are not covered from day one under the base policy; PED and direct complications are excluded until 36 months of continuous coverage. An optional PED add-on covers pre-existing diseases after 1 year or as stated in Part I of the Policy.","display":"Not day one in base; PED excluded for 36 months, optional add-on after 1 year or as stated in Part I","note":"The policy schedule may state different terms for the optional cover.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer. ... Cover for Pre-Existing Diseases: By way of this add-on, Pre-existing Diseases shall be covered after 1 year (or as stated in Part I of the Policy.)","sources":[{"clause":null,"heading":"Standard Exclusions A. Pre-Existing Diseases - Code- Excl01","page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-standard-exclusions-a-pre-existing-diseases-code"},{"clause":null,"heading":"II. 3) Add-Ons/ Extensions","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-ii-3-add-ons-extensions"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"conflicting","value":"Under the policy wording, cashless treatment is only available at a Network Provider and requires pre-authorisation. The CIS also refers to a non-network cashless route through health assistance, creating a different reader-facing statement.","display":"Policy wording: cashless only at a Network Provider","note":"CIS says: 'For cashless hospitalization in a non-network hospital, contact health assistance at least 48 hours before admission or within 24 hours for emergencies. Use \"Anywhere Cashless\" through IL TakeCare App's > Services We Offer > Health Assistance.'","quote":"Cashless treatment is only available at a Network Provider (List of Network Providers is available at our website). ... For cashless hospitalization in a non-network hospital, contact health assistance at least 48 hours before admission or within 24 hours for emergencies. Use \"Anywhere Cashless\" through IL TakeCare App's > Services We Offer > Health Assistance.","sources":[{"clause":null,"heading":"1. Claims Procedure","page":28,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-1-claims-procedure"},{"clause":"Row 6","heading":"Piles","page":5,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/20235#c-row-6"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims may be handled by the Company or the TPA. The cashless procedure says the insured must contact the company or the TPA, and the reimbursement procedure requires notice to the TPA and in writing at the Company’s address.","display":"Company or TPA","note":null,"quote":"Prior to taking treatment and/or incurring Medical Expenses at a Network Provider, the insured must contact the company or the TPA ... The insured shall give\niii) to the TPA by calling the toll free number as specified in the Policy provided to the insured and also in writing at the Company’s address","sources":[{"clause":null,"heading":"Pre-authorization","page":28,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812#c-pre-authorization"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, immediate family can share the same Sum Insured under a single policy","note":null,"quote":"Floater Benefit: The Insured can avail a Floater cover and get immediate family covered for the same Sum Insured under a single policy by paying one premium amount.","sources":[{"clause":null,"heading":"Salient Features","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19772#c-salient-features"}],"law":[]}],"documents":[{"kind":"wording","label":"Group Health (Floater) Insurance","pages":41,"fetched_at":"2026-10-20 01:53:31+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/ghi-4016_group-health-floater-insurance.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19812"},{"kind":"prospectus","label":"Group Health (Floater) Insurance Prospectus","pages":16,"fetched_at":"2026-10-20 01:50:57+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/group-health-(floater)-insurance_prospectus-4016.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/19772"},{"kind":"cis","label":"Group Health (Floater) Insurance","pages":8,"fetched_at":"2026-10-20 02:26:01+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/cis-for-ghi-floater-4016.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526/document/20235"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"ICICI LOMBARD General Insurance official website","url":"https://www.icicilombard.com","note":"Website as listed by IRDAI. Not checked: the site blocks automated requests (bot wall) for our crawler on 2026-10-19; we do not bypass walls."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Group Health (Floater) Insurance Prospectus (UIN ICIHLGP26055V072526), IndiaInsurances, https://indiainsurances.com/policy/icici-lombard-general-insurance/group-health-floater-insurance-prospectus-icihlgp26055v072526"}