{"uin":"ICIHLIP25041V022425","name":"Arogya Sanjeevani Policy, ICICI Lombard(C.I.S.)_ICIHLIP25041V022425","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425","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":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Arogya Sanjeevani Policy, ICICI Lombard is an indemnity health policy available on individual or floater basis for a policy period of 1 year. It has 30 days initial waiting period, 36 months pre-existing disease waiting period, 5% co-payment on every admissible claim, and room rent and ICU sub-limits.","analysis":{"state":"machine","analysed_at":"2026-10-20 04:26:28.118085+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":"quote-verified","value":["Individual","Floater"],"display":"Individual/ Floater","note":null,"quote":"Product Type | Individual/ Floater","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-table-of-benefits"}],"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":"1 year","display":"1 year","note":null,"quote":"Policy Period | 1 year","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-table-of-benefits"}],"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 claims, request pre-authorisation at least 48 hours before planned hospitalisation and within 24 hours of hospitalisation in an emergency. For reimbursement claims, provide notice immediately and in any event within 10 days of hospitalisation.","display":"Cashless: 48 hours before planned hospitalisation or within 24 hours of emergency hospitalisation; reimbursement notice: within 10 days of hospitalisation","note":null,"quote":"You must request pre-authorisation at least 48 hours before a planned Hospitalisation and in case of an emergency situation, within 24 hours of Hospitalisation. ... The above information needs to be provided to Us or Our In house claim processing team immediately and in any event within 10 days of Hospitalisation","sources":[{"clause":"8(i)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-8-i"},{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":18,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-icici-lombard-general-insurance-company-limited-18"}],"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 You and the Medical Practitioner","Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner","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.","Any other document as required by Us or Our In house claim processing team to investigate the Claim or Our obligation to make payment for it"],"display":"Claim form, original hospital bills/receipts/discharge card, chemist bills with prescription, investigation reports and receipts, indoor case papers, referral letter for non-accident hospitalisation, and any other required document","note":null,"quote":"a) Duly completed Claim form signed by You and the Medical Practitioner. The claim form can be downloaded from Our website www.icicilombard.com\nb) Original bills, receipts and discharge certificate/card from the Hospital/Medical Practitioner\nc) Original bills from chemists supported by proper prescription.\nd) Original investigation test reports and payment receipts.\ne) Indoor case papers\nf) Medical Practitioner’s referral letter advising Hospitalisation in non-Accident cases.\ng) Any other document as required by Us or Our In house claim processing team to investigate the Claim or Our obligation to make payment for it","sources":[{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":19,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-icici-lombard-general-insurance-company-limited-19"}],"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":"For cashless pre-authorisation, the company responds within 1 hours of receipt of the request and grants final authorisation within three hours of receipt of the discharge authorisation request from the hospital. Reimbursement claims are processed within 30 days of receipt of claim along with claim form and documents.","display":"Cashless response within 1 hours; final authorisation within three hours of discharge authorisation request; reimbursement processed within 30 days of receipt of claim with claim form and documents","note":null,"quote":"We will respond within 1 hours of the actual receipt of such pre authorization request Further, we shall grant final authorization within three hours of the receipt of discharge authorization request from the hospital ... The claim will be processed within 30 days of receipt of claim along with claim form and documents.","sources":[{"clause":"8(ii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-8-ii"},{"clause":"8(iii)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-8-iii"}],"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":["Pre-Existing Diseases","First Thirty Days Waiting Period","Specified Disease/Procedure waiting period/Specific Waiting Period","Investigation & Evaluation","Rest Cure, rehabilitation and respite care","Obesity/ Weight Control","Change-of-Gender treatments","Cosmetic or plastic Surgery","Hazardous or Adventure sports","Breach of law","Domiciliary Hospitalization and OPD treatment","Treatment taken outside the geographical limits of India"],"display":"PED, first 30 days, specified disease/procedure waiting period, investigation and evaluation, rest cure/rehabilitation/respite care, obesity/weight control, change of gender, cosmetic or plastic surgery, professional hazardous/adventure sports, breach of law, domiciliary and OPD treatment, and treatment outside India","note":null,"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 any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident ... Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months ... Expenses related to any admission primarily for diagnostics and evaluation purposes. ... Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: ... 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 unless for reconstruction following an Accident, Burn(s) or Cancer ... 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. ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl0l)","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-1"},{"clause":"6.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-2"},{"clause":"6.3","heading":"Specified Disease/Procedure waiting period/Specific Waiting Period (Code- Excl02)","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-3"},{"clause":"7.1","heading":"Investigation & Evaluation(Code- Excl04)","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care(Code- Excl05)","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-2"},{"clause":"7.3","heading":"Obesity/ Weight Control(Code- Excl06)","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-3"},{"clause":"7.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-4"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-6"},{"clause":"7.7","heading":"Breach of law: (Code- Excl10)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-7"},{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-18"},{"clause":"7.19","heading":"Treatment taken outside the geographical limits of India","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-19"}],"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 the grievance cell at a branch. If not satisfied, contact the grievance redressal officer, then IRDAI/Bima Bharosa or Insurance Ombudsman.","display":"Contact ICICI Lombard first through www.icicilombard.com, 1800 2666, customersupport@icicilombard.com, the stated office address, or a branch grievance cell; then grievance redressal officer/IRDAI/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 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 redressal officer","sources":[{"clause":"11","heading":"REDRESSAL OF GRIEVANCE","page":28,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-11"}],"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":"conflicting","value":"Minimum Sum Insured: ₹ 1,00,000; Maximum Sum Insured: ₹ 5,00,000, in multiples of fifty thousand.","display":"₹ 1,00,000 to ₹ 5,00,000, in multiples of fifty thousand","note":"The lower-priority brochure says: \"Sum Insured: Up to I10 Lakhs\".","quote":"Minimum Sum Insured: ₹ 1,00,000 Maximum Sum Insured: ₹ 5,00,000 (in multiples of fifty thousand)","sources":[{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":2,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19851#c-icici-lombard-general-insurance-company-limited-2"},{"clause":null,"heading":"Other terms and conditions","page":3,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19807#c-other-terms-and-conditions"}],"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":"Does not apply to covered accident claims; does not apply after Continuous Coverage for more than twelve months.","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.","sources":[{"clause":"6.2","heading":"First Thirty Days Waiting Period (Code- Excl03)","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-2"}],"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":"For enhanced sum insured, the exclusion applies afresh to the increased portion; portability credit may reduce the waiting period.","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 us.","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl0l)","page":12,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-1"}],"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":24},"display":"24 months","note":"Not applicable for claims arising due to an accident. If a condition also falls under the PED waiting period, the longer waiting period applies.","quote":"Expenses related to the treatment of the following listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage, as may be the case after the date of inception of the first policy with the insurer.","sources":[{"clause":"6.3","heading":"Specified Disease/Procedure waiting period/Specific Waiting Period (Code- Excl02)","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-3"}],"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":["Benign ENT disorder","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Hysterectomy","All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps","Benign prostate hypertrophy","Cataract and age related eye ailments","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Hernia of all types","Hydrocele","Non Infective Arthritis","Piles, Fissures and Fistula in anus","Pilonidal sinus, Sinusitis and related disorders","Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident","Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.","Varicose Veins and Varicose Ulcers","Treatment for joint replacement unless arising from accident","Age-related Osteoarthritis & Osteoporosis"],"display":"21 listed conditions/procedures including cataract, hernia, piles, sinusitis, spinal diseases, urinary/gall bladder calculi, varicose veins, joint replacement and osteoarthritis/osteoporosis","note":null,"quote":"i) 24 Months waiting period 1.Benign ENT disorder 2.Tonsillectomy 3.Adenoidectomy 4.Mastoidectomy 5.Tympanoplasty 6.Hysterectomy 7.All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps 8.Benign prostate hypertrophy 9.Cataract and age related eye ailments 10.Gastric/ Duodenal Ulcer 11.Gout and Rheumatism 12.Hernia of all types 13.Hydrocele 14.Non Infective Arthritis ... 15.Piles, Fissures and Fistula in anus 16.Pilonidal sinus, Sinusitis and related disorders 17.Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident 18.Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy. 19.Varicose Veins and Varicose Ulcers 20.Treatment for joint replacement unless arising from accident 21.Age-related Osteoarthritis & Osteoporosis","sources":[{"clause":"6.3(e)(i)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-6-3-e-i"},{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":13,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-icici-lombard-general-insurance-company-limited-13"}],"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 sum insured, sixty continuous months runs from the date of enhancement 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.","sources":[{"clause":"10.25","heading":"Moratorium Period","page":28,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-25"}],"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 and transfer credits gained to the extent of the sum insured and benefits available in the previous policy, subject to the company's underwriting policy. It is not applicable for enhanced sum insured.","display":"Can port to another insurer with waiting-period/benefit credit up to the sum insured; not for enhanced sum insured","note":null,"quote":"a) The insured has the choice to port his / her policies from one Insurer to another. ... b) 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 ... d) This benefit is not applicable for enhanced sum insured.","sources":[{"clause":"10.15","heading":"Portability","page":25,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-15"}],"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":"Lifetime renewability","note":"The policy wording also states that the policy is ordinarily renewable except on specified grounds and subject to moratorium conditions.","quote":"o Lifetime renewability","sources":[{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19851#c-icici-lombard-general-insurance-company-limited"}],"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.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"iv) No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"10.16","heading":"Renewal of Policy","page":25,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-16"}],"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":"quote-verified","value":["Investigation & Evaluation(Code- Excl04)","Rest Cure, rehabilitation and respite care(Code- Excl05)","Obesity/ Weight Control(Code- Excl06)","Change-of-Gender treatments: (Code- Excl07)","Cosmetic or plastic Surgery: (Code- Excl08)","Hazardous or Adventure sports: (Code- Excl09)","Breach of law: (Code- Excl10)","Excluded Providers: (Code-Excl11)","Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12)","Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Code- Excl13)","Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure (Code- Excl14)","Refractive Error:(Code- Excl15)","Unproven Treatments:(Code- Exc116)","Sterility and Infertility: (Code- Excl17)","Maternity Expenses (Code- Excl18)","War (whether declared or not) and war like occurrence or invasion","Nuclear, chemical or biological attack or weapons","Any expenses incurred on Domiciliary Hospitalization and OPD treatment","Treatment taken outside the geographical limits of India","existing diseases, disclosed by the insured and mentioned in the policy schedule"],"display":"Permanent exclusions include Excl04 to Excl18 and product exclusions for war, nuclear/chemical/biological attack, domiciliary/OPD treatment, treatment outside India, and specified ICD codes for existing diseases in the schedule","note":"The code for unproven treatments is printed as \"Exc116\" in the wording.","quote":"7.1 Investigation & Evaluation(Code- Excl04) ... 7.2 Rest Cure, rehabilitation and respite care(Code- Excl05) ... 7.3 Obesity/ Weight Control(Code- Excl06) ... 7.4 Change-of-Gender treatments: (Code- Excl07) ... 7.5 Cosmetic or plastic Surgery: (Code- Excl08) ... 7.6 Hazardous or Adventure sports: (Code- Excl09) ... 7.7 Breach of law: (Code- Excl10) ... 7.8 Excluded Providers: (Code-Excl11) ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12) ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... (Code- Excl13) ... Dietary supplements and substances that can be purchased without prescription ... (Code- Excl14) ... 7.12 Refractive Error:(Code- Excl15) ... 7.13 Unproven Treatments:(Code- Exc116) ... 7.14 Sterility and Infertility: (Code- Excl17) ... 7.15 Maternity Expenses (Code- Excl18) ... War (whether declared or not) and war like occurrence or invasion ... Nuclear, chemical or biological attack or weapons ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India ... In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule","sources":[{"clause":"7.1","heading":"Investigation & Evaluation(Code- Excl04)","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care(Code- Excl05)","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-2"},{"clause":"7.3","heading":"Obesity/ Weight Control(Code- Excl06)","page":14,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-3"},{"clause":"7.4","heading":"Change-of-Gender treatments: (Code- Excl07)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-4"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery: (Code- Excl08)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports: (Code- Excl09)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-6"},{"clause":"7.7","heading":"Breach of law: (Code- Excl10)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-7"},{"clause":"7.8","heading":"Excluded Providers: (Code-Excl11)","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-8"},{"clause":"7.9","heading":"Treatment for, Alcoholism, drug or substance abuse or any addictive condition and","page":15,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-9"},{"clause":"7.10","heading":null,"page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-10"},{"clause":"7.11","heading":"Dietary supplements and substances that can be purchased without prescription, including","page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-11"},{"clause":"7.12","heading":"Refractive Error:(Code- Excl15)","page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-12"},{"clause":"7.13","heading":"Unproven Treatments:(Code- Exc116)","page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-13"},{"clause":"7.14","heading":"Sterility and Infertility: (Code- Excl17)","page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-14"},{"clause":"7.15","heading":"Maternity Expenses (Code- Excl18)","page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-15"},{"clause":"7.16","heading":null,"page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-16"},{"clause":"7.17","heading":null,"page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-17"},{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-18"},{"clause":"7.19","heading":"Treatment taken outside the geographical limits of India","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-19"},{"clause":"7.20","heading":"In respect of the existing diseases, disclosed by the insured and mentioned in the policy","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-20"}],"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 by giving 7 days notice. For a term up to one year, proportionate premium for the unexpired period is refunded if no claim has been made; no refund is made where any claim has been admitted or lodged or any benefit availed.","display":"7 days notice; proportionate refund for unexpired period for term up to one year if no claim; no refund if a claim is admitted/lodged or benefit availed","note":"Free-look cancellations follow the free-look clause; for policies with term more than 1 year, premium is refunded for unexpired policy years where risk coverage has not commenced.","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. ... 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":"10.10","heading":"Cancellation","page":23,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-10"},{"clause":"10.10(a)(i)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-10-a-i"},{"clause":"10.10(a)(ii)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-10-a-ii"}],"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":"All medical treatment for this insurance must be taken in India only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only.","sources":[{"clause":"10.7","heading":"Territorial Limit","page":22,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-7"}],"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":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Applies to new individual health insurance policies except policies with tenure of less than a year.","quote":"shall be provided a free look period of 30 days beginning from the date of receipt of policy document, whether received electronically or otherwise, to review the terms and conditions of such policy.","sources":[{"clause":"10.19","heading":"Free look period","page":26,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-19"}],"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":15},"display":"fifteen days where premium payment mode is monthly and thirty days in all other cases","note":"The table of benefits in the wording says: \"For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period and for all other modes of payment a fixed period of 15 days be allowed as grace period.\"","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.","sources":[{"clause":"3.18","heading":"Grace period","page":4,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-3-18"},{"clause":null,"heading":"TABLE OF BENEFITS","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-table-of-benefits"}],"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":"Policy can be availed by proposers aged 18 years to 65 years. Dependent children can be covered from 3 months to 25 years, with children above 18 years ineligible in later renewals if financially independent.","display":"Proposer: 18 years to 65years; dependent children: 3 months to 25 years","note":"A proposer above 65 years can obtain the policy for family without covering self.","quote":"Policy can be availed by persons between the age of 18 years and 65years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. ... Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years.","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-table-of-benefits"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["Yearly","Half Yearly","Quarterly","Monthly"],"display":"Yearly, Half Yearly, Quarterly or Monthly","note":null,"quote":"For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period ... If the insured person has opted for Payment of Premium on an installment basis i.e. Half Yearly, Quarterly or Monthly","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-table-of-benefits"},{"clause":"10.17","heading":"Premium Payment in Installments","page":25,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-17"}],"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 is not available during the grace period except if the premium is paid in instalments.","display":"Not available during grace period, except if premium is paid in instalments","note":"The grace period definition also says coverage need not be available during the period for which no premium is received, and that coverage is offered during the grace period if premium is paid in instalments during the policy period.","quote":"Coverage is not available during the grace period except if the premium is paid in instalments.","sources":[{"clause":"10.16","heading":"Renewal of Policy","page":25,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-16"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room Rent, Boarding and Nursing Expenses are covered up to 2% of the sum insured, subject to a maximum of Rs.5000/- per day.","display":"2% of sum insured, max Rs.5000/- per day","note":null,"quote":"Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home up to 2% of the sum insured subject to maximum of Rs.5000/- per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":9,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-1"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-applicable","value":null,"display":null,"note":"The policy states room rent as a percentage/rupee sub-limit, not as a permitted room category.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU/ICCU expenses are covered up to 5% of the sum insured, subject to a maximum of Rs.10,000/- per day.","display":"5% of sum insured, max Rs.10,000/- per day","note":null,"quote":"Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of Rs.10,000/- per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":9,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-1"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"quote-verified","value":"If admitted to a room/ICU/ICCU at rates exceeding the limits, reimbursement/payment of all other hospital expenses, except medicines, is affected in the same proportion as the admissible rate per day bears to the actual rate per day.","display":"Yes, proportionate deduction applies except for cost of medicines","note":null,"quote":"In case of admission to a room/lCU/ICCU at rates exceeding the aforesaid limits, the reimbursement/payment of all other expenses incurred at the Hospital, except for cost of medicines, shall be affected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent/lCU/lCCU charges.","sources":[{"clause":"4.1.1","heading":"Other expenses","page":10,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-1-1"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"Each and every claim is subject to a 5% co-payment on the admissible and payable claim amount.","display":"5% co-payment on every admissible and payable claim","note":null,"quote":"Each and every claim under the Policy shall be subject to a Copayment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy.","sources":[{"clause":"9.2","heading":"Co-payment","page":20,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-9-2"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"quote-verified","value":"Deductible is not applicable.","display":"Not applicable","note":null,"quote":"Deductible (It is a specified amount: - Up to which an insurance company will not pay any claim, and - Which will be deducted from total claim amount (if claim amount is more than the specified amount) Not applicable","sources":[{"clause":"6.17(b)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19773#c-6-17-b"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days prior to the date of admissible hospitalization","note":null,"quote":"The company shall indemnify pre-hospitalization medical expenses incurred, related to an admissible hospitalization requiring inpatient care, for a fixed period of 30 days prior to the date of admissible hospitalization covered under the policy.","sources":[{"clause":"4.4","heading":"Pre Hospitalization","page":10,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-4"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"All day care treatments are covered. Day care treatment is treatment or a surgical procedure in a hospital/day care centre in less than twenty-four hours because of technological advancement and that would otherwise have required more than twenty-four hours hospitalisation.","display":"All day care treatments covered","note":"Treatment normally taken on an out-patient basis is not included in the day care definition.","quote":"iv) All day care treatments ... Day Care Treatment means medical treatment, and/or surgical procedure which is:\ni) undertaken under general or local anesthesia in a hospital/day care centre in less than twenty-four hours because of technological advancement, and\nii) which would have otherwise required a hospitalisation of more than twenty-four hours.","sources":[{"clause":"4.1.1","heading":"Other expenses","page":10,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-1-1"},{"clause":"3.13","heading":"Day Care Treatment","page":3,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-3-13"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary hospitalization is excluded.","display":"Excluded","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-18"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"Inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy is covered during each policy year up to the sum insured limit in any AYUSH Hospital.","display":"Covered up to the sum insured in any AYUSH Hospital","note":null,"quote":"The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.","sources":[{"clause":"4.2","heading":"AYUSH Treatment","page":10,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-2"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"The listed technological advancement procedures, including oral chemotherapy, immunotherapy, robotic surgeries, stereotactic radio surgeries and stem cell therapy for specified haematological conditions, are covered up to 50% of the Sum Insured.","display":"Listed modern treatments covered up to 50% of Sum Insured","note":null,"quote":"The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to 50% of Sum Insured ... D. Oral chemotherapy E. Immunotherapy- Monoclonal Antibody to be given as injection F. Intra vitreal injections G. Robotic surgeries H. Stereotactic radio surgeries ... L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"4.6","heading":null,"page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-6"},{"clause":"4.6(I)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-6-i"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance expenses are covered subject to a maximum of Rs.2000/- per hospitalization.","display":"Road ambulance up to Rs.2000/- per hospitalization","note":null,"quote":"Expenses incurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalization.","sources":[{"clause":"4.1.1","heading":"Other expenses","page":10,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-1-1"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"quote-verified","value":"No restoration of sum insured is stated; the coverage automatically terminates for the policy year upon exhaustion of sum insured and Loyalty bonus.","display":"No restoration stated; cover terminates for the policy year on exhaustion of sum insured and Loyalty bonus","note":null,"quote":"Upon exhaustion of sum insured and Loyalty bonus, for the policy year. However, the policy is subject to renewal on the due date as per the applicable terms and conditions.","sources":[{"clause":"10.11","heading":"Automatic change in Coverage under the policy","page":23,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-10-11"},{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":23,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-icici-lombard-general-insurance-company-limited-23"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"Loyalty Bonus increases the sum insured by 5% if the policy is renewed with the company without a break, subject to a maximum of 50% of the sum insured under the current policy year.","display":"Loyalty Bonus: 5% increase on renewal without break, maximum 50% of sum insured","note":"Policy wording calls this Loyalty Bonus and does not state that it depends on having no claims.","quote":"Loyalty Bonus will be increased by 5% provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year.","sources":[{"clause":"4.8","heading":"Loyalty Bonus","page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-8"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"List I expenses are not covered, including items such as GLOVES and MASK. Lists II, III and IV are to be subsumed into room charges, procedure charges, or cost of treatment.","display":"List I non-medical items not covered; Lists II-IV subsumed into room/procedure/treatment charges","note":null,"quote":"The expenses that are not covered in this policy are placed under List-I of Annexure-A. The list of expenses that are to be subsumed into charges, or procedure charges or costs of treatment are placed under List-Il, List-III and List-IV of Annexure-A respectively. ... 56 | GLOVES ... 60 | MASK","sources":[{"clause":"4.7","heading":null,"page":11,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-4-7"},{"clause":null,"heading":"ICICI Lombard General Insurance Company Limited","page":31,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-icici-lombard-general-insurance-company-limited-31"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity expenses are excluded, including medical treatment expenses traceable to childbirth, complicated deliveries and caesarean sections during hospitalization, except ectopic pregnancy, and expenses towards miscarriage unless due to an accident and lawful medical termination of pregnancy during the policy period.","display":"Excluded, except ectopic pregnancy and miscarriage due to accident","note":null,"quote":"i) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;\nii) expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.","sources":[{"clause":"7.15","heading":"Maternity Expenses (Code- Excl18)","page":16,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-15"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"Dependent children are eligible between 3 months and 25 years; newborn cover from birth is not stated.","display":"Dependent children covered only from 3 months to 25 years","note":"The documents do not state cover for a newborn from birth.","quote":"Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years.","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":29,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-table-of-benefits"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD treatment is excluded.","display":"Excluded","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":17,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-7-18"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"quote-verified","value":"Cashless treatment is available only at a Network Provider, where approved costs of treatment are paid directly to the network provider to the extent pre-authorisation is approved.","display":"Available only at Network Provider hospitals, subject to pre-authorisation","note":null,"quote":"Cashless treatment is only available at a Network Provider (List of Network Providers is available at our website). ... Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured person in accordance with the Policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved.","sources":[{"clause":"8","heading":"CLAIM PROCEDURE","page":18,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-8"},{"clause":"3.6","heading":"Cashless Facility","page":2,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-3-6"}],"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 are handled by the Company or its in house claim processing team.","display":"Company / in house claim processing team","note":null,"quote":"You must contact the Company or Our in house claim processing team ... You shall give notice to Us or Our In house claim processing team","sources":[{"clause":"8(i)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-8-i"},{"clause":"8(ii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634#c-8-ii"}],"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, Floater Sum Insured","note":null,"quote":"Floater Sum Insured- ₹ XXXX – where all members under the policy have a single sum insured limit which may be utilized by any or all members","sources":[{"clause":null,"heading":"Customer Information Sheet/ Know Your Policy","page":1,"url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19773#c-customer-information-sheet-know-your-policy"}],"law":[]}],"documents":[{"kind":"wording","label":"Arogya Sanjeevani Policy, ICICI Lombard","pages":42,"fetched_at":"2026-10-20 02:01:10+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/arogya-sanjeevani.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19907"},{"kind":"wording","label":"Arogya Sanjeevani","pages":38,"fetched_at":"2026-10-20 02:47:13+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/arogya-sanjeevani8c0007ff45fd68ff8a0df0055fa7613a.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/20634"},{"kind":"prospectus","label":"Arogya Sanjeevani Policy, ICICI Lombard","pages":15,"fetched_at":"2026-10-20 01:56:11+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/arogya-sanjeevni-prospectus-sales-literature8c0007ff45fd68ff8a0df0055fa7521c.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19851"},{"kind":"cis","label":"Arogya Sanjeevani Policy, ICICI Lombard(C.I.S.)_ICIHLIP25041V022425","pages":13,"fetched_at":"2026-10-20 01:51:03+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/arogya-sanjeevani-cis8c0007ff45fd68ff8a0df0055f8a9598.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19773"},{"kind":"brochure","label":"Arogya Sanjeevani -ICIHLIP25041V022425","pages":6,"fetched_at":"2026-10-20 01:53:16+00","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/aarogya-sanjeevani-brochure8c0007ff45fd68ff8a0df0055fa50a69.pdf","url":"https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425/document/19807"}],"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":"Arogya Sanjeevani Policy, ICICI Lombard(C.I.S.)_ICIHLIP25041V022425 (UIN ICIHLIP25041V022425), IndiaInsurances, https://indiainsurances.com/policy/icici-lombard-general-insurance/arogya-sanjeevani-policy-icici-lombard-c-i-s-icihlip25041v022425-icihlip25041v022425"}