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ICICI Lombard's Hospifund Insurance is an affordable product specifically designed to cater to incidental expenses which occur at the time of hospitalization. It takes care of the additional expenses incurred by an individual along with other unforeseen expenses which put an unnecessary burden on the insured and their family whether or not they have an indemnity policy in place. As such this product is targeted to act as a cushion to all unanticipated expenses by giving a daily payout in the event of hospitalization over and above the existing health insurance plan

Salient Features

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Eligibility and Policy Period

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• Proposer should be 18 years or above
• Minimum entry age:
  Child – 91 days,
  Adult - 18 years
• Maximum entry age - 65 years
• Mandatory medicals if the customer is suffering from a pre-existing disease/condition
• Mandatory medicals after the age of 55 years*
• Policy offers option of covering on individual basis.
• Per day payout options available (in `) - 500 -10000
• Payout period options - 5 - 180 days
• Deductible/Franchise of upto 5 days can be opted
• Policy period - 1, 2, and 3 years

*Minimum 50% of the expenses incurred on pre-policy Health check-up will be reimbursed by Us. Also, a proposer below the age of 55 Years may be asked to undergo medicals, based on certain underwriting criteria.

Benefits

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The product gives an option of selecting from 2 base covers and 12 extension covers. Claim payout is given to the customer in the event of every consecutive 24 hours of hsopitalization.

Claim payouts are additive.

Base Benefits

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Insured can avail any one or both of the following base benefits. In case both the benefits are chosen, the payout in such case, will be additive of both the base benefits.

Claims Procedure

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What documents would you require

• Completed claims form (claim form can be downloaded from the website)
• Discharge summary and bank account details (example cancelled cheque)
• If required, our claims team may ask you to submit additional documents

WHAT WILL WE NOT PAY FOR?

(Some* exclusions and limitations under the policy)

• Any pre - existing condition(s) until 24 months of your continuous coverage has elapsed, since period of insurance start date
• Any illness contracted within 30 days of period of insurance start date, except those incurred as a result of injury
• Any hospitalization due to following illnesses within the first two (2) consecutive years of period of insurance start date:
  • Cataract
  • All types of hernia, hydrocele
  • Arthritis, gout, rheumatism and spinal disorders
  • Surgery on tonsils, adenoids and sinuses
  • Dilatation and curettage, endometriosis
  • Gastric and duodenal erosions and ulcers
  • Varicose veins / varicose ulcers
  • Benign prostatic hypertrophy
  • Joint replacements unless due to accident
  • Sinusitis and related disorders
  • Stones in the urinary and billiary systems
  • Dialysis required for chronic renal failure
  • Deviated nasal septum
  • Fissures / fistula in anus, hemorrhoids / piles
  • All types of internal congenital anomalies / illness / defects
  • Myomectomy, hysterectomy unless because of malignancy
  • All types of skin and internal tumors / cysts / nodules / polyps of any kind including breast lumps unless malignant

Major** Permanent Exclusions

• Any illness / disease / injury pre - existing before the inception of the policy for the first 2 years. Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations
• Hospitalization incurred during the first 30 days of inception of the policy, except those arising out of accidents. This exclusion does not apply for subsequent renewals without a break
• Expenses attributable to self - inflicted injury (resulting from suicide, attempted suicide)
• Expenses arising out of or attributable to alcohol or drug use / misuse / abuse
• Cost of spectacles / contact lenses, dental treatment
• Medical expenses incurred for treatment of AIDS
• Treatment arising from or traceable to pregnancy (This exclusion does not apply to ectopic pregnancy proved by diagnostic means and is certified to be life threatening by the medical practitioner)

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