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Reviewed by Finzony Finance TeamLast updated:
ICICI Lombard Family Shield is a fixed-benefit health plan. Instead of paying your hospital bill, it pays a pre-agreed lump sum when you are hospitalised for a listed condition, and you can use the money however you like. You choose one or more sections. The infectious diseases section pays on hospitalisation of 2 successive days or more for vector-borne diseases (malaria, dengue, chikungunya, kala azar, Japanese encephalitis, Zika fever and filariasis), rabies and tetanus, typhoid and acute inflammatory diarrhoea, viral hepatitis, measles, mumps, polio, avian and swine flu, and meningitis, encephalitis, Creutzfeldt-Jakob disease and Guillain-Barré syndrome. The second section, Hospital Daily Cash, pays a fixed amount for each completed day in hospital, with an optional ICU cash extension. The third section covers accidents: death, permanent and temporary disablement, accidental hospitalisation expenses, adventure sports, a children's education grant and many more benefits, with a long list of optional covers on top. The sum insured for each benefit, the daily cash amount and the maximum number of days are set in your policy certificate. The infection benefits have a 30-day waiting period, can be claimed once per benefit for each insured person, and do not pay pre- or post-hospitalisation expenses.
Pays a fixed benefit for listed infectious diseases, not actual bills
Finzony reads Family Shield as a top-up for specific risks, not as health insurance in the usual sense. A regular indemnity policy pays the bill. Family Shield pays a number you chose in advance when a defined event happens, and that is a different job. The infection section is aimed at the seasonal diseases that fill hospitals each monsoon, and the lump sum can help with the costs a bill-based policy ignores, such as lost income or caregiver expenses. Read the conditions before you rely on it. The benefit is paid only for a listed infection, only if you stay in hospital for 2 successive days or more, and only if the diagnosis is confirmed by the laboratory test the wording names. The gastrointestinal definitions are strict: typhoid needs fever for more than 5 days, Salmonella Typhi in the blood and multi-organ involvement, and acute inflammatory diarrhoea needs blood and pus cells in the stool, dehydration and high fever. A claim under one benefit ends your cover under that benefit for the period of cover, and the 30-day waiting period applies until your first renewal. Be clear about the gap on the accident side too. The accident benefits do not pay for illness or injury caused or transmitted by viruses, bacteria, parasites or insect, reptile and animal bites. And the hospital daily cash section carries its own 24-month waits for pre-existing and specified diseases. It suits someone who already has a main health policy and wants a fixed cash cushion for infections and accidents. It is not a replacement for a plan that pays a large hospital bill. Check the sum insured and daily amounts on your quote, because the product page does not publish them.
ICICI Lombard Health Insurance
Key Insights
Founded
2001
ICICI Lombard Health Insurance was established 25 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
86% CSR, calculated as a 3-year average
ICICI Lombard Health Insurance settles 86% of all claims it receives.
Network Hospitals
10,700+
ICICI Lombard Health Insurance has a network of 10,700+ hospitals, ensuring wide accessibility and convenience for policyholders.
Pays the sum insured you chose if you are hospitalised for malaria, dengue, chikungunya, kala azar, Japanese encephalitis, Zika fever or filariasis.
Needs a stay of at least 2 successive days and the laboratory test named in the wording, such as the NS1 antigen or IgM Elisa for dengue and a peripheral smear for malaria.
Pays a lump sum if rabies or tetanus caused by an accidental injury puts you in hospital for at least 2 successive days. A separate death benefit pays if you die within 15 days of the first laboratory diagnosis.
A death claim ends all cover under the policy for that person.
Pays a lump sum for hospitalisation with acute inflammatory diarrhoea or typhoid fever.
Acute inflammatory diarrhoea needs blood and pus cells in the stool, signs of dehydration and high fever. Typhoid needs fever for more than 5 days, Salmonella Typhi in the blood and multi-organ involvement.
Pays a lump sum for hospitalisation with viral hepatitis A, B, C or E, measles, mumps, poliomyelitis, avian influenza or swine influenza.
Each needs the specific test named in the wording, such as the HBsAg test for hepatitis B or a throat swab for avian and swine influenza.
Pays a lump sum for hospitalisation with meningitis, encephalitis, Creutzfeldt-Jakob disease or Guillain-Barré syndrome.
Needs confirmation through CSF examination, MRI, EEG or EMG as the wording specifies.
Pays a daily amount for each continuous and completed day you spend in an intensive care unit, with a minimum stay of 24 hours.
The days limit is in your certificate, and a deductible applies except for days already spent in a non-ICU room.
Reimburses accident-related medical costs for up to 7 days before and up to 60 days after hospitalisation.
Needs an accepted accidental hospitalisation expenses claim.
Conditions or treatments that the policy clearly says it will not cover.
These conditions are excluded for the first 24 months only under the Hospital Daily Cash section, even if they begin after the policy starts. The infectious disease and accident benefits do not use this list. Accident claims are not held to this wait, and if one of these is also a pre-existing disease, the longer wait applies. Your policy certificate and wording are the final reference.
Insurer
ICICI Lombard Health Insurance plans and claim process
Family Shield is a fixed-benefit plan from ICICI Lombard. It pays a pre-agreed lump sum when you are hospitalised for a listed infection, pays a fixed daily amount for hospital stays, and pays accident benefits such as death, disablement and accidental hospitalisation. You choose one or more sections, and the amounts are set in your policy certificate.
The infectious diseases section covers vector-borne diseases (malaria, dengue, chikungunya, kala azar, Japanese encephalitis, Zika fever and filariasis), rabies and tetanus after an accidental injury, typhoid and acute inflammatory diarrhoea, viral hepatitis A, B, C and E, measles, mumps, poliomyelitis, avian and swine influenza, and meningitis, encephalitis, Creutzfeldt-Jakob disease and Guillain-Barré syndrome.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Claim settlement ratios are from IRDAI Annual Reports. Finzony is not an insurance broker or agent. Verify all details on the official ICICI Lombard Health Insurance website before purchasing.
Contact Details
1800 2666
Headquarters: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400025, Maharashtra, India.
The aforementioned ratios have been averaged over three years (FY24-FY26)
Pays the sum insured for air ambulance transport after an accident, from the site to the nearest hospital or to a higher centre of care, within 7 days.
You must be alive when boarding, and it is one claim in the period of cover.
Covers ambulance costs after an accident that needs hospitalisation.
The full wording of this benefit was cut off in our copy, so check your policy certificate for the limit.
Pays the sum insured if an accident puts you in a coma within 30 days, confirmed by a specialist.
One claim in a lifetime. Coma from alcohol or drug abuse is excluded.
Pays a percentage of the sum insured for a fracture caused by an accident, from 20% for most fractures up to 100% for a compound skull fracture with brain damage.
The fracture must be diagnosed by a doctor at a medical facility.
Pays 25% to 100% of the sum insured for second or third degree burns, depending on the body area and severity.
First degree burns are not covered.
Pays for a common carrier ticket for an immediate family member to reach you when you are hospitalised at least 100 km from home.
Needs an accepted death, permanent total disablement or major broken bones claim, and the doctor's written advice.
Pays a lump sum equal to your disablement claim for modifying your home, office or vehicle, or buying a prosthesis.
Needs an accepted permanent disablement claim. One claim in a lifetime.
Pays towards last rites and transporting mortal remains to the residence after accidental death.
Needs an accepted death benefit claim.
Pays for professional counselling for you or your nominee after accidental death or permanent total disablement.
Needs an accepted death or disablement claim.
Pays to take you home after permanent total disablement from an accident that happened away from your city of residence.
Needs an accepted permanent total disablement claim.
Chauffeur Cash and Home Tuition (linked to temporary total disablement), Skill Development, On Duty Enhanced, Outstanding Bills Payment and Major Surgery are also listed as optional covers.
These appear in ICICI Lombard's Key Information Sheet with their claim documents, but their payout terms were not in the wording we could read. Check your policy certificate.
It pays the sum insured you chose for the benefit, as a fixed lump sum, not your actual bill. The sum insured for each benefit, the daily cash amount and the maximum number of days are all written in your policy certificate, and the product page does not publish them.
For the infection benefits you must stay in hospital for at least 2 successive days. For Hospital Daily Cash and ICU Cash the minimum is 24 continuous hours, and for the accident hospitalisation benefits you must be admitted within 7 days of the accident.
The infectious disease benefits have a 30-day waiting period that ends from your first renewal. Hospital Daily Cash has a 30-day wait, and 24-month waits for pre-existing diseases and a list of specified diseases. The accident section is listed with no waiting period.
Under each infection benefit, only one claim is accepted for each insured person during the period of cover, and cover under that benefit then ends. Cover under your other benefits continues. The permanent total disablement benefit is paid once in a lifetime.
Each infection needs a specific laboratory test named in the wording, such as the NS1 antigen or IgM Elisa for dengue, a peripheral smear for malaria, a stool examination for acute inflammatory diarrhoea and a CSF examination for meningitis. You also need the discharge summary signed by the treating doctor.
No. It pays fixed amounts for defined events and does not reimburse a general hospital bill. Most buyers use it alongside a main health policy, to add a cash payout for infections and accidents.
Hospital Daily Cash pays a fixed amount for each continuous and completed day in hospital for an illness or accidental injury, after a minimum stay of 24 hours. ICU Cash is an optional extension that pays a daily amount for days in intensive care. The daily amount and the maximum days are in your certificate.
The base accident benefits include accidental death, permanent total and partial disablement, temporary total disablement, accidental hospitalisation expenses and daily cash, adventure sports, children's education grant, orphan benefit, parental care, common carrier accidents, loan protection, assault, recovery, reconstructive surgery and diagnostic tests. Optional covers add air ambulance, broken bones, burns, comatose benefit and more.
No. The accident section excludes any injury or illness caused or transmitted by viruses, bacteria, parasites or other microorganisms, including bites of insects, reptiles, animals and other vectors. Infections are handled only by the infectious diseases section, and rabies and tetanus are covered there when they follow an accidental injury.
Yes. You can opt for any one or more base benefits under one or more sections. Extensions can be added only if you have opted for a base benefit under the same section, and you are covered only for the benefits whose premium you have paid.
Send the claim form, the hospital discharge summary signed by the treating doctor and the laboratory report that confirms the diagnosis. Accident claims need an FIR or medico-legal case papers, hospital bills and reports. The wording asks for the documents within 30 days of the insured event, so inform ICICI Lombard as soon as you are admitted.