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Reviewed by Finzony Finance TeamLast updated:
ICICI Lombard Golden Shield is a health insurance plan for people aged 56 and above, with no maximum entry age and lifelong renewal. It is an indemnity plan with a built-in 50% base co-payment on every admissible claim, which can be lowered to 40%, 30% or 20% for extra premium. The base cover pays for inpatient treatment, day care, twelve listed modern treatments, 60 days of pre-hospitalisation and 180 days of post-hospitalisation expenses, domiciliary and home care treatment, AYUSH hospitalisation, organ donor expenses, and road and air ambulance. A Cumulative Bonus adds 10% of the sum insured for every claim-free policy year, up to 100%, and a reset benefit restores the sum insured for unrelated illnesses. You also get a cashless preventive health check-up each year, a Care Management Program with unlimited teleconsultation, e-counselling, diet consultations and care calls, and a doubled sum insured after a road traffic accident that meets the policy conditions. Pre-existing diseases and a long list of specified conditions wait 24 months, and there are sub-limits on cataract, cancer, heart, renal, bone and robotic surgery claims. Premium depends on the zone where you live, and treatment in a higher-priced zone attracts an additional co-payment.
Built for 56+ with a co-payment that can be reduced for extra premium
Finzony reads Golden Shield as a plan that trades price for sharing. The 50% base co-payment is the defining term: on every admissible hospital claim you pay half and ICICI Lombard pays half. A ₹4 lakh admissible bill leaves you with ₹2 lakh, so the sum insured is not the figure that tells you how protected you are. You can reduce the co-payment to 40%, 30% or 20% with an add-on, but only at renewal, only subject to underwriting, and the wording says a fresh waiting period applies to the part of the co-payment you reduce. You cannot change it mid-term. Look at the other limits together with the co-payment, because they stack. Cataract is capped per eye, and cancer, cardiac and cerebrovascular treatment, renal disorders, long bone fractures, joint replacement and robotic surgery are capped between ₹1 lakh and ₹5 lakh depending on the sum insured. Those caps include pre- and post-hospitalisation costs. Room rent is twin sharing below ₹10 lakh and a single private AC room from ₹10 lakh. Treatment in a more expensive zone than your premium zone adds a further 12% to 25% co-payment, except for road accidents. What you get in return is a plan that does not refuse older buyers and does not load renewal premium for claims history. The Cumulative Bonus (10% a year, up to 100%, kept after a claim) and the preventive check-up are useful, and the Care Management Program is generous for the age group. It suits a buyer who wants lifelong cover that does not turn away age, accepts a high share of every bill, and may pair it with a separate larger policy. If you want low out-of-pocket on every claim, compare a plan with a lower or no co-payment before you buy.
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.
Covers hospital stays of more than 24 hours: room rent, ICU, nursing, doctor fees, anaesthesia, blood, oxygen, operation theatre, medicines, consumables, surgical appliances used during surgery and related investigations. Room cover is twin sharing for sum insured below ₹10 lakh and a single private AC room from ₹10 lakh.
A costlier room reduces associated expenses in proportion (room, nursing, OT and doctor fees). ICU, pharmacy, implants and diagnostics are not cut. The 50% base co-payment applies on top.
Covers procedures that need less than 24 hours in hospital, including intravenous chemotherapy, radiotherapy and haemodialysis.
Outpatient treatment and diagnostics are not covered under this benefit.
Covers 12 listed treatments: uterine artery embolisation and HIFU, monoclonal antibody immunotherapy, laser prostate vaporisation, stem cell therapy for bone marrow transplant, balloon sinuplasty, oral chemotherapy, robotic surgery, stereotactic radiosurgery, deep brain stimulation, intravitreal injections, bronchial thermoplasty and intra-operative neuro monitoring.
Robotic surgery is subject to the sub-limits in the wording.
Medical expenses for the same condition in the 60 days before admission are covered once the inpatient claim is accepted.
Paid on reimbursement only, not cashless. Nursing care at home is excluded, and so are costs before your first ICICI Lombard policy.
Medical expenses for the same condition in the 180 days after discharge are covered, including physiotherapy advised in writing.
Nursing care at home is excluded.
Pays items on IRDAI's list of non-payable expenses that relate to an accepted inpatient claim, up to the annual sum insured.
The base co-payment you chose still applies.
Reduces your base co-payment from 50% to 40%, 30% or 20%, so you share less of every claim.
Only at renewal, subject to underwriting. A fresh waiting period applies to the portion you reduce.
Conditions or treatments that the policy clearly says it will not cover.
These listed illnesses and procedures are covered only after a 24-month waiting period, even if they begin after the policy starts. If one of them is also a pre-existing disease, the longer wait applies. Accident claims are not held to this wait. Your policy wording and schedule are the final reference.
Insurer
ICICI Lombard Health Insurance plans and claim process
Golden Shield is a senior citizen health insurance plan from ICICI Lombard for people aged 56 and above. It covers hospitalisation, day care, modern treatments, home care, AYUSH and ambulance, with a 50% base co-payment on every admissible claim. It also offers a cumulative bonus, a reset benefit, an annual preventive health check-up and an optional Care Management Program.
Entry starts at 56 years, with no maximum entry age, and the policy is renewable for life. Renewal cannot be refused because you made a claim, and no loading applies to renewal premium based on your claims. Medical underwriting at purchase can add a risk loading of up to 100% per diagnosis, up to 200% overall.
You pay 50% of the admissible amount of every claim and ICICI Lombard pays 50%. For example, on an admissible bill of ₹4 lakh you pay ₹2 lakh. The co-payment does not reduce your sum insured. It does not apply to the Care Management Program or the preventive health check-up, and it does not apply if you opt for a voluntary deductible.
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)
You bear a deductible of 20% of your annual sum insured on total hospital expenses in a policy year, and pay a lower premium. When it is opted, the base co-payment is not applied.
The zone-based co-payment still applies, and the deductible cannot be changed mid-term.
An upgrade to the Care Management Program with a dedicated nutritionist, family health updates with your consent, and limited OPD, diagnostics, pharmacy and nursing at home cover.
Needs extra premium. It is the only way to get any OPD cover in this plan.
Covers up to 4 outpatient consultations a policy year with general, specialist, super specialist or AYUSH doctors, including e-consultations.
Part of Care Management Plus. Physiotherapy and mental health counselling are excluded here.
Covers outpatient diagnostic tests and a list of minor procedures such as injections, suturing and wound management, up to ₹2,000.
Part of Care Management Plus. Genetic studies are excluded.
Covers prescribed medicines, drugs and medical consumables bought through the app network, up to ₹2,000.
Part of Care Management Plus. Supplements, vitamins, tonics and vaccines are excluded.
Pays up to ₹2,000 a day for up to 15 days after hospitalisation for a qualified nurse at home, when a doctor certifies it as necessary.
Part of Care Management Plus. Needs an accepted inpatient claim.
A certified nutritionist guides your diet and fitness, and your family can receive updates on your health and diet adherence, if you consent.
Part of Care Management Plus.
Yes, with the Modification of Base Co-payment cover you can lower it from 50% to 40%, 30% or 20% for extra premium. The change can happen only at renewal and is subject to underwriting. A fresh waiting period applies to the portion of co-payment you reduce, and you cannot change it mid-term.
ICICI Lombard adds 10% of the annual sum insured at the end of each claim-free policy year, up to 100%, if you renew without a break. On a floater policy no member can have claimed. The bonus is available only after the annual sum insured is fully exhausted, and a later claim does not reduce the bonus already earned.
When earlier claims in a policy year leave too little sum insured, it is restored by up to 100% for later claims. For claims unrelated to an illness already paid for that person it works unlimited times, and for related claims only once. It does not trigger on the first claim of the year, applies only to inpatient and day care claims, and is not available for a relapse within 45 days.
Room cover is twin sharing when your sum insured is below ₹10 lakh and a single private AC room from ₹10 lakh. If you take a costlier room, associated expenses such as room, nursing, OT and doctor fees are reduced in proportion. ICU charges, pharmacy, implants and diagnostics are not reduced.
Cataract is capped per eye at ₹25,000 on ₹3 to ₹5 lakh covers, ₹50,000 on ₹10 to ₹20 lakh covers and ₹75,000 above ₹20 lakh. Cardiovascular and cerebrovascular disorders, cancer treatment, other renal disorders, long bone fractures and joint replacements, and robotic surgeries are capped between ₹1 lakh and ₹5 lakh depending on the sum insured. These caps include pre- and post-hospitalisation expenses, so check the exact figures for your plan in the brochure.
There is a 30-day initial wait for any illness except accidents, and a 90-day wait for hypertension, diabetes and cardiac conditions unless declared as pre-existing. Pre-existing diseases and a long list of specific diseases and procedures each wait 24 months. Waiting periods can be reduced to the extent of prior cover if you port or migrate without a break.
Your premium depends on the zone you choose, with Zone A the most expensive, then Zone B and Zone C. If you take medically necessary treatment in a higher zone than the one you paid for, an extra co-payment applies on top of the base co-payment: 15% for Zone A treatment on a Zone B policy, 25% on a Zone C policy, and 12% for Zone B treatment on a Zone C policy. It does not apply to road traffic accidents.
It includes unlimited teleconsultations, 12 e-counselling sessions and 12 diet and nutrition e-consultations a year, care calls from a health coach, a second e-opinion for 33 listed critical illnesses, a medical vault, health assistance, ambulance assistance and wellness points worth ₹0.20 each. The optional Care Management Plus adds a nutritionist, 4 OPD consultations, ₹2,000 each for diagnostics and pharmacy, and nursing at home up to ₹2,000 a day for 15 days.
Not in the base plan. Outpatient treatment is excluded unless you opt for Care Management Plus, and then only within its small limits. Maternity and childbirth are excluded. Dental treatment is covered only after an accident.
Yes. The wording says the policy is ordinarily renewable except on grounds of fraud or misrepresentation, and renewal cannot be denied because you made a claim. You have a 30-day grace period to renew, though there is no cover during it. After 8 continuous years the moratorium applies and claims cannot be contested except for proven fraud and permanent exclusions.