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Reviewed by Finzony Finance TeamLast updated:
ICICI Lombard Arogya Sanjeevani Policy is the insurer's version of the standard health plan that IRDAI asks every general and health insurer to offer. It pays your hospital bills, up to the sum insured, for in-patient stays of more than 24 hours. It also covers day care procedures, AYUSH treatment, 30 days of pre-hospitalisation and 60 days of post-hospitalisation expenses, cataract treatment, and a list of modern treatments such as robotic surgery, oral chemotherapy and stem cell therapy up to 50% of the sum insured. You can buy it for yourself or as a floater for your spouse, dependent children, parents and parents-in-law. ICICI Lombard's product page lists a sum insured of ₹1 lakh to ₹5 lakh, and the policy renews for life. Because it is a standard product, it is simple, but it has clear limits. Every claim carries a 5% co-payment, room rent is capped at 2% of the sum insured up to ₹5,000 a day, ICU is capped at 5% up to ₹10,000 a day, and pre-existing diseases wait 3 years. Maternity and OPD are not covered.
IRDAI standard product with the same core terms across insurers
Finzony treats Arogya Sanjeevani as a basic, low-cost hospital-bill plan, not a complete health policy. The strongest point is the price. ICICI Lombard lists a starting premium of ₹4,025 a year for one adult with a ₹1 lakh sum insured, and because the product is standardised, its core terms are easy to compare with other insurers' versions. The 8-year moratorium and lifelong renewal are also real strengths for a plan this cheap. The limits matter more once you are in hospital. Every claim carries a 5% co-payment. Room rent is capped at 2% of the sum insured up to ₹5,000 a day, and that ₹5,000 cap is already reached at a ₹2.5 lakh sum insured. If you take a room above the cap, the other hospital expenses, except medicines, are reduced in the same proportion. ICU is capped at 5% up to ₹10,000 a day. Cataract is paid at 25% of the sum insured or ₹40,000 per eye, whichever is lower, and it also sits in the 24-month waiting list. Pre-existing diseases wait 3 years, and a top sum insured of ₹5 lakh on the product page can fall short for a long stay in a big-city hospital. It suits someone who wants simple, affordable cover for routine hospitalisation and accepts a co-payment and room limits in return. If you want a larger sum insured or fewer limits, compare it with ICICI Lombard's other health plans. Get a quote for your own age before you decide, because the premium rises with the age of the oldest insured member.
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 room rent, boarding and nursing, ICU, surgeon, anaesthetist, doctor and specialist fees, blood, oxygen, operation theatre charges, surgical appliances, medicines and diagnostics for a hospital stay of at least 24 consecutive hours, up to the sum insured.
A 5% co-payment applies to the admissible claim amount, and the room and ICU limits below apply.
Room, boarding and nursing are paid up to 2% of the sum insured, subject to ₹5,000 a day. ICU and ICCU charges are paid up to 5% of the sum insured, subject to ₹10,000 a day.
If you take a room or ICU above these limits, every other expense except medicines is reduced in the same proportion. The ₹5,000 room cap is reached at a ₹2.5 lakh sum insured.
All day care treatments are covered, meaning procedures done under anaesthesia in less than 24 hours that would otherwise need a hospital stay of more than 24 hours.
The 24-hour minimum stay does not apply to day care.
Pays medical expenses for the same condition for 30 days before admission and 60 days after discharge.
Needs an admissible hospitalisation claim. Post-hospitalisation bills must be submitted within 15 days of finishing that treatment.
Pays in-patient treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, up to the sum insured.
ICICI Lombard says it must be at a government hospital or an institute recognised by the government or accredited by the Quality Council of India or NABH, on a reimbursement basis.
Conditions or treatments that the policy clearly says it will not cover.
These conditions and surgeries are excluded for the first 24 months of continuous cover, even if they begin after the policy starts and even if you declared them. The wait does not apply to claims arising from an accident, and if one of them 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
It is ICICI Lombard's version of the standard health plan that IRDAI requires insurers to offer. It pays hospital bills for stays of more than 24 hours, plus day care procedures, AYUSH treatment, pre- and post-hospitalisation expenses and some modern treatments, with a 5% co-payment on every claim.
ICICI Lombard's product page lists a sum insured of ₹1 lakh to ₹5 lakh. Its brochure mentions up to ₹10 lakh, so confirm the options on your quote before you buy.
ICICI Lombard lists a starting premium of ₹4,025 a year for one adult with a ₹1 lakh sum insured. Your premium depends on your age, the sum insured and the number of people covered, and for a family it depends on the age of the oldest member. Get a quote for your own age.
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)
The proposer must be between 18 and 65 years old. A proposer above 65 can buy cover for family members without covering themselves. You can cover your spouse, parents, parents-in-law and dependent children from 3 months to 25 years, and applicants above 45 go through medical underwriting.
Yes. You pay 5% of the admissible claim amount on every claim, and the insurer pays the rest. The co-payment does not reduce your sum insured.
Room, boarding and nursing are paid up to 2% of the sum insured, with a maximum of ₹5,000 a day. ICU and ICCU are paid up to 5% of the sum insured, with a maximum of ₹10,000 a day. If you choose a room or ICU above these limits, other expenses except medicines are reduced in the same proportion.
Pre-existing diseases wait 3 years of continuous cover. After that they are covered only if you declared them in the proposal and ICICI Lombard accepted them. If you port from another insurer without a break, the wait is reduced by your years of prior cover.
Twenty-two listed conditions and procedures wait 24 months, including cataract, hernia, piles, gallstones and kidney stones, benign tumours and cysts, hysterectomy, joint replacement, and age-related osteoarthritis. The wait does not apply to claims arising from an accident.
No. Maternity, childbirth, infertility treatment and OPD treatment are excluded, and so are domiciliary hospitalisation and treatment outside India.
Cataract is paid up to 25% of the sum insured or ₹40,000, whichever is lower, per eye in one policy year. For example, on a ₹1 lakh sum insured the limit is ₹25,000 per eye. Cataract also has a 24-month waiting period.
Yes. The policy wording adds a cumulative bonus of 5% of the sum insured for each claim-free year, up to 50%, if you renew without a break. ICICI Lombard's product page describes it as a 20% increase, so check the rate on your policy certificate.
Yes. The policy is renewable for life, renewal cannot be refused because you made a claim, and there is no premium loading for your own claims. You get a 30-day grace period for yearly payment and 15 days if you pay in instalments, and cover is not available during the grace period.
For cashless treatment, use a network hospital and get pre-authorisation from ICICI Lombard. Inform ICICI Lombard within 24 hours of an emergency admission, or at least 48 hours before a planned one. For reimbursement, send the claim form, bills, discharge summary and test reports within 30 days of discharge. You can call 1800 2666.