I bought ICICI Lombard Travel Medical Insurance for my visiting parents, unfortunately. I wish I had seen this web site before and all the experiences people have gone through. Based on their claims procedure and the hassles I have been going through, I would not recommend anyone to buy this policy.

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ICICI CLAIMS Procedure and my comments
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Dear Sir,

This has reference to your call regarding your father’s medical ailment.

Your reference number is 06DEL0***.
ICICI Lombard shall compensate the Insured for expenses incurred for availing immediate medical assistance required on account of any illness or injury sustained or contracted whilst on a Trip abroad but not exceeding the Sum Insured for the coverage as mentioned in Part I of the Schedule hereto.

Please find appended below the claim procedure information and claim form for your kind perusal.

1. For outpatient consultation(s) / visit to a hospital / doctor including short stays in emergency room of hospital for a few hours, please self-pay the medical expenses and then file the claim directly with the Claims Department at the address below. Please file your claim immediately once the treatment is completed and the claim will be settled within 7 days of having received complete documents. Payment will be made in Rupees only with the exchange rate on the date of loss. The documents must be sent within 30 days of the return to India or expiry of policy, whichever is earlier. The list of
documents required to attached with the claim for reimbursement are as follows:
· Covering letter to specify the claim and address for sending the claim ( same as in proposal form)

· Claim Form duly signed by the Treating Doctor and Insured.

· Doctor’s medical report / admission / discharge card and prescriptions in original.

· Original bills and payment receipts for payments made.

· Copy of X-ray report, pathological and investigative reports.

· Copy of passport, visa with entry and exit stamp.

Send To:

CLAIMS DEPARTMENT
ICICI LOMBARD
C/O International SOS
2nd Floor, 2 B, Lotus Towers
New Friends Colony Community Center
New Friends Colony
New Delhi – 110065
INDIA


KRISHNAN>>>>>>>>>>>>> They did not provide any health insurance card. There is no direct payment. After my parents go back to India, they have to file claims in New Delhi and they will get paid in Indian Rupees. The claims can't be filed before going back because they require the proof of entry back into India for that.

Don't think that for outpatient emergencies, the charges will be low. I had to use several facilities (following the hospitalization as per details in point 2 below) and outpatient bills have run into several thousand dollars that has become very difficult for me to pay out of my pocket.

I am worried how my parents are going to deal with the paperwork and bureaucracy back in India to get that money back.


2. In case of medical hospitalization where the insured is hospitalized for 24 hours or more, please call and notify us immediately. In case of hospitalization, the Insurance medical assistance department will review the medical reports received from the hospital and / or the treating doctor as well as the report from the family / regular doctor in India. If it is confirmed that the admission to a hospital is NOT due to any pre-existing conditions or any exclusion listed in the policy, then the Insurance Company shall settle the payments directly with the hospital less the policy deductible of USD100.

KRISHNAN >>> My father needed to be hospitalized and the hospital was not willing to file claims to India and deal with them in New Delhi, India. They said they will give the bills to me and we need to file the claims myself and we will be liable for treatment charges ourselves.

Collection agencies are after me. It has been more than 4 months and ICICI has not yet settled the claim. In fact, they are not going settle the claim until my parents go back because they require the proof of entering back into India (See the requirement in point #3 below.) My parents are going to stay for 6 months total. And the hospital or collection agency is not going to wait that long.

Therefore, it does not matter what insurance company claims. They claim that the payment will be directly to the hospital. But the hospital needs to be willing to accept that insurance. Otherwise, there is no meaning as hospital is demanding that money from me.



3. In order to expedite processing of the claim for hospitalization, you must send the following documents immediately by fax to +91- 11-5189 8801 or scan and email to us at [email protected]

· Completed Claim Form signed by the Treating Doctor and Insured.

· Name, address and contact details of the Regular/ Family Medical Doctor in India.

· Signed copy of the RELEASE OF MEDICAL INFORMATION FORM (ROMIF) to authorize your Treating Doctor and Medical Doctor in India to release your medical information to the Insurance Medical assistance Department.

· Treating Doctor's medical report

· Copy of passport, visa with entry and exit stamp.

KRISHNAN>>> They require Medical doctor in India to give all the medical records. Is there any such system of maintaining the records in India? I am having hard time regarding this.

And I have faxed several documents many times. They claim they never received it. Fax again to India. Fax again to India.


4. Policy Excess. For medical sickness/accident there is a policy excess of USD 100 (deductible) which the Insured will have to bear and this amount cannot be claimed. This implies for any claim the first USD100.00 are to be borne by the insured. This applies for both outpatient and inpatient treatment and is applicable on per diagnosis basis.

5. Sub Limits: If the Insured is treated and / or hospitalized due to medical sickness, disease or accident on the trip abroad and are aged above 56 years, then medical expense will be subjected to sub limits for the benefit of Medical sickness. The following maximum eligible expenses per sickness or Disease are applicable to Insured person aged above 56 years. (Coverage limits are applicable only once the liability is confirmed under the terms and conditions of the policy)

Hospital Room and board, and hospital misc. expenses - maximum US$ 1,600 per day up to 30 days
Intensive care unit - maximum US$ 3,000 per day up to 7 days
Surgical treatment - maximum up to US$ 12,000
Anaesthetist services - up to 25% of surgical treatment
Physician's visit - maximum US$ 75 per day up to 10 visits
Diagnostic and pre-admission testing - maximum US$ 750
Ambulance services - maximum US$ 500

KRISHNAN>>>> This is a big drawback. Even if my claims get settled, it will only be a small portion of the actual expenses. How good is $50,000 or $100,000 that they claim? No body ever explained this to me before. And they don't mention this anywhere in the brochure either, how clever!

Now, after doing lot of research on this topic, I found that there are 2 types of plans. Fixed and comprehensive. And this ICICI plan is only fixed for ages over 55. And just like most people's parents, my parents are above 55. (They are 67 and 63 actually.) I wish I had read http://www.insubuy.com


6. As per policy terms and conditions “Pre-Existing Condition means the chronic illnesses or ailments and consequences of such illnesses or ailments existing or known to exist at the commencement of the Period of Insurance, even if the same had not been treated, including illnesses treated or for which medical advice has been sought in the last six months before commencement of the Period of Insurance including their consequences.” However, in case of an emergency the policy covers emergency treatment and hospitalization up to the stage of initial stabilization. Thereafter, if the condition is not pre-existing the full treatment will be covered.

KRISHNAN>>> This is another joke. They claim this but they come up so many excuses and reasons claiming that this is not included in that and that is not included in that, it is becomes practically worthless.

7. Your prompt submission of the above documents will enable the medical assistance department to make a medical assessment and recommendation of coverage thereby expediting the claims process.

8. I have attached the Claim Form / ROMIF for your necessary action. Please confirm once you have received this claims advise either on the 24 hr help line or by e-mail.

9. Should you require any further assistance or clarification on this claims procedure matter, please do not

hesitate to contact us at Telephone number +91 11 5189-8868, fax number +91 11 5189-8801 or email to us at [email protected]

KRISHNAN>>>> This may not get attention of many. I have spent lot of money and countless time during the nights calling them, as when I call them during the day time in US, many of the supervisor staff is not available as it is night there.

Teneichong Telien
Claims Department
For ICICI LOMBARD
Tel: 91 11 5189-8868
Fax: +91 11 5189-8801
Email: [email protected].