Need for health insurance in India
Rising medical
costs
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public at large.
Health care expenses
borne by patients
No social security
system
Increasing
senior citizen
population
What is the customer looking for?
Complete hospitalisation coverage
Reimbursement of all medical
related expenses
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To take care of customer needs…
Presenting
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3
Health Plan with multiple benefits
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4
Offers hospitalisation coverage &
health savings kitty
Hospitalisation
Cover
+
Health Savings
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5
Product Positioning
ICICI Pru Health Saver
Returns
+
liquidity
Health
cover
Tax
benefit
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Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
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6
The customer will live longer
…but not necessarily work longer
Age 18 to 60
Age 60 to 67
Working – 42 yrs
Retirement – 7 yrs
Age 25 to 55
Age 55 to 75
Working – 30 years
Retirement – 20 years
Previous
generation
Today
Life stage of average individual
Is our customer prepared to meet health expenses during this phase?
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7
The customer will buy insurance to save tax
…but not necessarily only for Section 80 C
91% of the consumers are aware of health
insurance as a tax saving instrument.
26% of the consumers investing in tax saving
instruments in the last two years invested in
health insurance.
23% of the consumers who are planning to
invest in tax saving instruments in the next one
year want to invest in health insurance.
Findings from a consumer research conducted by ICICI
Prudential in Sep 08 across Mumbai, Chennai and Delhi
8
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and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its
advisors, corporate agents or brokers and
should not be further circulated or used for
presentation to a prospect or general public
at large.
Yes, the customer will need a health plan
…but not necessarily the one You have in mind
A plan which:
Provides guaranteed reimbursement
hospitalization cover till age 75
Builds up a health fund and allows
claims for health expenses not
covered in the hospitalization cover
Flexibility in premium payment
Gives complete tax benefit under
Section 80D
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How does the plan work?
Select the annual limit for the hospitalization cover
Select a suitable premium
Basis age and annual limit chosen, part of premium will go
towards the health cover and remaining invested to build a
health fund*
Hospitalisation Insurance
Benefit
To cover you against
hospitalization expenses
*Invested premiums mean premiums post deduction of
10 charges
applicable
Health Savings
Benefit
To cover you against all other
health expenses
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the organization/ solely for training and/or education
of the employees of ICICI Prudential Life Insurance
Co. Ltd. or its advisors, corporate agents or brokers
and should not be further circulated or used for
presentation to a prospect or general public at large.
The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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11
The features in detail
Hospitalisation
Insurance Benefit
Covers actual expenses
incurred during
hospitalization
Health Savings
Benefit
Room, boarding and nursing charges, ICU charges
Maximum room rent payable to be 1% of selected
annual limit only for single A/C rooms
Fees for doctor, surgeon, specialist, etc
Anesthesia, blood, oxygen, operation theatre,
surgical appliances, medicines, etc
Pre & Post hospitalization expenses for 30 & 60
days
125 listed day care procedures
Ambulance charges upto Rs 1000 per year
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12
The features in detail
Hospitalisation
Insurance Benefit
Guaranteed coverage
till age 75
No claims Bonus
Health Savings
Benefit
No re-evaluation of health status
No refusal of cover during term
No addition of exclusions or increase in premiums
due to claims made
A bonus of 5% on annual limit added for every claim
free year
Bonus amount up to 25% can be added
Family floater
Cover yourself, spouse and upto 3 dependant children
under same plan
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13
The features in detail
Hospitalisation
Insurance Benefit
Free Health Checkup
Health Savings
Benefit
A free health check-up once every 2 policy years after
the first year
Reimbursement of amount up to 1% of annual limit or
Rs 5000 whichever is lower
Pre-Existing illnesses
Cover
Pre-existing illnesses covered after 2 years
The disease to be declared at inception & accepted
by the company
Cashless
Hospitalization
Cashless claims settlement in over 5000 network
hospitals
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14
The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Wide network access
with preferred benefits
Access to a network of over 5000 hospitals
A Co Pay of 20% applicable for room upgrade over
prescribed limit in single A/c room or for claims in
outside network hospitals
In Emergency, co-pays does not apply in cardiac or
trauma cases at a outside network hospital
Click here for co-pay illustration
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15
The features in detail
Hospitalisation
Insurance Benefit
Health Savings
Benefit
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16
The features in detail
Hospitalisation
Insurance Benefit
Build a Health Fund for
the future
Health Savings
Benefit
Choose from two portfolio strategies :
Lifecycle strategy wherein allocation is based
on customer’s age with rebalancing on a quarterly
basis
As age progresses, allocation changed to suit Life
stage.
Click here to know more.
Fixed strategy wherein a customer can do his
own asset allocation.
The customer can chose from 7 funds
Click here to know more
Includes Health
Return
Guarantee Fund
With
Automatic
Transfer
Strategy
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17
The features in detail
Hospitalisation
Insurance Benefit
Claim for any health
expenses after 3 years
Health Savings
Benefit
Claim are allowed from 4th year onwards against
medical bills. Claims can be made for:
Daily medicines and drugs
Diagnostic expenses
Doctor bills and other OPD expenses
Co-pays /deductibles of other medical insurance cover
Miscellaneous medical expense over and above that
covered by Hospitalization Insurance
Claim schedule:
Policy Years
Maximum claim
(% of fund value)
4th & 5th Yr
6th -10th Yr
From 11th Yr
20%
50%
100%
Claims can be made once every year, with minimum claim amount of
Rs 1000
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18
The features in detail
Hospitalisation
Insurance Benefit
Cover Continuance
option after 5 years
Health Savings
Benefit
Option of premium holiday after completion of 5
policy years
Hospitalization Insurance and Health Savings
benefit continues by deduction of charges from
accumulated fund
Once the fund value drops to <110%of annual
premium, the customer can still claim from it for the
next 5 years ( max 50% every year)
Tax benefit under
Section 80D
Complete tax benefit under Section 80 D even for this
component of the premium
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19
Features summarized
Hospitalisation
Insurance Benefit
Health Savings
Benefit
Guaranteed
Coverage till age 75
No Claim Bonus
Family Floater
Pre-existing Illness
Cover after 2 yrs
Over 125 Daycare
coverage
Free Health Checkup
20
Build a health fund
for the future
Tax Benefits of upto
Rs 15000 u/s 80D
Click here
Allows you to claim
for any health
expenses after 3
years
Cover Continuance
option after 5 years
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and/or education of the employees of ICICI Prudential Life Insurance Co. Ltd. or its
advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
Therefore the product positioning
Builds a
health fund
and allows
Claims for all
health expenses
Comprehensive
guaranteed
reimbursement
coverage
A dual benefit
health plan
Flexibility in
premium payment
Complete tax
benefit
under
Section 80 D
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
Boundary conditions at-a-glance
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within the organization/ solely for training and/or
education of the employees of ICICI Prudential
Life Insurance Co. Ltd. or its advisors, corporate
agents or brokers and should not be further
circulated or used for presentation to a prospect
or general public at large.
Term
Whole Life Plan
(Hospitalisation Insurance guaranteed upto age 75 years)
Annual Limit Options
(Rs.)
2 lacs / 3 lacs / 5 lacs / 7 lacs / 10 lacs
Min/Max Age at Entry
25 - 55 years for individual policies
18 - 55 years for spouse in a family floater
Dependent children (90 days - 25 years of age)
Waiting period
30 Days

No waiting period applies for claims due to accident

Waiting period of two years will apply to some conditions
Premium Paying
Modes
Yearly, Half Yearly, Monthly
Minimum Premium
Premiums would be subject to the minimum premium grid
based on the age of the primary life, number of dependents
covered and annual limit.
Please check Login Assistant to check the minimum premium
for your case.
Boundary conditions at-a-glance
Switch
4 Free switches in a year.
Additional switches chargeable at Rs.100 per switch
Change in portfolio
strategy
CIPS allowed once in every 2 years
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23
Health Saver charges
Allocation Charge

Year
1
2-3
4-10
Thereafter
% of Annual Premium
20%
9%
2%
0

Policy Admin Charges
 For Monthly : Rs 90 per month
 For Yearly and Half yearly mode: Rs 60 per month

Fund Management Charge
 1.5% for Health Flexi Growth , Health Multiplier, Health RGF
 1.0% for Health Flexi Balanced, Health Balancer
 0.75% for Health Protector, Health Preserver
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Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
All charges deducted in the form of units from fund
24
Health Saver charges

Health Insurance Charges:
Annual Limit
25 yrs
2 Lacs
3 lacs
5 lacs
2337
35 yrs
2756
3564
55 yrs
7052
2693
3179
3928
7836
3402
4203
8384
2881
45 yrs
7 lacs
3069
3624
4476
8929
10 lacs
3283
3878
4790
9554
Inclusive of ST & Education Cess
The health insurance charges are valid from 1 year of policy
commencement date and are subject to change post IRDA approval

This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
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25
Health Saver – the real Health ULIP plan
Tax benefit under
80 C
Reimbursement
Hospitalization
plan
Fixed benefit
Hospitalization
plan
Tax benefit under
80 D
The only insurance plan to have
the complete 80D tax advantage
Health Saver
The only insurance plan to have a
reimbursement based floater
hospitalization cover
•Reliance Health + Wealth
•LIC Health Plus
•TATA AIG invest assure
Most comprehensive coverage with maximum tax advantage
26
The Health Saver advantage: The most
comprehensive coverage
Benefits
Health
Saver
Traditional
Mediclaim
Hospitalisation
Coverage


Daycare Procedures


OPD expenses


Maternity expenses


Dental treatment


Medical equipment
expenses


Day to day medicines &
drugs expenditure


Comprehensive coverage against
both inpatient and outpatient
medical instances
Pays for any kind of medical
expense incurred during the
policy term
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27
The Health Saver advantage: Takes care of you
today and invests your money for tomorrow
Retirement
Working Phase
Age 25
Retirement Phase
Regular premium
Age 55
Premium paying term 30 years
Age 75
Whole life
Cover continuation phase
Hospitalisation Cover
Relax!
Relax!
Pay premiums
during
working years
Get a health
cover + build
a health fund
Opt for CCO
on retirement
and remain
protected
Continue
claiming from
health fund
for whole life
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Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
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Strictly for internal circulation and/or for training/ education of employees/advisors/ corporate agents/ brokers of ICICI Prudential Life Insurance Co. Ltd. Should not be
further circulated/ used for presentation to a prospect/ general public.
What makes Health Saver a winner
Long Term
Coverage against
Hospitalisation
Expenses
Flexible premium
payment options
continue cover even
after stopping
premiums
Build a health fund
which allows you to
claim for any other
health expenses
Tax Benefits on
entire premiums u/s
80D
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presentation to a prospect or general public at large.
29
Case study: Dinesh’s dilemma…

Dinesh, aged 30, is
interested in a health
plan which offers:

Health coverage for
a longer term

Affordable premium

Tax benefit under
sec 80D

Plan which can
cover his spouse &
2 children as well
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30
Solution: ICICI Pru Health Saver
•
Provides hospitalisation coverage till age 75 with
family floater & additionally builds a health fund
which allows Claims for all health expenses
Dinesh likes the proposition but is worried about his medical
expenses post 75 years of his age
•
Health Saver – The cover ceases at age 75 but the
health fund continues to grow and takes care of
his medical expenses till age100
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31
Dinesh opts for health saver
Takes care of his medical expenses & invests his money for tomorrow
Retirement
Working Phase
Retirement Phase
Regular premium
Age 30
Age 60
Premium paying term 30 years
Age 75
Cover continuation phase
Hospitalisation Cover
Pays premiums
during working
years
Gets a health
cover + builds
a health fund
Opts for CCO
on retirement
and remain
protected
Whole life
Relax!
Continues
claiming from
health fund for
whole life
Relaxed!
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32
Dinesh's : Returns on Investment
Scenario: 15 years
Age: 30 yrs
Annual premium: Rs. 15,000
Cover: 5 lakhs Family Floater
Total Premium Paid for 15 Years
2,25,000
Tax advantage availed for the premiums paid in 15 yrs
Total fund value after 15 yrs @ 10% rate of return
67,500
1,95,480
Avails health check ups claims of Rs. 5000 in every 2 years
Total monetary benefit at the end of 15 yrs
35,000
2,97,980
Total gain of Rs. 72,980 /= in a span of 15 yrs on an investment of
2.25 lacs i.e. 32.43% overall returns
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organization/ solely for training and/or education of the
employees of ICICI Prudential Life Insurance Co. Ltd. or
its advisors, corporate agents or brokers and should not
be further circulated or used for presentation to a
prospect or general public at large.
*For 30 year old with highest income tax slab of 30%
Tax advantage under section 80 D
33 net of all charges and insurance charges for a 5 lakh annual limit
** fund value
Dinesh's : Returns on Investment
Scenario: 15 Years
Age: 30 yrs
Annual premium: Rs. 15,000
Cover: 5 lakhs Individual policy
Total Premium Paid for 15 Years
Tax advantage availed for the premiums paid in 15 yrs
Total fund value after 15 yrs @ 10% rate of return
Health Check ups claims of Rs. 5000 every 2nd yr after 1st year
Total monetary benefit at the end of 15 yrs
2,25,000
67,500
3,18,231
35,000
4,20,731
Total gain of Rs. 1,95,731/= in a span of 15 yrs on an investment of
2.25 lacs i.e. 87% overall returns
*For 30 year old with highest income tax slab of 30%
Tax advantage under section 80 D
** fund value net
34 of all charges and insurance charges for a 5 lakh annual limit
This material is strictly meant for
circulation within the organization/
solely for training and/or education of
the employees of ICICI Prudential Life
Insurance Co. Ltd. or its advisors,
corporate agents or brokers and should
not be further circulated or used for
presentation to a prospect or general
public at large.
Premium payment frequency & mode
Premium payment frequency:

Yearly/
 Semi-annually/
 Monthly ECS/Monthly Non-ECS
Premium payment mode:


Cheque/DD/PDC/Pay Orders/Bankers Cheque/
Internet facility/Electronic Clearing System/Credit Card
To ensure all health policy customers derive 80 D tax benefits CASH will not be
accepted as a mode of First Premium Deposit.
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
•Amount & Modalities will be subject to company rules &
relevant legislation/regulations.
35
LIFECYCLE BASED PORTFOLIO STRATEGY
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presentation to a prospect or general public at large.
36
How Does It Work



Initial allocation based on customer’s age
Rebalancing on a quarterly basis
As age progresses, allocation changed to suit Life
stage
Age Band
37
Allocation
Health Flexi Growth
Health Protector
0 – 25
85%
15%
26 – 35
75%
25%
36 – 45
65%
35%
46 – 55
55%
45%
56 – 65
45%
55%
66 – 75
35%
65%
75+
0%
100%
This material is strictly meant for circulation within the organization/ solely for training and/or
education of the employees of ICICI Prudential Life Insurance Co. Ltd. or its advisors,
corporate agents or brokers and should not be further circulated or used for presentation to a
Flowchart for lifecycle based strategy
NAV CHANGES
ALTER THE
EQUITY-DEBT
RATIO
Customer
Age = 30
Policy Inception
25%
75%
EQUITY
WITH CHANGE IN
AGE,
ALLOCATION IS
ALTERED
Age = 36
Every Quarter
75%
50%
Every shift
in age
band
35%
50%
25%
65%
DEBT
EQUITY
ALLOCATIONS
BASED ON AGE
DEBT
PORTFOLIO
REBALANCING
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
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38
Asset Allocation
What is it?
It is the diversification of your portfolio
How can it be done?
By distributing wealth amongst different asset
classes viz. equity, debt & money market
Why should you do it?
In order to optimize your risk-return balance
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
39
Why is Asset Allocation
important?
Brinson Study on the Importance of Asset
Allocation
Market
1%
StudiesSecurity
have shown that
asset
allocationOthers,
is the single
timing,
2%
Selection ,
most5%
important factor in determining returns
Long Term
Asset
Allocation ,
92%
Long Term Asset Allocation
Security Selection
Market timing
Others
Studies have shown that asset allocation is the single
most important factor in determining returns
40
40
FIXED PORTFOLIO STRATEGY
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Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
41
Fixed Strategy : Choice of Funds
A customer may wish to do his allocations on his own
We have given him a flexibility of allocating his wealth
as per his choice
 Health Flexi Growth
 Health Multiplier
 Health Flexi Balanced
 Health Balancer
 Health Protector
 Health Preserver
 Health Return Guarantee Fund
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Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
42
42
Automatic Transfer Strategy (ATS)
ATS ( Automatic Transfer Strategy ) is a mechanism that
eliminates the need to time one’s investments in the market.
Through ATS you can regularly switch a fixed sum of
investment at a monthly frequency from Health Preserver to
Health Multiplier or Health Flexi Growth
Advantages
Reduce risk in overall investment
Bulk of investment in Health Preserver
A good strategy in a volatile market to average out cost of acquisition
43
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of the employees of ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers
and should not be further circulated or used for presentation to a prospect or general public at large.
What is the Return Guarantee Fund?

Return Guarantee Fund ( RGF) is a close ended
debt fund

It offers a Minimum Guaranteed NAV at the end
of 5 years.
Indicative Portfolio Allocation
Max (%)
Min (%)
Debt, Money market & Cash
100
100
Fund Management Charge: 1.50%
45
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the employees of ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and
should not be further circulated or used for presentation to a prospect or general public at large.
Health RGF – Snapshot
46

Only your First Premium Deposit is invested in the RGF

Subsequent Premiums:
 Allocation must be chosen at inception ( in app form); and can be allocated
into any of the fund / strategy available with the product

Switch out of Return Guarantee fund at the prevailing NAV at any point of time
and re-invest in any of our other funds

Subscription to this fund is open for a limited period

The fund can be closed by giving a notice of 5 working days notice
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employees of ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should
not be further circulated or used for presentation to a prospect or general public at large.
Co-pay illustration


Plan : Annual limit of Rs 5L
Following expenses incurred during treatment
Expenses
Eligible for cover
Total Bill (Rs)
Total Eligible Bill (Rs)
Room & ICU

30000
30000
Doctors Fees

5000
5000
Medicines

4000
4000
Opn Procedure

10000
10000
Telephone

1000
0
Food bill for
attending
person

1500
0
51500
49000
Grand Total (Rs)
47
This material is strictly meant for circulation within the organization/ solely for training and/or education of the
employees of ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be
further circulated or used for presentation to a prospect or general public at large.
Co-pay illustration … 2

Appropriate choice of hospital will avoid any copay for the customer
Network
Network Hospital
Non Network Hospital
Amount covered
by policy (Rs)
49000
(100% of eligible bill)
39200
(80% of eligible bill)
Amount to be
0
9800
paid by customer (0% Co Pay for within
(20% Co Pay for
(Rs)
network claims)
outside network claims)
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of ICICI
presentation to a prospect or general public at large.
Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or used for
presentation to a prospect or general public at large.
48
Increase in premiums after claims
Premium (Rs)

Mr Rakesh K (age 72) with a 10 year old
mediclaim policy of Rs 3 lacs
60000
Claim
12000
8000
No Claim
Year 1
Year 2
Reason for this huge rise in premium: Customer had
claimed Rs 1,50,000 for an angioplasty after
developing a heart ailment
Source: Mediclaim premium hike capped at 75%,1 Dec
49 2007, IST,Prabhakar Sinha,TOI,
This material is strictly meant for circulation
within the organization/ solely for training
and/or education of the employees of ICICI
Prudential Life Insurance Co. Ltd. or its
Adding exclusions after claims

Mr Joshi (age 67) had purchased a mediclaim
policy in 1992
1992
1999
2002
Policy Issued
Disease/Condition
Occurs
New Exclusion
added at renewal
Current Status
Premium Doubled
New Exclusion added
“For the first 10 years of taking the policy, there was
no claim and now that the time has come to encash
on the policy, they are asking me to discontinue”, Joshi
Source: Two more PILs filed in Mediclaim cases.14 Apr 2003, TOI
50
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of
ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or
used for presentation to a prospect or general public at large.
Pre existing illnesses not covered
1986
Mr Vasant Rao underwent by-pass
Mar 95
Bought Mediclaim with disclosure of by-pass
and renewed regularly since
Apr 99
Underwent Angioplasty and diagnosed with
Ischemic Heart Disease (IHD)
Jul 99
Underwent surgical procedure for the same
Claim was not honoured by the company citing
exclusion clause on pre-existing disease
(Source:Honour Mediclaim policy: National panel
Friday July 7 2006 ,www.newindpress.com)
51
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of
ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or
used for presentation to a prospect or general public at large.
Exclusions
Please refer to policy document for detailed exclusions
Permanent exclusions & Pre existing illness or conditions unless specifically
accepted by the Company
Pre and Post Hospitalization benefits are payable only when the ailments or illnesses
are directly related to the covered hospitalization event/Day care Procedure.
Any expenses more than 30 days prior to hospitalization/Day care Procedure & 60
days beyond discharge are not payable
Diagnosis and treatment or any expenses incurred outside India.
Treatment & investigations for conditions arising due to Diabetes & Hypertension if
disclosed at inception are excluded for first 2 policy years from risk commencement
date or 2 years from the reinstatement date in case reinstatement done after 60 days
from last unpaid premium.
Any treatment directly or indirectly consequent to war, civil war, terrorism, active
military or police duties ,military aircraft or vessels
Circumcision, Sex change surgery ,cosmetic surgery & plastic surgery not due to
accident or treatment of disease etc
Vaccinations, inoculations & expenses on vitamins & tonics until medically necessary
Refractive error correction, Hearing impairment correction, Corrective & cosmetic
Dental surgeries apart from for any treatment arising due to systemic disease or
injury.
Any hospitalization for tests or diagnosis wherein such investigations are possible as
out patient procedures / weight loss / weight gain / Preventive / recuperation
purposes/ routine check-ups & issue of any medical certificate or examination for
employment or travel.
Any treatment / expenses incurred by a Donor of an Organ











52
This material is strictly meant for circulation within the organization/ solely for training and/or education of the employees of
ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate agents or brokers and should not be further circulated or
used for presentation to a prospect or general public at large.
Exclusions (Continued)

Any Treatment for Congenital Conditions / Physical defects/genetic
disorders etc
Any stream or type of medicines other than Allopathy ( Western medicine)
Any Treatment related to Contraception / Pregnancy / Child birth and
infertility or assisted conception procedures except for life threatening
ectopic pregnancy.
Any treatment directly or indirectly arising from alcoholism/drug abuse,
self-inflicted injuries or attempted suicide or intoxication of drugs,
psychiatry ailments.
Any treatment due to and as a result of HIV / AIDS / Sexually Transmitted
Disease (STD)
Any treatment related to sleep disorders & Sleep Apnoea syndrome.
Durable medical/Non medical equipments including all non medical
expenses including personal comfort expenses, domiciliary treatment.
More than one coronary angiography in a policy year.
Any treatment arising out of professional / hazardous sports or activities
etc. or deliberate exposure to exceptional danger.
Any kind of service charge, surcharge, admission fees, registration fees.
Extension of duration of hospital stay without any medical requirement as
per the specialist or expenses incurred for investigations/treatment not
relevant to the reason for hospitalization.
Disease or ailment other for one where hospitalisation was necessary &
Hospitalization or treatment not actually performed











53
Back
This material is strictly meant for circulation within the organization/ solely for training and/or
education of the employees of ICICI Prudential Life Insurance Co. Ltd. or its advisors, corporate
agents or brokers and should not be further circulated or used for presentation to a prospect or
Procedures covered after 2 years
1
Functional Endoscopic Sinus Surgery / Septoplasty for Deviated Nasal
Septum / Sinusitis
2
Surgery for Tonsillitis / Adenoiditis
3
Thyroidectomy for Nodule / Multi Nodular Goitre
4
Hernia (Inguinal / Ventral / Umbilical / Incisional)
5
Hydrocoel / Varicocoel / Spermatocoel surgery
6
Piles / Fissure / Fistula / Rectal prolapse
7
Trans Urtheral Resection of Prostrate / Open Prostatectomy for Benign
Enlargement of Prostrate
8
Dilation & Curettage for menstrual irregularities
9
Hysterectomy for Fibroids, menorrhagia, Dysfunctional Uterine Bleeding ,
Prolapse
10
Myomectomy for Fibroids and menorrhagia
11
Lap / Open Chole cystectomy for Cholecystitis / Gall stones
12
Lithotripsy / Basketing for Renal Calculus
54
Strictly for internal circulation and/or for training/ education of employees/advisors/ corporate agents/ brokers of ICICI Prudential Life Insurance Co. Ltd. Should not be
further circulated/ used for presentation to a prospect/ general public.
Procedures covered after 2 years
13
Traction / Discectomy / Laminectomy for Prolapsed Inter Vertebral Disc
14
Vitrectomy and Retinal Detachment surgery for Retinopathy
15
Amputation due to diabetes
16
Renal failure due to diabetes
17
Osteoporosis leading to Fracture Neck of Femur
18
Cataract (After two years from Risk Commencement Date or revival
date, where the revival occurred more than 60 days after the first unpaid
premium, whichever is later, only claims up to Rs. 20,000 will be covered
in any policy year)
19
Osteoarthrosis leading to Total Knee Replacement or Total Hip
Replacement (After two years from Risk Commencement Date or revival
date, where the revival occurred more than 60 days after the first unpaid
premium, whichever is later, claims for up to one knee or hip treatment
will be covered in any policy year )
55
Strictly for internal circulation and/or for training/ education of employees/advisors/ corporate agents/ brokers of ICICI Prudential Life Insurance Co. Ltd. Should not be
further circulated/ used for presentation to a prospect/ general public.