ICICI Lombard Health Insurance Claim Settlement: CSR Ratio, How to Claim & claim Status (2024)

Founded in the year 2001, ICICI Lombard Health Insurance is one of the top general insurance providers in India. The company has settled over 3.6 million claims and with a claim settlement ratio of 99.80% in FY 2023, ICICI Lombard proves to be a dedicated and customer-centric company. This page covers all the details you should know about the claim settlement ratio, its importance, how to file a claim through ICICI Lombard health insurance, how to check your claim status and essential contact details. [1]

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Claim settlement Ratio of ICICI Lombard Health Insurance

The claim settlement ratio of ICICI Lombard Health Insurance is calculated by dividing total claims paid in a period of 30 days by the overall sum of claims paid. The claim settlement ratio or CSR of ICICI Lombard Health Insurance for the past 5 years are listed below [2]:

Fiscal Year

Claim Settlement Ratio

2023

99.7%

2022

99.7%

2021

97.07%

2020

97.84%

2019

97.8%

Why is Claim Settlement Ratio Important?

A company’s claim settlement ratio (CSR) is a strong and reliable insurance metric that helps you in choosing the right health insurance company for you and your loved ones. Two major reason why claim settlement ratio is important are listed below:

  1. Helps in Assessing Insurer: While purchasing a policy, CSR is a performance metric that can help you gauge if an insurer is right for you. You must look at the CSR and compare them against the CSR of other companies that you may be exploring before the purchase. The higher an insurer’s claim settlement ratio is, the better are your chances of getting a claim.

  2. Showcases Percentage of Claims Paid by the Insurer: A strong claim settlement ratio helps in understanding that the insurer pays claims at the time of need to the insured. However, at times claims get rejected when the appropriate documentation is not submitted, this also results in lowering a company’s claim settlement ratio.

ICICI Lombard Health Insurance Claim Initiation

To file a claim from ICICI Lombard Health Insurance follow the process mentioned below:

How to File a Claim

Step 1: Initiation

As soon as your medical appointment is made or an emergency occurs, contact the customer support team of InsuranceDekho or ICICI Lombard Health.

You can call an ICICI Lombard customer care team on their toll free number 1800 2666 or send an SMS ‘HEALTHCALIM’ to 575758 (there is an SMS charge of INR 3 per SMS). You can also email their customer care team at ihealthcare@icicilombard.com

To connect with an InsuranceDekho executive call on the customer support number 7551196989 or email us at support@insurancedekho.com

Step 2: Verification

Once your claim documents are submitted, ICICI Lombard’s claim team will verify all your documents. If everything is fine, your claim will be processed further.

Step 3: Tracking

For tracking your claim, you can check your ICICI Lombard app or connect with their customer care. You can also connect with an InsuranceDekho customer assistant to help you in getting regular updates.

Details to be Filled in the ICICI Lombard Health Claim Form

The details to be filled in the claim process for ICICI Lombard Health Insurance are divided in two parts. The segregated details are mentioned below:

PART A

PART B

Self Declaration

Hospital Details

Employee Details

Doctor Details

Policy Copy

Patient Details

Discharge Summary

Treatment Details

Hospital Bills

Hospital Declaration

ETF Details


Additionally, the below-mentioned details are also required:

  1. Duly filled claim form

  2. Discharge or daycare summary

  3. Final hospital bill

  4. Payment receipts

  5. Investigation report

  6. Pharmacy bills

  7. Implant invoice

  8. Doctor Prescriptions

  9. Consultation Papers

  10. Age Proof

  11. Indoor Case Paper

  12. Copy of cancelled cheque

  13. KYC Form

Claim Process of ICICI Lombard Health

ICICI Lombard's Cashless Everywhere feature enables you to receive cashless treatments at any hospital within India, including those outside the network, subject to specific terms and conditions. For treatments at non-network hospitals, it's essential to notify ICICI Lombard within 48 hours in advance for planned procedures and within 48 hours in case of emergencies. Please be aware that obtaining approval for cashless treatment at non-network hospitals is contingent upon the terms and conditions outlined in your ICICI Lombard health insurance policy and agreements with the hospital.

Additionally, below are the steps to follow in case of cashless and reimbursement claims:

Cashless

  1. Visit the nearest hospital

  2. Go to the front desk and meet the third-party administrator or TPA

  3. TPA will fill and submit your form on your behalf to ICICI Lombard health insurance

  4. The claim executive will review the reports and process the claim if everything gets approved

  5. Once you have the approval, you can take treatment at the hospital

  6. Post-treatment, the bill will be settled directly between your insurer and the hospital

Reimbursement

  1. Inform ICICI Lombard about your hospitalisation (48 hours before in case of planned hospitalisation and within 48 hours in case of emergency).

  2. Clear your bills at the hospital and submit all documents.

  3. Fill out and submit claim form

  4. Wait for approval and status update from the insurer

Note that you need to

  • submit all documents within 15 days of discharge along with your claim form

  • keep all duly signed documents for submission for a smooth claim process

How to check the ICICI Lombard Health Insurance Claim Status?

To check the claim status of ICICI Lombard health, follow the steps mentioned below for both online and offline [4]:

Online

  • Visit the official website of ICICI Lombard Health Insurance

  • Go to the health insurance page and click on the “claims” link which will redirect you to the claim page

  • Choose “retail user” from the two options suggested - retail or corporate

  • Enter your claim number and select “Proceed”

  • Now your real time claim status will be displayed on the screen

Offline

  • Visit your nearest ICICI Lombard branch and carry the copy of your policy document with you

  • Connect with an executive at the branch office who will understand your policy and claim status and then assist you

Alternatively, you can also call on the toll-free number 1800 2666 or from the list of numbers mentioned on ICICI’s website, share your claim reference number with the customer care executive, and get the update.


ICICI Lombard Health Insurance Claim Settlement Time

According to the Insurance Regulatory and Development Authority of India (IRDAI), any insurer takes about 30 days from the date of reimbursement or claim document submission for claim settlement. [5]

Tips to Get Your Claim Settlement Faster

In order to get your claims settled faster, here are some points to keep in mind:

  1. Understand your policy better

  2. Submit completed documents only

  3. Document everything you communicate with your insurer

  4. Have an active policy

  5. Carefully review all your documents

  6. Seek the help of an attorney if required

ICICI Lombard Health Insurance Claim Assistance & Support

To get claim assistance and support from ICICI Lombard:

  • Call on toll free at 1800 2666

  • Email at ihealthcare@icicilombard.com

  • Connect through the IL TakeCare app

  • Whatsapp ICICI Lombard on by saying 'Hi' at 7738282666

To get claim assistance and support from InsuranceDekho you can:

  • Email at support@insurancedekho.com

  • Call on +91-755 1196 989.

References

  1. https://www.insurancedekho.com/health-insurance/icici-lombard

  2. https://www.icicilombard.com/claim-settlement-ratio

  3. https://www.icicilombard.com/blogs/health-insurance/hi/how--to-ensure-your-reimbursement-claim-on-health-insurance-is-processed-smoothly

  4. https://www.icicilombard.com/blogs/health-insurance/hi/how-to-check-health-insurance-policy-status

  5. https://irdai.gov.in/health-dept

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FAQs

  • What are the different claim settlement options offered by ICICI Lombard Insurance?

    ICICI Lombard Insurance offers cashless, and reimbursement claims. In case of emergency treatments, cashless claims are provided if the insurer is informed within 24 hours of hospitalisation and in any other cases a 48-hour notice before hospitalisation is required by the insurer.

  • How long does it take for ICICI Lombard Insurance to settle a claim?

    Settlement of a claim is made within 15 days by ICICI Lombard Health Insurance.

  • What documents are required to file a claim with ICICI Lombard Insurance?

    The following documents are required while filing a claim are, original investigation report, final hospital discharge summary, FIR or post-mortem report (if happened), pharmacy bills and prescriptions, cancelled cheque or NEFT details for payment, original bills, receipts, indoor case paper, and duly filled claim settlement form, treating doctor’s reports, consultation reports, nature of operation performed, surgeon’s bills and receipts and test reports along with assisted doctor’s report.

  • What steps should I take if my claim with ICICI Lombard Insurance is denied or delayed?

    Reach out to an InsuranceDekho advisor for any problem due to claim denial or rejection. The advisor will help you resolve the problem.

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