ICICI Lombard Health Insurance Review

ICICI Lombard, founded in 2001, is a joint venture between ICICI Bank and Fairfax Holdings and is considered one of the largest general insurance companies across the country. This general insurer has many financial products that can be regarded as comprehensive. However, when it comes to health insurance plans from ICICI Lombard, the policies are mostly a bit expensive and, hence, not so popular, despite its recently launched “Anywhere Cashless” perk, wherein policyholders can avail of the cashless claim settlement even at non-network hospitals (with specific terms and conditions).

The issues with issuance and popularity of its plans can also be attributed to the insurer’s below-average performance in the metrics of Claim Settlement Ratio and number of network hospitals. However, its track record in Incurred Claim Ratio and complaint volume is decent enough.

So, considering its metrics and policy features, should you opt for a health insurance plan from ICICI Lombard? Let’s find out!

Metrics of ICICI Lombard Health Insurance

ICICI Lombard Health Insurance has been in the industry for over a couple of decades now. Considering its extensive track record across the insurance sector, expectations are high that this insurer will reflect the data of a credible provider. However, despite being considered one of the leading insurance companies in the market, the insurer doesn’t fare well across the credibility metrics (as you will see below).

Now, regarding its health insurance policies, plans from ICICI Lombard are usually equipped with premium features like maternity and OPD coverage. Unfortunately, such perks also increase the premiums compared to the other plans in its category. Thus, the pricier health insurance plans, accompanied by the lack of diversities of the policies (iHealth and iHealth Plus) and their non-comprehensive nature, make it a tough choice for potential policyholders.

However, before we delve into such details about the health insurance plans offered by ICICI Lombard, let’s first evaluate its market-acclaimed credibility.

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Claim Settlement Ratio of ICICI Lombard Health Insurance

A health insurer's Claim Settlement Ratio (CSR) is one of the popular metrics that policyholders usually check before approaching any provider. While CSR isn’t the only metric used to check a health insurance provider's reliability, it is a crucial and determining factor.

CSR is given by -

(The total number of claims settled in a year by an insurer / The total number of claims raised in the year to the insurer) * 100

Regarding the significance of the CSR numbers, here’s an overview -

• Below 80 - With such a poor CSR, the insurer definitely is not well known for settling its claims. As a policyholder, you should avoid these providers, considering there are high chances of claim rejections.
• Above 90, but below 100 - This is the sweet spot for health insurers; such providers are considered top-notch (in terms of CSR). Approaching such providers ensures that you have gone in for a credible insurer.
• Above 100 - Often marketed as a great insurer, this beyond-perfect score is a red signal, considering that these numbers suggest delayed claim settlements. And since this is a health insurance claim settlement you are talking about, the last thing you want is a delay in the settlement process that would lead you to dig into your savings (even if it’s temporary, to be reimbursed later or delays in the reimbursement too) that defies the purpose of you availing of health insurance plans.

Insight: While you can say “hats off” to the consistency of ICICI Lombard Health Insurance in terms of its CSR, the numbers aren’t exactly encouraging. ICICI Lombard’s CSR numbers consistently stay below the recommended threshold of 90.

Incurred Claim Ratio of ICICI Lombard Health Insurance

As stated before, an insurer's Claim Settlement Ratio cannot be the only metric used to determine a provider’s credibility. Hence, other important metrics like the Incurred Claim Ratio (ICR) are included.

Now, CSR falls short when indicating a brand's sustainability and its future claim settlement potential. This is where ICR comes into play.

A health insurer’s Incurred Claim Ratio or ICR is given by -

(Total amount of claim settled / Total amount of claim filed for a single year) * 100

In case you are looking at the metrics of ICR, here is an idea of the range and its subsequent interpretation of the insurer’s credibility -

• Below 50 - This insurer focuses more on its business profitability and less on its client settlement. Hence, it’s best to avoid health insurers with an ICR of less than 50 since these insurers might be more inclined to reject your claims or settle claims partially only.
• Between 50 and 70 - This is the ideal range of ICR for health insurance providers. Such insurers have hit the balance between ensuring their business profitability and settling proper claims. Thus, approaching such insurers is the perfect move, considering their prioritisation of client requirements and yet working towards their financial stability in the long run.

(Please note: While we say that 50 to 70 is ideal for health insurance policyholders, we don’t mind an insurer with an ICR in the 80s. This generally reflects that the provider is a tad bit more inclined towards prioritising its client’s claim settlement requirements without raising any major risks of financial crunch.)

• Above 100 - This score is anything but perfect. If you come across an insurer with an INCR of 100+, it’s best to steer clear of it, considering that they are spending more on settling claims. While this might be a temporary relief for policyholders, in the long run, the insurer might face some financial crunch that would hinder its sustainability. Since health insurance policies are meant to be long-term financial commitments, insurers with a 100+ ICR are best avoided.

Insight: ICICI Lombard’s ICR numbers have been almost consistently good (in the higher 70s), except for the case of 2021 to 2022. However, considering the pandemic outbreak that prefixed this year and the industry average, such numbers cannot be held accountable for the insurer.

Complaint Volume of ICICI Lombard Health Insurance

One of the most crucial metric to fall back upon when choosing a health insurance provider is a glance at the records of client experiences with the insurer. And the metric that can help you with this analysis is the complaint volume of an insurer.

Complaint Volume records the number of complaints registered against the provider per 10,000 claims. They lower the claim amount and the better the insurer because complaints are almost always about the client’s claim settlement experience and reflect the insurer's overall operational proficiency.

Insight: Regarding complaint volume, ICICI Lombard has had a great sprint for the last 3 years. The numbers are pretty much like the other top-notch health insurance providers in the market and are an encouraging sign for its potential and existing policyholders.

(Please note: We have taken the metrics–data of the last 3 years, drawn an average of them and tallied them against the industry average of the years. This will give you a better insight into the consistency of the overall performance of the insurer)

Top Health Insurance Plans Offered by ICICI Lombard Health Insurance

1. ICICI Lombard iHealth

The iHealth insurance plan from the stable of ICIC Lombard is one of the comprehensive policies available in the market. The policy offers all the standard perks without many restrictions, sub-limits, or exclusions. Here is a look at some of the highlighted features of the plan: no room rent restrictions, no copayment, no disease-wise sub-limits, daycare treatment coverage, free annual health check-ups, AYUSH coverage, and a 2-year waiting period for those with pre-existing medical conditions. Apart from these standard offerings, the plan also offers a few add-ons, including organ donor expenses, critical illness coverage, daily hospital cash, etc.

Overall, it is quite a decent policy from the stable at affordable premiums.

Drawbacks: The policy does have home care coverage, but it misses out on covering the expenses related to domiciliary treatments. Additionally, despite being a comprehensive plan, the policy’s No-Claim Bonus offerings are quite measly—increments of 10% each year during renewal and capped at 50% of the total base sum insured. Moreover, there is a claw-back involved in the bonus.

2. ICICI Lombard iHealth Plus

The ICICI Lombard iHealth Plus is an upgraded version of its iHealth plan with premium features like maternity and OPD coverage. While such additional perks make the plan more comprehensive, feature-rich, and appealing to potential policyholders, they also lead to a higher premium, which might not be an excellent sign for some.

Drawbacks: Apart from the measly No-Claim Bonus (maximum of 50%) and no domiciliary coverage, in the case of the ICICI Lombard iHealth Plus plan, the maternity and OPD features have certain sub-limits and restrictions associated with it -

• The maternity perk is capped at a maximum of ₹50,000 and has a waiting period of 3 years. It is also available only if you and your spouse have opted for a single-family floater health insurance plan together.
• The OPD feature comes with an annual capping of ₹5000.

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Conclusion

ICICI Lombard Health Insurance has only a couple of policies across the board. Hence, although the insurer might be a common name in the health insurance industry, its limited product portfolio, accompanied by its less-than-preferred Claim Settlement Ratio numbers and a tad bit pricey plans, have led to the provider losing its foothold. You are naturally encouraged to look for more comprehensive options at affordable prices from its competitors.