Is ICICI Health Insurance Good? Comparing Plans, Premiums, and Claim Experience

At a Glance

• Introduction: Why evaluate if ICICI health insurance is good?
   
• Overview of ICICI Lombard: Company background and market position.
   
• Active Health Insurance Plans: Features of Elevate, Max Protect, Health AdvantEdge, and more.
   
• Premium Analysis: Costs across plans and variants.
   
• Claim Experience: Settlement ratio, process, and user feedback.
   
• Pros and Cons: Strengths and weaknesses based on reviews.
   
• Comparison with Competitors: How ICICI stacks up against HDFC ERGO and Niva Bupa.
   
• Key Takeaways: Is ICICI health insurance right for you?

With healthcare costs rising in India, choosing a reliable health insurance provider is important. ICICI Lombard, a leading private insurer, offers a range of health plans tailored to individuals, families, and seniors. But is ICICI health insurance good? This blog dives into its active plans, premiums, claim experiences, and ICICI health insurance reviews to help you decide. We’ll compare features, costs, and user feedback to provide a clear picture for 2025.

Overview of ICICI Lombard

ICICI Lombard General Insurance, a joint venture between ICICI Bank and Fairfax Holdings, is one of India’s largest private insurers, serving millions since 2001. It offers health insurance with sum insured options up to ₹3 crore, covering 9,500+ network hospitals. 

With a claim settlement ratio of 85% (Q4, FY 2023-2024) and an incurred claim ratio of 76.89%, it’s a trusted name, though its claim metrics lag behind competitors like HDFC ERGO (98%). Its innovative plans, like Elevate, and value-added services make it popular, but ICICI health insurance reviews highlight mixed experiences.

Active ICICI Health Insurance Plans in 2025

ICICI Lombard offers several active health insurance plans, each catering to specific needs. Below are the key plans, their variants, and standout features.

1. ICICI Lombard Elevate

Overview: Launched in 2024, Elevate is a plan with individual and family floater options, ideal for comprehensive coverage with global benefits.

Variants: Base plan with customizable add-ons.

Key Features:

• Infinite Care: Unlimited coverage for one claim in the policy lifetime.
   
• Power Booster: 100% sum insured increase annually, even with claims.
   
• Worldwide Cover: Up to ₹3 crore cashless hospitalization abroad.
   
• Jumpstart: 30-day waiting period for conditions like diabetes (if declared).
   
• Cashless OPD: Covers consultations and diagnostics with the BeFit add-on.
   
• Reset Benefit: Unlimited sum insured resets for future claims.
   
• Maternity Cover: Pre/post-natal expenses after 24 months (add-on).
   
• Suitability: Best for frequent travelers or those seeking outpatient benefits.

2. ICICI Lombard Max Protect

Overview: A high sum insured plan for extensive coverage, available in Classic and Premium variants.

Variants:

• Classic: Basic high-coverage plan.
   
• Premium: Includes worldwide cover and home care.
  
  Key Features:
   
• Sum Insured: ₹50 lakh to no upper limit.
   
• Loyalty Bonus: 20% sum insured increase per claim-free year (up to 100%).
   
• Unlimited Reset: Restores the sum insured for unrelated claims.
   
• Coverage: Inpatient, AYUSH, bariatric surgery, and teleconsultations.
   
• Premium Variant Extras: Worldwide cover (up to ₹3 crore), home care, and preventive check-ups.
   
• Optional Covers: Pre-existing disease (PED) waiting period reduction, room eligibility.
   
• Suitability: Ideal for high-net-worth individuals needing premium care.

3. ICICI Lombard Health AdvantEdge

Overview: Focuses on outpatient and maternity coverage, perfect for young families.

Variants: Individual and family floater

Key Features:

• OPD Coverage: Consultations, diagnostics, and pharmacy bills.
   
• Maternity Benefits: Covers pre/post-natal expenses (24-month waiting period).
   
• Critical Illness Rider: Lump-sum for specified illnesses.
   
• Cashless Everywhere: Treatment at any hospital in India.
   
• Wellness Benefits: Free health check-ups, dietitian consultations.
   
• No Room Rent Limits: Flexibility in hospital room choice.
   
• Suitability: Great for families planning pregnancies or frequent OPD visits.

4. ICICI Lombard Complete Health Insurance (Health Shield)

Overview: A comprehensive plan with flexible sum insured options (₹3 lakh–₹50 lakh).
Variants: Health Shield, Health Shield 360 (group policy).

Key Features:

• No Co-Payment: Full coverage without out-of-pocket costs.
   
• No Room Rent Caps: Choose any hospital room.
   
• AYUSH Coverage: Includes Ayurveda and homeopathy.
   
• Free Health Check-Ups: Annual check-ups for all insured members.
   
• Add-Ons: Critical illness, hospital cash, organ donor expenses.
   
• No-Claim Bonus: 10–50% sum insured increase for claim-free years.
   
• Suitability: Versatile for individuals and families seeking balanced coverage.

5. ICICI Lombard Activate Booster

Overview: A super top-up plan to enhance existing base policies.
Variants: Single plan with flexible deductibles.

Key Features:

• Unlimited Coverage: Kicks in after base policy exhaustion.
   
• Deductible Options: ₹3 lakh–₹10 lakh.
   
• Coverage: Inpatient, pre/post-hospitalization, and day-care treatments.
   
• Cashless Network: Access to 9,500+ hospitals.
   
• Tax Benefits: Under Section 80D (up to ₹55,000).
   
• Suitability: Best for those with basic plans needing extra protection.

6. ICICI Lombard Arogya Sanjeevani

Overview: An affordable, IRDAI-standardized plan for basic coverage.
Variants: Individual and family floater.

Key Features:

• Sum Insured: ₹1 lakh–₹10 lakh.
   
• Coverage: In-patient, day-care, and AYUSH treatments.
   
• Co-Payment: 5% co-pay on all claims.
   
• Pre/Post-Hospitalization: 30/60 days coverage.
   
• No-Claim Bonus: 5% sum insured increase per claim-free year (up to 50%).
   
• Suitability: Budget-conscious buyers needing essential coverage.

Premium Analysis

Premiums vary by plan, sum insured, age, and add-ons. Below are approximate premiums for a family floater (two adults aged 30, one child, Zone 1) as of February 2025.

• Elevate: ~₹33,000 for ₹10 lakh sum insured. Add-ons like Infinite Care increase costs by 10–20%.
   
• Max Protect:
  • Classic: ~₹40,000 for ₹50 lakh.
  • Premium: ~₹60,000 for ₹1 crore (includes worldwide cover).
     
• Health AdvantEdge: ~₹28,000 for ₹10 lakh with OPD and maternity add-ons.
   
• Complete Health (Health Shield): ~₹25,000–₹45,000 for ₹10 lakh (Health Shield 360 group plan starts at ₹18,000 but risks premium hikes).
   
• Activate Booster: ~₹10,000 for ₹50 lakh with ₹5 lakh deductible.
   
• Arogya Sanjeevani: ~₹12,000 for ₹5 lakh (most affordable due to co-pay).

Observations:

• Elevate and Max Protect are pricier but offer unique benefits like global coverage.
   
• Health Shield 360 (group policy) appears cheap but faces criticism for steep renewal hikes (e.g., doubling from ₹15,000 to ₹30,000).
   
• Arogya Sanjeevani is budget-friendly but limited by co-payment and basic coverage.
   
• Premiums are tax-deductible under Section 80D (up to ₹55,000), adding financial value.

Claim Experience

The claim process and settlement efficiency are critical to assessing is ICICI health insurance good. Here’s an overview based on user feedback and industry data:

• Claim Settlement Ratio: 85% (Q4, FY 2023-2024), lower than HDFC ERGO (98%) and Niva Bupa (91%). This indicates a higher chance of claim rejections.
   
• Process:
   
  • Cashless Claims: Processed within 4 hours at 9,500+ network hospitals. “Cashless Everywhere” allows claims at non-network hospitals (if not blacklisted).
     
  • Reimbursement Claims: Settled within 14–15 days, though some users report delays up to 40–45 days for complex cases.
     
  • Documentation: Requires claim form, ID proof, medical bills, prescriptions, and discharge summary.

Pros and Cons of ICICI Health Insurance

Pros

• Comprehensive Plans: Elevate and Max Protect offer unique features like worldwide cover and unlimited resets.
   
• Cashless Everywhere: Access to non-network hospitals enhances flexibility.
   
• OPD and Maternity: Health AdvantEdge excels for young families.
   
• No Medical Tests: Required only for ages 56+ or high sum insured.
   
• Tax Benefits: Up to ₹55,000 under Section 80D.
   
• Add-Ons: Flexible options like critical illness and hospital cash.

Cons

• Lower Claim Settlement Ratio: 85% lags behind competitors.
   
• Premium Hikes: Group policies like Health Shield 360 face unpredictable increases.
   
• Network Limitations: 9,500+ hospitals are fewer than HDFC ERGO’s 16,000+.
   
• Claim Delays: Some users report slow reimbursement processing.
   
• Customer Service: Mixed reviews on executive knowledge and responsiveness.

Comparison with Competitors

To gauge is ICICI health insurance good, let’s compare it with HDFC ERGO Optima Secure and Niva Bupa Aspire:

Analysis:

• HDFC ERGO: Superior claim settlement (98%) and larger network make it more reliable for frequent claims.
   
• Niva Bupa: Competitive premiums and innovative features like Lock the Clock appeal to budget-conscious buyers.
   
• ICICI Lombard: Stands out for global coverage and OPD benefits but falls short in claim efficiency and network size.

Is ICICI Health Insurance Good for You?

ICICI health insurance reviews show it’s a strong choice for those needing global coverage, OPD benefits, or maternity cover, with plans like Elevate and Health AdvantEdge leading the way. Its 9,500+ hospital network and cashless everywhere feature add convenience. However, the 85% claim settlement ratio and occasional delays in complex claims are concerns. Group policies like Health Shield 360 may face steep premium hikes, so opt for individual plans for stability. Compared to HDFC ERGO and Niva Bupa, ICICI excels in flexibility but lags in claim reliability. 

Evaluate your needs (travel, family size, or budget), and consult platforms like OneAssure for proper guidance!

Key Takeaways Table