Health AdvantEdge in one table
| Insurer | ICICI LOMBARD General Insurance Company Limited |
|---|---|
| Sum insured | ₹3 lakh to ₹3 crore. The room, consumables and worldwide benefits change at ₹5 lakh, ₹15 lakh and ₹25 lakh, so the tier you pick changes the plan you get |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Health AdvantEdge covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from ICICI Lombard's own policy wording.
| Feature | This plan | What good looks like |
|---|---|---|
| What kind of plan this is | Indemnity health insurance. It reimburses hospital bills up to the sum insured. | Read this first |
| Co-payment | No co-payment as standard, and no zone-based co-payment. A voluntary co-payment of 10% or 20% can be chosen for a lower premium | No Co-payment |
| Room Rent Limit | 1% of sum insured a day on covers up to ₹4 lakh, a single private A/C room from ₹5 lakh to ₹20 lakh, and no capping above ₹25 lakh | No room rent capping |
| Disease sub-limit | No disease sub-limits. Road ambulance, home care and animal-bite vaccination carry their own caps | No sub-limit |
| Loyalty Bonus | 20% of the sum insured for each completed and continuous policy year, up to 100%, with no reduction in the event of a claim | 50% each year (Minimum upto 100%) |
| Reset Benefit | Up to 100% of the annual sum insured, unlimited times, for any illness, disease or injury. It does not apply to the first claim of the policy year | 100% restoration once in a year |
| Pre-Hospitalization | 60 days | At least 60 days |
| Post-Hospitalization | 180 days | At least 120 days |
| Consumables (Claim Protector) | Built in on a sum insured of ₹15 lakh and above; an optional cover below that | Consumables covered |
| Day Care Procedures | All day care procedures covered up to the sum insured | Covered without a capped list |
| Domestic Air Ambulance | Covered up to the sum insured, built into the base plan | Included |
| Convalescence benefit | ₹20,000 once each policy year after 10 consecutive days in hospital, built in | Included |
| AYUSH Treatment | Covered up to the sum insured, as an in-patient | Included |
| Entry age | 6 to 65 years. Children aged 91 days to 5 years only on a floater, and a dependent child can stay until 25 | No maximum entry age |
Health AdvantEdge add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
Health AdvantEdge discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise - what you actually get depends on the case.
| Discount | Worth | When it applies |
|---|---|---|
| Zone discount | Up to 10% or 15% | 10% off the Zone A premium in Zone B and 15% in Zone C. Rest-of-NCR districts carry an 8% loading instead. |
| Voluntary co-payment | Up to 10% or 20% | Agree to bear that share of every claim and the premium falls. It applies in addition to any other co-payment on the policy, and not to the optional covers. |
| Voluntary deductible | ₹25,000 to ₹1 lakh | Agree to fund the first ₹25,000, ₹50,000, ₹75,000 or ₹1 lakh of a year's basic-cover claims yourself. Not available above a ₹20 lakh sum insured, and not combinable with a voluntary co-payment. |
| Room rent capping option | Varies | On covers of ₹5 lakh to ₹20 lakh, accepting the single private A/C room entitlement lowers the premium. |
| Pneumococcal vaccination | Up to 2.5% | Where every adult on the policy has had the conjugate pneumococcal vaccine in the year before the policy starts. It continues for as long as you renew. |
From the ICICI Lombard Health AdvantEdge prospectus. Premium also varies by zone, and this plan has no zone-based co-payment.
Health AdvantEdge waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Diabetes, hypertension and cardiac conditions | 90 days, unless declared as pre-existing and accepted at underwriting |
| Specific Illness | 24 months |
| Pre-Existing Disease | 24 months |
The named illnesses that wait 24 months
Payable once the policy has run 24 months without a break; an accident is covered from day one. This list is indicative – the policy wording carries the full set.
Health AdvantEdge exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where Health AdvantEdge falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
Health AdvantEdge questions, answered
Does Health AdvantEdge cap the room I can take?
It depends on the cover you buy. On a sum insured up to ₹4 lakh the room is capped at 1% of the sum insured a day. From ₹5 lakh to ₹20 lakh the entitlement is a single private air-conditioned room, and this is built into the plan at those tiers. Above ₹25 lakh there is no room rent capping at all. If you take a category above your entitlement, you bear a proportionate share of the associated medical expenses, not just the room charge.
I have diabetes or high blood pressure. What should I watch for?
Expenses for hypertension, diabetes and cardiac conditions are excluded for the first 90 days from the policy start date unless they were disclosed as pre-existing at underwriting and accepted. If they are declared and accepted, the ordinary 24-month pre-existing wait applies instead. In both cases the protection comes from declaring the condition, so do not leave it off the proposal form.
Is the Loyalty Bonus a no-claim bonus?
No. The customer information sheet says the 20% is added for each completed and continuous policy year and that there is no reduction in the event of a claim. Claiming does not reset what you have accumulated. What it has is a ceiling at 100% of the sum insured, reached after five unbroken years.
How many times does the cover reset?
Unlimited times, up to 100% of the annual sum insured each time, and it applies to any illness, disease or injury – including one you have already claimed for that year. The one restriction is that the Reset Benefit does not apply to the first claim of the policy year.
Are consumables covered?
On a sum insured of ₹15 lakh and above, yes – Claim Protector is built into the base plan at those tiers and makes the items on IRDAI's non-payable list payable up to the annual sum insured. Below ₹15 lakh you have to buy it as an optional cover. It is one of the clearest reasons to price the ₹15 lakh tier rather than settling at ₹10 lakh.
Can I buy this after 65?
No. Entry closes at 65 on this plan. Renewal has no upper age limit, so an existing policy carries on for life, but a first-time buyer over 65 needs a different product. Elevate, from the same insurer, has no practical maximum entry age.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other ICICI Lombard plans we have read
ICICI Lombard files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.