CUSTOMER INFORMATION SHEET –ICICI Lombard Criti Shield Plus

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

CUSTOMER INFORMATION SHEET –ICICI Lombard Criti Shield Plus

Description is illustrative and not exhaustive

S.NO

Title

Description

Policy Clause No.

1

Product Name

ICICI Lombard Criti Shield Plus

2

What am I covered for?

Section A : Critical Illness

Benefit 1 : Comprehensive Critical Illness

Part III of Wordings

This cover has been broadly divided into five critical illness buckets.

Name of the bucket

No. of illnesses covered

Bucket 1 - Cancer and blood

disorders

4 Major/1 Minor

Bucket 2 -Heart and Blood Vessel

10 Major/11 Minor

Bucket 3 -Major Organs

14 Major /12 Minor

Bucket 4 -Nervous System

24 Major/8 Minor

Bucket 5 -Other Illness

3 Major/5Minor

 In the event of any minor illness the company shall pay 25% of

the Sum Insured subject to a maximum of 12.50lac specified in

the Policy Schedule against that bucket and for any major critical

illness the company shall pay 100 % of the Sum Insured

specified in the Policy Schedule against that bucket. If a major

illness is followed by a minor illness from the same bucket the

company shall only pay the remaining 75% of the sum insured

as specified against that bucket in the Policy Schedule.

 The amount payable will be on the First Diagnosis of any one of

the Critical Illnesses listed in the policy wordings.

 There is a survival period and waiting period applicable to this

cover as specified on the policy schedule.

Illustration 1

Insured can opt for any of the Critical Illness bucket as per plan

available at inception. The SI payable will be independent for each

bucket if more than one bucket is selected.

1. e.g At policy inception if Mr. XYZ opts for all buckets Cancer

and blood disorders, Heart and Blood Vessel, Major Organs,

Nervous System, Other Illness, he can intimate a claim under all

these buckets independently/simultaneously.

 Incase Mr. XYZ is diagnosed with Stroke resulting in permanent

symptoms (Nervous System -Major) in 5

th

month, if the claim is

payable as per policy Terms and conditions we will pay 100% of

SI allocated for Nervous System bucket.

 The Nervous System bucket will be exhausted and no renewal

of this bucket will be allowed to the customer.

 In the 7

th

month Mr. XYZ is diagnosed with Pulmonary Embolism

(Heart and Blood Vessel-Minor),he can claim for 25% of SI from

Heart and Blood Vessel bucket.

 Incase Mr. XYZ consequently suffers from a Myocardial

Infarction (Heart and Blood Vessel -Major) we will pay balance

75% (since we have already paid minor claim of 25% under this

bucket) once this claim has been paid the Heart and Blood

Vessel bucket will be exhausted and no subsequent renewal will

be done for this bucket

Illustration 2:

Mr. PQR a 33yr old has opted for plan which has “Heart and Blood

Vessel” bucket for 1 year Policy Tenure and 3lac SI for a base

premium of 270/- . After the waiting period of the policy is over Mr.

PQR is diagnosed with Other Serious Coronary Artery Diseases in

the 5

th

month. He is eligible to claim for 25% SI which is 75000/-.

Now only 75% of the SI is remaining in “Heart and Blood Vessel

bucket. At the time of renewal, we will be collecting the premium for

100% of SI however our liability will be only towards the balance

Sum Insured which is 75% of SI(in this example 225000).

Under Section A

1.1

Benefit 2: ICU Benefit (Add On)

Part III of Wordings

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

In the event of a hospital admission if an insured is admitted in ICU

on account of any surgery or infection for a minimum of 5 or 7 days

as specified in Policy Schedule, the company shall pay the Sum

Insured as specified in the Policy Schedule against this benefit, in

consideration of payment of additional premium. The surgery or

infection and stay in the ICU must be directly due to the same cause

and confirmed as necessary medical treatment. Add on cover will

not be renewed incase base bucket is exhausted

Under Section A

2.1

Benefit 3: Cancer Restore Benefit (Add On)

Part III of Wordings

In consideration of payment of additional premium this cover pays

the sum insured specified against this Benefit on account of a re

diagnosed or recurred major cancer once a Major cancer (Cancer

of Specified Severity) claim has already been considered and paid

under this policy. A Waiting period of 3 years will be applicable from

the date of diagnosis of the first Major Cancer (Cancer of Specified

Severity) claim admitted under this policy for this Benefit to be

triggered

This Benefit 3 cannot be opted at the time of renewal or during the

policy period.

Illustration 3:

Mr. RST a 40yr old male has opted for plan which has ‘Cancer and

blood disorders’ bucket and add on ‘Cancer Restore Benefit’ for 1

year tenure for 5lac SI with base premium as 970/- & 340/- for

‘Cancer and blood disorders Bucket’ and ‘Cancer Restore Cover’

respectively. After the initial waiting period Mr. RST is diagnosed

with Major Cancer (Cancer of Specified severity),after evaluation of

required documents we pay the major claim with 100% payout of 5

lac sum insured. Since the customer has opted for cancer restore

benefit he will be eligible to claim under this benefit provided the

customer renews this policy subject to having received the premium

for the ‘Cancer and blood disorders’ bucket under benefit 1 and

cancer restore benefit as per the original Sum Insured and age at

the time of renewal. Mr. RST is diagnosed with Cancer relapse after

the 3 years waiting period he will be eligible to claim for ‘Cancer

Restore’ Benefit.

Under Section A

3.1

Section B : Add on Cover

Benefit: 4: Major Surgical Procedures

Part III of Wordings

In the event an Insured Person is Hospitalized on the written advice

of the treating Medical Practitioner due to an Illness contracted or

any Injury sustained during the Period of Cover, and is advised by a

Medical Practitioner qualified as a Surgeon to undergo a Surgical

Procedure specified in Annexure 2 of this Policy and has undergone

the surgery, we will pay the percentage of the Sum Insured as a

lumpsum specified in the Policy Schedule in the manner specified in

the Annexure 2 for each of the listed surgeries. This cover can only

be availed with benefit 1. Add on cover will not be renewed incase

base bucket is exhausted

Illustration 4:

Ms. PQR has opted for plan which has Cancer and blood disorders

bucket and add on Section B: Major Surgical Procedures. After the

initial waiting period she undergoes Pericardectomy. She is eligible

to claim for 50% payout under Major Surgical Procedures(Add on

Cover). Subsequently she has to undergo Amputation of Leg she

will be eligible to claim for 100% payout under Major Surgical

Procedure, however as we have already honoured a 50% claim on

Under Section B

4.1

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

account of Pericardiactomy now she will be eligible to claim for

balance 50% only. Hence we will be honouring 50% payout here

subject to policy terms and conditions

Section C: PERSONAL ACCIDENT(Add on)

Benefit 5: Accidental Death Benefit

Part III of Wordings

We will pay the specified Sum Insured in the manner specified in the

Policy Schedule, if an Insured Person suffers an Injury due to an

Accident that occurs during the Period of Cover and that Injury solely

and directly results in the Insured Person’s death within 365 days

from the date of the Accident. On the acceptance of a claim under

this Benefit and any other applicable Benefit pertaining to the same

event, all Benefit under this Policy shall immediately and

automatically cease in respect of that Insured Person and no

subsequent Renewals of the Policy will be allowed. Add on cover

will not be renewed incase base bucket is exhausted

Under Section C

5.1.1

Benefit 6: Permanent Total Disablement (PTD) Benefit:

Part III of Wordings

We will pay the Sum Insured specified against this Benefit in the

Policy Schedule in the manner specified in the Policy Schedule if an

Insured Person suffers an Injury due to an Accident that occurs

during the Period of Cover and that Injury solely and directly results

in the Permanent Total Disablement of the Insured Person within

365 days from the date of the Accident. Add on cover will not be

renewed incase base bucket is exhausted

Under Section C

5.1.2

Benefit 7 : Permanent Partial Disablement (PPD) Benefit:

Part III of Wordings

We will pay the percentage of the specified Sum Insured in the

manner specified in the policy wordings if an Insured Person suffers

an Injury due to an Accident that occurs during the Period of Cover

and that Injury solely and directly results in the Permanent Partial

Disablement of the Insured Person (which is of the nature specified

in the table below) within 365 days from the date of the Accident.

Add on cover will not be renewed incase base bucket is exhausted

Under Section C

5.1.3

Section D : Value Added Services

1. Tele-consultation:

We will arrange consultations and recommendations for any

listed Critical illnesses under Annexure 1 by a qualified General

Practitioner. For the purpose of this benefit Telephonic/Virtual

consultation shall mean consultation provided by a qualified

General Practitioner through various mode of communication

like audio, chat or mobile app. The services provided under this

Benefit will be made available subject to the terms and

conditions, and in the manner prescribed below:

 The General Practitioner may suggest /recommend

/prescribe over the counter medications based on the

information provided, if required on a case to case basis.

However, the services under this Benefit should not be

construed to constitute medical advice and/or substitute the

Insured Person's visit/ consultation to an independent

Medical Practitioner/Healthcare professional*.

 This service will be available 24 hours a day, and 365 days

in a year.

Part III of Wordings

Under Section D

6.1

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

 The General Practitioner may refer the Insured Person to a

specialist or a general physician, if required**, and the

charges for such specialist or a general physician will have

to be borne by the Insured Person.

 We shall not be liable for any discrepancy in the information

provided under this Benefit.

 Choosing the services under this Benefit is purely upon the

customer’s own discretion and at own risk.

 You will be eligible to avail maximum of 4 tele-consultation

per policy period.

 The insured will be able to use this service only with respect

to the listed Critical Illnesses under Annexure 1.

 This benefit will lapse incase not used during the policy

tenure

*The proposer should seek assistance from a health care

professional when interpreting and applying them to the Insured

person’s individual circumstances. If the Insured person has any

concerns about His/ her health, He/ She may consult His/ her

general practitioner.

**Consultations charges would be applicable.

2. E-opinion (second opinion)

In the event of your diagnosis with any of the critical illness

covered under your policy and during the policy period, we shall

facilitate in arranging an E-Consultation second opinion from a

super specialty medical practitioner within our Network with

respect to that critical illness only, subject to the following

condition. It will be based on the medical records submitted by

the insured person which should include investigation reports

citing the final diagnosis and relevant consultation papers. We

will not be reimbursing/bearing the cost for E-

opinion/consultation (second opinion).

3. Health and Wellness Offers

Health and Wellness Offers on services/products provided

by our network providers/ Health service providers – We shall

only facilitate the Insured Person in availing offers and

discounts on services/products offered by our network providers/

health service providers. Customer can avail Health and

Wellness Offers on our app on various health, fitness and

wellness products and other services available on the app.

4. Health assistance:

We also provide Health Assistance as a part of Our Value added

services, Our Health Assistance Team (HAT) will assist the

Insured Person in understanding his/her health condition better

by providing answers to any queries related to health and health

care providers on Our dedicated helpline. To avail this service,

the Insured Person may call Our helpline on 040-66274205

(please note that this number is subject to change).

The services provided under this shall include:

 Identifying a Physician/ Specialist

 Scheduling an appointment with any Medical Practitioner

empanelled with Us

 Scheduling appointments for a second opinion

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

 Providing suitable options with respect to Hospitals as well

as providing assistance in Cashless facility, wherever

applicable.

 Providing preventive information on ailments

 Providing guidance on post Hospitalization care, such as

Physiotherapy/ Nursing at home.

Please note that services provided under this Benefit are solely

for assistance, and should not be construed to be a substitute for

a visit/ consultation to an independent Medical Practitioner. This

Benefit does not include the charges for any independent

Medical Practitioner/nutritionist consulted on HAT’s

recommendation, and such charges are to be borne by the

Insured Person. We do not accept any liability towards quality of

the services made available by our network providers/ service

providers and are not liable for any defects or deficiencies on

their part

While deciding to obtain such value-added service, You

expressly note and agree that it is entirely for You to decide

whether to obtain these services and also to decide the use (if

any) to which these services is to be put for

3

What are the major

exclusions in the policy

Please refer to the policy wordings for the complete list.

We shall not be liable under this Policy for payment for any claim in

respect of an Insured person, caused by, arising from or in any way

attributable to any of the following:

Section A:

Benefit 1 : Comprehensive Critical Illness

Part III of Wordings

1. Any Critical Illness where the symptoms indicative of such

Critical Illness have first manifested or first occurred prior to the

Risk Inception Date or arisen within the waiting period of

90/120/150 days as specified in the Policy Schedule at

commencement of the Period of Cover.

2. Insured should survive for 0/3/7/14 days as mentioned in the

Policy Schedule from the date of diagnosis and fulfilment of the

critical illness definition(definitions mentioned in Annexure 1)

before the claim benefit will be paid.

3. Any Critical Illness arising on account of or in connection with

any Pre-Existing Disease(s).

4. Any Critical Illness or Surgery/Surgical Procedure arising out of

any external Congenital Anomaly or internal Congenital

Anomaly known at the commencement of the policy.

5. Any physical, medical or mental condition or treatment or service

that is specifically excluded in the Policy Schedule under the

head “Special Conditions”.

6. Any claim made without a medical certificate from the treating

Medical Practitioner evidencing the diagnosis of such Critical

Illness.

7. Any Critical Illness traceable to pregnancy, childbirth, abortion,

or related consequences.

Under Section A

1.2

Section A:

Benefit 2: ICU Benefit (Add on)

Part III of Wordings

1. Any ICU hospitalization where the appearance of first

(signs/symptom/diagnosis) of the infection or advice for surgery

was done during or prior to the initial waiting period of 90/120/150

days (as specified on the Policy Schedule) shall not be

considered payable under this Benefit.

2. We shall not consider any domiciliary/Home ICU care under this

Benefit.

Under Section A

2.3

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

3. We shall not consider ICU stay in an AYUSH hospital as payable

for this Benefit

4. Any Critical Illness or Surgery/Surgical Procedure arising out of

any external Congenital Anomaly or internal Congenital

Anomaly known at the commencement of the policy.

5. Any physical, medical or mental condition or treatment or service

that is specifically excluded in the Policy Schedule under the

head “Special Conditions”.

6. Any claim made without a medical certificate from the treating

Medical Practitioner mandating the stay in ICU.

7. Any claim traceable to pregnancy, childbirth, abortion, or related

consequences.

8. ICU admissions on account of Sterility/Infertility or any plastic

surgery for cosmetic purpose.

9. ICU admission due to any treatment necessitated due to

participation as a professional in hazardous or adventure sports,

including but not limited to, para-jumping, rock climbing,

mountaineering, rafting, motor racing, horse racing or scuba

diving, hand gliding, sky diving, deep-sea diving.

10. ICU admission directly arising from or consequent upon any

Insured Person committing or attempting to commit a breach of

law with criminal intent.

11. ICU admission on account of Alcoholism, drug or substance

abuse or any addictive condition and consequences thereof.

12. ICU admission on account of Intentional self-injury (whether

arising from an attempt to commit suicide or otherwise)

13. Any ICU admission arising from or attributed to war, invasion,

acts of foreign enemies, hostilities (whether war be declared or

not), civil war, commotion, unrest, rebellion, revolution, military

or usurped power or confiscation or nationalisation or requisition

of or damage by or under the order of any government or public

local authority

14. Any ICU admission caused by or contributed to by nuclear

weapons/materials or contributed to by or arising from ionising

radiation or contamination by radioactivity by any nuclear fuel or

from any nuclear waste or from the combustion of nuclear fuel

Section A:

Benefit 3: Cancer Restore Benefit (Add On)

Part III of Wordings

 No claim shall be payable within the waiting period of 3 years

from the date of diagnosis of first Major Cancer.

 In the event of death of the insured during the 3 years waiting

period, the claim shall not be payable.

Under Section A

3.2

Section B:

Benefit: 4: Major Surgical Procedures (Add On)

Part III of Wordings

1. Any covered Surgery/Surgical Procedure arising out of an

Illness diagnosed/contracted prior to Risk Inception Date or

arising within the waiting period of 90/120/150 days as specified

in policy schedule. However, no Waiting Period will be

applicable in case of any Surgical Procedure arising out of/due

to an Accident during the Period of Cover.

2. Any Surgery/Surgical Procedure arising out of an Accident

which occurred prior to Risk Inception Date.

3. Any Pre-Existing Disease(s) or any disability arising out of a Pre-

Existing Disease or any complication arising therefrom.

Under Section B

4.2

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

4. Any Critical Illness or Surgery/Surgical Procedure arising out of

any external Congenital Anomaly or internal Congenital

Anomaly known at the commencement of the policy.

5. Any of the covered Surgery/Surgical Procedure performed

which was otherwise deemed unnecessary, or against standard

health practices.

6. Any Unproven/Experimental treatment.

7. Any Surgery/Surgical Procedure performed solely due to

cosmetic or aesthetic reasons.

8. Any claim made without a medical certificate from the treating

Medical Practitioner evidencing the diagnosis of such Illness or

Injury or the undergoing of the medical / Surgical Procedure.

Section C: Personal Accident (Add On)

Benefit 5: Accidental Death Benefit

Part III of Wordings

Benefit 6: Permanent Total Disablement (PTD) Benefit:

Benefit 7 : Permanent Partial Disablement (PPD) Benefit:

1. War, invasion, act of foreign enemy hostilities or warlike

operations (whether war be declared or not) or civil commotion

or rebellion, revolution, insurrection, mutiny, arrests,

detainments of all kinds and political gatherings, engaging in

aviation other than as a passenger (fare paying or otherwise) in

any licensed standard type of aircraft.

2. Any Injury sustained while performing duty in army, navy, air

force, paramilitary force, police or any other such institution,

except to the extent it is expressly covered under any Benefit

3. Any event which occurs whilst the Insured Person is operating

or learning to operate any aircraft or common carrier, or

performing duties as a member of the crew on any aircraft, or

scheduled airlines or is engaging in aviation, or whilst the

Insured Person is mounting into, or dismounting from or

traveling in any balloon or aircraft other than as a passenger

(fare-paying or otherwise) in any scheduled airline anywhere in

the world.

4. Breach of law/ statutory provisions or while being involved in any

unlawful activity.

5. Any Injury / Illness arising from full-time involvement in

professional sports for livelihood and remuneration, except to

the extent it is expressly covered under any Benefit.

6. Any Injury / Illness arising from intentional self- Injury, suicide or

attempted suicide.

7. Any Injury / Illness arising from a failure to take reasonable

precautions to avoid a claim under the Policy.

8. Any Injury / Illness arising whilst under the influence of alcohol

or intoxicating drugs or substance abuse of any kind.

9. Any Injury / Illness occurring whilst working in underground

mines or explosives magazines, or involving electrical

installation with high tension supply, or as jockeys or circus

personnel or any other high risk occupations.

10. Any Injury that has occurred prior to the commencement of

Policy of Benefit whether or not the same has been treated, or

medical advice, diagnosis, care or treatment has been sought.

11. Any Illness, complication or ailment not arising out of or

connected to Injury.

12. Payment of compensation in respect of death, disablement

(whether of a permanent nature or of a temporary nature), Injury,

Illness or Hospitalization of the Insured Person resulting directly

from, or indirectly caused by, or contributed to or aggravated or

prolonged by, childbirth or pregnancy or in consequence thereof.

13. Payment of compensation in respect of death, disablement

(whether of a permanent nature or of a temporary nature), Injury,

Illness or Hospitalization of Insured Person due to an insect or

mosquito bite.

14. Death, disablement (whether of a permanent nature or of a

temporary nature), Injury, Illness or Hospitalization arising from

or caused by ionizing radiation or contamination by radioactivity

Under Section C

5.2

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

from any nuclear fuel (explosive or hazardous form) or resulting

from or from any other cause or event contributing concurrently

or in any other sequence to the loss, claim or expense from any

nuclear waste from the combustion of nuclear fuel, nuclear,

chemical or biological attack.

GENERAL EXCLUSIONS

Part IV of Wordings

1. Any physical, medical or mental condition or treatment or service

that is specifically excluded in the Policy Schedule under the

head “Special Conditions”.

2. Any breach of the law by the Insured Person with a criminal

intent.

3. War, invasion, act of foreign enemy, hostilities (whether war be

declared or not) civil war, rebellion, revolution, insurrection,

mutiny, military or usurped power, seizure, capture, arrests,

restraints and detainment of citizens of whatever nation, riots or

civil commotion.

4. Any Injury sustained while performing duty in army, navy, air

force, paramilitary force, police or any other such institution,

except to the extent it is expressly covered under any Benefit.

5. Ionising radiation or contamination by radioactivity from any

nuclear fuel or from any nuclear waste or from nuclear weapon

materials or from the combustion of nuclear fuel. For the purpose

of this exclusion, combustion shall include any self-sustaining

process of nuclear fission.

6. Use or misuse of intoxicating drugs and/or alcohol.

7. Participation (aggravation) in any kind of strike, processions,

riots etc.

8. Any act of self-destruction or self-inflicted injury, attempted

suicide or suicide and deliberate participation of the Insured in

an illegal or criminal act with criminal intent.

9. Any Injury / Illness occurring whilst working in underground

mines or explosives magazines, or involving electrical

installation with high tension supply, or as jockeys or circus

personnel

10. Any consequential or indirect losses or expenses related to any

Insured Event.

11. Any tests and treatment relating to infertility and in vitro

fertilization.

12. Any Injury / Illness occurring whilst engaging in any Adventure

Sports, either as an instructor/ trainer, or as a participant.

13. Any natural peril (including but not limited to storm, tempest,

avalanche, earthquake, volcanic eruptions, hurricane, or any

other kind of natural hazard).

4

Waiting Period

Following Waiting Periods shall be applicable under the Policy,

unless specified otherwise in the Policy Certificate.

 Section A:

Benefit 1 – 90/120/150 Days

Benefit 2 – 90/120/150 Days

Benefit 3 – There is a 3 Year waiting period from the date of first

diagnosis of a major cancer

 Section B:

Benefit 4 – 90/120/150 Days

 Section C:

Benefit 5,6,7 – No Waiting Period

Part III of Wordings

Section A

Section B

Section C

& Policy Certificate

5

Payment Basis

 We shall make payment of an admissible claim to the Insured

Person’s nominee/assignee, as the case may be, or in the

absence of an assignee, to the Insured Person or the Insured

Person’s nominee. If there is no assignee or Nominee and the

Insured Person is incapacitated or deceased, we will pay to the

Insured Person’s heir, executor or validly appointed legal

representative.

Part V of Wordings

“Specific Terms and

Conditions”

Clause No.1 “Payments”

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

 Any payment we make in this manner will be a complete and

final discharge of our obligations under this Policy and Our

liability towards the claim.

6

Loss Sharing

NA

7

Renewal Conditions

1. The Policy may be renewed by mutual consent under the then

prevailing (ICICI Lombard Criti Shield Plus) Policy or its nearest

substitute product (in case of product withdrawal) approved by

the IRDAI, and in such event the Renewal premium should be

paid to Us on or before the date of expiry of the Policy and in no

case later than the Grace Period of 30 days from the expiry of

the Policy. We will not be liable to pay for any Claim arising out

of an Insured Event that occurs during the Grace Period.

2. Once the Sum Insured under any of the Benefits opted and

available to the insured is exhausted any future renewal under

that Benefit shall not be allowed.

3. You shall on tendering any premium for the Renewal of this

Policy give notice in writing to Us of any Illness, physical defect

or infirmity with which any of the Insured Person(s) have become

affected since the payment of the expiring Policy start date.

4. Renewals will not be denied except on grounds of

misrepresentation, moral hazard, fraud, non-disclosure of

material facts. We may, revise the Renewal premium payable

under the Policy or the terms of Benefit, provided that all such

changes are approved in accordance with the IRDAI rules and

regulations as applicable from time to time. We will intimate You

of any such changes at least 3 months prior to date of such

revision or modification.

5. We shall not be bound to give any notice to You/ Insured Person

that the premium for the Renewal is due.

6. Policyholder will not be allowed to make any changes in his/her

policy coverage’s, terms and conditions and Sum Insured at the

time of renewal in case a claim has already been settled

7. Policyholder will not be allowed to make any changes in his/her

policy coverage’s, terms and conditions at the time of renewal,

unless decided by Us on exceptional call or case to case basis

8. In the event where the base cover(s) has been exhausted the

insured shall not be allowed to renew the add on cover(s)

9. The above conditions for Renewal are to be read in unison, and

not standalone.

Part V of Wordings

“Specific Terms and

Conditions”

Clause No. 2 “Terms of

Renewal”

8

Renewal Benefits

No Waiting Periods shall be applicable in case of subsequent

Renewals, subject to no Break In Policy.

Part I of Wordings

“General Definitions”

Definition No. 23 “Waiting

Period”

9

Cancellation

1. The policyholder may cancel this policy by giving 15days'written

notice and in such an event, the Company shall refund premium

for the unexpired policy period as detailed below.

2. We shall from the date of receipt of the notice cancel the Policy,

retain the premium for the period this Policy has been in force,

and refund at Our short period scales as per the Refund Grid

provided below, provided that no refund of premium shall be

made if any claim has been made under the Policy by or on

behalf of the Insured Person.

3. Notwithstanding anything contained herein or otherwise, no

refunds of premium shall be made in respect of the Insured

Person where any Claim has been admitted by Us or has been

lodged with Us or any Benefit has been availed by the Insured

Person under the Policy.

4. In case of a cancellation request by You/ Insured Person, the

Policy will be cancelled in its entirety, and any selected Benefits

or Sections under the Policy cannot be cancelled.

5. The Company may cancel the policy at any time on grounds of

misrepresentation non-disclosure of material facts, fraud by the

Part V of Wordings

“General Terms and

Conditions”

Clause No. 6

“Cancellation/

Termination”

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

insured person by giving 15 days' written notice. There would be

no refund of premium on cancellation on grounds of

misrepresentation, non-disclosure of material facts or fraud.

6. For any cancellation initiated by Us, due to any other reason the

company may choose to refund the premium on pro-rata basis.

10

Claims

 The Company shall settle or reject a claim, as the case may be,

within 30 days from the date of receipt of last necessary

document.

 In the case of delay in the payment of a claim, the Company

shall be liable to pay interest to the policyholder from the date of

receipt of last necessary document to the date of payment of

claim at a rate 2% above the bank rate.

 However, where the circumstances of a claim warrant an

investigation in the opinion of the Company, it shall initiate and

complete such investigation at the earliest, in any case not later

than 30 days from the date of receipt of last necessary

document- In such cases, the Company shall settle or reject the

claim within 45 days from the date of receipt of last necessary

document.

 In case of delay beyond stipulated 45 days, the Company shall

be liable to pay interest to the policyholder at a rate 2% above

the bank rate from the date of receipt of last necessary

document to the date of payment of claim.

 On occurrence of an any event that may give rise to a Claim

under this Policy, You shall-

 Notify Us immediately on toll free number 1800 2666 or on our

website www.icicilombard.com or email us at

[email protected]

 Along with the completed and signed Claim form, provide all the

relevant documents, specified within the relevant Section of the

Policy for the Benefit being claimed, must be submitted in full

within 30 days.

 Wherever details pertaining to happening of Claim are conveyed

by you to Us after reasonable period, You shall provide the

reasons of such delay to Us.

 Customer to send documents to Us at :- ICICI Lombard General

Insurance Company Limited ICICI Bank Tower, Plot No. 12,

Financial District, Nanakram Guda, Gachibowli, Hyderabad,

Andhra Pradesh- 500032

 If any claim is not made within 30 days of the Insured Event,

then We will condone such delay on merits only where the delay

has been proved to be for reasons beyond the claimant’s control.

 All claims will be investigated (as required) and settled in

accordance with the applicable regulatory guidelines, including

the IRDAI (Protection of Policyholders Interests) Regulations,

2017.

 The admissible Claim amount will be calculated post

applicability of Deductible, Co-pay, Sub-limits, if any, and as

specifically defined in Policy Schedule.

 The role of the TPA (if any) would be limited to facilitate the flow

of information between Us and the Insured Person.

Part V of Wordings

“Standard General Terms

and Clauses”

Clause No. 3 :Claim

Settlement”

&

“Specific Terms and

Conditions”

Clause No. 3 “Claim

Procedure”

11

Policy Servicing/

Grievances/Complaints

 Call Us at toll free number: 1800 2666 or email us at

[email protected]

If You are not satisfied with the resolution then You may

successively write to Manager- Service Quality, Corporate

Manager- Service Quality, National Manager- Operations &

finally Director-services and Business development at the

following address:

ICICI Lombard General Insurance Company Limited,

ICICI Lombard House,

414, Veer Savarkar Marg,

Near Siddhi Vinayak Temple,

Prabhadevi, Mumbai 400025

Part V of Wordings

“General Terms and

Conditions”

Clause No. 15

“Redressal of

Grievances”

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

 If the issue still remains unresolved, You may, subject to vested

jurisdiction, approach Insurance Ombudsman for the redressal

of the grievance.

 Please refer to the policy wordings for the details of Insurance

Ombudsman.

12

Insured’s Rights

The insured person shall be allowed free look period of fifteen days

(30 days when policy is sourced through distance marketing) from

date of receipt of the policy document to review the terms and

conditions of the policy, and to return the same if not acceptable.

 lf the insured has not made any claim during the Free Look

Period, the insured shall be entitled to

 A refund of the premium paid less any expenses incurred by the

Company on medical examination of the insured person and the

stamp duty charges or

 Where the risk has already commenced and the option of return

of the policy is exercised by the insured person, a deduction

towards the proportionate risk premium for period of cover or

 Where only a part of the insurance coverage has commenced,

such proportionate premium commensurate with the insurance

coverage during such period

 The Policy can be cancelled only if no claims have been made

under the Policy. All Your rights under this Policy will

immediately stand extinguished on the free look cancellation of

the Policy.

 In case the request for cancellation comes 15 days after the

receipt of Policy by the Insured Person, We would refund the

premium paid as per the applicable refund grid provided in the

Cancellation clause of the Policy.

 The Company shall settle or reject a claim, as the case may be,

within 30 days from the date of receipt of last necessary

document.

 In the case of delay in the payment of a claim, the Company

shall be liable to pay interest to the policyholder from the date of

receipt of last necessary document to the date of payment of

claim at a rate 2% above the bank rate.

 However, where the circumstances of a claim warrant an

investigation in the opinion of the Company, it shall initiate and

complete such investigation at the earliest, in any case not later

than 30 days from the date of receipt of last necessary

document- In such cases, the Company shall settle or reject the

claim within 45 days from the date of receipt of last necessary

document.

 In case of delay beyond stipulated 45 days, the Company shall

be liable to pay interest to the policyholder at a rate 2% above

the bank rate from the date of receipt of last necessary

document to the date of payment of claim.

 If any claim is not made within 30 days of the Insured Event,

then We will condone such delay on merits only where the delay

has been proved to be for reasons beyond the claimant’s control.

 All claims will be investigated (as required) and settled in

accordance with the applicable regulatory guidelines, including

the IRDAI (Protection of Policyholders Interests) Regulations,

2017.

 The admissible Claim amount will be calculated post

applicability of Deductible, Co-pay, Sub-limits, if any, and as

specifically defined in Policy Schedule.

Part V of Wordings

“General Terms and

Conditions”

&

Clause No. 14 “Free look

period”

“Standard General Terms

and Clauses”

Clause No. 3 :Claim

Settlement”

&

“Specific Terms and

Conditions”

Clause No. 3 “Claim

Procedure”

13

Insured’s Obligations

 Please disclose all material information (Including Pre-existing

illnesses) before buying the Policy.

 The Policy shall be null and void and no Benefit shall be payable

in the event of untrue or incorrect statements,

misrepresentation, mis-description or on non-disclosure in any

material particular in the proposal form, personal statement,

Part V of Wordings

“General Terms and

Conditions”

“Standard General Terms

and Clauses”

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

declaration and connected documents, or any material

information having been withheld.

 Cooperation from the Insured/ Person claimant is solicited in

providing all or sufficient documents as per the claims procedure

in support of claim.

Clause No. 1 “Disclosure

of Information”

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Benefit Illustration in respect of policies offered individual basis or family floater basis

Age of

the

member

s insured

Coverage opted on

individual basis

covering each

member of the family

separately (at a single

point in time)

Coverage opted on individual basis covering

multiple members of the family under a single

policy (Sum insured is available for each member

of the family)

Coverage opted on family floater basis with

overall Sum insured (Only one sum insured

is available for the entire family)

Premium(

Rs)

Sum

Insured(

Rs)

Premium(

Rs)

Discount

if any

Premium(

After

Discount)(

Rs)

Sum

Insured(Rs

)

Premium

or

consolida

ted

premium

for all

members

of

family(Rs

)

Floate

r

disco

unt if

any

Premium

after

discount(

Rs)

Sum

Insured(

Rs)

3mon-

20yrs

214

5,00,000

214

11

204

5,00,000

NA

21 - 25

yrs

254

5,00,000

254

13

241

5,00,000

NA

26 - 30

yrs

299

5,00,000

299

15

284

5,00,000

NA

31 - 35

yrs

452

5,00,000

452

23

429

5,00,000

NA

36 - 40

yrs

1,112

5,00,000

1,112

56

1,056

5,00,000

NA

41 - 45

yrs

2,105

5,00,000

2,105

105

2,000

5,00,000

NA

46 - 50

yrs

3,572

5,00,000

3,572

179

3,394

5,00,000

NA

51 - 55

yrs

6,174

5,00,000

6,174

309

5,866

5,00,000

NA

56 - 60

yrs

9,566

5,00,000

9,566

478

9,088

5,00,000

NA

61 - 65

yrs

12,552

5,00,000

12,552

628

11,924

5,00,000

NA

>65 yrs*

14,431

5,00,000

14,431

722

13,710

5,00,000

NA

Total Premium for all members of

the family is Rs. 965/-, when each

member is covered separately.

Sum Insured available for each

individual is 500000/-**

Total Premium for all members of the family is Rs.

917/-, when each member is covered separately.

Sum Insured available for each individual is

500000/-**

NA

Note: Premium rates specified in the above illustration are standard premium rates without considering any loading. The premium

rates are exclusive of taxes applicable

Plan considered above is Cancer Shield plan without any Add on cover for 1 year policy tenure has been opted. Waiting period

considered here is 90 days and 0 days Survival period

1. The above Illustration is considering primary applicant to be 35yrs of age, spouse 30yrs of age and child 10yrs of age. If they opt

for individual policies the total base premium would be 965/-. Incase Multi Life option is chosen 917/-.

2.**The above illustration is considering an equal Sum Insured for entire family, however the Sum Insured offered to spouse/child will

be as per the company's UW guidelines.

3. *Premium rates are for renewal only.

4. Please refer rate chart for more details

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

ICICI Lombard Criti Shield Plus

PREAMBLE

ICICI Lombard General Insurance Company Limited (“We / Us”),

having received a Proposal and the premium from the Proposer

named in Part I of the Policy (hereinafter referred to as the “Policy

Schedule”) and the said Proposal and Declaration together with

any statement, report or other document leading to the issue of

this Policy and referred to therein having been accepted and

agreed to by Us and the Proposer as the basis of this contract do,

by this Policy agree, in consideration of and subject to the due

receipt of the subsequent premiums, as set out in the Policy

Schedule, and further, subject to the terms and conditions

contained in this Policy that on proof to Our satisfaction of the

compensation having become payable as set out in the Policy

Schedule to the title of the said person or persons claiming

payment or upon the happening of an event upon which one or

more benefits become payable under this Policy, the Annual Sum

Insured / appropriate benefit amount will be paid by Us.

Part II of Schedule: Policy Wordings

I GENERAL DEFINTIONS

Standard Definitions

1. Accident: An accident means sudden, unforeseen and

involuntary event caused by external, visible and violent

means.

2. Any one illness: Any one illness means continuous period

of illness and includes relapse within 45 days from the date

of last consultation with the Hospital/Nursing Home where

treatment was taken.

3. AYUSH Hospital: An AYUSH Hospital is a healthcare

facility wherein medical/surgical/para-surgical treatment

procedures and interventions are carried out by AYUSH

Medical Practitioner(s) comprising of any of the following:

a. Central or State Government AYUSH Hospital; or

b. Teaching hospital attached to AYUSH College

recognized by the Central Government/Central Council

of Indian Medicine/Central Council for Homeopathy; or

c. AYUSH Hospital, standalone or co-located with in-patient

healthcare facility of any recognized system of medicine,

registered with the local authorities, wherever applicable,

and is under the supervision of a qualified registered

AYUSH Medical Practitioner and must comply with all the

following criterion:

i. Having at least 5 in-patient beds;

ii. Having qualified AYUSH Medical Practitioner in

charge round the clock;

iii. Having dedicated AYUSH therapy sections as

required and/or has equipped operation theatre

where surgical procedures are to be carried out;

iv. Maintaining daily records of the patients and making

them accessible to the insurance company’s

authorized representative.

4. Cashless facility: Cashless facility means a facility

extended by the insurer to the insured where the payments,

of the costs of treatment undergone by the insured in

accordance with the policy terms and conditions, are

directly made to the network provider by the insurer to the

extent pre-authorization is approved.

5. Condition Precedent: Condition Precedent means a policy

term or condition upon which the Insurer's liability under the

policy is conditional upon.

6. Congenital Anomaly: Congenital Anomaly means a

condition which is present since birth, and which is

abnormal with reference to form, structure or position.

a) Internal Congenital Anomaly Congenital anomaly which

is not in the visible and accessible parts of the body.

b) External Congenital Anomaly Congenital anomaly which

is in the visible and accessible parts of the body

7. Day Care Centre: A day care centre means any institution

established for day care treatment of illness and/or injuries

or a medical setup with a hospital and which has been

registered with the local authorities, wherever applicable,

and is under supervision of a registered and qualified

medical practitioner AND must comply with all minimum

criterion as under –

i) has qualified nursing staff under its employment;

ii) has qualified medical practitioner/s in charge;

iii) has fully equipped operation theatre of its own

where surgical procedures are carried out;

iv) maintains daily records of patients and will make

these accessible to the insurance company’s

authorized personnel.

8. Day Care Treatment: Day care treatment means medical

treatment, and/or surgical procedure which is:

i. undertaken under General or Local Anesthesia in

a hospital/day care centre in less than 24 hrs

because of technological advancement, and

ii. which would have otherwise required

hospitalization of more than 24 hours. Treatment

normally taken on an out-patient basis is not

included in the scope of this definition.

9. Disclosure to information norm: The policy shall be void and

all premium paid thereon shall be forfeited to the Company

in the event of misrepresentation, mis-description or non-

disclosure of any material fact.

10. Domiciliary Hospitalization: Domiciliary hospitalization

means medical treatment for an illness/disease/injury

which in the normal course would require care and

treatment at a hospital but is actually taken while confined

at home under any of the following circumstances:

i) the condition of the patient is such that he/she is

not in a condition to be removed to a hospital, or

ii) the patient takes treatment at home on account of

non-availability of room in a hospital.

11. Emergency Care: Emergency care means management for

an illness or injury which results in symptoms which occur

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

suddenly and unexpectedly, and requires immediate care

by a medical practitioner to prevent death or serious long

term impairment of the insured person’s health.

12. Grace Period: Grace period means the specified period of

time immediately following the premium due date during

which a payment can be made to renew or continue a policy

in force without loss of continuity Benefits such as waiting

periods and coverage of pre-existing diseases. coverage is

not available for the period for which no premium is

received.

13. Hospital: A hospital means any institution established for

in-patient care and day care treatment of illness and/or

injuries and which has been registered as a hospital with

the local authorities under Clinical Establishments

(Registration and Regulation) Act 2010 or under

enactments specified under the Schedule of Section 56(1)

of the said act Or complies with all minimum criteria as

under: i) has qualified nursing staff under its employment

round the clock; ii) has at least 10 in-patient beds in towns

having a population of less than 10,00,000 and at least 15

in-patient beds in all other places; iii) has qualified medical

practitioner(s) in charge round the clock; iv) has a fully

equipped operation theatre of its own where surgical

procedures are carried out; v) maintains daily records of

patients and makes these accessible to the insurance

company’s authorized personnel;

14. Hospitalization: Hospitalization means admission in a

Hospital for a minimum period of 24 consecutive ‘In-patient

Care’ hours except for specified procedures/ treatments,

where such admission could be for a period of less than 24

consecutive hours.

15. Illness: Illness means a sickness or a disease or

pathological condition leading to the impairment of normal

physiological function and requires medical treatment.

(a) Acute condition - Acute condition is a disease, illness or

injury that is likely to respond quickly to treatment which

aims to return the person to his or her state of health

immediately before suffering the disease/ illness/ injury

which leads to full recovery

(b) Chronic condition - A chronic condition is defined as a

disease, illness, or injury that has one or more of the

following characteristics:

1. it needs ongoing or long-term monitoring through

consultations, examinations, check- ups, and /or tests

2. it needs ongoing or long-term control or relief of

symptoms

3. it requires rehabilitation for the patient or for the patient

to be specially trained to cope with it

4. it continues indefinitely

5. it recurs or is likely to recur

16. Injury: Injury means accidental physical bodily harm

excluding illness or disease solely and directly caused by

external, violent, visible and evident means which is verified

and certified by a Medical Practitioner.

17. Inpatient Care: Inpatient care means treatment for which

the insured person has to stay in a hospital for more than

24 hours for a covered event.

18. Intensive Care Unit: Intensive care unit means an identified

section, ward or wing of a hospital which is under the

constant supervision of a dedicated medical practitioner(s),

and which is specially equipped for the continuous

monitoring and treatment of patients who are in a critical

condition, or require life support facilities and where the

level of care and supervision is considerably more

sophisticated and intensive than in the ordinary and other

wards.

19. ICU Charges: ICU (Intensive Care Unit) Charges means

the amount charged by a Hospital towards ICU expenses

which shall include the expenses for ICU bed, general

medical support services provided to any ICU patient

including monitoring devices, critical care nursing and

intensivist charges.

20. Medical Advice: Medical Advice means any consultation or

advice from a Medical Practitioner including the issuance

of any prescription or follow-up prescription.

21. Medical Expenses: Medical Expenses means those

expenses that an Insured Person has necessarily and

actually incurred for medical treatment on account of Illness

or Accident on the advice of a Medical Practitioner, as long

as these are no more than would have been payable if the

Insured Person had not been insured and no more than

other hospitals or doctors in the same locality would have

charged for the same medical treatment.

22. Medical Practitioner: Medical Practitioner means a person

who holds a valid registration from the Medical Council of

any State or Medical Council of India or Council for Indian

Medicine or for Homeopathy set up by the Government of

India or a State Government and is thereby entitled to

practice medicine within its jurisdiction; and is acting within

its scope and jurisdiction of license. The registered

practitioner should not be the insured or close member of

the family.

23. Medically Necessary Treatment: Medically necessary

treatment means any treatment, tests, medication, or stay

in hospital or part of a stay in hospital which:

i) is required for the medical management of the

illness or injury suffered by the insured;

ii) must not exceed the level of care necessary to

provide safe, adequate and appropriate medical

care in scope, duration, or intensity;

iii) must have been prescribed by a medical

practitioner;

iv) must conform to the professional standards widely

accepted in international medical practice or by

the medical community in India.

24. Migration: Migration means, the right accorded to individual

health insurance policyholders (including all member under

family cover and members of group health insurance

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

policy), to transfer the credit gained for pre-existing

conditions and time bound exclusions, with same insurer.

25. Network Provider: Network Provider means hospitals or

health care providers enlisted by an insurer, TPA or jointly

by an Insurer and TPA to provide medical services to an

insured by a cashless facility.

26. New Born Baby: Newborn baby means baby born during

the Policy Period and is aged upto90 days.

27. Non- Network Provider: Non-Network means any hospital,

day care centre or other provider that is not part of the

network.

28. Notification of Claim: Notification of claim means the

process of intimating a claim to the insurer or TPA through

any of the recognized modes of communication.

29. OPD treatment: OPD treatment means the one in which the

Insured visits a clinic / hospital or associated facility like a

consultation room for diagnosis and treatment based on the

advice of a Medical Practitioner. The Insured is not

admitted as a day care or in-patient.

30. Portability: Portability means, the right accorded to

individual health insurance policyholders (including all

member under family cover), to transfer the credit gained

for pre-existing conditions and time bound exclusions, from

one insurer to another insurer.

31. Post-hospitalization Medical Expenses means medical

expenses incurred during predefined number of days

immediately after the insured person is discharged from the

hospital provided that: i. Such Medical Expenses are for the

same condition for which the insured person’s

hospitalization was required, and ii. The inpatient

hospitalization claim for such hospitalization is admissible

by the insurance company.

32. Pre-Existing Disease: Pre-existing Disease means any

condition, ailment, injury or disease:

a) That is/are diagnosed by a physician within 48 months

prior to the effective date of the policy issued by the insurer

or

b) For which medical advice or treatment was

recommended by, or received from, a physician within 48

months prior to the effective date of the policy or its

reinstatement.

33. Pre-hospitalization Medical Expenses Pre-hospitalization

Medical Expenses means medical expenses incurred

during pre-defined number of days preceding the

hospitalization of the Insured Person, provided that:

i. Such Medical Expenses are incurred for the

same condition for which the Insured Person’s

Hospitalization was required, and

ii. The In-patient Hospitalization claim for such

Hospitalization is admissible by the Insurance

Company.

34. Qualified Nurse: Qualified nurse means a person who holds

a valid registration from the Nursing Council of India or the

Nursing Council of any state in India.

35. Reasonable and Customary Charges: Reasonable and

Customary charges means the charges for services or

supplies, which are the standard charges for the specific

provider and consistent with the prevailing charges in the

geographical area for identical or similar services, taking

into account the nature of the illness / injury involved.

36. Renewal: Renewal means the terms on which the contract

of insurance can be renewed on mutual consent with a

provision of grace period for treating the renewal

continuous for the purpose of gaining credit for pre-existing

diseases, time-bound exclusions and for all waiting periods.

37. Room Rent: Room Rent means the amount charged by a

Hospital towards Room and Boarding expenses and shall

include the associated medical expenses.

38. Surgery or Surgical Procedure: Surgery or Surgical

Procedure means manual and / or operative procedure (s)

required for treatment of an illness or injury, correction of

deformities and defects, diagnosis and cure of diseases,

relief from suffering and prolongation of life, performed in a

hospital or day care centre by a medical practitioner.

39. Unproven/Experimental treatment: Unproven/Experimental

treatment means the treatment including drug experimental

therapy which is not based on established medical practice

in India, is treatment experimental or unproven

Specific Definitions:

1. Admission means admission of the Insured Person in a

Hospital as an in-patient for the purpose of medical

treatment of an Injury and/or Illness, for a minimum duration

of 24 hours.

2. Adventure Sport means sports/activities including but not

limited to Sky Diving, Bungee Jumping, Bungee swoop,

Bungee slingshot, Dune sliding, Hot air ballooning, Bridge

Swinging, Zip Lining, Zip Trekking, Rock Climbing, Bicycle

Polo, Bamboo rafting, Rock Scrambling, Rappelling, Via

Ferrata, Fell Running, Fell Walking, Gorge Walking, Indoor

Rock Climbing, Mountain Biking, Mountaineering, Body

Boarding, Sailing, Ski boarding, Scuba Diving, Snorkeling,

Shark Diving, Sky Diving, Swimming with Dolphins, Banana

boating/donuts/inflatable’s behind power boat Diving with

Whales, Wakeboarding, Surfing, Auto (car) racing, Motor

rallying, Motorcycle racing, Air racing, Kart racing, Boat

racing, Hovercraft racing, Lawn mower racing, Snowmobile

racing, Zorbing, and Truck racing.

3. Age means the completed years of the Insured Person on

his/her last birthday as per the English calendar as on the

Risk Inception Date.

4. Break In Policy means the period that occurs at the end of

the existing policy term, when the premium due for

Renewal on a given Policy is not paid on or before the

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

premium Renewal date, or within 30 days thereof. In case

of Premium collected on Installment basis the grace period

is 7 days.

5. Common Carrier shall mean to include any commercial

public airline, railway, bus, or water borne vessel carrying

fare paying passengers and licensed by the appropriate

authority for transportation of passengers

6. Family means, the Family that consists of the proposer and

any one or more of the family members as mentioned

below:

i. Legally wedded spouse.

ii. Dependent Children (i.e. natural or legally adopted)

between 3months of age to 25 years. If the child above 18

years of age is financially independent, he or she shall be

ineligible for coverage.

7. Financial Institution shall have the same meaning assigned

to the term under Section 45-I of the Reserve Bank of India

Act, 1934, and shall include a Non-Banking Financial

Company as defined under Section 45-I of the Reserve

Bank of India Act, 1934.

8. First Diagnosis shall mean the point in time at which the

requirements of any Critical Illness under this Policy were

first satisfied with respect to the Insured Person, including

the availability of the test reports and medical reports

evidencing such diagnosis and confirmed by a medical

practitioner

9. Infection: means an invasion of human body by pathogenic

microorganisms including bacteria, viruses, parasites and

fungi.

10. Income means and includes the amount that the Insured

Person earns each month from his/her Primary Occupation.

For Salaried Individuals, this would mean salary including

regular bonuses, regular commissions, superannuation

contributions or any other allowances, any Benefits

explicitly mentioned in CTC (Cost to Company) or any

compensation structure provided to the Insured Person by

his/her employer for the financial year, or as declared in the

previous ITR (Income Tax Return) filed by the Insured

Person. For self-employed individuals having an ownership

in a business, or operating as a sole trader or under a

partnership, company or trust, Income will be considered

as the gross annual income (before tax) filed before the

relevant tax authorities in the previous assessment year.

11. Insured Event means any event or occurrence specifically

mentioned as covered under this Policy for which

applicable premium has been received by Us.

12. Insured Person means the individual(s) whose name(s) are

specifically appearing under the heading “Insured name” in

the Policy Schedule to the Policy, and for whom the Insured

Events are covered in lieu of the applicable premium

received by Us under the Policy.

13. Loan means the sum of money lent at interest or otherwise

to the Insured Person by any Financial Institution, as

identified by a Loan Account Number. .

14. Nominee means the person(s) nominated by the Insured

Person to receive the applicable Benefits under this Policy

payable in the event of death of the Insured Person caused

by any Critical Illness or Surgical Procedure defined and

specified under the Policy. For the purpose of avoidance of

doubt it is clarified that if the Nominee is a minor, the legal

guardian appointed by the Insured Person will take care of

any relevant proceedings.

15. Permanent Total Disablement means any of the following:

i. Total and irrevocable loss of sight in both eyes, and

ii. Total and irrevocable physical separation of two entire

hands or two entire feet, or

iii. Total and irrevocable loss of one entire hand and one

entire foot, or

iv. Total and irrevocable loss of sight of one eye and

physical separation of one entire hand or physical

separation of one entire foot, or Total and irrevocable loss

of use of two hands or two feet, or

v. Total and irrevocable loss of use of one hand and one

foot, or

vi. Total and irrevocable of loss of sight of one eye and

loss of use of one hand or one foot. For the purpose of this

definition:

i. Physical separation of a hand or foot means separation

of the hand at or above the wrist, and of the foot at or

above the ankle.

ii. Loss of use or Loss of sight means total paralysis of

one or more limb, or loss of vision respectively, which is

certified in writing by a Medical Practitioner to be

permanent, complete and irreversible and substantiated

by physical examination and investigation to be

permanent, complete and irreversible.

16. Policy Period means the period commencing from the

Policy Start Date and ending at the Policy End Date as

specifically appearing in the Policy Schedule, inclusive of

both dates. It is the duration in which the policy is valid and

the Insured Person is liable to get a claim subject to any

applicable waiting Periods and the terms and conditions

under this Policy.

17. Public Authority means any governmental or quasi-

governmental organization, statutory body, or duly

authorized organization which exercises autonomous

authority in a regulatory or supervisory capacity.

18. Risk Inception Date means the date of commencement of

the Period of cover, as specified in the Policy Schedule for

the Insured Person.

19. Salaried Individuals means those Insured Persons who

work as an employee or a worker, with government or

private organization, whether confirmed or on probation as

on the Risk Inception Date, and earn a fixed amount of

compensation at a fixed frequency as salary.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

20. Sum Insured means the amount specified in the Policy

Schedule against a Benefit or set of Benefits that

represents Our maximum, total and cumulative liability for

any and all claims made in respect of that Insured Person

during the Period of cover under that Benefit/set of

Benefits.

21. Surgeon means a specialist Medical Practitioner who is

fully qualified as per applicable law to practice

Surgery/carry out Surgical Procedures in India.

22. Survival period- refers to the period from the diagnosis and

fulfilment of the critical illness definition which the life

assured or Insured Person must survive before the claim

benefit will be paid

23. Waiting Period means a time-bound exclusion period

related to condition(s) specified in the Policy Schedule

which shall be served before a claim related to such

condition becomes admissible. No Waiting Periods shall be

applicable in case of subsequent Renewals, subject to no

Break In Policy.

24. We/Our/Ours/Us/ Company means the ICICI Lombard

General Insurance Company Limited.

25. You/Your/Yours/Yourself means the person or the entity

named as the policyholder in the Policy Schedule and who

is responsible for payment of premium.

II. SCOPE OF COVER:

This Policy is a contract of insurance between the Policyholder

and Us which is subject to the receipt of premium against each

Benefit in full (or first instalment, where the Premium payment in

Instalment Clause is opted) in respect of the Insured Persons, and

the terms, conditions and exclusions of this Policy.

The Policy Schedule will specify which of the following Benefits

and Endorsements are applicable and in force for the Insured

Person. Claims made in respect of an Insured Person for any

Benefit applicable to the Insured Person shall be subject to the

occurrence of the Insured Event during the Period of cover,

availability of the Sum Insured specified against the Benefit

claimed, applicable sublimits for such Benefit as may be specified

in the Policy Schedule and the terms, conditions and exclusions

of this Policy.

All claims shall be made in accordance with the procedures set

out in this Policy. The coverage under each Benefit terminates in

relation to an Insured Person(s) in the event of one or more

claim(s) in respect of that Insured Person becoming admissible

and accepted by Us to the extent of the Sum Insured specified

against each Benefit in the Policy Schedule. Admitted claims will

be payable to the Insured Person or the Nominee (as applicable).

III Benefits under Product

Section A: Critical Illness

1.1 Base Cover: Benefit 1: Comprehensive Critical Illness

This Benefit has been bucketed under 5 Critical Illness buckets.

Each Bucket has further been divided into major and minor Critical

Illness. If an Insured Person(s) is First Diagnosed with any of the

Critical Illnesses from the bucket, based on the categorization We

will pay the Sum Insured specified in the Policy Schedule against

that bucket in the manner as described below.

In the event of any minor illness listed in Annexure 1 the company

shall pay 25% of the Sum Insured subject to a maximum of 12.50lac,

as specified in the Policy Schedule against that bucket. In the event

of any major critical illness listed in Annexure 1 the company shall

pay 100 % of the Sum Insured specified in the Policy Schedule

against that bucket. In any scenario if a major illness is followed by

a minor illness from the same bucket the company shall only pay

the remaining 75% of the sum insured as specified against that

bucket in the Policy Schedule .

The company shall only allow an insured to make one major critical

illness claim and one minor Critical Illness claim from each of the

buckets opted upto the exhaustion of the sum insured against that

bucket.

Once the sum Insured has been exhausted against a bucket, it will

cease and the policyholder shall not be allowed to renew that bucket

in any subsequent renewals and only the remaining buckets if not

exhausted up to their respective Sum Insured can be renewed in

subsequent renewals

The policy holder cannot opt for any new bucket at the time of

renewal

The Insured can claim independently from each of the critical illness

bucket opted and specified in the Policy Schedule upto the Sum

Insured specified against each of these buckets in the Policy

Schedule subject to due receipt of premium(or premium instalment,

incase premium payment in instalment clause is opted) as the case

may be.

The list of minor and major conditions under each bucket and their

definitions have been stated in Annexure 1 of these wordings

Note:

The maximum payout against any minor Critical Illness under

any Critical illness bucket is restricted to 25% of the base cover

Sum Insured upto a maximum of 12.5lacs however for “Cardiac

Arrhythmia with surgical intervention” and “Angioplasty ” the

Sum Insured is further restricted to a maximum of 5lac

Illustration 1

Insured can opt for any of the Critical Illness bucket as per plans

available at inception. The SI payable will be independent for each

bucket if more than one bucket is selected.

e.g At policy inception if Mr. XYZ opts for all buckets-Cancer

and blood disorders, Heart and Blood Vessel, Major Organs,

Nervous System, Other Illness he can intimate a claim under

all these buckets independently/simultaneously.

 Incase Mr. XYZ is diagnosed with Stroke resulting in

permanent symptoms (Nervous System -Major) in 5

th

month, if the claim is payable as per policy Terms and

Conditions we will pay 100% of SI allocated for Nervous

System bucket.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

 The Nervous System bucket will be exhausted and no

renewal of this bucket will be allowed to the customer.

 In the 7th month Mr. XYZ is diagnosed with Pulmonary

embolism (Heart and Blood Vessel -Minor)he can claim

for 25% of SI from Heart and Blood Vessel bucket.

 Incase Mr. XYZ consequently suffers from a

Myocardial Infarction (Heart and Blood Vessel -Major)

we will pay balance 75% (since we have already paid

minor claim of 25% under this bucket) once this claim

has been paid the Heart and Blood Vessel bucket will

be exhausted and no subsequent renewal will be done

for this bucket.

Illustration 2:

Mr. PQR a 33yr old has opted for plan which has Heart and Blood

Vessel bucket for 1 year Policy Tenure and 3lac SI for a base

premium of 270/- . After the waiting period of the policy is over Mr.

PQR is diagnosed with Other Serious Coronary Artery Diseases

in the 5

th

month.

He is eligible to claim for 25% SI which is 75000/-. Now only 75%

of the SI is remaining in Heart and Blood Vessel bucket.

At the time of renewal, we will be collecting the premium as per

the original 100% of SI however our liability will be only towards

the balance Sum Insured which is 75% of SI(in this example

225000).

1.2 Exclusions applicable to Section A: Benefit 1:

We shall not be liable to make any payment for any claim under

Benefit 1 of Section A of this Policy in respect of an Insured

Person, directly or indirectly for, caused by, arising from or in any

way attributable to any of the following:

a) Any Critical Illness where the symptoms indicative of

such Critical Illness have first manifested or first

occurred prior to the Risk Inception Date or arisen within

the waiting period of 90/120/150 days as specified in the

Policy Schedule at commencement of the Period of

Cover.

b) Insured should survive for 0/3/ 7/14 days as mentioned

in the Policy Schedule from the date of diagnosis and

fulfilment of the critical illness definition (definitions

mentioned in Annexure 1) before the claim benefit will

be paid.

c) Any Critical Illness arising on account of or in connection

with any Pre-Existing Disease(s).

d) Any Critical Illness or Surgery/Surgical Procedure

arising out of any external Congenital Anomaly or

internal Congenital Anomaly known at the

commencement of the policy.

e) Any physical, medical or mental condition or treatment

or service that is specifically excluded in the Policy

Schedule under the head “Special Conditions”.

f) Any claim made without a medical certificate from the

treating Medical Practitioner evidencing the diagnosis of

such Critical Illness.

g) Any Critical Illness traceable to pregnancy, childbirth,

abortion, or related consequences.

1.3 Claim Documents for Section A: Benefit 1:

On the occurrence of an Insured Event which may give rise

to a claim under this Benefit, We shall be provided with the

necessary and mandatory information specified in A:

Common documents required for all claims under this Benefit

for all claims, within 30 days of occurrence of the Insured

Event:

A: Common documents required for all claims under

this Benefit:

1.

Claim Form duly filled and signed by Insured

Person/Nominee/claimant

2.

EMS Paper

3.

Discharge Card/Summary papers

4.

Indoor Case papers

5.

Hospital Bills

6.

All Investigation Reports – blood, pathology, radiology, etc.

7.

Certificate by treating Medical Practitioner confirming

diagnosis

8.

Current and past consultation papers

9.

Certificate of Medical Cause of Death issued by last

attending Medical Practitioner (wherever applicable)

10.

Certificate from last attending Medical Practitioner /medical

authority for underlying medical condition/s leading to death

of the Insured Person

11.

Post Mortem Report, FSL Report, Viscera and Chemical

Analysis Report, Histopathoilogy Report (wherever

applicable)

12.

Any other specific investigation / document to support the

diagnosis of such Critical Illness, as may be reasonably

required by Us in addition to the documents specified under

this Section.

13.

Income Proof(ITR/Salary Slip,etc)

The Company shall seek for specific investigation reports

depending on the nature of ailment. The list of the specific

requirements will be shared with the insured/ nominee at the time

of claim

2.1 Add on cover: Benefit 2: ICU Benefit

In the event of a hospital admission if an insured is admitted in ICU

on account of any surgery or infection for a minimum of 5 or 7 days

as specified in Policy Schedule the company shall pay the Sum

Insured as specified against this Benefit on the Policy Schedule in

consideration of payment of additional premium

The surgery or infection and the stay in the ICU must be directly

due to the same cause and confirmed as necessary medical

treatment.

2.2 Terms and conditions applicable to Benefit 2

 This Benefit is paid only once during the entire Policy

Period.

 Once a claim has been paid under this Benefit the Benefit

shall stand terminated and no subsequent renewals of

this Benefit will be allowed.

 This Benefit shall be paid as a lump sum to the extent of

Sum Insured specified in the Policy Schedule against this

Benefit.

 This Benefit shall not reimburse any expenses incurred

during the stay of the insured in the hospital(ICU) or any

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

expenses incurred prior or post hospitalization/ICU stay.

We shall be liable to only pay the Sum Insured

irrespective of the expenses incurred during the stay in

the hospital.

 The 5 or 7 day stay in ICU(as specified in policy schedule)

should form part of single hospitalization stay relating to

insured peril.

 For ICU benefit cover: No Waiting Period will be

applicable in case of ICU stay on account of any

Surgery/infection arising out of/due to an Accident during

the Period of Cover.

 The surgery or infection and the stay in the ICU must be

directly due to the same cause and confirmed as

necessary medical treatment.

 We will not consider a stay in ICU as necessary medical

treatment if the insured can be safely and adequately

treated in any other facility.

 This Benefit shall be payable subject to providing proof of

Surgery or Infection to the satisfaction of the Company.

 All Procedures claimed should be confirmed as Medically

Necessary, by a qualified Physician or Surgeon, to the

satisfaction of the Company.

 The Stay in an ICU shall only be considered subject to

the definition of ICU being met as defined above in the

Policy Wordings and subject to the satisfaction of the

Company.

 In the event of death in ICU the claim shall be considered

payable subject to the insured having survived for

minimum 3 days of continuous stay in ICU

 In the event where the base cover(s) has been exhausted

the insured shall not be allowed to renew the add on

cover(s)

2.3 Exclusions applicable to Section A: Benefit 2:

a) Any ICU hospitalization where the appearance of first

(signs/symptom/diagnosis) of the infection or advice for

surgery was done during or prior to the initial waiting

period of 90/120/150 days (as specified on the Policy

Schedule) shall not be considered payable under this

Benefit.

b) We shall not consider any domiciliary/Home ICU care

under this Benefit.

c) We shall not consider ICU stay in an AYUSH hospital as

payable for this Benefit

d) Any Critical Illness or Surgery/Surgical Procedure

arising out of any external Congenital Anomaly or

internal Congenital Anomaly known at the

commencement of the policy.

e) Any physical, medical or mental condition or treatment

or service that is specifically excluded in the Policy

Schedule under the head “Special Conditions”.

f) Any claim made without a medical certificate from the

treating Medical Practitioner mandating the stay in ICU.

g) Any claim traceable to pregnancy, childbirth, abortion, or

related consequences.

h) ICU admissions on account of Sterility/Infertility or any

plastic surgery for cosmetic purpose.

i) ICU admission due to any treatment necessitated due to

participation as a professional in hazardous or adventure

sports, including but not limited to, para-jumping, rock

climbing, mountaineering, rafting, motor racing, horse

racing or scuba diving, hand gliding, sky diving, deep-

sea diving.

j) ICU admission directly arising from or consequent upon

any Insured Person committing or attempting to commit

a breach of law with criminal intent.

k) ICU admission on account of Alcoholism, drug or

substance abuse or any addictive condition and

consequences thereof.

l) ICU admission on account of Intentional self-injury

(whether arising from an attempt to commit suicide or

otherwise)

m) Any ICU admission arising from or attributed to war,

invasion, acts of foreign enemies, hostilities (whether

war be declared or not), civil war, commotion, unrest,

rebellion, revolution, military or usurped power or

confiscation or nationalisation or requisition of or

damage by or under the order of any government or

public local authority

n) Any ICU admission caused by or contributed to by

nuclear weapons/materials or contributed to by or arising

from ionising radiation or contamination by radioactivity

by any nuclear fuel or from any nuclear waste or from

the combustion of nuclear fuel

2.4 Claim Documents for Section A: Benefit 2:

Documents required for claims under this Benefit:

1.

Claim Form duly filled and signed by Insured

Person/Nominee/claimant

2.

EMS Paper

3.

Discharge Card/Summary papers

4.

Indoor Case papers

5.

Hospital Bills

6.

All Investigation Reports – blood, pathology, radiology, etc.

7.

Certificate by treating Medical Practitioner confirming

diagnosis

8.

Current and past consultation papers

9.

Certificate of Medical Cause of Death issued by last

attending Medical Practitioner (wherever applicable)

10.

Certificate from last attending Medical Practitioner /medical

authority for underlying medical condition/s leading to death

of the Insured Person

11.

Post Mortem Report, FSL Report, Viscera and Chemical

Analysis Report, Histopathoilogy Report (wherever

applicable)

12.

Any other specific investigation / document to support the

diagnosis of such Critical Illness, as may be reasonably

required by Us in addition to the documents specified under

this Section.

13.

ICU admission papers

14.

Proof for advice on ICU admission by Medical practitioner

15.

Income Proof(ITR/Salary Slip,etc)

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

The Company shall seek for specific investigation reports

depending on the nature of ailment. The list of the specific

requirements will be shared with the insured/ nominee at the time

of claim

3.1 Add on cover: Benefit 3: Cancer Restore Benefit

In consideration of payment of additional premium this cover pays

the sum insured specified against this Benefit on account of a re

diagnosed or recurred major cancer once a Major cancer (Cancer

of Specified Severity) claim has already been considered and paid

under this policy. A Waiting period of 3 years will be applicable

from the date of diagnosis of the first Major Cancer (Cancer of

Specified Severity) claim admitted under this policy.

The insured can claim under this Benefit only if he has opted for

this Benefit 3 along with the Cancer Bucket under Benefit 1 at the

time of first purchase of this policy subject to due receipt of

premium by the company.

This Benefit 3 cannot be opted at the time of renewal or during

the policy period

“Re-diagnosed Major Cancer” (Cancer of Specified Severity)

means cancer for which any of the following conditions are met

after the stipulated waiting period of 3 years from the date of

diagnosis of the last Major Cancer(Cancer of Specified Severity)

claim admitted under this policy.

 The Major Cancer(Cancer of Specified Severity)

persists since first diagnosis;

 The Major Cancer(Cancer of Specified Severity)

relapses, that is, though recovered temporarily (in

remission), the same Major Cancer(Cancer of Specified

Severity) recurs at the same organ as the preceding

Major Cancer(Cancer of Specified Severity);

 Metastasis of the preceding Major Cancer (Cancer of

Specified Severity) to other parts of the body; or

 The new Major Cancer (Cancer of Specified Severity) is

unrelated to the preceding Major Cancer(Cancer of

Specified Severity).

Re-diagnosed Major Cancer(Cancer of Specified Severity) must

be confirmed by an oncologist on the basis of histopathological

diagnosis. Clinical re-diagnosis of Cancer can only be adopted if

histopathological diagnosis is medically not possible; in which

case, the Insured must have medical documentary proof or record

from a certificated oncologist of ongoing cancer therapy (including

but not limited to radiotherapy or chemotherapy or surgery).

Ongoing preventive cancer therapy (including but not limited to

Tamoxifen or Raloxifene) will not be accepted as a basis of clinical

re-diagnosis.

The date of diagnosis of Re-diagnosed Major Cancer (Cancer of

Specified Severity) refers to the date of the histopathological

report.

If histopathological diagnosis is medically not possible; the date

of diagnosis of Re-diagnosed Major Cancer(Cancer of Specified

Severity) refers to the date of documentary proof or record from

a certificated oncologist of ongoing cancer therapy (including but

not limited to radiotherapy or chemotherapy or surgery).

The rediagnosed cancer must meet the definition of “Cancer of

specified severity” as stated in the policy wordings

This feature is only applicable only once during the entire policy

period Once the Cancer restore Benefit feature has been utilised

and exhausted, this Benefit terminates and no subsequent

renewal of Cancer Bucket under Benefit 1 and of this Benefit 3

will be allowed

3.2 Exclusions applicable to Section A: Benefit 3:

a) No claim shall be payable within the waiting period of 3

years from the date of diagnosis of first Major

Cancer(Cancer of Specified Severity).

b) In the event of death of the insured during the 3 years

waiting period the claim shall not be payable.

3.3 Claim Documents for Section A: Benefit 3:

Claim Form duly filled and signed by Insured

Person/Nominee/claimant

EMS Paper

Discharge Card/Summary papers

Indoor Case papers

Hospital Bills

All Investigation Reports – blood, pathology, radiology, etc.

Certificate by treating Medical Practitioner confirming diagnosis

Current and past consultation papers

Certificate of Medical Cause of Death issued by last attending

Medical Practitioner (wherever applicable)

Certificate from last attending Medical Practitioner /medical

authority for underlying medical condition/s leading to death of

the Insured Person

Post Mortem Report, FSL Report, Viscera and Chemical

Analysis Report, Histopathoilogy Report (wherever applicable)

Any other specific investigation / document to support the

diagnosis of such Critical Illness, as may be reasonably

required by Us in addition to the documents specified under

this Section.

All histology/cytology/FNAC/Biopsy/Immuno-chemistry

reports, X-ray, CT Scan, MRI, PET Scan, Bone Marrow Test,

Cancer Markers, all other pathological tests

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Income Proof(ITR/Salary Slip,etc)

The Company shall seek for specific investigation reports

depending on the nature of ailment. The list of the specific

requirements will be shared with the insured/ nominee at the time

of claim

Illustration 3:

Mr. RST a 40yr old male has opted for plan which has ‘Cancer

and blood disorders’ bucket and add on ‘Cancer Restore Benefit’

for 1 year tenure for 5lac SI with base premium as 970/- & 340/-

for ‘Cancer and blood disorders Bucket’ and ‘Cancer Restore

Cover’ respectively. After the initial waiting period Mr. RST is

diagnosed with Major Cancer (Cancer of Specified severity),after

evaluation of required documents we pay the major claim with

100% payout of 5 lac sum insured. Since the customer has opted

for cancer restore benefit he will be eligible to claim under this

benefit provided the customer renews this policy subject to having

received the premium for the ‘Cancer and blood disorders’ bucket

under benefit 1 and cancer restore benefit as per the original Sum

Insured and age at the time of renewal. Mr. RST is diagnosed

with Cancer relapse after the 3 years waiting period he will be

eligible to claim for ‘Cancer Restore’ Benefit.

4.1 Section B: Add on cover : Benefit: 4: Major Surgical

Procedures

In consideration of payment of additional premium if the Insured

Person is Hospitalized on the written advice of the treating

Medical Practitioner due to an Illness contracted or any Injury

sustained during the Period of Cover, and is advised by a Medical

Practitioner qualified as a Surgeon to undergo a Surgical

Procedure specified in Annexure 2 of this Policy and has

undergone the surgery, then We will pay the percentage of the

Sum Insured as a lumpsum (specified against this Benefit in the

Policy Schedule) in the manner specified in the Annexure 2 for

each of the listed surgeries.

This Benefit shall be payable subject to the following:

1. We will consider more than one claim in respect of the

Insured Person under Section B Major Surgical Procedure

of the Policy), subject to the availability of the Sum Insured

as specified in the Policy Schedule against Section B, and

provided that the Illness/Accident causing the Injury is

distinct and unrelated for each such claim. On exhaustion of

the Sum Insured, the Benefit under this Benefit will terminate

in relation to the Insured Person.

2. Once a claim has been considered admissible and payable

by Us under this Benefit and Sum Insured has been

exhausted no subsequent Renewal of this Cover will be

allowed

3. In case of multiple Surgeries/Surgical Procedures

performed in a single Admission to a Hospital, or arising out

of the same Illness/Injury, We will pay the amount specified

against only one such Surgical Procedure, having the higher

payout

4. 24 hours of continuous and completed Hospitalization is

mandatory for any claim to be admissible.

5. In case the customer has opted for both Comprehensive

Critical Illness and Major Surgical Procedures Benefit, in a

scenario where the customer is covered for a surgical

procedure under both these Benefits the company, shall be

liable to pay under either of the Benefits whichever is having

a higher payout and the Insured shall not be eligible to claim

for it in the future.

6. Add on cover will not be renewed incase all Critical Illness

buckets under base cover are exhausted

4.2 Exclusions applicable to Section B: Benefit 4 :

We shall not be liable to make any payment for any claim under

Benefit 4 of Section B of this Policy in respect of an Insured

Person, directly or indirectly for, caused by, arising from or in any

way attributable to any of the following:

a) Any covered Surgery/Surgical Procedure arising out of an

Illness diagnosed/contracted prior to Risk Inception Date

or arising within the 90/120/150 days waiting period as

specified in policy schedule. However, no Waiting Period

will be applicable in case of any Surgical Procedure arising

out of/due to an Accident during the Period of Cover

b) Any Surgery/Surgical Procedure arising out of an Accident

which occurred prior to Risk Inception Date.

c) Any Pre-Existing Disease(s) or any disability arising out of

a Pre- Existing Disease or any complication arising

therefrom.

d) Any Critical Illness or Surgery/Surgical Procedure arising

out of any external Congenital Anomaly or internal

Congenital Anomaly known at the commencement of the

policy.

e) Any of the covered Surgery/Surgical Procedure performed

which was otherwise deemed unnecessary, or against

standard health practices.

f) Any Unproven/Experimental treatment.

g) Any Surgery/Surgical Procedure performed solely due to

cosmetic or aesthetic reasons.

h) Any claim made without a medical certificate from the

treating Medical Practitioner evidencing the diagnosis of

such Illness or Injury or the undergoing of the medical /

Surgical Procedure.

Illustration 4:

Ms. PQR has opted for plan which has Cancer bucket and add

on Section B: Major Surgical Procedures. After the initial

waiting period she undergoes Pericardectomy.

She is eligible to claim for 50% payout under Major Surgical

Procedures(Add on Cover).

Subsequently she has to undergo Amputation of Leg she will

be eligible to claim for 100% payout under Major Surgical

Procedure, however as we have already honoured a 50%

claim on account of Pericardiactomy now she will be eligible

to claim for balance 50% only.

Hence we will be honouring 50% payout here subject to policy

terms and conditions

4.3 Claim Documents for Section B:Benefit 4:

Claim Documents On the occurrence of an Insured Event which

may give rise to a claim under this Benefit, We shall be provided

with the following necessary and mandatory information and

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

documentation specified in relation to the Benefit being claimed

within 30 days of occurrence of the Insured Event:

1. Duly filled claim form and signed by the Insured Person

or claimant

2. Scan copy of original Hospital discharge summary

3. All pre and post-Surgery investigation reports/scans

4. Scan copy of original Policy copy

5. Consultation papers of the surgeon advising for the

Surgical Procedure

6. If the claim amount is more than ₹1 lakh, AML Documents

- Pan Card Copy, Residence Proof, and 2 passport sized

color photos of Insured Person/claimant

7. Cancelled cheque and NEFT mandate form - duly filled in

by the Insured Person/claimant

8. All post Hospitalisation, consultation or treatment details

and documents.

9. Copies of Indoor case papers from the Hospital

10. Income Proof(ITR/Salary Slip,etc)

5.1 Section C: Add on Cover: PERSONAL ACCIDENT

Our maximum, total and cumulative liability for claims arising in

respect of the Insured Person during the Period of Cover under

Benefit 5, Benefit 6, and Benefit 7 under Section C, shall be the

Sum Insured as specified against this set of Benefits in the Policy

Schedule.

5.1.1 Benefit 5: Accidental Death Benefit:

We will pay the Sum Insured specified against this Benefit in the

Policy Schedule in the manner specified in the Policy Schedule if

an Insured Person suffers an Injury due to an Accident that occurs

during the Period of Cover and that Injury solely and directly

results in the Insured Person’s death within 365 days from the

date of the Accident. On the acceptance of a claim under this

Benefit and any other applicable Benefit pertaining to the same

event, all Benefit under this Policy shall immediately and

automatically cease in respect of that Insured Person and no

subsequent Renewals of the Policy will be allowed.

Add on cover will not be renewed incase base bucket is

exhausted

5.1.2 Benefit 6: Permanent Total Disablement (PTD) Benefit:

We will pay the Sum Insured specified against this Benefit in the

Policy Schedule in the manner specified in the Policy Schedule if

an Insured Person suffers an Injury due to an Accident that occurs

during the Period of Cover and that Injury solely and directly

results in the Permanent Total Disablement of the Insured Person

within 365 days from the date of the Accident.

This Benefit shall be payable subject to the following:

i. If the Insured Person dies inconsequence to the accident

event before a claim has been admitted under this Benefit,

then no amount will be payable under this Benefit, but a claim

will be considered under Benefit 5, if in force for the Insured

Person.

ii. If the Insured Person suffers Injuries resulting in more than

one of the Permanent Total Disablements, then Our

maximum, total and cumulative liability under this Benefit shall

be limited to the Sum Insured.

iii. If We have admitted a claim for Permanent Total

Disablement in accordance with this Benefit, then We shall not

be liable to make any payment under the Policy under Benefit

5 on the death of the Insured Person, if the Insured Person

subsequently dies.

iv. We will only accept one claim under this Benefit in the

lifetime of the Insured Person. On the acceptance of a claim

under this Benefit, all Benefit under this Benefit in respect of

the Insured Person shall immediately and automatically

cease.

v. On the acceptance of a claim under this Benefit, this

Benefit will terminate and no subsequent renewal of this

Benefit will be allowed

vi. Add on cover will not be renewed incase base bucket is

exhausted

vii. This benefit has been capped at flat 1lac Sum Insured for

less than 10 yrs of age

5.1.3 Benefit 7: Permanent Partial Disablement (PPD) Benefit:

We will pay the percentage of the Sum Insured (specified against

this Benefit in the Policy Schedule) in the manner specified in the

table below if an Insured Person suffers an Injury due to an

Accident that occurs during the Period of Cover and that Injury

solely and directly results in the Permanent Partial Disablement

of the Insured Person (which is of the nature specified in the table

below) within 365 days from the date of the Accident.

For the purpose of this Benefit, Permanent Partial Disablement

means total and/or partial irreversible loss of use or the actual loss

by physical separation of the body parts as specified in the table

below

PPD Table:

Sr

No.

LOSSES COVERED

% OF

SUM

INSU

RED

payab

le

1

Loss of one entire hand

70

2

Loss of one entire foot

70

3

Loss of use of one eye

50

4

Loss of all toes

20

5

Loss of great toe - both phalanges

5

6

Loss of great toe - one phalanx

2

7

Other than great toe if more than one toe

lost each

5

8

Loss of use of both ears

75

9

Loss of use of one ear

30

10

Loss of four fingers and thumb of one

hand

40

11

Loss of four fingers

35

12

Loss of thumb - both phalanges

25

13

Loss of thumb - one phalanx

10

14

Loss of index finger - three phalanges

10

15

Loss of index finger - two phalanges

8

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

16

Loss of index finger - one phalanx

4

17

Loss of middle finger - three phalanges

6

18

Loss of middle finger - two phalanges

4

19

Loss of middle finger - one phalanx

2

20

Loss of ring finger - three phalanges

5

21

Loss of ring finger - two phalanges

4

22

Loss of ring finger - one phalanx

2

23

Loss of little finger - three phalanges

4

24

Loss of little finger - two phalanges

3

25

Loss of little finger - one phalanx

2

26

Loss of metacarpus - first or second

(additional)

3

27

Loss of metacarpus - third, fourth or fifth

(additional)

2

This Benefit shall be payable subject to the following:

i. If the Insured Person dies in consequence to the

accident event before a claim has been admitted

under this Benefit, then no amount will be payable

under this Benefit, but a claim will be considered

under Benefit 5, if in force for the Insured Person.

ii. If a claim is accepted under this Benefit in respect

of an Insured Person and the amount due under this

claim and claims already admitted under the Benefit

in respect of the Insured Person will cumulatively

lead to the Sum Insured being exceeded then Our

maximum, total and cumulative liability under any

and all such claims will be limited to the Sum

Insured.

iii. On exhaustion of Sum Insured, this Benefit shall

terminate and cease to operate in relation to such

Insured Person.

iv. Once a claim has been considered admissible and

payable by Us under this Benefit, any subsequent

Renewal of this this Benefit will be solely as per Our

discretion, on a case to case basis.

v. Add on cover will not be renewed incase base

bucket is exhausted

vi. This benefit has been capped at flat 1lac Sum

Insured for less than 10 yrs of age, however claim

will be payable in accordance to the above PPD

table.

5.2 EXCLUSIONS AND LIMITATIONS APPLICABLE TO

SECTION C

We shall not be liable to make any payment for any claim under

Section C of this Policy in respect of an Insured Person, directly

or indirectly for, caused by, arising from or in any way attributable

to any of the following:

a) War, invasion, act of foreign enemy hostilities or warlike

operations (whether war be declared or not) or civil

commotion or rebellion, revolution, insurrection, mutiny,

arrests, detainments of all kinds and political gatherings,

engaging in aviation other than as a passenger (fare

paying or otherwise) in any licensed standard type of

aircraft.

b) Any Injury sustained while performing duty in army, navy,

air force, paramilitary force, police or any other such

institution, except to the extent it is expressly covered

under any Benefit

c) Any event which occurs whilst the Insured Person is

operating or learning to operate any aircraft or common

carrier, or performing duties as a member of the crew on

any aircraft, or scheduled airlines or is engaging in

aviation, or whilst the Insured Person is mounting into, or

dismounting from or traveling in any balloon or aircraft

other than as a passenger (fare-paying or otherwise) in

any scheduled airline anywhere in the world.

d) Breach of law/ statutory provisions or while being involved

in any unlawful activity.

e) Any Injury / Illness arising from full-time involvement in

professional sports for livelihood and remuneration,

except to the extent it is expressly covered under any

Benefit.

f) Any Injury / Illness arising from intentional self- Injury,

suicide or attempted suicide.

g) Any Injury / Illness arising from a failure to take

reasonable precautions to avoid a claim under the Policy.

h) Any Injury / Illness arising whilst under the influence of

alcohol or intoxicating drugs or substance abuse of any

kind.

i) Any Injury / Illness occurring whilst working in

underground mines or explosives magazines, or involving

electrical installation with high tension supply, or as

jockeys or circus personnel or any other high risk

occupations.

j) Any Injury that has occurred prior to the commencement

of Policy of Benefit whether or not the same has been

treated, or medical advice, diagnosis, care or treatment

has been sought.

k) Any Illness, complication or ailment not arising out of or

connected to Injury.

l) Payment of compensation in respect of death,

disablement (whether of a permanent nature or of a

temporary nature), Injury, Illness or Hospitalization of the

Insured Person resulting directly from, or indirectly

caused by, or contributed to or aggravated or prolonged

by, childbirth or pregnancy or in consequence thereof.

m) Payment of compensation in respect of death,

disablement (whether of a permanent nature or of a

temporary nature), Injury, Illness or Hospitalization of

Insured Person due to an insect or mosquito bite.

n) Death, disablement (whether of a permanent nature or of

a temporary nature), Injury, Illness or Hospitalization

arising from or caused by ionizing radiation or

contamination by radioactivity from any nuclear fuel

(explosive or hazardous form) or resulting from or from

any other cause or event contributing concurrently or in

any other sequence to the loss, claim or expense from

any nuclear waste from the combustion of nuclear fuel,

nuclear, chemical or biological attack.

5.3 Claim documents applicable to Section C:

On the occurrence of an Insured Event which may give rise to a

claim under this Section, We shall be provided with the following

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

necessary and mandatory information and documentation as

specified in relation to the particular Benefit being claimed within

30 days of occurrence of the Insured Event:

Benefit 5 – Accidental Death Benefit

1

Duly filled claim form by the claimant

2

Scan of original policy report

3

MLC / FIR

4

Cause of Death Certificate

5

Death Certificate issued by the Government Authority

6

Post Mortem Report

7

Viscera / Chemical Analysis / Forensic Report

8

Police Final Charge sheet / Court Final Order

9

Spot Inquest / Panchnama

10

RACT award in case of rail accident

11

Indoor Case Papers

12

If the claim amount is more than ₹1 lakh, AML Documents

- Pan Card Copy, Residence Proof, and 2 passport sized

color photos of Insured Person/claimant

13

Cancelled cheque and NEFT mandate form - duly filled in

by the Insured Person/claimant

14

Income Proof(ITR/Salary Slip,etc)

Benefit 6 – Permanent Total Disablement (PTD) Benefit

1

Duly filled claim form by the claimant

2

Scan of original policy report

3

MLC or FIR

4

Police Final Charge sheet / Court Final Order

5

Spot Inquest / Panchnama

6

Indoor Case Papers

7

Disability Certificate by Civil Surgeon / Government

Hospital

8

Certificate from treating Medical Practitioner

9

RACT award in case of rail accident

10

Hospitalisation records and Discharge

summary(wherever applicable)

11

If the claim amount is more than ₹1 lakh, AML Documents

- Pan Card Copy, Residence Proof, and 2 passport sized

color photos of Insured Person/claimant

12

Cancelled cheque and NEFT mandate form - duly filled in

by the Insured Person/claimant

13

Income Proof(ITR/Salary Slip,etc)

Benefit 7 - Permanent Partial Disablement (PPD) Benefit

1

Duly filled claim form by the claimant

2

Scan of original policy report

3

MLC or FIR

4

Police Final Charge sheet / Court Final Order

5

Spot Inquest / Panchnama

6

Indoor Case Papers

7

Disability Certificate by Civil Surgeon / Government

Hospital

8

Certificate from treating Medical Practitioner

9

If the claim amount is more than ₹1 lakh, AML Documents

- Pan Card Copy, Residence Proof, and 2 passport sized

color photos of Insured Person/claimant

10

Cancelled cheque and NEFT mandate form - duly filled in

by the Insured Person/claimant

11

Income Proof(ITR/Salary Slip,etc)

Section D: Value Added Services

1. Tele-consultation:

We will arrange consultations and recommendations for any

listed Critical illnesses under Annexure 1 by a qualified

General Practitioner. For the purpose of this benefit

Telephonic/Virtual consultation shall mean consultation

provided by a qualified General Practitioner through various

mode of communication like audio, chat or mobile app. The

services provided under this Benefit will be made available

subject to the terms and conditions, and in the manner

prescribed below:

 The General Practitioner may

suggest/recommend/prescribe over the counter

medications based on the information provided, if

required on a case to case basis. However, the

services under this Benefit should not be construed to

constitute medical advice and/or substitute the

Insured Person's visit/ consultation to an independent

Medical Practitioner/Healthcare professional*.

 This service will be available 24 hours a day, and 365

days in a year.

 The General Practitioner may refer the Insured

Person to a specialist or a general physician, if

required**, and the charges for such specialist or a

general physician will have to be borne by the Insured

Person.

 We shall not be liable for any discrepancy in the

information provided under this Benefit.

 Choosing the services under this Benefit is purely

upon the customer’s own discretion and at own risk.

 You will be eligible to avail maximum of 4 tele-

consultation per policy period

 The insured will be able to use this service only with

respect to the listed Critical Illnesses under Annexure

1.

 This benefit will lapse incase not used during the

policy tenure

*The proposer should seek assistance from a health care

professional when interpreting and applying them to

the Insured person’s individual circumstances. If the

Insured person has any concerns about His/ her

health, He/ She may consult His/ her general

practitioner.

**Consultations charges would be applicable.

2. E-opinion (second opinion)

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

In the event of your diagnosis with any of the critical illness

covered under your policy and during the policy period, we

shall facilitate in arranging an E-Consultation second opinion

from a super specialty medical practitioner within our Network

with respect to that critical illness only, subject to the following

condition. It will be based on the medical records submitted by

the insured person which should include investigation reports

citing the final diagnosis and relevant consultation papers. We

will not be reimbursing/bearing the cost for second E-

opinion/consultation.

3. Health and Wellness Offers:

Health and Wellness Offers on services/products provided

by our network providers/ Health service providers – We shall

only facilitate the Insured Person in availing offers and

discounts on services/products offered by our network

providers/ health service providers. Customer can avail

Health and Wellness Offers on our app on various health,

fitness and wellness products and other services available on

the app.

4. Health assistance:

We also provide Health Assistance as a part of Our Value

added services, Our Health Assistance Team (HAT) will assist

the Insured Person in understanding his/her health condition

better by providing answers to any queries related to health

and health care providers on Our dedicated helpline. To avail

this service, the Insured Person may call Our helpline on 040-

66274205 (please note that this number is subject to change).

The services provided under this shall include:

 Identifying a Physician/ Specialist

 Scheduling an appointment with any Medical

Practitioner empanelled with Us

 Scheduling appointments for a second opinion

 Providing suitable options with respect to Hospitals as

well as providing assistance in Cashless facility, wherever

applicable.

 Providing preventive information on ailments

 Providing guidance on post Hospitalization care, such as

Physiotherapy/ Nursing at home.

Please note that services provided under this Benefit are

solely for assistance, and should not be construed to be a

substitute for a visit/ consultation to an independent Medical

Practitioner. This Benefit does not include the charges for any

independent Medical Practitioner/nutritionist consulted on

HAT’s recommendation, and such charges are to be borne by

the Insured Person. We do not accept any liability towards

quality of the services made available by our network

providers/ service providers and are not liable for any defects

or deficiencies on their part

While deciding to obtain such value-added service, You

expressly note and agree that it is entirely for You to decide

whether to obtain these services and also to decide the use (if

any) to which these services is to be put for

IV GENERAL EXCLUSIONS:

We shall not be liable to make any payment for any claim under

this Policy in respect of an Insured Person, directly or indirectly

for, caused by, arising from or in any way attributable to any of the

following:

1. Any physical, medical or mental condition or treatment or

service that is specifically excluded in the Policy Schedule under

the head “Special Conditions”.

2. Any breach of the law by the Insured Person with a criminal

intent.

3. War, invasion, act of foreign enemy, hostilities (whether war be

declared or not) civil war, rebellion, revolution, insurrection,

mutiny, military or usurped power, seizure, capture, arrests,

restraints and detainment of citizens of whatever nation, riots or

civil commotion.

4. Any Injury sustained while performing duty in army, navy, air

force, paramilitary force, police or any other such institution,

except to the extent it is expressly covered under any Benefit.

5. Ionising radiation or contamination by radioactivity from any

nuclear fuel or from any nuclear waste or from nuclear weapon

materials or from the combustion of nuclear fuel. For the purpose

of this exclusion, combustion shall include any self-sustaining

process of nuclear fission.

6. Use or misuse of intoxicating drugs and/or alcohol.

7. Participation (aggravation) in any kind of strike, processions,

riots etc.

8. Any act of self-destruction or self-inflicted injury, attempted

suicide or suicide and deliberate participation of the Insured in an

illegal or criminal act with criminal intent.

9. Any Injury / Illness occurring whilst working in underground

mines or explosives magazines, or involving electrical installation

with high tension supply, or as jockeys or circus personnel

10. Any consequential or indirect losses or expenses related to

any Insured Event.

11. Any tests and treatment relating to infertility and in vitro

fertilization.

12. Any Injury / Illness occurring whilst engaging in any Adventure

Sports, either as an instructor/ trainer, or as a participant.

13. Any natural peril (including but not limited to storm, tempest,

avalanche, earthquake, volcanic eruptions, hurricane, or any

other kind of natural hazard).

V. GENERAL TERMS AND CONDITIONS

i. Standard General Terms and Clauses

1. Disclosure of lnformation

The policy shall be void and all premium paid thereon shall

be forfeited to the Company in the event of

misrepresentation, mis description or non-disclosure of

any material fact by the policyholder.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

"Material facts" for the purpose of this policy shall mean

all relevant information sought by the company in the

proposal form and other connected documents to enable

it to take informed decision in the context of underwriting

the risk

2. Condition Precedent to Admission of Liability:

The terms and conditions of the policy must be fulfilled by

the insured person for the Company to make any payment

for claim(s) arising under the policy.

3. Claim Settlement

i. The Company shall settle or reject a claim, as

the case may be, within 30 days from the date

of receipt of last necessary document.

ii. In the case of delay in the payment of a claim,

the Company shall be liable to pay interest to

the policyholder from the date of receipt of last

necessary document to the date of payment of

claim at a rate 2% above the bank rate.

iii. However, where the circumstances of a claim

warrant an investigation in the opinion of the

Company, it shall initiate and complete such

investigation at the earliest, in any case not

later than 30 days from the date of receipt of

last necessary document- In such cases, the

Company shall settle or reject the claim within

45 days from the date of receipt of last

necessary document.

iv. In case of delay beyond stipulated 45 days, the

Company shall be liable to pay interest to the

policyholder at a rate 2% above the bank rate

from the date of receipt of last necessary

document to the date of payment of claim.

4. Complete Discharge Any payment to the policyholder,

insured person or his/ her nominees or his/ her legal

representative or assignee or to the Hospital, as the case

may be, for any benefit under the policy shall be a valid

discharge towards payment of claim by the Company to

the extent of that amount for the particular claim.

5. Fraud

lf any claim made by the insured person, is in any respect

fraudulent, or if any false statement, or declaration is

made or used in support thereof, or if any fraudulent

means or devices are used by the insured person or

anyone acting on his/her behalf to obtain any benefit

under this policy, all benefits under this policy and the

premium paid shall be forfeited.

Any amount already paid against claims made under this

policy but which are found fraudulent later shall be repaid

by all recipient(s)/policyholder(s), who has made that

particular claim, who shall be jointly and severally liable

for such repayment to the insurer.

For the purpose of this clause, the expression "fraud"

means any of the following

acts committed by the insured person or by his agent or

the hospital/doctor/any

other party acting on behalf of the insured person, with

intent to deceive the insurer or to induce the insurer to

issue an insurance policy:

a) the suggestion, as a fact of that which is not true and

which the insured person does not believe to be true;

b) the active concealment of a fact by the insured

person having knowledge or belief of the fact;

c) any other act fitted to deceive; and

d) any such act or omission as the law specially

declares to be fraudulent

The Company shall not repudiate the claim and / or

forfeit the policy benefits on the ground of Fraud, if the

insured person / beneficiary can prove that the

misstatement was true to the best of his knowledge and

there was no deliberate intention to suppress the fact or

that such misstatement of or suppression of material fact

are within the knowledge of the insurer.

6. Cancellation/ Termination

i. The policyholder may cancel this policy by giving

15days'written notice and in such an event, the

Company shall refund premium for the unexpired

policy period as detailed below.

ii. We shall from the date of receipt of the notice

cancel the Policy, retain the premium for the period

this Policy has been in force, and refund at Our

short period scales as per the Cancellation Grid

provided below, provided that no refund of

premium shall be made if any claim has been made

under the Policy by or on behalf of the Insured

Person.

iii. Notwithstanding anything contained herein or

otherwise, no refunds of premium shall be made in

respect of the Insured Person where any Claim has

been admitted by Us or has been lodged with Us

or any Benefit has been availed by the Insured

Person under the Policy.

iv. In case of a cancellation request by You/Insured

Person, the Policy will be cancelled in its entirety,

and any selected Benefits or Sections under the

Policy cannot be cancelled.

v. The Company may cancel the policy at any time on

grounds of misrepresentation non-disclosure of

material facts, fraud by the insured person by

giving 15 days' written notice. There would be no

refund of premium on cancellation on grounds of

misrepresentation, non-disclosure of material facts

or fraud.

vi. For any cancellation initiated by Us, due to any

other reason the company may choose to refund

the premium on prorata basis.

vii.

Cancellation Grid:

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Time of

cancellation

Policy Duration

1Yr

2Yrs

3Yrs

15 days - 30 days

77%

80%

82%

31 days - 90 days

62%

72%

77%

91 days - 180 days

42%

62%

70%

181 days - 270

days

20%

52%

62%

271 days - 365

days

0%

42%

55%

366 days - 455

days

30%

47%

456 days - 545

days

20%

42%

546 days - 635

days

10%

35%

636 days - 730

days

0%

27%

731 days - 820

days

20%

821 days - 910

days

12%

911 days - 1000

days

5%

Above 1000 days

0%

7. Migration: The insured person will have the option to

migrate the policy to other health insurance

products/plans offered by the company by applying for

migration of the policy atleast 30 days before the policy

renewal date as per IRDAI guidelines on Migration. lf

such person is presently covered and has been

continuously covered without any lapses under any

health insurance product/plan offered by the company,

the insured person will get the accrued continuity benefits

in waiting periods as per IRDAI guidelines on migration.

Migration benefit will be offered to the extent of sum of

previous sum insured, this benefit shall not apply to any

additional sum insured.

For Detailed Guidelines on migration, kindly refer the link

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layou

t.aspx?page=PageNo3986andflag=1

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layou

t.aspx?page=PageNo3987andflag=1

8. Portability: The insured person will have the option to

port the policy to other insurers by applying to such

insurer to port the entire policy along with all the members

of the family, if any, at least 45 days before, but not earlier

than 60 days from the policy renewal date as per IRDAI

guidelines related to portability. lf such person is presently

covered and has been continuously covered without any

lapses under any health insurance policy with an lndian

General/Health insurer, the proposed insured person will

get the accrued continuity benefits in waiting periods as

per IRDAI guidelines on portability.

For Detailed Guidelines on portability, kindly refer the

link

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.

aspx?page=PageNo3986andflag=1

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.

aspx?page=PageNo3987andflag=1

9. Renewal of Policy: The policy shall ordinarily be

renewable except on misrepresentation by the insured

person

i. The Company shall endeavor to give notice for

renewal. However, the Company is not under

obligation to give any notice for renewal.

ii. Request for renewal along with requisite premium

shall be received by the Company before the end of

the policy period.

iii. At the end of the policy period, the policy shall

terminate and can be renewed within the Grace

Period of 30 days

iv. No loading shall apply on renewals based on

individual claims experience

10. Withdrawal of Policy: in the likelihood of this product

being withdrawn in future, the Company will intimate the

insured person about the same 90 days prior to expiry of

the policy. lnsured Person will have the option to migrate

to similar health insurance product available with the

Company at the time of renewal with all the accrued

continuity benefits such as cumulative bonus, waiver of

waiting period. as per IRDAI guidelines, provided the

policy has been maintained without a break.

11. Moratorium

Period After completion of eight continuous years under the

policy no look back to be applied. This period of eight years

is called as moratorium period. The moratorium would be

applicable for the sums insured of the first policy and

subsequently completion of 8 continuous years would be

applicable from date of enhancement of sums insured only

on the enhanced limits. After the expiry of Moratorium Period

no health insurance claim shall be contestable except for

proven fraud and permanent exclusions specified in the

policy contract. The policies would however be subject to all

limits, sub limits, co-payments, deductibles as per the policy

contract.

12. Premium Payment in installments

lf the insured person has opted for Payment of Premium on

an instalment basis i.e. Half Yearly, Quarterly or Monthly, as

mentioned in the policy Schedule/Certificate of lnsurance,

the following Conditions shall apply (notwithstanding any

terms contrary elsewhere in the policy)

i. Grace Period of 7 days would be given to pay the

instalment premium due for the policy.

ii. During such grace period, coverage will not be

available from the due date of instalment premium

till the date of receipt of premium by Company.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

iii. The insured person will get the accrued continuity

benefit in respect of the "Waiting Periods", "Specific

Waiting Periods" in the event of payment of premium

within the stipulated grace Period.

iv. No interest will be charged lf the instalment premium

is not paid on due date

v. ln case of instalment premium due not received

within the grace period, the policy will get cancelled.

We shall not be liable under this Policy for any loss

occurring thereafter, including the intervening period,

nor shall any refund of premium become due under

the Policy. We shall not be bound to give any notice

that such Premium Installment is due.

vi. ln the event of a claim, all subsequent premium

instalments shall immediately become due and

payable.

vii. We shall not be obligated to give any notice to the

Insured Person/Policyholder for payment of premium

installment, and will recover and deduct any or all the

pending premium installments from the claim amount

falling due under the Policy.

13. Possibility of Revision of Terms of the Policy

lncluding the Premium Rates

The Company, with prior approval of lRDAl, may revise or

modify the terms of the policy including the premium

rates. The insured person shall be notified three months

before the changes are effected.

14. Free look period

The Free Look Period shall be applicable on new individual

health insurance policies and not on renewals or at the time of

porting/migrating the policy. The insured person shall be

allowed free look period of fifteen days(30days when policy is

sourced through distance marketing) from date of receipt of

the policy document to review the terms and conditions of the

policy, and to return the same if not acceptable.

lf the insured has not made any claim during the Free Look

Period, the insured shall be entitled to

i. a refund of the premium paid less any expenses incurred

by the Company on medical examination of the insured

person and the stamp duty charges or

ii. where the risk has already commenced and the option of

return of the policy is exercised by the insured person, a

deduction towards the proportionate risk premium for period

of cover or

iii. Where only a part of the insurance coverage has

commenced, such proportionate premium commensurate

with the insurance coverage during such period

The Policy can be cancelled only if no claims have been made

under the Policy. All Your rights under this Policy will immediately

stand extinguished on the free look cancellation of the Policy.

In case the request for cancellation comes 15 days after the

receipt of Policy by the Insured Person, We would refund the

premium paid as per the applicable refund grid provided in the

Cancellation clause of the Policy.

15. Redressal of Grievances:

ln case of any grievance the insured person may contact the

company through

Website: www. icicilombard.com (Customer Support

section).

Toll free: 1800 2666

E-mail: [email protected]

Fax : ……..

Courier: ICICI Lombard General Insurance Company

Ltd.

ICICI Lombard House,

414, Veer Savarkar Marg,

Near Siddhi Vinayak Temple,

Prabhadevi, Mumbai- 400025

Insured person may also approach the grievance cell at

any of the company's branches with the details of

grievance lf Insured person is not satisfied with the

redressal of grievance through one of the above

methods, insured person may contact the grievance

officer at Manager- Service Quality, Corporate

Manager- Service Quality, National Manager-

Operations & finally Director-services and Business

development at the following address:

ICICI Lombard General Insurance Company Limited,

ICICI Lombard House,

414, Veer Savarkar Marg,

Near Siddhi Vinayak Temple,

Prabhadevi, Mumbai 400025

For updated details of grievance officer, kindly refer the link.

.https://www.icicilombard.com/grievance-redressal...

As per the IRDAI’s guidelines on special provision for senior

citizens, We will provide a separate channel for addressing

grievances of Insured Persons who are senior citizens. You

may avail the service by contacting the above mentioned toll

free no and selecting suitable option provided on the

Interactive Voice Response System (IVRS)

If lnsured person is not satisfied with the redressal of

grievance through above methods, the insured person may

also approach the office of lnsurance Ombudsman of the

respective area/region for redressal of grievance as per

lnsurance Ombudsman Rules 2017.

If You are not satisfied with Our response or do not receive

a response from Us within 15 days, You may approach the

Grievance Cell of the Authority at:

Insurance Regulatory and Development Authority of India;

Grievance Call Centre (IGCC) Toll Free No:155255 Email

ID: [email protected]

Grievance may also be lodged at IRDAI lntegrated

Grievance Management System - https:/ligms. irda.qov. in

You can also register Your complaint through fax/letter by

submitting Your complaint to:

Consumer Affairs Department Insurance Regulatory and

Development Authority of India; Sy No. 115/1 Financial

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

District Nanakramguda Gachibowli -500032 If the issue still

remains unresolved,

You may, subject to vested jurisdiction, approach Insurance

Ombudsman for the redressal of the grievance.

The details of Insurance Ombudsman are available below:

S

no

.

Name of office of insurance

Ombudsman

Territorial Area of

jurisdiction

1

AHMEDABAD

Office of the Insurance

Ombudsman, Jeevan Prakash

Building, 6th floor,

Tilak Marg, Relief Road,

Ahmedabad – 380 001. Tel.: 079 -

25501201/02/05/06

Email:

[email protected]

.in

Gujarat, Dadra

and Nagar Haveli,

Daman and Diu.

2

BENGALURU

Office of the Insurance

Ombudsman,

Jeevan Soudha Building,PID No.

57-27-

N-19

Ground Floor, 19/19, 24th Main

Road,

JP Nagar, Ist Phase,

Bengaluru – 560 078.

Tel.: 080 - 26652048 / 26652049

Email:

[email protected]

n

Karnataka

3

BHOPAL

Office of the Insurance

Ombudsman,

Janak Vihar Complex, 2nd Floor,

6, Malviya Nagar, Opp. Airtel

Office,

Near New Market,

Bhopal – 462 003.

Tel.: 0755 - 2769201 / 2769202

Fax: 0755 - 2769203

Email:

[email protected]

Madhya Pradesh

Chattisgarh.

4

BHUBANESHWAR

Office of the Insurance

Ombudsman,

62, Forest park,

Bhubneshwar – 751 009.

Tel.: 0674 - 2596461 /2596455

Fax: 0674 - 2596429

Email:

[email protected]

o.in

Orissa.

5

CHANDIGARH

Office of the Insurance

Ombudsman,

S.C.O. No. 101, 102 and 103, 2nd

Floor,

Batra Building, Sector 17 – D,

Chandigarh – 160 017.

Punjab,

Haryana,

Himachal

Pradesh,

Jammu and

Kashmir,

Chandigarh.

Tel.: 0172 - 2706196 / 2706468

Fax: 0172 - 2708274

Email:

[email protected]

n

6

CHENNAI

Office of the Insurance

Ombudsman,

Fatima Akhtar Court, 4th Floor,

453,

Anna Salai, Teynampet,

CHENNAI – 600 018.

Tel.: 044 - 24333668 / 24335284

Fax: 044 - 24333664

Email:

[email protected]

Tamil Nadu,

Pondicherry Town

and

Karaikal (which

are part of

Pondicherry).

7

DELHI

Office of the Insurance

Ombudsman,

2/2 A, Universal Insurance

Building,

Asaf Ali Road,

New Delhi – 110 002.

Tel.: 011 - 23232481/23213504

Email:

[email protected]

Delhi

8

ERNAKULAM

Office of the Insurance

Ombudsman,

2nd Floor, Pulinat Bldg.,

Opp. Cochin Shipyard, M. G. Road,

Ernakulam - 682 015.

Tel.: 0484 - 2358759 / 2359338

Fax: 0484 - 2359336

Email:

[email protected]

n

Kerala,

Lakshadweep,

Mahe-a part of

Pondicherry.

9

GUWAHATI

Office of the Insurance

Ombudsman,

Jeevan Nivesh, 5th Floor,

Nr. Panbazar over bridge, S.S.

Road,

Guwahati – 781001(ASSAM).

Tel.: 0361 - 2632204 / 2602205

Email:

[email protected]

Assam,

Meghalaya,

Manipur,

Mizoram,

Arunachal

Pradesh,

Nagaland and

Tripura.

10

HYDERABAD

Office of the Insurance

Ombudsman,

6-2-46, 1st floor, "Moin Court",

Lane Opp. Saleem Function

Palace,

A. C. Guards, Lakdi-Ka-Pool,

Hyderabad - 500 004.

Tel.: 040 - 67504123 / 23312122

Fax: 040 – 23376599

Email:

[email protected]

n

Andhra Pradesh,

Telangana,

Yanam and

part of Territory of

Pondicherry.

11

JAIPUR

Office of the Insurance

Ombudsman,

Jeevan Nidhi – II Bldg., Gr. Floor,

Rajasthan.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Bhawani Singh Marg,

Jaipur - 302 005.

Tel.: 0141 - 2740363

Email:

[email protected]

12

KOLKATA

Office of the Insurance

Ombudsman,

Hindustan Bldg. Annexe, 4th Floor,

4, C.R. Avenue,

KOLKATA - 700 072.

Tel.: 033 - 22124339 / 22124340

Fax : 033 - 22124341

Email:

[email protected]

West Bengal,

Sikkim,

Andaman and

Nicobar Islands.

13

LUCKNOW

Office of the Insurance

Ombudsman,

6th Floor, Jeevan Bhawan, Phase-

II,

Nawal Kishore Road, Hazratganj,

Lucknow - 226 001.

Tel.: 0522 - 2231330 / 2231331

Fax: 0522 - 2231310

Email:

[email protected]

Districts of Uttar

Pradesh :

Laitpur, Jhansi,

Mahoba,

Hamirpur,

Banda, Chitrakoot,

Allahabad,

Mirzapur,

Sonbhabdra,

Fatehpur,

Pratapgarh,

Jaunpur,Varanasi,

Gazipur, Jalaun,

Kanpur, Lucknow,

Unnao, Sitapur,

Lakhimpur,

Bahraich,

Barabanki,

Raebareli,

Sravasti,

Gonda, Faizabad,

Amethi,

Kaushambi,

Balrampur, Basti,

Ambedkarnagar,

Sultanpur,

Maharajgang,

Santkabirnagar,

Azamgarh,

Kushinagar,

Gorkhpur,

Deoria, Mau,

Ghazipur,

Chandauli,

Ballia,

Sidharathnagar.

14

MUMBAI

Office of the Insurance

Ombudsman,

3rd Floor, Jeevan Seva Annexe,

S. V. Road, Santacruz (W),

Mumbai - 400 054.

Tel.: 022 - 26106552 / 26106960

Fax: 022 - 26106052

Email:

[email protected]

Goa,

Mumbai

Metropolitan

Region

excluding Navi

Mumbai and

Thane.

15

NOIDA

Office of the Insurance

Ombudsman,

Bhagwan Sahai Palace

4th Floor, Main Road,

State of

Uttaranchal and

the following

Districts of Uttar

Pradesh:

Naya Bans, Sector 15,

Distt: Gautam Buddh Nagar,

U.P-201301.

Tel.: 2514252 / 2514253

Email:

[email protected]

Agra, Aligarh,

Bagpat, Bareilly,

Bijnor, Budaun,

Bulandshehar,

Etah,

Kanooj, Mainpuri,

Mathura, Meerut,

Moradabad,

Muzaffarnagar,

Oraiyya,

Pilibhit, Etawah,

Farrukhabad,

Firozbad,

Gautambodhanag

ar,

Ghaziabad,

Hardoi,

Shahjahanpur

16

PATNA

Office of the Insurance

Ombudsman,

1st Floor,Kalpana Arcade

Building,,

Bazar Samiti Road,

Bahadurpur,

Patna 800 006.

Tel.: 0612-2680952

Email:

[email protected]

Bihar,

Jharkhand.

17

PUNE

Office of the Insurance

Ombudsman,

Jeevan Darshan Bldg., 3rd Floor,

C.T.S. No.s. 195 to 198,

N.C. Kelkar Road, Narayan Peth,

Pune – 411 030.

Tel.: 020-41312555

Email:

[email protected]

Maharashtra,

Area of Navi

Mumbai and

Thane

excluding Mumbai

Metropolitan

Region.

16. Nomination

The policyholder is required at the inception of the policy to

make a nomination for the purpose of payment of claims

under the policy in the event of death of the policyholder. Any

change of nomination shall be communicated to the

company in writing and such change shall be effective only

when an endorsement on the policy is made. ln the event of

death of the policyholder, the Company will pay the nominee

{as named in the Policy Schedule/Policy

Certificate/Endorsement (if any)} and in case there is no

subsisting nominee, to the legal heirs or legal

representatives of the policyholder whose discharge shall be

treated as full and final discharge of its liability under the

policy.

ii. Specific Terms and Clauses:

1. PAYMENTS

We shall make payment of an admissible claim to the

Insured Person’s Nominee/assignee, as the case may be,

or in the absence of an assignee, to the Insured Person or

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

the Insured Person’s nominee. If there is no assignee or

Nominee and the Insured Person is incapacitated or

deceased, We will pay to the Insured Person’s heir, executor

or validly appointed legal representative.

Any payment We make in this manner will be a complete

and final discharge of Our obligations under this Policy and

Our liability towards the claim.

2. TERMS OF RENEWAL

 The Policy may be renewed by mutual consent under

the then prevailing (ICICI Lombard Criti Shield

Plus)Policy or its nearest substitute product (in case of

product withdrawal) approved by the IRDAI, and in

such event the Renewal premium should be paid to Us

on or before the date of expiry of the Policy and in no

case later than the Grace Period of 30 days from the

expiry of the Policy. We will not be liable to pay for any

Claim arising out of an Insured Event that occurs

during the Grace Period.

 Once the Sum Insured under any of the Benefits opted

and available to the insured is exhausted any future

renewal under that Benefit shall not be allowed.

 You shall on tendering any premium for the Renewal

of this Policy give notice in writing to Us of any Illness,

physical defect or infirmity with which any of the

Insured Person(s) have become affected since the

payment of the expiring Policy start date.

 Renewals will not be denied except on grounds of

misrepresentation, moral hazard, fraud, non-

disclosure of material facts. We may, revise the

Renewal premium payable under the Policy or the

terms of Benefit, provided that all such changes are

approved in accordance with the IRDAI rules and

regulations as applicable from time to time. We will

intimate You of any such changes at least 3 months

prior to date of such revision or modification.

 We shall not be bound to give any notice to

You/Insured Person that the premium for the Renewal

is due.

 Policyholder will not be allowed to make any changes

in his/her policy coverages, terms and conditions and

Sum Insured at the time of renewal in case a claim

has already been settled

 Policyholder will not be allowed to make any changes

in his/her policy coverages, terms and conditions at the

time of renewal, unless decided by Us on exceptional

call or case to case basis and subject to fresh proposal

form

 In the event where the base cover(s) has been

exhausted the insured shall not be allowed to renew

the add on cover(s)

 The above conditions for Renewal are to be read in

unison, and not standalone.

3. CLAIM PROCEDURE:

 The fulfillment of the terms and conditions of this Policy

(including payment of premium by the due dates

mentioned in the Policy Schedule) insofar as they

relate to anything to be done or complied with by You

or any Insured Person, including complying with the

procedures and requirements in relation to claims,

shall be Conditions Precedent to Our liability under this

Policy.

 We shall be under no obligation to make any payment

under this Policy unless We have received all premium

payments in full and on time in respect of the Insured

Person’s Benefit under the Policy and all payments

have been realised.

 On occurrence of an any event that may give rise to a

Claim under this Policy, You shall-

o Notify Us immediately on toll free number 1800

2666 or on our website www.icicilombard.com

or also in writing at Our address specified in the

Policy Schedule or email us at

[email protected]

o Along with the completed and signed Claim

form, provide all the relevant documents,

specified within the relevant Section of the

Policy for the Benefit being claimed, must be

submitted in full within 30 days.

o Wherever details pertaining to happening of

Claim are conveyed by you to Us after

reasonable period, You shall provide the

reasons of such delay to Us.

 If any Claim is not made within 30 days of the Insured

Event, then We will condone such delay on merits only

where the delay has been proved to be for reasons

beyond the claimant’s control.

 All claims will be investigated (as required) and settled

in accordance with the applicable regulatory

guidelines, including the IRDAI (Protection of

Policyholders Interests) Regulations, 2017.

 The admissible Claim amount will be calculated post

applicability of Deductible, Co-pay, Sub-limits, if any,

and as specifically defined in Policy Schedule.

 The role of the TPA (if any) would be limited to facilitate

the flow of information between Us and the Insured

Person.

4. Incontestability and Duty of Disclosure :

The Policy shall be null and void and no Benefit shall be

payable in the event of untrue or incorrect statements,

misrepresentation, mis description or on non-disclosure in

any material particular in the proposal form, personal

statement, declaration and connected documents, or any

material information having been withheld, or a claim being

fraudulent or any fraudulent means or devices being used

by the Insured Person or any one acting on his/her behalf to

obtain any Benefit under this Policy.

5. Observance of terms and conditions

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

The due observance and fulfilment of the terms, conditions

and endorsement of this Policy in so far as they relate to

anything to be done or complied with by the Insured Person,

shall be a condition precedent to Our liability to make any

payment under this Policy.

6. Records to be maintained

The Insured Person shall keep an accurate record

containing all relevant particulars and shall allow Us to

inspect such record.

7. No constructive Notice

Any knowledge or information of any circumstances or

condition in relation to the Insured Person, or in connection

with which a claim may be made under this Policy coming to

the knowledge or possession of any of Our officials shall not

be construed as notice to or be held to bind or prejudicially

affect Us notwithstanding subsequent acceptance of any

premium.

8. Notice of Charge

We shall not be bound to take notice or be affected by any

notice of any trust, charge, lien, assignment or other dealing

with or relating to this Policy, but the payment by Us to the

Insured Person, Nominee, assignee or his legal heirs of any

amount under the Policy shall in all cases be an effectual

discharge to Us.

9. Special Provisions

Any special provisions subject to which this Policy has been

entered into and endorsed in the Policy, Policy Schedule or

in any separate instrument or Endorsement shall be deemed

to be part of this Policy and shall have effect accordingly.

10. Overriding effect of Part II of the Schedule

The terms and conditions contained herein and in Policy

Schedule(Policy certificate or Certificate of Insurance) shall

be deemed to form part of the Policy and shall be read as if

they are specifically incorporated herein; however in case of

any inconsistency of any term and condition with the scope

of Benefit contained in Policy Schedule, then the term(s) and

condition(s) contained herein shall be read mutatis mutandis

with the scope of Benefit/terms and conditions contained in

Policy Schedule and shall be deemed to be modified

accordingly or superseded in case of inconsistency being

irreconcilable.

11. Electronic Transactions

The Insured Person agrees to adhere to and comply with

all such terms and conditions as We may prescribe from

time to time, and hereby agrees and confirms that all

transactions effected by or through facilities for conducting

remote transactions including the internet, the world wide

web, electronic data interchange, call centres, teleservice

operations (whether voice, video, data or combination

thereof) or by means of electronic, computer, automated

machines network or through other means of

telecommunication, established by or on Our behalf, for and

in respect of the Policy or its terms, or Our other products

and services, shall constitute legally binding and valid

transactions when done in adherence to and in compliance

with Our terms and conditions for such facilities, as may be

prescribed from time to time. The Insured Person agrees

that We may exchange, share or part with any information

with any government institution or statutory body, as may be

determined by Us and shall not hold Us liable for such

use/application.

12. Right to inspect

In case of any loss or occurrence to the Insured Person that

has given or may give rise to a claim under the Policy, If

required by Us, Our agent/representative, including any loss

assessor or surveyor/investigator or any individual or entity

appointed on Our behalf shall be permitted at all reasonable

times to examine the circumstances of such loss or

occurrence. The Insured Person shall on being required to

do so by Us, produce all books of accounts, receipts,

documents relating to or containing entries relating to the

loss or such circumstance in his/her possession and furnish

copies of or extracts from such of them as may be required

by Us so far as they relate to such claim(s), or may in any

way assist Us to ascertain the correctness thereof or Our

liability under the Policy.

13. Policy Disputes

Any dispute concerning the interpretation of the terms,

conditions, limitations and/or exclusions contained herein is

understood and agreed to by both the Insured Person and

Us to be subject to Indian Law. Each party agrees to submit

to the jurisdiction of the Courts in India and to comply with all

requirements necessary to give such Court the jurisdiction.

All matters arising hereunder shall be determined in

accordance with the law and practice of such Court.

14. Arbitration clause

i. If any dispute or difference shall arise as to the

quantum of claim to be paid under this Policy

(liability/claim being otherwise admitted by the

Insurer), such difference shall independently of

all other question be referred to the decision of a

sole arbitrator to be appointed mutually in writing

by the Insurer and the Insured who has made

claim under this Policy or if they cannot agree

upon a single arbitrator within 30 days of any

party [the Insurer or the and the Insured who has

made claim under this Policy] invoking

arbitration, the same shall be referred to a panel

of three arbitrators, comprising of two arbitrators

one to be appointed by the Insured who has

made claim under this Policy and the Insurer,

respectively, who are the parties to the dispute/

difference and the third arbitrator to be appointed

by such two appointed arbitrators and arbitration

shall be conducted under and in accordance with

the provisions of the Arbitration and Conciliation

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Act, 1996 as amended from time to time. The law

of the arbitration will be Indian law.

ii. It is clearly agreed and understood that no

difference or dispute shall be referable to

arbitration as herein before provided if the Insurer

has disputed or not accepted/admitted the

liability/claim under the Policy.

iii. It is hereby expressly stipulated and declared that

it shall be a Condition Precedent to any right of

action or suit read with this Policy that the award

by such arbitrator/ arbitrators of the amount of the

benefits shall be first obtained

iv. It is also hereby further expressly agreed and

declared that if the Insurers shall

disclaim/repudiate the liability to the Insured for

any claim under the Policy, and such claim shall

not, within 12 calendar months from the date of

such disclaimer/repudiation have been made the

subject matter of a suit in a court of law, then all

benefits under the Policy shall be forfeited and

the rights of Insured shall stand extinguished and

the liability of the Insurer shall also stand

discharged.

15. Notices:

Any notice, direction or instruction given under this Policy

shall be in writing and delivered by hand, post, or facsimile

to:

In case of You, at the address specified in Policy Schedule,

and in case of the Insured Person, at the Insured Person’s

address specified in the Policy Schedule.

In case of Us:

ICICI Lombard General Insurance Company Limited, ICICI

Lombard House,

414, Veer Savarkar Marg, Near Siddhi Vinayak Temple,

Prabhadevi,

Mumbai 400025, Toll-free number: 1800-2666

Notice and instructions will be deemed served 7 days after

posting or immediately upon receipt in the case of hand

delivery, facsimile or e mail.

16. Customer Service

If at any time the Insured Person (or his Nominee/ legal heir,

as the case may be) requires any clarification or assistance,

they may contact Our offices at the address specified below,

during normal business hours.

ICICI Lombard General Insurance Company Limited

ICICI Lombard House 414, Veer Savarkar Marg,

Siddhi Vinayak Temple, Prabhadevi, Mumbai 400025.

You could also call us on Toll free No: 1800 2666 or E-mail:

[email protected].

 Please inform Us immediately of any change in the

address, occupation, state of health, or of any other

changes affecting the Insured Person (or his Nominee/

legal heir, as the case may be).

VI OTHER TERMS AND CONDITIONS

1. AGE LIMIT

The age of proposer: minimum and maximum age of

entry for proposer into the Policy is 18 years and 65

years respectively

Age of insured: minimum and maximum age of entry

for an insured into the Policy is 3 months and 65 years

respectively

2. In case You choose to pay the premium in instalments,

then You shall not be able to change the frequency of

payments within the Period of Cover

3. In case You have opted for auto renewal, the Policy shall

be Renewed with the same terms and conditions

including but not limited to the Sum Insured, coverage,

premium paying terms and claim payment terms.

4. The scope of Benefit shall be worldwide unless specified

otherwise.

5. Any change in the policy terms and conditions including

but not limited to Sum Insured and/or coverage shall not

be permitted within the policy period

6. Nationality: The policy can only be opted by Indian

Nationality citizens or Non Residents of India holding an

Indian Passport & account

VII ADDITIONAL CLAUSES AVAILABLE UNDER THIS

POLICY

1. Assignment clause

It is hereby declared and agreed that upon due written consent

granted by the Proposer as stated under the head of “Proposer

name” in the Policy Schedule to the Policy:

i. Any amount becoming payable to the Insured

Person in accordance with policy terms and

conditions) including all rights, title, benefits and

interest of the Insured Person under this Policy

stand assigned in favour of the Financial Institution

(assignee) specified in the Policy Schedule of the

Policy with respect to only that Loan Account

Number, as specified in the Policy Schedule.

ii. The receipt of such amount in the manner aforesaid

by the Financial Institution (assignee) specified in

the Policy Schedule of this Policy, shall completely

discharge Us from all Our liability under the Policy

in respect of such payable amount, and this shall

be binding on the Insured Persons and their legal

heirs, executors, administrators, and successors.

iii. This is to clarify that such assignment shall be

subject to the condition that in the event of the

Insured Person’s death during the Period of Cover,

the amounts payable as per the Policy terms and

conditions will be paid to the said Financial

Institution (assignee) only to the extent of the Loan

amount outstanding, if any, and any amount in

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

excess after such payment shall be paid to the

Insured Person’s Nominee.

2. Auto Renewal Clause

a. On due consent by the Proposer We will automatically

renew the Policy for the Period of Cover as opted by the

Insured Person. However, after completing an entire auto

Renewal period on expiry of the Policy on the Policy End

Date, We shall not be bound to accept any Renewal

premium nor give notice that such Renewal premium is due.

b. Every Renewal premium shall be paid and accepted as

per the terms of Renewal specified under this Policy and

upon the distinct understanding that no alteration has taken

place in the facts contained in the Proposal and Declaration

Form herein before mentioned and that nothing is known to

the Insured Person that may result to enhance the risk of We

under the guarantee hereby given. Any change in the risk

will be intimated to Us by the Policyholder/ Insured Person.

Nothing herein or otherwise shall affect Our right to impose

any additional terms and conditions on Renewal or restrict

any Renewal terms as to premium or otherwise.

No Renewal receipt shall be valid unless it is on the printed

form of Our and signed by Our authorized official.

3. Increase/decrease in sum insured:

Sum insured can be changed (increased/ decreased)

only at the time of renewal or at any time, subject to

underwriting by the Company subject to revised proposal

form. For any increase in Sum Insurance, the waiting

period and survival period if any shall start afresh only

for the enhanced portion of the sum insured.

Annexure 1:

Major(55)

Minor(37)

Cancer and

blood

disorders(4/1)

Cancer of Specified

severity(Major

Cancer)

Early stage

cancer/Carcinoma-

in- Situ

Bone Marrow

Transplant

Aplastic Anaemia

Primary

Myelofibrosis

Heart and

Blood Vessel

(10/11)

Takayasu Arteritis

Pulmonary Artery

Graft Surgery

Refractory Heart

Failure

Cardiac Arrhythmia

with surgical

intervention(Sum

Insured capped at 5

lacs)

Eisenmenger's

Syndrome

Other Serious

Coronary Artery

Diseases

Myocardial

Infarction (First

Heart Attack - Of

Specified Severity

Insertion of a

Permanent Cardiac

Defibrillator

Cardiomyopathy of

specified severity

Complete Heart

Block or Third

Degree Heart Block

with pacemaker

Open Chest CABG

Pericardectomy

Open Heart

Replacement Or

Repair Of Heart

Valves

Balloon Valvotomy or

Valvuloplasty

Surgery Of Aorta

Angioplasty (Sum

Insured capped at 5

lacs)

Primary (Idiopathic)

Pulmonary

Hypertension

Minimally Invasive

Surgery to Aorta

Infective

Endocarditis

Pulmonary embolism

Moderately Severe

Cardiomyopathy

Major

Organs(14/12)

Systemic Lupus

Erythematous With

Renal Involvement

Severe Acquired Or

Secondary

Pulmonary Alveolar

Proteinosis (Pap)

Rheumatoid

Arthritis

Glomerulonephiritis

with Nephrotic

Syndrome

Scleroderma

Moderately Severe

Kidney Disease

Good Pastures

Syndrome With

Lung or Renal

Involvement

Moderately Severe

Systemic Lupus

Erythematous With

Lupus Nephritis

Myasthenia Gravis

Intestinal Gangrene

End Stage Lung

Failure

Portal Vein

Thrombosis

Kidney Failure

Requiring Regular

Dialysis

Surgical Removal of

One Lung

Medullary Cystic

Kidney Disease

Moderately Severe

Crohn's Disease

Fulminant Hepatitis

Moderaterly Severe

Ulcerative Colitis.

End Stage Liver

Failure

Small bowel

transplant

Major Organ

transplant

Ankylosing

Spondylytis

Severe Crohn’s

Disease

Surgical Removal of

one kidney

Severe Ulcerative

Colitis

Chronic Relapsing

Pancreatitis

Nervous

System(24/8)

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Stroke Resulting in

Permanent

Symptoms

Loss of Hearing of

One Ear

Permanent

Paralysis of Limbs

Loss Of Sight In One

Eye

Motor Neuron

Disease With

Permanent

Symptoms

Dissolution of the

nerve roots of

Brachial Plexus

Parkinson's

Disease

Syringomelia or

Syringobulbia

Requiring Surgery

Benign Brain Tumor

Carotid Artery

Surgery

Alzheimer's

Disease

Loss of Use of One

Limb

Progressive

Supranuclear Palsy

Idiopathic Scoliosis

Multiple Sclerosis

with Persisting

Symptoms

Coma 72 Hours

Creutzfeldt-Jakob

Disease

Muscular Dystrophy

Coma of Specified

Severity

Apallic Syndrome

Major Head Trauma

Guillain-Barre

Syndrome

Deafness

Loss Of Speech

Blindness

Spinal Stroke

Benign Spinal Cord

Tumour with

Neurological Deficit

Poliomyelitis

Bacterial Meningitis

Encephalitis

Tuberculousis

Meningitis

Severe Progressive

Bulbar Palsy

Other

Illness(3/5)

Third Degree Burns

Elephantiasis

Necrotising Fasciitis

Adrenalectomy for

Adrenocortical

Adenoma

Pheochromocytoma

Wilson's Disease

Optic Neuropathy

Facial

Reconstructive

Surgery due to

accident

Note:

The maximum payout against any minor Critical Illness under

any Critical illness bucket is restricted to 25% of the base cover

Sum Insured upto a maximum of 12.5lacs however for “Cardiac

Arrhythmia with surgical intervention” and “Angioplasty” the

Sum Insured is further restricted to a maximum of 5lac

Definitions:

1. Cardiomyopathy of specified severity

An impaired function of the heart muscle, unequivocally

diagnosed as Cardiomyopathy by a registered Medical

Practitioner who is a cardiologist, and which results in permanent

physical impairment to the degree of New York Heart Association

Classification Class IV, or its equivalent, based on the following

classification criteria:

Class IV - Inability to carry out any activity without discomfort.

Symptoms of congestive cardiac failure are present even at rest.

With any increase in physical activity, discomfort will be

experienced. The Diagnosis of Cardiomyopathy has to be

supported by echocardiographic findings of compromised

ventricular performance.

Irrespective of the above, Cardiomyopathy directly related to

alcohol or drug abuse is excluded.

2. Surgery of Aorta :

The actual undergoing of medically necessary major surgery for

a disease of the aorta needing excision and surgical replacement

of the diseased aorta with a graft. For the purpose of this definition

aorta shall mean the thoracic and abdominal aorta but not its

branches.

Traumatic injury of the aorta is excluded.

Surgery performed using only minimally invasive or intra-arterial

techniques are excluded.

3. Complete Heart Block or Third Degree Heart Block with

pacemaker:

A specific kind of abnormality of heart beat (arrhythmia)

characterized by complete cessation of transmission of

electrical impulses to the ventricles (lower chambers) of the

heart. The diagnosis of Complete Heart Block or Third

Degree Heart Block must be made by a cardiologist and

substantiated by findings in ECG suggestive of Complete

Heart Block or Third Degree Heart Block .The insured must

have undergone pacemaker insertion for treating Complete

Heart Block.

4. Eisenmenger's Syndrome

Development of severe pulmonary hypertension and shunt

reversal resulting from heart condition. The diagnosis must be

made by a registered Medical Practitioner who is a specialist with

echocardiography and cardiac catheterisation resulting in

permanent physical impairment to the degree of New York Heart

Association Classification Class IV, or its equivalent, based on the

following classification criteria:

Class IV - Inability to carry out any activity without discomfort.

Symptoms of congestive cardiac failure are present even at rest.

With any increase in physical activity, discomfort will be

experienced.

5. Infective Endocarditis

Inflammation of the inner lining of the heart caused by infectious

organisms, where all of the following criteria are met:

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

• Positive result of the blood culture proving presence of the

infectious organism(s);

• Presence of at least moderate heart valve incompetence

(meaning regurgitant fraction of 20% or above) or moderate heart

valve stenosis (resulting in heart valve area of 30% or less of

normal value) attributable to Infective Endocarditis; and

• The Diagnosis of Infective Endocarditis and the severity of

valvular impairment are confirmed by a registered Medical

Practitioner who is a cardiologist

6. Pulmonary Embolism

The medically necessary surgical insertion of a veno-caval filter

after there has been documented proof of recurrent pulmonary

emboli. The need for the insertion of a veno-caval filter must be

certified to be absolutely necessary by a specialist in the relevant

field.

7. Bacterial Meningitis

Bacterial infection resulting in severe inflammation of the

membranes of the brain or spinal cord resulting in significant,

irreversible and permanent neurological deficit. The neurological

deficit must persist for at least 6 weeks resulting in permanent

inability to perform three or more

Activities of Daily Living.

This diagnosis must be confirmed by:

a. The presence of bacterial infection in cerebrospinal fluid by

lumbar puncture; and

b. A consultant neurologist certifying the diagnosis of bacterial

meningitis.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an

upright chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room

on level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain

a satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

8. Encephalitis

Severe inflammation of the brain tissue due to infectious agents

like viruses or bacteria which results in significant and permanent

neurological deficits for a minimum period of 6 weeks, certified by

a specialist Medical Practitioner (Neurologist)

The permanent deficit must result in permanent inability to

perform three or more Activities of Daily Living.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room

on level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain

a satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

9. Tuberculosis Meningitis

Meningitis caused by tubercle bacilli. Such a diagnosis must

be supported by:

1) Findings in the cerebrospinal fluid (csf) report

2) Presence of acid fast bacilli in the cerebrospinal fluid or

growth of M. Tuberculosis demonstrated in the culture report

or Nucleic acid amplification tests like PCR

3) Certification by a registered doctor who is a specialist in

neurology, or a physician with a degree of MD

The condition must have resulted in irreversible and

permanent neurological deficit which persist for at least 6

weeks and resulting in permanent inability to perform three

or more Activities of Daily Living.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room

on level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain

a satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

10. Progressive Supranuclear Palsy

Confirmed by a registered doctor who is a specialist in neurology

of a definite diagnosis of progressive supranuclear palsy.

The condition must have resulted in irreversible and permanent

neurological deficit which persist for at least 6 weeks and resulting

in permanent inability to perform three or more Activities of Daily

Living.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room

on level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain

a satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

11. Fulminant Hepatitis

A sub-massive to massive necrosis of the liver by the Hepatitis

virus, leading precipitously to liver failure. This diagnosis must be

supported by all of the following:

a. Rapid decreasing of liver size;

b. Necrosis involving entire lobules, leaving only a collapsed

reticular framework;

c. Rapid deterioration of liver function tests;

d. Deepening jaundice; and

e. Hepatic encephalopathy.

Acute Hepatitis infection or carrier status alone does not meet the

diagnostic criteria.

12. Pheochromocytoma

Presence of a neuroendocrine tumour of the adrenal or extra‐

chromaffin tissue that secretes excess catecholamines requiring

the actual undergoing of surgery to remove the tumour.

The Diagnosis of Pheochromocytoma must be supported by

plasma metanephrine levels and / or urine catecholamines and

metanephrines and confirmed by a registered doctor who is an

endocrinologist.

13. Guillain Barre Syndrome:

It is a disorder in which the immune system of a person attacks

the person’s peripheral nervous system resulting in irreversible

and permanent neurological deficit which persist for at least 6

weeks and resulting in permanent inability to perform three or

more Activities of Daily Living. The diagnosis has to be confirmed

by a neurologist and substantiated by typical findings in CSF,

EMG and NC studies.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room on

level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain a

satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

14. Takayasu’s Arteritis:

It is a specific kind of arteritis and the inflammation damages the

aorta and its main branches resulting in the medically necessary

bypass surgery or aortic valve surgery. The diagnosis has to be

confirmed by a specialist medical practitioner and substantiated

by typical findings in angiography.

15. Rheumatoid Arthritis

Widespread chronic progressive joint destruction with major

deformity, where all of the following criteria are met:

 Unequivocal diagnosis of Rheumatoid Arthritis made

based on the American College of Rheumatology

criteria;

 Damage and deformity of at least 3 (three) of the following

joints: hand (metaphalangeal joints), wrist, elbow, knee,

hip, or feet (metatarsophalangeal joints). Such deformity

must be confirmed by imaging studies showing such

changes; and Disability resulting in the inability of the

Insured to perform (whether aided or unaided) at least 3

of the following 6 “Activities of Daily Living” for a

continuous period of at least 6 months.

Activities of Daily Living are defined as:

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room on

level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain a

satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

16. Ankylosing spondylitis:

It is a type of arthritis that causes inflammation between the

vertebrae and in the joints between the spine and pelvis. The

condition must have progressed to the extent of irreversible and

permanent neurological deficit which persist for at least 6 weeks

and resulting in permanent inability to perform three or more

Activities of Daily Living. The diagnosis must be made by a

specialist medical practitioner and substantiated by typical

findings in MRI.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room on

level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain a

satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

17. Intestinal Gangrene:

Death of a part or whole of the intestine due to lack of blood flow

and superimposed infection. The diagnosis must be made by a

specialist medical practitioner and substantiated by typical

findings in MRI and histopathology report.

18. Severe Crohn’s Disease

Crohn’s Disease is a chronic, transmural inflammatory disorder of

the bowel. To be considered as severe, there must be evidence

of continued inflammation in spite of optimal therapy, with all of

the following having occurred:

• Stricture formation causing intestinal obstruction requiring

admission to Hospital, and

• Fistula formation between loops of bowel, and

• At least one bowel segment resection.

The diagnosis must be made by a registered Medical

Practitioner who is a specialist Gastroenterologist and be

proven histologically on a pathology report and/or the results of

sigmoidoscopy or colonoscopy.

19. Severe ulcerative colitis

Acute fulminant ulcerative colitis with life threatening electrolyte

disturbances.

All of the following criteria must be met:

• The entire colon is affected, with severe bloody diarrhoea; and

• The necessary treatment is total colectomy and ileostomy; and

• The diagnosis must be based on histopathological features

and confirmed by a registered Medical Practitioner who is a

specialist in gastroenterology

20. Chronic Relapsing Pancreatitis

More than three attacks of pancreatitis resulting in pancreatic

dysfunction causing malabsorption needing enzyme replacement

therapy.

The Diagnosis must be made by a gastroenterologist and

confirmed by Endoscopic Retrograde Cholangio

Pancreatography (ERCP).

21. Elephantiasis

The result and complication of filariasis, characterized by massive

swelling in the tissues of the body as a result of obstructed

circulation in lymphatic vessels. Unequivocal Diagnosis of

elephantiasis must be clinically confirmed by a Specialist in the

relevant medical field, including laboratory confirmation of

microfilariae, and must be supported by our medical adviser.

The benefit does not cover Lymphoedema caused by infection

with a sexually transmitted disease, trauma, postoperative

scarring, congestive heart failure, or congenital lymphatic system

abnormalities.

22. Primary Myelofibrosis

A disorder which can cause fibrous tissue to replace the normal

bone marrow and results in severe anaemia below 10 g/dl, low

platelet count below 100,000 microL and enlarged spleen. The

condition must have progressed to the point that it is permanent,

and the severity is such that the Insured

Person requires a blood transfusion at least monthly over at least

six (6) consecutive months. The diagnosis of Primary

Myelofibrosis must be supported by bone marrow biopsy and

confirmed by a registered Medical Practitioner who is a specialist.

Secondary Myelofibrosis is excluded.

23. Carcinoma-In-Situ(Cis) / Early Stage Cancer

Carcinoma -in-situ

Carcinoma-in-situ shall mean a histologically proven, localized

pre-invasion lesion where cancer cells have not yet penetrated

the basement membrane or invaded (in the sense of infiltrating

and / or actively destroying) the surrounding tissues or stroma in

any one of the following covered organ groups, and subject to any

classification stated:

(a) breast, where the tumour is classified as Tis according to the

TNM Staging method;

(b) corpus uteri, vagina, vulva or fallopian tubes where the

tumour is classified as Tis according to the TNM Staging

method ;

(c) cervix uteri, classified as Tis according to the TNM Staging

method;

(d) ovary –include borderline ovarian tumours with intact

capsule, no tumour on the ovarian surface, classified as

T1aN0M0, T1bN0M0 (TMN Staging) or FIGO 1A, FIGO 1B

(e) Colon and rectum;

(f) Penis;

(g) Testis;

(h) Lung;

(i) Liver;

(j) Stomach and esophagus;

(k) Urinary tract, for the purpose of in-situ cancers of the

bladder, stage Ta of papillary carcinoma is included

(l) Nasopharynx

For purposes of this Policy, Carcinoma-in-situ must be confirmed

by a biopsy.

Pre-malignant lesions and Carcinoma-in-situ of any organ unless

listed above are excluded.

Early Stage Cancer

Early Stage Cancer shall mean the presence of one of the

following malignant conditions:

(i) Prostate tumour histologically described as TNM

Classification T1a or T1b or T1c or of another

equivalent or lesser classification.

(ii) Chronic lymphocytic leukaemia classified as RAI Stage I or

II;

(iii) Any malignant tumor of the thyroid, positively diagnosed with

histological confirmation and characterised by the uncontrolled

growth of malignant cells and invasion of tissue, which is

histologically classified as T1N0M0 according to the TNM

classification system, or another equivalent classification.

This benefit will be payable only when total thyroidectomy is

performed to treat this condition.

The Diagnosis must be based on histopathological features and

confirmed by a Pathologist. Pre-malignantlesions and conditions,

unless listed above, are excluded.

24. Necrotizing Fasciitis

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IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

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The occurrence of necrotising fasciitis where the following

conditions are met:

(i) the usual clinical criteria of necrotising fasciitis are met;

and

(ii) the bacteria identified is a known cause of necrotising

fasciitis; and

(iii) there is widespread destruction of muscle and other

soft tissues that results in a total and permanent loss

of function of the affected body part.

The Unequivocal Diagnosis must be made by a Specialist in the

relevant medical field.

25. Idiopathic Scoliosis

Severe Idiopathic scoliosis with spinal curvature of more than 40

(forty) degrees Cobb angle where spinal surgery is necessitated

to correct idiopathic scoliosis (of unknown cause) in order to

restore the spinal cord to a normal vertical position.

Spinal deformity caused by congenital abnormalities and

neuromusclar diseases are excluded.

26. Dissolution of the nerve roots of Brachial Plexus

Permanent loss of sensory function of the upper limb caused by

the dissolution of 2 (two) or more brachial plexus nerve roots

caused by an accident or injury. The diagnosis must be confirmed

via electrodiagnostic tests performed by a consultant neurologist.

27. Optic Neuropathy

The Unequivocal Diagnosis of optic nerve atrophy affecting both

eyes leading to a permanent best corrected visual acuity of 6/60

or less on the Snellen Chart in both eyes. The optic nerve atrophy

and quantum of visual loss of sight must be certified by a

Specialist in the relevant medical field.

Optic nerve atrophy resulting from alcohol or drug abuse will be

excluded.

28. Wilson Disease

Wilson's disease is an inherited disorder that causes copper to

accumulate in your liver, brain and other vital organs. Following

criteria must be confirmed by a relevant specialist

1. Unequivocal diagnosis of Wilson’s Disease using relevant

blood tests, eye examination and other imaging techniques

2. Treatment of Wilsons disease with a chelating agent

documented for at least six(6) months

3. Diagnosis of liver cirrhosis based on abnormal liver

biochemistry and findings of the liver biopsy or Fibroscan/USG

liver

Liver disease secondary to alcohol and drug abuse is excluded.

29. Cardiac arrhythmia with surgical intervention

Procedures like Maze surgery, RF Ablation therapy or any

relevant procedure/surgery deemed absolutely necessary by a

cardiologist to treat life threatening arrhythmias. Diagnosis must

be evidenced by monitoring through a Holter monitor, event

monitor or loop recorder and should be confirmed by a consultant

cardiologist.

The following are excluded:

 Cardio version and any other form of non-surgical

treatments

 Claim arising due to Internal Congenital Anomalies

within 1 year from the date of commencement of cover

or revival of coverage, whichever occurs later.

30. Benign Spinal Cord Tumor with Neurological Deficit

Benign spinal cord tumor is defined as a life threatening, non-

cancerous tumor of the spinal cord or its meninges. The presence

of the underlying tumor must be confirmed by imaging studies

such as CT scan or MRI.

This spinal cord tumor must result in Permanent Neurological

deficit with persisting clinical symptoms for a continuous period of

at least 90 consecutive days and must be confirmed by the

relevant medical specialist. The Neurological deficit must result in

permanent inability to perform three or more Activities of Daily

Living.

Activities of Daily Living are defined as :

a. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

b. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

c. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

d. Mobility: the ability to move indoors from room to room

on level surfaces;

e. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain

a satisfactory level of personal hygiene;

f. Feeding: the ability to feed oneself once food has been

prepared and made available.

31. Facial Reconstructive Surgery due to accident

The actual undergoing of plastic or reconstructive surgery

(restoration or reconstruction of the shape and appearance of

facial structures above the neck which are defective, missing,

damaged due to Accident happened during the policy period)

which, in the opinion of a Specialist Medical Practitioner, is

deemed Medically Necessary for the treatment of facial

disfigurement due to Injury requiring in-patient treatment and

subsequently the performance of such surgery. Surgery solely for

cosmetic reasons, isolated dental restorations, isolated nasal

fractures or isolated skin wounds are excluded.

32. Pulmonary Artery Graft Surgery

The undergoing of surgery requiring median sternotomy (surgery

to divide the breastbone) on the advice of a Cardiologist for

disease of the pulmonary artery to excise and replace the

diseased pulmonary artery with a graft.

The following conditions are excluded:

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

o Pulmonary artery graft surgery necessitated as a result of

Coronary Artery Bypass Grafting

o Pulmonary artery graft surgery necessitated as a result of Post

trauma

33. Glomerulonephiritis with Nephrotic Syndrome

Primary or Secondary glomerulonephritis with Nephrotic

Syndrome for a continuous period of six (6) months.

The nephrotic syndrome is defined by the presence of all of the

below :

 heavy proteinuria (protein excretion greater than 3.5

g/24 hours),

 hypoalbuminemia (less than 3.0 g/dL),

 peripheral edema.

The nephrotic syndrome must have continued for a period of at

least six (6) months with or without intervening periods of

remission and the life assured must have received treatment

regimen appropriate to the clinical presentation over the period of

time. Other forms of kidney disease are not covered.

34. Severe Acquired Or Secondary Pulmonary Alveolar

Proteinosis (PAP)

Pulmonary alveolar proteinosis (PAP)_ is a lung disorder

characterized by an abnormal accumulation of surfactant derived

lipoprotein compounds within the alveoli of the lung.

Only Secondary PAP is covered. The followings are excluded :

 Autoimmune PAP

 Genetic PAP / Congenital PAP

Secondary PAP must be confirmed by Certified Medical

Practitioner with evidence of the underlying cause and diagnosis

confirmed through any one of the following :

 bronchoalveolar lavage fluid (BALF) staining ,

 transbronchial lung biopsy

 video-assisted thoracoscopic lung biopsy

35. Moderately Severe Kidney Disease

It means chronic renal insufficiency which meets all of the

following criteria :

(i) Creatinine Clearance corrected for body surface area

(CCr- corrected) is lower than 30mL/min/1.73 m2 and

this abnormality has been consistently documented for

at least ninety (90) consecutive calendar days; and

(ii) Such Unequivocal Diagnosis must be confirmed by a

Medical Practitioner who is an urologist or

nephrologist.

36. Moderately Severe Systemic Lupus Erythematous With

Lupus Nephritis

Means a multisystem autoimmune disorder, characterized by the

development of auto-antibodies.

All of the following criteria must be met:

(i) Presence of at least three (3) of the below five (5)

criteria;

a. Arthritis: non-erosive arthritis, involving two (2) or

more joints;

b. Serositis: pleuritis or pericarditis;

c. Renal Disorder: persistent proteinuria > 0.5 g per

day or cellular casts;

d. Hematologic disorder: hemolytic anemia,

Leukopenia, Lymphopenia, or thrombocytopenia; or

e. Positive anti-nuclear antibody, Anti-dsDNA or anti-

Smith antibody.

(ii) Such Unequivocal Diagnosis must be confirmed by a

Medical Practitioner who is a rheumatologist or

immunologist.

37. Syringomyelia or Syringobulbia Requiring Surgery

The unequivocal diagnosis of Syringomyelia or Syringobulbia with

evidence of a fluid-filled cavity or cyst found within the spinal cord

or brainstem resulting in neurological deficit for continuous period

of 3 months or more.

The insured must have undergone surgery for treatment of

Syringomyelia or Syringobulbia and the surgery must be certified

to be Medically Necessary by the relevant Medical Practitioner.

The following is excluded:

 Congenital syringomyelia

38. Surgical removal of one lung

Complete surgical removal of the entire right or entire left lung

necessitated by an illness or an Accident of the Insured. The

surgery must be certified to be Medically Necessary by a Medical

Practitioner who is a pulmonologist or thoracic surgeon.

39. Moderately Severe Crohn's Disease

Crohn’s Disease is a chronic, transmural inflammatory disorder of

the bowel. For the purposes of this benefit, the Unequivocal

Diagnosis of Crohn's disease must be made by a Specialist in the

relevant medical field on the basis of an endoscopy and bowel

biopsy which confirms the Unequivocal Diagnosis of Crohn's

disease. The condition must require continuous

immunosuppressive treatment or continuous treatment with

immunomodulating drugs/steriod under the direction of a

Specialist in the relevant medical field for a period of at least six

(6) consecutive months

40. Moderately Severe Ulcerative Colitis

Ulcerative Colitis shall mean acute ulcerative colitis with life

threatening electrolyte disturbances usually associated with

intestinal distention and a risk of intestinal rupture. For the

purpose of Unequivocal Diagnosis, there must be biopsy

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

evidence which unequivocally confirms the presence of ulcerative

colitis and there must be imaging or endoscopic evidence that the

condition involves the entire colon.

For the purposes of this benefit, there must be a requirement for

ongoing systemic immunosuppression therapy or

immunomodulatory therapy for a period of at least six (6)

consecutive months supervised by a Specialist in

gastroenterology.

Other forms of inflammatory colitis are specifically excluded.

Ulcerative colitis confined to the rectum is specifically excluded.

41. Small Bowel Transplant

The actual undergoing of surgery to replace a diseased or

shortened small bowel (intestine) of the insured with a healthy

bowel to treat intestinal failure.

The surgery must be certified to be Medically Necessary by a

relevant Medical Practitioner.

42. Adrenalectomy for Adrenocortical Adenoma

Adrenalectomy for treatment of malignant systemic hypertension

that was secondary to an aldosterone secreting adrenal

adenoma. Malignant hypertension was uncontrolled by medical

therapy. The adrenalectomy must be considered Medically

Necessary for the management of poorly controlled hypertension

by a Specialist in the relevant medical field

43. Spinal Stroke

Death of spinal cord tissue due to inadequate blood supply or

haemorrhage within the spinal canal resulting in neurological

deficit with persisting clinical symptoms.

Evidence of

permanent neurological deficit lasting for at least 3

months has to be produced.Diagnosis has to be

confirmed by a

specialist medical practitioner and evidenced by typical clinical

symptoms as well as typical findings in CT Scan or MRI.

44. Portal Vein Thrombosis

The unequivocal diagnosis of Portal Vein Thrombosis evidenced

by the complete or partial obstruction of blood flow in the portal

vein. The diagnosis must be made by a specialist through doppler

ultrasonography, CT Scans , MRI or angiography requiring

surgical thrombectomy on an inpatient basis.

The surgery must be certified to be Medically Necessary by a

relevant Medical Practitioner.

45. Surgical Removal of One Kidney

The actual undergoing of surgical removal of one kidney due to

diseases or trauma of the kidney. The surgery must be considered

Medically Necessary by a Medical Practitioner who is a

nephrologist.

Removal of kidney as a donor or due to congenital kidney

condition including renal agenesis and non functioning kidney is

excluded

46. Severe Progressive Bulbar Palsy

Neurological disorder with paralysis in the head region, difficulties

in chewing and swallowing, problems in speaking, persistent

signs of involvement of the spinal nerves and the motor centres

in the brain and spastic weakness and atrophy of the muscles of

the extremities. The disease must be Unequivocally Diagnosed

by a Medical Practitioner who is a neurologist. The condition must

result in the permanent inability to perform, without assistance, at

least three (3) of the six (6) Activities of Daily Living. These

conditions have to be medically documented for at least three (3)

consecutive months.

The Activities of Daily Living are:

I. Washing: the ability to wash in the bath or shower

(including getting into

and out of the bath or shower) or

wash satisfactorily by other means;

II. Dressing: the ability to put on, take off, secure and

unfasten all garments

and, as appropriate, any braces,

artificial limbs or other surgical

appliances;

III. Transferring: the ability to move from a bed to an upright

chair or

wheelchair and vice versa;

IV. Mobility: the ability to move indoors from room to room on

level surfaces;

V. Toileting: the ability to use the lavatory or otherwise

manage bowel and

bladder functions so as to maintain

a satisfactory level of personal

hygiene;

VI. Feeding: the ability to feed oneself once food has

been prepared and

made available.

47. Coma 72 hours

A state of unconsciousness with no reaction or response to

external stimuli or

internal needs. This diagnosis must be

supported by evidence of all of the

following:

I. No response to external stimuli continuously for at least 72

hours;

II. Life support measures are necessary to sustain life; and

III. Permanent neurological deficit which must be assessed

at least 30 days

after the onset of the coma.

The condition has to be confirmed by a specialist medical

practitioner. Coma

resulting directly from alcohol or drug abuse is

excluded.

48. Moderately Severe Cardiomyopathy

The unequivocal Diagnosis of cardiomyopathy which has resulted

in the presence of permanent physical impairments to at least

Class III of the New York Heart Association (NYHA) classification

of Cardiac Impairment.

The Diagnosis must be confirmed by a Specialist in the relevant

field. Cardiomyopathy that is directly related to alcohol misuse is

excluded.

The NYHA Classification of Cardiac Impairment:

Class I: No limitation of physical activity. Ordinary physical activity

does not cause undue fatigue, dyspnea, or anginal pain.

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Class II: Slight limitation of physical activity. Ordinary physical

activity results in symptoms.

Class III: Marked limitation of physical activity. Comfortable at

rest, but less than ordinary activity causes symptoms.

Class IV: Unable to engage in any physical activity without

discomfort. Symptoms may be present even at rest.

49. Other Serious Coronary Artery Diseases

Severe coronary artery disease in which at least three (3) major

coronary arteries are individually occluded by a minimum of sixty

percent (60%) or more, as proven by coronary angiogram only

(non-invasive diagnostic procedures excluded).

For purposes of this definition, “major coronary artery” refers to

any of the left main stem artery, left anterior descending artery,

circumflex artery and right coronary artery (but not including their

branches).

50. Insertion of a Permanent Cardiac Defibrillator

Insertion of a permanent cardiac defibrillator as a result of

cardiac arrhythmia which cannot be treated via any other

method. The surgical procedure must be certified to be

medically necessary by a specialist in the relevant field.

Documentary evidence of cardiac arrhythmia must be

provided.

51. Pericardiectomy

The undergoing of a pericardiectomy performed by open

heart surgery or keyhole techniques as a result of pericardial

disease. The surgical procedures must be certified to be

medically necessary by a consultant cardiologist.

The following are excluded:

Other procedures on the pericardium including pericardial

biopsies and pericardial drainage procedures by needle

aspiration.

52. Balloon Valvotomy or Valvuloplasty

The actual undergoing of Valvotomy or Valvuloplasty

necessitated by damage of the heart valve as confirmed by a

specialist in the relevant field and established by a cardiac

echocardiogram or any other appropriate diagnostic test that

is available.

The following are excluded:

Procedures done for treatment of Congenital Heart Disease

within 4 years from the date of commencement of cover or

revival of coverage, whichever occurs later.

53. Minimally Invasive Surgery to Aorta

The actual undergoing of minimally invasive surgical repair

(i.e. via percutaneous intra-arterial route) of a diseased

portion of an aorta to repair or correct an aneurysm,

narrowing, obstruction or dissection of the aorta. For the

purpose of this definition, aorta shall mean the thoracic and

abdominal aorta but not its branches.

The following are excluded:

Claim arising due to Internal Congenital Anomalies

within 4 years from the date of commencement of cover

or revival of coverage, whichever occurs later.

54. Loss of Hearing of One Ear

Total and irreversible loss of hearing in one ear as a result of

illness or accident. This diagnosis must be supported by pure tone

audiogram test and certified by an Ear, Nose and Throat (ENT)

specialist.

Total means “the loss of hearing to the extent that the loss is

greater than 90decibels across all

frequencies of hearing” in one ear.

55. Loss Of Sight In One Eye

Total, permanent and irreversible loss of all vision in one eye as

a result of illness or accident.

The Blindness is evidenced by:

I. corrected visual acuity being 3/60 or less in one eye

or;

II. the field of vision being less than 10 degrees in one

eye.

The diagnosis of blindness must be confirmed and must not be

correctable by aids or surgical procedure.

56. Carotid Artery Surgery

The actual undergoing of surgery to the Carotid Artery to treat

carotid artery stenosis of fifty percent (50%) or above, as proven

by angiographic evidence, of one (1) or more carotid arteries.

Both criteria (a) and (b) below must be met:

a) Either:

i). Actual undergoing of endarterectomy to alleviate the

symptoms; or

ii). Actual undergoing of an endovascular intervention

such as angioplasty and/or stenting or atherectomy to

alleviate the symptoms; and

b) The Diagnosis and medical necessity of the treatment must be

confirmed by a Registered Medical Practitioner who is a specialist

in the relevant field.

57. Loss of Use of One Limb

Total and irreversible loss of use of one or more limbs as a result

of injury or disease of the brain or spinal cord. A specialist medical

practitioner must be of the opinion that the paralysis will be

permanent with no hope of recovery and must be present for more

than 3 months.

58. MYOCARDIAL INFARCTION (First Heart Attack of

specific severity)

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I. The first occurrence of heart attack or myocardial

infarction, which means the death of a portion of the heart

muscle as a result of inadequate blood supply to the

relevant area.

The diagnosis for Myocardial Infarction should be

evidenced by all of the following criteria:

1. A history of typical clinical symptoms consistent

with the diagnosis of acute myocardial infarction

(For e.g. typical chest pain)

2. New characteristic electrocardiogram changes

3. Elevation of infarction specific enzymes, Troponins

or other specific biochemical markers.

II. The following are excluded:

1. Other acute Coronary Syndromes

2. Any type of angina pectoris

3. A rise in cardiac biomarkers or Troponin T or I in

absence of overt ischemic heart disease OR

following an intra-arterial cardiac procedure.

59. REFRACTORY HEART FAILURE

Refractory heart failure is defined as a systolic dysfunction

that does not respond to optimal medical therapy (“triple

therapy”) and results in permanent physical impairment to

the degree of New York Heart Association Classification

Class IV, or its equivalent, for at least six months. The

diagnosis of refractory heart failure has to be supported by

echocardiographic findings of compromised ventricular

performance. The diagnosis must be made by a cardiology

specialist.

The following is excluded:

1. Reversible causes of heart failure such as

hypocalcemia, alcohol abuse, thyroid, anaemia.

60. END STAGE LUNG FAILURE

I. End stage lung disease, causing chronic respiratory

failure, as confirmed and evidenced by all of the

following:

1. FEV1 test results consistently less than 1 litre

measured on 3 occasions 3 months apart; and

2. Requiring continuous permanent supplementary

oxygen therapy for hypoxemia; and

3. Arterial blood gas analysis with partial oxygen

pressure of 55mmHg or less (PaO2 < 55mmHg);

and

4. Dyspnoea at rest.

61. PRIMARY (IDIOPATHIC) PULMONARY HYPERTENSION

I. An unequivocal diagnosis of Primary (Idiopathic)

Pulmonary Hypertension by a Cardiologist or specialist

in respiratory medicine with evidence of right ventricular

enlargement and the pulmonary artery pressure above

30 mm of Hg on Cardiac Cauterization. There must be

permanent irreversible physical impairment to the

degree of at least Class IV of the New York Heart

Association Classification of cardiac impairment.

II. The NYHA Classification of Cardiac Impairment are as

follows:

1. Class III: Marked limitation of physical activity.

Comfortable at rest, but less than ordinary activity

causes symptoms.

2. Class IV: Unable to engage in any physical activity

without discomfort. Symptoms may be present

even at rest.

III. Pulmonary hypertension associated with lung disease,

chronic hypoventilation, pulmonary thromboembolic

disease, drugs and toxins, diseases of the left side of the

heart, congenital heart disease and any secondary

cause are specifically excluded

62. END STAGE LIVER FAILURE

I. Permanent and irreversible failure of liver function that

has resulted in all three of the following:

1. Permanent jaundice; and

2. Ascites; and

3. Hepatic encephalopathy.

II. Liver failure secondary to drug or alcohol abuse is

excluded.

63. MULTIPLE SCLEROSIS WITH PERSISTING SYMPTOMS

I. The unequivocal diagnosis of Definite Multiple Sclerosis

confirmed and evidenced by all of the following:

1. Investigations including typical MRI findings which

unequivocally confirm the diagnosis to be multiple

sclerosis and

2. There must be current clinical impairment of motor

or sensory function, which must have persisted for

a continuous period of at least 6 months.

II. Other causes of neurological damage such as SLE and

HIV are excluded.

64. MOTOR NEURON DISEASE WITH PERMANENT

SYMPTOMS

I. Motor neuron disease diagnosed by a specialist medical

practitioner as spinal muscular atrophy, progressive bulbar

palsy, amyotrophic lateral sclerosis or primary lateral

sclerosis. There must be progressive degeneration of

corticospinal tracts and anterior horn cells or bulbar

efferent neurons. There must be current significant and

permanent functional neurological impairment with

objective evidence of motor dysfunction that has persisted

for a continuous period of at least 3 months.

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Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

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65. PERMANENT PARALYSIS OF LIMBS

Total and irreversible loss of use of two or more limbs as

a result of injury or disease of the brain or spinal cord. A

specialist medical practitioner must be of the opinion that

the paralysis will be permanent with no hope of recovery

and must be present for more than 3 months.

66. STROKE RESULTING IN PERMANENT SYMPTOMS

I. Any cerebrovascular incident producing permanent

neurological sequelae. This includes infarction of brain

tissue, thrombosis in an intracranial vessel, haemorrhage

and embolisation from an extracranial source. Diagnosis

has to be confirmed by a specialist medical practitioner

and evidenced by typical clinical symptoms as well as

typical findings in CT Scan or MRI of the brain. Evidence

of permanent neurological deficit lasting for at least 3

months has to be produced.

II. The following are excluded:

1. Transient ischemic attacks (TIA)

2. Traumatic injury of the brain

3. Vascular disease affecting only the eye or optic

nerve or vestibular functions.

67. COMA OF SPECIFIED SEVERITY

I. A state of unconsciousness with no reaction or response

to external stimuli or internal needs. This diagnosis must

be supported by evidence of all of the following:

1. No response to external stimuli continuously for at

least 96 hours;

2. Life support measures are necessary to sustain life;

and

3. Permanent neurological deficit which must be

assessed at least 30 days after the onset of the

coma.

II. The condition has to be confirmed by a specialist medical

practitioner. Coma resulting directly from alcohol or drug

abuse is excluded.

68. ALZEIMER’S DISEASE

Progressive and permanent deterioration of memory and

intellectual capacity as evidenced by accepted standardised

questionnaires and cerebral imaging.

The diagnosis of Alzheimer’s Disease must be confirmed by

an appropriate consultant and supported by a Medical

Practitioner appointed by Us. There must be significant

reduction in mental and social functioning requiring the

continuous supervision of the Insured Person. There must

also be an inability of the Insured Person to perform

(whether aided or unaided) at least three of the Activities of

Daily Living, for a continuous period of at least 3 months:

For the purpose of this clause, Activities of Daily Living are

defined as:

1. Washing – the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

2. Dressing – the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

3. Transferring – the ability to move from a bed to an

upright chair or wheelchair and vice versa;

4. Toileting – the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain

a satisfactory level of personal hygiene;

5. Feeding – the ability to feed oneself once food has

been prepared and made available.

6. Mobility - the ability to move from room to room without

requiring any physical assistance.

The following are excluded:

• Any other type of irreversible organic

disorder/dementia

• Alcohol-related brain damage.

69. PARKINSON’S DISEASE

I. The occurrence of Parkinson’s Disease where there is an

associated Neurological Deficit that results in permanent inability

to perform independently at least three of the Activities of Daily

Living, for a continuous period of at least 3 months:

For the purpose of this clause, Activities of Daily Living are

defined as:

1. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means

2. Dressing: the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

3. Transferring: the ability to move from a bed to an upright

chair or wheelchair and vice versa;

4. Mobility: the ability to move indoors from room to room on

level surfaces;

5. Toileting: the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain a

satisfactory level of personal hygiene;

6. Feeding: the ability to feed oneself once food has been

prepared and made available.

The following is excluded:

Parkinson’s Disease accompanied with drug and/or alcohol

abuse.

70. APALLIC SYNDROME

Universal non-functioning of the brain cortex, with the brain

stem intact. Diagnosis of Apallic Syndrome must be

definitely confirmed by a registered Medical Practitioner who

is also a neurologist and substantiated by clinical and

investigation findings. This condition must be documented

for a continuous period of at least one month.

ICICI Lombard General Insurance Company Limited

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71. BENIGN BRAIN TUMOR

I. Benign brain tumor is defined as a life threatening, non-

cancerous tumor in the brain, cranial nerves or meninges

within the skull. The presence of the underlying tumor

must be confirmed by imaging studies such as CT scan

or MRI.

II. This brain tumor must result in at least one of the

following and must be confirmed by the relevant medical

specialist.

1. Permanent Neurological deficit with persisting

clinical symptoms for a continuous period of at least

90 consecutive days or

2. Undergone surgical resection or radiation therapy

to treat the brain tumor.

III. The following conditions are excluded:

Cysts, Granulomas, malformations in the arteries or

veins of the brain, hematomas, abscesses, pituitary

tumors, tumors of skull bones and tumors of the spinal

cord.

72. CREUTZFELDT-JAKOB DISEASE (CJD)

A diagnosis of Creutzfeldt Jakob Disease must be made by

a specialist Medical Practitioner who is a neurologist and the

diagnosis must be substantiated by CSF examination, EEG,

CT Brain and MRI of the brain. There must be permanent

clinical loss of the ability in mental, physical and social

functioning for a minimum period of 30 days to the extent

that permanent supervision or assistance by a third party is

required.

73. MAJOR HEAD TRAUMA

I. Accidental head injury resulting in permanent

Neurological deficit to be assessed no sooner than 3

months from the date of the accident. This diagnosis must

be supported by unequivocal findings on Magnetic

Resonance Imaging, Computerized Tomography, or other

reliable imaging techniques. The accident must be caused

solely and directly by accidental, violent, external and

visible means and independently of all other causes

II. The Accidental Head injury must result in an inability to

perform at least three (3) of the following Activities of Daily

Living either with or without the use of mechanical

equipment, special devices or other aids and adaptations

in use for disabled persons. For the purpose of this Benefit,

the word “permanent” shall mean beyond the scope of

recovery with current medical knowledge and technology.

III. The Activities of Daily Living are:

I. Washing: the ability to wash in the bath or shower

(including getting into and out of the bath or

shower) or wash satisfactorily by other means;

II. Dressing: the ability to put on, take off, secure

and unfasten all garments and, as appropriate,

any braces, artificial limbs or other surgical

appliances;

III. Transferring: the ability to move from a bed to an

upright chair or wheelchair and vice versa;

IV. Mobility: the ability to move indoors from room to

room on level surfaces;

V. Toileting: the ability to use the lavatory or

otherwise manage bowel and bladder functions

so as to maintain a satisfactory level of personal

hygiene;

VI. Feeding: the ability to feed oneself once food has

been prepared and made available.

IV. The following are excluded:

i. Spinal cord injury;

74. KIDNEY FAILURE REQUIRING REGULAR DIALYSIS

I. End stage renal disease presenting as chronic irreversible

failure of both kidneys to function, as a result of which

either regular renal dialysis (haemodialysis or peritoneal

dialysis) is instituted or renal transplantation is carried out.

Diagnosis has to be confirmed by a specialist medical

practitioner.

75. MEDULLARY CYSTIC DISEASE

I. Medullary Cystic Disease where the following criteria are

met:

i. The presence in the kidney of multiple cysts in the

renal medulla accompanied by the presence of

tubular atrophy and interstitial fibrosis;

ii. Clinical manifestations of anaemia, polyuria, and

progressive deterioration in kidney function; and

iii. The diagnosis of Medullary Cystic Disease is

confirmed by renal biopsy along with specialist

Medical Practitioner opinion.

II. The following are excluded

i. Isolated or benign kidney cysts are specifically

excluded from this Benefit

ii. Any condition is which cysts are absent

76. MUSCULAR DYSTROPHY

Diagnosis of muscular dystrophy by a registered Medical

Practitioner who is a neurologist based on the presence of

following conditions:

1. Clinical presentation including weakness and loss of

muscle mass, absence of sensory disturbance, normal

cerebrospinal fluid and mild tendon reflex reduction;

2. Characteristic electromyogram

3. Clinical suspicion confirmed by muscle biopsy.

The condition must result in the inability of the Insured Person

to perform (whether aided or unaided) at least three of the

Activities of Daily Living, for a continuous period of at least 6

months.

For the purpose of this clause, Activities of Daily Living are

defined as:

1. Washing – the ability to wash in the bath or shower

(including getting into and out of the bath or shower) or

wash satisfactorily by other means;

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

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2. Dressing – the ability to put on, take off, secure and

unfasten all garments and, as appropriate, any braces,

artificial limbs or other surgical appliances;

3. Transferring – the ability to move from a bed to an upright

chair or wheelchair and vice versa;

4. Toileting – the ability to use the lavatory or otherwise

manage bowel and bladder functions so as to maintain a

satisfactory level of personal hygiene;

5. Feeding – the ability to feed oneself once food has been

prepared and made available.

6. Mobility - the ability to move from room to room without

requiring any physical assistance

77. POLIOMYELITIS

The occurrence of Poliomyelitis, where the following

conditions are met:

I. Poliovirus is identified as the cause through

laboratory investigation

II. Paralysis of the limb muscles or respiratory

muscles must be present and persist for at least

3 months.

The diagnosis of Poliomyelitis must be confirmed by a

registered Medical Practitioner who is a neurologist.

78. APLASTIC ANEMIA

Irreversible persistent bone marrow failure which results in

anaemia, neutropenia and thrombocytopenia requiring

treatment with at least two (2) of the following:

1. Blood product transfusion;

2. Marrow stimulating agents;

3. Immunosuppressive agents; or

4. Bone marrow transplantation.

The diagnosis of Aplastic anaemia must be confirmed by a

bone marrow biopsy. Atleast two of the following values

should be present:

1. Absolute Neutrophil count of 500 per cubic

millimetre or less;

2. Absolute Reticulocyte count of 20,000 per cubic

millimetre or less; and

3. Platelet count of 20,000 per cubic millimetre or less.

79. Systemic lupus erythematosus (SLE) with renal

involvement

I. Multi-system, autoimmune disorder characterized by the

development of auto-antibodies, directed against various

self-antigens. For purposes of the definition of “SLE”

under this policy is restricted to only those forms of

systemic lupus erythematosus, which involve the

kidneys and are characterized as Class III, Class IV,

Class V or Class VI lupus nephritis under the

Abbreviated International Society of Nephrology/Renal

Pathology Society (ISN/RPS) classification of lupus

nephritis (2003) below based on renal biopsy.

Diagnosis by a nephrologist, supported by renal biopsy

report is mandatory. There must be positive antinuclear

antibody test

II. The following are excluded

i. Other forms such as discoid lupus, and those forms

with only hematological and joint involvement are

specifically excluded.

ii. Class I - Minimal mesangial lupus nephritis

iii. Class II - Mesangial proliferative lupus nephritis

80. MYASTHENIA GRAVIS

I. An acquired autoimmune disorder of neuromuscular

transmission leading to fluctuating muscle weakness

and fatigability, where all of the following criteria are met:

1. Presence of permanent muscle weakness

categorized as Class IV or V according to the

Myasthenia Gravis Foundation of America Clinical

Classification below; and

2. The diagnosis of Myasthenia Gravis and

categorization are confirmed by a registered

Medical Practitioner who is a neurologist.

Myasthenia Gravis Foundation of America Clinical

Classification is as follows:

Class I: Any eye muscle weakness, possible ptosis, no

other evidence of muscle weakness elsewhere.

Class II: Eye muscle weakness of any severity, mild

weakness of other muscles.

Class III: Eye muscle weakness of any severity,

moderate weakness of other muscles.

Class IV: Eye muscle weakness of any severity, severe

weakness of other muscles.

Class V: Intubation needed to maintain airway.

II. The following are excluded:

1. Congenital myasthenic syndrome

2. Transient neonatal or juvenile myasthenia gravis

81. SCLERODERMA

A systemic collagen-vascular Illness causing progressive

diffuse fibrosis in the skin, blood vessels and visceral

organs. This diagnosis must be unequivocally supported by

biopsy and serological evidence and the disorder must have

reached systemic proportions to involve the heart, lungs or

kidneys.

The following conditions are excluded:

1. Localised scleroderma (linear scleroderma or

morphea);

2. Eosinophilic fascitis; and

3. CREST syndrome.

82. GOOD PASTURES SYNDROME with lung or renal

involvement

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Goodpastures Syndrome is an autoimmune disease in

which antibodies attack the lungs and kidneys, leading to

permanent lung and kidney damage. The permanent

damage should be for continuous period of at least 30 days.

The diagnosis must be proven by kidney biopsy and

confirmed by a specialist Medical Practitioner who is a

rheumatologist.

83. BLINDNESS

I. Total, permanent and irreversible loss of all vision in both

eyes as a result of illness or accident.

II. The Blindness is evidenced by:

1. Corrected visual acuity being 3/60 or less in both

eyes or ;

2. The field of vision being less than 10 degrees in

both eyes.

III. The diagnosis of blindness must be confirmed and must

not be correctable by aids or surgical procedure.

84. DEAFNESS

I. Total and irreversible loss of hearing in both ears as a

result of illness or accident. This diagnosis must be

supported by pure tone audiogram test and certified by

an Ear, Nose and Throat (ENT) specialist. Total means

“the loss of hearing to the extent that the loss is greater

than 90 decibels across all frequencies of hearing” in

both ears.

85. CANCER OF SPECIFIED SEVERITY

I. A malignant tumor characterized by the uncontrolled

growth and spread of malignant cells with invasion and

destruction of normal tissues. This diagnosis must be

supported by histological evidence of malignancy. The term

cancer includes leukemia, lymphoma and sarcoma.

II. The following are excluded –

1. All tumors which are histologically described as

carcinoma in situ, benign, pre-malignant,

borderline malignant, low malignant potential,

neoplasm of unknown behaviour, or non-invasive,

including but not limited to: Carcinoma in situ of

breasts, Cervical dysplasia CIN-1, CIN -2 and CIN-

3.

2. Any non-melanoma skin carcinoma unless there is

evidence of metastases to lymph nodes or beyond;

3. Malignant melanoma that has not caused invasion

beyond the epidermis;

4. All tumors of the prostate unless histologically

classified as having a Gleason score greater than

6 or having progressed to at least clinical TNM

classification T2N0M0

5. All Thyroid cancers histologically classified as

T1N0M0 (TNM Classification) or below;

6. Chronic lymphocytic leukaemia less than RAI stage

3

7. Non-invasive papillary cancer of the bladder

histologically described as TaN0M0 or of a lesser

classification,

8. All Gastro-Intestinal Stromal Tumors histologically

classified as T1N0M0 (TNM Classification) or

below and with mitotic count of less than or equal

to 5/50 HPFs;

9. All tumors in the presence of HIV infection.

86. THIRD DEGREE BURNS

There must be third-degree burns with scarring that cover at

least 20% of the body’s surface area. The diagnosis must

confirm the total area involved using standardized, clinically

accepted, body surface area charts covering 20% of the

body surface area.

87. LOSS OF SPEECH

I. Total and irrecoverable loss of the ability to speak as a

result of injury or disease to the vocal cords. The inability

to speak must be established for a continuous period of

12 months. This diagnosis must be supported by medical

evidence furnished by an Ear, Nose, throat (ENT)

specialist.

II. All psychiatric related causes are excluded.

88. OPEN HEART REPLACEMENT OR REPAIR OF HEART

VALVES

I. The actual undergoing of open-heart valve surgery is to replace

or repair one or more heart valves, as a consequence of defects

in, abnormalities of, or disease affected cardiac valve(s). The

diagnosis of the valve abnormality must be supported by an

echocardiography and the realization of surgery has to be

confirmed by a specialist medical practitioner. Catheter based

techniques including but not limited to, balloon

valvotomy/valvuloplasty are excluded.

89. Major Organ Transplant

I. The actual undergoing of a transplant of:

i. One of the following human organs: heart, lung, liver, kidney,

pancreas, that resulted from irreversible end-stage failure of the

relevant organ,

II. The following are excluded:.

i. Where only islets of Langerhans are transplanted.

90. BONE MARROW TRANSPLANT

The actual undergoing of a transplant of:

Human bone marrow using haematopoietic stem cells. The

undergoing of a transplant has to be confirmed by a specialist

medical practitioner.

II. The following are excluded:

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

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Other stem-cell transplants

91. OPEN CHEST CABG

I. The actual undergoing of heart surgery to correct blockage or

narrowing in one or more coronary artery(s), by coronary artery

bypass grafting done via a sternotomy (cutting through the breast

bone) or minimally invasive keyhole coronary artery bypass

procedures. The diagnosis must be supported by a coronary

angiography and the realization of surgery has to be confirmed by

a cardiologist.

II. The following are excluded:

I. Angioplasty and/or any other intra-arterial procedures

92. Angioplasty

I. Coronary Angioplasty is defined as percutaneous coronary

intervention by way of balloon angioplasty with or without

stenting for treatment of the narrowing or blockage of

minimum 50 % of one or more major coronary arteries. The

intervention must be determined to be medically necessary

by a cardiologist and supported by a coronary angiogram

(CAG)

II. Coronary arteries herein refer to left main stem, left anterior

descending, circumflex and right coronary artery.

III. Diagnostic angiography or investigation procedures

without angioplasty/stent insertion are excluded.

Annexure 2

Final Major Surgical Procedures List

Payout

Open Heart Replacement Or Repair Of Heart

Valves

100%

Valvotomy/Valvuloplasty

50%

CABG (Coronary Artery Bypass Grafting)

100%

Other vascular bypass grafts( eg. Femoral

popliteal grafts)

50%

Clipping or repair of Aneurysm(including aortic,

cerebral, femoral or iliac ) with or without graft

50%

Coronary Angioplasty with Stent implantation

50% -inr

5lac

which

ever

lower

Excision of benign mediastinal lesions (evidence

of thoracotomy needs to be ascertained)

50%

Heart Proximal aortic aneurysm, Aortic root

transplantation with coronary artery

reimplantation

50%

Initial implantation of permanent

pacemaker/ICD/VAD device in heart

50%

Major Surgery of Aorta

100%

Major vein repair with or without grafting for

traumatic & non traumatic lesions

50%

Pericardiotomy / Pericardectomy

50%

Carotid endarterectomy/ Ext carotid Int. carotid

bypass/Carotid tumour excision

50%

Closure Of Semilunar Valve

50%

Minimally Invasive Surgery to Aorta

50%

Pulmonarry Artery Graft

50%

Cardiac Arrhythmia with Ablative Procedure

50%-

capping

of 5lac

Hemicolectomy

50%

Partial Gastrectomy

50%

Complete Gastrectomy

100%

Partial Eosophagectomy

50%

Complete Eosophagectomy

100%

Pancrepancreaticoduodenectomy- Whipples

surgery

100%

Partial Hepatectomy

50%

Complete Hepatectomy

100%

Partial splenectomy

50%

Complete splenectomy

100%

small bowel transplant

50%

Resection/anastamosis for small intestine

50%

Partial Pancreatectomy

50%

Complete Pancreatectomy

100%

Amputation of arm

100%

Amputation of foot

100%

Amputation of hand

100%

Amputation of leg

100%

Excision reconstruction of joint(small joints-hand

& feet)

50%-cap

of 2lac

microvascular replantation of finger due to trauma

50%-cap

of 2lac

Implantation of prosthesis for limb for amputees

100%

Open/closed Reduction and Internal fixation of

fracture Long bone (Humerus, Radius, ulna,

Femur, Tibia, Fibula, clavicle) with or without

Bone grafting-

50%-cap

3lac

Osteomyelitis - Surgical Drainage and Curettage

50%-cap

of 2lac

core decompression with graft for osteonecrosis

of femoral head

50%

Replantation of lower limb

100%

Replantation of upper limb

100%

Spinal Fusion (arthrodesis of spine with bone

graft/internal fixation)

50%

Therapeutic endoscopic operations on cavity of

knee/hip joint

50%-cap

of 2lac

Therapeutic endoscopic operations on cavity of

Shoulder/elbow joint

50%-cap

of 2lac

ACL/PCL repair/reconstruction

50%-cap

of 2lac

Total replacement of

hip/knee/shoulder/elbow/head of femur/head of

humerus-unilateral

50%

reconstruction or arthroplasty of

hip/knee/shoulder/elbow/head of femur/head of

humerus(unilateral/bilateral)

50%

ICICI Lombard General Insurance Company Limited

IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22131V012122 ICICI Lombard Criti Shield Plus

Mailing Address: Registered Office Address: Toll free no : 1800 2666

601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Marg, Alternate no : 86552 22666 (chargeable)

New Linking Road, Malad (West) Near Siddhi Vinayak Temple, Prabhadevi, E-mail : customersupport@icicilombard.com

Mumbai - 400 064 Mumbai 400 025 Website : www.icicilombard.com

Total replacement of

hip/knee/shoulder/elbow/head of femur/head of

humerus-bilateral

100%

HIND QUARTER AMPUTATION

100%

Open Reduction And Internal Fixation Of

Fracture Of Small Bones /patella With Or Without

Graft

50%-cap

to 1lac

Prosthetic Replacement of small joints

50%-cap

to 2lac

Multiple (more than 2)Tendon Transfer - Sts Hand

/ Foot

50%

Surgery for Idiopathic Scoilosis

50%

Bur-hole Drainage of Extradural, subdural or

intracerebral space

50%

Craniotomy for non malignant space occupying

lesions

100%

Craniotomy for Drainage of Extradural, subdural

or intracerebral space

100%

Craniotomy for malignant Brain tumors

100%

Decompression surgery for Entrapment

Syndrome

100%

Embolectomy / Thrombectomy/ Endarterectomy

with or without Graft

100%

Excision of deep seated peripheral nerve tumor

100%

Excision of pineal gland

100%

Fixation of fracture of spine

100%

Free Fascia Graft for Facial Nerve Paralysis

50%

Intracranial transection of Cranial nerve

100%

Laminectomy/Discectomy for Spinal nerve root

decompression

100%

Microvascular decompression of cranial

nerves/nervectomy

100%

Multiple Microsurgical Repair of digital nerve

100%

Operations on Subarachnoid space of brain

100%

Other operations on the meninges of the Brain

100%

Peripheral nerve Graft

100%

Repair of Cerebral or Spinal Arterio- Venous

Malformations or aneurysms

100%

Total or Partial Excision of the pituitary gland - Any

approach (Transforntal or Trans Sphenoid)

100%

Surgery for ACOUSTIC NEUROMA

50%

Brachial Plexus Surgery

50%

neuro endoscopy for removal of brain tumor/

foreign body

50%

STA MCA BYPASS SURGERY

50%

SYMPATHECTOMY

CERVICAL/LUMBAR/THORACOLUMBAR

50%

Bone Marrow transplant (as recipient)

100%

Heart/Heart-Lung Transplant

100%

Liver Transplantation

100%

Lung Transplantation

100%

Renal transplant (recipient)

100%

Pancrease Transplant

100%

Major reconstructive oro-maxillafacial surgery due

to trauma or burns and not for cosmetic purpose

100%

Osteotomy including segmental resection with

bone grafting for Mandibular and maxillary lesions

100%

Commando Operation-for only cancer

100%

Total Larygectomy And Neck Dissection And

Flap-only for cancer

100%

Excision and Major Flap Repair of skin and

Subcutaneous tissue due to Major Burns

100%

Surgical treatment of cancer with removal of

organ & excluding biopsy & other diagnostics

100%

Surgical removal of an eye ball

50%

Surgical treatment of cancer without removal of

organ excluding biopsy & other diagnostics

50%

THYMECTOMY

50%

Amputation of penis

50%

Excision of ureter

50%

Total excision of bladder

50%

Partial nephrectomy due to medical advice (not

as a transplant donor)

50%

Total nephrectomy due to medical advice (not as

a transplant donor)

100%

Bilateral excision of testes

50%

Urinary diversion

50%

Adrenelectomy

50%

Pneumonectomy/Lobectomy/removal of 1 lung

50%

Pleurectomy/lung decortication

50%

Chronic bronchopleural fistula requiring a surgical

procedure for closure of the fistula through an

open thoracotomy

50%

pulmonary embolectomy/enderectomy

50%