Policy review · ICICI Lombard
Complete Health Insurance (Health Elite)
ICICI Lombard's individual plan, reviewed on the clauses that actually decide your claim — room rent, co-pay, sub-limits, waiting periods and the insurer's claims record.
InsuranceScope score
3.8
★★★★☆
The verdict
Complete Health Insurance (Health Elite) is an individual health insurance plan from ICICI Lombard. It stands out for no room-rent cap, no co-payment and built-in restoration. On the downside, disease-wise sub-limits apply on some treatments — worth weighing before you buy. On the insurer side, it reports 82.79% of claims settled by count and a 10,700+ cashless hospital network.
Where it wins
No room-rent cap — you can be admitted to any room category without a proportionate deduction on the rest of your bill.Standout
No co-payment — the insurer pays the full approved claim, with nothing deducted as your share.
Restoration is included — the sum insured refills once in a policy year for related illness. unlimited times for unrelated illness, triggered on partial exhaustion of sum insured, for a unrelated illness (available after 45 days for related illness).
Cover grows by 10% for each claim-free year, up to 100% of the base sum insured.
Modern treatments such as robotic surgery and other advanced procedures are covered, usually up to a specified limit.
Day-care procedures that take under 24 hours — cataract, dialysis, chemotherapy and similar — are covered.
Where it stings
Disease-wise sub-limits apply — some treatments are capped below your sum insured, so verify the caps for conditions like cataract or joint replacement.
Premium positioning is on the expensive side of the market.
Waiting periods
No cover in this window except for accidental hospitalisation.
Named conditions such as cataract, hernia and joint replacements wait this long.
Conditions you already have are covered only after this period.
Claims snapshot
ICICI Lombard, latest IRDAI disclosure year — how the insurer behind the plan actually performs.
Approved by number of claims.
Claims paid vs premium collected.
How quickly claims are paid.
On overall claims — lower is better.
Key features
No limit — you can pick any room category without a proportionate cut on the rest of your bill.
No separate cap on ICU charges.
None — the insurer bears the full approved claim.
Applies — certain treatments are capped below the sum insured.
The sum insured refills once in a policy year for related illness. unlimited times for unrelated illness, triggered on partial exhaustion of sum insured, for a unrelated illness (available after 45 days for related illness).
Cover grows by 10% for each claim-free year, up to 100% of the base sum insured.
Pre-hospitalisation 30 days and post-hospitalisation 60 days of connected medical costs are covered.
Procedures under 24 hours, such as cataract and dialysis, are covered.
Advanced procedures like robotic and laser surgery are covered, usually up to a limit.
Non-medical items like gloves, syringes and PPE are paid, not deducted.
At-home treatment is covered when hospital admission is not possible.
Common exclusions
Typical across most Indian health plans — always confirm the exact exclusions in Complete Health Insurance (Health Elite)'s policy wording.
Cosmetic or aesthetic treatment, unless needed to reconstruct after an accident or burns.
Self-inflicted injuries and conditions arising from alcohol or substance abuse.
Treatment arising from war, nuclear or allied perils.
Admissions purely for investigation, evaluation or bed rest with no active treatment.
Unproven or experimental treatments not backed by established medical practice.
Frequently asked questions
No. Complete Health Insurance (Health Elite) does not require a co-payment under the base cover.
No. Complete Health Insurance (Health Elite) has no room rent cap for standard hospitalisation, so you can choose any room without a proportionate cut.
2. Claims for conditions you already had are covered only after this waiting period.
Yes. Complete Health Insurance (Health Elite) refills the sum insured after it is exhausted (once in a policy year for related illness. unlimited times for unrelated illness).
Yes. Complete Health Insurance (Health Elite) covers day care procedures that take under 24 hours, such as cataract surgery or dialysis.
10,700+ cashless network hospitals are reported for Complete Health Insurance (Health Elite), where the insurer settles bills directly.
Yes. Complete Health Insurance (Health Elite) covers modern treatments such as robotic surgery, usually up to a specified limit.