Policy review · ICICI Lombard
MaxProtect (Premium)
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
3.7
★★★★☆
The verdict
MaxProtect (Premium) is an individual health insurance plan from ICICI Lombard. It stands out for no room-rent cap, no co-payment and no disease sub-limits. 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.
No disease-wise sub-limits — covered treatments are paid up to your full sum insured rather than a smaller per-illness cap.
Restoration is included — the sum insured refills unlimited times in a policy year, triggered on partial exhaustion of sum insured, for a unrelated illness (after 45 days for related illness\u002fcomplications).
Cover grows by 20% for each claim-free year, up to 100% of the base sum insured.
Consumables like gloves, syringes and PPE are paid rather than deducted from your claim at discharge.
Where it stings
No major red flags in the data — still, confirm add-on pricing and fine print before you buy.
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.
None — treatments are paid up to your full sum insured.
The sum insured refills unlimited times in a policy year, triggered on partial exhaustion of sum insured, for a unrelated illness (after 45 days for related illness\u002fcomplications).
Cover grows by 20% for each claim-free year, up to 100% of the base sum insured.
Pre-hospitalisation 60 days and post-hospitalisation 180 days of connected medical costs are covered.
Non-medical items like gloves, syringes and PPE are paid, not deducted.
Donor hospitalisation costs are covered (Yes).
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 MaxProtect (Premium)'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. MaxProtect (Premium) does not require a co-payment under the base cover.
No. MaxProtect (Premium) 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. MaxProtect (Premium) refills the sum insured after it is exhausted (unlimited times in a policy year).
Day care procedures are not listed as covered under MaxProtect (Premium).
10,700+ cashless network hospitals are reported for MaxProtect (Premium), where the insurer settles bills directly.