ICICI Lombard General Insurance
Health Shield
Sum insured options: 2L, 3L, 5L, 10L, 15L, 25L
Feature DNA
Coverage Basics
Room Rent Limit
1% of SI per day on all variants
Even on 25L SI, room rent is capped at 25,000/day. This is adequate but any upgrade triggers proportionate deductions on the entire bill.
Co-Payment
Nil up to age 55; 10% above 55
Network Hospitals
11,500+
Daycare Procedures
Listed procedures only (not exhaustive)
Only daycare procedures explicitly listed are covered. New procedures not on the approved list may be rejected even if medically necessary.
Waiting Periods
Pre-Existing Waiting
48 months
Maternity Cover
Not covered in base plan
Wellness Benefits
Mental Health
Covered per Mental Healthcare Act
AYUSH Coverage
Not covered
Annual Health Checkup
Not included
Domiciliary Treatment
Covered with strict conditions
Claims Features
No Claim Bonus
Up to 50% (10% per year)
NCB increment is only 10% per year, the slowest in the industry. Takes 5 claim-free years to reach the cap.
Restoration Benefit
50% for unrelated illness
Ambulance Cover
Up to 2,000 per hospitalisation
Organ Donor
Covered up to SI
Score Breakdown
Premium Estimates
Indicative annual premiums for a 5 lakh sum insured individual policy. Actual premiums vary by age, location, and health status.
| Age Group | Estimated Premium (5L SI) |
|---|---|
| Age 30 | ₹5,100/yr |
| Age 45 | ₹11,200/yr |
| Age 60 | ₹24,600/yr |
Key Exclusions
Gotcha Alerts (3)
Room Rent Limit
Even on 25L SI, room rent is capped at 25,000/day. This is adequate but any upgrade triggers proportionate deductions on the entire bill.
Source: Health Shield Policy Wording
Daycare Procedures
Only daycare procedures explicitly listed are covered. New procedures not on the approved list may be rejected even if medically necessary.
Source: Health Shield Policy Wording
No Claim Bonus
NCB increment is only 10% per year, the slowest in the industry. Takes 5 claim-free years to reach the cap.
Source: Health Shield Policy Wording
Compare With Another Plan
Oquilia Analysis: Health Shield
Health Shield from ICICI Lombard General Insurance is a individual health insurance plan that has earned an Oquilia Score of 6.8/10, placing it in the “Good” category. This score is derived from our analysis of 14 critical coverage parameters, cross-referenced against industry benchmarks and the actual policy wording filed with the Insurance Regulatory and Development Authority of India (IRDAI).
Starting with the coverage fundamentals, this plan offers room rent limits that buyers should be aware of. Room rent is one of the most consequential features in a health insurance policy because exceeding the limit does not just result in paying the room rent difference — it triggers proportionate deductions across the entire hospital bill, including surgery charges, doctor fees, and medication costs. For co-payment, this plan offers nil up to age 55; 10% above 55, which means the policyholder will need to bear a portion of every claim from their own funds.
The pre-existing disease waiting period stands at 48 months, which is on the longer side compared to leading plans in the market. Buyers with existing health conditions should factor this waiting period into their purchase decision, as any claim related to a pre-existing condition during this period will be outright rejected.
On the wellness and benefits front, the plan includes coverage for AYUSH treatments (Not covered), mental health (Covered per Mental Healthcare Act), and domiciliary treatment (Covered with strict conditions). The no-claim bonus structure offers Up to 50% (10% per year), which lags behind competitors offering faster bonus accumulation. Restoration benefit is available but with conditions: 50% for unrelated illness.
We flagged 3 gotcha alerts for this plan. These are fine-print conditions that most buyers overlook during purchase but discover painfully at claim time. Each gotcha is sourced directly from the policy wording and represents a material condition that could affect claim outcomes. We recommend reading each gotcha carefully and factoring them into your purchase decision.
In terms of value for money, the estimated premium for a 30-year-old at 5 lakh sum insured is ₹5,100 per year. When evaluated against the feature depth delivered at this price point, Health Shield requires careful consideration of its limitations before purchase, especially when alternatives in a similar price range offer fewer gotchas. We recommend comparing this plan side-by-side with at least one alternative using the Oquilia comparison tool to ensure it aligns with your specific health profile and financial needs.
Frequently Asked Questions
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Not sure if Health Shield is right for you?
Compare it side-by-side with another plan to see which one wins feature-by-feature.