RISK ASSUMPTION LETTER

Ref. No.: W395388654

Date: 12-10-2021

Dear Sir / Madam,

We thank you for placing your confidence with ICICI Lombard for your Insurance needs.

Please find attached herewith Policy No. : 4172/229137199/00/000 , which has been issued based on the details furnished
by the applicant in the proposal form

Name of the Applicant : NEERAJ KUMAR

Date of Birth : XX-XX-1979
Mailing Address : NEERAJ KUMAR ,S/O SHRI SATPAL VED,,VPO SADHAURA, DICT YAMUNANAGAR
HARYANA, YAMUNANAGAR,HARYANA - 133204
Mobile No. : 98******40
Product Name : Family Shield
Nominee Name : MANISHA DEVI
Nominee Relationship : SPOUSE
with Applicant
Period of Insurance : From 00:00 hrs 12-Oct-2021 To 23:59 hrs 11-Oct-2024
Policy Duration (years) : 3

Insured Details

Name of the Relationship Date Of Birth Age in Years Occupation Pre Abha No
Insured with Applicant Existing
illness
NEERAJ
SELF 09/12/1979 41 SALARIED
KUMAR

Please go through the details as furnished in the format and the policy document. Please confirm that same are in order. In
case there is any discrepancies / variations, you are requested to write back to us immediately at
customersupport@icicilombard.com or contact at 24 hour helpline number 1800 2666 for necessary changes / rectification.
In the absence of any communication from you in this connection within a period of 15 days of receipt of this letter, we
would take it that the issued policy is in order and as per your proposal.

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 1 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
Family Shield
PART I OF THE SCHEDULE

Applicant Name NEERAJ KUMAR Policy No. 4172/229137199/00/000

Address NEERAJ KUMAR ,S/O SHRI SATPAL Period of Insurance From 00:00 hrs 12-Oct-2021 To
VED,,VPO SADHAURA, DICT 23:59 hrs 11-Oct-2024
YAMUNANAGAR HARYANA,
YAMUNANAGAR,HARYANA - 133204
Contact No. 98******40 Policy Tenure (in Years) 3
Loan Account Number Loan Tenure
Loan Sanction Date Loan Sanction Amount
Loan Disbursal Date Basis of SumInsured
Applicant PAN Number Nature of Assignment
Name of Assignee Status in the Loan
Alternate Policy No. GSTIN Number
(Customer)
Previous Policy No. Previous Policy Period
of Insurance
Nominee Name MANISHA DEVI Nominee Relationship SPOUSE
with Applicant
Email Address NE************@YAHOO.IN Policy Issued On 14-Oct-2021
Service Branch Name MUMBAI - CO Policy Issuing Office Prabhadevi, Mumbai
Servicing Branch Zenith House, 2nd Floor, Opp Invoice Number 101021748013
Address Mahalakshmi Race CourseMUMBAI
MAHARASHTRA - 400034

Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of PEPs*? No

Insured Details

Name of the Relationship with Date Of Birth Age in Years Occupation Pre Existing Abha No
Insured Applicant illness
NEERAJ KUMAR SELF 09/12/1979 41 SALARIED

2. Details of the Insured Event along with the Benefits (as per tablebelow):
0
Cover Name Sum Insured Benefit Amount
Death Benefit 3000000 100% of Sum Insured
Permanent Total Disablement PTD Benefit 3000000 100% of Sum Insured
Broken Bones Benefit 60000 As per disability table
Comatose Benefit 300000 100% of Sum Insured
Burns Benefit 150000 As per disability table
Ambulance Charges Benefit 5000 100% of Sum Insured

Premium Details
Basic Premium 6515.83 Stamp Duty 150
IGST % 18.0 IGST Amount 1172.85
Total Tax Payable 1172.85 Total Premium 7689
Place of Supply HARYANA

IL GSTIN Registration No. HSN/SAC Code The stamp duty of `150 paid vide deface no.
997133 / GENERAL INSURANCE MH006295418202122M dated 16-Sep-2021
27AAACI7904G1ZN
SERVICES
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of
the said sub-rule.

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 2 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
Important Notes:
1. Insurance cover will start only on receipt of full premium (First Installment in case the customer has opted for Periodic
Premium Payment option) stated in PART I of the Policy Schedule by ICICI Lombard General Insurance Company Limited.
2. Insurance cover is subject to the terms and conditions mentioned in the Policy wordings provided to you with this Certificate.
3. On renewal of policy benefits and terms & conditions of policy including premium may be subject to change.
4. The above covers would not be applicable for persons occupied in underground mines, explosives and electrical installations on
high tension lines unless otherwise covered and stated in the Policy Schedule.
5. Major exclusions: Intentional self-injury, suicide or attempted suicide whilst under the influence of intoxicating liquor or drugs,
any loss arising from an act of breach of law with or without criminal intent. Please refer to the Policy wordings for a complete
list of exclusions.
6. For any endorsements such as name correction or change in nominee details, you can contact us at Toll Free Number
1800-2666 or Email us at customersupport@icicilombard.com or visit our nearest branch.
7. The claimant can contact us at Toll Free Number 1800-2666 or Email us at customersupport@icicilombard.com for lodging the
claim.
8. Address for claim notification: IL Health Care, ICICI LOMBARD HEALTHCARE ICICI BANK TOWER, PLOT NO.12,
FINANCIAL DISTRICT, NANAKRAM GUDA, GACHIBOWLI, HYDERABAD, ANDHRA PRADESH PIN CODE: 500032

D:/CLICK/images/Sanjay_Dutta.png

Scan QR for Customer Information

Sheet and Policy-wordings

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 3 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 Family Shield

Customer Information Sheet/ Know Your Policy

This document provides key information about your policy. You are advised to go through your policy document.
Description Policy Clause
Sr.No
(Please refer to applicable Policy Clause Number in next column) Number
1. Name of Insurance Product/Policy
Family Shield
2. Policy Number
4172/229137199/00/000
3. Type of insurance Product/Policy

Benefit-
4. Sum Insured (Basis)
INDIVIDUAL SI

Individual Sum Insured - Where each member has a separate sum insured under the
policy
5. Policy Coverages (Policy Number/s)

Section A - Infectious Disease Benefits

Section A.1 – Specific Vector Borne Disease Benefit

For the purpose of this section, specific vector-borne diseases refer to malaria, dengue,
chikungunya, kala azar, Japanese encephalitis, filariasis, and Zika fever.
Cover Name Pay-out
Base Benefit: Specific vector borne diseases related A 1.1
hospitalization benefit
Section A.2 – Rabies and Tetanus Benefit A 2.1

Base Benefit: Hospitalization benefits related to rabies and

tetanus
Death benefits related to rabies and tetanus A 2.2.
Section A.3 – Specific Gastrointestinal Infections Benefit A 3.1.

For the purpose of this section, 'Specific Gastrointestinal

Infection' means acute inflammatory diarrhea and typhoid
fever.

Base Benefit: Hospitalization benefits related to specific

gastrointestinal infections.
Base Benefit: Hospitalization benefits related to specific viral A 4.1.
infections.

Section A.5 – Specific Nervous System Infections Benefit A 5.1.

For the purpose of this section, 'Specific Nervous System
Infection' includes meningitis, encephalitis, Creutzfeldt–Jakob
disease, and Guillain–Barré syndrome.

Base Benefit: Hospitalization benefits related to specific

nervous system infections
Section B - Hospital Daily Cash Benefit B.1
Base Benefit: Hospital Daily Cash Benefit
Extension: Intensive Care Unit (ICU) Cash Benefit B.2

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 4 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 Section C - Accidental Injury Benefits C 1.1
Base Benefit: Death Benefit
Base Benefit: Permanent Total Disablement (PTD) Benefit C.1.2
Base Benefit: Permanent Partial Disablement (PPD) Benefit C.1.3
Base Benefit: Temporary Total Disablement (TTD) Benefit C.1.4
Base Benefit: Adventure Sports Benefit C.1.5
Base Benefit: Children’s Education Grant Benefit C.1.6
Base Benefit: Orphan Benefit C.1.7
Base Benefit: Parental care Benefit C.1.8
Base Benefit: Accidental Hospitalization Expenses C.1.9
Reimbursement Benefit
Base Benefit: Accidental Hospitalization Daily Cash Benefit C.1.10
Base Benefit: Common Carrier Accident Benefit C.1.11
Base Benefit: Loan Protection Benefit C.1.12
Base Benefit: Assault Benefit C.1.13
Base Benefit: Mysterious Disappearance Benefit C.1.14
Base Benefit: Reconstructive Surgery Benefit C.1.15
Base Benefit: Catastrophic Evacuation Benefit C.1.16
Base Benefit: Physical Rehabilitation Benefit C.1.17
Base Benefit: Loss Of Job C.1.18
Base Benefit: Recovery Benefit C.1.19
Base Benefit: Diagnostic Test Benefit C.1.20
Extension Benefit: Lifestyle Support Benefit C.2.1
Extension Benefit: Last Rite Benefit C.2.2
Extension Benefit: Counselling Benefit C.2.3
Extension Benefit: Repatriation in case of Permanent C.2.4
Disability Benefit
Extension Benefit: Accidental Pre & Post Hospitalization C.2.5
Expenses Benefit
Extension Benefit: Air Ambulance Benefit C.2.6
Extension Benefit: Comatose Benefit C.2.7
Extension Benefit: Broken Bones Benefit C 2.8
Extension Benefit: Compassionate Visit Benefit C 2.9
Extension Benefit: Burns Benefit C 2.10
Extension Benefit: Ambulance Charges Benefit C 2.11
Extension Benefit: Chauffeur Cash Benefit C 2.12
Extension Benefit: Skill Development Benefit C 2.13
Extension Benefit: On Duty Enhanced Benefit C 2.14
Extension Benefit: Home Tuition Benefit C 2.15
Extension Benefit: Outstanding Bills Payment Benefit C 2.16
Extension Benefit: Major Surgery Benefit C 2.17

6. Exclusions (What the policy does not cover) As per Exclusion

section of policy
Exclusions and limitations applicable to Section B wordings

i. Standard Exclusions -

1. 30-day waiting period(Code – Excl 03

2. Pre-existing Diseases (Code – Excl 01)

3. If the insured person has continuous coverage without any break, the waiting period will

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 5 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 3. If the insured person has continuous coverage without any break, the waiting period will
be reduced based on prior coverage

4. Pre-existing diseases will be covered after 24 months, provided they are declared at
the time of application and accepted by the insurer.

3. Maternity (Code – Excl 18)

4. Cosmetic or plastic surgery (Code – Excl 08)

5. Investigation & evaluation (Code – Excl 04)

6. Obesity/Weight control (Code – Excl 06) -

7. Rest Cure, rehabilitation and respite care(Code – Excl 05):

8. Hazardous or adventure sports (Code – Excl 09).

9. Change of gender treatments (Code – Excl 07) -

10. Breach of Law (Code – Excl 10):

11.Treatment for, Alcoholism, drug or substance abuse or any addictive condition and
consequences thereof. (Code – Excl 12)

12. Refractive error (Code – Excl 15

13. Unproven treatments (Code – Excl 16) -

14.Treatments received in heath hydros, nature cure clinics, spas or similar

establishments etc. (Code – Excl 13)

15.Dietary supplements and substances that can be purchased without prescription,

including but not limited to Vitamins, minerals and organic substances unless prescribed
by a medical practitioner as part of hospitalization claim or day care procedure (Code –
Excl 14)

16. Excluded providers (Code – Excl 11)

31. Specified disease/procedure waiting period (Code – Excl 02) -

ii. Specific Exclusions -

1. Any physical, or medical condition or treatment or service which is specifically

excluded in the Policy Certificate under Special Conditions.

2. Dental treatment (except for accidents) and alternative treatments (excluding AYUSH).

3. Circumcision unless necessary for the treatment of an underlying diseases

4. Any treatment received outside India.

5. Hormone replacement therapy.

6. Routine medical, dental, eye and ear examinations is not covered unless specifically
covered and specified in the Policy Certificate.

7. Any medical examination for the purpose of employment or travel.

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 6 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 8. Intentional self-injury, suicide or attempt to suicide.

9. Event before policy inception

10. Any external congenital anomalies

11. While operating air carrier

12. Treatment by a family member and self-medication, or any treatment that is not
scientifically recognized.

13. War, invasion, civil commotion, rebellion, revolution, insurrection, mutiny, arrests,
detainments, and participation in political or military activities, including aviation (except
as a passenger in a licensed standard aircraft).

14. Event due to radio-activity, nuclear etc.

Specific exclusions and limitations applicable to Section C

(Except Benefit C.1.9 and C.2.5)

1. War, invasion, foreign hostilities, civil unrest, rebellion, revolution, insurrection, mutiny,
arrests, detentions, political gatherings, and participation in aviation (excluding passenger
travel in licensed standard aircraft)

2. Any injury sustained while performing duty in army, navy, air force, paramilitary force,
police, or any other such institutions.

3. While operating air carrier except as passenger.

4. Breach of law or while being involved in any unlawful activity.

5. Any injury / illness arising from intentional self-injury, suicide, or attempted suicide.

6. Any injury / illness arising whilst under the influence of alcohol or intoxicating drugs or
substance abuse of any kind.

7. 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.

8. Injury sustained whilst engaging in adventure sports (This exclusion shall not apply if
Benefit C.1.5 is in force for the insured person)

9. Event before policy inception

10. Expenses incurred on eyeglasses, contact lenses, hearing aids and examination for
the prescription or fitting thereof.

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

12. Event due to complication of pregnancy, child birth.

13. Event due to radio-activity, ionizing radiation, nuclear attack etc.

14. Event due to cancer, pregnancy complication etc.

15. Circumcision, strictures, vaccination, inoculation, sex change, beauty treatments,

intentional self-injury (including general debility), venereal disease, use of intoxicating

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 7 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 intentional self-injury (including general debility), venereal disease, use of intoxicating
drugs, and any illness, injury, death, or disablement directly or indirectly resulting from
these.

16. Dental treatment, eye treatment and plastic surgery unless medically necessitated as
a consequence of an injury sustained in accident during the coverage period.

17. Hospitalization unrelated to injuries sustained in an accident during the coverage

period.

18. Medical expenses not incurred as a direct result of the injury sustained in an accident
during the coverage period.

19. Routine medical, dental, eye and ear examinations.

20. All cosmetic/aesthetic surgeries including but not limited to Lasik surgery.

21. Any medical examination or diagnostics or hospitalization for the sole purpose of
investigation or employment or travel

22. Any injury sustained while working professionally with any animals reptiles or insects.

23. Any injury or illness caused or transmitted by viruses, parasites, bacteria, or other
microorganisms, including those introduced or caused by bites of insects, reptiles,
animals, or other vectors.

24. Any medical expense not incurred in the hospital as defined in the Policy Wordings.

Exclusions applicable to Benefits C.1.9 and C.2.5

i. Standard Exclusions –

• Unproven treatment (Code - Excl 16);

• Maternity (Code - Excl 18);
• Sterility and infertility :(Code - Excl 17);
• Cosmetic or plastic surgery (Code - Excl 08);
• Investigation and evaluation (Code - Excl 04);
• Hazardous or adventure sports (Code – Excl 09);
• Breach of Law (Code – Excl 10);
• Treatment for alcoholism, drug or substance abuse or any addictive condition and
consequences thereof. (Code – Excl 12);
• Rest Cure, rehabilitation and respite care (Code – Exc 05);
• Expenses related to any admission primarily for enforced bed rest and not for
receiving treatment. As per standard exclusions (Code – Excl 13). As per standard
exclusions (Code – Excl 14)
• Excluded Providers (Code – Excl 11)
ii.Specific Exclusions -
• All dental treatment or dental surgery of any kind unless necessitated due to an
accident.
• Routine medical, dental, eye and ear examinations is not covered unless specifically
covered and specified in the Policy Certificate.
• Event prior to policy inception
• Any external congenital anomalies

• Any injury / illness occurring whilst engaging in any adventure sports as an Amateur.
Any event which occurs while operating air carrier other than as passenger.
• War, invasion, foreign hostilities, civil unrest, rebellion, revolution, insurrection,

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 8 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 War, invasion, foreign hostilities, civil unrest, rebellion, revolution, insurrection,
mutiny, arrests, detentions, political gatherings, and participation in aviation

• Any Injury sustained while performing duty in army, navy, air force, paramilitary
force, police or any other such institution.
• While operating air carrier other than as passenger
• Any injury / illness arising from intentional self- Injury, suicide or attempted suicide.
• Any illness, complication or ailment not arising out of or connected to injury.

The above is an indicative list of exclusions, please refer to the Policy Wordings for
detailed description.
7. Waiting Period
Initial period when certain diseases/treatments are not covered, starting from the policy's
inception.

The following waiting periods apply under the policy, unless specified otherwise in the
Policy Certificate –
Section A – 30 days
Section B – 30 days (Except in case of accidents)
Section C- No Waiting Period

8. Financial Limits of coverage

As per the sum insured opted in the policy

9. Claims /Claim Procedure

• Claims under this policy should be intimated and registered with the Company on our
24x7 toll free helpline 1800 2666 and in writing to our address.
• The list of documentation required is provided under each specific section.
• The Insured shall intimate the claims with all the necessary documents to our claim
processing team immediately and in any event within 7 days of claim intimation.
• Customer to send documents to company at :-

ICICI Lombard GIC LTD, 1st, 4th, 5th & 6th Floor Varun Towers-II, Opp Hyderabad Public
School, Begumpet Hyderabad-500016 Telangana.

Download the Claim Form here https://www.icicilombard.com/downloads

Find our extensive list of hospitals providing services on our website

https://www.icicilombard.com/health-insurance/health-claim/partner-hospital or on the IL
TakeCare App.

List of excluded providers/delisted hospitals is available on our website

https://www.icicilombard.com/docs/default-source/apps/healthclaims/assets/files/delisted-
hospital-list.pdf

The Company shall settle or reject a claim, as the case may be, within 15 days from the
date of receipt of last necessary document.

10. Policy Servicing

• You may contact us on our Toll Free no: 1800 2666, or email to
customersupport@icicilombard.com or use our IL TakeCare App or send a Hi to RIA,
our Responsive Intelligent Assistant on WhatsApp (7738282666) for policy services.
• For details of Company officials kindly visit our
https://www.icicilombard.com/customer-support.
11. Grievances/Complaints
ln case of any grievance the insured person may contact the Company through

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 9 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 ln case of any grievance the insured person may contact the Company through
Website: www.icicilombard.com
Toll free: 1800 2666
Email: customersupport@icicilombard.com
Address: ICICI Lombard General Insurance Co. Ltd. Ground floor- Interface 11, Sixth
floor- Interface 16 , Office no 601 & 602, New linking Road, Malad (West), Mumbai –
400064
There is an interactive voice response (IVR) facility for senior citizens’ grievance
redressal for easy and faster resolution
lnsured person may also approach the grievance cell at any of the company's branches with the details
of grievance. For branch details, please visit
https://www.icicilombard.com/docs/default-source/policy-wordings-product-brochure/final-gro-mapping.pdf.
lf lnsured person is not satisfied with the redressal of grievance ,insured person may contact the
Grievance Redressal Officer of the Company at the details provided in the below link:

https://www.icicilombard.com/grievanceredressal.com

lf lnsured person is not satisfied with the redressal of grievance, the insured person may
also approach Insurance Regulatory and Development Authority of India (IRDAI) through
the Bima Bharosa Portal - https://bimabharosa.irdai.gov.in/ or IRDAI Grievance Call
Centre(IGCC) at their toll free no. 1800 4254 732 / 155255

Insured may also approach Insurance Ombudsman, subject to vested jurisdiction, for the
redressal of grievance. Details of Insurance Ombudsman offices are available at IRDAI
website: www.irdai.gov.in, or on the Company’s website at www.icicilombard.com or on
https://www.cioins.co.in/Ombudsma

12. Things to remember

Free look period: Every insured of new health insurance policies, except for those
policies with tenure of less than a year, shall be provided a free look period of 30 days
beginning from the date of receipt of policy document, whether received electronically or
otherwise, to review the terms and conditions of such policy. If the insured cancels the
policy within free look period then the insured shall be entitled to a refund of the premium
paid subject only to a deduction of a proportionate risk premium for the period of cover
and the expenses, if any, incurred by the insurer on medical examination of the insured
and stamp duty charges

Refer to Policy Wordings and Prospectus for details.

If you wish to cancel the policy, contact us through our website www.icicilombard.com
(Customer Support section), call us toll-free at 1800 2666, or email
customersupport@icicilombard.com.

Policy Renewal:
• We shall ordinarily renew the Policy except on grounds of , misrepresentation or
established fraud or non-disclosure by the Insured, provided the policy is not
withdrawn and also subject to moratorium conditions.

Migration:
In case of migration of this policy with the Company, the insured can transfer the credits
gained to the extent of the Sum Insured and benefits available in the previous policy to
the migrated policy.
The Company may underwrite the proposal in case of migration, if the insured is not
continuously covered for 36 months.

Portability:

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 10 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 Portability:
a. The insured has the choice to port his / her policies from one Insurer to another. An
Insured desirous of porting his/her policy to another insurer shall apply to such insurer to
port the entire policy along with all the members of the family, if any, at least 30 days
before, but not earlier than 60 days from the due date for renewal.
b. The insured is entitled to transfer the credits gained to the extent of the sum insured
and the benefits available in the previous policy, subject to the underwriting policy of the
Company
c. The Company shall decide and communicate on the proposal upon receipt of
information from Existing insurer within prescribed timelines.

Change in Sum Insured: The sum insured can be modified (increase/decrease) only at
renewal or anytime, subject to company underwriting. Waiting period restarts for
increased sum insured.

Moratorium Period: After completion of sixty continuous months of coverage (including

portability and migration) in health insurance policy, no policy and claim shall be
contestable by the Company on grounds of non-disclosure, misrepresentation, except on
grounds of established fraud. This period of sixty continuous months is called as
moratorium period. The moratorium would be applicable for the sums insured of the first
policy. Wherever, the sum insured is enhanced, completion of sixty continuous months
would be applicable from the date of enhancement of sums insured only on the enhanced
limits.
Withdrawal of Policy
i. ln 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.
ii. 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 the regulatory prescriptions,
provided the policy has been maintained without a break.

13. Your Obligations

Please disclose all pre-existing disease/s or condition/s before buying a policy.

Non-disclosure may affect the claim settlement.

If there is misrepresentation, non-disclosure of material facts, fraud, or non-cooperation

in the proposal form, personal statement, medical history, or claim documents, the policy
becomes void. In such cases, any benefits obtained through fraudulent means result in
the forfeiture of all paid premiums.

Declaration by the Policy Holder:

I have read the above and confirm having noted the details.

Place:

Date: Signature:

NOTE: In case of any conflict, the terms and conditions mentioned in the policy document shall prevail.

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 11 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com
 Signature Not Verified
Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2025.02.05 16:24:10 IST

ICICI Lombard General Insurance Company Limited

Family Shield
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICIHLIP22092V032122
Mailing Address: Registered Office: Toll free no.: 1800 2666
ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414 Veer Savarkar Alternate No.: +918655 222 666 (chargeable)
Interface Building No.: 16, 601 / 602, 6th Floor, New Marg, Near Siddhi Vinayak Temple, Email: customersupport@icicilombard.com 12 / 12
Link Road, Malad (West), Mumbai - 400 064. Prabhadevi, Mumbai - 400 025. Website: www.icicilombard.com