Overview
The ICICI Lombard Golden Shield plan is a health insurance policy specifically designed for senior citizens aged 56 years and above. It provides coverage for pre- and post-hospitalization expenses of 60 and 180 days, respectively, daycare treatments up to SI, domiciliary hospitalization up to SI, and ambulance charges (including air ambulance). The plan offers a high sum insured range of ₹5 lakhs to ₹50 lakhs and includes features like annual health check-ups, cashless treatment at network hospitals, and a benefit reset option that restores 100% of the sum insured once during the policy term, in addition to the loyalty bonus of 10% up to 100% even if the claims are made.
Experts Review
Written by Nikhil Nair
Senior Writer
The ICICI Lombard Golden Shield plan is a decent option for senior citizens seeking basic health insurance coverage with some notable benefits. Its reduced waiting period of 24 months for pre-existing conditions is a significant advantage, ensuring faster access to coverage for individuals with pre-existing conditions.
The inclusion of annual health check-ups and cashless treatment at over 10,200 network hospitals adds convenience and promotes preventive care. Additionally, the benefit reset feature provides financial security by reinstating the sum insured once during the policy term in case of multiple claims.
However, the plan has several limitations that may deter prospective buyers. The mandatory co-payment clause requires policyholders to bear 50% of hospitalization costs, which can be financially burdensome for seniors on a fixed income. However, do note that co-pay can be reduced to either 40%, 30% or 20% by paying additional premiums.
Apart from this, room rent restrictions further limit flexibility during hospitalization, particularly for those preferring private accommodations. Apart from this, there are also disease-wise sub-limits for cataracts (₹25,000 to ₹75,000) and robotic surgeries (₹1 lakh to ₹2.5 lakhs), which are quite limiting.
Pros
Feature set is satisfactory.
Great pick if you're looking for something affordable.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some. Need to opt add-on for doctor consultations.
ICICI Lombard
Key Insights
Founded
2001
ICICI Lombard was established 24 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
85% claims settled in 30 Days
ICICI Lombard settles only 85% of claims it receives, which is relatively low and may raise concerns about reliability during claim payouts.
Network Hospitals
10,200+
ICICI Lombard maintains a moderate network of 10,200 hospitals, offering reasonable coverage across key locations.
Complaints
11 complaints per 10,000 claims registered
ICICI Lombard experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Bad
Co-payment
The policy will only cover 50% of the final bill. The rest is on you. They call this a co-payment.
Customisable
Modifies the co-payment from 50% to 40%, 30% or 20%.
Room Rent
Tough luck if you are thinking about opting for a single private room and a lower cover Because the policy only lets you stay in a shared room for cover below 10 lakhs. If you still want to pick a better room, then be ready to pay a lot more when the final bill shows up.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for cataract, cerebrovascular & cardiovascular disorders, cancer, renal complications, robotic surgeries and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after just 2 years. It’s probably the best deal you can get to be honest.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Claim Protector
Recommended
Covers list of 68 non-medical items as per list I
Deductible
Deductible will be 20% of the base sum insured chosen. If deductible is opted, then co-payment will NOT apply except for treatment taken in higher than eligible category of room.
Co-payment Modifier
Modifies the co-payment from 50% to 40%, 30% or 20%.
Care Management Plus Program
Provides benefits like Health Care Professional (Health coach), Health update to family members, Out-patient consultations, Routine Diagnostics and Minor Procedure cover, Pharmacy cover and Nursing at Home.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
STDs except HIV
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
ENT-related conditions:
CSOM: Chronic Suppurative Otitis Media
Mastoidectomy
Tympanoplasty
Myringotomy
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
Maternity benefits not offered.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
R
Ramesh P.
The 24-month PED waiting period is a relief for seniors like me. Got my coverage faster than expected!
S
Sunita K.
Reset benefit is a fantastic feature. Knowing my sum insured restores once gives me peace of mind.
A
Alok M.
Annual health check-ups included, which is great for keeping track of my health. Good initiative.
D
Deepak V.
Plan has disease wise limits. Should be a last option
G
Girish L.
The 50% co-payment is very steep. It really cuts into the claim amount, making it less beneficial.
M
Meera J.
Domiciliary hospitalization is covered, which is helpful as sometimes recovery at home is better.
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Frequently Asked Questions
Does Golden Shield have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 2-year waiting period for any pre-existing disease you may have while buying the policy.
- 90-Day Waiting Period: There's a 90-day waiting period for conditions arising out of Hypertension, Diabetes, cardiac unless declared as a PED.
Does Golden Shield have room rent restrictions?
Does Golden Shield offer a restoration benefit?
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