health insurance review
ICICI Lombard
“Why waste time say lot word, when few word do trick?”
Large-brand option with a broad network, but it settled 85.4% of health claims by number in FY 2024-25, below our 90% flag line.
- Overall score 7.9/10
- Top fit: brand-loyal-buyers, urban-users
- Compare plan-level pages before purchase.
Quick Facts
Founded
2001
Headquarters
Mumbai, India
Ownership
ICICI Bank (51%) & Public (49%)
Official Website
icicilombard.com ↗Score breakdown
Claim settlement statistics
Figures for ICICI Lombard come straight from IRDAI publications and the insurer's own statutory filings, and each one links to its source. Where we could not verify a figure we say so instead of printing a number. Read our rating methodology for how these feed our scores.
Claim settlement ratio
85.43%
FY 2024-25, by number of health claims · Below 90%
Incurred claims ratio
85.5%
FY 2024-25, all health business (healthy band 60-90%)
Complaints per 10,000 claims
23.8
FY 2024-25, all lines of business (benchmark under 20)
Solvency ratio
2.69
31 Mar 2025 · above the 1.50 regulatory floor
| Year | Claims reported | Settlement ratio | Repudiation rate | Source |
|---|---|---|---|---|
| FY 2024-25 | 12,50,322 | 85.43% | 14.57% | Insurer Form NL-37 (public disclosure) |
- Settlement figures for ICICI Lombard use the Health column of its own Form NL-37 filing, which excludes personal accident and travel. Complaints are counted across all of ICICI Lombard's business, motor included, because IRDAI does not publish them by line.
- 14,057 claims moved to the unclaimed account are shown separately and are not part of the identity.
- Settlement ratio = claims paid ÷ (claims outstanding at the start + reported − closed without payment − outstanding at the end). We band it at 95% and 90%.
- Our Claim Settlement score of 8.1/10 is provisional: the methodology needs three consecutive years of verified data and a published score mapping, and both are still being completed. Read the methodology.
- Sources: ICR from IRDAI Handbook 2024-25 Table 62, complaints from Table 56; solvency from IRDAI Annual Report 2024-25, Statement 12.
Industry benchmark
In FY 2024-25, general and health insurers together paid 87.5% of all health claims they handled by number, repudiated 7.92% and had 4.58% outstanding at year end. By amount, only 71.14% of the money claimed was paid; 13.98% was disallowed under policy terms (deductions such as room-rent limits and non-payable items). Source: IRDAI Annual Report 2024-25, Table I.29. These shares use all claims handled as the base, so they run slightly lower than the settlement ratio we compute for each insurer.
Three numbers that get confused
Claim settlement ratio
Claims settled as a share of claims registered. Count-based, so many small settled claims can flatter it.
Settled within 3 months
A speed measure, not a payout measure. Often quoted because it looks higher.
Incurred claim ratio
Claim amount paid against premium collected. A different thing entirely, and frequently mislabelled as settlement ratio.
We take ratios from IRDAI publications and insurer statutory filings, never from insurer marketing, and show each year separately rather than blending them. See our metric definitions and benchmarks for the formula behind each figure, or go straight to the primary sources: IRDAI annual reports and insurer public disclosures.
All plans
ICICI Lombard Health Shield 360
7.9/10Good network-driven choice for metro policyholders.
Rs 16k-31k
ICICI Lombard Elevate
Not scoredA feature-rich modular plan: a claim-proof loyalty bonus, long pre/post windows and add-ons such as Jumpstart. We have not yet verified its sum insured range, entry age or pre-existing wait.
Quote-based (age, city and cover)
Network cashless hospitals
11,000+ Cashless Hospitals
At a network hospital, ICICI Lombard settles approved bills directly, so you pay only deductibles and non-covered items. Network size matters less than whether the hospitals you would actually use are on the list, so check your own city before buying.
How a ICICI Lombard claim works
Which route you use depends entirely on where you get treated. At a ICICI Lombard network hospital you can usually go cashless. Anywhere else, you pay first and claim it back.
Cashless
Network hospital- 1
Show your policy at the insurance desk
Carry your health card or policy number plus a photo ID. A soft copy is normally accepted.
- 2
Hospital raises pre-authorisation
The hospital sends the estimate and diagnosis to the insurer on your behalf.
- 3
Insurer approves an amount
Approval can be full, partial, or come back with queries. A rejected pre-auth does not stop treatment; you switch to reimbursement.
- 4
Settlement at discharge
The insurer pays the hospital directly. You settle the deductible, co-pay, and any non-payable items.
Reimbursement
Any hospital- 1
Tell the insurer early
Intimate the claim even though you are paying yourself. Late intimation is a common reason for disputes.
- 2
Pay and collect originals
You will need the discharge summary, itemised bills, payment receipts, prescriptions, and diagnostic reports.
- 3
File within the claim window
Submit the signed claim form with all documents. Keep photocopies of everything you hand over.
- 4
Insurer assesses and pays
The approved amount is credited to your bank account after deductions under your policy terms.
Intimation windows
Planned admission
~48 hours before
Gives the insurer time to pre-authorise.
Emergency admission
Within 24 hours
Some insurers allow up to 48 hours.
Reimbursement filing
15 to 30 days after discharge
Counted from the discharge date.
These are typical industry windows, not ICICI Lombard's guarantee. Exact deadlines are set in your policy wording and vary by plan, so confirm yours before you need them. For the full walkthrough, read our health insurance claim process guide. IRDAI's own deadlines for insurers, including the one-hour cashless decision, are in cashless vs reimbursement claims, and the usual reasons a claim is cut or refused are in why health insurance claims get rejected.
Renewing your ICICI Lombard policy
Renewal is the one moment each year when you can actually restructure your cover. Most people just pay the premium and lose that window. Renew before the due date, because a lapse can reset your waiting periods and your accumulated bonus.
Only possible at renewal
Increase your sum insured
You generally cannot raise cover mid-year. If your city or family situation changed, do it now.
Add or remove members
A spouse, newborn, or parent is normally added at renewal, subject to underwriting.
Port to another insurer
Apply to the new insurer between 60 and 30 days before renewal. Your waiting-period and no-claim bonus credits move with you.
Check before you pay
Your no-claim bonus was applied if you did not claim
The premium change is explained by age band, not a silent downgrade
Room-rent, co-pay, and sub-limit terms have not been revised
Waiting periods you have already served are preserved
Thinking of switching instead? Read how to port your health insurance before you let this policy lapse.
Renew on ICICI Lombard's official site ↗Check these terms in any ICICI Lombard plan
The insurer name tells you little about what a claim will pay. These four policy terms decide it, and each guide shows how to read them in the plan wording.
Pros and cons
Pros
- Strong app experience
- Large network presence
Cons
- Price can trend high
- Feature depth varies by plan
- Health claim settlement ratio of 85.4% in FY 2024-25 (Form NL-37)
Compare ICICI Lombard head-to-head
Who this is for
Our verdict on ICICI Lombard
tldr.money editorial score: 7.9/10
Large-brand option with a broad network, but it settled 85.4% of health claims by number in FY 2024-25, below our 90% flag line.
This is our own editorial assessment, not a customer rating. We do not publish testimonials and we are not paid for placement. See how we score insurers for the inputs and their limits.
ICICI Lombard Frequently Asked Questions
What is the claim settlement timeline for cashless hospitalizations at ICICI Lombard?+
Editorial Team
Research and writing by the tldr.money editorial team. We link the IRDAI publications and insurer documents behind our figures, and say so plainly when a figure is not yet verified.
FAQ
Should I shortlist ICICI Lombard?
It can be, but shortlist it with at least two competitors and compare plan-level exclusions before buying.
Which ICICI Lombard plan is top pick?
Use the plan cards above to review score, verdict, and segment fit before finalizing.
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The insurers scored closest to ICICI Lombard, plus others of the same type.
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