ICICI Lombard OPD Claim Process with American Express Health Cover

A few years ago I purchased health insurance from American Express underwritten by ICICI Lombard. My policy included an OPD benefit of Rs.10,000 on a 10 lakh cover. Recently I decided to use that benefit.

I finally got new spectacles from Titan Eye Plus and claimed the OPD benefit—the invoice was issued in the last five minutes of the store closing, coincidentally on the final day of my policy period.

Update: The policy’s OPD benefit no longer covers spectacles, gym, or yoga.

Reimbursement

With the invoice in hand I contacted ICICI Lombard to learn the reimbursement procedure. It took numerous calls and emails to complete the process. Eventually I was asked to submit the following:

• Completed OPD claim form
• All invoices (a single invoice in my case)
• Cancelled cheque for bank details
• Identity and address proofs

I emailed these documents to the insurer. Note: for spectacles claims, the policy covered only the lens component and not the frame.

The Rs.10,000 reimbursement was credited to my bank account roughly 10 days after submitting the documents.

Policy Renewal

After receiving the reimbursement I proceeded to renew the policy. At the time of purchase I was told renewal premiums would be slightly lower—perhaps 5% less, or up to 10% less for a two-year renewal. In practice my renewal quote was higher by roughly INR 2,000, which I suspect was related to Covid-19 market adjustments.

When I attempted to negotiate, the insurer offered a renewal without the OPD benefit as a lower-cost option. My renewal choices ended up being:

1. ~Rs.8,000 – 10L cover, without OPD benefit
2. ~Rs.16,000 – 10L cover, with Rs.10,000 OPD benefit

Paying an additional ~Rs.8,000 for a Rs.10,000 OPD benefit seemed reasonable, but I didn’t plan to replace spectacles annually or use gym/yoga benefits, so I chose the ~Rs.8,000 renewal without OPD.

Covid-19 Updates

Regarding Covid-19 coverage: this policy covers hospitalisation expenses related to Covid-19. For testing kit expenses there are limits. As of early October 2020 the insurer communicated a maximum claim for test kits of 2 kits per day, up to approximately Rs.800 per kit.

This limit may change over time depending on government pricing and policy updates, so always confirm current terms before claiming.

Customer Service

Although the claim process is straightforward, I had to make over 20 calls and send multiple emails to complete it. My main frustration was dealing with the American Express side of the arrangement. The Amex insurance teams (health and motor) were difficult to reach and, despite claims of a dedicated team working with ICICI Lombard, that coordination did not materialize in my experience.

Even Amex Platinum concierge was unable to help effectively: they would initiate a conference call to the insurer, which frequently disconnected after a few minutes. I repeatedly reported these issues to American Express but saw no meaningful improvement.

Despite the support hurdles, the claim itself was processed once the required documents were submitted. If you follow the document checklist and submission steps, you should be able to claim the OPD benefit successfully.

Bottom line

Despite support and coordination issues, the ICICI Lombard policy has been suitable for my needs and remains a solid option for individuals in their 30s. For family coverage or older dependents, consider other insurers that specialise in family plans—my parents have a policy with Star Health, which is popular in Tamil Nadu and offers extensive hospital coverage.

If you’re new to American Express and want to access the Rs.10,000 OPD benefit that I used, these Amex cards have historically included this perk:

• Amex Membership Rewards Credit Card (MRCC)
• Amex Platinum Travel Card

Do you have health insurance from American Express or another provider? Share your experience and any tips for smoother claims.