One of the biggest and less known advantage of holding American Express Credit Card in India is their Insurance benefit. I’ve been availing their Car Insurance benefit for past 3 years and have saved over 30% on premium compared to the regular rate in the market.
But I’ve never checked their health insurance offers in the past as I was quite ignorant about it. When I recently checked their Insurance offer, I was surprised that I’ve been missing out on this for years. If you’re new to Amex Health Insurance, here’s everything you need to know.
Health Insurance Plans
Amex has multiple customised health insurance plans with wellness benefits from different providers – covers ranging from 5L to 1Cr based on the needs of its cardholders.
The smaller/individual covers upto 10L are provided by ICICI Lombard, while the high/family covers are provided by Bharti AXA. The insurance providers may keep changing from time to time.
Among the available two, I see the ICICI Lombard offer to be very attractive (for my needs) and that’s what I opted for.
While the similar insurance plan is also available with ICICI Lombard, there are certain advantages if you go through Amex.
- OPD Benefit (Covers Specs too)
- Dedicated Helpline
- Priority claims processing
- No TPA
- Note: Covid-19 Hospitalisation expenses are covered as well
The most important benefit according to me is OPD benefit which is very rare and especially as the expense on spectacles (lens part of the bill) is covered, the plan fits perfectly for me.
You may also get your Gym/Yoga & other doctor consultation bills re-imbursed as a part of OPD benefit. Remember, the direct ICICI policy does have the OPD benefit but it doesn’t cover spectacles.
How to get it?
- Email: insuranceservices [at] aexp.com
- SMS: HLT to 5616166
- Call: 0124-4405500 (Monday to Saturday) 9:30 am to 6:30 pm
To get the Amex Health Insurance Policy, all you need to do is call the Amex Insurance line. They’ll do the formalities and charge the card directly in ~2 days.
The process is usually quick and you get the documents both soft copy & hard copy within 10 days. This is all done online via direct Amex online sourcing.
Apart from this, Amex also started selling health insurance via offline medium (especially during pandemic) and surprisingly the premium might vary a bit from online vs offline quotes (as I saw that with car insurance).
So I think its better to go with online quote as that’s what I see as lowest.
So I went for the 10L Cover that costs me ~Rs.14,700 p.a. (varies with age) with Rs.10,000 OPD benefit. Now that’s like paying Rs.4,700 for 10L cover.
It gets even better if you fall under higher income tax slab as the amount you save under tax deduction would be significant.
The ICICI Lombard Health Care card is bit simple and feels cheap. I wish it looks more premium. Yup, first world problems 😀
- CardExpert Rating: 4.5/5 [yasr_overall_rating]
I’ve been ignoring health insurance for long time and finally I’m more than happy to find the best ever plan that fits my needs.
Even-though I know that I can get better rates by going with ICICI Lombard directly, I went through Amex for the unique OPD benefit and the peace of mind that American Express offers.
These plans are limited to American Express Primary Cardholder & his/her family. Just incase if you are not in the Amex ecosystem yet, here are some of cards worth applying,
- Amex Plat Travel (Currently FREE)
- Amex MRCC (Currently FREE)
Do you have Health insurance from Amex or from any other providers? Feel free to share your experiences in the comments below.
I am having the heath insurance from Axis Bank (Through their partner) and got the same features in just less than 6 thousand.
Feel free to share the partner info & the plan opted. I’m more than happy to get that as well 😛
Keshav, can you please share the details of the health insurance which you have? TIA
FYI, this is not exclusive to Amex. I have the same insurance via an ICICI agent.
And that does not cover you for specs expense (OPD benefit) + no peace of mind. lol 😀
When I held Amex Platinum in the past, I have been contacted abt insurance customer care from Amex saying that abcd,xyz etc options which are only offered to Amex customers, I believed their words as I trusted Amex so much in the initial days. Later I got insurance papers delivered to my place. When I checked all the T&C with ICICI helpline and asked if that abcd, xyz are specific to amex customers, they responded as “NO” . Its the same policy issued by ICICI for general customers as well which can be taken from ICICI website, it’s just explaining the product more in detail and trying to sell. The only concern if you buy from Amex/third party is that in future if Amex as a company will break the partnership with Insurance, then Customers don’t have to other option but to choose some policies in accordance with the ICICI T&C. We not only lose the experience with the policy as the customer ID but details etc would also be changed and thereby we will end up paying more premium in future as we are a new customer (with high age bar) with no experience in the system. As its the same product offered directly from ICICI, its better to take from them directly them to avoid such situations in the future. I have so many mails on escalation to Amex top management about this. Seems like nothing has changed.
Sorry Sid but it does.
I did atleast 10 calls to re-confirm this before I took policy with Amex. ICICI Lombard guys said its not possible!
What I came to know is.. earlier Amex-ICICI were allowing swimming bills and now its specs.
That’s when you take it directly from ICICI. If you go via an insurance agent, they can tweak the plans or merge two or more plans in a way which allows them to bundle stuff together. And I am not going by what agent said, I did read all the terms in the document received and I can submit OPD, Specs, Gym, Yoga club etc bills for reimbursement.
Agree. Even I had Amex Platinum in the past. I was fooled by insurance guys telling the same details but told that Amex customers have unique offerings (which does not). When I checked with ICICI Lombard helpline and verified. Everything was the same including the OPD
Great find. Does provide full reimbursement in case of hospitalization like Apollo, Star, etc. ?
Yes, Just like any other. Go through the Amex site for detailed info.
U can call on this 01244405500 and it’s a amex insurance helpline number to know about this plan better … and
mention my name is sumin singh
Please don’t rub it in Sid. Can’t get one.
Regarding the insurance, I had heard about their car insurance. This is new. Although I am not too sure about ICICI’s claim settlement ratio. Let’s hope amex helps you with that.
I checked their car insurance the promotional claimed 65% discount and wanted to try it, but when they sent me the quote it was almost equivalent to my Hdfc Ergo existing renewal quote, so I went with Hdfc itself.
Siddharth- ru sure they r offering 35% less than market value ?
Yes, they do. Check the linked article and the comments for more. But as many say this now, I need to verify this again to see if they changed anything recently.
Car insurance every time is not less than mrket but mostly….last time i purchased through them but in this renewal they were more than the market but last time they were a steal….
I recently renewed my car insurance through amex (2nd year thru amex). They provided me the discount on own damage premium. I also checked the quote from other providers, no one matched this. @Kiran, is the IDV value offered by ERGO & Amex same ?
In fact IDV offered by Hdfc was better than amex that’s the reason I continued with HDFC.
1. Is it available with all Amex cards?
2. Family floater health insurance available in this? Does the spouse also need to be Amex card holder?
2. Yes – Family floater via “Bharti AXA” which I’ve not analyzed much. Spouse don’t need to be a cardholder.
Yea, family floater is available for spouse.
Spouse need not have any relationship with Amex.
Thank you Sidharth for review.
Can you elaborate a bit more on OPD benefit and its coverage/exclusions. For example, I visit a clinic for back pain, then does this plan cover the OPD charges ?
Yes, that’s covered.
Almost all medical expenses are covered. But if you declare any existing illness, spends of that type will be excluded.
Hi Siddharth. Great article and so helpful!
Is the OPD cover applicable to family members as well? (in my case my child has the max OPD visits 🙂 )
Thanks in advance!
Can you share the policy T&C, unable to find it on either website?
Check this link
Thanks Sid for the post. Any idea if one can continue the policy if down the line he/she decides to discontinue the Amex CC?
Yes, you can.
I understand this policy works for you now but in your view, would you continue it for long term?
YES – For next 5 yrs. By then I’m sure other credit card issuers too will come up with nice offers. So will have to decide by then.
Just received call from them and came to learn that you may utilize the OPD benefits for Gym/Yoga Memberships as well.
Does it available with others as well??
Not available at such a price & T&Cs with other insurance providers.
Also, take it directly with ICICI Lombard as you get a 5% discount if you take it for 1 year & 15% discount if you take it for 2 years. I paid 22797/- (inclusive of taxes) for 2 years Complete Health Insurance Individual Policy with 10 Lacs cover & 10K OPD/year. This is the same applicable premium amount till the age of 35 years
But with Amex you get additional 10 lac coverage in case you utilise the 10 lac offered by ICICI.
Which makes a 20 lac cover in total.
Kiran, that is known as refill benefit & the same is provided by ICICI Lombard & not Amex. You can avail the same even if you apply directly with ICICI Lombard.
Hi Sid , Can you please explain about OPD benefit more.
I have ICICI Lombard insurance through Amex but im not sure about this benefit. Where can i check ? is it mentioned any where in policy ?
OPD benefit is applicable on covers of 5L or more. Its better to call Amex to check if you have this benefit on your existing policy as the offer keeps changing.
I working as a employee in amex lombard insurance
Good review,i wanted to know how to get gym fees reimburse,like i pay around 20k early ,so 10k will be refunded? Secondly amex started sending Summer spend based voucher from today, I just received my 2.5k flipkart voucher 🙂
That’s right. You just collect all bills and send them to ICICI once a year for re-imbursement.
Oh yes, Fulfilment of the last Amex Spend Based offer is done.
its very simple process as told by Sid.. fill the claim form and mail it along with receipts… I have used it last yr and its smooth…. i did renew again this yr tooo..
You guys say about normal gym fees?? i usually pay yearly gym fees which offers discount
I have tried to use their Car Insurance. I have heavily negotiated. In spite of my best efforts the rates quoted by them was far inferior. The value of the car they quoted was less and the premium came out high. I compared with my existing renewal rates offered by my ensurer. So I decided to stop buying the insurance through AMEX. I tried both Bharthi AXA and ICICI for the Car Insurance. I am yet to try Health Insurance though.
So which one are you using for car insurance now?
I don’t see how no TPA is an advantage, if there is not tpa the claims will be settled inhouse by icici lombard. This should be considered a disadvantage.
Hey Sid… I took the same policy from ICICI directly for some 1k less i guess and renewed for 2nd yr as well.. pretty good benefit of OPD… ICICI is also offering additional 10 lakh cover @ no additional cost in case we exhaust the initial 10 lakh coverage… do check if the same applies for your policy as well…
Yes, it has it. Amex policy comes with Hospital cash as add-on benefit as well.
They will not give u reimbursement of gym yoga and spectacles lenses …if u taken through icici lombard
Hey Sid, does this Rs.14,700 p.a covers for you only or your family?
Where does it say it will cover yoga and gym expenses. What are the conditions for OPD coverage?
I try to apply for MRCC through your referral link. It is showing Card Renewal fee is only 1500 (if don’t spend 1.5 Lakh) where as in direct Amex Website it is showing 4500. Can you please tell me is this due to Referral program?
I have taken this last year, although did not claim any OPD benefits. Anyone using the Term Insurance they are offering in partnership with Future Generali?
I had this policy last year and decided not to renew it this year. The reasons for not renewing it are:
1. I’m already covered under my company’s group insurance policy with a high coverage.
2. I have a personal health insurance policy from New India Assurance where the premium is little lower (Around 3.7K if you remove that 10K that you would be getting reimbursed for OPD ) and I get almost the same coverage as Amex (8L)
3. I have a gym in my society with a trainer so no expenses on that front.
4. There is also the hassle of claiming the OPD reimbursements. You can claim it only once a year so you need to keep your bills throughout the year and send it to them prior to your policy renewal date. I didn’t send them any bills so can’t comment on the acceptance of the expense categories.
Amex policy only makes sense if you able to claim the reimbursement to the tune of 10K. I don’t wear specs and I hardly spent 1K on OPD and medical expenses in the past 1 year (May be I’m too healthy 🙂 )
But company policy will seize to exist when you retire and thats the time you will need the insurance. Most companies then either do not offer insurances or premiums are way too high. That’s my understanding. Am I wrong here?
I am using last 7 years Religare health insurance. There was no claim till date.
Can I make port from Religare to this amex health insurance?
If yes, pls tell me the process
Can I also get it using AMEX co-branded cards, eg IndusInd Iconia AMEX variant?
Did you ever checked the Policy Wording Document. How many Day Care Procedures covered as part of Hospitalization. I had enquired the Policy Wording Document, the wording in the document is not correct.
When you look for Insurance Product we should review through the various count of Day Care Procedures.
I will enquire again with them
Day care procedures are excluded. Bummer!
But I didn’t get you point Sujan. What do you exactly mean by – “Day Care Procedures covered as part of Hospitalization”???
Surgeries are termed ‘Day care’ procedures when you don’t have to get hospitalized even for a day because those surgeries don’t require hospitalization! And if you’re hospitalized, then those surgeries aren’t termed as ‘day care’ I guess.
In their policy words: “Cosmetic surgeries, plastic surgeries, circumcision, vaccination, dental treatment / surgeries which do not require hospitalisation.”
Ya, prima facie it looks a steal. I actually got convinced into buying their plan. For me it was 16500. So effectively 6500 after considering opd benefit. But then I consulted with my insurance advisor, and found my current max life policy better in terms of price. Max life do not have the opd benefit, but then the plan cost is also less.
AMEX also have life insurance in tie up with future Generali. I was again quite satisfied with the plan initially – around 24k p. a., for me, 38 years. Its around the same for a non smoker for HDFC LIFE. And, AMEX do not ask for any health checkup – cool isnt it. However, I was taken aback when I checked future generali online term plan with same benefits – only around 13k for my age, non smoker. On my next call, I informed the advisor about the same, and he promised to look into it and get back to me shortly. Its more than a month, and shortly hasn’t some.
Now, believe me, I would still recommend this life term plan for anyone who has some health issues and may not want to get a health checkup, or a smoker catagory person. But it isnt suitable for people like me.
Another genuine advice – I didnt like the health plan much. If you end up not availing the OPD benefit, it is hugely expensive. And even if you do take the complete OPD benefits, it’s only ‘competitive’, if not more expensive.
I called the ICICI Lombard customer care and they told me all the benefits which are listed in this post (Including OPD for specs) are covered in the policy. And the premium is approx 1k less if i take the policy directly (They offered 5% discount on premium)
With this, it looks beneficial to go through ICICI Lombard directly.
Can you please confirm if the understanding is correct.
@Sid Co-branded Amex Card will do?
Yes, but not the bank issued ones AFAIK.
How did you get to know about Gym bill reimbursement, I checked the entire link Sid, couldn’t find any? Can you help you out with the link that talks about gym bill reimbursement?
I have used the you need to courier them the invoice along with the form which can b downloaded from ICICI website. Within 2 weeks you would get your refund of ₹10,000 or actual gym fees paid which ever is the least.
Thanks for pushing this article.
You forgot to mention one special thing about the OPD charges that it includes Dental consultation and treatment fees too. Almost all the health insurance policies do not allow user to reimburse against the dental treatment. Hope you will update the article.
Sid, I’m a big fan of all your blogs. But, this seems to be a little less researched article. Most insurers provide the best rates for direct customers. (Customer who buy policy online through their website without any intermediary like an Agent, Affiliate Marketer, Aggregator and etc., since they could pass the commision paid to these intermediaries as discount to the direct customers). In this case Amex acts as an intermediary to ICICI Lombard and hence it increases the cost for ICICI Lombard. I’m not very familiar with Health Insurance – But, when it comes to Term Life Insurance and Vehicle Insurance, you get the best rates by directly purchasing from their website. Almost all insurance companies have a e-Term policy and that premium is the lowest when compared to other Term Insurance products of the same company offered through intermediaries. But, the point is that the premium rates for the ETerm product vary from Insurer to Insurer based on the Insured Age and Policy Term.
So, the best way to get the cheapest Term Insurance is to get a quotation directly from the Website of Leading Companies for your age and term. (Aggregators like Policy Bazaar help you to get quotes from multiple companies, but they trick you and lead you to buy some additional featuers that you may not really need). I have 3 term life policies taken at different times for different policy terms – each time I went with the lowest premium – ended up with one policy each from Metlife, HDFC and ICICI.
As far as Car/ Bike Insurance is concerned, Acko is the best – The HDFC Ergo/ Bajaj Allianz and ICICI Lombard agents simply could not believe the premium offered by Acko. Acko is a start up funded by Amazon and their cost structure is the lowest. They also offer more generous IDV when compared to agents. Acko has a wonderful / highly intuitive user interface. One important piece of advice while buying insurance is that never give false information OR hide some facts to get cheaper premium (Example: Not Disclosing Pre Exsiting Illness in case of Health/ Life Policies, Hiding Previous Claims from new Insurer to get NCB and etc – all these must be avoided). Insurance companies may provide a policy for a lower premium based on what you state in the policy, but they can deny the claim if they can prove that you have willfully lied in the application.
You’re all right. But this case is bit different. And it also varies a bit with Age factor.
Yeah, I got their insurance for all the 2 wheelers in our family. They’re super cheap indeed.
Thanks Siddharth for the post!
Is this policy portable…in case one wants to switch int he future?
When it comes to health insurance, we have to check for renew-ability, customer service, also there is something called “loading”. hi, sid can you explain the experience with customer care, informations in renewability for life time and whether loading is applicable, if so how much increase in % ?
After i opted for their heath insurance plan, few weeks later i received another call from AMEX regarding cancer plan which is an optional coverage on top of this. The caller gave me the details about the plan but i don’t recollect now. Did anyone receive a call on this, do you have details about the cancer plan?
I have taken the policy through Amex. I got the policy document today. To verify, I checked the plan on ICICI Lombard website and the premium, coverage and the plan was same. For 26-35 yrs age slab and 10lac cover, the premium was 15,504 which was charged by Amex. It includes addon of Hospital cash and Convalescence Benefit in case of hospitalization of more than 3 days, you get 2k per day upto 10 days + 10k if more than 10 days. Same comes out in ICICI Lombard website. Unless, they give some discount, premium is same. I checked on website, there was no discount for direct customer on date.
I re-checked whatever Amex guy told me about the plan with policy document and ICICI customer care, there is no discrepancy.
However, the policy document does not explicitly mentions about gym bills reimbursement. I asked ICICI customer care and they agreed it will be reimbursed under OPD cover.
Also, you get 1 health check coupon every year which includes ECG, CBC, Blood sugar, Urine routine, Hb% which in open market would cost 1k-2k.
Plus you get wellness points which you can redeem against OPD expenses.
1: If you are particiapating in Gym/Yoga you can earn 2500 points.
2: Participation in events like Marathon/Cyclothon/ Swimathon can earn 2500 points.
3: Preventive Risk assessment: Earn 2000 points by undergoing additional tests
4: Medical Risk assessment: Use your free medical checkup coupon and earn 1000 points at one go and
5: Online HRA: Just respond to a few questions related to health and Quality of life you lead and earn 250 points.
Each wellness points will be equivalent to Rs 0.25.
It also includes maternity cover after 3 years.
Also, I clarified with Amex, I need not be a Amex customer to continue with policy. Only at the time of first premium payment, you have to be Amex customer. From 2nd year onwards, you can choose to change the mode of payment.
If you calculate in 15.5k premium, you can reimburse 10k with OPD expense plus 1k of health check coupon and wellness points upto 5000 points i.e. INR1250; effective premium comes down to INR3,250 which is a steal for 10lac cover in my view. I have existing policy from Royal Sundaram where I pay 2.5k for 3 lac cover with many sub limits and no maternity cover. Here, there is no sub-limits for 7lac and above cover.
In my exprience, if you go to hospital easily you have to pay 2k-3k if diagnostic test is required. Even if you are lucky to not visit hospital in a year, you can claim OPD expense with Gym bills. Point to note, at an older age, your OPD expense will increase and you will not have company health insurance at that time. Buying health insurance at that time will be very costly.
Hope this helps you to make your decision regrading taking a health insurance policy.
Can anyone please tell me which form is to be filled for claiming OPD expenses? Went through their site but couldn’t find a relevant one.
Call ICICI Lombard line for details. Amex has no info on this. Will do a detailed article on it shortly.
Waiting for the detailed article promised here. I too have availed the car insurance from AmEx, reassured by your article, and found it better than what the competition was offering.
Would also appreciate your one year review of the health insurance program and a view on the term insurance that AmEx offers in partnership with the insurers.
I am also confused about which form to be filled for claiming OPD expenses of lenses?
Do you have any idea from where we could get the info ?
Also please let me know if a doctor prescription is required for availing OPD expenses of purchasing lenses ?
P.S. Purchased the policy through AMEX
I think the specs/swimming/gym benefit is no more in the AMEX Advantage. Not mentioned on the dedicated insurance website by AMEX. Anyone plz confirm if it was never mentioned on the website.
Its still there but for some reason they’ve removed it from website. Verified the info with support.
Oh Great! Thanks.
Agreed Sid, we can still get reimbursement for Gym or swimming membership upto 10K.
Its not there in their website, but a quick call to their claims team helps.
Hi . I recently got health insurance poilcy from AMEX. its a family floater (for my parents only) written by Bharti AXA.
I read through the policy document which I received few days back. Although I have many doubts regarding the policy, my main queries / worries are:
1. DId i make a right decision considering that its for my parents (ages in early 50’s) !! OR Would buying a policy directly from a company been a better option, considering long term ?
2 What if after 1 year, I want to switch to the same policy, but under the company and not via amex. ? Because i am thinking, what will happen if in future Amex and Bharti AXA or ICICI dont have partnership ?
3 Will porting to a new policy be difficult in future, lets say after 4- 5 years ?
4. After reading comments here and checking myself, I did not find any additional benefits which I as a cardholder is getting !!! Anyone with the same experience ?
5. In general, if I had to buy a policy for my parents again, any suggestions for any health policies ?
Can you suggest me a good family floater policy for 31 years of age?