LIC's
Jeevan Arogya is a unique non-participating non-linked plan which
provides health insurance cover against certain specified health
risks and provides you with timely support in case of medical
emergencies and helps you and your family remain financially
independent in difficult times.
Health
has been a major concern on everybody’s mind, including yours. In
these days of skyrocketing medical expenses, when a family member is
ill, it is a traumatic time for the rest of the family. As a caring
person, you do not want to let any unfortunate incident to affect
your plans for you and your family. So why let any medical
emergencies shatter your peace of mind.
In
Lic Jeevan Arogya Plan, policy holder can choose Rs. 1,000 to Rs.
4000 per day of Initial daily benefit i.e. the daily Hospital Cash
Benefit (HCB) applicable in the first year of the policy. This HCB
will be payable to the policyholder in the event of hospitalization
in the first year on a per day basis.
The
Major Surgical Benefit (MSB) will be 100 times the Initial Daily
Benefit that the insured have chosen. Thus the initial MSB sum
assured will be Rs. 1 lakh to 4 lakh respectively. Some other
benefits like Dare Care Procedure Benefit (DCPB), Other Surgical
Benefit (OSB) and Premium Waiver Benefit (PWB) will also be payable
depending upon the daily Hospital Cash Benefit chosen.
Key features in Lic Jeevan Arogya:
Lump sum benefit irrespective of actual medical costs.
Flexible
premium payment options.
Financial
protection in case of surgery, hospitalization, etc.
Increasing
health cover every year.
No
claim benefit.
LIC's
Jeevan Arogya (Plan No: 904) Smart Health Insurance plan
|
Features
|
Principle
Insured
|
Insured
Spouse (If any), Parents/ In-Law
|
Insured
Children
|
|
Min.
Initial Daily Benefit
|
Rs.
1000/-
|
Rs.
1000/-
|
Rs.
1000/-
|
|
Max.
Initial Daily Benefit
|
Rs.4000/-
|
Equal
or Less than PI
|
Equal
or Less than PI
|
|
Min.
Entry Age
|
18
yrs LBD
|
18
yrs LBD
|
3
months (completed)
|
|
Max.
Entry Age
|
65
yrs LBD
|
75
yrs LBD
|
17
yrs LBD
|
|
Max.
Age for Cover
|
80
years
|
80
years
|
25
years
|
There are three types of rebates under Lic Jeevan Arogya Plan, they are
Mode rebate
HCB
rebate
CEIS
rebate
Mode
rebate:
Mode Percentage
Yearly
mode 2% of tabular premium
Half-yearly
mode 1% of tabular premium
HCB rebate:
If HCB is more than Rs. 1000, then the premium amount arrived at in respect of a member covered under the policy will be reduced by an amount given below.
HCB For PI (Principal Insured) For each insured member other than PI
Rs.
2000/- 500 250
Rs.
3000/- 1000 500
Rs.
4000/- 1500 750
CEIS
rebate:
For eligible lic employees CEIS rebate will be 10% of the tabular premium.
Lic Jeevan Arogya Benefits:
Hospital Cash Benefit (HCB)
An amount equal to the Applicable Daily Benefit (ADB) available under Lic Jeevan Arogya policy during the policy year will be payable, if PI or any insured covered under the policy is hospitalized.
During the 1st year of cover ADB shall be the Initial Daily Benefit amount (i.e., Rs. 1,000, Rs. 2000, Rs. 3000 or Rs. 4000 per day) which is chosen by policyholder.
Later
every year ADB increases by 5% and will continue until it attains a
maximum amount of 1.5 times the initial daily benefit (i.e. 150%).
Benefits will be payable only after the first 24 hours of hospitalization. If the hospitalization extends for a continuous period of 7 days then, the daily HCB would also be paid for 1st 24 hours of the hospitalization.
Limits of HCB:
Total number of days for which HCB would be payable, in a policy year would be restricted to,
Maximum
of 30 days of hospitalization including 15 days of I.C.U i.e. total
45 days in the 1st policy year.
Maximum
of 90 days of hospitalization including 45 days of I.C.U i.e. total
135 days in the 2nd and subsequent policy years.
Total
no. of days for which HCB would be payable during the policy period,
shall be limited to a maximum of 720 days out of which 360 days shall
be in an ICU.
Major Surgical Benefit (MSB)
Under Lic Jeevan Arogya Plan, if PI or any insured covered under policy undergoes any surgery within the cover period, then the percentage of MSB Sum Assured as specified in the MSB Annexure shall be payable.
Quick Cash Facility is available in which 50% of eligible MSB amount will be payable in advance.
In
case of surgery, total 1 year premium will be waived from the
installment due date following the surgery date.
An
additional lump sum of Rs. 1000/- will be paid for Ambulance service.
Limits of MSB:
MSB will be paid only if Surgery occurs within India.
It
will be paid as lump sum by providing proof of surgery to the
company.
MSB
sum assured is 100 times the ADB (Applicable Daily Benefit).
Amount
payable under the MSB in any policy year during the cover period
shall not exceed 100% of the MSB SA (Sum Assured) in that policy
year.
Total
amount payable under the MSB during the cover period (i.e. maximum
lifetime benefit) shall not exceed 800% of the MSB SA.
Day
Care Procedure Benefit (DCPB)
Under Lic Jeevan Arogya Plan, if PI or any insured covered under policy undergoes any Day Care Procedure mentioned in the Day Care Procedure Annexure, a lump sum amount equal to 5 times the ADB will be paid.
Limits of DCPB:
DCPB will be paid only if the Surgery occurs within India.
It
will be paid as lump sum by providing proof of surgery to the
company.
It
will be payable upto maximum of 3 surgical procedures in any policy
year during the cover period.
DCPB
will be payable only upto maximum of 24 surgical procedures during
the cover period i.e. Maximum Lifetime benefit is for 24 surgical
procedures.
Other Surgical Benefit (OSB)
Under Lic Jeevan Arogya Plan, if PI or any insured covered under the policy undergoes any surgery not listed under MSB or DCPB, then a daily benefit equal to 2 times the ADB will be paid. It will be paid for each continuous period of 24 hours within the cover period.
Limits of OSB:
OSB will be paid only if the Surgery occurs within India.
It
will be paid as lump sum by providing proof of surgery to the
company.
It
will be payable under Lic Jeevan Arogya Plan for the maximum of 15
days in the 1st policy year and 45 days for 2nd and subsequent policy
years following the date of commencement.
OSB
will be payable for the maximum of 360 days during the cover period.
No Claim Benefit
Under Lic Jeevan Arogya Policy, if there are no claims in respect of any insured under policy then no claim benefit will be payable. No claim benefit = 5% of the Initial Daily Benefit. It will be paid during the period between date of commencement and next Automatic Renewal Date or between 2 Automatic Renewal dates of policy.
Riders available under Lic Jeevan Arogya Policy
Two riders are available under Lic Jeevan Arogya Policy, they are
Term Assurance Rider.
Accident
Benefit Rider.
Term
Assurance Rider:
Term Assurance Rider is applicable for PI and/or Insured Spouse only. They can opt this rider as optional rider which is equal to the MSB Sum Assured. An amount equal to Term Assurance Sum assured will be payable on unfortunate death during the policy term.
Eligibility conditions for Term Assurance Rider:
ENTRY AGE:
Minimum:
18 years (completed).
Maximum:
50 years (Nearest birthday).
MAXIMUM
AGE FOR COVER:60
years (Nearest birthday).
MAXIMUM
POLICY TERM:35
years.
SUM
ASSURED:Minimum:
Rs. 100,000.
Maximum:
Amount equal to MSB sum assured, subject to the maximum of Rs. 25
lakh overall limit of existing policies.
SUM
ASSURED IN MULTIPLES:Rs.
25,000/-.
Accident Benefit Rider:
Accident
Benefit Rider is also applicable for PI and/or Insured Spouse only.
Maximum Accident Benefit SA (Sum Assured) will be equal to the Term
Assurance Rider SA. If you have opted for this rider, an amount equal
to Accident Benefit SA will be payable on unfortunate death due to an
accident during the policy term. You can get this Accident Benefit by
paying additional of Rs. 0.50/- for every thousand rupees of the
Accident Benefit SA per policy year.
Eligibility conditions for Accident Benefit Rider:
ENTRY AGE:
Minimum:
18 years (completed).
Maximum:
50 years (Nearest birthday).
MAXIMUM
AGE FOR COVER: 60 years (Nearest birthday).
MAXIMUM
TERM: 35 years.
SUM
ASSURED: Minimum: Rs. 25,000.
Maximum:
Amount equal to Term assurance sum assured, subject to the maximum of
Rs. 50 lakh overall limit of existing policies.
SUM
ASSURED IN MULTIPLES: Rs. 5,000/-.
Death Benefit under Lic Jeevan Arogya Plan
Under Lic Jeevan Arogya plan,
On the death of any insured, no death benefits will be paid unless Term assurance or Accident benefit rider has been opted for.
On
death of the PI, the insured spouse will become the Principal Insured
(PI) only if the option is exercised at the beginning of the
contract.
Lic
Jeevan Arogya Policy will be terminated if the option is not
exercised at the beginning of the contract.
If
the insured spouse had died before the Principal Insured, then the
existing policy will terminate. The other insured will have the
option to take new Lic Jeevan Arogya Policy. In that case,
If
the new policy is bought within 90 days of the termination, then the
policy will be issued without any underwriting.
Maximum
age at entry condition will not apply.
Other
terms and conditions will be applicable for the new policy.
On
death of an Insured person other than the PI, the jeevan arogya
policy will continue after removal of the insured. The change in
premium will apply from installment premium due date.
Lic Jeevan Arogya Maturity Benefit
Under
Lic Jeevan Arogya Plan Maturity Benefit is not applicable. That is at
the end of the policy cover, no benefits are payable to the insured.
Lic Jeevan Arogya Policy Additional Information
Revival:
If Lic jeevan arogya policy is lapsed, it can be revived with in a period of 2 years from the due of FUP (First Unpaid Premium) but before the expiry of cover.
Discontinuance of premiums:
In case of discontinuance of premiums, a grace period not less than 30 days will be allowed for the payment of yearly or half yearly premiums. If premium is not paid before the expiry of a grace period jeevan arogya policy lapses.
You
may return the jeevan arogya policy to the company within 15 days
from the date of receipt of the policy, if you are not satisfied with
the terms and conditions of Policy.
Surrender
Value:
Under
Jeevan Arogya plan, Surrender Value is not available.
Loan
/ Assignment:
Under
Jeevan Arogya plan, Loan / Assignment facility is not available.
Automatic Renewal Date:
The installment premium will be guaranteed with reference to each insured for a period of three years from the Date Of Commencement of the policy. At the end of every 3rd policy anniversary the premiums may be reviewed.
Termination of Jeevan Arogya Policy:
If
policy is issued on single life, the LIC Jeevan Arogya policy will
terminate at the earliest of the following,
On the date of cover expiry.
Non-payment
of premiums within the revival period.
On
death of the insured.
On
exhausting all the maximum lifetime benefit limits.
If
policy is issued on more than one life, the Jeevan Arogya policy will
terminate at the earliest of the following,
On PI exhausting all the maximum lifetime benefit limits.
On
the death or date of cover expiry, of the PI and if the policy is
discontinued with the Insured spouse as the PI.
On
the death or date of cover expiry, of Insured Spouse after the policy
continues with the Insured spouse as the PI.
Non-payment
of premiums within the revival period.
Waiting
Period:
General Waiting Period:
There
will be no general waiting period in case the hospitalization is due
to Accidental bodily injury.
If
the hospitalization is due to sickness, general waiting period is
applicable during which no benefits shall be payable.
It
will be 90 days from the date of commencement of cover, in respect of
each insured.
In
case of revived policy,
General
waiting period will be of 45 days from the revival date, if the
request for revival is within 90 days from the due date of the FUP.
General
waiting period will be of 90 days from the revival date, if the
request for revival is beyond 90 days from the due date of the FUP.
Specific
Waiting Period:
No benefits are available and no payment will be made to any of the following during specific waiting period in respect of each Insured.
Treatment for benign uterine disorders like fibroids, uterine prolapse, dysfunctional uterine bleeding etc.
Treatment
for Piles.
Treatment
for benign enlargement of prostate gland.
Treatment
for adenoid or tonsillar disorders.
Treatment
for slip disc.
Treatment
for benign thyroid disorders.
Treatment
for anal fistula or anal fissure.
Treatment
for degenerative joint conditions.
Treatment
for benign breast disorders e.g. fibroadenoma, fibrocystic disease
etc.
Treatment
for kidney or urinary tract stones.
Treatment
for Carpal tunnel syndrome.
Treatment
for sinus disorders.
Treatment
for varicose veins.
Treatment
for Cataract.
Treatment
for hydrocele.
Treatment
for Gall stones.
Treatment
for Hernia.
Options
under Lic Jeevan Arogya Policy
Option to Migrate:
Children covered under Jeevan Arogya plan will have the option to take a new health insurance plan at the end of the specified exit age or at the policy renewal after completion of 18 years of age. New lic jeevan arogya policy should be purchased within 90 days of the termination of child’s membership.