LIC Jeevan Arogya - Health Plan

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.

Jeevan Arogya

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.

LIC’s Jeevan Arogya gives you:

• Valuable financial protection in case of hospitalisation, surgery etc
• Increasing Health cover every year
• Lump sum benefit irrespective of actual medical costs
• No claim benefit
• Flexible benefit limit to choose from
• Flexible premium payment options

Very easy to choose your plan
           

Step 1	Choose the level of Health cover you need
Step 2	Work out the premium payable along with our Representative

Step 1: Choose the level of Health cover you need:

You can choose the amount of Initial Daily Benefit (i.e. the daily Hospital Cash Benefit applicable in the first year of the policy) as per your need from out of the following choices:

` 1000 per day

` 2000 per day

` 3000 per day

` 4000 per day

This is the amount that will be payable to you in the event of hospitalisation in the first year on a per day basis. The Major Surgical Benefit that you will be covered for will be 100 times the Initial Daily Benefit you have chosen. Thus the initial Major Surgical Benefit Sum Assured will be ` 1 lakh, 2 lakh, 3 lakh, 4 lakh respectively. Other benefits such as Day Care Procedure Benefit, Other Surgical Benefit and Premium waiver Benefit (PWB) mentioned below shall also be payable depending upon the daily Hospital Cash Benefit chosen.

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Step 2: Work out the premium payable along with our representative
Your premium will depend on your age, gender, the Health cover option you have chosen, whether you are Principal Insured or other insured life and the mode of payment.

Tables below give an indicative annual premium, payable yearly, for all health benefits corresponding to an Initial Daily Benefit of ` 1000 per day, for some of the ages in respect of  various lives that can be covered under a single policy:

     PRINCIPAL INSURED (Male)

Age at entry	Premium (`)
20	1922.65
30	2242.90
40	2799.70
50	3768.00

         SPOUSE (Female) / PARENT (of PI/Spouse) (Female)

Age at entry	Premium (`)
20	1393.15
30	1730.65
40	2240.60
50	2849.10

CHILD

Age at entry	Premium (`)
0	792.00
5	794.75
10	812.35
15	870.75

(Premiums indicated are exclusive of Service Tax)

Who can be insured?
You (as Principal Insured (PI)), your spouse, your children, your parents and parents of your spouse can all be insured under one policy. Quite a relief isn’t it, to have all insured under one policy!
The minimum and maximum age at entry is as under:

	Minimum age at entry	Maximum age at entry
Self / spouse	18 years	65 years (last birthday)
Parents / parents-in-law	18 years	75 (last birthday)
Children	91 days	17 years (last  birthday)

How long are each insured under this policy?
Each of the insured are covered for Health risks up to age (80). Children are insured up to age 25 years.

LIC Jeevan Arogya

1. Benefits offered under the plan are

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB)

• Day Care Procedure Benefit 

• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)

• Hospital Cash Benefit: If you or any of the insured lives covered under the policy is hospitalised due to Accidental Body Injury or Sickness and the stay in hospital exceeds a continuous period of 24 hours, then for any continuous period of 24 hours or part thereof, provided any such part stay exceeds a continuous period of 4 hours (after having completed the 24 hours as above) in a non-ICU ward/room of a hospital, an amount equal to the Applicable Daily Benefit (ADB) available under the policy during that policy year shall be payable subject to benefit limits and conditions mentioned in Para 11A) and exclusions mentioned in Para 15 below.

During the first year of cover commencement in respect of each insured, the Applicable Daily Benefit shall be the Initial Daily Benefit amount chosen by you and mentioned in the policy Schedule.  

The amount of ADB for each policy year, after the first policy year, shall consist of 2 parts:

• An arithmetic addition of an amount equal to 5% (five percent) of the Initial Daily Benefit to the Applicable Daily Benefit of the previous Policy Year. Such increase in the Applicable Daily Benefit shall be effected on each policy anniversary during the Cover Period and shall continue until it attains a maximum amount of 1.5 times the Initial Daily Benefit. Thereafter, this amount in each Policy Year in future shall remain at that maximum level attained.
• Further arithmetic addition of an amount equal to “No Claim Benefit” (as described in Para 1.G) below) provided the policy attracts and is eligible for it. There shall be no maximum limit for such increase which means that if this policy is eligible for “No Claim Benefit”, the same shall be granted throughout the Cover Period without any maximum limit.

For members included subsequently under the policy, the benefit in the first year shall be equal to Initial Daily Benefit amount and thereafter the Applicable Daily Benefit shall increase as above.

If any of the member insured is required to stay in an Intensive Care Unit of a hospital, two times the Applicable Daily Benefit will be payable subject to benefit limits and conditions mentioned in Para 11A) and exclusions mentioned in Para 15 below.

During one period of 24 continuous hours (i.e. one day) of Hospitalisation (after having completed the 24 hours as above), if the said Hospitalisation included stay in an Intensive Care Unit as well as in any other in-patient (non-Intensive Care Unit) ward of the Hospital, the Corporation shall pay benefits as if the admission was to the Intensive Care Unit provided that the period of Hospitalisation in the Intensive Care Unit was at least 4 continuous hours.

No benefit will be payable for the first 24 hours of hospitalisation. However, for every Hospitalization that extends for a continuous period of 7 days or more, the Daily Hospital Cash Benefit would also be paid for first 24 hours (day one) of hospitalization, regardless of whether the Insured was admitted in a general or special ward or in an intensive care unit.

• Major Surgical Benefit: In the event of an Insured under this plan, due to medical necessity, undergoing one of the surgeries defined in Major Surgical Benefit Annexure, within the cover period in a hospital due to Accidental Bodily Injury or Sickness, the respective benefit percentage of the Major Surgical Benefit Sum Assured, as specified against each of the eligible surgeries mentioned in Major Surgical Benefit Annexure, shall be paid subject to benefit limits and conditions mentioned in Para 11B) and exclusions mentioned in Para 15 below.

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• Day Care Procedure Benefit: In the event of an Insured under this Plan undergoing any specified Day Care Procedure mentioned in the Day Care Procedure Benefit Annexure due to medical necessity, a lump sum amount equal to 5 (five) times the Applicable Daily Benefit shall be paid, regardless of the actual costs incurred, subject to benefit limits and conditions mentioned in Para 11C) and exclusions mentioned in Para 15 below.

• Other Surgical Benefit: In the event of an Insured under this Plan, due to medical necessity, undergoing any Surgery not listed under Major Surgical Benefit or Day Care Procedure Benefit, causing the Insured’s Hospitalization to exceed a continuous period of 24 hours within the Cover Period,  then, a daily benefit equal to 2 (two) times the Applicable Daily Benefit shall be paid for each continuous period of 24 hours or part thereof provided any such part stay exceeds a continuous period of 4 hours of Hospitalization, subject to benefit limits and conditions mentioned in Para 11D) and exclusions mentioned in Para 15 below.

• Ambulance Benefit: In the event that a Major Surgical Benefit falling under Category 1 or Category 2 (as mentioned in the Major Surgical Benefit Annexure) is payable and emergency transportation costs by an ambulance have been incurred, an additional lump sum of ` 1,000 will be payable in lieu of ambulance expenses.

• Premium Waiver Benefit: In the event that a Major Surgical Benefit falling under Category 1 or Category 2 (as mentioned in the Major Surgical Benefit Annexure) is payable in respect of any Insured covered under the policy, the total annualized premium i.e. total one year premium in respect of that Policy from the date of instalment premium due coinciding with or next following the date of the Surgery will be waived.

No claim benefit: A no claim benefit will be paid in the event that during the period between Date of Commencement of policy and next Automatic Renewal Date or between two Automatic Renewal Dates (described in Para 4 below) there are no claims in respect of any Insured covered under your policy. The amount of the no claim benefit would be equal to 5% (five percent) of the Initial Daily Benefit in respect of each Insured and the resulting amount shall be added to arrive at the Applicable Daily Benefit in respect of each Insured for the Policy Year next following the most recent Automatic Renewal Date. 

Payment of Premiums: You may pay premiums regularly at yearly or half-yearly intervals over the term of the policy.

The premium in respect of each individual will be payable from the date of entry into the policy till the date of exit from the policy and will depend on the age of the insured member, the level of Hospital Cash Benefit (HCB) chosen, whether the insured member is Principal Insured or any other Insured life (in case of cover for more than one member in a policy). The level of premium for Principal Insured and the other insured members shall be different for the same age and same level of cover.

The premiums are guaranteed for 3 years from the date of commencement of policy. Thereafter i.e. at the end of every 3 years, the Corporation reserves the right to review the premium to take account of the experience of the portfolio subject to prior approval from IRDA. The rates applicable on every Automatic Renewal Date shall be guaranteed for a further period of 3 years i.e. till next Automatic Renewal Date.

The premium rates in respect of each insured member on renewal will be based on age of that member at the time of inclusion into the policy.

The total premium to be charged for a policy will be the sum of premiums in respect of each member to be covered in that policy.

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Mode and High HCB Rebates:

Mode Rebate:
Yearly mode                : 2% of tabular premium
Half-yearly mode       : 1% of the tabular premium

HCB Rebates:
In respect of a member covered under a policy, if HCB is more than ` 1000, then the premium arrived at in respect of that member shall be reduced by an amount (`) given below:
HCB (`)                                           For PI                  For each insured member 
                                                                                                  other than PI
2000                                                   500                                250
3000                                                  1000                               500
4000                                                  1500                               750                      

 Automatic Renewal Date: The installment premium will be guaranteed in respect of each Insured for a period of 3 years from the Date of Commencement of the policy, i.e. for the first 3 years of the policy. Thereafter, at the end of every third policy anniversary, the premiums may be reviewed to take into account the Corporation’s experience, subject to prior approval from IRDA. These premium due dates, at the end of every third policy anniversary, starting from the date of commencement of policy till the date of cover expiry, on which the installment premiums are reviewable, will be referred as Automatic Renewal Dates in respect of all Insured in the Policy.

On any Automatic Renewal Date in the future, the installment premium will be based on the age of the Insured at the time of inclusion into the policy and the Corporation’s premium rates then prevailing for this product.

1. Options:
2. Cover to new additional members: If PI gets married/ remarried during the term of the policy, the spouse and parents-in-law can be included in the policy within six months from the date of marriage / remarriage, but the cover shall start from the policy anniversary coinciding with or next following the date of inclusion. Enhanced premium shall be due from such policy anniversary.

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Similarly, Any child born/legally adopted after taking the policy can also be covered from the next immediate policy anniversary date following the date on which the child completes the age of 3 months. If the age of legally adopted child on the date of adoption is more than 3 months, the child can be covered from policy anniversary coinciding with or next following the date of adoption. Enhanced premiums shall be due from such policy anniversary.

Inclusion of each additional member will be on payment of enhanced premiums and subject to various terms and conditions of the plan.

Any addition of new lives shall be allowed by the PI only. After the death of PI, no addition will be allowed.

Addition in any other case will not be allowed. The existing spouse, parents, parents-in-law and children, if not covered at the time of taking policy, shall not be covered under the policy.

If both of the parents (father and mother) are alive and are eligible for cover, then either both of them will have to be covered or none of them will be covered. The PI will not have any option to choose one of them. The same condition will apply for parents-in-law also at the time of purchasing a policy or on addition of new members under an existing policy.

1. Option to migrate: Children covered under this plan shall have the option to take a suitable new health insurance policy (subject to underwriting) at the end of the specified exit age or at the renewal of the policy after completion of 18 years of age. 

1. The new policy should be purchased within 90 days of the termination of child’s membership from the existing policy.
2. The Insured member shall be eligible for suitable credits gained for pre-existing conditions and time bound exclusions for all the previous years, provided the policy is in-force. The outstanding Waiting periods and outstanding period of any Exclusion will however apply under the new policy.
3. These credits shall be available up to a maximum of the current SA level under the existing policy.
4. Other terms and conditions including premium rates will be as applicable for the new policy.

1. Quick Cash facility: If any of the insured lives undergoes any eligible surgery covered under Category I or II of MSB in any of the listed network hospitals, you, as PI will have an option to avail Quick Cash facility. Under this facility, 50% of eligible MSB amount would be made available even during the period of hospitalization of any of the insured lives covered (the surgery may be either planned or emergency due to accident) instead of waiting for making a claim for the benefit after discharge. It will be only an advance payment in the event of hospitalization for any MSB defined in the surgeries listed under categories I & II and permissible under the policy conditions of the plan. This will be, however, subject to approval from the Corporation, and the advance amount will be adjusted from the final settlement of MSB claim amount.

This facility of advance payment could be availed by submitting your Bank Account details in the prescribed format. The amount of advance shall be credited to your bank account directly.

1. Term Assurance Rider: You, as PI, and/ or your spouse may opt for Term Assurance as optional rider equal to the MSB SA. In case of unfortunate death, an amount equal to Term Assurance Sum Assured will be payable on death during the term for which Term Assurance Rider is opted for.

1. Accident Benefit Rider: You and/ or your spouse may also opt for Accident Benefit Rider if Term Assurance Rider has been opted for. Maximum Accident Benefit Sum Assured shall be equal to the Term Assurance Rider SA. In case of unfortunate death due to an accident, an amount equal to Accident Benefit Sum Assured shall be payable.

Accident Benefit Rider will be available under the plan by payment of additional premium of ` 0.50 for every ` 1,000/- of the Accident Benefit Sum Assured per policy year in respect of each life to be covered.

The additional premium for this benefit will not be required to be paid on and after the Policy anniversary on which the Term Assurance Rider ceases.

                                                             More Info On LIC Official Document 

For More Info Contact – US or

Call or SMS “Plan” to 9977143290