Lic India Jeevan Arogya Health Insurance

LIC India Health Insurance Plan

For

Self, Spouse, Children, Parents and In-Laws

Health Insurance (Hospital, Claims & Family)

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Understanding Of

LIC’s Jeevan Arogya



LIC’s Jeevan Arogya

Gives You …. Valuable financial protection in

case of hospitalization, 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

Benefits

Hospital cash benefit (HCB) & Rebate

Major Surgical Benefit (MSB)

Day Care Procedure Benefit (DCPB)

Other Surgical Benefit (OSB)

Premium waiver Benefit (PWB)

Ambulance Benefit

Other Optional benefits

Term Rider Benefit

Accident Benefit Rider

Death Benefit

Quick Cash facility

Maturity Benefit*



Hospital Cash Benefit (HCB)

HCB (Within India only) is payable on per day basis. Double the cash benefit for ICU. HCB to increase 5% till it reaches 1.5 times And arithmetic addition of an amount equal to “No Claim Benefit” Stay in Hospital exceeds a continuous period of 24 hrs or part thereof thereafter. Stay more than 7 days even for1st 24 hours also payable. The installment premium will be guaranteed in respect of each Insured for a period of 3 years from the Date ofCommencement of the policy, i.e. for the first 3 years of the policy. Cover to new additional members for Spouse/Parent/In-Laws should be done with 6 months of the policy. ForChildren, within 3 months. If both of the parents (father and mother) are alive and are eligible for cover, then either both of them will haveto be covered or none of them will be covered. The PI will not have any option to choose one of them. The samecondition will apply for parents-in-law also. The existing spouse, parents, in-laws and children, if not covered at the time of taking policy, shall not becovered under the policy.

Feature Principal Insured (PI) 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

Max Age for Cover 80 yrs 80 yrs 25 yrs

Maximum annual benefit period, applicable to each insured

30 days in year 1 of the policy90 days per year thereafter, inclusive of stay in ICU. Maximum number of days in ICU is restricted to 15 days in year 1 and to 45 days thereafter

Maximum Lifetime Benefit period, applicable to each insured

720 days inclusive of stay in ICU. Maximum number of days in ICU is restricted to 360 days during entire policy term for each insured



Major Surgical Benefit (MSB)

Quick Cash facility: 50% of eligible MSB amount subject to approval from TPA in select Hospitals MSB shall be a percentage of Sum Assured and is payable regardless of actual costs incurred Rs. 1000/- towards Ambulance expenses Premium Waiver benefit for next one year Surgery within India (the surgery may be either planned or emergency due to accident). You, as PI, and your spouse may opt for Term Assurance as optional rider equal to the MSB SA. In case ofunfortunate death, an amount equal to Term Assurance Sum Assured will be payable on death during the term forwhich Term Assurance Rider is opted for. MSB is only a Advance payment in the event of hospitalization for any MSB defined in the surgeries listedunder categories I & II and permissible under the policy . The Categories are listed at the end.

Feature Principal Insured (PI) Insured Spouse(If any), Parents/In law

Insured Children

Sum Assured (MSB SA) 100 times Applicable Daily Benefit (ADB) of PI

Insured Spouse- 100 times of ADB of Insured SpouseInsured Parents / parents-in-law-100 times of ADB of each parent

100 times of ADB of each child

Max Annual benefit applicable to each insured

100% of Sum Assured

Max Life Time Benefit applicable to each insured

800% of MSB SA



Day Care Procedure Benefit (DCPB)Feature Principal Insured (PI) Insured Spouse(If any), Parents/In law Insured Children

Lump sum benefit payable 5 times of Applicable Daily Benefit (ADB) of PI

Insured Spouse- 5 times of ADB of Insured SpouseInsured Parents / parents-in-law- 5 times of ADB of each parent

5 times of ADB of each child

Maximum annual benefit, applicable to each insured

3 Surgical Procedures

Maximum Lifetime Benefit, applicable to each insured

24 Surgical Procedures

If a DCPB is performed, no HCB shall be paid DCPB is payable as one lump sum and proof of surgery is required All surgical procedures should be done by a Physician or Surgeon, to the satisfaction of the Corporation No transfer of left over benefit to other insured Surgery within India Only.

Premium Waiver Benefit (PWB) Total one year premium waiver limit. Any Major Surgical Benefit event, total one year premium coinciding with or next following the date of the Surgery will be waived. Only Major Surgical Benefit falling under Category 1 or Category 2 as one lump sum and proof of surgery is required.



Other Surgical Benefit (OSB)Feature Principal Insured (PI) Insured Spouse(If any), Parents/In

lawInsured Children

Daily Benefit amount 2 times of ADB 2 times of ADB 2 times of ADB

Max Annual benefit 15 Days in Year 1 and 45 days per year thereafter

Max Life Time 360 days

OSB is payable as daily benefit Proof of surgery done by a Physician or Surgeon, is subject to the satisfaction of the Corporation No transfer of left over benefit to other insured Surgery required but not listed under MSB or DCPB

Other OptionsTerm Rider benefit Min Term Assurance SA: Rs. 100000/-

Max Term Assurance SA: Equal to MSBSA

Min Entry Age: 18 Years completed

Max Entry Age: 50 Years NBD

Max Maturity Age: 60 Years NBD

Max Term: 35 Years

(SA be in multiples of Rs. 25000/-)

Accident Benefit Rider (AB) Min AB SA: Rs. 25000/-

Max AB SA: Equal to Term Assurance SA

Additional premium of “0.50 for every” 1,000/-

Additional premium not required when Term Assurance Rider ceases

AB SA shall be in multiples of Rs. 5000/-



Death Benefit No death benefit unless Term (TA) Rider benefit is opted for.

Other Benefits

Surviving Insured Spouse will become PI, if already option given at the beginning of contract.

If the Insured Spouse had predeceased the PI, Then the other Insured will have the option to take new policy on following conditions

The new policy will be issued without any underwriting if the new policy is bought within 90 days of the termination of the existing policy

The maximum entry age will not apply for the new policy

The outstanding Waiting periods and outstanding period of any exclusion will however apply under the new policy

Other terms and conditions including premium rates will be as applicable for the new policy

Maturity Benefit No benefits are payable at the end of the cover period

On death of the Principal Insured(PI)



Eligibility ConditionsFeature Principal Insured

(PI)/Insured Spouse

Parents & Parents-in-law Insured Children

Minimum Entry Age 18 Yrs 18 Yrs 3 Months(Completed)

Maximum Entry Age 65 Yrs 75 Yrs 17 Yrs

Max Cover ceasing age 80 Yrs 80 yrs 25 yrs

Date of cover expiry in respect of each Insured covered under the plan

Policy anniversary on which the Insured life attains Maximum cover ceasing age

Loan No Loan Allowed

Nominations Allowed

Assignments Not Allowed

Mode of Premium Yearly, Half Yearly and Monthly(ECS Only)

Premium Guarantee 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 .

Grace Period 30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode

Revival Period 2 Years from due date of FUP

Surrender No surrender value will be available under the plan



Important Points All existing members must be added in first instance. New members can be

added through Child birth (Children)-3 Months, Marriage (Spouse, Parents-in-law)- 6 Months from next Policy anniversary

Premium guaranteed for first 3 years and may be revised after every 3 years based on Health conditions

Always opt for Term Assurance Rider and Accident Benefit Rider to over come unforeseen situations.

Hospital Cash Benefit applicable out of the following choices:“1000 per day” | “2000 per day” | “3000 per day” | “4000 per day”.

Major Surgical Benefit Sum Assured will be “1 lakh”, “2 lakh”, “3 lakh”, “4 lakh” respectively

No surrender value will be available under the plan



Important PointsWaiting Period 90 days from DOC other than accidental bodily injury

45 days from DOR, if request for revival recd within 90 days from the due date of FUP

90 days from DOR, if request for revival recd beyond 90 days from the due date of FUP

Specific Waiting Period (Treatments) 2 years from Date of Cover Commencement (DOCC)

2 Years from DOCC, if request for revival recd within 90 days from the due date of FUP

2 Years days from DOR, if request for revival recd beyond 90 days from the due date of FUP

Treatments (waiting period )

Treatment for adenoid or tonsillar disorders Treatment for anal fistula or anal fissure Treatment for benign enlargement of prostate gland Treatment for benign uterine disorders like fibroids, uterine prolapse, dysfunctional uterine bleeding etc Treatment for Cataract Treatment for Gall stones Treatment for slip disc Treatment for Piles Treatment for benign thyroid disorders Treatment for Hernia Treatment for hydrocele Treatment for degenerative joint conditions Treatment for sinus disorders Treatment for kidney or urinary tract stones Treatment for varicose veins Treatment for Carpal tunnel syndrome Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc



Important PointsSECTION 45 OF INSURANCE ACT, 1938

No policy of life insurance shall after the expiry of two years from the dateon which it was effected, be called in question by an insurer on the groundthat a statement made in the proposal for insurance or in any report of amedical officer, or referee, or friend of the insured, or in any otherdocument leading to the issue of the policy, was inaccurate or false, unlessthe insurer shows that such statement was on a material matter orsuppressed facts which it was material to disclose and that it wasfraudulently made by the policyholder and that the policyholder knew atthe time of making it that the statement was false or that it suppressedfacts which it was material to disclose.Provided that nothing in this section shall prevent the insurer from callingfor proof of age at any time if he is entitled to do so, and no policy shall bedeemed to be called in question merely because the terms of the policy areadjusted on subsequent proof that the age of the life assured wasincorrectly stated in the proposal.

Termination of PolicyIf policy is issued on a single life Non Payment of premium within revival period

On death

On Date of cover expiry

On exhausting all the life time maximum Benefits Limits as specified above

If policy is issued on more than one life Non Payment of premium within revival period

On death or Date of cover expiry of the PI and if the Policy does not continue with the IS as the PI

On death or Date of cover expiry of IS after Policy continues with the IS as the PI after the PI dies or reaches his/her Date of cover expiry

On PI exhausting all the life time maximum Benefits Limits as specified above

SECTION 41 OF INSURANCE ACT 1938

(1) No person shall allow or offer to allow, either directly or indirectly, as aninducement to any person to take out or renew or continue an insurance inrespect of any kind of risk relating to lives or property in India, any rebate ofthe whole or part of the commission payable or any rebate of the premiumshown on the policy, nor shall any person taking out or renewing orcontinuing a policy accept any rebate, except such rebate as may be allowedin accordance with the published prospectuses or tables of the insurer:provided that acceptance by an insurance agent of commission in connectionwith a policy of life insurance taken out by himself on his own life shall not bedeemed to be acceptance of a rebate of premium within the meaning of thissub-section if at the time of such acceptance the insurance agent satisfiesthe prescribed conditions establishing that he is a bona fide insurance agentemployed by the insurer.(2) Any person making default in complying with the provisions of thissection shall be punishable with fine which may extend to five hundredrupees.



Decision ???What is different from Mediclaim?

Pre defined benefit- No reimbursement, butlump sum paid based on pre-defined benefit Not based on expenses incurred This will tend to indirectly reduce theHealth care cost, which is rising due to cash lessmediclaim benefit All benefit is dependent on HCB

Health Insurance plan must take care……

1) Daily Expenses in Hospital

2) Surgical Expenses

3) Out Patient expenses

4) All expenses in and out of Hospital

5) Waiver of premium during stay at Hospital

6) Risk Coverage in case of any exigencies

7) Should cover your Parents, In-Laws

8) Riders available to support my Family

9) No Claim Benefit

Whether your existing plan offers all the above

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Lic India Jeevan Arogya Health Insurance

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