Health Insurance (Hospital, Claims & Family)

Understanding Of LICs Jeevan Arogya

LIC India Health Insurance Plan For Self, Spouse, Children, Parents and In-Laws
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Health Insurance (Hospital, Claims & Family)

LICs 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*
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Health Insurance (Hospital, Claims & Family)

Hospital Cash Benefit (HCB)

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

Min Initial Daily Benefit Max Initial Daily Benefit Max Age for Cover

Rs. 1000/Rs. 4000/80 yrs

Rs. 1000/Equal or less than PI 80 yrs

Rs. 1000/Equal or less than PI 25 yrs

Maximum annual benefit period, applicable to each insured

Maximum Lifetime Benefit period, applicable to each insured

30 days in year 1 of the policy 90 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
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

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 for 1st 24 hours also payable. 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. Cover to new additional members for Spouse/Parent/In-Laws should be done with 6 months of the policy. For Children, within 3 months. 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. The existing spouse, parents, in-laws and children, if not covered at the time of taking policy, shall not be covered under the policy.
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Health Insurance (Hospital, Claims & Family)

Major Surgical Benefit (MSB)

Feature Principal Insured (PI) Insured Spouse(If any), Parents/In law Insured Children 100 times of ADB of each child

Sum Assured (MSB SA)

100 times Applicable Daily Benefit (ADB) of PI

Insured Spouse- 100 times of ADB of Insured Spouse Insured Parents / parents-in-law100 times of ADB of each parent

Max Annual benefit applicable to each insured Max Life Time Benefit applicable to each insured

100% of Sum Assured 800% of MSB SA

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 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. MSB is only a Advance payment in the event of hospitalization for any MSB defined in the surgeries listed under categories I & II and permissible under the policy . The Categories are listed at the end.

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Health Insurance (Hospital, Claims & Family)

Day Care Procedure Benefit (DCPB)

Feature Principal Insured (PI) Insured Spouse(If any), Parents/In law Insured Children 5 times of ADB of each child

Lump sum benefit payable

5 times of Applicable Daily Benefit (ADB) of PI

Insured Spouse- 5 times of ADB of Insured Spouse Insured Parents / parents-in-law- 5 times of ADB of each parent 3 Surgical Procedures 24 Surgical Procedures

Maximum annual benefit, applicable to each insured Maximum Lifetime Benefit, applicable to each insured

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.
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Health Insurance (Hospital, Claims & Family)

Other Surgical Benefit (OSB)

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

Daily Benefit amount Max Annual benefit Max Life Time

2 times of ADB

2 times of ADB

2 times of ADB

15 Days in Year 1 and 45 days per year thereafter 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 Options
Term 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/-)
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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/Copyright CustBase Corporation, 2011 | All rights reserved

Health Insurance (Hospital, Claims & Family)

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

On death of the Principal Insured(PI)

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

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Health Insurance (Hospital, Claims & Family)

Eligibility Conditions
Feature Principal Insured (PI)/Insured Spouse 18 Yrs Parents & Parents-in-law Insured Children Minimum Entry Age 18 Yrs 3 Months(Completed)

Maximum Entry Age

Max Cover ceasing age Date of cover expiry in respect of each Insured covered under the plan Loan Nominations

65 Yrs
80 Yrs

75 Yrs
80 yrs

17 Yrs
25 yrs

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

No Loan Allowed Allowed

Assignments
Mode of Premium Premium Guarantee

Not Allowed
Yearly, Half Yearly and Monthly(ECS Only) 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 . 30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode 2 Years from due date of FUP No surrender value will be available under the plan
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Grace Period Revival Period Surrender

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Health Insurance (Hospital, Claims & Family)

Important Points
All existing members must be added in first instance. New members can be added through Child birth (Children)-3 Months, Marriage (Spouse, Parentsin-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
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Health Insurance (Hospital, Claims & Family)

Important Points
Waiting 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

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

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

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Health Insurance (Hospital, Claims & Family)

Important Points
Termination of Policy
If 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

SECTION 45 OF INSURANCE ACT, 1938

No policy of life insurance shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policyholder and that the policyholder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose. Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life assured was incorrectly stated in the proposal.

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 an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer. (2) Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees.

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Health Insurance (Hospital, Claims & Family)

Decision ???
Health Insurance plan must take care
1) 2) 3) 4) 5) 6) 7) 8) 9) Daily Expenses in Hospital Surgical Expenses Out Patient expenses All expenses in and out of Hospital Waiver of premium during stay at Hospital Risk Coverage in case of any exigencies Should cover your Parents, In-Laws Riders available to support my Family No Claim Benefit

What is different from Mediclaim?

Pre defined benefit- No reimbursement, but lump sum paid based on pre-defined benefit Not based on expenses incurred This will tend to indirectly reduce the Health care cost, which is rising due to cash less mediclaim benefit All benefit is dependent on HCB

Whether your existing plan offers all the above

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