LIC's Jeevan Arogya Plan No. 904

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.