LIC Jeevan Arogya Plan

One health insurance policy that covers self, spouse, children, parents and parents-in-law.

Provides benefit payout irrespective of actual medical cost incurred

Can be availed along with existing mediclaim policy for the same hospitalisation / surgery

Cover can be extended to new members of the family in case of marriage and childbirth

Quick Cash Facility is available on hospitalisation instead of waiting to make a claim for the benefit after discharge. Under Quick Cash, 50% advance payment is given by LIC (for 57 surgeries performed in network hospitals).

• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)

In Jeevan Arogya, selecting the Hospital Cash Benefit (HCB), is the most important and starting point in understanding its benefits. All other benefits are linked to this amount.

Hospital Cash Benefit is the cash you get on a daily basis in case any member covered by this plan is hospitalised. You can choose your HCB to be any of the following:

• Rs. 1,000 per day
• Rs. 2,000 per day
• Rs. 3,000 per day
• Rs. 4,000 per day

You are eligible to receive the HCB if you have been admitted to the hospital for 24 hours. The daily cash benefit is only extended for the hospitalisation period after the first 24 hours in a non-ICU ward or room of the hospital.

Every year, this Daily Cash Benefit shall be increased by 5% of the HCB selected on purchase till it reached 1.5 times the HCB value chosen on purchase. So if you had chosen an HCB of Rs. 2,000 per day, the value of HCB will be as follows:

1st year HCB = Rs. 2,000
2nd year HCB = Rs. 2,100
3rd year HCB = Rs. 2,200
… it will keep increasing every year till it reaches 1.5 times i.e. Rs. 3,000 per day and the continue to remain the same.

Note:

In case there are no claims in the policy in a year, the HCB will be increased by 5% in addition to the increase shown above. Tho No Claim Benefit does not have an upper limit and will continue to accrue as long as no claims are made in the policy.
In case of hospitalisation of greater than 4 hours in the ICU ward of the hospital, you would be eligible to double the HCB benefit for that period.

In case of a major surgery during the policy period, an amount equal to 100 times the initial HCB selected will be paid to the policyholder as part of this benefit. So the payouts for MSB will be as follows:

The list of Major Surgeries are divided into Category 1, Category 2, Category 3 and Category 4. You will be paid only a % of the total MSB as shown below:

Example: In case you have opted for HCB of Rs. 2,000 per day, the MSB will work out to Rs. 2,00,000. Now you will get the following payouts in case of a Major Surgery.

List of Major Surgeries covered under LIC Jeevan Arogya.

Note:

• You can only claim the the Major Surgical Benefit for treatment of a condition which first occurred or manifested itself after the policy was taken.
• Maximum annual benefit that can be availed for each of the persons covered in the plan - 100% of Major Surgical Benefit Sum Assured.
• Maximum lifetime benefit that can be availed for each of the persons covered in the plan - 800% of Major Surgical Benefit Sum Assured.

In case any of the members covered in the plan undergoes a Daycare Procedure, an amount equal to 5 times the HCB will be paid out. It does not matter what the actual cost of the daycare treatment is.

List of Daycare Procedures covered in LIC Jeevan Arogya Plan.

Note:

• Maximum annual benefit that can be availed for each of the persons covered in the plan - 3 Surgical Procedures.
• Maximum lifetime benefit that can be availed for each of the persons covered in the plan- 24 Surgical Procedures.

In case of a of a surgery which is not part of the Major Surgical Benefit List of the Daycare Procedure List, an amount equal to 2 times the HCB shall be paid for each day of hospitalisation. The period of hospitalisation should be greater than 24 hours to eligible for this amount.

Note:

• Maximum annual benefit that can be availed for each of the persons covered in the plan - 15 days in first policy year and 45 days per year thereafter.
• Maximum lifetime benefit that can be availed for each of the persons covered in the plan - 360 days.

In case of a major surgery listed under Category 1 & Category 2 and if a cost of ambulance has been incurred, an additional sum of Rs. 1,000 will be paid out.

In case of Category 1 & Category 2 surgeries, the one-year premium for the next policy year is waived off.

In case of no claims in a policy year, the HCB would increase by 5% of the initial amount selected. So for every year of no claims, you will get an increased HCB and hence the associated increase in other benefits too.

If the policyholders get married after taking the policy, spouse and in-laws can be added to the plan. They have to be added within 6 months of marriage. The cover though will only start from the next policy anniversary. The increase in premium will also be on the next renewal date.

You can add a new born also to the plan once the child is 90 days old. The cover though will only start from the next policy anniversary. The increase in premium will also be on the next renewal date. Adopted children can also be added to the plan.

Addition of parents or existing in-laws will only be allowed at the start of the plan. It will not be allowed at a later point of time

In case of a Category 1 or Category 2 Major Surgery in a Network Hospital of LIC, the applicant can claim 50% of the amount while in hospital itself. They do not have to wait for the hospitalisation to get over to get the total amount.