Lic Jeevan Arogya Policy Review

Lic Jeevan Arogya Plan no. 904 Details

Lic Jeevan Arogya is a Non-linked Health Insurance plan. It was introduced by Life Insurance Corporation of India. Lic Jeevan Arogya covers you (Principal Insured) and your family such as Spouse, Parents, Children and Parents-in-law. You can cover entire family under single policy. We can say that Lic Jeevan Arogya covers three generations. Lic Jeevan Arogya provides financial support in case of medical emergencies, any health risks, etc.

Key features involved in Lic Jeevan Arogya are, it gives you

• 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.

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.

Lic Jeevan Arogya Policy Conditions

	Self / Spouse	Parents / Parent-in-laws	Children
Minimum age at entry	18 years	18 years	91 days
Maximum age at entry	65 years	75 years	17 years (last birthday)
Maximum cover Ceasing Age	80 years	80 years	25 years (last birth day)

Premium paying mode

Half-yearly and yearly

Lic Jeevan Arogya Health Plan Rebates

There are three types of rebates under Lic Jeevan Arogya Plan, they are

1. Mode rebate
2. HCB rebate
3. 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

Example:

For Principal Insured (PI):

As per Premium table, if annual premium is Rs. 2500/- per 1000/- HCB and policyholder wanted HCB is Rs. 2000/- per day, then the premium will be 2500 x 2 = 5000/- but as per HCB rebate under this plan, 500/- will be reduced from 5000/- i.e. the premium is reduced to Rs. 4500.

For each insured member other than PI:

If annual premium is Rs. 2000/- per 1000/- HCB and policyholder chosen HCB is Rs. 2000/- per day, then the premium will be 2000 x 2 = 4000/- but as per HCB rebate under this plan, 250/- will be reduced from 4000/- i.e. the premium is reduced to Rs. 3750.

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. For example if the chosen HCB is Rs. 1000 then per day he/she will be paid Rs. 1000.

• 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%).

Example:

If policy holder has chosen Rs. 1000 of ADB, it increases by 5% every year i.e. for 2nd policy year it will be Rs. 1050, on 3rd year ADB will be Rs. 1100 and so on up to Rs. 1500/- daily benefit.

• 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.

Example:

For HCB 1000,

In the 1st policy year, HCB + ICU benefit will be 1000/- (ADB) x 45 days = 45,000/-.

In the 2nd policy year, ADB increases by 5% i.e. ADB will be 1050/- now HCB including ICU benefit will be 1050/- (ADB) x 135 days = 1,41,750/-.

HCB including ICU benefit that is Maximum eligible during the policy term is 1500/- (ADB) x 720 days = 16,20,000/-.

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.

Example:

For HCB 1000

In the 1st policy year, MSB i.e. maximum annual benefit will be 100% (MSB sum assured) that equals to 100% (100 times of ADB).

=> 100% (100 x 1000) = Rs. 1,00,000/-

In the 2nd policy year, ADB increases by 5% i.e. ADB will be 1050/-, now the maximum annual benefit will be 100% (MSB sum assured) that equals to 100% (100 times of ADB).

=> 100% (100 x 1050) = Rs. 1,05,000/-

Maximum eligible during the policy term i.e., Maximum lifetime benefit will be 800% (MSB sum assured) that equals to 800% (100 times of ADB).

=> 800% (100 x 1500) = Rs. 12,00,000/-

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.

Example:

For HCB 1000

In the 1st policy year, lump sum benefit payable will be 5 times of ADB for each surgical procedure i.e. 5 x 1,000 (ADB for 1st policy year ) x 3 (since DCPB will be payable up to maximum of 3 surgical procedures during any policy year) = 15,000 DCPB will be payable for 1st policy year.

In the 2nd policy year, lump sum benefit payable will be 5 times of ADB for each surgical procedure i.e. 5 x 1,050 (ADB for 2nd policy year ) x 3 (since DCPB will be payable up to maximum of 3 surgical procedures during any policy year) = 15,750 DCPB will be payable for 2nd policy year.

Maximum eligible during the policy term i.e. Maximum lifetime benefit will be for 24 surgical procedures i.e. 5 x 1500 (Maximum level of ADB) x 24 (since DCPB will be payable up to maximum of 24 surgical procedures during cover period) = 1,80,000 DCPB will be payable.

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.

Example:

For HCB 1000

In the 1st policy year, daily benefit payable will be 2 times of ADB

i.e. 2 x 1,000 (ADB for 1st policy year ) x 15 (since OSB will be payable up to maximum of 15 days during 1st policy year) = Rs. 30,000 OSB will be payable for 1st policy year.

In the 2nd policy year, daily benefit payable will be 2 times of ADB

i.e. 2 x 1,050 (ADB for 2nd policy year ) x 45 (since OSB will be payable upto maximum of 45 days for 2nd and subsequent policy years) = Rs. 94,500 OSB will be payable for 2nd policy year.

Maximum eligible during the policy term i.e. Maximum lifetime benefit will be for 360 days

i.e. 2 x 1,500 (Maximum level of ADB) x 360 (since OSB will be payable upto maximum of 360 days during cover period) = Rs. 10,80,000 OSB will be payable.

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.

Benefit Illustration for HCB 1000

Nature of Benefit	First Policy year (Rs)	Second Policy year (Rs)	Max. eligible during the policy term (Rs)
Hospital Cash Benefit (HCB) including ICU Benefit	45,000 (1000 per day x 45 days)	1,41,750 (1050 per day x 135 days)	16,20,000 (1500 per day x 720 days)
Major Surgical Benefit (MSB)	1,00,000 [100% (100 x 1000 per day)]	1,05,000[100% (100 x 1050 per day) ]	12,00,000[ 800% (100 x 1500 per day)]
Day Care Procedure Benefit (DCPB)	15,000 (5 x 1000 per day x 3 surgical procedures)	15,750 (5 x 1050 per day x 3 surgical procedures)	1,80,000 (5 x 1500 per day x 24 surgical procedures)
Other Surgical Benefit (OSB)	30,000 (2 x 1000 per day x 15 days)	94,500 (2 x 1050 per day x 45 days)	10,80,000 (2 x 1500 per day x 360 days)

Maximum Benefit under the policy per insured	Rs. 40, 80,000/-
No claim benefit	Increase in HCB by 5%
Ambulance charges	1000/- per insured per year
Premium Waiver Benefit (PWB)	1 year premium

Lic Jeevan Arogya Premium Calculator

Lic Jeevan Arogya Premium Calculator helps you to calculate the premium amount. You can calculate the premium just by entering some details like Name, Email ID, Mobile Number, Age, Relation ship and HCB amount.

Riders available under Lic Jeevan Arogya Policy

Two riders are available under Lic Jeevan Arogya Policy, they are

1. Term Assurance Rider.
2. 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.

Cooling Off Period:

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.

1. Treatment for benign uterine disorders like fibroids, uterine prolapse, dysfunctional uterine bleeding etc.
2. Treatment for Piles.
3. Treatment for benign enlargement of prostate gland.
4. Treatment for adenoid or tonsillar disorders.
5. Treatment for slip disc.
6. Treatment for benign thyroid disorders.
7. Treatment for anal fistula or anal fissure.
8. Treatment for degenerative joint conditions.
9. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc.
10. Treatment for kidney or urinary tract stones.
11. Treatment for Carpal tunnel syndrome.
12. Treatment for sinus disorders.
13. Treatment for varicose veins.
14. Treatment for Cataract.
15. Treatment for hydrocele.
16. Treatment for Gall stones.
17. 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.

Eligibility Conditions

For Hospital Cash Benefit (HCB) (under Basic Plan):

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / Parents-in-law (if any)	Insured Dependent Children (if any)
Minimum Initial Daily Benefit (in a ward other than Intensive Care Unit)	` 1,000/-	` 1,000/-	` 1,000/-
Maximum initial daily amount	` 4,000/-	Insured Spouse- Less than or equal to that of PIInsured Parents /  Parents-in-law- Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included parents / parents-in-law shall be covered for equal benefits.	Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included children shall be covered for equal benefits.
Maximum annual benefit period, applicable to each insured	30 days in year 1, 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.
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

Initial Daily Benefit shall be in multiples of Rs. 1000/-.

For Major Surgical Benefit (MSB) (under Jeevan Arogya Basic Plan):

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / parents-in-law (if any)	Insured Dependent Children (if any)
Major Surgical Benefit Sum Assured (MSB SA)	100 times of Applicable Daily Benefit (ADB) of PI (as specified in Para 1A) above).	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
Maximum annual benefit, applicable to each insured	100% of Major  Surgical Benefit Sum Assured
Maximum Lifetime Benefit, applicable to each insured	800% of  Major  Surgical Benefit Sum Assured

For Day Care Procedure Benefit (DCPB) (under Jeevan Arogya Basic Plan):

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / parents-in-law (if any)	Insured Dependent Children (if any)
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

For Other Surgical Benefit (OSB) (under Basic Jeevan Arogya Plan):

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / parents-in-law (if any)	Insured Dependent Children (if any)
Daily benefit amount	2 times of ADB of PI	Insured Spouse- 2 times of ADB of Insured SpouseInsured Parents / parents-in-law- 2 times of ADB of each parent	2 times of ADB of each child
Maximum annual benefit, applicable to each insured	15 days in first policy year and 45 days per year thereafter
Maximum Lifetime Benefit, applicable to each insured	360 days

Example

PRINCIPAL INSURED (Male)

Entry Age	Premium
20	1922.65
30	2242.90
40	2799.70
50	3768.00

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

Entry Age	Premium
20	1393.15
30	1730.65
40	2240.60
50	2849.10

CHILD

Entry Age	Premium
0	792.00
5	794.75
10	812.35
15	870.75

(Premiums indicated are exclusive of Service Tax)

For More information about LIC Jeevan Arogya Policy please click on below link.
LIC Jeevan Arogya Policy.