LIC Jeevan Arogya Plan:

LIC Jeevan Arogya is a non-linked Health Insurance Policy which helps individuals to cope up with the rising medical costs. In this plan, you can cover yourself, spouse, children, parents as well as mother-in-law and father-in-law. It is a comprehensive health insurance policy for the entire family.

In this plan, you get paid an amount irrespective of the treatment costs. So Jeevan Arogya can be effectively used as a backup to your health insurance plan to provide an additional cover to some of the incidental expenses which you incur during hospitalization.

We will explain in detail how LIC Jeevan Arogya works with the help of examples to help you understand this plan health plan better.

Key Features of LIC Jeevan Arogya Policy:

• One health insurance policy that covers self, spouse, children, parents, and parents-in-law
• Covers hospitalization, surgery costs and more
• Provides benefit payout irrespective of the actual medical cost incurred
• Can be availed along with existing mediclaim policy for the same hospitalization/surgery
• The cover can be extended to new members of the family in case of marriage and childbirth
• Quick Cash Facility is available on hospitalization 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)
• Payout made on the basis of the photocopy of bills
• No Claim Benefit is 5% of initial Hospitalisation Cash Benefit (HCB)

Benefits of LIC Jeevan Arogya Policy:

LIC Jeevan Arogya Plan Benefits are classified as follows: 

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

Let us understand each of these benefits in detail.

Hospital Cash Benefit (HCB)

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 hospitalized. 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 hospitalization 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 the 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 until it reaches 1.5 times i.e. Rs. 3,000 per day and the continue to remain the same.

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 hospitalization of greater than 4 hours in the ICU ward of the hospital, you would be eligible to double the HCB benefit for that period.

Note: 
In case the total length of the hospitalization is less than 7 days, no benefits are paid for the first 24 hours of hospitalization. 
The maximum annual benefit that can be availed for each of the persons covered in the plan - 30 days in year 1, 90 days per year thereafter, inclusive of stay in ICU. The maximum number of days in ICU is restricted to 15 days in year 1 and to 45 days thereafter.
Maximum lifetime benefit that can be availed for each of the persons covered in the plan - 720 days inclusive of stay in ICU. The maximum number of days in ICU is restricted to 360 days.

Major Surgical Benefit (MSB):

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:

Initial Hospital Cash Benefit( HCB) Selected	Major Surgical Benefit (MSB)
Rs. 1,000 per day	Rs. 1,00,000
Rs. 2,000 per day	Rs. 2,00,000
Rs. 3,000 per day	Rs. 3,00,000
Rs. 4,000 per day	Rs. 4,00,000

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:

Category of Surgery	% of MSB to be Paid
Category 1	100%
Category 2	60%
Category 3	40%
Category 4	20%

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.

Category of Major Surgery	Payout
Category 1	Rs. 2,00,000
Category 2	Rs. 1,20,000
Category 3	Rs. 80,000
Category 4	Rs. 40,000

List of Major Surgeries covered under LIC Jeevan Arogya.

Note: 

• You can only claim the Major Surgical Benefit for treatment of a condition which first occurred or manifested itself after the policy was taken.
• The 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.

 

Daycare Procedure Benefit

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: 

• The 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.

 

Other Surgical Benefit:

In case 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 hospitalization. The period of hospitalization should be greater than 24 hours to eligible for this amount.

Note: 

• The maximum annual benefit that can be availed for each of the persons covered in the plan - 15 days in a 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.

Ambulance Charge Benefit:

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

Premium Waiver Benefit (PWB)

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

No Claims Benefit (NCB):

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.

Eligibility & Other Conditions in Jeevan Arogya Policy:

	Minimum	Maximum
Entry age of Self/Spouse	18 years	65 years
Entry age of Children	91 days	17 years
Entry age of Parents	18 years	75 years
Age at Maturity	-	80 years

Sample Premium Illustration in Jeevan Arogya:

The below illustration is for an individual opting for a Daily Hospitalisation Benefit of Rs 1,000 per day:

The plan will not see a revision in premiums for 3 years from taking the plan. After that, LIC may revise the premiums. Similarly for a block of 3 years premiums will not be revised on renewals also.

Other Benefits & Options in Jeevan Arogya Policy:

Adding new members

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.


Quick Cash Facility

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 the hospital itself. They do not have to wait for the hospitalization to get over to get the total amount.


Choice of Riders

There are 2 additional benefits which can be taken with this plan in the form of Riders:

1. LIC’s New Term Assurance Rider
2. LIC Accident Benefit Rider

Exclusions in Jeevan Arogya Plan:

The Jeevan Arogya plan has the following exclusions in its coverage:

 

• Pre-existing conditions (unless disclosed and accepted by LIC)
• Routine check-ups and Non-allopathic treatments
• Epidemic diseases or conditions (classified by Central or State Government)
• Cosmetic or beauty treatments, circumcision, dental treatments
• Plastic surgery (unless necessary for treatment of illness or due to an accident and performed within 6 months of the event occurrence)
• Any treatment arising from insured person’s failure  to act on proper medical advice
• Self-inflicted injuries or attempted suicide
• Abuse of drugs, alcohol or intoxicants
• Conditions existing at birth (congenital conditions)
• Rest cure, general weakness, nervous breakdown or related conditions, infertility or sterilization
• Sexually transmitted diseases like HIV / AIDS
• Pregnancy or childbirth-related conditions
• Any act of war, invasion of the foreign enemy, naval or military operations etc
• Radioactive contamination
• Criminal or illegal acts
• A natural catastrophe like earthquake, floods etc
• Participation in dangerous sports like racing, scuba diving, bungee jumping

Tax Benefits in Jeevan Arogya Plan:

The premiums paid in Jeevan Arogya are exempted from tax under Sec 80D.