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Showing posts with label HEALTH PLANS. Show all posts
Showing posts with label HEALTH PLANS. Show all posts

Monday, December 3, 2018

12:13 PM

LIC Cancer Cover

LIC Cancer Cover Plan - Table No. 905:


This is a fixed benefit health plan offering payouts for the treatment of cancer. In case the customer is diagnosed with cancer, this plan will offer benefits irrespective of the costs incurred in the treatment. LIC Cancer Cover provides protection in case of Early Stage and Major Stage Cancer.

LIC is launching another health insurance related plan called LIC Cancer Cover (Plan 905) on 14th Nov 2017. This is such second health insurance product launched by LIC. Let us see it’s features, benefits, and review.

Many of you may not aware that LIC also offering one health insurance plan. I already wrote about this plan. Please refer the same at “Jeevan Arogya-Do you know this LIC’s Health or Medical Insurance Policy?“. This plan is a comprehensive health insurance plan.
Now LIC is launching a disease-specific health insurance plan. This is called LIC Cancer Cover (Plan 905). This is a non-linked (traditional), regular premium payment health insurance plan which provides fixed benefit in case the Life Assured is diagnosed with any of the specified stages of Cancer during the policy term (subject to certain terms and conditions).

Eligibility:

First, let us look at the eligibility conditions to buy this product.

LIC Cancer Cover (Plan 905) Eligibility

You noticed that the maximum coverage is Rs.50,00,000 only. Also, the maximum entry age is 65 years. You can buy this plan ONLINE. Policy can be assigned under as per Sec 38 of Insurance Act 1983.

Options:


This product offers you two types of Sum Assured options. Also, your premium varies based on the option you choose. You have to choose this option at the time of buying this plan.

Option I – Level Sum Insured

The Basic Sum Insured shall remain unchanged throughout the policy term. Hence, the premium will also remain the same throughout the policy period.

Option II – Increasing Sum Insured

The Sum Insured increases by 10% of Basic Sum Insured each year for the first five years starting from the first policy anniversary or until the diagnosis of the first event of Cancer (whichever is earlier). On diagnosis of any specified cancer, all the claims payable shall be based on the Increased Sum Insured at the policy anniversary coinciding or prior to the diagnosis of the first claim and further increases to this Sum Insured will not be applicable
Hence, if you choose this second option, then the premium will not remain the same throughout the policy period.

Benefits:


The benefits under LIC Cancer Cover (Plan 905) is divided into two stages. Do remember that this is disease specific. Hence, if you suffer CANCER disease during the policy period, then only you will get the benefits.
There is no Surrender Value, No Loan Facility, and No maturity benefit. There are two classifications of benefit.

1. Early Stage Cancer

Benefits payable on the first diagnosis of any one of the specified Early Stage Cancers, provided the same is admissible are as below.
(a) Lump sum benefit-25% of Applicable Sum Insured shall be payable.
(b) Premium Waiver Benefit– Premiums for next three policy years or balance policy term whichever is lower, shall be waived from the policy anniversary coinciding or following the date of diagnosis.
c) After 3 years premium waiver, insured has to pay the premium regularly up to the policy period.
Early Stage Cancer Benefit shall be payable only once for the first ever event and Life Assured shall not be entitled to make another claim for the Early Stage Cancer of same or any other cancer. However, the coverage for the Major Stage Cancer under the policy shall continue until the policy terminates.

2. Major Stage Cancer

Benefits payable on the first diagnosis of the specified Major Stage Cancer, provided the same is admissible are-
(a) Lump Sum-100% of Applicable Sum Insured less any previously paid claims in respect of Early Stage Cancer shall be payable.
(b) Income Benefit-In addition to above lump sum benefit, Income Benefit of 1% of Applicable Sum Insured shall be payable on each policy month following the payment of Lump Sum, for a fixed period of next ten years irrespective of the survival of the Life Insured and even if this period of 10 years goes beyond the policy term. In case of death of the Life Assured while receiving this Income Benefit, the remaining payouts, if any, will be paid to his/her nominee.
(c) Premium Waiver Benefit-All the future premiums shall be waived from the next policy anniversary and the policy shall be free from all liabilities except to the extent of Income Benefit as specified above.
Once a Major Stage Cancer Benefit is paid no payment for any future claims under Early Stage Cancer or Major Stage Cancer would be admissible.
If the life assured claims for different stages of the same Cancer at the same time, the benefit shall only be payable for the higher claim admitted under the policy.
If there is more than one Cancer diagnosed in an event, the Corporation will only pay one benefit. That benefit will be the amount relating to the stage of Cancer which has the highest benefit amount.
I will explain you the same in detail from below the table.
Benefits of LIC Cancer Cover (Plan 905)
You may feel somewhat confused by referring above table. Let me explain the same using the below image.
LIC Cancer Cover (Plan 905) Benefit Illustration
Do remember one thing again. THERE IS NO MATURITY VALUE, NO SURRENDER VALUE AND THIS POLICY IS NOT ELIGIBLE FOR LOAN.

Tax benefits:

The Premium you pay towards this plan will be eligible for deduction under Sec.80D up to Rs.55,000 per year. Do remember that you will not be eligible to claim the benefits of premium paid under Sec.80C. (To know more about Sec.80D, refer my post “Tax Savings options other than Sec.80C for FY 2017-18“.

Review of the Premium:

Premium calculated will remain unchanged up to 5 years ONLY. After 5 years premium may change according to the claim experience of LIC and if changed, it will then remain unchanged for next 5 years. (Any revision in premium will be calculated according to entry age of proposer at the date of commencement of the policy)

Definitions of the Cancer covered:

I. Early Stage Cancer-

The diagnosis of any of the listed below conditions must be established by histological evidence and be confirmed by a specialist in the relevant field.
# Carcinoma-in-situ(CIS)
Carcinoma-in-situ means the presence of malignant cancer cells that remain within the cell group from which they arose. It must involve the full thickness of the epithelium but does not cross basement membranes and it does not invade the surrounding tissue or organ. The diagnosis of which must be positively established by microscopic examination of fixed tissues.
# Prostate Cancer–early stage
Early Prostate Cancer that is histologically described using the TNM classification as T1N0M0 with a Gleason Score 2 (two) to 6 (six).
# Thyroid Cancer – early stage
All thyroid cancers that are less than 2.0 cm and histologically classified as T1N0M0 according to TNM classification.
# Bladder Cancer – early stage
All tumors of the urinary bladder histologically classified as TaN0M0 according to TNM classification.
# Chronic lymphocytic Leukaemia – early stage
Chronic Lymphocytic Leukaemia categorized as stage 0(zero) to 2 (two) as per the Rai classification.
# Cervical Intraepithelial Neoplasia
Severe Cervical Dysplasia reported as Cervical Intraepithelial Neoplasia 3 (CIN3) on cone biopsy.

II. Major Stage Cancer-

A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukemia, lymphoma, and sarcoma.

Exclusions from all early-stage cancer benefits

# All tumors which are histologically described as benign, borderline malignant, or low malignant potential
# Dysplasia,intra-epithelial neoplasia or squamous intraepithelial lesions
# Carcinoma-in-situ of skin and Melanoma in – situ
# All tumors in the presence of HIV infection are excluded

Exclusions from all major-stage cancer benefits

A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukemia, lymphoma, and sarcoma. The following are excluded from major stage cancer benefits.
# All tumors which are histologically described as carcinoma in-situ, benign, premalignant, borderline malignant, low malignant potential, neoplasm of unknown behavior, or non-invasive, including but not limited to Carcinoma-in-situ of breasts, Cervical dysplasia CIN-1, CIN-2, and CIN-3.
# Anynon – melanoma skin carcinoma unless there is evidence of metastases to lymph 4 nodes or beyond;
# Malignant melanoma that has not caused invasion beyond the epidermis;
# All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0
# All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
# Chronic lymphocytic leukemia less than Rai stage 3
# Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,
# All Gastro – Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with the mitotic count of less than or equal to 5/50HPFs;
# All tumors in the presence of HIV infection.

Waiting Period :


A waiting period of 180 days will apply from the date of issuance of policy or date of revival of risk cover whichever is later, to the first diagnosis of “any stage” cancer. “Any stage” here means all stages of Cancer that occur during the waiting period. This would mean that nothing shall be paid under this policy and the policy shall terminate if any stage of Cancer occurs:

  1. At any time on or after the date of issuance of the Policy but before the expiry of 180 days reckoned from that date; or
  2. Before the expiry of 180 days from the Date of Revival.

Survival Period:

No benefit shall be payable if the Life Assured dies within a period of 7 days from the date of diagnosis of any of the specified Early Stage Cancer or Major Stage Cancer. The 7 days survival period includes the date of diagnosis. The benefit under this plan shall be payable subject to fulfilling all of the below criteria:
  1. 7 days survival period from the date of diagnosis
  2. Signs and symptoms relevant to cancer should have been present and documented before death
  3. All investigations to confirm the diagnosis of cancer should have been done before the death of the insured.
  4. Satisfaction of the cancer definition as per the policy condition

Review:

  • The biggest advantage to save the cost is, customers can buy this plan ONLINE. By purchasing it online, you can save the premium (7% of Tabular Premium).
  • The premium will be less as this product acts like typical term life insurance where there will not be any maturity benefit, surrender value, paid-up value or loan value. Only in the case of event happening (in this product if you suffer due to cancer), insured will get the benefit.
  • In case of identifying the major stage cancer, the benefits are much much better. Because you no need to pay the future premiums, 1% of applicable sum assured will be payable for the next 10 years (irrespective of the term of the policy left).
  • Premium changes every 5 years. Hence, unlike endowment or money back plans where the premium remains constant, here the premium will alter based on the claim experience of LIC. Hence, if the premium is not affordable after 5 years, then you will end up with cancer cover.
  • There are 180 days waiting period. Hence, the risk will not start immediately after buying the policy.
  • Survival period of 7 days also applies to this policy.
  • In case of increasing sum assured, even though your sum assured will increase each year by 10%, but such increase is restricted to “for first five years starting from the first policy anniversary or until the diagnosis of the first event of Cancer, whichever is earlier”. Hence, it will not benefit you in long run. You have to again buy one more such policy after such 5 years over to cover the cost of cancer treatment at that time.
  • This is exactly like term life insurance but disease-specific. Hence, if you do not suffer from cancer during the policy period, then you will not get any policy benefits like typical endowment or money back plans.
  • NO TPA involved here. Hence, the claim may be bit cumbersome and sometimes depends on how the concerned official will take it forward.
  • Tax benefits under Sec.80D BUT not under Sec.80C.
  • There are many cancer-specific insurance products available from general insurance companies. I am not sure why LIC entered into this field.
  • A normal person finds it hard to understand the exclusions. Hence, hard for common man to relieve that they are protected from cancer disease.
  • You can’t buy it for your family like general insurers provides you. You have to buy individually. This may create managing multiple plans and also cost may shoot up.
  • If there is more than one Cancer diagnosed in an event, the Corporation will only pay one benefit. That benefit will be the amount relating to the stage of Cancer which has the highest benefit amount. This I think a hindrance to this product also.
  • Also, early-stage cancer can be claimed ONLY ONCE during the policy period.



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11:33 AM

LIC Jeevan Arogya Plan

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) SelectedMajor Surgical Benefit (MSB)
      Rs. 1,000 per dayRs. 1,00,000
      Rs. 2,000 per dayRs. 2,00,000
      Rs. 3,000 per dayRs. 3,00,000
      Rs. 4,000 per dayRs. 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 1100%
        Category 260%
        Category 340%
        Category 420%
        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 SurgeryPayout
        Category 1Rs. 2,00,000
        Category 2Rs. 1,20,000
        Category 3Rs. 80,000
        Category 4Rs. 40,000

        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:

         MinimumMaximum
        Entry age of Self/Spouse18 years65 years
        Entry age of Children91 days17 years
        Entry age of Parents18 years75 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.
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        10:54 AM

        Health Ensure

        Health Ensure:


        Expenses Covered:

        • In-patient Hospitalisation Treatment
        • Pre-Hospitalisation
        • Post-Hospitalisation
        • Road Ambulance
        • Day Care Procedures
        • Organ Donor Expenses
        • Preventive Health Check Up
        • Ayurvedic / Homeopathic Hospitalisation Expenses

        Members Covered:


        Individual Policy -Self, Spouse, Dependent Children, Grandchildren, Parents, Sister, Brother, Parents In law, Grand Parents
        Floater Policy -Self, Spouse, Dependent Children, for Parents, Parents In law, a separate floater policy can be taken.

        Age Criteria:

        Proposer/ Spouse/ Dependent Parents/ Sister/ Brother/Parent In law/Grand Parents - 18 years to lifetime.

        Sum Insured Options:
        Floater Policy
          200000  300000  400000  500000  1000000

        Discounts:


        Long-Term Policy Discount
        • 4% discount is applicable if the policy is opted for 2 years
        • 8% discount is applicable if the policy is opted for 3 years

        Loading due to adverse Health Conditions:


        The loading would be applicable on per individual basis for the proposals with adverse health conditions given below: Hypertension, Diabetes, Obesity, Cholesterol Disorder, Cardiovascular diseases, or multiple risk factors.

        ConditionLoading on premium of the Individual
        Diabetes5%
        Hypertension5%
        Cholesterol Disorder5%
        Obesity5%
        Cardiovascular diseases5%

        Zone wise premiums:


        Zone AZone B
        Delhi / NCR, Mumbai including (Navi Mumbai, Thane and Kalyan), Hyderabad and Secunderabad, Bangalore, Kolkata, Ahmedabad, Vadodara, and Surat.Rest of India apart from Zone A cities are classified as Zone B.

        Waiting Period:


        Details of Waiting PeriodDuration
        All treatments except for Accidental injuries30 days
        Any types of gastric or duodenal ulcers, Surgery of varicose veins and varicose ulcers, hydrocele, etc12 months
        Any Pre-existing condition24 months
        Specific diseases like-Hernia of all types, Hysterectomy, All types of sinuses etc24 months
        Joint replacement surgery, Hypertrophied turbinate etc48 months




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