LIC JEEVAN AROGYA POLICY REVIEW

New Jeevan Arogya Plan 904 Review

LIC Jeevan Arogya Plan is a new non-linked unique Health insurance plan where an individual can take the health cover for himself/ herself (i.e., Principal Insured) and also for Spouse, Children, Parents and Parents-in-laws. In short, three generations will be covered under this plan. Lic Jeevan Arogya plan provides you with appropriate support in case of health risks and medical emergencies etc.

Lic Jeevan Arogya policy gives you,

• Financial protection in case of hospitalisation, surgery etc.,
• No claim benefit.
• Increasing health cover every year.
• Lump sum benefit regardless of actual medical costs.
• Flexible premium payment options.

The Policyholder can choose Rs. 1,000/- , Rs. 2000/-, Rs. 3000/- or Rs. 4000/- per day of Initial daily benefit i.e., the daily HCB (Hospital Cash Benefit) applicable in the 1st year of the policy.

This is the amount that will be payable to insured in the event of hospitalisation in the 1st year on a per day basis. The MSB (Major Surgical Benefit) will be 100 times the Initial Daily Benefit that the insured have chosen. Thus the initial MSB sum assured will be Rs. 1 lakh, 2 lakh, 3 lakh, 4 lakh respectively.

Other benefits like DCPB (Dare Care Procedure Benefit), OSB (Other Surgical Benefit) and PWB (Premium Waiver Benefit) will also be payable depending upon the daily HCB 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 Policy Rebates

Under Lic Jeevan Arogya policy, there are 3 types of rebates.

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 (Hospital Cash Benefit) rebate:

If HCB is more than Rs. 1000/-, then the premium arrived at in respect of a member covered 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.

For Example:

For 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 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 3750/-.

CEIS rebate:

For eligible employees of the corporation CEIS rebate will be 10% of the tabular premium.

New LIC Jeevan Arogya Policy Benefits

Hospital Cash Benefit (HCB) :

If PI or any of the insured covered under the Jeevan Arogya policy is hospitalised, an amount equal to the Applicable Daily Benefit (ADB) available under the policy during the policy year will be payable. i.e., if chosen HCB is 1000/- then per day he will be paid 1000/-.

• During the 1st year of cover commencement 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.

• ADB increases by 5% every year and will continue until it attains a maximum amount of 1.5 times (i.e., 150%) the initial daily benefit.

For 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 1050/-, on 3rd policy year ADB will be 1100/- and so on up to 1500/- daily benefit.
• Benefits will be payable only after the first 24 hours of hospitalisation. If the hospitalisation extends for a continuous period of 7 days then, the daily HCB would also be paid for 1st 24 hours of the hospitalisation.

LIMITS OF HCB:

• HCB will be payable only if hospitalisation occurs within India.
• Total number of days for which HCB would be payable, in a policy year would be restricted to,
• Maximum of 90 days of hospitalisation inclusive of 45 days of ICU i.e., total 135 days in the second and subsequent policy years.
• Maximum of 30 days of hospitalisation inclusive of 15 days of ICU i.e., total 45 days in the first policy year.
• Total number of days for which HCB would be payable during the cover 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 first policy year, HCB including ICU benefit will be 1000/- (ADB) x 45 days = 45,000/-.

In the second 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):

If PI or any of the insured covered under Jeevan Arogya plan, undergoes any of the surgery within the cover period, then the percentage of MSB sum assured as specified against each of the eligible surgeries mentioned in MSB Annexure shall be paid.

1. Quick cash facility is available. Under this facility, 50% of eligible MSB amount will be paid in advance.
2. In case of surgery, total 1 year premium from the date of installment due following the surgery date will be waived.
3. For proceeding to surgery, an additional lump sum of Rs. 1000/- will be payable for Ambulance service.

LIMITS OF MSB:

1. Major Surgical Benefit shall be paid as lump sum by providing proof of surgery to the Corporation.
2. MSB will be payable only after the Corporation is satisfied on the basis of medical evidence that the specified surgery has been performed.
3. MSB will be payable only if Surgery occurs within India.
4. Amount payable under the MSB in any policy year during the cover period shall not exceed 100% of the MSB sum assured in that policy year.
5. MSB sum assured is 100 times the Applicable Daily Benefit (ADB)
6. Total amount payable under the MSB during the cover period (i.e., maximum lifetime benefit) shall not exceed 800% of the MSB sum assured.

Example: 

For HCB 1000

In the first 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) = 1,00,000/-

In the second 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) = 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) = 12,00,000/-

Day Care Procedure Benefit (DCPB):

If PI or any of the insured covered under Jeevan Arogya plan, undergoing any specified Day Care Procedure mentioned in the Day Care Procedure Annexure, a lump sum amount equal to 5 times the ADB (Applicable Daily Benefit) will be paid.

LIMITS OF DCPB:

1. Day Care Procedure Benefit shall be paid as lump sum by providing proof of surgery to the Corporation.
2. DCPB will be payable only after the Corporation is satisfied on the basis of medical evidence that the specified surgery has been performed.
3. DCPB will be payable only if Surgery occurs within India.
4. DCPB will be payable only upto maximum of three surgical procedures in any policy year during the cover period.
5. Maximum Lifetime benefit is 24 surgical procedures i.e., DCPB will be payable only upto maximum of 24 surgical procedures during the cover period.

Example:

For HCB 1000

In the first 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 upto maximum of 3 surgical procedures during any policy year) = 15,000 DCPB will be payable for 1st policy year.

In the second 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 upto 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 upto maximum of 24 surgical procedures during cover period) = 1,80,000 DCPB will be payable.

Other Surgical Benefit (OSB)

If PI or any of the insured covered under Jeevan Arogya plan, undergoing any surgery not listed under MSb or DCPB then, a daily benefit equal to two times the ADB will be paid for each continuous period of 24 hours within the cover period.

LIMITS OF OSB:

1. Other Surgical Benefit shall be paid as lump sum by providing proof of surgery to the Corporation.
2. OSB will be payable only after the Corporation is satisfied on the basis of medical evidence that the specified surgery has been performed.
3. OSB will be payable only if Surgery occurs within India.
4. OSB will be payable for the maximum of 15 days in the first policy year and 45 days for second and subsequent policy years following the date of commencement of cover in respect of each and every insured covered under policy.
5. OSB will be payable for the maximum of 360 days during the cover period, in respect of each and every insured covered under policy.

Example:

For HCB 1000

In the first 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 upto maximum of 15 days during 1st policy year) = 30,000 OSB will be payable for 1st policy year.

In the second 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) = 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) = 10,80,000 OSB will be payable.

 No Claim Benefit:

If there are no claims in respect of any insured covered under Jeevan Arogya policy, then no claim benefit equal to 5% of the Initial Daily Benefit will be paid during the period between date of commencement and next Automatic Renewal Date or between two Automatic Renewal dates of policy.

Benefit illustration – for HCB 1000 

Nature of Benefit	1st Policy year (Rs)	2nd Policy year (Rs)	Max. eligible during the policy term (Rs)
HCB (Hospital Cash Benefit) 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)
MSB (Major Surgical Benefit)	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)]
DCPB (Day Care Procedure Benefit)	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)
OSB (Other Surgical Benefit)	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
PWB (Premium Waiver Benefit)	1 year premium

 Lic Jeevan Arogya Premium Calculator

Lic Jeevan Arogya Plan Riders

There are 2 riders available under Lic Jeevan Arogya policy, they are

1. Term Assurance Rider
2. Accident Benefit Rider

Term Assurance Rider

It is applicable for Principal Insured (PI) and/or Insured Spouse only. They can opt Term Assurance as optional rider which is equal to the MSB (Major Surgical Benefit) Sum Assured.

An amount equal to Term Assurance Sum assured will be payable on unfortunate death during the term.

Eligibility conditions for Term Assurance Rider:

Age At Entry	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. 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 

It is applicable for Principal Insured (PI) and Insured Spouse only. Maximum Accident Benefit Sum Assured will be equal to the Term Assurance Rider SA (Sum Assured). On unfortunate Death due to an accident, an amount equal to Accident Benefit Sum Assured will be payable during the term for which Accident Benefit Rider is opted for.

Accident benefits rider will be available by payment of the additional premium of Rs. 0.50/- for every Rs. 1000/- of the Accident Benefit SA (Sum Assured) per policy year.

Additional premium for Accident Benefits rider will not be required on and after the policy anniversary on which the Term Assurance Rider ceases.

Eligibility Conditions for Accident Benefit Rider:

Age At Entry	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/-

Lic Jeevan Arogya Policy Death Benefit

No death benefits will be payable on the death of any insured unless Term assurance rider benefit or Accident benefits rider have been opted for.

On the death of the Principal Insured (PI), the surviving insured spouse will become the PI only if the option is exercised at the beginning of the contract. The Jeevan Arogya policy will continue with revised premium rate by taking the age of insured spouse as on that day, and the new premium would be based on tabular premium rates applicable for PI’s.

If the option is not exercised at the beginning of the contract, the Jeevan Arogya policy will terminate.

If the Insured spouse had died before the PI, then the existing Jeevan Arogya policy will end, and the other insured will have the option to take a new policy. In that case,

• If the new policy is bought within 90 days of the termination of the existing policy, the new policy will be issued without any underwriting.
• Maximum entry age condition will not apply for the new policy.
• Other terms and conditions including premium rates will be applicable for the new policy.

On the death of an Insured person other than the PI (Principal Insured), the policy will continue after removal of the insured and change in premium will apply from installment premium due date.

Lic Jeevan Arogya policy Maturity Benefit:

At the end of the cover period, no benefits are payable.

Additional Information about Lic Jeevan Arogya Policy

Discontinuance of premiums:

A grace period not less than 30 days will be allowed for payment of yearly or half-yearly premiums. The Jeevan Arogya policy lapses if the premium is not paid before the expiry of a grace period.

Also, all the benefits payable under this plan will cease.

Revival:

The lapsed Jeevan Arogya policy can be revived by the PI (Principal Insured) with in a period of 2 years from the due of FUP (First Unpaid Premium) but before the expiry of cover.

Cooling off period:

If the policyholder is not satisfied with the Terms and Conditions of the policy, he/she may return the Jeevan Arogya policy to the corporation within 15 days from the date of receipt of the plan.

Surrender value:

Under Jeevan Arogya plan, Surrender value is not available.

Loan / Assignment

Loan / Assignment facility is not available under Jeevan Arogya plan.

Automatic Renewal Date:

The installment premium will be guaranteed concerning each insured for 3 years from the Date Of Commencement (DOC) of the policy. At the end of every 3rd policy anniversary, the premiums may be reviewed.

Termination of Policy:

If Jeevan Arogya policy is issued on single life, the plan will terminate at the earliest of the following,

• Non-payment of premiums within the revival period.
• On the death of the insured.
• On the date of cover expiry.
• On exhausting all the maximum lifetime benefits limits.

If Jeevan Arogya policy is issued on more than one life, the policy will terminate at the earliest of the following,

• Non-payment of premiums within the revival period.
• On Principal Insured (PI) exhausting all the maximum lifetime benefits limits.
• On the death or date of cover expiry, of the PI and if the policy is discontinued 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.

Waiting Period:

General waiting period:

If hospitalisation is due to Accidental bodily injury, there will be no general waiting period.

There shall be General waiting period during which no benefits shall be payable if the hospitalisation occurred due to sickness.

In respect of each insured, the General waiting period will be 90 days from the date of cover commencement.

In case of revived policy,

If the request for revival is within 90 days of the due date of the FUP (First Unpaid Premium), then the General waiting period will be of 45 days from the date of revival.

If the request for revival is beyond 90 days from the due date of the FUP (First Unpaid Premium), then the General waiting period will be of 90 days from the date of revival.

Specific waiting period:

In respect of each insured, no benefits are available, and no payment will be made to any of the following during specific waiting period,

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

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 the policy renewal after completion of 18 years of age.

The new 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 benefits period, applicable to each insured	30 days in year 1, 90 days per year after that, inclusive of stay in ICU. A maximum number of days in ICU is restricted to 15 days in year 1 and to 45 days after that.
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)

Age at entry	Premium
20	1922.65
30	2242.90
40	2799.70
50	3768.00

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

Age at entry	Premium
20	1393.15
30	1730.65
40	2240.60
50	2849.10

CHILD

Age at entry	Premium
0	792.00
5	794.75
10	812.35
15	870.75

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