LIC Jeevan Arogya

LIC Jeevan Arogya

LIC Jeevan Arogya

Jeevan Arogya is a unique non-participating and non-linked plan which provides health insurance cover against certain health risks to the entire family of the insured, including new members in case of a marriage or childbirth. This article seeks to cover the insurance plan in detail.

Range of Offers

Jeevan Arogya offers:

  • Valuable financial protection in case of hospitalization, surgery, etc.
  • Increased health cover.
  • No claim benefits.
  • Flexible choice of benefits.
  • Flexible premium payment options.
  • Assurance of 50% of sum prior to hospitalization.
  • Waiver of one year of premium.
  • A grace period of thirty days for annual and semi-annual premium payment.
  • Coverage of all types of surgeries, including Day Care treatment.
  • Coverage of critical illnesses.
  • No Claim Bonuses.
  • Additional Critical Illness Rider Benefit.
  • Online tracking of applications.
  • Online procurement and renewal of plans.
  • Income Tax Benefits.
  • Ambulance Benefits.
  • Death benefits.
  • Premium waiver benefits,
  • Benefit payout irrespective of the medical costs.
  • Flexible premium payment options.
  • Flexible benefit limit.
  • Extension of coverage to new family members.
  • Integration with an existing medical claim policy for the same medical cause.
  • Increased health cover.
  • The option of flexible benefit limit.

Choice of Plan

To start with, the person availing the insurance must choose the level of health cover, which is the sum of the Initial Daily Benefit based on his/her requirements, ranging from INR 1000, INR 2000, INR 3,000, and INR 4,000 per day. This would constitute the daily sum payable to the concerned person during the initial year of policy coverage. Besides this, Major Surgical Benefits would accrue to be 100 times the Initial Daily Benefit. As a result, the Major Surgical Benefits assured during the first year of policy cover would be INR 1,00,000, INR 2,00,000, INR 3,00,000, and INR 4,00,000, respectively, based on the Initial Daily Benefit amount chosen. Benefits like Day Care Procedure Benefit, Premium Waiver Benefit and Other Surgical Benefits are also linked to the Daily Hospital Cash Benefits.

Age of Entry

Criteria Minimum Age Maximum Age
Age of entry for self/spouse18 years65 years
Age of entry for Children91 Days17 years
Age of entry for parents18 years75 years
Age of maturity
Daily hospitalization benefitINR 1000 a day (excluding ICU)INR 4000 a day (excluding ICU)
Major surgical benefitINR 1,00,000INR 4,00,000

Scope of Coverage

The plan offers the following mode of coverage:

Type of Coverage Coverage Offered Maximum Coverage
Daily Hospital Cash (DHC)As already observed, a sum ranging between INR 1,000-INR 4,000 will be providedCovers hospitalization of up to 30 days in the first year for 15 days spent in ICU. The benefit gets thrice from the second year onwards.
Major Surgical Benefits (MSB)Benefit ranging between INR 1,00,000- INR 4,00,000Maximum 100 times the DHC. Covers up to 140 major surgeries.
Daycare Procedure BenefitsFive times the DHCA maximum of three times in a year and 24 times during the policy tenure
Other Surgical BenefitsTwice the DHC, for hospitalization of more than 24 hours when the insured undergoes a surgery other than the one included in MSBMaximum days of coverage in the initial years are 15 and 45 thereafter

Exclusions

The following benefits are not offered under this plan:

  • Pre-existing medical conditions
  • Epidemic conditions
  • Plastic surgery
  • Cosmetic treatments
  • Beauty treatments
  • Attempted suicide
  • Injuries through self-harm
  • Abuse of drugs
  • Congenital conditions
  • Pregnancy conditions
  • Child-birth conditions
  • Radioactive conditions
  • Injuries due to natural catastrophe
  • Injuries resulting out of participating in dangerous sports

Exclusions

The following benefits are not offered under this plan:

  • Pre-existing medical conditions
  • Epidemic conditions
  • Complications related to AIDS/HIV
  • Plastic surgery
  • Cosmetic treatments
  • Beauty treatments
  • Attempted suicide
  • Injuries through self-harm
  • Abuse of drugs, acute alcoholism or usage of narcotics without the professional advice of the Doctor.
  • Involvement in criminal or illegal activities.
  • Injury on account of involving in any violent labour disturbances, riot, public disorder or civil commotion
  • Congenital conditions
  • Conditions related to pregnancy
  • Conditions related to childbirth
  • Radioactive conditions
  • Injuries due to natural catastrophe
  • Injuries resulting out of participating in dangerous sports
  • Compensation on account of injury, death, disablement, etc. on contamination by radioactivity/ionizing radiation from a nuclear fuel or waste, nuclear and radioactive weapon materials, chemical and biological weapon, terrorism, or working in electrical installations with high tension supply, or engagement in activities such as racing on horseback, wheels, and big game hunting.
  • Any experimental treatment/surgery.
  • Organ donor expenses
  • Dental treatment
  • Nervous issues or mental health treatment
  • Genetic disorders, congenital conditions or birth defects, except if the same is specifically covered.
  • Treatments arising out of the failure of heeding to medical advice.
  • Non-Allopathic treatments.

Modes of Claim

LIC insurance claims can be made on both cash and reimbursement claims. In either of the modes, a Third-Party Administrator (TPA) would assist the insured person in processing the LIC claims. Cashless claims could generally be used for planned hospitalization or emergency admission.

Documents Required

For receiving the claim, the following documents must be furnished, supported with the filled-up LIC claim form and Doctor’s Certificate:

  • Discharge Summary
  • Prescriptions
  • Bills
  • Advance and final receipts
  • Diagnostic test reports, scan, x-ray, ECG and other related reports
  • Proof of identity
  • Attested photocopies of Discharge Summary
  • Attested photocopies of the Hospital Bills, with the breakup of charges.
  • Package treatment and details of package bills
  • Medico-Legal Certificate (MLC), in case of an accident.
  • Copies of investigations
  • Copies of medical bills and prescriptions

Also Read About –Income Tax Exemptions for Life Insurance 

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