LIC Jeevan Arogya Policy Review

By | April 25, 2016
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LICs-Jeevan-ArogyaLIC Jeevan Arogya Plan no. 904

Introduction to the LIC Jeevan Arogya Plan no. 904 :

LIC Jeevan Arogya is majorly a Non – linked Health Insurance plan. It was initiated by the Life Insurance Corporation of India. LIC Jeevan Arogya includes you (Principal Insured) & your family which may include your Spouse, Parents, Children & Parents – in- law. Especially, this policy gives you the advantage to cover your entire family under a single policy. Basically, it can be said that the LIC Jeevan Arogya covers 3 generations under a single plan. LIC Jeevan Arogya also offers financial support in the case of medical emergencies, any health risks, etc.

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Main highlights under the LIC Jeevan Arogya are mentioned below. It provides you with :

  • Lump sum advantage irrespective of the actual medical costs.
  • Flexible premium payment alternatives.
  • Financial protection in the case of surgery, hospitalization, etc.
  • Rising health cover every year.
  • No claim advantage.

In the LIC Jeevan Arogya Plan, the policy holder can select Rs. 1, 000 to Rs. 4, 000 per day of first daily advantage i.e. the daily Hospital Cash Advantage (HCA) pertinent in the initial year of the policy. This HCA will be payable to the policy holder in the incident of hospitalization in the initial year on a per day basis.

The Major Surgical Advantage (MSA) will be 100 times to the Initial Daily Advantage that the insured have selected. Therefore, the initial Major Surgical Advantage sum assured will be Rs. 1 lakh to 4 lakh correspondingly. Various other advantages like Dare Care Procedure Advantage (DCPA), Other Surgical Advantage (OSA) & Premium Waiver Advantage (PWA) will also be payable depending upon the daily Hospital Cash Advantage Selected.

LIC Jeevan Arogya Policy Conditions

Self / Spouse Parents / Parents – in – law 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 – annually & annually

Rebates under the LIC Jeevan Arogya Health Plan :

There are basically 3 kinds of rebates under the LIC Jeevan Arogya Plan. The 3 types of rebates are mentioned below :

  1. Mode rebate
  2. HCA rebate
  3. CEIS rebate

Mode rebate:

Mode Percentage
Annually mode 2 percent of tabular premium
Half – annually mode 1 percent of tabular premium

HCA rebate:

In case the HCA is more than Rs. 1000, then the premium amount, decided in respect of a member covered under the policy, will be condensed by an amount mentioned below.

HCA For PI (Principal Insured) For each insured member other than PI
Rs. 2, 000 /- Rs. 500 /- Rs. 250 /-
Rs. 3, 000 /- Rs. 1, 000 /- Rs. 500 /-
Rs. 4, 000 /- Rs. 1, 500 /- Rs. 750 /-

 

An Example:

For Principal Insured (PI) :

According to the Premium table, if annual premium is Rs. 2, 500 /- per Rs. 1, 000 /- HCA & the policy holder wanted HCA to be Rs. 2, 000 /- each day, then the premium will be :

2, 500 x 2 = 5,000 /-

However, as per HCA rebate under this plan, 500 /- will be reduced from 5, 000/- i.e. the premium is reduced to Rs. 4,500 /-.

For each insured member other than PI :

If the yearly premium is Rs. 2, 000 /- per 1, 000 /- HCA & the selected HCA by the policy holder chosen is Rs. 2, 000/- per day, then the premium will be :

2, 000 x 2 = 4, 000 /-

However, as per the HCA rebate under this plan, Rs. 250 /- will be reduced from 4, 000 /- i.e. the premium is reduced to Rs. 3, 750 /-.

CEIS rebate :

For eligible LIC employees CEIS rebate will be 10 percent of the tabular premium.

The Advantages of the Lic Jeevan Arogya Policy :

Hospital Cash Advantage (HCA) :

An amount equivalent to the Applicable Daily Advantage (ADA) obtainable under the LIC Jeevan Arogya policy all through the policy year will be payable, if PI or any insured covered under the policy is hospitalized. For instance, if the chosen HCA is Rs. 1, 000 then per day he / she will be paid Rs. 1, 000.

  • During the 1st year of cover ADA shall be the Initial Daily Advantage amount (i.e., Rs. 1, 000, Rs. 2, 000, Rs. 3, 000 or Rs. 4, 000 per day) which is selected by the policy holder.
  • Afterwards, each year ADA increases by 5 percent & will carry on until it attains a maximum amount of 1.5 times the initial daily advantage (i.e. 150 percent).

An illustration :

If a policy holder has selected Rs. 1, 000 of ADA, it enhances by 5 percent every year i.e. for 2nd policy year it will be Rs. 1, 050, on 3rd year ADA will be Rs. 1, 100 & further more up to Rs. 1, 500/- daily advantage.

  • Advantages will be payable only after the first 24 hours of the hospitalization. If the hospitalization extends for a continuous period of 7 days then in such a case the daily HCA would also be paid for the first 24 hours of the hospitalization.

Limits of HCA :

  • Total number of days for which HCA 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 & subsequent policy years.
  • Total no. of days for which HCA 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 HCA Rs. 1, 000,

In the First policy year, HCA + ICU advantage will be 1, 000/- (ADA) x 45 days = 45, 000 /-.

In the Second policy year, ADA rises by 5 percent i.e. ADA will be 1, 050/- now HCA together with ICU advantage will be :

1, 050 /- (ADA) x 135 days = 1, 41, 750 /-.

HCA together with ICU advantage that is Maximum eligible during the policy tenure is :

1, 500 /- (ADA) x 720 days = 16, 20, 000 /-.

Major Surgical Advantage (MSA) :

In the LIC Jeevan Arogya Plan, if PI or any insured covered under policy experiences any surgery inside the cover period, then the percentage of MSA Sum Assured as specified in the MSA Annexure shall be payable.

  • Quick Cash service is obtainable in which 50 percent of eligible MSA amount will be payable in advance.
  • In case of surgery, total 1 year premium will be waived from the installment due date subsequent to the surgery date.
  • An extra lump sum of Rs. 1, 000 /- will be paid for the Ambulance service.

Limits of the MSA :

  • MSA will be paid only if the Surgery occurs within the territory of India.
  • It will be paid as lump sum by giving a proof of the surgery to the company.
  • MSA sum assured is 100 times that of the ADA (Applicable Daily Advantage).
  • Amount payable under the MSA in any policy year during the cover period shall not go beyond 100 percent of the MSA SA (Sum Assured) in that policy year.
  • Total amount payable under the MSA during the cover period (i.e. maximum lifetime advantage) shall not exceed 800 percent of the MSA sum assured.

An illustration :

For HCA being Rs. 1, 000 /- :

In the 1st policy year, MSA i.e. maximum annual advantage will be 100 percent (MSA sum assured) that equals to 100 percent (100 times of ADA).

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

In the 2nd policy year, ADA rises by 5 percent i.e. ADA will be 1,050 /- , now the maximum yearly advantage will be 100 percent (MSA sum assured) that is equivalent to 100 percent (100 times of ADA).

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

Maximum entitled during the policy tenure i.e., Maximum lifetime advantage will be 800 percent (MSA sum assured) that is equivalent to 800 percent (100 times of ADA).

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

Day Care Procedure Advantage (DCPA) :

Under Lic Jeevan Arogya Plan, if PI or any insured covered under policy undergoes any Day Care Procedure given in the Day Care Procedure Annexure, a lump sum amount equivalent to 5 times the ADA will be paid.

Limits of the DCPA :

  • DCPA will be paid only if the Surgery occurs within the territory of India.
  • It will be paid as lump sum by giving the proof of surgery to the company.
  • It will be payable up to a maximum of 3 surgical procedures in any policy year at some stage in the cover period.
  • DCPA will be payable only up to maximum of 24 surgical procedures at some stage in the cover period i.e. Maximum Lifetime advantage is for 24 surgical procedures.

An illustration :

For HCA being Rs. 1, 000 /- :

In the First policy year, lump sum advantage payable will be 5 times of ADA for each surgical procedure, that is :

5 x 1, 000 (ADA for First policy year) x 3 (since DCPA will be payable up to maximum of 3 surgical procedures during any policy year) = 15, 000 DCPA (payable for First policy year)

In the Second policy year, lump sum advantage payable will be 5 times of ADA for each surgical procedure, that is :

5 x 1, 050 (ADA for 2nd policy year ) x 3 (since DCPA will be payable up to maximum of 3 surgical procedures during any policy year) = 15, 750 DCPA (payable for 2nd policy year)

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

Other Surgical Advantage (OSA) :

In the LIC Jeevan Arogya Plan, if PI or any insured covered under the policy undergoes any surgery which is not listed under the MSA or DCPA, then a daily advantage equivalent to 2 times the ADA will be paid. It will be paid for each incessant period of 24 hours within the cover period.

Limits of the OSA :

  • OSA will be paid only if the Surgery occurs within the territory of India.
  • It will be paid as lump sum by giving the proof of surgery to the company.
  • It will be payable under Lic Jeevan Arogya Plan for the maximum time period of fifteen days in the first policy year & 45 days for second & following policy years following the date of beginning.
  • OSA will be payable for the maximum of 360 days during the cover period.

An illustration :

For HCA being Rs.  1, 000/- :

In the 1st policy year, daily advantage payable will be 2 times of ADA, that is :

2 x 1, 000 (ADA for 1st policy year) x 15 (since OSA will be payable up to maximum of 15 days at some stage in 1st policy year) = Rs. 30, 000 OSA (payable for 1st policy year)

In the 2nd policy year, daily advantage payable will be 2 times of ADA, that is :

2 x 1, 050 (ADA for 2nd policy year) x 45 (since OSA will be payable up to maximum of 45 days for 2nd & subsequent policy years) = Rs. 94, 500 OSA (payable for 2nd policy year)

Maximum eligible during the policy tenure i.e. Maximum lifetime advantage will be for 360 days, that is :

2 x 1, 500 (Maximum level of ADA) x 360 (since OSA will be payable up to maximum of 360 days during cover period) = Rs. 10, 80, 000 OSA will be payable.

No Claim Advantage :

In the LIC Jeevan Arogya Policy, if there are no claims in respect of any insured under policy then no claim advantage will be payable.

No claim advantage = 5 percent of the Initial Daily Advantage

It will be paid at some point in the phase between date of commencement & next Automatic revival Date or between 2 Automatic revival dates of policy.

Advantage Illustration for HCA 1000

Nature of Advantage 1st Policy year (Rs) 2nd Policy year (Rs) Maximum eligible during the policy tenure (Rs)
Hospital Cash Advantage (HCA) including ICU Advantage 45, 000 (1, 000 per day x 45 days) 1, 41, 750 (1, 050 per day x 135 days) 16, 20, 000 (1, 500 per day x 720 days)
Major Surgical Advantage (MSA) 1, 00, 000 [100 percent (100 x 1, 000 per day)] 1, 05, 000[100 percent (100 x 1, 050 per day) ] 12, 00, 000[ 800 percent (100 x 1500 per day)]
Day Care Procedure Advantage (DCPA) 15,000 (5 x 1, 000 per day x 3 surgical procedures) 15, 750 (5 x 1, 050 per day x 3 surgical procedures) 1, 80, 000 (5 x 1, 500 per day x 24 surgical procedures)
Other Surgical Advantage (OSA) 30, 000 (2 x 1, 000 per day x 15 days) 94, 500 (2 x 1, 050 per day x 45 days) 10, 80, 000 (2 x 1, 500 per day x 360 days)
Maximum Advantage under the policy per insured       Rs. 40, 80, 000 /-
No claim advantage  Increase in HCA by 5 percent
Ambulance charges  1, 000 /- per insured per year
Premium Waiver Advantage (PWB)  1 year premium

Premium Calculator for the LIC Jeevan Arogya :

LIC Jeevan Arogya Premium Calculator assists you to calculate the premium amount. Now, one can very easily calculate the premium by just entering some simple details like :

  • Name
  • Email ID
  • Mobile Number
  • Age, Relationship
  • HCA amount

Riders obtainable under the LIC Jeevan Arogya Policy

There are 2 riders obtainable under the LIC Jeevan Arogya Policy. They are mentioned as under :

  1. Term Assurance Rider.
  2. Accident Advantage Rider.

Term Assurance Rider:

Term Assurance Rider is appropriate for PI & / or Insured Spouse only. They can choose this rider as optional rider which is equivalent to the MSA Sum Assured. An amount equivalent to Term Assurance Sum assured will be payable on unfortunate demise during the policy tenure.

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 TENURE : ·         35 years.
SUM ASSURED : ·         Minimum : Rs. 1, 00, 000.

·         Maximum : Amount equal to MSA sum assured, subject to the maximum of Rs. 25 lakh overall limit of existing policies.

SUM ASSURED IN MULTIPLES : ·         Rs. 25, 000 /-.

 

Accident Advantage Rider:

Accident Advantage Rider is as well appropriate for PI & / or Insured Spouse only. Maximum Accident Advantage SA (Sum Assured) will be equivalent to the term Assurance Rider Sum Assured. If you have chosen this rider, then in such a case an amount equivalent to Accident Advantage SA will be payable on unfortunate demise because of an accident during the policy tenure. You can get this Accident Advantage by paying additional of Rs. 0.50 /- for every thousand rupees of the Accident Advantage SA per policy year.

Eligibility conditions for Accident Advantage Rider:

ENTRY AG E: ·         Minimum : 18 years (completed).

·         Maximum : 50 years (Nearest birthday).

MAXIMUM AGE FOR COVER : ·         60 years (Nearest birthday).
MAXIMUM TENUR E: ·         35 years.
SUM ASSURED : ·         Minimum : Rs. 25, 000.

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·         Maximum : Amount equal to Tenure assurance sum assured, subject to the maximum of Rs. 50 lakh overall limit of existing policies.

SUM ASSURED IN MULTIPLES : ·         Rs. 5, 000 /-.

Demise Advantage under the LIC Jeevan Arogya Plan :

In the LIC Jeevan Arogya plan :

  • On the demise of any insured, no demise advantages will be paid unless term assurance or Accident advantage rider has been chosen.
  • On demise of the PI, the insured spouse will become the Principal Insured (PI) only if the option is exercised at the start of the contract.
  • Lic Jeevan Arogya Policy will be concluded if the option is not exercised at the commencement 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 choice to take new Lic Jeevan Arogya Policy. In such a 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 & conditions will be appropriate for the new policy.
  • On demise of an Insured person other than the PI, the jeevan arogya policy will continue after elimination of the insured. The change in premium will apply from instalment premium due date.

The Advantage of the LIC Jeevan Arogya Maturity

Under Lic Jeevan Arogya Plan Maturity Advantage is not applicable. To be precise, at the end of the policy cover, no advantages are payable to the insured.

Added Information on the LIC Jeevan Arogya Policy :

Renewal :

If LIC jeevan arogya policy is lapsed, it can be renewed within a period of 2 years from the outstanding FUP (First Unpaid Premium) but before the expiry of the cover.

Discontinuance of the premiums :

In instance of discontinuance of premiums, a grace period of not less than 30 days will be legitimate for the payment of annually or half annually premiums. If premium is not paid before the expiry of a grace period, then in such a case the jeevan arogya policy lapses.

Cooling – Off Period :

You may return the jeevan arogya policy to the company within a time period of 15 days from the date of receiving of the policy, if you are not satisfied with the terms & conditions of Policy.

Surrender Value :

Under Jeevan Arogya plan, Surrender Value is not obtainable.

Loan / Assignment:

Under Jeevan Arogya plan, Loan / Assignment facility is not obtainable.

Automatic Revival Date:

The installment premium will be guaranteed with reference to each insured for a period of 3 years from the Date Of beginning of the policy. At the end of every 3rd policy anniversary the premiums may be reviewed.

Termination of the Jeevan Arogya Policy :

If policy is issued on single life, the LIC Jeevan Arogya policies will be terminated at the most primitive of the below mentioned :

  • On the date of cover ending.
  • Non – payment of premiums within the renewal period.
  • On demise of the insured.
  • On exhausting all the maximum lifetime advantage limits.

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

  • On PI exhausting all the maximum lifetime advantage limits.
  • On the demise or date of cover expiry, of the PI & if the policy is discontinued with the Insured spouse as the PI.
  • On the demise 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 renewal period.

Waiting Period :

General Waiting Period :

  • In the instance of the hospitalization is due to Accidental bodily injury, there will be no general waiting period.
  • General waiting period is applicable during which no advantages shall be payable, if the hospitalization is due to sickness.
  • It will be 90 days from the date of beginning of cover, in respect of each insured.
  • In case of renewed policy,
    • General waiting period will be of 45 days from the renewal date, if the request for renewal is within 90 days from the due date of the FUP.
    • General waiting period will be of 90 days from the renewed date, if the request for renewal is beyond 90 days from the due date of the FUP.

Specific Waiting Period :

No advantages are obtainable & no payment will be made to any of the following during specific waiting period in respect of each Insured :

  • Treatment for varicose veins.
  • Treatment for Cataract.
  • Treatment for hydrosol.
  • Treatment for adenoid or tensile disorders.
  • Treatment for slip disc.
  • Treatment for benign thyroid disorders.
  • Treatment for benign breast disorders e.g. fibro adenoma, fibrocystic disease etc.
  • Treatment for kidney or urinary tract stones.
  • Treatment for Carpal tunnel syndrome.
  • Treatment for sinus disorders.
  • Treatment for benign uterine disorders like fibroids, uterine prolapsed, dysfunctional uterine bleeding etc.
  • Treatment for Piles.
  • Treatment for benign enlargement of prostate gland.
  • Treatment for Gall stones.
  • Treatment for Hernia.
  • Treatment for anal fistula or anal fissure.
  • Treatment for degenerative joint conditions.

Opportunities available under LIC Jeevan Arogya Policy

Opportunity to Migrate:

Children covered under Jeevan Arogya plan will have the choice to take a new health insurance plan at the conclusion of the specified exit age or at the policy revival after achievement of 18 years of age. New lic jeevan arogya policy should be bought within 90 days of the termination of child’s membership.

Pertaining Eligibility Conditions :

For Hospital Cash Advantage (HCA) (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 Advantage (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 advantages. Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included children shall be covered for equal advantages.
Maximum annual advantage 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 & to 45 days thereafter.
Maximum Lifetime Advantage 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 Advantage shall be in multiples of Rs. 1, 000 /-.

For Major Surgical Advantage (MSA) (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 Advantage Sum Assured (MSA SA) 100 times of Applicable Daily Advantage (ADA) of PI (as specified in Para 1A) above). Insured Spouse- 100 times of ADA of Insured Spouse Insured Parents / parents-in-law- 100 times of ADA of each parent 100 times of ADA of each child
Maximum annual advantage, applicable to each insured 100 percent of Major  Surgical Advantage Sum Assured
Maximum Lifetime Advantage, applicable to each insured 800 percent of  Major  Surgical Advantage Sum Assured

 

For Day Care Procedure Advantage (DCPA) (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 advantage payable 5 times of Applicable  Daily Advantage (ADA) of PI Insured Spouse- 5 times of ADA of Insured Spouse Insured Parents / parents-in-law- 5 times of ADA of each parent 5 times of ADA of each child
Maximum annual advantage, applicable to each insured 3 Surgical Procedures
Maximum Lifetime Advantage, applicable to each insured 24 Surgical Procedures

 

For Other Surgical Advantage (OSA) (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 advantage amount 2 times of ADA of PI Insured Spouse- 2 times of ADA of Insured SpouseInsured Parents / parents-in-law- 2 times of ADA of each parent 2 times of ADA of each child
Maximum annual advantage, applicable to each insured 15 days in first policy year & 45 days per year thereafter
Maximum Lifetime Advantage, applicable to each insured 360 days

An illustration :

PRINCIPAL INSURED (Male)


Entry Age
Premium
20 years of age Rs. 1, 922.65 /-
30 years of age Rs. 2, 242.90 /-
40 years of age Rs. 2, 799.70 /-
50 years of age Rs. 3, 768.00 /-

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


Entry Age
Premium 
20 years of age Rs. 1, 393.15 /-
30 years of age Rs. 1, 730.65 /-
40 years of age Rs. 2, 240.60 /-
50 years of age Rs. 2, 849.10 /-

 CHILD


Entry Age
Premium 
0 years of age Rs. 792.00 /-
5 years of age Rs. 794.75 /-
10 years of age Rs. 812.35 /-
15 years of age Rs. 870.75 /-

 

(Premiums indicated are exclusive of Service Tax)

For further details regarding the LIC Jeevan Arogya Policy please click on below given link :

LIC Jeevan Arogya Policy.

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