All About LIC's Health Insurance Plans
Updated On Jun 29, 2022
Table of Contents
LIC Jeevan Arogya health plan offers health insurance coverage to you and your family including children, spouse, and parents against specified ailments. It offers timely financial support to the insured in case of medical needs.
Key Features of LIC Jeevan Arogya Plan
Some of the key features of LIC Jeevan Arogya policy are given below:
- The policy offers coverage on both individual and family floater basis.
- The premium can be paid in yearly and half-yearly modes.
- Waiver of premium benefit is also provided
- This LIC health insurance policy also covers day care procedures.
- Ambulance cover is also provided
- All the major surgeries are covered under this LIC health insurance plan.
Inclusions of LIC Jeevan Arogya Plan
LIC Jeevan Arogya policy provides valuable financial coverage in case of medical emergencies like hospitalization or surgery. This mediclaim policy comes with a health cover that increases every year and provides a lump sum benefit irrespective of actual medical costs. The policy comes with an array of coverage benefits that are given below:
1. Hospital Cash Benefit (HCB)
In case the insured person or any member of his/her family covered under the plan undergoes hospitalization due to sickness or accidental injury, they will be eligible for the Hospital Cash Benefit. The distribution of this benefit under the basic plan will be in multiples of Rs. 1000, and the details are as follows:
Minimum initial daily hospital cash benefit for any ward other than the ICU: Rs. 1000 for the insured/spouse/kids/parents or parents-in-law. (When the principal sum insured is Rs. 1000)
Maximum initial daily cash benefit for a ward other than the ICU: Less than or equal to the principal sum insured for insured/spouse/kids/parents or parents-in-law. (When principal insured is Rs. 4000)
No benefit is paid for the first day of the hospitalization. Maximum ICU hospitalization days are 15 days in the first year and up to 45 days for subsequent years. The hospital cash benefit can be claimed for a maximum of 30 days in the first policy year and 90 days in subsequent years, including the ICU days. A maximum lifetime benefit period is limited to 720 days, including ICU days for not more than 360 days.
2. Major Surgical Benefit (MSB)
This benefit is provided to the insured in case he/she undergoes surgery during the policy period. It is always 100 times your Hospital Cash Benefit or the Applicable Daily Benefit (ADB). It ranges from Rs 1 lakh to Rs 4 lakh. The maximum Surgical Benefit applicable to each insured in a year is 100% of the Major Surgical Benefit sum insured. The maximum benefit applicable in a lifetime to each insured is 800% of the MSB sum insured.
3. Day Care Procedure Benefit
This is a lump sum benefit payable to the insured for any Day Care procedures undergone by the insured in India, for which continuous hospitalization is not required. It is up to 5 times the ADB or the Applicable Daily Benefit. The insured is eligible to receive this benefit annually for up to three surgical procedures in a year. Maximum Lifetime Benefit, applicable to each insured. The insured is eligible to receive this benefit for up to 24 surgical procedures throughout the lifetime of the policy.
4. Other Surgical Benefit
If the insured undergoes any surgery which is not covered under the Major Surgical Benefit, the cost of surgery will be covered under OSB or the Other Surgical Benefit. The daily benefit amount is up to 2 times of ADB principal sum insured. The insured can get this benefit for a maximum of 15 days in the first policy year and up to 45 days per year in subsequent years. The insured can get this benefit for a maximum of 360 days in the policy lifetime.
5. Ambulance Benefit
If the insured undergoes hospitalization due to an accident or sickness and qualifies for Major Surgical Benefit, he/she can also avail of the Ambulance Benefit. This is applicable only if any emergency ambulance charges are incurred to transport the insured to the hospital.
The benefit is applicable for a maximum of Rs. 1000.
6. Premium Waiver Benefit (PWB)
LIC policyholders can get a Premium Waiver Benefit if they undergo any major surgery for which they have received MSB or Major Surgical Benefit. Under this benefit, the insured can get a complete waiver of the one-year premium from the due date of the policy following the surgery date.
7. No Claim Benefit (NCB)
If the policyholder does not file any insurance claims in a policy year or between two automatic renewal dates, he/she will be eligible for the No Claim Benefit. The NCB amount will be 5% of the initial daily benefit for every insured.
8. Tax Benefits
LIC Jeevan Arogya policy premiums are subject to tax exemption under Sec 80D of the Indian Income Tax Act.
Exclusions of LIC Jeevan Arogya Plan
The LIC Jeevan Arogya plan excludes coverage for any injury or illness due to:
- Any pre-existing diseases or conditions
- Any injury due to war, naval or military operations, participation in riots, etc.
- Radioactive contamination
- Criminal or illegal acts
- Natural calamities like earthquakes, floods etc.
- Participation in dangerous sports like racing, scuba diving, bungee jumping, etc.
- Self-inflicted injuries or attempted suicide
- Abuse of drugs, alcohol or intoxicants
- Plastic surgery, unless necessary for accidental injury treatment
- Congenital conditions
- STDs like HIV / AIDS
- Infertility or sterilization
- Pregnancy or childbirth-related conditions
- Epidemic diseases or conditions
- Dental treatment
Documents Required for LIC Mediclaim Policy
Documents Required for Policy Purchase: Proofs of identity, age, and address, like PAN card, passport, driving license, voter ID, Aadhaar card, utility bills, etc.
Documents Required for Filing Claims: Hospital Discharge Summary or Discharge Certificate, medical prescriptions, all investigative and diagnostic reports, payment invoices or receipts, medical bills, claim form, Photo ID, etc.
Conclusion
The waiting period for the LIC mediclaim policy is 90 days from the date of policy commencement, except in case of accidental hospitalization or surgery.
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