We know that LIC offers Life Insurance products. However, do you know LIC also offers a health insurance or medical insurance plan? Name of this plan is JEEVAN AROGYA. Even though it launched long back, but I felt that, many of us have not aware of this plan. So let us review it in today’s post.
Who can buy this plan?
You can buy this policy to cover yourself, spouse, kids, parents, and even in-laws too. Below is age eligibility to buy this plan.
Maximum age of cover for major family members will be 80 Yrs and for children it is 25 Yrs.
What is covered under this plan?
Daily Hospital Cash Benefit (HCB)-
This is the amount which will be payable to you in the event of hospitalization on a daily base. Currently this plan offers daily payout of Rs.1, 000, Rs.2, 000, Rs.3, 000 and Rs.4, 000. All rest of the benefits will be base to the HCB you choose. So for example, you opted for Rs.4, 000 as a daily hospital cash benefit, then the maximum Major Surgical Benefit (It is explained below) will be 100 times of HCB i.e. Rs.4, 00,000. However, do remember that minimum 24 hours hospitalization requires and covers only in India.
In the first year maximum 30 days of HCB will be payable to each insured, out of which not more than 15 days for ICU hospitalization. In subsequent years, the maximum limit per year will be 90 days and for ICU it will be 45 days. Also the total HCB payable to each individual covered under this plan is restricted to 720 days, out of which not more than 360 days of ICU payment (Note that for ICU admission HCB payout will be double of normal daily HCB payout). Once any insured member reaches this limit, then he/she will not be eligible to receive HCB. In addition, one insured member’s HCB facility cannot be transferred to another insured member.
This initial daily benefit will go to increase every year at the rate of 5%. However, up-to a maximum of 1.5 times of original benefit. This feature takes care of inflation in medical cost and be called as renewal bonus.
Along with that, this plan offers No Claim Bonus too. Another 5% of initial HCB will go on add to for each no claim previous year. There is no maximum limit specified for this benefit.
If you include any new member in this plan the HCB will be the initial HCB of what you opted.
No benefit will be payable for first 24 hours of hospitalization (first day). However, in case the hospitalization extends to 7 days or more, then the daily HCB will also be payable to first 24 hrs hospitalization.
Major Surgical Benefit (MSB)-
Along with HCB, if the patient undergoes major surgeries described in the policy document, then he will be eligible for the benefit of maximum 100 times of HCB. So the maximum surgical benefit under this plan will range from Rs.1, 00,000 to Rs.4, 00,000. It means, suppose you opted for Rs.1, 000 HCB then you will be entitled to maximum of Rs.1, 00,000 MSB The list covers 140 major surgeries.
This amount will be payable irrespective of the actual amount expended. MSB will be payable only in case surgeries performed in India. The total amount payable under MSB to each individual during the policy period must not cross the 800% of actual MSB. It means, MSB be can be claimed once in a year and maximum 8 times in a policy period for an individual. Once this attained, then he/she will not be eligible to receive any further MSB facility. In addition, you cannot claim twice to the same type of surgery. You cannot transfer one insured MSB benefit to another family member. If you undergo multiple surgeries during the single surgery period, then MSB will be payable to one surgery expenses but not for all.
Day care Procedure Benefit-
In case patient undergoes any day care procedure as a medical necessity, then he will be entitled to the benefit of 5 times of daily HCB benefit. It means suppose you opted for daily HCB of Rs.4, 000 then day care procedure benefit you can avail will be Rs.20, 000 (5 times of initial HCB you opted), irrespective of what you actually incurred.
Maximum limit to avail this benefit in a year will be 3 and 24 during the policy tenure. Such day care must be applicable to India only.
Other Surgical Benefit-
If an insured person undergoes surgery, which was not listed in the major surgical benefit or MSB and causing him for hospitalization of more than 24 hours than 2 times of actual daily HCB will be payable. Maximum benefit in a year is 15 days in first year and 45 days thereafter. However, maximum limit during the whole policy period will be 360 days.
How to add new member into this policy during the policy period?
Spouse or parents in-law must be included within 6 months from the date of marriage. However, actual cover starts from the immediate next policy anniversary. Newborn child will be covered from the immediate next policy anniversary. Therefore, from immediate next policy anniversary your premium will rise based on the age, term opted and HCB you selected for him/her. Do remember that only principal insured or PI can add members. If he dies during the policy period then the rest of the members cannot add new members.
Below are a few unique features of this plan–
- It is non-linked and non-participating plan. Therefore, you will not get any bonus, LA or FAB like what you get from any typical LIC plans. In addition, this plan covers only health issues. Hence, it is not an investment plan like ULIP.
- This is a defined benefit health insurance plan. Means, all benefits are fixed in advance. So whether you incurs higher or lower will not matter.
- This plan is a hospital cash benefit plan. Therefore, you need to submit the hospital bills to claim. Hence, even though you claim health insurance under your typical health insurance plan (either on your own or through an employer), you still can claim for the benefits.
- You can include your in-laws too.
- This plan offers health cover up-to age of 80 Yrs of major family members and up-to age of 25 Yrs of minor children. Life Insurance and Accident coverage will be up-to 60 Yrs of age.
- You can remove, add any family members during the policy period.
- You can pay premium Monthly, Quarterly, Half Yearly, or Yearly. This will not be possible in typical health insurance plans.
- You can avail term assurance and accident assurance as riders. Maximum Term Assurance riders will be 100 times of HCB (Hospital Cash Benefit) and Accident Assurance will be less than or equal to sum assured offered in term assured rider.
- If due to medical complications, patient is admitted to ICU then he can claim two times of HCB (Hospital Cash Benefit).
- Even though this plan offers you claim only after you submit the hospital bills. However, in case of surgeries covered under MSB (Major Surgical Benefit), 50% of the sum assured can be claimed during the hospitalization period itself. This advance payout will be adjusted during final settlement.
- If the patient undergoes surgery under special categories defined under MSB (Major Surgical Benefit), then one-year premium will be waived off.
- No loan facility available under this plan.
- You will get a grace period of 30 days for half yearly and yearly premium amount.
- Any pre-existing condition unless disclosed to and accepted by LIC.
- Treatment or Surgery did not perform by a Physician or Surgeon.
- Any routine or medical check up examination.
- Medical expenses such as X-Ray or laboratory examinations.
- Any epidemic.
- Circumcision, cosmetic or plastic surgery.
- Hospitalization or Surgery for donation of an organ.
- Treatment for correction of birth defects or congenital anomalies.
- Dental treatment.
- Nervous breakdown, sterilization or infertility.
- Attempted suicide and/or the use or misuse of any drugs or alcohol.
- Any sexually transmitted diseases, AIDS, HIV.
- Pregnancy and childbirth related.
- War, invasion. Naval or military operations.
- Any natural peril.
- Participation in any hazardous activity or sports, criminal or illegal activities.
- Radioactive contamination.
Whatever premium you pay towards this plan will be eligible for deduction under Sec.80D.
Whether you can buy this plan?
- You can add your parents and in-laws in a single policy.
- Maximum age for major individual is 80 Yrs. This I feel fair.
- A Renewal bonus of 5 % is unique, which you will not find in any health insurance policies.
- Along with that, this policy offers No Claim Bonus of 5%. No maximum limit for this benefit.
- Premium waiver benefits in case you underwent surgery and got benefit under MSB.
- Premium paying flexibility like monthly, quarterly, half yearly or yearly.
- No in house team to process the claims at the earliest. So you may feel procedural delays.
- This is not cashless health insurance. So hard for those who completely depend on this plan. Because in case of emergencies they first need to pay the bills at the hospital then get reimbursed by LIC. So even though you buy this plan, but still having an alternative health insurance from general insurance companies or creating a corpus is mandatory.
- Maximum benefit one can avail under this plan is Rs.4,00,000. So considering the current medical cost, this restricts you to satisfy with less coverage.
- You may feel MSB low when you compare the actual cost of few surgeries.
- If pre existing diseases not covered under this plan then you have no choice but to pay from your pocket related to those diseases.
- Too many limitations for getting HCB, MSB or other benefits like first year, subsequent years or lifetime benefits. This may confuse the insured.
- All claims will be payable if you hospitalized or treated in India.
- If both parents survive, then only you can opt them this plan. Means you can opt this policy to both father and mother. But not either to mother or father. Same applies to in-laws.
- During surgery, hospitalization, you will get payment related to only one surgery but not for all surgery.
- No benefit for 1st day of hospitalization in case your hospitalization is less than a 7-day period.
- Too complex to understand.
Overall, I consider this plan as additional safety to my existing health insurance. However, I will not depend on this policy along. In addition, I felt that this is too complicated for the common person. Hence, one may miss few exclusions or policy wordings. Take your own decision based on your requirement 🙂