Jeevan Arogya-Do you know this LIC’s Health or Medical Insurance Policy?

By / December 4, 2014

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.

LIC's Jeevan Arogya

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.

Jeevan Arogya 1

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.

Exclusions-

  • 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.

Tax Benefits-

Whatever premium you pay towards this plan will be eligible for deduction under Sec.80D.

Whether you can buy this plan?

Advantages-

  • 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.

Disadvantages-

  • 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 🙂

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62 thoughts on “Jeevan Arogya-Do you know this LIC’s Health or Medical Insurance Policy?”

  2. Aman Garg

    Hi Basu,

    It was my 10th link while searching about LIC Jeevan Arogya Policy and now I think I understood the policy. Thank you so much for writing in simple English.
    I am looking for Health Insurance specially for my parents because me and my wife are covered by my employer but if I get a good deal I would like to have one personal health insurance for me and my wife.

    However, the worst part about this policy is; you need to be hospitalized for 7 days to get the HCB. Now-a-days even Chemotherapy patients return home within that stipulated time. So hardly one will be in position to avail this facility and if at all they are able to avail, they must be the unluckiest persons who have to go through this much.

    Overall, initially I was interested in this policy but now I am not. I’ve checked on PolicyBazaar and BankBazaar and found Universal Sompo is providing good coverage at reasonable price so planning to buy that.

    Thank you once again, keep doing good job.

    Warm Regards,
    Aman

    Reply
  3. vishal kumar

    Sr i want to know that from how much day after the policy start i will get the benifit ….?
    Nd if one time i get the benifit in surgery and after some year again i have to get surgery then can i again get a benifit ???

    Reply
  4. Madhavi

    Dear basavaraj.

    I am a 35 year old working women in Mumbai. Myself n my spouse are insured under Bharati axa health insurance policy. I want to get a health insurance policy for my parents, mother aged 65 and father aged 67. Is it possible to get a health insurance for them at this age? If so, which company offers such policy.

    Reply
  5. jitendra gohil

    Dear sir

    I have jeevN arogya policy. Last mont i have acciddnt so i am hospitalized.

    For claim purpose LIC requiremt of indoor case paper but my hospital is refused.

    So what is oother option so i will get my claim

    Please guide me

    Thank you

    Reply
  6. Adarsh

    Hi Basu,
    I wanted to take a medical insurance policy for my brother in law. He is autistic. Our idea was to put a certain amount in LIC’s annuity plan and then use that amount to pay the medical insurance amount. Is that a practical approach? Is there a policy available with fixed premium amount for say like 80 years? At present he is close to 38 years old. What can be a suitable policy for a person like him?
    Thanks in advance

    Adarsh

    Reply
    1. Basavaraj Tonagatti

      Adarsh-You can check with public sector health insurance companies. If you don’t want the hurdle of paying from your pocket, then you can set up such recurring income. However, do remember that annuity plans are less liquid and it is taxable income for him.

      Reply
      1. Adarsh

        Thank you Basavaraj, We are planning to take a health insurence + a mediclaim policy. Is this a good idea? There will be an increase in the premium for each year. What can be the approx. expected appreciation could you please advice?

        Reply
  7. Amit

    Dear Sir,

    Could I port to any other health insurance like religare from Jeevan arogya? I’ve paid premium for 2 years. My next premium is due for june but I want to change it. Will I get a benift if I change to some other insurance? I want a cashless insurance. I’m confused between religare and Max Bupa. Kindly suggest.

    Thank you

    Reply
    1. Basavaraj Tonagatti

      Amit-Sadly you can’t port. Because this is offered by life insurance and portability is allowed only among general insurance companies products. Both MaxBupa and Religare offers cashless facilities. You can opt any one.

      Reply
  8. Hari

    Sir,

    I want to take health insurance to my parents. and I am expecting the insured amount should come at the time of emergency not after 3 or 4 months. can you please suggest me where should I take insurance?

    Reply
  11. chandan sood

    Dear sir
    can i purchage jeevan arogayplan and apolomunic optima restore plan togeather.if yes how i pass my claim in further

    Reply
    1. Basavaraj Tonagatti

      Chandan-Yes, you can purchase. Claim will be settled based on the % of sharing. But do remember that Jeevan Arogya will not give you cashless benefit and you have to run behind LIC office to settle the claim.

      Reply
  12. ARUP CHATTERJEE

    Sir, my age is 43 yrs, my wife is 33, elder son 9 yrs, younger son 2 yrs. I can spend Rs. 12000-13000/- per year. which health insurance is suitable for me ? please give your valuable suggestion..

    Reply
  13. rahul

    everyone, pls think atleast 1000 times before buying this policy and take every point in writing before buying.
    In my case they only given 2000 rs for bed charges and nothing else, that also after 5 months … after continuous follow up they said that this policy only gives bed charges and its not a medicliam or health policy … my suggestion think more than 1000 times and get all clarifications in writing before buying

    Reply
  14. Jerry

    LIC is not suggested as a health insurance policy, please do not get disappointed afterwards, this is my personal opinion, after being a customer for more than 1 year.

    Reply
  15. Aman Sharma

    Hello Basu,

    I want to invest 5000-7000 per month, pls guide me where i can invest , i am confused whether in mutual fund or RDs.

    regards
    aman

    Reply
  16. Sudheer

    Hi basu good morning.
    My daughter is gifted Rs. 10000 by their grand parents which they like to keep in fixed deposit. But now banks r giving less than 9%. I thought of keeping in any closed ended mutual funds for 3yrs which may gives more than 9%. What ll u suggest. Is my thought correct? If so pl suggest me good closed ended fund. Pl share your thoughts.

    Reply
    1. Basavaraj Tonagatti

      Sudheer-I assume the gifted amount is for long term expenses like your kid’s marriage or education. So let me know her current age or the time frame of these expenses in your life. Stay away from any such closes ended funds. I think some agent might have guide you (if I am correct 🙂 ).

      Reply
      1. Sudheer

        Hi basu my daughter is 1yr old. Definitely it is for long term investment. I don’t want to use it personal. So what’s ur suggestion?

        Reply
  17. amar

    Can u pls suggest me some best life insurance policies. I can invest 5000 per month for 20-25 years. Can I consider hdfc click to protect plan.pls give ur valuable suggestions

    Reply
      1. Karthik G

        I meant to ask, if you have compared their existing plans in Apollo Munich, you can share the Pros & Cons for each of the plan, just like you have spelled out the Advantages & Disadvantages for LIC Jeevan Arogya.

        Based on my analysis, I find Optima Restore, a good option in Apollo Munich.

        Reply
        1. Basavaraj Tonagatti

          Karthik-In what way in emergency time one can pay the bills and afterward get it back from insurance? Insurance is meant for emergencies and if it fail to the main idea of it then what is the use. Second point is, there are so many restrictions and complications which common man can’t understand. Usually health insurance is an emergency need. We buy this product only to protect any unseen eventualities. What is use if we need to create corpus for it separately and then get it back from LIC? One can buy this plan only if he is fond of LIC or his or her uncle is LIC agent 🙂

          Reply
          1. Karthik G

            Basu – Exactly my point… LIC Jeevan Arogya does not interest me either, because it does not serve the purpose of an Emergency. In Apollo Munich, Optima Restore plan, i find that the Restore Benefit & Multiplier Benefit is more advantageous, compared to other Health Insurance plans, because, no individual is sure, if emergencies can re-occur in the same year.

            Restore Benefit provides me the advantage such that If emergencies occur in the same policy year, the individual need not worry, since the Insurance benefit is restored, even if Basic Sum assured, has already been exhausted.

            So, I wanted your assessment of Health Insurance policies of Apollo Munich ( Basically Advantages & Disadvantages )

            Reply
          2. Rajiv Kumar Tripathi

            U have not considered the point it being a fixed benefit plan specifically. It s an add on and not mein stake. So as teir 2 defence I think it is a best fixed benefit medical insurance. Ppl already covered by employer can go for it. Say what?

            Reply
  21. SRINIVASAN GOPAL

    Sir, What would be the premium payable? Second, is it possible for my son (DOB 21.2.1998) to take out a policy include his parents name whose premium initially will be discharged by his parents?

    Thanking you in advance,

    Regards,

    SRINIVASAN GOPAL

    Reply
    1. Basavaraj Tonagatti

      Srinivasan-Regarding premium, please contact your LIC branch. Maximum age for kids to enter into this plan is 17 years. So your kid already completed the 17 years. Check with LIC branch and if possible then include him too.

      Reply
  22. Sameer

    Very well explained….

    It is actually complex….and when you say “no cashless” and procedural delays, you cannot rely on this. Only good point is that you may include parents upto 80 yrs. Hope the premium in that case will not be the bomb.

    Reply
  23. DB DESAI

    Yes, it is complex but useful as an addition to basic medical cover. It is complex for the policyholder but if he/she is being serviced by able advisor, then it can be easier. I have experienced it.

    Reply
      1. Chetan

        Good to see, your suggestions are realistic and practical. The problem is not with the agents but the problem is with LIC where the staff are not much trained about health plans and there is no department called health in the branches where in people can get details about the service aspects. As medical terminologies are difficult to understand other than Doctors.

        Introducing the separate department for health in LIC would give the boost for the lic health plans

        Reply
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