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Jeevan arogya

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Nirmal Goyal
Nirmal Goyal

The document discusses LIC's Jeevan Arogya health insurance plan. It provides details on the plan's benefits like hospital cash benefit, major surgical benefit, day care procedure benefit, and other surgical benefit. It covers expenses for hospitalization, surgery, outpatient treatments and more. The document also outlines eligibility conditions, waiting periods, and termination of the policy. Key benefits of the plan are lump sum payouts irrespective of actual medical costs and increasing health coverage annually.

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What is the situation today What New
The Cost of Health care shooting up exponentially Present Generation spend more on Health Care Next 18/01/13 Ajay Kumar Kurup
Health Insurance Health Insurance plan must take care 1)Daily Expenses in Hospital 2)Surgical Expenses 3)Out Patient expenses 4)All expenses in and out of Hospital 5)Waiver of premium during stay at Hospital 6)Risk Coverage in case of any exigencies Whether your existing plan offers all the above 18/01/13 Ajay Kumar Kurup
LICs Jeevan Arogya 18/01/13 Ajay Kumar Kurup
LICs Jeevan Arogya gives you Valuable financial protection in case of hospitalisation, surgery etc Increasing Health cover every year Lump sum benefit irrespective of actual medical costs No claim benefit Flexible benefit limit to choose from Flexible premium payment options 18/01/13 Ajay Kumar Kurup
Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Other Optional benefits(PWB) 18/01/13 Ajay Kumar Kurup
Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) 18/01/13 Ajay Kumar Kurup
Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB)) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) 18/01/13 Ajay Kumar Kurup
Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) 18/01/13 Ajay Kumar Kurup
Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit 18/01/13 Ajay Kumar Kurup
Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) Other Optional benefits 18/01/13 Ajay Kumar Kurup
Hospital Cash Benefit (HCB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Min Initial Daily Rs. 1000/- Rs. 1000/- Rs. 1000/- Benefit Max Initial Daily Rs. 4000/- Equal or less than PI Equal or less than PI Benefit Max Age for Cover 80 yrs 80 yrs 25 yrs HCB (Within India only) is payable on per day basis. Double the cash benefit for ICU. Max 30 days hospitalization & not more than 15 days in ICU (2 times HCB) for 1 st policy year for each one Max 90 days and incl not more than 45 days in ICU in the 2 nd year onwards for each insured Limited to a max of 720 days (incl of 360 days for ICU) during entire policy term for each insured HCB to increase 5% till it reaches 1.5 times And arithmetic addition of an amount equal to No Claim Benefit Stay in Hospital exceeds a continuous period of 24 yrs or part thereof thereafter. Stay more than 7 days even for 1s 24 hours also payable. 18/01/13 Ajay Kumar Kurup Next
Major Surgical Benefit(MSB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Sum Assured (MSB 100 times ADB 100 times of ADB of 100 times of ADB of SA) of PI insured Spouse each child Max Annual benefit 100% of Sum 100% of Sum Assured 100% of Sum Assured Assured Max Life Time 800% of MSB SA 800% of MSB SA 800% of MSB SA Quick Cash facility: 50% of eligible MSB amount subject to approval from TPA in select Hospitals MSB shall be a percentage of Sum Assured and is payable regardless of actual costs incurred Rs. 1000/- towards Ambulance expenses Premium Waiver benefit for next one year Surgery within India. 18/01/13 Ajay Kumar Kurup Next
Day Care Procedure Benefit (DCPB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Lump sum benefit 5 times of ADB 5 times of ADB in HCB 5 times of ADB IN payable in HCB HCB Max Annual benefit 3 Surgical Procedures Max Life Time 24 Surgical Procedures If a DCPB is performed, no HCB shall be paid DCPB is payable as one lump sum and proof of surgery is required All surgical procedures should be done by a Physician or Surgeon, to the satisfaction of the Corporation No transfer of left over benefit to other insured 18/01/13 Ajay Kumar Kurup Next
Other Surgical Benefit (OSB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Daily Benefit amount 2 times of ADB 2 times of ADB 2 times of ADB Max Annual benefit 15 Days in Year 1 and 45 days per year thereafter Max Life Time 360 days OSB is payable as daily benefit Proof of surgery done by a Physician or Surgeon, is subject to the satisfaction of the Corporation No transfer of left over benefit to other insured Surgery required but not listed under MSB or DCPB Next 18/01/13 Ajay Kumar Kurup
Other Options Accident Benefit Rider Min AB SA: Rs. 25000/- Max AB SA: Equal to Term Assurance SA AB SA shall be in multiples of Rs. 5000/- 18/01/13 Ajay Kumar Kurup
Other Benefits Contd. Death Benefit: No death benefit unless TA Rider benefit is opted for On death of the Principal Insured(PI) Surviving Insured Spouse will become PI, if already option given at the beginning of contract If the Insured Spouse had predeceased the PI, Then the other Insured will have the option to take new policy on following conditions The new policy will be issued without any underwriting if the new policy is bought within 90 days of the termination of the existing policy The maximum entry age will not apply for the new policy The outstanding Waiting periods and outstanding period of any Exclusion will however apply under the new policy Other terms and conditions including premium rates will be as applicable for the new policy Maturity Benefit: No benefits are payable at the end of the cover period 18/01/13 Ajay Kumar Kurup
Feature Eligibility Conditions Principal Parents & Parents-in- Insured Children Insured law (PI)/Insured Spouse Minimum Entry Age 18 Yrs LBD 18 Yrs LBD 3 Months(Completed) Maximum Entry Age 65 Yrs LBD 75 Yrs LBD 17 Yrs LBD Max Cover ceasing 80 Yrs 80 yrs 25 yrs age Date of cover expiry Policy anniversary on which the Insured life attains Maximum cover in respect of each ceasing age Insured covered under the plan Nominations Allowed s even for 1s 24 hoursNot Allowed Assignments also payable. Mode of Premium Yearly, Half Yearly and Monthly(ECS Only) Grace Period 30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode Revival Period 2 Years from due date of FUP 18/01/13 Ajay Kumar Kurup
Points to be noted Premium guaranteed for first 3 years and may be revised after every 3 years based on Health conditions All existing members must be added in first instance. New members can be added through Child birth (Children)-3 Months, Marriage (Spouse, Parents-in-law)- 6 Months from next Policy anniversary 18/01/13 Ajay Kumar Kurup
Points to be noted Contd Waiting Period 90 days from DOC other than accidental bodily injury 45 days from DOR, if request for revival recd within 90 days from the due date of FUP 90 days from DOR, if request for revival recd beyond 90 days from the due date of FUP Specific Waiting Period (treatments) 2 years from Date of Cover Commencement 2 Years from DOCC, if request for revival recd within 90 days from the due date of FUP 2 Years days from DOR, if request for revival recd beyond 90 days from the due date of FUP 18/01/13 Ajay Kumar Kurup Next
Treatments in respect of Specific waiting period i. Treatment for adenoid or tonsillar disorders ii. Treatment for anal fistula or anal fissure iii. Treatment for benign enlargement of prostate gland iv. Treatment for benign uterine disorders like fibroids, uterine prolapse, dysfunctional uterine bleeding etc v. Treatment for Cataract vi. Treatment for Gall stones vii. Treatment for slip disc viii. Treatment for Piles ix. Treatment for benign thyroid disorders x. Treatment for Hernia xi. Treatment for hydrocele xii. Treatment for degenerative joint conditions xiii. Treatment for sinus disorders xiv. Treatment for kidney or urinary tract stones xv. Treatment for varicose veins xvi. Treatment for Carpal tunnel syndrome Enter Please xvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc 18/01/13 Ajay Kumar Kurup
Points to be noted Contd Termination of Policy If policy is issued on a single life Non Payment of premium within revival period On death On Date of cover expiry On exhausting all the life time maximum Benefits Limits as specified above If policy is issued on more than one life Non Payment of premium within revival period On death or Date of cover expiry of the PI and if the Policy does not continue with the IS as the PI On death or Date of cover expiry of IS after Policy continues with the IS as the PI after the PI dies or reaches his/her Date of cover expiry On PI exhausting all the life time maximum Benefits Limits as specified above 18/01/13 Ajay Kumar Kurup
What is different from Mediclaim Pre defined benefit- No reimbursement, but lump sum paid based on pre-defined benefit Not based on expenses incurred This will tend to indirectly reduce the Health care cost, which is rising due to cash less mediclaim benefit All benefit is dependent on HCB 18/01/13 Ajay Kumar Kurup
18/01/13 Ajay Kumar Kurup

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Jeevan arogya

  • 1. What is the situation today What New
  • 2. The Cost of Health care shooting up exponentially Present Generation spend more on Health Care Next 18/01/13 Ajay Kumar Kurup
  • 3. Health Insurance Health Insurance plan must take care 1)Daily Expenses in Hospital 2)Surgical Expenses 3)Out Patient expenses 4)All expenses in and out of Hospital 5)Waiver of premium during stay at Hospital 6)Risk Coverage in case of any exigencies Whether your existing plan offers all the above 18/01/13 Ajay Kumar Kurup
  • 4. LICs Jeevan Arogya 18/01/13 Ajay Kumar Kurup
  • 5. LICs Jeevan Arogya gives you Valuable financial protection in case of hospitalisation, surgery etc Increasing Health cover every year Lump sum benefit irrespective of actual medical costs No claim benefit Flexible benefit limit to choose from Flexible premium payment options 18/01/13 Ajay Kumar Kurup
  • 6. Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Other Optional benefits(PWB) 18/01/13 Ajay Kumar Kurup
  • 7. Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) 18/01/13 Ajay Kumar Kurup
  • 8. Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB)) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) 18/01/13 Ajay Kumar Kurup
  • 9. Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) 18/01/13 Ajay Kumar Kurup
  • 10. Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit 18/01/13 Ajay Kumar Kurup
  • 11. Benefits Under Jeevan Arogya Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Ambulance Benefit Premium waiver Benefit (PWB) Other Optional benefits 18/01/13 Ajay Kumar Kurup
  • 12. Hospital Cash Benefit (HCB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Min Initial Daily Rs. 1000/- Rs. 1000/- Rs. 1000/- Benefit Max Initial Daily Rs. 4000/- Equal or less than PI Equal or less than PI Benefit Max Age for Cover 80 yrs 80 yrs 25 yrs HCB (Within India only) is payable on per day basis. Double the cash benefit for ICU. Max 30 days hospitalization & not more than 15 days in ICU (2 times HCB) for 1 st policy year for each one Max 90 days and incl not more than 45 days in ICU in the 2 nd year onwards for each insured Limited to a max of 720 days (incl of 360 days for ICU) during entire policy term for each insured HCB to increase 5% till it reaches 1.5 times And arithmetic addition of an amount equal to No Claim Benefit Stay in Hospital exceeds a continuous period of 24 yrs or part thereof thereafter. Stay more than 7 days even for 1s 24 hours also payable. 18/01/13 Ajay Kumar Kurup Next
  • 13. Major Surgical Benefit(MSB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Sum Assured (MSB 100 times ADB 100 times of ADB of 100 times of ADB of SA) of PI insured Spouse each child Max Annual benefit 100% of Sum 100% of Sum Assured 100% of Sum Assured Assured Max Life Time 800% of MSB SA 800% of MSB SA 800% of MSB SA Quick Cash facility: 50% of eligible MSB amount subject to approval from TPA in select Hospitals MSB shall be a percentage of Sum Assured and is payable regardless of actual costs incurred Rs. 1000/- towards Ambulance expenses Premium Waiver benefit for next one year Surgery within India. 18/01/13 Ajay Kumar Kurup Next
  • 14. Day Care Procedure Benefit (DCPB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Lump sum benefit 5 times of ADB 5 times of ADB in HCB 5 times of ADB IN payable in HCB HCB Max Annual benefit 3 Surgical Procedures Max Life Time 24 Surgical Procedures If a DCPB is performed, no HCB shall be paid DCPB is payable as one lump sum and proof of surgery is required All surgical procedures should be done by a Physician or Surgeon, to the satisfaction of the Corporation No transfer of left over benefit to other insured 18/01/13 Ajay Kumar Kurup Next
  • 15. Other Surgical Benefit (OSB) Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In law Daily Benefit amount 2 times of ADB 2 times of ADB 2 times of ADB Max Annual benefit 15 Days in Year 1 and 45 days per year thereafter Max Life Time 360 days OSB is payable as daily benefit Proof of surgery done by a Physician or Surgeon, is subject to the satisfaction of the Corporation No transfer of left over benefit to other insured Surgery required but not listed under MSB or DCPB Next 18/01/13 Ajay Kumar Kurup
  • 16. Other Options Accident Benefit Rider Min AB SA: Rs. 25000/- Max AB SA: Equal to Term Assurance SA AB SA shall be in multiples of Rs. 5000/- 18/01/13 Ajay Kumar Kurup
  • 17. Other Benefits Contd. Death Benefit: No death benefit unless TA Rider benefit is opted for On death of the Principal Insured(PI) Surviving Insured Spouse will become PI, if already option given at the beginning of contract If the Insured Spouse had predeceased the PI, Then the other Insured will have the option to take new policy on following conditions The new policy will be issued without any underwriting if the new policy is bought within 90 days of the termination of the existing policy The maximum entry age will not apply for the new policy The outstanding Waiting periods and outstanding period of any Exclusion will however apply under the new policy Other terms and conditions including premium rates will be as applicable for the new policy Maturity Benefit: No benefits are payable at the end of the cover period 18/01/13 Ajay Kumar Kurup
  • 18. Feature Eligibility Conditions Principal Parents & Parents-in- Insured Children Insured law (PI)/Insured Spouse Minimum Entry Age 18 Yrs LBD 18 Yrs LBD 3 Months(Completed) Maximum Entry Age 65 Yrs LBD 75 Yrs LBD 17 Yrs LBD Max Cover ceasing 80 Yrs 80 yrs 25 yrs age Date of cover expiry Policy anniversary on which the Insured life attains Maximum cover in respect of each ceasing age Insured covered under the plan Nominations Allowed s even for 1s 24 hoursNot Allowed Assignments also payable. Mode of Premium Yearly, Half Yearly and Monthly(ECS Only) Grace Period 30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode Revival Period 2 Years from due date of FUP 18/01/13 Ajay Kumar Kurup
  • 19. Points to be noted Premium guaranteed for first 3 years and may be revised after every 3 years based on Health conditions All existing members must be added in first instance. New members can be added through Child birth (Children)-3 Months, Marriage (Spouse, Parents-in-law)- 6 Months from next Policy anniversary 18/01/13 Ajay Kumar Kurup
  • 20. Points to be noted Contd Waiting Period 90 days from DOC other than accidental bodily injury 45 days from DOR, if request for revival recd within 90 days from the due date of FUP 90 days from DOR, if request for revival recd beyond 90 days from the due date of FUP Specific Waiting Period (treatments) 2 years from Date of Cover Commencement 2 Years from DOCC, if request for revival recd within 90 days from the due date of FUP 2 Years days from DOR, if request for revival recd beyond 90 days from the due date of FUP 18/01/13 Ajay Kumar Kurup Next
  • 21. Treatments in respect of Specific waiting period i. Treatment for adenoid or tonsillar disorders ii. Treatment for anal fistula or anal fissure iii. Treatment for benign enlargement of prostate gland iv. Treatment for benign uterine disorders like fibroids, uterine prolapse, dysfunctional uterine bleeding etc v. Treatment for Cataract vi. Treatment for Gall stones vii. Treatment for slip disc viii. Treatment for Piles ix. Treatment for benign thyroid disorders x. Treatment for Hernia xi. Treatment for hydrocele xii. Treatment for degenerative joint conditions xiii. Treatment for sinus disorders xiv. Treatment for kidney or urinary tract stones xv. Treatment for varicose veins xvi. Treatment for Carpal tunnel syndrome Enter Please xvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc 18/01/13 Ajay Kumar Kurup
  • 22. Points to be noted Contd Termination of Policy If policy is issued on a single life Non Payment of premium within revival period On death On Date of cover expiry On exhausting all the life time maximum Benefits Limits as specified above If policy is issued on more than one life Non Payment of premium within revival period On death or Date of cover expiry of the PI and if the Policy does not continue with the IS as the PI On death or Date of cover expiry of IS after Policy continues with the IS as the PI after the PI dies or reaches his/her Date of cover expiry On PI exhausting all the life time maximum Benefits Limits as specified above 18/01/13 Ajay Kumar Kurup
  • 23. What is different from Mediclaim Pre defined benefit- No reimbursement, but lump sum paid based on pre-defined benefit Not based on expenses incurred This will tend to indirectly reduce the Health care cost, which is rising due to cash less mediclaim benefit All benefit is dependent on HCB 18/01/13 Ajay Kumar Kurup
  • 24. 18/01/13 Ajay Kumar Kurup