jeevan arogya

What is the situation today

What New

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The Cost of Health care shooting up exponentially

Present Generation spend more on Health Care

03/05/23 Ajay Kumar Kurup

Health InsuranceHealth Insurance plan must take care……1)Daily Expenses in Hospital2)Surgical Expenses3)Out Patient expenses4)All expenses in and out of Hospital5)Waiver of premium during stay at Hospital6)Risk Coverage in case of any exigencies

Whether your existing plan offers all the above03/05/23 Ajay Kumar Kurup

LIC’s Jeevan Arogya


LIC’s 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 options03/05/23 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)


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)


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)


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)


Benefits Under Jeevan Arogya• Hospital cash benefit (HCB)• Major Surgical Benefit (MSB)• Day Care Procedure Benefit• Other Surgical Benefit


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


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 1st policy year for each oneMax 90 days and incl not more than 45 days in ICU in the 2nd year onwards for each insuredLimited to a max of 720 days (incl of 360 days for ICU) during entire policy term for each insuredHCB 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.

Hospital Cash Benefit (HCB)Feature Principal

Insured (PI)Insured Spouse(If any), Parents/In law

Insured Children

Min Initial Daily Benefit

Rs. 1000/- Rs. 1000/- Rs. 1000/-

Max Initial Daily Benefit

Rs. 4000/- Equal or less than PI Equal or less than PI

Max Age for Cover 80 yrs 80 yrs 25 yrs

Next03/05/23 Ajay Kumar Kurup

Major Surgical Benefit(MSB)Feature Principal


Insured Children

Sum Assured (MSB SA)

100 times ADB of PI

100 times of ADB of insured Spouse

100 times of ADB of each child

Max Annual benefit 100% of Sum Assured

100% of Sum Assured 100% of Sum 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 HospitalsMSB shall be a percentage of Sum Assured and is payable regardless of actual costs incurredRs. 1000/- towards Ambulance expensesPremium Waiver benefit for next one yearSurgery within India.


Day Care Procedure Benefit (DCPB)Feature Principal


Insured Children

Lump sum benefit payable

5 times of ADB in HCB

5 times of ADB in HCB 5 times of ADB IN HCB

Max Annual benefit 3 Surgical ProceduresMax Life Time 24 Surgical Procedures

If a DCPB is performed, no HCB shall be paidDCPB is payable as one lump sum and proof of surgery is requiredAll surgical procedures should be done by a Physician or Surgeon, to the satisfaction of the CorporationNo transfer of left over benefit to other insuredSurgery within India Next03/05/23 Ajay Kumar Kurup

Other Surgical Benefit (OSB)Feature Principal


Insured Children

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 thereafterMax Life Time 360 days

OSB is payable as daily benefitProof of surgery done by a Physician or Surgeon, is subject to the satisfaction of the CorporationNo transfer of left over benefit to other insuredSurgery required but not listed under MSB or DCPB


Other OptionsAccident Benefit Rider

Min AB SA: Rs. 25000/-

Max AB SA: Equal to Term Assurance SA

AB SA shall be in multiples of Rs. 5000/-


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


s even for 1s 24 hours also payable.

Eligibility ConditionsFeature Principal

Insured (PI)/Insured Spouse

Parents & Parents-in-law

Insured Children

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 age

80 Yrs 80 yrs 25 yrs

Date of cover expiry in respect of each Insured covered under the plan

Policy anniversary on which the Insured life attains Maximum cover ceasing age

NominationsAssignments

AllowedNot Allowed

Mode of PremiumGrace PeriodRevival Period

Yearly, Half Yearly and Monthly(ECS Only)30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode2 Years from due date of FUP


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


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


Treatments in respect of Specific waiting period

i. Treatment for adenoid or tonsillar disordersii. Treatment for anal fistula or anal fissureiii. Treatment for benign enlargement of prostate glandiv. Treatment for benign uterine disorders like fibroids, uterine prolapse,dysfunctional uterine bleeding etcv. Treatment for Cataractvi. Treatment for Gall stonesvii. Treatment for slip discviii. Treatment for Pilesix. Treatment for benign thyroid disordersx. Treatment for Herniaxi. Treatment for hydrocelexii. Treatment for degenerative joint conditionsxiii. Treatment for sinus disordersxiv. Treatment for kidney or urinary tract stonesxv. Treatment for varicose veinsxvi. Treatment for Carpal tunnel syndromexvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic

disease etc

Enter Please


Points to be noted Contd………

Termination of PolicyIf 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


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


jeevan arogya

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