What is the situation today

What New

The Cost of Health care shooting

up exponentially

Present Generation spend more on

Health Care

Next

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Health InsuranceHealth InsuranceHealth InsuranceHealth Insurance

Health Insurance plan must take care��

1) Daily Expenses in Hospital

2) Surgical Expenses

3) Out Patient expenses3) 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 aboveInsure Guru

LIC’s LIC’s LIC’s LIC’s JeevanJeevanJeevanJeevan ArogyaArogyaArogyaArogya

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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 • Lump sum benefit irrespective of actual

medical costs

• No claim benefit

• Flexible benefit limit to choose from

• Flexible premium payment options

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Benefits Under Jeevan Arogya

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB)

• Day Care Procedure Benefit• Day Care Procedure Benefit

• Other Surgical Benefit

• Other Optional benefits(PWB)

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Benefits Under Jeevan Arogya

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB)

• Day Care Procedure Benefit

• Other Surgical Benefit• Other Surgical Benefit

• Ambulance Benefit

• Premium waiver Benefit (PWB)

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Benefits Under Jeevan Arogya

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB))

• Day Care Procedure Benefit

• Other Surgical Benefit• Other Surgical Benefit

• Ambulance Benefit

• Premium waiver Benefit (PWB)

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Benefits Under Jeevan Arogya

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB)

• Day Care Procedure Benefit

• Other Surgical Benefit• Other Surgical Benefit

• Ambulance Benefit

• Premium waiver Benefit (PWB)

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Benefits Under Jeevan Arogya

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB)

• Day Care Procedure Benefit

• Other Surgical Benefit• Other Surgical Benefit

Insure Guru

Benefits Under Jeevan Arogya

• Hospital cash benefit (HCB)

• Major Surgical Benefit (MSB)

• Day Care Procedure Benefit

• Other Surgical Benefit• Other Surgical Benefit

• Ambulance Benefit

• Premium waiver Benefit (PWB)

• Other Optional benefits

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�HCB (Within India only) is payable on per day basis. Double the cash benefit for ICU.

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

�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 one

�Max 90 days and incl not more than 45 days in ICU in the 2nd 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.

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Major Surgical Benefit(MSB)Feature Principal

Insured (PI)

Insured Spouse(If any),

Parents/In law

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 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. Next

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Day Care Procedure Benefit (DCPB)

Feature Principal

Insured (PI)

Insured Spouse(If any),

Parents/In law

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 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

�Surgery within IndiaNextInsure Guru

Other Surgical Benefit (OSB)

Feature Principal

Insured (PI)

Insured Spouse(If any),

Parents/In law

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 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

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Other Options

Term Rider Benefit

Min Term Assurance SA: Rs. 100000/-

Max Term Assurance SA: Equal to MSBSA

Min Entry Age: 18 Years completed

Accident Benefit Rider

Min AB SA: Rs. 25000/-

Max AB SA: Equal to Min Entry Age: 18 Years completed

Max Entry Age: 50 Years NBD

Max Maturity Age: 60 Years NBD

Max Term: 35 Years

(SA be in multiples of Rs. 25000/-)

Max AB SA: Equal to

Term Assurance SA

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

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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 • 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 periodInsure Guru

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

�s even for 1s 24 hours also payable.

age

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

Nominations

Assignments

Allowed

Not Allowed

Mode of Premium

Grace Period

Revival Period

Yearly, Half Yearly and Monthly(ECS Only)

30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode

2 Years from due date of FUP

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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 • 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

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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 FUPdate 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

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Treatments in respect of Specific

waiting periodi. 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

xvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etcEnter Please

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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• 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

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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 • 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

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Why waitWhy wait

Get Get

LIC’s LIC’s JeevanJeevan ArogyaArogyaLIC’s LIC’s JeevanJeevan ArogyaArogya

Enjoy Your Life with Enjoy Your Life with

your familyyour familyInsure Guru