LIC Jeevan Arogya is a health insurance policy offered by LIC India. It is a non-participating, non-linked health plan which provides health cover for medical emergencies. While life insurance gained its huge popularity, health insurance has also become a household name.
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Life insurance gives financial protection to your family member after you leave them, but who will support you when you yourself are hospitalized? With this idea germination of health insurance happened.
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Health insurance gives you financial protection in times of hospitalization. While there is numerous insurer in the market offering health plans with so many features, LIC holds its fair share of pie here also with its health insurance plan named “LIC Jeevan Arogya”.
LIC Jeevan Arogya Policy 904 – An Introduction
While we are over-flooded with the health insurance plans that offer us reimbursement of the actual medical expenditures incurred up to the sum assured we opt with certain sub-limits, LIC is offering us a non-linked non-participating health insurance plan that gives a lump sum pre-defined financial help in times of hospitalizations of different degree irrespective of the amount of expenditure actually incurred.
Jeevan Arogya 904 Gives You
- Invaluable financial assistance at the neediest times of hospitalization,
- The benefit of coverage enhancement through yearly and no-claim bonus to fighting inflation and desire to stay healthy,
- Lump-sum benefits irrespective of actual medical bills paid,
- Flexible benefit ranging between 1000 per day to 4000 per day to choose from and
- Flexible premium payment options from monthly to yearly mode.
- Income tax benefit under section 80D
This plan can be entered by any person between the age of 18 to 65. Initial Daily Benefit (discussed later in the article) between Rs 1000 to Rs 4000 can be chosen. You can also include your family members like your spouse and children. The best part is that you can even get your parents or parents in law aged up to 75 years covered under the same policy umbrella.
The minimum age of entry is 18years, 18 years, and 91 days for self/spouse, parents/parent in law and children, and maximum age till which coverage is provided is 65 years, 75 years, and 25 years in the same order.
Income tax benefit by way of deduction under section 80D up to the amount of Rs 25000 (below 60 years) and Rs 50000 for senior citizens are allowed.
By supplementing this policy with accidental benefit and term plan riders, you can get benefits of term plan, health insurance, and accidental death benefits in the same plan by paying a single premium.
LIC Jeevan Arogya Policy Details – 2020
Unlike the other health insurance plans, we often hear, this plan offers the insured lump sum benefit irrespective of actual medical bills in spite of reimbursement of actual medical expenses. Defined benefits of this policy are-
- Hospital daily cash benefit (HCB)
- Major Surgical benefits (MSB)
- Daycare procedures benefit
- Other surgical benefits
- Ambulance benefit and
- Premium waiver benefit
Before understanding each of the benefits in detail, we need to first understand two important terms around which this plan revolves- Initial Daily Benefit and Applicable daily benefit.
Initial daily benefit in its simplest form is the amount of money that decides your benefits during medical exigencies. This amount is the basis to decide premium and other benefits. We will learn more about it in the section “how this plan works” section.
The applicable daily benefit is the sum total of initial daily benefit as increased by the annual addition and no claim bonus. This is the actual sum you receive during medical exigency. Annual addition is of 5% of the initial daily benefit of the previous year until the total initial daily benefit becomes 1.5 times of the actual initial daily benefit. No claim bonus is equal to 5% of the initial daily benefit of the previous year in which no claim was taken. This increases without any limit.
- Hospital daily cash benefit (HCB)- during your hospitalization, to support your medical expenditure LIC shall give you Applicable daily benefit for each day of hospitalization after the first day. Hospitalization should be more than 24 hours and subsequently any part in excess of 4 hours.
In case the hospitalization extends for 7 days or more, Applicable Daily Benefit is paid for the first day as well.
If hospitalization requires to stay in ICU (intensive care unit), the amount of Applicable Daily Benefit is doubled.
A maximum of 30 days of hospitalization in the first year and 45 days per year thereafter with a lifetime limit of 720 days is allowed. ICU limits are half of the ward days.
- Major Surgical Benefit- In case of covered person needs to undergo a Major surgery as specified, an amount equal to 100 times the Applicable daily benefit is paid.
A person shall receive a maximum of 800% of Major surgical benefits during his lifetime and 100% annually.
- Daycare procedures benefit- some medical procedures don’t require hospitalization for 24 hours. Daycare procedure benefit for specified procedures is provided for an amount 5 times the applicable daily benefit.
A maximum of 3 procedures in a year with 24 procedures during lifetime shall be allowed.
- Other surgical benefits- if the insured needs to undergo surgery mentioned neither in Major surgery list nor in the daycare procedures list, and hospitalization is for more than 24 hours, then the amount twice of Applicable day benefit is payable.
A maximum of 15 days of hospitalization in the first year and 45 days per year thereafter with a lifetime limit of 360 days is allowed.
- Ambulance benefit- In the event of the sum payable under Major Surgery benefit, and patient transportation is required; a lump sum benefit of Rs 1000 is paid.
- Premium waiver benefit- In the event of Major Surgical Benefit payable, premium for one year is waived.
How does this plan work?
Already excited to buy this plan? Let’s understand know how this plan works exactly and the quantum of premium.
Your premium depends upon your age, sex, status (parent/self), an initial daily benefit. Below is the calculation of premium per 1000 rs of Initial Daily Benefit. You can choose Initial Daily Benefit amount from Rs 1000, Rs 2000, Rs 3000, and Rs 4000. Other mentioned benefits accrue and are payable on the basis of Initial Daily Benefit.
PRINCIPAL INSURED (Male)
|Age at entry||Premium (in Rs)|
SPOUSE (Female) / PARENT (of PI/Spouse) (Female)-
|Age at entry||Premium (in Rs)|
|Age at entry||Premium (In Rs)|
(Premiums indicated are exclusive of Goods and Service Tax)
Here one thing is notable. Initial Day Benefit of family members cannot exceed that of Person Insured.
Let’s take an illustration of Mr. Rishabh Agarwal-
Mr. Rishabh, a healthy man aged 30 has a beautiful wife and a lovable infant. Rishabh lives in New Delhi with his Father and mother both aged 60. He wishes to cover the entire family under a single health insurance plan.
He decides to opt for the highest Initial Day benefit for each of the member which is Rs 4000 per day. His premium works out as follows-
|Member||Premium per Rs 1000||Multiplier||Total Premium|
So, Mr. Rishabh gets coverage of Rs 4000 initial daily benefit for each of the members. This means if each of the members gets admitted to the hospital, each one of them is entitled to receive Rs 4000 per day and other benefits in the proportion of Initial Daily Benefit as mentioned.
Benefit features under the policy
- HCB Rebate– HCB rebate is given through two ways- premium payment mode and amount of HCB.
- Premium frequency
|Mode of Premium||Rebate percentage|
- Amount of HCB
Where HCB of a member covered under the policy exceeds Rs 1000 then the premium is reduced by the following amounts-
|HCB||For PI||For each insured member other than PI|
- No change of premium– Premium shall remain changed at least for 3 years. After that LIC shall review the premium amount and change it subject to the approval of IRDA.
- Additions to policy– on the occasion of the marriage of PI, spouse and parents in law can be added to the policy subject to the relevant premium paid for them. Similarly, any newborn/adopted child can be added to the policy
- Quick Cash Facility– when surgery listed as Major surgery is finalized then even before undergoing the surgery, 50% of the sum payable shall be paid in advance
- Riders availability– LIC New Term Assurance Rider (512B210V01) and LIC Accident Benefit Rider (512B203V02) can be added to the policy by paying an additional premium on account of these risk coverage. Thus you can have one single policy to cover your life, health, and accidental death.
Other important features and conditions of Jeevan Arogya Plan-
- Freelook period– a free look period of 15 days is provided. During this period, the insured can take out time to understand the conditions and features in detail and if he or she doesn’t feel satisfied with it, the policy can be returned.
- Waiting period– 90 days of waiting period needs to be passed before admission of any claim. There is a specific waiting period for some specified conditions. However, no waiting period is there for accidental injuries and such hospitalizations are covered from day 1.
- Exclusions– there is a list of exclusions of the conditions that cannot be accepted as a valid claim. One must go through them so that they get to know what situations shall not be included as a valid circumstance for acceptance of the claim.
LIC has offered a plan which is simplistic in nature, offers a range of benefits, provides inflation immune coverage gives the option to include different riders, flexible payment terms, entry age, and accommodates entire family including ascendants and in-laws.
Although it has to compete with plans which are loaded with features like restoration, the sum assured independent of the type of treatment, and lifetime same premium guarantee but LIC enjoys a trust level and customer base.
FAQ (Frequently Asked Questions)
LIC Jeevan Arogya is a health insurance policy offered by LIC India. It is a non-participating, non-linked health plan which provides health cover for medical emergencies. Since it is an offline plan, you can buy it from any authorized LIC agent.
No, LIC Jeevan Arogya doesn’t offer a cashless treatment facility but it gives no-claim bonus benefit.
1. Offline – NACH, Bill Pay or ATM
2. LIC website – Net Banking, Debit Card and Credit Card
3. Franchisees – AP Online, MP Online, Suvidha Infoserve, and Easy Bill Pay
4. Merchant – Premium Point (Empowered Agents), Life-Plus (SBA) and Retired LIC Employee Collection
Please refer below to the required documents to make a claim.
> Discharge Summary
> Doctor’s Prescriptions
> All the diagnosis reports
> Invoice/Receipts of payments
> Photo ID proof with the claim form
I’m Tejas and, I am a web designer cum insurance, business researcher & professional writer. I love to write about insurance policies, and other financial products available in India. I write to help and educate people that how insurance can help them to secure their future.