LIC Jeevan Arogya Plan

Health is a valuable asset, and health protection has become a topmost priority in today's fast-paced world. With accelerating health and medical costs these days, insuring an individual along with his family becomes necessary. Proper medical insurance provides the insured person with the essential health coverage in times of medical emergencies and provides the required peace of mind.

With this need of the hour, India's Life Insurance Corporation or the LIC India offers its LIC Jeevan Arogya policy. This is a unique non-linked Health Insurance plan that caters to the needs of the Indian customers in the health insurance sector. This plan provides an appropriate health insurance cover against specified ailments. It gives the insured person and his family timely financial support in case of medical needs. This keeps the policyholder, and his family stay financially secure in difficult times.

Eligibility Criteria

The LIC Jeevan Arogya plan can be availed of for individuals along with spouse, children and parents, all under one umbrella policy cover.  It is available to all Indian nationals who meet the following eligibility criteria:

Entry Age

• Individual: 18-65 years
• Spouse: 18-65 years
• Parents / Parents-in-law: Maximum age is 75 years
• Children: 91 days- 17 years

(All ages as per last birthday)

Coverage Age

• The Insured person is covered for Health risks up to the age of a maximum of 80 years.
• For children, the maximum coverage age is up to the age of 25 years.

Key Benefits of LIC Jeevan Arogya

LIC Jeevan Arogya policy provides valuable financial coverage in case of medical emergencies like hospitalization or surgery. This policy comes with an increasing health cover every year and provides a lump sum benefit irrespective of actual medical costs. The policy comes along with an array of features and benefits, which are as follows:

Hospital Cash Benefit (HCB)

In case the insured person on any member of his family covered under the plan undergoes hospitalization due to sickness or accidental injury, they will be eligible for the HCB or the Hospitalisation Cash Benefit. The distribution of this benefit under the Basic Plan will be in multiples of Rs. 1000, and is as follows:

• Minimum initial daily HCB for an award other than the ICU: Rs. 1000 for the insured/spouse/kids/parents or parents-in-law. (When Principal Insured is Rs. 1000)
• Maximum initial daily HCB for a ward other than the ICU: Less than or equal to the Principal Inured for insured/spouse/kids/parents or parents-in-law. ( When Principal Insured is Rs. 4000)
• No benefit is paid for the first day of hospitalization.
• The HCB can be claimed for a maximum of 30 days in the first policy year and 90 days in subsequent years. This includes the ICU days.
• Maximum ICU hospitalization days are 15 days in the first year and up to 45 days after that.
• A maximum lifetime benefit period is limited to 720 days, including ICU, stay for not more than 360 days.

* Standard T&C Apply

Major Surgical Benefit (MSB)

• This benefit is provided to the insured person in case he undergoes surgery during the policy period.
• It is always 100 times your Hospital Cash Benefit or the Applicable Daily Benefit (ADB).  
• It ranges from Rs. 1 lakh to Rs. 4 Lakh.
• The maximum Surgical Benefit applicable to each insured in a year is 100% of the Major Surgical Benefit Sum Assured.
• The maximum MSB applicable in a lifetime to each insured is 800% of the MSB Sum Assured.

* Standard T&C Apply

Day Care Procedure Benefit

• This is a lump sum benefit payable to the insured for any Day Care procedures undergone by the insured in India for which continuous hospitalization is not required.
• It is up to 5 times the ADB or the Applicable Daily Benefit.
• Each insured person under this plan is eligible to receive this benefit annually for up to three Surgical Procedures in a year.
• Maximum Lifetime Benefit, applicable to each insured
• Each insured person under this plan is eligible to receive this benefit during the policy lifetime for up to 24 surgical procedures.

* Standard T&C Apply

Other Surgical Benefit

• If the insured person undergoes any surgery which is not covered under the MSB or the Major Surgical Benefit, the cost of surgery will be covered under this OSB or the Other Surgical Benefit.
• The daily Benefit Amount is up to 2 times of ADB principal Insured.
• Each insured person under the policy can get this benefit for a maximum of 15 days in the first policy year and up to 45 days per year after that.
• Each insured person under the policy can get this benefit for a maximum of 360 days in the policy lifetime.

* Standard T&C Apply

Ambulance Benefit

• If the insured person undergoes hospitalization due to accident or sickness and qualifies for Major Surgical benefits, he can also avail of an Ambulance Benefit.
• This is applicable if any emergency ambulance charges are incurred to transport him to the hospital.
• It is applicable for a maximum of Rs. 1000.

*Standard T&C Apply

Premium Waiver Benefit (PWB)

• LIC policyholders can get a Premium Waiver Benefit if they undergo any major surgery for which they have received MSB or Major Surgical benefits.
• Under this benefit, the insured can get a waiver of a complete one-year premium from the due date of the premium following the surgery date.

*Standard T&C Apply

No Claim Benefit (NCB)

• If the policyholder does not file any insurance claims in a policy year or between two Automatic Renewal Dates, he will be eligible for the No Claim benefit.
• The NCB amount will be 5% of the Initial Daily Benefit for each Insured person.

*Standard T&C Apply

Tax Benefits

LIC Jeevan Arogya policy premiums are subject to tax exemption under Sec 80D of the Indian Income Tax Act.

*Standard T&C Apply

“Tax benefit is subject to changes in tax laws.”

Premium Structure

• LIC Jeevan Arogya policy premium is determined on the basis of age, gender, insurance cover, Principal assured premium payment mode, etc.
• The premium will also depend on the extent of HCB or Hospital Cash Benefit chosen and whether the insured member is Principal Insured or any other Life Insured.
• The premium for Principal Insured and the other life insured will be different even if they have the same age or insurance cover.
• Premiums can be paid yearly, half-yearly, quarterly or monthly (ECS mode only).
• LIC can review the premium amounts every third year, subject to IRDA approval.

*Standard T&C Apply

Documents Required

Documents required for policy purchase: Proofs of Identity, Age, and Address, like PAN card, Passport, Driving License, Voter ID, AADHAAR card, utility bills, etc.

Documents required for filing Claims: Hospital Discharge Summary or Discharge Certificate, medical prescriptions, all investigative and diagnostic reports, payment invoices or receipts, medical bills, Claims Form, Photo ID

The Process to Buy Online

• Interested individuals can access the official website of LIC or any registered insurance aggregator to buy the LIC Jeevan Arogya policy.
• They need to provide their individual details on the application request form provided online. This will include name, age, DOB, address, mobile number, insurance coverage required, and health details like any pre-existing diseases or whether they are alcohol or tobacco users.
• Accordingly, the users would be required to upload a scanned copy of documents, or an insurance representative from LIC would call them back to guide them through the purchase procedure.
• Upon verification of the documents, a premium quote will be presented. If the user agrees, he can go ahead and make the purchase as per the suggested payment modes.

Exclusions

The LIC Jeevan Arogya plan offers the following exclusions in its coverage for any injury or illness due to:

• Any pre-existing diseases or conditions
• Any injury due to war, naval or military operations, participation in riots, etc.
• Radioactive Contamination
• Criminal or illegal acts
• Natural calamities like earthquakes, floods etc.
• Participation in dangerous sports like racing, scuba diving, bungee jumping
• Self-inflicted injuries or attempted suicide
• Abuse of drugs, alcohol or intoxicants
• Plastic surgery, unless necessary for accidental injury treatment
• Congenital conditions
• General weakness, rest cure, nervous breakdown or related conditions
• STDs like HIV / AIDS
• Infertility or sterilization
• Pregnancy or childbirth-related conditions
• Routine check-ups
• Non-allopathic treatments
• Epidemic diseases or conditions
• Cosmetic or beauty treatments
• Circumcision
• Dental treatment

LIC Jeevan Arogya Plan - FAQs