LIC's Jeevan Arogya

Life Insurance Corporation of India is known for introducing premium insurance products that cover for all the needs and requirements of people. One such insurance product introduced by the corporation is the health insurance plan called as LICs Jeevan Arogya Plan. This plan is non-market linked and non-participating health insurance plan of LIC. The LICs Jeevan Arogya Plan offers coverage against pre-defined specified health issues and provides financial support to help the family be financially independent in event of medical emergency.

Why buy LICs Jeevan Arogya Plan?

Health issues are seen on a rise nowadays and so are the medical expenses associated with it. Tackling the medical expenses has become an expensive affair so availing a health insurance policy is advantageous. LICs Jeevan Arogya Plan covers for few pre-defined diseases and helps to cover for rising medical expenses. Following are the key features of the LICs Jeevan Arogya Plan :

  • The plan provides umbrella protection i.e. the plan covers not only for individuals but also covers family members like the spouse, children, parents, parents-in-law etc.
  • Financial protection and support in case of hospitalization, surgeries etc
  • Health cover offered enhances every passing policy year
  • The benefits paid under the plan is in lump sum regardless of actual medical expenses
  • A benefit is offered to ‘NO CLAIM’ policies
  • Policyholders have a choice to choose benefit limit
  • The plan offers flexible premium payment options to the policyholder

Who can be insured under the Jeevan Arogya Plan?

The LICs Jeevan Arogya Plan is a comprehensive health insurance plan that covers for the entire family which includes the principal insured, spouse of the principal insured, children, parents and parents-in-law of principal insured everyone under one single policy. LICs Jeevan Arogya health insurance policy is a one-stop policy that covers for all family members and takes care of their medical expenses. Following is the age eligibility criteria of all family members under the LICs Jeevan Arogya Plan :

Particulars Min. Entry Age Max. Entry Age
Principal Insured/Spouse 18 Years 65 Years
Children 91 days 17 years
Parents/Parents-in-Law 18 Years 75 Years

Thus the above eligibility table helps us understand the minimum and maximum age at entry of various prospective members to be covered under the health insurance coverage net of the LICs Jeevan Arogya Plan.

What are the benefits offered by the LICs Jeevan Arogya Plan?

The LICs Jeevan Arogya Plan is a very comprehensive health insurance plan that covers for almost all the medical expenses related to hospitalization, surgery etc. Following are the highlight benefits of availing a LICs Jeevan Arogya Plan :

1. Hospital Cash Benefit : Hospital Cash Benefit is offered when any of the insured covered under the health insurance policy is hospitalized for reasons of Injury due to accident or Sickness. The Hospital Cash benefit shall be payable if the hospital stay of the insured exceeds 24 hours on a continuous basis then an amount equivalent to Applicable Daily Benefit applicable for that policy year as per the terms and conditions of the policy shall be payable by the corporation. The Applicable Daily Benefit for the first policy year shall be the amount chosen by the primary insured. The Applicable Daily Benefit is subject to enhance after the completion of the first policy year. This increase in applicable daily benefit is represented as under :

  • a. Incremental addition of 5% of the initial daily benefit is added to the applicable daily benefit on every policy anniversary. This increased applicable daily benefit shall be effective during the entire coverage period till the amount reaches to 1.5 X of Initial Daily Benefit.
  • b. Incremental addition of 5% of an amount equivalent to ‘No Claim Benefit’ shall be granted during the entire coverage period with no maximum limit.

Kindly note, for the members who are covered subsequently under the Jeevan Arogya policy for them the Hospital Cash Benefit initially shall be equivalent to Initial Daily Benefit and subsequently increase as per above-mentioned conditions.

2. Major Surgical Benefit : As the name suggests the benefit offered under this category is paid in event of major medical surgery on any of the insured covered under the Jeevan Arogya Plan shall be payable. The payout of Major Surgical Benefit is dependent on two categories namely the Hospital Cash Benefit and Major Surgical Benefit Sum Assured. First, let us understand the permissible limits offered under each of these categories :

Hospital Cash Benefit Major Surgical Benefit
INR 1,000/ day INR 1,00,000
INR 2,000/day INR 2,00,000
INR 3,000/day INR 3,00,000
INR 4,000/ day INR 4,00,000

Kindly note the Major Surgical Benefit is equivalent to a HUNDRED times of the initial Hospital Cash Benefit. After this the Major Surgical Benefit is decided as per the category of major surgery. LICs Jeevan Arogya Plan has divided all the major surgeries under 4 categories and the payout of major surgical benefit is a certain percentage of the Major Surgical Benefit based on the initial Hospital Cash Benefit.

The different surgical categories and their permissible percentage payout is as under :

Major Surgery Categories Payout as a percentage of Major Surgical Benefit
Category 1 100 % payout of Major Surgical Benefit
Category 2 60 % payout of Major Surgical Benefit
Category 3 40 % payout of Major Surgical Benefit
Category 4 20 % payout of Major Surgical Benefit

Let us understand the Major Surgical Benefit with an example : Mr. A has opted for initial Hospital Cash Benefit of Rs 2,000 / day so the Major Surgical Benefit will be considered as Rs 2,00,000/- and the benefit payout shall now be calculated as per the category of the surgery as under :

Major Surgery Categories under Jeevan Arogya Plan Payout as a percentage of Major Surgical Benefit
Category 1 100 % payout of Major Surgical Benefit i.e. Rs 2.00 Lakhs
Category 2 60 % payout of Major Surgical Benefit i.e. Rs 1.20 Lakhs
Category 3 40 % payout of Major Surgical Benefit i.e. Rs 80,000.00
Category 4 20 % payout of Major Surgical Benefit i.e. Rs 40,000.00

Following are important terms and conditions of the Major Surgical Benefits :

  • The Major Surgical Benefit can be availed only for the surgeries that occurred or manifested post the purchase of the policy
  • Max annual benefit that can be availed per person is 100% of Major Surgical Benefit Sum Assured.
  • Max Lifetime Benefit applicable to each person insured under the plan is 800% of Major Surgical Benefit Sum Assured.

3. Daycare Procedure Benefit : In the scenario where the insured is undergoing daycare procedure and is admitted in the hospital for a day then a lump sum daycare procedure benefit equivalent to FIVE times of the Applicable Daily Benefit is paid. The daycare procedure benefit payable is irrespective of the actual expenses incurred.

4. Other Surgical Benefit : The Other Surgical Benefit is payable when the insured under the policy is undergoing medical surgery that is not a part of either Major Surgical Benefit or the Daycare Procedure Benefit. The payment of TWO times the Applicable Daily Benefit shall be on the admission of the insured for more than 24 hours.

5. Ambulance Benefit : Ambulance Benefit under the policy is payable in the case where the insured is undergoing Major Surgery mentioned into Category 1 / Category 2 of the Major Surgical Benefit. An additional sum of Rs 1,000 is payable as ambulance benefit if any such expense has been incurred.

6. Premium Waiver Benefit : As the name suggests the premium of one year shall be waived in event of major surgery falling in either category 1 or category 2.

7. No Claim Benefit : The No Claim Benefit is earned when there is no claim registration between the date of commencement of the policy and renewal date or between two consecutive renewal dates. This clause applies to all any insured covered under the Jeevan Arogya Plan. The No Claim Amount payable is equivalent to 5% of Initial Daily Benefit for each insured under the Jeevan Arogya Plan. The entire No Claim Benefit amount would then be added to the Applicable Daily Benefit of each insured at the time of renewal of the Jeevan Arogya Plan.

What is the premium payment mode of LICs Jeevan Arogya Plan?

The premium of the Jeevan Arogya plan can be paid in two modes namely Yearly or Half-Yearly. The Premium payment of each insured will fall as per the date of entry of the insured under the policy net. The amount of premium shall be dependent on the factors like Age of the insured, initial Hospital Cash Benefit opted, whether the insured is principal insured or other than Principal Insured. Kindly note that under the Jeevan Arogya Plan the premium of the principal insured differs from the premium charged for other insured irrespective of the same age and same cover. The premium charged under the policy is guaranteed for THREE years and are subject to review at the end of this period. The premium rates shall be reviewed on each renewal date and shall be applicable till next Automatic Renewal Date i.e. for the further period of THREE Years. The Premium rate of Jeevan Arogya Plan is different for every insured member as it depends upon their age and the time of inclusion under the health insurance cover. The total premium charged under the LICs Jeevan Arogya Plan is the sum total of all the premiums charged of each insured covered under the policy.

What rebates are offered under the LICs Jeevan Arogya Plan?

The LICs Jeevan Arogya Plan offers TWO types of rebates as under :

  • Premium Payment Mode Rebate
    • For Yearly mode of Premium Payment a rebate of 2% on tabular premium
    • For Half-Yearly mode of Premium Payment a rebate of 1% on tabular premium
  • Hospital Cash Benefit Rebate
    The Hospital Cash Benefit Rebate is applicable in the cases where the Hospital Cash Benefit opted is more than Rs 1,000. The premium amount under the Hospital Cash Benefit Rebate shall be offered by reducing the premium amount in the following manner :
Initial Hospital Cash Benefit Opted Rebate for Principal Insured Rebate for each insured covered under the policy apart from Principal Insured
Rs 2,000 Rs 500 Rs 250
Rs 3,000 Rs 1,000 Rs 500
Rs 4,000 Rs 1,500 Rs 750

Additional Information

  • Automatic Renewal Date
    • The Premium amount is guaranteed for a period of 3 years for each insured from the date of commencement of the policy.
    • After the completion of the 3 years period at every 3rd policy anniversary the premium rates shall be reviewed based on factors like age of the every insured and the time or date of inclusion of the insured into the policy.
    • This date on which such review is done is called as the automatic renewal date.
  • Addition of new insured
    • Additions of a new member under the policy is done at the time of marriage/ remarriage/ child birth or legal adoption.
    • In such scenarios the addition of new insured can be done under the policy but kindly note that the cover for the new members will commence from the start of the next policy year.
    • Also the inclusion of a new member under the policy shall attract an enhanced premium.
    • Any addition or deletion from the policy cover shall be done by the Principal Insured only.
    • After the demise of the principal insured no addition under the Jeevan Arogya Plan is allowed.
    • In the case of Marriage or Remarriage the addition of the spouse or parents-in-law can be done within 6 months starting from the date of marriage or remarriage.
    • While in case of childbirth the child can be added under the policy after completing the age of 3 months and in the case of legal adoption the addition under the policy can be done within 3 months from the date of adoption.
  • Migrate
    • The children covered under the LICs Jeevan Arogya Plan have an option to migrate to some other insurance plan once they complete 18 Years of Age.
  • Quick Cash Facility
    • Quick Cash Facility is the availability of 50% major surgical benefit made available in cash to the principal insured.
    • This facility can be availed by the principal insured if any of the life insured under the policy is undergoing surgery stated under category 1 or category 2 either planned or due to an accidental emergency.
    • The quick cash facility is a type of advance payment and it shall be adjusted from the total final major surgical benefit claim amount by the corporation.
  • Riders
    • The policyholder’s of LICs Jeevan Arogya Health Insurance Plan can opt riders to extend the insurance cover net. The Jeevan Arogya policy offers two riders under this plan namely
      • LIC New Term Assurance Rider
      • LIC Accident Benefit Rider

What are the eligibility conditions of LIC Jeevan Arogya Plan?

Following are the eligibility conditions for basic Jeevan Arogya Plan for Hospital Cash Benefit

Particulars For Principal Insured For Spouse / Parents For Children
Min. Initial Daily Benefit Rs 1,000 Rs 1,000 Rs 1,000
Max. Initial Daily Benefit Rs 4,000 For spouse ≤ Principal Insured, and For Parents / Parents-in-law ≤ Spouse Children ≤ Spouse in case spouse is not covered then Children ≤ Principal Insured
Max Annual Benefit
period for each insured
30 days in the first policy year, thereafter 90 days per policy year (inclusive of ICU stay) Maximum ICU stay is limited to 15 days in the 1st policy year, thereafter 45 days per policy year
Max Lifetime Benefit
period for each insured
720 days including ICU stay where the maximum ICU stay is limited to 1 year i.e. 365 days

Following are the eligibility conditions for Major Surgical Benefit under basic Jeevan Arogya Plan

Particulars For Principal Insured For Spouse / Parents For Children
Major Surgical Benefit Sum Assured 100 X Applicable Daily Limit 100 X Applicable Daily Limit 100 X Applicable Daily Limit
Max Annual Benefit per insured member 100% of Major Surgical Benefit Sum Assured
Max Lifetime Benefit for each insured 800% of Major Surgical Benefit Sum Assured

Following are the eligibility terms for daycare procedure benefit under the basic Jeevan arogya plan

Particulars For Principal Insured For Spouse / Parents For Children
Lump Sum Benefit 5 X Applicable Daily Limit 5 X Applicable Daily Limit 5 X Applicable Daily Limit for each child
Max Annual Benefit per insured member 3 surgical procedures
Max Lifetime Benefit for each insured 24 surgical procedures

Following are the eligibility terms for other surgical benefits under the basic Jeevan Arogya Plan

Particulars For Principal Insured For Spouse / Parents For Children
Daily Benefit amount 2 X Applicable Daily Limit 2 X Applicable Daily Limit 2 X Applicable Daily Limit for each child
Max Annual Benefit per insured member 15 days in 1st policy year thereafter 45 days / year
Max Lifetime Benefit for each insured 360 days

FAQs

The LICs Jeevan Arogya Plan does not offer any maturity benefit at the end of the policy cover period.


The LICs Jeevan Arogya Plan offers a grace period of 30 days for the Yearly or Half-Yearly mode of premium payment. If the policyholder fails to pay the premium within the grace period then the policy shall lapse and all the benefits shall cease.


A lapsed Jeevan Arogya Plan can be revived within 2 years from the due date of 1st unpaid premium.


No Surrender benefit is payable under the LICs Jeevan Arogya Plan


No, the LICs Jeevan Arogya Plan does not offer loan facility.


Assignment of policy is not allowed under LICs Jeevan Arogya Plan


Yes, if the policyholder is not satisfied with the terms and conditions offered under the plan then the Jeevan Arogya Policy can be cancelled in the free-look period also called as the cooling-off period. On receipt of such request the corporation shall cancel the policy and pay the premium amount subject to certain deductions.


The most common exclusions for LIC Jeevan Arogya Plan like other health plans of LIC, such as:

  • Any pre-existing ailments that were not disclosed at the time of policy inception, which could have resulted directly or indirectly to increase the premium
  • Any surgical procedure not performed by a registered physician or for any experimental purpose
  • Regular or routine medical check up
  • Any expenses for diagnostic purposes or a medical examination or check-up.
  • Any sickness from an epidemic
  • Cosmetic surgery, plastic surgery (other than what is necessary after an accident), change of gender surgery, treatment for any congenital illnesses, circumcision, etc.
  • Surgery related to organ donation
  • Self inflicted ailments
  • Dental treatment or surgery (other than what is necessary after an accident)
  • Attempted suicide
  • Sexually transmitted ailments
  • Medical termination of pregnancy, childbirth or pre and post-natal ailments of the mother or the newborn
  • Physiotherapy
  • War, terrorism, invasion, etc.
  • Non-allopathic treatment
  • Taking active participation in criminal activity
  • Treatment due to an improper following of the medical advice
  • Participation in any hazardous sports or activities like deep sea diving, mountaineering, skydiving, scuba diving, bungee jumping etc.
  • Any natural calamities like earthquake, fire, flood, etc.

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