Medical emergencies might strike any time and when they do they incur considerable expenses. Meeting these expenses proves difficult for average middle-class individuals and so they look for health insurance coverage. LIC’s Jeevan Arogya policy is one such LIC mediclaim policy which covers specific medical expenses and gives you financial assistance. Let’s understand the policy in details –
Overview of LIC’s Jeevan Arogya Plan
LIC’s Jeevan Arogya is a non-participating health insurance plan which covers specific medical costs. This LIC mediclaim policy is a fixed benefit policy which pays a lump sum benefit if the covered expenses incurred irrespective of the actual expenses that you face. Thus, you get a lump sum financial assistance from the policy which you can use for meeting medical or any other financial needs.
Key features of LIC’s Jeevan Arogya Plan
LIC’s Jeevan Arogya plan has the following key features –
- You get covered for hospitalisation as well as for undergoing surgical treatments
- The policy can be taken to insure yourself, your spouse, dependent children, dependent parents as well as parents-in-law
- You can enjoy coverage up to 80 years of age
- You get attractive premium discounts which help in lowering the premiums payable under the plan
- The premium does not change in the first three years of the policy irrespective of the claims that you make
- If you do not make claims in any policy year, you get a no claim bonus. This no claim bonus increases the coverage level by 5% after every successive claim-free year
- The coverage increases every year by 5% until it becomes 150% of the original coverage amount
- Two optional riders are available under the plan if you want to enhance the coverage.
What is covered under LIC’s Jeevan Arogya Plan?
LIC mediclaim policy Jeevan Arogya offers the following coverage benefits –
|What is covered
|Hospital Cash Benefit
|If the insured is hospitalised for 24 hours or more, a daily cash allowance is paid for each day of hospitalisation
|Major Surgical Benefit
|If the insured undergoes a major surgery during the term of the policy, a lump sum benefit is paid
|Day Care Procedure Benefit
|Daycare procedures are those which do not require hospitalisation for 24 hours or more because of advanced technology. If the insured undergoes such day care procedures, a lump sum benefit would be paid
|Other Surgical Benefit
|If the insured undergoes a surgery which is not a major surgery, a lump sum benefit would be paid under this coverage benefit
|If the insured is to be hospitalised and an ambulance is required to transfer the insured to the hospital, a lump sum benefit would be paid to cover the cost of the ambulance
|Premium Waiver Benefit
|If the insured undergoes a major surgery which is covered under the Major Surgical Benefit category, one annual premium under the policy would be waived off.
Benefits of LIC’s Jeevan Arogya Plan
Besides the coverage features offered by LIC mediclaim policy, here are other benefits which the plan offers –
- No Claim Benefit
If no claims are made in a policy year, the coverage limit would be allowed to be increased by 5%. This increase would be allowed for each consecutive claim-free year. There would be no limit up to which the increase in coverage can be availed through no claim bonus. You can, thus, increase the coverage amount as much as possible without making claims.
- Modal premium rebate
If you pay premiums annually or half-yearly, you can earn a premium discount. The discount allowed would be 2% of the tabular premium rate if the premiums are paid annually and 1% of the tabular premium rate if the premium is paid half-yearly.
- High Hospital Cash Benefit Rebate
If you choose a high level of Hospital Cash Benefit limit, you would be able to earn premium discounts. The discounts available would be as follows –
|Limit of Hospital Cash Benefit
|Premium discount for covering the primary insured member
|Premium discount for each family member other than the primary insured member
- Quick Cash Benefit
If the insured undergoes a major surgery which is covered under the Major Surgical Benefit, the claim is paid after the insured is discharged from the hospital. However, under the Quick Cash Benefit, 50% of the eligible Major Surgical Benefit claim can be availed during the period of hospitalisation for meeting medical expenses while the remaining would be paid after discharge.
- Rider benefits
The plan allows two optional riders. The first one is the LIC New Term Assurance Rider which covers death during the policy tenure. If the primary insured member or the spouse dies during the term of the plan, the coverage available under the Major Surgical Benefit would be paid under the rider. The second rider is the LIC Accident Benefit Rider. This rider pays an additional sum assured in case the insured dies in an accident during the policy tenure.
Eligibility parameters of LIC’s Jeevan Arogya Plan
|Entry age for primary insured and/or spouse
|18 years to 65 years
|Entry age for parents or parents-in-law
|18 years to 75 years
|Entry age for dependent children
|91 days to 17 years
|Maximum cover ceasing age for adults
|Maximum cover ceasing age for children
|Coverage amount for Hospital Cash Benefit
|Minimum – INR 1000Maximum – INR 4000
|Coverage amount for Major Surgical Benefit
|100 times the Applicable Hospital Cash Benefit
|Coverage amount for Day Care Procedures
|5 times the Applicable Hospital Cash Benefit
|Coverage amount for Other Surgical Benefit
|2 times the Applicable Hospital Cash Benefit
|Coverage amount for Ambulance Benefit
Exclusions under LIC’s Jeevan Arogya
LIC mediclaim policy Jeevan Arogya does not cover the following types of claims –
- Pre-existing conditions
- Treatments or surgeries that are not performed by a medical practitioner
- Experimental treatments or surgeries
- Routine medical check-ups
- Diagnostic tests, X-Rays and other investigative tests
- Illnesses due to an epidemic
- Cosmetic treatments, circumcision, treatment of birth defects, etc.
- Organ donor surgeries or treatments
- Illnesses due to infections caused by HIV or the AIDS virus
- Pregnancy-related treatments
- War, nuclear threats and related perils
- Illnesses due to participation in adventure sports or any other hazardous activities
- Non-allopathic treatments and surgeries
- Acts of criminal nature and intent
- Treatments when the insured does not pay heed to a doctor’s advice
Waiting periods applicable under LIC’s Jeevan Arogya Plan
- There is a waiting period of 90 days from the date of buying the policy for any hospitalisation or surgery undertaken by the insured
- If the policy has lapsed and revived by the insured within 90 days of such lapse, there would be a waiting period of 45 days for covering hospitalisation or surgical procedures
- If the policy has lapsed and revived after 90 days of lapse, the waiting period for hospitalisation and surgical claims would be for 90 days from the date of revival of the plan
- There is a waiting period of 2 years from the date of buying or reviving a lapsed policy for undertaking specific treatments like treatments for hernia, cataract, piles, tonsillar disorders, slip disc, etc.
Premium calculation of LIC’s Jeevan Arogya Plan
Here are the different premium rates applicable under LIC mediclaim policy if the Hospital Cash Benefit selected by the insured is INR 4000 –
|The premium for adult males
|The premium for adult females
The premium payable for covering a dependent child would be as follows –
|Entry age of the child
Tax benefits of LIC’s Jeevan Arogya Plan
The premiums paid for the plan are allowed as a deduction under Section 80D of the Income Tax Act, 1961. The maximum deduction you can claim is up to INR 25,000. This limit would increase and become INR 50,000 if you are a senior citizen.
Moreover, if you buy separate coverage for your dependent parents, you can claim an additional deduction of up to INR 25,000. If your parents are senior citizens, the additional deduction would become INR 50,000. Thus, through this LIC mediclaim policy, you can claim a tax deduction of up to INR 1 lakh.
How to buy LIC’s Jeevan Arogya Plan?
The policy can be easily bought through an agent of LIC or from any of the branch offices of the company.
However, if you are interested to buy any other mediclaim plan you can compare and choose the best through Turtlemint. Turtlemint gives you a hassle-free buying platform wherein you can enter in your details to view the most suitable health insurance plans which are available in the market. You can easily compare the available plans and choose the one which is the best. Pay the premium for the policy online through Turtlemint’s payment gateway and your policy would be bought.
Documents required for buying LIC Jeevan Arogya
To buy the LIC mediclaim policy, the following documents would be required –
- Identity proof of all insured members
- Age proof of all the members
- Address proof of the primary insured member
- Income proof
- Photographs of all the members to be insured under the plan
- Any medical check-up reports if asked by LIC
How to make claims under the LIC Jeevan Arogya Plan?
In case of a claim under the policy, you should immediately inform the insurance company of the claim. Fill up the claim form and submit it along with the following documents –
- Identity proof of the insured member
- Doctor’s reports
- Hospital records
- All medical bills and receipts
- Investigative reports
- Any other medical records associated with the treatments which have been done on the insured
Once the documents are submitted, the company would review them and settle your claims.
You can also make a claim under the LIC mediclaim policy through Turtlemint. Turtlemint allows its customer’s hassle-free claim settlements as the customers are spared the task of following the claim process. Turtlemint’s dedicated claims handling team handles your health insurance claims. They follow the claim process themselves and let you get the promised claim benefit under your insurance policy. You just have to inform Turtlemint either by calling 1800 266 0101 or through an email sent to firstname.lastname@example.org and the rest would be handled by the company itself.
When the children attain 25 years of age, they would not be allowed to get coverage along with the primary insured member under the same policy. They can migrate to a new LIC mediclaim policy in their name and continue their coverage.
If you get married or have a baby and want to insure your spouse or child under the policy, you can do so. You should inform the insurance company about the new members to be added within 6 months of marriage or childbirth. However, coverage for the new members would be available only from the next policy anniversary.
If the primary insured member dies, no death benefit would be paid. The spouse can become the primary insured if such an option was availed by the primary insured at the time of buying the policy. The spouse can then continue the policy as the primary insured and the premiums would change.
This LIC mediclaim policy allows you yearly and half-yearly premium payments.
Yes, if the policy has lapsed, you can revive it within 2 years from the date of lapse of the plan. Revival would be allowed if you pay the outstanding premiums with interest and submit a proof of continued insurability. The insurance company would underwrite your revival request and would allow you to revive the policy if everything is in order.