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Home » Products » Withdrawn Plans » LIC's Jeevan Arogya (Plan No. 903, UIN No. 512N266V01)

LIC's Jeevan Arogya (Plan No. 903, UIN No. 512N266V01)

Sales Brochure(4.7 MB)
 
Features

Introductions :
Health has been a major concern on everybody’s mind, including yours. In these days of skyrocketing medical expenses, when a family member is ill, it is a traumatic time for the rest of the family. As a caring person, you do not want to let any unfortunate incident to affect your plans for you and your family. So why let any medical emergencies shatter your peace of mind.

LIC has launched LIC’s Jeevan Arogya, a unique non-linked Health Insurance plan which provides health insurance cover against certain specified health risks and provides you with timely support in case of medical emergencies and helps you and your family remain financially independent in difficult times.

LIC’s Jeevan Arogya gives you:

  1. Valuable financial protection in case of hospitalisation, surgery etc
  2. Increasing Health cover every year
  3. Lump sum benefit irrespective of actual medical costs
  4. No claim benefit
  5. Flexible benefit limit to choose from
  6. Flexible premium payment options


Very easy to choose your plan

Step 1 Choose the level of Health cover you need

Step 2 Work out the premium payable along with our Representative

Step 3: Choose the level of Health cover you need:
You can choose the amount of Initial Daily Benefit (i.e. the daily Hospital Cash Benefit applicable in the first year of the policy) as per your need from out of the following choices:
` 1000 per day ` 2000 per day ` 3000 per day ` 4000 per day

This is the amount that will be payable to you in the event of hospitalisation in the first year on a per day basis. The Major Surgical Benefit that you will be covered for will be 100 times the Initial Daily Benefit you have chosen. Thus the initial Major Surgical Benefit Sum Assured will be ` 1 lakh, 2 lakh, 3 lakh, 4 lakh respectively. Other benefits such as Day Care Procedure Benefit, Other Surgical Benefit and Premium waiver Benefit (PWB) mentioned below shall also be payable depending upon the daily Hospital Cash Benefit chosen.
Step 4: Work out the premium payable along with our representative
Your premium will depend on your age, gender, the Health cover option you have chosen, whether you are Principal Insured or other insured life and the mode of payment.
Tables below give an indicative annual premium, payable yearly, for all health benefits corresponding to an Initial Daily Benefit of ` 1000 per day, for some of the ages in respect of various lives that can be covered under a single policy:

PRINCIPAL INSURED (Male)
 

Age at entry Premium (`)
20 1922.65
30 2242.90
40 2799.70
50 3768.00
 

 

SPOUSE (Female) / PARENT (of PI/Spouse) (Female)
 
Age at entry Premium (`)
20 1393.15
30 1730.65
40 2240.60
50 2849.10

 

CHILD

 
Age at entry Premium (`)
0 792.00
5 794.75
10 812.35
15 870.75

 


Who can be insured?
You (as Principal Insured (PI)), your spouse, your children, your parents and parents of your spouse can all be insured under one policy. Quite a relief isn’t it, to have all insured under one policy!
The minimum and maximum age at entry is as under:
 

 
Category Minimum age at entry Maximum age at entry
Self / spouse 18 years 65 years (last birthday)
Parents / parents-in-law 18 years 75 (last birthday)
Children 91 days 17 years (last  birthday)

 

How long are each insured under this policy?
Each of the insured are covered for Health risks up to age (80). Children are insured up to age 25 years.

1. Payment of Premiums:
You may pay premiums regularly at yearly, half-yearly, quarterly or monthly (ECS mode only) intervals over the term of the policy.

The premium in respect of each individual will be payable from the date of entry into the policy till the date of exit from the policy and will depend on the age of the insured member, the level of Hospital Cash Benefit (HCB) chosen, whether the insured member is Principal Insured or any other Insured life (in case of cover for more than one member in a policy). The level of premium for Principal Insured and the other insured members shall be different for the same age and same level of cover.

The premiums are guaranteed for 3 years from the date of commencement of policy. Thereafter i.e. at the end of every 3 years, the Corporation reserves the right to review the premium to take account of the experience of the portfolio subject to prior approval from IRDA. The rates applicable on every Automatic Renewal Date shall be guaranteed for a further period of 3 years i.e. till next Automatic Renewal Date.

The premium rates in respect of each insured member on renewal will be based on age of that member at the time of inclusion into the policy.
The total premium to be charged for a policy will be the sum of premiums in respect of each member to be covered in that policy.

2. Mode and High HCB Rebates:

Mode Rebate:
Yearly mode : 2% of tabular premium
Half-yearly mode : 1% of the tabular premium

HCB Rebates:
In respect of a member covered under a policy, if HCB is more than ` 1000, then the premium arrived at in respect of that member shall be reduced by an amount (`) given below:
HCB (`) For PI For each insured member
other than PI
2000 500 250
3000 1000 500
4000 1500 750

3. Automatic Renewal Date: The installment premium will be guaranteed in respect of each Insured for a period of 3 years from the Date of Commencement of the policy, i.e. for the first 3 years of the policy. Thereafter, at the end of every third policy anniversary, the premiums may be reviewed to take into account the Corporation’s experience, subject to prior approval from IRDA. These premium due dates, at the end of every third policy anniversary, starting from the date of commencement of policy till the date of cover expiry, on which the installment premiums are reviewable, will be referred as Automatic Renewal Dates in respect of all Insured in the Policy.

On any Automatic Renewal Date in the future, the installment premium will be based on the age of the Insured at the time of inclusion into the policy and the Corporation’s premium rates then prevailing for this product.

4. Options:
A) Cover to new additional members: If PI gets married/ remarried during the term of the policy, the spouse and parents-in-law can be included in the policy within six months from the date of marriage / remarriage, but the cover shall start from the policy anniversary coinciding with or next following the date of inclusion. Enhanced premium shall be due from such policy anniversary.

Similarly, Any child born/legally adopted after taking the policy can also be covered from the next immediate policy anniversary date following the date on which the child completes the age of 3 months. If the age of legally adopted child on the date of adoption is more than 3 months, the child can be covered from policy anniversary coinciding with or next following the date of adoption. Enhanced premiums shall be due from such policy anniversary.

Inclusion of each additional member will be on payment of enhanced premiums and subject to various terms and conditions of the plan.
Any addition of new lives shall be allowed by the PI only. After the death of PI, no addition will be allowed.
Addition in any other case will not be allowed. The existing spouse, parents, parents-in-law and children, if not covered at the time of taking policy, shall not be covered under the policy.

If both of the parents (father and mother) are alive and are eligible for cover, then either both of them will have to be covered or none of them will be covered. The PI will not have any option to choose one of them. The same condition will apply for parents-in-law also.

B) Quick Cash facility: If any of the insured lives undergoes any eligible surgery covered under Category I or II of MSB in any of the listed network hospitals, you, as PI will have an option to avail Quick Cash facility. Under this facility, 50% of eligible MSB amount would be made available even during the period of hospitalization of any of the insured lives covered (the surgery may be either planned or emergency due to accident) instead of waiting for making a claim for the benefit after discharge. It will be only an advance payment in the event of hospitalization for any MSB defined in the surgeries listed under categories I & II and permissible under the policy conditions of the plan. This will be, however, subject to approval from the TPA (Third Party Administrator), and the advance amount will be adjusted from the final settlement of MSB claim amount.

This facility of advance payment could be availed by submitting your Bank Account details in the prescribed format. The amount of advance shall be credited to your bank account directly.

C) Term Assurance Rider: You, as PI, and your spouse may opt for Term Assurance as optional rider equal to the MSB SA. In case of unfortunate death, an amount equal to Term Assurance Sum Assured will be payable on death during the term for which Term Assurance Rider is opted for.

D) Accident Benefit Rider: You and your spouse may also opt for Accident Benefit Rider if Term Assurance Rider has been opted for. Maximum Accident Benefit Sum Assured shall be equal to the Term Assurance Rider SA. In case of unfortunate death due to an accident, an amount equal to Accident Benefit Sum Assured shall be payable.

Accident Benefit Rider will be available under the plan by payment of additional premium of ` 0.50 for every ` 1,000/- of the Accident Benefit Sum Assured per policy year in respect of each life to be covered.

The additional premium for this benefit will not be required to be paid on and after the Policy anniversary on which the Term Assurance Rider ceases.

5. Eligibility Conditions And Other Restrictions:

FOR BASIC PLAN

i) For Hospital Cash Benefit (HCB) (under Basic Plan)

Feature Principal Insured (PI) Insured Spouse (if any) & Insured Parents / Parents-in-law (if any) Insured Dependent Children (if any)
Minimum Initial Daily Benefit (in a ward other than Intensive Care Unit) ` 1,000/- ` 1,000/- ` 1,000/-
Maximum initial daily amount ` 4,000/- Insured Spouse- Less than or equal to that of PI
Insured Parents /  Parents-in-law- Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included parents / parents-in-law shall be covered for equal benefits.
Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included children shall be covered for equal benefits.
Maximum annual benefit period, applicable to each insured 30 days in year 1, 90 days per year thereafter, inclusive of stay in ICU. Maximum number of days in ICU is restricted to 15 days in year 1 and to 45 days thereafter.
Maximum Lifetime Benefit period, applicable to each insured 720 days inclusive of stay in ICU. Maximum number of days in ICU is restricted to 360 days

 

Initial Daily Benefit shall be in multiples of ` 1000/-

ii) For Major Surgical Benefit (MSB) (under Basic Plan)

 
Feature Principal Insured (PI) Insured Spouse (if any) & Insured Parents / parents-in-law (if any) Insured Dependent Children (if any)
Major Surgical Benefit Sum Assured (MSB SA) 100 times of Applicable Daily Benefit (ADB) of PI (as specified in Para 1A) above). Insured Spouse- 100 times of ADB of Insured Spouse
Insured Parents / parents-in-law- 100 times of ADB of each parent
100 times of ADB of each child
Maximum annual benefit, applicable to each insured
100% of Major  Surgical Benefit Sum Assured
Maximum Lifetime Benefit, applicable to each insured
800% of  Major  Surgical Benefit Sum Assured

 

iii) For Day Care Procedure Benefit (DCPB) (under Basic Plan)

Feature Principal Insured (PI) Insured Spouse (if any) & Insured Parents / parents-in-law (if any) Insured Dependent Children (if any)
Lump sum benefit payable
5 times of Applicable  Daily Benefit (ADB) of PI Insured Spouse- 5 times of ADB of Insured Spouse
Insured Parents / parents-in-law- 5 times of ADB of each parent
5 times of ADB of each child
Maximum annual benefit, applicable to each insured
3 Surgical Procedures
Maximum Lifetime Benefit, applicable to each insured
24 Surgical Procedures

 

iv) For Other Surgical Benefit (OSB) (under Basic Plan)

 
Feature Principal Insured (PI) Insured Spouse (if any) & Insured Parents / parents-in-law (if any) Insured Dependent Children (if any)
Daily benefit amount 2 times of ADB of PI Insured Spouse- 2 times of ADB of Insured Spouse
Insured Parents / parents-in-law- 2 times of ADB of each parent
2 times of ADB of each child
Maximum annual benefit, applicable to each insured 15 days in first policy year and 45 days per year thereafter
Maximum Lifetime Benefit, applicable to each insured 360 days

 

FOR ACCIDENT BENEFIT RIDER OPTION:


(a) Minimum Accident Benefit Sum Assured: ` [25] in '000's

(b) Maximum Accident Benefit Sum Assured: An amount equal to the Term Assurance Sum Assured in respect of the insured, subject to maximum of ` 50 lakhs overall limit considering the Accident Benefit Sum Assured in respect of all existing policies under individual as well as group policies on the life of the insured including the policies taken from Life Insurance Corporation of India and other insurance companies and the Accident Benefit Sum Assured under new proposals into consideration.

The Accident Benefit Sum Assured shall be in multiples of ` 5,000/-.

(c) Minimum Entry Age: 18 years completed
(d) Maximum Entry Age: 50 years (Nearest Birthday)
(e) Maximum age for cover: 60 years (Nearest Birthday)
(f) Maximum term: 35 years

FOR TERM ASSURANCE RIDER OPTION:


(a) Minimum Term Assurance Sum Assured: ` [100] in '000's

(b) Maximum Term Assurance Sum Assured: An amount equal to the Major Surgical Benefit Sum Assured (MSB SA) at the time of inception/ inclusion into the policy (i.e. 100 times of Initial Daily Hospital Cash Benefit) in respect of the insured, subject to the maximum of ` 25 lakh overall limit taking all term assurance riders under all existing policies of the Life Assured and Term Assurance Sum Assured under other proposals into consideration.

The Term Assurance Sum Assured shall be in multiples of ` 25,000/-.

(c) Minimum Entry Age: 18 years (completed)
(d) Maximum Entry Age: 50 years (Nearest Birthday)
(e) Maximum Maturity Age: 60 years (Nearest Birthday)
(f) Maximum Term: 35 years
 

6. Other Features:

A) Death Benefit under the basic plan: No death benefits will be payable on the death of any Insured unless any of the Rider Benefits mentioned above has been opted for.
On death of the Principal Insured;

a) The surviving Insured Spouse will become the Principal Insured provided the option is exercised at the beginning of the contract and the Policy will continue. In such case, the premium for the Insured Spouse will change from the date coinciding with or following instalment premium due date and the new premium would be based on tabular premium rates applicable for PIs and the age for calculation of revised premium rate will be the age at entry of the spouse. If the option is not exercised at the beginning of the contract, the Insured Spouse will not become PI and the policy will terminate.

b) If the Insured Spouse had predeceased the Principal Insured, then the other Insured will have the option to take a new policy and the existing Policy will terminate. In respect of these other Insured:

i. 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.
ii. The maximum entry age condition will not apply for the new policy.
iii. The outstanding Waiting periods and outstanding period of any Exclusion will however apply under the new policy.
iv. Other terms and conditions including premium rates will be as applicable for the new policy.

In the event of death of an Insured person other than the Principal Insured, the policy will continue after removal of the Insured and change in premium will apply from the instalment premium due date coinciding with or next following the date of intimation of death of the Insured.

B) Maturity Benefit: No benefits are payable at end of the Cover Period.

C) Discontinuance of premiums: A grace period of one month but not less than 30 days will be allowed for payment of yearly or half yearly or quarterly premiums and 15 days for monthly premiums.

If premium is not paid before the expiry of the days of grace, the Policy lapses and all the benefits payable under this plan will cease.

D) Revival: A lapsed policy may be revived by the PI within a period of 2 years from the due date of first unpaid premium but before the expiry of cover in respect of PI, on submission of proof of continued insurability to the satisfaction of the Corporation and the payment of all the arrears of premium together with interest at such rate as may be fixed by the Corporation from time to time. The Corporation reserves the right to accept at original terms, accept with modified terms or decline the revival of a discontinued policy. The revival of the discontinued policy shall take effect only after the same is approved by the Corporation and is specifically communicated to the PI.

Waiting periods and Exclusions, as described in Para 14 and 15 respectively, will apply on revival. The Principal Insured may need to provide satisfactory evidence of good health in respect of each Insured as required by the Corporation, at his own expense. The Date of Revival will be when all requirements for revival/reinstatement are met and approved by the Corporation at its sole discretion.

No benefit will be paid for an event that occurred during the lapse period till the Date of Revival when the Policy was in a discontinued state.
Further, if the Automatic Renewal Date falls between the revival period and revival is done after the Automatic Renewal Date, the premium before and after the Automatic Renewal Date may be different.

Revival will not be allowed post the revival period.

E) Surrender:
No surrender value will be available under the plan.
 

7. Cooling off period:

If you are not satisfied with the “Terms and Conditions” of the policy, you may return the policy to us within 15 days.

8. Loan:

No loan will be available under this plan.

9. Assignment:

 

No Assignment will be allowed under this plan.

10. Exclusions:

 

No benefits are available hereunder and no payment will be made by the Corporation for any claim under this policy on account of hospitalization or surgery directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following:
 

  1. Any Pre-existing Condition unless disclosed to and accepted by the Corporation prior to the Date of Cover Commencement or the Date of Revival (if the Policy is revived after discontinuance of the Cover).
  2. Any treatment or Surgery not performed by a Physician/Surgeon or any treatment or Surgery of a purely experimental nature.
  3. Any routine or prescribed medical check up or examination.
  4. Medical Expenses relating to any treatment primarily for diagnostic, X-ray or laboratory examinations.
  5. Any Sickness that has been classified as an Epidemic by the Central or State Government.
  6. Circumcision, cosmetic or aesthetic treatments of any description, change of gender surgery, plastic surgery (unless such plastic surgery is necessary for the treatment of Illness or accidental Bodily Injury as a direct result of the insured event and performed with in 6 months of the same).
  7. Hospitalisation or Surgery for donation of an organ.
  8. Treatment for correction of birth defects or congenital anomalies.
  9. Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
  10. Convalescence, general debility, nervous or other breakdown, rest cure, congenital diseases or defect or anomaly, sterilisation or infertility (diagnosis and treatment), any sanatoriums, spa or rest cures or long term care or hospitalization undertaken as a preventive or recuperative measure.
  11. Self afflicted injuries or conditions (attempted suicide), and/or the use or misuse of any drugs or alcohol.
  12. Any sexually transmitted diseases or any condition directly or indirectly caused to or associated with Human Immuno Deficiency (HIV) Virus or any Syndrome or condition of a similar kind commonly referred to as AIDS.
  13. Removal or correction or replacement of any material that was implanted in a former surgery before Date of Cover commencement or Date of Revival (if the Policy is revived after discontinuance of the Cover).
  14. Any diagnosis or treatment arising from or traceable to pregnancy (whether uterine or extra uterine), childbirth including caesarean section, medical termination of pregnancy and/or any treatment related to pre and post natal care of the mother or the new born.
  15. Hospitalisation for the sole purpose of physiotherapy or any ailment for which hospitalization is not warranted due to advancement in medical technology.
  16. War, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection military or usurped power of civil commotion or loot or pillage in connection herewith.
  17. Naval or military operations(including duties of peace time) of the armed forces or air force and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like.
  18. Any natural peril (including but not limited to avalanche, earthquake, volcanic eruptions or any kind of natural hazard).
  19. Participation in any hazardous activity or sports including but not limited to racing, scuba diving, aerial sports, bungee jumping and mountaineering or in any criminal or illegal activities.
  20. Radioactive contamination
  21. Non-allopathic methods of treatment or surgery.
  22. Participation in any criminal or illegal activities.
  23. Treatment arising from the Insured’s failure to act on proper medical advice.

Benefit:

 

1.Benefits offered under the plan are
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)

A) Hospital Cash Benefit: If you or any of the insured lives covered under the policy is hospitalised due to Accidental Body Injury or Sickness and the stay in hospital exceeds a continuous period of 24 hours, then for any continuous period of 24 hours or part thereof, provided any such part stay exceeds a continuous period of 4 hours (after having completed the 24 hours as above) in a non-ICU ward/room of a hospital, an amount equal to the Applicable Daily Benefit (ADB) available under the policy during that policy year shall be payable subject to benefit limits and conditions mentioned in Para 11A) and exclusions mentioned in Para 15 below.

During the first year of cover commencement in respect of each insured, the Applicable Daily Benefit shall be the Initial Daily Benefit amount chosen by you and mentioned in the policy Schedule.

The amount of ADB for each policy year, after the first policy year, shall consist of 2 parts:

An arithmetic addition of an amount equal to 5% (five percent) of the Initial Daily Benefit to the Applicable Daily Benefit of the previous Policy Year. Such increase in the Applicable Daily Benefit shall be effected on each policy anniversary during the Cover Period and shall continue until it attains a maximum amount of 1.5 times the Initial Daily Benefit. Thereafter, this amount in each Policy Year in future shall remain at that maximum level attained.

Further arithmetic addition of an amount equal to “No Claim Benefit” (as described in Para 1.G) below) provided the policy attracts and is eligible for it. There shall be no maximum limit for such increase which means that if this policy is eligible for “No Claim Benefit”, the same shall be granted throughout the Cover Period without any maximum limit.

For members included subsequently under the policy, the benefit in the first year shall be equal to Initial Daily Benefit amount and thereafter the Applicable Daily Benefit shall increase as above.

If any of the member insured is required to stay in an Intensive Care Unit of a hospital, two times the Applicable Daily Benefit will be payable subject to benefit limits and conditions mentioned in Para 11A) and exclusions mentioned in Para 15 below.

During one period of 24 continuous hou