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Introducing LICs New Health Plan Jeevan Arogya. Special Attractions. Maximum Number of days for HCB increased to 720 days Maximum Number of days for ICU increased to 360 days No of Surgeries in MSB increased to 140 MSB available for Minors also - PowerPoint PPT Presentation
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Introducing
LICs New Health Plan
Jeevan Arogya
Special Attractions
Maximum Number of days for HCB increased to 720 days
Maximum Number of days for ICU increased to 360 days
No of Surgeries in MSB increased to 140
MSB available for Minors also
Addition of 140 Day Care Procedures (DCPB)
All other Surgeries covered under
Other Surgical Benefit (OSB)2
Special Attractions
Age at entry for PI and Spouse increased to 65 Years
Age at entry for Parents and Parents-in-law is 75 Years
Maximum Health cover for elders - up to 80 Yrs
Premiums are guaranteed for 3 Yrs
Optional Term Rider and Accident Benefit
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Income Tax Rebate
IT Rebate Under Section 80(D)
available for Full Premium Paid
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USP of LICs Jeevan Arogya
Comprehensive Family Health plan:
Covering entire family consisting of
Husband
Wife
Dependent Children Dependent Parents of Husband
and/or Wife
Entry age limits-LICs Jeevan Arogya
Entry Age up to 65 yrs for Husband and wife.
Entry Age up to 75 yrs for parents/in-lawsEntry Age from 91 days to 17 years for children
Risk cover Self, Spouse, Parents, in-laws : 80 YrsChildren : 25 Yrs
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USP of LICs Jeevan Arogya
A novel policy offering Multiple benefits:
Hospital cash benefit (HCB).
Major surgical benefit (MSB)
Day Care Procedure Benefit(DCPB)
Other Surgical Benefit(OSB)
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USP of LICs Jeevan ArogyaOther Benefits:
Premium waiver benefit
Ambulance expenses
Quick cash Advance Payment
No claim bonus
Auto increase in HCB& MSB to take care of inflation with no increase in premium
Risk cover under LICs Jeevan Arogya
Risk cover up to 4 lacs per insured Subject to overall limit of 10 lacs (All our Health Policies put togethor)
Guaranteed renewal after every three yrs
HCB options for each Life
Rs.1000/- per Day
Rs.2000/- per Day
Rs.3000/- per Day
Rs.4000/- per Day
HCB limits for each Insured
P.I As per his/her choice
Spouse < or = P.I
Children < or = Spouse / < or = P.I if no spouse
Parents < or = Insured Spouse
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HCB - Benefits at a glance HCB increases by 5% every year Up to1.5 times.
Eg. Rs 1000/- after 1 Yr becomes Rs.1050 and in the 11th Year becomes Rs.1500/-(Max) Hospitalization eligibility condition:
Fraction of 4 Hours treated as a day
First 28 hrs eligible for 1 day benefit
First 24 hours No benefit
Exception: When hospital stay exceeds continuous
period of 6 days and 4 hours, HCB for 7 days
(including First day also) will be allowed
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HCB - Benefits at a glance
Annual limit
for each insured
Maximum limit for each insured during entire
policy term
1st policy year
30 days of hospitalization of which 15 days of ICU is allowed.
subsequent years
Each year- 90 days of hospitalization of which 45 days of ICU is allowed.
720 days .
of which
360 days of ICU
allowed
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Hospital Cash Benefit( HCB)
Fixed per day benefit to cover expenses on the event of hospitalization of insured members for sickness/accidental body injury.
Benefit payout is fixed irrespective of actual expenses incurred.
Major Surgical Benefit (MSB)
• MSB = (HCB X 100)
• MSB risk cover limits do not include
MSB of Plan 901 & 902
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Major Surgical Benefit(MSB)
A percentage of sum assured is paid in the event of insured members undergoing specified surgeries.
Benefit is fixed irrespective of actual expenses incurred. Advantageous to the insured members
MSB is available to all the insured including children for all ages
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MSB- Benefits at a glance
MSB allowed for 140 surgical procedures
Annual Limit
100 times of HCB in a policy year (Min 1 Lac)
Life time Limit
800 times of HCB during entire policy term (Min 8 Lacs)
Premium waiver benefit
In the event of any insured undergoing major surgery under category I or 2 premium payable for one year from the next premium due date coinciding or following the date of surgery is waived
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Day care procedure benefit(DCPB)
DCPB = 5 X HCB
• 140 Listed day care procedures
• 3 Day care Procedures per year
• 24 Day care Procedures in
Policy Life time
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Other surgical benefit(OSB)
OSB = 2 x HCB
Any surgery other than MSB, DCPB surgeries
At least 24 hours stay in Hospital is required
Annual limit : 15 days in First policy year
45 days in each subsequent years
Life time limit : 360 days per insured
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Term Assurance Benefit Rider
Minimum Term Assurance SA : Rs. 1,00,000 Maximum Term Assurance SA : Equal to initial
MSB-SA (i.e.,100 X HCB ) Term Assurance SA - in multiples of Rs.25000/-
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Minimum Entry Age 18 Yrs completed
Maximum Entry Age 50 Yrs (NBD)
Maximum age for cover 60 Yrs (NBD)
Maximum Term 35 Years
Accident Benefit RiderThis benefit is available only if Term Assurance Benefit rider is opted
Minimum Benefit : Rs. 25,000 Maximum Benefit : Equal to initial MSB-SA
( i.e.,100 X HCB) AB Sum Assured shall be in multiples of Rs.5000/-
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Minimum Entry Age 18 Yrs completed
Maximum Entry Age 50 Yrs completed
Maximum age for cover 60 Yrs completed
Maximum Term 35 Years
Quick cash facility
Advance amount to PI
Cat I or Cat II Surgeries
Hospitalized in a ‘Net work’ Hospital
PI/relative informs LIC/TPA
TPA processes request/advices LIC on payment
LIC credits eligible amount to PI Bank account
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Ambulance charges
Rs. 1000/- reimbursed per insured towards
Ambulance charges
Ambulance charges incurred for transportation of the insured to undergo Major Surgeries under category 1 or 2
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No claim Benefit
During the period between two automatic renewal dates or From DOC to next Automatic renewal date, if there are no claims in respect of any insured, No claim Benefit is payable
No claim benefit would be equal to 5% of initial Daily Benefit
Effective from the immediately following automatic renewal date
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USP of LICs Jeevan Arogya
Premium rate may be reviewed
for every 3 years
If revised, the new rate corresponding to
the age at entry of each insured will be
the new premium
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USP of LICs Jeevan Arogya
Example
PI takes a Policy in 2011
Age of PI in 2011 = 36
If premium revised in 2014
The new premium rate of PI will
be the revised premium corresponding
to age 36 in the new table.
Rebates available on Tabular premiums
Mode Rebate
Rebate for HCB Opted
Hly Yly
2000 HCB 3000HCB 4000HCB
PI others PI others PI others
1% 2% Rs.500 Rs.250 Rs.1000 Rs.500 Rs.1500 Rs.750
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Addition of members
ConditionWhen to include
The cover
starts from
Marriage/remarriage of the Principal Insured after DOC
Within 1 Year from the date of marriage
The following policy anniversary
A Child born or Legally adopted child after DOC
Health Cover starts from the policy anniversary falling immediately after the child completes 3 months
Legally adopted child is more than 3 months old
From the policy anniversary falling after date of adoption
New members must be included by the Principal Insured only. No new
members will be allowed after the death of the principal insured.
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USP of LICs Jeevan Arogya
Addition of newly eligible members during the currency of the policy.
Fixed Benefit scheme: Benefit paid as opted irrespective of actual expenses for hospitalization and Surgeries
Benefits are payable independent of payments received through mediclaim or any other health schemes.
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The policy lapses…
When premium is not paid within days of grace, the policy lapses and no benefits will be payable there after .
Policy can be revived within 2 years from the date of first unpaid premium subject to payment of outstanding premiums with interest and underwriting.
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The waiting Period for availing the benefits……………….
0 days for accident claims
90 days from the Date of Commencement for HCB & MSB
45 days after revival, if revived within 90 days from FUP of the policy. for Hospital Cash Benefit and Major Surgical Benefit
90 days if revived after 90 days from FUP
Things to remember:
• Since it is purely MEDICAL INSURANCE plan and premium does not have any saving element hence there is no maturity claim
• No Death claim under basic plan. • Loan, surrender, assignment- n.a.• Mode of payment- Yly, Hly, Mly(ECS only)
Underwriting
NM(S)
Age n.b.d Upto 45yrs 46 to 50
SUC 5 LAC 4 LAC
NM(G)
Age n.b.d UPTO 35 yrs 36 to 50
SUC 5 LAC 2 LAC
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Nature of Benefit1st Pol
Year (Rs)2nd Pol Year (Rs)
Max. eligible
During the Policy term (Rs)
Hospital Cash Benefit (HCB) including ICU Benefit
45,000 1,41,750 16,20,000
Major Surgical Benefit (MSB) 1,00,000 1,05,000 12,00,000
Other Surgeries Benefit (OSB) 30,000 94,500 10,80,000
Day Care Procedure Benefit (DCPB)
15,000 15,750 1,80,000
Maximum Benefit under the policy per insured
40,80,000
Ambulance Charges incurred Rs.1000/- per insured per year
Premium Waiver Benefit One Year Premium
No Claim Benefit Increase in HCB by 5%
Sample Benefit Illustration – for HCB 1000
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Benefits during the policy term for a HCB of Rs.2000/-Benefit LIC ICICI
Daily Hospital Cash Benefit(including. ICU benefit)
90,000 1st yr1,80,000/year
2,83,500 2nd YrMajor Surgical Benefit 80,000 to 2 lacs 20,000 to 3 lacsDay care surgical Benefit 30,000 1st yr ---
Other surgical Benefit60,000 1st yr
---1,89,000 2nd yr
Non surgical benefit -- 2000/day (Max8000)Recuperative benefit -- 6000
Prolonged stay benefit --2000/day after 30days of Hospital stay
Health check up benefit --4000(Total for all insured in the pol term)
Benefit comparision with ICICI prudential Hospital care II
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Benefits during the policy term for a HCB of Rs.2000/-
Benefit LIC ICICI
Max per annum3,61,000 1st yr
8,00,0006,84,000 2nd Yr
Benefits in the policy term
68,00,000 40,00,000
Ambulance charges(extra)
1000/member/yr ---
Additional BenefitsPWB, AB rider,
No such facilitiesDeath Benefit
rider
Benefit comparision with ICICI prudential Hospital care II
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THANK YOU