1. What is the situation today
What New

2. The Cost of Health care shooting
up exponentially
Present Generation spend more on
Health Care
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07/04/12 Ajay Kumar Kurup

3. Health Insurance
Health Insurance plan must take care……
2)Daily Expenses in Hospital
3)Surgical Expenses
4)Out Patient expenses
5)All expenses in and out of Hospital
6)Waiver of premium during stay at Hospital
7)Risk Coverage in case of any exigencies
Whether your existing plan offers all the above
07/04/12 Ajay Kumar Kurup

4. LIC’s Jeevan
Arogya
07/04/12 Ajay Kumar Kurup

5. LIC’s Jeevan Arogya gives you……
• Valuable financial protection in case of
hospitalisation, surgery etc
• Increasing Health cover every year
• Lump sum benefit irrespective of actual
medical costs
• No claim benefit
• Flexible benefit limit to choose from
• Flexible premium payment options
07/04/12 Ajay Kumar Kurup

6. Benefits Under Jeevan Arogya
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Other Optional benefits(PWB)
07/04/12 Ajay Kumar Kurup

7. Benefits Under Jeevan Arogya
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)
07/04/12 Ajay Kumar Kurup

8. Benefits Under Jeevan Arogya
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB))
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)
07/04/12 Ajay Kumar Kurup

9. Benefits Under Jeevan Arogya
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)
07/04/12 Ajay Kumar Kurup

10. Benefits Under Jeevan Arogya
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
07/04/12 Ajay Kumar Kurup

11. Benefits Under Jeevan Arogya
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)
• Other Optional benefits
07/04/12 Ajay Kumar Kurup

12. Hospital Cash Benefit (HCB)
Feature Principal Insured Spouse(If any), Insured Children
Insured (PI) Parents/In law
Min Initial Daily Rs. 1000/- Rs. 1000/- Rs. 1000/-
Benefit
Max Initial Daily Rs. 4000/- Equal or less than PI Equal or less than PI
Benefit
Max Age for Cover 80 yrs 80 yrs 25 yrs
HCB (Within India only) is payable on per day basis. Double the cash benefit for ICU.
Max 30 days hospitalization & not more than 15 days in ICU (2 times HCB) for 1st policy
year for each one
Max 90 days and incl not more than 45 days in ICU in the 2nd year onwards for each
insured
Limited to a max of 720 days (incl of 360 days for ICU) during entire policy term for each
insured
HCB to increase 5% till it reaches 1.5 times And arithmetic addition of an amount equal
to “No Claim Benefit”
Stay in Hospital exceeds a continuous period of 24 yrs or part thereof thereafter. Stay
more than 7 days even for 1s 24 hours also payable.
07/04/12 Ajay Kumar Kurup
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13. Major Surgical Benefit(MSB)
Feature Principal Insured Spouse(If any), Insured Children
Insured (PI) Parents/In law
Sum Assured (MSB 100 times ADB 100 times of ADB of 100 times of ADB of
SA) of PI insured Spouse each child
Max Annual benefit 100% of Sum 100% of Sum Assured 100% of Sum
Assured Assured
Max Life Time 800% of MSB SA 800% of MSB SA 800% of MSB SA
Quick Cash facility: 50% of eligible MSB amount subject to
approval from TPA in select Hospitals
MSB shall be a percentage of Sum Assured and is payable
regardless of actual costs incurred
Rs. 1000/- towards Ambulance expenses
Premium Waiver benefit for next one year
Surgery within India.
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14. Day Care Procedure Benefit (DCPB)
Feature Principal Insured Spouse(If any), Insured Children
Insured (PI) Parents/In law
Lump sum benefit 5 times of ADB 5 times of ADB in HCB 5 times of ADB IN
payable in HCB HCB
Max Annual benefit 3 Surgical Procedures
Max Life Time
24 Surgical Procedures
If a DCPB is performed, no HCB shall be paid
DCPB is payable as one lump sum and proof of surgery is
required
All surgical procedures should be done by a Physician or
Surgeon,
to the satisfaction of the Corporation
No transfer of left over benefit to other insured

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15. Other Surgical Benefit (OSB)
Feature Principal Insured Spouse(If any), Insured Children
Insured (PI) Parents/In law
Daily Benefit amount 2 times of ADB 2 times of ADB 2 times of ADB
Max Annual benefit 15 Days in Year 1 and 45 days per year thereafter
Max Life Time
360 days
OSB is payable as daily benefit
Proof of surgery done by a Physician or Surgeon, is subject to the
satisfaction of the Corporation
No transfer of left over benefit to other insured
Surgery required but not listed under MSB or DCPB
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07/04/12 Ajay Kumar Kurup

16. Other Options
Accident Benefit Rider
Min AB SA: Rs. 25000/-
Max AB SA: Equal to
Term Assurance SA
AB SA shall be in multiples of Rs. 5000/-
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17. Other Benefits Contd…….
Death Benefit:
• No death benefit unless TA Rider benefit is opted for
On death of the Principal Insured(PI)
• Surviving Insured Spouse will become PI, if already option given at the
beginning of contract
• If the Insured Spouse had predeceased the PI, Then the other Insured
will have the option to take new policy on following conditions
– 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
– The maximum entry age will not apply for the new policy
– The outstanding Waiting periods and outstanding period of any Exclusion will
however apply under the new policy
– Other terms and conditions including premium rates will be as applicable for
the new policy
Maturity Benefit: No benefits are payable at the end of the cover period
07/04/12 Ajay Kumar Kurup

18. Feature
Eligibility Conditions
Principal Parents & Parents-in- Insured Children
Insured law
(PI)/Insured
Spouse
Minimum Entry Age 18 Yrs LBD 18 Yrs LBD 3 Months(Completed)
Maximum Entry Age 65 Yrs LBD 75 Yrs LBD 17 Yrs LBD
Max Cover ceasing 80 Yrs 80 yrs 25 yrs
age
Date of cover expiry Policy anniversary on which the Insured life attains Maximum cover
in respect of each ceasing age
Insured covered
under the plan
Nominations Allowed
Assignments1s 24 hoursNot Allowed
s even for also payable.
Mode of Premium Yearly, Half Yearly and Monthly(ECS Only)
Grace Period 30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode
Revival Period 2 Years from due date of FUP
07/04/12 Ajay Kumar Kurup

19. Points to be noted
• Premium guaranteed for first 3 years and may
be revised after every 3 years based on Health
conditions
• All existing members must be added in first
instance. New members can be added
through Child birth (Children)-3 Months,
Marriage (Spouse, Parents-in-law)- 6 Months
from next Policy anniversary
07/04/12 Ajay Kumar Kurup

20. Points to be noted Contd………
Waiting Period
• 90 days from DOC other than accidental bodily injury
• 45 days from DOR, if request for revival recd within 90 days from the due
date of FUP
• 90 days from DOR, if request for revival recd beyond 90 days from the due
date of FUP
Specific Waiting Period (treatments)
• 2 years from Date of Cover Commencement
• 2 Years from DOCC, if request for revival recd within 90 days from the due
date of FUP
• 2 Years days from DOR, if request for revival recd beyond 90 days from
the due date of FUP
07/04/12 Ajay Kumar Kurup
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21. Treatments in respect of
Specific waiting period
i. Treatment for adenoid or tonsillar disorders
ii. Treatment for anal fistula or anal fissure
iii. Treatment for benign enlargement of prostate gland
iv. Treatment for benign uterine disorders like fibroids, uterine prolapse,
dysfunctional uterine bleeding etc
v. Treatment for Cataract
vi. Treatment for Gall stones
vii. Treatment for slip disc
viii. Treatment for Piles
ix. Treatment for benign thyroid disorders
x. Treatment for Hernia
xi. Treatment for hydrocele
xii. Treatment for degenerative joint conditions
xiii. Treatment for sinus disorders
xiv. Treatment for kidney or urinary tract stones
xv. Treatment for varicose veins
xvi. Treatment for Carpal tunnel syndrome Enter Please
xvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc
07/04/12 Ajay Kumar Kurup

22. Points to be noted Contd………
Termination of Policy
If policy is issued on a single life
• Non Payment of premium within revival period
• On death
• On Date of cover expiry
• On exhausting all the life time maximum Benefits Limits as specified above
If policy is issued on more than one life
• Non Payment of premium within revival period
• On death or Date of cover expiry of the PI and if the Policy does not
continue with the IS as the PI
• On death or Date of cover expiry of IS after Policy continues with the IS as
the PI after the PI dies or reaches his/her Date of cover expiry
• On PI exhausting all the life time maximum Benefits Limits as specified
above
07/04/12 Ajay Kumar Kurup

23. What is different from Mediclaim
• Pre defined benefit- No reimbursement, but
lump sum paid based on pre-defined benefit
• Not based on expenses incurred
• This will tend to indirectly reduce the Health
care cost, which is rising due to cash less
mediclaim benefit
• All benefit is dependent on HCB
07/04/12 Ajay Kumar Kurup

24. 07/04/12 Ajay Kumar Kurup