What is the situation today                              What New
The Cost of Health care shooting             up exponentially    Present Generation spend more on               Health Car...
Health InsuranceHealth Insurance plan must take care……2)Daily Expenses in Hospital3)Surgical Expenses4)Out Patient expense...
LIC’s Jeevan             Arogya07/04/12       Ajay Kumar Kurup
LIC’s Jeevan Arogya gives you……• Valuable financial protection in case of  hospitalisation, surgery etc• Increasing Health...
Benefits Under Jeevan Arogya•   Hospital cash benefit (HCB)•   Major Surgical Benefit (MSB)•   Day Care Procedure Benefit•...
Benefits Under Jeevan Arogya•   Hospital cash benefit (HCB)•   Major Surgical Benefit (MSB)•   Day Care Procedure Benefit•...
Benefits Under Jeevan Arogya•   Hospital cash benefit (HCB)•   Major Surgical Benefit (MSB))•   Day Care Procedure Benefit...
Benefits Under Jeevan Arogya•   Hospital cash benefit (HCB)•   Major Surgical Benefit (MSB)•   Day Care Procedure Benefit•...
Benefits Under Jeevan Arogya•   Hospital cash benefit (HCB)•   Major Surgical Benefit (MSB)•   Day Care Procedure Benefit•...
Benefits Under Jeevan Arogya•   Hospital cash benefit (HCB)•   Major Surgical Benefit (MSB)•   Day Care Procedure Benefit•...
Hospital Cash Benefit (HCB)Feature                Principal          Insured Spouse(If any),     Insured Children         ...
Major Surgical Benefit(MSB)Feature              Principal          Insured Spouse(If any),     Insured Children           ...
Day Care Procedure Benefit (DCPB)Feature              Principal         Insured Spouse(If any),   Insured Children        ...
Other Surgical Benefit (OSB)Feature              Principal          Insured Spouse(If any),   Insured Children            ...
Other Options                            Accident Benefit Rider                            Min AB SA: Rs. 25000/-         ...
Other Benefits                                                   Contd…….Death Benefit:•   No death benefit unless TA Ride...
Feature              Eligibility Conditions                       Principal         Parents & Parents-in-    Insured Child...
Points to be noted• Premium guaranteed for first 3 years and may  be revised after every 3 years based on Health  conditio...
Points to be noted                                              Contd………Waiting Period•   90 days from DOC other than acci...
Treatments in respect of                 Specific waiting periodi. Treatment for adenoid or tonsillar disordersii. Treatme...
Points to be noted                                                   Contd………Termination of PolicyIf policy is issued on a...
What is different from Mediclaim• Pre defined benefit- No reimbursement, but  lump sum paid based on pre-defined benefit• ...
07/04/12   Ajay Kumar Kurup
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Jeevan arogya

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Jeevan arogya

  1. 1. What is the situation today What New
  2. 2. The Cost of Health care shooting up exponentially Present Generation spend more on Health Care Next07/04/12 Ajay Kumar Kurup
  3. 3. Health InsuranceHealth Insurance plan must take care……2)Daily Expenses in Hospital3)Surgical Expenses4)Out Patient expenses5)All expenses in and out of Hospital6)Waiver of premium during stay at Hospital7)Risk Coverage in case of any exigencies Whether your existing plan offers all the above07/04/12 Ajay Kumar Kurup
  4. 4. LIC’s Jeevan Arogya07/04/12 Ajay Kumar Kurup
  5. 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 options07/04/12 Ajay Kumar Kurup
  6. 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. 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. 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. 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. 10. Benefits Under Jeevan Arogya• Hospital cash benefit (HCB)• Major Surgical Benefit (MSB)• Day Care Procedure Benefit• Other Surgical Benefit07/04/12 Ajay Kumar Kurup
  11. 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 benefits07/04/12 Ajay Kumar Kurup
  12. 12. Hospital Cash Benefit (HCB)Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In lawMin Initial Daily Rs. 1000/- Rs. 1000/- Rs. 1000/-BenefitMax Initial Daily Rs. 4000/- Equal or less than PI Equal or less than PIBenefitMax 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 Next
  13. 13. Major Surgical Benefit(MSB)Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In lawSum Assured (MSB 100 times ADB 100 times of ADB of 100 times of ADB ofSA) of PI insured Spouse each childMax Annual benefit 100% of Sum 100% of Sum Assured 100% of Sum Assured AssuredMax 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. 07/04/12 Ajay Kumar Kurup Next
  14. 14. Day Care Procedure Benefit (DCPB)Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In lawLump sum benefit 5 times of ADB 5 times of ADB in HCB 5 times of ADB INpayable in HCB HCBMax Annual benefit 3 Surgical ProceduresMax 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 orSurgeon, to the satisfaction of the CorporationNo transfer of left over benefit to other insured 07/04/12 Ajay Kumar Kurup Next
  15. 15. Other Surgical Benefit (OSB)Feature Principal Insured Spouse(If any), Insured Children Insured (PI) Parents/In lawDaily Benefit amount 2 times of ADB 2 times of ADB 2 times of ADBMax Annual benefit 15 Days in Year 1 and 45 days per year thereafterMax 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 Next 07/04/12 Ajay Kumar Kurup
  16. 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/-07/04/12 Ajay Kumar Kurup
  17. 17. Other Benefits Contd…….Death Benefit:• No death benefit unless TA Rider benefit is opted forOn 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 policyMaturity Benefit: No benefits are payable at the end of the cover period07/04/12 Ajay Kumar Kurup
  18. 18. Feature Eligibility Conditions Principal Parents & Parents-in- Insured Children Insured law (PI)/Insured SpouseMinimum Entry Age 18 Yrs LBD 18 Yrs LBD 3 Months(Completed)Maximum Entry Age 65 Yrs LBD 75 Yrs LBD 17 Yrs LBDMax Cover ceasing 80 Yrs 80 yrs 25 yrsageDate of cover expiry Policy anniversary on which the Insured life attains Maximum coverin respect of each ceasing ageInsured coveredunder the planNominations AllowedAssignments1s 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 ModeRevival Period 2 Years from due date of FUP 07/04/12 Ajay Kumar Kurup
  19. 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 anniversary07/04/12 Ajay Kumar Kurup
  20. 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 FUPSpecific 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 FUP07/04/12 Ajay Kumar Kurup Next
  21. 21. Treatments in respect of Specific waiting periodi. Treatment for adenoid or tonsillar disordersii. Treatment for anal fistula or anal fissureiii. Treatment for benign enlargement of prostate glandiv. Treatment for benign uterine disorders like fibroids, uterine prolapse,dysfunctional uterine bleeding etcv. Treatment for Cataractvi. Treatment for Gall stonesvii. Treatment for slip discviii. Treatment for Pilesix. Treatment for benign thyroid disordersx. Treatment for Herniaxi. Treatment for hydrocelexii. Treatment for degenerative joint conditionsxiii. Treatment for sinus disordersxiv. Treatment for kidney or urinary tract stonesxv. Treatment for varicose veinsxvi. Treatment for Carpal tunnel syndrome Enter Pleasexvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc07/04/12 Ajay Kumar Kurup
  22. 22. Points to be noted Contd………Termination of PolicyIf 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 aboveIf 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 above07/04/12 Ajay Kumar Kurup
  23. 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 HCB07/04/12 Ajay Kumar Kurup
  24. 24. 07/04/12 Ajay Kumar Kurup

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