Insurance is one of the effective ways to reduce out-of-pocket expenditire

1. Presented By:
Palka Mittal
LIC JEEVAN AROGYA PLAN

2. CONTENTS
• INTRODUCTION
• KEY FEATURES
• BENEFITS
• ELIGIBILITY CRITERIA
• COVERAGE AREA
• EXCLUSIONS
• CLAIM

3. INTRODUCTION
• LIC health insurance
• Non- linked health insurance plan
• Financial cover against death or sickness
• Financial support to policy holder if he/she is disabled after an accident
• Minor injuries are also covered

4. KEY FEATURES
• One health insurance policy that covers self, spouse, children, parents and
parents-in-law
• Covers hospitalisation, surgery costs and more
• Provides benefit payout irrespective of actual medical cost incurred
• Can be availed along with existing mediclaim policy for the same
hospitalisation / surgery
• Cover can be extended to new members of the family in case of marriage
and childbirth
• Quick Cash Facility is available on hospitalisation instead of waiting to
make a claim for the benefit after discharge. Under Quick Cash, 50%
advance payment is given by LIC (for 57 surgeries performed in network
hospitals)
• Payout made on the basis of photocopy of bills
• No Claim Benefit is 5% of initial Hospitalisation Cash Benefit (HCB)

5. BENEFITS
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)

6. ELIGIBILITY CRITERIA
COVERAGE FOR MINIMUM AGE MAXIMUM AGE
YOU/SPOUSE 18 YEARS 65 YEARS
PARENTS/PARENTS-
IN-LAW
18 YEARS 75 YEARS
CHILDREN 91 DAYS 17 YEARS

7. COVERAGE AREA
COVERAGE TYPE COVERAGE
OFFERED
MAXIMUM
COVERAGE
DILY HOSPITAL CASH 1000,2000,3000,4000
Minimum 24 hrs.
hospitalization required
COVERS HOSPITALIZATION
UPTO 30 DAYS IN 1 YEAR
WHICH BECOME THRICE
SECOND YEAR ONWARDS
MAJOR SURGICAL
BENEFITS
1,00,000-4,00,000 COVERS UPTO 140 MAJOR
SURGERIES
DAYCARE PROCEDURE
BENEFITS
5 Times in case of Daycare
procedure
MAXIMUM 3 TIMES IN A
YEAR & 24 TIMES DURING
THE POLICY TENURE IN
INDIA
OTER SURGICAL BENEFITS TWICE THE DHC IN CASE
OF HOSPITALIZATION
MORE THAN 24 HRS
MAX DAYS OF COVERAGE
IN 1 YEAR ARE 15 AND 45
THEREAFTER

8. EXCLUSIONS
• Pre-existing conditions (unless disclosed and accepted by LIC)
• Routine check-ups and Non-allopathic treatments
• Epidemic diseases or conditions (classified by Central or State
Government)
• Cosmetic or beauty treatments, circumcision, dental treatments
• Plastic surgery (unless necessary for treatment of illness or due to an
accident and performed within 6 months of the event occurrence)
• Any treatment arising from insured person’s failure to act on proper
medical advice
• Self-inflicted injuries or attempted suicide
• Abuse of drugs, alcohol or intoxicants
• Conditions existing at birth (congenital conditions)

9. • Rest cure, general weakness, nervous breakdown or
related conditions, infertility or sterilisation
• Sexually transmitted diseases like HIV / AIDS
• Pregnancy or child-birth related conditions
• Any act of war, invasion of foreign enemy, naval or
military operations etc
• Radioactive contamination
• Criminal or illegal acts
• Natural catastrophe like earthquake, floods etc
• Participation in dangerous sports like racing, scuba
diving, bungee jumping​

10. CLAIMS
• Cashless claims
• Reimbursement claim
• Documents required to claim are: discharge summary, prescription,bills
reciept & test reports