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What is the situation today

What New

The Cost of Health care shooting up exponentially Present Generation spend more on Health Care

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5/26/2011 Ajay Kumar Kurup

Health Insurance
Health Insurance plan must take care«« 1) Daily Expenses in Hospital 2) Surgical Expenses 3) Out Patient expenses 4) All expenses in and out of Hospital 5) Waiver of premium during stay at Hospital 6) Risk Coverage in case of any exigencies
Whether your existing plan offers all the above
5/26/2011 Ajay Kumar Kurup

LIC·s Jeevan Arogya

5/26/2011

Ajay Kumar Kurup

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
5/26/2011 Ajay Kumar Kurup

Benefits Under Jeevan Arogya
‡ ‡ ‡ ‡ ‡ Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit Other Optional benefits(PWB)

5/26/2011

Ajay Kumar Kurup

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)

5/26/2011

Ajay Kumar Kurup

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)

5/26/2011

Ajay Kumar Kurup

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)

5/26/2011

Ajay Kumar Kurup

Benefits Under Jeevan Arogya
‡ ‡ ‡ ‡ Hospital cash benefit (HCB) Major Surgical Benefit (MSB) Day Care Procedure Benefit Other Surgical Benefit

5/26/2011

Ajay Kumar Kurup

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
Ajay Kumar Kurup

5/26/2011

Hospital Cash Benefit (HCB)
Feature Min Initial Daily Benefit Max Initial Daily Benefit Max Age for Cover Principal Insured (PI) Rs. 1000/Rs. 4000/80 yrs Insured Spouse(If any), Parents/In law Rs. 1000/Equal or less than PI 80 yrs Insured Children Rs. 1000/Equal or less than PI 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.
5/26/2011 Ajay Kumar Kurup

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Major Surgical Benefit(MSB)
Feature Sum Assured (MSB SA) Max Annual benefit Max Life Time Principal Insured (PI) 100 times ADB of PI 100% of Sum Assured Insured Spouse(If any), Parents/In law 100 times of ADB of insured Spouse 100% of Sum Assured Insured Children 100 times of ADB of each child 100% of Sum Assured 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.
5/26/2011 Ajay Kumar Kurup

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Day Care Procedure Benefit (DCPB)
Feature Lump sum benefit payable Max Annual benefit Max Life Time Principal Insured (PI) 5 times of ADB in HCB Insured Spouse(If any), Parents/In law 5 times of ADB in HCB Insured Children 5 times of ADB IN HCB

3 Surgical Procedures

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 Surgery within India 5/26/2011 Ajay Kumar Kurup

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Other Surgical Benefit (OSB)
Feature Principal Insured (PI) Insured Spouse(If any), Parents/In law 2 times of ADB Insured Children 2 times of ADB Daily Benefit amount 2 times of ADB Max Annual benefit Max Life Time

15 Days in Year 1 and 45 days per year thereafter

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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5/26/2011 Ajay Kumar Kurup

Other Options
Term Rider Benefit
Min Term Assurance SA: Rs. 100000/Max Term Assurance SA: Equal to MSBSA Min Entry Age: 18 Years completed Max Entry Age: 50 Years NBD Max Maturity Age: 60 Years NBD Max Term: 35 Years
(SA be in multiples of Rs. 25000/-)

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/-

5/26/2011

Ajay Kumar Kurup

Other Benefits
Death Benefit: On death of the Principal Insured(PI)
‡ ‡

Contd

.

‡ No death benefit unless TA Rider benefit is opted for

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
5/26/2011 Ajay Kumar Kurup

Feature

Eligibility Conditions
Principal Insured (PI)/Insured Spouse 18 Yrs LBD 65 Yrs LBD 80 Yrs Parents & Parents-inlaw 18 Yrs LBD 75 Yrs LBD 80 yrs 17 Yrs LBD 25 yrs

Insured Children

Minimum Entry Age Maximum Entry Age Max Cover ceasing age Date of cover expiry in respect of each Insured covered under the plan

3 Months(Completed)

Policy anniversary on which the Insured life attains Maximum cover ceasing age

Nominations Allowed Assignments s even for 1s 24 hoursNot Allowed also payable. Mode of Premium Grace Period Revival Period
5/26/2011

Yearly, Half Yearly and Monthly(ECS Only) 30 days for Yearly , Half Yearly mode and 15 days for Monthly Mode 2 Years from due date of FUP
Ajay Kumar Kurup

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
5/26/2011 Ajay Kumar Kurup

Points to be noted
Waiting Period

Contd

‡ 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
5/26/2011 Ajay Kumar Kurup

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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 xvii. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc
5/26/2011 Ajay Kumar Kurup

Enter Please

Points to be noted
Termination of Policy If policy is issued on a single life
‡ ‡ ‡ ‡

Contd

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
5/26/2011 Ajay Kumar Kurup

hat 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

5/26/2011

Ajay Kumar Kurup

Why wait Get LIC¶s Jeevan Arogya Enjoy Your Life with your family
5/26/2011 Ajay Kumar Kurup