Arogya Rakshak

(Plan 906)
P. Sridhar, DO, Chennai
 Health as a Portfolio in LIC
• LIC entered into Health Market in 2008
• Huge demand from Customers
• Our Greatest Advantage is Brand Equity
• Our Core Area of Operation is LIFE only
• Every Insurer have Statutory Limitations
• Even then, our Health Products are Good
 History of LIC’s Health Plans
• Health Plus – Plan No 901 (2008 to 2010)
• Health Protection Plus – 902 (2009 to 13)
• Jeevan Arogya – 903 (2011 to 2013)
• Jeevan Arogya – 904 (2013 to 2021)
• Cancer Cover – 905 (2017 to till date)
 AROGYA RAKSHAK PLAN
• Non-Linked Fixed Benefits Health Plan
• Provides Benefits for Hospitalization
• Also for all types of Surgical Procedures
• Benefits doesn’t depend on actual cost
• Claim is in addition to other Mediclaim
 Who all can take this Plan?
• Any Healthy Individual can Propose the Plan
• They are referred as Principal Insured (PI)
• Family members covered in Same Policy
• Spouse, Children & Parents
• 1 Policy = Multiple LIVES covered
• Mode of Payment: Yearly/Half-Yearly
• Cover ceases at Age 80
 AROGYA RAKSHAK PLAN
• Minimum Age at Entry
– PI, Spouse & Parents: 18
– For Children: 91 Days Completed
• Maximum Age at Entry
– PI, Spouse & Parents: 65
– Children: 20
• Maximum cover ceasing Age
– PI, Spouse, Parents: 80
– Children: 25
 Key Benefits of Arogya Rakshak

• Hospital Cash Benefit (HCB)

• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit (DCPB)
• Other Surgical Benefit (OSB)
Other Ancillary Benefits

• Medical Management Benefit (MMB)

• Extended Hospitalization Benefit

• Auto Health Cover

• Health Check-up Benefit

 Rider Benefits
• Term Assurance Rider

• Accident Benefit Rider

• Available to PI/Spouse
 How Premium is arrived at?
• Arogya Rakshak Premium is based on:
– Age at Entry of Every Life
– Initial HCB chosen
– Gender
– Whether Life Assured is PI or not
• Final Premium is Sum Total of all LIVES
• Premium is Reviewable after 3-Years but
charged as per Age at Entry during DOC
 Let us understand HCB…
• Hospital Cash Benefit (Focal Point in 906)
• It is the daily benefit for Hospitalization
• Min HCB is 2500; Max is 10000 (in multiples of 500)
• This is applicable to all LIVES
• HCB of Others cannot exceed HCB of PI
• Sum Assured is dependent on HCB only
• More about this in the forthcoming slides
 Little more on HCB & ADB…
• HCB automatically increases by 15% at
the end of every 3 Policy years
– 5000 HCB becomes 5750 at the end of 3rd
Year
– Becomes 6500 at the end of 6th Year
– This increase will continue till 1.5 times of
initial HCB
• HCB from 2nd year onwards takes the
name of “Applicable Daily Benefit”
 Premium Revision & NCB
• Premium would be revised every 3 years
• What is No Claim Bonus (NCB)?
• If there is No Claim from any Insured, LIC
adds “No Claim Bonus” to the Policy
– It will be 5% of HCB (Once in 3 years)
– No ceiling for NCB Addition
See how ADB increases…

HCB Chosen 5000.

Claim in the 5th Year.

NCB added in 4th

and 10th year only.
As Claim happened
in 5th year, No NCB
in 7th year
 AROGYA RAKSHAK PLAN
• Normal Ward: ADB ICU: 2-Times of ADB
• Maximum Annual Benefit of HCB
– 1st Year: 30 Days overall (including ICU)
– 2nd Year onwards: 90 Days overall
• Maximum LIFETIME Benefit of HCB
– 900 Days inclusive of stay in ICU
 Let us understand what is MSB?
• Major Surgical Benefit (Actual SA in 906)
• It is 100 Times of ADB (Very Simple)
• Min Initial SA is 2.5 Lacs & Max SA is 10 Lacs
• This is applicable to all LIVES
• 263 Surgeries are covered (check the list)
• 4-Categorization for MSB (I, II, III, IV)
• Max MSB Claim Life time = 1000 times ADB
• % SA Claim would be 100, 60, 40, 20
 MSB Claim in detail
• Hospitalization due to Accident/Sickness
• MSB amount doesn’t depend on Actuals
• Just an Evidence of Surgery is enough
• Quick Cash Facility (50% MSB) for Cat I/II
• Maximum Annual Benefit: 100% MSB
• MSB Restoration Benefit is also applicable
• Premium Waiver for 1 year (Cat I & II only)
 What is DCPB & OSB?
• Let us see what is Day Care Procedure Benefit
• 244 Surgeries covered in DCPB (See list)
• Lumpsum Amount of 5-times ADB given
• 3 times in a Year; 30 times during life time
• Next is Other Surgical Benefit
• All other Surgeries not listed are covered
• OSB amount is 2.5 times of ADB
• HCB Claim is also admissible for OSB Claim
 DCPB & OSB Claim
• Day Care Procedure Benefits
– Maximum Annual Benefit : 3 Surgeries listed
– Maximum Lifetime Benefit: 30 Surgeries listed
• Other Surgical Benefits
– Maximum Annual Benefit : 15 days in 1st year
45 days thereafter
– Maximum Lifetime Benefit: 450 days
ENTRY AGE : 30 YEARS INITIAL HCB CHOSEN : Rs. 5000/-
ADB MSB Sum DC PB (Lump OSB (Per
Policy Year Age
Norma ward ICU Assured Sum) Day)
1 30 5000 10000 500000 25000 12500
2 31 5000 10000 500000 25000 12500
3 32 5000 10000 500000 25000 12500
4 33 6000 12000 600000 30000 15000
5 34 6000 12000 600000 30000 15000
6 35 6000 12000 600000 30000 15000
7 36 7000 14000 700000 35000 17500
8 37 7000 14000 700000 35000 17500
9 38 7000 14000 700000 35000 17500
10 39 8000 16000 800000 40000 20000
11 40 8000 16000 800000 40000 20000
12 41 8000 16000 800000 40000 20000
13 42 8500 17000 850000 42500 21250
14 43 8500 17000 850000 42500 21250
15 44 8500 17000 850000 42500 21250
 Medical Management Benefit
• Hospitalisation due to 5 diseases

• Dengue, Malaria, TB, Pneumonia, Hepatitis A

• 2.5 times of the ADB paid as 1 Lumpsum

 Extended Hospitalisation Benefit

• Allowed if hospital stay exceeds 30 days

• 10 times of ADB payable as Lumpsum
• This is in addition to HCB, MSB, OSB etc
• Allowed 10 times during entire Policy
 Auto Health Cover
• If PI dies, future Premium waived for others

• For next 15 Yrs, Free Health cover to Family

• What a Marvel this Point is……!

 Health Check-up Benefit

• Available once in 3 Years to all Members

• To do Health Check-up in any Lab
• Half of ADB will be given
• Copy of Bill & Diagnostic Report needed
 Underwriting Points in 906
• Males & Females (All Categories) eligible
• Minor Children & Non-Earning Majors(PI)
• SA Limits for NMS & NMP are:
– Upto Age 45 : 6 Lacs
– Age 46 to 50 : 4 Lacs
• SA Limits for NMG are:
– Upto Age 45: 5 Lacs
– Age 46 to 50: 2.5 Lacs
• Standard Age Proof is Mandatory
• Refer Spl Reports Chart in the next Slide
 MSB Surgeries
• Its Very Important to know what are
the Surgeries which are allowed in
Arogya Rakshak and the relative
percentage claim. Check on the next
few slides
 List of DCPB Surgeries….
• Let us see what are all the 241
Day Care Procedure Benefits
allowed in Arogya Rakshak in the
next few slides
 General Restrictions
• Waiting Period is 90 Days from date of
commencement of risk. For Accident cases,
no waiting period.
• Benefits to be payable only for
Hospitalization/Surgeries performed in
India
• MSB Claim cannot be entertained for the
Same Surgery once again
 General Restrictions

• Pregnancy & Child birth

• HIV/STD related
• Dental Surgeries
• Physio-related Hospitalization
• Non-Allopathic Treatment & Surgeries
 CASE STUDY 1
DOC : 01-07-2021 AGE : 25 HCB 5000/- Yearly : 10,182/-

Bypass Surgery @ age 41 (16 years from DOC)

This is the 1st claim in his Poicy

Applicable Daily Benefit

HCB @ the end of 12 years Rs.7500
No Claim Bonus on automatic renewal dates @ 4th, 7th, 10th, 13th & 16th year Rs.1250
Total ADB @ 16th year RS.8750

MSB Sum Assured Rs.875000

Hospital Cash benefit for 20 days with 10 days in ICU 8750*10(Normal ward) Rs.87500
17500*10 (in ICU) Rs.175000
Rs.262500

TOTAL CLAIM Rs.1137500

 Reason No.1
• Cost of Medical Treatment is increasing
year-after-year. Any Mediclaim Plan will
not at all be sufficient to manage the total
expenses. Further, Post-Hospitalization
expenses erode our Bank Balance. A Fixed
Benefit Plan like AROGYA RAKSHAK will act
as a Hedge against this & also ensure that
LA’s hard-earned Savings are Protected.
 Reason No.2
• Mediclaim Premium is always increasing
Phenomenally as compared to marginal
increase with us. For Major Surgeries,
AROGYA RAKSHAK is definitely better than
any other MEDICLAIM due to increased
Benefits which is based on A.D.B.
 Reason No.3
• Most of the Clients would NOT have
exhausted 80-D Limit of Rs.25000/-.
This applies specifically to People
employed in Pvt Sector as well as in
Govt. Eventhough they would be
covered in Group Mediclaim, AROGYA
RAKSHAK can be pitched on 80-D angle
also. Twin Purpose of Extra Protection +
Tax Savings would be served by taking
AROGYA RAKSHAK
 Reason No.4
• Overall Life-Time Benefits in AROGYA RAKSHAK is
extraordinary. For instance, if a Client choses
Rs.1000 HCB initially, the Life-Time Benefits touch
around 40 Lacs which is inclusive of HCB, MSB,
DCPB & OSB. Such a Financial Support is
impossible in any other Health Insurance Plan.
 Reason No.5
• Sum Assured in Family Floater
Mediclaim of General Insurance
company is for all LIVES put together.
For instance, if SA is 5 Lacs, then the
Total claim by ALL LIVES in the Floater
cannot exceed 5 Lacs in a year. In
Arogya Rakshak Plan, for every LIFE,
Individual Limits apply so that Every
Insured Life can individually claim HCB,
MSB, DCPB & OSB. Truly a Marvel
indeed in Arogya!
 Reason No.6
• AROGYA RAKSHAK Plan is a Very Good Friend for
AGENTS. If you are covering 6 Lives in a Family
through a Single Jeevan Arogya Policy, it would be
counted as SIX DIFFERENT LIVES by LIC. It will serve
NOT only Agency Month Purpose but extremely
Useful for CLUB MEMBERSHIP too which please note