LIC‘s Arogya Rakshak – Plan No 906 – is a Regular Premium fixed benefit health insurance plan which can help you financially to tide over the difficult situations arising from hospitalization and various surgical procedures. The main point to remember is that the benefits provided are independent of the actual expenses incurred for the treatment. Actually, the new plan is an improved version of LIC’s Jeevan Arogya with enhanced coverage and more benefits to boast off.
An individual can take coverage for himself/herself in this plan and will be addressed as Principal Insured (PI). Principal insured can add spouse, children, or parents to the plan at the time of joining.
Major benefits of Arogya Rakshak – plan 906
Arogya Rakshak -Major Inbuilt Benefits
- Hospital Cash Benefit (HCB)
- Major Surgical Benefit(MSB)
- Day Care Procedure Benefit(DCB)
- Other Surgical Benefit(OSB)
- Medical Management Benefit(MMB)
- Extended Hospitalization Benefit(EHB)
Other Benefits and Riders
- Auto Step Up Benefit
- No Claim Benefit
- Health Check Up benefit
- Auto Health Cover Benefit (AHC)
- Term Assurance Rider
- Accident benefit Rider
Eligibility conditions and restrictions
|Eligibility Conditions and Restrictions|
|Condition||Principal Insured||Insured Spouse/Parents||Insured Children|
|Minimum age at entry||18 Years (Last Birth Day)||18 Years (Last Birth Day)||91 days Completed|
|Maximum age at entry||65 Years (Last Birth Day)||65 Years (Last Birth Day)||20 Years (Last Birth Day)|
|Cover ceasing age||80 Years (Last Birth Day)||80Years (Last Birth Day) and 70 Years (for AHC)||25 Years (Last Birth Day)|
|Minimum Initial Daily Benefit||Rs 2,500||Rs 2,500||Rs 2,500|
|Maximum Initial Daily Benefit||Rs 10,000||Less than or equal to PI||Less than or equal to insured spouse (if no spouse <=PI)|
|Cover period||80- (age at entry)||70-(age at entry for AHC) else 80 -(age at entry)||25 – (age at entry)|
Let us have a detailed look at the benefit pattern and the key features of the plan.
Hospital Cash Benefit (HCB) – Arogya Rakshak
In the event of hospitalization, resulting from a bodily injury or sickness occurring during the coverage period, and exceeding a minimum period of 24 hours, Hospital Cash Benefit (HCB) will become payable. Period exceeding 24 hours will be reckoned as one day if the period exceeds by at least 4 hours.
- Hospitalization in General or Special ward – Applicable daily benefits in a policy year for each completed 24 hours and the part exceeding 4 hours as mentioned above will become payable.
- Hospitalization in Intensive Care Unit – Two times the Applicable Daily Benefit in a policy year as detailed above shall become payable.
- Combined stay in Non ICU and ICU – Amount will be paid as per the days admitted in each unit.
Special conditions and restrictions
- Hospital Cash benefit (HCB) applies only if hospitalization occurs in India
- Total number of days of HCB payable in the first policy year is restricted to 30 days.
- Total number of days of HCB payable in subsequent policy yeas is restricted to 90 days.
- Total number of days of HCB payable in the entire policy term cannot exceed 900 days
Major Surgical Benefit (MSB) – Arogya Rakshak
If an insured member undergoes a surgery specified in the list provided, during the policy period and arising due to a condition that occurred during the coverage period, a portion of the Major surgical benefit (100 times of HCB) shall become payable. The percentage of the benefits payable varies depending on the category of the surgery as mentioned in the list provided here. You can view or download the list of surgeries covered under Major Surgical Benefit under LIC’s Arogya Rakshak plan by clicking on the link provided.
Special conditions and restrictions
- Surgery should be performed in India.
- If more than one surgery is performed on the insured during the same surgical session, amount allowed for the most severe surgery shall be paid.
- Total MSB payable in any policy year cannot exeed 100 % of the Major Surgical Benefit applicable for that policy year.
- Total MSB paid in the entire policy period cannot exceed 1000 % of MSB for any insured member.
- All surgical procedures claimed should be confirmed as essential and required by a qualified physician or a surgeon to the satisfaction of the corporation.
In addition to the surgical benefits, some other additional benefits are available under the Major Surgical Benefits.
- Ambulance Benefit – An additional lumpsum payment of Rs.1000 shall be paid if transportation by ambulance become necessary.
- Premium Waiver Benefit – In the event that a Major Surgical Benefit falling under category 1 or Category 2 (as mentioned in the MSB List) is payable in respect of any insured, the total annualized premium following the claim will be waived. Even if more than one surgery is performed in a year, one annualized premium only will be waived.
- Major Surgical Benefit Restoration – In the event of Major Surgical Benefit Sum Assured is exhausted in a policy year, additional major surgical benefit may be avaible if the second MSB surgery is from a different category or procedure and the subsequent claim does not arise from or due to the previous claim.
Day Care Procedure – Arogya Rakshak
In the event of an insured, due to medical necessity undergoing any specified Day Care Procedure as mentioned in the Arogya Rakshak – Daycare procedure benefit annexure, during the policy term, a lumpsum amount equal to five times Applicable Daily Cash benefit shall become payable.
- Day care benefit shall be paid only if the procedure is performed in India.
- Maximum DCP allowed in any policy year for a particular insured member cannot exceed three.
- Maximum DCP allowed in the entire policy term for a prticular insured member cannot exceed thirty.
Other Surgical Benefit – Arogya Rakshak
In the event of an insured undergoing within the cover period, any surgery not listed under the Major Surgical Benefit or Day Care Procedure Benefit, a daily benefit equal to 2.5 times the Applicable Daily Benefit shall be payable. Other surgical benefits shall be paid only if inpatient hospitalization stay exceeds 24 hours.
- The total number of days of hospitalization for which the Other Surgical Benefit is payable during the first policy year in respect of each insured member cannot exceed 15 days and for subsequent years, 45 days.
- Total number of days of hospitalization in the entire policy term cannot exceed 450 days for a particular insured member.
Medical Management Benefit
In the event of an insured undergoing inpatient hospitalization within the cover period due to any of the following diseases,
- pulmonary tuberculosis
- Viral Hepatitis A
A lump sum of 2.5 times of applicable daily benefit shall be payable.
Extended Hospitalization Benefit
In the event of an insured undergoing a single period of continuous inpatient hospitalization, in excess of 30 days, within the cover period due to accidental bodily injury or sickness, a lump sum of 10 times the applicable daily benefit shall be paid in addition to other benefits. In respect of each insured, the extended hospitalization benefit shall be payable only once in a policy year. The total claim in the entire policy term is limited to 10 claims per insured person.
Auto Step Up Benefit
An amount equal to 15% of the Initial Daily Benefit shall be added to the Applicable Daily Benefit of the previous policy year at the end of every third policy anniversary during the Cover Period and shall continue to be added until Applicable Daily Benefit attains a maximum amount of 1.5 times the Initial Daily Benefit.
In case of all the insured(s) covered under the policy join at the inception of the policy, the date on which Auto Step Up Benefit is effected in respect of each member may be the same but if the members joined at a different point of time, the third policy anniversaries will be taken in respective cases.
No Claim Benefit
In the event of every three claim-free policy years, in an Arogya Rakshak policy, an amount equal to 5 % of the initial daily cash benefit shall be added to the Applicable Daily Cash Benefit at the end of the third claim-free policy year. The point to remember is that claim-free policy years are taken considering the policy as a whole.
Health Check-up Benefit
An amount equal to the actual expenses incurred but not exceeding half of Applicable Daily Benefit shall be payable in respect of each insured towards health check-up expenses once in every three policy years, provided he/she undergoes Health Check-up and shares a copy of the medical report and the medical bills.
Auto Health Cover(AHC) Benefit
In case of the death of the Original Principal insured, the policy shall continue with new PI along with other eligible surviving insured(s) covered under the policy, without any payment of premium from the policy anniversary coinciding with or next following the date of death of the Principal Insured, for a further period fo 15 years or up to specified age in respect of each of the insured(s) whichever is earlier. provided they are eligible for this AHC benefit.
The period of AHC benefit shall be applicable in respect of each eligible member for the period as mentioned below.
- For Insured Children: AHC period shall be a period of 15 years or till the policy anniversary on which the insured child is 25 years, which ever is earlier.
- For Insured Spouse /Insured Parents: AHC Period shall be a period of 15 years or till the policy anniversary on which the age of the insured Spouse/Parents is 70 Years, which ever is earlier.
Note: AHC benefit will not be applicable if the PI commits suicide within any time within 12 months from the Effective date of Cover or within 12 months from the date of revival.
Anish L J is a ‘Financial Planner’ and member of Chartered Insurance Institute(CII), London and Insurance Institute of India. He is also a finance, insurance and software consultant. He thoroughly follows the developments in finance, insurance, and other related sectors.