The Life Insurance Corporation of India (LIC) has launched a new health insurance policy by the name of LIC Jeevan Arogya. LIC laments that in these days of exorbitant health-care costs, you should be armed with a health insurance policy so that your goal based investing approach to making money is not affected. That is honest good advice.
But is this new policy a good buy if you are looking to shop for a health insurance policy ? Does it fit well in your overall financial planning ?
With so many insurance companies offering so many products, are you scratching your head to make a decision ?
Read on the the LIC Jeevan Arogya review.
Introduction
LIC Jeevan Arogya is a non-linked health insurance plan that offers comprehensive hospitalization benefits for the whole family.
This is a defined benefit health insurance policy – what that means is that benefits are fixed in terms of policy conditions and are payable irrespective of the actual amount spent on treatment.
The policy is essentially a Hospital Cash Benefit Product with additional lumpsum benefits for surgeries.
Salient Features
1. All in a family can be covered under the same policy. So the principal insured (PI), the spouse, children, parents, parents of your spouse can be covered under the same policy.
2. Health benefit for all surgeries is covered (expect those that are excluded).
3. Offers health cover up-to age 80 years for major family members and up-to age 25 for minor children. Life insurance cover and accident benefit is covered up-to 60 years of age.
4. Provision to add or remove eligible family members in case of any change in family dynamics.
5. Benefits are payable irrespective of the life insured getting reimbursement from any other insurance company. Certified photocopies of original bills are needed for the same.
6. You can make premium payments Monthly, Quarterly, Semi Annually or Annually. This is unlike most Mediclaim products where payment modes are mostly annual.
What is covered ?
Following are some of the benefits available.
Daily Hospital Cash Benefit (HCB) : HCB is a benefit for the number of days of hospitalization. This is same as Initial Daily Benefit – the amount of money you will receive per day in case of hospitalization. This depends on your needs.
As of now, the offerings are Rs 1000, Rs 2000, Rs 3000, Rs 4000 per day.
Major Surgical Benefit : An additional lumpsum benefit called the Major Surgical Benefit for major listed surgeries for a maximum limit of 100 times the Initial Daily Benefit. This translates into a handsome coverage of 1 lakh to 4 lakhs for the major listed surgeries.
What this means is that if you get operated for any listed surgery, the Major Surgical Benefit amount for which you are eligible will be paid out to you.
To take an example, if you have taken an Initial Daily Benefit of Rs 3000/- , you stand to receive Rs 300,000/- (100 times the Initial Daily Benefit) irrespective of what the actual expenditure is.
| Initial Daily Benefit (Rs) | Major Surgical Benefit (Rs) |
| 1,000 | 100,000 |
| 2,000 | 200,000 |
| 3,000 | 300,000 |
| 4,000 | 400,000 |
Day Care Procedure Benefit : An additional lumpsum benefit for all listed Day Care Procedures at 5 times the Daily Hospital Cash Limit is available.
What this means is that if you go under the knife for listed procedures, a lump sum amount equal to 5 (five) times the Initial Daily Benefit shall be paid, regardless of the actual costs incurred.
To take an example, if you have taken an Initial Daily Benefit of Rs 3000/- , you stand to receive Rs 15,000/- (5 times the Initial Daily Benefit) irrespective of what the actual expenditure is.
What this also means is that the maximum benefit is Rs 20,000/- (5 times Rs 4,000/-) for the Day Care Procedures.
Other Surgical Benefit : An additional benefit for Other Surgeries (Not Listed ones) is also provided at 2 times the daily benefit, per hospitalization day per insured but subject to maximum 360 days.
To sum up, this policy provides :
- Daily hospital cash benefit of Rs 1000, Rs 2000, Rs 3000, Rs 4000 per day.
- An additional lumpsum benefit for listed major surgeries for a maximum limit of 100 times the Initial Daily Benefit.
- An additional lumpsum benefit for all listed Day Care Procedures at 5 times of the Initial Daily Benefit.
- An additional benefit for Other Surgeries (Not Listed ones) are covered by providing 2 times of the Initial Daily Benefit, per hospitalization day.
- LIC Jeevan Arogya covers majorly all surgeries. Around 140 major surgeries are covered under Major Surgical Benefit, another 140 surgeries which do not need overnight hospitalization are covered under Day Care Procedure Benefit and all other surgeries are covered under special category of Other Surgical Benefit.
Other benefits
Apart from the above, the following benefits have been thrown in.
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In case of 57 major illnesses, quick cash facility is available as advance, subject to 50% of entitlement.
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In case of no claim for the first three years, the benefits will be enhanced by 5% to the Initial Daily Benefit.
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The benefits will increase 5% every year up-to a maximum of 1.5 times the original benefit given the rising health-care costs every year. This essentially is the renewal bonus.
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Term Assurance rider is up-to 100 times Initial Daily Benefit.
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Accident benefit rider is also available where the sum assured offered should be less than or equal to sum assured under Term Assurance rider.
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In event of a claim for a Major Surgical Benefit, the premium waiver feature in the product would waive the subsequent one year’s annual premium.
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Ambulance benefit of Rs 1000/- is available in case of 50 major surgeries.
Who can be insured ?
The minimum and maximum age at entry are as follows :
| Minimum age at entry | Maximum age at entry | |
| Self / spouse | 18 years | 65 years (last birthday) |
| Parents / parents-in-law | 18 years | 75 (last birthday) |
| Children | 91 days | 17 years (last birthday) |
Exclusions
The following are not covered under LIC Jeevan Arogya. Exclusions is one of the most important parameter when choosing a health insurance policy. So make sure you understand this clearly before signing up for the plan.
- Any Pre-existing Condition unless disclosed to and accepted by LIC.
- Any treatment or surgery not performed by a Physician/Surgeon.
- Any routine or prescribed medical check up or examination.
- Medical expenses relating to any treatment primarily for diagnostic, X-ray or laboratory examinations.
- Any epidemic.
- Circumcision, cosmetic or plastic surgery.
- Hospitalization or Surgery for donation of an organ.
- Treatment for correction of birth defects or congenital anomalies.
- Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
- Nervous breakdown, sterilization or infertility.
- Attempted suicide and/or the use or misuse of any drugs or alcohol.
- Any sexually transmitted diseases, AIDS, HIV.
- Pregnancy and childbirth related.
- War, invasion.
- Naval or military operations.
- Any natural peril.
- Participation in any hazardous activity or sports, criminal or illegal activities.
- Radioactive contamination.
Tax Benefits
This plan offers tax benefits for the premiums that you pay as a deduction from the taxable income under section 80D of the Income Tax Act.
Should you buy LIC Jeevan Arogya – our view !
In a world where general insurance companies were offering health insurance policies in abundance, we could have done without another one and that too from a life insurance company.
The first thing that catches your eye is that under this policy, the maximum benefit is limited to Rs 4 lakhs. If you are looking at a long term arrangement with your favourite life insurer, then this might look a tad lower given the rising health-care costs of India of 25% per annum.
Whatever happened to pre existing illnesses ? If this is not covered for life, why buy ? To top it, there is no cashless network available either.
The policy is ridden with hidden wordings you are bound to miss if you do not read the policy wordings yourself- for example, the Daily Hospital Cash Benefit has limitations on it in the first year; the Major Surgical Benefit can be claimed once in one year and Day Care Procedure Benefit for three in a year. There are limitations on the term insurance and accidental benefit rider as well.
An ordinary investor needs to be a doctor, a statistician and a magician to buy Jeevan Arogya from LIC.
Personal finance is a very simple exercise, our product providers need to keep things simple.
This is no doubt the only policy of its kind with so many benefits thrown in but if those benefits have limitations, which is the case with LIC Jeevan Arogya, then the purpose of the product is defeated. You could rather go for a standard health insurance product where the limitations are less and the coverage is more. Imagine you have a large claim but it falls under Other Surgeries (Not Listed ones) where there is a cap on reimbursement. You would be at a disadvantage in such cases.
To sum up, while the new policy from LIC is a great policy to market and sell, it might not be the first right one to buy. If this is an add on policy for you, then go for it. If this is the first policy for you, think once, think twice.
Disclaimer :
The views expressed are those of the author and are not meant to influence any buying decisions. Investors are expected to take the decision of buying any health insurance policy after reading the policy wordings carefully.
I agree. It become very confusing for me to buy with so many policies around.
I dont think most of the customers read the policy wordings and if they are so complicated, then who will understand ?
I think I will not buy this plicy.
@Lokesh,
In my opinion the onus should be on the provider to simplify the jargon of the policy wordings so that the customer can understand this in a bdetter way.
Right now, most of these policies are sold rather than bought.
Which health insurance policy do you have ?
@Lokesh,
Hi Lokesh , Plz feel free to call me on my cell – 9769617690
i want to have jeevan arogya policy for my mother(66yrs age),father(71 yrs),myself(34 yrs),wife(31yrs),child(3.2yrs) for tenure of 15 yrs.what premium we have to pay
@sudhir swarnkar, Hey, please check the website or with your local LIC agent for the premium.
You can call me on 9820513307
I LIKED THIS PLAN BCOSE IT MAKES ME FREE OF A TIDIOUS PAPER FORMALITIES’BILLS’ VOUCHERS ETC.
Hello Radhey, thank you for sharing your thoughts on the LIC Jeevan Arogya health insurance policy. It was very helpful, very well written, easy to understand and thought provoking for a common insurance policy buyer. I had a few questions I’d like to ask, as I am planning to buy a policy for my mum who is 61 yrs.
Q1: What is the meaning of a non-linked health insurance plan?
Q2: In Salient Features-“Benefits are payable irrespective of the life insured getting reimbursement from any other insurance company. Certified photocopies of original bills are needed for the same”.
– Do you mean if I have 2 policies from 2 different insurance providers, I can claim from both of them?
If u’d be willing to share your email id, I’d like to ask a few more questions, as I am thoroughly confused & all the sales reps. try to brain wash you and I’m not sure which a good policy for my requirement.
Best regards,
Mr.Fernandes
@Mr.A Fernandes, I am not sure this is the right policy for 61 year old. You might be better off with a pure mediclaim policy.
Ans to Q2 is yes.
I will find reconfirm ans to Q1 and let you know though I think I know.
Sir, my employer is providing family floater of 5 lakh including parents. I searched online but could not find a suitable policy as my father is 68. Now i have got jeevan arogya where my fater can be insured. Plese tell me is this policy can be considered as family floater? will i be able to reimbush the premium paid from my employer by convincing them it as family floater?
@N Khanikar, I do not understand your question here – what is it that you are trying to do ? Note that you should take this policy as a add on to a basic mediclaim policy. So you should ideally have a mediclaim policy and then look at this.
Hi Radhey Sir,
Thanks for the information.
Could you please let me know what is Day Care Procedure and when we can use the Day Care Procedure benfit. If possible plz give some example.
@Stalin, Day care procedure are meant for reimbursement of expenses on hospitalization for minimum period of 24 hours.
The scope is limited to some precedures which you need to check with the insurance companies as I think, they could differ, though only slightly.
Can you please also suggest a mediclaim for my mother and parent in-laws.
Myself and My wife both are working but the mediclaim policy offered from our companies seems very costly and also we will lost them once we leave/change the company so we want to take some private mediclaim policies for our parents.
Then we would like to take jeevan arogya as secondary as you suggested. but i think the max limit in 80D is 20,000.
Please suggest me.
@Stalin, What is the current cover they have from the company and how much you paying as premium ? The max limit you are talking about is the premium that will be eligible for tax deductions – its not the maximum limit of health insurance one can take.
Hi , Plz feel free to call me on my cell – 9769617690
@Malan,
What are you trying to communicate? Call U for what?
i know that this policy nessecry to medical report to family member
@Jayesh,
Don’t fall into trap to buy such junk policies, Instead buy term plans.
I would like to know if jeevan arogya is a good policy for self and wife, we are covered under ECHS and this would be an add on policy.
if the yrly premium is Rs 25000/- can both the persons insured claim IT deduction of say Rs 25000/- and Rs 10000/- together?
Pl indicate if there are any Fine Print Issues?
sanjay
Avoid. What did you mean by ECHS ?
ECHS is ex servicemen contributory health scheme, something similar to CGHS, meant for defence services retired persons.
sanjay
why dental tretment is not covered by health insurance ? IS it not an health issue? if one has dental problems whole body is affected aswell as any other problem. cosmetic surgery is understood..
sanjay
Good question, never thought of that, let me check it out.
Sir,
My wife recently went for lumpectomy.I have taken the JeevanArgoya Policy in the year 2011 December.Can I claim for the amount.She underwent surgery in october 19th 2012.
I am not sure, you will need to check with your agent. If she was hospitalized then yes, it should be paid out. But you better check it out first.
@Supratik,
Please contact the agent who sold you this policy, he will be in a better position to assist you.
I don’t think treatment of cancer is covered where no surgery required but chemo and radiotherapy required which is not covered.
veecing decease is allowed a jeevan argoya policy or Not ?
Dear sir,
pls. suggest me any beneficial mediclaim policy for my whole family. Myself 35 year, wife 32 years, daughter 8 years and son 3 years . right now i have no mediclaim policy and want to buy best suitable policy with lower premium.
just thinking about Jivan Argoya of LIC or suggest any other option.
Dear Sunil Kadam
Based on your budget go for Optima or Comprehensive policy from Star Health.
Among public sector think of New India Floater Plans.
If living in Metro, go for Rs. 5 Lacs sum assured.
I want health policy for my whole family (husband and 2 children) with low primium.i dont have heallth policy uptil now.which wil be the best
1. Jeevan Arogya is supplementary to Mediclaim policy.
2. The claims are not linked to hospital expenses
3. Claims are settled on basis of copies of bills submitted to Mediclaim
4. Hospital Cash Benefit increases every year by 5% upto max of Rs. 6000
5. Major Surgical Benefit is also linked to Hospital Cash Benefit
6. No Claim Benefit is given every three years.
If above points are taken into consideration, some time spent in analysing with unbiased mind, this is a great product to have in your portfolio. I have sold this product to Surgeons who have loved the features.
Warm regards
Shreeniwas P. Gadiyar
Agent -LIC of India
My policy is jeevan aro gya (903). Is this policy cover mutanity and this policy is cashless or not?
everyone, pls think atleast 1000 times before buying this LIC jeevan arogya policy and take every point in writing before buying.
In my case they only given 2000 rs for bed charges and nothing else, that also after 5 months … after continuous follow up they said that this policy only gives bed charges and its not a medicliam or health policy … my suggestion think more than 1000 times and get all clarifications in writing before buying and if you are only satisfied with bed charges, thats it
LIC Jeevan Arogya. It is a fixed benefit policy. It is not linked to bed charges or any other actual expenses. The calculation is based on Hospital Cash Benefit (HCB) which can be Rs. 1000 to Rs. 4000 per day. Major Surgical Benefit is 100 times of HCB. It is an international award winner product.
you may be right i am not denying.
Instead i want to make aware of all to what has happened with me and what i had faced after paying premium to jeevan arogya policy from last 5 years.
LIC people at greivance cell at hyderabad confirmed me on phone that this is neither a health insurance policy nor a mediclaim policy, its just a substitute.
my hospitalisation claim was 2.5 lacs and i got only 28000 stating on phone that its just the bed charges which we reimburse and nothing else is to be paid. also no one dare to reply on mails and no written communication is there on settlement even after 1 month now, actually they hardly reply on mails at all
i still suggest to everyone, before taking this LIC jeevan arogya policy, pls read each and every word in the policy document carefully and take written clarification from LIC otherwise you will also get only bed charges like me
This is what happens when one purchases a product without understanding features properly. I repeat one more and the last time, there is no concept of bed charges in LIC Jeevan Arogya. It is a fixed benefits policy. Anyone wanting to understand this product can meet me in Mumbai by prior appointment on 9833570575. I will be glad to explain.
Dear Mr Shreeniwas ,
Instead of denying someone’s statement, u must also listen and understand things, may be u also will get some learning out it . Well i dont want to prove anything but just to make people aware of it.
This policy LIC jeevan arogya i taken 5 years back and put the claim on may 2015 which got settle on october 2015. i got 28k out of 2.5lac.
You tell me which health policy deny the ICU charges, medicine charges, doctor charges, pathology charges, MRI and CT scan charges and so on …. none of these charges are been paid to me … then on which basis shall i speak more …
As been rightly said by you, the daily cash benefit of only 2200 has been passed and nothing else.
what is the meaning of a health policy which doesnt reimburse the cost of even a single tablet. … strange that still u saying its the right one
if u r marketing this policy so hard then come forward and help me to fight for the right
Dear Rahul and others
Please read my earlier reply dated 29th March 2015 in this series.
1. Jeevan Arogya is supplementary to Mediclaim policy.
2. The claims are not linked to hospital expenses
Please note that there is Hospital Cash Benefit which you have received.
There are then Major Surgical Benefits covering 140 listed diseases. There are also another 140 diseases which are covered under Day Care Procedure Benefits.
Was not yours covered in any of these?
Can you please elaborate what was your claim for and under what reason was it rejected.
If in Mumbai, I am always available for personal meeting.
Warm regards
SPG
Dear Mr. SPG, thanks for your post.
Well thats the first line where my fight begins – “Supplement to health policy “.
My dad wad hospitalised for pneumonia and chest congestion for 13 days. out of which almost 11 days he was in ICU and also was on ventilator for almost 4 days when situation was not in control.
I had fight very hard with LIC guys for almost 5 months to get my claim processed. They dont even reply on mails even when the top most persons are also been marked in mail. The hospital bill including icu charges, ventitalor charges, daily pathology charges, daily doctor visits , MRI/ CT scan was 2.5 lacs. After fighting for more than 5 months what i got was 28600. Their calculation was 2200*13 days, as daily cash benefit. Even the ICU bed charges are double of it.
There is no reason from LIC side as hardly anyone knows there about this policy, secondly when i called to their hyderabad greivance cell then they said “in this policy we only give daily cash benefit of 2200 and nothing else, if your agent has told you someting else then its false, this policy only and only gives daily cash benefit and nothing else and this is neither and health policy nor a mediclaim policy”
From last 5 years i am paying premium of 20k and now i got only 28000.
Sir, if this is a supplement of health policy and day care procedure charges are linked to it …… then daily medicines /doctor visits/pathology tests/daily ICU charges should be covered in this …. but LIC clearly denied all these
that is the reason i am making all aware of the time i face with the stubborn behaviour when we ask the status. I am not telling anyone – not to buy it but i am only making everyone aware to think atleast 100 times and to take every small clarifications before buying it
I will surely call u up on ur mobile for further discussion and if you can help me in any way, thanks
Can i use this LIC Jeevan Arogya for maternity coverage, if yes please tell me the process
Dear Rama,
LIC Jeevan Arogya policy aim is to cover day care procedures and to cover various surgeries. For maternity benefit it is better to go with a family mediclaim policy. If you already have one, look for maternity option or if you are not covered try Apollo Munich Easy Health Exclusive Plan.