Introducing LICs New Health Plan Jeevan Arogya 1

Introducing LICs New Health Plan Jeevan Arogya 1

Special Attractions v Maximum Number of days for HCB increased to 720 days v Maximum Number of days for ICU increased to 360 days v No of Surgeries in MSB increased to 140 MSB available for Minors also v Addition of 140 Day Care Procedures (DCPB) v All other Surgeries covered under Other Surgical Benefit (OSB) 2

Special Attractions v Age at entry for PI and Spouse increased to 65 Years v Age at entry for Parents and Parents-in-law is 75 Years v Maximum Health cover for elders - up to 80 Yrs v Premiums are guaranteed for 3 Yrs v Optional Term Rider and Accident Benefit 3

Income Tax Rebate IT Rebate Under Section 80(D) available for Full Premium Paid 4

USP of LICs Jeevan Arogya Comprehensive Family Health plan: Covering entire family consisting of v Husband v Wife v Dependent Children v Dependent Parents of Husband and/or Wife 5

Entry age limits-LICs Jeevan Arogya v Entry Age up to 65 yrs for Husband wife. v Entry Age up to 75 yrs for parents/in-laws v Entry Age from 91 days to 17 years for children Self, Spouse, Parents, in-laws : 80 Yrs v Risk cover Children : 25 Yrs

USP of LICs Jeevan Arogya A novel policy offering Multiple benefits: v Hospital cash benefit (HCB). v Major surgical benefit (MSB) v Day Care Procedure Benefit(DCPB) v Other Surgical Benefit(OSB) 7

USP of LICs Jeevan Arogya Other Benefits: v Premium waiver benefit v Ambulance expenses v Quick cash Advance Payment v No claim bonus v Auto increase in HCB& MSB to take care of inflation with no increase in premium 8

Risk cover under LICs Jeevan Arogya v. Risk cover up to 4 lacs per insured Subject to overall limit of 10 lacs (All our Health Policies put togethor) v Guaranteed renewal after every three yrs

HCB options for each Life v. Rs. 1000/- per Day v. Rs. 2000/- per Day v. Rs. 3000/- per Day v. Rs. 4000/- per Day

HCB limits for each Insured v. P. I As per his/her choice v. Spouse < or = P. I v. Children < or = Spouse / < or = P. I if no spouse v. Parents < or = Insured Spouse

HCB - Benefits at a glance HCB increases by 5% every year Up to 1. 5 times. Eg. Rs 1000/- after 1 Yr becomes Rs. 1050 and in the 11 th Year becomes Rs. 1500/-(Max) v Hospitalization eligibility condition: Fraction of 4 Hours treated as a day First 28 hrs eligible for 1 day benefit First 24 hours No benefit Exception: When hospital stay exceeds continuous period of 6 days and 4 hours, HCB for 7 days (including First day also) will be allowed 12

HCB - Benefits at a glance Annual limit for each insured 1 st policy year 30 days of hospitalization of which 15 days of ICU is allowed. subsequent years Each year- 90 days of hospitalization of which 45 days of ICU is allowed. Maximum limit for each insured during entire policy term 720 days. of which 360 days of ICU allowed 13

Hospital Cash Benefit( HCB) v Fixed per day benefit to cover expenses on the event of hospitalization of insured members for sickness/accidental body injury. v Benefit payout is fixed irrespective of actual expenses incurred. 14

Major Surgical Benefit (MSB) • MSB = (HCB X 100) • MSB risk cover limits do not include MSB of Plan 901 & 902 15

Major Surgical Benefit(MSB) v A percentage of sum assured is paid in the event of insured members undergoing specified surgeries. v Benefit is fixed irrespective of actual expenses incurred. Advantageous to the insured members v MSB is available to all the insured including children for all ages 16

MSB- Benefits at a glance v MSB allowed for 140 surgical procedures Annual Limit 100 times of HCB in a policy year (Min 1 Lac) Life time Limit 800 times of HCB during entire policy term (Min 8 Lacs) 17

Premium waiver benefit In the event of any insured undergoing major surgery under category I or 2 premium payable for one year from the next premium due date coinciding or following the date of surgery is waived 18

Day care procedure benefit(DCPB) DCPB = 5 X HCB • 140 Listed day care procedures • 3 Day care Procedures per year • 24 Day care Procedures in Policy Life time 19

Other surgical benefit(OSB) OSB = 2 x HCB v Any surgery other than MSB, DCPB surgeries v At least 24 hours stay in Hospital is required v Annual limit : 15 days in First policy year 45 days in each subsequent years v Life time limit : 360 days per insured 20

Term Assurance Benefit Rider Ø Minimum Term Assurance SA : Rs. 1, 000 Ø Maximum Term Assurance SA : Equal to initial MSB-SA (i. e. , 100 X HCB ) Ø Term Assurance SA - in multiples of Rs. 25000/Minimum Entry Age 18 Yrs completed Maximum Entry Age 50 Yrs (NBD) Maximum age for cover 60 Yrs (NBD) Maximum Term 35 Years 21

Accident Benefit Rider This benefit is available only if Term Assurance Benefit rider is opted Ø Minimum Benefit : Rs. 25, 000 Ø Maximum Benefit : Equal to initial MSB-SA ( i. e. , 100 X HCB) Ø AB Sum Assured shall be in multiples of Rs. 5000/Minimum Entry Age 18 Yrs completed Maximum Entry Age 50 Yrs completed Maximum age for cover 60 Yrs completed Maximum Term 35 Years 22

Quick cash facility v Advance amount to PI v Cat I or Cat II Surgeries v Hospitalized in a ‘Net work’ Hospital v PI/relative informs LIC/TPA v TPA processes request/advices LIC on payment v LIC credits eligible amount to PI Bank account 23

Ambulance charges v Rs. 1000/- reimbursed per insured towards Ambulance charges v Ambulance charges incurred for transportation of the insured to undergo Major Surgeries under category 1 or 2 24

No claim Benefit v During the period between two automatic renewal dates or From DOC to next Automatic renewal date, if there are no claims in respect of any insured, No claim Benefit is payable v No claim benefit would be equal to 5% of initial Daily Benefit v Effective from the immediately following automatic renewal date 25

USP of LICs Jeevan Arogya Ø Premium rate may be reviewed for every 3 years Ø If revised, the new rate corresponding to the age at entry of each insured will be the new premium 26

USP of LICs Jeevan Arogya Example PI takes a Policy in 2011 Age of PI in 2011 = 36 If premium revised in 2014 The new premium rate of PI will be the revised premium corresponding to age 36 in the new table. 27

Rebates available on Tabular premiums Mode Rebate Hly 1% Rebate for HCB Opted 2000 HCB 3000 HCB 4000 HCB PI PI PI Yly 2% others Rs. 500 Rs. 250 Rs. 1000 others Rs. 500 Rs. 1500 Rs. 750 28

Addition of members Condition When to include The cover starts from Marriage/remarriage of the Principal Insured after DOC Within 1 Year from the date of marriage A Child born or Legally adopted child after DOC Health Cover starts from the policy anniversary falling immediately after the child completes 3 months Legally adopted child is more than 3 months old From the policy anniversary falling after date of adoption The following policy anniversary New members must be included by the Principal Insured only. No new members will be allowed after the death of the principal insured. 29

USP of LICs Jeevan Arogya v Addition of newly eligible members during the currency of the policy. v Fixed Benefit scheme: Benefit paid as opted irrespective of actual expenses for hospitalization and Surgeries v Benefits are payable independent of payments received through mediclaim or any other health schemes. 30

The policy lapses… v When premium is not paid within days of grace, the policy lapses and no benefits will be payable there after. v Policy can be revived within 2 years from the date of first unpaid premium subject to payment of outstanding premiums with interest and underwriting. 31

The waiting Period for availing the benefits………………. v 0 days for accident claims v 90 days from the Date of Commencement for HCB & MSB v 45 days after revival, if revived within 90 days from FUP of the policy. for Hospital Cash Benefit and Major Surgical Benefit 32

Things to remember: • Since it is purely MEDICAL INSURANCE plan and premium does not have any saving element hence there is no maturity claim • No Death claim under basic plan. • Loan, surrender, assignment- n. a. • Mode of payment- Yly, Hly, Mly(ECS only)

Underwriting NM(S) Age n. b. d Upto 45 yrs 46 to 50 SUC 5 LAC 4 LAC Age n. b. d UPTO 35 yrs 36 to 50 SUC 5 LAC 2 LAC NM(G)

Sample Benefit Illustration – for HCB 1000 Max. eligible 1 st Pol Year (Rs) 2 nd Pol Year (Rs) Hospital Cash Benefit (HCB) including ICU Benefit 45, 000 1, 41, 750 16, 20, 000 Major Surgical Benefit (MSB) 1, 000 1, 05, 000 12, 000 Other Surgeries Benefit (OSB) 30, 000 94, 500 10, 80, 000 Day Care Procedure Benefit (DCPB) 15, 000 15, 750 1, 80, 000 Nature of Benefit Maximum Benefit under the policy per insured Ambulance Charges incurred Premium Waiver Benefit No Claim Benefit During the Policy term (Rs) 40, 80, 000 Rs. 1000/- per insured per year One Year Premium Increase in HCB by 5% 35

Benefit comparision with ICICI prudential Hospital care II Benefits during the policy term for a HCB of Rs. 2000/Benefit Daily Hospital Cash Benefit (including. ICU benefit) Major Surgical Benefit Day care surgical Benefit Non surgical benefit Recuperative benefit LIC 90, 000 1 st yr 2, 83, 500 2 nd Yr 80, 000 to 2 lacs 30, 000 1 st yr 60, 000 1 st yr 1, 89, 000 2 nd yr --- Prolonged stay benefit -- Health check up benefit -- Other surgical Benefit ICICI 1, 80, 000/year 20, 000 to 3 lacs ----2000/day (Max 8000) 6000 2000/day after 30 days of Hospital stay 4000(Total for all insured in the pol term) 36

Benefit comparision with ICICI prudential Hospital care II Benefits during the policy term for a HCB of Rs. 2000/Benefit Max per annum Benefits in the policy term Ambulance charges(extra) Additional Benefits LIC 3, 61, 000 1 st yr 6, 84, 000 2 nd Yr ICICI 8, 000 68, 000 40, 000 1000/member/yr --- PWB, AB rider, Death Benefit No such facilities rider 37

THANK YOU 38