ntroductions :
Health has been a major concern on everybody’s mind,
including yours. In these days of skyrocketing medical expenses, when a
family member is ill, it is a traumatic time for the rest of the family.
As a caring person, you do not want to let any unfortunate incident to
affect your plans for you and your family. So why let any medical
emergencies shatter your peace of mind.
LIC has launched LIC’s Jeevan
Arogya, a unique non-linked Health Insurance plan which provides health
insurance cover against certain specified health risks and provides you
with timely support in case of medical emergencies and helps you and
your family remain financially independent in difficult times.
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
Very easy to choose your plan
Step 1 Choose the level of Health cover you need
Step 2 Work out the premium payable along with our Representative
Step 1: Choose the level of Health cover you need:
You can choose the amount of
Initial Daily Benefit (i.e. the daily Hospital Cash Benefit applicable
in the first year of the policy) as per your need from out of the
following choices:
` 1000 per day ` 2000 per day ` 3000 per day ` 4000 per day
This is the amount that will be
payable to you in the event of hospitalisation in the first year on a
per day basis. The Major Surgical Benefit that you will be covered for
will be 100 times the Initial Daily Benefit you have chosen. Thus the
initial Major Surgical Benefit Sum Assured will be `
1 lakh, 2 lakh, 3 lakh, 4 lakh respectively. Other benefits such as Day
Care Procedure Benefit, Other Surgical Benefit and Premium waiver
Benefit (PWB) mentioned below shall also be payable depending upon the
daily Hospital Cash Benefit chosen.
Step 2: Work out the premium payable along with our representative
Your premium will depend on your
age, gender, the Health cover option you have chosen, whether you are
Principal Insured or other insured life and the mode of payment.
Tables below give an indicative
annual premium, payable yearly, for all health benefits corresponding to
an Initial Daily Benefit of ` 1000 per day, for some of the ages in respect of various lives that can be covered under a single policy:
PRINCIPAL INSURED (Male)
| Age at entry |
Premium (`)
|
20
|
1922.65
|
30
|
2242.90
|
40
|
2799.70
|
50
|
3768.00
|
SPOUSE (Female) / PARENT (of PI/Spouse) (Female)
| Age at entry |
Premium (`)
|
20
|
1393.15
|
30
|
1730.65
|
40
|
2240.60
|
50
|
2849.10
|
CHILD
| Age at entry |
Premium (`)
|
0
|
792.00
|
5
|
794.75
|
10
|
812.35
|
15
|
870.75
|
Who can be insured?
You (as Principal Insured (PI)),
your spouse, your children, your parents and parents of your spouse can
all be insured under one policy. Quite a relief isn’t it, to have all
insured under one policy!
The minimum and maximum age at entry is as under:
|
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) |
How long are each insured under this policy?
Each of the insured are covered
for Health risks up to age (80). Children are insured up to age 25
years.
1. Payment of Premiums:
You may pay premiums regularly at yearly, half-yearly, quarterly or
monthly (ECS mode only) intervals over the term of the policy.
The premium in respect of each
individual will be payable from the date of entry into the policy till
the date of exit from the policy and will depend on the age of the
insured member, the level of Hospital Cash Benefit (HCB) chosen, whether
the insured member is Principal Insured or any other Insured life (in
case of cover for more than one member in a policy). The level of
premium for Principal Insured and the other insured members shall be
different for the same age and same level of cover.
The premiums are guaranteed for
3 years from the date of commencement of policy. Thereafter i.e. at the
end of every 3 years, the Corporation reserves the right to review the
premium to take account of the experience of the portfolio subject to
prior approval from IRDA. The rates applicable on every Automatic
Renewal Date shall be guaranteed for a further period of 3 years i.e.
till next Automatic Renewal Date.
The premium rates in respect of
each insured member on renewal will be based on age of that member at
the time of inclusion into the policy.
The total premium to be charged for a policy will be the sum of premiums in respect of each member to be covered in that policy.
2. Mode and High HCB Rebates:
Mode Rebate:
Yearly mode : 2% of tabular premium
Half-yearly mode : 1% of the tabular premium
HCB Rebates:
In respect of a member covered under a policy, if HCB is more than ` 1000, then the premium arrived at in respect of that member shall be reduced by an amount (`) given below:
HCB (`) For PI For each insured member
other than PI
2000 500 250
3000 1000 500
4000 1500 750
3. Automatic Renewal Date:
The installment premium will be guaranteed in respect of each Insured
for a period of 3 years from the Date of Commencement of the policy,
i.e. for the first 3 years of the policy. Thereafter, at the end of
every third policy anniversary, the premiums may be reviewed to take
into account the Corporation’s experience, subject to prior approval
from IRDA. These premium due dates, at the end of every third policy
anniversary, starting from the date of commencement of policy till the
date of cover expiry, on which the installment premiums are reviewable,
will be referred as Automatic Renewal Dates in respect of all Insured in
the Policy.
On any Automatic Renewal Date
in the future, the installment premium will be based on the age of the
Insured at the time of inclusion into the policy and the Corporation’s
premium rates then prevailing for this product.
4. Options:
A) Cover to new additional
members: If PI gets married/ remarried during the term of the policy,
the spouse and parents-in-law can be included in the policy within six
months from the date of marriage / remarriage, but the cover shall start
from the policy anniversary coinciding with or next following the date
of inclusion. Enhanced premium shall be due from such policy
anniversary.
Similarly, Any child
born/legally adopted after taking the policy can also be covered from
the next immediate policy anniversary date following the date on which
the child completes the age of 3 months. If the age of legally adopted
child on the date of adoption is more than 3 months, the child can be
covered from policy anniversary coinciding with or next following the
date of adoption. Enhanced premiums shall be due from such policy
anniversary.
Inclusion of each additional
member will be on payment of enhanced premiums and subject to various
terms and conditions of the plan.
Any addition of new lives shall be allowed by the PI only. After the death of PI, no addition will be allowed.
Addition in any other case will
not be allowed. The existing spouse, parents, parents-in-law and
children, if not covered at the time of taking policy, shall not be
covered under the policy.
If both of the parents (father
and mother) are alive and are eligible for cover, then either both of
them will have to be covered or none of them will be covered. The PI
will not have any option to choose one of them. The same condition will
apply for parents-in-law also.
B) Quick Cash facility:
If any of the insured lives undergoes any eligible surgery covered
under Category I or II of MSB in any of the listed network hospitals,
you, as PI will have an option to avail Quick Cash facility. Under this
facility, 50% of eligible MSB amount would be made available even during
the period of hospitalization of any of the insured lives covered (the
surgery may be either planned or emergency due to accident) instead of
waiting for making a claim for the benefit after discharge. It will be
only an advance payment in the event of hospitalization for any MSB
defined in the surgeries listed under categories I & II and
permissible under the policy conditions of the plan. This will be,
however, subject to approval from the TPA (Third Party Administrator),
and the advance amount will be adjusted from the final settlement of MSB
claim amount.
This facility of advance
payment could be availed by submitting your Bank Account details in the
prescribed format. The amount of advance shall be credited to your bank
account directly.
C) Term Assurance Rider:
You, as PI, and your spouse may opt for Term Assurance as optional
rider equal to the MSB SA. In case of unfortunate death, an amount equal
to Term Assurance Sum Assured will be payable on death during the term
for which Term Assurance Rider is opted for.
D) Accident Benefit Rider:
You and your spouse may also opt for Accident Benefit Rider if Term
Assurance Rider has been opted for. Maximum Accident Benefit Sum Assured
shall be equal to the Term Assurance Rider SA. In case of unfortunate
death due to an accident, an amount equal to Accident Benefit Sum
Assured shall be payable.
Accident Benefit Rider will be available under the plan by payment of additional premium of ` 0.50 for every ` 1,000/- of the Accident Benefit Sum Assured per policy year in respect of each life to be covered.
The additional premium for this
benefit will not be required to be paid on and after the Policy
anniversary on which the Term Assurance Rider ceases.
5. Eligibility Conditions And Other Restrictions:
FOR BASIC PLAN
i) For Hospital Cash Benefit (HCB) (under Basic Plan)
| Feature |
Principal Insured (PI) |
Insured Spouse (if any) & Insured Parents / Parents-in-law (if any) |
Insured Dependent Children (if any) |
- Minimum Initial Daily Benefit (in a ward other than Intensive Care Unit)
|
` 1,000/- |
` 1,000/- |
` 1,000/- |
- Maximum initial daily amount
|
` 4,000/- |
Insured Spouse- Less than or equal to that of PI
Insured Parents / Parents-in-law-
Less than or equal to that of Insured Spouse (PI, if there is no
Insured Spouse). Further, included parents / parents-in-law shall be
covered for equal benefits. |
Less
than or equal to that of Insured Spouse (PI, if there is no
Insured Spouse). Further, included children shall be covered for equal
benefits. |
- Maximum annual benefit period, applicable to each insured
|
30
days in year 1, 90 days per year thereafter, inclusive of stay in
ICU. Maximum number of days in ICU is restricted to 15 days in year 1
and to 45 days thereafter. |
- Maximum Lifetime Benefit period, applicable to each insured
|
720 days inclusive of stay in ICU. Maximum number of days in ICU is restricted to 360 days |
Initial Daily Benefit shall be in multiples of ` 1000/-.
ii) For Major Surgical Benefit (MSB) (under Basic Plan)
| Feature |
Principal Insured (PI) |
Insured Spouse (if any) & Insured Parents / parents-in-law (if any) |
Insured Dependent Children (if any) |
- Major Surgical Benefit Sum Assured (MSB SA)
|
100 times of Applicable Daily Benefit (ADB) of PI (as specified in Para 1A) above). |
Insured Spouse- 100 times of ADB of Insured Spouse
Insured Parents / parents-in-law- 100 times of ADB of each parent |
100 times of ADB of each child |
- Maximum annual benefit, applicable to each insured
|
100% of Major Surgical Benefit Sum Assured |
- Maximum Lifetime Benefit, applicable to each insured
|
800% of Major Surgical Benefit Sum Assured |
iii) For Day Care Procedure Benefit (DCPB) (under Basic Plan)
| Feature |
Principal Insured (PI) |
Insured Spouse (if any) & Insured Parents / parents-in-law (if any) |
Insured Dependent Children (if any) |
- Lump sum benefit payable
|
5 times of Applicable Daily Benefit (ADB) of PI |
Insured Spouse- 5 times of ADB of Insured Spouse
Insured Parents / parents-in-law- 5 times of ADB of each parent |
5 times of ADB of each child |
- Maximum annual benefit, applicable to each insured
|
3 Surgical Procedures |
- Maximum Lifetime Benefit, applicable to each insured
|
24 Surgical Procedures |
iv) For Other Surgical Benefit (OSB) (under Basic Plan)
| Feature |
Principal Insured (PI) |
Insured Spouse (if any) & Insured Parents / parents-in-law (if any) |
Insured Dependent Children (if any) |
- Daily benefit amount
|
2 times of ADB of PI |
Insured Spouse- 2 times of ADB of Insured Spouse
Insured Parents / parents-in-law- 2 times of ADB of each parent |
2 times of ADB of each child |
- Maximum annual benefit, applicable to each insured
|
15 days in first policy year and 45 days per year thereafter |
- Maximum Lifetime Benefit, applicable to each insured
|
360 days |
FOR ACCIDENT BENEFIT RIDER OPTION:
(a) Minimum Accident Benefit Sum Assured: ` [25] in '000's
(b) Maximum Accident Benefit Sum
Assured: An amount equal to the Term Assurance Sum Assured in respect
of the insured, subject to maximum of ` 50
lakhs overall limit considering the Accident Benefit Sum Assured in
respect of all existing policies under individual as well as group
policies on the life of the insured including the policies taken from
Life Insurance Corporation of India and other insurance companies and
the Accident Benefit Sum Assured under new proposals into consideration.
The Accident Benefit Sum Assured shall be in multiples of ` 5,000/-.
(c) Minimum Entry Age: 18 years completed
(d) Maximum Entry Age: 50 years (Nearest Birthday)
(e) Maximum age for cover: 60 years (Nearest Birthday)
(f) Maximum term: 35 years
FOR TERM ASSURANCE RIDER OPTION:
(a) Minimum Term Assurance Sum Assured: ` [100] in '000's
(b) Maximum Term Assurance Sum
Assured: An amount equal to the Major Surgical Benefit Sum Assured (MSB
SA) at the time of inception/ inclusion into the policy (i.e. 100 times
of Initial Daily Hospital Cash Benefit) in respect of the insured,
subject to the maximum of ` 25 lakh overall
limit taking all term assurance riders under all existing policies of
the Life Assured and Term Assurance Sum Assured under other proposals
into consideration.
The Term Assurance Sum Assured shall be in multiples of ` 25,000/-.
(c) Minimum Entry Age: 18 years (completed)
(d) Maximum Entry Age: 50 years (Nearest Birthday)
(e) Maximum Maturity Age: 60 years (Nearest Birthday)
(f) Maximum Term: 35 years
6. Other Features:
A) Death Benefit under the basic
plan: No death benefits will be payable on the death of any Insured
unless any of the Rider Benefits mentioned above has been opted for.
On death of the Principal Insured;
a) The surviving Insured Spouse
will become the Principal Insured provided the option is exercised at
the beginning of the contract and the Policy will continue. In such
case, the premium for the Insured Spouse will change from the date
coinciding with or following instalment premium due date and the new
premium would be based on tabular premium rates applicable for PIs and
the age for calculation of revised premium rate will be the age at entry
of the spouse. If the option is not exercised at the beginning of the
contract, the Insured Spouse will not become PI and the policy will
terminate.
b) If the Insured Spouse had
predeceased the Principal Insured, then the other Insured will have the
option to take a new policy and the existing Policy will terminate. In
respect of these other Insured:
i. 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.
ii. The maximum entry age condition will not apply for the new policy.
iii. The outstanding Waiting
periods and outstanding period of any Exclusion will however apply under
the new policy.
iv. Other terms and conditions
including premium rates will be as applicable for the new policy.
In the event of death of an
Insured person other than the Principal Insured, the policy will
continue after removal of the Insured and change in premium will apply
from the instalment premium due date coinciding with or next following
the date of intimation of death of the Insured.
B) Maturity Benefit: No benefits are payable at end of the Cover Period.
C) Discontinuance of premiums: A
grace period of one month but not less than 30 days will be allowed for
payment of yearly or half yearly or quarterly premiums and 15 days for
monthly premiums.
If premium is not paid before
the expiry of the days of grace, the Policy lapses and all the benefits
payable under this plan will cease.
D) Revival: A lapsed policy
may be revived by the PI within a period of 2 years from the due date of
first unpaid premium but before the expiry of cover in respect of PI,
on submission of proof of continued insurability to the satisfaction of
the Corporation and the payment of all the arrears of premium together
with interest at such rate as may be fixed by the Corporation from time
to time. The Corporation reserves the right to accept at original terms,
accept with modified terms or decline the revival of a discontinued
policy. The revival of the discontinued policy shall take effect only
after the same is approved by the Corporation and is specifically
communicated to the PI.
Waiting periods and Exclusions,
as described in Para 14 and 15 respectively, will apply on revival.
The Principal Insured may need to provide satisfactory evidence of good
health in respect of each Insured as required by the Corporation, at his
own expense. The Date of Revival will be when all requirements for
revival/reinstatement are met and approved by the Corporation at its
sole discretion.
No benefit will be paid for an
event that occurred during the lapse period till the Date of Revival
when the Policy was in a discontinued state.
Further, if the Automatic
Renewal Date falls between the revival period and revival is done after
the Automatic Renewal Date, the premium before and after the Automatic
Renewal Date may be different.
Revival will not be allowed post the revival period.
E) Surrender:
No surrender value will be available under the plan.
7. Cooling off period:
If you are not satisfied with
the “Terms and Conditions” of the policy, you may return the policy to
us within 15 days.
8. Loan:
No loan will be available under this plan.
9. Assignment:
No Assignment will be allowed under this plan.
10. Exclusions:
No benefits are available
hereunder and no payment will be made by the Corporation for any claim
under this policy on account of hospitalization or surgery directly or
indirectly caused by, based on, arising out of or howsoever attributable
to any of the following:
i. Any Pre-existing Condition
unless disclosed to and accepted by the Corporation prior to the Date of
Cover Commencement or the Date of Revival (if the Policy is revived
after discontinuance of the Cover).
ii. Any treatment or Surgery not
performed by a Physician/Surgeon or any treatment or Surgery of a
purely experimental nature.
iii. Any routine or prescribed medical check up or examination.
iv. Medical Expenses relating to
any treatment primarily for diagnostic, X-ray or laboratory
examinations.
v. Any Sickness that has been
classified as an Epidemic by the Central or State Government.
vi. Circumcision, cosmetic or
aesthetic treatments of any description, change of gender surgery,
plastic surgery (unless such plastic surgery is necessary for the
treatment of Illness or accidental Bodily Injury as a direct result of
the insured event and performed with in 6 months of the same).
vii. Hospitalisation or Surgery for donation of an organ.
viii. Treatment for correction of birth defects or congenital anomalies.
ix. Dental treatment or surgery
of any kind unless necessitated by Accidental Bodily Injury.
x. Convalescence, general
debility, nervous or other breakdown, rest cure, congenital diseases
or defect or anomaly, sterilisation or infertility (diagnosis and
treatment), any sanatoriums, spa or rest cures or long term care or
hospitalization undertaken as a preventive or recuperative measure.
xi. Self afflicted injuries or
conditions (attempted suicide), and/or the use or misuse of any drugs or
alcohol.
xii. Any sexually transmitted
diseases or any condition directly or indirectly caused to or associated
with Human Immuno Deficiency (HIV) Virus or any Syndrome or condition
of a similar kind commonly referred to as AIDS.
xiii. Removal or correction or
replacement of any material that was implanted in a former surgery
before Date of Cover commencement or Date of Revival (if the Policy is
revived after discontinuance of the Cover).
xiv. Any diagnosis or treatment
arising from or traceable to pregnancy (whether uterine or extra
uterine), childbirth including caesarean section, medical termination of
pregnancy and/or any treatment related to pre and post natal care of
the mother or the new born.
xv. Hospitalisation for the sole
purpose of physiotherapy or any ailment for which hospitalization is
not warranted due to advancement in medical technology.
xvi. War, invasion, act of
foreign enemy, hostilities (whether war be declared or not), civil war,
rebellion, revolution, insurrection military or usurped power of civil
commotion or loot or pillage in connection herewith.
xvii. Naval or military
operations(including duties of peace time) of the armed forces or air
force and participation in operations requiring the use of arms or which
are ordered by military authorities for combating terrorists, rebels
and the like.
xviii. Any natural peril
(including but not limited to avalanche, earthquake, volcanic eruptions
or any kind of natural hazard).
xix. Participation in any
hazardous activity or sports including but not limited to racing, scuba
diving, aerial sports, bungee jumping and mountaineering or in any
criminal or illegal activities.
xx. Radioactive contamination.
xxi. Non-allopathic methods of treatment or surgery.
xxii. Participation in any criminal or illegal activities.
xxiii. Treatment arising from the Insured’s failure to act on proper medical advice.
Benefit:
1.Benefits offered under the plan are
• Hospital cash benefit (HCB)
• Major Surgical Benefit (MSB)
• Day Care Procedure Benefit
• Other Surgical Benefit
• Ambulance Benefit
• Premium waiver Benefit (PWB)
A) Hospital Cash Benefit: If
you or any of the insured lives covered under the policy is hospitalised
due to Accidental Body Injury or Sickness and the stay in hospital
exceeds a continuous period of 24 hours, then for any continuous period
of 24 hours or part thereof, provided any such part stay exceeds a
continuous period of 4 hours (after having completed the 24 hours as
above) in a non-ICU ward/room of a hospital, an amount equal to the
Applicable Daily Benefit (ADB) available under the policy during that
policy year shall be payable subject to benefit limits and conditions
mentioned in Para 11A) and exclusions mentioned in Para 15 below.
During the first year of cover
commencement in respect of each insured, the Applicable Daily Benefit
shall be the Initial Daily Benefit amount chosen by you and mentioned in
the policy Schedule.
The amount of ADB for each policy year, after the first policy year, shall consist of 2 parts:
An arithmetic addition of an
amount equal to 5% (five percent) of the Initial Daily Benefit to the
Applicable Daily Benefit of the previous Policy Year. Such increase in
the Applicable Daily Benefit shall be effected on each policy
anniversary during the Cover Period and shall continue until it attains a
maximum amount of 1.5 times the Initial Daily Benefit. Thereafter, this
amount in each Policy Year in future shall remain at that maximum level
attained.
Further arithmetic addition of
an amount equal to “No Claim Benefit” (as described in Para 1.G) below)
provided the policy attracts and is eligible for it. There shall be no
maximum limit for such increase which means that if this policy is
eligible for “No Claim Benefit”, the same shall be granted throughout
the Cover Period without any maximum limit.
For members included
subsequently under the policy, the benefit in the first year shall be
equal to Initial Daily Benefit amount and thereafter the Applicable
Daily Benefit shall increase as above.
If any of the member insured is
required to stay in an Intensive Care Unit of a hospital, two times the
Applicable Daily Benefit will be payable subject to benefit limits and
conditions mentioned in Para 11A) and exclusions mentioned in Para 15
below.
During one period of 24
continuous hours (i.e. one day) of Hospitalisation (after having
completed the 24 hours as above), if the said Hospitalisation included
stay in an Intensive Care Unit as well as in any other in-patient
(non-Intensive Care Unit) ward of the Hospital, the Corporation shall
pay benefits as if the admission was to the Intensive Care Unit provided
that the period of Hospitalisation in the Intensive Care Unit was at
least 4 continuous hours.
No benefit will be payable for
the first 24 hours of hospitalisation. However, for every
Hospitalization that extends for a continuous period of 7 days or more,
the Daily Hospital Cash Benefit would also be paid for first 24 hours
(day one) of hospitalization, regardless of whether the Insured was
admitted in a general or special ward or in an intensive care unit.
B) Major Surgical Benefit: In
the event of an Insured under this plan, due to medical necessity,
undergoing one of the surgeries defined in Major Surgical Benefit
Annexure, within the cover period in a hospital due to Accidental Bodily
Injury or Sickness, the respective benefit percentage of the Major
Surgical Benefit Sum Assured, as specified against each of the eligible
surgeries mentioned in Major Surgical Benefit Annexure, shall be paid
subject to benefit limits and conditions mentioned in Para 11B) and
exclusions mentioned in Para 15 below.
C) Day Care Procedure Benefit:
In the event of an Insured under this Plan undergoing any specified Day
Care Procedure mentioned in the Day Care Procedure Benefit Annexure due
to medical necessity, a lump sum amount equal to 5 (five) times the
Applicable Daily Benefit shall be paid, regardless of the actual costs
incurred, subject to benefit limits and conditions mentioned in Para
11C) and exclusions mentioned in Para 15 below.
D) Other Surgical Benefit: In
the event of an Insured under this Plan, due to medical necessity,
undergoing any Surgery not listed under Major Surgical Benefit or Day
Care Procedure Benefit, causing the Insured’s Hospitalization to exceed a
continuous period of 24 hours within the Cover Period, then, a daily
benefit equal to 2 (two) times the Applicable Daily Benefit shall be
paid for each continuous period of 24 hours or part thereof provided any
such part stay exceeds a continuous period of 4 hours of
Hospitalization, subject to benefit limits and conditions mentioned in
Para 11D) and exclusions mentioned in Para 15 below.
E) Ambulance Benefit: In the
event that a Major Surgical Benefit falling under Category 1 or Category
2 (as mentioned in the Major Surgical Benefit Annexure) is payable and
emergency transportation costs by an ambulance have been incurred, an
additional lump sum of ` 1,000 will be payable in lieu of ambulance expenses.
F) Premium Waiver Benefit: In
the event that a Major Surgical Benefit falling under Category 1 or
Category 2 (as mentioned in the Major Surgical Benefit Annexure) is
payable in respect of any Insured covered under the policy, the total
annualized premium i.e. total one year premium in respect of that Policy
from the date of instalment premium due coinciding with or next
following the date of the Surgery will be waived.
G) No claim benefit: A no claim
benefit will be paid in the event that during the period between Date
of Commencement of policy and next Automatic Renewal Date or between two
Automatic Renewal Dates (described in Para 4 below) there are no claims
in respect of any Insured covered under your policy. The amount of the
no claim benefit would be equal to 5% (five percent) of the Initial
Daily Benefit in respect of each Insured and the resulting amount shall
be added to arrive at the Applicable Daily Benefit in respect of each
Insured for the Policy Year next following the most recent Automatic
Renewal Date.
ii) Benefit Limits and Conditions:
A) Hospital Cash Benefit:
i) The Hospital Cash Benefit
shall be payable only if Hospitalisation has occurred within India.
ii) The total number of days for
which hospital cash benefit would be payable, in respect of each
Insured, in a Policy Year would be restricted to -
a) A maximum of 30 (thirty) days
of Hospitalization out of which not more than 15 (fifteen) days shall
be in an Intensive Care Unit in the first Policy Year following the date
of commencement of cover in respect of that Insured
b) A maximum of 90 (ninety) days
of Hospitalization out of which not more than 45 (forty five) days
shall be in an Intensive Care Unit in the second and subsequent Policy
Years following the date of commencement of cover in respect of that
Insured
iii) The total number of days of
Hospitalization for which Hospital Cash Benefit is payable during the
Cover Period, in respect of each and every Insured covered under the
policy, shall be limited to a maximum of 720 (seven hundred and twenty)
days out of which not more than 360 (three hundred and sixty) days shall
be in an Intensive Care Unit. Upon attainment of this limit by an
Insured, the Hospital Cash Benefit in respect of that Insured shall
cease immediately.
iv) The Benefit Limits specified
in the above clauses in respect of an Insured under this Policy, shall
solely and exclusively apply to that Insured. Any unclaimed Hospital
Cash Benefit of any one Insured is not transferable to any other
Insured.
v) The Hospital Cash Benefit
shall not be payable in the event of an Insured under this Policy
undergoing any specified Day Care Procedure (as mentioned in the Day
Care Procedure Benefit Annexure).
B) Major Surgical Benefit:
i) If more than one Surgery is
performed on the Insured, through the same incision or by making
different incisions, during the same surgical session, the Corporation
shall only pay for that Surgery performed in respect of which the
largest amount shall become payable.
ii) The Major Surgical Benefit
shall be paid as a lump sum as specified for the benefit concerned and
is subject to providing proof of Surgery to the satisfaction of the
Corporation.
iii) All Surgical Procedures
claimed should be confirmed as essential and required, by a qualified
Physician or Surgeon, to the satisfaction of the Corporation.
iv) The Major Surgical Benefit
will be payable only after the Corporation is satisfied on the basis of
medical evidence that the specified Surgery covered under the Policy has
been performed.
v) The Major Surgical Benefit
shall be payable only if the Surgery has been performed within India.
vi) The amount in lieu of
ambulance expenses shall be payable only once in respect of each Insured
in any Policy Year and is subject to providing satisfactory evidence to
the Corporation.
vii) The total amount payable in
respect of each Insured under the Major Surgical Benefit in any Policy
Year during the Cover Period shall not exceed 100% of the Major Surgical
Benefit Sum Assured in that Policy year.
viii) The total amount payable
in respect of each Insured during the Cover Period under the Major
Surgical Benefit shall not exceed a maximum limit of 800% of the Major
Surgical Benefit Sum Assured. If the total amount paid in respect of an
Insured equals this lifetime maximum limit, the Major Surgical Benefit
in respect of that Insured will cease immediately.
ix) The Benefit Limits specified
in the above clauses in respect of an Insured under this Policy, shall
solely and exclusively apply to that Insured. Any unclaimed Major
Surgical Benefit of any one Insured is not transferable to any other
Insured.
x) The Major Surgical benefit
for any surgery cannot be claimed and shall not be payable more than
once for the same surgery during the term of the policy.
C) Day Care Procedure Benefit:
i) If more than one Day Care
Procedure is performed on the Insured, through the same incision or by
making different incisions, during the same surgical session, the
Corporation shall only pay for one Day Care Surgical Procedure.
ii) The Day Care Procedure
Benefit shall be paid as a lump sum and is subject to providing proof of
Surgery to the satisfaction of the Corporation.
iii) All Surgical Procedures
claimed should be confirmed as essential and required, by a qualified
Physician or Surgeon, to the satisfaction of the Corporation.
iv) The Day Care Procedure
Benefit will be payable only after the Corporation is satisfied on the
basis of medical evidence that the specified Surgical Procedure covered
under the policy has been performed.
v) The Day Care Procedure
Benefit shall be payable only if the Surgical Procedure has been
performed within India.
vi) In respect of each Insured,
the Day Care Procedure Benefit will be payable only up to a maximum of 3
(three) Surgical Procedures in any Policy Year during the Cover Period.
vii) In respect of each Insured
during the Cover Period, the Day Care Procedure Benefit will be payable
only up to a maximum of 24 (twenty four) Surgical Procedures. If the
number of Surgical Procedures eligible for the Day Care Procedure
Benefit in respect of an Insured equals this lifetime maximum limit, the
Day Care Procedure Benefit in respect of that Insured will cease
immediately.
viii) The Benefit Limits
specified in the above clauses in respect of an Insured under this
Policy, shall solely and exclusively apply to that Insured. Any
unclaimed Day Care Procedure Benefit of any one Insured is not
transferable to any other Insured.
ix) If a Day Care Procedure
Benefit is performed no Hospital Cash Benefit shall be paid.
D) Other Surgical Benefit:
i) If more than one Surgical
Procedure is performed on the Insured, through the same incision or by
making different incisions, during the same surgical session, the
Corporation shall only pay for one Surgical Procedure.
ii) The Other Surgical Benefit
shall be paid as a Daily Benefit and is subject to providing proof of
Surgery to the satisfaction of the Corporation.
iii) All Surgical Procedures
claimed should be confirmed as essential and required, by a qualified
Physician or Surgeon, to the satisfaction of the Corporation.
iv) The Other Surgical Benefit
will be payable only after the Corporation is satisfied on the basis of
medical evidence that the specified Surgical Procedure covered under the
policy has been performed.
v) The Other Surgical Benefit
shall be payable only if the Surgical Procedure has been performed
within India.
vi) The total number of days of
Hospitalization for which the Other Surgical Benefit is payable during a
Policy Year in respect of each and every Insured covered under the
Policy shall not exceed 15 (fifteen) days in the first Policy Year
following the date of commencement of cover in respect of that Insured
and 45 (forty five) days for the second and subsequent Policy Years
following the date of commencement of cover in respect of that Insured.
vii) The total number of days of
Hospitalization for which the Other Surgical Benefit is payable during
the Cover Period, in respect of each and every Insured covered under the
Policy shall not exceed a maximum limit of 360 (three hundred and
sixty) days. Upon attainment of this lifetime maximum limit, the Other
Surgical Benefit in respect of that Insured will cease immediately.
viii) The Benefit Limits
specified in the above clauses in respect of an Insured under this
Policy, shall solely and exclusively apply to that Insured. Any
unclaimed Other Surgical Benefit on any one Insured is not transferable
to any other Insured.
iii) Commencement And Termination Of Benefit Covers:
The Hospital Cash Benefit, Major
Surgical Benefit, Day Care Procedure Benefit and Other Surgical Benefit
cover in respect of each Insured covered under your policy shall
commence on the Date of Cover Commencement individually stated in the
Policy Schedule.
The Hospital Cash Benefit,
Major Surgical Benefit, Day Care Procedure Benefit and Other Surgical
Benefit cover in respect of each Insured shall terminate at the earliest
of the following:
i. The Date of Cover Expiry mentioned in the Policy Schedule;
ii. On exhausting all the
lifetime maximum Benefit Limits as specified in Para 11 above;
iii. On death or Date of Cover
Expiry of the Principal Insured and if the Policy does not continue with
the Insured Spouse as the Principal Insured;
iv. On death or Date of Cover
Expiry of Insured Spouse after the Policy continues with the Insured
Spouse as the Principal Insured after the PI dies or reaches his/her
Date of Cover Expiry.
v. On death of the Insured;
vi. In respect of the Insured
Spouse, on divorce or legal separation from the Principal Insured;
vii. On termination of the Policy due to non-payment of premium or any other reason.
iv) Termination of Policy:
A) If policy is issued on single life:
The policy shall terminate at the earliest of the following:
i) Non-payment of premiums within the revival period;
ii) On death;
iii) On the Date of Cover Expiry mentioned in the Policy Schedule;
iv) On exhausting all the lifetime maximum Benefit Limits as specified in Para 11 above.
B) If policy is issued on more than one life:
The policy shall terminate at the earliest of the following:
i) Non-payment of premiums within the revival period;
ii) On PI exhausting all the
lifetime maximum Benefit Limits as specified in Para 11 above.
iii) On death or Date of Cover
Expiry, of the Principal Insured and if the Policy does not continue
with the Insured Spouse as the Principal Insured.
iv) On the death or Date of
Cover Expiry, of Insured Spouse after the Policy continues with the
Insured Spouse as the Principal Insured after the PI dies or reaches
his/her Date of Cover Expiry.
v) Waiting Period:
General waiting period:
There shall be no general
waiting period in case Hospitalization or Surgery is due to Accidental
Bodily Injury. There shall be a general waiting period during which no
benefits shall be payable in the event of Hospitalization or Surgery, if
the said Hospitalization or Surgery occurred due to Sickness.
i. The general waiting period shall be 90 (ninety) days from the Date of Cover Commencement in respect of each Insured.
ii. If the policy is revived
after discontinuance of the Cover then the following shall apply in
respect of each Insured:
a) If the request for revival is
received by the Corporation within 90 (ninety) days from the due date
of the first unpaid premium, then there shall be a general waiting
period of 45 (forty five) days from the Date of Revival in respect of
each Insured.
b) If the request for revival is
received by the Corporation beyond 90 (ninety) days from the due date
of the first unpaid premium, then there shall be a general waiting
period of 90 (ninety) days from the Date of Revival in respect of each
Insured.
Specific waiting period:
In addition, in respect of each
Insured, no benefits are available hereunder and no payment will be made
by the Corporation for any claim under this Policy on account of
Hospitalization or Surgery directly or indirectly caused by, based on,
arising out of or howsoever attributable to any of the following during
the 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
The specific waiting period in respect of the treatments specified in the list above shall be as follows:
i. The specific waiting period
shall be 2 (two) years from the Date of Cover Commencement in respect of
each Insured.
ii. If the policy is revived
after discontinuance of the Cover then the following shall apply in
respect of each Insured:
a) If the request for revival is
received by the Corporation within less than 90 (ninety) days from the
due date of the first unpaid premium, then the specific waiting period
shall continue to be till 2 (two) years from the Date of Cover
Commencement in respect of each Insured.
b) If the request for revival is
received by the Corporation beyond 90 (ninety) days from the due date
of the first unpaid premium, then there shall be a specific waiting
period of 2 (two) years from the Date of Revival in respect of each
Insured.
No charges for this benefit shall be deducted after the benefit ceases.
Benefit Illustration :
SECTION 45 OF INSURANCE ACT, 1938:
No policy of life insurance
shall after the expiry of two years from the date on which it was
effected, be called in question by an insurer on the ground that a
statement made in the proposal for insurance or in any report of a
medical officer, or referee, or friend of the insured, or in any other
document leading to the issue of the policy, was inaccurate or false,
unless the insurer shows that such statement was on a material matter or
suppressed facts which it was material to disclose and that it was
fraudulently made by the policyholder and that the policyholder knew at
the time of making it that the statement was false or that it suppressed
facts which it was material to disclose.
Provided that nothing in this
section shall prevent the insurer from calling for proof of age at any
time if he is entitled to do so, and no policy shall be deemed to be
called in question merely because the terms of the policy are adjusted
on subsequent proof that the age of the life assured was incorrectly
stated in the proposal.
SECTION 41 OF INSURANCE ACT 1938:
(1) No person shall allow or
offer to allow, either directly or indirectly, as an inducement to any
person to take out or renew or continue an insurance in respect of any
kind of risk relating to lives or property in India, any rebate of the
whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or
continuing a policy accept any rebate, except such rebate as may be
allowed in accordance with the published prospectuses or tables of the
insurer: provided that acceptance by an insurance agent of commission
in connection with a policy of life insurance taken out by himself on
his own life shall not be deemed to be acceptance of a rebate of premium
within the meaning of this sub-section if at the time of such
acceptance the insurance agent satisfies the prescribed conditions
establishing that he is a bona fide insurance agent employed by the
insurer.
(2) Any person making default
in complying with the provisions of this section shall be punishable
with fine which may extend to five hundred rupees.
Note: Conditions apply for which please refer to the Policy document or contact our nearest Branch Office.
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உங்களின் குழந்தைகள் எதிர்கால படிப்பு 
100 பயனுள்ள Run command
