LIC Health Insurance Plans: LIC Health Insurance Policy

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Plans: Established in 1956, Life Insurance Corporation of India is an Indian state-owned insurance company. With the cost of medical treatment rising rapidly, the insurance company has introduced health insurance products to protect one’s finances in the event of an illness or injury. 

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The corporation, headquartered in Mumbai, is the country’s largest insurance provider. It today operates with 8 regional offices, 113 divisional offices, 2048 fully computerized branch offices, 1381 satellite offices and corporate offices. LIC was formed by an Act of Parliament, ie. LIC Act, 1956, with a Rs. 5 crore-capital contribution from the government.

Lic Health Insurance Policies

LIC provides two types of health insurance products offers. Offered products are :
• LIC Jeevan Arogya
• LIC Cancer cover

LIC Jeevan Arogya

It is a unique non-participating non-linked health insurance plan that provides cover against certain health risks. Additionally, it provides timely assistance in the event of a medical emergency and helps the insured and his family remain financially independent during difficult times.

Features of LIC Jeevan Arogya (LIC Health Insurance)

  • Valuable financial security for hospitalization, surgery etc.
  • Increased health cover every year
  • Flexible benefits range to choose from
  • Flexible premium payment option
  • Benefit of lump sum, actual medical irrespective expenses
  • No claim benefits

LIC JEEVAN AROGYA (Benefits)

Below are some benefits of LIC Jeevan Arogya:

  • Cash benefit in hospital:

The amount equal to the daily benefit applicable for hospital stay is more than 24 hours continuous period. The applicable daily benefit for the first year cover commencement will be the initial daily benefit amount chosen by the insured.

  • Major Surgical Benefit:

If the insured under this scheme undergoes the surgery as defined in the Annex Major Surgical Benefit due to physical injury or illness, then the respective benefit percentage of the major surgical benefit will be paid.

  • Day Care Procedure Benefit:

If the insured come by any of the specified day care procedures listed in the policy documents. A lump sum equal to 5 times the applicable daily benefit is payable, regardless of the cost actually incurred.

  • Other surgical benefits:

If the insured undergoes a surgery that is not listed under the major surgical benefits or benefits of the day care procedure, resulting in a continuous period of 24 hours when the person is hospitalized, daily. The benefit is equal to 2 times the profit is payable for a continuous period of 24 hours or part thereof.

  • Ambulance benefit:

If a major surgical falling under category 1 or category 2, then benefit is payable. And its emergency transportation costs are incurred by the ambulance, Rs. 1,000 will be payable for ambulance expenses.

  • Premium Waiver Benefit:

If a major surgical falling under Category 1 or Category 2, then benefit is payable. And the total annual premium will be waived.

  • No claim benefit:

A no-claim benefit, which is equal to 5% of the initial daily benefit, is payable if no claim is made between the policy start date and the next automatic renewal date, or between two automatic renewal dates goes.

LIC’s Cancer Cover

It is a regular premium health plan that provides financial protection if the insured is diagnosed with any of the early and / or major stage cancers specified during the policy period.

Features of LIC Cancer Cover

  • Includes early and / or major stage cancer
  • Two benefit options:
    Sum Insured and Sum Assured
  • Regular premium payment
  • Initial waiting period of 180 days

Benefits of LIC Health Insurance – Cancer cover

Early stage cancer:

Benefits are payable on first diagnosis of one of the listed early stage cancers, provided that it is acceptable –

  • Lump sum benefit:

25% of the applicable sum insured will be payable

  • Premium Waiver Benefit:

For the next three policy years the premium or balance policy period, whichever is less, will be waived from the policy anniversary day or from the date of diagnosis.

  • Major stage cancer:

Benefits are payable on first diagnosis of listed major stage cancer, provided that these are acceptable-

  • Lump Sum:

100% of the Sum Insured will be paid before the claims for Early Stage Cancer are paid.

  • Income Tax Benefit:

Even if the Sum Assured is alive, 1% of the Sum Assured will be paid on each policy month, for the next 10 years after a lump sum payment, irrespective of the life of the Life Assured. Goes beyond In case of death of the insured while receiving income benefit, the remaining pay-out (if any) will be paid to the nominee.

  • Premium Waiver Benefit:

All future premiums will be waived from the next policy anniversary and will be exempt from all liability, except for the above mentioned income benefit limit.

Eligibility Criteria for LIC Health Insurance

LIC Jeevan Arogya

Minimum age and maximum age:

  • Spouse/Self 18 years 65 years (last birthday)
  • Parents / parents 18 years 75 (last birthday)
  • Children 91 days 17 years (last birthday)
  • Insured persons are up to the age of 80 years. Children up to 25 years old are insured.

LIC Cancer Cover

Age (Minimum age and maximum):

  • Minimum age at entry is 20 years (completed)
  • Maximum age 65 years (last birthday)
  • Policy term (minimum) 10 years
  • Policy term (maximum) is 30 years
  • Minimum Maturity Age 50 years
  • Maximum Maturity Age 75 years

Required documents

Documents required to claim LIC Health Insurance

Documents required to claim LIC Jeevan Arogya Yojana:

  • Discharge card with details of the exact date and time of admission and discharge from the hospital, along with treatment, diagnosis and investigation received.
  • Copy or summary of the surgeon’s operation notes where surgical intervention was performed (in case the claimant has undergone a surgery).
  • A death summary in case of the patient’s death during treatment.
  • Certificate from Physician under clause 19 (vi) above.
  • Bills as proof of expenses during hospitalization and / or surgery (including emergency ambulance).

Documents required to claim cancer cover:

  • Duly signed claim form with original policy document
  • Hospital treatment certificate / discharge summary
  • Confirmation test report such as radiology, histology and laboratory evidence

process to renew LIC health insurance

Individuals can renew their cover by visiting the insurance company’s website or visiting one of the company’s branches. Under the online mode, a person has to enter the policy information on the website of the insurance company and then proceed to make the payment.

Question & Answer (LIC Health Insurance)

What is the claim procedure for LIC Health Insurance?

In the event for an illness or injury (covered by the policy), individual will be required to immediately inform the servicing branch of LIC. This will enable the insurer to start the claim process accordingly. If the insured is unable to do so, his / her relatives can reach the LIC branch and tell them about the incident.

Within 30 days from the date of discharge, the insured must provide the corporation with written notification of a claim and supporting evidence in the forms prescribed by LIC. If a person is claiming LIC cancer cover, the insured must provide a report of diagnosis along with a claim form to serve as evidence.

What is the difference between LIC’s life cover and LIC’s cancer cover?

Against certain health risks, LIC’s Jeevan Arogya offered health insurance. The policy pays a lump sum benefit, regardless of the actual medical costs incurred on treatment of an insured illness or injury. Cancer cover, on the other hand, is a policy that provides financial protection to the insured during the policy term when he is diagnosed with any of the specified early and / or major stage cancers. It pays benefits only if the insured has cancer.

What is under LIC Jeevan Arogya?

  • Hospital Cash Profit (HCB)
  • Major Surgical Benefits (MSB)
  • Ambulance Benefits
  • Premium Waiver Benefit (PWB)
  • Day Care Process Benefits
  • Other surgical benefits

What is covered under LIC Cancer cover?

Some exclusions under this policy are:

  • Any pre-existing condition until disclosed and accepted by LIC before the date of commencement of cover.
  • Any treatment which is not performed by a physician or surgeon or any treatment or surgery of a pure experimental nature.
  • Regular medical examination or examination.
  • Medical expenses related to any treatment, mainly for clinical, X-ray or laboratory examinations.
  • Disease classified by the government as an epidemic.
  • Cosmetic, circumcision or beauty treatments, gender change surgery and plastic surgery.
  • Hospitalization expenses or surgery for organ donation by the donor.
  • Treatment to correct birth defects or congenital anomalies.
  • Medical treatment or any type of surgery, unless an accidental body injury is required.
  • Suicide, suicide attempt and / or use and misuse of any drugs or alcohol or complications arising from it.
  • Caused by any STD or any condition or associated with HIV or any syndrome or a similar type of condition, commonly known as AIDS.

What is not covered under LIC Cancer cover?

Early stage cancer exclusion:

  • As benign tumor histologically described, borderline malignant or less malignant potential
  • Tumors in the presence of HIV infection.
  • Dysplasia, intraepithelial neoplasia or squamous intraepithelial lesions.
  • Skin carcinoma in-situ and melanoma in-situ.

Major stage cancer exclusion:

  • Tumor histologically (stated as carcinoma), including but not limited to in situ, benign, premignant, borderline malignancy, low malignancy, impotence of unknown behavior, or non-invasive: carcinoma in situ of breasts, cervical dysplasia (CIN -1), cervical dysplasia (CIN – 2), cervical dysplasia (CIN – 3)
  • Non-melanoma skin carcinoma, unless there is evidence of metastases to the lymph nodes or beyond;
  • Melanoma (malignant) that has not created attack beyond the epidermis.
  • Tumors of the prostate unless classified histologically unless a Gleason score exceeds 6 or at least the clinical TNM classification T2N0M0
    Thyroid cancer Histologically classified as T1N0M0 (TNM classification) or below.
  • Chronic lymphocytic leukemia below RAI stage 3
  • Non-invasive papillary cancer of the bladder is histologically described as TaN0M0 or younger.
  • All gastro-intestinal stromal tumors are histologically classified with a mitotic count of T1N0M0 (TNM classification) or below or equal to or less than 5/50 hpf.
  • All tumors in the presence of HIV infection.

LIC Customer Service (LIC Health Insurance)

In case of any query, individuals can reach LIC by calling their toll-free number 18004259876 or call center on 022 6827 6827. Users can also SMS LICHELP <pol.no.> to 9242492224 or SMS LICHELP <pol.no. > 56767877. To locate nearby branches, users can use the branch locator facility available on the company’s website.


 

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