Plan Highlights
LIC’s Arogya Rakshak Plan is a Non-Linked, Non-Participating, Regular Premium, Individual; Health Insurance plan which provides fixed benefits in case of hospitalization and for various surgical procedures. This plan also provides Auto Health Cover Benefit in case of death of the original PI. The Unique Identification Number (UIN) for LIC’s Arogya Rakshak plan is 512N318V01.
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)
Hospital Cash Benefit (HCB)
1)Hospital Cash Benefit (With in India only) is payable on per day basis. HCB amount varies from minimum of Rs. 2500 to maximum of Rs. 10000
2)During first policy year: Maxi. 30 days hospitalization & including 15 days in ICU (2 times HCB) for each one.
3)In second and onwards, Maximum 90 days of hospitalization and including 45days in I.C.U. for each insured.
4)Maximum of 900 days (inclusive of stay in ICU) during entire policy term for each insured.
5)Cover 140 surgeries.
6)Benefit payout is fixed irrespective of actual expenses incurred.
Major Surgical Benefit (MSB)
1) If more than one Surgery is performed on the Insured during the same surgical session, the Corporation shall pay 100% as per the category in respect of the most severe Surgery performed and for other surgeries 25% of the eligible amount shall be paid. This benefit shall be paid for each of the additional surgery done in the single session and is subject to the overall annual and lifetime limits.
2)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.
3) The Major Surgical Benefit shall be payable only if the Surgery has been performed within India.
4) 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.
Day Care Procedure Benefit:
In the event of an Insured, due to medical necessity undergoing any specified Day Care Procedure (as mentioned Annexure) within the Cover Period in a Hospital or Day Care Centre due to Accidental Bodily Injury or Sickness first occurring or manifesting itself on or after the Effective Date of Cover in respect of that Insured and during the Cover Period then, subject to Benefit Limits and Conditions as mentioned below, Waiting Period as mentioned under Para 6.IV and Exclusions as mentioned under Para 7 etc., a lump sum amount equal to 5 (five) times the Applicable Daily Benefit, shall be payable, regardless of the actual costs incurred
Other Surgical Benefit:
In the event of an Insured due to medical necessity, undergoing within the Cover Period any Surgery not listed under Major Surgical Benefit or Day Care Procedure Benefit, in a Hospital due to Accidental Bodily Injury or Sickness first occurring or manifesting itself on or after the Effective Date of Cover in respect of that Insured and during the Cover Period then, subject to the Benefit Limits and Conditions as mentioned below, Waiting Period as mentioned under Para 6.IV and Exclusions as mentioned under Para 7 etc., a Daily Benefit equal to 2.5 (two and a half) times the Applicable Daily Benefit, shall be payable, regardless of the actual costs incurred for each continuous period of 24 hours or part thereof provided any such part stay exceeds a continuous period of 4 hours of Hospitalization. Other Surgical Benefit shall be payable only if inpatient hospitalization stay exceeds 24 hours.
Ambulance Benefit:
In the event that a Major Surgical Benefit (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 Rs 1,000 will be payable in lieu of ambulance expenses.
Premium Waiver Benefit:
In case of major surgery as specified 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.
Auto Health Cover (AHC) Benefit:
In case of death of 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 premiums from the policy anniversary coinciding with or next following the date of death of the Principal Insured, for a further period of 15 years or upto specified age in respect of each of the Insured’s, whichever is earlier, provided they are eligible for this AHC Benefit.
Rider Benefits:-
The two riders, Term Rider and Accidental Benefit rider are available under this plan. The Accidental Benefit rider can be opted only if the Term rider has been opted.
Maturity Benefit:
No benefits are payable at end of the Cover Period