LIC Health Insurance

All About LIC Health Insurance Policy

With the cost of medical treatments rising quickly, the insurance giant has introduced health insurance products to safeguard one’s finances in the event of an illness or injury. LIC offers two types of health insurance products, namely LIC Jeevan Arogya and LIC Cancer Cover. In this article, we will have a detailed look at what the two products have to offer.

(Note: All the information in this article has been sourced from the official website of Life Insurance Corporation of India.)

All About LIC - Life Insurance Corporation Company

Founded in 1956, Life Insurance Corporation of India is an Indian state-owned insurance company. The Corporation, which is headquartered in Mumbai, is the largest insurance provider in the country. It functions today with 8 zonal offices, 113 divisional offices, 2048 fully computerized branch offices, 1381 satellite offices and the Corporate office. LIC was formed by an Act of Parliament, viz. LIC Act, 1956, with a Rs. 5 crore-capital contribution from the government.

Some Important Facts

Incurred Claim Ratio 98%
Network Hospitals 5000+
Age 18 Years to 65 years
Branches 3542
Customer Care Toll Free No 1800-425-9876

Two Types of LIC Health Insurance Plans

LIC's Jeevan Arogya

This is a unique non-participating non-linked health insurance plan that offers cover against certain health risks. Additionally, it provides one with timely support in the event of medical emergencies and helps the insured and his or her family remain financially independent during difficult times.

Features of LIC Health Insurance - Jeevan Arogya

  • Valuable financial protection for hospitalization, surgery etc.
  • Increasing health cover each year
  • Flexible benefit limit to choose from
  • Flexible premium payment options
  • Lump sum benefit, irrespective of actual medical expenses
  • No-claim benefit

Benefits of LIC Health Insurance - LIC Jeevan Arogya

Below are some of the benefits of LIC Jeevan Arogya:

  • Hospital cash benefit: An amount equal to the applicable daily benefit is payable for hospital stays exceeding a continuous period of 24 hours. In the first year of cover commencement, the applicable daily benefit shall be the initial daily benefit amount chosen by the insured.
  • Major surgical benefit: If the insured under this plan undergoes a surgery defined in major surgical benefit annexure due to accidental bodily injury or sickness, the respective benefit percentage of the major surgical benefit shall be paid.
  • Day care procedure benefit: If the insured undergoes any specified day care procedure listed in the policy documents, a lump sum amount equal to 5 times the applicable daily benefit is payable, irrespective of the costs actually incurred.
  • Other surgical benefit: If the insured undergoes a surgery that is not listed under major surgical benefit or day care procedure benefit, which results in the individual's hospitalization to exceed a continuous period of 24 hours, a daily benefit equal to 2 times the applicable daily benefit is payable for each continuous period of 24 hours or part thereof.
  • Ambulance benefit: If a major surgical benefit falling under Category 1 or Category 2 is payable and emergency transportation costs by an ambulance have been incurred, an additional lump sum of Rs. 1,000 will be payable for ambulance expenses.
  • Premium waiver benefit: If a major surgical benefit falling under Category 1 or Category 2 is payable, the total annualized 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 claims are made between the date of policy commencement and next automatic renewal date or between two automatic renewal dates.

LIC's Cancer Cover

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

Features of LIC Health Insurance - LIC Cancer Cover

  • Covers early and/or major stage cancer
  • Two benefit options: Level Sum Insured and Increasing Sum Insured
  • Regular premium payments
  • Initial waiting period of 180 days

Benefits of LIC Health Insurance - Cancer Cover

The following benefits are payable under LIC Cancer Cover:

  • Early Stage Cancer: Benefits are payable on first diagnosis of any one of the listed Early Stage Cancers, provided the same is admissible are -

  • Lump sum benefit: 25% of Applicable Sum Insured shall be payable

  • Premium Waiver Benefit: Premiums for next three policy years or balance policy period, whichever is lesser, shall be waived from the policy anniversary coinciding or following the date of diagnosis.
  • Major Stage Cancer: Benefits are payable on first diagnosis of the listed Major Stage Cancer, provided the same is admissible are-
  • Lump Sum: 100% of applicable sum insured less any earlier paid claims of Early Stage Cancer shall be paid.
  • Income Benefit: Income Benefit of 1% of applicable sum insured shall be paid on every policy month following the lump sum payment, for a fixed period of next 10 years, irrespective of the survival of the insured and even if this period of 10 years goes beyond the policy term. In case of the insured's demise while receiving the income benefit, the remaining pay-outs (if any) shall be paid to the nominee.
  • Premium Waiver Benefit: All future premiums will be waived from the next policy anniversary and the cover shall be free from all liabilities, except to the extent of income benefit as mentioned above.

Inclusion of LIC Health Insurance

What Is Covered Under LIC Jeevan Arogya?

  • Hospital cash benefit (HCB)
  • Major Surgical Benefit (MSB)
  • Ambulance Benefit
  • Premium waiver Benefit (PWB)
  • Day Care Procedure Benefit
  • Other Surgical Benefit

What Is Covered Under LIC Cancer Cover?

Early Stage Cancer:

  • Carcinoma-in-situ (CIS)
  • Prostate Cancer - early stage
  • Thyroid Cancer - early stage
  • Bladder Cancer - early stage
  • Chronic Lymphocytic Leukaemia - early stage
  • Cervical Intraepithelial Neoplasia

Major Stage Cancer: A malignant tumour characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. The diagnosis must be supported by histological evidence of malignancy. The term cancer includes lymphoma, leukaemia and sarcoma.

Exclusion of LIC Health Insurance

What Is Not Covered Under LIC Jeevan Arogya?

Some of The Exclusions Under This Policy Are:

  • Any pre-existing condition unless disclosed to and accepted by the LIC prior to the date of cover commencement.
  • Any treatment that is not undertaken by a physician or surgeon or any treatment or surgery of a purely experimental nature.
  • Routine medical check-up or examination.
  • Medical expenses relating to any treatment primarily for diagnostic, X-ray or laboratory examinations.
  • Sickness classified as an epidemic by the government.
  • Cosmetic, circumcision or aesthetic treatments, gender change surgery and plastic surgery.
  • Hospitalisation expenses or surgery for organ donation by a donor.
  • Treatment for correcting birth defects or congenital anomalies.
  • Dental treatment or surgery of any kind, unless required by Accidental Bodily Injury.
  • Self-harm, attempted suicide and/or the use or misuse of any drugs or alcohol and complications resulting from it.
  • Any STD or any condition caused or associated with HIV or any Syndrome or condition of a similar kind, commonly referred to as AIDS. ####What Is Not Covered Under LIC Cancer Cover?

Early Stage Cancer Exclusions:

  • Tumours histologically described as benign, borderline malignant or low malignant potential
  • Tumours in the presence of HIV infection
  • Dysplasia, intraepithelial neoplasia or squamous intraepithelial lesions
  • Carcinoma in-situ of skin and Melanoma in-situ

Major Stage Cancer Exclusions:

  • Tumours histologically described as carcinoma in situ, benign, premalignant, borderline malignant, low malignant potential, neoplasm of unknown behavior, or non-invasive, including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 and CIN-3.
  • Non-melanoma skin carcinoma, unless there is proof of metastases to lymph nodes or beyond;
  • Malignant melanoma that has not caused invasion beyond the epidermis;
  • Tumours of the prostate, unless histologically categorized as having a Gleason score higher than 6 or having progressed to at least clinical TNM classification T2N0M0
  • Thyroid cancers histologically categorized as T1N0M0 (TNM Classification) or below;
  • Chronic lymphocytic leukaemia below RAI stage 3
  • Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,
  • All Gastro-Intestinal Stromal Tumours histologically categorized as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs; All tumours in the presence of HIV infection.

What is the Difference Between LIC's Jeevan Arogya and LIC's Cancer Cover?

LIC's Jeevan Arogya provides health insurance cover against certain health risks. The policy pays out a lump sum benefit, irrespective of the actual medical costs incurred on treating an insured’s illness or injury. Cancer Cover, on the other hand, is a policy that provides financial protection if the insured is diagnosed with any of the specified early and/or major stage cancer during the policy period. It pays out the benefits only if the insured individual has been diagnosed with cancer.

Eligibility Criteria to Apply for LIC Health Insurance

LIC Jeevan Arogya

Factors 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)

Insured individuals are covered up to the age of 80 years. Children are insured up to 25 years of age.

LIC Cancer Cover

Minimum Age At Entry 20 years (completed)
Maximum Age At Entry 65 years (last birthday)
Minimum Policy Term 10 years
Maximum Policy Term 30 years
Minimum Age At Maturity 50 years
Maximum Age At Maturity 75 years

Documents Required To Buy & Claim LIC Health Insurance

Documents Required to Buy LIC Health Insurance

An individual will have to submit certain documents to avail LIC Health Insurance Policy. The documents include: **Identity Proof - PAN card, Aadhaar card, Passport, etc. **Address Proof - Aadhaar card, Passport, Driving license, etc.

Easy Procedure to Renew LIC Health Insurance

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

What Is Claim Procedure for LIC Health Insurance

In the event that the insured individual has been hospitalised for an illness or injury (covered by the policy), he or she will be required to notify the servicing branch of LIC right away. This will enable the insurer to start the claim procedure accordingly. If the insured is unable to do so, his or her relative can reach out to the LIC branch and intimate them about the incident. Within 30 days from the date of discharge, the insured has to provide the Corporation with written notification of a claim in the forms prescribed by LIC and along with the supporting evidence. In case an individual is making a claim on LIC Cancer Cover, the insured will have to provide reports of the diagnosis along with the claims form to serve as evidence.

Documents Required to Claim LIC Health Insurance

Documents required to make a claim on LIC Jeevan Arogya Plan:

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

Documents Required to make a claim on Cancer Cover:

  • Claim form duly signed with original policy document
  • Hospital Treatment certificate/discharge summary
  • Confirmatory investigation reports like radiology, histology and laboratory evidence

LIC Customer Care

In case of any queries, individuals can reach out to LIC by dialling on their toll-free number 18004259876 or call centre at 022 6827 6827. Users can also SMS LICHELP <pol.no.> to 9222492224 or SMS LICHELP <pol.no.> to 56767877. To locate nearby branches, users can make use of the Branch Locator facility available on the company’s website.

Conclusion & Reviews

Conclusion

Having a health insurance policy is a must in this day and age when one considers the high cost of quality healthcare. LIC has designed its health insurance to protect an insured’s finances in the event an unforeseen medical emergency occurs. The policy options from LIC provide higher coverage at affordable rates, making it easy for individuals of all walks to avail health insurance.

Reviews of LIC Health Insurance

“I chose to buy health insurance from LIC since it is one of the most trusted brands in the country. The benefits of Jeevan Arogya were exactly what I was looking for. I was able to purchase this in very short time without any trouble.” • Shristi Mishra, Indore

After going through the policy document, I realized that Cancer Cover by LIC is a good option for me. The premiums are lower compared to some of the policies and benefits are much better.” • Romil Kapoor, Mumbai

FAQ's On LIC Health Insurance Plan

What is Features & Benefits Of LIC Senior Citizens Health Insurance Plan?

LIC Health Insurance for Senior Citizens

Having a health insurance policy is important as a health insurance policy has become a necessity in today’s day and age. Diet and changing lifestyle have an undesirable impact on our health and senior citizens are more likely to be affected by health disorders. The possibility of having medical issues increases with age and might require serious medical attention. Health is the first companion that starts forsaking senior citizens and drag their hard-earned savings with it.

Cost of hospitalisation, medicines, and medical treatments are rising at a rapid rate. Moreover, senior citizens have less or no scope on the increase in their income. For senior citizens, a health insurance policy has proved to be a boon at such times.

Life Insurance Corporation was founded in 1956 and is an Indian company. LIC India was formed by the LIC Act, 1956, with a capital of Rs. Five crores contributed from the government of India. The company is presently headquartered in Mumbai and is the largest insurance provider in the country. The company functions today with its eight zonal offices, 113 divisional offices, 2048 branch offices, 1381 satellite offices, and the corporate office.

Over many decades, LIC has surpassed several landmarks and has set a remarkable performance record in the domain of life and health insurance. LIC Jeevan Arogya health insurance plan provides robust monetary security to senior citizens in case of hospitalisation, surgeries, and day care procedures at hospitals.

Value-added benefits of LIC health insurance for senior citizens

Over the years, the life expectancy of an average Indian citizen has increased with advanced and improved healthcare facilities. With increasing age, health tends to get affected at a more rapid rate while income tends to decrease as a result of retirement. Health insurance is a vital tool to take care of medical expenses during this stage of life for senior citizens.

LIC Jeevan Arogya is designed for individuals as well as people above the age of 60. This health insurance covers hospitalisation expenses of the insured member during the policy tenure.

Some of the most significant value-added benefits of LIC health insurance policy for senior citizens in India are as stated below –

  • Hospital cash benefit
  • Day care expenses arising out of technological advancements
  • Ambulance charges are covered under LIC health insurance for senior citizens
  • Flexible premium payment option
  • Increasing health cover every year
  • Lump sum benefit regardless of actual medical costs
  • Considerable financial coverage in case of hospitalisation and surgery

Advantages you get under LIC health insurance policy:

  • All types of operations, including day care treatments, are covered under the health insurance policy
  • You are eligible for a no claim bonus
  • Critical illness rider is offered with the plan along with critical illness being covered
  • Income tax benefits of up to Rs. 50,000 as they are permissible for deduction from your taxable income every year under Section 80D of the Income Tax Act, 1961.
  • Thirty days grace perio,d in case the individual has selected annual or half-yearly premium payment modes.

Inclusion of LIC health insurance for senior citizens

Hospital Cash Benefit: In case of hospitalisation due to sickness or accidental injury for a period not less than 24 hours, and where such a stay continues for more than four hours in a non-ICU ward, the company would pay an amount equal to the applicable daily benefit.

Day Care Procedure Benefit: In case the day care procedures fall under the health insurance policy, a lump sum amounting five times of such daily benefit would be paid to take care of the insured's medical needs.

Major Surgical Benefit: In case the policyholder has to undergo a surgery due to accidental injury or illness, then the respective benefit percentage would be paid to the policyholder as long as the surgery or illness is covered under the health insurance policy.

Other Surgical Benefits: In case the conducted surgery is not covered under the major surgical benefit, twice of an applicable daily benefit will be paid to the policyholder for an extended period of 24 hours.

Ambulance Benefit: As per the insurance policy, the policyholder will be provided an emergency transportation cost up to Rs. 1000. Premium waiver benefit: Under any event where the major surgical benefits are not successful, the insurance company would waive off the total annualized premium of one year.

Exclusion of LIC health insurance for senior citizens

Following are the list of exclusions under LIC health insurance for senior citizens:

  • Any complications arising out of pre-existing conditions.
  • Illness arising out of HIV/AIDS and related diseases.
  • Hospitalisation due to criminal proceedings, the court of law or war.
  • Any experimental surgery or treatment undertaken.
  • Expenditure arising out of organ donation.
  • Dental treatment.
  • Damages arising out of self-inflicted injuries.
  • Injury or illness arising due to alcohol, drugs, or substance abuse.
  • Injuries arising out of sports such as mountaineering, skydiving, race car driving, etc.
  • Mental or nervous treatment.
  • Birth defects, genetic or congenital disorders.
  • Damage arising out of working in hazardous environments such as high electric voltage establishments, underground mines, etc.
  • Injuries arising due to working in chemical or biologically contaminated environments.
  • Injuries arising due to terrorism.
  • Treatments arising due to failure to act upon sound medical advice.
  • Injuries arising due to prolonged pregnancy.
  • Suicide attempted / injuries occurred due to suicide.
  • Non-Allopathic treatments.
  • Injuries arising out of involvement in criminal activities.
  • Plastic or cosmetic surgery.

Eligibility criteria apply to LIC health insurance for senior citizens

Age: Age plays an important role while buying a health insurance policy for senior citizens. Jeevan Arogya offered by LIC comes in a wide age group parameter, thereby granting entry to almost all.

Maximum age permitted for enrolment is 75 years, whereas the maximum age of coverage is 80 years. Children are insured up to age 25 years.

Coverage offered: A daily hospitalisation benefit of Rs. 1000 to Rs. 4000

Documents required to buy LIC health insurance for senior citizens

Following are the documents required to purchase a health insurance policy from LIC:

  • Duly filled and signed the policy application form
  • Photo ID proof (Aadhaar card, PAN card, driving license, passport, voter ID, etc.)
  • Address proof (Aadhaar card, utility bills, voter ID, etc.)
  • Age proof (Birth certificate, passport, driving license, etc.)
  • Passport sized photograph ###Documents required to claim LIC health insurance for senior citizens

Following is the list of documents to make a successful claim under LIC health insurance plan.

  • Certificate issued by the hospital or discharge summary
  • Prescriptions subscribed by the doctor
  • Reports of all types of diagnosis conducted, such as X-ray, ECG, etc.
  • Receipts or invoice of all payments made
  • Claim form and photo ID proof
  • All investigative reports
  • Medico-legal certificates
  • Details of packaged bills with break up

A health insurance plan plays an essential role in the insurance portfolio, especially for senior citizens. Health insurance for senior citizens is basically for individuals who are above 60 years of age. Children can also avail this health insurance policy for their entire family and ageing parents.

It is important to note that health insurance policies taken for senior citizens must suit their particular needs and health conditions. With a steady increase in healthcare expenses, it can be difficult to pay medical costs out of your pocket. This is where a health insurance plan can come in handy so that you and your family can get adequate medical assistance for emergency and planned hospitalisation.

Advancement in medical technology has caused health care costs to rise exponentially, making good medical treatment affordability a puzzle. A good health insurance plan for senior citizens can save the day and help you to cater to medical needs without financial stress.

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