LIC Health Insurance

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.

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.)

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 - 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 - 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

FactorsMinimum age at entryMaximum age at entry
Self / spouse18 years65 years (last birthday)
Parents / parents-in-law18 years75 (last birthday)
Children91 days17 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 Entry20 years (completed)
Maximum Age At Entry65 years (last birthday)
Minimum Policy Term10 years
Maximum Policy Term30 years
Minimum Age At Maturity50 years
Maximum Age At Maturity75 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

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