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HEALTH
PLANS
LIC’s Health Plans are not plans but opportunities
that knock on your door once in a lifetime. These plans are
a perfect blend of insurance, investment and a lifetime of
happiness!
Health Protection Plus
Introduction:
IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO
IS BORNE BY THE POLICYHOLDER
Health is a major concern on everybody's mind these days.
With sky rocketing medical expenses, the possibility of any
illness leading to hospitalization or surgery is a constant
source of anxiety unless the family has actively provided
for funds to meet such an eventuality. Most families rarely
provide for healthcare, and even if they do, it is grossly
inadequate. Given this scenario, LIC has launched LIC's Health
Protection Plus plan, a unique long term health insurance
plan that can combine health insurance covers for the entire
family (husband, wife and the children) ' Hospital Cash Benefit
(HCB) and Major Surgical Benefit (MSB) along with a ULIP component
(investment in the form of Units) that is specifically designed
to meet Domiciliary Treatment Benefit (DTB) / Out Patient
Department (OPD) expenses for the insured members.
I. Vital Information
Accumulation
period |
1.Age |
Principal
Insured |
Spouse
Insured |
Child
Insured |
Min Policy Entry
Age , Age Last Birthday |
18
|
18
|
3months |
Min Age , HCB
Cover , Age Last Birthday |
18
|
18
|
3months |
Min Age , MSB
Cover , Age Last Birthday |
18
|
18
|
18 |
Maximum Entry
Age Age Nearest Birthday |
55
|
55 |
|
2. Premium Payment.
Mode of Payment:
Yearly, Half-Yearly
& Monthly (ECS Mode only)
Minimum
Annual Premium Conditions |
Number
of Lives covered |
Higher of the two conditions in each category listed
below: |
Single Life
|
6
times the HCB of the Principal Insured OR Rs.5000
p.a.
|
Two Lives |
The
arithmetic sum of 6 times the HCB of PI and 3 times
the HCB of the second insured. OR Rs.7500 p.a.
|
More than two
Lives
|
The
arithmetic sum of 6 times the HCB of PI and 3 times
the HCB of each of the others insured OR Rs.10,000
p.a.
|
Annualized Premiums are payable in multiples of Rs.500. |
3. Sum Assured.
The Principal Insured must first choose the respective levels
of HCB for each member to be covered under the policy. The
sum assured for major surgical benefits will be 200 times
of the HCB you choose.
Major
Surgical Sum Assured |
Principal Insured |
Spouse Insured |
Child
Insured |
200 times the HCB applicable
to each insured life under the policy. |
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4. Other Terms of the Policy.
Age Nearest Birthday |
Principal Insured |
Spouse
Insured |
Child Insured |
Max. HCB and MSB Cover ceasing age
|
75 |
75 |
25 |
Premium Ceasing Age |
65 Years Nearest Birthday
of the Principal Insured |
DTB ceasing age |
No age limit |
No age limit |
25 |
5. Addition of New Members. It is important for the Principal
Insured (the person taking the policy) to decide which of
the existing family members are to be covered and include
them at the beginning (proposal stage) itself. Eligible existing
family members cannot be added at a later stage. New members
can however be added under the following three situations.
Situation |
When to include? |
The
cover starts from |
Marriage/remarriage of the
Principal insured after taking the policy |
Within one year from the date of
marriage |
The following policy
anniversary |
A Child born or Legally
adopted child less than 3 months after taking the policy |
Health Cover
starts from the policy anniversary falling immediately
after the child completes 3 months |
Legally adopted child is
more than 3 months old |
From the policy anniversary
falling after date of adoption |
- The new members will be eligible for the cover only if
they satisfy the conditions of minimum premium and benefits.
- New members must be included by the Principal Insured
only. No new members will be allowed after the death of
the principal insured.
6. Increase/Decrease of Premiums. Increase or decrease of
premiums is allowed during the term of the policy. Increase
in premium must be in multiples of Rs.500. In case of decrease,
the minimum premium conditions must be satisfied. However,
increase/decrease in premiums does not affect the level
of health cover and HCB and MSB benefits.
II. CONDITIONS & RESTRICTIONS
1. Premium Discontinuance and Revival. The policy will lapse
if the premiums are not paid within the days of grace. The
PI shall have the option to revive the policy any time within
a period of two years from the due date of first unpaid premium
by payment of arrears of premiums or by availing Premium Holidays.
During the period of discontinuity, the charges for HCB and
MSB covers will continue to be deducted (even beyond two years)
from the policy fund till:
i. the policy fund has sufficient balance, or
ii.the lives covered reach the benefit ceasing age, or
iii.the maximum lifetime benefits are exhausted, or
iv.the policy is terminated due to death or any other reason,
if any,
whichever is earlier.
In case the policy is not revived during the revival period
and the balance in the Policy Fund is not sufficient to recover
the charges i.e. if the Policy Fund exhausts, the policy shall
compulsorily be terminated with a notice to the PI.
All other charges will also continue to be deducted from the
Policy Fund till the fund exhausts.
2. Premium Holidays. If the policy lapses after at least 3
years’ premiums have been paid the Principal Insured has the
option of either paying all the due premiums in full or avail
of premium holiday by just paying the latest instalment premium
without any interest. The premium holidays can be availed
only as long as the policy fund has a balance of at least
one annualized premium at the time of revival.
3. Surrender. No surrender will be allowed.
4. Policy Loans. No policy loan will be available under this
policy.
5. Assignment. No assignment will be allowed under this policy.
6. Tax Benefit. The premium payable under this product is
eligible for Section 80(D) benefit of Income Tax Act, 1961.
7. Risks borne by the Policyholder:
i)LIC’s Health Protection Plus is a Unit Linked Health Insurance
product which is different from the traditional insurance
products and is subject to risk factors.
ii)The premium paid in Unit Linked Life Insurance policies
are subject to investment risks associated with capital markets
and the NAVs of the units may go up or down based on the performance
of fund and factors influencing the capital market and the
insured is responsible for his/her decisions.
iii)Life Insurance Corporation of India is only the name of
the Insurance Company and LIC’s Health Protection Plus is
only the name of the unit linked health insurance contract
and does not in any way indicate the quality of the contract,
its future prospects or returns.
iv)Please know the associated risks and the applicable charges,
from your Insurance agent or the Intermediary or policy document
of the insurer.
v)The fund offered under this contract is the name of the
fund and do not in any way indicate the quality of these plans,
their future prospects and returns.
vi)All benefits under the policy are also subject to the Tax
Laws and other financial enactments as they exist from time
to time.
8. 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.
III. EXCLUSIONS
1. Common Exclusions in respect of HCB & MSB Benefits:
No benefits are available hereunder and no payment will be
made by the Corporation for any claim for Hospital Cash Benefit
and Major Surgical Benefit under this Policy on account of
Hospitalization directly or indirectly caused by, based on,
arising out of or howsoever attributable to any of the following:
a.Pre-existing condition- any medical condition or any related
condition (e.g. illnesses, symptoms, treatments, pains and
surgery) that have arisen at some point prior to the commencement
of this coverage, irrespective of whether any medical treatment
or advice was sought. Any such condition or related condition
about which the PI or insured dependant know, knew or could
reasonably have been assumed to have known, will be deemed
to be pre-existing. The following conditions will also be
deemed to be pre-existing:
i.Conditions arising between signing the application form
and confirmation of acceptance by the Corporation
ii.Any Sickness, illness, complication or ailment arising
out of or connected to the pre-existing illness
b.Any Sickness that has been classified as an Epidemic by
the -Central or State Government.
c.Self afflicted injuries or conditions (attempted suicide),
and/or the use or misuse of any drugs or alcohol.
d.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.
e.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.
f.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.
g.Any natural peril (including but not limited to avalanche,
earthquake, volcanic eruptions or any kind of natural hazard).
h.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.
i.Radioactive contamination.
j.Non-allopathic methods of surgery and treatment.
2. Additional Exclusions in respect of Hospital Cash Benefit:
No benefits are available hereunder and no payment will be
made by the Corporation for any claim for Hospital Cash Benefit
under this Policy on account of Hospitalization directly or
indirectly caused by, based on, arising out of or howsoever
attributable to any of the following:
a.Hospitalization due to illness within the first 180 days
from the Date of Cover commencement or 90 days from the date
of revival/reinstatement if revived after discontinuance of
the cover.
b.Removal of any material that was implanted in a former surgery
before Date of Cover commencement
c.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.
d.Hospitalization for the sole purpose of physiotherapy or
any ailment for which hospitalization is not warranted due
to advancement in medical technology
e.Any treatment not performed by a Physician or any treatment
of a purely experimental nature.
f.Any routine or prescribed medical check up or examination.
g.Medical Expenses relating to any hospitalization primarily
for diagnostic, X-ray or laboratory examinations
h.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).
i.Hospitalization for donation of an organ.
j.Hospitalization for correction of birth defects or congenital
anomalies
k.Dental treatment or surgery of any kind unless necessitated
by Accidental Bodily Injury.
l.Convalescence, general debility, nervous or other breakdown,
rest cure, congenital diseases or defect or anomaly, , sterilization
or infertility (diagnosis and treatment), any sanatoriums,
spa or rest cures or long term care or hospitalization undertaken
as a preventive or recuperative measure.
3. Additional Exclusions in respect of Major Surgical Benefit:
No benefits are available hereunder and no payment will be
made by the Corporation for any claim for Major Surgical Benefit
under this Policy directly or indirectly caused by, based
on, arising out of or howsoever attributable to any of the
following:
a.Surgeries not listed in the Surgical Benefit Annexure I
b.Surgery triggered by health related causes (and not by Accident)
within the first 180 days from the commencement date or 90
days from the date of revival/reinstatement if revived after
discontinuance of the cover.
c.Any Surgery for which claim has already been made and paid
by the Corporation.
d.Any treatment not performed by a Physician/Surgeon.
e.Any treatment including Surgery that is performed un-conventionally
under experimental conditions and purely experimental in nature.
f.Circumcision, cosmetic or aesthetic treatments of any description,
change of life surgery or treatment, treatment (including
surgery) for obesity, plastic surgery (unless 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).
g.Surgery for donation of an organ.
h.Removal or correction or replacement of any material that
was implanted in a former Surgery before Date of Cover commencement
i.Surgery for correction of birth defects or congenital anomalies.
j.Any diagnosis or treatment or surgery arising from or traceable
to pregnancy (whether uterine or extra uterine).
IV. INVESTMENT OF FUNDS
The premiums allocated to purchase units will be strictly
invested in a Health Protection Plus Fund (Income and Growth
Low Risk) as follows:
A.
Government/ Government Guaranteed/ Corporate Securities/
Debt |
Not
less than 50% |
B. Short term investments:
Money Market instruments including A above |
Not more than
90% |
C. Investment in listed
equity shares |
Not less than 10% & Not more
than 50% |
1. Method of Calculation of Unit price: Units will be allotted
based on the Net Asset Value (NAV) on the date of allotment.
There is no Bid-Offer spread. The NAV will be computed on
daily basis and will be based on investment performance, Fund
Management Charge and whether the fund is expanding or contracting.
a. Applicability of Net Asset Value (NAV): The premiums received
up to 3 p.m. (as per IRDA guidelines) by the servicing branch
of the corporation by a local cheque or by a demand draft
payable at par at the place where the premium is received,
the closing NAV of the day on which premium is received shall
be applicable. The premiums received after such time by the
servicing branch of the corporation by a local cheque or by
a demand draft payable at par at the place where the premium
is received, the closing NAV of the next business day shall
be applicable.
b. Redeeming of Units: In respect of valid applications received
for reimbursement of medical expenses, death claim, etc up
to such time by the servicing branch of the Corporation closing
NAV of that day shall be applicable. For the valid applications
received in respect of Domiciliary Treatment Benefit, death
claim etc after 3 p.m. (as per IRDA guidelines) by the servicing
branch of the Corporation the closing NAV of the next business
day shall be applicable.
2. Charges under the Plan:
a. Premium Allocation Charge: This is the percentage of the
premium appropriated towards charges from the premium received.
The balance known as allocation rate constitutes that part
of the premium which is utilized to purchase (Investment)
units for the policy. The allocation charges are as below:
First
year |
thereafter |
30% |
6% |
The above allocation charges shall be applicable for all
premiums including any additional premium paid in that particular
policy year.
b. Health Insurance Charge: There will be two separate charges
for the following benefits:
i) Hospital Cash Benefit
ii) Major Surgical Benefits.
These charges will be taken every month in respect of all
the members covered by canceling appropriate number of units
out of the Policy Fund.
These charges, during a policy year, will be based on the
age nearer birthday, of each of the members covered, as at
the Policy anniversary coinciding with or immediately preceding
the due date of cancellation of units and hence may increase
every year on each policy anniversary. The charges will also
depend on whether the person covered is male or female and
standard or sub-standard as per the underwriting decision.
If more than one member is covered under the policy then the
total charges shall be based on the individual ages of all
the members and the amount of cover for each such member.
In case of Hospital Cash Benefit, the charges will be applied
on the Initial Daily Benefit as mentioned in the Policy Schedule.
The charges for Hospital Cash Benefit and/or Major Surgical
Benefit will not be deducted once the benefit terminates.
Specimen charges for Rs. 100/- per day for HCB and Rs. 1000/-
SA for MSB for standard lives are given as under:
Age |
HCB |
MSB |
5 |
24.43 |
20.43 |
0 |
0 |
15 |
20.71 |
20.71 |
0 |
0 |
25 |
31.39 |
24.34 |
1.02 |
1.38 |
35 |
33.59 |
29.96 |
1.58 |
1.75 |
45 |
49.29 |
53.20 |
3.54 |
2.64 |
55 |
76.08 |
72.53 |
7.28 |
5.16 |
b. Health Insurance Charge:
Policy
Administration Charges |
Rs.75 per month during the first year and Rs. 25 per
month during the subsequent years. |
Fund
Management Charges |
Levied @ 1.25%
per annum of the unit fund, at the time of computation
of NAV which will be done on daily basis. |
Bid/
Offer Spread |
Nil |
Service
Tax Charge |
A service tax charge
shall be levied on the following charges:
i)Policy Administration charge and Health Insurance
charges - by canceling appropriate number of units
out of the Policyholder’s Fund Value on a monthly
basis as and when the corresponding Policy Administration
and Health Insurance charges are deducted.
ii)Premium allocation charge - at the time of allocation
of premium.
iii)Fund Management charge at the time of computation
of NAV on daily basis.
The level of this charge will be as per the rate
of service tax as applicable from time to time. Currently,
the rate of service tax is 10% with an educational
cess at the rate of 3% thereon and hence effective
rate is 10.30%.
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d. Right to revise charges-The Corporation reserves
the right to revise all or any of the above charges except
the Premium Allocation charge. The modification in charges
will be done with prospective effect with the prior approval
of IRDA.
Although the charges are reviewable, they will be subject
to the following maximum limit:
Policy Administration Charge-Rs. 150/- per month during the
first policy year and Rs.50/- per month thereafter, throughout
the term of the policy.
Fund Management Charge-The Maximum for Fund will be 2.5% p.a.
of Unit Fund
Hospital Cash Cover charges and Major Surgical Benefit charges
shall not exceed by more than 200% of the current rate.
Disclaimer : For more details on risk factors
, terms and conditions please read sales brochure carefully
before concluding a sale .
Benefits
1. Hospital Cash Benefit (HCB). A daily benefit is payable
in case the insured is hospitalized due to either accidental
body injury or sickness. The quantum of benefit depends upon
the level of cover opted.
Insured |
Initial
Daily Benefit (IDB)*# |
Minimum |
Maximum |
Principal Insured |
Rs.250 |
Rs.2500 |
Spouse/Child |
Rs.250 |
Rs.1500 |
*The Applicable Daily Benefit. IDB is applicable during the
first year of risk cover. The daily benefit will increase
@5% simple p.a. of the IDB on each policy anniversary until
it hits a cap of 1.5 times the initial benefit.
IDB of the spouse cannot exceed the Principal Insured’s IDB;
IDB of the children cannot exceed the spouse’s IDB.
The initial HCB must be in multiples of Rs. 50.
#Initial daily benefit that is payable in respect of stay
in a non-ICU room or ward. In case the insured is required
to stay in the ICU of a hospital, an enhanced rate of daily
benefit is payable, which is twice the eligible daily cash
benefit.
2. Major Surgical Benefit (MSB). In the event of the insured
undergoing one of the major surgeries defined in the Annexure
I, a lump sum benefit (regardless of the actual costs incurred)
equivalent to the percentage of the sum assured mentioned
against that surgery will be payable on providing proper proof
of surgery to the satisfaction of the corporation.
3. Domiciliary Treatment Benefit (DTB). The Principal Insured
can claim an amount equivalent to the actual expense he or
she has incurred in respect of any domiciliary treatment or
to meet the medical expenses incurred over and above the hospital
cash/major surgical benefits in respect of either oneself
or the others insured under the policy.
BEFORE
CESSATION OF HCB AND MSB COVERS ON ALL MEMBERS COVERED |
Minimum domiciliary
claimable |
Rs.2500 |
Maximum amount that can be claimed/
payable* |
Up to 50% of the policy
fund at the date of payment |
* Subject to a minimum
balance of one annualized premium being left in the
policy fund after making the payment.
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AFTER CESSATION OF HCB
AND MSB COVERS ON ALL MEMBERS COVERED |
Minimum domiciliary claimable |
Rs.2500* |
No limit on maximum
amount that can be claimed/ payable |
* If the balance in
the Policy Fund is less than Rs. 2,500/-, then the payment
of entire amount shall be made in one lump sum only. |
Note: i. A maximum of two payments will be allowed in a policy
year subject to the above conditions on production of supporting
proof of treatment and bills for expenses. DTB is available
only after at least 3 years premiums are paid.
ii. DTB is payable for the children covered until the health
cover ceasing age.
4. Death Benefit. No death insurance cover is available under
the plan. Following benefits/charges will take place on the
happening of unfortunate death of principal insured (PI) and/or
other insured member.
a)
On death of the PI (if policy is issued on single
life) or on death of all Insured members (if more
than one life is covered under the policy). |
The
Policy Fund Value will be payable to the nominee/
legal heir. |
b) On death
of PI (if other Insured members are there). |
The
payment of premiums will cease and the cover will
continue for the other Insured lives till the fund
is sufficient to recover all the charges or till the
maximum benefit ceasing age for each of the Insured
lives, whichever is earlier.
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c) On death
of insured member(s), other than PI |
The
payment of premiums and the cover for PI and other
Insured members, if any, will continue.
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5. Waiting Period. Both HCB and MSB covers are available
subject to a waiting period from the commencement of the risk
cover specified hereunder in respect of each insured member:
Waiting
Period from |
Principal
Insured |
Spouse
Insured |
Child
Insured |
Date of the
cover |
180 days |
180 days |
180*
days |
Date of reinstatement
of cover during the revival period |
90 days |
90 days |
90
days |
No waiting period
in respect of Accidental Bodily Injury.
*No waiting period in case of children for MSB from
the date of cover. |
6. Benefit Period Limits Hospital Cash Benefit.
HCB
|
Maximum Annual Benefit
Period |
Maximum
Lifetime Benefit Period |
1st
Year |
2nd year & after |
Principal Insured |
18
days incl. 9 days for ICU |
60
days incl. 30 days for ICU |
365
days |
Spouse Insured |
Child Insured* |
*Maximum period of
HCB for an insured child until he or she completes
5 years age is limited to 90 days.
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IMPORTANT
NOTE: HCB is available only in respect of hospitalization
in a ward or ICU for continuous period of 24 hours
or part thereof, over and above 48 hours, provided
such part stay exceeds 4 hours. |
7. Conditions for Availing Major Surgery Benefit
MSB
|
Principal
Insured |
Spouse
Insured |
Child
Insured |
Maximum Annual
benefit |
100%
of the Sum Assured applicable in respect of the each
insured member |
Maximum Lifetime
Benefit |
3 times
the Sum Assured applicable in respect of the each
insured member
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NOTE: i. Various HCB and MSB Benefit limits and restrictions
applicable under this policy in respect of each insured shall
solely and exclusively apply to that insured only and are
not transferable to any other insured.
ii. HCB/MSB is payable only if the hospitalisation/surgery
is performed in India.
8. Termination of HCB and MSB Benefits in respect of each
insured.
On attainment
of the insured’s maximum cover ceasing age 75 years
nearest birthday for PI/spouse insured and 25 years
nearest birthday for the children insured |
On reaching the maximum
lifetime benefit limits under HCB (365 days) and MSB
(3 times the sum assured) |
On the death of the
insured or on the date of termination of the policy
for any other reason
Insured spouse’s cover terminates on the date of divorce/
legal separation |
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We have Services in:
Andheri east,Andheri west,Borivali east,Borivali west,Chandivali,
Dadar,Ghatkopar,Goregaon east,Goregaonwest,Jogeshwari east,Jogeshwari
west, Kandivali east,kandivali west,Khar,Mumbai,Malad east,Malad
west,mtunga, Mulund,Mumbai,JVPD juhu,juhu scheme,vazira naka,kandivali
big bazar,samata nagar kandivali,kuluwadi,Mira bhayander,,kankia
kandivali,kankia miraroad,gokul aanand hotel,grant road,lower
parel west,lower parel east,khar east, Khar west,Versova,Fort,
Central,Parel,Juhu tara road,kandivali charkop,aakurli road,Lokhandwala
township,chakala,mahim,bandra east,Bandra west,malad sv road,mind
space Malad,samarpan ,marve road,colaba,mantralaya,lic of india,
Thakur complex,worli,Bandra,juhu,miraroad,bhyandar, worli,malbarhill,fort,gorai,dahisar,SantaCruz
east,Santacruz west,mahalaxmi,Worli,dahisar east ,Dahisar west,
(Mumbai), Sion, Mumbai, thakur village,Thane, Vile Parle east,
Vile Parle West,lokhandwala kandivali. malad west,malad east,gokuldham,
andheri vileparle,ashokvan,national park,mahindra kandivali
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