LIC launches benefit based health insurance plan Arogya Rakshak, know how it will work, 10 Points to Know before Buying. Life Insurance Corporation of India has introduced Arogya Rakshak, a non-linked, non-participating, regular premium individual health insurance plan.
“This plan provides fixed benefit health insurance cover against certain specified health risks and provides timely support in case of medical emergencies and helps the insured and his family to remain financially independent in difficult times,” LIC said.
LIC Arogya Rakshak Plan (No 906) : Important Details
The plan is aimed at providing timely support in case of medical emergencies and helping the insured and his/her family to remain financially independent in difficult times.
It differs from the conventional health insurance plan in terms of method of payment. While the latter re-imburses the actual cost incurred on treatment, Arogya Rakshak provides fixed benefit health insurance cover. It pays a lump sum benefit irrespective of actual medical costs.
This plan is also not a comprehensive plan as it works only against certain specified health risks.
LIC Arogya Rakshak Plan (No 906) : Key Features
This LIC health insurance plan is being launched from 19th July 2021.
This is non linked, non-participating, individual and family floater health insurance plans.
Under family floater plan, principal insured (PI) would be policy holder and can include spouse, children and parents into the policy.
This is a defined benefit plan. Means, irrespective of actual hospitalization or surgery expenses, the amount would be paid based on the eligible amounts.
There are several benefits like hospital cash benefit, major surgery benefit, quick cash benefit etc. in this health insurance plan.
The initial daily benefit (IDB) is ranging between Rs 2,500 to Rs 10,000 per day.
There is grace period of 30 days for free look period and to surrender the policy.
Riders available with additional premiums.
LIC Arogya Rakshak Plan (No 906) : Eligibility
Minimum Age of entry: Principal Insured – 18 years; Spouse and parents – 18 years; Children – 90+ days
Maximum Age of entry: Principal Insured – 65 years; Spouse and parents – 65 years; Children – 20 years
Cover Ceasing Age: Principal Insured – 80 years; Spouse and parents – 70 years; Children – 25 years
LIC Arogya Rakshak Plan (No 906) : Benefits
#1 – Hospital Cash Benefit (HCB)
- This benefit is payable in case of hospitalization due to accident or illness.
- Minimum Initial Daily Benefit (IDB) would be Rs 2,500 and maximum would be Rs 10,000 per day.
- Insured IDB of other members in the policy need to have less IDB compared to policy holder. Means if your family members are insured, their IDB would be lower than or equal to person insured IDB.
- Twice the insured IDB would be payable in case of admission in ICU for a maximum period of 15 days for 1st year of the policy period. From 2nd year onwards this maximum period is increased to 45 days in a year.
- Maximum benefit is available for 900 days per person per entire policy term.
#2 – Major Surgery Benefit (MSB)
- This benefit is payable in case of major surgeries.
- 100 Times of Assured Daily Benefit (ADB) would be paid (apart from HCB).
- There are 263 listed surgeries which are covered under this benefit. However, these surgeries are classified into 4 parts. Each part would be paid only fixed % of total benefit. It would be Category-I – 31 surgeries (100%), Category-II – 59 surgeries (60%), Category-III – 112 surgeries (40%) and Category-I – 62 surgeries (20%).
- Premium waived for 1 year from the date of surgery.
- Major surgery restoration in case of exhaust of MSB in a year provided it is not the same surgery.
#3 – Quick Cash Benefit (QCB)
- This benefit is paid in case of any surgery happens which is covered in Category-1 and Category-II.
- 50% of eligible MSB would be paid in advance. Means this is not an additional benefit beyond MSB, but one can claim 50% in advance and balance 50% would be paid later.
- Surgery should be done in LIC listed network hospitals only.
- This benefit is paid as advance to insured’s bank account directly.
#4 – Auto Health Cover
- If person insured dies, all future premiums would be waived of for a period of 15 years or up to 70 years of the insured individual which every is earlier. In case of children, premiums would be waived of till they attain 25 years of age.
#5 – Ambulance Benefit
- Ambulance benefit of Rs 1,000 lumpsum per person would be paid in case of surgery happened from the list of diseases indicated in category-I and category-II.
#6 – No Claim Bonus (NCB)
- 5% of Initial Daily Benefit (IDB) would be increased for every 3 free claim free policy years.
#7 – Daycare procedures benefit
- Day care procedure would be covered as part of this benefit.
- This covers all surgeries listed in Category-I to Category-IV.
- No need to admit in hospital to claim this benefit.
- Maximum 3 times per insured member in a year can be claimed.
- Maximum 30 times in a lifetime per insured member can be claimed.
#8 – Medical Management Benefit
- This benefit covers diseases like Dengue, Malaria, Pneumonia, Pulmonary Tuberculosis and Virals Hepatitis A.
- Lumpsum amount of 2.5 times of assured daily benefit is paid along with hospital cash benefit.
- Maximum 2 times in a policy period would be paid.
- Maximum 20 times in a lifetime per insured member would be paid.
- Major exclusion here is that this benefit is not paid if MSB, OCB and DCB are paid for same disease.
#9 – Free Health check-ups
- Health check-up benefit is paid once in 3 years with a maximum of 50% of Applicable daily benefit.
#10 – Premium Waiver Benefit
- In case any of the insured family member undergoes surgery, one year premium would be waived.
#11 – Income tax benefits
- Premiums paid under this plan would qualify for income tax benefits u/s 80D.
LIC Arogya Rakshak Plan (No 906) : Waiting period
General Waiting Period: For hospitalization or surgery, there is waiting period of 90 days from the date of taking the policy. This is not applicable if the hospitalization or surgery is due to accident.
Waiting period for specific diseases: There is waiting period of 2 years for 24 listed diseases.
Waiting period of pre-existing diseases: There is 2 years waiting periods for all pre-existing diseases apart from 31 diseases which would not be covered as part of this health insurance plan.
LIC Arogya Rakshak Plan (No 906) : Negative factors
Here are some of the reasons not to buy Arogya Rakshak health insurance Policy of LIC.
1) This is defined health insurance policy. Means, you need to incur the expenses and then claim from LIC as per the eligible amount. You need to keep funds in your account in case of hospitalization. Means this is not a typical health insurance policy what everyone would be looking.
2) The eligible amount to claim might be lower than actual expenses as there is no comparison to both.
3) We all know what can go wrong if we do not have health insurance. However, this health insurance policy has several restrictions which might create confusion to policy holders about features, what is eligible, what is excluded etc.
4) Some benefits like Medical Management Benefit is not paid if MSB, OCB and DCB are paid for same disease. Insured individuals need to go through all these exclusions for each benefit.
5) There is waiting period of 2 years for pre-existing diseases and for specific diseases. Also, there are 31 diseases which are excluded from the coverage.
As per Arogya Rakshak review by Basunivesh, he says “If I am the buyer of health insurance, I will go for pure health insurance which offers me indemnity cover than defined benefit cover. I know many LIC agents may push you to buy this product as LIC is offering a high commission to them (first year 35%, 2-10 years 6% and thereafter 5%), but look at your own requirements and how it will benefit and accordingly take a call”.
LIC Arogya Rakshak Plan (No 906) : Points to Consider Before Buying
Arogya Rakshak health insurance plan from LIC is a defined benefit plan. Benefits under this policy would be paid based on eligible amounts irrespective of the amount which policy insured might have incurred for hospitalization or surgeries or medicines.
This is not a typical health insurance plan that offers cashless hospitalization or reimbursements of expenses in case hospitalized due to illness. Means this policy would not help you for emergency hospitalization without having funds with you.
You need to keep funds for hospitalization and later claim from LIC based on the eligible amount under various benefits. The eligible amount would depend on initial daily benefit (IDB) which is capped Rs 10,000 per day. If a person is hospitalized say for 10 days and incurred Rs 5 Lakhs, the maximum eligible amount one can get under this plan is only Rs 1 Lakh (Rs 10,000 maximum x 10 days) even if we apply all benefits under this plan.
Join Our Telegram Channel - Click Here to Join
 : 10 Points to Know before Buying){kind=link}
0 Comments