LIC Arogya Rakshak Plan : Everyone has been quite concerned about their health, even you. When a family member is unwell, it is a painful moment for the rest of the family in these days of rapidly rising medical costs. Being a kind person, you don’t want any bad event to interfere with your plans for your family and yourself. Therefore, don’t allow any medical emergencies to ruin your peace of mind.
LIC has introduced Arogya Rakshak, a special non-linked health insurance plan that offers coverage against specific health risks, prompt assistance in the event of an emergency, and assistance in maintaining your family’s financial independence during hard times.
- Priceless financial security in the event of surgery, hospitalization, etc.;
- Annually increasing health coverage
- A lump sum payment regardless of the actual cost of medical care
- No-claim insurance
- A variable benefit cap to select from
- Variable methods for paying for premiums
Incredibly simple to select a Plan
Step 1: Determine the extent of health coverage you require
Step 2: With our Representative, calculate the premium that must be paid.
Step 3: Determine the amount of health insurance you require:
From the options below, you can select the Initial Daily Benefit amount (i.e., the daily Hospital Cash Benefit payable for the first year of the policy) that best suits your needs:
2500 daily, 3000 daily, 4000 daily
This is the daily amount that you will be responsible for paying in the event that you are hospitalized within the first year.
You will be eligible for a Major Surgical Benefit that is 100 times greater than the Initial Daily Benefit you choose. The first Major Surgical Benefit Sum Assured will therefore be 2.5 lakh, 3 lakh, and 4 lakh, in that order. Depending on the daily hospital cash benefit selected, additional benefits such the Day Care Procedure Benefit, Other Surgical Benefit, and Premium Waiver Benefit (PWB) listed below may also be paid.
Step 4: Calculate the premium that must be paid in conjunction with our agent.
Your age, gender, the health coverage choice you select, whether you are the principal insured or a life insured, and the method of payment will all affect your premium.
For some of the ages in relation to different lives that can be covered under a single policy, the following tables provide an illustrative annual premium, payable annually, for all health benefits corresponding to an Initial Daily Benefit of less than Rs-2,500 per day:
1. Premium Payment:
Throughout the policy’s duration, you may choose to pay premiums on a yearly, half-yearly, quarterly, or monthly (for ECS mode only) basis.
The premium for each individual will be due on the date of entry into the policy until the date of exit. This will depend on the insured member’s age, the level of Hospital Cash Benefit (HCB) selected, and whether or not the insured member is the Principal Insured (if more than one member is covered by the policy). For the same age and coverage level, the Principal Insured and the other insured members will pay different premiums.
From the date the coverage started, the premiums are guaranteed for three years. After then, or once every three years, the Corporation retains the ability to revise the premium in order to account for the portfolio’s experience, provided that IRDA has given its previous consent. For an additional three years, or until the following Automatic Renewal Date, the rates in effect on each Automatic Renewal Date will be guaranteed.
The age of each insured member at the time of policy inclusion will determine the renewal premium rates for that member.
The total of the premiums for each member who will be covered by the policy will be the total premium that will be charged.
2. Moderate and Elevated HCB Rebates:
Rebate: Annual Rebate: 2% of Tabular Premium
50% of the tabular premium is the half-yearly mode.
HCB Rebates: If a member covered by a policy has an HCB of more than Rs 2500, the premium calculated for that member will be lowered by the sum listed below:
For PI, HCB For every insured person who isn’t PI
3. Automatic Renewal Date:
For the first three years of the policy, or three years from the date of policy commencement, each insured person’s instalment premium will be guaranteed. After then, the premiums may be adjusted to reflect the Corporation’s experience at the conclusion of every third policy anniversary, provided that IRDA has given its previous approval. For all insured parties covered by the policy, these premium due dates—which occur at the conclusion of every third policy anniversary, beginning on the date of policy initiation and ending on the date of cover expiry, while instalment premiums are reviewable—will be known as Automatic Renewal Dates.
The instalment premium on any future Automatic Renewal Date will be determined by the Insured’s age at policy inclusion and the then-current premium rates for this product set by the Corporation.
4. Choices:
A) Coverage for new members:
If the policyholder marries or remarries during its term, the spouse and in-laws may be added to the policy within six months of the date of the marriage or remarriage; however, coverage will begin on the policy anniversary that falls on or immediately after the date of inclusion. The increased premium is due on that policy anniversary.
Comparably, any child born or legally adopted after the policy is taken out can also be covered starting on the day the kid reaches the age of three months, which is the next immediate policy anniversary date. The child may be covered from the policy anniversary that falls on the same day as the adoption or the one that follows if the lawfully adopted child was older than three months on the adoption date. Increased premiums will start to come owing on that policy anniversary.
Each additional member’s inclusion will be contingent upon payment of increased premiums and compliance with the plan’s different terms and conditions.
Any additional life additions must be approved by the PI alone. There will be no more after PI passes away.
Any other scenario will not permit additions. If they were not insured when the insurance was taken out, the current spouse, parents, parents-in-law, and children will not be protected under the policy.
In the event that the mother and father are both still living and qualified for coverage, either one of them must receive coverage, or none at all. There will be no way for the PI to select one of them. The parents-in-law will likewise be subject to the same requirements.
A) Coverage for new members:
You, as the principal investigator, will be able to utilize the Quick Cash facility in the event that any insured lives undergo any qualified procedure covered under MSB Categories I or II in any of the network hospitals indicated. Instead of waiting to make a claim for the benefit after discharge, with this facility, 50% of the eligible MSB amount will be made available even throughout the hospitalization term of any insured lives covered (the surgery may be either planned or emergency due to accident). Only an advance payment will be made in the event that any MSB included in the procedures listed under categories I and II is admitted to the hospital and is allowed by the plan’s policy restrictions.
However, the TPA (Third Party Administrator) must approve this, and the advance payment would be deducted from the MSB claim amount’s final settlement.
By providing your bank account data in the required format, you can take use of this advance payment feature. The advance amount will be directly deposited to your bank account.
C) Term Assurance Rider:
As PI and your spouse, you have the opportunity to add an extra rider equal to the MSB SA called Term Assurance. If the tragic death occurs during the term for which the Term Assurance Rider is selected, a sum equal to the Term Assurance Sum Assured will be payable.
D) Accident Benefit Rider:
If you and your spouse have chosen the Term Assurance Rider, you may additionally choose the Accident Benefit Rider. The Term Assurance Rider SA will be equivalent to the Maximum Accident Benefit Sum Assured. An amount equal to the Accident Benefit Sum Assured will be paid in the terrible event that an accident results in death.
For each life to be covered under the plan, an additional premium of 0.50 will be required for each 2,500 of the Accident Benefit Sum Assured every policy year in order to access the Accident Benefit Rider.
It will not be necessary to pay the extra premium for this benefit on or after the Policy anniversary when the Term Assurance Rider expires.
5. Qualifications and Additional Limitations:
FOR SMALL PLAN
i) Under the Basic Plan, for Hospital Cash Benefit (HCB)
ii) Under the Basic Plan, for Major Surgical Benefit (MSB)
iii) For the Basic Plan’s Day Care Procedure Benefit (DCPB)
iv) Under the Basic Plan, for Other Surgical Benefit (OSB)
FOR RIDER OPTION OF ACCIDENT BENEFIT:
(a) The Minimum Assured Accident Benefit Sum:
(b) Maximum Accident Benefit Sum Assured: This is the same as the Term Assurance Sum Assured for the insured, up to a total of 50 lakhs, taking into account the Accident Benefit Sum Assured for all current policies under individual and group policies on the insured’s life, including those obtained from Life Insurance Corporation of India and other insurance companies, as well as the Accident Benefit Sum Assured under new proposals.
The Accident Benefit Sum Assured must be expressed in multiples of less than Rs 5,000.
(c) Must be at least eighteen years old to enter.
(d). 50 years old is the maximum entry age (nearest birthday).
(e) 60 years old is the maximum age for a cover (nearest birthday).
f) Term maximum: 35 years
FOR RIDER OPTION OF ACCIDENT BENEFIT:
(a) Assurance with Minimum Term Total Guaranteed: 100in thousands
(b) Maximum Term Assurance Sum Assured: Up to a maximum of 25 lakh overall, taking into account all term assurance riders under all current policies of the Life Assured and Term Assurance Sum Assured under other proposals, this amount is equal to the Major Surgical Benefit Sum Assured (MSB SA) at the time of inception/inclusion into the policy (i.e., 100 times of Initial Daily Hospital Cash Benefit) in respect of the insured.
The Guaranteed Term There will be multiples of less than Rs 25,000.
(c) The minimum age of entry is eighteen (full).
(d) 50 years old is the maximum entry age (nearest birthday).
(e) 60 years is the maximum maturity age (nearest birthday).
(f) 35 Years is the Maximum Term
6. Other Elements
A) Death Benefit under the base plan:
Unless one of the aforementioned Rider Benefits has been selected, no death benefit will be paid upon the death of an insured.
upon the Principal Insured’s passing
(a) Should the option be exercised at the outset of the contract and the Policy be renewed, the surviving Insured Spouse will become the Principal Insured. In such a scenario, the Insured Spouse’s premium will be adjusted starting on the date that coincides with or follows the instalment premium due date. The new premium will be based on the tabular premium rates that apply to PIs, and the spouse’s entry age will be used to calculate the revised premium rate. The policy will expire and the Insured Spouse will not become PI if the option is not exercised at the start of the contract.
(b) The current policy will expire and the other insured will have the opportunity to obtain a new one if the insured spouse predeceased the principal insured. Regarding these additional insureds:
1.If the new policy is purchased within ninety days of the previous policy’s termination, it will be granted without the need for any underwriting.
2.The new policy will not be subject to the maximum entry age requirement.
3. The new policy will still apply to any outstanding waiting periods and exclusion periods.
4. All other terms and conditions, such as premium amounts, will apply to the new policy.
If an insured person, other than the principal insured, passes away, the policy will still be in effect after the insured is removed, and the premium will be adjusted starting on the date that the insurance company notifies the beneficiary of the insured’s death, whichever comes first.
B) Maturity Benefit:
At the conclusion of the Cover Period, there are no benefits due.
C) Termination of premiums:
Annual, half-annual, and quarterly premium payments will be accepted for a grace period of one month, but no fewer than thirty days, and monthly premium payments will have a grace period of fifteen days.
The policy lapses and all benefits payable under this plan stop if the premium is not paid before the days of grace expire.
D) Revival:
If the PI provides evidence of continuous insurability to the satisfaction of the Corporation and pays all outstanding premium arrears plus interest at a rate the Corporation may from time to time fix, a lapsed policy may be revived by the PI within two years of the first unpaid premium due date but before the PI’s coverage expires.The Corporation retains the ability to approve a terminated policy at its original terms, approve it with modifications, or reject it. The resuscitation of the terminated policy will only happen following approval by the Corporation and notification to the PI.
On revival, the exclusions and waiting periods listed in paragraphs 14 and 15, respectively, will be applicable. At his own cost, the Principal Insured may be asked by the Corporation to furnish adequate proof of good health for each Insured. When all conditions for revival or reinstatement are satisfied and accepted by the Corporation at its sole discretion, that date shall be known as the Date of Revival.
For any occurrence that happened between the date of the policy’s discontinuation and the date of its revival, no benefit will be provided.
Furthermore, the premium before and after the Automatic Renewal Date may differ if the Automatic Renewal Date comes within the revival period and revival is completed after the Automatic Renewal Date.
Following the revival time, revival will not be permitted.
- E) Surrender: The plan provides no value for surrender.
- Cooling-off period: You have 15 days to return the policy to us if the “Terms and Conditions” are unacceptable to you.
- Loan: This plan does not offer any loans.
- Assignment No.:
This strategy will not allow for any assignments.
- Not Included:
Benefits under this insurance are not accessible, and the Corporation will not pay claims resulting from hospitalization or surgery that are caused by, based on, arising out of, or in any way related to any of the following:
- Any pre-existing conditions that have not been revealed to and approved by the Corporation before the Date of Cover Commencement or, in the event that the Policy is revived following the discontinuation of Coverage, the Date of Revival.
- Any procedure or surgery that is solely experimental or that is not carried out by a physician or surgeon.
- Any regular or recommended medical examination or check-up.
- Medical costs associated with any care mostly for radiological, laboratory, or diagnostic tests.
- Any illness that the federal or state governments have declared to be an epidemic.
- Circumcision, any kind of cosmetic or aesthetic treatment, gender-neutral surgery, and plastic surgery (unless the latter is required to address an illness or unintentional bodily injury resulting directly from the insured occurrence and must be done within six months of the incident).
- Surgery or hospitalization in order to donate an organ.
- Therapy to address congenital abnormalities or birth problems.
- Dental care or surgery of any type, unless an accident-related bodily injury requires it.
- Recuperated states, general weakness, nervous or other breakdowns, rest cures, congenital illnesses, defects, or anomalies, sterilization or infertility (diagnostic and treatment), any sanatoriums, spas, or rest cures, as well as long-term care or hospitalizations carried out as a preventive?
- Injuries or ailments caused by oneself, including suicide attempts, as well as the improper use or abuse of alcohol or narcotics.
- Any sexually transmitted infections, conditions that are either directly or indirectly linked to the Human Immunodeficiency Virus (HIV), syndromes, or conditions of a similar nature that are frequently referred to as AIDS.
- Removal, correction, or replacement of any material implanted during a previous surgery prior to the start date of the policy or, in the event that the policy is revived following the termination of the coverage, the date of the revival.
- Any diagnostic or treatment connected to or resulting from a pregnancy (uterine or extrauterine), childbirth, including caesarean sections, medical termination of pregnancy, and/or any care given to the mother or the newborn throughout the prenatal and postnatal phases.
- being in a hospital just to receive physical therapy or for any illness for which modern medical technology does not justify being in a hospital.
- War, invasion, hostile act by a foreign power, hostilities (whether or not a war is proclaimed), civil war, military revolt, revolution, usurped power of civil unrest, and related looting and pillage.
- Participation in military or naval activities (including peacetime responsibilities) of the armed forces or the air force, as well as actions requiring the use of force or directed by military authorities to combat terrorists, rebels, and similar groups.
- Any natural danger, such as an earthquake, avalanche, volcanic eruption, or other natural hazard.
- Engaging in any risky sport or activity, such as mountaineering, bungee jumping, racing, scuba diving, or aerial sports, or engaging in any unlawful or criminal action.
- Contamination by radioactivity
- non-allopathic surgical or therapeutic approaches.
- Engaging in any unlawful or criminal activity.
- Care resulting from the insured’s disregard for appropriate medical advice.
Advantage:
major surgical benefit (MSB),
day care procedure benefit,
other surgical benefit, ambulance benefit, and
premium waiver benefit (PWB) is among the benefits provided by the plan.Hospital cash benefit (HCB),
A) Hospital Cash Benefit:
In the event that you or any of the insured lives covered by the policy are admitted to the hospital for an Accidental Body Injury or Sickness and your stay there surpasses a continuous 24-hour period, you will be entitled to receive an amount equal to the Applicable Daily Benefit (ADB) available under the policy during that policy year, subject to the benefit limits and conditions outlined in Paragraph 11A) and the exclusions listed in Paragraph 15 below. This will happen for any continuous 24-hour period or part thereof, provided that any such part-stay exceeds a continuous 4-hour period (after having completed the 24 hours as above) in a non-ICU ward or room of a hospital.
The Initial Daily Benefit amount that you select and that is specified in the policy schedule will be the Applicable Daily Benefit for each insured during the first year of coverage commencement.
After the first policy year, the amount of ADB for each policy year will be divided into two parts:
An amount equal to 5% (five percent) of the Initial Daily Benefit is added arithmetically to the Applicable Daily Benefit from the prior Policy Year. During the Cover Period, this increase in the Applicable Daily Benefit will take place on each policy anniversary and will continue until it reaches a maximum of 1.5 times the Initial Daily Benefit. After that, this sum will always stay at the highest level reached in each Policy Year going forward.
Additional arithmetic addition of the “No Claim Benefit” (specified in Paragraph 1.G) below, if the policy qualifies for and attracts it. There won’t be a cap on this increase, so if this policy qualifies for “No Claim Benefit,” it will be paid out for the duration of the Cover Period without any upper limit.
For members who are added to the policy later, the benefit will start off at the same amount as the Initial Daily Benefit and will increase as previously mentioned in the Applicable Daily Benefit in the following years.
In the event that a member insured is hospitalized in an intensive care unit, the applicable daily benefit will be paid twice, subject to the benefit limits and criteria outlined in Paragraph 11A) and the exclusions listed in Paragraph 15 below.
The Corporation will pay benefits as if the admission was to the Intensive Care Unit for a period of 24 continuous hours (one day) of hospitalization (after the 24 hours as above), if the said hospitalization included a stay in an Intensive Care Unit as well as any other in-patient (non-Intensive Care Unit) ward of the Hospital. The requirement is that the period of hospitalization in the Intensive Care Unit was at least 4 continuous hours.
During the first 24 hours of hospitalization, no benefits will be given. Nevertheless, regardless of whether the insured was admitted to a general, special, or intensive care unit, the Daily Hospital Cash Benefit would also be paid for the first 24 hours (day one) of any hospitalization that lasts for a continuous period of seven days or longer.
B) Major Surgical Benefit:
If, during the coverage period, an insured person undergoes one of the surgeries listed in the Major Surgical Benefit Annexure out of medical necessity for an Accidental Bodily Injury or Sickness, in a hospital, the corresponding benefit percentage of the Major Surgical Benefit Sum Assured will be paid, subject to the benefit limits and conditions listed in Paragraph 11B) and the exclusions listed in Paragraph 15 below, for each eligible surgery.
C) Day Care Procedure Benefit:
Subject to the benefit limits and conditions outlined in Paragraph 11C) and the exclusions listed in Paragraph 15 below, a lump sum payment equal to five (five) times the applicable daily benefit will be made in the event that an insured person under this plan undergoes any of the specified day care procedures listed in the Day Care Procedure Benefit Annexure due to medical necessity.
D) Other Surgical Benefit:
If an insured person under this plan undergoes a surgery that is not covered by the Major Surgical Benefit or Day Care Procedure Benefit due to medical necessity and their hospital stay exceeds a continuous 24-hour period during the Cover Period, they will be paid a daily benefit equal to two times the applicable daily benefit for each continuous 24-hour period, or a portion of it, if their hospital stay exceeds a continuous 4-hour period. This is subject to the benefit limits and conditions outlined in Paragraph 11D) and the exclusions listed in Paragraph 15 below.
E) Ambulance Benefit:
A lump sum payment of approximately Rs 2500 will be made in lieu of ambulance expenses if a Major Surgical Benefit falling under either Category 1 or Category 2 (as specified in the Major Surgical Benefit Annexure) is payable and emergency transportation costs have been incurred.
F) Premium Waiver Benefit:
The entire annualized premium, or the entire one-year premium for that policy, from the date of instalment premium due coinciding with or next following the date of the surgery, will be waived in the event that a Major Surgical Benefit falling under Category 1 or Category 2 (as mentioned in the Major Surgical Benefit Annexure) is payable in respect of any Insured covered under the policy.
G) No claim benefit:
If there are no claims for any Insured covered by your policy during the time between the date of policy initiation and the following automatic renewal date, or between two automatic renewal dates (see paragraph 4 below), you will get a no claim benefit. To determine the Applicable Daily Benefit for each insured for the Policy Year that follows the most recent Automatic Renewal Date, the no claim benefit amount is equivalent to 5% (five percent) of the Initial Daily Benefit for each insured. This amount is then added.
ii) Benefit Restrictions and Guidelines:
A) Benefit of Hospital Cash:
i) Only hospitalization that has taken place in India would qualify for the Hospital Cash Benefit.
ii) The total number of days that each insured person would be eligible for hospital cash benefits in a policy year would be limited to:
a) 30 (thirty) days of hospitalization, of which no more than 15 (fifteen) days would be spent in an intensive care unit in the first policy year after the date that coverage for that insured person began.
b) In the second and subsequent Policy Years from the date of commencement of cover with respect to that Insured, a maximum of 90 (ninety) days of hospitalization, of which no more than 45 (forty-five) days shall be in an Intensive Care Unit
The maximum number of hospital days for which a Hospital Cash Benefit is payable during the Cover Period for each and every insured person covered by the policy is 720 (seven hundred and twenty) days, of which no more than 360 (three hundred and sixty) days must be spent in an Intensive Care Unit. When an insured person reaches this maximum, the hospital cash benefit for that person will end right away.
iv) The Benefit Limits mentioned in the aforementioned paragraphs regarding an insured person under this policy will only and exclusively apply to that person. Any hospital cash benefit that is not claimed by one insured person cannot be transferred to another insured person.
v) If an insured person under this policy undergoes any of the day care procedures listed in the Day Care Procedure Benefit Annexure, the Hospital Cash Benefit will not be paid.
B) Significant Surgical Gain:
i) The Corporation will only cover the procedure for which the highest sum will become payable if multiple surgeries are done on the insured during the same surgical session, either through the same incision or by making separate incisions.
ii) If the Corporation is satisfied with the proof of surgery, the Major Surgical Benefit will be paid as a lump payment as stated for the benefit in question.
iii) To the satisfaction of the Corporation, every surgical procedure claimed should be validated as necessary and required by a licensed physician or surgeon.
iv) The Major Surgical Benefit will not be paid until the Corporation is satisfied that the specific Surgery covered by the Policy has been carried out, based on medical proof.
v) Only if the surgery was done in India is the Major Surgical Benefit eligible to be paid.
vi) The payment of the amount in place of ambulance charges is limited to one time per insured person during each policy year, and it is contingent upon the insured party supplying the Corporation with adequate proof.
vii) In any Policy Year throughout the Cover Period, the total amount payable for each Insured under the Major Surgical Benefit shall not exceed 100% of the Major Surgical Benefit Sum Assured in that Policy year.
viii) The Major Surgical Benefit’s total payment to any insured person throughout the Cover Period may not surpass 800% of the Major Surgical Benefit Sum Assured. The Major Surgical Benefit for an insured person will end immediately if the total amount paid in relation to that insured person equals this lifetime maximum limit.
ix) For an insured person covered by this policy, the Benefit Limits mentioned in the aforementioned clauses will only and exclusively apply to that insured person. One insured person’s unclaimed major surgical benefit cannot be transferred to another insured person.
x) During the policy’s term, the Major Surgical benefit for any procedure cannot be claimed and will not be paid more than once for the same procedure.
C) Advantage of the Day Care Process:
i) The Corporation will only cover one Day Care Surgical Procedure if multiple procedures are performed on the insured during the same surgical session, either by making separate incisions or by using the same incision.
ii) The Day Care Procedure Benefit will be reimbursed in full and is contingent upon presenting documentation of the surgery to the Corporation’s satisfaction.
iii) To the satisfaction of the Corporation, every surgical procedure claimed should be validated as necessary and required by a licensed physician or surgeon.
iv) The Day Care Procedure Benefit will not be paid until the Corporation is satisfied that the specific Surgical Procedure covered by the policy has been carried out, based on medical proof.
v) Only if the surgical procedure was carried out in India will the Day Care Procedure Benefit be paid.
vi) The Day Care Procedure Benefit will only be paid for a maximum of 3 (three) Surgical Procedures per Insured throughout the Cover Period in any given Policy Year.
vii) The Day Care Procedure Benefit will only be paid for a maximum of 24 (twenty-four) Surgical Procedures for each Insured throughout the Cover Period. The Day Care Procedure Benefit for an insured person will end immediately if the total number of surgical procedures for that insured person that qualify for the benefit equals this lifetime maximum limit.
viii) An insured person under this policy shall only and exclusively be covered by the Benefit Limits mentioned in the aforementioned provisions with regard to such insured person. An insured person’s unclaimed day care procedure benefit cannot be transferred to another insured person.
ix) No hospital cash benefit will be given if a day care procedure is conducted.
D) Extra Surgical Advantage:
i) The Corporation will only cover one surgical procedure if multiple incisions are made on the insured during the same surgical session, either by using the same incision or different ones.
ii) The Corporation must be satisfied with the proof of surgery before the Other Surgical Benefit can be paid as a Daily Benefit.
iii) To the satisfaction of the Corporation, every surgical procedure claimed should be validated as necessary and required by a licensed physician or surgeon.
iv) The Corporation will only be satisfied that the specific surgical procedure covered by the policy has been carried out based on medical evidence before the Other Surgical Benefit becomes payable.
v) Only if the surgical procedure was carried out in India will the other surgical benefit be paid.
vi) For each insured person covered by the policy, the total number of hospital days for which the Other Surgical Benefit is payable during a policy year cannot exceed 15 (fifteen) days in the first policy year after the date on which cover for that insured person began, and 45 (forty-five) days in the second and subsequent policy years after the date on which cover for that insured person began.
vii) A maximum of 360 (three hundred and sixty) days may be the total number of hospital days for which the Other Surgical Benefit is payable during the Cover Period, for each and every insured covered by the Policy. The Other Surgical Benefit for the Insured will end immediately upon reaching this lifetime maximum limit.
viii) An insured person under this policy shall only and exclusively be covered by the Benefit Limits mentioned in the aforementioned provisions with regard to such insured person. One insured person’s unclaimed Other Surgical Benefit cannot be transferred to another insured person.
iii) Benefit Coverage Commencement and Termination:
For each insured covered by your policy, the Hospital Cash Benefit, Major Surgical Benefit, Day Care Procedure Benefit, and Other Surgical Benefit cover will begin on the Date of Cover Commencement specifically indicated in the Policy Schedule.
The coverage for each insured person’s hospital cash benefit, major surgical benefit, day care procedure benefit, and other surgical benefit will end as soon as possible.
- The Policy Schedule specifies the Date of Cover Expiry.
- When the lifetime maximum Benefit Limits, as outlined in Paragraph 11 above, are exhausted.
- When the Principal Insured dies or reaches his/her Date of Cover Expiry, and if the Policy does not continue with the Insured Spouse as the Principal Insured.
- When the Insured Spouse dies or reaches his/her Date of Cover Expiry after the Policy continues with the Insured Spouse as the Principal Insured.
- In the event of the insured’s death;
- In the event of the insured spouse’s divorce or other legal separation from the principal insured;
- In the event that the policy is terminated for any reason, including nonpayment of premiums.
iv) Policy Termination:
A) In the event that a single-life insurance is issued: The policy will expire at the earliest opportunity.
I Failure to pay premiums during the revival period; ii) Death; iii) Date of Cover Expiry shown in the Policy Schedule; iv) When all lifetime maximum Benefit Limits as listed in Paragraph 11 above are exhausted.
B) In the event that an insurance is issued for several lives, it will expire at the earliest possible date of the following:
i) Failure to pay premiums during the revival period; ii) When a principal investigator reaches all of the maximum lifetime benefit limits as outlined in paragraph 11 above.
iii) If the policy does not continue with the Insured Spouse as the Principal Insured, upon the Principal Insured’s death or the Date of Cover Expiration.
iv) On the insured spouse’s death or day of Cover Expiry, provided that the policy remains in effect and the insured spouse serves as the Principal Insured following the death of the principal insured or the day on which the policy expires.
v) The Waiting Time
General waiting period: If hospitalization or surgery is required as a result of an accidental bodily injury, there won’t be a general waiting period. If a hospital stay or surgery is required and the reason for the hospitalization or surgery was illness, there will be a general waiting time during which benefits will not be paid.
- For each insured, the usual waiting time will last 90 (ninety) days starting on the date of cover commencement.
- The following will apply to each insured if the policy is reinstated following the discontinuation of the Cover:
- a) There will be a general waiting time of 45 (forty-five) days from the Date of Revival with regard to each insured if the request for revival is received by the Corporation within 90 (ninety) days of the first delinquent premium due.
b) A general waiting time of 90 (ninety) days from the Date of Revival for each Insured will apply if the Corporation receives the request for revival after the first unpaid premium has been past due.
A particular waiting time:
Furthermore, for each insured person, no benefits are available under this policy, and the Corporation will not pay any claim arising from hospitalization or surgery related to, resulting from, or attributable in any way to any of the following during the designated waiting period:
Treatment for disorders of the adenoids or tonsils;
Treatment for anal fistula or anal fissure;
Treatment for benign enlargement of the prostate gland;
Treatment for benign uterine disorders, such as fibroids, uterine prolapse, dysfunctional uterine bleeding, etc.;
Treatment for cataracts;
Treatment for gallstones;
Treatment for slip discs;
Treatment for piles;
Treatment for benign thyroid disorders;
Treatment for Hernia;
Treatment for hydrocele;
Treatment for degenerative joint conditions;
Treatment for kidney or urinary tract stones;
Treatment for varicose veins;
Treatment for Carpal tunnel syndrome;
Treatment for benign breast disorders, such as fibroadenoma, fibrocystic disease, etc.
The following is the precise waiting period that applies to the therapies listed in the above list:
- For each insured, the specified waiting period will be two (two) years from the Date of Cover Commencement.
- The following will apply to each insured if the policy is reinstated following the discontinuation of the Cover:
a) The defined waiting time will last until 2 (two) years from the Date of Cover Commencement for each insured if the Corporation receives the request for revival within 90 (ninety) days of the first unpaid premium being due.
b) There will be a particular waiting period of 2 (two) years from the Date of Revival with regard to each insured if the request for revival is received by the Corporation after 90 (ninety) days from the due date of the first unpaid premium.
After the benefit expires, no money will be taken out for it.
Pingback: LIC CANCER COVER 905 PLAN DETAILS, REVIEW - LICMDRT