Details of Jivan Arogya Plan

7/28/2019 Details of Jivan Arogya Plan

http://slidepdf.com/reader/full/details-of-jivan-arogya-plan 1/4

Let us understand 'Jeevan Arogya' (T-903) better

1. What is a fixed Benefit Health lnsurance plan?

Ans: ln a fixed Benefit plan, a fixed amount is paid irrespective of costs incurred for the surgery.amount payable is defined in the policy conditions.

2. A Policyholder has one Mediclaim Policy and one 'Jeevan Arogya'. He undergoes hospitalization andMediclaim Benefit. Can he claim again under 'Jeevan Arogya' policy for the same hospitalization?

Ans: Since 'ieevan Arogya' Policy is a fixed Benefit Policy, the benefit (Claim) is in addition to any other HealthInsurance Policy. Hence, he can claim under both the policies.

3' what are the various benefits offered under 'Jeevan Arogya' plan?

Ans: (a) Hospital Cash Benefit (HcB) (b) Major Surgical Benefit (MsB) (c) Day Care procedure benefit (DcpB)(d) Other Surgical Benefit (OSB)

4. Who can be covered under 'Jeevan Arogya'?

Ans: Under 'Jeevan Arogya', besides Principal lnsured, Spouse, Parents, Parents-in-law and dependent children canbe covered.

5. What is the lnitial Daily Benefit under ,JeevanArogya'?

Ans: The lnitial Daily Benefit (lDB) is the level of HCB chosen by the insured. The levels available are (a) < lOOO/-(b) < 2000/- (c) { 3000/- (4) < 4000/-

6. Does lnitial Daily Benefit remains the same or changes over policy term?Ans: The Initial Daily Benefit (lDB) under 'Jeevan Arogya' plan increases arithmetically by 5% every year till a

maximum of 1.5 times lDB. Eg' if IDB is Rs.4000i-, each year, ( 200/- is added for 10 years till it becomes { 6000/-

Year Daily Benefit

1 IDB4000(level chosen by lnsured)

2 4200

3 4400

4 4600

5 4800

6 5000

7 5200

8 5400

9 5500

10 580011 6000

(Maximum allowed i.e.1.5 times IDB)

7.

Ans:

What is no Claim Benefit?

lf there is no claim on all lives insured for a continuous period of 3 years from date of commencement, IDBincreases by an amount equal to5% of lDB. This continues and it increases for every block of 3 years withoutany upper limit if there are no claims during the preceding 3 years.

8. What is Applicable Daily Benefit (ADB)? '

Ans: Applicable Daily Benefit is the rate of IDB applicable after adding the yearly increase of 5o/o and no Claim

a@fia 22



Benefit of 5o/o as per the eligibility.

9. How does ADB affect the benefits payable?

Ans: All the benefits of JA are in multiples of ADB. As ADBincreases, all

thebenefits payable also increase. Eg, if

there are no claims on any of the lives assured,

Year HCB lcu M5B DCPB osB

Non-lCU

1.t 4000 8000 400,000 20,000 8,000

6th 5200 {4000+ 1000 (@200 pa) +200 (in 4tn year )} 10400 520,000 26,000 10,400

'lO. What is the maximum term of 'Jeevan Arogya' Policy?

Ans: 'Jeevan Arogya' provides health cover upto age 80 years. Hence,

Term of the Policy for PI/Spouse/Parents/Parents-in-law = 80 years-Age at entry

For Children, the coverage is upto 25 years' Hence,Term of the Policy for Children =25 - Age at entry

11. For all health policies, normally premium changes every year. ls it so for our'Jeevan Arogya' plan?

Ans: No, For 'Jeevan Arogya', Premium rate is guaranteed for 3 years. Based on the Corporation's experience,

Premium may change at the end of 3'd year. The revised premium is again guaranteed for a further period

of 3 years and so on. This date is called 'Automatic Renewal Date' (ARD)

12. NoW I am 35 years old. When I become 50 years, will I have to pay premium rate applicable for age 50 years?

Ans: No, Premium is charged based on the age at date of commencement. Even at age 50 or 75 years, you can

pay applicable premium @ age 35 years (Age at entry)

What are the riders available for Jeevan Arogya?

Two riders are available - Term Assurance Rider and Accident Benefit Rider for Principal lnsured & Spouse onlyCan the lnitial Daily Benefit of Principal lnsured be t 3000 & that of Spouse be { 4000?

No. the IDB of Spouse and other dependents should be less than or equal to that of Principal lnsured (Pl). lt

cannot be more than that of Pl.

Suppose MSB of < 400,000 is paid for the surgery undergone by Principal lnsured. Next month in the same

Policy year, the spouse is also hospitalized and claims for MSB of Rs. 400,000. Can we consider this claim?

yes, MSB if otherwise payable, can be paid as all members covered have separate limits independent of each other.

ls Other Surgical Benefit (OSB), a lump sum benefit or daily benefit?

OSB is a daily Benefit and the maximum annual & life time limits are expressed in terms of number of days.

What is the maximum Term Assurance Sum Assured allowed under Jeevan Arogya?

Maximum Term Assurance SA is equal to MSB SA i.e. 100 times lDB.

What is the maximum cover ceasing age for Term Assurance & Accident Benefit under Jeevan Arogya?

Term Assurance & Accident Benefit riders cease at age 50 years (Nearest Birthday).

Does JA Policy terminate on the death of Principal lnsured?

The Policy continues if the option to allow surviving spouse to become Principal lnsu.red is exercised at the

beginning of the Policy. Otherwise, it terminates with the death of the Principal lnsured.

What is the maximum cover ceasing age for 'Jeevan Arogya'?

Under 'Jeevan Arogya', the maximum cover ceasing age for Principal lnsured, Spouse, Parents & Parents'in-

law is 80 years and for insured dependent children, it is 25 years.

ls HCB paid along with Day Care Procedure Benefit (DCPB) and Other Surgical Benefit (OSB)? .., EuE

- -,, !q:4*l

.'-&"3,i*ftfl5t*

13.

Ans:

14.

Ans:

'15.

Ans:

't6.

Ans:

17.

Ans:

18.

Ans:

19.

Ans:

20.

Ans

21.

23 WWffifz :It





38.

Ans:

39.

Ans:

40.

Ans:

41.

Ans:

(a) Surgery should pertain to Category I or ll.(b) surgery shourd be performed in a network hospitar of the servicing TpA.How many surgeries are covered under Day care procedure Benefit?Under Day care Procedure Benefit, 140 surgeries other

than those covered under MSB are covered.what is the amount payabre under Day care procedure Benefit (DcpB)?Day Care Procedure Benefit (DCPB) is a lump sum benefit paid @ 5 times Applicable Daily Benefit (ADB).What is Premium Waiver Benefit under ,Jeevan

Arogya,?Premium waiver Benefit is the waiver of one annual premium due from the date coinciding or next toate of surgery in respect to Major surgicar Benefit under category r & il.What is E-Card under Health plans?

TPA maintains the Health cards issued by them as E-card which can be printed from their website, inase of non-receipt of Health card. It can be accessed with policy number as log-in and date of birth ofPrincipal lnsured as password.

what is the grace periodfor payment of premium under

,JeevanArogya,?There is a grace period of 30 days from First Unpaid Premium in case of yearly / Half-yearly / euarterly modend '15 days in case of ECS Mode.

Can a lapsed 'Jeevan Arogya, policy be revived?

A lapsed 'Jeevan Arogya' plan can be revived within 2 years from due date of First Unpaid premium, calledPeriod of Revival,.

What are the waiting periods for ,JeevanArogya, plan?

The general waiting Period under 'Jeevan Arogya' plan is 90 days. The special waiting period is 2 years for7 listed treatments.

Are there any exclusions under ,JeevanArogya, plan?

Yes' thereare 23 specified Exclusion under'Jeevan Arogya'plan where no Benefit is payable.

What is the role of TpA in Health claims under ,JeevanArogya, plan?

TPA processes the Health claim and recommends about the health claim to co-HlD, Hyderabad. The claimantan submit the Health claim forms to TPA directly or through ftc eranch / Divisional Health Unit.Who makes the Health Claim payment under ,Jeevan

Arogya, plan?co-HlD' Hyderabad decides and makes the payment to the claimant, based on the recommendations of the TpA.

Yi".::::::::lr-r::esthe Death ctaim payment under ,rerm

Rider Benefit, of ,reevanArosya, ptan?

The servicing Branch office processes and makes the payment of Death claim under;;;;r;;#;J;,;",

tlaatrrn Araa',^lJeevan Arogya'.

who processes the 'cooring off' requests under ,JeevanArogya, pran?

The servicing Branch office processes and makes the payment in respect of ,cooling off, cases under ,JeevanArogya'.

42.

Ans:

43.

Ans:

44.

Ans:

45.

Ans:

46.

Ans:

47.

Ans:

48.

Ans:

49.

Ans:

50.

Ans:

lf 4 members of the famiry- principar rnsured, spouse and 2 chirdren are coveredArogya' Policy, credit for how many lives is given to Agent?under a single 'Jeevan

fJ,ffIl;f ;l,liJillr;:Tlrl,ij]1.111-"-y:.,1!2,.hirdren are covered under a sinsre ,JeevanArosya,olicy, credit for 4 lives is given both for Agents'club ,".u.rrr,ip as well as for minimrr't'rl,r.tt;ffi::l:

Naga Nalini K.

Asst. Secretary,

Health lnsurance, Central Office

25 WN@*rrW

Details of Jivan Arogya Plan

Documents