Fwd: MUST READ VERY USEFUL INFO --- 🇮🇳 Let us understand ‘Jeevan Arogya’ (T-904) better
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LUGI CHENNAITEAM
Sep 21, 2015, 4:49:02 AM9/21/15
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🙏DO YOU WANTS TO BE MDRT AGENT BEFORE 30TH NOVEMBER THEN SELL JEEVAN AROGYA Under Employer Employee Scheme
🇮🇳 Let us understand ‘Jeevan Arogya’ (T-904) better
QUESTIONS
1. What is a fixed Benefit Health Insurance Plan?
2. A Policyholder has one Mediclaim Policy and one Jeevan Arogya. He undergoes hospitalization and receives Mediclaim Benefit. Can be claim again under Jeevan Arogya policy for the same hospitalization?
3. What are the various Benefits offered under Jeevan Arogya plan?
4. Who can be covered under Jeevan Arogya?
5. What is the Initial Daily Benefit under JA?
6. Does Initial Daily Benefit remains the same or changes over Policy term?
7. What is no Claim Benefit?
8. What is Applicable Daily Benefit (ADB)?
9. How does ADB affect the Benefits payable?
10. What is the maximum term of Jeevan Arogya Policy?
11. For all Health Policies, normally premium changes every year. Is it so for our Jeevan Arogya plan?
12. Now I am 35 years old. When I become 50 years, will I have to pay premium rate applicable for age 50 years?
13. What are the riders available for JA?
14. Can the Initial Daily Benefit of PI be Rs. 3000 & that of Spouse be Rs. 4000?
15. Suppose MSB of Rs. 400,000 is paid for the surgery undergone by PI. 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?
16. Is Other Surgical Benefit (OSB), a lump sum benefit or daily benefit?
17. What is the maximum Term Assurance Sum Assured allowed under JA?
18. What is the maximum cover ceasing age for Term Assurance & Accident Benefit under JA?
19. Does JA Policy terminate on the death of PI?
20. What is the maximum cover ceasing age for Jeevan Arogya?
21. Is HCB paid along with Day Care Procedure Benefit (DCPB)?
22. Is HCB paid along with Other Surgical Benefit (OSB)?
23. If the Option for Spouse to become PI in case of PI’s death is not exercised in the beginning of the Policy, is there any way to continue the Health Cover?
24. In which case the Daily HCB for first 24 hours is paid?
25. What is the Commission payable to Agents under Jeevan Arogya?
26. Is Bonus Commission payable under Jeevan Arogya plan?
27. What is the minimum Age at entry under Jeevan Arogya plan?
28. What is the maximum Age at entry for PI/ Spouse under Jeevan Arogya Plan?
29. What is the maximum Age at entry for Parents / Parents-in-law under Jeevan Arogya Plan?
30. What is the maximum Age at entry for Children under Jeevan Arogya plan?
31. Up to what age can Jeevan Arogya plan be considered under Non-Medical?
32. What are the Non-Medical (General) limits for Jeevan Arogya?
33. What are the Non-Medical (Special) limits for Jeevan Arogya?
34. How many surgeries are covered under Major Surgical Benefit?
35. Is 100% Major Surgical Benefit paid for all the 140 Surgeries covered?
36. Is ‘Quick Cash Benefit’ payable for all Surgeries covered under MSB?
37. Is ‘Quick Cash Benefit’ amount paid to the Hospital?
38. What are the conditions to avail ‘Quick Cash Benefit’?
39. How many surgeries are covered under Day Care Procedure Benefit?
40. What is the amount payable under Day Care Procedure Benefit (DCPB)?
41. What is Premium Waiver Benefit under ‘Jeevan Arogya’?
42. What is E-Card under Health Plans?
43. What is the grace period for payment of premium under ‘Jeevan Arogya’?
44. Can a lapsed ‘Jeevan Arogya’ policy be revived?
45. What are the waiting periods for ‘Jeevan Arogya plan?
46. Are there any exclusions under ‘Jeevan Arogya’ plan?
47. What is the role of TPA in Health claims under ‘Jeevan Arogya’ plan?
48. Who makes the Health Claim payment under ‘Jeevan Arogya’ plan?
49. Who processes and makes the Death Claim payment under ‘Term Rider Benefit’ of Jeevan Arogya plan?
50. Who processes the ‘Cooling Off’ requests under ‘Jeevan Arogya’ plan?
51. If 4 members of the family- Principal Insured, Spouse and 2 children are covered under a single ‘Jeevan Arogya’ Policy, Credit for how many lives is given to Agent?
ANSWERS:
1. In a fixed Benefit plan, a fixed amount is paid irrespective of costs incurred for the surgery. The amount payable is defined in the Policy conditions.
2. Since Jeevan Arogya Policy is a fixed Benefit Policy, the benefit (Claim) is in addition to any other Health Insurance Policy. Hence, he can claim under both the Policies.
3. (a) Hospital Cash Benefit (HCB) (b) Major Surgical Benefit (MSB) (c) Day Care Procedure benefit (DCPB) (d) Other Surgical Benefit (OSB)
4. Under Jeevan Arogya, besides PI, Spouse, Parents, Parents-in-law and dependent children can be covered.
5. The Initial Daily Benefit (IDB) is the level of HCB chosen by the insured. The levels available are (a) Rs. 1000/- (b) Rs. 2000/- (c) Rs. 3000/- (4) Rs. 4000/-
6. The Initial Daily Benefit (IDB) under Jeevan Arogya plan increases arithmetically by 5% every year till a maximum of 1.5 times IDB. For e.g. if IDB is Rs. 4000, each year, Rs. 200 is added for 10 years till it becomes Rs. 6000.
Year Daily Benefit
1 - IDB 4000
(level chosen by Insured)
2 4200
3 4400
4 4600
5 4800
6 5000
7 5200
8 5400
9 5600
10 5800
11 6000
(Maximum allowed i.e.1.5 times IDB)
7. If there is no claim on all lives insured for a continuous period of 3 years from DOC, IDB increases by an amount equal to 5% of IDB. This continues and it increases for every block of 3 years without any upper limit if there are no claims during the preceding 3 years.
8. Applicable Daily Benefit is the rate of IDB applicable after adding the yearly increase of 5% and No Claim Benefit of 5% as per the eligibility.
9. All the Benefits of JA are in multiples of ADB. As ADB increases, all the Benefits payable also increase. For eg, if there are no claims on any of the lives assured,
Year HCB MSB DCPB OSB
Non-ICU ICU
1st 4000 8000 400,000 20,000 8,000
6th 5200 {4000+ 1000 (@200 pa) +200 (in 4th year )} 10400 520,000 26,000 10,400
10. 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. No, For Jeevan Arogya, Premium rate is guaranteed for 3 years. Based on the Corporation’s experience, Premium may change at the end of 3rd 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. No, Premium is charged based on the age at b b b DOC. Even at age 50 or 75 years, you can pay applicable premium @ age 35 years (Age at entry)
13. Two riders are available – Term Assurance Rider and Accident Benefit Rider for PI & Spouse only
14. No. the IDB of Spouse and other dependents should be less than or equal to that of Principal Insured (PI). It cannot be more than that of PI.
15. Yes, MSB if otherwise payable, can be paid as all members covered have separate limits independent of each other
.
16. OSB is a daily Benefit and the maximum annual & life time limits are expressed in terms of no. of days
17. Maximum Term Assurance SA is equal to MSB SA i.e. 100 times IDB.
18. Term Assurance & Accident Benefit riders cease at age 60 years (Nearest Birthday)
19. The Policy continues if the option to allows surviving spouse to become PI is exercised at the beginning of the Policy. Otherwise, it terminates with the death of the PI.
20. Under Jeevan Arogya, the maximum cover ceasing age for PI, Spouse, Parents & Parents-in-law is 80 years and for insured dependent children, it is 25 years.
21. No, HCB is not payable along with DCPB.
22. Yes, HCB is payable along with OSB.
23. In case the Option for Spouse to become PI is not exercised at the beginning of the Policy, in case of unfortunate death of PI, a new Policy can be issued for other members WITHOUT ANY UNDERWRITING if such a request comes within 90 days. Other terms and conditions and Premium rates are applicable as for a new Policy.
24. Daily HCB for first 24 hours is paid in case the Hospitalization exceeds a continuous period of 6 days and 4 hours (which is considered as 7 days).
25. Commission under J. Arogya Plan:- 1st year – 25%; 2nd & 3rd
year – 7.5%; Subsequent years – 5%
26. Under ‘Jeevan Arogya’ plan, Bonus Commission @ 40% of First Year Premium is payable.
27. Under ‘Jeevan Arogya’ plan, the
minimum age at entry for PI/Spouse/Parents / Parents-in-law is 18 years. For children, it is 3 months.
28. The maximum Age at entry for PI/Spouse under Jeevan Arogya is 65 years .
29. The maximum Age at entry for Parents/ Parents-in-law under Jeevan Arogya is 75 years
.
30. The maximum Age at entry for Children under Jeevan Arogya is 17 years
.
31. Jeevan Arogya can be taken upto age 50 years under Non-Medical.
32. NM (General) limits for J Arogya – Rs. 5 lakhs upto age 35 years & Rs. 2 Lakhs from Age 36 to 50.
33. NM (Sl) limits for Jeevan Arogya – Rs. 5 lakhs upto age 45 years & Rs. 4 lakhs from Age 46 to 50.
34. 140 Surgeries are covered under Major Surgical Benefit.
35. No, these 140 Surgeries are categorized and MSB is paid as follows:
• Category I – 100%
• Category II – 60%
• Category III – 40%
• Category IV – 20%
36. ‘Quick Cash Benefit’ is payable only for Category I & II Surgeries only.
37. No, Quick Cash Benefit amount is directly credited to the PI’s Bank A/C.
38. To avail Quick Cash Benefit,
(a) Surgery should pertain to Category-I or II
(b) Surgery should be performed in a network hospital of the servicing TPA
39. Under Day Care Procedure Benefit, 140 Surgeries other than those covered under MSB are covered.
40. Day Care Procedure Benefit (DCPB) is a lump sum Benefit paid @ 5 times Applicable Daily Benefit (ADB).
41. Premium Waiver Benefit is the waiver of one annual premium due from the date coinciding or next to date of surgery in respect to Major Surgical Benefit under Category I & II.
42. TPA maintains the Health Cards issued by them as E-Card which can be printed from their web-site, in case of non-receipt of Health Card. It can be accessed with Policy number as log-in and date of Birth of PI as password.
43. There is a grace period of 30 days from FUP in case of Yearly / Half-yearly / Quarterly mode and 15 days in case of ECS Mode.
44. A lapsed ‘Jeevan Arogya’ plan can be revived within 2 years from due date of FUP, called ‘Period of Revival’.
45. The general Waiting Period under ‘Jeevan Arogya’ plan is 90 days. The Special Waiting Period is 2 years for 17 listed treatments.
46. Yes, there are 23 specified Exclusion under ‘Jeevan Arogya’ plan where no Benefit is payable.
47. TPA processes the Health Claim and recommends about the health Claim to CO-HID, Hyderabad. The Claimant can submit the Health Claim forms to TPA directly or through LIC Branch / Divisional Health Unit.
48. CO-HID, Hyderabad decides and makes the payment to the Claimant, based on the recommendations of the TPA.
49. The Servicing Branch Office processes and makes the payment of Death Claim under ‘Term Rider’ Benefit of “Jeevan Arogya”.
50. The Servicing Branch Office processes and makes the payment in respect of ‘Cooling Off’ cases under ‘Jeevan Arogya’.
51. If 4 members of the family- Principal Insured, Spouse and 2 children are covered under a single ‘Jeevan Arogya’ Policy, Credit for 4 lives is given both for Agents’ club Membership as well as for MBG
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