Life Insurance is a contract that pledges payment of an amount to the person assured (or his nominee) on the happening of the event insured against. LIC is the biggest life insurance company in India, insuring more than 220 million lives. It has a number of interesting policies.
Today’s world is very fast paced. It is imperative that each life is insured to give an individual security as well as those who are dependent him/her or living with him/her. Along with security and insurance benefits LIC’s Special Plans are opportunities that knock on your door once in a lifetime. These plans are a perfect blend of insurance as well as investment.
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.
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Insured
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Initial Daily Benefit (IDB)*#
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| 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.
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BEFORE CESSATION OF HCB AND MSB COVERS ON ALL MEMBERS COVERED
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| 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. | |||
| 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.
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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).
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The Policy Fund Value will be payable to the nominee/ legal heir.
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b) On death of PI (if other Insured members are there).
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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
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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:
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Waiting Period from
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Principal Insured
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Spouse Insured
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Child Insured
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Date of the cover
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180 days
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180 days
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180* days
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Date of reinstatement of cover during the revival period
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90 days
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90 days
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90 days
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| No waiting period in respect of Accidental Bodily Injury. *No waiting period in case of children for MSB from the date of cover. |
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6. Benefit Period Limits –Hospital Cash Benefit.
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HCB
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Maximum Annual Benefit Period |
Maximum Lifetime Benefit Period
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1st Year
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2nd year & after | |||||
| Principal Insured |
18 days incl. 9 days for ICU
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60 days incl. 30 days for ICU
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365 days
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| 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.
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7. Conditions for Availing Major Surgery Benefit
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MSB
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Principal Insured
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Spouse Insured
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Child Insured
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Maximum Annual benefit
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100% of the Sum Assured applicable in respect of the each insured member
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Maximum Lifetime Benefit
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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 |
FEATURES
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
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Accumulation period
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1.Age
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Principal Insured
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Spouse Insured
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Child Insured
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Min Policy Entry Age � Age Last Birthday
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18
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18
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3months
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Min Age � HCB Cover � Age Last Birthday
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18
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18
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3months
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Min Age � MSB Cover � Age Last Birthday
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18
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18
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18
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Maximum Entry Age Age Nearest Birthday
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55
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55
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17
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2. Premium Payment.
Mode of Payment: Yearly, Half-Yearly & Monthly (ECS Mode only)
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Minimum Annual Premium Conditions
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Number of Lives covered
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Higher of the two conditions in each category listed below:
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Single Life
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6 times the HCB of the Principal Insured OR Rs.5000 p.a.
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Two Lives
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The arithmetic sum of 6 times the HCB of PI and 3 times the HCB of the second insured. OR Rs.7500 p.a.
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More than two Lives
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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.
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Annualized Premiums are payable in multiples of Rs.500.
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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.
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Major Surgical Sum Assured
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Principal Insured | Spouse Insured |
Child Insured
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| 200 times the HCB applicable to each insured life under the policy. | |||||
4. Other Terms of the Policy.
| Age Nearest Birthday | Principal Insured |
Spouse Insured
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Child Insured | ||
| Max. HCB and MSB Cover ceasing age |
75
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75
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25
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| Premium Ceasing Age | 65 Years Nearest Birthday of the Principal Insured | ||||
| DTB ceasing age |
No age limit
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No age limit
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25
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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
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| 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 | ||||
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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 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. 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: 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. 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: 2. Additional Exclusions in respect of Hospital Cash Benefit:
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.
The above allocation charges shall be applicable for all premiums including any additional premium paid in that particular policy year. Specimen charges for Rs. 100/- per day for HCB and Rs. 1000/- SA for MSB for standard lives are given as under:
b. Health Insurance Charge:
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. |
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BENEFIT ILLUSTRATION
i.This illustration is applicable to a non-smoker male standard (from medical, life style and occupation point of view) life.
ii.The non-guaranteed benefits (1) and (2) in above illustration are calculated so that they are consistent with the Projected Investment Rate of Return assumption of 6% p.a.(Scenario 1) and 10% p.a. (Scenario 2) respectively. In other words, in preparing this benefit illustration, it is assumed that the Projected Investment Rate of Return that LICI will be able to earn throughout the term of the policy will be 6% p.a. or 10% p.a., as the case may be. The Projected Investment Rate of Return is not guaranteed.
iii.The main objective of the illustration is that the client is able to appreciate the features of the product and theflow of benefits in different circumstances with some level of quantification.
iv.LIC does not authorize its agents/intermediaries, staff and officials to express their opinion on the future performance of the “ULIP” fund, excepting the above illustrative rate of 6% and 10% growth.
v.Domiciliary Treatment Benefit can be claimed from the 3rd year onwards after at least three years premiums have been paid.
vi.Maximum Hospital Cash Benefit can be claimed for 365 days.
vii.Maximum Major Surgical Benefit can be claimed upto three times of the Sum Assured
| BENEFIT ILLUSTRATION | ||||||||||||||||||||||
| (This shall form a part of policy document) | ||||||||||||||||||||||
| PRODUCT FEATURES : | ||||||||||||||||||||||
| 1 | Name of the Product: | LIC’s Health Protection Plus | 2 | Unique Identification No. | 512L253V01 | |||||||||||||||||
| 3 | Premium Paying Term: | 30 Years | 4 | Mode of Premium Payment : | Yearly | |||||||||||||||||
| 5 | Amount of Instalment Premium: | 12000 | 6 | Funds opted for: | Health Protection Plus Fund | |||||||||||||||||
| 7 | Age: | 35 Years | 8 | Number of lives covered: | SINGLE MALE | |||||||||||||||||
| 9 | Per day Hospital Cash Benefit (HCB): | 2000 | 10 | Per day Hospital Cash Benefit | 4000 | |||||||||||||||||
| 11 | Major Surgical Benefit (MSB): | 400000 | in ICU (HCB): | |||||||||||||||||||
| Statement of Various charges alongwith growth of the fund expected over the duration of the policy with assumed rate of interst as mentioned | (All charges are in Rupees) | |||||||||||||||||||||
| Assuming gross interest rate of 6% p.a. | Assuming gross interest rate of 10% p.a. | |||||||||||||||||||||
| Policy Year |
Annualised Premium |
Premium Allocation Charge |
Amount Available for investment ( out of premium ) |
Policy Admin Charge |
Fund Mgt Charge |
Other Charges |
Total Charges |
Addition to Fund (if any) |
Fund at the End |
Surrender Value |
Death Benefit | Maximum Guaranteed Benefit During the year |
Fund Mgmt. Charge |
Other Charges |
Total Charges |
Addition to Fund (if any) |
Fund at the End |
Surrender Value |
Death Benefit | Maximum Guaranteed Benefit During the year |
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| HCB | MSB | HCB | MSB | |||||||||||||||||||
| 1 | 12000 | 3600 | 8400 | 900 | 86 | 1912 | 2898 | 401 | 5902 | 0 | – | 54000 | 400000 | 88 | 1912 | 2900 | 668 | 6168 | 0 | – | 54000 | 400000 |
| 2 | 12000 | 720 | 11280 | 300 | 207 | 1626 | 2132 | 961 | 16011 | 0 | – | 189000 | 400000 | 214 | 1626 | 2141 | 1629 | 16936 | 0 | – | 189000 | 400000 |
| 3 | 12000 | 720 | 11280 | 300 | 336 | 1691 | 2327 | 1562 | 26527 | 0 | – | 198000 | 400000 | 355 | 1693 | 2348 | 2696 | 28565 | 0 | – | 198000 | 400000 |
| 4 | 12000 | 720 | 11280 | 300 | 470 | 1767 | 2537 | 2187 | 37457 | 0 | – | 207000 | 400000 | 507 | 1771 | 2577 | 3848 | 41115 | 0 | – | 207000 | 400000 |
| 5 | 12000 | 720 | 11280 | 300 | 610 | 1874 | 2783 | 2836 | 48789 | 0 | – | 216000 | 400000 | 670 | 1880 | 2850 | 5090 | 54636 | 0 | – | 216000 | 400000 |
| 6 | 12000 | 720 | 11280 | 300 | 754 | 2015 | 3070 | 3507 | 60507 | 0 | – | 225000 | 400000 | 846 | 2025 | 3171 | 6427 | 69172 | 0 | – | 225000 | 400000 |
| 7 | 12000 | 720 | 11280 | 300 | 903 | 2246 | 3449 | 4199 | 72537 | 0 | – | 234000 | 400000 | 1035 | 2259 | 3594 | 7860 | 84717 | 0 | – | 234000 | 400000 |
| 8 | 12000 | 720 | 11280 | 300 | 1056 | 2389 | 3745 | 4912 | 84985 | 0 | – | 243000 | 400000 | 1237 | 2407 | 3945 | 9398 | 101450 | 0 | – | 243000 | 400000 |
| 9 | 12000 | 720 | 11280 | 300 | 1215 | 2547 | 4062 | 5650 | 97853 | 0 | – | 252000 | 400000 | 1455 | 2572 | 4327 | 11053 | 119456 | 0 | – | 252000 | 400000 |
| 10 | 12000 | 720 | 11280 | 300 | 1379 | 2732 | 4411 | 6412 | 111133 | 0 | – | 261000 | 400000 | 1690 | 2764 | 4754 | 12833 | 138815 | 0 | – | 261000 | 400000 |
| 11 | 12000 | 720 | 11280 | 300 | 1548 | 2913 | 4761 | 7198 | 124850 | 0 | – | 270000 | 400000 | 1942 | 2953 | 5195 | 14748 | 159647 | 0 | – | 270000 | 400000 |
| 12 | 12000 | 720 | 11280 | 300 | 1722 | 3135 | 5157 | 8009 | 138983 | 0 | – | 270000 | 400000 | 2213 | 3185 | 5698 | 16807 | 182036 | 0 | – | 270000 | 400000 |
| 13 | 12000 | 720 | 11280 | 300 | 1902 | 3355 | 5558 | 8845 | 153550 | 0 | – | 270000 | 400000 | 2504 | 3417 | 6222 | 19020 | 206114 | 0 | – | 270000 | 400000 |
| 14 | 12000 | 720 | 11280 | 300 | 2087 | 3581 | 5969 | 9707 | 168569 | 0 | – | 270000 | 400000 | 2818 | 3656 | 6774 | 21402 | 232022 | 0 | – | 270000 | 400000 |
| 15 | 12000 | 720 | 11280 | 300 | 2278 | 3830 | 6409 | 10595 | 184036 | 0 | – | 270000 | 400000 | 3155 | 3921 | 7376 | 23964 | 259890 | 0 | – | 270000 | 400000 |
| 16 | 12000 | 720 | 11280 | 300 | 2475 | 4064 | 6839 | 11511 | 199987 | 0 | – | 270000 | 400000 | 3518 | 4172 | 7990 | 26721 | 289901 | 0 | – | 270000 | 400000 |
| 17 | 12000 | 720 | 11280 | 300 | 2679 | 4248 | 7226 | 12456 | 216497 | 0 | – | 270000 | 400000 | 3910 | 4375 | 8585 | 29695 | 322291 | 0 | – | 270000 | 400000 |
| 18 | 12000 | 720 | 11280 | 300 | 2889 | 4509 | 7697 | 13433 | 233512 | 0 | – | 270000 | 400000 | 4332 | 4657 | 9289 | 32900 | 357182 | 0 | – | 270000 | 400000 |
| 19 | 12000 | 720 | 11280 | 300 | 3105 | 4774 | 8179 | 14440 | 251053 | 0 | – | 270000 | 400000 | 4787 | 4947 | 10034 | 36354 | 394783 | 0 | – | 270000 | 400000 |
| 20 | 12000 | 720 | 11280 | 300 | 3328 | 5073 | 8701 | 15476 | 269108 | 0 | – | 270000 | 400000 | 5277 | 5274 | 10851 | 40075 | 435287 | 0 | – | 270000 | 400000 |
| 21 | 12000 | 720 | 11280 | 300 | 3558 | 5364 | 9221 | 16544 | 287711 | 0 | – | 270000 | 400000 | 5805 | 5595 | 11700 | 44086 | 478953 | 0 | – | 270000 | 400000 |
| 22 | 12000 | 720 | 11280 | 300 | 3794 | 5681 | 9775 | 17644 | 306860 | 0 | – | 270000 | 400000 | 6374 | 5946 | 12620 | 48409 | 526021 | 0 | – | 270000 | 400000 |
| 23 | 12000 | 720 | 11280 | 300 | 4038 | 5988 | 10326 | 18777 | 326591 | 0 | – | 270000 | 400000 | 6988 | 6292 | 13580 | 53071 | 576792 | 0 | – | 270000 | 400000 |
| 24 | 12000 | 720 | 11280 | 300 | 4289 | 6307 | 10896 | 19944 | 346919 | 0 | – | 270000 | 400000 | 7650 | 6653 | 14603 | 58100 | 631568 | 0 | – | 270000 | 400000 |
| 25 | 12000 | 720 | 11280 | 300 | 4547 | 6652 | 11499 | 21145 | 367845 | 0 | – | 270000 | 400000 | 8365 | 7045 | 15709 | 63525 | 690664 | 0 | – | 270000 | 400000 |
| 26 | 12000 | 720 | 11280 | 300 | 4813 | 7003 | 12116 | 22382 | 389391 | 0 | – | 270000 | 400000 | 9135 | 7448 | 16883 | 69380 | 754440 | 0 | – | 270000 | 400000 |
| 27 | 12000 | 720 | 11280 | 300 | 5087 | 7452 | 12838 | 23653 | 411486 | 0 | – | 270000 | 400000 | 9967 | 7954 | 18221 | 75694 | 823193 | 0 | – | 270000 | 400000 |
| 28 | 12000 | 720 | 11280 | 300 | 5366 | 7960 | 13627 | 24955 | 434095 | 0 | – | 270000 | 400000 | 10863 | 8527 | 19690 | 82500 | 897284 | 0 | – | 270000 | 400000 |
| 29 | 12000 | 720 | 11280 | 300 | 5653 | 8456 | 14410 | 26288 | 457254 | 0 | – | 270000 | 400000 | 11829 | 9093 | 21222 | 89837 | 977179 | 0 | – | 270000 | 400000 |
| 30 | 12000 | 720 | 11280 | 300 | 5946 | 9048 | 15294 | 27651 | 480891 | 0 | – | 270000 | 400000 | 12870 | 9761 | 22931 | 97745 | 1063273 | 0 | – | 270000 | 400000 |
| 31 | 0 | 0 | 0 | 300 | 6102 | 9495 | 15897 | 28376 | 493369 | 0 | – | 270000 | 400000 | 13847 | 10293 | 24439 | 105159 | 1143993 | 0 | – | 270000 | 400000 |
| 32 | 0 | 0 | 0 | 300 | 6258 | 10113 | 16671 | 29101 | 505799 | 0 | – | 270000 | 400000 | 14898 | 11003 | 26201 | 113148 | 1230939 | 0 | – | 270000 | 400000 |
| 33 | 0 | 0 | 0 | 300 | 6413 | 10755 | 17468 | 29822 | 518153 | 0 | – | 270000 | 400000 | 16032 | 11745 | 28077 | 121753 | 1324615 | 0 | – | 270000 | 400000 |
| 34 | 0 | 0 | 0 | 300 | 6567 | 11418 | 18285 | 30537 | 530405 | 0 | – | 270000 | 400000 | 17253 | 12519 | 30071 | 131026 | 1425571 | 0 | – | 270000 | 400000 |
| 35 | 0 | 0 | 0 | 300 | 6719 | 12106 | 19125 | 31246 | 542526 | 0 | – | 270000 | 400000 | 18569 | 13326 | 32195 | 141022 | 1534397 | 0 | – | 270000 | 400000 |
| 36 | 0 | 0 | 0 | 300 | 6870 | 12820 | 19989 | 31946 | 554483 | 0 | – | 270000 | 400000 | 19988 | 14171 | 34458 | 151798 | 1651737 | 0 | – | 270000 | 400000 |
| 37 | 0 | 0 | 0 | 300 | 7018 | 13522 | 20841 | 32637 | 566280 | 0 | – | 270000 | 400000 | 21518 | 15016 | 36834 | 163420 | 1778323 | 0 | – | 270000 | 400000 |
| 38 | 0 | 0 | 0 | 300 | 7165 | 14237 | 21702 | 33318 | 577896 | 0 | – | 270000 | 400000 | 23169 | 15886 | 39355 | 175960 | 1914928 | 0 | – | 270000 | 400000 |
| 39 | 0 | 0 | 0 | 300 | 7309 | 14925 | 22534 | 33989 | 589351 | 0 | – | 270000 | 400000 | 24952 | 16742 | 41994 | 189497 | 2062432 | 0 | – | 270000 | 400000 |
| 40 | 0 | 0 | 0 | 300 | 7452 | 15565 | 23317 | 34652 | 600686 | 0 | – | 270000 | 400000 | 26877 | 17566 | 44743 | 204120 | 2221810 | 0 | – | 270000 | 400000 |
| IN THIS POLICY, THE INVESTMENT RISK IS BORN BY THE POLICY HOLDER AND THE ABOVE INTEREST RATES ARE ONLY FOR ILLUSTRATION PURPOSE. | ||||||||||||||||||||||
| Note: | 1) Other charges includes the charges for HCB,MSB and service tax. | |||||||||||||||||||||
| 2)For fund at the end in the above benefit illustration, it is assumed that premiums have been paid as and when due and no domiciliary treatment benefit has been availed earlier. | ||||||||||||||||||||||
| 3)Maximum HCB shown above is inclusive of 9 days stay in ICU in the first year and 30 days in subsequent years | ||||||||||||||||||||||
| 4) Maximum life time benefit for HCB is 365 days and for MSB 3 times of the initial sum assured. | ||||||||||||||||||||||
Statutory warning
“Some benefits are guaranteed and some benefits are variable with returns based on the future performance of the life insurance company. If your policy offers guaranteed returns then these will be clearly marked “guaranteed” in the illustration table on this page. If your policy offers variable returns then the illustrations on this page will show two different rates of assumed investment returns. These assumed rates of return are not guaranteed and they are not upper or lower limits of what you might get back as the value of your policy is dependant on a number of factors including future investment performance.”
SECTION 41 OF INSURANCE ACT 1938
(1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
(2) Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees.
SECTION 45 OF INSURANCE ACT 1938 – INDISPUTABILITY CLAUSE
No policy of Life Insurance shall, after the expiry of two years from the date on which it was effected, be called in question by an Insurer on the ground that a statement made in the proposal for insurance or any report of a medical officer or referee or friend of the Insured or in any other document leading to the issue of the Policy, was inaccurate or false, unless the insurer shows such statement was on material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy holder and that the policy holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose.
Note: “Material” shall mean and include all important, essential and relevant information in the context of underwriting the risk to be covered by the corporation.
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
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18
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3months
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Min Age � HCB Cover � Age Last Birthday
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18
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18
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3months
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Min Age � MSB Cover � Age Last Birthday
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18
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18
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18
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Maximum Entry Age Age Nearest Birthday
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55
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55
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17
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2. Premium Payment.
Mode of Payment: Yearly, Half-Yearly & Monthly (ECS Mode only)
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Minimum Annual Premium Conditions
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Number of Lives covered
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Higher of the two conditions in each category listed below:
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Single Life
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6 times the HCB of the Principal Insured OR Rs.5000 p.a.
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Two Lives
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The arithmetic sum of 6 times the HCB of PI and 3 times the HCB of the second insured. OR Rs.7500 p.a.
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More than two Lives
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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.
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Annualized Premiums are payable in multiples of Rs.500.
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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.
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Major Surgical Sum Assured
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Principal Insured | Spouse Insured |
Child Insured
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| 200 times the HCB applicable to each insured life under the policy. | |||||
4. Other Terms of the Policy.
| Age Nearest Birthday | Principal Insured |
Spouse Insured
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Child Insured | ||
| Max. HCB and MSB Cover ceasing age |
75
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75
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25
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| Premium Ceasing Age | 65 Years Nearest Birthday of the Principal Insured | ||||
| DTB ceasing age |
No age limit
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No age limit
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25
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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
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| 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 | ||||
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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 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. 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: 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. 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: 2. Additional Exclusions in respect of Hospital Cash Benefit:
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.
The above allocation charges shall be applicable for all premiums including any additional premium paid in that particular policy year. Specimen charges for Rs. 100/- per day for HCB and Rs. 1000/- SA for MSB for standard lives are given as under:
b. Health Insurance Charge:
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. |
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