LIC Arogya Rakshak Plan Benefits: Features and Exclusions

LIC Arogya Rakshak is a Non-Linked, Non-Participating, Regular, Premium, Individual Life insurance plan that provides health insurance coverage against certain specified health risks. 

The best part of this life insurance plan is that it covers the whole family under one policy. This means you and your loved ones will stay financially secure when health issues arise.

Eligibility Criteria

Key Benefits of LIC Arogya Rakshak Policy

Buy LIC Arogya Rakshak policy to enjoy the following benefits. 

• Hospital Cash Benefit (HCB)
  If any insured family member is hospitalized due to an accidental injury or illness and stays in the hospital for more than 24 continuous hours, a daily cash benefit will be provided. The amount paid will be the daily benefit amount mentioned in your policy, no matter the actual treatment costs, and is subject to the limits and conditions.
  This benefit applies for each full day or part of a day as long as the partial stay is at least 4 hours in a regular hospital room. If the hospital stay is in an Intensive Care Unit (ICU), the daily benefit amount will be doubled.

• Major Surgical Benefit
  If any of the insured entities need to undergo one of the surgeries listed in the Major Surgical Benefit Annexure due to an accident or illness, a percentage of the Major Surgical Benefit Sum Assured will be paid out. Hospital cash benefits will also be provided based on the hospital stay.
  Additionally, the following benefits are also included:

• • Ambulance Benefit: An additional lump sum of $1,000 for ambulance expenses.
  • Premium Waiver Benefit: If a major surgery is needed, the total policy premium, including any rider premium, will be waived for one year starting from the next premium due date after the surgery. This waiver is available only once per policy year, even if multiple surgeries are needed. 
  • Major Surgical Benefit Restoration: If the Major Surgical Benefit Sum Assured is completely used up in a policy year due to multiple surgeries, an additional surgery in the same year will still be covered if:
    • It is not related to previous surgeries claimed in that year.
    • It is from a different medical category or procedure (e.g., Cardiovascular System, Digestive System).

• Day Care Procedure Benefit
  If any of the insured entities need a specified Day Care Procedure listed in the Day Care Procedure Benefit Annexure due to an accident or illness, a lump sum payment equal to five times the daily benefit amount will be provided.

• Other Surgical Benefit
  If there is a requirement for surgery not listed under the Major Surgical Benefit or Day Care Procedure Benefit, and the hospital stay exceeds 24 continuous hours, a daily benefit equal to 2.5 times the daily benefit amount will be paid.

• Medical Management Benefit
  In the event of an Insured undergoing hospitalization due to major medical conditions such as Dengue, Malaria, Pneumonia, Pulmonary Tuberculosis, or Viral Hepatitis A, a lump sum payment of 2.5 times the daily benefit amount will be provided, regardless of the actual costs incurred. 

• Extended Hospitalization Benefit
  In the event of an insured being hospitalized for more than 30 continuous days due to an accident or illness, a lump sum payment equal to 10 times the daily benefit amount will be provided, regardless of the actual costs incurred.

Additional Benefits of LIC Arogya Rakshak Policy

• Auto Step-Up Benefit
  This benefit increases the daily benefit amount over time. On every third policy anniversary, an additional 15% of your initial daily benefit is added to the coverage. This continues until your daily benefit reaches a maximum of 1.5 times the initial amount.
• No Claim Benefit
  No claim benefit rewards policyholders for every three consecutive years without any claims. At the end of each third claim-free year, an amount equal to 5% of the Initial Daily Benefit is added to the daily benefit amount. There is no maximum limit to this benefit throughout the policy's coverage period.
• Health Check-up Benefit
  Alongside the benefits for hospitalization mentioned earlier, this policy includes a Health Check-up Benefit for each insured person. Under this benefit, you can claim expenses incurred for health check-ups, up to half of the Applicable Daily Benefit.
  This benefit is available once every three policy years, provided you undergo the health check-up and provide copies of the medical report and bills. 

• Death Benefit
  (i) On the death of an Insured person other than the Principal Insured
  If an insured person other than the Principal Insured passes away, the policy continues for the remaining insured individuals. Premium payments for the deceased insured stop from the next premium due date following their death.
  
  (ii) On the death of the Original Principal Insured:
  Upon the death of the original Principal Insured:

• • The policy continues with a new Principal Insured and the other surviving insured individuals.
  • Premiums for the base policy are waived during the Auto Health Cover (AHC) Period.
    
    Below are some of the benefits of Auto Health Cover explained. 

• • After the original policyholder's death, the policy stays active with a new main policyholder and the surviving insured people.
  • Premiums for the base policy are waived for another 15 years or until a specified age for each eligible person, whichever comes first.
    
    
• Maturity Benefit
  At the end of the Cover Period, no benefits are paid out, and the policy concludes.

Riders Available

• Cover To New Additional Members
  • Marriage/Remarriage of Principal Insured:
    If the Principal Insured gets married or remarried during the Cover Period, their spouse can be included in the policy within twelve months from the marriage or remarriage date.

• • Childbirth/Legal Adoption:
    Any child born or legally adopted after the policy's inception can be covered from the next immediate policy anniversary after reaching 91 days of age.

Important: No additions are allowed in any other cases. If spouses, parents, and children are not covered at the policy's inception, they cannot be added later. If both parents (father and mother) are alive and eligible for coverage, either both must be covered or neither, with no option to cover only one.

• Removal of Existing Members
  • Death or Divorce:
    If an insured person dies or gets divorced, the Principal Insured can request to remove them from the policy.  

• • Other Circumstances:
    In any other cases, removing an existing insured person is allowed at the sole discretion of the Corporation.
• Option to Migrate
  Children covered under this plan have the option to switch to a new suitable health insurance policy (subject to underwriting) on the policy anniversary after they turn 25 years old, subject to specific terms and conditions. 
• Quick Cash Facility
  If any insured person needs surgery in a network hospital, the main policyholder (PI) can use the Quick Cash facility. This allows 50% of the eligible Major Surgical Benefit amount to be paid during the hospital stay instead of waiting to claim the benefit after discharge. This advance payment can be made for both planned surgeries and emergencies due to accidents. 
• LIC’s New Term Assurance Rider
  If the insured person dies during the term of this rider, an amount equal to the Term Assurance Sum Assured will be paid. The main policyholder and/or insured spouse can choose the Term Assurance Rider at the time of inception/inclusion into the policy. 
• LIC’s Accident Benefit Rider
  The main policyholder and/or insured spouse can also choose the Accident Benefit Rider if they have opted for the Term Assurance Rider. The maximum sum assured under this rider is equal to the Term Assurance Rider sum assured. If the insured person dies due to an accident, the Accident Benefit Sum Assured will be paid.

Premium Chart

Below is the sample illustrative premium for all health benefits. 

• Principal Insured (Male)

• Spouse (Female)

• Child

• Spouse (Female)

Exclusions

No benefits will be provided, and no payments will be made for any claim resulting from hospitalization or surgery if caused directly or indirectly by the following:

• Any pre-existing condition unless it was disclosed and accepted before the cover started or was revived.
• Any treatment or surgery not performed by a licensed physician or surgeon, or if it's purely experimental.
• Any treatment received outside India, use of unproven treatments or experimental devices. 
• Cosmetic or plastic surgeries unless they are necessary due to illness or injury and done within six months of the incident.
• Pre and post-hospitalization treatments. Conditions from war, civil unrest, or terrorism.
• Treatments for sterility, fertility issues, or sexually transmitted diseases. Sex change operations, stem cell therapies, and hormone replacement therapy.
• Conditions from attempted suicide or self-inflicted injuries.
• Injuries or conditions from being under the influence of drugs, alcohol, or non-prescribed substances.

Disclaimer: The exclusions may vary according to the company’s terms and conditions. 

How to Buy LIC Arogya Rakshak Policy Online? 

You can buy LIC Arogya Rakshak Policy online by following the below steps. 

• Click here and select “life Insurance” under the “Insurance” tab. 
• Enter your name and mobile number. Then, click on the “View Plans” button to view all the available life  insurance policies. 
• Choose the “LIC Arogya Rakshak” plan. If you want to explore more plans and compare them, schedule a call back with an InsuranceDekho advisor at +91-7551196989. They will call you at your preferred time and help you find the best life insurance policy. 
• Now, complete the proposal form with accurate information. This includes personal details, medical history, and any other relevant information required for underwriting.
• Submit necessary documents such as identity proof, address proof, age proof, and recent photographs. Additionally, provide medical reports if required.
• Proceed to make the payment for the calculated premium amount. Upon successful processing and approval, you’ll receive confirmation via mail or registered mobile number. 

Frequently Asked Questions (FAQs) 

Ques 1. Is Grace Period available for LIC Arogya Rakshak Policy? 

Ans. Yes, a 30-day Grace Period is allowed for payment of yearly or half-yearly premiums. 

Ques 2. Can the lapsed LIC Arogya Rakshak Policy be revived?

Ans. Yes, If the policy lapses due to non-payment of premiums, the Principal Insured (PI) can revive it within 5 consecutive years from the due date of the first unpaid premium. 

Ques 3. Can I surrender the plan? 

Ans. No surrender value is available under the LIC Arogya Rakshak plan.

Ques 4. Can I take a loan under the LIC Arogya Rakshak Policy? 

Ans. No! A loan facility is not allowed under the LIC Arogya Rakshak Policy. 

Ques 5. Is LIC Arogya Rakshak a good life insurance policy to buy? 

Ans. Choose LIC Arogya Rakshak if you are looking for a life insurance policy that offers comprehensive coverage for various medical expenses. The best part is that it covers not only one but the whole family under one plan.