![](https://visionindiainsurance.com/wp-content/plugins/elementor/assets/images/placeholder.png)
Arogya Rakshak is a health insurance plan offered by the Life Insurance Corporation of India (LIC). It is a non-linked, non-participating, regular premium, individual health insurance plan that provides coverage against various illnesses and hospitalization expenses.
The plan offers a range of benefits, including coverage for hospitalization expenses such as room charges, boarding charges, nursing charges, surgeon and consultant fees, among others. It also covers pre and post-hospitalization expenses for up to 30 and 60 days respectively.
-
Lump sum benefit irrespective of Actual Medical Costs
A lump sum benefit is a type of insurance benefit that provides a fixed amount of money to the policyholder in the event of a covered loss or event, regardless of the actual medical costs incurred
-
Increasing Health Cover Every Year
Auto StepUp Bonus and No Claim Benefit will be used to expand health coverage.
-
Premium Waiver Benefit
If more than one person is covered by a policy, the other insured(s) will not be required to pay premiums in the event that the policyholder, who was the original principal insured, passes away tragically.
-
No Claim Benefit
Every three claim-free policy years, at the end of the third year, the applicable daily benefit should be increased by an amount equal to 5% (five percent) of the initial daily benefit.
Plan Benefits
Flexible premium payment options
Ambulance Benefit
Health Check-up Benefit
-
Eligibility Conditions
- Benefits
-
Other Benefits:
Eligibility Conditions | Principal Insured | Insured Spouse / Parents | Insured Children |
Minimum Age at Entry | 18 Yrs Last Birthday | 18 Yrs Last Birthday | 91 Days Last Birthday |
Maximum Age at Entry | 65 Yrs Last Birthday | 65 Yrs Last Birthday | 20 Yrs Last Birthday |
Cover Period:
Principal Insured, Insured Spouse, Parents
[80 minus Age at entry]
[70 minus Age at entry], if AHC benefit is triggered and the policy is not continued by payment of premium after expiry of AHC period.
Insured Children
[25 minus Age at entry]
Initial Daily Benefit (i.e. the level of Hospital Cash Benefit (HCB) at inception):
Initial Daily Benefit | Pricipal Insured (PI) | Insured Spouse (if any), Insured Parents (if any) | Insured Children (if any) |
Minimum Initial Daily Benefit | 2500/- | 2500/- | 2500/- |
Maximum Initial Daily Benefit | 10,000/- per Life * | Insured Spouse - Less than or equal to that of PI | Less than or equal to that of Insured Spuse (PI, if there is no Insured Spouse). Further, included children shall be covered for equal benefits. |
Insured Parents - Less than or equal to that of Insured Spouse )PI, if there is no Insured Spouse). Further, included parents shall be covered for equal benefits. | |||
Initial Daily Benefit shall be in multiple of Rs. 500/- | |||
* The total Initial Benefit under all policies issued to an individual under this plan shall not exceed Rs. 10,000/- The Applicable Daily Benefit (ADB), which is how this plan's benefits are paid out, is: An applicable daily benefit is the amount of hospital cash benefit calculated as follows for a policy year: The Applicable Daily Benefit shall be equivalent to the Initial Daily Benefit (i.e., the amount of Hospital Cash Benefit) for the first three years following the Effective Date of Cover in respect of an Insured. |
Benefits paid for hospitalization as an inpatient throughout the Cover Period:
For any continuous period of 24 hours or part thereof (after having completed the 24 hours), provided that any such part stay exceeds a continuous period of 4 hours in a non-ICU ward/room of a hospital, an amount equal to the applicable daily benefit (ADB) available under the policy during that policy period will be paid to the insured.
Subject to the Benefit Limitations and Conditions specified, two times the Applicable Daily Benefit will be paid if any of the Insured(s) is(are) required to stay in a hospital's Intensive Care Unit. The Corporation shall pay benefits as if the admission was to the Intensive Care Unit during a period of 24 continuous hours (i.e., one day) of hospitalization if the hospitalization included stay in an intensive care unit as well as in any other inpatient (non-intensive care unit) ward of the hospital, provided that the period of hospitalisation in the intensive care unit was at least 4 continuous hours.
Major Surgical Benefit (MSB): If an insured person has one of the surgeries listed in the Major Surgical Benefit Annexure due to a medical necessity resulting from an accident-related illness or injury, the benefit percentage of the Major Surgical Benefit Sum Assured that is specified against each of the eligible surgeries listed in the Major Surgical Benefit Annexure will be paid, subject to the benefit limits and conditions mentioned. The Applicable Daily Benefit for that Insurance Year in respect of each Insured is multiplied by 100 (one hundred) to determine the Major Surgical Benefit Sum Guaranteed. Depending on how long the patient stays in the hospital, an additional $5 Hospital Cash Benefit will be given on top of the lump sum Major Surgical Benefit.
Moreover, the Major Surgical Benefit shall additionally include the following benefits:
Ambulance Benefit
Premium Waiver Benefit
Major Surgical Benefit Restoration: In the event that 100% of the Major Surgical Benefit Sum Assured is exhausted in a policy year in respect of an Insured due to the prior Major Surgical Benefit claims in that policy year, the subsequent Major Surgical Benefit claim in that policy year (i.e., in case of any specified surgeries as mentioned in the Major Surgical Benefit Annexure) will be covered, post-sum assured-assured-exhaustion, subject to:
Any additional Major Surgical Benefit claims made during that policy year must be for a different category or bucket (e.g., Cardiovascular System, Digestive System, etc.).
The following Major Surgical Benefit claim shouldn't be caused by, arising from, or be related to the prior Major Surgical Benefit claims in that policy year.
The subsequent Major Surgical Benefit claim must be for a different operation than any of the prior Major Surgical Benefit claims made during that coverage year (for example, a CABG, pancreatolithotomy, etc.).
Day Care Procedure Benefit:
Based on the length of stay in the hospital, a hospital cash benefit will be granted in addition to the medical management benefit for the following conditions:
- Dengue
- Malaria
- Pneumonia
- Pulmonary tuberculosis
- Viral Hepatitis and
- Pneumonia.
Extended Hospitalization Benefit: In the event that an insured individual experiences a single episode of continuous inpatient hospitalization lasting longer than 30 days as a result of an accidental bodily injury or illness, a lump sum equal to 10 times the applicable daily benefit shall be payable, subject to the previously mentioned benefit limits and conditions, regardless of the actual cost incurred. Any applicable Hospital Cash Benefit, Major Surgical Benefit, Other Surgical Benefit, or Day Care Benefit due for the same occurrence of inpatient hospitalization would be paid in addition to the Extended Hospitalization Benefit.
Other Benefits:
- Auto Step-Up Benefit
- No Claim Benefit
- Health Check-up Benefit
Death Benefit:
- On the death of an Insured person other than the Principal Insured
- On the death of the Original Principal Insured
Auto Health Cover (AHC) Benefit
- For Insured Child(ren)
- For Insured Spouse/Insured Parent(s)
Maturity Benefit: At the conclusion of the Cover Period, no benefits are payable, and the Policy is deemed to have expired.
Documents Required:
- Medical history
- Address proof
- Know your customer documents
- Medical examination (depending on your age or the sum assured)
- Medical examination (depending on your age or the sum assured)