LIC's Arogya Rakshak (Plan 906)

LIC's Arogya Rakshak (Plan 906): The Complete Health Insurance Guide by Ashuram Insurance Expert in Bhadra

Health is widely considered the greatest blessing for all human beings, acting as the central pillar for human happiness, well-being, prosperity, and wealth. Because every aspect of life depends on good health, and due to modern changing lifestyles, health issues and their related treatment costs have escalated significantly. Understanding this critical need for medical financial planning, Ashuram Insurance Expert, your trusted Mediclaim Policy Advisor in Bhadra, brings you this comprehensive and detailed guide on LIC's Arogya Rakshak (Plan 906).

What is LIC’s Arogya Rakshak?

LIC’s Arogya Rakshak is a Non-Linked, Non-Participating, Regular Premium, Individual, Health Insurance plan. It was meticulously designed to provide fixed benefit health insurance cover against certain specified health risks. This plan provides timely financial support during medical emergencies, ensuring that you and your family remain financially independent during difficult times.

One of the most remarkable features of this plan is its umbrella coverage. Under a single policy, you can insure yourself as the Principal Insured (PI), your spouse, all your children, and your parents. It offers a lump sum benefit regardless of the actual medical costs incurred.

Eligibility Conditions and Cover Limits

For residents of Bhadra managing their Saving and Investment Planning, understanding the strict age parameters of their policies is crucial for future claim settlements.

Minimum Age at Entry

• Principal Insured (PI): The minimum entry age is 18 years (last birthday).
• Insured Spouse / Parents: The minimum entry age is 18 years (last birthday).
• Insured Children: The minimum entry age is 91 days (completed).

Maximum Age at Entry

• Principal Insured (PI): The maximum entry age is 65 years (last birthday).
• Insured Spouse / Parents: The maximum entry age is 65 years (last birthday).
• Insured Children: The maximum entry age is 20 years (last birthday).

Cover Period Details

• Principal Insured, Spouse, and Parents: The cover period is calculated as 80 minus the Age at entry. However, if the Auto Health Cover (AHC) benefit is triggered and the policy is not continued by premium payment after the AHC period expires, the cover period is calculated as 70 minus the Age at entry.
• Insured Children: The cover period is calculated as 25 minus the Age at entry.

Initial Daily Benefit (Hospital Cash Benefit)

The core of this policy revolves around the Initial Daily Benefit, which is the Hospital Cash Benefit (HCB) level chosen at inception.

• The minimum Initial Daily Benefit for all members (PI, Spouse, Parents, Children) is ₹2,500.
• The maximum Initial Daily Benefit for the Principal Insured is ₹10,000 per life.
• The total Initial Daily Benefit under all policies issued to an individual under this specific plan cannot exceed ₹10,000.
• For an Insured Spouse, the benefit must be less than or equal to that of the PI.
• For Insured Parents and Children, the benefit must be less than or equal to that of the Insured Spouse (or the PI if there is no Insured Spouse).
• Included parents must be covered for equal benefits.
• Included children must also be covered for equal benefits.
• The Initial Daily Benefit is always in multiples of ₹500.

Comprehensive Inpatient and Surgical Benefits

As the leading Insurance Advisor in Bhadra, Ashuram Insurance Expert ensures that policyholders understand the exact payouts they are entitled to. The benefits under this plan are payable based on the Applicable Daily Benefit (ADB), which equals the Initial Daily Benefit during the first three years of cover.

1. Hospital Cash Benefit (HCB)

• If an Insured is hospitalized due to Accidental Bodily Injury or Sickness and the stay exceeds a continuous period of 24 hours, the Applicable Daily Benefit is payable.
• For any part stay exceeding a continuous period of 4 hours in a non-ICU ward after the initial 24 hours, the benefit is also payable.
• This payment is made regardless of the actual costs of treatment.
• If the Insured is required to stay in an Intensive Care Unit (ICU), two times the Applicable Daily Benefit is payable.
• If a 24-hour period includes both ICU and non-ICU stays, it is treated as an ICU admission provided the ICU stay was at least 4 continuous hours.
• Limits: The HCB is payable for a maximum of 30 days in the first Policy Year, and a maximum of 90 days in the second and subsequent Policy Years. The lifetime maximum limit for HCB is 900 days per Insured.

2. Major Surgical Benefit (MSB)

• If an Insured undergoes a medical necessity surgery listed in the Major Surgical Benefit Annexure due to injury or sickness, a respective percentage of the Major Surgical Benefit Sum Assured is payable.
• The Major Surgical Benefit Sum Assured is equal to 100 times the Applicable Daily Benefit for that Policy Year.
• The initial Major Surgical Benefit Sum Assured ranges from ₹2.5 lakh to ₹10 lakh in multiples of ₹50,000.
• Hospital Cash Benefit is paid over and above this lump sum MSB based on the hospital stay length.
• Limits: The total amount payable in any Policy Year cannot exceed 100% of the Major Surgical Benefit Sum Assured. The lifetime maximum limit is 1000% of the Major Surgical Benefit Sum Assured.

3. Day Care Procedure Benefit

• For specified Day Care Procedures, a lump sum amount equal to 5 times the Applicable Daily Benefit is payable regardless of actual costs.
• Limits: This is payable up to a maximum of 3 procedures per Policy Year, and a lifetime maximum of 30 procedures per Insured.

4. Other Surgical Benefit

• For surgeries not listed under MSB or Day Care, which cause hospitalization exceeding 24 hours, a daily benefit equal to 2.5 times the Applicable Daily Benefit is payable.
• Limits: This is payable for a maximum of 15 days in the first Policy Year, 45 days in subsequent years, and a lifetime maximum of 450 days per Insured.

5. Medical Management Benefit

• For inpatient hospitalization due to Dengue, Malaria, Pneumonia, Pulmonary Tuberculosis, or Viral Hepatitis A, a lump sum of 2.5 times the Applicable Daily Benefit is payable.
• Limits: This is restricted to a maximum of 2 times per Policy Year, and 20 times over the lifetime per Insured.

6. Extended Hospitalization Benefit

• If an Insured undergoes a single continuous hospitalization period exceeding 30 days, a lump sum of 10 times the Applicable Daily Benefit is payable.
• Limits: This is payable a maximum of 1 time per Policy Year, and 10 times over the lifetime per Insured.

Unique Financial Protections and Enhancements

Auto Step Up Benefit

To combat medical inflation in Bhadra, this policy automatically increases your cover. After the third year of cover, the Applicable Daily Benefit is increased by way of an Auto Step Up Benefit. An amount equal to 15% of the Initial Daily Benefit is added to the Applicable Daily Benefit at the end of every third policy anniversary. This continues until the Applicable Daily Benefit reaches a maximum of 1.5 times the Initial Daily Benefit.

No Claim Benefit

For healthy families, LIC rewards you. In the event of three claim-free policy years, an amount equal to 5% of the Initial Daily Benefit is added to the Applicable Daily Benefit. A 'claim-free policy year' means there are no claims in respect of any Insured covered under the policy during the immediate previous three years. There is absolutely no maximum limit for this benefit throughout the cover period.

Premium Waiver Benefit

If any Insured undergoes a surgery falling under Category 1 or Category 2 of the Major Surgical Benefit Annexure, the total one-year premium for the Policy (including Rider Premium) is waived from the next instalment due date. This is available only once during a policy year, even in the case of multiple claims.

Ambulance & Health Check-up Benefits

• Ambulance: If a Major Surgical Benefit is payable and emergency ambulance costs are incurred, an additional lump sum of ₹1,000 is payable.
• Health Check-up: Actual expenses up to one-half of the Applicable Daily Benefit are payable for health check-ups once every 3 policy years per Insured.

Auto Health Cover (AHC) & Death Benefit Mechanisms

If an Insured person other than the Principal Insured dies, the policy continues for the remaining members, and the premium for the deceased member ceases. However, if the Original Principal Insured dies, the Auto Health Cover (AHC) Benefit is triggered.

• In case of the PI's death, the policy continues with a new PI and eligible surviving members without any premium payments for a specific period.
• For Insured Children: The AHC period lasts for 15 years or until the policy anniversary when the child turns 25, whichever is earlier.
• For Insured Spouse/Parents: The AHC period lasts for 15 years or until the policy anniversary when they turn 70, whichever is earlier.
• During this AHC Period, base policy premiums for eligible Insureds are waived, though rider premiums must still be paid.
• During the AHC period, the Applicable Daily Benefit remains at the level it was on the date of the PI's death, meaning no further Auto Step Up or No Claim Benefits are added during this time.
• If the AHC Benefit cannot be triggered (e.g., the spouse is already 70 or older), the cover continues only if the premiums are paid by the new PI.

Waiting Periods and Strict Exclusions

Ashuram Insurance Expert always emphasizes transparency regarding policy limitations to ensure seamless claim processing in Bhadra.

Waiting Periods

• General Waiting Period: There is a general waiting period of 90 days from the Effective Date of Cover during which no benefits are payable for Hospitalization or Surgery due to Sickness. There is no general waiting period for Accidental Bodily Injury.
• Specific Waiting Period: There is a specific waiting period of 2 years from the Effective Date of Cover for certain treatments like Cataract, Hernia, Piles, Gall stones, Benign Prostate enlargement, Slip disc, Varicose Veins, Gastric/Duodenal Ulcer, and Knee/Joint Replacement Surgery (unless caused by an accident).

Major Exclusions

No benefits are payable for hospitalization or surgery caused by:

• Any Pre-existing Condition unless disclosed and accepted by LIC prior to the Effective Date of Cover.
• Admission into a Hospital outside India.
• Routine examinations, preventive check-ups, or Out Patient Basis treatments.
• Cosmetic, plastic surgery, or aesthetic treatments unless medically necessary due to an accident within 6 months.
• Pregnancy, childbirth (including caesarean), medical termination of pregnancy, or pre/post-natal care (though ectopic pregnancy is covered).
• Attempted suicide or intentional self-inflicted injury within 12 months.
• War, riots, civil commotion, or participation in unlawful acts.
• Participation in hazardous pursuits like scuba diving, bungee-jumping, martial arts, or racing.
• Pre and Post Hospitalization treatments are not payable.

Final Provisions: Surrender, Loans, and Taxes

It is imperative to note that there is No surrender value and No loan available under LIC's Arogya Rakshak Plan. Furthermore, no assignment of the policy is allowed. Statutory Taxes imposed by the Government of India are payable by the Policyholder on premiums and are not considered for calculating benefits.

---

Why Ashuram Insurance Expert is Your Lifeline in Bhadra

Since LIC's Arogya Rakshak was discontinued on January 1, 2025, you can no longer purchase this specific plan. However, for the families in Bhadra who are currently protected under this comprehensive policy, maintaining your cover, tracking your Auto Step-Up benefits, and filing complex medical claims requires professional intervention.

Ashuram Insurance Expert stands as your premier Mediclaim Policy Advisor in Bhadra. Whether you need assistance decoding your accrued No Claim Benefits, require guidance during a medical emergency to claim your Major Surgical Benefit, or need support navigating the Auto Health Cover transition in the unfortunate event of a family tragedy, our dedicated team is here to ensure your Family Financial Security remains impenetrable.