JEEVAN AROGYA Plan Features

Automatic Renewal Date

The installment premium will be guaranteed in respect of each Insured for a period of 3 years from the Date of Commencement of the policy, i.e. for the first 3 years of the policy. Thereafter, at the end of every third policy anniversary, the premiums may be reviewed to take into account the Corporation’s experience, subject to prior approval from IRDA. These premium due dates, at the end of every third policy anniversary, starting from the date of commencement of policy till the date of cover expiry, on which the installment premiums are reviewable, will be referred as Automatic Renewal Dates in respect of all Insured in the Policy.

On any Automatic Renewal Date in the future, the installment premium will be based on the age of the Insured at the time of inclusion into the policy and the Corporation’s premium rates then prevailing for this product.

Options
A) Cover to new additional members: If PI gets married/ remarried during the term of the policy, the spouse and parents-in-law can be included in the policy within six months from the date of marriage / remarriage, but the cover shall start from the policy anniversary coinciding with or next following the date of inclusion. Enhanced premium shall be due from such policy anniversary.
Similarly, Any child born/legally adopted after taking the policy can also be covered from the next immediate policy anniversary date following the date on which the child completes the age of 3 months. If the age of legally adopted child on the date of adoption is more than 3 months, the child can be covered from policy anniversary coinciding with or next following the date of adoption. Enhanced premiums shall be due from such policy anniversary.
Inclusion of each additional member will be on payment of enhanced premiums and subject to various terms and conditions of the plan.
Any addition of new lives shall be allowed by the PI only. After the death of PI, no addition will be allowed.
Addition in any other case will not be allowed. The existing spouse, parents, parents-in-law and children, if not covered at the time of taking policy, shall not be covered under the policy.
If both of the parents (father and mother) are alive and are eligible for cover, then either both of them will have to be covered or none of them will be covered. The PI will not have any option to choose one of them. The same condition will apply for parents-in-law also.


B) Quick Cash facility: 
If any of the insured lives undergoes any eligible surgery covered under Category I or II of MSB in any of the listed network hospitals, you, as PI will have an option to avail Quick Cash facility. Under this facility, 50% of eligible MSB amount would be made available even during the period of hospitalization of any of the insured lives covered (the surgery may be either planned or emergency due to accident) instead of waiting for making a claim for the benefit after discharge. It will be only an advance payment in the event of hospitalization for any MSB defined in the surgeries listed under categories I & II and permissible under the policy conditions of the plan. This will be, however, subject to approval from the TPA (Third Party Administrator), and the advance amount will be adjusted from the final settlement of MSB claim amount.
This facility of advance payment could be availed by submitting your Bank Account details in the prescribed format. The amount of advance shall be credited to your bank account directly.


C) Term Assurance Rider: 
You, as PI, and your spouse may opt for Term Assurance as optional rider equal to the MSB SA. In case of unfortunate death, an amount equal to Term Assurance Sum Assured will be payable on death during the term for which Term Assurance Rider is opted for.


D) Accident Benefit Rider: 
You and your spouse may also opt for Accident Benefit Rider if Term Assurance Rider has been opted for. Maximum Accident Benefit Sum Assured shall be equal to the Term Assurance Rider SA. In case of unfortunate death due to an accident, an amount equal to Accident Benefit Sum Assured shall be payable.
Accident Benefit Rider will be available under the plan by payment of additional premium of  0.50 for every 1,000/- of the Accident Benefit Sum Assured per policy year in respect of each life to be covered.
The additional premium for this benefit will not be required to be paid on and after the Policy anniversary on which the Term Assurance Rider ceases.

Eligibility Conditions and Other Restrictions:

FOR BASIC PLAN
i) For Hospital Cash Benefit (HCB) (under Basic Plan)

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / Parents-in-law (if any)	Insured Dependent Children (if any)
Minimum Initial Daily Benefit (in a ward other than Intensive Care Unit)	1,000/-	1,000/-	1,000/-
Maximum initial daily amount	4,000/-	Insured Spouse- Less than or equal to that of PI Insured Parents /  Parents-in-law- Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included parents / parents-in-law shall be covered for equal benefits.	Less than or equal to that of Insured Spouse (PI, if there is no Insured Spouse). Further, included children shall be covered for equal benefits.
Maximum annual benefit period, applicable to each insured	30 days in year 1, 90 days per year thereafter, inclusive of stay in ICU. Maximum number of days in ICU is restricted to 15 days in year 1 and to 45 days thereafter.
Maximum Lifetime Benefit period, applicable to each insured	720 days inclusive of stay in ICU. Maximum number of days in ICU is restricted to 360 days

Initial Daily Benefit shall be in multiples of  1000/-.

ii) For Major Surgical Benefit (MSB) (under Basic Plan)

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / parents-in-law (if any)	Insured Dependent Children (if any)
Major Surgical Benefit Sum Assured (MSB SA)	100 times of Applicable Daily Benefit (ADB) of PI (as specified in Para 1A) above).	Insured Spouse- 100 times of ADB of Insured Spouse Insured Parents / parents-in-law- 100 times of ADB of each parent	100 times of ADB of each child
Maximum annual benefit, applicable to each insured	100% of Major  Surgical Benefit Sum Assured
Maximum Lifetime Benefit, applicable to each insured	800% of  Major  Surgical Benefit Sum Assured

iii) For Day Care Procedure Benefit (DCPB) (under Basic Plan)

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / parents-in-law (if any)	Insured Dependent Children (if any)
Lump sum benefit payable	5 times of Applicable  Daily Benefit (ADB) of PI	Insured Spouse- 5 times of ADB of Insured Spouse Insured Parents / parents-in-law- 5 times of ADB of each parent	5 times of ADB of each child
Maximum annual benefit,        applicable to each insured	3 Surgical Procedures
Maximum Lifetime Benefit, applicable to each insured	24 Surgical Procedures

iv) For Other Surgical Benefit (OSB) (under Basic Plan) 

Feature	Principal Insured (PI)	Insured Spouse (if any) & Insured Parents / parents-in-law (if any)	Insured Dependent Children (if any)
Daily benefit amount	2 times of ADB of PI	Insured Spouse- 2 times of ADB of Insured Spouse Insured Parents / parents-in-law- 2 times of ADB of each parent	2 times of ADB of each child
Maximum annual benefit, applicable to each insured	15 days in first policy year and 45 days per year thereafter
Maximum Lifetime Benefit, applicable to each insured	360 days