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The new members will be eligible for the cover only if they satisfy the conditions of minimum premium and benefits.
New members must be included by
the Principal Insured only. No new members will be allowed after the
death of the principal insured.
Increase or decrease of premiums is allowed during the term of the
policy. Increase in premium must be in multiples of Rs.500. In case of
decrease, the minimum premium conditions must be satisfied. However,
increase/decrease in premiums does not affect the level of health cover
and HCB and MSB benefits.
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
ii.the lives covered reach the benefit ceasing age, or
iii.the maximum lifetime benefits are exhausted, or
iv.the policy is terminated due to death or any other reason, if any,
whichever is earlier.
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.
All other charges will also continue to be deducted from the Policy Fund till the fund exhausts.
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.
No surrender will be allowed.
No policy loan will be available under this policy.
No assignment will be allowed under this policy.
The premium payable under this product is eligible for Section 80(D) benefit of Income Tax Act, 1961.
i)LIC’s Health Protection
Plus is a Unit Linked Health Insurance product which is different from
the traditional insurance products and is subject to risk factors.
ii)The premium paid in Unit Linked Life
Insurance policies are subject to investment risks associated with
capital markets and the NAVs of the units may go up or down based on the
performance of fund and factors influencing the capital market and the
insured is responsible for his/her decisions.
iii)Life Insurance Corporation of India
is only the name of the Insurance Company and LIC’s Health Protection
Plus is only the name of the unit linked health insurance contract and
does not in any way indicate the quality of the contract, its future
prospects or returns.
iv)Please know the associated risks and
the applicable charges, from your Insurance agent or the Intermediary or
policy document of the insurer.
v)The fund offered under this contract is
the name of the fund and do not in any way indicate the quality of
these plans, their future prospects and returns.
vi)All benefits under the policy are also
subject to the Tax Laws and other financial enactments as they exist
from time to time.
If you are not satisfied with the ?Terms and Conditions? of the policy, you may return the policy to us within 15 days.
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:
a.“Pre-existing condition”- any medical
condition or any related condition (e.g. illnesses, symptoms,
treatments, pains and surgery) that have arisen at some point prior to
the commencement of this coverage, irrespective of whether any medical
treatment or advice was sought. Any such condition or related condition
about which the PI or insured dependant know, knew or could reasonably
have been assumed to have known, will be deemed to be pre-existing. The
following conditions will also be deemed to be “pre-existing”:
i.Conditions arising between signing the
application form and confirmation of acceptance by the Corporation
ii.Any Sickness, illness, complication or
ailment arising out of or connected to the pre-existing illness
b.Any Sickness that has been classified as an Epidemic by the -Central or State Government.
c.Self afflicted injuries or conditions
(attempted suicide), and/or the use or misuse of any drugs or alcohol.
d.Any sexually transmitted diseases or
any condition directly or indirectly caused to or associated with Human
Immuno Deficiency (HIV) Virus or any Syndrome or condition of a similar
kind commonly referred to as AIDS.
e.War, invasion, act of foreign enemy,
hostilities (whether war be declared or not), civil war, rebellion,
revolution, insurrection military or usurped power of civil commotion or
loot or pillage in connection herewith.
f.Naval or military operations(including
duties of peace time) of the armed forces or air force and participation
in operations requiring the use of arms or which are ordered by
military authorities for combating terrorists, rebels and the like.
g.Any natural peril (including but not
limited to avalanche, earthquake, volcanic eruptions or any kind of
natural hazard).
h.Participation in any hazardous activity
or sports including but not limited to racing, scuba diving, aerial
sports, bungee jumping and mountaineering or in any criminal or illegal
activities.
i.Radioactive contamination.
j.Non-allopathic methods of surgery and treatment.
No benefits are available hereunder and
no payment will be made by the Corporation for any claim for Hospital
Cash 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:
a.Hospitalization due to illness within
the first 180 days from the Date of Cover commencement or 90 days from
the date of revival/reinstatement if revived after discontinuance of the
cover.
b.Removal of any material that was
implanted in a former surgery before Date of Cover commencement
c.Any diagnosis or treatment arising from
or traceable to pregnancy (whether uterine or extra uterine),
childbirth including caesarean section, medical termination of pregnancy
and/or any treatment related to pre and post natal care of the mother
or the new born.
d.Hospitalization for the sole purpose of
physiotherapy or any ailment for which hospitalization is not warranted
due to advancement in medical technology
e.Any treatment not performed by a Physician or any treatment of a purely experimental nature.
f.Any routine or prescribed medical check up or examination.
g.Medical Expenses relating to any
hospitalization primarily for diagnostic, X-ray or laboratory
examinations
h.Circumcision, cosmetic or aesthetic
treatments of any description, change of gender surgery, plastic surgery
(unless such plastic surgery is necessary for the treatment of Illness
or Accidental Bodily Injury as a direct result of the insured event and
performed with in 6 months of the same).
i.Hospitalization for donation of an organ.
j.Hospitalization for correction of birth defects or congenital anomalies
k.Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
l.Convalescence, general debility,
nervous or other breakdown, rest cure, congenital diseases or defect or
anomaly, , sterilization or infertility (diagnosis and treatment), any
sanatoriums, spa or rest cures or long term care or hospitalization
undertaken as a preventive or recuperative measure.
No benefits are available hereunder and
no payment will be made by the Corporation for any claim for Major
Surgical Benefit under this Policy directly or indirectly caused by,
based on, arising out of or howsoever attributable to any of the
following:
a.Surgeries not listed in the Surgical Benefit Annexure I
b.Surgery triggered by health related
causes (and not by Accident) within the first 180 days from the
commencement date or 90 days from the date of revival/reinstatement if
revived after discontinuance of the cover.
c.Any Surgery for which claim has already been made and paid by the Corporation.
d.Any treatment not performed by a Physician/Surgeon.
e.Any treatment including Surgery that is
performed un-conventionally under experimental conditions and purely
experimental in nature.
f.Circumcision, cosmetic or aesthetic
treatments of any description, change of life surgery or treatment,
treatment (including surgery) for obesity, plastic surgery (unless
necessary for the treatment of Illness or accidental Bodily Injury as a
direct result of the insured event and performed with in 6 months of the
same).
g.Surgery for donation of an organ.
h.Removal or correction or replacement of
any material that was implanted in a former Surgery before Date of
Cover commencement
i.Surgery for correction of birth defects or congenital anomalies.
j.Any diagnosis or treatment or surgery
arising from or traceable to pregnancy (whether uterine or extra
uterine).
The premiums allocated to purchase units will be strictly invested in a Health Protection Plus Fund, SFIN No: ULIF001290409LICHPR+FND512 (Income and Growth – Low Risk) as follows:
A. Government/ Government Guaranteed/ Corporate Securities/ Debt
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Not less than 50%
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Not more than 90%
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| Not less than 10% & Not more than 50% |
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 day to day basis and will be based on investment performance and
Fund Management Charge and shall be computed as:
Market value of investment held by the fund + Value of Current Assets – Value of Current Liabilities & Provisions, if any
_______________________________________________________________________________
Number of Units existing on Valuation Date (before creation / redemption of Units)
The premiums received up to 3 p.m. (as per IRDA guidelines) by the
servicing branch of the corporation by a local cheque or by a demand
draft payable at par at the place where the premium is received, the
closing NAV of the day on which premium is received shall be applicable.
The premiums received after such time by the servicing branch of the
corporation by a local cheque or by a demand draft payable at par at the
place where the premium is received, the closing NAV of the next
business day shall be applicable.
In respect of valid applications received for reimbursement of medical
expenses, death claim, etc up to such time by the servicing branch of
the Corporation closing NAV of that day shall be applicable. For the
valid applications received in respect of Domiciliary Treatment Benefit,
death claim etc after 3 p.m. (as per IRDA guidelines) by the servicing
branch of the Corporation the closing NAV of the next business day shall
be applicable.
This is the percentage of the premium appropriated towards charges from
the premium received. The balance known as allocation rate constitutes
that part of the premium which is utilized to purchase (Investment)
units for the policy. The allocation charges are as below:
First year
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thereafter
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30%
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6%
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The above allocation charges shall be
applicable for all premiums including any additional premium paid in
that particular policy year.
There will be two separate charges for the following benefits:
i) Hospital Cash Benefit
ii) Major Surgical Benefits.
These charges will be taken every month
in respect of all the members covered by canceling appropriate number
of units out of the Policy Fund.
These charges, during a policy year,
will be based on the age nearer birthday, of each of the members
covered, as at the Policy anniversary coinciding with or immediately
preceding the due date of cancellation of units and hence may increase
every year on each policy anniversary. The charges will also depend on
whether the person covered is male or female and standard or
sub-standard as per the underwriting decision.
If more than one member is covered
under the policy then the total charges shall be based on the individual
ages of all the members and the amount of cover for each such member.
In case of Hospital Cash Benefit, the
charges will be applied on the Initial Daily Benefit as mentioned in the
Policy Schedule.
The charges for Hospital Cash Benefit
and/or Major Surgical Benefit will not be deducted once the benefit
terminates.
Specimen charges for Rs. 100/- per day for HCB and Rs. 1000/- SA for MSB for standard lives are given as under:
Age
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5
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24.43
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20.43
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0
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0
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15
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20.71
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20.71
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0
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0
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25
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31.39
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24.34
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1.02
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1.38
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35
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33.59
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29.96
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1.58
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1.75
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45
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49.29
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53.20
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3.54
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2.64
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55
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76.08
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72.53
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7.28
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5.16
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Policy Administration Charges
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Rs.75 per month during the first year and Rs. 25 per month during the subsequent years.
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Fund Management Charges
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Levied @ 1.25% per annum of the unit fund, at the time of computation of NAV which will be done on daily basis.
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Bid/ Offer Spread
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Nil
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A service tax charge shall be levied on the following charges:
i)Policy Administration charge and
Health Insurance charges - by canceling appropriate number of units out
of the Policyholder’s Fund Value on a monthly basis as and when the
corresponding Policy Administration and Health Insurance charges are
deducted.
ii)Premium allocation charge - at the time of allocation of premium.
iii)Fund Management charge– at the time of computation of NAV on daily basis.
The level of this charge will be
as per the rate of service tax as applicable from time to time.
Currently, the rate of service tax is 10% with an educational cess at
the rate of 3% thereon and hence effective rate is 10.30%.
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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.
Although the charges are reviewable, they will be subject to the following maximum limit:
Policy Administration Charge-Rs. 150/-
per month during the first policy year and Rs.50/- per month thereafter,
throughout the term of the policy.
Fund Management Charge-The Maximum for Fund will be 2.5% p.a. of Unit Fund
Hospital Cash Cover charges and Major
Surgical Benefit charges shall not exceed by more than 200% of the
current rate.
For more details on risk factors , terms and conditions please read sales brochure carefully before concluding a sale .
Read More - http://www.licindia.in/Health_Protection_Plus_features.htm |
