### LIC's Health Protection Plus....

### LIC's Health Protection Plus......... Hospital Cash Benefit (HCB). A daily benefit is payable in case the insured is hospitalized due to either accidental body injury or sickness. The quantum of benefit depends upon the level of cover opted. Insured Initial Daily Benefit (IDB)*# Minimum Maximum Principal Insured Rs.250 Rs.2500 Spouse/Child Rs.250 Rs.1500 *The Applicable Daily Benefit. IDB is applicable during the first year of risk cover. The daily benefit will increase @5% simple p.a. of the IDB on each policy anniversary until it hits a cap of 1.5 times the initial benefit. IDB of the spouse cannot exceed the Principal Insured’s IDB; IDB of the children cannot exceed the spouse’s IDB. The initial HCB must be in multiples of Rs. 50. #Initial daily benefit that is payable in respect of stay in a non-ICU room or ward. In case the insured is required to stay in the ICU of a hospital, an enhanced rate of daily benefit is payable, which is twice the eligible daily cash benefit. 2. Major Surgical Benefit (MSB). In the event of the insured undergoing one of the major surgeries defined in the Annexure I, a lump sum benefit (regardless of the actual costs incurred) equivalent to the percentage of the sum assured mentioned against that surgery will be payable on providing proper proof of surgery to the satisfaction of the corporation. 3. Domiciliary Treatment Benefit (DTB). The Principal Insured can claim an amount equivalent to the actual expense he or she has incurred in respect of any domiciliary treatment or to meet the medical expenses incurred over and above the hospital cash/major surgical benefits in respect of either oneself or the others insured under the policy. BEFORE CESSATION OF HCB AND MSB COVERS ON ALL MEMBERS COVERED Minimum domiciliary claimable Rs.2500 Maximum amount that can be claimed/ payable* Up to 50% of the policy fund at the date of payment * Subject to a minimum balance of one annualized premium being left in the policy fund after making the payment. AFTER CESSATION OF HCB AND MSB COVERS ON ALL MEMBERS COVERED Minimum domiciliary claimable Rs.2500* No limit on maximum amount that can be claimed/ payable * If the balance in the Policy Fund is less than Rs. 2,500/-, then the payment of entire amount shall be made in one lump sum only. Note: i. A maximum of two payments will be allowed in a policy year subject to the above conditions – on production of supporting proof of treatment and bills for expenses. DTB is available only after at least 3 years premiums are paid. ii. DTB is payable for the children covered until the health cover ceasing age. 4. Death Benefit. No death insurance cover is available under the plan. Following benefits/charges will take place on the happening of unfortunate death of principal insured (PI) and/or other insured member. a) On death of the PI (if policy is issued on single life) or on death of all Insured members (if more than one life is covered under the policy). The Policy Fund Value will be payable to the nominee/ legal heir. b) On death of PI (if other Insured members are there). The payment of premiums will cease and the cover will continue for the other Insured lives till the fund is sufficient to recover all the charges or till the maximum benefit ceasing age for each of the Insured lives, whichever is earlier. c) On death of insured member(s), other than PI The payment of premiums and the cover for PI and other Insured members, if any, will continue. 5. Waiting Period. Both HCB and MSB covers are available subject to a waiting period from the commencement of the risk cover specified hereunder – in respect of each insured member: Waiting Period from Principal Insured Spouse Insured Child Insured Date of the cover 180 days 180 days 180* days Date of reinstatement of cover during the revival period 90 days 90 days 90 days No waiting period in respect of Accidental Bodily Injury. *No waiting period in case of children for MSB from the date of cover. 6. Benefit Period Limits –Hospital Cash Benefit. HCB Maximum Annual Benefit Period Maximum Lifetime Benefit Period 1st Year 2nd year & after Principal Insured 18 days incl. 9 days for ICU 60 days incl. 30 days for ICU 365 days Spouse Insured Child Insured* *Maximum period of HCB for an insured child until he or she completes 5 years age is limited to 90 days. IMPORTANT NOTE: HCB is available only in respect of hospitalization in a ward or ICU for continuous period of 24 hours or part thereof, over and above 48 hours, provided such part stay exceeds 4 hours. 7. Conditions for Availing Major Surgery Benefit MSB Principal Insured Spouse Insured Child Insured Maximum Annual benefit 100% of the Sum Assured applicable in respect of the each insured member Maximum Lifetime Benefit 3 times the Sum Assured applicable in respect of the each insured member NOTE: i. Various HCB and MSB Benefit limits and restrictions applicable under this policy in respect of each insured shall solely and exclusively apply to that insured only and are not transferable to any other insured. ii. HCB/MSB is payable only if the hospitalisation/surgery is performed in India. 8. Termination of HCB and MSB Benefits in respect of each insured. On attainment of the insured’s maximum cover ceasing age – 75 years nearest birthday for PI/spouse insured and 25 years nearest birthday for the children insured On reaching the maximum lifetime benefit limits under HCB (365 days) and MSB (3 times the sum assured) On the death of the insured or on the date of termination of the policy for any other reason Insured spouse’s cover terminates on the date of divorce/ legal separation