Health Protection Plus
(Table No.902) is health insurance plan from LIC.
LIC’s Health Protection Plus plan is a unique long term health insurance plan that offers health insurance covers for the entire family (husband, wife and the children) – Hospital Cash Benefit (HCB) and Major Surgical Benefit (MSB) along with a ULIP component (investment in the form of Units) that is specifically designed to meet Domiciliary Treatment Benefit (DTB) / Out Patient Department (OPD) expenses for the insured members.
Hospital Cash Benefit (HCB) is a daily benefit payable in case of hospitalization . It can
range from Rs.250/- to Rs.2500/- for the Principal Insured (the person who proposes for
insurance). For the Spouse or the children, the maximum amount of HCB is Rs.1500/-. The amount of daily benefit doubles in case of hospitalization in ICU. The IDB (Initial Daily Benefit) is applicable during the first year of risk cover. The amount of daily HCB will increase @ 5% simple p.a. every year on policy anniversary until it hits a cap of 1.5 times the initial benefit.
Major Surgical Benefit (MSB): In the event of the insured undergoing one of the major surgeries defined in the the policy, 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. The sum assured for major surgical benefits will be 200 times of the HCB you choose.
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. Both HCB and MSB covers are available subject to a waiting period from the commencement of the risk cover – in respect of each insured member: No death insurance cover is available under the plan.
All eligible existing family members are to be covered at the beginning (proposal stage)
itself. New members can however be added under certain specified conditions.
Modes of Payment: Yearly, Half-Yearly, & Monthly (ECS Mode only). The
premiums allocated to purchase units will be strictly invested in a Health Protection Plus Fund (Income and Growth – Low Risk).
Tax Benefit: One of the important features of the Plan that makes it doubly attractive is that the premiums paid under the policy are eligible for Tax Rebate under Section 80(D) of Income Tax Act, 1961.
LIC’s Health Insurance plan comes with a Tax benefit of upto Rs. 15000/- under section 80D.
Health Protection Plus Eligibility:
Minimum age at entry for PI and spouse: 18 years, 3 months for children.
Maximum age at entry for PI and spouse: 55, 17 yrs NBD or children.
Premium payable upto 65 years lbd for PI, extended health cover upto 75 years of age.
Minimum premium: Rs. 5000/- for single life and Rs. 7500 p.a; for two lives, Rs. 10,000 for more than 2 lives.
Maximum premium: No limit
Increase or decrease in premium: Allowed
Assignment & Loan : Not allowed.
Key Points:
HCB is payable on per day basis if hospitalization exceeds a continuous period of 48 hrs.
This benefit will increase at each policy anniversary by 5% till it reaches a maximum of 1.5 times the initial Daily Benefit
ICU Daily Benefit : Twice the applicable daily Benefit of that Policy year.
Maximum 18 days hospitalization out of which not more than 9 days in intensive care unit in the 1st policy year of each insured.
Maximum 60 days hospitalization out of which not more than 30 days in I.C.U in the 2nd & subsequent policy years of each insured.
A maximum of 365 days is allowed during entire policy term for each insured.
Insured child up to age 5 years: maximum period of 90 days
Waiting period 180 days for new policy and 90 days after revival. no waiting for accidental cases.
Termination: On reaching 65 years in case of Pl & Spouse or 25 years in case of children.
Minimum Initial Daily Benefit Rs. 250 ( for each of the member)
Maximum Initial Daily Benefit: P.I. Rs.2,500/- Spouse and Dependent children ; Rs. 1,500/- each.
Major Surgical Benefit Amount, calculated as a % of sum assured is payable regardless of actual costs incurred.
Maximum Annual Benefit; 100% of sum assured for each member.
Maximum MSB is three times the sum assured during entire term.
A child included will be automatically covered after age 18 years.
Applicable for surgery conducted only within India.
Waiting period: 180 days for new policy and 90 days after revival. No waiting period for accidental cases.
Sum Assured: 200 times of Initial Daily Benefit for each member.
On payment of premium for 3 years, this is payable out of Policy fund and is over & above those paid through hospital cash surgical benefits.
The claimed amount should be atleast Rs. 2500
Maximum amount to be paid shall be 50% of the Policy Fund.
Minimum one annualized premium should be left in the Policy Fund after the payment.
During a year, 2 payments shall be allowed.