6.
Increase/Decrease of Premiums. 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.
II.
CONDITIONS & RESTRICTIONS
1.
Premium Discontinuance and Revival. 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.
2.
Premium Holidays. 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.
3.
Surrender. No surrender will be allowed.
4.
Policy Loans. No policy loan will be available
under this policy.
5.
Assignment. No assignment will be allowed
under this policy.
6.
Tax Benefit. The premium payable under this
product is eligible for Section 80(D) benefit
of Income Tax Act, 1961.
7.
Risks borne by the Policyholder:
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.
8.
Cooling off period: If you are not satisfied
with the ?Terms and Conditions? of the policy,
you may return the policy to us within 15 days..
III.
EXCLUSIONS
1.
Common Exclusions in respect of HCB & MSB
Benefits: 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.
2.
Additional Exclusions in respect of Hospital
Cash Benefit:
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.
3.
Additional Exclusions in respect of Major Surgical
Benefit:
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).
IV.
INVESTMENT OF FUNDS
The premiums allocated to purchase units will
be strictly invested in a Health Protection
Plus Fund (Income and Growth – Low Risk)
as follows:
| A.
Government/ Government Guaranteed/ Corporate
Securities/ Debt |
Not
less than 50% |
| B.
Short term investments: Money Market instruments
including A above |
Not
more than 90% |
| C.
Investment in listed equity shares |
Not
less than 10% & Not more than 50% |
1.
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
daily basis and will be based on investment
performance, Fund Management Charge and whether
the fund is expanding or contracting.
a. Applicability of Net Asset Value (NAV):
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.
b. Redeeming of Units: 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.
2. Charges under the Plan:
a. Premium Allocation Charge:
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
|
thereafter
|
|
30%
|
6%
|
The
above allocation charges shall be applicable
for all premiums including any additional premium
paid in that particular policy year.
b. Health Insurance Charge: 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
|
HCB
|
MSB
|
|
5
|
24.43
|
20.43
|
0
|
0
|
|
15
|
20.71
|
20.71
|
0
|
0
|
|
25
|
31.39
|
24.34
|
1.02
|
1.38
|
|
35
|
33.59
|
29.96
|
1.58
|
1.75
|
|
45
|
49.29
|
53.20
|
3.54
|
2.64
|
|
55
|
76.08
|
72.53
|
7.28
|
5.16
|
b.
Health Insurance Charge:
| Policy
Administration Charges |
Rs.75 per month during the first year and
Rs. 25 per month during the subsequent years. |
| Fund
Management Charges |
Levied
@ 1.25% per annum of the unit fund, at the
time of computation of NAV which will be
done on daily basis. |
| Bid/
Offer Spread |
Nil |
|
Service
Tax Charge
|
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%.
|
d.
Right to revise charges-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.
Disclaimer
: For more details on risk factors , terms and
conditions please read sales brochure carefully
before concluding a sale .
