Health Insurance Policy Review: LIC Jeevan Arogya — Why You’ll Need a Statistician and a Doctor Living With You?

[Posted on priority and out of turn due to many reader requests.]

Who’d have thought that Health Insurance could be this complicated?

If you opt for LIC’s Jeevan Arogya health insurance policy, be prepared to have a Statistician and a Doctor living with you full-time. Because when you’re hospitalized, you’d need the Doctor to tell you whether you need a “intracranial transection of the cranial nerve” or a “craniotomy for drainage of extradural, subdural or intracerebral space” or a “microvascular reattachment of penis following traumatic amputation.”

Honestly! I’m not kidding. Read this annexure.

Why do I feel traumatized already?

Now, once the Doctor tells you what reattachment you’re up against, the Statistician takes over.

Because, you’d be in no shape to interpret statistical terms and conditions such as:

If you or any of the insured lives covered under the policy is hospitalized due to Accidental Body Injury or Sickness and the stay in hospital exceeds a continuous period of 24 hours, then for any continuous period of 24 hours or part thereof, provided any such part stay exceeds a continuous period of 4 hours (after having completed the 24 hours as above) in a non-ICU ward/room of a hospital, an amount equal to the Applicable Daily Benefit (ADB) available under the policy during that policy year shall be payable subject to benefit limits and conditions mentioned in Para 11A and exclusions mentioned in Para 15 below.

Para 11A? Para 15? WTF?

Or how about:

In the event of an Insured under this plan, due to medical necessity, undergoing one of the surgeries defined in Major Surgical Benefit Annexure, within the cover period in a hospital due to Accidental Bodily Injury or Sickness, the respective benefit percentage of the Major Surgical Benefit Sum Assured, as specified against each of the eligible surgeries mentioned in Major Surgical Benefit Annexure, shall be paid subject to benefit limits and conditions mentioned in Para 11B and exclusions mentioned in Para 15 below.

Para 11B? Para 15 — again? Seriously, WTF? I doubt if you’d have the patience to pull out that PDF Annexure when you’re lying on a hospital bed.

My advise:

Stay away from this policy. Stay away from these complexities. Buy a simple health insurance policy for each member in your family who you wish to insure.

I’ve taken individual Star Health Medi Classic policies for both D and myself.

And before I forget, that “microvascular reattachment of penis following traumatic amputation” pays out only 60% of the sum assured. Ouch! Don’t you think it deserves more?

18 thoughts on “Health Insurance Policy Review: LIC Jeevan Arogya — Why You’ll Need a Statistician and a Doctor Living With You?

  1. Extending the calculations for fun:

    Organ Value = 60% of Sum Assured

    Sum Assured = 100 x Hospital Cash Benefit (HCB)

    HCB = 1,000, 2,000, 3,000 or 4,000 (depending upon what you choose)


    Organ Value = 60% x 100 x 1000 (min) and 60% x 100 x 4000 (max)


    Organ Value = Range (60,000 : 240,000) in steps of 60,000.

    QED. :-)

  2. Haha… ;)…. Now I need to find ways to avoid the LIC agent , I have almost commited to him that will be buying this… I was so stupid not read the fine print as you did.

    Thanks again pal .. have a nice time….

  3. @Madhu:

    That’s quite common. Stay tuned for a scheduled post next week on the fine print from a Videocon DTH ad. :-)


    He he he…I do. But imagine the patience of the person who wrote that legal mumbo-jumbo in the first place!

  4. Vinaya,

    Thanks for the detailed explanation. I was looking for reviews about this policy.
    Will not buy it. Can you share your experience with Star Health?


  5. dear sir
    thats problem with u metro guys….legal language is common ….private companies ke dikhawe pe mat least LIC showed the conditions others insurance companies will show u door while claim settlement….LIC has consistant record of 99.53 claim settlement….dont misguide people with such nonsense….u need psychologist to treat you…and if u can take Jeevan Arogya….only LIC can settle that claim….so long…

  6. @amit:

    “…and if u can take Jeevan Arogya….only LIC can settle that claim.” That’s obvious isn’t it? Why will someone else settle that claim?

    And, out of curiosity, what happens when you can’t reattach? Does LIC cover that as well? My point is that all this legal mumbo jumbo is what’s ailing this industry. LIC’s only adding to the mess.

  7. @Rakesh:

    Star Health is one of the better run health insurance companies out there. They paid the claims without much hassle when my mom was hospitalized. Last week, I also bought their Senior Citizen Red Carpet Policy for my father-in-law.

    And, I also renewed our individual Medi Classic policies. Star Health was prompt in calling me up about the renewal and taking it closure.

  8. Why don’t you analyse the fine print of Star health policies also. Are you a reviewer or agent of star health???
    which health policy is simple? So many claims are not paid or are underpaid by many? leave the regulation to IRDA.

    Give unbiased views.

  9. @ r ram:

    Every insurance policy has its nuances. But this policy from LIC takes things to the extreme. Tell me, is it realistically possible for you to have the “precise” diseases/ailments mentioned in the T & C? Can you even understand the medical terminology? Doesn’t it become all that more easier for LIC to reject your claims? Think about that.

    And do you seriously believe that IRDA regulates anything?

  10. that’s the most ridiculous answer. Jeevan Arogya is a defined benefit policy. All Insurance is to cover a given risk.
    Can you please elaborate how many claims star health has paid and how many times they increase the premium in a 3 years time span?
    Medical Terminology is inevitable in a health policy. As your views are biased and your eyes are jaundiced you can never see the advantages of Jeevan Arogya. You never answered my query on Start health ‘ small print.

  11. @ r ram:

    Dude. You can only show someone the correct way. By all means, go ahead and get one “Jeevan Arogya” policy for yourself. Come back and comment when you realize your folly. I’ll wait to hear from you.

  12. Hi vinaya,

    Being one of the victim by myself frm STAR Health insurance i advice you pls dont declare it is the better without knowing abt them completely . after seeing many of my friends cases and experienced my own i have to say Star health is one of the least claim settlement ratio in the market (which is less than 48%). where as LIC is 98.3%. No where comparable to the Giant LIC. But i agree with you that the premiums are far costlier in LIC than Star. But when it comes to health i think we should not compromise with the money we pay as premium as there is no use in paying premium howeber less it is if there is no gurantee that our claim is accepted. Also the customer service and the response of the Star is v v bad. They just respond after you pay the premium. for me it costed another 2000 just for thier STD calls.still its not resolved. i came frm a doctors family even then i wonder abt the queries they place to settle your claim i dont know how much the common ppl are suffering. its v tiresome.pls dnt go for this and pls dont guide ppl like this frm ur personal interest.i request you to enquire well before posting anything.

  13. After much research I have zeroed on two health plans,specifically for critical illness cover. MaxBupa and ApolloMunich. Both the Companies are claiming that they dont have any loading charges but I saw in ApolloMunich website where they mentioned that the Company might charge a loading MaxBupa they pay only 80% of the claim after 65years of age.ApolloMunich has a rider clause which is not there in MaxBupa. In ETWealth they ranked Apollo as no.1 but MaxBupa does provide for annual checkups which is n0t there in Apollo.I am confused as to which one is better since I am planning to buy the insurance purely for critical illness, since I already have basic mediclaim policy from NIA.Please advise.

  14. when u show one finger to anyone , Remaining fingers show u only.
    LIC has settled claims which are perfect and not to cheaters . First u have to know this , OK. I think U are the authorized Person for some Companies which Show Bear Bucks at the time of claims.

  15. Sir,

    Are you paid advisors for the MNCs dealing with Health Insurance. Each policy has its ups & downs. Do the policies of the MNCs cover all the medical treatments being faced by the people. You should not BANG any Health or other product of the Life Insurance Corporation of India.

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