How to make a claim in LIC Jeevan Arogya?

Jeevan Arogya plan is a Health Insurance Plan offered by LIC of India. Jeevan Arogya is a fixed benefit plan. In other words, on hospitalization, you will get a fixed amount on Hospitalization and surgery. LIC currently serves two Jeevan Arogya Plans. Jeevan Arogya, Plan No. 903, and Jeevan Arogya, Plan No. 904. Jeevan Arogya, Plan no. 903 is now available for sale. After hospitalization, Principal Insured has to claim the amount from LIC of India. You have to submit the claim forms with treatment papers to get the claim. 

What to do on Hospitalization

Whenever the insured person gets hospitalized, you should immediately inform the LIC office. You can intimate the branch during the hospitalization period or immediately after the discharge of the insured. In any case, intimation along with the claim forms should reach the servicing branch within the 30 days of the discharge from the hospital.

Claim Forms required in Jeevan Arogya Plan

Whenever you claim the benefits of the Jeevan Arogya Plan, Principal Insured has to submit certain forms along with the discharge and treatment papers. In the Jeevan Arogya plan, you can submit the attested copies of all the documents to claim the benefits. You can use the originals to make a claim in your Mediclaim policy (General Insurance policy). You will require the following forms to claim the benefits of Jeevan Arogya:

Claim Intimation Form

This is the intimation form, which you have to submit to the LIC servicing branch. You have to fill the following details in the form:

1. Policy number
2. Name, address and contact details  of Principal insured
3. TPA (Third Party Administrator) details if any
4. Details of the insured person for whose treatment claim is being made
5. Details of the Hospitalization

You will also find the guidelines for submission of claim form printed at the end of Claim Intimation Form

Hospital Treatment Form

The hospital will fill this form. This form summarizes all the details about hospitalization. In other words, details about the number of the day of the treatment, ailment, ICU details (if insured was in ICU during the hospitalization), and surgeries if any. You have to paste the copy of the health card on this form. The doctor or the hospital authority will attest to the ID. However, if you do not have a health card, then you can paste a copy of the photo ID (of the insured who was hospitalized). The principal insured has to sign this form.

Form for claiming HCB/ MSB/ DCPB/ OSB/ Quick Cash under LIC’s Health Insurance Policy

The PI fills this form. The form required the details of the policyholder (insured) who underwent treatment. Therefore you have to furnish the details about the type and duration of the hospitalization. You also have to give your bank details in this form. The principal insured must sign this form without fail.

Document required with claim forms

You have to submit some other documents besides the above-mentioned forms. These documents are mentioned as under

1. Bill, Receipt, and discharge certificate/card from the Hospital.
2. Cash Memos from the Hospital / Chemist(s), supported by a proper prescription.
3. Receipt and pathological test reports from a Pathologist supported by the prescription from the attending Medical (Please do not submit x-rays/scan reports. Submit the copies of doctor’s prescription for the x-ray/scan; the X-Ray/scan Bill and the X-Ray/Scan report only.)
4. Practitioner / Surgeon for such Pathological tests.
5. Surgeon’s certificate stating the nature of operation performed and the Surgeon’s bill and receipt.
6. Attending Doctor’s / Consultant’s / Specialist’s / Anesthetist’s bill and receipt and certificate regarding diagnosis.
7. FIR and related documents in respect of an accidental bodily injury claim (Medico-Legal cases)
8. ID proof of the insured and Principal Insured/Claimant.
9. A canceled cheque of the account which was mentioned in the claim forms to get the benefits when admitted.

Submit all these documents in the original. However, if you require the original document somewhere else, submit an attested photocopy.  Principal Insured/must also self-attests each document which he/she submitting with claim forms without fail.

Where to submit the claim forms

Principal Insured can submit the claim forms to his servicing branch or the Health Insurance department of the concerned divisional office directly. All the claim forms submitted to the branch are sent to the Health insurance department of that particular division and later it is sent to TPA for further processing.

Process of Claim settlement in Jeevan Arogya

1. When you submit the claim forms to LIC of India branch. Branch then send these papers to its divisional office.
2. The health insurance department then checks the paper and sends them to LIC panel doctors for an expert opinion. (Earlier LIC used TPA services)
3. The medical examiner scrutinizes the claim papers. If they are found incomplete, he will inform the LIC to call for additional details from the claimant. If papers are complete then he will give his opinion to accept or reject the claim.
4. LIC intimate the claimant to submit the required information.
5. The claimant submits the requirements.
6. The medical examiner again scrutinize the papers and give his opinion related to acceptance for rejection of claim
7. LIC then issue the final decision about acceptance or rejection of the claim.
8. LIC then issue the payment instruction to the bank for payment of the admitted claim amount or send the rejection letter to the policyholder if the claim got rejected due any reason.

Checklist before your submits your claim form

1. Make sure you have filled the forms, strikeout the column which is not applicable or write –NA-
2. you/Principal Insured (PI) must sign the Hospital treatment form without fail.
3. The doctor must sign the Hospital treatment form.
4. Make sure you have pasted the Copy of Health Card (E-Card) or photo ID of insured (who underwent the treatment) on hospital treatment form, and the doctor has attested the form.
5. The self attests all the papers.
6. Submit all the bills and self attest them.
7. Submit all the pathology reports with forms.
8. Principal insured must self attest original/attested copies of FIR for any medico-legal case.
9. PI must submit the photo ID of the insured and self.
10. A Canceled cheque of the bank account to get the claim amount.
11. submit a genuine reason for late form submission.

Download the Claim Form

1. Claim Intimation Form

2. Hospital Treatment Form

3. Form for claiming HCB/ MSB/ DCPB/ OSB/ Quick Cash

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