How to make a claim in LIC Jeevan Arogya

how-to-make-claim-in-jeevan-arogya-policy

Jeevan Arogya plan is a Health Insurance Plan offered by LIC of India. Jeevan Arogya is a fixed benefit plan ie on hospitalization you will get the fixed amount related to your number of days of Hospitalization and surgery. There are two Jeevan Arogya plans which are currently serviced by LIC of India; one is Jeevan Arogya, Plan No. 903 and Jeevan Arogya, Plan No. 904. Jeevan Arogya, Plan no. 903 is now discontinued for sale. After hospitalization, Principal Insured has to claim the amount from LIC of India by submitting the claim form along with the treatment papers in original or with attested copies of all the treatment papers.

What to do on Hospitalization

Whenever the insured person gets hospitalized, he/she or his/her relative must intimate the servicing 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 of the insured from the hospital.

How to check your Jeevan Arogya Claim Status

Third Party Administrator (TPA) for LIC Health Plans is Emeditek. You can check the status of your claim in Jeevan Arogya Policy by visiting the link provided below. You can check your profile and also the claim status.  You can also download the E-Card of your policy from here. Claim status will only show if it is registered on Emeditek site.

To check the claim status of your Jeevan Arogya Policy Visit the Link: Claim Status

After you enter your policy number and date of birth as mentioned in policy, you will be able to see your profile. Click on the Locate the claim option given in the left sidebar of the page and you will be able to see the claim status, you can also see the requirements, if any called by TPA. For enquiry from LIC call any of your nearest LIC Customer Zone. You can also call to these numbers of Emeditek: Customer Care: 18001023242 or +91-124-4980555.

Claim Forms required in Jeevan Arogya Plan

While claiming the benefits of Jeevan Arogya Plan, Principal Insured has to submit certain forms along with the discharge and treatment papers. In 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). Following forms are required to claim the benefits of Jeevan Arogya:

Claim Intimation Form

This is the intimation form, which Principal Insured must submit to the LIC servicing branch. This form requires the following details

  1. Policy number
  2. Name, address and contact details  of Principal insured
  3. TPA (Third Party Administrator) details if any
  4. Details of 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

Hospital Treatment Form is the form which Principal Insured/Claimant has to submit to LIC of India after getting it filled by the hospital authority where the insured underwent the treatment. This form summarizes all the 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 performed. The claimant must paste the copy of Health card provided by LIC of India in the provided space on form and get it attested by the hospital authorities. If the claimant does not have the health card, then a copy of photo ID (of the insured who was hospitalized) to be pasted on the provided place of the form and must be attested by the hospital authorities. This form must also be signed by Principal Insured/Claimant at the required place.

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

This form is to be filled by the Principal Insured to claim the benefits of the Jeevan Arogya Policy. This form required the details of the policyholder (insured) who underwent treatment, type and duration of the hospitalization along with the bank details of the claimant, this form must be signed by the Principal Insured/claimant at the required places.

Document required to be submitted with above-mentioned claim forms

Besides the above-mentioned forms, there are other documents which have to be submitted with claim 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 nature of operation performed and 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 account which was mentioned in the claim forms to get the benefits when admitted.

These documents must be submitted in original or attested copies along with the claim forms. 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 concern divisional office directly. All the claim forms submitted to the branch are sent to Health insurance department of that particular division and later it is sent to TPA for further processing.

Process of Claim settlement in Jeevan Arogya

When the Principal Insured/Claimant submits the claim forms along with the required documents in the branch, it is then sent to the Health Insurance department of concern divisional office of LIC. Health insurance department checks the paper and sends them to TPA for the further processing of Claim. TPA scrutinize the claim papers and if found incomplete, TPA calls for the requirement from the policyholder. If all the requirements are met by the claimant then TPA process the claim and decide whether to admit the claim or not on the basis of the documents provided. The decision regarding acceptance or rejection is later sent to the LIC by the TPA. 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 claim got rejected due any reason.

flowchart-claim-process-in-jeevan-arogya

Flowchart-Claim process in LIC Jeevan Arogya policy.

Checklist before your submits your claim form

  1. Make sure you have filled the forms completely, strikeout the column which is not applicable or write  –NA-
  2. Hospital treatment form should be duly filled and self-attested by you/Principal Insured (PI).
  3. Hospital treatment form is signed by hospital authorities or doctor who gave the treatment
  4. Copy of Health Card (E-Card) or photo ID of insured (who underwent the treatment) is pasted on hospital treatment form and attested by hospital authorities/doctor
  5. Original/attested copy of hospital discharge card, self-attested by you/principal insured.
  6. Bills provided by the hospital should be submitted (original or attested copies) and must be self-attested by principal insured.
  7. Original/attested copies of pathology reports or any special report advised by doctor and any mentioned in discharge summary should be submitted and self-attested by PI (Principal Insured)
  8. Original/attested copies of FIR for any medico-legal case, self-attested by PI
  9. Photo ID of insured underwent treatment along with photo ID of PI both self-attested by PI
  10. A Canceled cheque of bank account in which claim amount to be credited
  11. If in any case claim forms are submitted after 30 days of discharge, reason for the same if genuine.

Principal Insured in Jeevan Arogya plan must self-attest all the documents which he/she submitting to make the claim without fail.

Download the Claim Form

  1. Claim Intimation Form

  2. Hospital Treatment Form

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

4 Comments on "How to make a claim in LIC Jeevan Arogya"

  1. dipak.madlani@gmail.com' DIPAK M MADLANI | October 10, 2016 at 11:00 am | Reply

    IN FACT LIC OF INDIA (BRACNH)NEVER ISSUES CLAIM FORM AFTER SUBMITTING CLAIM INTIMATION
    EVEN AFTER SUBMITTING ALL REQUIREMENTS NEVER GIVES UPDATES,QUERRY,REQUIREMENT……ONLY IF AGENT OR INSURED ASK VARIOUS TIMES THAN ONLY THEY ARE GIVING ANSWER AFTER 15 DAYS. EVEN HOME BRANCH DOES NOT KNOW WHETHER ANY QUERRY OR WHETHER CLAIM IS SETTLED OR NOT THIS IS VERY REDICIOUS FOR ANY LIC MEDICLAIM POLICY …….DIPAK MADLANI…PORBANDAR…9825223360

  2. dipak.madlani@gmail.com' DIPAK M MADLANI | October 10, 2016 at 11:02 am | Reply

    LIC PLAN IS THE BEST BUT FOLLOOW UP BY LIC OFFICERS AND IN BRANCH AND EVEN IN DIVISION THEY ARE NOT TAKING FOLOW UP STEPS ……..HENCE LIC IS LACKING IN GIVING SERVICE TO THEIR MEDICLAIM POLICY HOLDERS

  3. Dipak M Madlani’s information is right.Day by day lic loss his concentration from service.

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