HEALTH PLUS

T-901

(UNIT LINKED HEALTH INSURANCE)

NO OF PERSONS IN THE FAMILY

SUM.ASSD
1
2
3
4
5
6
50000
5000 7500 10000 10000 10000 10000
60000
5000 7500 10000 10000 10000 10000
70000
5000 7500 10000 10000 10000 10000
80000
5000 7500 10000 10000 10000 10000
90000
5000 7500 10000 10000 10000 10000
100000
5000 7500 10000 10000 10000 10500
110000
5000 7500 10000 10000 10000 12000
120000
5000 7500 10000 10000 11000 13000
130000
5000 7500 10000 10000 12000 14000
140000
5000 7500 10000 10500 13000 15000
150000
5000 7500 10000 11500 13500 16000
160000
5000 7500 10000 12000 14500 17000
170000
5500 8000 10500 13000 15500 18000
180000
5500 8500 11000 13500 16500 19000
190000
6000 9000 11500 14500 17500 20000
200000
6000 9000 12000 15000 18000 21000
210000
6500 9500 13000 16000 19000 22500
220000
7000 10000 13500 16500 20000 23500
230000
7000 10500 14000 17500 21000 24500
240000
7500 11000 14500 18000 22000 25500
250000
7500 11500 15000 19000 22500 26500
260000
8000 12000 16000 19500 23500 27500
270000
8500 12500 16500 20500 24500 28500
280000
8500 13000 17000 21000 25500 29500
290000
9000 13500 17500 22000 26500 30500
300000
9000 13500 18000 22500 27000 31500
310000
9500 14000 18500 23000 27500 32000
320000
10000 14500 19000 23500 28000 32500
330000
10000 14500 19000 23500 28000 32500
340000
10500 15000 19500 24000 28500 33000
350000
10500 15000 19500 24000 28500 33000
360000
11000 15500 20000 24500 29000 33500
370000
11500 16000 20500 25000 29500 34000
380000
11500 16000 20500 25000 29500 34000
390000
12000 16500 21000 25500 30000 34500
400000
12000 16500 21000 25500 30000 34500
410000
12500 17000 21500 26000 30500 35000
420000
13000 17500 22000 26500 31000 35500
430000
13000 17500 22000 26500 31000 35500
440000
13500 18000 22500 27000 31500 36000
450000
13500 18000 22500 27000 31500 36000
460000
14000 18500 23000 27500 32000 36500
470000
14500 19000 23500 28000 32500 37000
480000
14500 19000 23500 28000 32500 37000
490000
15000 19500 24000 28500 33000 37500
500000
15000 19500 24000 28500 33000 37500

HCB
250
300
350
400
450
500
550
600
650
700
750
800
850
900
950
1000
1050
1100
1150
1200
1250
1300
1350
1400
1450
1500
1550
1600
1650
1700
1750
1800
1850
1900
1950
2000
2050
2100
2150
2200
2250
2300
2350
2400
2450
2500

HCB (PI)
91250
109500
127750
146000
164250
182500
200750
219000
237250
255500
273750
292000
310250
328500
346750
365000
383250
401500
419750
438000
456250
474500
492750
511000
529250
547500
565750
584000
602250
620500
638750
657000
675250
693500
711750
730000
748250
766500
784750
803000
821250
839500
857750
876000
894250
912500

MAXIMUM IN LIFE TIME

MSB (PI) HCB(SP+CH) MSB(SP+CH)
150000
91250
150000
180000
109500
180000
210000
127750
210000
240000
146000
240000
270000
164250
270000
300000
182500
300000
330000
200750
330000
360000
219000
360000
390000
237250
390000
420000
255500
420000
450000
273750
450000
480000
292000
480000
510000
310250
510000
540000
328500
540000
570000
346750
570000
600000
365000
600000
630000
383250
630000
660000
401500
660000
690000
419750
690000
720000
438000
720000
750000
456250
750000
780000
474500
780000
810000
492750
810000
840000
511000
840000
870000
529250
870000
900000
547500
900000
930000
547500
900000
960000
547500
900000
990000
547500
900000
1020000
547500
900000
1050000
547500
900000
1080000
547500
900000
1110000
547500
900000
1140000
547500
900000
1170000
547500
900000
1200000
547500
900000
1230000
547500
900000
1260000
547500
900000
1290000
547500
900000
1320000
547500
900000
1350000
547500
900000
1380000
547500
900000
1410000
547500
900000
1440000
547500
900000
1470000
547500
900000
1500000
547500
900000

HCB for spouse and children=Less than or equal to that of PI subject to a maximum of Rs. 1,500
MSB FOR SPOUSE AND CHILDREN IS 200 times of HCB - MAXIMUM=Rs.3,00,000 P.A

Premium
Net funding

24000
22287
1713

18000
16710
1290

12000
11132
868

10000
9313
687

Telefax:(0831)2454190
Cell:9731867502

PRABHUSWAMI A.PRABHUDEVARMATH
Agency Code:06058635

DESIRED
PREMIUM

HEALTH PLUS
MSB FOR P.I

NO.

500000

NAMES

AGE

HCB
for pi
=M / F

HCB /
DAY

2500
CHARGES
FOR HCB
Rs./ YEAR

CHARGES FROM 1st MONTH

HCB+MSB CHARGES PER MONTH (D) Rs.

SERVICE TAX @ 12.36% ON 'D' (E)
Rs.

Rs.

INCOME TAX REBATE U / S-80D UP

TO Rs.15000. (In addition to the
1 LAKH benefit under sec.80.C

WAITING PERIOD :
180 DAY AT STARTING & 90 DAYS
ON REVIVAL(EXCLU.ACCIDENTS)

GRACE PERIOD :
30 DAYS.
POLICY LAPSES IF NOT PAID.

10

REVIVAL : WITHIN 2 YEARS

FROM LAPSE.REQUIREMENTS
AS PER CHARTS & AGE

14

13

PREMIUM TO BE PAID UP TO 65 OF AGE

25000

TOTAL AMOUNT TO BE PAID Rs.750000

CHARGES

1630
905
416
0
0
0
2950

PER
MONTH
136
75
35
0
0
0
246

MAXIMUM HCB
MAXIMUM MSB
PER MEMBER IN
PER MEMBER IN
LIFE =(365 DAYS)
LIFE
912500
1500000
547500
900000
547500
900000
0
0
0
0
0
0
2007500
3300000
IN CASE OF I.C.U DOUBLE HCB IS PAID
PROJECTED MATURITY AS PER IRDA

1st YEAR 2nd YEAR

YEARLY PREMIUM
(A) Rs.
ALLOCATION CHARGES PER YEAR (B) Rs.
ADMIN CHARGES PER MONTH '(C)
Rs.

NET FOR FUNDING= A-(B+C+D+E)

YEARLY PREMIUM

TOTAL
MSB
FOR MSB
/YEAR Rs./ YEAR /YEAR

PI
35
M
2500
840
500000
790
SP
33
F
1500
404
300000
501
C1
0.3
F
1500
416
MSB STARTS
C2
FROM AGE 18
YEARS ON
C3
WARDS
C4
NOTE: C1, C2, C3, C4 MEANS CHILD - 1, 2, 3, 4
TOTAL FOR FAMILY ===>
PI = PRINCIPLE INSURED ( PROPOSER ), SP = SPOUSE

25000

TOTAL BENEFIT U CAN

CLAIM
FROM THIS POLICY IS
Rs.53.075 LAKHS

AT THE RATE OF 6%

AT THE RATE OF 10%

1474591

3268675

HCB / MSB BENEFITS ARE

PAYABLE IRRESPECTIVE OF
THAT AMOUNT SPENT

ALL BENEFITS ARE INDEPENDENT

OF ANY MEDICLAIM BENEFITS
CLAIMED. ( NOT LINKED TO ANY)

THE INITIAL DAILY BENEFIT (HCB)

INCREASES 5% EVERY YEAR.
(WITHOUT CHARGE) (MAXI UPTO 50%)

ADDITION OF MEMBERS IS ALLOWED IN

CASE OF MARRIAGE & NEW BORN CHILD
IF NOT AT STARTING OF THE POLICY

CHILDREN : COVERED UPTO 25

YRS OF AGE. MAJORS CAN
TAKE INDEPENDENT POLICY

11

HOSPITAL CASH BENEFIT :

FIRST YEAR 18 DAYS, 2nd YEAR
ONWARDS 60 DAYS PER YEAR

12 DELETION OF MEMBERS : ON REQUEST

"PREMIUM HOLIDAY"
(AFTER 3 yearly premiums are
paid)
PAY ONLY LATEST DUE ON

15

HCB IF IN ICU : DOUBLE PAYMENT.

HALF OF THE DAYS OF ELIGIBLE
PER YEAR, 1ST YR=9, SUB=30 DAYS

16 THIS IS ONLY SHORT INFORMATION

FOR FULL DETAILS VISIT B.O

25000
7500
75
246
30
17149

25000
1500
25
221
27
23227

ON MATURITY : ON 65 YEARS
OF AGE OF PROPOSER(PI)
=FUND VALUE IS PAYABLE
DOMICILIARY TREATMENT
BENEFIT :
AFTER 3 YRS PREMIUMS ARE
PAID

MATURITY AT THE RATE OF

Rs.

49.25

12%

LAKHS

BY PROPOSER, WILL BE EXCLUDED.

(PREMIUM ALSO WILL BE REDUCED)

(This shall form a part of policy documen

PRODUCT FEATURES :
1 Name of the Product:
LIC's Health Protection Plus
3 Premium Paying Term:
5 Amount of Instalment Premium:
7 Age:
9 Per day Hospital Cash Benefit (HCB):
11 Major Surgical Benefit (MSB):

Statement of Various charges alongwith growth of the fund expected over the duration of the policy with assum

Premium
Policy Annualised Allocation
Year
Premium
Charge
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000
12000

3600
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720
720

Amount Available
for investment
( out of premium )
8400
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280
11280

27
28
29
30
31
32
33
34
35
36
37
38
39
40

12000
12000
12000
12000
0
0
0
0
0
0
0
0
0
0

720
720
720
720
0
0
0
0
0
0
0
0
0
0

11280
11280
11280
11280
0
0
0
0
0
0
0
0
0
0

IN THIS POLICY, THE INVESTMENT RISK IS BORN BY THE

Note: 1) Other charges includes the charges for HCB,MSB and se

2)For fund at the end in the above benefit illustration, it is a
3)Maximum HCB shown above is inclusive of 9 days stay in
4) Maximum life time benefit for HCB is 365 days and for M

I .(Name), having received the information with respect

Marketing officials' Signature:
Company Seal:
Place:
Date:

BENEFIT ILLUSTRATION
(This shall form a part of policy document)
LIC's Health Protection Plus
30 Years
12000
35 Years
2000
400000

2
4
6
8
10

Unique Identification No.

Mode of Premium Payment :
Funds opted for:
Number of lives covered:
Per day Hospital Cash Benefit
in ICU (HCB):

512L253V01
Yearly
Health Protection Plus Fund
SINGLE MALE
4000

xpected over the duration of the policy with assumed rate of interst as mentioned

Assuming gross interest rate of 6% p

Policy Admin
Charge

Fund Mgt
Charge

Other
Charges

Total
Charges

Addition to
Fund (if any)

900
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300

86
207
336
470
610
754
903
1056
1215
1379
1548
1722
1902
2087
2278
2475
2679
2889
3105
3328
3558
3794
4038
4289
4547
4813

1912
1626
1691
1767
1874
2015
2246
2389
2547
2732
2913
3135
3355
3581
3830
4064
4248
4509
4774
5073
5364
5681
5988
6307
6652
7003

2898
2132
2327
2537
2783
3070
3449
3745
4062
4411
4761
5157
5558
5969
6409
6839
7226
7697
8179
8701
9221
9775
10326
10896
11499
12116

401
961
1562
2187
2836
3507
4199
4912
5650
6412
7198
8009
8845
9707
10595
11511
12456
13433
14440
15476
16544
17644
18777
19944
21145
22382

300
300
300
300
300
300
300
300
300
300
300
300
300
300

5087
5366
5653
5946
6102
6258
6413
6567
6719
6870
7018
7165
7309
7452

7452
7960
8456
9048
9495
10113
10755
11418
12106
12820
13522
14237
14925
15565

12838
13627
14410
15294
15897
16671
17468
18285
19125
19989
20841
21702
22534
23317

23653
24955
26288
27651
28376
29101
29822
30537
31246
31946
32637
33318
33989
34652

THE INVESTMENT RISK IS BORN BY THE POLICY HOLDER AND THE ABOVE INTEREST RATES ARE ONLY

includes the charges for HCB,MSB and service tax.

end in the above benefit illustration, it is assumed that premiums have been paid as and when due and no d
shown above is inclusive of 9 days stay in ICU in the first year and 30 days in subsequent years
ime benefit for HCB is 365 days and for MSB 3 times of the initial sum assured.

having received the information with respect to the above , have understood the above statement before entering into
Policyholders' Signature:

Protection Plus Fund

gross interest rate of 6% p.a.

Assuming

Fund at
the End

Surrender
Value

Death
Benefit

5902
16011
26527
37457
48789
60507
72537
84985
97853
111133
124850
138983
153550
168569
184036
199987
216497
233512
251053
269108
287711
306860
326591
346919
367845
389391

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

---------------------------

Maximum
Guaranteed Benefit
During
HCB
MSB
54000
400000
189000
400000
198000
400000
207000
400000
216000
400000
225000
400000
234000
400000
243000
400000
252000
400000
261000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000
270000
400000

Fund
Mgmt.
Other
Total
Charge Charges Charges
88
214
355
507
670
846
1035
1237
1455
1690
1942
2213
2504
2818
3155
3518
3910
4332
4787
5277
5805
6374
6988
7650
8365
9135

1912
1626
1693
1771
1880
2025
2259
2407
2572
2764
2953
3185
3417
3656
3921
4172
4375
4657
4947
5274
5595
5946
6292
6653
7045
7448

2900
2141
2348
2577
2850
3171
3594
3945
4327
4754
5195
5698
6222
6774
7376
7990
8585
9289
10034
10851
11700
12620
13580
14603
15709
16883

411486
434095
457254
480891
493369
505799
518153
530405
542526
554483
566280
577896
589351
600686

0
0
0
0
0
0
0
0
0
0
0
0
0
0

---------------

270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000

400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000

9967
10863
11829
12870
13847
14898
16032
17253
18569
19988
21518
23169
24952
26877

ST RATES ARE ONLY FOR ILLUSTRATION PURPOSE.

nd when due and no domiciliary treatment benefit has been availed earlier.
uent years

ment before entering into the contract.

7954
8527
9093
9761
10293
11003
11745
12519
13326
14171
15016
15886
16742
17566

18221
19690
21222
22931
24439
26201
28077
30071
32195
34458
36834
39355
41994
44743

(All charges are in Rupees)

Assuming gross interest rate of 10% p.a.

Addition to Fund at
Fund (if any) the End
668
1629
2696
3848
5090
6427
7860
9398
11053
12833
14748
16807
19020
21402
23964
26721
29695
32900
36354
40075
44086
48409
53071
58100
63525
69380

6168
16936
28565
41115
54636
69172
84717
101450
119456
138815
159647
182036
206114
232022
259890
289901
322291
357182
394783
435287
478953
526021
576792
631568
690664
754440

Maximum Guaranteed
Surrender Death
Benefit During
Value
Benefit
the year
HCB
MSB
0
-54000
400000
0
-189000
400000
0
-198000
400000
0
-207000
400000
0
-216000
400000
0
-225000
400000
0
-234000
400000
0
-243000
400000
0
-252000
400000
0
-261000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000
0
-270000
400000

75694
82500
89837
97745
105159
113148
121753
131026
141022
151798
163420
175960
189497
204120

823193
897284
977179
1063273
1143993
1230939
1324615
1425571
1534397
1651737
1778323
1914928
2062432
2221810

0
0
0
0
0
0
0
0
0
0
0
0
0
0

---------------

270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000
270000

400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000
400000

age
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65

PRE ALLOC ADMIN HCB MSB TOT ST

25000
7500
900 1659 793 2452 303
25000
1500
300 1686 858 2543 314
25000
1500
300 1703 918 2620 324
25000
1500
300 1726 988 2714 335
25000
1500
300 1757 1068 2824 349
25000
1500
300 1841 1123 2964 366
25000
1500
300 1955 1253 3208 396
25000
1500
300 2034 1368 3402 420
25000
1500
300 2109 1498 3607 446
25000
1500
300 2190 1638 3828 473
25000
1500
300 2277 1774 4051 501
25000
1500
300 2346 1954 4300 532
25000
1500
300 2417 2124 4541 561
25000
1500
300 2480 2309 4789 592
25000
1500
300 2578 2505 5082 628
25000
1500
300 2671 2680 5351 661
25000
1500
300 2777 2805 5583 690
25000
1500
300 2885 3011 5896 729
25000
1500
300 2946 3452 6398 791
25000
1500
300 3078 3705 6783 838
25000
1500
300 3206 3944 7150 884
25000
1500
300 3360 4211 7572 936
25000
1500
300 3514 4461 7975 986
25000
1500
300 3671 4720 8391 1037
25000
1500
300 3859 4974 8833 1092
25000
1500
300 3689 4819 8508 1052
25000
1500
300 4041 5055 9096 1124
25000
1500
300 4392 5525 9917 1226
25000
1500
300 4803 6231 11034 1364
25000
1500
300 5308 7177 12485 1543

FUND end
13845
15507
20343
40151
20256
67656
20151
98344
20027
132575
19870
170738
19596
213174
19378
260458
19147
313158
18899
371903
18649
437418
18368
510481
18098
592008
17819
683006
17489
784555
17188
897952
16927 1024665
16575 1166189
16012 1324065
15578 1500400
15166 1697434
14693 1917582
14239 2163640
13772 2438701
13275 2746213
13640 3091035
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