Jeevan Arogya ----Table No 903 of LICI

At last LICI found time to introduce a truly unique policy of its own at last. A uniquely defined health Insurance Scheme (Table No – 903) has started form 1 June 2011.

 You alone (Principal Insured) or all your family members including parents-in-law, from age 18 to 65 (75 for parents) and 3 months onwards for children cover up to 80 years for your family and 25 for dependent children.

Hospital Cash Benefit (HCB) – for hospitalization = Initial Daily Benefit amount chosen by you (will increase by 5% every year and No Claim Bonus on completion of 3 years, and will be called Applicable Daily Benefit

Major Surgical Benefit – for major surgeries = 100 times of Applicable Daily Benefit

Day Care Procedure Benefit – for minor surgeries done within one day = 5 times of Applicable Daily Benefit

Other Surgical Benefit – for all surgeries not covered in above two benefits = 2 times of Applicable Daily benefit 

Hospital Cash Benefit (HCB) 

• For hospitalization of more than one day where surgery may or may not be involved
• Choose between Rs.1000 and Rs.4000 as initial daily cash benefit
• Increases by 5% every year
• Additional no claim bonus of 5% every fourth year
• Less than or equal amount for every additional member as per choice
• Can avail 30 days in year one, 90 days every year thereafter not to exceed 720 days total during the policy period
• Double the cash benefit for treatment in ICU

Major Surgical Benefit (MSB) 

• For surgeries that require prolonged hospitalization
• 100 times of applicable daily benefit (including 5% increase and no claim bonus)
• Maximum annual benefit 100% of major surgical benefit per person insured
• Maximum life time benefit 800% or 8 times of major surgical benefit per person insured
• See annexure for full list of MSBs

Day Care Procedure Benefit (DCPB) 

• For surgeries that may not require hospitalization of more than one day
• 5 times of Applicable Daily Benefit
• Maximum annual benefit = 3 surgical procedures per person insured
• Maximum lifetime benefit = 24 surgical procedures per person insured

Other Surgical Benefits (OSB) 

• Where surgery is required but does not fall under the MSB and DCPB category
• 2 times of Daily Benefit Amount for each person insured
• Maximum annual benefit = 15 days in the 1st year and 45 days in subsequent years for each person insured
• Maximum lifetime benefit = 360 days for each person insured

Other things to know:

• Optional accident benefit and term insurance benefit
• Initial premium fixed guaranteed for 3 years and revised every 3 years depending on age and health condition
• All members to be added at the beginning except where new members are through childbirth (next policy anniversary), marriage new spouse and parents in law within 6 months and risk cover starts from next policy anniversary)

Emergency Cash Facility: 
Only for instances where the treatment is from listed network hospitals and for Major Surgical Benefits alone – 50% of the MSB credited to the bank account to be treated as an advance from the claim amount

Exclusions 

• Pre-existing condition unless disclosed and accepted by the insurer
• Routine checkups, cosmetic treatments, epidemics, dental treatment, non-allopathic treatments, reopening of former surgeries, self-inflicted injury, dangerous sports, war, participation in illegal and criminal activities

Premiums: 

• Yearly, Half-yearly, of monthly (ECS)
• 30 days of grace for all modes except Monthly where it is 15 days
• Cooling off cancellation 15 days
• Nomination available
• Approximate premium – Rs.1922/- (age 20) to Rs.3768/- (age 50) for males and Rs.1393 (age 20) to Rs.2849 (age 50) for females

What is different from Mediclaim

• Pre defined benefit- No reimbursement, but lump sum paid based on pre-defined benefit
• Not based on expenses incurred
• This will tend to indirectly reduce the Health care cost, which is rising due to cash less mediclaim benefit
• All benefit is dependent on HCB

Termination of Policy

• If policy is issued on a single life

1. Non Payment of premium within revival period
2. On death
3. On Date of cover expiry
4. On exhausting all the life time maximum Benefits Limits as specified above

• If policy is issued on more than one life

1. Non Payment of premium within revival period
2. On death or Date of cover expiry of the PI and if the Policy does not continue with the IS as the PI
3. On death or Date of cover expiry of IS after Policy continues with the IS as the PI after the PI dies or reaches his/her Date of cover expiry
4. On PI exhausting all the life time maximum Benefits Limits as specified above

Treatments in respect of Specific waiting period

1. Treatment for adenoid or tonsillar disorders
2. Treatment for anal fistula or anal fissure
3. Treatment for benign enlargement of prostate gland
4. Treatment for benign uterine disorders like fibroids, uterine prolapse, dysfunctional uterine bleeding etc
5. Treatment for Cataract
6. Treatment for Gall stones
7. Treatment for slip disc
8. Treatment for Piles
9. Treatment for benign thyroid disorders
10. Treatment for Hernia
11. Treatment for hydrocele
12. Treatment for degenerative joint conditions
13. Treatment for sinus disorders
14. Treatment for kidney or urinary tract stones
15. Treatment for varicose veins
16. Treatment for Carpal tunnel syndrome
17. Treatment for benign breast disorders e.g. fibroadenoma, fibrocystic disease etc.

Identity crisis

A report says number of PAN cards far exceeds the number of tax payers. This raises concern that tax dodgers may be using multiple cards to hide income. The Income Tax (I- T) department has issued close to 10 crore permanent account number (PAN) cards but the number of taxpayers in the country is only one- third of this number, giving rise to serious concern that many tax dodgers are using two or more cards to conceal income.

According to the latest report of the Comptroller and Auditor General of India (CAG), while 958 lakh PAN cards were issued till the end of March 2010 only 340.9 lakh tax returns were filed during 2009- 10.

A senior official told M AIL T ODAY that instances of assesses with two or more PAN cards have been detected which show that multiple cards are being used to hide income.

The PAN card allotted to a taxpayer is the unique identification number that helps track individual tax compliance. It has to be furnished for all major transactions and opening bank accounts so that the IT authorities can trace the money trail of assesses. “However, this prime purpose for which a PAN card is issued gets defeated if taxpayers get hold of more than one card," a senior official pointed out.

An I- T official confirmed that the department has now initiated the exercise to weed out duplicate PAN cards but it is will take a long time given the huge database that has to be sifted through.

According to sources, the Income Tax department is looking for similar names, residential addresses and identical dates of birth to detect such multiple cardholders and check tax evasion.

PAN cards are issued by the Income Tax department, but the front- end of the process has been outsourced to UTI Technology Services Ltd and the National Securities Depository Ltd since July 2003.

The CAG report points out that the Central Board of Direct Taxes (CBDT) needs to identify the reasons for the huge gap between the number of PAN cards and the number of taxpayers who actually file returns. “The gap might be due to the issuance of duplicate PAN cards and death of some PAN card holders," it adds.

According to sources, the death of PAN card holders can account for only a small portion of this gap. “Some of the PAN card holders use them for establishing their identity and may genuinely not be required to pay tax. But there is a huge number of individuals who are misusing multiple PANs to dodge taxes," a senior official said. It is this category that the CAG wants the Income Tax department to crack down on so that tax evasion is checked and revenue collection gets a boost, a senior official said.

The report points out that the growth in direct tax revenue has not been keeping pace with the growth in gross domestic product (GDP). The logic is that a higher GDP growth rate leads to higher incomes, which should translate into higher taxes.

However, this is not happening. The report said, for every unit of growth in the GDP, direct taxes grew from 1.7 per cent in 2005- 06 to 2.6 per cent in 2007- 08. However, this figure came down to 0.5 per cent and 0.8 per cent in 2008- 09 and 2009- 10, respectively. This sharp decline in tax buoyancy is a matter of concern, the report added.

New Technology for Banks

PSU banks are shifting to a technology-based platform to calculate non-performing assets (NPAs) in the fourth quarter — a period the lenders reported fresh defaults and made higher provisioning for bad loans. Bankers and analysts said the shift to the new platform was one of the main reasons for the rise in bad assets during the fourth quarter. The new technology is part of the banks’ core banking solution (CBS), replacing the earlier practice of tracking bad loans manually. According to the Reserve Bank of India’s (RBI) norms, if either the interest or the principal on a loan is overdue for more than 90 days, the account becomes NPA. Banks have to make provisions, or set aside funds, against such loans. Last year, the finance ministry had directed PSU banks to identify bad loans with the help of technology rather than manually. The ministry had asked the banks to migrate to such a system by March 31. This deadline has now been extended till September because of software-related problems. Indian Bank began moving to the new system from April last year, while the Bank of India, Canara Bank, Andhra Bank are in various stages of implementation with agricultural loans and advances up to Rs 50 lakh yet to come under the platform. Bankers say by September, the remaining loans will be covered. Under the technology-based platform, NPAs are tracked on a daily basis through the use of computers.Bankers pointed out that the earlier practice gave some discretion to the officials, which might have led to lower NPAs. However, in the system-generated method, NPAs are immediately identified. This is one of the reasons why PSU banks adopting the new system have shown a rise in bad loans. To me It (the new method) certainly leads to transparency and prevents any form of manipulation. Moreover, it gives an accurate picture compared with the manual intervention. A significant part of BoB’s loans is now under the new method. Recently, bulk of the slips in the fourth quarter was because of the efforts made by public sector banks towards a stringent recognition platform for non-performing loans that disallowed any manual intervention.  I Personally expect more slippages in the first half 2011-12 from this transition as most public sectors are yet to fully complete the transition of their overall loan portfolio.