MET health insurance

Met health care

Health problems strike unexpectedly. In addition to causing ill health, it can also scar your financial
health. You need to protect yourself against such a situation through a health insurance plan. In
order to ensure you are well protected to face any health condition that could befall you, MetLife
presents - Met Health Care, a simple health insurance policy with unique and smart advantages for
you and your family#

# Family means spouse and two children. Every additional family member shall be underwritten as
per the underwriting conditions laid by the Company from time to time.

What is Met Health Care?

Met Health Care is a long term health insurance plan from MetLife. This plan covers you

1. Against Hospitalisation expenses by providing you a Daily Cash benefit as chosen by you.

2. Against 10 major Critical Illnesses by providing you a lumpsum benefit.

3. Against Total & Permanent Disability due to accident by providing you a lumpsum benefit.

Further, all the above benefits can be availed without the hassle of undergoing any medical
examination. Just fill up the simple application form and start enjoying the unmatched benefits of
Met Health Care.

Plan At A Glance
Minimum/Maximum age of 18 years-55 years (At first entry, for the
entry Principal insured)
3 months-55 years (For Secondary
Insured lives)
Cover ceasing age 65 years

Maturity/Death Benefit No Maturity/Death Benefit payable

Benefits Offered (a) Daily Hospitalisation Cash Benefit

(b) Daily ICU Cash Benefit 
(c) Recuperation Benefit 
(d) Critical Illness Benefit 
(e) Accidental Total & Permanent
Disability
Benefit
Premium paying frequency Yearly. Half-Yearly mode is avaiable only
if each of the persons insured choose a
daily cash benefit of Rs. 3000 or more.
Modal factor Half-yearly -0.5131. Multiply the tabular
premium by the modal factor to arrive at
the premium payable.
 Product Benefits
Benefit Option 1 Option 2 Option 3 Option 4 Option 5

Daily Hospitalisation Cash Rs. 1000 Rs. 2000 Rs. 3000 Rs. 4000 Rs. 5000
Benefit per day per day per day per day per day

Daily ICU Cash Benefit Rs. 2000 Rs. 4000 Rs. 6000 Rs. 6000 Rs. 6000
per day per day per day per day per day

Recuperation Benefit Rs. 3000 Rs. 6000 Rs. 9000 Rs. 10000 Rs. 10000

Critical Illness Benefit Rs. 1 Lakh Rs. 2 Lakh Rs. 3 Lakh Rs. 3 Lakh Rs. 3 Lakh

Accidental Total & Rs. 1 Lakh Rs. 2 Lakh Rs. 3 Lakh Rs. 3 Lakh Rs. 3 Lakh
Permanent Disability Benefit

Death/Maturity Benefit

There is no Death/Maturity Benefit under Met Health Care.

Tax Benefits

The premium paid (excluding the service tax) under this plan is eligible for Tax Benefits under
Section 80 D of the Income Tax Act, 1961 as per the provisions and conditions given therein and
are subject to any changes made in the tax laws in future.

Please consult your tax advisor for more details.

Premium Table
LIC

Introduction: 

IN THIS POLICY, THE INVESTMENT RISK IN INVESTMENT PORTFOLIO IS BORNE BY THE

POLICYHOLDER

Health is a major concern on everybody�s mind these days. With sky rocketing medical expenses, the
possibility of any illness leading to hospitalization or surgery is a constant source of anxiety unless the
family has actively provided for funds to meet such an eventuality. Most families rarely provide for
healthcare, and even if they do, it is grossly inadequate. Given this scenario, LIC has launched LIC�s
Health Protection Plus plan, a unique long term health insurance plan that can combine health
insurance covers for the entire family (husband, wife and the children) � Hospital Cash Benefit (HCB)
and Major Surgical Benefit (MSB) along with a ULIP component (investment in the form of Units) that
is specifically designed to meet Domiciliary Treatment Benefit (DTB) / Out Patient Department (OPD)
expenses for the insured members.

I. Vital Information

Accumulation period
1.Age Principal Insured Spouse Insured Child Insured
Min Policy Entry Age � Age Last
18 18 3months
Birthday
Min Age � HCB Cover � Age Last
18 18 3months
Birthday
Min Age � MSB Cover � Age Last
18 18 18
Birthday
Maximum Entry Age Age Nearest
55 55 17
Birthday

2. Premium Payment.
Mode of Payment: Yearly, Half-Yearly & Monthly (ECS Mode only) 

Minimum Annual Premium Conditions

Number of Lives
Higher of the two conditions in each category listed below:
covered
Single Life 6 times the HCB of the Principal Insured OR Rs.5000 p.a.
The arithmetic sum of 6 times the HCB of PI and 3 times the HCB of the second
Two Lives
insured. OR Rs.7500 p.a.
The arithmetic sum of 6 times the HCB of PI and 3 times the HCB of each of the
More than two Lives
others insured OR Rs.10,000 p.a. 
Annualized Premiums are payable in multiples of Rs.500.
3. Sum Assured.
The Principal Insured must first choose the respective levels of HCB for each member to be covered
under the policy. The sum assured for major surgical benefits will be 200 times of the HCB you
choose. 

Principal Insured Spouse Insured Child Insured

Major Surgical
200 times the HCB applicable to each insured life
Sum Assured  
under the policy.
4. Other Terms of the Policy.

Age Nearest Birthday Principal Insured Spouse Insured Child Insured

Max. HCB and MSB Cover
75 75 25
ceasing age
65 Years Nearest Birthday of the Principal
Premium Ceasing Age
Insured
DTB ceasing age No age limit No age limit 25
5. Addition of New Members. It is important for the Principal Insured (the person taking the
policy) to decide which of the existing family members are to be covered and include them at the
beginning (proposal stage) itself. Eligible existing family members cannot be added at a later stage.
New members can however be added under the following three situations.

Situation When to include? The cover starts from

Marriage/remarriage of
Within one year from the
the Principal insured after The following policy anniversary
date of marriage
taking the policy
A Child born or Legally
Health Cover starts from the policy
adopted child less than 3
anniversary falling immediately after the
months after taking the
child completes 3 months
policy
Legally adopted child is From the policy anniversary falling after
more than 3 months old date of adoption

 The new members will be eligible for the cover only if they satisfy the conditions of minimum
premium and benefits.
 New members must be included by the Principal Insured only. No new members will be allowed
after the death of the principal insured.

6. Increase/Decrease of Premiums. Increase or decrease of premiums is allowed during the

term of the policy. Increase in premium must be in multiples of Rs.500. In case of decrease, the
minimum premium conditions must be satisfied. However, increase/decrease in premiums does not
affect the level of health cover and HCB and MSB benefits.

II. CONDITIONS & RESTRICTIONS

1. Premium Discontinuance and Revival. The policy will lapse if the premiums are not paid
within the days of grace. The PI shall have the option to revive the policy any time within a period of
two years from the due date of first unpaid premium by payment of arrears of premiums or by availing
Premium Holidays. During the period of discontinuity, the charges for HCB and MSB covers will
continue to be deducted (even beyond two years) from the policy fund till:

i. the policy fund has sufficient balance, or

ii.the lives covered reach the benefit ceasing age, or
iii.the maximum lifetime benefits are exhausted, or
iv.the policy is terminated due to death or any other reason, if any,
whichever is earlier. 

In case the policy is not revived during the revival period and the balance in the Policy Fund is not
sufficient to recover the charges i.e. if the Policy Fund exhausts, the policy shall compulsorily be
terminated with a notice to the PI.
All other charges will also continue to be deducted from the Policy Fund till the fund exhausts.

2. Premium Holidays. If the policy lapses after at least 3 years’ premiums have been paid the
Principal Insured has the option of either paying all the due premiums in full or avail of premium
holiday by just paying the latest instalment premium without any interest. The premium holidays can
be availed only as long as the policy fund has a balance of at least one annualized premium at the time
of revival.

3. Surrender. No surrender will be allowed. 

4. Policy Loans. No policy loan will be available under this policy.

5. Assignment. No assignment will be allowed under this policy.

6. Tax Benefit. The premium payable under this product is eligible for Section 80(D) benefit of
Income Tax Act, 1961. 

7. Risks borne by the Policyholder:

i)LIC’s Health Protection Plus is a Unit Linked Health Insurance product which is different from the
traditional insurance products and is subject to risk factors.
ii)The premium paid in Unit Linked Life Insurance policies are subject to investment risks associated
with capital markets and the NAVs of the units may go up or down based on the performance of fund
and factors influencing the capital market and the insured is responsible for his/her decisions.
iii)Life Insurance Corporation of India is only the name of the Insurance Company and LIC’s Health
Protection Plus is only the name of the unit linked health insurance contract and does not in any way
indicate the quality of the contract, its future prospects or returns.
iv)Please know the associated risks and the applicable charges, from your Insurance agent or the
Intermediary or policy document of the insurer.
v)The fund offered under this contract is the name of the fund and do not in any way indicate the
quality of these plans, their future prospects and returns.
vi)All benefits under the policy are also subject to the Tax Laws and other financial enactments as they
exist from time to time. 

8. Cooling off period: If you are not satisfied with the �Terms and Conditions� of the policy, you
may return the policy to us within 15 days. 
III. EXCLUSIONS

1. Common Exclusions in respect of HCB & MSB Benefits:  No benefits are available hereunder
and no payment will be made by the Corporation for any claim for Hospital Cash Benefit and Major
Surgical Benefit under this Policy on account of Hospitalization directly or indirectly caused by, based
on, arising out of or howsoever attributable to any of the following:
a.“Pre-existing condition”- any medical condition or any related condition (e.g. illnesses, symptoms,
treatments, pains and surgery) that have arisen at some point prior to the commencement of this
coverage, irrespective of whether any medical treatment or advice was sought. Any such condition or
related condition about which the PI or insured dependant know, knew or could reasonably have been
assumed to have known, will be deemed to be pre-existing. The following conditions will also be
deemed to be “pre-existing”:
i.Conditions arising between signing the application form and confirmation of acceptance by the
Corporation
ii.Any Sickness, illness, complication or ailment arising out of or connected to the pre-existing illness 
b.Any Sickness that has been classified as an Epidemic by the -Central or State Government. 
c.Self afflicted injuries or conditions (attempted suicide), and/or the use or misuse of any drugs or
alcohol. 
d.Any sexually transmitted diseases or any condition directly or indirectly caused to or associated with
Human Immuno Deficiency (HIV) Virus or any Syndrome or condition of a similar kind commonly
referred to as AIDS.
e.War, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion,
revolution, insurrection military or usurped power of civil commotion or loot or pillage in connection
herewith.
f.Naval or military operations(including duties of peace time) of the armed forces or air force and
participation in operations requiring the use of arms or which are ordered by military authorities for
combating terrorists, rebels and the like.
g.Any natural peril (including but not limited to avalanche, earthquake, volcanic eruptions or any kind
of natural hazard). 
h.Participation in any hazardous activity or sports including but not limited to racing, scuba diving,
aerial sports, bungee jumping and mountaineering or in any criminal or illegal activities.
i.Radioactive contamination. 
j.Non-allopathic methods of surgery and treatment.

2. Additional Exclusions in respect of Hospital Cash Benefit:

No benefits are available hereunder and no payment will be made by the Corporation for any claim for
Hospital Cash Benefit under this Policy on account of Hospitalization directly or indirectly caused by,
based on, arising out of or howsoever attributable to any of the following:
a.Hospitalization due to illness within the first 180 days from the Date of Cover commencement or 90
days from the date of revival/reinstatement if revived after discontinuance of the cover.
b.Removal of any material that was implanted in a former surgery before Date of Cover
commencement
c.Any diagnosis or treatment arising from or traceable to pregnancy (whether uterine or extra uterine),
childbirth including caesarean section, medical termination of pregnancy and/or any treatment related
to pre and post natal care of the mother or the new born. 
d.Hospitalization for the sole purpose of physiotherapy or any ailment for which hospitalization is not
warranted due to advancement in medical technology 
e.Any treatment not performed by a Physician or any treatment of a purely experimental nature. 
f.Any routine or prescribed medical check up or examination. 
g.Medical Expenses relating to any hospitalization primarily for diagnostic, X-ray or laboratory
examinations 
h.Circumcision, cosmetic or aesthetic treatments of any description, change of gender surgery, plastic
surgery (unless such plastic surgery is necessary for the treatment of Illness or Accidental Bodily
Injury as a direct result of the insured event and performed with in 6 months of the same). 
i.Hospitalization for donation of an organ.
j.Hospitalization for correction of birth defects or congenital anomalies 
k.Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury. 
l.Convalescence, general debility, nervous or other breakdown, rest cure, congenital diseases or defect
or anomaly, , sterilization or infertility (diagnosis and treatment), any sanatoriums, spa or rest cures
or long term care or hospitalization undertaken as a preventive or recuperative measure. 

3. Additional Exclusions in respect of Major Surgical Benefit:

No benefits are available hereunder and no payment will be made by the Corporation for any claim for
Major Surgical Benefit under this Policy directly or indirectly caused by, based on, arising out of or
howsoever attributable to any of the following:
a.Surgeries not listed in the Surgical Benefit Annexure I
b.Surgery triggered by health related causes (and not by Accident) within the first 180 days from the
commencement date or 90 days from the date of revival/reinstatement if revived after discontinuance
of the cover.
c.Any Surgery for which claim has already been made and paid by the Corporation. 
d.Any treatment not performed by a Physician/Surgeon.
e.Any treatment including Surgery that is performed un-conventionally under experimental conditions
and purely experimental in nature. 
f.Circumcision, cosmetic or aesthetic treatments of any description, change of life surgery or
treatment, treatment (including surgery) for obesity, plastic surgery (unless necessary for the
treatment of Illness or accidental Bodily Injury as a direct result of the insured event and performed
with in 6 months of the same). 
g.Surgery for donation of an organ.
h.Removal or correction or replacement of any material that was implanted in a former Surgery before
Date of Cover commencement
i.Surgery for correction of birth defects or congenital anomalies.
j.Any diagnosis or treatment or surgery arising from or traceable to pregnancy (whether uterine or
extra uterine).
IV. INVESTMENT OF FUNDS
The premiums allocated to purchase units will be strictly invested in a Health Protection Plus Fund
(Income and Growth – Low Risk) as follows:

A. Government/ Government Guaranteed/ Corporate

Not less than 50%
Securities/ Debt
B. Short term investments: Money Market instruments
Not more than 90%
including A above
Not less than 10% & Not more
C. Investment in listed equity shares
than 50%

1. Method of Calculation of Unit price: Units will be allotted based on the Net Asset Value (NAV)
on the date of allotment. There is no Bid-Offer spread. The NAV will be computed on daily basis and
will be based on investment performance, Fund Management Charge and whether the fund is
expanding or contracting. 
a. Applicability of Net Asset Value (NAV): The premiums received up to 3 p.m. (as per IRDA
guidelines) by the servicing branch of the corporation by a local cheque or by a demand draft payable
at par at the place where the premium is received, the closing NAV of the day on which premium is
received shall be applicable. The premiums received after such time by the servicing branch of the
corporation by a local cheque or by a demand draft payable at par at the place where the premium is
received, the closing NAV of the next business day shall be applicable.
b. Redeeming of Units: In respect of valid applications received for reimbursement of medical
expenses, death claim, etc up to such time by the servicing branch of the Corporation closing NAV of
that day shall be applicable. For the valid applications received in respect of Domiciliary Treatment
Benefit, death claim etc after 3 p.m. (as per IRDA guidelines) by the servicing branch of the
Corporation the closing NAV of the next business day shall be applicable.
2. Charges under the Plan: 
a. Premium Allocation Charge: This is the percentage of the premium appropriated towards
charges from the premium received. The balance known as allocation rate constitutes that part of the
premium which is utilized to purchase (Investment) units for the policy. The allocation charges are as
below:

First year thereafter

30% 6%
The above allocation charges shall be applicable for all premiums including any additional premium
paid in that particular policy year.
b. Health Insurance Charge: There will be two separate charges for the following benefits:
i) Hospital Cash Benefit
ii) Major Surgical Benefits.
These charges will be taken every month in respect of all the members covered by canceling
appropriate number of units out of the Policy Fund. 
These charges, during a policy year, will be based on the age nearer birthday, of each of the members
covered, as at the Policy anniversary coinciding with or immediately preceding the due date of
cancellation of units and hence may increase every year on each policy anniversary. The charges will
also depend on whether the person covered is male or female and standard or sub-standard as per the
underwriting decision. 
If more than one member is covered under the policy then the total charges shall be based on the
individual ages of all the members and the amount of cover for each such member.
In case of Hospital Cash Benefit, the charges will be applied on the Initial Daily Benefit as mentioned in
the Policy Schedule.
The charges for Hospital Cash Benefit and/or Major Surgical Benefit will not be deducted once the
benefit terminates.

Specimen charges for Rs. 100/- per day for HCB and Rs. 1000/- SA for MSB for standard lives are
given as under:

Age HCB MSB

 5 24.43 20.43 0 0
15 20.71 20.71 0 0
25 31.39 24.34 1.02 1.38
35 33.59 29.96 1.58 1.75
45 49.29 53.20 3.54 2.64
55 76.08 72.53 7.28 5.16
b. Health Insurance Charge:

Rs.75 per month during the first year and Rs. 25

Policy Administration Charges
per month during the subsequent years.
Levied @ 1.25% per annum of the unit fund, at
Fund Management Charges the time of computation of NAV which will be done
on daily basis.
Bid/ Offer Spread Nil

Service Tax Charge A service tax charge shall be levied on the

following charges: 
i)Policy Administration charge and Health
Insurance charges - by canceling appropriate
number of units out of the Policyholder’s Fund
Value on a monthly basis as and when the
corresponding Policy Administration and Health
Insurance charges are deducted. 
ii)Premium allocation charge - at the time of
allocation of premium. 
iii)Fund Management charge– at the time of
computation of NAV on daily basis.

The level of this charge will be as per the rate of

service tax as applicable from time to time.
Currently, the rate of service tax is 10% with an
educational cess at the rate of 3% thereon and
hence effective rate is 10.30%.

d. Right to revise charges-The Corporation reserves the right to revise all or any of the above
charges except the Premium Allocation charge. The modification in charges will be done with
prospective effect with the prior approval of IRDA. 
Although the charges are reviewable, they will be subject to the following maximum limit:
Policy Administration Charge-Rs. 150/- per month during the first policy year and Rs.50/- per month
thereafter, throughout the term of the policy.
Fund Management Charge-The Maximum for Fund will be 2.5% p.a. of Unit Fund
Hospital Cash Cover charges and Major Surgical Benefit charges shall not exceed by more than 200%
of the current rate.

Disclaimer : For more details on risk factors , terms and conditions please read sales brochure
carefully before concluding a sale

1. Hospital Cash Benefit (HCB).  A daily benefit is payable in case the insured is hospitalized due
to either accidental body injury or sickness. The quantum of benefit depends upon the level of cover
opted.

Initial Daily Benefit (IDB)*#

Insured
Minimum Maximum
Principal Insured Rs.250 Rs.2500
Spouse/Child Rs.250 Rs.1500
*The Applicable Daily Benefit. IDB is applicable during the first year of risk cover. The daily
benefit will increase @5% simple p.a. of the IDB on each policy anniversary until it hits a cap of 1.5
times the initial benefit.
IDB of the spouse cannot exceed the Principal Insured’s IDB; IDB of the children cannot exceed the
spouse’s IDB.
The initial HCB must be in multiples of Rs. 50.
#Initial daily benefit that is payable in respect of stay in a non-ICU room or ward. In case the insured
is required to stay in the ICU of a hospital, an enhanced rate of daily benefit is payable, which is twice
the eligible daily cash benefit. 
2. Major Surgical Benefit (MSB). In the event of the insured undergoing one of the major
surgeries defined in the Annexure I, a lump sum benefit (regardless of the actual costs incurred)
equivalent to the percentage of the sum assured mentioned against that surgery will be payable on
providing proper proof of surgery to the satisfaction of the corporation.
3. Domiciliary Treatment Benefit (DTB).  The Principal Insured can claim an amount equivalent
to the actual expense he or she has incurred in respect of any domiciliary treatment or to meet the
medical expenses incurred over and above the hospital cash/major surgical benefits in respect of
either oneself or the others insured under the policy.

BEFORE CESSATION OF HCB AND MSB COVERS ON ALL MEMBERS COVERED

Minimum domiciliary claimable Rs.2500
Up to 50% of the policy fund at the date of
Maximum amount that can be claimed/ payable*
payment
* Subject to a minimum balance of one annualized premium being left in the policy fund after making
the payment.
AFTER CESSATION OF HCB AND MSB COVERS ON ALL MEMBERS COVERED
Minimum domiciliary claimable Rs.2500*
No limit on maximum amount that can be claimed/ payable
* If the balance in the Policy Fund is less than Rs. 2,500/-, then the payment of entire amount shall be
made in one lump sum only.
Note: i. A maximum of two payments will be allowed in a policy year subject to the above
conditions – on production of supporting proof of treatment and bills for expenses.DTB is available
only after at least 3 years premiums are paid. 
ii. DTB is payable for the children covered until the health cover ceasing age.
4. Death Benefit. No death insurance cover is available under the plan. Following benefits/charges
will take place on the happening of unfortunate death of principal insured (PI) and/or other insured
member.

a) On death of the PI (if policy is issued on

single life) or on death of all Insured members The Policy Fund Value will be payable to the
(if more than one life is covered under the nominee/ legal heir.
policy).
The payment of premiums will cease and the cover
will continue for the other Insured lives till the fund
b) On death of PI (if other Insured members are
is sufficient to recover all the charges or till the
there).
maximum benefit ceasing age for each of the
Insured lives, whichever is earlier. 
The payment of premiums and the cover for PI and
c) On death of insured member(s), other than PI
other Insured members, if any, will continue.
5. Waiting Period. Both HCB and MSB covers are available subject to a waiting period from the
commencement of the risk cover specified hereunder – in respect of each insured member:

Waiting Period from Principal Insured Spouse Insured Child Insured

Date of the cover 180 days 180 days 180* days
Date of reinstatement
of cover during the 90 days 90 days 90 days
revival period
No waiting period in respect of Accidental Bodily Injury. 
*No waiting period in case of children for MSB from the date of cover.

6. Benefit Period Limits –Hospital Cash Benefit. 

Maximum Annual Benefit Period Maximum Lifetime Benefit

HCB
1st Year 2nd year & after Period
Principal Insured
18 days incl. 9 days 60 days incl. 30 days
Spouse Insured 365 days
for ICU for ICU
Child Insured*
*Maximum period of HCB for an insured child until he or she completes
5 years age is limited to 90 days. 
IMPORTANT NOTE: HCB is available only in respect of hospitalization in
a ward or ICU for continuous period of 24 hours or part thereof, over
 and above 48 hours, provided such part stay exceeds 4 hours.

7. Conditions for Availing Major Surgery Benefit 

Spouse Child
MSB Principal Insured
Insured Insured
100% of the Sum Assured applicable in respect of
Maximum Annual benefit
the each insured member
3 times the Sum Assured applicable in respect of
Maximum Lifetime Benefit
the each insured member
NOTE: i. Various HCB and MSB Benefit limits and restrictions applicable under this policy in respect of
each insured shall solely and exclusively apply to that insured only and are not transferable to any
other insured. 
ii. HCB/MSB is payable only if the hospitalisation/surgery is performed in India.

8. Termination of HCB and MSB Benefits in respect of each insured. 

On attainment of the insured’s maximum cover ceasing age – 75 years nearest birthday for PI/spouse
insured and 25 years nearest birthday for the children insured
On reaching the maximum lifetime benefit limits under HCB (365 days) and MSB (3 times the sum
assured)
On the death of the insured or on the date of termination of the policy for any other reason
Insured spouse’s cover terminates on the date of divorce/ legal separation