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List of Major Surgeries covered in LIC Jeevan Arogya Plan
List of Major Surgeries covered in LIC Jeevan Arogya Plan
Sep 19, 2017 | 9402 VIEWS
One of the significant benefit of the LIC Jeevan Arogya Policy is the Major Surgical Benefit (MSB) which offers a lumpsum payment in case any of the members covered in the plan undergoes a major surgery. Let us understand this benefit before going through the list of Major Surgeries and 

Major Surgical Benefit (MSB)

In case of a major surgery during the policy period, an amount equal to 100 times the initial HCB selected will be paid to the policyholder as part of this benefit. So the payouts for MSB will be as follows:
 
Initial Hospital Cash Benefit( HCB) Selected Major Surgical Benefit (MSB)
Rs. 1,000 per day Rs. 1,00,000
Rs. 2,000 per day Rs. 2,00,000
Rs. 3,000 per day Rs. 3,00,000
Rs. 4,000 per day Rs. 4,00,000

The list of Major Surgeries are divided into Category 1, Category 2, Category 3 and Category 4. You will be paid only a % of the total MSB as shown below:
 
Category of Surgery % of MSB to be Paid
Category 1 100%
Category 2 60%
Category 3 40%
Category 4 20%

Example: In case you have opted for HCB of Rs. 2,000 per day, the MSB will work out to Rs. 2,00,000. Now you will get the following payouts in case of a Major Surgery.
 
Category of Major Surgery Payout
Category 1 Rs. 2,00,000
Category 2 Rs. 1,20,000
Category 3 Rs. 80,000
Category 4 Rs. 40,000

So here is the list of 140 Major Surgeries which are eligible for the payout and the Category of these Surgeries which will determine the amount of payment you will receive.
 
# List of Major Surgeries Category % of MSB
Sum Assured
I Cardiovascular System    
1 Major Surgery of Aorta Category 1 100%
2 CABG (two or more coronary arteries must be bypassed) via open chest surgery Category 1 100%
3 Heart Valve Replacement using mechanical prosthesis Category 1 100%
4 Heart/Heart-Lung Transplant Category 1 100%
5 Aortic root transplantation with coronary artery reimplantation for proximal aortic aneurysm Category 1 100%
6 Pericardiotomy / Pericardectomy Category 2 60%
7 Initial implantation of permanent pacemaker in the heart Category 2 60%
8 Mitral valve repair Category 2 60%
9 Aortic valve repair Category 2 60%
10 Tricuspid valve repair Category 2 60%
11 Pulmonary valve repair Category 2 60%
12 Coronary Angioplasty with stent implantation (two or more coronary arteries must be stented) Category 3 40%
13 Major vein repair with or without grafting for traumatic & nontraumatic lesions Category 3 40%
II Haemic & Lumphatic System    
14 Bone marrow transplant (as recipient) Category 1 100%
15 Major excision and grafting of Lymphoedema Category 2 60%
16 Splenectomy Category 2 60%
III Nervous System    
17 Repair of Cerebral or Spinal Arterio- Venous Malformations or aneurysms Category 1 100%
18 Craniotomy for malignant Cerebral tumours Category 1 100%
19 Excision of pineal gland Category 1 100%
20 Excision of the pituitary gland Category 1 100%
21 Craniotomy for non malignant space occupying lesions Category 2 60%
22 Operations on Surbaracahnoid space of brain Category 2 60%
23 Intracranial transection of Cranial nerve Category 2 60%
24 Other operations on the meninges of the Brain Category 2 60%
25 Microvascular decompression of cranial nerves/nervectomy Category 2 60%
26 Craniotomy for drainage of extradural, subdural or intracerebral space Category 3 40%
27 Decompression surgery for Entrapment Syndrome Category 3 40%
28 Unilateral or Bilateral sympathectomy Category 3 40%
29 Peripheral nerve Graft Category 3 40%
30 Free Fascia Graft for Facial Nerve Paralysis Category 3 40%
31 Excision of deep seated peripheral nerve tumour Category 3 40%
32 Multiple Miscrosurgical Repair of digital nerve Category 3 40%
33 Bur-hole Drainage of Extradural, subdural or intracerebral space Category 4 20%
IV Respiratory Sysytem    
34 Lung Transplantation Category 1 100%
35 Unilateral Pneumonectomy Category 2 60%
36 Diaphragmatic/Hiatus Hernia Repair Category 2 60%
37 Thoracotoplasty Category 2 60%
38 Open Lobectomy of Lung Category 2 60%
39 Excision of benign mediastinal lesions Category 2 60%
40 Partial Extirpation of Bronchus Category 2 60%
41 Partial Pharyngectomy Category 2 60%
42 Total Pharyngectomy Category 2 60%
43 Total Laryngectomy Category 2 60%
44 Excision of Diaphragmatic tumours Category 2 60%
45 Pleurectomy or Pleural decortication Category 3 40%
46 Tracheal reconstruction for various lesion Category 3 40%
V Digestive System    
47 Excision of esophagus and stomach Category 1 100%
48 Abdominal-Perineal Pull Through Resection of rectum with Colo-Anal Anastomosis Category 1 100%
49 Total excision of oesophagus Category 2 60%
50 Total excision of stomach Category 2 60%
51 Resection and Anastomosis of any part of digestive tract Category 3 40%
52 Open Surgery for treatment of Peptic Ulcer Category 3 40%
53 Artificial opening into stomach Category 4 20%
VI Endocrine System    
54 Complete excision of Adrenal glands Category 2 60%
55 Complete excision of Thyroid gland Category 2 60%
56 Complete excision of Parathyroid gland Category 2 60%
57 Partial excision of Adrenal glands Category 3 40%
58 Partial excision of Thyroid gland Category 3 40%
59 Partial excision of Parathyroid gland Category 3 40%
VII ENT    
60 Total ear amputation with reconstruction Category 2 60%
61 Transmastoid removal cholesteatoma with extended Mastoidectomy Category 2 60%
62 Total Nasal Reconstruction due to Traumatic lesions Category 2 60%
63 Labyrinthotmy for various lesions Category 3 40%
VIII Oral    
64 Wide excision and Major reconstruction of malignant Oro-pharyngeal tumours Category 2 60%
65 Total Glossectomy Category 3 40%
66 Wide local Excision for oral leukoplakia Category 4 20%
IX Eye    
67 Orbit Tumour Exenteration /Flap reconstruction Category 3 40%
68 Corneal or Retinal Repair for Traumatic eye injuries Category 4 20%
69 Penetrating injuries of the eye or repair of ruptured globe Category 4 20%
X Liver, Gall Bladder & Pancreas    
70 Liver Transplantation Category 1 100%
71 Partial Resection of Liver Category 2 60%
72 Partial Pancreatectomy Category 2 60%
73 Cholecystectomy/Choledochotomy for various Gall bladder lesions Category 3 40%
XI Musculoskeletal System (Due to accident only)    
74 Replantation of upper limb Category 2 60%
75 Replantation of lower limb Category 2 60%
76 Total prosthetic replacement of hip joint using cement Category 3 40%
77 Total prosthetic replacement of hip joint not using cement Category 3 40%
78 Other total prosthetic replacement of hip joint Category 3 40%
79 Total prosthetic replacement of knee joint using cement Category 3 40%
80 Total prosthetic replacement of knee joint not using cement Category 3 40%
81 Other total prosthetic replacement of knee joint Category 3 40%
82 Total prosthetic replacement of other joint using cement Category 3 40%
83 Total prosthetic replacement of other joint not using cement Category 3 40%
84 Other total prosthetic replacement of other joint Category 3 40%
85 Prosthetic replacement of head of femur using cement Category 3 40%
86 Prosthetic replacement of head of femur not using cement Category 3 40%
87 Other prosthetic replacement of head of femur Category 3 40%
88 Prosthetic replacement of head of humerus using cement Category 3 40%
89 Prosthetic replacement of head of humerus not using cement Category 3 40%
90 Other prosthetic replacement of head of humerus Category 3 40%
91 Prosthetic replacement of any other bone using cement Category 3 40%
92 Prosthetic replacement of any other bone not using cement Category 3 40%
93 Other prosthetic replacement of any other bone Category 3 40%
94 Prosthetic interposition reconstruction of joint Category 3 40%
95 Other interposition reconstruction of joint Category 3 40%
96 Excision reconstruction of joint Category 3 40%
97 Other reconstruction of joint Category 3 40%
98 Implantation of prosthesis for limb Category 3 40%
99 Amputation of arm Category 3 40%
100 Amputation of leg Category 3 40%
101 Fixation of fracture of spine Category 3 40%
102 Elevation, Exploration and Fixation of fractured Zygoma Category 3 40%
103 Amputation of hand Category 4 20%
104 Amputation of foot Category 4 20%
105 Therapeutic endoscopic operations on cavity of knee joint Category 4 20%
106 Replantation of finger following traumic amputation Category 4 20%
107 Surgical Drainage and Curettage for osteomyelitis Category 4 20%
XII Oro-Maxillofacial Surgery    
108 Major reconstructive oro-maxillafacial surgery due to trauma or burns and not for cosmetic purpose Category 2 60%
109 Osteotomy including segmental resection with bone grafting for Mandibular and maxillary lesions Category 2 60%
XIII Kidney / Urinary Tract / Reproductive System    
110 Renal transplant (recipient) Category 1 100%
111 Hysterectomy for malignant conditions Category 2 60%
112 Radical prostatovesiculectomy Category 2 60%
113 Microvascular reattachment of penis following traumatic amputation Category 2 60%
114 Total nephrectomy due to medical advic (not as a transplant donor) Category 3 40%
115 Partial excision of kidney Category 3 40%
116 Open extirpation of lesion of kidney Category 3 40%
117 Excision of ureter Category 3 40%
118 Total excision of bladder Category 3 40%
119 Kidney injury repair Category 3 40%
120 Pyloplasty/Ureterocalcycostomy for pelvic ureteric junction obstruction Category 3 40%
121 Amputation of penis Category 3 40%
122 Excision of vagina Category 3 40%
123 Unilateral or Bilateral excision of adnexa of uterus Category 3 40%
124 Partial excision of bladder Category 4 20%
125 Therapeutic ureteroscopic operations on ureter Category 4 20%
126 Urinary diversion Category 4 20%
127 Replantation of ureter Category 4 20%
128 Unilateral or Bilateral excision of testes Category 4 20%
129 Other operations on Scrotum and tunica vaginalis testis Category 4 20%
130 Reconstruction of the testis Category 4 20%
131 Open surgical excision and destruction of prostate tissue Category 4 20%
132 Extirpation of lesion of vulva Category 4 20%
133 Excision of vulva Category 4 20%
XIV Operations on the sinuses    
134 Operations on frontal sinus Category 3 40%
135 Operations on maxillary antrum using sublabial approach Category 4 20%
XV Others    
136 Radical Mastectomy Category 2 60%
137 Malignant soft tissue tumour excision and reconstruction Category 3 40%
138 Excision and Major Flap Repair of skin and Subcutaneous tissue due to Major Burns Category 3 40%
139 Simple Mastectomy Category 4 20%
140 TIPS procedure for portal Hypertension Category 4 20%


Understand the plan in detail - Review of the LIC Jeevan Arogya Plan.


Do drop in a comment, if there is any clarification you would want on this plan.

Deepak Yohannan
Deepak Yohannan is the CEO of MyInsuranceClub. He enjoys writing on Personal Finance and contributes regularly on sites like Reuters & Moneycontrol. He is a strong proponent of online insurance and is often found pointlessly babbling about it!

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