List of Major Surgeries covered in LIC Jeevan Arogya Plan

A 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 significant 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 is 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 an 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 the 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 a 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 a 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 & Lymphatic System
14	Bone marrow transplant (as the 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 tumors	Category 1	100%
19	Excision of the 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 the Surbaracahnoid space of the brain	Category 2	60%
23	Intracranial transaction of Cranial nerve	Category 2	60%
24	Other operations on the meninges of the Brain	Category 2	60%
25	Microvascular decompression of cranial nerves/neurectomy	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 tumor	Category 3	40%
32	Multiple Microsurgical Repair of digital nerve	Category 3	40%
33	Bur-hole Drainage of Extradural, subdural or intracerebral space	Category 4	20%
IV	Respiratory System
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 tumors	Category 2	60%
45	Pleurectomy or Pleural decortication	Category 3	40%
46	Tracheal reconstruction for various lesions	Category 3	40%
V	Digestive System
47	Excision of the esophagus and stomach	Category 1	100%
48	Abdominal-Perineal Pull-Through Resection of the rectum with Colo-Anal Anastomosis	Category 1	100%
49	Total excision of the esophagus	Category 2	60%
50	Total excision of stomach	Category 2	60%
51	Resection and Anastomosis of any part of the digestive tract	Category 3	40%
52	Open Surgery for the treatment of Peptic Ulcer	Category 3	40%
53	Artificial opening into the stomach	Category 4	20%
VI	Endocrine System
54	Complete excision of Adrenal glands	Category 2	60%
55	Complete excision of the 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 the 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 tumors	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 a 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	Another total prosthetic replacement of the 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 joints using cement	Category 3	40%
83	Total prosthetic replacement of other joints not using cement	Category 3	40%
84	Other total prosthetic replacements of other joints	Category 3	40%
85	Prosthetic replacement of the head of the femur using cement	Category 3	40%
86	Prosthetic replacement of the head of the femur not using cement	Category 3	40%
87	Other prosthetic replacement of the head of the femur	Category 3	40%
88	Prosthetic replacement of the head of the humerus using cement	Category 3	40%
89	Prosthetic replacement of the head of the humerus not using cement	Category 3	40%
90	Other prosthetic replacement of the head of the 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 replacements of any other bone	Category 3	40%
94	Prosthetic interposition reconstruction of the joint	Category 3	40%
95	Other interposition reconstruction of the joint	Category 3	40%
96	Excision reconstruction of the joint	Category 3	40%
97	Other reconstruction of the joint	Category 3	40%
98	Implantation of a prosthesis for the limb	Category 3	40%
99	Amputation of arm	Category 3	40%
100	Amputation of leg	Category 3	40%
101	Fixation of fracture of the 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 the cavity of the knee joint	Category 4	20%
106	Replantation of a finger following traumatic amputation	Category 4	20%
107	Surgical Drainage and Curettage for osteomyelitis	Category 4	20%
XII	Oro-Maxillofacial Surgery
108	Major reconstructive oro-maxillofacial 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 advice (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	Pyeloplasty/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 the uterus	Category 3	40%
124	Partial excision of bladder	Category 4	20%
125	Therapeutic ureteroscopic operations on the 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 the 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 tumor 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.