CLOSED : JIO Mediclaim Renewals 2018 ( Policy for 2018-19 )

From: 31 Mar 2018

Till: 30 Mar 2019

Payment for policy premium is accepted only through Online Payment

CASH/ CHEQUE/ NEFT & RTGS WILL NOT BE ACCEPTED

 

SALIENT FEATURES OF SHRAVAK AROGYAM - JIO
RENEWAL HEALTH PLAN
2018-2019

 

CLICK HERE for CONTACT DETAILS

 

Star Policy Renewal, Phase 7 Renewal & New Policy

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: STAR Health & Allied Insurance Co. Ltd.
Insurance Brokers: Alliance Insurance Brokers Pvt. Ltd.

PREMIUM Details for STAR POLICY RENEWAL, PHASE 7 RENEWAL & NEW POLICY

FAMILY SIZE SUM INSURED PREMIUM FOR 12 MONTHS GST @ 18% AMOUNT PAYABLE
Family Floater of size 1+7 Rs.10 Lacs 32,500 5,850 38,350
Family Floater of size 1+7 Rs. 5 Lacs 19,500 3,510 23,010
Family Floater of size 1+7 Rs. 2 Lacs 16,250 2,925 19,175
Individual below 40 Yrs Only Rs. 2 Lacs 5,350 963 6,313

Comparison of Terms & Conditions of 2017-18 and 2018 -19

Please go through the Major Changes in Terms & Conditions between the last year (2017-18) & this year renewal (2018-19).

For the benefits of JIO members, we have ADDED lots of coverages as compared to last year for the benefit of all the JIO members.

Improvements are highlighted in RED in 2018-19 columns.

Scope of Coverage: 2017 - 18 2018 - 19
1) Cashless & Reimbursement Facility CASHLESS FACILITY ONLY - Claims will be Payable ONLY ON CASHLESS Basis. No Reimbursement facility available.

However in the case of Medical Emergencies & Accidents, treatment can be taken in other Hospitals and seek reimbursement. Such claims are subject to ADDITIONAL COPAY OF 30%

In all cashless cases immediate intimation shall be given to our Call Center within 72 hours of Hospitalization.

Member can avail BOTH CASHLESS facility & as well as REIMBURSEMENT facility.

NO ADDITIONAL COPAY FOR any hospitalization.

In case of cashless claims, immediate intimation shall be given to our Call Center within 72 hours of Hospitalization. In case of reimbursement claims, immediate intimation shall be given to Call Centre within 24 hours of Hospitalization.

2) Maternity Benefit available only for the Member or Dependent Spouse

Rs.25,000 for Normal Delivery & C-section both

Maternity benefits, applicable only for the Member or Dependent Spouse, subject to a limit of Rs.25,000/- for normal and Rs.30,000/- for CAESAREAN delivery.

3) Maternity waiting period

Waiting period of 9 months for maternity waived off for all existing members. However waiting period of 9 months is applicable for new members enrolled under this policy.

Waiting period of 9 months for maternity waived off for all existing members & Members covered under Phase 7 of National; However waiting period of 9 months is applicable for new members enrolled under this policy.

4) Room Rent Restriction

S.I. Rs.2 Lakhs - Room Rent - 2,500 and ICU capped at 3,500 S.I. Rs.5 Lakhs - Room Rent - 2,500 and ICU capped at 4,000 S.I. Rs.10 Lakhs - Room Rent - 3,500 and ICU capped at 4,000 Room rent limit is incl. of Nursing Charges. If the Insured occupies a room with a room rent limit other than his eligibility as per the insurance policy, then all the other charges shall be limited to the charges applicable for the eligible room rent or actuals, whichever is lower.

S.I. Rs.2 Lakhs - Room Rent - 2,500 and ICU capped at 3,500 S.I. Rs.5 Lakhs - Room Rent - 3,000 and ICU capped at 5,000 S.I. Rs.10 Lakhs - Room Rent -4,000 and ICU capped at 5,000

Room rent limit is incl. of Nursing Charges.

If the Insured occupies a room with a room rent limit other than his eligibility as per the insurance policy, then all the other charges shall be limited to the charges applicable for the eligible room rent or actuals, whichever is lower.

5) Co-Payment

i. 50% co-pay on all PED claims irrespective of age. However if it is proved during Cashless that the ailment is NON-PED, then insurer will deduct NON-PED Co-pay of 10% only b. In case if 50% Co-pay is deducted in cashless for PED claim and the member can prove the concerned ailment was NON-PED, Insurer will pay difference of 40% on Reimbursement basis. This claim will not be construed as Reimbursement claim.

ii. 10% co-pay on all Non-PED claims irrespective of age

iii. 30% additional co-pay on all reimbursement claims. Incase reimbursement claim is due to accident and submitted with FIR co-payment is not applicable.

iv. Co pay will not apply on cataract & maternity related claims

i. 25% copay ONLY on all PED claims except sublimited ailments.

ii. No additional Co pay for REIMBURSEMENT claims

iii. Co pay will not be applied on capped ailments / inner limits including Cataract & Maternity (No Co-pay on sublimited cases.)

iv.No co pay will applied on Non-PED Cases

v. If the member feels that his/her aliment is not pre – existing disease they may come for reimbursement with the relevant document

6) Waiting period applicable OR Joint Replacement & Knee Replacement Not covered 1) Joint Replacement OR Knee Replacement covered subject to Maximum any One Joint per Family for existing members as well as members of from (National Phase- 7) as per sublimit below i.e.

A) 2 Lac Sum Insured : Rs. 75,000 Per Joint

B) 5 Lac Sum Insured : Rs 100,000 Per Joint

C) 10 Lac Sum Insured : Rs 125,000 Per Joint

2) In case of ROAD TRAFFIC ACCIDENT the second joint replacement is covered. (FIR is MANDATORY) with above same capping.

3) There will be One Year Waiting Period applicable for New Members in case of Knee and Joint Replacement.

7) Non availability of break-up of package details 20% deduction apply Not Applicable
8) Capping on Major surgeries. *All other major surgeries – Acute/Sub Acute/Chronic, Bilo Pancreatic Surgery, Gastro-Intestinal Surgeries, Surgeries on Prostate, Surgery related to Genito Urinary Tract.

1) 2 Lac Sum Insured : Rs. 96,000

2) 5 Lac Sum Insured : Rs 180,000

3) 10 Lac Sum Insured : Rs 220,000

Not Applicable
9) Reimbursement Not Available Available with mandatory 24 Hrs intimation
10) Claim Intimation Within 72 hours intimation In case of Cashless Claims, immediate intimation shall be given to our Call Center within 72 hours of Hospitalization. In case of Reimbursement Claims, immediate intimation shall be given to Call Centre within 24 hours of Hospitalization.

COMPARISON OF CAPPINGS 2017 – 18 AND 2018 - 19

Please go through the differentiating point of major Changes in Cappings between the last year (2017-18) & this year renewal (2018-19) For the benefits of JIO members, we have ADDED lots of coverages as compared to last year for the benefit of all the JIO members.

 

Star Health terms :- 2017-2018

Star Health terms :- 2018-2019

Sum Insured Bracket

200,000

500,000

10,00,000

200,000

500,000

10,00,000

Ailments / Procedures

 Limits of Insurance Company's Liability Per Person in Rs.

 Limits of Insurance Company's Liability Per Person in Rs.

Cataract (per eye)

15,000

21,500

25,000

  24,000  

Cerebro- vascular Accident

120,000

220,000

280,000

Same as per expiring terms
Cardiovascular Diseases

120,000

220,000

280,000

Cancer

120,000

220,000

280,000

Treatment for Breakage of Bones

120,000

220,000

280,000

Renal Complications

120,000

220,000

280,000

Genito Urinary Calculus

40,000

50,000

60,000

Dialysis in case of PED cases only

35,000

35,000

35,000

35,000

45,000

50,000

Cholecystectomy

40,000

40,000

40,000

40,000

50,000

60,000

Hysterectomy

40,000

40,000

40,000

40,000

50,000

60,000

Appendicectomy

40,000

40,000

40,000

40,000

50,000

60,000

Fistula (Anal)

30,000

30,000

30,000

30,000

40,000

45,000

Hernia (All types)

30,000

30,000

30,000

30,000

40,000

50,000

Anaemia (Not for evaluation)

50,000

50,000

50,000

 Same as per expiring terms

Angiogram

18,000

18,000

18,000

18,000

21,000

24,000

Joint and Knee Replacement

 Not Covered

 Not Covered

 Not Covered

75,000

100,000

 1,25,000

All Major Surgeries

96,000

180,000

220,000

 No capping

*All other major surgeries – Acute/Sub Acute/Chronic, Bilo Pancreatic Surgery, Gastro-Intestinal Surgeries, Surgeries on Prostate, Surgery related to Genito Urinary Tract.

Co-pay will Not apply on sub limit / Inner Limit Claims

We are happy to announce that the existing ELDERLY MEMBERS covered under the Policy who have already completed 80 years of age, are welcomed to continue the cover in the Renewal also for life time.

#Note: For Phase 7 members more than 82 years; members cannot be covered.

  1. FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.5 Lacs and Rs.10 Lacs (Renewal Member Can’t increase their Sum Insured)
  2. FAMILY DEFINITION: (1+7) maximum 8 members with self-mandatory : Primary Member + Spouse + 4 Dependent children up to 25 years of age + Parents or Parents in law (Any one set of parents only allowed)
  3. INDIVIDUAL POLICY with Sum Insured of Rs.2 Lacs available only for member BELOW 40 years
    #Note: INDIVIDUAL POLICY with sum insured of Rs. 2 Lacs is available only for Renewal Members.
  4. Member can avail Cashless as well as Reimbursement facility.
  5. Claim Intimation In case of Cashless claims, immediate intimation shall be given to our Call Center within 72 hours of hospitalization. In case of Reimbursement claims, immediate intimation shall be given to Call Centre within 24 hours of hospitalization.
  6. PRE-EXISTING DISEASES are covered from Day One
  7. CO PAYMENT:
    • 25% copay ONLY on all PED claims except sublimated ailments including Maternity & Cataract.
    • No Co pay on reimbursement claims
    • Co pay will not be applied on capped ailments / inner limits including Cataract & Maternity (No Co-pay on sublimated cases.)
    • No co- pay will applied on Non-PED Cases
  8. NO MEDICAL CHECK-UP required
  9. AGE LIMIT- For 2 Lacs SI (individual) - Age limit up to 40 years
  10. As per INCOME TAX Act deductions under Sec 80D, Proposer will be eligible for exemption. (Exemption for Payment by Cash not applicable)
  11. Joint Replacement or Knee Replacement Joint Replacement or Knee Replacement covered subject to Maximum One Joint and Knee per Family for existing members as well as members of from (National Phase- 7) as per sublimit below i.e.

    1) 2 Lac Sum Insured: Rs. 75,000 Per Joint

    2) 5 Lac Sum Insured: Rs 100,000 Per Joint

    3) 10 Lac Sum Insured: Rs 125,000 Per Joint

    #Note: 1. There will be ONE YEAR waiting period for Joint Replacement & Knee Replacement for New Members.

    2. In case of ROAD TRAFFIC ACCIDENT the second joint replacement is covered. (FIR is MANDATORY) with above same capping.

  12. Maternity Benefit Maternity benefits, applicable only for the Member or Dependent Spouse, subject to a limit of Rs.25, 000/- for normal and Rs.30, 000/- for caesarean delivery.
  13. Maternity waiting period Waiting period of 9 months for maternity waived off for all existing members & Members covered under Phase 7 of National; however waiting period of 9 months is applicable for new members enrolled under this policy
  14. AYUSH Treatment Covered up to Rs.10, 000 per claim maximum up to Rs.20,000 per year per family subject to the treatment being taken in a Government hospital or in any institute recognized by Government and/or accredited by Quality Council of India or National Accreditation Board on Health.
  15. Cyberknife, Cochlear Implant, and Psychiatric Treatment: Cyberknife and Cochlear implant covered with 50% copayment and Psychiatric treatment covered upto Rs.30,000.
  16. Dental Treatment: Covered in case of Road Accident Requiring Hospitalization.
  17. Day Care Procedures 405 day Care Procedures covered (list attached in the annexure)
  18. Emergency Ambulance Charges Covered maximum upto Rs. 2500/- per case
  19. Pre-Post Hospitalization Expenses (30/60 days respectively) Covered within Family Floater Sum Insured
  20. Internal Congenital Ailments Covered
  21. Organ transplant: Donor Expenses for organ transplantation where the insured person is the recipient are payable provided the claim for transplantation is payable and subject to the liability of the sum insured. Donor screening expenses and Post-dontaion complications of the donor are not payable. This cover is subject to limit of 10% of the Sum insured or Rs. One Lakh whichever is less.
  22. CAPPINGS UNDER THE RENEWAL POLICY

    Sum Insured Bracket

    200,000

    500,000

    1,000,000

    Ailments / Procedures

    Limits of Insurance Company's Liability Per Person in Rs.

    Cataract (per eye)

    15,000

    24,000

    25,000

    Cerebral- vascular Accident

    120,000

    220,000

    280,000

    Cardiovascular Diseases

    120,000

    220,000

    280,000

    Cancer

    120,000

    220,000

    280,000

    Treatment for Breakage of Bones

    120,000

    220,000

    280,000

    Renal Complications

    120,000

    220,000

    280,000

    Genito Urinary Calculus

    40,000

    50,000

    60,000

    Dialysis in case of PED cases only

    35,000

    45,000

    50,000

    Cholecystectomy

    40,000

    50,000

    60,000

    Hysterectomy

    40,000

    50,000

    60,000

    Appendectomy

    40,000

    50,000

    60,000

    Fistula (Anal)

    30,000

    40,000

    45,000

    Hernia (All types)

    30,000

    40,000

    50,000

    Anemia (Not for evaluation)

    50,000

    50,000

    50,000

    Angiogram

    18,000

    21,000

    24,000

    Joint and Knee Replacement

    75,000

    100,000

    1,25,000

    All Major Surgeries

    No capping

    *All other major surgeries – Acute/Sub Acute/Chronic, Bilo Pancreatic Surgery, Gastro-Intestinal Surgeries, Surgeries on Prostate, and Surgery related to Genito Urinary Tract.

  23. Shravak Arogyam Star Renewal, Phase 7 Renewal and New Policy Group Personal Accident Policy
    1. In case of Road accident where FIR copy is provided, capping of Breakage of bone will not apply.
    2. Phase7 members to enjoy continuity as per star renewal terms considering as old members

    GPA also offers cover to Proposer in case of Accidental Death only

    • Accidental Death cover to the main member upto the Health Sum Insured.