JIO Mediclaim Renewals / New Policy 2019 ( Policy for March 2019 - March 2020 )

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 / NEW HEALTH PLAN
2019-2020

JIO Policy Renewal, Phase 7 Renewal & New Policy
PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: United India Insurance Co. Ltd. and Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Insurance Brokers Ltd.
PREMIUM Details for JIO POLICY RENEWAL, PHASE 7 RENEWAL & NEW POLICY

FAMILY SIZE

SUM INSURED

AMOUNT PAYABLE

Family Floater of size 1+7

Rs.10 Lacs

40500

Family Floater of size 1+7

Rs. 5 Lacs

25000

Family Floater of size 1+7

Rs. 2 Lacs

20876

Individual Only

Rs. 2 Lacs

7500

Scope of Coverage:

2019-20

1) Cashless & Reimbursement Facility

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

In case of cashless claims, immediate intimation shall be given to our Call Center within 48 hours of Hospitalization. In case of reimbursement claims, immediate intimation shall be given to Call Centre within 48 hours of Hospitalization.

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

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.Maternity cover is not applicable for Rs. 2 lakh SI Self only band.

3) Maternity waiting period

9 months waiting period waived off for all existing members who are insured under 2018-19 JIO Mediclaim.Waiting period of 9 months is applicable for other members.

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

Room rent limit is incl. of Nursing Charges.

If the Insured gets admitted in room higher than eligibility room rent then all the correspoding charges shall be restricted to the eligibility room rent or actuals,

5) Co-Payment

i. 25% Co-payment is applicable ONLY on all Pre-existing diseases (PED) claims. It is not applicable for ailments for which expenses are sub-limited(capped) under this policy.

ii. Co-payment would not be applicable on capped ailments / inner limits including Cataract & Maternity (No Co-pay on sublimited cases.).
Deductible of Rs. 5000 is applicablefor each and every admissible claim above Rs 50,000/-

iv.Co-payment is not applicable for Non-PED Claims

v. If the member feels that his/her aliment is not pre – existing disease they may come for reimbursement with the relevant document. Decision of TPA would be final during Cashless process.

6) Waiting period applicable OR Joint Replacement & Knee Replacement

1) Joint Replacement OR Knee Replacement Hospitalisation Expenses is covered but it is subject to Only One Joint Replacement claim per Family for members insured under expiring(2018-19 JIO’s Star Mediclaim) policy.

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

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

C) 10 Lac Sum Insured Band : 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)1 Year Waiting Period would be applicable for New Members in case of Knee and other Joint Replacement cases.

7) Reimbursement

Available with mandatory 24 Hrs intimation

8) Claim Intimation

In case of Cashless Claims, immediate intimation would be given to our Call Center within 72 hours of Hospitalization or before discharge, whichever is earlier. In case of Reimbursement Claims, immediate intimation shall be given to Call Centre within 24 hours of Hospitalization.

CAPPINGS 2019 - 20

Ailment/Disease Capping List

2 Lakh

5 Lakh

10 Lakh

Cataract

15000

24000

25000

Cerebrovascular Accident

120000

220000

280000

Cardiovascular Disease

120000

220000

280000

Cancer

120000

220000

280000

Treatment for breakage of bone

120000

220000

280000

Renal Complication

120000

220000

280000

Genitourinary calculus

40000

50000

60000

Dialysis in case of PED case only

35000

45000

50000

Cholecystectomy

40000

50000

60000

Hysterectomy

40000

50000

60000

Appendectomy

40000

50000

60000

Fistula(Anus)

30000

40000

45000

Hernia (All types

30000

40000

50000

Anaemia(not for evaluation)

50000

50000

50000

Angiogram

18000

21000

24000

Joint and Knee Replacement per joint/per knee

75000

100000

125000

* Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above subject to their capping is above Rs.50,000/-.

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

  1. FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.5 Lacs and Rs.10 Lacs

  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). All members to be Jain only.

  3. INDIVIDUAL POLICY with Sum Insured of Rs.2 Lacs can only be opted by any member who is alone and without any living dependents in his family.

  1. #Note: INDIVIDUAL POLICY with sum insured of Rs. 2 Lacs is available only for Renewal Members. Any Member (proposer or dependent) can get insured only once under this scheme. If found enrolled more than once, both certificates/policies would be deemed null and void and the Insurance company, claim would be rejected and policy would be cancelled void-ab-initio without any refund of premium

  1. Claim Intimation In case of Cashless claims, immediate intimation shall be given to our Call Centre within 72 hours of hospitalization. In case of Reimbursement claims, immediate intimation shall be given to Call Centre within 24 hours of hospitalization.

  2. PRE-EXISTING DISEASES are covered from Day One

  3. CO PAYMENT:

    • 25% copay ONLY on all PED claims except sublimated ailments including Maternity & Cataract.

    • 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

  4. NO MEDICAL CHECK-UP required

  5. AGE LIMIT - For 2 Lacs SI (individual) - INDIVIDUAL POLICY with sum insured of Rs. 2 Lacs is available.

  6. As per INCOME TAX Act deductions under Sec 80D, Proposer will be eligible for exemption. (Exemption for Payment by Cash not applicable)

  7. Joint Replacement or Knee Replacement Joint Replacement or Knee Replacement covered subject to Maximum One Joint and Knee per Family for existing members

    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. (Police FIR is MANDATORY) with above same capping.
  1. 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.

  2. 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

  3. 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.

  4. Cyberknife, Cochlear Implant, and Psychiatric Treatment: Cyberknife and Cochlear implant covered with 50% copayment and Psychiatric treatment covered upto Rs.30,000.

  5. Dental Treatment : Covered in case of Road Accident and requiring Hospitalization.

  6. Day Care Procedures Day Care Procedures covered (list attached in the annexure)

  7. Emergency Ambulance Charges Covered maximum uptoRs. 2500/- per case

  8. Pre-Post Hospitalization Expenses (30/60 days respectively) Covered within Family Floater Sum Insured

  9. Internal Congenital Ailments Covered Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above subject to their capping is above Rs.50,000/-.

    Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above subject to their capping is above Rs.50,000/-.

  10. 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.

CAPPINGS UNDER THE RENEWAL POLICY

Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above subject to their capping is above Rs.50,000/-.

Disease Capping List

2 Lakh

5 Lakh

10 Lakh

Cataract

15000

24000

25000

Cerebrovascular Accident

120000

220000

280000

Cardiovascular Disease

120000

220000

280000

Cancer

120000

220000

280000

Treatment for breakage of bone

120000

220000

280000

Renal Complication

120000

220000

280000

Genitourinary calculus

40000

50000

60000

Dialysis in case of PED case only

35000

45000

50000

Cholecystectomy

40000

50000

60000

Hysterectomy

40000

50000

60000

Appendectomy

40000

50000

60000

Fistula(Anus)

30000

40000

45000

Hernia (All types

30000

40000

50000

Anaemia(not for evaluation)

50000

50000

50000

Angiogram

18000

21000

24000

Joint and Knee Replacement per joint/per knee

75000

100000

125000

* Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above subject to their capping is above Rs.50,000/-.

  1. All JIO members who were associated with JIO Group Mediclaim Policy since year 2014 but discountined in any of the year can also avail the benefit of above policy by enrolling their family in 2019-2020 renewal.

  2. Shravak Arogyam JIO 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.

     

    Group Personal Accident cover is also offered cover to Proposer in case of Accidental Death & Permanent Total Disability for sum insured of Rs.500,000/- irrespective of his sum insured under mediclaim policy. The personal Accident benefit is extended to all family members covered mediclaim policy. The family member for this benefit to avail should be within 18 years to 75 years of age.

    This personal accident policy will have following covers

  2. Death
  3. Permanent Total Disablement
  4. Funeral Expenses Rs.2500/-
  5. Children Grant Rs.50,000/- per child for two child below the age of 21 years of age.