JIO Mediclaim Renewal 2020

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW POLICY(2020-2021 )

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

Wellness Partner – Wockhardt Hospitals, Metropolis, Med life, RG Urology & Laparoscopy Hospital,Apollo Pharmacy, Infigo Eye Care Hospital, IGENETIC DIAGNOSTICS

PREMIUM Details for JIO POLICY RENEWAL, RENEWAL/NEW POLICY

Plan Subscription Details for Mediclaim Policy RENEWAL or NEW POLICY with Wellness and GPA Policy

Base Policy Premium Chart
FAMILY SIZE	SUM INSURED	Option-1 (With Continuity Benefits) TOTAL Amount incl. Mediclaim Plan Subscription ,Wellness,GPA (With GST)	Option-2 (Without Continuity Benefits) TOTAL Amount incl. Mediclaim Plan Subscription ,Wellness,GPA (With GST)
Family Floater of size 1+7	Rs.10 Lakh	41,000	35,945
Family Floater of size 1+7	Rs.6 Lakh	28,675	25,140
Family Floater of size 1+7	Rs. 2 Lakh	21,500	18,849
Individual below 45 Yrs. Only	Rs. 2 Lakh	8,000	7,014

Please Note: Continuity coverage is as per your option selected for "JAIN SWASTHYA BIMA YOJANA RENEWAL (2020-21)":

With Continuity Benefits – The policy period will be from 16-May-20 to 30-Mar-20. However waiting period for Maternity, Joint Replacement, Knee Replacement is waived.
Without Continuity- Policy period will be from 16-May-20 to 30-Mar-20. Waiting period for Maternity, Joint Replacement, Knee Replacement is applicable

We recommend you to also enroll for Supertopup policy to avoid deduction on account of capping in base policy. For e.g. In 10 lac policy there is capping of Rs. 2.80 Lakh for Cardiovascular disease. If you enroll in Supertopup policy with deductible of Rs. 3 Lakh with SI of Rs. 10 Lakh, you can claim balance amount above 3 Lakh from the Supertopup policy.

For more details on Supertopup plan, please visit www.jiojac.com/STU20

PLEASE NOTE:

Corona Virus disease treatment is covered under the policy.
The above plan covers Personal Accident cover for Rs.500,000/- per person for each member of the family between the age of 18 years to 75 years of age. So in a family if there are 6 members than total Rs.30,00,000/- sum insured is available under the above plan. Nominee of the member will be spouse in case of married members and in case of unmarried children or parents it will be self.
All wellness benefits approximately of Rs.24,000/- benefits for the family is added into the above plan.
Member can increase the Sum Insured during renewal, But can’t decrease it. No Changes or cancellation can be done after payment.
As Plan Subscription will be transferred first to JIO by members individually and then JIO will be paying this Plan Subscription to insurance company as one consolidated payment, there is a time gap for reconciliation and procedure. We request you to pay the Plan Subscription at the earliest to start coverage on time
Plan Subscription can be PAID only via Online Payment. CHEQUE / NEFT / RTGS will not be accepted.
Additional amount will be charged by payment gateway (Ease buzz) for providing safe & secure online money transfer facility, which is addition to above Plan Subscription charges.

Easy instalment facility is available by Ease buzz on RBL Bank, Axis Bank, Standard Chartered Bank, Kotak Bank, IndusInd Bank, HSBC Bank

Payment gateway Convenience fees (+18% GST on Convenience Fees) - 1.7 % for Net banking,

- 1.1 % for debit card transfer, 1.1 % for UPI,

- 1.75 % for credit card transfer, 2.2 % for Cash Card, 2 % for OLA money

GST refund certificate will not be available under this policy.
JIO JAC membership fees is Rs. 1000 per financial year which is additional to above Plan Subscription.(Payment will get updated in next 1 week)
Wellness Benefit like :

Medicine Discount (Upto 22%)
Laboratory Discount (Upto 25%)
OPD consultation – Dental & Eye Checkups
Newsletter
Health Tips
Doctor on Call
Cancer screening camp
Red carpet treatment at Wockhadt Hospital, RG Stone & Infigo Eye care Hospital

Scope of Coverage:	2020-21
1) Cashless & Reimbursement Facility	Member can avail BOTH CASHLESS facility & as well as REIMBURSEMENT facility.
1) Cashless & Reimbursement Facility	In case of cashless claims, immediate intimation shall be given to our Call Centre within 48 hours of Hospitalization. In case of reimbursement claims, immediate intimation shall be given to Call Centre within 48 hours of Hospitalization.Toll Free Number : 1800222034
2) Corona Virus COVID-19 Cover	Corona Virus Treatment is covered under this policy. Subject to tested positive in government authorized lab and treated in Government Hospital.


3) Reimbursement	Available with mandatory 48 Hrs intimation (Toll Free Number : 1800222034)
4) Claim Intimation	In case of Cashless Claims, immediate intimation would be given on Toll Free Number : 1800222034 within 48 hours of Hospitalization or before discharge, whichever is earlier. In case of Reimbursement Claims, immediate intimation shall be given to Call Centre within 48 hours of Hospitalization.

CAPPINGS 2020 - 21

Ailment/Disease Capping List	2 Lakh	6 Lakh	10 Lakh
Cataract (per eye)	15000	24000	25000
Cerebrovascular Accident	120000	220000	280000
Cardiovascular Disease (Including Angiogram limit)	120000	220000	280000
Cancer	120000	220000	280000
Treatment for breakage of bone including spine surgery	120000	220000	280000
Renal Complication (Including Dialysis limit)	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 + Mesh charges	40000+ Mesh charges	50000+ Mesh charges
Anaemia (not for evaluation)	50000	50000	50000
Angiogram	18000	21000	24000
Joint and Knee Replacement Per Family	75000	100000	125000

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

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.

FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.6 Lacs and Rs.10 Lacs.
FAMILY DEFINITION: (1+7) maximum 8 members with self-mandatory : Primary Member + Spouse + 4 Dependent, Unmarried children up to 25 years of age + Parents or Parents in law. (Any one set of parents only allowed). All members has to be Jain only.
INDIVIDUAL POLICY with Sum Insured of Rs.2 Lacs can only be opted by any member who is alone and without any living members in his family as per family definition ( Widow or widower). Member must be below age of completed 45 yrs. Only.

#Note: INDIVIDUAL POLICY with sum insured of Rs. 2 Lacs is available only for Renewal Members, Widower & Widow.

Any person can not be covered in multiple family policy. If found enroled in more than one fmily, claim will be paid on anyone family floater policy only during whole year.

4. Claim Intimation In case of Cashless claims, immediate intimation shall be given on Toll Free Number : 1800222034 within 48 hours of hospitalization. In case of Reimbursement claims, immediate intimation shall be given to Call Centre within 48 hours of hospitalization. You can also send claim intimation mail to jiointimation@ericsontpa.com

5.PRE-EXISTING DISEASES are covered from Day One subject to 25% Co-payment.

6.CO PAYMENT:

- 25% co-pay 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

7.NO MEDICAL CHECK-UP required

8. AGE LIMIT: 0-85 years Entry Age of Proposer Between 18 to 85 Years

9. Joint Replacement or Knee Replacement covered subject to Maximum One Joint/Knee per Family for existing members.

1) 2 Lac Sum Insured: Rs. 75,000 per family

2) 6 Lac Sum Insured: Rs 100,000 per family

3) 10 Lac Sum Insured: Rs 125,000 per family

#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.

10.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 up to 2 live children only.

11. Maternity waiting period Waiting period of 9 months for maternity waived off for all existing members(2019-2020 Policy); however waiting period of 9 months is applicable for new members enrolled under this policy. Maternity cover is not applicable for Rs. 2 lakh SI Self only band.

12. 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.

13. Cyberknife, Cochlear Implant, and Psychiatric Treatment: Cyberknife and Cochlear implant covered with 50% co-payment and Psychiatric treatment covered upto Rs.30,000.

14. Dental Treatment : covered if due to Road accident only and requiring 24 hours Hospitalisation (Police FIR compulsory).

15. DAY CARE PROCEDURES: Day care procedures as per IRDA rule to be covered.

16. Emergency Ambulance Charges Covered maximum upto Rs. 2500/- per case

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

18. Internal Congenital Ailments Covered

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

20.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-donation complications of the donor are not payable. Donor expenses 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 below subject to their capping is Rs.50,000/- and above.

21.All JIO members who were associated with JIO Group Mediclaim Policy since year 2014 but discontinued in any of the year can also avail the benefit of above policy by enrolling their family in 2020-2021 as a new member.

22.Corona Virus Cover Treatment of COVID-19 is covered under policy even though it will be declared as Epidemic and/or Pandemic.

23.Shravak Arogyam Personal Accident Policy (GPA cover)

Group Personal Accident cover is also offered to all family members covered in the mediclaim policy, in case of Accidental Death for sum insured of Rs.500,000/- irrespective of his sum insured under mediclaim policy. Police FIR is compulsory for all PA claims.

The personal Accident benefit is extended to all family members covered in mediclaim policy. The family member for this benefit to avail should be within 18 years to 75 years of age at the time of enrollment.

This personal accident policy will have only Accidental Death cover.

For detailed Term & Condition please refer Terms & Conditions tab.

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW HEALTH PLAN (2020-2021 )

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

Wellness Partner – Wockhardt Hospitals, Metropolis, Med life, RG Urology & Laparoscopy Hospital,Apollo Pharmacy, Infigo Eye Care Hospital, IGENETIC DIAGNOSTICS

FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.6 Lacs and Rs.10 Lacs.

FAMILY DEFINITION: Proposer + Spouse (Husband / Wife) + 4 Dependent children up to 25 years of age (Dependent & Unmarried) + 2 Parents OR In-Laws (Any 1 set of Parents to be covered. Combination not allowed) means Maximum 8 membersallowed in one family (1+7)
INDIVIDUAL POLICYwith Sum Insured of Rs.2 Lacs can only be opted by any member who is alone and without any living members in his family as per family definition ( Widow or widower). Member must be below age of completed 45 yrs. Only.
INDIVIDUAL POLICY with sum insured of Rs. 2 Lacs is available only for Renewal Members.
AGE LIMIT: 0-85 years (Entry Age of Proposer Between 18 to 85 Years), However ELDERLY MEMBERS who have already covered last year can continue in the Policy till LIFETIME
1st year entry age is up to 85 years and upon renewal they can continue in the policy till LIFETIME
Any Member cannot be covered for more than one time under policy, If found enrolled more than once, claim will be paid under one certificate only.
ROOM RENT & ICU CHARGES: Room Rent limitation Per Day will be capped as below:

Sum Insured	Per Day Limit (Inclusive of Nursing charges etc.)
Sum Insured	Normal Room	ICU
200,000	2,500	3,500
600,000	3,000	5,000
10,00,000	4,000	5,000
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

No addition or deletion of members are allowed during policy period, except for New born child in the family or newly married spouse,subject to intimation received in mail on jio.insurance@edelweissfin.comwithin 20 days of marriage or birth (for newly married SPOUSE & new born BABY) coverage will start from date of birth / Marriage
DAY CARE PROCEDURES: Day care procedures as per IRDA rule to be covered.
All Internal congenital Diseases are covered
Deductible of Rs. 5000 is applicable in each claim of Rs 50,000/- and above.
Domiciliary Hospitalisation & OPD treatment is not covered.
HOSPITALISATION AYUSH TREATMENT(AYURVEDIC / HOMEOPATHIC / UNANI): Covered upto 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.
Hospitalization arising out of PSYCHIATRIC AILMENTS Covered upto Rs.30,000
Cyber knife treatment : Covered with Co-pay of 50%
Cochlear Implant : Covered with Co-pay of 50%
Joint Replacement / Knee Replacement : Joint Replacement / Knee Replacement covered subject to Maximum One Joint per Family for existing members as per sublimit below i.e
1. 2 Lac Sum Insured: Rs. 75,000 per family
2. 6 Lac Sum Insured: Rs 100,000 per family
3. 10 Lac Sum Insured: Rs 125,000 per family

#Note:

There will be ONE YEAR waiting period for Joint Replacement or Knee Replacement for New Members.

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

Emergency Ambulance Charges : upto Rs.2,500
TERRORISM : Covered from Day One
30 Days Pre Hospitalisation & 60 Days Post Hospitalisation expenses covered within Family Sum Insured
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 up to 2 live children only.

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

NEW BORN BABY COVER : Baby covered from Day 1 SUBJECT TO INTIMATION mail on jio.insurance@edelweissfin.com WITHIN 20 DAYS from Birth.

To add name in policy, Submit New born baby birth certificate issued by local government authority within 2 month from date of baby birth.

Pre Post Natal Expenses : Covered on IPD Basis only and within Maternity limits. These Expenses are not covered on OPD Basis.
CO PAYMENT:

Sum Insured	Non Pre Existing Diseases	Pre Existing Diseases
200,000	NO-COPAY	25%
600,000	NO-COPAY	25%
1,000,000	NO-COPAY	25%

NO CO-PAY will be appliedon all NON-PRE EXISTING DISEASE. However Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above subject to their capping is Rs.50,000/- and above.
25% CO-PAY on all PRE-EXISTING DISEASE CLAIMS irrespective of age
Co pay will not be applied on capped ailments / inner limits including Cataract & Maternity.
(**If it is proved during Cashless that the ailment is NON-PED e.g in case of Fever or Accidental cases, etc. then no Co-Payment will be applied
(**In case if 25% 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 25% on Reimbursement basis. **)
Co pay will not apply on maternity and Cataract claims.
Reimbursement Claims : -Reimbursement of claims will be entertained. Subject to admission SHOULD BE intimated to TPA WITH IN 48 HOURS on jiointimation@ericsontpa.com and Toll free Number 1800222034 (If member fails to intimate to TPA within 48 Hours then the claim may be rejected).

DISEASE WISE CAPPING ( UPPER LIMIT ) :

Sum Insured Bracket	200,000	600,000	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 Disease (Including Angiogram limit)	120,000	220,000	280,000
Cancer	120,000	220,000	280,000
Treatment for breakage of bone including Spine surgery	120,000	220,000	280,000
Renal Complication (Including Dialysis limit)	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)	30000 + Mesh charges	40000+ Mesh charges	50000+ Mesh charges
Anemia (Not for evaluation)	50,000	50,000	50,000
Angiogram	18,000	21,000	24,000
Joint and Knee Replacement Per Family	75,000	100,000	1,25,000

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

SAMPLE CLAIM PROCESS FOR REFRENCE

i) If Claim is PED but falling under Sublimit ailment

In case of claim relating to PED; but falling in sublimit ailment. Say the hospital bill is Rs. 5 lakhs for the disease CVA which has sublimit of Rs.2,80,000/- (sum insured opted is Rs.10 lacs), the following procedure is adopted :

First the amount payable to the insured is worked out after adjusting the non-medicals and non-payables, room rent difference if any, proportionate deduction if the insured occupied a room with room rent more than his eligible amount.

Hospital bill	Rs. 5.00 lakhs
Deductions due to Non-payables	- Rs. 2.00 lakhs
	Rs. 3.00 lakhs

Since the assessed amount is more than the sub-limit of Rs.2,80,000/- the claim amount is restricted to the sub-limit viz. Rs.2,80,000/-.Further Rs.5000/- will be deducted as mentioned above and hence final payable amount will be Rs.2,75,000/-.

ii) If Claim is PED but not falling under any Sublimit ailment

In case of claim relating to PED; but not falling in any sublimit ailment. Say the hospital bill is Rs. 5 lakhs. (sum insured opted is Rs.10 lacs), the following procedure is adopted :

First the amount payable to the insured is worked out after adjusting the non-medicals and non-payables, room rent difference if any, proportionate deduction if the insured occupied a room with room rent more than his eligible amount.

Hospital bill	Rs. 5.00 lakhs
Deductions due to Non-payables	- Rs. 2.00 lakhs
	Rs. 3.00 lakhs
Deduct 25% Co-payment for PED	- Rs. 75 Thousand
	Rs. 2.25 lakhs

Since the diseases is not falling in any sublimit ailment; If on the contrary the assessed amount after co-pay is Rs.2,25,000/-,.Further Rs.5000/- will be deducted as mentioned above and hence final payable amount will be Rs.2,20,000/-.

iii) If Claim is Non- PED & Not Falling in any sublimit ailment:

In case of claim is not relating to PED & not falling in any sublimit ailment. Say the hospital bill is Rs. 5 lakhs. (sum insured opted is Rs.10 lacs), the following procedure is adopted :

First the amount payable to the insured is worked out after adjusting the non-medicals and non-payables, room rent difference if any, proportionate deduction if the insured occupied a room with room rent more than his eligible amount.

Hospital bill	Rs. 5.00 lakhs
Deductions due to Non-payables	- Rs. 2.00 lakhs
	Rs. 3.00 lakhs

Since the diseases is NON-PED & not falling in any sublimit ailment; the claim payable is Rs.3,00,000/-. Further Rs.5000/- will be deducted as mentioned above and hence final payable amount will be Rs.2,95,000/-.

For Corona Virus disease treatment if tested positive for corona virus at government approved lab and treated at government hospital. Hospitalisation is compulsory for this coverage.

ORGAN TRANSPLANT :The Insurance Company will pay expenses incurred on the 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 availability of the sum insured. Donor screening expenses and post-donation complications of the donor are not payable. Donor expenses cover is subject to a limit of 10% of the Sum Insured or Rupees One lakh, whichever is less
DENTAL TREATMENT : covered if due to Road accident only and requiring 24 hours Hospitalisation. ( FIR compulsory)
MID-TERM ADDITIONS allowed only for natural additions subject to intimation received in mail on jio.insurance@edelweissfin.com within 20 days of marriage or birth (for newly married SPOUSE & new born BABY)

To add name in policy, Submit New born baby birth certificate & marriage certificate issued by local government authority within 2 month from date of baby birth or marriage.

Any person CAN’T BE COVERED MORE THAN ONCE under whole group in JIO Policy. If declared more than once, benefit would be payable under one Sum Insured only
CLAIM INTIMATION in case of cashless claims, immediate intimation shall be given to jiointimation@ericsontpa.com or toll free number 1800222034 within 48 hours of Hospitalisation. In case of reimbursement claims, immediate intimation shall be given to Call Centre within 48 hours of Hospitalisation.
CLAIM SUBMISSION of documents for reimbursement claims Within 30 Days from Date of Discharge. Claim may get rejected due to delay submission.
In case of Road accident where FIR copy is provided, capping of Breakage of bone will not apply. For claims under accident Police FIR is compulsory.

Plan Subscription Details for Mediclaim Policy RENEWAL or NEW POLICY with Wellness and GPA Policy

Base Policy Premium Chart
FAMILY SIZE	SUM INSURED	Option-1 (With Continuity Benefits) TOTAL Amount incl. Mediclaim Plan Subscription ,Wellness,GPA (With GST)	Option-2 (Without Continuity Benefits) TOTAL Amount incl. Mediclaim Plan Subscription ,Wellness,GPA (With GST)
Family Floater of size 1+7	Rs.10 Lakh	41,000	35,945
Family Floater of size 1+7	Rs.6 Lakh	28,675	25,140
Family Floater of size 1+7	Rs. 2 Lakh	21,500	18,849
Individual below 45 Yrs. Only	Rs. 2 Lakh	8,000	7,014

For more details on Supertopup plan, please visit www.jiojac.com/R20

Please Note: Continuity coverage is as per your option selected for "JAIN SWASTHYA BIMA YOJANA RENEWAL (2020-21)":

With Continuity Benefits – The policy period will be from 16-May-20 to 30-Mar-20. However waiting period for Maternity, Joint Replacement, Knee Replacement is waived.
Without Continuity- Policy period will be from 16-May-20 to 30-Mar-20. Waiting period for Maternity, Joint Replacement, Knee Replacement is applicable

PLEASE NOTE:

Corona Virus disease treatment is covered under the policy.
The above plan covers Personal Accident cover for Rs.500,000/- per person for each member of the family between the age of 18 years to 75 years of age. So in a family if there are 6 members than total Rs.30,00,000/- sum insured is available under the above plan. Nominee of the member will be spouse in case of married members and in case of unmarried children or parents it will be self.
All wellness benefits approximately of Rs.24,000/- benefits for the family is added into the above plan.
Member can increase the Sum Insured during renewal, But can’t decrease it. No Changes or cancellation can be done after payment.
As Plan Subscription will be transferred first to JIO by members individually and then JIO will be paying this Plan Subscription to insurance company as one consolidated payment, there is a time gap for reconciliation and procedure. We request you to pay the Plan Subscription at the earliest to start coverage on time
Plan Subscription can be PAID only via Online Payment. CHEQUE / NEFT / RTGS will not be accepted.
Additional amount will be charged by payment gateway (Ease buzz) for providing safe & secure online money transfer facility, which is addition to above Plan Subscription charges.

Easy instalment facility is available by Ease buzz on RBL Bank, Axis Bank, Standard Chartered Bank, Kotak Bank, IndusInd Bank, HSBC Bank

Payment gateway Convenience fees (+18% GST on Convenience Fees) - 1.7 % for Net banking,

- 1.1 % for debit card transfer, 1.1 % for UPI,

- 1.75 % for credit card transfer, 2.2 % for Cash Card, 2 % for OLA money

GST refund certificate will not be available under this policy.
JIO JAC membership fees is Rs. 1000 per financial year which is additional to above Plan Subscription.(Payment will get updated in next 1 week)
Wellness Benefit like :

Medicine Discount (Upto 22%)
Laboratory Discount (Upto 25%)
OPD consultation – Dental & Eye Checkups
Newsletter
Health Tips
Doctor on Call
Cancer screening camp
Red carpet treatment at Wockhadt Hospital, RG Stone & Infigo Eye care Hospital

GENERAL EXCLUSIONS IN MEDICLAIM POLICY

WAR like situation etc.:Treatment directly or indirectly arising from or consequent upon war or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, uprising, revolution, insurrection, military or usurped acts, nuclear weapons / materials, chemical and biological weapons, ionizing radiation, contamination by radioactive material or radiation of any kind, nuclear fuel, nuclear waste.
SUICIDE attempt, CRIME etc. :An Insured Person committing or attempting to commit a breach of law with criminal intent, intentional self-Injury or attempted suicide while sane or insane.
Risky Sports, Military :Wilful or deliberate exposure to danger, intentional self-Injury, participation or involvement in naval, military or air force operation, circus personnel, racing in wheels or horseback, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing, bungee jumping, paragliding, parasailing, ballooning, skydiving, river rafting, polo, snow and ice sports in a professional or semi-professional nature.
Alcohol, Addiction etc.:Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including alcohol withdrawal, smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies, impairment of Insured Person’s intellectual faculties by abuse of stimulants or depressants
Weight management programs or treatment in relation to the same including vitamins and tonics, treatment of obesity (including morbid obesity).
Correction of eyesight :Treatment for correction of eyesight due to refractive error including routine examination.
Health check-ups :All routine examinations and preventive health check-ups, including corona virus when hosptizalation is not done
Cosmetic surgery, aesthetic and re-shaping treatments and Surgeries. Plastic Surgery or cosmetic Surgery or treatments to change appearance unless medically necessary and certified by the attending Medical Practitioner for reconstruction following an Accident, cancer or burns.
Circumcision (unless necessitated by Illness or Injury and forming part of treatment); aesthetic or change-of-life treatments of any description such as sex transformation operations.
Hospitalisation not required :Conditions for which treatment could have been done on an outpatient basiswithout any Hospitalization.
Experimental treatment:Investigational treatments, Unproven / Experimental treatment, or drugs yet under trial, devices and pharmacological regimens.
Diagnostic Only :Diagnostic tests/procedures/treatment/consumables not related to Illnessfor which Hospitalization has been done.
REST CURE :Convalescence, cure, rest cure,sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care, treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification centre, home for the aged, mentally disturbed remodelling clinic or any treatment taken in an establishment which is not a Hospital.
PREVENTIVE CARE, vaccination including inoculation and immunizations (except in case of post-bite treatment); any physical, psychiatric or psychological examinations or testing.
Admission for enteral feedings (infusion formulas via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
Hearing aids, contact lenses orspectacles including optometric therapy, multifocal lens.
Baldness :Treatment for alopecia, baldness, wigs, or toupees, and all treatment related to the same.
Diabetic test strips etc.:Medical supplies including elastic stockings, diabetic test strips, and similar products.
External durable medical equipment:Any expenses incurred on prosthesis, corrective devicesexternal durable medical equipment of any kind, like wheelchairs crutches, instruments used in treatment of sleep apnea syndrome or continuous ambulatory peritoneal dialysis (C.A.P.D.), devices used for ambulatory monitoring of blood pressure, blood sugar, glucometers, nebulizers and oxygen concentrator for bronchial asthma/ COPD conditions. Cost of artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively). Sleep-apnea and other sleep disorders.
External Congenital Anomalies or diseases or defects.
Stem cell therapy or Surgery, or growth hormone therapy.
Venereal disease,all sexually transmitted disease or Illness including but not limited to HPV, Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis.
“AIDS”(Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human Immunodeficiency Virus) including Opportunistic infections but not limited to any conditions related to or arising out of HIV/AIDS such as ARC (AIDS Related Complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis, Pneumocystis Carinii Pneumoniae etc.
Voluntary termination, miscarriage (except as a result of an Accident or Illness)
Infertility:Treatment for sterility, infertility,sub-fertility or other related conditions and complications arising out of the same, assisted conception, surrogate or vicarious pregnancy, birth control, and similar procedures; contraceptive supplies or services including complications arising due to supplying services.
Organ donor screening :Expenses for organ donor
Illegal Organ Transplantation :Admission for Organ Transplant but not compliant under the Transplantation of Human Organs Act, 1994 (amended).
Spinal subluxation :Treatment and supplies for analysis and adjustments of spinal subluxation,diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
Dental Treatment: Dentures, implants and artificial teeth, Dental Treatment and Surgery of any kind, unless requiring Hospitalization due to an Accident.
Cost incurred for any health check-up or for the purpose of issuance of medical certificates and examinations required for employment or travel or any other such purpose.
Artificial life maintenance ,including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health.
Treatment for developmental problems,learning difficulties eg. Dyslexia, behavioural problems including attention deficit hyperactivity disorder (ADHD).
Treatment for Age Related Macular Degeneration (ARMD), Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, high intensity focused ultrasound, balloon sinuplasty, Deep Brain Simulation,
Non-Medical Expenses (1):Expenses which are medically not necessary such as items of personal comfort and convenience including but not limited to television (if specifically charged), charges for access to telephone and telephone calls (if specifically charged), food stuffs (save for patient’s diet), cosmetics, hygiene articles, body care products and bath additives, barber expenses, beauty service, guest service as well as similar incidental services and supplies, vitamins and tonics unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
Treatment taken from a person not falling within the scope of definition of registered Medical Practitioner with any state medical council/ medical council of India.
Treatment charges or fees charged by any Medical Practitioner acting outside the scope of license or registration granted to him by any medical council.
Treatments rendered by a Medical Practitioner who is a member of the Insured Person’s family or stays with him, except if pre- approved by Us.
Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary;drugs or treatments which are not supported by a prescription.
Non-Medical Expenses :(2)Administrative charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, registration, bio-medical, linen, documentation and filing, including MRD charges (medical records department charges).
Non-Medical Expenses :(3)including but not limited to RMO, CMO, DMO charges, surcharges, night charges, service charges levied by the Hospital under any head and as specified in the Annexure for Non- Medical Expenses and on Our website adityabirlacapital.com
Treatment taken outside India
Insured Person whilst flying or taking part in aerial activities except as a fare-paying passenger in a regular scheduled airline or air charter company.
Robotic surgery (whether invasive or non-invasive)
All forms of Bariatric surgery.
Use of Radio Frequency (RF) probe for ablation or other procedure.
Admission primarily for diagnostic purposes not consistent with the treatment taken.
Blacklisted Hospital, Doctor :Treatment in any Hospital or by any Medical Practitioner or any other provider of services that We have blacklistedas listed on Our website.
Treatment provided by anyone with the same residence as Insured Person or who is a member of the Insured Person’s immediate family.
Holmium Laser Enucleation of Prostate, KTP Laser Surgeries, Femto laser surgeries, bio-absorbable stents, bioabsorbable valves, bioabsorbable implants, oral chemotherapy, Hormonal Chemotherapy, Adjuvant Chemotherapy, Neo-adjuvant Chemotherapy, Immuno-therapy, use of Infliximab, rituximab, avastin, lucentis group of drugs.

Group Personal Accident (GPA) policy is also applicable for all the members covered under the family subject to age between 18 years to 75 years of age for only ACCIDENTAL DEATH cover.( FIR Compulsary )
1. GENERAL EXCLUSIONS IN PERSONAL ACCIDENT POLICY:
  - Suicide/ Intentional self-injury
  - Death due to Pregnancy/childbirth etc.
  - Accident while under influence of alcohol/drugs
  - Sexually Transmitted Infections
  - Participation in a criminal act
  - Participation in a hazardous sport
  - War, civil war, surgical strike, similar situations etc
  - Other exclusion as per the Standard PA Policy

For more detailed exclusions, please refer standard Group Mediclaim Policy Condition.

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW POLICY (2020-2021 )

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

Wellness Partner – Wockhardt Hospitals, Metropolis, Med life, RG Urology & Laparoscopy Hospital,Apollo Pharmacy, Infigo Eye Care Hospital, IGENETIC DIAGNOSTICS

1. MISUNDERSTANDINGS AND MYTHS OF JIO HEALTH PLAN

Will my policy divided in to 2 insurance company ?

- NO

JIO is an Insurance Company?

- No. JIO is not an insurance company and does not give any type of insurance policy. JIO is the Group Manager of this policy. JIO has only played the role of negotiator for benefit of its Shravak/ Shravika Members

Who manages the Insurance Policy ?

The Policy is serviced by the following three entities:

Insurance Brokers (Like Prudent, Alliance, Almonds, Edelweiss, etc.) Insurance brokers are the mediators and communicator between JIO and Insurance Company to receive best terms. The responsibility of compiling the enrolment data, getting the policy endorsed, overview on claims process and resolving the queries of members is to be executed by the Insurance brokers. The Insurance brokers are the working hand of JIO for overall assistance for Group Policies.

Insurance Company (Like Govt. companies - National Insurance, Oriental Insurance & Pvt. Companies - ICICI Lombard, Star Health, Aditya Birla, Universal Sompo, etc.) The Mediclaim policy is issued by the government approved Insurance Companies under the regulation of IRDA. Means, the premium collected from members is transferred to the Insurance Company. The Insurance company bears the risks of the policy and pays claims to the members as per terms of the policy.

Third Party Administrators - TPA (Like Paramount, Vipul TPA, IL Health Care, Vidal, Health India,etc)

The TPA's are appointed by the Insurance Companies for issuing members Medi-claim card, communicate terms to policy holders, prepare panel of hospitals for cashless, receiving claim documents, evaluating the documents and sanctioning the claim amount.

Is JIO is making profits from the policies?

NO
JIO is not a profit making organization and is formed with a noble objective of serving its Shravak / Shravika members as well as society at large. Under the medical insurance scheme, the premiums are collected individually from the members and then full amount is transferred as a group premium to the insurance company. In-fact, Gurudev has inspired several Jain Shravaks to donate partly towards the premiums for members of their respective Samaj / Gnyati, who are financially troubled. Hence the health security could be availed by members of their Samaj at further discounted premiums. This will immensely help such families to face the additional financial burden of medical expenses, if any.

Is the Enrolment process very complex?

NO
The enrolment process requires registering accurate details of the member and their family so that they do not face any trouble during the full year or at time of claim. The forms have been designed in a way to get the important details only and no un-necessary details are to filled.

Whether any person are available for help during enrolment or at the time of claim like Insurance Agents ?

JIO has not appointed/authorized any retail agents for selling / marketing its policies. When the enrolment for policy is started, JIO chapters and volunteers across India assist in the policy and enrolment process and spreading information of policy. Because of the dedicated service of its volunteers, JIO has been able to reach huge number of Shravaks across India easily, without additional cost of hiring huge number of professionals.

And at the time of claim, members can take help / advice from helpline number of the insurance company. Alternatively, the members can also take help from any insurance agent because the process of claim is same as retail insurance policies.

Why so much importance is given to online process which may be difficult for a common man ?

JIO has pioneered in adopting to the latest technologies and online tool for your convenience and better service. The online enrolment process has the following major advantages:

The data entry and processing time is saved.

Accuracy of the data entered. This will also help in hassle free claims to the members.

Enrol anytime from anywhere

Immediate confirmation of enrolment completion.

Why JIO JAC number is compulsory?

JIO JAC is required not only for group Mediclaim but also for other JIO schemes. JIO introduced the Jain Advantage Card (JAC) as a comprehensive scheme for benefit of its members through bulk buying.

JIO JAC is a unique and permanent identification for availing benefits of various schemes launched by JIO. Members can easily participate in the programs of JIO without having to provide various details every time.

JAC members can also connect with fellow Shravaks and take full advantage of the JIO Global network.

Why does the policy coverage starts very late after payment of insurance premium to JIO?

JIO Group Policy is negotiated with Insurance Company for the Best TERMS and Lowest PREMIUM based on a commitment of certain Minimum NUMBERS of enrollment.

For enrolling the members, messages are sent to Shravaks residing all over India. An enrolment window period is kept open for members to fill forms and make premium payment.

In case the numbers fall short of the minimum target, then the enrolment period is extended for few days. After the closure of enrolment period, a list is compiled for all the forms received and payments are reconciled. Any errors found at the stage of validation and verification are corrected by contacting the members.

JIO pays the insurance premium to the Insurance Company through a single payment for all the members together for commencing policy. Upon payment, the Insurance cover period starts on common date for all the members. A single group policy document is issued in the name of JIO with the list of enrolled members and their families. On the basis of this TPA's issue Health Cards to all members with unique enrolment number for taking benefits of the policy.

The above process takes lot of time and efforts, hence the commencement of policy is after necessary period from the date of payment.

Why the Claims process is complex?

The process of filing claims for Cashless or Reimbursement with the Insurance Company is the same for JIO policy like any other retail mediclaim policies and in accordance with IRDA guidelines. In-fact, the norms for intimation of claim and the period for submitting claim documents after discharge are more beneficial in JIO Policy.

Whether insurance companies wrongly make huge deductions in JIO policy?

The deductions from claims are as per the terms of the policy and no ad-hoc deductions are made by the TPA or Insurance Company. The TPA and insurance company are bound by the guidelines of Insurance Regulatory & Development Authority.

However, in case any claims are wrongly deducted or disallowed, then the members can approach grievance department of Insurance company or Ombudsman department of IRDA. These actions are within the rights of every policy holder.

Whether JIO is responsible for answering queries on claims disbursal and deductions?

As clarified above, JIO is neither the Insurance Broker / Agent to the policy nor the company undertaking the insurance. JIO has played a role of Group Leader to the policy issuance. All the queries regarding the claims process, status of claims, reasons of deductions from claim etc., are handled by the concerned Insurance Company.

In cases, where the grievances of the policy members remain unresolved by the Insurance Company, the members can escalate such urgent / important issues with the Broking Company or JIO officials. JIO in turn will take up these issues with the concerned authorities through brokers. However the claims will be decided on merits of the case and within the terms of the policy.

Why has JIO not kept its word at the time of renewal by Increasing Insurance premiums and altering certain terms like amount capping on specific treatments and Co-pays on pre-existing diseases?

The 1st phase of policy saw an overwhelming response due to unbelievably low premiums and attractive benefits which are not available in any other policies. The biggest benefit of the policy was to cover elder members and members who were already ill. Due to such extra ordinary benefits, our Shravak families received a claim of almost 350% over the premiums paid. As a result of the heavy claim ratio, the renewal premiums were bound to be increased extensively by the Insurance Companies.

However it was necessary for JIO to keep the premium low and also provide suitable terms to members who have not lodged any claim. It is also necessary that group policy has a good share of healthy families to keep the claim ratio balanced along-with affordable premiums year after year. This will help to serve more number of needy and sick people with stable premium year after year. Accordingly JIO had renegotiated the terms of policy with insurance company and achieved a group policy with balanced terms and appropriate premiums which were still better than the market rates.

The JIO Mediclaim policy still continues to be hugely beneficial to the middle class families and the senior citizens who otherwise were not able to take benefit out of medical insurance.

Why do Insurance Companies, brokers or TPA change at time of each renewal?

Each phase of policy had been negotiated with different insurance companies and the Best offer with maximum benefits and lowest premiums has been selected. The brokers and TPA change accordingly.

When do the new phase are introduced and how will the Shravaks be informed about the same?

The introduction of new phases is not as per a planned schedule. JIO receives proposals from different insurance companies and if JIO is convinced about the suitability of the terms, the new phase will be announced through SMS, e-mails and website to all JIO JAC members.

Why there are no proper contact details for call or email for filing grievances? Why No one answers the call or proper answers are not received from helpline?

The responsibility for coordination of enrolment and claims has been assigned to the brokers by JIO. The brokers are required to maintain appropriate number of contact points in the form of helpline numbers and email id for helping members and resolving their queries.

For any help or assistance at the time of enrolment the members can contact the brokers helpline numbers.Toll Free Number : 180030103360

jiointimation@ericsontpa.com & Toll Free No :1800222034

Whether the policy is a temporary affair or will continue for several years to come?

The JIO group policy is NOT a temporary affair and will continue in future like all other insurance policies.

However, as discussed earlier, the terms of the policies and the premiums are subject to change at the time of each renewal based on previous year experience & analysis.

JIO group Mediclaim policy was started with a noble vision of giving financial security in medical emergency to all the Shravak / Shravika families. Therefore JIO will never think about discontinuing the scheme.

DELAY & STATUS OF PHASE 7 Renewal

Why was the commencement of Phase – 7 renewal delayed?

As everyone is aware that before any group policy is incepted or renewed, there are few steps to be executed which are as follows.

The important point :

For Renewal is that the same insurance company or some other should get ready to renew, But due to high claim ratio insurance companies refused to renew, so many a times the delay occur.

Various levels of negotiations with the Insurance Companies through insurance brokers.

Drafting of MOU for terms with the insurance company

Intimation of the policy terms to the members

Collection of premium by JIO from members

Sending detailed list of members with amounts of coverage by JIO to Insurance Company

Issue of payment for Premium by JIO to Insurance Company

Commencement of Group Insurance Policy.

How is the premium calculated for group policy?

If a group policy is issued for the first time then the general claim ratio of individual policies is considered. Further the fact that the company receives huge number of policy holders at one time, the reduced advertisement costs can be passed on by way of discount on premium.

For renewal of group policy, the premiums are decided on the basis of past claim ratio, age composition of the policy holders, types of claims made earlier and assumptions made for future claims.

What are the changes in the revised terms of policy?

Most of the policy benefits of earlier JIO Mediclaim policy have been retained.

Any person can not be covered in multiple family policy. If found enroled in more than one fmily, claim will be paid on anyone family floater policy only during whole year.

Co-pay will Not apply on sub limit / Inner Limit Claims, Compulsory deduction of Rs 5000 in each claim will be deducted, even in capped ailment subject to their capping is Rs.50,000/- or above.

What is the procedure for renewal?

A member is required to visit the designated website for renewal and login with JIO JAC ID. The details of proposer, family members will be reflected for last year Existing Members Only. The member is required to confirm the complete details before proceeding. The member can also read the detailed terms and conditions of the new policy. On acceptance of the terms of the policy the member can make payment of premium and complete the process.

Whether Physical Submission of forms is allowed?

Physical forms will not be accepted at all for the renewal of policy. All the information has to be provided online .

What are the options for making payment of premium amount?

The members can choose to make payment of premium amount only from following options

Online payment through credit / debit card or net banking

Payment gateway Convenience fees

- 1.7 % for Net banking,

- 1.1 % for debit card

- 1.1 % for UPI,

- 1.75 % for credit card

- 2.2 % for Cash Card,

- 2 % for OLA money

Easy instalment facility is available by Ease buzz on RBL Bank, Axis Bank, Standard Chartered Bank, Kotak Bank, IndusInd Bank, HSBC Bank

If a member is not aware about the online process or the working on internet and computers, how will they be able to renew?

In this age of digitization, internet and computer facility is easily available. The members who are not very conversant with use of computers are advised to approach young members in their family for help in completing the online process.

TERMS, CONDITIONS & PROCEDURE for this New Plan

Can I opt individual policy in JIO Mediclaim Renewals?

Yes.

INDIVIDUAL POLICY with Sum Insured of Rs.2 Lacs can only be opted by any member who is alone and without any living members in his family as per family definition(Widow/Widower). Member has to be below age of completed 45 yrs. Only

Can I opt Family Floater policy in JIO Mediclaim Renewals?

Yes.

This is an insurance scheme where a family can opt for an insurance plan for Rs.2, 6 & 10 Lac against Mediclaim for Self + Spouse + 4 Unmarried, Dependent Children up to 25 years of Age and Parents or parents in-laws (Jain only) this policy includes personal accident cover for a sum of Rs.5 Lac for Proposer.

I am a Jain but my wife is not a Jain? Can I insure my wife?

Under the family floater policy you can cover your wife as long as the proposer is Jain and because now she is a part of the Jain family.

If I have only 3 members in my family can I buy a Family Floater Policy?

Family Floater Policy is available for family size ranging between 2 to 8 members i.e. Proposer + Spouse + 4 Unmarried, Dependent Children up to 25 years of Age + Parents/or Parents or Laws (jain only) up to 85 years

Can I and my brother / sister cover our parents under our individual family floater schemes?

Yes you can but any person can’t be covered more than once under whole group in JIO Policy. If declared more than once, benefit would be payable under one Sum Insured only

We are two brothers & we have two different policies, Can we enrol our Parents in both policies?

No. One person can be covered only once in a JIO policy.

Can I take my married daughter in policy?

No. As she is now not part of your family.

Can a member above age of 45 years take individual policy of Rs.2 lac?

No. Individuals above the Age of 45 would compulsory need to buy a floater policy of 2 lac/ 6 lacs /10 lacs cover

Is this Applicable on Pan India basis?

Yes this policy is for Pan India, Jain population only.

What if I am or my family member is already suffering from a disease? Can I yet get myself or my family members covered?

Pre-Existing Diseases are covered since day 1, however Co-pay of 25% will be applicable for PRE-EXISTING Ailments and Co pay will not be applied on Cataract & Maternity

In my family few are having Jain certificate but my parents don’t have any proof? Then what I can do?

Please get a confirmation from your Sangh / Gyati that you are a Jain.

What are the major changes in the revised terms of policy?

Co-pay of 25% will be applicable for Pre-existing Ailments / Diseases

No co- pay will applied on Non-PED Cases for Sum Insured of 2 Lacs, 6 Lacs & 10 Lacs

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

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

Reason for including this deductible of Rs 5000 in this policy ?

As we are aware that the JIO Mediclaim Policy is now in its 6th Year. In the past there was huge claim ratio in JIO policy. To Adjust (recover) the additional burden of high claims, the Insurance Company increases the insurance premium every year at the time of renewal.

There was a considerable hike in the JIO Insurance Premium in the previous year. Gurudev and JIO Directors have decided that there should not be any major increase in the renewal premium this year.

To compensate the Insurance Company and make the policy viable considering the high claim ratio, it is decided to introduce additional deduction of Rs. 5000/- on claim amount of Rs.50,000/- and above .

What is the name of Insurance Company?

Universal Sompo General Insurance Co.Ltd

How do I renew?

Please follow the below mentioned steps

Please go on www.jiojac.com/R20

Select “Renewal” Scheme

Read revise Terms & Conditions carefully

Enter JIOJAC ID

Fill your enrolment details

Make payment ONLINE

Can I submit physical form?

You can’t submit Physical Form. The process of enrolment and payment is online only through JIO website.

What are the options for making payment I am not aware of online procedure?

You need to Enrol Online only, however payment can be done via Online through Easebuzz after completing Online Enrolment Procedure.

If I don’t have JIO JAC Id, can I opt for Mediclaim Policy ?

No, JIOJAC ID is compulsory for proposer. Please register online for JIOJAC ID.

What is the premium?

Premium details are available in Salient features section.

Does this scheme have cashless as well as Reimbursement facility?

Yes, cashless facility is available in 6000 Network of hospitals and Member can avail Cashless as well as reimbursement facility. In all case of cashless claims, immediate intimation shall be given to our Call Centre within 48 hours of Hospitalisation. In case of reimbursement claims, immediate intimation shall be given to Call Centre within 48 hours of Hospitalisation.

When will I be eligible for my maternity claim?

For Existing Members, Maternity Benefit is covered from Day 1 up to 2 live children only. However for New Members, Maternity benefit is available after completion of 9 months from the date of enrolment in JIO – Shravak Arogyam scheme. This benefit is not available for Individual Policy Holder with 2 Lakh Individual sum insured.

Are pre & post-natal expenses under Maternity benefits covered?

Covered for the Hospitalization for more than 24 hours within Maternity Limit up to 2 live children only, But Pre & Post Natal expenses on OPD bases are not covered

What shall be the next year premium?

The next year premium will be decided after the end of the policy tenure based on the Claim Experience of the current Policy

Can I have the policy number?

No, you will not get Policy Number. However you will receive Cover Certificate and Health ID card, which you can show in Network Hospitals to avail Cashless Benefit under this Policy.

Do we get no claim bonus if we do not claim in the existing year?

No, as this is a Group scheme you will not get NO Claim Bonus

If my wife is the proposer can she cover her parents?

Yes, only if she is a Jain by birth.

How different is TPA from Insurance Company?

Third Party Administrator (TPA) in Health Insurance Sector servicing all insurance companies. Health Insurance policies for individuals are basic products of Insurance Companies on which TPA adds value and facilitates smooth operation through its value-addition like network of healthcare service providers, medical care standardization, Claims management, Client servicing, expert opinion etc. Thus TPA administers a `healthcare package' for its clients with customized healthcare delivery.

Will location of dependent family matter in availing services under TPA?

No, Location does not affect the operational activities, main member or the dependent member can avail same and equal benefits irrespective of their location. TPA Network of Healthcare Service Providers is across the country. These accredited healthcare providers would assure qualitative healthcare delivery to TPA members.

Will the change in names in between policy period matters?

Yes, According to the Insurance Company the claim will not be settled (unless prior intimation to Insurance company) if there is any alterations in the name, It has to be intimated to your respective Insurance Co. within 15 days on receipt of your cards & requisite Endorsement for the change in name needs to be passed by Insurance co. This has to be done first hand and not only if any claim arises.

Corona Virus Cover

Treatment of COVID-19 is covered under this policy. even though it will be declared as Epidemic and/or Pandemic.

What are the documents required to be submitted to TPA to claim under reimbursement procedure?

Documents that you need to submit for a hospitalization reimbursement claim are:

Original completely filled in Claim form

Covering letter stating your complete address, contact numbers and email address (if available), along with Schedule of Expenses

Copy of the TPA ID card or current policy cover certificate copy and previous years' policy copies(if any)

Original Discharge Card/ Summary

Original hospital final bill

Original numbered receipts for payments made to the hospital

Complete breakup of the hospital bill

All bills for investigations done with the respective Doctor

All bills for medicines supported by relevant prescriptions

Bank Details with Cancel Cheque

You are advised to keep Photo Copy of the entire set of claim documents submitted to us.

TPA or Insurance Company may ask for additional documents (apart from the list shared) as required during the claim process

How to send reimbursement claims?

Under this Policy, You can avail Reimbursement facility and claims can be submitted to Ericson Insurance TPA Pvt. Ltd office at 11-C, Corporate Park, S. T. Road, Chembur, Mumbai - 400071, Maharashtra.through registered post / courier.

What are “NON-MEDICAL EXPENSES"?

Your health insurance policy pays for reasonable and necessary medical expenditure. There are several items that do not classify as medical expenses during hospitalization. These items will not be payable and expenditure towards such items will have to be borne by you.

Can I claim medical expenses incurred before and after a surgery?

You can claim medical expenses incurred 30 days before and 60 days after hospitalization (as specified in your policy), provided they are related to the ailment/treatment for which you were hospitalized. Such expenses are termed as pre and post hospitalization, except for Maternity Claims.

Can I claim my dentist's bills?

No. You can do so only in cases arising from Road Accidents. (FIR Compulsary)

Are all the tests prescribed by the doctor at a hospital reimbursed under the Health Insurance Plan?

Expenses incurred at a hospital or a nursing home for diagnostic purposes such as X-rays, blood analysis, ECG, etc. will be reimbursed if they are consistent with or incidental to the diagnosis and treatment of the ailment for which the policy holder has been hospitalized. In any other scenario, these expenses will not be reimbursed.

Will my claims be reimbursed even if I do not get myself treated at a network hospital?

Yes, you can avail Reimbursement facility.

Is there a minimum time limit for stay within the hospital under the health insurance plan?

Typically, the insured can make a claim if her/his hospitalized stay is for over 24 hours. However, for certain treatments, such as dialysis, chemotherapy, eye surgery, etc. the stay could be less than 24 hours. Day care claims will be processed as per IRDA rule.

What happens when the limit of insurance is exhausted under a Health Insurance Policy?

If the insurance limit i.e. the sum insured is exhausted in a particular year due to large medical expenses, the insurer is not liable to bear/reimburse the insured for any further expenses.

Who will receive the claim amount if the proposer dies at the time of treatment?

The insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. Alternatively, the insurers can deposit the claim amount in the court for disbursement to the legal heirs of the deceased.

What is the procedure for availing cashless facility?

In case of planned hospitalization, insurers require the first prescription with the details of the case history indicating following details:

Provisional diagnosis or reason for getting admitted in hospital

Proposed date of admission

Approximate expenses

Name of the hospital and consultants

Approximate duration of stay at the hospital

Attached doctor's prescription with admission note

The above documents need to be delivered to the TPA/insurer at least 72 hours before admission.

If I avail of the cashless facility, will the insurance company pay the entire bill at the hospital?

No. From the Bill amount, Non-Medical Expenses will be deduced and if any, Copay, sub limits & Deductible is applicable that will be deducted. Also if the Room Rent limit is more than the eligible limits as per the respective Sum Insured, then all other eligible Medical Expenses will be paid in proportion to eligible Room Rent Category. And the balance amount will have to be borne by the insured if any.

Further Premium FOR Mediclaim & Personal Accident for all family members with wellness pack is inclusive of GST

What are Sub-limits in this policy?

Sum Insured Bracket	200,000	600,000	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 Disease (Including Angiogram limit)	120,000	220,000	280,000
Cancer	120,000	220,000	280,000
Treatment for breakage of bone including Spine surgery	120,000	220,000	280,000
Renal Complication (Including Dialysis limit)	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)	30000 + Mesh charges	40000+ Mesh charges	50000+ Mesh charges
Anemia (Not for evaluation)	50,000	50,000	50,000
Angiogram	18,000	21,000	24,000
Joint and Knee Replacement Per Family	75,000	100,000	1,25,000

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

Sub-limit is available under Salient features section.

What are Wellness Benefits ?

Wellness Benefit are as follows :

Medicine Discount (Upto 22%)
Laboratory Discount (Upto 25%)
OPD consultation – Dental & Eye Checkups
Newsletter
Health Tips
Doctor on Call

a) Sample claim process

(I) If Claim is PED but falling under Sublimit ailment

In case of claim relating to PED; but falling in sublimit ailment. Say the hospital bill is Rs. 5 lakhs for the disease CVA which has sublimit of Rs.2,80,000/- (sum insured opted is Rs.10 lacs), the following procedure is adopted :
First the amount payable to the insured is worked out after adjusting the non-medicals and non-payables, room rent difference if any, proportionate deduction if the insured occupied a room with room rent more than his eligible amount.

Hospital bill	Rs. 5.00 lakhs
Deductions due to Non-payables	Rs. 2.00 lakhs
	Rs. 3.00 lakhs

Since the assessed amount is more than the sub-limit of Rs.2,80,000/- the claim amount is restricted to the sub-limit viz. Rs.2,80,000/-. Further Rs.5000/- will be deducted as mentioned above and hence final payable amount will be Rs.2,75,000/-.

(II) If Claim is PED but not falling under any Sublimit ailment

In case of claim relating to PED; but not falling in any sublimit ailment. Say the hospital bill is Rs. 5 lakhs. (sum insured opted is Rs.10 lacs), the following procedure is adopted :
First the amount payable to the insured is worked out after adjusting the non-medicals and non-payables, room rent difference if any, proportionate deduction if the insured occupied a room with room rent more than his eligible amount.

Hospital bill	Rs. 5.00 lakhs
Deductions due to Non-payables	Rs. 2.00 lakhs
	Rs. 3.00 lakhs
Deduct 25% Co-payment for PED	Rs. 75 Thousand
	Rs. 2.25 lakhs

Since the diseases is not falling in any sublimit ailment; If on the contrary the assessed amount after co-pay is Rs.2,25,000/-, the claim payable is Rs.2,25,000/-. Further Rs.5000/- will be deducted as mentioned above and hence final payable amount will be Rs.2,20,000

(iii) If Claim is Non- PED & Not Falling in any sublimit ailment:

In case of claim is not relating to PED & not falling in any sublimit ailment. Say the hospital bill is Rs. 5 lakhs. (sum insured opted is Rs.10 lacs), the following procedure is adopted :
First the amount payable to the insured is worked out after adjusting the non-medicals and non-payables, room rent difference if any, proportionate deduction if the insured occupied a room with room rent more than his eligible amount.

Hospital bill	Rs. 5.00 lakhs
Deductions due to Non-payables	Rs. 2.00 lakhs
	Rs. 3.00 lakhs

Since the diseases is NON-PED & not falling in any sublimit ailment; the claim payable is Rs.3,00,000/-. Further Rs.5000/- will be deducted as mentioned above and hence final payable amount will be Rs.2,95,000/-.

Deductible of Rs. 5000 is applicable in each claim above Rs 50,000/-

What happens in case of an Emergency hospitalization where Cashless facility is not authorized to me?

jiointimation@ericsontpa.com & toll free no.1800222034

How a hospital is defined with regards to the health insurance policies?

Any institution established for indoor care and treatment of sickness and/or injuries, which is duly registered and supervised actively by a registered medical practitioner.
OR
Any establishment that satisfies the following criteria can qualify as a hospital:

with at least 15 patient beds
With a fully equipped operation theatre of its own if surgical procedures need to be carried out
Employing fully qualified nursing staff around the clock
Having fully qualified doctors in charge around the clock Note: For Class 'C' towns, the number of beds relaxed to ten.

What is meant by hospitalization?

An instance where the insured individual is hospitalized for a minimum period of 24 hours can be termed as hospitalization. Specific treatments like dialysis, chemotherapy, radiotherapy, laser eye surgery, dental surgery, etc. when the patient is discharged on the same day are also considered hospitalization under day care as per IRDA guidelines.

Is maternity benefit available under an individual Health Insurance Plan?

No. Maternity benefit is not payable under Individual Health Insurance Plan.

What is my room rent eligibility under both the schemes?

S.I. Rs.2 Lakhs - Room Rent - 2,500 and ICU capped at 3,500
S.I. Rs.6 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 inclusive 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.

What are the age limit restrictions under both the policies?

INDIVIDUAL POLICY with Sum Insured of Rs.2 Lacs can only be opted by any member who is alone and without any living members in his family as per family definition. Member has to be below age of completed 45 yrs. Only

. In case of Family Floater of Rs.6 Lacs & 10 Lacs, below age limit will apply

For Unmarried, Dependent Children maximum age allowed is 25 years. After completion of 25 years, Child will not be covered in next year
For Parents / parents in law (jain only) maximum entry age is 85 years, Renewal till LIFETIME

Can one prepare a Jain Certificate?

The Jain certification has to be from Gyati / Samaj / Sang only

What is covered under Personal accident Cover?

Death Benefit is covered under personal accident cover (FIR Compulsary)

What claim documents do I need under a Personal Accident Claim?

CLAIM DOCUMENTS REQUIRED FOR PERSONAL ACCIDENT CLAIM – ALL DOCUMENTS HAVE TO BE DULY ATTESTED / CERTIFIED / NOTARIZED

Compete Filled Claim Form
Photocopy Of ID Proof
Death Certificate
Post Mortem Report
Police FIR Copy Compulsary.
Driving license (if self driving)
Police Panchnama Copy
Panchayat Certificate wherever applicable
Income Proof
Bank Account Details of Nominee

जैन स्वास्थ्य बीमा योजना रिन्युअल / न्यू पॉलिसी (2020-21)

की विशेषताएं

इंश्योरेंस कंपनी : युनिव्हर्सल सोंपो जनरल इंश्योरेंस कंपनी लिमिटेड

ब्रोकर: एडलवाइज गेलेगर इंश्योरेंस ब्रोकर्स लिमिटेड

टीपीए : एरिक्सन इंश्योरेंस टीपीए प्रा. लि.

वेलनेस पार्टनर: वोक्हार्ट हॉस्पिटल, मेट्रोपोलिस, मेडलाईफ, आर. जी. यूरोलॉजी एंड लेप्रोस्कोपी हॉस्पिटल, अपोलो फार्मेसी, इंफिगो आय हास्पिटल, आय जेनेटिक डायग्नोस्टिक

नोट: यह हिंदी अनुवाद मात्र आसानी से समझाने और समझने के मकसद से किया गया है, सभी प्रकार के न्यायिक प्रकियाओं के लिए अंग्रेजी भाषांतर (English Version) ही मुख्य रूप से मान्य और फायनल होगा।

रिन्युअल पॉलिसी एवं न्यू पॉलिसी की प्रिमियम सूची, वेलनेस और जीपीए (ग्रुप पर्सनल एक्सीडेंट) के साथ

परिवार का विवरण	बीमा राशि (Sum Insured)	कुल रक्कम (मेडीक्लेम योजना का सब्सक्रिप्शन, वेलनेस, जीपीए (जीएसटी के साथ) को जोड़कर
फैमिली फ्लोटर 1+7 साईज में	₹10 लाख	₹41,000
फैमिली फ्लोटर 1+7 साईज में	₹6 लाख	₹28,675
फैमिली फ्लोटर 1+7 साईज में	₹2 लाख	₹21,500
व्यक्तिगत (Individual) पॉलिसी (45 वर्ष से कम)	₹2 लाख	₹8,000

नोट : हम आपको सुपर टॉप अप पॉलिसी के लिए भी आग्रह करते हैं ताकि आप बेस पॉलिसी के अंतर्गत कैपिंग डिडक्सन से बचने के लिए यह पॉलिसी जरूर लें। उदाहरण के लिए ₹10 लाख की बेस पॉलिसी में ह्रदय रोग के लिए कैपिंग लिमिट ₹2,80,000/- है यदि आप सुपर टॉप अप ₹10 लाख बीमा राशि पॉलिसी के साथ ₹3 लाख डिडक्टिबल बीमा राशि लेते हैं तो ₹3 लाख के बाद की बची हुई रक्कम सुपर टॉप अप से क्लेम कर सकते हैं।

सुपर टॉप अप प्लान की जानकारी के लिए कृपया www.jiojack.com/STU20ट

कोरोना वायरस के उपचार पॉलिसी के अंतर्गत कवर है।
परिवार में 18 से 75 वर्ष की आयु तक के प्रति व्यक्ति को ₹5 लाख का व्यक्तिगत दुर्घटना बीमा (जीपीए) कवर दिया गया है इसलिए यदि परिवार में कुल 6 सदस्य है तो उपर की जीपीए योजना के अंदर पूरे परिवार पर कुल ₹30,00,000/--तक का कवर उपलब्ध है. यदि व्यक्ति शादीशुदा है तो पति/पत्नी साथ ही यदि व्यक्ति अविवाहित है तो प्रस्तावक के माता-पिता या उसे स्वयं को ही नॉमिनी माना जाएगा।
इस योजना के साथ वेलनेस के फायदे लगभग ₹24,000/- दिया गया है |
सदस्य पॉलिसी रिन्युअल करते समय बीमा राशि बढ़ा सकते हैं लेकिन घटा नहीं सकते। पॉलिसी के प्रिमियम देने के बाद किसी भी प्रकार के बदलाव या रद्द / कैंसल नही किया जा सकता है।
इस योजना में सदस्य व्यक्तिगत रूप से जिओ संस्था के पास पॉलिसी का सब्सक्रिप्शन / आवेदन के साथ प्रिमियम राशि भरते है, फिर जिओ संस्था आप जैसे सभी लोगों के आवेदन और एकत्रित की गई प्रिमियम राशि को इंश्योरेंस कंपनी के पास भेज देती हैं, इंश्योरेंस कंपनी को सभी सदस्य लोगों की जानकारियां और प्रिमियम की गणना करने में कुछ समय लग जाता है। आप सभी से हम आग्रह करते है कि आप सभी इस योजना में जल्द से जल्द जुड़ें ताकि आप को समय से इस योजना के लाभ मिल सकें।
योजना के सब्सक्रिप्शन का भुगतान ऑनलाईन पेमेंट द्वारा ही स्वीकारे जाएंगे. चेक/एनईएफटी/आरटीजीएस स्वीकार नहीं किए जाएंगे।
ऑनलाईन भुगतान की राशि को अत्यधिक सुरक्षित और सरल रूप से ट्रांसफर करने के लिए गेटवे (Ease Buzz) अतिरिक्त शुल्क लेता है जो निम्मलिखित है।

गेटवे( Ease Buzz) पेमेंट सुविधा शुल्क / फीस:

नेट बैंकिंग के लिए 1.7%
डेबिट कार्ड या यूपीआई ट्रांसफर पर 1.1%
क्रेडिट कार्ड ट्रांसफर पर 1.75%
कैश कार्ड ट्रांसफर पर 2.2%
ओला मनी पर 2%

गेटवे (Ease Buzz) पर आरबीएल बैंक, एक्सिस बैंक, कोटक बैंक, स्टैंडर्ड चार्टर्ड बैंक, इंडसइंड बैंक, एचएसबीसी बैंक द्वारा आसान किश्त (ईएमआई) योजना की सुविधा उपलब्ध है।
इस योजना के अंतर्गत जीएसटी सर्टिफिकेट उपलब्ध नहीं होगा।
जिओ जैक सदस्यता पाने के लिए ₹1,000/- अतिरिक्त शुल्क प्रति वर्ष प्रति सदस्य रखा गया है, यह अतिरिक्त किसी भी पॉलिसी की प्रिमियम जोड़ा नहीं गया है।(पेमेंट का अपडेट होने के लिए लगभग एक हप्ते का समय लग सकता है)
वेलनेस की सुविधाएं इस प्रकार है:

दवाओं पर 22% तक डिस्काउंट
लॅबोरेटरी पर 25% तक डिस्काउंट
ओपीडी सलाह में डिस्काउंट
हेल्थ पर टिप्स और पत्रिका
डॉक्टर ऑन कॉल
कैंसर परिक्षण शिबीर
वोक्हार्ट हॉस्पिटल, आर. जी. स्टोन और इनफिगो आय केअर हॉस्पिटल में चिकित्सा उपचार पर प्राथमिकता दी जाएगी।

कवरेज	2020-21
कैशलेस और रिइंबर्समेंट सुविधा	सदस्य कैशलेस और रिइंबर्समेंट दोनों प्रकार की सुविधाओं का उपयोग कर सकते हैं। कैशलेस सुविधा दिनांक 1 मई 2020 से लागू हो जाएगी।
कैशलेस और रिइंबर्समेंट सुविधा	कैशलेस और रिइंबर्समेंट क्लेम के मामले में अस्पताल में भर्ती होने पर 48 घंटों के भीतर हमारे कॉल सेंटर को तत्काल सूचना देना अनिवार्य है। टोल फ्री नंबर : 1800 222 034 नोट: यदि सूचना 48 घंटों के भीतर नहीं दी गई तो क्लेम अमान्य होगा और रद्द कर दिया जाएगा।
कोरोना वायरस कोविड-19 कवर	इस पॉलिसी के अंतर्गत कोरोना वायरस के उपचार का कवर दिया गया है। (संक्रमित व्यक्ति का सरकारी अस्पताल या सरकार मान्यताप्राप्त प्रयोगशालाओं में परीक्षण और उपचार किया गया मान्य होगा।)
रिइंबर्समेंट	रिइंबर्समेंट क्लेमों की सूचना अस्पताल में भर्ती होने के 48 घंटों के भीतर कॉल सेंटर को देना अनिवार्य है।(टोल फ्री नंबर:1800 222 034)
क्लेमों की सूचना	कैशलेस क्लेमों की सूचना अस्पताल में भर्ती होने के 48 घंटों के भीतर कॉल सेंटर को देना अनिवार्य है।(टोल फ्री नंबर:1800 222 034)

कैपिंग 2020-21
बीमारियां	₹2 लाख	₹6 लाख	₹10 लाख
मोतियाबिंद (Cataract) प्रति आँख	₹15,000	₹24,000	₹25,000
सरेब्रल वेस्कुलर दुर्घटना (Cerebral Vascular Accident)	₹1,20,000	₹2,20,000	₹2,80,000
हृदय रोग (Heart Disease) (एंजिओग्राम सहित)	₹1,20,000	₹2,20,000	₹2,80,000
कैंसर (Cancer)	₹1,20,000	₹2,20,000	₹2,80,000
अस्थिभंग उपचार(Treatment for Breakage of Bones) (रीढ़ की सर्जरी सहित)	₹1,20,000	₹2,20,000	₹2,80,000
किडनी रोग(Renal Complications) (डायलिसिस के साथ)	₹1,20,000	₹2,20,000	₹2,80,000
पथरी (Genito Urinary Calculus)	₹40,000	₹50,000	₹60,000
डायलिसिस PED के मामलों में(Dialysis in Case of PED cases only)	₹35, 000	₹45, 000	₹50, 000
पित्त की थैली में पथरी (Cholecystectomy)	₹40,000	₹50,000	₹60,000
एपेन्डेक्टॉमी (Appendectomy)	₹40,000	₹50,000	₹60,000
बच्चेदानी का ऑपरेशन (Hysterectomy)	₹40,000	₹50,000	₹60,000
फिस्टुला (Fistula (Anal))	₹30,000	₹40,000	₹45,000
हर्निया (सभी प्रकार के) (Harnia)	₹30,000+ जाली (मेश) शुल्क	₹40,000 + जाली (मेश) शुल्क	₹50,000 + जाली (मेश) शुल्क
एनीमिया (Anaemia) (मूल्यांकन के लिए नहीं)	₹50,000	₹50,000	₹50,000
एंजियोग्राम (Angiogram)	₹18,000	₹21,000	₹24,000
ज्वाइंट और घुटने रिप्लेसमेंट प्रति परिवार(Joint and Knee Replacement )	₹75,000	₹1,00,000	₹1,25,000

कैप्ड बीमारी सूची के मामले में ₹50,000 या उससे उपर के सभी क्लेमों पर ₹5,000 की कटौती की जाएगी।
हमें सूचित करते हुए खुशी हो रही है कि पॉलिसी में पहले से मौजूद बुजुर्ग सदस्यों की 80 वर्ष आयु पूरी होने के बाद भी पॉलिसी को रिन्युअल करते हुए जीवनभर जारी रख सकते हैं।

फैमिली फ्लोटर मेडीक्लेम: ₹2 लाख, ₹6 लाख और ₹10 लाख की बीमा राशि (Sum Insured)
1. परिवार का विवरण (1+7): आवेदक स्वतः + पति/पत्नी + 25 वर्ष के आयु तक के आश्रित और अविवाहित 4 बच्चे + माता-पिता या सास-ससुर (परिवार ग्रुप पॉलिसी में किसी एक ही जोड़ी का समावेश किया जा सकता है, दोनों जोड़ियों का संमिश्रण की अनुमति नहीं है) अर्थात इस पॉलिसी में एक परिवार के अंतर्गत अधिकतम 8 (1+7) सदस्यों को समाहित किया गया है। परिवार के सभी सदस्य जैन होना जरूरी है।
2. कोई सदस्य जिनकी आयु 45 वर्ष से अधिक ना हो जिनके परिवार में कोई जीवित सदस्य नहीं है और वे अकेले रह रहे हैं उनको व्यक्तिगत (Individual) मेडीक्लेम पॉलिसी के अंतर्गत ₹2 लाख का ही बीमा राशि कवर मिल पाएगा।

#नोट : व्यक्तिगत पॉलिसी (Individual) सदस्यों की पॉलिसी के रिन्युअल पर ₹2 लाख की बीमा राशि उपलब्ध है।

जिओ के सदस्य एक ही पॉलिसी में अपना नाम दर्ज करा सकते हैं। यदि एक ही व्यक्ति का नाम एक से अधिक पॉलिसियों में पाया जाता है तो ऐसे सदस्य को एक ही पॉलिसी में कवर दिया जाएगा अन्यथा पॉलिसी रद्द कर दी जाएगी और पॉलिसी के लिए दिए गए प्रिमियम राशि को वापस नहीं किया जाएगा।
कैशलेस क्लेमों के मामले में अस्पताल में भर्ती होने की सूचना तत्काल हमारे टोल फ्री नंबर- 1800 222 034 पर 48 घंटे के भीतर देना अनिवार्य है। रिइंबर्समेंट के क्लेमों में अस्पताल में भर्ती होने के 48 घंटों के भीतर टोल फ्री नंबर- 1800 222 034 पर सूचना देना अनिवार्य हैं। आप हमें jiointimation@ericsontpa.com पर ईमेल द्वारा भी सूचित कर सकते हैं।
पूर्व ग्रसित बीमारी को पहले दिन से 25% सह-भुगतान (Co-payment) के साथ कवर दिया जाएगा।
सह-भुगतान (Co-payment) :

मातृत्व और मोतियाबिंद को छोड़कर 25% सह-भुगतान के साथ पूर्व ग्रसित बिमारियों पर कवर दिया जाएगा।
मातृत्व और मोतियाबिंद को जोड़कर कैप्ड / अंदरूनी बीमारी पर सह-भुगतान नहीं लागू हैं (सब्लिमेट केस में सह-भुगतान नहीं है)
पूर्व ग्रसित बीमारी नहीं है तो सह-भुगतान लागू नहीं होगा।

कोई स्वास्थ्य परीक्षण (Medical Checkup) की आवश्यकता नहीं।
आयु सीमा : प्रवेश आयु 0-85 वर्ष तक, प्रस्तावक की प्रवेश आयु सीमा 18 -85 वर्ष तक मान्य हैं।
आयकर अधिनियम में धारा 80D के तहत छूट, प्रस्तावक इस छूट के लिए पात्र होगा।
ज्वाइंट रिप्लेसमेंट और घुटनों के रिप्लेसमेंट:

इस पॉलिसी के अंतर्गत पहले से मौजूदा सदस्य के प्रत्येक परिवार से एक ही व्यक्ति का नीचे दिए सब लिमिट के तहत ज्वाइंट और घुटनों के रिप्लेसमेंट (Joint and Knee replacement) करा सकते हैं।
₹2 लाख के बीमित राशि - ₹75,000/- प्रति परिवार प्रति वर्ष
₹6 लाख के बीमित राशि - ₹1,00,000/- प्रति परिवार प्रति वर्ष।
₹10 लाख के बीमित राशि - ₹1,25,000/- प्रति परिवार प्रति वर्ष।

नोट : अ) नये पॉलिसी धारक सदस्यों के लिए घुटनों या जोड़ों का रिप्लेसमेंट कराने के लिए प्रतीक्षा अवधि (Waiting period) एक वर्ष है।

आ) सड़क दुर्घटना की स्थिति में उपर दिए कैपिंग के तहत दूसरा ज्वाइंट रिप्लेसमेंट (Joint replacement) कवर दिया जाएगा (पुलिस एफआईआर का होना जरूरी है)

मातृत्व लाभ :

पॉलिसी धारक या आश्रित पत्नी ( Dependent Spouse) को मातृत्व लाभ (Maternity Benefit) की दशा में साधारण डिलीवरी (Normal) पर ₹25,000 और सिझेरियन डिलीवरी पर ₹30,000 की लिमिट के साथ कवर दिया जाएगा साथ ही मातृत्व लाभ में मात्र दो जिवित बच्चों तक का ही कवर किया गया है।

पहले से मौजूद पॉलिसी धारक (2019-20) सदस्यों को मातृत्व लाभ के लिए 9 महीनों की प्रतीक्षा अवधि (Waiting Period ) में छूट दी गई है; हालांकि इस पॉलिसी के तहत नए पॉलिसी धारक सदस्यों के लिए 9 महीने की प्रतीक्षा अवधि लागू है। ( व्यक्तिगत ₹2 लाख बीमा राशि तक के मेडीक्लेम पॉलिसी में मातृत्व लाभ (Maternity Benefits) पर प्रतिबंध है।)
आयुष (आयुर्वेद/होम्योपैथी/युनानी/योगा व नेचुरोपैथी/सिद्धा) उपचार के अंतर्गत अस्पताल में भर्ती होने पर प्रत्येक क्लेम में अधिकतम ₹10,000 का कवर दिया जाएगा और पूरे परिवार पर अधिकतम वार्षिक क्लेम ₹20,000 दिया जाएगा बशर्ते की यह उपचार सरकारी अस्पताल, राष्ट्रीय स्वास्थ्य बोर्ड या भारतीय गुणवत्ता परिषद द्वारा मान्यताप्राप्त अस्पताल में ही किया गया हो।
सायबर नाईफ (Cyberknife), श्रवण यंत्र (Cochlear Implant) और मनोरोग (Psychiatric) उपचार में 50% सह-भुगतान के साथ ₹30,000 तक का कवर दिया जाएगा।
दंतचिकित्सा: सड़क दुर्घटना की दशा में 24 घंटे अस्पताल में भर्ती होने पर कवर दिया जाएगा। (पोलीस एफआईआर जरूरी)
एक दिवसीय प्रोसिजर(Day care Procedure) आईआरडीए के निर्देशों के अधीन डे केयर प्रक्रिया को कवर किया गया है।(नीचे सूची देखें)
आपातकालीन एम्बुलेंस खर्च – अधिकतम ₹2,500/-
पूर्व-पश्चात अस्पताल के खर्च (क्रमश: 30/60 दिन) फैमिली फ्लोटर बीमा में कवर दिया गया है।
अंदरूनी जन्मजात बीमारी कवर की गई है।
सूचीबद्ध बीमारीयों की कैपिंग में ₹5,000 की कटौती की ही जाएगी, जिनके दावे (क्लेम) ₹50000 या ऊपर के है।
अवयव प्रत्यारोपण -विमित व्यक्ति को अवयव प्रत्यारोपण की जरूरत पड़ने पर दाता(डोनर) पर किए गए खर्च का भुगतान कवर हैं बशर्ते कि प्रत्यारोपण के लिए क्लेम देय है और बीमा राशि की उपलब्धता के अधीन है। दाता परीक्षण का खर्च और अवयव दान के बाद उभरी जटिल समस्याओं का खर्च देय नहीं हैं। दाता खर्च पर बीमित राशि के 10% या ₹1 लाख जो कभी कम होता है वह देय होगा।
रिन्युअल पॉलिसी के अंतर्गत कैपिंग:

*सूचीबद्ध बीमारीयों की कैपिंग में ₹5,000 की कटौती की ही जाएगी, जिनके दावे (क्लेम) ₹50,000 या ऊपर के है।

सभी जिओ सदस्य जो 2014 से जिओ ग्रुप मेडीक्लेम पॉलिसी के साथ जुड़े हुए थे और किसी कारणवश बंद कर दिए थे वे भी 2020-21 में आवेदन करके नए पॉलिसी धारक के तौर पर पूरे परिवार के साथ लाभ ले सकते हैं।

कोरोना वायरस (कोविड-19): महामारी घोषित करने के बावजूद इस पॉलिसी के अंतर्गत कोरोना वायरस(कोविड-19) के उपचार पर कवर दिया गया हैं।
श्रावक आरोग्यम व्यक्तिगत दुर्घटना बीमा (GPA cover)

आकस्मिक मृत्यु होने पर इस मेडिक्लेम पॉलिसी के अंतर्गत परिवार के सभी सदस्यों को ₹5 लाख के बीमा राशि ग्रुप व्यक्तिगत दुर्घटना कवर प्रदान किया गया है। सभी व्यक्तिगत दुर्घटना के दावे के लिए पुलिस एफआईआर अनिवार्य है। (नोट : यह दुर्घटना बीमा योजना जैन स्वास्थ्य बीमा योजना के अंतर्गत आने वाले सभी सदस्यों पर लागू है।)

मेडिक्लेम पॉलिसी में शामिल सभी परिवार के सदस्यों को व्यक्तिगत दुर्घटना लाभ दिया गया है। उसके लाभ के लिए परिवार के सदस्यों की आयु 18 वर्ष से 75 वर्ष के बीच होनी चाहिए।

इस व्यक्तिगत दुर्घटना पॉलिसी में केवल आकस्मिक मृत्यु का ही कवर दिया जाएगा।

अधिक जानकारी के लिए उपर दिए नियम व शर्तों को देखें

नोट: उपर दिए गए हिंदी अनुवाद मात्र आसानी से समझाने और समझने के मकसद से किया गया है, सभी प्रकार के न्यायिक प्रकियाओं के लिए अंग्रेजी भाषांतर (English Version) ही मुख्य रूप से मान्य और फायनल होगा।

कृपया विस्तृत जानकारी के लिए जिओ वेबसाइट देखें या जिओ सहायकों से संपर्क करें।

I am Thankful

1. I appreciate JIO for being a facilitator for this highly beneficial Group Mediclaim Policy for social upliftment of Community.

2. Jain International Organisation (JIO) is NOT an Agent, a Broker or an Insurer but JIO is an organisation who has selected Mediclaim Service Partners (Insurance Co., TPA and Broker) for the wellbeing of its members.

3. The policy would be issued by Insurance Co. on main name of JIO i,e JIO is the primary Insured. I and my family members would be beneficiaries under JIO’s policy.

4. Claims are processed by TPA and JIO has no role in claim processing. If any need arise, I can take assistance of JIO and its service partner (Broker) to guide me in the claim process and/or legal solution.

I UNDERSTAND THIS AND ACCEPT that if the services of Insurer, TPA or Broker are found to be improper, I will not blame JIO and will not take any legal action against my own organisation JIO.

I Confirm

Continuity coverage is as per option selected for "JAIN SWASTHYA BIMA YOJANA RENEWAL (2020-21)"

I HAVE READ, UNDERSTAND AND ACCEPT THE TERMS AND CONDITIONS.

Timing : 10 AM to 1 PM & 2 PM to 5 PM
STATE	CITY	OFFICE Address	CONTACT PERSON	MOBILE NO	EMAIL
Maharashtra	Mumbai	11-C, Corporate Park, S. T. Road, Chembur, Mumbai - 400071,	Mr. Nikhil Ashokan	022-25221093	nikhil.ashokan@ericsontpa.com
	Mumbai	11-C, Corporate Park, S. T. Road, Chembur, Mumbai - 400071,	Mr. Nikhil Ashokan	022-25221093	nikhil.ashokan@ericsontpa.com
	Pune	98, 4th Floor, A wing, Shreenath Plaza, F. C. Road, Shivaji Nagar, Pune-411004	Dr. Sandip Kadam	022-25221093	drsandip@ericsontpa.com
Gujrat	Ahmedabad	437, B-wing , Advance Business Park , Opp: Swaminarayan Temple, Shahibaug, Ahmedabad-380004	Mr Imran Shaikh	022-25221093	imrans@ericsontpa.com
	Vadodara	Will operate from residence.	Mr. Jaimin Gandhi	022-25221093
	Surat	316, Jolly Plaza, Near Navdi Bhandar, Athwa Gate, Surat - 395001	MR. Rinkesh Patel	022-25221093	rpatel@ericsontpa.com
Delhi		#809, Pragati Tower, Rajendra Palace, New Delhi-110008	Dr Satyakam Bhairma	022-25221093	satyakam@ericsontpa.com
Bengaluru		105, Level 1, Prestige Centre Point, Cunningham Road, Bangalore - 560052	Mr Shiva Kumar	022-25221093	shivakumar@ericsontpa.com
Chennai		7K, Century Plaza, New No. 526, Old No. 560-562, Anna Salai, Chennai- 600018	Mr Balajee	022-25221093	ksbalajee@ericsontpa.com
Kolkatta		515, M.A Business Centre Pvt Ltd.5th Floor, Poddar Point, North Block, Park Street, Kolkata -700116	Mr Partha Sarkar	022-25221093	parthas@ericsontpa.com

Policy Servicing - JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW POLICY (2020-2021)

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW POLICY(2020-2021 )

PARTNERS for JIO MEDICLAIM POLICY Insurance Company: Universal Sompo General insurance Co. Ltd. TPA: Ericson Insurance TPA Pvt. Ltd. Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

Wellness Partner – Wockhardt Hospitals, Metropolis, Med life, RG Urology & Laparoscopy Hospital,Apollo Pharmacy, Infigo Eye Care Hospital, IGENETIC DIAGNOSTICS

PREMIUM Details for JIO POLICY RENEWAL, RENEWAL/NEW POLICY

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW HEALTH PLAN (2020-2021 )

PARTNERS for JIO MEDICLAIM POLICY Insurance Company: Universal Sompo General insurance Co. Ltd. TPA: Ericson Insurance TPA Pvt. Ltd. Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

Wellness Partner – Wockhardt Hospitals, Metropolis, Med life, RG Urology & Laparoscopy Hospital,Apollo Pharmacy, Infigo Eye Care Hospital, IGENETIC DIAGNOSTICS

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW POLICY (2020-2021 )

PARTNERS for JIO MEDICLAIM POLICY Insurance Company: Universal Sompo General insurance Co. Ltd. TPA: Ericson Insurance TPA Pvt. Ltd. Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

Wellness Partner – Wockhardt Hospitals, Metropolis, Med life, RG Urology & Laparoscopy Hospital,Apollo Pharmacy, Infigo Eye Care Hospital, IGENETIC DIAGNOSTICS

What are Wellness Benefits ?

परिवार का विवरण

बीमा राशि (Sum Insured)

कुल रक्कम

फैमिली फ्लोटर 1+7 साईज में

₹10 लाख

₹41,000

फैमिली फ्लोटर 1+7 साईज में

₹6 लाख

₹28,675

फैमिली फ्लोटर 1+7 साईज में

₹2 लाख

₹21,500

व्यक्तिगत (Individual) पॉलिसी (45 वर्ष से कम)

₹2 लाख

₹8,000

कैपिंग 2020-21

बीमारियां

₹2 लाख

₹6 लाख

₹10 लाख

मोतियाबिंद (Cataract) प्रति आँख

₹15,000

₹24,000

₹25,000

सरेब्रल वेस्कुलर दुर्घटना (Cerebral Vascular Accident)

₹1,20,000

₹2,20,000

₹2,80,000

हृदय रोग (Heart Disease) (एंजिओग्राम सहित)

₹1,20,000

₹2,20,000

₹2,80,000

कैंसर (Cancer)

₹1,20,000

₹2,20,000

₹2,80,000

अस्थिभंग उपचार(Treatment for Breakage of Bones) (रीढ़ की सर्जरी सहित)

₹1,20,000

₹2,20,000

₹2,80,000

किडनी रोग(Renal Complications) (डायलिसिस के साथ)

₹1,20,000

₹2,20,000

₹2,80,000

पथरी (Genito Urinary Calculus)

₹40,000

₹50,000

₹60,000

डायलिसिस PED के मामलों में(Dialysis in Case of PED cases only)

₹35, 000

₹45, 000

₹50, 000

पित्त की थैली में पथरी (Cholecystectomy)

₹40,000

₹50,000

₹60,000

एपेन्डेक्टॉमी (Appendectomy)

₹40,000

₹50,000

₹60,000

बच्चेदानी का ऑपरेशन (Hysterectomy)

₹40,000

₹50,000

₹60,000

फिस्टुला (Fistula (Anal))

₹30,000

₹40,000

₹45,000

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd

PARTNERS for JIO MEDICLAIM POLICY
Insurance Company: Universal Sompo General insurance Co. Ltd.
TPA: Ericson Insurance TPA Pvt. Ltd.
Insurance Brokers: Edelweiss Gallagher Insurance Brokers Ltd