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

Payment for policy premium is accepted only through Online Payment

CASH/ CHEQUE/ NEFT & RTGS WILL NOT BE ACCEPTED

 



 

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

TOTAL Amount  incl. Mediclaim Plan Subscription ,Wellness,GPA (With GST)

 Family Floater of size 1+7

 Rs.10 Lakh

 41,000

 Family Floater of size 1+7

 Rs.6 Lakh

 28,675

 Family Floater of size 1+7

 Rs. 2  Lakh

 21,500

 Individual below 45 Yrs. Only

 Rs. 2 Lakh

8,000

  

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 :
  1. Medicine Discount (Upto 22%)
  2. Laboratory Discount (Upto 25%)
  3. OPD consultation – Dental & Eye Checkups
  4. Newsletter
  5. Health Tips
  6. Doctor on Call
  7. Cancer screening camp
  8. 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. However Cashless facility will start from 1st May,2020 onwards.

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.

  1. FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.6 Lacs and Rs.10 Lacs. 
  2. 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.
  3. 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 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.

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.

 




 

 

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
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