JIO Super Top Up Renewal 2020

1. Available for All JAIN Shravak-Shravika Members of JIO

2. ENHANCED YOUR SUM INSURED UPTO Rs.20 Lakh at very Nominal Premium.

3. Available SUPER TOP-UP sum Insured of Rs. 2 Lakh, Rs.5 Lakh and Rs.10 Lakh

4. FAMILY Floater for Maximum 6 members (1 + 5).

5. Proposer + Spouse ( Husband/wife)

   + 2 Dependent Unmarried Children Up to 25 years of age

   + 2 Dependent PARENTS OR PARENTS IN-LAWS Up to 85 years

   ( Any one set of parents to be covered, combination not allowed).

6. Maximum entry age: - Up to - 85 YEARS.. Once enrolled LIFE TIME renewal possible.

7. NO MEDICAL CHECKUP required.

8. PRE-EXISTING DISEASE Cover from DAY ONE.

9. NO WAITING PERIOD. (Waiting period for 1st year, 2nd year and 4th year disease are not applicable.)

10. Chemotherapy is  5000/- per cycle maximum Upto 1 lakh per family per policy year. Dialysis is  5000/- per cycle maximum Upto 1 lakh per family per policy year. Radiotherapy is  5000/- per cycle maximum Upto 1 lakh per family per policy year. Major Organ transplant / Surgery to be limited to 50% of Sum Insure.

11. NO CO-PAYMENT APPLICABLE ON ANY TYPE OF CLAIMS.

12. Opportunity to avoid heavy deduction due to ROOM RENT LIMITS.

13. PRE-HOSPITALIZATION Medical Expenses up to 30 DAYS COVERED.

14. POST-HOSPITALIZATION Medical Expenses up to 60 DAY COVERED.

15. IRDA Daycare procedure are covered.

16. Claims Payable on REIMBURSEMENT BASIS only

17. AYUSH TREATMENT is also covered up to limits defined by IRDA.

18. Portability available for the policy after a year at the time of renewal.

19. Proposer will be eligible for DEDUCTION UNDER SEC. 80 D of Income Tax Act.

20. POINTS TO BE NOTED FOR “SUPER TOP UP”

21. It ENHANCED YOUR existing mediclaim SUM INSURED

22. This plan is also available for members without any Mediclaim

23. You can top up any type of your existing mediclaim may it be JIO Mediclaim, Retail Individual Mediclaim, Family floater mediclaim or Group Mediclaim by this plan.

24. You can choose from any option as deductible limit irrespective of your existing mediclaim sum insured.

25. DEDUCTIBLE LIMIT: The chosen amount up to which the aggregate medical claims of family will not be payable by this super top up policy incurred during the policy period.

Super Top Up Mediclaim PREMIUM CHART :

With GST
Deductible SI	SUM INSURED	Rate below 60	Rate above 61 to 85
200000	200000	10,606	17,610
	500000	15,909	26,670
300000	200000	8,729	14,634
	500000	13,095	21,953
	1000000	19,459	32,311
500000	1000000	13,235	22,188
	500000	8,824	14,791
	200000	6,874	11,636
1000000	1000000	7,941	13,313
	500000	6,188	10,372
	200000	4,123	6,913

26. Members who do not have any mediclaim policy can get this policy with Minimum deductible of Rs.3 Lakh

27. If any member of the family is not covered under any existing mediclaim policy still he/she can be covered under super top up policy in family floater. But for that particular member Minimum deductible of Rs.3 Lakh is applicable at the time of claim.

28. If any member of the family is not covered under any existing mediclaim policy at the time of claim . Minimum deductible of Rs.3 Lakh is applicable in such cases.

29. Member can choose SUM INSURED from Rs. 2 Lakh, Rs.5 Lakh or Rs.10 Lakh.

30. Options of DEDUCTIBLES for Rs. 2 Lakh, Rs. 3 Lakh, Rs.5 Lakh or Rs.10 Lakh are available. Deductible is amount up to which member’s base policy will pay the claim and super top up policy will respond once the deductible amount is exhausted. If the insured does not have base policy, the insured will have to bear the expenses upto deductible limit.

31. higher of room rent between super top up sum insured or base policy sum insured is applicable when claim under super top will be calculated.

32. Super top up policy will pay all the claims those are falling within policy period of super top up policy. If base policy sum insured is exhausted or partially exhausted before inception of super top up policy then the same will not be paid.

33. Hospitalisation claims incurred during the super top up policy period for the whole family in one or more occasions once cross the deductible limit will be paid under the policy.

34. Addition / Deletion : New born babies and newly married spouse can be added provided baby birth and marriage intimation is given in mail on jio.insurance@edelweissfin.com within 20 days of birth / Marriage. Deletion / Cancellation not allowed since this is a Group Mediclaim policy.

35. GENERAL EXCLUSIONS IN MEDICLAIM POLICY

    1. 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.

    2. 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.
    3. Risky Sports, Military etc. : 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.
    4. 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
    5. Weight management programs or treatment in relation to the same including vitamins and tonics, treatment of obesity (including morbid obesity).
    6. Correction of eyesight : Treatment for correction of eyesight due to refractive error including routine examination.
    7. Health check-ups : All routine examinations and preventive health check-ups.
    8. 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.
    9. 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.
    10. Hospitalisation not required : Conditions for which treatment could have been done on an outpatient basis without any Hospitalization.

         

    11. Experimental treatment: Investigational treatments, Unproven / Experimental treatment, or drugs yet under trial, devices and pharmacological regimens.

    12. Diagnostic Only : Diagnostic tests/procedures/treatment/consumables not related to Illness for which Hospitalization has been done.

         

    13. 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.

         

    14. PREVENTIVE CARE, vaccination including inoculation and immunizations (except in case of post-bite treatment); any physical, psychiatric or psychological examinations or testing.

         

    15. 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.

         

    16. Hearing aids, contact lenses or spectacles including optometric therapy, multifocal lens.

         

    17. Baldness : Treatment for alopecia, baldness, wigs, or toupees, and all treatment related to the same.

         

    18. Diabetic test strips etc.: Medical supplies including elastic stockings, diabetic test strips, and similar products.

         

    19. External durable medical equipment: Any expenses incurred on prosthesis, corrective devices external 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.

         

    20. External Congenital Anomalies or diseases or defects.

         

    21. Stem cell therapy or Surgery, or growth hormone therapy.

         

    22. 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.

         

    23. “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.

         

    24. Complications arising out of pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy for in-patient only. This exclusion is applicable for 1 yr. only. After 1st renewal Maternity is covered as per limit.

         

    25. 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.

         

    26. Organ donor screening: Expenses for organ donor screening, or save as and to the extent provided for in the treatment of the donor (including Surgery to remove organs from a donor in the case of transplant Surgery).

         

    27. Illegal Organ Transplantation : Admission for Organ Transplant but not compliant under the Transplantation of Human Organs Act, 1994 (amended).

         

    28. 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.

         

    29. Dental Treatment: Dentures, implants and artificial teeth, Dental Treatment and Surgery of any kind, unless requiring Hospitalization due to an Accident.

         

    30. 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.

         

    31. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health.

         

    32. Treatment for developmental problems, learning difficulties eg. Dyslexia, behavioural problems including attention deficit hyperactivity disorder (ADHD).

         

    33. 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,

         

    34. 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.

         

    35. 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.

         

    36. Treatment charges or fees charged by any Medical Practitioner acting outside the scope of license or registration granted to him by any medical council.

         

    37. 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.

         

    38. 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.

         

    39. 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).

         

    40. 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

         

    41. Treatment taken outside India

         

    42. 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.

         

    43. Robotic surgery (whether invasive or non-invasive)

         

    44. All forms of Bariatric surgery.

         

    45. Use of Radio Frequency (RF) probe for ablation or other procedure unless specifically approved by Us in writing in advance.

         

    46. Admission primarily for diagnostic purposes not consistent with the treatment taken.

         

    47. Blacklisted Hospital, Doctor : Treatment in any Hospital or by any Medical Practitioner or any other provider of services that We have blacklisted as listed on Our website.

         

    48. Treatment provided by anyone with the same residence as Insured Person or who is a member of the Insured Person’s immediate family.

         

    49. Holmium Laser Enucleation of Prostate, KTP Laser Surgeries, Femto laser surgeries, bio-absorbable stents, bioabsorbable valves, bioabsorbable implants, oral chemotherapy, use of Infliximab, rituximab, avastin, lucentis.

36.  

101)  What is JIO Super Top Up Insurance Policy?

Super Top Up policy brought to you by JIO is family floater policy which offers you coverage of Mediclaim above your chosen deductible limit along with extra ordinary features.

It offers you financial relaxation in the event when your hospitalisation claim bill crosses your sum insured under any other Mediclaim policy. Thus it acts as cushion & comes in to action when you have exhausted the chosen limit.

102)   What is difference between Mediclaim and Super top-Up policy ?

Mediclaim policy  pay the claim from Rs. 1/- till maximum Sum Insured under your base policy. Whereas Super top-up policy cover hospitalization expenses beyond the chosen Deductible limit.  The deductible limit is chosen by you. In other word it is a Mediclaim policy which triggers after a certain pre-decided limit of expense has crossed. Further mediclaim and super top up policy can work along with one another. That is, if you have a mediclaim you can also purchase a super top up policy to get an enhance cover. Insert Half Pie chart here

103)   Why should I take JIO Super top-up policy when I already have Mediclaim Policy ?

• It increase your sum insured at very reasonable premium
• NO Co-Pay, No waiting period.
• Chemotherapy is 5000/- per cycle maximum Upto 1 lakh per family per policy year. Dialysis is 5000/- per cycle maximum Upto 1 lakh per family per policy year. Radiotherapy is 5000/- per cycle maximum Upto 1 lakh per family per policy year. Major Organ transplant / Surgery to be limited to 50% of Sum Insure.
• Pre-existing Disease are also covered from Day One.
• Opportunity to avoid heavy deduction due to Room Rent limits.
• JIO Super Top Up plan is cheapest super top up plan available in the market.
• For higher age person above 55 years of age it is very difficult to increase the sum insured hence JIO super top up policy is advisable where we are offering sum insured of Rs.10 lakh up to 85 years of age.

104)   How Super top-up policy is more beneficial than general Top up policy?

Whenever any one hospitalisaion exceed your base policy sum insured then claim is payable under top up policy.   It is rare incident that single hospitalisation can arise where total hospitalisation bill will cross Rs.2 lakh or deductible selected by you. Whereas under Super Top Up Policy aggregate of all claims made by your family members once crosses the base policy sum insured then your super top policy will start making the claim payment.

105)   If I have floater mediclaim policy then how super top up policy will pay the claim ?

In floater Mediclaim policy the base sum insured will be for all the members of the family. Hence either the claim amount should exceed the deductible amount or sum insured should be exhausted for super top up policy to respond. Under floater policy claims of one or more member of the family or one or more claim of one of the family member should exceed the deductible amount chosen under super top up sum insured.

106)     If I have Individual mediclaim policy then how super top up policy will respond ?

In individual Mediclaim policy every family member will have his own sum insured under base policy. Hence for super top up policy to respond his claim amount should cross the deductible limit under super top up policy. His / her other family members sum insured still remaining balance under base policy.

107)   Who can be covered under JIO Super Top Up Policy ?

All sharavak & shravika members of JIO can covered under Super top up policy.

108)   Who all from my family member can be covered under the Super Top UP policy?

Your entire family can be covered under the policy maximum up to 6 members. Yourself, Spouse, 2 dependent unmarried Children up to the age of 25 years of age and two parents/Parents In-Laws Up-to 85years can be covered under the policy.

109)   What is the maximum age to be covered  in the policy?

85 years is the age limit for policy holder. Once join then they will be covered life long on renewal of policies.  

110)   What is a base policy you are referring to?

Base policy is your Mediclaim policy. It can be your JIO mediclaim policyindividual Mediclaim policy or family floater Mediclaim policy. It can also be your group Mediclaim policy offered by your employer. The sum insured under your base policy is base policy sum insured.  

111)   How to select  Sum-Insured under super top up policy?

Higher the better. You can select sum insured from Rs.2 Lakh, Rs.5 Lakh or Rs.10 Lakh option. However it is better you select Rs.10 lakh as sum insured because sum-Insured cannot be enhanced for 3years once chosen. However it can be reduced at renewal.  

112)   What you mean by deductible Limit ?

Deductible limit is a pre-decided limit chosen in super top-up Policy by you.  Super Top-up policy gets triggered and starts paying claim once the aggregate expense crosses this deductible limit. 

Example-1: Single Claim in a policy year

Example-2: Multiple Claims in a policy year

 

113)   Can I choose deductible limit less then/ more then my base policy sum insured?  

Ideally we should choose deductible limit which is equal to your Mediclaim policy sum insured so you should get optimum cover. However it is not compulsory to choose only the same. You can choose lower than/ Higher then your base policy sum insured. We have option of Rs.2 lakh, Rs.3 lakh, 5 Lakh or Rs.10 Lakh as deductible sum insured. You can choose any of the above.  

114)   What are the deductible option available in JIO Super Top-Up policy ?  

Member with Base Policy : Deductible 2lakh, 3lakh , 5lakh and 10 lakh Member without base Policy : Deductible 3lakh , 5lakh and 10lakh .  

115)   Can I get super top up policy if I don’t have base Mediclaim policy ?

If you or your family member does not have Mediclaim policy then you can still get super top up policy.

116)   If some of my family member do not have cover under any mediclaim policy Can I get super top up policy?

Yes. Still you will get super top up policy and cover these members also in super top up policy. However for those members who do not have any other mediclaim policy their deductible under super top up policy will be minimum Rs.3 Lakh. 

117)   High value claim is rare to occur then why I should take super top up policy ?  

It is not necessary that in single hospitalisation your sum insured should be exhausted. Even in aggregate of multiple hospitalisation of smaller claims, cross your  base policy sum insured then super top up policy will come to your rescue and pay the balance hospitalisation bills. All the hospitalisation bills for more than one member of your family can also be accumulated to claim under super top up policy.  

118)   Can I accumulate hospitalisation bills of my all family members to exhaust the deductible limit?

In super top up policy, all the hospitalisation claims of all the members covered under the policy can be accumulated. So super top up policy will trigger once multiple hospitalisation claims of your all family members crosses the deductible limit.  

119)   What period’s hospitalization claims I can get under super top up policy?  

You can claim all the bills for which hospitalization has occured during super top up policy period. If your base policy period is 1st Jan, 2018 to 31st December, 2018. Super top up policy period is 1st April, 2018 to 30th March, 2019 and If you have claims paid under base policy before inception of super top up policy i.e. 1st April 2018  then the same will not be considered for exhaustion of deductible limit of super top up policy. 

121)    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.    

122)   What cover super top up policy offers to you ?

Super top up policy covers all hospitalisation expenses covered under your base policy. In addition whether your base policy is covering Pre- existing disease or not it covers Pre existing disease from Day 1 under the policy. If your base policy has waiting period for PED cover then you opt for deductible more than Rs.3 lakh in which case your PED claims will also be paid under Super Top Up Policy.

• Hospitalisation expenses covered Pan India occurred either due to accident or natural diseases.
• In patient hospitalisation expenses will be covered in reimbursement basis.
• No Medical test to be done prior taking this policy.
• No waiting period is applicable under the policy for hospitalization claims.
• 30 days pre hospitalization expenses are included: Medical expenses incurred 30 days prior to the hospitalization are reimbursed.
• Post Hospitalization expenses up to 60 days are covered.
• Internal congenital diseases covered.
• Minimum Hospitalization of 24 hours required for the treatment, which cannot be taken at home.
• The minimum hospitalization clause is not applicable for Cataract, Chemotherapy & fracture or any Day Care treatment.

123)   What will be the general exclusions as per policy terms and conditions?

The list of exclusions are mentioned in Terms and condition applicable to super top up policy. All the exclusions are common between your base policy and super top up policy. However under super top up policy exclusions like Pre-existing diseases , Waiting period of special disease & 30days are not applicable (For more details please refer point no. 34 available in Terms & Conditions section)

125)   I have completed 60 years of age and running 61 years of age will premium for my family will be charged as per up to 61 or Up to 85 years ?

In mediclaim completed age is counted. Hence to consider where the premium of upto 85 years slab will be charged you or not, no one in your family should be borne before 1st April, 1957.

126)   I am a proposer & my age is 45 years, my father’s age is 65 years.   which slab premium will be applicable to me?  

Since maximum age of the one of the family member is above 61 years you will be charged premium of 61 – 85 years of age.

127)   I am I eligible for Tax Benefit under Super Top UP Policy  

Yes, you will get Tax benefit under section 80D  

128)   Is there any co-payment under Super Top Up Policy  

No. There is no co-payment applicable to Super Top Up Policy.

129)   Would this policy is subject to any medical test?  

No, this is Super Top Up Policy need not to undergo any medical test.  

130)   What would be the period of the policy?  

The policy would be for one year from the date of inception.

131)   What is the name of Insurance Company? 

New India Assurance Co. Ltd

132)   What is the name of Broker?

Edelweiss Gallagher Insurance Brokers Limited ( EGIBL )  

133)   Where would my policy copy & cards delivered?

Your Super Top Up policy certificate will be available on groupinsurance.bluebox.com. The TPA I-cards will be made available to each customer and their dependents on groupinsurance.bluebox.com. E-cards are also available at TPA site and JIO site as well.    

135)   In how many days Company will issue Policy Copy and TPA card?  

Policy would be issued within 15 days and the e-card would be issued after 10 days of policy issuance.  

136)   How do i purchase the policy?

Please follow the below mentioned steps:

1. Please go on www.jiojac.com
2. Select “JIO SUPER TOP UP RENEWAL 2020 ” Scheme
3. Read revise Terms & Conditions carefully
4. Enter JIOJAC ID
5. Fill your enrolment details on BlueBox (Edelweiss Broker Partner)
6. Make payment ONLINE on JIO website

137)   If I don’t have JIO JAC Id, can I opt for Mediclaim Policy under JIO Super top up plan?  

No, You can’t opt for Super top-up plan . JIOJAC ID is compulsory. Please register online for JIOJAC ID.

138)   Does this scheme have cashless facility?  

No, You can only claim through reimbursement. But in all cases immediate intimation shall be given to our Call Center within 24 hours of Hospitalization.  

139)   Is there any tax rebate?  

Yes, under section 80 D you can claim TAX Rebat  

140)   Can I have the policy number?  

No, you will not get Policy Number. However you will receive Health ID card thorough which you can come for reimbursement claim  

141)   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  

142)   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.

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

No, Loction does not affect the operational activities, main member or the dependent member can avail same and equal benefits irrespective of their location. In other words if few members covered under the policy is staying at Native place or some other cities than of the self under the policy. They can raise their claim under the policy and submit the attested copies of the document in the nearest city in Ericson TPA office.  

144)   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. 

145)   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.

146)   If I have a health insurance policy in Mumbai, can I make a claim if I am transferred to Delhi?  

Yes, your health insurance policy is valid all over INDIA

147)   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.

148)   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 6 members i.e. Proposer + Spouse + 2 Dependent Unmarried Children up to 25 years of Age + Parents/or Parents or Laws.

149)   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

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

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

151)   Can I take my married daughter in policy?

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

152)   Is this Applicable on Pan India basis?

Yes this policy is for Pan India Jain population only.

153)   Is this applicable for NRI?

Yes , NRI Jain can take the policy but hospitalization should happen in India and the proposer should have Bank account in India.

154)   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.Also there is no waiting period in any illness.

155)   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.

156)   If I don’t have JIO JAC Id, can I opt for Mediclaim Policy under JIO HEALTH PLAN?

No, You can’t opt for MEDICLAIM Policy.  

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

Yes only is she is a Jain by birth.

158)   Can one prepare a Jain Certificate?

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

159)   If I am running 61 years of age will premium for my family will be charged as per up to 61 or Up to 85 years ?

In mediclaim completed age is counted. Hence to consider where the premium of upto 85 years slab will be charged you or not, no one in your family should be borne before 1st April, 1957.

Section II : claim Procedure

160)   How I can claim Under Super Top Up Policy ?  

Your super top up policy will pay claim on reimbursement basis. Once your base policy has paid the claim either under cashless or reimbursement basis, you need to submit attested copy of entire claim file under Super top Up policy. The attested claim file from your base policy TPA should have settlement voucher which will show details of claim payment. Only you should not forget to intimate claim under your Super Top Up Policy during hospitalisation. Once your claim under base policy is paid you should submit the attested claim file within 30 days under Super Top Up Policy.  

161)   Basic Criteria to claim under Plan A?  

Claim need to be settled under Base Policy. Base policy Sum Insured should get exhausted. In case of base policy having individual sum insured the Top Up policy will come in picture when his individual sum insured is exhausted of the respective patient. 

162)   Whether copayment or sublimit category of deduction can be claimed under Super Top-Up policy ?  

No till the time your basic Policy Sum Insured is balance.  

163)   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.  

164)   Can I claim my dentist's bills?

No. You can do so only in cases arising from Road Accidents

165)   When will I be eligible for my maternity claim?  

No. Maternity benefit is not their in this scheme.

166)   Whether Non Medical expenses can be claimed under Super top-Up policy?  

No. Non medical expenses as per list prepared by IRDAI like hand gloves, savlon, apron, registration fees, service charges are not payable under any Mediclaim policy.  

167)   Whether claim denied under exclusion clause in Base policy can be claimed under Super to-up policy?  

No,  

168)   What are the expenses that can be claimed under the Super top-up policy?  

The expenses that are reimbursed under Mediclaim policy are –

• 30 days prior to hospitalization all the expenses related to disease for which hospitalization is done like doctors bill, medical cost, test and report cost etc.
• Hospitalization bill which will include Room charges, doctors fees, surgeon fees, operation theatre cost, nursing charges, medicine charges and internal implant cost.
• After discharge all doctors bill, medical cost, test and report cost till 60 days from date of discharge from hospital. Cost of Prosthetic devices implanted during surgical procedure like pacemaker

169)   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.

170)   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.  

171)   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 or inception of the policy. However for policy to start paying claims your deductible Sum insured should exhaust.  

172)   How would I get the payment of claim?

The claim amount would be transferred to CUSTOMER’s Bank account made available with claim file by NEFT.

173)   Who will receive the claim amount if the insured dies at the time of treatment?  

The claim amount is paid to the nominee of the insured. If no nominee has been assigned under the policy, 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    

174)   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 registered with local government body. 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.

175)   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.

176)   Is maternity benefit available under an individual Health Insurance Plan?

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

177)   What is my room rent eligibility under both the schemes?

Room Rent Limit : Member with Base Policy : As per Base Policy or 1% for Normal Room & 2 % for ICU Room per day on Base Policy SI or 1% for Normal Room and 2 % for ICU per day on Super top up sum insured whichever is higher. Member without Base Policy : 1% for Normal Room and 2 % for ICU per day on Super top up deductible sum insured. (If the Insured occupies a room with a room rent limit other than his eligibility, then all the other charges except medicine shall be limited to the charges applicable for the eligible room rent or actual).

178)   Why the Claims process is complex?  

The process of filing claims for 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 are relaxed in super top up Policy.      

179)   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 for easy processing of claims.        

180)   What are the options for making payment of balance premium amount?  

The members have to make payment of premium amount online through our Website only from following options

1. Credit / debit card.
2. UPI
3. Netbanking
4. EMI
5. OLA Postpaid
6. Wallets

181)   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.    

182)   When and where to intimate at the time of hospitalization?  

At the time of hospitalization the person should intimate TPA and Edelweiss Gallagher Insurance Brokers (EGIBL) on jio.insurance@edelweissfin.com Toll free 1860-425-0254 within 24hrs. One can use either the TOLL FREE number or on email or by fax to the numbers mentioned on Cashless cards or policy document.  

183)   In how many days claims get settled?  

It takes around 21 working days to get the claim settled on reimbursement basis  

184)   Claim Documents (for reimbursement)  

1. Attested hospital final bill
2. Attested photocopy of numbered receipts for payments made to the hospital
3. Attested photocopy of Complete breakup of the hospital bill
4. Attested photocopy of Discharge Card/Summary
5. Attested photocopy of investigation reports
6. Attested photocopy of medicine bills with relevant prescriptions
7. Original Settlement voucher of Base Policy in case of Option A
8. Original signed claim form
9. Photo ID card copy of claimant
10. TPA Card copy
11. Intimation mail copy/ Claim Registration no. 11. Attested photocopy of FIR/MLC copy incase of Road accidents. If MLC is not applicable then written confirmation from Doctor/Hospital that the patient was not under influence of alcohol ordrugs.
12. Any further document which claim assessor feel necessary to adjudicate the claim.

-All the bills/reports/prescription are to be submitted in duplicate attested from previous insurer.

185)   Would any one assist me in claim process?  

Yes. Edelweiss Gallagher Insurance Brokers (EGIBL) and respective TPA, would assist you in your claim settlement. You may write to us on jio.insurance@edelweissfin.com or call 1860-425-0254. Few Examples of how your claim will be paid under Super top-Up policy :-  

 

Section III Myths and Facts about JIO Insurance Policies.

301)  JIO is an Insurance Company?

NO,
JIO is not an insurance company and does not give any type of insurance policy. JIO has ONLY played the role of a negotiator for benefits of its Shravak / Shravika members.

302) Who manages the Insurance Policy?  

The Policy is serviced by the following three entities:

1. Insurance Brokers (Like Prudent, Alliance, Almonds, Edelweiss Insurance Brokers ltd ( EIBL) 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.
2. Insurance Company (Like Govt. companies - National Insurance, Oriental Insurance & Pvt. Companies - ICICI Lombard, Star Health , Aditya Birla Health etc.) The Mediclaim policy is issued by the government approved Insurance Companies under the regulation of IRDAI. 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.
3. Third Party Administrators - TPA (Like Paramount, Vipul TPA, Vidal TPA, 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 .

303)  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.  

304)  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. Taking into consideration feedback of member’s , JIO always try to make the process more user friendly .   305)  Whether any persons are available for help during enrollment or at the time of claim    like Insurance Agents? NO, JIO has not appointed/authorized any retail agents for selling / marketing its policies. But, 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. Members can take help / advice from helpline number of the insurance company/TPA/Insurance Broker for detailed enquiry regarding enrollment or claim . Alternatively, at the time of claim,  members can also take help from any insurance agent because the process of claim is same as retail insurance policies.  

306)   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.
• Speedy Enrollment anytime from anywhere
• Immediate confirmation of enrolment completion.

307)  Why JIO JAC number is compulsory?  

This is an exclusive insurance policy for Sharvak and Shravika members of Jain International Organisation(A Known worldwide organization of Jain’s ). For effective control and to maintain exclusivity of policy , JIO has linked all processes with JAC ID . Jain Advantage Card (JAC) is a unique & permanent identification issued by JIO to all its member’s . Members can easily participate in the programme’s of JIO without having to provide various details everytime & they can also easily connect with fellow Shravaks.     

308)   Why the  policy does not start immediately after the payment of premium ?  

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, 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.  

309)   Why the claim process is complex ?

NO The process of filling claim for cashless or reimbursement with the Insurance Company is the same for JIO policy like any other retail Mediclaim policy’s and in accordance with IRDA guideline. The timeline of intimation is 24 hour and after intimation you can submit the claim paper’s within 30days .  

310)  Whether insurance company wrongly make huge deduction in JIO policy ?

No The deduction from claim are as per the terms of the policy and no add –hoc deduction’s are made by the TPA or insurance company. The TPA and Insurance company are bound by the guidelines of IRDA . However , in case any claim’s are wrongly deducted or disallowed , than the members can approach greviance department of insurance company or Ombudsmen department of IRDA. These actions are within the rights of every policy holders.

311)  Whether the JIO is responsible for answering queries on claims disbursal and deduction?  

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 claim process , status of claim, reasons of deduction from claim etc. are handled by the concern TPA . In cases where the greviances of policy members remain unresolved by the TPA the member can escalate such urgent/important issues with the servicing brokers or JIO officials.JIO in turn will take up these issues with the concern authority through Brokers. However the claims will be decided on merits of the case and within the terms of the policy.  

312)   Whom to contact for resolving queries and complains ?

For any queries and complaint in regard to Super Top-Up plan , please contact Edelweiss Gallagher Insurance Brokers over Toll Free No. 1800-3010-3360 , email id jio.insurance@edelweissfin.com . As you are aware , the responsibility for coordination of enrollment 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 enrollment the members can contact the brokers helpline numbers. For any assistance at the time of claim, the members can contact the TPA helpline. The details of contact numbers and emails of service provider are available on JIO's website.