Enrolment CLOSED: Corona Special Policy

Terms:

CORONA Special Policy:  Period 1 year

Premium Chart:

Rs.1,00,000/-: Premium Rs.650/- GST Rs.117/- = Rs.767/-

Rs.2,00,000/-: Premium Rs.1100/- GST Rs.198/- = Rs.1298/-

Rs.3,00,000/-: Premium Rs.1550/- GST Rs.279/- = Rs.1829/-

Insured: Jain International Organization

Insurance Company Name: Universal Sompo General Insurance Co. Ltd.

Type: Indemnity Program for Member of Jain International Organization    

Beneficiary: Member, Spouse, and 2 Children.

Age: Member– 65years, Spouse – 65 Years & 2 Children up to 21years.

Scope: Expenses incurred on being tested Positive to COVID-19 / Corona Virus infection, established & confirmed from registered ICMR Lab & kits. Hospitalization occurred due to COVID 19 infection. 

Age Min-Max -  Self and Spouse – 18 to 65 Years and Children 90days to 21 Years.

Policy Term: 1 Year

Pre-Existing Disease: Not Covered

Claims Pay-out: Cashless and Reimbursement

Waiting Period: 7 Days Initial waiting period from the policy start date.

Room Rent: Room rent of 2% & ICU 4% of Sum Insured.  All charges to be paid in proportion to the room rent.

Cover applicable for all hospitals (i.e.  Private, Military, Army, Govt. etc.). Pvt Hospital which is allowed or approved by the State health Ministry for treatment of COVID positive patient shall be considered.

Pre-Post: 30/30 days, Limited to maximum up to 10% of Sum Insured.

Ambulance: Up to Rs. 5000

Condition:

The premium shall be per life basis

The person with Co-Morbid condition or Pre-existing Diseases – Like HTN/ Diabetes / Lung/ cardiac diseases, etc. will be covered under the policy, however, the claim shall be paid only pertaining to COVID treatment for such members.

No deletion & refund allowed in the scheme

All other terms as per our Group Health Policy.

Exclusion:

1. Insured should not have traveled (Overseas) after 15th Feb 2020 OR Insured should not travel (Overseas) to restricted areas as per the Travel Advisory of  MoHFW, after issuance of such advisory or from the inception of the policy.
2. The person with Co-Morbid condition or Pre-existing Diseases – Like HTN/ Diabetes / Lung/ cardiac diseases etc. will be covered under the policy, however, the claim shall be paid only pertaining to COVID treatment for such members.   
3. PED diseases of symptoms of COVID or Person already suspected or quarantine prior to the inception of the policy or within the 7 days from inception of the policy.
4. All other terms as per our Group Health Policy.

Standard Exclusion of Group Health Policy are applicable:

Terms :

CORONA Special Policy 

Premium Chart:

Rs.1,00,000/-: Premium Rs.650/- GST Rs.117/- = Rs.767/-

Insurance Company Name : Universal Sompo General Insurance Company Limited

Insured : Jain International Organization

Type : Indemnity Program for Member of Jain International Organization    

Beneficiary : Member ,Spouse and 2 Children .

Age : Member – 65years , Spouse – 65 Years and 2 Children upto 21years.

Sum-Insured : 1 Lakh , 2 Lakh and 3 lakh

Scope : Expenses incurred on being tested Positive to  COVID-19 / Corona Virus infection , established & confirmed from registered ICMR Lab & kits . Hospitalization occurred due to COVID 19 infection . 

Relationship : Self , Spouse and 2 Children.

Age Min-Max -  Self and Spouse – 18 to 65 Years and Children 90days to 21 Years.

Policy Term : 1 Year

Pre-Existing Disease : Not Covered

Claims Pay-out : Cashless and Reimbursement

Waiting Period : 7 Days Initial waiting period from policy start date.

Room Rent : Room rent of 2% & ICU 4% of Base SI,.  All charges to be paid in proportion to room rent.

Cover applicable for all hospitals  ( i.e.  Private, Military, Army, Govt. etc.). Pvt Hospital which are allowed or approved by State health Ministry for treatment of COVID positive patient shall be considered .

Pre-Post : 30/30 days , Limited to maximum upto 10% of SI .

Ambulance : Upto Rs. 5000

Condition :

The premium shall be per life basis

All complications & morbidity arising out of COVID diagnosis, in a normal person not having any PED, shall be covered during hospitalization.

No deletion & refund allowed in the scheme

All other terms as per our Group Health Policy.
 

Exclusion :

1. Insured should not have traveled (Overseas) after 15th Feb 2020 OR Insured should not travel (Overseas) to restricted areas as per the Travel Advisory of  MoHFW, after issuance of such advisory or from the inception of the policy.
2. The person with Co-Morbid condition or Pre-existing Diseases – Like HTN/ Diabetes / Lung/ cardiac diseases etc. will be covered under the policy , however the claim shall be paid only pertaining to COVID treatment for such members .   
3. PED diseases of symptoms of covid or Person already suspected or quarantine prior to inception of the policy or within the 7 days from inception of the policy.
4. All other terms as per our Group Health Policy .

Standard Exclusion of Group Health Policy are :

1. WAR like situation etc.: Treatment directly or indirectly arising from or consequent upon war or any act of war, invasion, the act of a foreign enemy, warlike operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defense, 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. Non allopathic treatment
11. Hospitalisation not required : Conditions for which treatment could have been done on an outpatient basis without any Hospitalization.
12. Experimental treatment: Investigational treatments, Unproven / Experimental treatment, or drugs yet under trial, devices and pharmacological regimens.
13. Diagnostic Only : Diagnostic tests/ procedures/ treatment/ consumables not related to Illness for which Hospitalization has been done.
14. 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.
15. PREVENTIVE CARE, vaccination including inoculation and immunizations (except in case of post-bite treatment); any physical, psychiatric or psychological examinations or testing.
16. 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.
17. Hearing aids, contact lenses or spectacles including optometric therapy, multifocal lens.
18. Baldness : Treatment for alopecia, baldness, wigs, or toupees, and all treatment related to the same.
19. Diabetic test strips etc.: Medical supplies including elastic stockings, diabetic test strips, and similar products.
20. 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 cochlear implant(s) unless necessitated by an Accident or required intra-operatively. 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.
21. Psychiatric Treatment : or psychological disorders, mental disorders (including mental health treatments), Parkinson and Alzheimer’s disease, general debility or exhaustion (“rundown condition”).
22. External Congenital Anomalies or diseases or defects.
23. Stem cell therapy or Surgery, or growth hormone therapy.
24. 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.
25. “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.
26. 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.
27. 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.
28. 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).
29. Illegal Organ Transplantation : Admission for Organ Transplant but not compliant under the Transplantation of Human Organs Act, 1994 (amended).
30. 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.
31. Dental Treatment: Dentures, implants and artificial teeth, Dental Treatment and Surgery of any kind, unless requiring Hospitalization due to an Accident.
32. 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.
33. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health.
34. Treatment for developmental problems, learning difficulties eg. Dyslexia, behavioural problems including attention deficit hyperactivity disorder (ADHD).
35. 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,
36. 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.
37. 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.
38. Treatment charges or fees charged by any Medical Practitioner acting outside the scope of license or registration granted to him by any medical council.
39. 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.
40. 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.
41. 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).
42. 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
43. Treatment taken outside India
44. 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.
45. Robotic surgery (whether invasive or non-invasive)
46. All forms of Bariatric surgery.
47. Use of Radio Frequency (RF) probe for ablation or other procedure unless specifically approved by Us in writing in advance.
48. Admission primarily for diagnostic purposes not consistent with the treatment taken.
49. 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.
50. Treatment provided by anyone with the same residence as Insured Person or who is a member of the Insured Person’s immediate family.
51. Holmium Laser Enucleation of Prostate, KTP Laser Surgeries, cyber knife treatment, Femto laser surgeries, bio-absorbable stents, bioabsorbable valves, bioabsorbable implants, oral chemotherapy, use of Infliximab, rituximab, avastin, lucentis.

FAQ 

Q 1 ) Who can be covered in the policy ?

Ans: JIO members with their spouse and children.

Q 2 ) Age -Min and Max?

Ans: Self: 18- 65years, Spouse: 18-65 years and Children 90 days to 21 years.

Q 3 ) What is covered in this policy?

Ans: Expenses incurred due to hospitalization due to COVID 19 Infection.

Q 4 ) Whether Parents are covered?

Ans: No. Parents are not covered. 

Q 5 ) Type of claim allowed?

Ans: Cashless and Reimbursement both. 

Q 6 ) Which hospital are allowed?

Ans: Cover applicable for all hospitals  ( i.e.  Private, Military, Army, Govt. etc.). Pvt Hospital which is allowed or approved by the State Health Ministry for treatment of COVID positive patient shall be considered.

Q 7 ) What if the beneficiary is already suffering from any co-morbid condition?

Ans: Person with Co-Morbid condition or Pre-existing Diseases – Like HTN/ Diabetes / Lung/ cardiac diseases etc. will be covered under the policy, however, the claim shall be paid only pertaining to COVID treatment for such customers.   

Q 8 ) Whether PED is covered?

Ans: NO.

Q 9 ) Any waiting period?

Ans: 7 days from the start of the policy.

Q 10 ) Whether policy cover Complication?

Ans: All complications & morbidity arising out of COVID diagnosis, in a normal person not having any PED, shall be covered during hospitalization.

Q 11) Whether deletion or refund allowed?

Ans: No

Q 12 ) Whether coverage has any impact from travel history?

Ans: Yes. Insured should not have traveled (Overseas) after 15th Feb 2020 OR Insured should not travel to restricted areas as per the Travel Advisory of  MoHFW, after issuance of such advisory or from the inception of the policy.

Q 13 ) Whether this is a benefit or indemnity policy?

Ans: It is an indemnity policy.

Q 14) Where to intimate claim?

Ans: Please intimate claim at jio.insurance@edelweissfin.com.

Q 15) Who will give enrollment support and resolve our Queries related to policies?

Ans: For enrollment and policy related queries write at Vidhyut.shah@edelweissfin.com.