Terms:
| Insured Name |
Jain International Organisation |
| Location |
PAN India |
| Benefits and Additional covers considered for Rating |
| Policy Period |
One Year |
| Elligibility |
Member of JIO and their family member will be covered under this policy |
| Family Definition |
Self, Spouse,Any number of Dependent Children up to Age 25 years,One set of Dependent Parent or Parent inlaw. |
| Age Limit |
Age limit 18 years to 65 years |
| Floater/Individual |
Individual SI |
| Sum Insured |
Rs. 3,00,000 |
| Minimum Lives to start the policy |
2,500 Lives |
| Name of coverage |
Medical Expenses of Coronavirus Disease (COVID-19) will be coverd under this Group Health Insurance policy |
| Claim Admissibility Criteria |
Member should be tested positive for the Covid 19 through a government approved diagnostic test in a government authorized diagnostic centre to be eligible for claim under this policy |
| Pre-Existing Diseases |
Not covered |
| Waiting Period |
Expenses related to the treatment of Covid-19 within 14 days from the first policy commencement date shall be excluded.
In case of persons undertaking international travel, expenses related to the treatment of Covid-19 within 14 days from of their date of return to India shall be excluded. |
| Room Rent Capping |
Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home – With an upper limit of 1% of Sum Insured & Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses – With an upper limit of 2% of Sum Insured OR As applicable Room Rent / ICU charges mentioned in the Local Govt notification. |
| Pre and Post hospitalization expenses |
Covered upto 15 days prior to Hospitalisation & 30 days after Hospitalisation |
| AYUSH Treatment |
The expenses incurred on treatment for Covid-19 under Ayurveda,Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital will be covered |
| Home Care Treatment Expenses |
Treatment availed by the Insured Person at home for Covid 19 on positive diagnosis of Covid 19 will be cover subjected to:
a) The Medical practitioner advices the Insured person to undergo treatment at home.
b) There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through the duration of the home care treatment. |
| Ambulance Charges |
Per hospitalization and per Policy Period: Rs. 2000/- |
| Claim Intimation/ submission |
All reimbursement claims should be intimated to Insurer within 48 hours of Hospitalization and documents of claim should be submitted to the Insurer within 30 days of discharge. Intimation & other Queries to be sent to jio.insurance@edelweissfin.com. |
| Mid-term Deletion & Addition |
Deletion of members would be permitted,Premium will refund on pro-Rata basis subjected to no claim in respect of the particular insured Person. Addition of members would be allowed only for the New Joinee, premium will charged on pro-rata basis. |
| OPD Cover |
Maximu up to Rs. 3000/- will be covered for Consultations, Prescribed Diagnostics and Prescribed Pharmacy on OPD basis with in the Sum insured Limit. |
| |
|
|
Co-Morbidity cover however expenses for treatment of co-morbidity is not covered. For ex. Patient has diabetes then during hospitalisation treatment to control sugar level will not be paid but treatement of COVID will be paid |
| Hospital Cash Cover |
Maximum up to Rs.1000/-for each 24 hours of continuous hospitalization subject to maximum of 14 days in a policy period will be covered with in theSum Insured Limit. |
| |
Premium, SI & Lives Details |
| Per life Premium including GST |
2,200/- |
| TPA |
Universal Sompo In House TPA |
| |
EXCLUSIONS |
| Investigation & Evaluation |
Expenses related to any admission primarily for diagnostics and evaluation purposes. Any diagnostic expenses which are not related or not incidental
to the current diagnosis and treatment |
| Rest Cure, Rehabilitation and Respite Care |
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs. |
| Dietary supplements and substances |
Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or Home care treatment. |
| Unproven Treatments |
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness. However, treatment authorized by the government for the treatment of COVID-19 shall be covered. |
| Biological attack or weapons |
Biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion:
Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death |
|
Other Exclusions
|
Any expenses incurred on Day Care treatment |
| Diagnosis /Treatment outside the geographical limits of India |
| Testing done at a Diagnostic centre which is not authorized by the Government shall not be recognized under this Policy |
| Any expenses incurred in respect of inoculations, vaccinations or other preventive treatment. |
| All covers under this Policy shall cease if the Insured Person travels to any country placed under Travel restriction by the Government of India. |
| The person who are already affected by Corona Virus / or have suspected quarantine previously will be not covered under this policy |
| Pre-existing disease |
Terms:
| Insured Name |
Jain International Organisation |
| Location |
PAN India |
| Benefits and Additional covers considered for Rating |
| Policy Period |
One Year |
| Elligibility |
Member of JIO and their family member will be covered under this policy |
| Family Definition |
Self, Spouse,Any number of Dependent Children up to Age 25 years,One set of Dependent Parent or Parent inlaw. |
| Age Limit |
Age limit 18 years to 65 years |
| Floater/Individual |
Individual SI |
| Sum Insured |
Rs. 3,00,000 |
| Minimum Lives to start the policy |
2,500 Lives |
| Name of coverage |
Medical Expenses of Coronavirus Disease (COVID-19) will be coverd under this Group Health Insurance policy |
| Claim Admissibility Criteria |
Member should be tested positive for the Covid 19 through a government approved diagnostic test in a government authorized diagnostic centre to be eligible for claim under this policy |
| Pre-Existing Diseases |
Not covered |
| Waiting Period |
Expenses related to the treatment of Covid-19 within 14 days from the first policy commencement date shall be excluded.
In case of persons undertaking international travel, expenses related to the treatment of Covid-19 within 14 days from of their date of return to India shall be excluded. |
| Room Rent Capping |
Room Rent, Boarding, Nursing Expenses as provided by the Hospital / Nursing Home – With an upper limit of 1% of Sum Insured & Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses – With an upper limit of 2% of Sum Insured OR As applicable Room Rent / ICU charges mentioned in the Local Govt notification. |
| Pre and Post hospitalization expenses |
Covered upto 15 days prior to Hospitalisation & 30 days after Hospitalisation |
| AYUSH Treatment |
The expenses incurred on treatment for Covid-19 under Ayurveda,Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital will be covered |
| Home Care Treatment Expenses |
Treatment availed by the Insured Person at home for Covid 19 on positive diagnosis of Covid 19 will be cover subjected to:
a) The Medical practitioner advices the Insured person to undergo treatment at home.
b) There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through the duration of the home care treatment. |
| Ambulance Charges |
Per hospitalization and per Policy Period: Rs. 2000/- |
| Claim Intimation/ submission |
All reimbursement claims should be intimated to Insurer within 48 hours of Hospitalization and documents of claim should be submitted to the Insurer within 30 days of discharge. Intimation & other Queries to be sent to jio.insurance@edelweissfin.com. |
| Mid-term Deletion & Addition |
Deletion of members would be permitted,Premium will refund on pro-Rata basis subjected to no claim in respect of the particular insured Person. Addition of members would be allowed only for the New Joinee, premium will charged on pro-rata basis. |
| OPD Cover |
Maximu up to Rs. 3000/- will be covered for Consultations, Prescribed Diagnostics and Prescribed Pharmacy on OPD basis with in the Sum insured Limit. |
| |
|
|
Co-Morbidity cover however expenses for treatment of co-morbidity is not covered. For ex. Patient has diabetes then during hospitalisation treatment to control sugar level will not be paid but treatement of COVID will be paid |
| Hospital Cash Cover |
Maximum up to Rs.1000/-for each 24 hours of continuous hospitalization subject to maximum of 14 days in a policy period will be covered with in theSum Insured Limit. |
| |
Premium, SI & Lives Details |
| Per life Premium including GST |
2,200/- |
| TPA |
Universal Sompo In House TPA |
| |
EXCLUSIONS |
| Investigation & Evaluation |
Expenses related to any admission primarily for diagnostics and evaluation purposes. Any diagnostic expenses which are not related or not incidental
to the current diagnosis and treatment |
| Rest Cure, Rehabilitation and Respite Care |
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs. |
| Dietary supplements and substances |
Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or Home care treatment. |
| Unproven Treatments |
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness. However, treatment authorized by the government for the treatment of COVID-19 shall be covered. |
| Biological attack or weapons |
Biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion:
Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death |
|
Other Exclusions
|
Any expenses incurred on Day Care treatment |
| Diagnosis /Treatment outside the geographical limits of India |
| Testing done at a Diagnostic centre which is not authorized by the Government shall not be recognized under this Policy |
| Any expenses incurred in respect of inoculations, vaccinations or other preventive treatment. |
| All covers under this Policy shall cease if the Insured Person travels to any country placed under Travel restriction by the Government of India. |
| The person who are already affected by Corona Virus / or have suspected quarantine previously will be not covered under this policy |
| Pre-existing disease |
FAQ
Q 1 ) Who can covered in policy ?
Ans : JIO Members their Spouse ,Children , Parents or In-Laws.
Q 2 ) Age -Min and Max ?
Ans : Self : 18- 65years , Spouse : 18-65 years , Children 90 days to 21 years and Parents or In-Laws – 18-65Years.
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 : Yes. Parents are 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 are allowed or approved by State health Ministry for treatment of COVID positive patient shall be considered .
Q 7 ) What if 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 : 14 days from start of 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 travelled 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 inception of the policy.
Q 13 ) Whether this is a benefit or indemnity policy ?
Ans : It is a indemnity policy .
Q 14 ) Home Quarentine treatment Covered ?
Ans : Yes
Q 14 ) For any query ?
Ans : Please write to jio.insurance@edelweissfin.com
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
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
" Jai Jinendra, If you are facing any problem with your Phase-1 Renewal, send us your queries with JIO UFN ID, JIOJAC ID, Name and Problem type in our complaint box above."
