Jain International Organisation|

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW HEALTH SUBSCRIPTION OFFER (2023-2024 )

Insurance benefit provided by Go Digit General Insurance Ltd.

Health Subscription Terms (April 2023 – 2024):

Subscription start date: Your cover already expired on 31st March, 2023. Membership benefit will start from 15th May, 2023 to 31st March, 2024.

Since your payment received after expiry of your cover, no cover benefit will be provided for pre-hospitalisation and hospitalisation from 1st April, 2023 to 14th May, 2023.

Specialised Health Subscription in which member will get following benefits on OPD services through the Kenko App only

OPD Benefits:

20% discount on Prescribed Medicine,
15% discount on Doctor consultation,
15% on Diagnostic test

In case of hospitalisation eligible initial amount (Security deposit) will be transferred in members account after uploading requisite documents in Kenko’s app. At the time of discharge final amount will be transferred in member’s account after uploading requisite documents.

FAMILY FLOATER Health subscription with Sum Insured options of Rs. 2 Lacs, Rs. 6 Lacs and Rs. 10 Lacs (Offered by Go Digit General Insurance Ltd.)

1. FAMILY DEFINITION: Proposer + Spouse (Husband / Wife) + 4 Dependent children up to 25 years of age (Dependent & Unmarried) + 2 Parents OR In-Laws (Any 1 set of Parents to be covered. Combination not allowed) means Maximum 8 members allowed in one family (1+7) All covered members has to be Jain.

2. INDIVIDUAL PLAN with Sum Insured of Rs.2 Lacs can only be opted by members who were covered last year under individual plan (Widow or widower) who do not have live spouse, children, parent or parent in law.

3. AGE LIMIT: 0-90 years (Entry Age of Proposer Between 18 to 90 Years), However ELDERLY MEMBERS who have already covered last year can continue in the Plan till LIFETIME

4. 1st year entry age is up to 90 years and upon renewal they can continue in the plan till LIFETIME

5. Any person cannot be covered in multiple family plan. If found enrolled in more than one plan, claim will be paid under one plan Sum Insured only during the whole year.

6. ROOM RENT & ICU CHARGES: Room Rent limitation Per Day will be capped as below:

Sum Insured	Per Day Limit (Inclusive of Nursing, RMO, BMW, O2, Infection control charges etc.)
Sum Insured	Normal Room	ICU
200,000	3,000	6,000
600,000	4,500	9,000
10,00,000	7,000	10,000
IF THE INSURED OCCUPIES A ROOM WITH A ROOM RENT LIMIT OTHER THAN HIS ELIGIBILITY AS PER THE HEALTH PLAN, THEN ALL THE OTHER CHARGES SHALL BE LIMITED TO THE CHARGES APPLICABLE FOR THE ELIGIBLE ROOM RENT OR ACTUALS, WHICHEVER IS LOWER e.g. If you are admitted in 6000 Room and you are eligible for 3000 Room rent, then your all claim will get deducted by 50%.

7. No addition or deletion of members are allowed during plan period, except for New born child in the family or newly married spouse, subject to intimation received in mail on jio.insurance@ajg.com within 20 days of marriage or birth (for newly married SPOUSE & new born BABY) coverage will start from date of birth / Marriage. However, claim of New-Born Baby will be processed under reimbursement basis only.

Mid-term addition is not allowed in the plan. Any changes with relation to name, date of birth, age & sex of members informed after date of hospitalisation will not be corrected by Kenko. Hence any correction with regards to same has to be informed to jio.insurance@ajg.com within 5 days of payment. Post loss corrections/ endorsement is also not allowed. Claim will get rejected if there is discrepancy in submitted documents & enrolment data.

8. DAY CARE PROCEDURES: Day care procedures covered.

9. All Internal congenital Diseases are covered

10. Compulsory deduction of Rs. 5000 will be applicable for each & every claim (applicable also in capped ailment listed below).

11. Domiciliary Hospitalisation, OPD treatment is not covered (Home quarantine not covered).

12. HOSPITALISATION AYUSH TREATMENT (AYURVEDIC / HOMEOPATHIC / UNANI): Treatment Covered up to 50,000 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. Hospitalization arising out of PSYCHIATRIC AILMENTS Covered upto Rs.30,000

14. Cyber knife treatment: Covered with Co-pay of 50% including pre/post claim.

15. Cochlear Implant: Covered with Co-pay of 50% including pre/post claim.

16. Joint Replacement or Knee Replacement (including pre & post exp.) : covered subject to maximum one Joint Per family /per plan period for sum insured of Rs.2 Lakh & Rs.6 Lakh.

For Rs.10 Lakh Sum Insured both joints or bilateral Joint Treatment Per family /per plan period allowed.

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

2. 6 Lac Sum Insured: Rs 125,000 per family per plan period.

3. 10 Lac Sum Insured: Rs 150,000 per family per plan period.

#Note:

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

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

17. Emergency Ambulance Charges: upto Rs.2,500 per hospitalisation for shifting patient from home to hospital.

18. TERRORISM: Covered from Day One

19. 30 Days Pre-Hospitalisation & 60 Days Post-Hospitalisation Expenses: Covered within Family Floater Sum Insured. Capping limit is including pre/post limit. Pre / Post claim is not allowed under Maternity claim.

20 MATERNITY BENEFIT : Maternity benefits, applicable only for the Member or Dependent Spouse, subject to a limit of Rs.30,000/- for normal and Rs.40,000/- for caesarean delivery up to first 2 live children only. Maternity is not covered in individual plan. Pre / Post claim is not allowed under Maternity claim.

21 MATERNITY WAITING PERIOD : Waiting period of 9 months for maternity waived off for all existing renewal members; however waiting period of 9 months is applicable for new members enrolled under this plan. Maternity is not covered in individual plan.

22. NEW-BORN BABY COVER : Baby covered from Day 1 SUBJECT TO INTIMATION mail on jio.insurance@ajg.com WITHIN 20 DAYS from Birth. However, claim of New-Born Baby will be processed under reimbursement basis only. To add name in plan, Submit New-born baby birth certificate issued by local government authority within 2 months from date of baby birth.

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

24. CO-PAYMENT:

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

25 . # PRE-EXISTING DISEASES are covered from Day One subject to 25% Co-payment ( any disease which is incepted prior to 1st April 2023 shall be consider as PED and 25% Co-Pay shall get deducted)

26. Compulsory deduction of Rs. 5000 will be applicable for each & every claim (applicable also in capped ailment listed below).

27. 25% CO-PAY on all PRE-EXISTING DISEASE CLAIMS irrespective of age .

28 CLAIM INTIMATION –
•   Intimation given through Kenko App 7 days in advance in case of planned hospitalization.
•   Immediate intimation shall be given on Keko’s app within 48 hours of hospitalization
•   Claim will get rejected if intimation given after 48 hrs. of hospitalisation.

Claim will get rejected if intimation given after 48 hrs. of hospitalisation.

CLAIM SUBMISSION of physical claim documents for REIMBURSEMENT claims Within 30 Days from Date of Discharge and any deficiency documents are to be provided within 7 days to avoid claim rejection.

29 DISEASE-WISE CAPPING ( 2023-2024 ) : This limit is overall limit, including Pre/post claim

Sum Insured	2 Lacs	6 Lacs	10 Lacs
Cataract (per eye)	15,000	30,000	35,000
Cerebrovascular Accident including Brain related medical management and Surgery	1,20,000	2,75,000	3,25,000
Cardiovascular Disease (Including Angiogram limit)	1,20,000	2,75,000	3,25,000
Cancer	1,20,000	2,75,000	3,25,000
Treatment for breakage of bone including spine surgery, Tendon & ligament repair / surgery	1,20,000	2,20,000	2,80,000
Renal Complication (Including Dialysis limit)	1,20,000	2,75,000	3,25,000
Genito Urinary / Calculus	40,000	60,000	70,000
Dialysis	35,000	45,000	50,000
Cholecystectomy including Medical Management	40,000	60,000	70,000
Hysterectomy including salpingo-oophorectomy	40,000	60,000	70,000
Appendectomy including Medical Management	40,000	50,000	60,000
Fistula, Piles, Fissure	30,000	40,000	50,000
Hernia overall limit (All types)	30,000	40,000	50,000
Anaemia (Not for evaluation)	50,000	50,000	50,000
Angiogram	18,000	21,000	24,000
Joint and Knee Replacement	75,000	1,25,000	1,50,000
maximum one Joint Per family /per plan period for sum insured of Rs.2 Lakh & Rs.6 Lakh. For Rs.10 Lakh Sum Insured both joints or bilateral Joint Treatment Per family /per plan period allowed.	75,000	1,25,000	1,50,000

* Compulsory deduction of Rs. 5000 will be applicable for each & every claim (applicable also in capped ailment listed below).

Co-pay not applicable on Capped ailment.

30. **Joint replacement capping will be applicable even if cause of Joint replacement is fracture.

31. For Corona Virus disease treatment if tested positive for corona virus at government approved lab. Home quarantine treatment is not covered.

32. ORGAN TRANSPLANT: will pay expenses incurred on the Donor expenses for organ transplantation where the insured person is the recipient are payable provided the claim for transplantation is payable and subject to the availability of the sum insured. Donor screening expenses and post-donation complications of the donor are not payable. Donor expenses cover is subject to a limit of 10% of the Sum Insured or Rupees One lakh, whichever is less, including pre/post claim.

33. DENTAL TREATMENT: covered if due to Road accident only and requiring 24 hours Hospitalisation. (FIR compulsory)

34. MID-TERM ADDITIONS allowed only for natural additions subject to intimation received in mail on jio.insurance@ajg.com within 20 days of marriage or birth (for newly married SPOUSE & new-born BABY) However claim of New-Born Baby will be processed only under reimbursement basis only. To add name in plan, Submit New born baby birth certificate & marriage certificate issued by local government authority within 2 month from date of baby birth or marriage.

35. Any person cannot be covered in multiple family plan. If found enrolled in more than one plan, claim will be paid under one plan Sum Insured only during the whole year.

Health plan Pro-rata Subscription Details for RENEWAL or NEW PLAN (2023 - 2024)

Cover start date 15th May, 2023, No cover benefit will be provided for pre-hospitalisation and hospitalisation from 1st April, 2023 to 14^th May, 2023.

Family Size	Sum Insured	Subscription Amount (With GST) 0-45 Y rs.	Subscription Amount (With GST) 46-60 Yrs.	Subscription Amount (With GST) 61-90 Yrs.
Individual (only for Renewal members who had 2 Lac individual SI last year under same plan plan)	Rs. 2 Lakh	7,036	7,036	7,036
Family Floater of size 1+7	Rs. 2 Lakh	13,192	17,589	26,559
Family Floater of size 1+7	Rs.6 Lakh	18,468	26,384	41,092
Family Floater of size 1+7	Rs.10 Lakh	26,384	33,419	55,669

PLEASE NOTE:

Corona Virus disease treatment is covered under the plan as per Terms & Conditions & as per local state tariff
The above plan covers Personal Accident cover for Rs.5,00,000/- per person( death only ) for each covered member of the family between the age of 18 years to 75 years of age only. 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 proposer's death and in case of unmarried proposer death, father or mother will be nominee.
Member can increase the Sum Insured during renewal but can't decrease it.
No Changes or cancellation are allowed in the plan once the payment is done.
Subscription amount can be PAID only via Online Payment. CHEQUE / NEFT / RTGS will not be accepted.
Additional amount will be charged by payment gateway for providing safe & secure online money transfer facility, which is addition to above amount.
Payment gateway Convenience fees (+18% GST on Convenience Fees)

Payment Modes	Convenience fees (GST extra)
Debit Card (Visa, Master, Rupay, Maestro, etc.) Below 2000 Rs.	0.40% per transaction
Debit card (Visa, Master, Rupay, Maestro, etc.) Above 2000 Rs.	0.90% per transaction
Credit Card(Visa, Master, Rupay, Maestro, etc.)	1.40% per transaction
Net Banking	Rs. 20 per transaction
UPI (G-Tez, Phone Pe, etc.)	Rs 20 per transaction

JIO JAC membership fees (non-refundable / non-transferable) for the financial year 23-24 is Rs. 2000 (GST extra). The same is additional to above Plan Subscription. (Payment will get updated in next 1 week)
GST refund certificate & 80D benefit will not be available under this plan.

40. GENERAL EXCLUSIONS :

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 :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, including corona virus when hosptizalation is not done

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 etc. : Genetic disorders and stem cell implantation / 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. Voluntary termination, miscarriage (except as a result of an Accident or Illness)

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

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, Bio-Medical waste charges , Infection Control Charges etc. surcharges, night charges, service charges levied by the Hospital under any head are not payable because they are part of Nursing Charges and as specified in the Annexure for Non- Medical Expenses Click Here for more details

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) and Any form of Laser Surgery

44. All forms of Bariatric surgery.

45. Use of Radio Frequency (RF) probe for ablation or other procedure.

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

47. Intra vitreal Injections.

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, Hormonal Chemotherapy, Adjuvant Chemotherapy, Neo-adjuvant Chemotherapy, Immuno-therapy, use of Monoclonal antibody e.g. Trastuzumab , Antibody cocktail , Infliximab, rituximab, avastin, lucentis group of drugs.

50. Domiciliary Hospitalisation, OPD treatment is not covered (Home quarantine not covered).

51. Out of Scope for OPD benefits

Vision Corrections, Contact lens, and cost of spectacles
Dental treatments
Mental health consultations
Any Cosmetic treatments
Non prescription medicines and diagnostic tests
Consultation, Medicines or diagnostic tests purchased out of network unless agreed in advance
Physiotherapy sessions
Medicines, diagnostic tests on prescriptions written before scheme start date
Cost of Insulin
Medicine, doctor consultation or diagnostic test cost covered by any insurance policy
of beneficiary are outside the scope
Cost of equipment for disabled people
Orthopaedic equipment cost
Cost of dialysis (excluded for OPD but is included in In-Patient as Day Care)
Cost of Oral Cancer Drugs and cancer related diagnostics
Abortion, Mis-carriage, Termination of Pregnancy (Voluntary/Accidental)
Medicines administered at hospital or medical facility
Uterine Artery Embolization & High Intensity Focussed Ultrasound (HIFU)
Balloon Sinuplasty, Intra vitreal Injections, Deep Brain Stimulation, Bronchial Thermoplasty
Robotic Surgeries (Including Robotic Assisted Surgeries), Stereotactic Radio Surgeries,
Vaporisation of the Prostate (Green laser treatment for holmium laser treatment,
Intra Operative Neuro Monitoring (IONM)
Immunotherapy- Monoclonal Antibody to be given as injection

Kenko Health

Who is Kenko Health?

Kenko Health is your health insurer-tech partner offering comprehensive health plans focused on OPD expenses. We offer financial solutions for doctor consultations, medicines, lab tests, and other healthcare services with our affordable plans. Our benefits also include planned hospital treatments, emergencies, selected preventive care, and more.

List down the key benefits given by Kenko Health?

We offer prepaid benefits on all your medical expenses. OPD expenses include doctor consultation, medicines, lab tests, etc.

Hospital expenses are provided by an insurance company which takes care of planned hospital treatment and emergencies.

For more information, please look at your plan benefits document.

Why should we go with Kenko? List down the benefit of Kenko care

With Kenko, you get:

· Great Discounts on medicines, doctor fees, lab tests and more.

· No hidden clauses. What you see is what you get.

· Paperless benefits - you don’t need to send us any physical documents.

· Hassle-free advance settlements of benefits at the tap of your finger (through the Kenko app).

How to avail Kenko Benefits?

Just subscribe to a Kenko plan, download the app and you’re done. All your health benefits are available at your fingertips.

Is this an Annual Subscription?

Yes, it’s an annual subscription.

Who would be the Insurer in this arrangement?

Kenko is not an insurance company. We are a healthcare subscription platform. Our subscribers help us partner directly with health and wellness services to deliver the best health financing solutions for you. While your OPD benefits discounts are provided by Kenko.

Hospital benefits are provided by an insurance company.

What is the difference between the traditional Mediclaim Plan and Kenko Health Scheme?

Kenko Health is a subscription plan that provides discounts on OPD expenses in a quick, easy, and efficient process- with all your healthcare needs covered in a few clicks.

What would be the Benefit utilization process?

For OPD: All your OPD benefits like medicines, doctor fees, lab tests, and more can be booked, ordered, and processed via our app.

For Hospitalisation benefit:

If it's an emergency, visit any hospital nearby and inform us as soon as possible. The team will guide you through the next steps.

If it's a planned treatment, inform at least 7 days in advance through the app.

At the time of discharge, share your itemized bills on the app, and Kenko will transfer the requisite amount.

Whom to contact for benefit utilization?

You can inform us about the app that is available on the play store and app store or email us at care@kenko-health.in or connect with us on our toll-free number 1800 1211 63177.

What documents would we get post purchasing the Kenko subscription?

You get a subscription docket on your phone once your plan is active. But you don’t need anything more than that. Just download the app and you are all set.

Whom to approach in case of Grievance or dissatisfaction?

You can reach out to us at grievance.jio@kenko-health.in

How benefits are Utilised -Reimbursement basis ?

We are one step ahead. We do prepaid benefits transfer.

Name the office address?

Redkenko Health Tech Pvt Ltd

16 Floor, 1608 B & C Wing, One

BKC C/66 G Block, JIO Trade Centre Road, Bandra East, Mumbai,

Mumbai Suburban, Maharashtra, 400051

How to pay the Health Subscription?

Your subscription fees can be paid by visiting this website JIO website

Click on apply now and proceed to payment.

When will the Kenko medical benefit start?

Your subscription will start on a common date notified by JIO & not from the payment of subscription amount.

Whom to contact in case of addition/deletion & Correction?

Please write on jio.insurance@ajg.com

Is it advisable to close our existing medical policy and enroll in Kenko Health?

Choice is entirely yours. it is always good idea to continue the old policy and kenko subscription can be used for OPD and IPD benefits.

How to avail OPD benefits?

All your OPD benefits can be availed via the Kenko app. You can order your medicines, book lab tests, doctor consults and more.

Where to send our Physical papers later on post completion of treatment?

We don’t expect our subscribers to send us any papers. Just upload everything on the app.

Who would process our benefits? Is there any TPA?

OPD are processed by Kenko through the app and Hospital benefits are processed by Insurance company but that too through Kenko App.

What is Room Rent Eligibility?

Sum Insured	Per Day Limit (Inclusive of Nursing, RMO, BMW, Infection control charges etc.)
Sum Insured	Normal Room	ICU
200,000	3,000	6,000
600,000	4,500	9,000
10,00,000	7,000	10,000
IF THE INSURED OCCUPIES A ROOM WITH A ROOM RENT LIMIT OTHER THAN HIS ELIGIBILITY AS PER THE HEALT PLAN, THEN ALL THE OTHER CHARGES SHALL BE LIMITED TO THE CHARGES APPLICABLE FOR THE ELIGIBLE ROOM RENT OR ACTUALS, WHICHEVER IS LOWER

JIO

JIO is a Health / Wellness Company?

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

Is JIO is making profits from the policies / Health plans?

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 Wellness Plan scheme, the Subscriptions are collected individually from the members and then full amount is transferred as a group Subscription to the Wellness Provider company. In-fact, Gurudev has inspired several Jain Shravaks to donate partly towards the Subscriptions 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 Subscriptions. This will immensely help such families to face the additional financial burden of medical expenses, if any.

Is the Enrolment process very complex?

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

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

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

The data entry and processing time is saved.

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

Enrol anytime from anywhere

Immediate confirmation of enrolment completion .

Why JIO JAC number is compulsory?

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

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

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

Why does the plan coverage starts very late after payment ofSubscription to JIO?

JIO Group Health Plan is negotiated with Provider Company for the Best TERMS and Lowest Subscription based on a commitment of certain Minimum NUMBERS of enrolment.

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 Subscription payment.

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

JIO pays Subscription to the Wellness Company through a single payment for all the members together for commencing Group Health Subscription. Upon payment, the cover period starts on common date for all the members. A single group document is issued in the name of JIO with the list of enrolled members and their families.

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

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

JIO has played a role of Group Leader in issuance. All the queries regarding the claims process, status of claims, reasons of deductions from claim etc., are handled by the concerned Wellness Company.

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

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

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

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

The JIO group plan is NOT a temporary affair and will continue in future like all other Plan.

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

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

How is the Subscription calculated for group plan?

If a group plan 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 members at one time, the reduced advertisement costs can be passed on by way of discount on Subscription.

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

What is the procedure for renewal?

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

Whether Physical Submission of forms is allowed?

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

What are the options for making payment ofSubscription amount?

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

Online payment through credit / debit card or net banking

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.

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

Under the family floater plan you can cover your wife as long as the proposer is Jain and because now she is a part of the Jain family. All covered members has to be Jain.

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

Family Floater Plan is available for family size ranging between 2 to 8 members i.e. Proposer + Spouse + 4 Unmarried, Dependent Children up to 25 years of Age + Parents/or Parents or Laws (jain only) up to 90 years

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

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

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

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

Can I take my married daughter in plan?

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

Is this Applicable on Pan India basis?

Yes this plan is for Pan India, Jain population only. All covered members has to be Jain.

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

Pre-Existing Diseases are covered since day 1, however Co-pay of 25% will be applicable for PRE-EXISTING Ailments .

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.

How do I renew?

Please follow the below mentioned steps

Please go on

https://jio.net.in/R23-24.php

Read revise Terms & Conditions carefully

Select "Apply Now"

Enter JIOJAC ID

Fill your enrolment details

Make payment ONLINE

Can I submit physical form?

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

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

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

If I don't have JIO JAC Id, can I opt for Health Plan ?

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

What is theSubscription?

Subscription details are available in T & C section.

When will I be eligible for my maternity claim?

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

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

Pre & Post Natal expenses on OPD/IPD bases are not covered

What shall be the next year Subscription?

The next year Subscription will be decided after the end of the plan tenure based on the Claim Experience of the current Plan

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

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

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

Yes, only if she is a Jain by birth.

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

No, Location does not affect the operational activities, main member or the dependent member can avail same and equal benefits irrespective of their location.

Hospitalization (IPD Claims)

CLAIM INTIMATION –

Intimation given through Kenko App 7 days in advance in case of planned hospitalization.
Immediate intimation shall be given on Keko’s app within 48 hours of hospitalization
Claim will get rejected if intimation given after 48 hrs. of hospitalisation.

To avail of Hospitalization (IPD) benefits, a minimum of 24 hrs of hospital admission is required except day Care Procedure.

Each subscription plan has different tiers of hospitalization benefits. Subscribers will be able to claim their benefits, as offered by their subscription plan.

Note: If the subscriber has multiple plans, they can choose any of their active plans to avail themselves of the respective benefit. At the time of claims, customers can claim from only 1 plan and multiple plans cannot be clubbed together for the same order.

Online/Offline Claims Process (Via App or Email/Call )

1.The employee/ patient will log-in to their Kenko app (Android / iOS) and create a Hospitalization

(IPD) ticket on the app (Under Hospital Admission). Kenko’s Customer Delight team will get in touch with the employee/ patient and guide them with next steps.

Alternatively, the employee/ patient can also notify their Kenko Relation Manager (Kenko-RM) either by calling at our toll free number - 1800 1211 63177 OR by sending an email to care@kenko-health.in at least 5-7 days in advance of the hospitalization event.

2. The employee/ patient will need to share the following documents (only soft copies) by sending an email to care@kenko-health.in

• Doctor's Diagnosis on Doctor's letterhead mentioning the need for hospitalization and an estimated cost of treatment.
• Any (and all) test reports supporting the need for the treatment or hospitalization, and
• Any other documentation, incase there is a specific need for it, though it will not be a part of the standard process

3. Insurance company will give the customer 3 choices of hospitals from their Network list. Insurance company
4.When the employee/ patients goes to the hospital, he/ she will be required to take a selfie in which the name and surrounding of the hospital are visible and share the same at care@kenko- health.in
5.Once the claim documentation is validated by the Insurance company, a payment link will be sent to the employee/ patient via SMS to their registered mobile number, where the employee/ patient will have to fill up their Bank Account number and IFSC code. [For deposit and initial payments]

6.10% to 20% of the estimated amount will be transferred to the employee/ patient's account as security deposit/initial payments for hospitals.
7. At the time of discharge, the following documents will have to be shared from employee/ patient at care@kenko-health.in

• Deposit Slip
• Discharge card/summary,
• Full itemized bill,
• Any other documentation, incase there is a specific need for it, though it will not be a part of the standard process

8. Once the claim documentation is validated by insurance company, a payment link will be sent to the employee/ patient via SMS on their registered mobile number, where the employee/ patient will have to fill up A/C no and IFSC code [For final payments]
9. The total admissible amount will be credited to the employee/ patient's account.

Emergency Hospitalization
1. The employee/ patient will call a 24/7 dedicated emergency hotline (+91 91138-39585) or click on the Emergency Button on Kenko App.
2.An ambulance will be arranged if required.
Scenario 1 - The employee/ patient is not at a hospital and requires an ambulance
>> Kenko customer care team will take up this request on priority and arrange an ambulance at the location specified by the employee/ patient
Scenario 2 - The employee/ patient is already at a hospital and undergoing treatment
>> In these cases, the employee/ patient will be required to share a soft copy of the “hospital admission form” at care@kenko-health.in — a payout link will be sent to the employee/ patient by insurance company based on the deposit amount being asked by the hospital.
3. At the time of discharge, the following documents will have to be shared from employee/ patient at care@kenko-health.in -

• Deposit Slip
• Discharge card/summary,
• Fullitemized bill,
• Any other documentation, incase there is a specific need for it, though it will not be a part of the standard process

4. A final payment link will be sent for final settlement.

OPD and Wellness Discount Benefits

Customers can raise the order request either through the Kenko App.

For Doctor Consultation –

• Plan Name and Member Name
• Date & Time of consultation
• Doctor Specialization
• Address & Location details
• Confirmation is sent through an email & SMS to the customer on the Doctor Consultation Appointment
• The benefit amount will be discounted value as per the subscription plan

For Medicine Order

• Plan Name and Member Name.
• Medicine Name
• Prescription Upload
• Address & Location details
• Confirmation is sent through an email, SMS and Whatsapp to the customer on medicine Delivery
• The benefit amount will be discounted value as per the subscription plan

For Diagnostic
• Plan Name and Member Name
• Date & Time of sample collection
• Test Name
• Address & Location details
• Confirmation is sent through an email, SMS and Whatsapp to the customer on the Diagnostic Order
• The benefit amount will be discounted value as per the subscription plan

Note:

• For medicine order, after an invoice is generated, a payment link would be shared with the customer. Post payment, medicines will be delivered within 24 hours. A delivery fee is applicable.
• If Kenko is unable to process doctor consultations and diagnostics, customers can get it done by themselves and upload the documents on the Kenko app for reimbursement. We do not reimburse medicines bills.
• Incase of grievance or dissatisfaction, you can reach out to us at grievance.jio@kenko-health.in

Some Useful Links:
How to Claim on App : https://www.youtube.com/playlist?list=PLQ1e7DbiLFva7H5atyVhHfMajaTX6e1DF

I am Thankful

· I appreciate JIO for being a facilitator for this highly beneficial Group health & OPD Wellness Subscription Plan for the social and health upliftment of the Community.

· Jain International Organization (JIO) is NOT an Agent, a Broker, or an Insurer but JIO is an organization who has selected Wellness Service Partners (Health Care Company) for the well-being of its members.

· The policy will be issued by the Insurance Company in the name of Group Manager. I and my family members would be beneficiaries under the Health Subscription plan.

· OPD benefits are processed by Kenko Health Tech, JIO has no role in benefit processing. If any need arises, I can take assistance from JIO and its service partner to guide me in the benefits process and/or legal solution.

· This is a Group health subscription plan. It will start from a common date and not from the date you pay the subscription fee.

· Subscription start date: Your cover already expired on 31st March, 2023. Membership benefit will start from 15th May, 2023 to 31st March, 2024.

Since your payment received after expiry of your cover, no cover benefit will be provided for pre-hospitalisation and hospitalisation from 1st April, 2023 to 14th May, 2023.

· If any grievance under the policy I will solve through discussion and writing to jio.insurance@ajg.com or meeting personally at JIO office. In any case, I understand that Jain International Organisation is NGO founded by P.P. Nayapadmasagar M.S. and if I file any case in court of law it means I am not filing case against NGO but against respected M.S.

· Policy Cancellation not allowed after payment.

· To avail continuity benefit under policy cover, it is necessary to complete enrolment process and pay ONLINE using same JIOJAC id which was used previous year.

· Cover continuity will break if JIOJAC id is changed and member will be considered fresh / new and all 1st year exclusion and waiting clause will be applicable.

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

JAIN SWASTHYA BIMA YOJANA RENEWAL / NEW HEALTH SUBSCRIPTION (2023-2024)