JAIN SWASTHYA SURAKSHA YOJANA RENEWAL / NEW HEALTH SUBSCRIPTION OFFER (2024-2025) JIO – Community Subscription Base Plan – April 2024-2025 (Open for all four Sects of Jain Community) (Also open for Fresh members) Community Servicing plan catering to all round Healthcare needs of Jain family. Conventional benefit processing through Cashless and Reimbursement

 

Jain International organisation is an NGO introducing "Community service Program" Only for its own Jain community families.

That will take care of Jain families Expenses on healthcare through their own raised contribution Fund. This is not an insurance plan, supported by Insurance Company or any healthcare company.  It is by the Jain community, for the Jain community programme of sharing healthcare expenses of few Jain members by many.

Self-enrolment in Community Service Program Closes on 14th April 2024.

Health Subscription features (April 2024 – 2025):

Subscription start date: 16th April 2024 to 31st March 2025.

During this extension period, if any hospitalization claim will not be paid

Specialized Health Subscription in which member will get following benefits through JIO health contributory self-fund scheme.

This is self-contributory program which is run by JIO. All benefits of hospitalization expenses are processed by Ericson Health Care Services.  Both Cashless and reimbursement of IPD benefits are available.

Avail cashless in 14000 hospitals Pan India. Reimbursement of benefit through Ericson Healthcare Pvt. Ltd.

 

FAMILY FLOATER Health subscription with benefit limit of Rs. 6 Lacs and Rs. 10 Lacs 

1. FAMILY DEFINITION: Self + 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. 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.

3. 1st year entry age is up to 90 years.

4. No single person can be beneficiary multiple times, once as proposer & other as dependent or any other relationship in multiple family plan. If found enrolled in more than one plan, then subscription will get cancelled & no refund allowed in case of member enrolled more than once and only one plan will continue with lower benefit limit.

5. JIO member can get sdmitted in Hospital with max. room rent limit as under :

 

Benefit limit	Per Day Limit (Inclusive of Nursing, RMO, BMW, O2, Infection control charges etc.)
	Normal Room	ICU
600,000	4,000	9,000
10,00,000	6,000	10,000
**IF THE JIO MEMBER STAYS IN ROOM ABOVE HIS BENEFIT LIMIT PER DAY 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** IT MEANS PROPORTIONATE DEDUCTIONS WILL BE APPLICABLE.   e.g. If you are admitted in 8000 Room and you are eligible for 4000 Room rent, then your whole claim will get deducted by 50% i.e. for 20,000 expenses, you will get only 10,000.

 

6. No addition or deletion of JIO members are allowed during plan period, except for New born child in the family or newly married spouse, subject to intimation received in mail for admission purposes on claimhelp@jio.net.in 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.

 

7. Mid-term addition is not allowed in the community service program for administrative reasons. Any changes with relation to name, date of birth, age & sex of members informed after date of hospitalisation will not be corrected. Hence any correction with regards to same has to be informed to claimhelp@jio.net.in within 5 days of payment. Post loss corrections are also not allowed. If malafide intensions are found with respect to discrepancy in family member details then membership benefit will be null & void from inception & no refund will be given.

 

8. DAY CARE PROCEDURES: Day care procedures covered.

 

9. All Internal congenital Diseases are covered up to 50,000 per family.

 

10. Compulsory deduction of Rs. 5000 will be applicable for each and every claim.

 

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

 

12. HOSPITALISATION for 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 per family.

 

14. Cyber knife treatment: Covered up to 1 Lac including pre/post claim per family.

 

15. Cochlear Implant: Covered up to 1 Lac including pre/post claim per family.

 

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

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

 

1. 6 Lac Benefit limit: Rs 125,000 per family per plan period.

2. 10 Lac Benefit limit: Rs 150,000 per family per plan period.

 

#Note:

There will be ONE YEAR waiting period for Joint Replacement or Knee Replacement and Maternity benefit 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 in case of emergency only.

 

 

18. 30 Days Pre-Hospitalisation & 60 Days Post-Hospitalisation Expenses: Covered within Family Benefit limit up to 10% of Benefit limit during the year.

 

Disease wise, Capping limit is including pre/post limit. No separate limit is available in case of capped ailment.

 

Pre / Post claim is not allowed under Maternity claim.

 

19 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.

 

20 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.

 

21. NEW-BORN BABY COVER : Baby covered from Day 1 SUBJECT TO INTIMATION mail on claimhelp@jio.net.in  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.

 

New born baby expenses related to Hospitalisation shall be covered from Day One of the birth up to 90 days up to 35000 limit and thereafter up to Family Benefit limit.

 

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

 

23. CO-PAYMENT:

 

Member Type	Non Pre-Existing Diseases #	Pre-Existing Diseases #	Medical Management cases #
Fresh	NO-COPAY	50%	10% co-pay will be deducted in each & every case of medical management (Other than Surgical Cases like Fever, Breathlessness)
Renewal	NO-COPAY	25%	10% co-pay will be deducted in each & every case of medical management (Other than Surgical Cases like Fever, Breathlessness)

 

24. # PRE-EXISTING DISEASES are covered from Day One subject to 50% Co-pay for fresh members and 25% co-pay for renewal members (any disease which is incepted prior to 1st April 2024 shall be consider as PED and Co-Pay shall get deducted)

 

25. Compulsory deduction  of Rs. 5000 will be applicable for each and every claim.

 

26. 10% co-pay will be deducted in each & every case of medical management (Other than Surgical Cases like Fever, Breathlessness) This co-pay will be over & above other deductions. i.e. in case of PED ailment copay of PED & 10% co-pay of medical management will get deducted.

 

27 CLAIM INTIMATION –
 

•    In case of claims, immediate intimation shall be given to Ericson Healthcare within 48 hours of Hospitalization on claimsinfo@ericsonhealthcare.com / 022-41548303.

 

•    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.

 

28 DISEASE-WISE CAPPING (2024-2025) : This limit is overall limit, including Pre/post claim

 

Benefit limit	6 Lacs	10 Lacs
Cataract (per eye)	30,000	35,000
All expenses related to Disorder of Nervous system including Stroke	2,50,000	3,00,000
All expenses related to Cardiovascular Disease including CABG, Angioplasty (Including Angiogram limit)	2,50,000	3,00,000
Expenses related to Cancer including Radio therapy & chemotherapy	2,50,000	3,00,000
Treatment for breakage of bone including spine surgery, Tendon & ligament repair / surgery	2,20,000	2,80,000
All Expenses related to Renal disease including Dialysis	2,50,000	3,00,000
All Expenses related to Digestive System including Genito Urinary Calculus / Renal Calculus, Cholecystectomy, Hysterectomy, Appendectomy, Hernia, Piles, Fissure, Fistula	2,20,000	2,80,000
All Expenses related to Musculoskeletal system excluding Joint replacement	2,20,000	2,80,000
Genito Urinary Calculus / Renal Calculus	60,000	70,000
Dialysis	45,000	50,000
Cholecystectomy including Medical Management	60,000	70,000
Hysterectomy including salpingo-oophorectomy / Prostate operation	60,000	70,000
Appendectomy including Medical Management	50,000	60,000
Fistula, Piles, Fissure	40,000	50,000
Hernia overall limit (All types)	40,000	50,000
Anaemia (Not for evaluation)	50,000	50,000
Angiogram	21,000	24,000
Joint and Knee Replacement	1,25,000	1,50,000
maximum one Joint Per family /per plan period for Benefit limit of Rs.6 Lakh. For Rs.10 Lakh Benefit limit both joints or bilateral Joint Treatment Per family /per plan period allowed.

 

* Compulsory deduction of Rs. 5000 will be applicable for each and every claim

 

Co-pay not applicable on capped ailments.

 

10% co-pay will be deducted in each & every case of medical management (Other than Surgical Cases like Fever, Breathlessness)

 

1% TDS will be deducted from benefit amount on reimbursement mode.

 

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

 

30. For Corona Virus disease home quarantine treatment is not covered.

 

31. 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 Benefit limit. 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 Benefit limit or Rupees One lakh, whichever is less, including pre/post claim.

 

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

 

33. MID-TERM ADDITIONS allowed only for natural additions subject to intimation received in mail on claimhelp@jio.net.in  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.

 

 

34. Health plan contribution details for RENEWAL or NEW PLAN (2024 - 2025) 

 

 

Family Size	Benefit limit	Contribution Amount 0-45 Y rs.	Contribution Amount 46-60 Yrs.	Contribution Amount 61-90 Yrs.
Family Floater of size 1+7	Rs.6 Lakh	25,200	36,000	56,070
Family Floater of size 1+7	Rs.10 Lakh	36,000	45,600	75,960

 

 

PLEASE NOTE:

• Contribution amount can be PAID only via Online Payment. CHEQUE / NEFT / RTGS will not be accepted.
• Member can’t increase the Benefit limit during renewal.
• No Changes or cancellation are allowed in the plan once the payment is done.
• Additional amount will be charged by payment gateway  for providing safe & secure online money transfer facility, which is addition to above amount.
• Corona Virus disease treatment is covered under the plan as per Terms & Conditions & as per local state tariff 
• 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 24-25 is Rs. 2000 (GST extra). The same is additional to above Plan Subscription. (Payment will get updated in next 1 week)
• GST refund certificate & 80-D benefit will not be available under this plan. Certificate of Insurance will not be provided because this is community contributory health plan.

 

35. 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).