JIO Star New Mediclaim Policy 2018 – Salient Features

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SALIENT FEATURES OF SHRAVAK AROGYAM-JIO NEW HEALTH PLAN
2018-2019


JIO Mediclaim Policy 2018-19 Our Insurance Partners Are: STAR Health & Allied Insurance Co. Brokers: – Alliance Insurance Brokers Pvt. Ltd.

PREMIUM Details for NEW POLICY


Sr. No. FAMILY SIZE SUM INSURED PREMIUM FOR 12 MONTHS GST @ 18% AMOUNT PAYABLEFamily Floater of size 1+7
1 Family Floater of size 1+7 Rs.10 Lacs 32,500 5,850 38,350
2 Family Floater of size 1+7 Rs.5 Lacs 19,500 2,510 23,010
3 Rs.2 Lacs Royal Associates 16,250 2,925 19,175

1. FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.5 Lacs and Rs.10 Lacs.

2. FAMILY DEFINITION: (1+7) maximum 8 members with self-mandatory : Primary Member + Spouse + 4 Dependent children up to 25 years of age + Parents or Parents in law (Any one set of parents only allowed)

3. ENTRY AGE:Proposer, Spouse & Either set of two Parents / Two In laws – Entry age is from 18 years to maximum age of 80 years for all floater policies.

4. Member can avail Cashless as well as Reimbursement facility.

5. Claim Intimation In case of Cashless claims, immediate intimation shall be given to our Call Center within 72 hours of hospitalization. In case of Reimbursement claims, immediate intimation shall be given to Call Centre within 24 hours of hospitalization.

6. PRE-EXISTING DISEASES are covered from Day One

7. CO PAYMENT:

a) 25% copay ONLY on all PED claims except sublimated ailments including Maternity & Cataract.
b) No Co pay on reimbursement claims
c) Co pay will not be applied on capped ailments / inner limits including Cataract & Maternity (No Co-pay on sublimated cases.)
d) No co- pay will applied on Non-PED Cases

8. NO MEDICAL CHECK-UP required

9. As per INCOME TAX Act deductions under Sec 80D, Proposer will be eligible for exemption. (Exemption for Payment by Cash not applicable)

10. Joint Replacement or Knee Replacement:One Year waiting period applicable

11. Maternity Benefit9 Month waiting period applicable. Maternity benefits, applicable only for the Member or Dependent Spouse, subject to a limit of Rs.25, 000/- for normal and Rs.30, 000/- for caesarean delivery.

12. AYUSH Treatment Covered up to Rs.10, 000 per claim maximum up to Rs.20,000 per year 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. Cyberknife, Cochlear Implant, and Psychiatric Treatment: Cyberknife and Cochlear implant covered with 50% copayment and Psychiatric treatment covered upto Rs.30,000.

14. Dental Treatment: Covered in case of Road Accident Requiring Hospitalization.

15. Day Care Procedures 405 day Care Procedures covered (list attached in the annexure)

16. Emergency Ambulance Charges Covered maximum upto Rs. 2500/- per case

17. Pre-Post Hospitalization Expenses (30/60 days respectively) Covered within Family Floater Sum Insured

18. Internal Congenital Ailments Covered

19. Organ transplant: 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 liability of the sum insured. Donor screening expenses and Post-dontaion complications of the donor are not payable. This cover is subject to limit of 10% of the Sum insured or Rs. One Lakh whichever is less.

20.CAPPINGS UNDER THE RENEWAL POLICY

Sum Insured Bracket
             200,000
     500,000
                             1,000,000
Ailments / Procedures
 Limits of Insurance Company’s Liability Per Person in Rs.
Cataract (per eye)
               15,000
        24,000
                                  25,000
Cerebral- vascular Accident
             120,000
     220,000
                                280,000
Cardiovascular Diseases
             120,000
     220,000
                                280,000
Cancer
             120,000
     220,000
                                280,000
Treatment for Breakage of Bones
             120,000
     220,000
                                280,000
Renal Complications
             120,000
     220,000
                                280,000
Genito Urinary Calculus
               40,000
        50,000
                                  60,000
Dialysis in case of PED cases only
               35,000
        45,000
                                  50,000
Cholecystectomy
               40,000
        50,000
                                  60,000
Hysterectomy
               40,000
        50,000
                                  60,000
Appendectomy
               40,000
        50,000
                                  60,000
Fistula (Anal)
               30,000
        40,000
                                  45,000
Hernia (All types)
               30,000
        40,000
                                  50,000
Anemia (Not for evaluation)
               50,000
        50,000
                                  50,000
Angiogram
               18,000
        21,000
                                  24,000
All Major Surgeries
 No capping
*All other major surgeries – Acute/Sub Acute/Chronic, Bilo Pancreatic Surgery, Gastro-Intestinal Surgeries, Surgeries on Prostate, and Surgery related to Genito Urinary Tract.

21. Shravak Arogyam Star Renewal, Phase 7 Renewal and New Policy Group Personal Accident Policy

1. In case of Road accident where FIR copy is provided, capping of Breakage of bone will not apply.
GPA also offers cover to Proposer in case of Accidental Death only
Accidental Death cover to the main member upto the Health Sum Insured.