Super Top Up - November 2023-24
JIO Super Top Up plan - Nov 2023-24 Trust managed, Community based contributory health plan with OPD discount Benefit (COI, Income tax benefit under 80-D deductions not available in Community based contributory program)
Scheme Enrollment Closed on 01-12-2023
For any query please call on 1800 1211 63177 or you can mail us on: claimhelp@jio.net.in
Terms & Conditions Of JIO Super Top-Up (Community based contributory program)
Health contribution Terms: (Nov 2023-2024):
Plan start date: 30th Nov, 2023 to 29th Nov, 2024.
Specialized Health Contribution in which member will get 15% discount on only Prescribed Medicine order through Saarthi Health Services and 10% discount on Doctor consultation, Diagnostic test order through Saarthi Health Services.
1. You can avail benefit under this plan once your personal Mediclaim, Employer Mediclaim get exhausted in deductible limit.
2. Available SUPER TOP-UP sum Insured of Rs. 3 Lakh, Rs.5 Lakh and Rs.10 Lakh
3. FAMILY Floater for Maximum 6 members (1 + 5).
4. Family definition :
Proposer + Spouse (Husband/wife)
+ 2 Dependent Unmarried Children Up to 25 years of age
+ 2 Dependent PARENTS OR PARENTS IN-LAWS Up to 85 years
(Any one set of parents to be covered, combination not allowed).
5. Maximum entry age: - Up to - 85 YEARS. Once enrolled LIFE TIME renewal possible.
6. NO MEDICAL CHECKUP required.
7. PRE-EXISTING DISEASE Cover from DAY ONE.
8. NO WAITING PERIOD. (Waiting period for 1st year, 2nd year and 4th year disease are not applicable.)
9. Chemotherapy is 5000/- per cycle maximum Up to 1 lakh per family per year.
Dialysis is 5000/- per cycle maximum Up to 1 lakh per family per year.
Radiotherapy is 5000/- per cycle maximum Up to 1 lakh per family per year.
Major Organ transplant & Major Surgery ( e.g. Cardiac/ Pace maker implantation/ Cancer/Brain & Spinal cord /Lung Surgery/ Hip replacement/Knee joint replacement /Surgeries of Vital Organs / Abdominal Surgeries / Major fracture.) to be limited to 50% of Sum Insure.
10. A member can only get covered only once under the Super top up plan. Any member who is enrolled more than one time will be eligible to get benefit under plan which has highest deductible and lowest benefit amount. Eg. if a member “A” is covered under 2 plans 1st with deductible of 3 Lacs and benefit amount of 10 lacs and 2nd with deductible of 10 lacs and benefit amount of 5 lacs then the benefit will be paid as per 2nd option where deductible is 10 lacs and benefit amount is 5 lacs.
11. PRE-HOSPITALIZATION Medical Expenses up to 30 Days Covered.
12. POST-HOSPITALIZATION Medical Expenses up to 60 Days Covered.
13. Day care procedure are covered.
14. Claims Payable on REIMBURSEMENT BASIS only
15. AYUSH TREATMENT is also covered up to Rs. 25,000.
16. Certificate of Insurance (COI) will not be provided in this health plan.
17. 80D benefit is not available under this plan.
18. Maternity not covered. Excluded ailment are not considered in deductible limit.
POINTS TO BE NOTED FOR "SUPER TOP UP"
19. It ENHANCED YOUR existing mediclaim SUM INSURED
20. This plan is also available for members without any Mediclaim
21. You can top up any type of your existing mediclaim may it be JIO Mediclaim, Retail Individual Mediclaim, Family floater mediclaim or Group Mediclaim by this plan.
22. You can choose from any option as deductible limit irrespective of your existing mediclaim sum insured.
23. DEDUCTIBLE LIMIT: The chosen amount up to which the aggregate admissible medical claims of family will not be payable by this super top up plan incurred during the plan period.
24. Super Top Up community based contributory program Chart with taxes (Nov 2023-2024) :
|
Deductible SI |
SUM INSURED |
Rate below 60 |
Rate above 61 to 85 |
|
300000 |
200000 |
11608 |
19461 |
|
500000 |
17413 |
29191 |
|
|
1000000 |
25874 |
42964 |
|
|
500000 |
1000000 |
17599 |
29504 |
|
500000 |
11734 |
19667 |
|
|
200000 |
9141 |
15473 |
|
|
1000000 |
1000000 |
10560 |
17702 |
|
500000 |
8228 |
13791 |
|
|
200000 |
5483 |
9192 |
|
25. Members who do not have any mediclaim plan can get this plan with Minimum deductible of Rs.3 Lakh
26. If any member of the family is not covered under any existing mediclaim plan still he/she can be covered under super top up plan in family floater. But for that particular member Minimum deductible of Rs.3 Lakh is applicable at the time of claim.
27. Member can choose SUM INSURED from Rs. 2 Lakh, Rs.5 Lakh or Rs.10 Lakh.
28. Options of DEDUCTIBLES for Rs. 2 Lakh, Rs. 3 Lakh, Rs.5 Lakh or Rs.10 Lakh are available. Deductible is amount up to which member's base plan will pay the claim and super top up plan will respond once the deductible amount is exhausted. If the insured does not have base plan, the insured will have to bear the expenses up to deductible limit.
29. Hospital ROOM RENT & ICU CHARGES limitation (Per Day, including Nursing, RMO, O2, Monitor and all associated charges): 1% of STU Sum Insured for Normal Room and 2% of STU sum Insured for ICU room.
30. Super top up plan will pay all the claims those are falling within plan period of super top up plan. If base plan sum insured is exhausted or partially exhausted before inception of super top up plan then the same will not be paid.
31. Hospitalisation admissible claims incurred during the super top up plan period for the whole family in one or more occasions once cross the deductible limit will be paid under the plan.
32. CLAIM INTIMATION - immediate intimation shall be given to our Call Centre within 48 hours of Hospitalisation.
Contact no. 1800 1211 63177 Email ID : care@kenko-health.in
33.Internal Congenital disease are payable upto Rs. 50,000 per family.
34. CLAIM SUBMISSION of 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.
35. A Deduction of 10% to be levied for late Intimation and Submission. This deduction is over and above other plan conditions.
36. GIPSA PPN Rate applicable. Reasonable, customary and Medically Necessary charges are paid under this plan.
REASONABLE AND CUSTOMARY CHARGES mean the charges for services or supplies, which are the standard charges for the specific provider/hospital and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the Illness / Injury involved. Your claim will be process as per reasonably and Customarily and Medically Necessarily charges.
37. Ambulance charges - 1.0% of the Sum Insured or actual, whichever is less, subject to maximum of Rs. 2,500/- in case patient has to be shifted from residence to hospital for admission in Emergency Ward or ICU or from one Hospital to another Hospital by fully equipped ambulance for better medical facilities. Air ambulance expenses not covered.
38. Not Payable benefit.
In Patient Hospitalisation (This exclusion is related to - Hospitalisation benefit)
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.: A 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: Willful 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, tobacco chewing, smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies, impairment of Covered 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 hospitalization 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 Illnessfor 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 center, 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 Covered 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. Covered 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. Blacklisted Hospital, Doctor: Treatment in any Hospital or by any Medical Practitioner or any other provider of services that We have blacklisted as listed on Our website.
48. Treatment provided by anyone with the same residence as Insured Person or who is a member of the Covered 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.
51.Consumables are not payable.
52.Any consequential or indirect loss arising out of or related to Hospitalization.
53.Air Ambulance.
OPD Discounts-out of Scope
Vision Corrections, Contact lens, and cost of spectacles
All Dental treatments
Mental health consultations
Any Cosmetic treatments
Nonprescription 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 of beneficiary are outside the scope
Cost of equipment for disabled people
Orthopedic 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, Miscarriage, Termination of Pregnancy (Voluntary/Accidental)
Medicines administered at hospital or medical facility.
Jain International Organization November base subscription plan. Community Service plan catering to all round Health care needs of Jain family.
November 2023
Jain International organization is an NGO introducing "Community service Program" Only for its own Jain community families. That will care take care of Jain families Expenses on healthcare through their own raised contribution Fund.
Self-enrolment in Community Service Program Closes on 14th November 2023.
Benefit Offer
OPD and Wellness Discount Benefits
Members can raise the order request 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:
Introduction to Kenko App : https://youtu.be/1Bd7iDeObkA
How to Get Benefit For Hospital Treatments : https://youtu.be/TJv1O-Ysujc
How to Get OPD Benefits : https://youtu.be/dtZVtx306vU
CLAIM INTIMATION –
- Most of the claim are plan in nature. Hence. They can be intimated. Prior to hospitalization. Members are requested to intimate the claim seven days in advance. 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. Intimation of claim is a must. At the time of hospitalization. Otherwise, the claim can get rejected. Claim will get rejected if intimation given after 48 hrs. of hospitalization.
To avail of Hospitalization (IPD) benefits, a minimum of 24 hrs. of hospital admission is required.
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, 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, in case there is a specific need for it, though it will not be a part of the standard process
3.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
4.Once the claim documentation is validated, 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]
5.10% to 20% of the estimated amount will be transferred to the employee/ patient's account as security deposit/initial payments for hospitals.
6. 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
7. Once the claim documentation is validated, 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]
8. 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 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,
• Full itemized bill,
• Any other documentation, in case 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.
JIO
JIO is a Health / Wellness Company?
No. JIO is NGO which run various scheme for the benefits of its community and members. and does not give any type of Plan. JIO is the Manager of this Plan. JIO has played the role of designing the scheme benefit and arranging the administering agencies for benefit of its Shravak/ Shravika Members
Is JIO is making profits from the Health plans?
NO
JIO is a Non profit 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 Contribution are collected from the members and then same is used to provide the benefits to needy as per rules. In-fact, Gurudev has inspired several Jain Shravaks to donate partly towards the contribution 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 contributions. 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 Benefit utilisation. The forms have been designed in a way to get the important details only.
JIO has made available their offices where company representative will be available to assist you in enrolment.
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 Benefits 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 Benefit availment 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 Benefit starts very late after payment of contribution to JIO?
There is fixed enrollment period for members to enroll. Benefit start date is fixed and known in the advance.
Data reconciliation takes time at JIO end, hence docket creation takes time.
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 Benefits disbursal and deductions?
All the queries regarding the Benefits process, status of Benefits, reasons of deductions from Benefit etc., are handled by the concerned Wellness Company and providers.
In cases, where the grievances of the plan members remain unresolved by the Wellness / Administrator, the members can escalate such urgent / important issues with the JIO officials. JIO in turn will take up these issues with the concerned providers. However, the Benefits will be decided on merits of the case and within the terms of the plan.
Saarthi Health Services
Who is Saarthi Health Services?
Saarthi Health is a digital platform to offer solutions for doctor consultations, medicines, lab tests and other out of hospital healthcare services.
Whom to contact in case of addition/deletion & Correction?
Please write on claimhelp@jio.net.in
Can I get certificate of Insurance?
No,
This is not insurance scheme but community welfare scheme managed by JIO. Every member will get docket with terms & conditions on their registered mail ID.
Why so much emphases is given on registered mail ID?
To avoid multiple mail communications / fraudulent mail communications JIO has made compulsory to raised query from registered mail ID only. Team will not reply if they get mail from unregistered mail ID.
What will be the room rent ? Is proportionate deductions applicable ?
Room rent including associated charges is given in below table. Proportionate deductions applicable in this plan.
What will be deductions in case of delay intimation & submission?
Your Benefit may get rejected if intimation/submission not given within time line.
Processor may deduct 10% additional in case of delay.
Intimation / Submission : 10% deductions will be applicable over & above all terms & condition if intimation not done within 48 hrs. of admission.
10% deductions will be applicable over & above all terms & condition if submission not done within 30 days of discharge.
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 and wellness plan is a temporary affair or will continue for several years to come?
The JIO community plan is NOT a temporary affair and will continue in future like all other Plan.
However, as discussed earlier, the terms of the welfare scheme are subject to change at the time of each year based on past experience & analysis.
JIO community Benefit plan was started with a noble vision of giving financial security in medical emergency to all the Shravak / Shravika families. Therefore, JIO will endeavor to continue the scheme.
What is the procedure for continuing the benefit year on year?
A member is required to visit the designated website for enrollment 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 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 of Contribution amount?
Only through Online payment by 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?
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 my wife enroll?
Yes.
Can I and my brother / sister add our parents under our subscription?
Yes, you can but any person can't take benefit more than once under whole group in JIO Plan. If declared more than once, benefit would be payable under one benefit amount only.
Can I add my married daughter in scheme?
No, because 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 have 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?
There is a waiting period of one year for Pre-existing disease if you are subscribing for the first time subject to terms & conditions.
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 enroll?
Please follow the below mentioned steps
Please go on https://jio.net.in/novstu2324.php
Read revise Terms & Conditions carefully
Select "Apply Now"
Enter JIOJAC ID
Fill your enrolment details.
Make payment ONLINE.
If I don't have JIO JAC Id, can I opt for health scheme?
No, JIOJAC ID is compulsory for proposer. Please register online for JIOJAC ID.
What is the Subscription?
Subscription details are available in T & C section.
When will I be eligible for my maternity Benefit?
Maternity benefit not available in this plan.
Are pre & post-natal expenses under Maternity benefits covered?
No
Can I submit physical form?
No, You have to do enrolment online only. You may visit designated centers for assistance.
Do we get no Benefit bonus if we do not Benefit in the existing year?
No
If my wife is Jain can she add her parents?
Yes, only if she is a Jain by birth.
Whom to approach in case of Grievance or dissatisfaction?
You can reach out to us at grievance.jio@kenko-health.in
How to pay the Health Subscription?
Your JIO Enrollment fees can be paid by visiting this website https://jio.net.in/novstu2324.php
Click on apply now and proceed to payment.
When will the JIO benefit start?
Your Contribution will start on a common date notified by JIO & not from the payment of contribution amount.
I am Thankful.
- I appreciate JIO for being a facilitator for this highly beneficial Community health & OPD Wellness contribution 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 Non Profit organization who has selected Wellness Service Partners for the well-being of its members.
- This is Self-managed hospitalisation benefit scheme, run by Jain International Organisation for its members. Vidal Health will be running the adjudication as per scheme rules
- KENKO will run the OPD discount program for its subscribers and help in administration of the self managed scheme of the NGO against fee
- This is a community health contribution plan. It will start from a common date and not from the date you pay the contribution fee.
- Contribution Period:Policy start date 30th Nov 2023 to 29th Nov 2024.
I UNDERSTAND THIS AND ACCEPT that if the services of providers are found to be improper, I would be bounded by the decision of the scheme administrator (including the agencies administrator appoints for scheme management and waive any right to legal or any remedy in all judicial or semi judicial forums. Benefits are processed by JIO.