1. Background and Object

1.1. Jain International Organisation ("JIO") is a charitable society registered under the Societies Registration Act, 1860 and engaged in social, educational, medical, cultural, and philanthropic activities for the welfare of the Jain community and society at large in accordance with its Memorandum of Association and Rules and Regulations.

1.2. In furtherance of its charitable and community welfare objectives, JIO has established a Community Welfare Contribution Fund for Healthcare, Education, Sports, and Philanthropic Activities, through which members of the Jain community voluntarily contribute amounts for the purpose of supporting fellow members and carrying out charitable and welfare activities of the organisation.

1.3. The said arrangement is a community welfare initiative based upon mutual contribution and mutual assistance and shall not be construed as a commercial activity, insurance scheme, financial product, or service provided for consideration.

1.4. This plan will start with minimum 555 families. If less members are enrolled than amount will be refunded to the members.

Hospitalization during enrolment / extension period is not covered.

2. Nature of the Community Welfare Contribution Fund

2.1. The Community Welfare Contribution Fund is a voluntary and self-contributory fund established by members of the Jain community for the collective welfare and benefit of the community.

2.2. All contributions received under the fund shall be pooled into a common fund and administered by JIO in a fiduciary, charitable, and non-commercial capacity.

2.3. Participation in the fund shall not create any contract of insurance, indemnity, guarantee, or enforceable right against the organisation.

2.4. The contribution made by any participant shall not be treated as premium, policy consideration, or payment for supply of goods or services.

2.5. Any financial assistance provided from the fund shall be purely discretionary in nature and shall depend upon availability of funds, administrative guidelines, and the decision of the organisation.

2.6. The contributors and beneficiaries form part of the same class of persons, and the organisation merely administers the common fund for the collective welfare of participating members.

3. Non-Insurance Declaration

3.1. The Community Welfare Contribution Fund is not an insurance scheme, mediclaim policy, or risk cover arrangement.

3.2. Any ceilings, limits, categories, or administrative guidelines mentioned in this document are solely for equitable administration and fair distribution of the common welfare fund and shall not be construed as guaranteed benefits or contractual obligations.

3.3. The contributions made under this arrangement are voluntary contributions towards a common welfare fund and shall not be treated as consideration for supply of goods or services.

4. Voluntary Contribution Structure

4.1. Members may voluntarily contribute to the Community Welfare Contribution Fund in accordance with contribution slabs prescribed by the organisation for administrative convenience.

4.2. Contribution once made shall ordinarily be non-refundable except at the sole discretion of the organisation and subject to such conditions as may be prescribed from time to time.

4.3 Purpose of the Fund

The fund may be utilised for providing financial assistance to members of the community for the following purposes:

1. Hospitalisation and medical expenses
2. Educational support
3. Social welfare activities
4. Disaster relief assistance
5. Charitable and philanthropic activities
6. Other charitable objects of JIO

Any assistance from the fund shall be subject to availability of funds and the sole discretion of the organisation.

Family Participation

For administrative purposes, participation under the Community Welfare Contribution Fund may be recorded for the following family members:

• Self
• Spouse
• Dependent children up to the age of 25 years
• Parents or parents-in-law (any one set only)

A maximum of 8 members (1 contributor + 7 family members) may be recorded under one family participation.

All participating and covered members must belong to the Jain community.

Recording of family members shall be solely for administrative purposes and shall not create any contractual or legal entitlement.

Age Limits

Participation may be permitted within such age limits as may be prescribed by JIO from time to time for administrative convenience.

• Entry age of contributor: 18 years to 90 years
• Fresh participation shall ordinarily be permitted up to 90 years of age during the first year.

Existing participants may be permitted to continue subject to rules, guidelines, and administrative decisions framed by the organisation.

Single Participation Rule

No individual shall be permitted to participate more than once under the fund for the same participation period.

In case of duplication, the organisation shall have the right to cancel any duplicate participation and retain the contribution amount in the common welfare fund.

Submission of incorrect, false, or misleading information may result in rejection of assistance and/or cancellation of participation.

Administrative Ceiling for Assistance

1.1. For proper administration of the Community Welfare Contribution Fund, the organisation has prescribed the following administrative ceilings for financial assistance.

1.2. The maximum financial assistance that may ordinarily be considered for one family during a financial year shall be:

• Rs. 5,00,000/- category
• Rs. 10,00,000/- category

depending upon the participation category selected by the participant.

1.3. These ceilings are administrative guidelines intended for equitable distribution of the common fund and shall not be construed as guaranteed benefits, contractual obligations, or enforceable rights.

1.4. All assistance shall be subject to availability of funds and the sole discretion of the organisation.

Room Rent Administrative Limit

2.1 For uniform and equitable administration of the Community Welfare Contribution Fund, the organisation may restrict financial assistance towards hospitalisation expenses based on the room rent limits prescribed under the applicable participation category.

The per day room rent limit shall be inclusive of charges relating to nursing, Resident Medical Officer (RMO), Biomedical Waste Management (BMW), monitoring charges, oxygen charges, infection control charges, and other similar hospital-related charges as may be applicable.

2.2. Where a participant opts for a room category higher than the eligible room rent limit prescribed under the applicable participation category, the financial assistance from the fund may be proportionately restricted.

If the participant is admitted in a room with rent exceeding the eligible room rent limit, all associated medical and hospital expenses shall be restricted to the charges applicable to the eligible room category or actual expenses incurred, whichever is lower. Accordingly, proportionate deductions may be applied to the entire admissible claim amount.

5. Proportionate Restriction Rule

5.1. If the hospitalization expenses incurred by a participant exceed the administrative limits, room rent eligibility, or internal ceilings prescribed by the organisation, the financial assistance from the Community Welfare Contribution Fund may be restricted proportionately in accordance with the applicable administrative guidelines.

5.2. The purpose of such proportionate restriction is to ensure fair, equitable, and sustainable utilisation of the common welfare fund for the benefit of all participating members.

6. Administrative Ceilings for Specific Treatments

6.1. For equitable distribution of the Community Welfare Contribution Fund and to ensure availability of financial assistance to the maximum number of participating members, the organisation may prescribe indicative administrative ceilings for specified categories of treatment and medical conditions.

6.2. Such ceilings are administrative guidelines intended solely for fair management and distribution of the common fund and shall not be construed as guaranteed benefits or contractual entitlements.

6.3. Indicative ceilings may be applied for various categories of treatment including, but not limited to, the categories specified below.

Disease-Wise Administrative Capping (FY 2026–2027)

The disease-wise ceilings mentioned below represent the overall administrative limit for the respective illness category and shall include related complications, pre-hospitalisation expenses, post-hospitalisation expenses, and associated treatment costs, unless otherwise specified by the organisation.

6.4. A compulsory deduction of Rs. 5,000/- shall be applicable for each and every request for financial assistance, including cases falling under disease-wise administrative capping.

6.5. The administrative ceiling prescribed for joint replacement procedures shall apply irrespective of whether the joint replacement arises due to fracture, injury, degeneration, or any other medical condition.

6.6. The organisation reserves the right to revise, modify, increase, reduce, or withdraw such administrative ceilings, limits, or guidelines from time to time for administrative convenience and equitable management of the Community Welfare Contribution Fund.

Day Care Procedures

14.1. Expenses relating to approved day-care procedures may be considered for financial assistance subject to the overall administrative ceiling applicable to the relevant participation category.

14.2. Such assistance shall be subject to submission and verification of supporting documents, availability of funds, and approval by the organisation.

Congenital / Special Conditions

Internal congenital diseases and specified special medical conditions may be considered for financial assistance up to Rs. 50,000/- per family, subject to administrative guidelines and availability of funds.

Psychiatric Treatment

Hospitalisation expenses arising from psychiatric or mental health ailments may be considered for financial assistance up to Rs. 30,000/-, subject to administrative guidelines and availability of funds.

AYUSH Treatment

Hospitalisation expenses incurred for treatment under AYUSH systems of medicine, including Ayurveda, Homeopathy, and Unani, may be considered for financial assistance up to Rs. 50,000/-, provided that such treatment is undertaken at a recognised institution and subject to the applicable administrative ceilings. Such assistance shall be subject to availability of funds and approval by the organisation.

Joint Replacement / Major Surgery

Expenses relating to joint replacement or similar major surgical procedures may be considered subject to the internal ceiling prescribed for the applicable participation category.

The organisation may restrict financial assistance to one such procedure during a participation period in order to ensure equitable utilisation of the common welfare fund.

Joint replacement assistance shall not ordinarily be available for fresh participants during the initial restriction period prescribed by the organisation.

Emergency Ambulance Charges

Ambulance charges incurred for emergency hospitalisation may be considered for financial assistance up to Rs. 2,500/- per admission or such other limit as may be prescribed internally by the organisation.

Pre-Hospitalisation / Post-Hospitalisation Expenses

Expenses incurred prior to and subsequent to hospitalisationfor 30 days and 60 days respectively may be considered as part of the total financial assistance, subject to the overall administrative ceiling applicable to the participation category.

Such expenses may be considered up to 10% of the applicable benefit limit during the participation period or such percentage as may be internally prescribed by the organisation.

Pre/Post Hospitalization Maximum payable limit will be 10% of overall applicable benefits limit.

Maternity Assistance

Expenses relating to maternity may be considered for financial assistance subject to the following internal ceilings:

• Normal Delivery: up to Rs. 30,000/-
• Caesarean Delivery: up to Rs. 40,000/-

Such assistance shall be limited to the first two living children only.

Maternity assistance shall not ordinarily be available for fresh participants during the prescribed restriction period.

New Born Child

Hospitalisation expenses incurred for a new-born child shall be considered for financial assistance from the date of birth up to 90 days, subject to a maximum limit of Rs. 35,000/-.

Thereafter, eligible expenses may be considered within the overall family benefit limit applicable under the participation category.

Late intimation or failure to comply with documentation requirements may result in rejection of the request for assistance.

Pre-Existing Illness / Co-Participation

PED co-participation deduction shall also apply to ailments falling under disease-wise capped categories.

Pre-existing diseases shall be considered for assistance from Day One, subject to the following co-participation conditions:

• 50% co-participation for fresh participants
• 25% co-participation for renewal participants

Any illness, disease, injury, or medical condition existing prior to 15 June 2026 shall be treated as a pre-existing disease for the purpose of administration of the fund, and applicable co-participation deductions shall apply.

The percentage of such participant sharing or co-participation may vary between new participants and renewal participants in accordance with the administrative guidelines prescribed by the organisation from time to time.

Compulsory Deduction of Rs. 5,000/- per Assistance Request

A compulsory deduction of Rs. 5,000/- shall apply to every assistance request, including disease-wise capped claims.

Such deduction is an internal administrative rule of the welfare fund and shall not be construed as an insurance deductible.

Administrative Waiting / Restriction Period

There shall be a one-year administrative restriction period for the following categories in respect of fresh participants:

• Joint replacement surgery
• Joint revision surgery
• Joint infection surgery
• Maternity assistance

This restriction is intended solely for protection and equitable administration of the common welfare fund and shall not be construed as an insurance waiting period.

Such restriction period is prescribed solely for administrative stability and equitable management of the Community Welfare Contribution Fund and shall not be construed as an insurance waiting period or contractual exclusion.

Participation Changes During Period

Mid-term addition shall be permitted only in case of natural additions to the family, namely marriage or birth of a child, subject to the following conditions:

• Intimation must be provided through email to claimhelp@jio.net.in within 20 days from the date of marriage or birth.
• In case of a new-born child, claims shall be processed only on reimbursement basis.
• The participant shall submit the birth certificate and/or marriage certificate issued by the competent local government authority within 2 months from the date of birth or marriage.

The above facility is provided solely for administrative convenience and shall not create any contractual or legal entitlement.

15. Hospitalisation Intimation

15.1. Participants shall intimate the organisation regarding hospitalisation within the prescribed timelines for proper administration of the Community Welfare Contribution Fund.

15.2. Failure to provide timely intimation may result in rejection or refusal of financial assistance.

15.3. This requirement is necessary for documentation, verification, and proper administration of the fund.

15.4. In case of hospitalisation, intimation shall ordinarily be provided to JIO within 48 hours from the time of admission through email at:

• contact@prologichealth.in

15.5. Delay in providing intimation beyond 48 hours from hospitalisation may result in rejection of the request for financial assistance, unless otherwise condoned by the organisation at its sole discretion.

In the event that intimation is not provided within 48 hours from the date of hospital admission, a 10% co-payment shall be deducted from the admissible claim amount, subject to the Rules and Regulation of the health plan.

16. Submission of Documents

16.1. Requests for financial assistance shall be accompanied by all necessary supporting documents, including but not limited to hospital bills, receipts, medical reports, prescriptions, investigation reports, and discharge summary.

In the event that the required claim documents are not submitted within 30 days from the date of hospital discharge, a co-payment of 10% of the admissible claim amount shall be applicable, unless otherwise waived at the sole discretion of the management in exceptional circumstances.

16.2. For reimbursement requests, physical claim documents shall ordinarily be submitted within 30 days from the date of discharge at the following address:

16.3. Any deficiency or pending documents as requested by the organisation or administrative agency shall ordinarily be submitted within 7 days from the date of communication.

16.4. Incomplete documentation, delayed submission, or failure to provide required information may result in rejection of the request for financial assistance.

17. Administrative Processing

17.1. For the purposes of documentation, verification, coordination, and record maintenance, the organisation may appoint administrative agencies or facilitators.

17.2. Such agencies shall act solely in an administrative and facilitative capacity.

17.3. No insurer-insured relationship or contractual relationship shall arise between any participant and such administrative agency.

17.4. The final decision regarding grant, restriction, or refusal of financial assistance shall remain solely with JIO.

18. Processing Through Health Administrator

18.1. For administrative convenience, hospitalisation-related documentation and coordination may be facilitated through the health administrator appointed by the organisation.

18.2. Such arrangement is purely administrative in nature and shall not alter the charitable, mutual, and non-commercial character of the Community Welfare Contribution Fund.

19. Contribution Slabs

19.1. Contribution slabs may be determined by the organisation based on the following administrative factors:

• Family size
• Age group
• Participation category

19.2. The applicable contribution structure for the financial year may be as follows:

19.3. The above slabs are administrative contribution categories only and shall not be construed as insurance premium or consideration for supply of services.

20. Payment of Contribution

20.1. Contributions shall be made through payment modes approved by the organisation.

20.2. Any payment gateway charges, convenience charges, bank charges, or transaction charges shall be borne separately by the participant and shall not form part of the contribution amount.

21. Non-Commercial Character

21.1. The Community Welfare Contribution Fund is not a commercial or business activity.

21.2. The organisation does not undertake any commercial service or insurance activity for consideration.

21.3. The arrangement is charitable, voluntary, and mutual in nature for the welfare of the Jain community.

22. Principle of Mutuality

22.1. The contributors and beneficiaries under the Community Welfare Contribution Fund constitute the same class of persons.

22.2. The common fund collectively belongs to and is administered for the benefit of participating members.

22.3. Any financial assistance is provided from members collectively to members collectively.

22.4. Accordingly, the arrangement does not involve supply between two distinct persons and is based upon the principle of mutuality.

23. Administrative Exclusions

23.1. For proper, fair, and sustainable administration of the Community Welfare Contribution Fund, the organisation may determine that financial assistance shall ordinarily not be provided in certain situations specified under these guidelines.

24. Situations Where Financial Assistance May Not Ordinarily Be Granted

24.1. For equitable administration of the Community Welfare Contribution Fund and protection of the stability of the common pool, the organisation may decide that financial assistance shall ordinarily not be granted in circumstances where the expenditure is inconsistent with the charitable objectives or internal administrative guidelines of the fund.

24.2. The following exclusions are illustrative and indicative in nature. The organisation reserves the right to consider each case independently and exercise discretion where deemed appropriate.

24.3. Expenses arising directly or indirectly from war, invasion, civil war, rebellion, military action, terrorism, nuclear events, radioactive contamination, biological hazards, chemical contamination, or similar extraordinary events may not ordinarily qualify for assistance.

24.4. Expenses arising from intentional self-injury, attempted suicide, unlawful acts, criminal activity, or deliberate exposure to danger may not be considered.

24.5. Expenses arising from participation in hazardous activities, professional sports, racing, mountaineering, scuba diving, aviation activities other than as a fare-paying passenger, or similar high-risk activities may not ordinarily qualify for assistance.

24.6. Expenses relating to alcohol abuse, drug abuse, substance addiction, intoxication, or de-addiction treatment may not ordinarily be considered unless specifically approved by the organisation.

24.7. Treatment undertaken primarily for cosmetic, aesthetic, weight reduction, appearance enhancement, or non-medically necessary plastic surgery may not ordinarily qualify for assistance unless arising from accident or medical necessity.

24.8. Routine health check-ups, preventive examinations, vaccination, inoculation, dietary supplements, vitamins, tonics, wellness therapies, or preventive care treatments may not ordinarily qualify for assistance except where specifically approved.

24.9. Expenses relating to eyesight, spectacles, contact lenses, hearing aids, dental appliances, external prosthesis, or corrective devices may not ordinarily qualify unless directly arising from covered hospitalisation due to accident.

24.10. Treatment undertaken without medically necessary hospitalisation, or where active line of treatment is absent, may not be considered for assistance.

24.11. Experimental treatment, investigational therapy, unproven medical procedures, or therapies not generally accepted under standard medical practice may not ordinarily qualify.

24.12. Expenses incurred solely for diagnostic evaluation or investigation without active treatment may not ordinarily qualify.

24.13. Expenses relating to rest cure, rehabilitation, custodial care, long-term nursing care, old-age care, or detoxification may not ordinarily be considered.

Preventive care expenses including vaccination, inoculation, immunisation (except post-bite treatment), routine physical examinations, psychiatric or psychological assessments, screening tests, or similar preventive or evaluative procedures may not ordinarily qualify for financial assistance under the Community Welfare Contribution Fund

24.14. Expenses relating to enteral feeding, nutritional supplements, electrolyte supplements, vitamins, or similar products may not ordinarily qualify unless certified by the treating medical practitioner as medically necessary.

Expenses relating to hearing aids, contact lenses, spectacles, optometric therapy, multifocal lenses, or similar corrective visual or hearing devices may not ordinarily qualify for financial assistance under the Community Welfare Contribution Fund.

24.15. Expenses relating to baldness treatment, alopecia treatment, wigs, toupees, cosmetic hair restoration, or related procedures may not ordinarily qualify.

24.16. Expenses relating to diabetic strips, elastic stockings, nebulizers, glucometers, oxygen concentrators, wheelchairs, crutches, home-use devices, external medical equipment, or similar appliances may not ordinarily qualify unless used intra-operatively during hospitalisation.

External Durable Medical Equipment:
Any expenses incurred on prosthesis, corrective devices, or external durable medical equipment of any kind—such as wheelchairs, crutches, instruments used in the treatment of sleep-apnea syndrome or Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.), devices used for ambulatory blood pressure monitoring, AV fistula and fistuloplasty-related charges—are not payable. Expenses related to blood sugar monitoring devices, glucometers, nebulizers, and oxygen concentrators for bronchial asthma/COPD conditions are also excluded. The cost of artificial limbs, crutches, or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively) shall not be covered. Sleep-apnea and other sleep disorders are also excluded from coverage.

24.17. External congenital anomalies, developmental disorders, behavioural disorders, dyslexia, ADHD, learning disabilities, or similar conditions may not ordinarily qualify for assistance.

24.18. Expenses relating to stem cell therapy, genetic disorders, growth hormone therapy, or similar specialised procedures may not ordinarily qualify unless specifically approved.

24.19. Expenses relating to sexually transmitted diseases, venereal diseases, HIV/AIDS-related conditions, or similar illnesses may not ordinarily qualify unless specifically permitted by the organisation.

24.20.A Expenses arising from voluntary termination of pregnancy, infertility treatment, sterility treatment, assisted conception, surrogate pregnancy, or related procedures may not ordinarily qualify except as specifically permitted under internal guidelines.

24.20.B Expenses arising from HIV, AIDS, sexually transmitted diseases, or related medical conditions shall not ordinarily be considered unless specifically permitted or approved by the organisation under exceptional circumstances.

24.20.C Expenses relating to organ transplant may be considered only up to the internal ceiling prescribed by the organisation and shall be subject to compliance with all applicable laws, rules, and regulatory requirements.

24.21. Spinal Subluxation:
Expenses incurred towards treatment and supplies for analysis and adjustment of spinal subluxation, diagnosis and treatment through manipulation of the skeletal structure, and muscle stimulation by any means are not payable. However, treatment related to fractures (excluding hairline fractures) and dislocations of the mandible and extremities may be considered.

24.21.A Dental treatment, dentures, implants, artificial teeth, and non-hospitalisation dental procedures may not ordinarily qualify unless arising from accidental injury requiring hospitalisation.

24.22. Expenses incurred for issuance of certificates, employment examinations, travel fitness examinations, or health check-ups conducted for administrative purposes may not ordinarily qualify.

24.23. Artificial life maintenance or prolonged life support where recovery or restoration of health is not reasonably expected may not ordinarily qualify for assistance.

Developmental and Behavioural Disorders:
Expenses incurred towards treatment for developmental problems, learning difficulties such as Dyslexia, and behavioural disorders including Attention Deficit Hyperactivity Disorder (ADHD) shall not be payable under the scheme.

24.24. Expenses relating to 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, Port removal treatment is not covered.

24.25. 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.

24.26. Expenses relating to external congenital conditions, developmental disorders, learning disabilities, behavioural conditions, or similar long-term medical conditions shall not ordinarily be considered under the scheme.

24.27. Expenses incurred towards medical equipment, appliances, prosthesis, external medical devices, corrective aids, or home-use medical equipment shall not normally qualify for assistance under the scheme.

24.28. Treatment undertaken outside India may not ordinarily qualify unless specifically approved by the organisation.

24.29. Treatment undertaken from unregistered medical practitioners or at unrecognised institutions may not ordinarily qualify for assistance.

24.31. Expenses that are not medically necessary, are excessive or unreasonable in nature, or are not supported by a valid medical prescription and relevant documentation shall not be considered under the scheme.

Per day visit charges are payable only once. If the doctor has levied two or three visit charges in a single day, the same will not be payable. Only a single visit charge per day is admissible.

In case of multiple surgeries during one hospitalization, the payable amount is generally: 100% of the charges for the first surgery, 50% of the charges for the second surgery, Subsequent surgeries are paid proportionately, as per plan terms and conditions

Administrative charges, service charges, registration fees, documentation charges, file handling charges, or any other similar non-medical expenses shall not ordinarily be considered for assistance under the scheme.

24.32. Expenses incurred towards medical treatment, consultation, hospitalization, or procedures undertaken outside India shall not be payable

24.33. Expenses arising while the Insured Person is flying or participating in aerial activities shall not be payable, except when travelling as a fare-paying passenger on a regular scheduled airline or a licensed air charter company.

24.34. Robotic surgery, laser surgery, bariatric surgery, radio frequency ablation procedures, OPD AYUSH treatment, naturopathy treatment ordinarily conducted without hospitalisation, and similar procedures may not ordinarily qualify unless specifically approved.

Expenses incurred towards all forms of Bariatric Surgery, including related treatments and procedures, shall not be payable under the scheme.

24.35. Expenses incurred towards the use of Radio Frequency (RF) probe for ablation or any other procedure shall not be payable under the scheme.

24.36. Hospitalization not justified by the medical condition, admission primarily for diagnostic purposes not consistent with the treatment taken, treatment where there is no active line of management for the diagnosis in question, or treatment related to another diagnosis not covered under the scheme, shall not be payable.

Domiciliary treatment, OPD treatment, home quarantine expenses, or treatment involving hospitalisation of less than 24 hours may not ordinarily qualify unless otherwise specifically provided.

24.37. Expenses incurred towards Intra Vitreal Injections shall not be payable under the scheme. Intramuscular injections and subcutaneous injections administered for cancer or any other treatment are also not covered. Further, Intra Vitreal Injections and Epidural Injections shall not be payable under any circumstances when administered to patients.

24.38. Treatment provided by persons residing with the participant or by immediate family members acting as medical practitioners may not ordinarily qualify.

24.39. Expenses incurred towards Holmium Laser Enucleation of Prostate (HOLEP), KTP Laser Surgeries, Femto Laser Surgeries, bio-absorbable stents, bio-absorbable valves, bio-absorbable implants, oral chemotherapy, hormonal chemotherapy, targeted chemotherapy, adjuvant chemotherapy, neo-adjuvant chemotherapy, chemo port/ insertion not payable, immunotherapy, and the use of monoclonal antibodies such as Trastuzumab, antibody cocktails, Infliximab, Rituximab, Avastin, Lucentis, and similar group of drugs shall not be payable under the scheme

24.40. Expenses incurred towards domiciliary hospitalization, hospitalization for less than 24 hours, and OPD treatment shall not be covered under the scheme. Home quarantine expenses shall also not be payable.

24.41. Expenses relating to targeted chemotherapy, immunotherapy, monoclonal antibody therapy, oral chemotherapy, hormonal chemotherapy, biologic drugs, or similar specialised medications may be restricted or excluded in accordance with internal administrative guidelines.

Expenses relating to bariatric surgery, robotic surgery, laser procedures, or other specialised procedures not covered under the organisation’s internal guidelines shall not ordinarily be considered under the scheme.

24.42. Failure to comply with prescribed procedures including delayed intimation, incomplete documentation, concealment, misrepresentation, or incorrect information may result in rejection of assistance.

Expenses relating to domiciliary treatment, OPD treatment, daycare treatment not requiring hospitalization, or any treatment not involving hospital admission shall not ordinarily be considered under the scheme

24.43. Expenses exceeding administrative ceilings or incurred at facilities beyond permissible administrative limits may be proportionately restricted in accordance with internal guidelines.

24.44. The organisation reserves the absolute right to consider, allow, restrict, or reject any request for financial assistance based on merits of each case, availability of funds, and protection of the stability and equitable administration of the Community Welfare Contribution Fund.