Jain International Organisation|

SUPER TOP UP Plan : Community Contributory Health Plan - Base May 2025-2026

UNIQUE TYPE OF Health Plan to cover

An ADDITIONAL COVERAGE of Base Health benefit coverage BEYOND a Chosen Specified Limit,

SO IT ACTS as a Cushion & Comes in to Action When Such Limit Is Exhausted.

Plan Start Date Shall be : 15th May, 2025

Terms & Conditions of JIO Super Top-Up Community Contributory Health Plan

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.

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 request will also be processed by JIO/ Prologic health T. Pvt Ltd.

This contribution is in form of donation towards community hospitalization expenses. If any lives enrolled under this scheme falls hospitalized then JIO will reimburse/pay to hospital directly his Hospitalization expenses. The fund thus raised through donation of many will be used for member of all sects of community. Members have to initiate their hospitalization in advance on this number 02235035391 or can send intimation at intimation@prologichealth.in . All claims’ documents can be submitted at Prologic health T. Pvt Ltd at A-310, Neelkanth Business Park, Nathani Road, Vidyavihar West, Mumbai: 400 086

Please be aware that settlement letters and attested documents are not provided under this plan. If you have another Mediclaim or health insurance policy, please file your claim with that policy first and then approach JIO for any remaining amount.

Community service program Subscription features (April 2025 – 2026):

Subscription start date: From 15^th May, 2025 to 30^th April, 2026.

1. Available for All JAIN Shravak-Shravika Members of JIO

2. Available SUPER TOP-UP benefit limit of 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 policy year. Dialysis is 5000/- per cycle maximum Up to 1 lakh per family per policy year. Radiotherapy is 5000/- per cycle maximum Up to 1 lakh per family per policy 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 benefit limit.

10. Opportunity to avoid heavy deduction due to ROOM RENT LIMITS.

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.

16. Proposer will not be eligible for DEDUCTION UNDER SEC. 80 D of Income Tax Act.

POINTS TO BE NOTED FOR "SUPER TOP UP"

17. It ENHANCED YOUR existing health BENEFIT LIMIT

18. This plan is also available for members without any Mediclaim with minimum 5 Lac deductible.

19. 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.

20. You need to choose base plan Benefit limit as deductible limit.

21. DEDUCTIBLE LIMIT: The chosen amount up to which the aggregate medical claims of family will not be payable by this super top up plan incurred during the policy period.

22. STU Plan rate chart (2025 - 2026)

Deductible SI	BENEFIT LIMIT	Rate below 60	Rate 60 to 85
500000	500000	18,000	29,000
	1000000	26,000	44,000

1000000	500000	13,000	21,000
	1000000	16,000	27,000

23. If any member of the family is not covered under any existing mediclaim policy still he/she can be covered under super top up plan in family floater. But for that particular member Minimum deductible of Rs.5 Lakh is applicable at the time of claim.

24. 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.

25. Member can choose BENEFIT LIMIT from Rs.5 Lakh or Rs.10 Lakh.

26. Options of DEDUCTIBLES for Rs.5 Lakh or Rs.10 Lakh are available. Deductible is amount up to which member's base policy will pay the claim and super top up plan will respond once the deductible amount is exhausted. If the benefit limit does not have base plan, the Plan Holder will have to bear the expenses up to deductible limit from his pocket.

27. Hospital ROOM RENT & ICU CHARGES limitation (Per Day, including Nursing, RMO, O2, Monitor and all associated charges): 1% of STU Benefit limit for Normal Room and 2% of STU benefit limit for ICU room.

28. Super top up plan will pay all the claims those are falling within plan period of super top up. If base policy benefit limit is exhausted or partially exhausted before inception of super top up policy then the same will not be paid.

29. Hospitalisation 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 policy.

30. Addition / Deletion: New born babies and newly married spouse can be added provided baby birth and marriage intimation is given in mail on contact@prologichealth.in within 20 days of birth / Marriage. Deletion / Cancellation not allowed.

31. CLAIM INTIMATION –

• In case of claims, immediate intimation shall be given to Prologic health within 48 hours of Hospitalization on initimation@prologichealth.in

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

32. 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 at below Address:

Prologic Health T. Pvt Ltd.

A-310, Neelkanth Business Park,

Nathani Road, Near Vidyavihar station,

Vidyavihar West, Mumbai - 400086

33. A Deduction of 10% to be levied for late Intimation and Submission. This deduction is over and above other policy conditions.

34. Reasonability & customarily clause applicable in this plan.

35. Ambulance charges - 1.0% of the Benefit limit 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

36. 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 Plan Holder 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 Plan Holder 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.

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.

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.

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 Plan Holder 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. Plan Holder 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.

Naturopathy treatment and Aayush treatment which are usually done on OPD basis are not covered.

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 Plan Holder Person or who is a member of the Plan Holder 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 Hospitalization, less than 24 hrs. hospitalization treatment & OPD treatment is not covered (Home quarantine not covered)

Is JIO a Health/Wellness Company?

No. JIO is not a Health/Wellness company.

Is this an Insurance Plan?

No, this is not an insurance plan. This is a “community service program” only for its own Jain community families. It will take care of Jain families' healthcare expenses through their own raised contribution fund. It is not supported by an insurance company or any healthcare company. It is by the Jain community, for the Jain community program of sharing healthcare expenses of a few Jain members by many.

Is JIO making profits from the policies/health plans?

No. JIO is not a profit-making organization and is formed with the noble objective of serving its Shravak/Shravika members as well as society at large. Under the Wellness Plan scheme, contributions are collected individually from members and then the full amount is transferred as a group subscription to the Wellness Provider company. In fact, Gurudev has inspired several Jain Shravaks to donate partly towards contributions for members of their respective Samaj/Gnyati who are financially troubled, enabling health security at a discounted price.

Is the enrolment process very complex?

No. The enrolment process requires registering accurate details of the member and their family to avoid trouble during the year or at the time of claim. The forms are designed to collect only important details, avoiding unnecessary information.

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

JIO has pioneered adopting the latest technologies and online tools for your convenience and better service. The online enrolment process offers:

Saved data entry and processing time.
Accuracy of entered data, aiding hassle-free claims.
Enrol anytime, anywhere.
Immediate confirmation of enrolment completion.

Why is the JIO JAC number compulsory?

JIO JAC is required not only for group Health Subscription but also for other JIO schemes. The Jain Advantage Card (JAC) is a unique and permanent identification for availing benefits of various JIO schemes. Members can participate in programsstraction without providing details repeatedly and connect with fellow Shravaks through the JIO Global network.

Is JIO responsible for answering queries on claims disbursal and deductions?

JIO acts as a Group Leader in issuance. Queries regarding claims processes, status, or deductions are handled by the concerned Wellness Company. Unresolved grievances can be escalated to JIO officials, who will take up issues with authorities, but claims are decided based on the merits and terms of the plan.

Can grievances on claims disbursal and deductions be raised with IRDAI or any other legal forum?

No. This is not insurance from an insurance company. Jain community members raise funds in JIO to manage healthcare needs for hospitalization expenses. Contributors are not consumers but comrades in a self-managed healthcare fund serviced by JIO’s in-house claim team. Email: claimhelp@jio.net.in.

When are new phases introduced, and how will Shravaks be informed?

New phases are not on a planned schedule. JIO evaluates proposals from Wellness Provider companies, and if terms are suitable, new phases are announced via SMS, emails, and the website to all JIO JAC members.

Is the Health Plan temporary or will it continue for several years?

The JIO group plan is not temporary and will continue. Terms and subscriptions may change at renewal based on previous year’s experience and analysis. JIO’s vision is to provide financial security in medical emergencies for all Shravak/Shravika families, ensuring the scheme’s continuity.

What is the procedure for renewal?

Members must visit the designated website, log in with their JIO JAC ID, confirm last year’s details (for existing members), read the new plan’s terms, accept them, and make the subscription payment online.

Is physical submission of forms allowed?

No. Physical forms are not accepted for plan renewal. All information must be provided online.

What are the payment options?

Payments can be made online via:

Credit/Debit card
Net banking

If a member is unaware of the online process, how can they renew?

In this age of digitization, internet and computer facilities are widely available. Members unfamiliar with computers are advised to seek help from younger family members to complete the online process.

Can a Jain proposer cover a non-Jain wife?

Yes, under the family floater plan, a non-Jain wife can be covered as part of the Jain family, provided the proposer is Jain.

Can a family with only 3 members buy a Family Floater Plan?

Yes. The Family Floater Plan is available for 2 to 8 members, including Proposer, Spouse, up to 4 unmarried, dependent children (up to 25 years), and parents/parents-in-law (Jain only, up to 90 years).

Can siblings cover parents under individual family floater schemes?

No. A person cannot be covered more than once under the JIO group plan.

Can two brothers enroll parents in two different policies?

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

Can a married daughter be included in the plan?

No, as she is no longer part of the proposer’s family.

Is the plan applicable on a Pan-India basis?

Yes, the plan is for the Jain population across India. All covered members must be Jain.

Can pre-existing diseases be covered?

Yes, pre-existing diseases are covered from day 1, but a 25% co-pay applies for pre-existing ailments.

If some family members lack a Jain certificate, what can be done?

Obtain confirmation from your Sangh/Gyati that you are Jain.

How to renew?

Follow these steps:

Visit https://jio.net.in/stu25-26.php.
Read revised Terms & Conditions carefully.
Select "Apply Now."
Enter JIO JAC ID.
Fill enrolment details.
Make payment online.

Can physical forms be submitted?

No. Enrolment and payment are online only through the JIO website.

What are the payment options for those unaware of online procedures?

Enrolment must be online, but payment can be made via Easebuzz after completing the online enrolment process.

Is JIO JAC ID mandatory for the Health Plan?

Yes, a JIO JAC ID is compulsory for the proposer. Register online for a JIO JAC ID.

When are maternity claims eligible?

For existing members, maternity benefits are covered from day 1 for up to 2 live children. For new members, maternity benefits are available after 1 year from enrolment in the JIO Shravak Arogyam scheme. This benefit is not available for individual plan holders with a 2 Lakh individual benefit limit.

Are pre- and post-natal expenses covered under maternity benefits?

No, pre- and post-natal expenses on OPD/IPD bases are not covered.

Can a Jain wife as proposer cover her parents?

Yes, if she is Jain by birth.

Does the location of dependent family members affect services?

No, location does not affect operational activities. Members can avail benefits anywhere in India.

Section I: JIO Super Top Up Plan

What is the JIO Super Top Up Plan?

The JIO Super Top Up Plan is a family floater plan offering coverage above your chosen deductible limit with extraordinary features. It provides financial relief when hospitalization claims exceed the benefit limit of any other Mediclaim plan, acting as a cushion after the chosen limit is exhausted.

What is the difference between Mediclaim and Super Top Up Plan?

Mediclaim pays claims from Rs. 1 up to the maximum benefit limit. Super Top Up covers hospitalization expenses beyond the chosen deductible limit. They can work together, enhancing coverage if you have a Mediclaim plan.

Why take the JIO Super Top Up Plan if I have a Mediclaim Plan?

Increases benefit limit at a low rate.
No waiting period.
Covers chemotherapy, dialysis, radiotherapy (Rs. 5000/cycle, up to 1 lakh/family/year).
Major organ transplants and surgeries limited to 50% of sum insured.
Pre-existing diseases covered from day 1.
Avoids deductions due to room rent limits.
Cheapest super top-up plan available.
Ideal for those over 55, offering up to Rs. 10 lakh benefit limit up to 85 years.

How is the Super Top Up Plan more beneficial than a general Top Up Plan?

A general Top Up Plan pays when a single hospitalization exceeds the deductible limit. The Super Top Up Plan triggers when the aggregate of all family claims crosses the deductible, covering multiple smaller claims.

How does the Super Top Up Plan work with a floater Mediclaim plan?

In a floater Mediclaim plan, the benefit limit applies to all family members. The Super Top Up Plan responds when the claim amount exceeds the deductible or the benefit limit is exhausted.

How does the Super Top Up Plan work with an individual Mediclaim plan?

Each family member has their own benefit limit. The Super Top Up Plan responds when an individual’s claim exceeds the deductible limit.

Who can be covered under the JIO Super Top Up Plan?

All Shravak and Shravika members of JIO can be covered, including up to 6 family members: proposer, spouse, 2 dependent unmarried children (up to 25 years), and parents/parents-in-law (up to 85 years).

What is the maximum age for coverage?

85 years. Once enrolled, members are covered lifelong upon renewal.

What is a base plan?

A base plan is your Mediclaim plan (individual, family floater, or employer group Mediclaim). Its benefit limit is the base plan benefit limit.

How to select the benefit limit under the Super Top Up Plan?

Choose Rs. 5 lakh or Rs. 10 lakh. Rs. 10 lakh is recommended as the benefit limit cannot be increased at renewal but can be reduced.

What is a deductible limit?

The amount up to which aggregate medical claims of the family are not payable by the Super Top Up Plan during the plan period.

Example 1: Single Claim in a Plan Year

Stage	Base Plan Benefit Limit	Super Top Up Benefit Limit Opted	Claim Amount Eligible	Base Plan Will Pay (Rs.)	Super Top Up Plan Will Pay
At Inception	200,000	500,000	0	0	0
Claim	200,000	500,000	350,000	200,000	150,000

Example 2: Multiple Claims in a Plan Year

Stage	Base Plan Benefit Limit	Super Top Up Benefit Limit Opted	Claim Amount Eligible	Base Plan Will Pay (Rs.)	Super Top Up Plan Will Pay
At Inception	200,000	500,000	0	0	0
Claim 1	200,000	500,000	350,000	200,000	150,000
Claim 2	200,000	500,000	200,000	0	200,000
Claim 3	200,000	500,000	200,000	0	150,000
Claim 4	200,000	500,000	100,000	0	0
Total Paid			850,000	200,000	500,000

Can I choose a deductible limit less or more than my base plan benefit limit?

Ideally, choose a deductible equal to your Mediclaim plan benefit limit for optimal cover. Options are Rs. 5 lakh or Rs. 10 lakh.

What are the deductible options available?

For members with or without a base plan: Deductible options are Rs. 5 lakh and Rs. 10 lakh.

Can I get the Super Top Up Plan without a base Mediclaim plan?

Yes, you can still get the Super Top Up Plan. For members without a Mediclaim plan, the minimum deductible is Rs. 5 lakh.

Why take the Super Top Up Plan if high-value claims are rare?

Multiple smaller claims or claims from multiple family members can exhaust the base plan limit, triggering the Super Top Up Plan to cover additional hospitalization bills.

Can hospitalization bills of all family members be accumulated?

Yes, all claims of covered members can be accumulated to exhaust the deductible limit, triggering the Super Top Up Plan.

What period’s hospitalization claims are covered?

Claims for hospitalizations during the Super Top Up Plan period are covered. Claims paid under the base plan before the Super Top Up Plan’s inception are not considered.

Subscription Period

1st May, 2025 to 30th April, 2026.

What does the Super Top Up Plan cover?

All hospitalization expenses covered under the base plan.
Pre-existing diseases from day 1, even if not covered by the base plan.
Pan-India hospitalization due to accidents or natural diseases.
In-patient hospitalization expenses on a reimbursement basis.
No medical tests required.
No waiting period for hospitalization claims.
30 days pre-hospitalization and 60 days post-hospitalization expenses.
Internal congenital diseases.
Minimum 24-hour hospitalization, except for cataract, chemotherapy, and day-care treatments.

What are the general exclusions?

Exclusions are listed in the Terms & Conditions. Common exclusions align with the base plan, but pre-existing diseases, special disease waiting periods, and 30-day exclusions are not applicable.

What are the benefit limit options?

Rs. 5 lakh or Rs. 10 lakh.

Contribution slab for a 45-year-old proposer with a 65-year-old father?

The contribution slab for 61–85 years applies, as the maximum age of a family member is 65.

Is there a tax benefit under the Super Top Up Plan?

No, there is no tax benefit under Section 80D.

Is there a co-payment?

No, except for major diseases/surgeries.

Are medical tests required?

No medical tests are needed.

What is the plan period?

One year from the date of inception.

Where are E-cards delivered?

E-cards are available on the Prologic Health website.

How long does it take to issue an E-card?

E-cards are issued after 10 days of plan issuance.

How to purchase the plan?

Visit http://jio.net.in/STU25.php.
Select "JIO SUPER TOP UP RENEWAL 2025" Scheme.
Read revised Terms & Conditions.
Enter JIO JAC ID.
Fill enrolment details.
Make payment online.

Is a JIO JAC ID required for the Super Top Up Plan?

Yes, a JIO JAC ID is compulsory. Register online for a JIO JAC ID.

Does the scheme offer cashless facilities?

No, claims are reimbursement-based. Immediate intimation is required within 24 hours of hospitalization.

Is there a tax rebate?

No, there is no tax rebate under Section 80D, and no GST benefit.

Is a plan number provided?

No, but a Health ID card is provided for reimbursement claims.

Is there a no-claim bonus?

No, as this is a wellness scheme, there is no no-claim bonus.

Does the location of dependent family members matter under TPA?

No, members can avail benefits irrespective of location in India.

Does a change in names during the plan period matter?

Yes, name changes must be intimated to JIO within 15 days of receiving cards, and an endorsement is required from the Wellness company.

Can medical expenses before and after surgery be claimed?

Yes, expenses 30 days before and 60 days after hospitalization related to the ailment are covered, except for maternity claims.

Section II: Claim Procedure

How to claim under the Super Top Up Plan?

Claims are reimbursement-based. Submit an attested copy of the entire claim file from the base plan TPA, including the settlement voucher, within 30 days of base plan claim payment. Intimate the claim during hospitalization. Late intimation or submission incurs a 10% deduction. Claims are rejected if:

Hospitalization intimation is not provided within 48 hours.
Original claim file is not submitted within 30 days of discharge.
Deficiency documents are not provided within 7 days.

Basic criteria to claim under STU?

The base plan benefit limit must be exhausted. For individual benefit limits, the Super Top Up Plan applies when the respective patient’s limit is exhausted.

What are non-medical expenses?

Non-medical expenses, such as hand gloves, savlon, aprons, registration fees, and service charges, are not payable.

Can dentist bills be claimed?

No, except in cases of road accidents requiring hospitalization with a police FIR.

Are maternity claims covered?

No, maternity benefits are not included in this scheme.

Can non-medical expenses be claimed?

No, non-medical expenses per IRDAI guidelines are not payable.

Can claims denied under the base plan be claimed under the Super Top Up Plan?

No.

What expenses can be claimed?

30 days prior to hospitalization: doctor bills, medical costs, tests, and reports related to the disease.
Hospitalization: room charges, doctor/surgeon fees, operation theatre, nursing, medicines, and internal implants.
60 days post-discharge: doctor bills, medical costs, tests, and reports.
Prosthetic devices implanted during surgery (e.g., pacemakers).

Are all hospital-prescribed tests reimbursed?

Diagnostic expenses (X-rays, blood analysis, ECG, etc.) are reimbursed if consistent with the diagnosis and treatment of the ailment for which hospitalized.

Is there a minimum hospitalization time limit?

Typically, 24 hours, but certain treatments (dialysis, chemotherapy, eye surgery, etc.) may require less.

How is the claim payment received?

The claim amount is transferred to the customer’s bank account via NEFT.

Who receives the claim if the plan holder dies?

The nominee receives the claim. If no nominee is assigned, a succession certificate from a court is required, or the amount is deposited in court for legal heirs.

What defines a hospital?

A registered institution for indoor care and treatment, supervised by a registered medical practitioner, or an establishment with:

At least 15 patient beds (10 in Class ‘C’ towns).
A fully equipped operation theatre for surgical procedures.
Fully qualified nursing staff and doctors around the clock.

What is hospitalization?

Hospitalization is a minimum 24-hour stay or specific treatments (dialysis, chemotherapy, etc.) where the patient is discharged the same day.

Why is the claims process complex?

The process is similar to retail Mediclaim policies, but norms for claim intimation are relaxed in the Super Top Up Plan.

When and where to intimate hospitalization?

Intimate Prologic Health within 48 hours of hospitalization at initimation@prologichealth.in and contact@prologichealth.in. Claims are rejected if intimated after 48 hours.

How long does claim settlement take?

Approximately 21 working days from receipt of the last document.

Claim Documents (for reimbursement with a base plan)

Attested hospital final bill.
Attested photocopy of numbered receipts for hospital payments.
Attested photocopy of complete hospital bill breakup.
Attested photocopy of discharge card/summary.
Attested photocopy of investigation reports.
Attested photocopy of medicine bills with prescriptions.
Original settlement voucher of the base plan.
Original signed claim form.
Photo ID/KYC copy of claimant.
TPA card copy.
Intimation mail copy/claim registration number.
Attested photocopy of FIR/MLC in road accidents or confirmation that the patient was not under the influence of alcohol/drugs.
Any additional documents required by the claim assessor.

All bills/reports/prescriptions must be submitted in duplicate, attested by the previous insurer.

Claims Prior to Start Date of STU

Claims before the Super Top Up Plan start date are not payable and are not considered in the deductible for future claims.

Section III: What is JIO and Role of JIO

JIO is a community-driven organization dedicated to serving the Jain community through initiatives like the Super Top Up Plan and other schemes. It facilitates group health subscriptions, manages contributions, and coordinates with Wellness Providers to ensure seamless service. JIO’s role includes enrolment, claim support, and grievance escalation, ensuring financial security for Shravak/Shravika families during medical emergencies.

I am Thankful

Jain International Organisation is an NGO introducing a "Community Service Program" exclusively for its Jain community families. This program will cover healthcare expenses for Jain families through a self-raised contribution fund. It is not an insurance plan supported by any insurance or healthcare company. It is a Jain community initiative for sharing healthcare expenses of a few members by many.
This is a Group Health Contribution Plan. It will commence on a common start date and not from the date of your subscription fee payment.
Self-funded scheme start date: Membership benefits will be effective from 15th-May-25 to 30-April-26.
No cover benefits will be provided for hospitalization and pre-post hospitalization from 01th April 2025 to 14th May 2025 during the extension periods.
If any grievance arises under the policy, I will resolve it through discussion, writing to claimhelp@jio.net.in , or meeting personally at the JIO office. I understand that Jain International Organisation is an NGO founded by P.P. Nayapadmasagar M.S., and filing any case in a court of law would not be against the NGO but against respected Maharaj Saheb.
Cancellation is not allowed after payment. JIO reserves the right to cancel membership and refund subscription fees.
This community program is not backed by any insurance company, and I am not a consumer as defined by the Consumer Act, as I am contributing to my community fund.

Super Top Up - 2025-26