COMMUNITY WELFARE CONTRIBUTION FUND – Super Top up Plan
For Healthcare, Education, Sports and Philanthropic Assistance
Financial Year 2026–2027
(Open for Jain Community Members)

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.

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.

3.1.1.
No insurance company is involved in administration or operation of the fund.

3.1.2.
No insurer-insured relationship exists between the organisation and any participant.

3.1.3.
No premium is charged under the arrangement.

3.1.4.
No insurance policy or contract of indemnity is issued.

3.1.5.
No legal or contractual right to reimbursement, compensation, or guaranteed financial assistance is created under this 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.

5. Super Top-Up Community Healthcare Assistance Plan
   A Super Top-Up Community Healthcare Assistance Plan is a voluntary contributory assistance arrangement under which additional healthcare assistance becomes available only after the aggregate eligible hospitalization expenses incurred by the participating family during a plan period exceed the specified deductible threshold selected by the member.

Unlike a standard top-up arrangement, where the deductible applies separately to each individual hospitalization event, the Super Top-Up structure considers the cumulative eligible hospitalization expenses arising from one or more hospitalizations during the entire plan period for determining eligibility of assistance beyond the deductible amount.

6. Subscription Period
   The subscription period of the program shall commence from 15th June 2026 and shall continue up to 14th June 2027.

7. Eligibility
   The program shall be available only for Jain Shravak–Shravika members enrolled with the organisation.

8. Available Benefit Limits
   Members may opt for either of the following voluntary assistance benefit limits:
   • Rs. 5,00,000
   • Rs. 10,00,000

Deductible Limit:
• Rs. 5,00,000
• Rs. 10,00,000

9. Family Floater Eligibility
   Coverage shall be available on a family floater basis for a maximum of six (6) members comprising:
   • Self
   • Spouse
   • Up to two dependent unmarried children up to 25 years of age
   • Either parents or parents-in-law (maximum two members and only one set permitted)

Combination of parents and parents-in-law together shall not be permitted.

10. Age Eligibility
    • Maximum entry age: 85 years.
    • Members once enrolled may continue renewal subject to continuity of the program and compliance with administrative guidelines.

11. Medical Examination
    No pre-enrollment medical examination shall ordinarily be required.

12. Pre-Existing Conditions
    Assistance for pre-existing ailments may be considered from the date of enrollment, subject to applicable administrative guidelines and benefit limits.

13. Waiting Period
    No initial waiting period or disease-specific waiting period shall ordinarily apply under the program.

14. Special Assistance Limits
    The following assistance limits shall apply:

14.1. Chemotherapy / Dialysis / Radiotherapy
• Maximum Rs. 5,000 per cycle
• Subject to an aggregate ceiling of Rs. 1,00,000 per family per program year.

14.2. Major Organ Transplant & Major Surgeries
Assistance shall be restricted to a maximum of 50% of the selected benefit limit.

Including but not limited to:
• Cardiac surgeries
• Pacemaker implantation
• Cancer-related surgeries
• Brain and spinal cord surgeries
• Lung surgeries
• Hip replacement
• Knee replacement
• Surgeries involving vital organs
• Major abdominal surgeries
• Major fracture surgeries

15. Room Category Flexibility
    The program provides flexibility to reduce the impact of proportionate deductions arising from higher room category selection, subject to applicable room eligibility limits.

16. Pre-Hospitalization Assistance
    Medical expenses incurred up to 30 days prior to hospitalization may be considered within the overall benefit limit.

17. Post-Hospitalization Assistance
    Medical expenses incurred up to 60 days after discharge may be considered within the overall benefit limit. 

18. Day Care Procedures
    Specified day care procedures may be considered under the program.

19. Mode of Assistance
    All eligible requests shall be processed strictly on reimbursement basis only.

20. AYUSH Treatment
    Hospitalization under AYUSH systems of treatment may be considered subject to treatment being taken at recognized institutions and in accordance with internal guidelines.

21. Tax Benefit
    Contributions made under this community welfare program shall not qualify for deduction under Section 80D of the Income Tax Act.

22. Special Conditions Applicable to Super Top-Up Assistance Program

22.1. Enhancement of Existing Benefit Limit
The Super Top-Up Assistance Program is intended to supplement an existing healthcare arrangement or deductible threshold selected by the member.

22.2. Availability Without Existing Health Plan
Members not covered under any existing healthcare arrangement may also enroll, subject to a minimum deductible threshold of Rs. 5,00,000.

22.3. Compatibility With Existing Arrangements
The Super Top-Up Assistance Program may be opted in conjunction with:
• Community health arrangements
• Individual healthcare arrangements
• Family floater arrangements
• Group healthcare arrangements

22.4. Deductible Selection
The member shall select a deductible threshold corresponding to the underlying healthcare arrangement.

22.5. Meaning of Deductible
“Deductible” means the aggregate amount of hospitalization expenses to be borne or exhausted under the member’s underlying arrangement before assistance under the Super Top-Up Program may be considered.

23. Contribution Chart (2025–2026)
    Contribution amount shall be determined based on the highest age of the family member.

24. Members Without Existing Arrangement
    Where any family member is not covered under an existing healthcare arrangement, a minimum deductible of Rs. 5,00,000 shall apply for such member at the time assistance is sought.

25. Certificates
    • GST refund certificates shall not be issued.
    • Benefits under Section 80D shall not be available.
    • Insurance certificates shall not be issued as this is a community welfare contributory program.

26. Benefit Limit Options
    Members may choose benefit limits of:
    • Rs. 5,00,000, or
    • Rs. 10,00,000

27. Deductible Options
    Deductible options of Rs. 5,00,000 and Rs. 10,00,000 are available.

Where no underlying arrangement exists, the member shall bear expenses up to the deductible threshold personally.

28. Room & ICU Assistance Limits
    Per-day room assistance including nursing, oxygen, monitoring, RMO and associated charges shall be limited as follows:
    • Normal Room: 1% of selected benefit limit
    • ICU Room: 2% of selected benefit limit

29. Period of Assistance
    Only hospitalization events occurring during the active program period shall be considered.

Where the underlying arrangement has already been exhausted prior to commencement of this program, such earlier expenses shall not be considered.

30. Aggregate Deductible Principle
    Where hospitalization expenses of the family during the program period exceed the selected deductible threshold, eligible assistance may be considered subject to applicable conditions.

31. Addition / Deletion of Members
    Addition shall be permitted only in case of:
    • Newly married spouse
    • New born baby

Provided intimation is sent within 20 days from date of marriage or birth at:
• claimhelp@jio.net.in

Deletion or cancellation shall not ordinarily be permitted.

32. Intimation Requirement
    Hospitalization intimation must be provided within 48 hours of hospitalization at:
    • contact@prologichealth.in

Delay in intimation may result in administrative deduction or rejection as per internal guidelines.

33. Submission of Documents
    Physical reimbursement documents must be submitted within 30 days from date of discharge.

Deficiency documents, if any, must be submitted within 7 days.

Documents should be submitted at:

Prologic Health T. Pvt. Ltd.
A-310, Neelkanth Business Park
Nathani Road, Near Vidyavihar Station
Vidyavihar West, Mumbai – 400086

34. Late Submission Deduction
    A deduction of 10% will be applied for delayed intimation or delayed submission of documents, in addition to other applicable conditions.

35. Reasonability & Customary Charges
    All assistance shall be subject to reasonable and customary charges prevailing for similar treatment and locality.

36. Ambulance Assistance
    Ambulance charges shall be restricted to:
    • 1% of benefit limit, or
    • Actual charges,

whichever is lower, subject to maximum Rs. 2,500 per hospitalization.

37. Payment of Contribution
    37.1.
    Contributions shall be made through payment modes approved by the organisation.

37.2.
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.

38. Non-Commercial Character
    38.1.
    The Community Welfare Contribution Fund is not a commercial or business activity.

38.2.
The organisation does not undertake any commercial service or insurance activity for consideration.

38.3.
The arrangement is charitable, voluntary, and mutual in nature for the welfare of the Jain community.

39. Principle of Mutuality
    39.1.
    The contributors and beneficiaries under the Community Welfare Contribution Fund constitute the same class of persons.

39.2.
The common fund collectively belongs to and is administered for the benefit of participating members.

39.3.
Any financial assistance is provided from members collectively to members collectively.

39.4.
Accordingly, the arrangement does not involve supply between two distinct persons and is based upon the principle of mutuality.

40. Administrative Exclusions
    40.1.
    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.

41. Situations Where Financial Assistance May Not Ordinarily Be Granted
    41.1.
    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.

41.2.
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.

41.3.
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.

41.4.
Expenses arising from intentional self-injury, attempted suicide, unlawful acts, criminal activity, or deliberate exposure to danger may not be considered.

41.5.
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.

41.6.
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.

41.7.
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.

41.8.
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.

41.9.
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.

41.10.
Treatment undertaken without medically necessary hospitalisation, or where active line of treatment is absent, may not be considered for assistance.

41.11.
Experimental treatment, investigational therapy, unproven medical procedures, or therapies not generally accepted under standard medical practice may not ordinarily qualify.

41.12.
Expenses incurred solely for diagnostic evaluation or investigation without active treatment may not ordinarily qualify.

41.13.
Expenses relating to rest cure, rehabilitation, custodial care, long-term nursing care, old-age care, or detoxification may not ordinarily be considered.

41.14.
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.

41.15.
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.

41.16.
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.

41.17.
Expenses relating to baldness treatment, alopecia treatment, wigs, toupees, cosmetic hair restoration, or related procedures may not ordinarily qualify.

41.18.
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.

41.19.
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.

41.20.
External congenital anomalies, developmental disorders, behavioural disorders, dyslexia, ADHD, learning disabilities, or similar conditions may not ordinarily qualify for assistance.

41.21.
Expenses relating to stem cell therapy, genetic disorders, growth hormone therapy, or similar specialised procedures may not ordinarily qualify unless specifically approved.

41.22.
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.

41.23.
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.

41.24.
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.

41.25.
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.

41.26.
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.

41.27.
Dental treatment, dentures, implants, artificial teeth, and non-hospitalisation dental procedures may not ordinarily qualify unless arising from accidental injury requiring hospitalisation.

41.28.
Expenses incurred for issuance of certificates, employment examinations, travel fitness examinations, or health check-ups conducted for administrative purposes may not ordinarily qualify.

41.29.
Artificial life maintenance or prolonged life support where recovery or restoration of health is not reasonably expected may not ordinarily qualify for assistance.

41.30.
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.

41.31.
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.

41.32.
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.

41.33.
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.

41.34.
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.

41.35.
Treatment undertaken outside India may not ordinarily qualify unless specifically approved by the organisation.

41.36.
Treatment undertaken from unregistered medical practitioners or at unrecognised institutions may not ordinarily qualify for assistance.

41.37.
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.

41.38.
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.

41.39.
Expenses incurred towards medical treatment, consultation, hospitalization, or procedures undertaken outside India shall not be payable.

41.40.
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.

41.41.
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.

41.42.
Expenses incurred towards all forms of Bariatric Surgery, including related treatments and procedures, shall not be payable under the scheme.

41.43.
Expenses incurred towards the use of Radio Frequency (RF) probe for ablation or any other procedure shall not be payable under the scheme.

41.44.
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.

41.45.
Domiciliary treatment, OPD treatment, home quarantine expenses, or treatment involving hospitalisation of less than 24 hours may not ordinarily qualify unless otherwise specifically provided.

41.46.
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.

41.47.
Treatment provided by persons residing with the participant or by immediate family members acting as medical practitioners may not ordinarily qualify.

41.48.
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, 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.

41.49.
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.

41.50.
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.

41.51.
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.

41.52.
Failure to comply with prescribed procedures including delayed intimation, incomplete documentation, concealment, misrepresentation, or incorrect information may result in rejection of assistance.

41.53.
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.

41.54.
Expenses exceeding administrative ceilings or incurred at facilities beyond permissible administrative limits may be proportionately restricted in accordance with internal guidelines.

41.55.
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.