SALIENT FEATURES OF SHRAVAK AROGYAM –

JIO RENEWAL HEALTH PLAN

2019-2020

PARTNERS for JIO MEDICLAIM POLICY

Insurance Company: United India Insurance Co. Ltd. and Universal Sompo
General insurance Co. Ltd.

TPA: Ericson Insurance TPA Pvt. Ltd.

Insurance Broker: Edelweiss Insurance Brokers Ltd.

PREMIUM Details for JIO POLICY RENEWAL, PHASE 7 RENEWAL & NEW POLICY

Scope of Coverage: 2019-20

1) Cashless & Reimbursement Facility
2) Maternity Benefit available only for
the Member or Dependent Spouse
3) Maternity waiting period
Member can avail BOTH CASHLESS facility & as well as
REIMBURSEMENT facility.
In case of cashless claims, immediate intimation shall be given
to our Call Center within 48 hours of Hospitalization. In case
of reimbursement claims, immediate intimation shall be given
to Call Centre within 48 hours of Hospitalization.
Maternity benefits, applicable only for the Member or
Dependent Spouse, subject to a limit of Rs.25,000/- for normal
and Rs.30,000/- for caesarean delivery. Maternity cover is not
applicable for Rs. 2 lakh SI Self only band.
9 months waiting period waived off for all existing members
who are insured under 2018-19 JIO Mediclaim.Waiting period
of 9 months is applicable for other members.
S.I. Rs.2 Lakhs - Room Rent - 2,500 and ICU capped at 3,500
S.I. Rs.5 Lakhs - Room Rent - 3,000 and ICU capped
at 5,000 S.I. Rs.10 Lakhs - Room Rent -4,000and ICU capped
at 5,000

4) Room Rent Restriction Room rent limit is incl. of Nursing Charges.

If the Insured gets admitted in room higher than eligibility
room rent then all the correspoding charges shall be
restricted to the eligibility room rent or actuals, whichever is
lower.
i. 25% Co-payment is applicable ONLY on all Pre-existing
diseases (PED) claims. It is not applicable for ailments for
5) Co-Payment which expenses are sub-limited(capped) under this policy.
iii. Co-payment would not be applicable on capped ailments /
inner limits including Cataract & Maternity (No Co-pay on
Scope of Coverage: 2019-20
sublimited cases.).
Deductible of Rs. 5000 is applicablefor each and every
admissible claim above Rs 50,000/-
iv.Co-payment is not applicable for Non-PED Claims
v. If the member feels that his/her aliment is not pre – existing
disease they may come for reimbursement with the relevant
document. Decision of TPA would be final during Cashless
process.
1) Joint Replacement OR Knee Replacement Hospitalisation
Expenses is covered but it is subject to Only One Joint
Replacement claim per Family for members insured under
expiring(2018-19 JIO’s Star Mediclaim) policy e
A) 2 Lac Sum Insured Band : Rs. 75,000 Per Joint
B) 5 Lac Sum Insured Band : Rs 100,000 Per Joint
6) Waiting period applicable OR Joint
Replacement & Knee Replacement C) 10 Lac Sum Insured Band : Rs 125,000 Per Joint
2) In case of ROAD TRAFFIC ACCIDENT the second joint
replacement is covered. (FIR is MANDATORY) with above
same capping.
3) be 1 Year Waiting Period would be applicable for New
Members in case of Knee and other Joint Replacement cases.
7) Reimbursement Available with mandatory 24 Hrs intimation
In case of Cashless Claims, immediate intimation would be
given to our Call Center within 72 hours of Hospitalization or
8) Claim Intimation before discharge, whichever is earlier. In case
of Reimbursement Claims, immediate intimation shall be
given to Call Centre within 24 hours of Hospitalization.

CAPPINGS 2019 - 20
Ailment/Disease Capping List 2 Lakh 5 Lakh 10 Lakh
Cataract 15000 24000 25000
Cerebrovascular Accident 120000 220000 280000
Cardiovascular Disease 120000 220000 280000
Cancer 120000 220000 280000
Treatment for breakage of bone 120000 220000 280000
Renal Complication 120000 220000 280000
Genitourinary calculus 40000 50000 60000
Dialysis in case of PED case only 35000 45000 50000
Cholecystectomy 40000 50000 60000
Hysterectomy 40000 50000 60000
Appendectomy 40000 50000 60000
Fistula(Anus) 30000 40000 45000
Hernia (All types 30000 40000 50000
Anaemia(not for evaluation) 50000 50000 50000
Angiogram 18000 21000 24000
Joint and Knee Replacement per joint/per knee 75000 100000 125000
* Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above
subject to their capping is above Rs.50,000/-.

We are happy to announce that the existing ELDERLY MEMBERS covered under the Policy
who have already completed 80 years of age, are welcome to continue the cover in the
Renewal for life time.

1. FAMILY FLOATER MEDICLAIM: Sum Insured of Rs.2 Lacs, Rs.5 Lacs and Rs.10 Lacs
FAMILY DEFINITION: (1+7) maximum 8 members with self-mandatory : Primary
Member + Spouse + 4 Dependent children up to 25 years of age + Parents or Parents in
law . (Any one set of parents only allowed). All members to be Jain only
2. INDIVIDUAL POLICY with Sum Insured of Rs.2 Lacs can only be opted by any member
who is alone and without any living dependents in his family.

1. #Note: INDIVIDUAL POLICY with sum insured of Rs. 2 Lacs is available only for
Renewal Members.
2. Any Member (proposer or dependent) can get insured only once under this scheme. If
found enrolled more than once, both certificates/policies would be deemed null and
void and the Insurance company, claim would be rejected and policy would be cancelled
void-ab-initio without any refund of premium

3. Claim Intimation In case of Cashless claims, immediate intimation shall be given to our
Call Centre within 72 hours of hospitalization. In case of Reimbursement claims,
immediate intimation shall be given to Call Centre within 24 hours of hospitalization.
4. PRE-EXISTING DISEASES are covered from Day One
5. CO PAYMENT:
o 25% copay ONLY on all PED claims except sublimated ailments including
Maternity & Cataract.

o Co pay will not be applied on capped ailments / inner limits including Cataract &
Maternity (No Co-pay on sublimated cases.)

o No co- pay will applied on Non-PED Cases

6. NO MEDICAL CHECK-UP required

7. AGE LIMIT- For 2 Lacs SI (individual) - INDIVIDUAL POLICY with sum insured of Rs. 2
Lacs is available.
8. As per INCOME TAX Act deductions under Sec 80D, Proposer will be eligible for
exemption. (Exemption for Payment by Cash not applicable)
9. Joint Replacement or Knee Replacement Joint Replacement or Knee Replacement
covered subject to Maximum One Joint and Knee per Family for existing members

1) 2 Lac Sum Insured: Rs. 75,000 Per Joint

2) 5 Lac Sum Insured: Rs 100,000 Per Joint

3) 10 Lac Sum Insured: Rs 125,000 Per Joint
#Note: 1. There will be ONE YEAR waiting period for Joint Replacement & Knee
Replacement for New Members.
2. In case of ROAD TRAFFIC ACCIDENT the second joint replacement is
covered. (Police FIR is MANDATORY) with above same capping.
 10. Maternity Benefit Maternity benefits, applicable only for the Member or Dependent
Spouse, subject to a limit of Rs.25, 000/- for normal and Rs.30, 000/- for caesarean
delivery.
11. Maternity waiting period Waiting period of 9 months for maternity waived off for all
existing members; however waiting period of 9 months is applicable for new members
enrolled under this policy
12. AYUSH Treatment Covered up to Rs.10, 000 per claim maximum up to Rs.20,000 per
year per family subject to the treatment being taken in a Government hospital or in any
institute recognized by Government and/or accredited by Quality Council of India or
National Accreditation Board on Health.
13. Cyberknife, Cochlear Implant, and Psychiatric Treatment: Cyberknife and Cochlear
implant covered with 50% copayment and Psychiatric treatment covered up to
Rs.30,000.
14. Dental Treatment: Covered in case of Road Accident and requiring Hospitalization.
15. Day Care Procedures Day Care Procedures covered (list attached in the annexure)
16. Emergency Ambulance Charges Covered maximum upto Rs. 2500/- per case
17. Pre-Post Hospitalization Expenses (30/60 days respectively) Covered within Family
Floater Sum Insured
18. Internal Congenital Ailments Covered
19. * Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above
subject to their capping is above Rs.50,000/-.
20. Organ transplant: Donor Expenses for organ transplantation where the insured person
is the recipient are payable provided the claim for transplantation is payable and subject
to the liability of the sum insured. Donor screening expenses and Post-dontaion
complications of the donor are not payable. This cover is subject to limit of 10% of the
Sum insured or Rs. One Lakh whichever is less.
21. CAPPINGS UNDER THE RENEWAL POLICY

Disease Capping List 2 Lakh 5 Lakh 10 Lakh

Cataract 15000 24000 25000
Cerebrovascular Accident 120000 220000 280000
Cardiovascular Disease 120000 220000 280000
Cancer 120000 220000 280000
Treatment for breakage of bone 120000 220000 280000
Renal Complication 120000 220000 280000
Genitourinary calculus 40000 50000 60000
Dialysis in case of PED case only 35000 45000 50000
Cholecystectomy 40000 50000 60000
Hysterectomy 40000 50000 60000
Appendectomy 40000 50000 60000
Fistula(Anus) 30000 40000 45000
Hernia (All types 30000 40000 50000
Anaemia(not for evaluation) 50000 50000 50000
Angiogram 18000 21000 24000
Joint and Knee Replacement per joint/per knee 75000 100000 125000

22. * Compulsory deduction of Rs. 5000 will be deducted even in capped ailment listed above
subject to their capping is above Rs.50,000/-. All JIO members who were associated
with JIO Group Mediclaim Policy since year 2014 but discountined in any of the year
can also avail the benefit of above policy by enrolling their family in 2019-2020 renewal..
23.
24. Shravak Arogyam JIO Renewal, Phase 7 Renewal and New Policy Group Personal
Accident Policy
 1. In case of Road accident where FIR copy is provided, capping of Breakage of
bone will not apply.

Group Personal Accident cover is also offered cover to Proposer in case of Accidental
Death & Permanent Total Disability for sum insured of Rs.500,000/- irrespective
of his sum insured under mediclaim policy. The personal Accident benefit is
extended to all family members covered mediclaim policy. The family member for
this benefit to avail should be within 18 years to 75 years of age.
This personal accident policy will have following covers
2. Death
3. Permanent Total Disablement
4. Funeral Expenses Rs.2500/-
5. Children Grant Rs.50,000/- per child for two child below the age of 21
years of age.