Tuesday, 24 Oct 2017

Shravak Arogyam Phase III

201502Nov


HEALTH INSURANCE

What is health insurance?
Health insurance plans in India are insurance coverage for medical treatments. Health Insurance Plan designed to offer complete protection to you and your family against sudden illness, accidents and unexpected hospitalization. The coverage benefits can be utilized by the insured when an expected health insurance premium is paid regularly.

Cover yourself, your spouse, your dependent children above the age of 0 days up to 25 years and dependent parents & Parents in -Law up to the age of 80.

Health Insurance provides the following benefits Cashless & Reimbursement of hospitalization expenses which are reasonably and necessarily incurred, Under the following heads:

  • Room, boarding expenses as provided by the hospital/nursing home.
  • Nursing expenses.
  • Fees of surgeon, anesthetist, medical practitioner, consultant and specialist.
  • Expenses on account of anesthesia, blood, oxygen, operation theatre charges, surgical

Appliances, medicines and drugs, diagnostic material, X-ray, dialysis, chemotherapy, Radiotherapy cost of pacemaker, artificial limbs and cost of organs and similar expenses.

FEATURES

  • Pre-Exting Diseases Are Covered Form Day One
  • No Medical Check Up Required
  • Entery Age Of The Proposer May Be 21 To 80 Years(Dependents May Be To 80 Years.)
  • All Day Care Procedures Covered
  • Internal Congential Diseases Covered
  • Terrorism Covered From Day One
  • 30 Days Hospitaloization & 60 Days Post Hospitalization Expenses Covered
  • Expenses Incuerred For Ayush Terament (ayurvedic Homeopathy Etc.) To Be Covered Up To Rs 10.000 Per Claim Is Admissble Maxmise Upto Rs 20000 Per Year.
  • New Born Baby Covered From One Day 1 Subject To Timely Enrollment In Jio Policy.(only Reimbursement)
  • Total Knee Replacment Shall Have A Wating Peroid Of 1 Year In The Policy.
  • Cashless Treament Facility In 6800+Hospitals Across India
  • All Person Age Above 40 Years Has To Covered Under Family Floter Policy3
  • Domiciiary Hospitallsation Coverd Upto 20% Of Sum Insured.
  • Addmission Fee Surcharges,Serviecs Tax Miscellanecous Charges And Other Non-Treatment/Non-Medical Expenses Are Payable ALL CLAIM TO BE SETTLED ON ACTUAL BASIS (COST INCURRED BY PATIENT ONY FOR MEDICAL TREATMENT ONLY TAKEN IN HOSPITAL)AND NO DEDUCTION SHALL BE APPLICABLE.
S. No Terms & Conditions Sum Insured Rs 2 Lac & 5 Lac Sum Insured Rs 10 Lac
1 Room Rent & Icu Charges (PER Day Limitation ) Rs. 2500.00 & 4000.00 Rs. 3000.00 & 4000.00
2 Ambulance Charges (PER Hospitalization) Rs. 2000.00 Rs. 2000.00
3 Cataract (PER Eye) Rs. 30000.00 For “A” & “B” City & Rs. 25000.00 For “C” City Rs. 30000.00 For “A” & “B” City & Rs. 25000.00 For “C” City
4 Maternity Benefit Normal Delivery Rs. 30000.00 C-Sec Delivery Rs. 50000.00 Normal Delivery Rs. 30000.00 C-Sec Delivery Rs. 50000.00

Claim Settlement Clause PPN/GIPSA SHALL BE APPLICABLE OR TPA NEGOTIATED RATES SHALL BE APPLICABLE WHERE A PATIENT GETS ADMITTED IN NETWORK OR GIPSA/PPN HOSPITAL.THE CLAIM SHALL BE SETTLED AS PER ACTUAL IF A PATIENT IS ADMITTED IN NETWORK HOSPITAL.

INDIVIDUAL 2 LACS

1. This policy covers only one member (Proposer).
2. Entry age of the member 21 to 80 years *.
3. Sum Insured for Individual Rs. 2 Lac.
4. Terms and Conditions as per below:-

  • Room Rent & ICU Charges-Rs. 2500 & Rs.4000 (Per day limitation)
  • Ambulance Charges- Rs.2000 (per Hospitalization).
  • Cataract (per Eye) – Rs. 30,000 for “A” & “B” City and Rs. 25,000 for “C” City.
  • Maternity Benefit Covered for Normal Delivery @ Rs. 30000- & C-Sec Delivery@ Rs.50000/- WITH 9 months waiting period applicable for maternity claims.

5. Salient Features of Shravak Arogyam Phase –II (Individual Scheme)

  • Pre-Existing Diseases Are Covered Form Day One.
  • No Medical Check Up Required.
  • All Day Care Procedures Covered.
  • Internal Congenital Diseases Covered.
  • Terrorism Covered From Day One.
  • 30 Days pre Hospitalization & 60 Days Post Hospitalization Expenses Covered.
  • Expenses Incurred for Ayush Treatment (Ayurvedic Homeopathy Etc.) To Be Covered Up To Rs.10,000 Per Claim Is
    Admissible Max. Up to Rs 20000 per Year.
  • Total Knee Replacement shall have a waiting period of 1(One) year in The Policy.
  • Cashless Treatment Facility In 6800+Hospitals Across India.
  • Domiciliary Hospitalization Covered Up to 20% Of Sum Insured.
  • Admission Fee, Surcharges, Service Charges, Service Tax, Miscellaneous Charges And Other Non-Treatment/Non-Medical Expenses Are Payable.
    ALL CLAIM TO BE SETTLED ON ACTUAL BASIS (COST INCURRED BY PATIENT ONLY FOR MEDICAL TREATMENT ONLY TAKEN IN HOSPITAL) AND NO DEDUCTION SHALL BE APPLICABLE.
  • Claim Settlement Clause PPN/GIPSA SHALL BE APPLICABLE OR TPA NEGOTIATED RATES SHALL BE APPLICABLE WHERE A PATIENT GETS ADMITTED IN NETWORK OR GIPSA/PPN HOSPITAL.THE CLAIM SHALL BE SETTLED AS PER ACTUAL IF A PATIENT IS ADMITTED IN NETWORK HOSPITAL.
  • Claims Submission days 45 days from the Date of Discharge from the Hospital.
  • TPA facility available.

*All person age above 40 years has to cover under family floater policy.
6. GENERAL EXCLUSIONS in Individual MEDICLAIM POLICY :-

We strive to provide you maximum cover and benefits; however, we would like you to know some of the major exclusions under the policy.

  • External Congenital diseases not covered.
  • Any dental treatment unless arising due to an accident.
  • Naturopathy treatment not covered.
  • HIV, AIDS and related medical conditions not covered.
  • External medical equipment used as post hospitalization care not covered.
  • Cost of contact lens, spectacles, hearing aid, cochlear implants not covered.
  • General debility, use of drugs or alcohol, intentional self-injury, sterility, venereal disease not covered.
  • Treatment for infertility etc. not covered.
  • Hospitalization treatment for less than 24 hrs. Other than specified treatment not covered.

7. Personal Accident policy is including with this policy applicable for proposer only.
8. Sum Insured for Personal Accident policy 10 Lac for earning member and 5 Lac for non earning member.
9. GENERAL EXCLUSIONS IN PERSONAL ACCIDENT POLICY :-

  • Suicide/ Intentional self‐injury
  • Death due to Pregnancy/child birth etc.
  • Accident while under influence of alcohol/drugs
  • Sexually Transmitted Infections
  • Participation in a criminal act
  • Participation in a hazardous sport
  • War, civil war, similar situations etc.

FAMILY FLOATER 5 LACS

1. This policy covers 1+5 members with family definition (Proposer, spouse, 2 dependent children and 2 parents/parents in law.

2. Entry age of the primary member 21 to 80 years.

3. Dependents covered up to age 0 to 80 Years.

4. New Born Baby covered from day one(1)subject to timely enrollment.(only reimbursement)

5. Terms and Conditions as per below:-

  • i. Room Rent & ICU Charges-Rs. 2500 & Rs.4000 for Sum Insured 5 Lac (per day limitation).
  • ii. Ambulance Charges- Rs.2000 (per Hospitalization).
  • iii. Cataract (per Eye) – Rs. 30,000 for “A” & “B” City and Rs. 25,000 for “C” City.
  • iv. Maternity Benefit Covered for Normal Delivery @ Rs. 30000- & C-Sec Delivery@ Rs.50000/- WITH 9 months waiting period applicable for maternity claims

6. Salient Features of Shravak Arogyam Phase –II (Family Floater)

  • Pre-Existing Diseases Are Covered Form Day One.
  • No Medical Check Up Required.
  • All Day Care Procedures Covered.
  • Internal Congenital Diseases Covered.
  • Terrorism Covered From Day One.
  • 30 Days Hospitalization & 60 Days Post Hospitalization Expenses Covered.
  • Expenses Incurred for Ayush Treatment (Ayurvedic Homeopathy Etc.) To Be Covered Up To Rs.10,000 Per Claim Is Admissible Maximize Up to Rs 20000 Per Year.
  • Total Knee Replacement Shall Have A Waiting Period of 1 Year in The Policy.
  • Cashless Treatment Facility In 6800+Hospitals Across India
  • Domiciliary Hospitalization Covered Up to 20% Of Sum Insured.
  • Admission Fee, Surcharges, Service Charges, Service Tax, Miscellaneous Charges And Other Non-Treatment/Non-Medical Expenses Are Payable ALL CLAIM TO BE SETTLED ON ACTUAL BASIS (COST INCURRED BY PATIENT ONLY FOR MEDICAL TREATMENT ONLY TAKEN IN HOSPITAL) AND NO DEDUCTION SHALL BE APPLICABLE.
  • Claim Settlement Clause PPN/GIPSA SHALL BE APPLICABLE OR TPA NEGOTIATED RATES SHALL BE APPLICABLE WHERE A PATIENT GETS ADMITTED IN NETWORK OR GIPSA/PPN HOSPITAL.THE CLAIM SHALL BE SETTLED AS PER ACTUAL IF A PATIENT IS ADMITTED IN NETWORK HOSPITAL.
  • Claims Submission days 45 days from the Date of Discharge from the Hospital.
  • TPA facility available.

7. GENERAL EXCLUSIONS IN MEDICLAIM POLICY :-
We strive to provide you maximum cover and benefits; however, we would like you to know some of the major exclusions under the policy.

  • External Congenital diseases not covered.
  • Any dental treatment unless arising due to an accident.
  • Naturopathy treatment not covered.
  • HIV, AIDS and related medical conditions not covered.
  • External medical equipment used as post hospitalization care not covered.
  • Cost of contact lens, spectacles, hearing aid, cochlear implants not covered.
  • General debility, use of drugs or alcohol, intentional self-injury, sterility, venereal disease not covered.
  • Treatment for infertility etc. not covered.
  • Hospitalization treatment for less than 24 hrs. Other than specified treatment not covered.

8. Personal Accident policy is including with this policy applicable for Proposer only.

9. Sum Insured for Personal Accident policy 10 Lac for earning member and 5 Lac for non earning member.

10. GENERAL EXCLUSIONS IN PERSONAL ACCIDENT POLICY :-

  • i. Suicide/ Intentional self‐injury
  • ii. Death due to Pregnancy/child birth etc.
  • iii. Accident while under influence of alcohol/drugs
  • iv. Sexually Transmitted Infections
  • v. Participation in a criminal act
  • vi. Participation in a hazardous sport
  • vii. War, civil war, similar situations etc.

FAMILY FLOATER 10 LACS

1. This policy covers 1+5 members with family definition (Proposer, spouse, 2 dependent children and 2 parents/parents in law.

2. Entry age of the primary member 21 to 80 years.

3. Dependents covered up to age 0 to 80 Years.

4. New Born Baby covered from day one(1)subject to timely enrollment.(only reimbursement)

5. Terms and Conditions as per below:-

  • i. Room Rent & ICU Charges-Rs. 3000 & Rs.4000 for Sum Insured 10 Lac (per day limitation).
  • ii. Ambulance Charges- Rs.2000 (per Hospitalization).
  • iii. Cataract (per Eye) – Rs. 30,000 for “A” & “B” City and Rs. 25,000 for “C” City.
  • iv. Maternity Benefit Covered for Normal Delivery @ Rs. 30000- & C-Sec Delivery@ Rs.50000/- WITH 9 months waiting period applicable for maternity claims

6. Salient Features of Shravak Arogyam Phase –II (Family Floater)

  • Pre-Existing Diseases Are Covered Form Day One.
  • No Medical Check Up Required.
  • All Day Care Procedures Covered.
  • Internal Congenital Diseases Covered.
  • Terrorism Covered From Day One.
  • 30 Days Hospitalization & 60 Days Post Hospitalization Expenses Covered.
  • Expenses Incurred for Ayush Treatment (Ayurvedic Homeopathy Etc.) To Be Covered Up To Rs.10,000 Per Claim Is Admissible Maximize Up to Rs 20000 Per Year.
  • Total Knee Replacement Shall Have A Waiting Period of 1 Year in The Policy.
  • Cashless Treatment Facility In 6800+Hospitals Across India
  • Domiciliary Hospitalization Covered Up to 20% Of Sum Insured.
  • Admission Fee, Surcharges, Service Charges, Service Tax, Miscellaneous Charges And Other Non-Treatment/Non-Medical Expenses Are Payable ALL CLAIM TO BE SETTLED ON ACTUAL BASIS (COST INCURRED BY PATIENT ONLY FOR MEDICAL TREATMENT ONLY TAKEN IN HOSPITAL) AND NO DEDUCTION SHALL BE APPLICABLE.
  • Claim Settlement Clause PPN/GIPSA SHALL BE APPLICABLE OR TPA NEGOTIATED RATES SHALL BE APPLICABLE WHERE A PATIENT GETS ADMITTED IN NETWORK OR GIPSA/PPN HOSPITAL.THE CLAIM SHALL BE SETTLED AS PER ACTUAL IF A PATIENT IS ADMITTED IN NETWORK HOSPITAL.
  • Claims Submission days 45 days from the Date of Discharge from the Hospital.
  • TPA facility available.

7. GENERAL EXCLUSIONS IN MEDICLAIM POLICY :-
We strive to provide you maximum cover and benefits; however, we would like you to know some of the major exclusions under the policy.

  • External Congenital diseases not covered.
  • Any dental treatment unless arising due to an accident.
  • Naturopathy treatment not covered.
  • HIV, AIDS and related medical conditions not covered.
  • External medical equipment used as post hospitalization care not covered.
  • Cost of contact lens, spectacles, hearing aid, cochlear implants not covered.
  • General debility, use of drugs or alcohol, intentional self-injury, sterility, venereal disease not covered.
  • Treatment for infertility etc. not covered.
  • Hospitalization treatment for less than 24 hrs. Other than specified treatment not covered.

8. Personal Accident policy is including with this policy applicable for Proposer only.

9. Sum Insured for Personal Accident policy 10 Lac for earning member and 5 Lac for non earning member.

10. GENERAL EXCLUSIONS IN PERSONAL ACCIDENT POLICY :-

  • i. Suicide/ Intentional self‐injury
  • ii. Death due to Pregnancy/child birth etc.
  • iii. Accident while under influence of alcohol/drugs
  • iv. Sexually Transmitted Infections
  • v. Participation in a criminal act
  • vi. Participation in a hazardous sport
  • vii. War, civil war, similar situations etc.

If you don't have the basic mediclaim insurance,we are there to help you to buy a proper, customise health insurance policysuitable to you.

 

We strongly recommend the Jains to purchase this mediclaim insurance policy. Also note that if you have purchased the policy in either phase I or phase II, you don’t need to buy the insurance in this phase. This policy becomes very handy to the Jains above the age of 45 years where you are not able to increase your insurance with the existing policy. The other biggest advantage is that there is no pre-existing clause applicable to this policy.

 

We urge you to continue with your existing medi-claim policy. If you don’t have any basic medi-claim policy, please contact us for the same. We will recommend you the most suitable policy as per your requirements!!!

 

Please note that we are neither the agents nor connected to Jain Shravak Arogyam as an organization. We are just recommending this policy as it is very beneficial to all the Jains.

 

Raise your questions Click here.


Contact us:-
MEGA FINANCIAL PLANNERS
+91 281 2588669, 6531399,
+91 9978937399

mega@megafina.in |   www.megafina.in |    www.fb.me/MegaFinancialPlanners 

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