AITO 6 Saal Khushhal Parivar 2020
Payment for policy premium is accepted only through Online Payment
Terms & Conditions
A NEW Innovative MEDICLAIM
For all Shravak-Shravika members of AITO
( From all AITO Sects, like Shwetamber, Digamber, Sthanakwasi, Terapanthi etc.)
AITO – Shravak Arogyam
Group Health Insurance Policy
6 Saal Khush-haal Pariwar
( 6 Saal Gold Plus Plan Details added)
Salient Features of the policy( 2020-2021):
- 8 Members Family Floater Policy including parents or In-law (Any one set, cross combination not allowed). All covered members has to be Jain only.
- Longest Entry age up to 90 years.
- NO MEDICALCHECK-UP required.
- Proposer will be eligible for INCOME TAX exemption under Sec 80-D for Mediclaim premium.
- Excellent Benefits at appropriate Premium.
- COVID is covered under the policy
- 6 Saal Gold Plus Plan will have additional COVID policy covering Home Care Treatment (Home quarantine Treatment) & Hospitalisation benefit.
- In case of COVID hospitalisation first claim will be processed under COVID policy so that non admissible amount payable under COVID policy but not payable under Group Mediclaim Policy ( 6 Saal ) will be paid to member.
- Cover is offered to all members of the family up to age of 90 years.
- 6 Saal Gold Plus Plan policy is separate policy and it is optional.
- Disease Contracted after taking policy shall be covered from day 1 except list of First Year Exclusion disease.
- Member can avail CASHLESS as well as REIMBURSEMENT facility across India.
- PRE-EXISTING DISEASE will cover after 1 year. (In 2nd year 75% of admissible claim amount & then after next 4 year 100% of admissible claim amount will be payable.) *** subject to capping mentioned in few diseases.
- Maternity cover starts after 1 year. No maternity benefit for individual policy.
- Knee Replacement / Cataract / Other Chronic disease which are mainly Pre-Existing or the treatment for same can be delayed (the list given in FAQ point no. 37 in FAQ ABOUT TERMS & CONDITIONS) cover starts after 1 year & will continue till next 5 years.
- Those who join in 1st year, can only get benefits of next 5 years. Subject to yearly renewal.
- 100% Claim settlement support by TPA, Broker & Insurance Company
- The right claim would certainly pass, whereas a fraudulent one wouldn’t.
- ROOM RENT& ICU CHARGES limitation per day:1. 2 & 5 lac Sum Insured: 1% of Sum Insured for Normal Room and 2% of sum Insured for ICU room2. 10 lac Sum Insured: 7,500 for Normal Room and 13,000 for ICU
New Born Baby covered from day 1, If you give intimation within 30 days from DOB on [email protected] email id.New-born baby e penses related to Hospitalization shall be covered from Day One of the birth up to 90 days within limit of Maternity amount.· New born baby of the insured person shall be covered from 91st day from date of birth under family floater Sum Insured.
- NEWLY MARRIED SPOUSE COVER:Request for addition of Newly married Spouse under the policy shall be allowed within 30 days from marriage date on [email protected] email id, Any delay / request coming after 30 days from marriage date for addition of Newly married Spouse to Insurer, shall not be considered.
- Emergency Ambulance Charges: up to Rs. 2,500 or actuals whichever is less
- DAY CARE PROCEDURES:covered as per IRDAI list.
- In all claim due to Accident (whatever cause, police MLC / FIR is compulsory
- 6 Saal Gold Plus Plan for 2 lakh Sum-Insured ( Separate Policy) :
Corona Premium for Rs.2 Lakh
+ 4 unmarried children
Parents / In Laws
+ 4 unmarried children
Parents / In Laws
+ 2 unmarried children
a) For Family Floater Policy 2 lakh Sum-Insured is on Floater basis. All family members will be automatically covered.
b.) For Individual Policy 2 Lakh is for on Individual Member.
c) It is to all Family.
d) 6 Saal Gold Plus Plan (2 Lakh Sum-Insured) allow: Hospitalization Benefit and Home Care Treatment
e) Patient should be diagnosed COVID positive after inception date of policy. No waiting period for COVID claims for renewal members, however, there will be 30 days waiting period applicable for COVID claims for fresh members
f) In case of claim for Corona treatment, patient’s dignosis report should be from Government approved laboratory is compulsory and patient’s report should be COVID POSITIVE. Also note that treatment should be only takeen in Government approved hospital to treat COVID Positive patient.
26. CLAIM INTIMATION in case of CASHLESS claims or REIMBURSEMENT Claim, immediate intimation shall be given to our Call Centre or on Email (mentioned below) within 48 hours of Hospitalization.
27. Member will be considered as fresh member if premium received after expiry of current policy. No grace period will be considered as this is a group Mediclaim policy
28. All covered Member will be considered as fresh member if any changes in covered members name / relation detail of expiring policy, Continuity benefit will be lost for all covered members.
29. Sum insured cannot be reduced or increased than previous year policy under the same plan.
30. If proposer had died then please renew the policy as it is and informed [email protected] with death certificate of proposer within 15 days. Edelweiss will get AITOJAC number transferred to Spouse of the deceased name. This will ensure continuity under the policy. Your continuity under the policy is tracked by AITOJAC number only.
Any claim in deceased proposer’s family, amount will be released in sequence covered Spouse, covered Elder child, father, mother name.
31. Member will be considered as fresh member if premium received after expiry of current policy No extension of date will be given as this is a group Mediclaim policy
32. 3rd year Continuity benefit will be provided to member only if they are covered under the same policy plan in 2018-2019 and 2019-2020 year.
33. 2rd year Continuity benefit will be provided to member only if they are covered under the same policy plan in 2019-20 year.
Annual Premium as per Highest Member’s age in the family per Year ##
*Rs 1000/- will be charged additional per financial year for AITO Membership fees, if not paid.
Children in the policy are defined as unmarried dependent children up to the age of 25 years.
Parents or Parents in law (Only one set of parents allowed)
COVID Insurance Cover for Family Floater Policy : 2 Lakh Sum-Insured is on Floater basis.
COVID Insurance is FOR ALL family.
Single person can also opt for Policy up to age of 65 years without maternity benefit.
No Family Members will be covered above acceptable age of that particular plan. (Premium is calculated as per highest members current age in the family)
Individual Policy (Plan G & Plan H) is available only for members, who don’t have any other eligible family member to take policy. (self-affidavit OR certification from JIO Director required) No Maternity benefit for individual policy.
As premium will be transferred first to JIO by members individually and then JIO have to pay premium to insurance company as one consolidated payment, there is a time gap for reconciliation and procedure. So, we request you to pay the premium at the earliest to start coverage on time
Premium can be PAID only via Online Payment. No changes or cancellation allowed after payment.
Additional Payment Gateway fees shall be charged by Gateway Company (Ease buzz) for providing safe & secure online money transfer facility.
* For detail terms and condition, rejections and sub-limits refer AITO website.
** Policy terms and rates may be continued for next 6 years and shall be reviewed annually and necessary corrective action shall be taken (if required) to keep the portfolio viable
## However, The portfolio will be reviewed by Insurance Company on periodic basis & to balance the claim ratio the Insurance company will offer Motor, Travel, Group Personal Accident, Home Insurance etc. policies to AITO members along with this policy.
PARTNERS for AITO MEDICLAIM POLICY
Insurance Company: UNIVERSAL SOMPO GENERAL INSURANCE Co. Ltd.(CIN- U66010MH2007PLC166770 UIN- UNIHLGP08001V020708)
Insurance Broker: Edelweiss Gallagher Insurance Brokers Ltd. (CIN: U72200MH2000PLC124096)
TPA Name :- Ericson Insurance TPA Services Pvt. Ltd.