Vado Mahajan.

Swasthya Suraksha Chakra: (Aug 2024-2025)

Subscription Details:

Start Date: 1st Sept 2024
End Date: 1st August 2025
Enrollment Close Date: 31st August 2024

No cover benefits will be provided for hospitalization and pre-post hospitalization from 03th Aug 2024 to 31st Aug 2024 for renewal members.

Overview:

Community Contribution Health Plan (Self-funded Plan) catering to all round Healthcare needs of Shree KVO Jain Manav Shushrusha Kendra members.

That will take care of Shree KVO Jain Manav Shushrusha Kendra member’s families Expenses on healthcare through their own raised Contribution. This is not an insurance plan, supported by Insurance Company or any healthcare company.

This is a fund raised by members of Kutchi Jain community for sharing healthcare expenses of few Kutchi Jain members .

Benefit will be available only to Native’s of 92 gaon’s of Kutch district as provided in scrolled down button on enrolment page.

Self-enrolment in Community Contribution Health Plan (Self-funded Plan ) Closes on 31^st Aug 2024 .

Specialized Health Plan in which member will get following benefits through Vado Mahajan health contributory self-fund scheme.

This is self-contributory program which is run by Shree KVO Jain Manav Shushrusha Kendra member’s families, supported by Vado Mahajan. All benefits of hospitalization expenses are processed by Prologic Health tourism Pvt. Ltd. Both Cashless and reimbursement of IPD benefits are available. Cashless facility will be available in network hospital only.

Last year August- KVO members will get continuity benefit in this plan.

If you have any insurance policy, please first file a claim with that policy. Once you have received the settlement amount from your insurance policy, you can approach Shree KVO Jain Manav Shushrusha Kendra, supported by Vado Mahajan. for the balance amount.

Please note that settlement letters and attested documents will not be provided under this plan.

Hospital Exclusions:

Cases treated at the following hospitals are not covered under this plan:

Breach Candy Hospital
Hinduja Hospital
Saifee Hospital
Leelavati Hospital
Nobel Hospital, Dombivli

Please ensure that any treatments or services you seek are from above hospitals are not included within the coverage of this plan.

Health Subscription features (Self-funded Plan)

1. Entry AGE is from 1 month to 90 Years and Renewal till LIFETIME

2. Family Subscription offer with medical benefit for 8 members. This includes Self, Spouse, 4 unmarried Dependent Children up to 25 years, 2 Dependent Parents or Parents-In-Laws (No cross combination will be possible in the Subscription). All members have to be Jain & member of Shree KVO Jain Manav Shushrusha Kendra, supported by Vado Mahajan..

3. Family option for 4 members. This includes Self, Spouse, 2 Dependent Unmarried Children up to 25 years.

4. NO Health Check-Up Required prior to Subscription.

5. Home care treatment for COVID allowed on reimbursement basis only. Maximum limit for home care COVID treatment is 25,000 per person on reimbursement basis only.

6. Hospital ROOM RENT & ICU CHARGES limitation (Per Day):

Maximum Benefit Amount	Room, Boarding Expenses in Rs. (including Nursing, RMO Expenses and all associated charges)
	Normal Room	ICU
5,00,000	3750	7500
10,00,000	7500	13000
In case, the enrolled person is admitted in a room with rent HIGHER than the eligible room rent limit, the total hospitalization benefits shall be reduced in proportion of eligible room rent limit. e.g. If you are admitted in 4000 Room and you are eligible for 2000 Room rent, then your all claim will get deducted by 50%.

Cashless & reimbursement claim will be processed as per agreed tariff only.

7. Fresh members : will have 1 year waiting period for hospitalization.

1 ) The first year new members will be given benefits as per table of capping given below in Accident Case and Sudden Illness for the first time in Mahajan run hospitals.

2) The first year new members will not get benefits for any type of illness in any hospital other than the following Mahajan-run hospitals.

3) The first year new members will not get the benefit of any pre-existing disease in Mahajan run or any other hospital.

4) The first year new members will not get the benefit of pre- and post-admission expenses in the hospital run by Mahajan for any illness.

5) New members can opt for only 5 lakhs plan. Sum Insured increase is not allowed for the renewal members.

Mahajan run trust hospital

Shree Mahavir Jain Hospital , Thane
Navneet Hi Tech Hospital, Dahisar
Mahavir Hospital, Dombivali
Manav Kalyan Kendra, Dombivali
Navneet Hospital, Nalasopara
Maaru Hospital, Parel (Ratanbai Palan Maru Hospital)
Navneet Jain Health Center, Dadar
Manav Kalyan Kendra, Dahisar (Run by Prince Health Center)
Navneet Hospital, Borivali (E)

8. PRE-EXISTING DISEASE:

Fresh members : will have 1 year waiting period for PED hospitalization.

35% co-pay is applicable in all cases if Members took treatment in hospital not approved by the trust (Non–Trust Network Hospital) This co-pay is over & above the other co-pay like PED, Delay etc.

This 35% co-pay will be applicable in Trust approved network hospital if member opt for room above Sharing Room e.g. Single Room, Deluxe Room etc.

1st Year Exclusion Disease: mentioned in Point no. 34

Fresh members : will have 1 year waiting period for 1^st year exclusion diseases.

35% co-pay is applicable if Members took treatment in Non–Trust Network Hospital including Capped ailments which is over & above other co-pay if any.

This 35% co-pay will be applicable in Trust approved network hospital if member opt for room above Sharing Room e.g. Single Room, Deluxe Room etc.

Compulsory deductions of 35% applicable on all ailment for which treatment is taken outside the Trust approved list of hospital given below

Shree Mahavir Jain Hospital , Thane
Navneet Hi Tech Hospital, Dahisar
Mahavir Hospital, Dombivali
Manav Kalyan Kendra, Dombivali
Navneet Hospital, Nalasopara
Maaru Hospital, Parel (Ratanbai Palan Maru Hospital)
Navneet Jain Health Center, Dadar
Manav Kalyan Kendra, Dahisar (Run by Prince Health Center)
Navneet Hospital, Borivali (E)

Sr.No.	Hospital Name	Area	Pin code
1	Shree Krishna Hospital	Bhayander West	401101
2	Shraddha Hospital	Dahisar East	400068
3	Garden View Nursing Home	Nalasopara East	401209
4	A R Hospital	Malad West	400064
5	Saraswati Hospital	Malad West	400064
6	Zenith Hospital	Malad West	400064
7	Siddhi Nursing Home	Andheri East	400059
8	Rms Multispeciality Hospital	Kandivali West	400067
9	Atharva Hospital	Kandivali West	400067
10	Sanjivani Hospital	Airoli	400708
11	Saiseva Hospital And Icu	Airoli	400708
12	Parakh Hospital & Research Centre	Ghatkopar East	400077
13	Arogyada Hospital	Ghatkopar East	400086
14	Priyadarshini Nursing Home	Virar	401305
15	Tulinj Hospital Multispeciality	Nalasopara East	401209
16	Sanjeevani Multispeciality Hospital	Ulhasnagar	421004
17	Yashasvi Hospital	Malad West	400095
18	Manav Kalyan Kendra	Dombivali East	421201
19	Disha Hospital	Ghatkopar West	400084
20	Global Hospital	Vashi	400703
21	Patani Eye Hospital	Bhandup	400078
22	Shrenik Hospital	Bhandup	400078
23	Sigma Hospital	Mulund	400080
24	Laxmi Hospital	Koparkhairne	400701
25	Vaidyanath Wellness Pande Hospital	Ghansoli	400709
26	Madhu Hospital	Bhandup	400078
27	Universe Multispeciality Hospital	Ghansoli	400701
28	Jay Ambe Surgical Nursing Home	Miraroad	401107
29	Asha Polyclinic & Sheetal Nursing Home	Ghatkopar East	400077

**This list is dynamic & subject to change & same will be available under Network Hospital tab.

AYUSH Treatment : Not covered.

Emergency Ambulance Charges: up to Rs.2,500 or actuals whichever is less.

Internal Congenital diseases are provided maximum up to Rs. 50,000 per family.

30 Days Pre- Hospitalisation & 60 Days Post Hospitalisation expenses covered up to 20% of admissible claim amount.

MATERNITY BENEFIT & NEW BORN BABY : not covered under this plan.

1% TDS will be deducted in case of reimbursement claim.
Intimation /Submission: 10% deductions will be applicable over & above all terms & condition if intimation not done within 48 hrs. of admission. (This co-pay is over and above other co-pay like non network hospital co-pay, PED co-pay etc.)

10% deductions will be applicable over & above all terms & condition if submission not done within 30 days of discharge.

NEWLY MARRIED SPOUSE: not covered under this plan.
ADVANCE SETTLEMENT, CASHLESS & REIMBURSEMENT facility available in subscription for medical benefit.
As per INCOME TAX Act, Proposer will be not eligiblefor exemption under Sec 80D for Health Subscription amount.
Dental treatment not covered.
In all Benefits requests due to Accident (whatever cause) police MLC / FIR is compulsory
MID-TERM ADDITIONS not allowed.
Any person CAN’T BE enrolled MORE THAN ONCE under same plan. If declared more than once, benefit would be payable under one Benefit limit of lower value only.
No grace period will be considered as this is a community Subscription offer.
From first year renewal onwards all Member will be considered as fresh member if renewed using different mobile no or any changes in members name / relation. Continuity benefit will be lost for all members.
Kindly read Terms & Condition properly prior to enrolling in the plan.
*** REASONABLE AND CUSTOMARY CHARGES mean the charges for services or supplies, which are the standard charges for the specific provider/hospital and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the Illness / Injury involved. Your claim will be process as per reasonably and Customarily and Medically Necessarily charges. Claims will be payable up to reasonable and customary charges only.
If proposer had died then please renew enroll for subscription offer as it is and informed contact@prologichealth.in with death certificate of proposer within 5 days from payment. Respective team will transfer the mobile no to Spouse of the deceased. This will ensure continuity benefit. Your continuity under the plan is tracked by mobile number only.

Any claim in deceased proposer’s family, amount will be released in sequence covered Spouse, covered elder child, father, mother name.

29. The enrolled person can make a benefit payment request if her/his hospitalized stay is for over 24 hours. However, for certain treatments, such as dialysis, chemotherapy, cataract surgery, etc. the stay could be less than 24 hours.

Organ transplantation charges are capped for 2 Lac including pre/post claim per family.

Cyber knife treatment / Gama Knife treatment, Cochlear Implant and Stem Cell transplant : Covered up to 1 Lac including pre/post claim per family.
Contribution Amount

Annual Contribution amount as per Highest Member’s age in the family per Year ##

Contribution amount - Shree KVO Jain Manav Shushrusha Kendra supported by Vado Mahajan - Aug 2024-2025

Plan	Type	Max. Person	Max. Age	Family Details				Benefit Amount	Contribution Amount
A	Family	8 members	90 years	Self	+ Spouse	+ 4 unmarried children	+2 Parents / In Laws	10 lacs	40,000
B								5 lacs	30,000
C			60 years	Self	+ Spouse	+ 4 unmarried children	+2 Parents / In Laws	10 lacs	35,000
D								5 lacs	26,000
E		4 members	45 years	Self	+ Spouse	+ 2 unmarried children		10 lacs	30,000
F								5 lacs	21,000

Notes:

· Self-managed health benefit scheme is run by Shree KVO Jain Manav Shushrusha Kendra supported by Vado Mahajan for its members.

· Children are defined as unmarried dependent children up to the age of 25 years.

· Either Parents or Parents-in-law covered (Cross combination not allowed)

· Family members to be covered as per acceptable age of specific plans only

· Contribution amount to be paid through Online Payment only. No changes or cancellation allowed after payment.

· Additional Payment Gateway fees shall be charged by Gateway Company for providing safe & secure online money transfer facility.

· ** Plan terms and amount shall be reviewed annually and necessary corrective action shall be taken (if required)

33. Not Payable benefit.

In Patient Hospitalisation (This exclusion is related to - Hospitalisation benefit)

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.: A 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: Willful 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, tobacco chewing, smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies, impairment of Covered 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 hospitalization is not done.

8. Cosmetic surgery, aesthetic and re-shaping treatments and Surgeries. Plastic Surgery or cosmetic Surgery or treatments to change appearance unless medically necessary and certified by the attending Medical Practitioner for reconstruction following an Accident, cancer or burns.

9. Circumcision not covered

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 Illnessfor 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 center, 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 not covered

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 of any kind.

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 Covered 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. Covered 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

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. Blacklisted Hospital, Doctor: Treatment in any Hospital or by any Medical Practitioner or any other provider of services that We have blacklisted as listed on Our website.

48. Treatment provided by anyone with the same residence as Insured Person or who is a member of the Covered 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. Intra-vitreal Injection not covered.

50. Domiciliary Hospitalisation, OPD treatment is not covered.

51.Consumables are not payable.

52.Any consequential or indirect loss arising out of or related to Hospitalization.

53.Air Ambulance.

34 . Treatments excluded in 1st Year: Even if diagnosed after Subscription Inception.

Sl No.	Body System	Illness	Treatment/ Surgery
1	Eye	Cataract	Cataract Surgery
		Glaucoma	Glaucoma Surgery
		Other Eye Surgeries	Other Eye Surgeries
2	Ear Nose Throat (ENT)	Serous Otitis Media
		Sinusitis	Sinus Surgery
		Rhinitis	Surgery for the nose
		Tonsillitis	Tonsillectomy
		Tympanitis	Tympanoplasty
		Deviated Nasal Septum	Surgery for Deviated Nasal Septum
		Otitis Media	Surgery or Treatment for Otitis Media
		Adenoiditis	Adenoidectomy
		Mastoiditis	Mastoidectomy
		Cholesteatoma	Resection of the Nasal Concha
3	Gynecology	All Cysts & Polyps of the female Genito urinary system	Dilatation & Curettage
		Polycystic Ovarian Disease	Myomectomy
		Uterine Prolapse	Uterine prolapsed Surgery
		Fibroids (Fibromyoma)	Hysterectomy unless necessitated by malignancy
		Breast lumps	Any treatment for Menorrhagia
		Prolapse of the uterus
		Dysfunctional Uterine Bleeding (DUB)
		Endometriosis
		Menorrhagia
		Pelvic Inflammatory Disease
4	Orthopedic Rheumatological	Gout	Joint replacement Surgery
		Rheumatism, Rheumatoid Arthritis	Surgery for Prolapse of the intervertebral disc
		Non infective arthritis
		Osteoarthritis
		Osteoporosis
		Prolapse of the intervertebral disc
		Spondylopathies

5	Gastroenterology (Alimentary Canal and related Organs)	Stone in Gall Bladder and Bile duct	Cholestectomy / Surgery for Gall Bladder
		Cholecystitis	Surgery for Ulcers (Gastric / Duodenal)
		Pancreatitis
		Fissure, Fistula in ano, hemorrhoids (piles), Pilonidal Sinus, Ano-rectal & Perianal Abscess
		Rectal Prolapse
		Gastric or Duodenal Erosions or Ulcers + Gastritis & Duodenitis
		Gastro Esophageal Reflux Disease (GERD)
		Cirrhosis
		Acute & Chronic Appendicitis, Appendicular lump, Appendicular abscess
6	Urogenital (Urinary and Reproductive system	Stones in Urinary system (Stone in the Kidney, Ureter, Urinary Bladder)	Prostate Surgery
		Benign Hypertrophy / Enlargement of Prostate (BHP / BEP)
		Hernia, Hydrocele,	Surgery for Hydrocele, Rectocele and Hernia
		Varicocoele / Spermatocoele	Surgery for Varicocoele / Spermatocoele
7	Skin	Skin tumour (unless malignant)	Removal of such tumour unless malignant
		All skin diseases
8	General Surgery	Any swelling, tumour, cyst, nodule, ulcer, polyp anywhere in the body (unless malignant)	Surgery for cyst, tumour, nodule, polyp unless malignant
		Varicose veins, Varicose ulcers	Surgery for Varicose veins and Varicose ulcers
		Congenital Internal Diseases or Anomalies
9	Cardiac Surgeries	CABG	Thoraco Vascular / Cardiac Surgeries
		Angioplasty
		Other Heart Surgeries / Thoraco Vascular Surgeries
10	Other Treatments	Chemotherapy/ Cancer Surgeries / Hypertension / Stroke / Diabetes	Cancer treatment
		Radiotherapy	Cancer treatment
		Dialysis	kidney / Liver Failure

35. List of Capping Ailments:

Maximum Amount payable per person for Ailments/ procedure. (INCL. Pre/post expenses)	Max limit – 500000	Max limit – 1000000
Cataract per eye	18,000	22,000
All expenses related to Disorder of Nervous system	1,80,000	2,25,000
All expenses related to Cardiovascular Disease	2,00,000	2,25,000
Expenses related to Cancer excluding Radio therapy & chemotherapy	2,20,000	2,80,000
Expenses related to Radio therapy / chemotherapy & Dialysis - Per Ailments	1,00,000	2,00,000
Expenses related to Renal disease excluding Dialysis	1,80,000	2,25,000
Expenses related to Prostate enlargement, Hysterectomy & all types of stone operation / removal including cholecystectomy - Per Ailments	50,000	60,000
Expenses related to Musculoskeletal System excluding Joint & or Knee replacement.	2,00,000	2,50,000
Joint & or Knee Replacement and implants (Maximum payable - per family per year)	2,00,000	2,25,000

Compulsory deductions of 35% is applicable on capped ailment.

Reimbursement claim from network hospital will be considered as non-network treatment & 35% co-pay will be applicable in such cases.

Shree KVO Jain Manav Shushrusha Kendra is a Health / Wellness Company?

- No. Shree KVO Jain Manav Shushrusha Kendra is not a Health / Wellness company

Is this is an Insurance Plan ?

No, this is not an insurance plan. This is “community service Program" Only for its own Jain community families. This 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. It is by the Jain community, for the jain community programme of sharing healthcare expenses of few jain members by many.

Whether grievances on claims disbursal and deductions can be raised with IRDAI or Any other legal forum.

Here you are not buying insurance from Insurance company. Rather all Jain community members are raising funds via donation in Shree KVO Jain Manav Shushrusha Kendra for taking healthcare needs of hospitalization expenses of their fellow community member. Here Jain family who is contributing is not a consumer but comrade is self manage healthcare fund.

Whether Physical Submission of forms is allowed?

Physical forms will not be accepted at all for the renewal of plan. All the information has to be provided online.

What are the options for making payment ?

The members can choose to make payment only from following options

Online payment through credit / debit card or net banking

If a member is not aware about the online process or the working on internet and computers, how will they be able to renew?

In this age of digitization, internet and computer facility is easily available. The members who are not very conversant with use of computers are advised to approach young members in their family for help in completing the online process.

I am a Jain but my wife is not a Jain? Can I insure my wife?

Under the family floater plan you can cover your wife as long as the proposer is Jain and because now she is a part of the Jain family. All covered members has to be Jain.

If I have only 3 members in my family can I buy a Family Floater Plan?

Family Floater Plan is available for family size ranging between 2 to 8 members i.e. Proposer + Spouse + 4 Unmarried, Dependent Children up to 25 years of Age + Parents/or Parents or Laws (Jain only) up to 90 years

Can I and my brother / sister cover our parents under our individual family floater schemes?

No. you cannot be covered more than once under whole group.

We are two brothers & we have two different policies, Can we enrol our Parents in both policies?

No. One person can be covered only once.

Can I take my married daughter in plan?

No. As she is now not part of your family.

Is this Applicable on Pan India basis?

Yes this plan is for Pan India, Jain population only. All covered members has to be Jain.

In my family few are having Jain certificate but my parents don't have any proof? Then what I can do?

Please get a confirmation from your Sangh / Gyati that you are a Jain.

If my wife is the proposer can she cover her parents?

Yes, only if she is a Jain by birth.

Will location of dependent family matter in availing services ?

No, Location does not affect the operational activities, main member or the dependent member can avail same and equal benefits irrespective of their location within India.

I am Thankful

• Shree KVO Jain Manav Shushrusha Kendra supported by Vado Mahajan 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 donation. This is not an insurance plan, supported by Insurance Company or any healthcare company. It is by the Jain community, for the jain community programme of sharing healthcare expenses of few jain members by many.

• This is a Group health contribution plan. It will start from a common date and not from the date you pay the subscription fee.

• Self-funded scheme start date: Membership benefit will start from 1st Sept 2024 to 1st Aug 2025.

• If any grievance under the policy I will solve through discussion and writing to contact@prologichealth.in or meeting personally at Shree KVO Jain Manav Shushrusha Kendra / Vado Mahajan office.

• Cancellation not allowed after payment. Shree KVO Jain Manav Shushrusha Kendra has reserved the right to cancel the membership fess & refund the subscription fees.

• This community program is not backed by any Insurance company nor I am consumer as per definition of consumer Act as I am contributing donation in my community fund.

• No cover benefits will be provided for hospitalization and pre-post hospitalization from 03th Aug 2024 to 31st Aug 2024 for renewal members.

Suraksha Chakra Scheme

Swasthya Suraksha Chakra: (Aug 2024-2025)