1. Self+ Any Five.

(including spouse, father or father in-law, Mother or Mother in-law and Dependant
children). Cross selection between parent and parent in-laws allowed.
Combination of parent &/or Parent in law subject to once selected can not be amended/Modified
during the currency of policy.
2. Any Two out of 4 (Father, Father in law, Mother & Mother in Law) can be selected.
Only in case of demise of parent & parent in law, modification/amendment is allowed .
Once covered in the policy not allowed to deleted unless demise.
3. Sum Insured Grade Wise (On Family Floater Basis):

Grade Base Sum Insured (Critical SI Including Base SI)

L01 To L12 Rs . 3 Lakhs Rs . 4 Lakhs
L13 To L15 Rs . 4 Lakhs Rs . 6.5 Lakhs
L16 And Above Rs . 5 Lakhs Rs . 8 Lakhs
(15).Room eligibility as per Grade as below ;
Grade L01 to L12 : - Standard / Twin Sharing. Rs-2500 for Non Metro city and 3500 is for metro city
Grade L13 to L15 :- Semi Deluxe. Rs-5500 for Non Metro city and Rs-7500 is for metro city
Grade L16 and Above :- Dluex. Rs-9000 for Non Metro city and Rs-10500 is for metro city
No Room Capping for L19 and above.
No limits for ICU, ICCU etc.
No room rent capping to be applicable for patient option for a higher room rent in case for COVID--19
due to non-availability of rooms in their eligibility.
4. Pre-existing diseases cover for day 1 (Including internal and external congenital Diseases)
5. New born baby to be covered from day 1.
6. Acts of Terrorism, SRCC, Snake Bite, Gas inhalation will be covered
7. Age Maximum up to 100 years.
8. Waiver of 30 days & First year Exclusion.
9. Maternity benefit, Rs . Normal Delivery 35,000 and Caesarean Section Rs . 50,000.
10. Nine months waiting period to be waived off.
11. Infertility treatment – Up to C-Section maternity limit. Only as a onetime benefit.
12. Domiciliary hospitalization expenses inclusion.
13. Pre-and post-hospitalization covered for 30 Days and 60 Days respectively.
14. Ambulance Expenses up to Rs . 3,000/-.
16. Limits for Common Ailments :- 1) Cataract – 15% of the Sum Insured Per Person per eye. 2) LASIK
Surgery – Rs . 35,000 Per Insured member for correction beyond -7.
17. Fracture treatment under OPD to be covered. Fracture of Bones, cartilage and muscles will be covered
under Mediclaim policy even if hospitalization for the same is not done / or required.
18. New Joiners will be covered from day 1 of Joining.
19. There will be no “Date Not Found” (DNF) case under the policy.
20. C3R procedure for retinal detachment.
21. Inj, Avastin Inj. Ozurdex, Inj. Ramicade, Inj. Zoaldex and similar injections under a claim to be covered.
22. Bariatric surgery for treatment of morbid obesity.
23. Hormone therapy for cancer treatment is covered.
24. Oral Chemotherapy – Limited to Rs . 1.5 Lacs.
25. Midterm Increases in sum insured, Addition and deletion of Employee / Dependents will be allowed in
case of midterm appraisal of the company or limit erroneously considered at the inception of the policy.
26. Midterm addition of dependents to be allowed in case erroneously left out.
27. All Kinds of surgery to be covered wherever hospitalization is not required.
28. Dental Treatment (Surgery) due to Accidental & or if needs Hospitalization to be covered.
31. Any modern treatment which does not required 24 hours treatment. For instance – Robotic surgeries,
Femto is covered. A detailed list as per annexure
32. List of day care surgeries as per annexure 1 to be covered.
34. Pacemaker Battery replacement is covered.
35. Assistance doctor charge covered if Required.
36.Expenses incurred at hospital or Nursing Home primarily for evaluation / diagnostic purposes which
are advised by the treating doctor during the hsopitalized period are payable. Any hospitalization less
than 24 with no active line of treatment should be considered case basis depending upon the
requirement of hospitalization – As per expiring policy.
37.Doctor home visit fees / charges are payable as hospitalization claim or OPD claim as the case may be
is case where the patient is immobile.
38. Invasive diagnostics covered which is done on general or local anaesthesia, but does not require 24
hours admission. Per family limit shall be Rs. 30,000 for such diagnosis procedures.
39. Non-Compliance of Gipsa package do not affect JSW claims in anyway. TPA/Insurer to take up with
Hospital
40. All medical advancements that result in Day Care treatments in hospitals are to be covered under
policy. List of the Day Care surgeries as per annexure 1 to be covered:- 1) Stapedotomy 2) Excision and
Destruction of a lingual Tonsil 3) Stapedectomy 4) Other Operations on the Tonsil and Adenoids 5)
Revisison of a Stapedectomy 6) Incision on Bone, Septic and Aseptic 7) Other Operations on the Auditory
Ossicles Ossicles 8) Closed Reduction on Fracture, Luxation or Epiphyseolysis with Osteosynthesis 9)
Myringoplasty (Type - 1 Tympanoplasty) 10) Suture and other Operations on Tendons and Tendon Sheath
11) Tympanoplasty (Closure of an Eardrum Perforation/Reconstruction of the Auditory Ossicles) 12)
Reduction of Dislocation Under Ga 13) Revision of a Tympanoplasty 14) Arthroscopic Knee Aspiration 15)
Other Microsurgical Operation on the Middle Ear 16) Incision of the Breast 17) Myringotomy 18)
Operation on the Nipple 19) Removal of a Tympanic Drain 20) Incision and Excision of Tissue in the
Perianal Region 21) Incision of the Mastoid Process and Middle Ear 22) Surgical Treatment of Anal Fistulas
23) Mastoidectomy 24) Surgical Treatment of Haemorrhoids 25) Recontruction of the Middle Ear 26)
Division of the Anal Sphincter (Sphincterotomy) 27) Other Excisions of the Middle and Inner Ear 28) Other
Operation on the Anus 29) Fenestration of the Inner Ear 30) Ultrasound Guided Aspirations 31) Revision
of a Fenestration of the Inner Ear 32) SclerotherapyEtc 33) Incision (Opening) and Destruction
(Elimination) of the Inner Ear 34) Incision of the Ovary 35) Other Operations on the Middle and Inner Ear
36) Insufflation on the Fallopian Tubes 37) Excision and Destruction of Diseased Tissue of the Nose 38)
Other Operatons on the Fallopian Tube 39) Operations on the Turbinated (Nasal Concha) 40) Dilatation of
the Cervical Canal 41) Other Operations on the Nose 42) Conisation of the Uterine Cervix 43) Nasal Sinus
Aspiration 44) Other Operations on the Uterine Cervix 45) Incision of Tear Glands 46) Incision of the
Uterus (Hysterotomy) 47) Other Operations of the Tear Ducts 48) Therapeutic Curettage 49) Incision of
Diseased Eyelids 50) Culdotomy 51) Excision and Destruction of Diseased Tissue of the Eyelid 52) Incision
of the Vagina 53) Operations on the Canthus and Epicanthus 54) Local Excision and Destruction of
Diseased Tissue of the Vagina and the Pouch of Douglas 55) Corrective Surgery for Entropion and
Ectropion 56) Incision of the Vulva 57) Corrective Surgery for Blepharoptosis 58) Operations on the
Bartholin's Glands (Cyst) 59) Removal of a Foreign Body from the Conjunctive 60) Incision of the Prostate
61) Removal of a Foreign Body from the Cornea 62) Transurethral Excision And Destruction of prostate
Tissue 63) incision of the cornea 64) Transurethral and Percutaneous Destruction of Prostate Tissue 65)
operation for pterygium 66) open surgical Excision and Destruction of prostate tisuue 67) other operation
on the cornea 68) Radical prostatovesiculectomy 69) Removal of the foreign body from the lens of the
eye 70) other Excision and Destruction of prostate Tissue 71) Removal of a foreign body from the
posterior chamber of the eye 72) operation on the seminal vesicle 73) Removal of a foreign body from the
orbit and eyeball 74) incision and Excision of periprostatic tissue 75) operation of cataract 76) other
operation on the prostate 77) incision of a pilonidal sinus 78) incision of the scrotum and Tunica Vaginalis
Testis 79) other incisions of th skin and subcutaneous Tissues 80) operation on a Testicular Hydrocele 81)
local Excision of Diseased Tissue of the skin and subcutaneous Tissues 82) Excision and Destruction of
diseased scrotal tissue 83) other Excision of the skin and subcutaneous Tissues 84) plastic Reconstruction
of the scrotum and tunica vaginalis testis 85) Simple Restoration of surface continuity of the skin and
subcutaneous Tissues 86) other operations on the scrotum and tunica vaginalis testes 87) Free skin
Transplanation Donor site 88) incision of the testes 89) free skin Transplanation,Recipient site 90) Excision
and Destruction of diseased Tissue of the testes 91) Revision of skin plasty 92) unilateral Orchidectomy
93) other restoration and reconstruction of the skin and subcutaneous Tissues 94) Bilateral of
orchidectomy 95) Chemosurgery to the skin 96) orchidopexy 97) Destruction of Diseased Tissue in the
skin and Subcutaneous Tissues 98) abdominal Exploration in cryptorchidism 99) incision Excision and
destruction of diseased tissue of the tongue 100) Surgical Repositioning oa an abdominal Testis 101)
Partial Glossectomy 102) Reconstruction of the testis 103) Glossectomy 104) implantation Exchange and
removal of a Testicular prosthesis 105) Reconstruction of the tongue 106) other operation on the testis
107) other operation on the tongue 108) surgical treatment of a varicocele and a hydrocele of the
spermatic cord 109) incision and lancing of a salivary gland and a salivary Duct 110) Excision in the area of
the Epididymis 111) Excision of Diseased tissue of a salivary gland and a salivary Duct 112)
Epididymectomy 113) Resection of a salivary Gland 114) Reconstruction of the spermatic cord 115)
Reconstruction of a salivary gland a Salivary duct 116) Reconstruction of the Ductus deferens and
epididymis 117) other operations on the salivary glands and salivary duct 118) other operations on the
spermatic cord,Epididymis and Ductus deferens 119) External incision and drainage in the region of the
mouth,jaw amd face 120) operations on the foreskin 121) incision of the hard and soft palate 122) Local
Excision and Destruction of diseased Tissue of the penis 123) Excision and Destruction of diseased hard
and soft palate 124) amputation of the penis 125) incision,Excision and destruction in the mouth 126)
Plastic Reconstrucion of the penis 127) Plastic Surgery to the floor of the mouth 128) other operations on
the penis 129) palatoplasty 130) Cystoscopical Removal of stones 131) Other operations in the mouth
132) Lithotripsy 133) Transoral incision and Drainage of a pharyngeal Abcess 134) coronary Angiography
135) Tonsillectomy Without Adenoidectomy 136) Hemodialysis 137) Tonsillectomy with Adenoidectomy
138) Radiotheraphy for cancer 139) Cancer Chemotheraphy.
41. List of illnesses to be considered as Critical illness for sanctioning Critical illness sum insured: -1)
Cancer. 2) Heart Attack- All Ailments to be considered as critical. 3) All kind of Heart Surgery including
Valve surgery / replacement. 4) Surgery to Aorta. 5) Stroke leading to Paralysis. 6) Kidney Failure including
Dialysis. 7) Aplastic Anaemic. 8) End Stage Liver Failure. 9) Coma. 10) Major Burns Leading to
hospitalisation. 11) Major Organ / Bone Marrow Transplantation. 12) Multiple Sclerosis. 13) Fulminate
Hepatitis. 14) Terminal illness leading to confinement at home. 15) Joint replacement arising due to an
accident. 16) Grievous Injury – All Ailments to be covered. 17) Neuro Surgery (Including all major
neurological disorders). 18) Organ Failure leading to life threat and or Death. 19) COVID-19
Hospitalization admitted to ICU.
Any Illness/diagnosis which is critical in nature in opining of treating doctor (and is not present in the list
above) to be considered eligible for critical sum insured.
Critical illness benefit of Rs . 25,000/- (in addition to the Sum insured and will not deplete the sum
insured) to employee only upon detection of such illness during the renewed policy period. this benefit in
once in life time. Not applicable to employees with pre-existing disease.
Ayush: expenses incurred for Ayurvedic, Homeopathic and Unani treatment are admissible up to 25% of
the sum insured excluding centres for Spas, massage and health rejuvenation process. Or as per latest
directive at the time of claim.
Hospitalization Expenses incurred on the donor during the course of organ transplant to the insured
person. Total of both donor and insured person claim is subject to max of sum insured of insured
recipient.
Genetic disorders to be covered under the policy.
All medical advantage that results in dry care treatment to be covered under this policy.
Biological drugs, immunomodulators or other adjuvant therapies as main claim.
Advanced treatment / procedure (Robotic, Cyber knife, Gamma knife etc.) Covered.
Yag laser, barrage laser, photo coagulation, photodynamic therapy for eye disease (taken on OPD basis)
Covered.
42. List of Senior management and their dependants to be flagged for personal attention during check-
ups.
43. No other capping (apart from sum insured) to be applied to the claims under capped ailment including
maternity and related claims.
44. No intimation for reimbursement claims, documents will generally be submitted within 90 days from
date of discharge (however claims within the policy period should be waived off from the time limit).
45. Right of TPA appointment to rest with JSW and to be quoted for external TPA only.
46. Any Dependents erroneously left out in the data provided while booking the policy to be covered
during the year with additional premium as per pro-date rate.
47. Modern Treatment Methods & Advancement in Technology. 1) Uterine Artery Embolization & High
Intensity Focused Ultrasound (HIFU) covered Up to 20% of sum insured subject to Maximum Rs. 2 Lakh. 2)
Balloon Sinuplasty covered Up to 20% of sum insured subject Maximum Rs.2 Lakh. 3) Deep Brain
Stimulation covered Up to 50% of sum insured subject to Maximum Rs. 5 Lakh. 4) Oral Chemotherapy
Limited to 1.5 lakh as per expiring cover. 5) Immunotherapy – Monoclonal Antibody to be given as
injection covered as per expiring policy. 6) Intra Vitreal Injection covered Up to 10% of sum insured
subject to Maximum Rs. 75,000 (these limits will not be applicable for Inj. Avastin, Inj. Ozurdex, Inj.
Ramicade). 7) Robotic Surgeries (Including Robotic Assisted Surgeries) covered Up to sum insured. 8)
Stereotactic Radio Surgeries covered Up to 50% of sum insured subject to Maximum Rs. 3 lakh. 9)
Bronchial Thermoplasty covered Up to 50% of sum insured subject to Maximum Rs. 2.5 lakh. 10)
Vaporisation of the Prostate (Green laser treatment for holmium laser treatment) covered Up to 50% of
sum insured subject to Maximum policy Rs. 2.5 lakh. 11) Intra Operative Neuro Monitoring (IONM)
covered Up to 10% of sum insured subject to Maximum Rs. 50,000. 12) Stem Cell Therapy: Hematopoietic
Stem Cells for bone marrow transplant for haematological condition to be covered only Up to 50% of sum
insured subject to Maximum Rs. 2.5 lakh. 13) HIV treatment covered Up to the sum insured only as
inpatient (Yes). 14) Mental illness cover limit 25% of sum insured.