JGEC Alumni Health Insurance - FAQ

If two JGECians are married, does it make sense to have the younger spouse buy this for the family?
No. The age of the oldest member in the family unit is considered to arrive at the slab rate.

Who will determine the alumni status? For instance, will executive or fellowship program students be considered as alumni?
All registered members in the JGEC Alumni portal are eligible for the program.

Can one exit the plan and join back again?
No, it is not allowed.

Is the age based on sign-up age or actual age at the time of premium payment?
Age is the completed age as on the premium payment date.

I am based in the UAE (NRI). I wanted to know how to enrol if we do not have an Indian mobile number?
An Indian mobile number is required for policy issuance. You can also share the contact number of your family members if you don’t have one. Additionally, you can add your international number as your WhatsApp contact during the enrolment process.

For employees retiring from organizations with corporate insurance, will they also qualify to be covered under this scheme?
Yes.

Will this plan work in conjunction with an individual health insurance plan that I have already purchased?
Yes. Absolutely.

Does the proposed plan apply to or is it useful to those who are NRI—permanently based abroad but spending sizable time in India?
Yes, since this policy permits claims that arise in India and for hospitalizations within the borders of India.

Is a base policy in my name a requisite for this plan? If I am covered up to ₹3 Lacs by my spouse's policy, can I go ahead and enrol in this Super Top-up plan without having a base policy in my name?
A base policy is not a prerequisite. Yes, you can enrol with the minimum deductible option of ₹3 Lacs.

I have a base policy from my employer where there is no waiting period. If I take the Super Top-up this year but leave my job next year, what happens to the waiting period when I renew the Super Top-up plan?
The Super Top-up policy functions independently of the employer-provided base policy. It will get triggered once you cross the chosen deductible amount.

Why are aspects like maternity not part of it?
Maternity claims rarely go beyond ₹3 Lacs, which are usually covered under the base policy. Additionally, the event is limited to a specific section of the population and most corporate policies already cover it.

Will the Super Top-up work even if there is no base plan? i.e., can the ₹5 Lakh deductible be covered through self-insurance?
Yes. This will also work if you are paying the deductible out of pocket.

If we choose base deductible as ₹10 Lacs, and have a base policy of ₹3 Lacs with one insurer, and a ₹10 Lacs Super Top-up with another provider (with ₹3 Lacs deductible), will the Super Top-up work beyond ₹10 Lacs? How will cashless be settled?
If you have chosen a Super Top-up plan with a ₹10 Lacs deductible, you will need to produce payment receipts up to ₹10 Lacs (paid by you or any policy). Beyond that, cashless settlement will occur in the network hospital up to the insured sum.

Is there any limit on the claim amount for each person in the policy?
No individual claim limit—alumni can claim up to the total sum insured. The policy is triggered after crossing the deductible amount.

What if your base plan is in the US but covers medical expenses out of the US, including India. Will all expenses above deductible be covered by the Super Top-up policy?
Yes, for hospitalizations in India. However, the deductible must also be spent in India for the Super Top-up policy to activate.

If I am diagnosed outside of India, can I avail this policy if I seek treatment within India?
Yes.

Does the basic scheme not provide coverage? Is it only available with a certain deductible (seems to start from ₹3 Lakh or ₹5 Lakh)? Will the claim settlement and enrolment process be online?
This is a Super Top-up insurance plan, which requires selection of a deductible. The entire enrolment and claims process is online through the JGEC Alumni Portal and the insurer’s digital portal.

Can policies already in force be continued concurrently?
Yes. The Super Top-up functions independently. To trigger it, alumni must submit proof of claim payment (claim settlement letter or receipt). Once the deductible threshold is crossed, the Super Top-up coverage kicks in.

Since it is a top-up insurance and hospitals will bill only once, how will the remaining amount be settled with the base insurer?
Once the deductible amount is met—either through another policy or out-of-pocket—the Super Top-up is triggered. All subsequent eligible claims are covered under this policy.

Is there any coverage for outpatient procedures or home treatments like nurse visits, where hospitalization isn't involved?
No. This is an IPD-only (In-Patient Department) program. However, home hospitalization is covered.

Does Zopper only offer Super Top-up coverage, or do they also provide base policy products?
Currently, Zopper is offering only the Super Top-up plan. The base policy may be considered in the second year based on alumni demand.

If I get married in the future, will I be able to add my spouse at no extra cost? Also, children in future?
Yes. One can add both children and spouse at a later date when entry is allowed during renewal, or during the policy period through an endorsement in case of natural life events such as childbirth or marriage.

Can the base sum insured be varied among different family members?
There are three policy combinations under the program: one for the immediate family (alumnus, spouse, and up to four children), one for parents, and one for parents-in-law. The deductible and coverage amounts can be selected independently for each of these three family categories.

If the deductible chosen is ₹5 Lacs and I take 3 policies (immediate family, parents, and in-laws), will ₹5 Lacs be deducted for each of the 3 policies OR just once, whichever gets triggered first?
The deductible applies separately to each of the three policy combinations:

• Alumni, Spouse & Kids
• Parents
• Parents-in-law

For example, if the deductible is crossed for the alumnus, then their spouse or kids (under the same floater) can claim without crossing it again. However, parents or in-laws would need to cross the deductible separately within their respective policy.

If an alum crosses 85 years, and the alum's spouse at that stage is less than 85 years, would the spouse continue to get enrolled in the policy after the alum crosses 85 years?
Yes. If the alum enrolls before the age of 85, they can continue to renew the policy even after crossing that age. Since the alumni must be the proposer, they need to enrol under eligible conditions, after which spouse and children can be added.

Is the policy open for alumni who are now foreign citizens, while parents still hold Indian citizenship?
Yes. The alum must enrol themselves to avail the policy for their parents/in-laws. As the policy jurisdiction is India, it can be used for treatments in India after the deductible has been spent in India.

If the alum passes away, does the policy continue for the family?
Yes. The family remains covered until the next renewal. After that, family members must reach out to the JGEC team to get login access to continue enrollment on behalf of the deceased alumnus.

Both of us, husband and wife, are alumni. If the policyholder passes away, can the cover pass on to the surviving alumni spouse?
Yes. The surviving spouse can join the plan in the following year based on their individual alumni status.

Can siblings be included?
No. Only spouses, children, parents, and parents-in-law are eligible for inclusion in the policy.

Premium for people over 85 years vary each year?
The costs are standardized for individuals above 85 years and do not vary from person to person. However, the cost for each age slab may change depending on the claim ratio of the group.

Will premium increase be the same for everyone or will it increase based on an individual's past claims?
This is a group insurance plan, so any premium changes—either increase or decrease—will apply to the entire group and will be based on age bands, not individual claim history.

Are payments for the Super Top-Up Policy eligible under Section 80D for income tax rebate?
Yes, premiums paid for this policy are eligible for tax benefits under Section 80D of the Income Tax Act.

Can we increase or decrease the sum insured year over year? For example, if I start with ₹30 lakhs in Year 1, can I reduce it to ₹20 lakhs in Year 2, and vice versa?
Decreasing the sum insured is allowed without restriction. However, increasing it may or may not be permitted depending on the insurer’s underwriting policy. It is recommended to opt for the highest sum insured during your first enrollment for maximum protection.

Can we take a multi-year Super Top-Up plan, say for 3 years?
No. The policy is valid for one year and must be renewed annually.

Are GST charges waived? Is there a discount for paying premiums for two years upfront?
No, since this is a group program, GST waivers and multi-year premium discounts are not available.

Are the deductible and super top-up amounts fixed for all individuals, or are they variable?
The deductible and coverage amounts are flexible and can vary across the three policy categories: the immediate family floater (alumnus, spouse, and up to four children), the parents' policy, and the in-laws' policy.

Can members opt for a top-up policy for one year and then change it in subsequent years?
Reducing the deductible or increasing the coverage in future years is restricted and subject to the insurer’s underwriting guidelines.

Who is the re-insurer for this scheme? What are the step-by-step procedures for lodging claims? A detailed claim process explanation would be helpful.
The insurance provider will be finalized shortly. We are partnered with multiple leading insurers, one of whom will issue the master policy. The claim process follows standard procedures applicable in the retail market, with additional support from the Zopper team to expedite claims.

(i) How would cashless work, with a deductible of ₹5/₹10 Lakhs? (ii) If deductible is paid by another insurance, must the limit be fully utilized first?
(i) Submit proof of bill payment up to the deductible; thereafter, cashless claims can be made at Care Health Insurance network hospitals.
(ii) No, the deductible just needs to be paid—whether by you or your insurance—before this policy activates.

What happens in case of more than one claim in a single financial year? Will the deductible apply again?
The deductible is cumulative and needs to be crossed only once per policy year. Once met (via personal payment or other insurance), further claims will be processed without reapplying the deductible.

If a hospital provides a consolidated bill and I submit it for base insurance (e.g., ₹5 lakh of ₹10 lakh), what documents are required for the super top-up claim?
You’ll need the claim settlement letter (if paid by insurance) or payment proof (if paid out-of-pocket), along with the discharge summary.

How does the claim process work if the hospital bill is ₹10 lakh and the base policy covers only ₹5 lakh? What documentation is required to claim the remaining amount?
Submit proof of ₹5 lakh deductible coverage (either via claim letter or payment receipt). The Super Top-up policy will trigger for the remaining claim.

If I am self-insured (no base insurance), how will claims be processed? Will it be cashless?
Present payment receipts up to the deductible amount to Care Health. Cashless will then be triggered for the remaining amount. Zopper will assist throughout.

What role will Zopper play in the claims process?
Zopper will coordinate with the insurer and TPA to protect alumni interests and support the entire claims journey.

Will there be a grievance redressal cell? How will data security be maintained?
Yes. A dedicated email ID and an escalation matrix will be shared. Zopper has NDAs and bank-level data privacy protocols in place, being a leading partner for Bancassurance in India.

Please provide a list of network hospitals across various cities.
The network list will be shared after finalizing the insurer, as it varies across companies.

More details are needed on exclusions related to Pre-Existing Diseases (PED).
All PEDs are covered after a 1-year waiting period. The specific exclusions list will depend on the final insurer.

Is there a No Claim Bonus? How many hospitals across India are covered under the proposed scheme?
No Claim Bonus and restoration benefits are only available in individual retail plans. The group insurance plan does not include these. The final network list will be available post insurer confirmation.

Is there a dedicated cell to assist families of our alumni members?
Yes. A dedicated email ID and account manager will be provided to support all queries related to enrollment and claims processing.

Please review the policy details thoroughly—including coverage, exclusions, cashless facility, and claim procedures—especially considering the many cases of alleged unfair practices in claim settlement reported in consumer courts.
Yes, we share the complete outline and scope of the program, including finalized deductibles and coverages as defined in the master policy. At the time of launch, we circulate a detailed brochure and run a comprehensive marketing campaign—this includes one-pagers, FAQs, and webinars—to ensure alumni make informed decisions and there are no challenges during claims settlement.

Should pre-existing diseases be covered after a maximum waiting period of 30 days from policy start, especially if we have a large member base?
As per the program designed along with our insurance companies who underwrite the program, there is a one-year waiting period for any pre-existing diseases. Even though this is a Group program, we are not taking the data from the Alumni Association nor the 100% of the group is coming into the program for participation which are typically a mandatory requirement for any group policy.

Can you share the list of Pre-Existing Chronic conditions that a person has suffered in the past or is currently suffering from that are not allowed to enter in the program?

Please mention the list of modern treatments

• Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound)
• Balloon Sinuplasty
• Deep Brain Stimulation
• Oral Chemotherapy
• Immunotherapy – Monoclonal Antibody to be given as injection
• Intra Vitreal Injections
• Robotic Surgery
• Stereotactic Radio Surgeries
• Bronchial Thermoplasty
• Vaporisation of Prostate (Green laser treatment or Holmium laser treatment)