FAQs for Swasthya Ratna Policy

The Gem & Jewellery Export Promotion Council (GJEPC) has introduced a Group Health Insurance Scheme (a CSR Health Insurance initiative) from March 1, 2015. This Scheme is named as Swasthya Ratna under which all GJEPC member companies can enrol employees and their families
Group Mediclaim is a floater insurance policy of insurance company. This covers expenses incurred for hospitalization for treatment of an illness, accident. This policy will cover you, your spouse, two children and two parents. Mediclaim Insurance can take care of medical expenses for the hospitalization and in-patient treatment for minimum 24 hrs hospitalization. The expenses can be reimbursed maximum up to the sum insured amount of the policy.
The Gem & Jewellery Export Promotion Council (GJEPC) has created this scheme with different options related to family size, nature of benefits etc. to make this scheme flexible and affordable.
Premium for the health insurance will be varying as per the different option selected by member company. The Gem & Jewellery Export Promotion Council (GJEPC) also contribute towards the scheme as CSR initiative for all GJEPC Member employees and their dependant. For more detail please get in touch with our Swasthya Ratna Team.
For availing Swasthya Ratna policy you can visit our website: CSR – Swasthya Ratna – Enroll Yourself section or you can contact GJEPC HO/RO or you can coordinate directly with our exclusive broker Edelweiss Gallagher Insurance Brokers Ltd. (EGIBL) for more detail.
Once you enrol under Swasthya Ratna policy you will receive the Medical card which is valid PAN INDIA basis and through that medical card you can avail cashless as well reimbursement claim service for you and your family.
If you wish to make a claim under Swasthya Ratna policy, you can contact the dedicated Third Party Administrator (TPA) for avail the benefits or you can get in touch with Edelweiss Gallagher Insurance Brokers Ltd. (EGIBL) dedicated health claim management team.
You will get the medical expenditure benefit under this scheme subject to plan option chosen by your company and or standard mediclaim claim settlement procedure carried out by the insurance company. For more detail you can contact our exclusive broker partner Edelweiss Gallagher Insurance Brokers Ltd. (EGIBL)
If you wish to update or correct the family detail under Swasthya Ratna scheme you can contact your HR or Edelweiss Gallagher Insurance Brokers Ltd. (EGIBL) to arrange the correction/update.
Up to 80 years is the limit for entry age in the policy.
  • Hospitalization expenses covered Pan India in more than 4500+ hospital occurred either due to accident or natural diseases
  • Pre-existing diseases are covered. Pre-existing disease is defined as a disease which the insured is having as on date of
  • inception of the policy of which, he may or may not be aware of existence of the same
  • No waiting period in the policy for hospitalization claims
  • Medical expenses incurred 30 days prior to the hospitalization are reimbursed
  • Post hospitalization expenses up to 60 days are covered
  • Ambulance expenses of the patient to the nearest hospital covered subject to maximum of Rs. 1500 as per certificate issued by treating doctor
  • Day Care expenses are covered under the policy
  • Internal congenital diseases covered
  • Minimum hospitalization of 24 hours required for the treatment, which cannot be taken at home. the minimum hospitalization clause is not applicable for day care treatment like cataract, chemotherapy etc.
  • Injury or disease directly or indirectly caused by or arising from an attributable to war, invasion, act of foreign enemy, warlike operation (whether war be declared or not)
  • Any hospitalization for health check up/investigation purpose or for observation of the patient or for giving any oral treatment is excluded
  • Cost of spectacles, contact lenses, hearing aids & denture
  • Dental treatment or surgery of any kind unless requiring hospitalization on account of accident cases
  • Circumcision unless necessary for treatment of the disease, cosmetic or aesthetic of any description, plastic surgery other than as may be necessary due to an accident or as a part of any illness
  • Acquired Immuno Deficiency Syndrome (AIDS)
  • Injury or disease caused directly or indirectly by or contributed to by nuclear weapons/ materials
  • General debility, obesity treatment & its complications
  • External congenital diseases, defects or anomalies
  • Infertility, sterility treatment
  • Homeopathic / Unani Hospitalization excluded
  • Use of intoxicating drugs / alcohol, use of tobacco leading to cancer is excluded
  • Genetical disorders and stem cell implantation / surgery
  • IVF Treatment
No, this is a Group Mediclaim Policy and hence one no need to undergo any medical test.
The expenses that are reimbursed under Mediclaim policy are as follows:
  • 30 days prior to hospitalization all the expenses related to disease for which hospitalization is done like doctors bill, medical cost, test and report cost etc.
  • Hospitalization bill which will include room charges, doctors fees, surgeon fees, operation theatre cost, nursing charges, medicine charges and internal implant cost
  • After discharge all doctors bill, medical cost, test and report cost till 60 days from date of discharge from hospital
No, individual tax benefit is not available as this is a Group Mediclaim policy.
  • Late submission of the claim documents (i.e. if claim papers not submitted within 21 days from the date of discharge)
  • Conditions of the policy not covering diseases/illness for which the claim is submitted
  • Required documents not submitted as per the claim settlement procedure of TPA
  • Any fake documents, misrepresentation and misappropriations in the figures of the bill submitted
  • Treatment taken in not registered hospital/doctor
  • Admission done for investigation purpose only Patient having habit of intoxication drugs, liquor, tobacco chewing and/or gutkha chewing
It takes around 21-30 working days to get the claim settled on reimbursement basis. Cashless claims get settled directly with hospital.
  • Original hospital final bill
  • Original numbered receipts for payments made to the hospital
  • Complete breakup of the hospital bill
  • Original Discharge Card/Summary
  • All original investigation reports
  • All original medicine bills with relevant prescriptions
  • Original signed claim form
  • Photo ID card copy of claimant
  • TPA Card copy
  • Intimation mail copy/ claim registration no.
  • Paginated copy of Indoor Case papers
  • FIR/MLC copy incase of road accidents. If MLC is not applicable then written confirmation from Doctor/Hospital that the patient was not under influence of alcohol or drugs
*****All the bills/reports/prescription are to be submitted in original
Yes. Edelweiss Gallagher Insurance Brokers and respective TPA, would assist you in your claim settlement. You may write to EGIBL on HCM@edelweissfin.com or call on 022-68591803.
This is Group Mediclaim Policy hence no policy copy will be handed over to each employee/artisan. The TPA E-cards will be made available to each employee/artisan.
Policy would be issued within 15-21 days and the card would be issued after 5 days of policy issuance.
The claim amount would be transferred to employee/artisan bank account directly by the insurance company.
The policy would be for one year from the date of inception.
No, the policy will be lapsed as soon as a employee/artisan quits the company.
Yes, 24 Hrs hospitalizations is required except for case under day care procedure e.g. Cataract, dialysis etc.
Reimbursement and cashless claim process will be as per chart given below: