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Objective to provide health care to the members of Self Help Groups (SHGs) and other credit-linked groups (CLGs) who avail loans from banks and co-operative institutions.
ABOUT THE POLICY
Pursuant to the Finance Minister's budget speech for 2004-05 a community based Group Health Insurance Scheme is prepared in consultation with the Public Sector General Insurance Companies with an objective to provide health care to the members of Self Help Groups (SHGs) and other credit linked groups (CLGs) who avail loans from banks and co-operative institutions.
WHAT WILL POLICY PAY AND HOW MUCH?
The salient features of the scheme are as follows:-
Hospitalization
Reimbursement of Hospitalization expenses up to Rs.10 0 an individual member.
Transportation
Reimbursement of the cost of transportation of Insured to hospital up to Rs.200/- during the Policy period.
Meals
Reimbursement of the cost of meal for the insured patient not exceeding Rs.30/- per day of hospitalization and not exceeding Rs.150/- during the Policy period (subject to admissible of claims).
Premium
For Individual Rs.120/- (Service tax & TPA Charges as applicable).
Age
15 to 65 years.
WHAT WILL POLICY NOT PAY?
Main exclusions
All pre-existing diseases.
All diseases contracted during the first 30 days from the commencement date of the Policy provided that in the opinion of the panel doctor/s the insured person could not have known about the existence of disease or its symptoms at the time of making the proposal and had not taken any consultation treatment for the disease prior to taking the insurance.
Some diseases such as cataract benign prostatic hypertrophy hysterectomy hernia Hydrocele Fistula in anus Sinusitis Congenital internal disease are not covered in the first year of policy.
Corrective cosmetic or aesthetic dental surgery or treatment / cost of spectacles contact lens and hearing aids.
Vaccination inoculation change of life or cosmetic treatment or surgery HIV AIDS Sterility Venereal diseases intentional self injury use of intoxicating drugs / alcohol.
Primarily diagnostic expenses not related to sickness / injury.
Treatment for pregnancy childbirth miscarriage abortion etc.
