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How does the scheme work
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The programme has been designed after
conducting a study of different health insurance models in the
country. Minimum administrative expenses and maximum convenience to
member remains the basic motto of the programme.
1. Medical expenses up to Rs. 25,000/-
for a family of five is taken care by the
insurance.
2. With each additional member the stakeholder is eligible for an
additional medical expense of Rs. 5,000/-
from the programme
3. Financial assistance from the groups will be provided to pay the
insurance premium
4. Every family has to renew its membership every year by paying
the specified amount.
The groups will also provide loan to meet the expenses in excess of
the insured amount.
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Features
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1. Member
can get cashless treatment of Rs.5000/-, cover increases by Rs 5000/- per member. The coverage is on
floater basis in multiple of Rs.5000/- .
2. Yearly Contribution is collected along with the weekly savings
of the members of the Self-help group so that it does not strain
the finances of the family
3. Cashless treatment facility is available in well equipped
hospitals with modern amenities, recognized by SKDRDP.
4. Any one member of the family can avail the benefit for any one
ailment to the extent of maximum limit available to the family.
5. In case of normal/accidental death of stake holder of the family
(or head of the family) Rs.5000/- and Rs.
2,000/- in case of members will be paid to the nominee as
consolation with in 24 hours of the death.
6. In case of accidental death of the stake holder of the family, Rs 20,000/- additional amount will be paid to
the nominee subject to production of connected records.
7. In case any disability is suffered by the stake holder of the
family due to accident Rs.12,500/- is given as consolation for
partial disability, Rs 25,000/- is given
in case of permanent disability.
8. Maternity expenses reimbursement during the first two deliveries
of the members of Sampoorna Suraksha: Rs.2,000/-
for normal delivery and Rs. 5,000/- for
caesarian delivery. In case of the delivery at home Rs. 1,500/- maternity allowance for the first
members and Rs. 750/- for the members.
9. In case the stake holder under goes domiciliary treatment and is
unable to attend to his routine work, rest allowance at Rs.50/- for
30 days is paid depending on his domiciliary treatment.
10. In case the dwelling house of the family is damaged due to
natural calamities such as cyclone, heavy rainfall etc. consolation
amount upto a maximum of Rs.1000/- is
paid to the family.
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Who
can become a member
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The scheme
is open to the members of SKDRDP promoted SHGs.
All the members of SKDRDP participate in this programme by contributing an annual subscription.
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The
contribution
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Sl.no
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Description
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Annual contribution
|
Eligible
limit for the family during the year for cashless treatment
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1
|
One member family
|
220
|
5000
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2
|
Two members family
|
365
|
10000
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3
|
Three members family
|
510
|
15000
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4
|
Four members family
|
655
|
20000
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5
|
Five members family
|
800
|
25000
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6
|
Six members family
|
945
|
30000
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7
|
Seven members family
|
1,090
|
35000
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8
|
Eight members Family
|
1,235
|
40000
|
9
|
Nine members Family
|
1,380
|
45000
|
10
|
Ten members Family
|
1,525
|
50000
|
|
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Every family has to renew its membership every
year by paying the specified amount. Eg:-
A family of five members can get cashless treatment for a whole year
up to the family limit Rs.25,000/-at a contribution of Rs.800/- by
paying the amount Rs.20/- per week for 40 weeks. Health security
and other benefits for just Rs.2.85 per day for 5 members.
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