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How does the scheme work
............................................................................................................................................................................................................................
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. 25000/-
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. 5000/- 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.
.................................................................................................................................................................
Features
................................................................................................................................................................
1. Member can get cashless treatment of
Rs.5000=00, 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/- 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.12500 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: Rs2,000 for normal
delivery and Rs 4,000 for caesarian delivery.
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 of the house damage due to
natural calamities such as cyclone, heavy
rainfall etc. consolation amount upto
a maximum of Rs.1000 is paid to the family.
11. If the medical expenses are not availed
then only the insured is eligible for
a maximum allowance of Rs. 1500- with
Rs.50/- per day based on the doctor's
recommendation.
............................................................................................................................................................................................................................
Who can become a member
..........................................................................................................................................................................................................................
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
..........................................................................................................................................................................................................................
| |
|
Sl.no |
Description |
Annual contribution |
Eligible limit for the family
during the year for cashless
treatment |
| 1 |
|
190 |
5000 |
| 2 |
|
305 |
10000 |
| 3 |
|
420 |
15000 |
| 4 |
|
535 |
20000 |
| 5 |
|
650 |
25000 |
| 6 |
|
765 |
30000 |
| 7 |
|
880 |
35000 |
| 8 |
|
995 |
40000 |
| 9 |
|
1110 |
45000 |
| 10 |
|
1225 |
50000 |
|
|
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.25000/-at a contribution of Rs.650.00
by paying the amount Rs.16.25 per week
for 40 weeks. Health security and other
benefits for just Rs.2.35 per day for
5 members.
............................................................................................................................................................................................................................
Benefits given
...........................................................................................................................................................................................................................
| |
|
Sl.no |
Description |
First Year 2004-05 |
Second year 2005-06 |
|
1 |
|
Numbers |
Amount |
Numbers |
Amount |
|
2 |
Health-treatment |
7737 |
26421143 |
8587 |
24989658 |
|
3 |
Delivery allowance |
2593 |
7017268 |
2761 |
6012452 |
|
4 |
Death Consolation |
227 |
1135000 |
208 |
1175000 |
|
5 |
Domiciliary treatment-Rest
allowances |
360 |
202090 |
518 |
223165 |
|
6 |
Consolation for natural
calamities |
893 |
648061 |
1061 |
416392 |
|
7 |
Total |
11810 |
3,542,3562 |
|
3,28,16,667 |
|
|
|
|