Coverage under the scheme would be provided for BPL (Absolute Poor), other Poor workers and their families [up to a unit of five) and such other families who subscribe to the Scheme. This would comprise the Household Head, spouse, and up to three dependents. The dependents would include such children and/or parents of the head of the family as are listed as part of the family in the database provided by State Government. If the parents are listed as a separate family in the database, they shall be eligible for a separate card. Issue of smart card would be the proof of the eligibility for the purpose of the scheme.
Benefits:
a.) The scheme shall provide coverage for meeting expenses of hospitalization for medical and/or surgical procedures of beneficiary members up to Rs.30,000 per family per year subject to limits, in any of the network hospitals. The benefit on family will be on floater basis, i.e., the total reimbursement of Rs.30,000 can be availed of individually or collectively by members of the family per year.
b.) Pre-existing conditions/diseases to be covered, subject to minimal exclusions.
c.) Coverage of health services relating to surgical nature can also be provided on a daycare basis. An indicative list of daycare treatment.
d.) Provision for transport allowance (actual with limit of Rs. 100 per visit) subject to an annual ceiling of Rs. 1000 shall be a part of the package.
e.) Pre and post hospitalization up to 1 day prior to hospitalization and up to 5 days from the date of discharge from the hospital shall be part of the package rates.
f.) Domiciliary treatment: Not required.
g.) Maternity benefit: Not required.
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