Chaitanya Insurance Scheme

Particulars and Mode of Implementation of Chaitanya Health Insurance Policy

Objectives:

Protection against emergency hospitalization expenses for the policyholders under Chaitanya Health Insurance Scheme.
Contact with local hospitals providing good service.
Hospital facility at concessional rate.
Loan facilities through Navodaya Self-Help Group to meet additional hospitalization expenses.

Chaitanya Insurance Policy Period:
The policy will be in force for a period of one year from the date of payment of the insurance premium.

Renewal of Insurance Policy:

The policy has to be renewed within the stipulated date.

Particulars of the Policy:

An individual will benefit from accident insurance facility and can claim hospitalization expenses if he pays Rs 175.00 in 52 weeks at the rate of Rs 3.37 per week.
A maximum of Rs 5000 will be provided under the policy for in-patient treatment in a hospital.
In case a policyholder desires, his/her family members can avail insurance cover in a simple and speedy manner in accordance to their numbers as per the below given table.

No.	Number of insured	Medical insurance premium	Accident insurance premium	Total Premium	Amount payable under Medical Insurance	Amount payable under Accident Insurance
1.	In case of a single individual	250	50	300	10000	100000
2.	In case of 2 family members	200	-	500	6000	-
3.	In case of 3 family members	200	-	700	6000	-
4.	In case of 4 family members	200	-	900	6000	-
5.	In case of 5 family members	200	-	1100	6000	-
6.	In case of six family members	200	-	1300	6000	-

(Family members means husband: wife: their dependent two children and their father: mother)

Medical expenditure (Terms of Janarogya Policy)

If a Chaitanya Insurance Policyholder is hospitalized owing to ill-health or an accident, then his medical expenses upto Rs 5000 will be reimbursed.
In case the family is insured (more than one), the total medical expenses that reimbursed would be according to the number of family members. But, a maximum medical expense of Rs 5000 would be reimbursed per policy holder.
Under this scheme, policyholders can avail upto Rs 10,000 towards hospital expenses for maternity related cases. Medical expenses towards two deliveries of a policyholder, who has renewed the policy, will be reimbursed under this policy.
Individuals in the age group of 5 to 70 can be covered under this policy.
A total of six members including husband/wife of member, their dependent mother/father, can be covered under the scheme.
The policyholders should avail treatment only in recognized nursing homes and hospitals and the hospitals must be under the supervision of a registered medical practitioner.

Accidental Death or Disability under (G.O.A) Regulations:

An insurance amount of Rs 25000 will be paid in case any dependent member of a family who is a member of the Navodaya Self-Help Group dies in an accident.
In case of permanent disability, the insured will get Rs 25000 and in case of partial disability, half the amount will be provided.
Insurance facility: Insurance claims in case of death or disability can be made only by policyholders who are members of self-help group. The dependent beneficiaries can avail only the medical insurance facility.

General Terms of Chaithanya Insurance Policy
The following diseases will not be covered under the policy.

Some diseases like cataract, benign prostrate hypertrophy, hysterectomy, hernia, hydrocele, fistula in anus, piles, sinusitis, congenital internal diseases, will not be covered in the initial year of the policy.
Corrective cosmetic or aesthetic dental surgery or treatment.
Expenses towards spectacles, contact lens and hearing aid.
Treatment during delivery and abortion (as per medical advice).
Vaccination, inoculation, cosmetic treatment or surgery, HIV(AIDS), steril, venereal diseases, intentional self injury, use of intoxicating drugs, alcohol.
Pre-existing diseases prior to taking up of the policy by the policy holder and his family members covered will not be entitled for insurance cover. No claim could be made during the first 30 days after availing the policy.
Medical expense incurred prior to hospitalization and after discharge from hospital, will not be reimbursed.

Documents to be produced while making claims

The claim form has to be submitted within 15 days of discharge from hospital.
Original copy of the medical treatment report.
Original copies of the receipts, bills and medical reports.
Discharge certificate from hospital.

In case of disability:

Bonafide letter from a government doctor.
First Information Report
Claim in the prescribed form.
Review Committee report.

In case of death:

Death certificate
First Information Report
Claim in the prescribed form.
Police FIR
Review committee report.

In case of death or disability, the sponsor Trust has to be intimated in writing within 30 days. The insurance amount can be availed within two months of the incident.

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