Introduction
"Sanjeevani Swasthya Bima Yojana" is a comprehensive Health Insurance Scheme launched by the Administration of Union Territory of Daman & Diu for the resident citizens of Daman and Diu.
The insurance coverage is provided by Public Sector General Insurance Company-United India Insurance Co.Ltd and claims services will be provided by MDIndia Healthcare Services(TPA)P.Ltd.
Objectives
The basic objective of Sanjeevani Swasthya Bima Yojana Health Insurance Scheme is to to improve access of families with a lower income to quality health care services.The following beneficiaries are identified who are eligible for the scheme:
1. BPL (Below Poverty Line) families
2. Domicile families whose family income is below 1lakh/annum.
3. Other residential families (APL families etc)
What are the Benefits provided to the beneficiaries?
• Cashless access service is provided so that the beneficiaries do not have to pay any sum prior to and post availing of services. The same are covered under the Comprehensive Health Insurance Scheme (CHIS).
• The scheme provides coverage of hospitalizations and surgeries procedures,upto Two lakh rupees per year for each family. The total amount of reimbursement can be availed individually or collectively by the family members per year.
• Coverage of Health services and pre-existing diseases are provided on a day care basis.
• The hospital stay one day prior to hospitalization to 5 days from discharge date, along with food allowance shall be a part of the package rate.
• This policy is also extended with Death insurance , including accidental death and disability benefit of one lakh rupees per person .Disability insurance will be covered as follows:
1. Permanent total disability due to accident: One lakh rupees per individual.
2. Loss of one eye/limb in accident-Rs.50000/- per individual.
• Maternal care and newborn child will be covered. If the newborn is sixth Member in the scheme, then also he/she shall be covered upto the discharge of the mother from hospital.
What is the process of Enrollment of Beneficiaries?
All the beneficiary families are issued Smart Cards with Bio Metric images of all family members captured in presence of Government Authorities through enrollment stations at all major locations-Taluka and village wise, announced through local representative and media and beneficiary can remain present with required document to give their bio metric images and photo with all family members,Smart card will be issued by authorized agencies on the spot.
The beneficiary will have to avail only network hospitals services where this smart card should be produced and thumb impression done to validate identification. The hospital will fill all the details of treatment and package codes and the cost will be paid directly to the hospital as per the package charges.
UT Administration will pay the premium for the BPL (Below Poverty Line) families and the Domicile Families with below one lakh/annum income, whereas the other residential families will pay the premium amount to avail the services.
What is the validity period of the scheme?
This policy is issued for a period of 1 year and will be renewed under contract for 3 years.
The Department of Health, Daman and Diu U.T. is inviting comments in this regard so that significant ideas can be co-opted and access to the beneficiaries can be improved.
The last date for submissions of suggestions is 31st March, 2017.
