MUKHYAMANTRI’R JIBON JYOTI BIMA ACHONI, 2005-06 :  At a Glance

This innovative scheme which may be considered as an important step to attain the goal of a welfare state has been launched by the Hon’ble Chief Minister, Assam on 25th of July 2005 in the presence of the Hon’ble Minister, Planning and Development and Finance etc. and other Hon’ble Ministers and senior officials of Government of Assam.
 

1.

The Scheme:

The Government of Assam has decided to implement the Mukhyomantrir Jibon Jyoti Bima Achoni w.e.f. 25-07-2005. This is a combined Health Insurance and Personal Accident Insurance scheme for all the citizens of the State of Assam whose names appear on the electoral list as in force when the claim is being made along with their dependents. The Employees of the Central and State Government, Public sector and Private Companies, all those persons who have an annual gross income before tax exceeding Rs. 2 lakhs shall not be entitled to the benefit for health and accident coverage. However, the employees of the Tea Companies, which are engaged in cultivation and processing of tea in the State shall be entitled to the benefit of the scheme both for health and personal accident cover.

The Government of Assam (GoA) and ICICI Lombard General Insurance Company Ltd (ILGICL) having it’s Registered office at ICICI Bank Towers, Zenith House, Keshavrao Khadye Marg, Mahalaxmi, Mumbai – 400034 and it’s branch office at Shanti Complex, Bhangagarh, Guwahati – 781005 has entered into an agreement for implementation of the Mukhyomantrir Jibon Jyoti Bima Achoni in the State. The scheme will be implemented by the ICICI Lombard General Insurance Co Ltd. through its branch office at Shanti Complex, Bhangagarh, Guwahati – 781005 .

2.

Objective of the scheme :

The objective of the scheme is to provide medical expenses upto a maximum of Rs.25,000/- under the health insurance scheme for the treatment of certain specified diseases to the eligible beneficiaries of the state as per the terms and conditions of the scheme mentioned herein after. The scheme will also provide compensation upto a maximum of Rs.50,000/- in case of death and reduced amounts as per the schedule at Serial 4.2 under the personal accident coverage scheme to the eligible beneficiaries of the state as per the terms and conditions of the scheme mentioned herein after.

3.

Salient features of the scheme :

(i)

This special contingency cover shall consist of two parts i.e. health insurance and personal accident insurance and the combined insurance policy shall be called “Mukhyomantri’r Jibon Jyoti Bima Achoni”

(ii)

This is an unnamed policy comprising of insured population as per the electoral list with exceptions as mentioned hereinabove, by the GoA. ILGICL takes the onus of insuring the resident of Assam covering insured persons.
 

(iii)

The period of insurance coverage shall be one year from the date of inception of the policy i.e. from 25th July 2005 till 24th July 2006 (both days inclusive). However, the health insurance coverage will start from 25th August, 2005.

(iv)

Any person holding multiple names or alias names and / or residing in multiple location and / or holding multiple Identities or identity cards shall be considered as one individual.
 

(v)

The word dependants shall include –

(a) Parents - Who are residing with the insured and have no independent source of income
(b) Children - Who have not attained eighteen years of age (minor)
(c) Spouse - Who is residing with the insured.
 

4.

Personal Accident Coverage :

4.1

Scope:

Under the Mukhyomantrir Jibon Jyoti Bima Achoni, if any of the Insured persons dies due to an accident or any accident results into dismemberments as mentioned in the benefit table, which occurs due to any bodily injury resulting solely and directly from accident, caused by external, visible means, the Insured persons or their benefeciaries will receive a sum not exceeding the amount mentioned in the benefits table given at serial 4.2 during the tenure of the policy to the extent and in the manner hereinafter provided. The personal accident cover shall also be extended towards medical expenses for major bone fracture, which arises out of an accident for which the insured shall be entitled to claims as per the benefit table mentioned.

The accident will include Snake bite, animal bite, drowning in River, Tank, Pond, Flood, falling and drowning in a well, Earthquake, landslide, rockslide, lightning, cloud burst, fire related accident, collapse of roof or falling from a tree or high-rise building, Vehicle accident, accidental explosion or firing, riot or scuffle, excluding intentional involvement in the said peril or someone putting oneself in needless perils other than whilst saving human life.

4.2

The benefit table of Personal Accident of this policy shall be :

4.3

Exclusions (where claims shall not be considered for payment)

4.4

All related expenses like medical expenses, body carrying expenses etc shall be considered as one settlement as per benefit table for death and disability /dismemberment related claims and shall be paid as per the benefit table mentioned above to the maximum limit of the Sum Insured.

4.5

Documents required in support of a claim on Personal Accident cases.

5.

Health Insurance Coverage :

Scope :

Under the health insurance scheme, medical expenses as mentioned in Serial 5.3 (upto a maximum of Rs.25,000/-) shall be reimbursed in the event of the claimant contracting any of the diseases mentioned in the list under Serial no. 5.2 as per the terms and conditions mentioned hereinafter.

The diseases covered under this part of the policy are :

a) Alzheimer’s disease.
b) open heart surgery
c) Cancer
d) Heart Attack
e) End Stage Renal failure
f) Stroke
g) Paralysis
h) Heart Valve replacement surgery
i) Major Burns
j) Coma – caused due to an accident
k) Parkinson’s disease
l) Multiple sclerosis
m) Deafness
n) Loss of Limbs
o) Major Organ Transplants

The medical expenses will include :

a. Hospital Room Charges
b. Boarding expenses
c. Nursing expenses
d. Fees for Surgeons, anesthetist, consultant, specialist, medical practitioner
e. Cost of Anesthesia, blood, oxygen
f. Operation theatre expenses
g. Cost of surgical appliances
h. Cost of scheduled drugs
i. Diagnostic expenses
j. Chemo Therapy
k. Radio Therapy
l. Pre hospitalization expenses for a period not exceeding 30 days and post hospitalization charges

  not exceeding 60 days, which are duly, certified by the attending doctor or surgeon as essential

    for the recovery.

Documents required for health related claims :

a. Initial contract of disease report, diagnosed by a registered medical practitioner.

b. Bills and cash memo’s of expenses towards treatment (if any) of the listed diseases

   authorized and approved by a Registered Medical Practitioner up to a maximum of the

   Sum Insured.

c. Claim form along with the above report and bills and signed duly by the Revenue Circle

   Officer(RCO).

d. Proof of identification as a resident of Assam duly stamped and authorized by the RCO’s office.

   In case of proof unavailability, the Certificate by the DC of the district or the SDO of the

   outlying Sub Division has to be provided.

e. Income proof or certificate issued by the RCO to be duly verified by ILGICL.

f. In case of dependants, RCO shall certify that the dependants are residing with the insured and

   have no independent source of Income.

Proof and confirmatory reports required for claim processing