Mediclaim Policy Insurance (Individual & Group)

GROUP MEDICLAIM INSURANCE POLICY (AVVNL) 2014-15 Download
GROUP MEDICLAIM INSURANCE POLICY (JDVVNL) 2014-15 Download
GROUP MEDICLAIM INSURANCE POLICY (JVVNL) 2014-15 Download
GROUP MEDICLAIM INSURANCE POLICY (RRVUNL) 2014-15 Download
GROUP MEDICLAIM INSURANCE POLICY (RRVPNL) 2014-15 Download
Instructions for Mediclaim Policy 2014-15 Download
RAJ MEDICLAIM Policy 2014-15 Download
Approved List of Private Hospitals in Rajasthan 2014-15 Download
Multi Speciality Hospitals Approved for Mediclaim Policy 2014-15 Download
Hospital Excluded from the Approved Hospital List for Mediclaim Policy 2014-15 Download
Information Regarding New TPA 2014-15 Download
Group Insurance Mediclaim Policy for BIP Download
Mediclaim Insurance Policy for Board of Secondary Education Rajasthan Download
Group Mediclaim Insuracne Policy for VMOU, Kota Download
Mediclaim Insurance Policy for Maharaja Gangasingh University Download
Rajasthan State Accredited Journalist Mediclaim Facility Scheme 2013-14 Download
Mediclaim Policy for Ramanandhacharya Rajasthan Sanskrit University Download
Group Mediclaim Insuracne Policy Sarvapalli Radhakrishan Ayurvedic University Download
Mediclaim Insurance Policy for Rajasthan State Warehousing Corparation Download
Order Dated 10-12-2013 Regarding Hospital Approved by Govt. for Mediclaim Policy Download
RajMediclaim Policy for Rajasthan Govt. Employees Year 2013-14 Download 
Vigyapti for Group Mediclaim Insurance Policy (RAJ MEDICLAIM) 2013-14 Download 
GROUP MEDICLAIM INSURANCE POLICY (RRVUNL)  2013-14 Download 
Approved List of Private Hospitals in Rajasthan 2013-14 Download 
Mediclaim Policy for Ajmer Vidhyut Vitran Nigam Ltd 2013-14 Download 
Approved List of Hospitals outside Rajasthan 2013-14 Download 
Contact Information of TPA for JVVNL, AVVNL, JDVVNL, RRVPNL, RVUNL2013-14 Download 
GROUP MEDICLAIM INSURANCE POLICY (JDVVNL)  2013-14 Download 
GROUP MEDICLAIM INSURANCE POLICY (JVVNL)  2013-14 Download 
GROUP MEDICLAIM INSURANCE POLICY (RRVPNL)  2013-14 Download 
Rajasthan State Accredited Journalist Mediclaim Scheme 2012-13 Download 
Press Note for NPS Employee Regarding Information for New TPA 2013-14 Mediclaim Policy  (1st July 2013 to 31st March 2014) Download

The Policy covers reimbursement of Hospitalisation / Domiciliary Hospitalisation expenses for illness/disease or injury sustained by the insured person within India only.

It was started by this department from 17.8.05 for the newly recruited state Govt. Employees (recruited on 1.1.2004 and after). Now department is also running mediclaim policies for employees of Electric Companies, Employees of Rajasthan State Warehouse Corporation, Jaipur, employees of Beauro Of Investment Promotion, jaipur.


Coverage

The policy holder shall be entitled to indoor treatment in all State Government hospitals, Government Approved private Hospitals outside Rajasthan, TPA (Third Party Administrator) approved private hospitals within the State of Rajasthan.

The policy holder and his family members shall be entitled to reimbursement of

  • Cost of medicines
  • Tests/investigations (carried out in government hospital and/or in a private institution on the recommendation of the treating government doctor)
  • Cost of implants implanted into the body of the patient and any payment made to the government hospital/concerned medicare relief society for all types of diseases/treatments taken as indoor patient in a government hospital.

For the indoor treatment taken in approved private hospital within State and hospitals outside Rajashan; policy holder Government servant and his family members shall be entitled for reimbursement of following expenses:-

  • Room
  • Boarding
  • Expenses charged by the Hospital/nursing home for
    • Nursing Expenses
    • Surgeon
    • Anesthetist
    • Medical Practitioners
    • Consultants
    • Specialists fees
  • Anesthesia, Blood, Oxygen, Operation Theatre charges, surgical appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker, Artificial Limbs and cost of organs and similar expenses.

In case of death of insured during policy period the names of family members to be continued till expiry of the policy.


Category and benefites define in the policy for Govt.Employees/ Electric Co./Boards/Corporation

Entitlement category for boarding/accommodation in the Hospital:

Category Pay Scale * Entitlement in Govt. Hospital Entitlement in Approved Private Hospital Maximum ceiling of Boarding/Accommodation Charges as per CGHS Package Rates
A Rs. 25000/- & above Deluxe Private Ward Rs. 3000/- per day
B Rs. 14000/- and about but less than Rs. 25000/- Cottage Semi Private Ward Rs. 2000/- per day
C Below Rs. 14000/- General Ward General Ward Rs. 1000/- per day

* Pay scale means basic pay (including grade pay) /fixed remuneration.

Note: Actual boarding / accommodation charges of hospital rate shall be applicable but these charges can not be more than CGHS packages rates, indicated as above.

If insured takes treatment in higher category other than his entitlement, the reimbursement of cost of treatment will be made according to his category as prevalent in the hospital.


Exclusion:

The GIF shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured person in connection with or in respect of:

  • Injury/disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not).
  • Circumcision unless necessary for treatment of a disease
  • Cost of Spectacles and contact lenses, hearing aids
  • Dental treatment or surgery of any kind unless requiring hospitalization due to an incident.
  • Convalescence, general debility; run-down condition or rest cure, congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self injury and use of intoxication drugs/alcohol.
  • All expenses arising out of any condition directly or indirectly cased to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV) or the Munts Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
  • Charges incurred at Hospital or Nursing Home primarily for diagnosis X- ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence of presence of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.
  • Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician.
  • Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials.
  • Naturopathy Treatment.
  • Pre existing disease shall not be covered under this scheme.
  • In such situations in which there are no urgency of hospitalisation and treatment can be given at home.

Claims

Claim under this Policy with full particulars should be sent to the TPA ,All supporting documents relating to the claim must be filed with TPA/GIF within 7 days from the date of discharge from the hospital. In case of post-hospitalisation, treatment (limited to 60 days), all claim documents should be submitted within 7 days after completion of such treatment.

If the TPA, as per terms and conditions of the policy or the GIF shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12 calendar months from the date or receipt of the notice of such disclaimer notify the TPA/GIF in writing that he does not accept such disclaimer and intends to recover his claim form the TPA/GIF then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.


Payment of Claims

  • The insured will submit the claim form directly to the TPA in the prescribed proforma.
  • For Re-imbursement photo will be pasted by the concerned employee (if he doesn’t possess the identity card) which will be duly verified by the treating doctor/ DDO so as to confirm the identity of the Patient.
  • No cashless facility will be provided if the identity cards have not been obtained by the policy holder.
  • Payment of claim shall be made through TPA/GIF to the Hospital or to the Insured Person as the case may be normally within 30 days from the date of receipt of completed claim proposals by the TPA.