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What is Jan Arogya Yojna?
Jan Arogya Yojna is a special low-priced medical insurance scheme. This policy has been designed for the lower income group of society. It is meant for the benefit of individuals who are unable to afford more comprehensive medical insurance covers. The idea is to protect them from the high costs of hospitalisation.
This scheme covers reimbursement of hospitalisation/domiciliary hospitalisation expenses incurred due to: a) a sudden illness, b) an accident, c) any surgery that is required in respect of any disease, which has arisen during the policy period. -
Which expenses are reimbursed under this policy?
- Hospitalisation expenses due to diseases/surgery are covered. These expenses are limited to Rs.5,000/- as the maximum sum insured under this scheme is Rs.5,000/-.
- Domiciliary hospitalisation expenses in lieu of hospitalisation: Medical treatment taken at home in India on the recommendation of the attending medical practitioner for a period exceeding three days is covered subject to certain conditions and exclusions.
- Pre-Hospitalisation expenses upto 30 days.
- Post-Hospitalisation expenses upto 60 days.
- Hospitalisation expenses due to diseases/surgery are covered. These expenses are limited to Rs.5,000/- as the maximum sum insured under this scheme is Rs.5,000/-.
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What is the age limit?
The age limits are between 5 to 70 years. Children between the ages of 3 months to 5 years can also be covered provided one or both parents are covered concurrently.
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Can treatment be taken from any hospital / nursing home?
The claim is payable only when the treatment is taken in a hospital / nursing home in India, which is either registered as a hospital or nursing home with the local authorities, and is under the supervision of a registered and qualified medical practitioner or which complies with the minimum criteria as under
- Has at least 15 beds.
- Has a fully equipped operation theatre of its own where surgical operations are being carried out.
- Has a fully qualified nursing staff available round the clock.
- Has a fully qualified doctor in-charge available round the clock.
- Has at least 15 beds.
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What is the minimum period of hospitalisation for claiming expenses?
The minimum period of hospitalisation for claiming expense is 24 hours. However, the time limit of 24 hours is not applicable in case of treatment like dialysis, chemotherapy, lithotripsy, radiotherapy, eye surgery, dental surgery, tonsillectomy, D&C operation.
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Upto what amount are the medical expenses covered?
Medical expenses upto Rs.5,000/- per annum/per person and Rs.20,000/- per family (i.e. head of the family, spouse and dependent children below the age of 25 years) are covered.
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What are the major exclusions under the policy?
- Any disease contracted within 30 days from commencement of risk
- Any injury or disease caused by war or nuclear perils
- Treatment for cataract, benign prostatic hypertrophy, hysterectomy, hernia, hydrocoele, internal diseases present from birth, fistula in anus, piles, sinusitis and related disorders for first year of policy unless such diseases are excluded as pre-existing
- All the expenses incurred in respect of any treatment relating to pregnancy or childbirth
- Naturopathy treatment
- Routine eye examination, cost of spectacles and contact lenses, and hearing aids
- Dental treatment or surgery unless requiring hospitalisation
- Convalescence, general debility, external disease present from birth
- Expenses on vitamins and tonics unless forming part of treatment for injury or disease
- Any disease contracted within 30 days from commencement of risk
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What should an insured do in case of claim?
- A preliminary notice should be given to the policy issuing office within 7 days of hospitalisation.
- Final claim duly supported by original documents should be submitted to the company within 30 days of discharge from hospital.
- A preliminary notice should be given to the policy issuing office within 7 days of hospitalisation.
