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2554-07-22

STATE INSURANCE AND PROVIDENT FUND DEPARTMENT

GOVERNMENT OF RAJASTHAN

STATE INSURANCE AND PROVIDENT FUND DEPARTMENT

(GENERAL INSURANCE FUND)

‘D’ BLOCK, VITTA BHAWAN, JANPATH, JAIPUR

Phone : 0141-2740219, 2740292

________________________________________________________________________________

MEDICLAIM INSURANCE POLICY(RAJ. RAJYA VIDYUT PRASARAN NIGAM LTD., JAIPUR)

(1-04-2011 –31-03-2012)

WHEREAS the insured designed in the Schedule hereto has by a proposal and declaration dated as stated in the Schedule which shall be the basis of this Contract and is deemed to be incorporated has applied to GENERAL INSURANCE FUND (herein after called the GIF) for the insurance hereinafter set forth in respect of Nigam Employees/Members (including their eligible family members) named in the Schedule hereto (hereinafter called the INSURED PERSON ) and has paid premium as consideration for such insurance.

NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and definitions contained herein or endorsed, or otherwise expressed hereon the GIF undertakes that if during the period stated in the Schedule or during the continuance of this policy by renewal any insured person shall contract any disease or suffer from any illness (herein after called DISEASE) or sustain any bodily injury through accident(hereinafter called INJURY) and if such disease or injury shall required any such insured person, upon the advice of a duly qualified Physician/Medical Specialist/Medical Practitioner (hereinafter called MEDICAL PRACTITIONER) or of a duly qualified Surgeon(hereinafter called SURGEON) to incur hospitalisation expenses for medical/surgical treatment at any Nursing Home/Hospital in Rajasthan as herein defined (hereinafter called HOSPITAL) as an inpatient, the GIF will pay through TPA/GIF to the Hospital/Nursing Home or the Insured Person the amount of such expenses as are reasonably and necessarily incurred in respect thereof by or on behalf of such Insured Person but not exceeding the Sum Insured in aggregate in any one period of insurance stated in the schedule hereto.

1. In the event of any claim/s becoming admissible under this scheme, the GIF will pay through TPA to the Hospital/Nursing Home or the insured person the amount of such expenses as would fall under different heads mentioned below and as are reasonably and necessarily incurred thereof by or on behalf of such Insured Person, but not exceeding the Sum Insured in aggregate mentioned in the schedule hereto.

(A) Room, Boarding and Nursing Expenses as provided by the Hospital/Nursing Home as per entitlement of the Nigam employee mentioned in the Schedule.

(B) Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.

(C) Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Coast of Pacemaker, Artificial Limbs implanted in the body & Cost of organs and similar expenses.

(N.B.: GIF’s Liability in respect of all claims admitted during the period of insurance shall

not exceed the Sum Insured per family as mentioned in the schedule)

2. DEFINITIONS :

2.1 HOSPITAL means any registered institution in or outside Rajasthan established for indoor care and treatment of sickness and injuries and which are :-

(a) All the Government hospitals in the State of Rajasthan

(b) The Hospitals outside Rajasthan which have been approved by the Govt. of Rajasthan (Appendix –1)

(c) Private Hospitals within Rajasthan duly approved by Govt. of Rajasthan under the Rajasthan Civil Services Medical Attendance Rules 2008 and also given the acceptance to work with GIF on CGHS Package Rates ( Appendix-2 ). Those private hospitals

which are added in approved list time to time by the Government of Rajasthan and give acceptance to work with GIF on CGHS Package Rates, shall also be automatically empanelled under the scheme.

2.2 ‘Surgical Operation’ means manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life.

2.3 Expenses on Hospitalisation for minimum period of 24 hours are only admissible. However, this time limit is not applied to specific treatments, i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery in case of accidents, Lithotripsy (Kidney Stone removal), D&C, Tonsillectomy taken in the approved Hospital/Nursing Home and the Insured is discharged on the same day, the treatment will be considered to be taken under hospitalisation Benefit. This condition will also not apply in case of stay in hospital of less than 24 hours provided Explanation the treatment is such that it necessitates hospitalisation and the procedure involves specialised infrastructural facilities available in hospitals and due to technological advancement hospitalisation is required for less than 24 hours only.

2.4 CGHS packages shall be applicable in Rajasthan, as laid down by CGHS for Jaipur City and in other States it shall be applicable as laid down by CGHS for various places in India. The bed charges shall be paid according to the category of the employee. The diseases for which no package rate is mentioned in CGHS package rate will be paid according to AIIMS package rates. If there is no CGHS and AIIMS package rate then actual payment shall be paid.

3. ANYONE ILLNESS :-

Any one illness will be deemed to mean continuous period of illness and it includes relapse within 45 days from the date of discharge from the Hospital/Nursing Home where treatment has been taken. Occurrence of the same illness after a lapse of 45 days as stated above will be considered as fresh illness for the purpose of this policy .

3.1 PRE-HOSPITALISATION :-

Relevant medical expenses incurred during period up to 10 days prior to hospitalisation on disease/illness/injury sustained will be considered as part of claim as mentioned under item 1.0 above.

3.2 POST HOSPITALISATION :-

Relevant medical expenses incurred during period up to 20 days after hospitalisation on disease/illness/injury sustained will be considered as part of claims as mentioned under item 1.0 above.

3.3 MEDICAL PRACTITIONER means a person who holds a degree/diploma of a recognised institution and is registered by Medical Council of respective State of Rajasthan. The term Medical Practitioner would include Physician, Specialist and Surgeon.

3.4 QUALIFIED NURSE means a person who holds a certificate of a recognised Nursing Council and who is employed on recommendation of the attending Medical Practitioner.

3.5 MATERNITY EXPENSES BENEFIT means treatment taken in Hospital/Nursing Home arising from or traceable to pregnancy. Childbirth including normal Caesarean Section.

3.6 TPA means a Third Party Administrator who, for the time being, is licensed by the Insurance Regulatory and Development Authority, and is engaged, for a fee or remuneration, by whatever name called as may be specified in the agreement with the GIF, for the provision of health services.

3.7 CASHLESS FACILITY – Cashless facility would be extended to the Insured in the private networking Hospitals for the critical ailments (Means:- i. Coronary Artery Surgery ii.Cancer iii.Renal Failure i.e. failure of both the kidneys iv. Stroke v. Multiple Sclerosis vi. Meningitis vii. Major Organ transplants like Kidney, Lung, Pancreas or Bone marrow Transplantation) and the treatment requiring surgical treatments as per Guide lines issued by the GIF. However, The TPA would decide the merit of the case and it will not be claimed as a matter of right by the insured. The denial of cashless facility does not mean the denial of treatment from concerned hospital & reimbursement thereof.

3.8 CLAIM INTIMATION TO TPA - It is required by the Nigam employees that the claims arising in private hospitals should be intimated by cashless request form/ claim intimation form, available in the hospital, to the TPA positively. If the claim intimation does not reach the TPA the same day when the patient is admitted to the hospital, then the Nigam employee shall not be entitled for re-imbursement.

3.9 CLAIM INTIMATION TO TPA IN CASE OF GOVERNMENT HOSPITALS – It is required by the Nigam employees that the claim arising in Govt. Hospitals should be intimated in writing to the concerned, District State Insurance & Provident Fund office, on the same day patient is admitted to the hospital, otherwise, the employee shall not be entitle for reimbursement.

3.10 DEPENDENT FAMILY The ‘family’ of the Nigam employee shall include the Nigam employee, his/her spouse, not more than two dependant children upto 21 years of age and dependant parents. The parents shall be regarded as wholly dependant upon the Nigam Employee, if-

(a) they normally reside with the Nigam Employee servant at the place of his duty, and

(b) their total monthly income from all sources does not exceed Rs.2000/- per month.

3.11 FAMILY DETAIL – Every newly recruited Nigam employee shall have to provide details of the family & photographs for preparing the database & for issuing identity cards in the prescribed form(Appendix 3) immediately after joining the service otherwise his salary bill of the designated month will not be passed by the concern Account officer.

Explanation – Details of the family means : Name, Designation, DDO, Date of joining Nigam employee, Names of Family members, Age, Pay/ Pay Scale/Stipend.

4. SCHEDULE : The Schedule enclosed will be deemed to be a part of the policy.

5 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:

5.1 Diagnostics/ Investigations unless followed by indoor treatment of 24 Hours.

5.2 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).

5.3 Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.

5.4 Cost of Spectacles and contact lenses, hearing aids

5.5 Dental treatment or surgery of any kind unless requiring hospitalisation.

5.6 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.

5.7 All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.

5.8 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 any ailments, sickness or injury, for which confinement is required at a Hospital/Nursing Home.

5.9 Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician.

5.10 Injury or Disease directly or indirectly caused by or contributed to nuclear weapon / materials.

5.11 Naturopathy Treatment.

5.12 Pre existing deseases of employee shall not be covered under this scheme.

5.13 In such situations in which there are no urgency of hospitilisation and treatment can be given at home and which is not pertain to section 2.3

6. CONDITIONS :

6.1 Every notice or communication to be given or made under this Policy shall be delivered in writing at the address of the TPA/GIF office.

6.2 The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form of the GIF signed by a duly authorised official of the GIF. The due payment of premium and the observance and fulfilment of the terms, provisions, conditions and endorsements of this policy by the Insured Person in so far as they relate to any thing to be done or complied with by the Insured Person shall be a condition precedent to any liability of the GIF to made any payment under this Policy. No waiver of any terms, provisions, condition and endorsements of this policy shall be valid unless made in writing and signed by an authorized official of the GIF.

6.3 In cases of grave emergency viz. life threatening diseases like kidney or heart ailments and accidents in which RRVPNL Employee has taken treatment as indoor patient in a private hospital within Rajasthan, he/she shall intimate to TPA with full particulars within 24 hours from the time of hospitalization and take approval from TPA / GIF. At the time of claim submission the emergent nature of hospitalization has to be established by an affidavit of the employee supported by a certificate of the treating doctor. Claim shall be paid as per CGHS Package Rates.

6.4 All supporting documents relating to the claim must be filed with TPA/GIF within 30 days from the date of discharge from the hospital. In case of post-hospitalization, treatment (limited to 20 days), all claim documents should be submitted within 30 days after completion of such treatment.

6.5 The Insured Person shall obtain and furnish the TPA/GIF with all original bills, receipts verifications and other documents upon which a claim is based and shall also give the TPA/GIF such additional information and assistance as the TPA/GIF may require in dealing with the claim.

6.6 Any medical practitioner or an officer authorized by the TPA/GIF shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospitalization when and so often as the same may reasonably be required on behalf of the TPA/GIF.

6.7 The GIF shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf.

6.8 If at the time when any claim arises under this Policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with India Cancer Society), whether it be effected by or on behalf of any Insured Person in respect of whom the claim may have arisen covering the same loss, liability, compensation , costs or expenses, the GIF shall not be liable to pay or contribute more than its rateable proportion of any loss, liability, compensation costs or expenses. The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy.

6.9 The Policy may be renewed by mutual consent. The GIF shall not however be bound to give notice that it is due for renewal and the GIF may at any time cancel this Policy by sending the Insured 30 days notice by registered letter at the insured’s last known address and in such event the GIF shall refund to the insured a pro-rate premium for unexpired Period of Insurance. The GIF shall however, remain liable for any claim, which arose prior to the date of cancellation. The Insured may at any time cancel this Policy and in such event the GIF shall allow refund of premium at GIF’s short period rate only (Table given here below) provided no claim has occurred up to the date of cancellation.

PERIOD ON RISK RATE OF PREMIUM TO BE CHARGED

Upto one month 1/4th of the annual rate

Upto three months ½ of the annual rate

Upto six months ¾th of the annual rate

Exceeding six months Full annual rate

6.10 If any dispute or difference shall arise as to the quantum to be paid under the policy (liability being otherwise admitted) such difference shall independently of all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.

It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, If the GIF has disputed or not accepted liability under or in respect of this Policy.

It is hereby expressly stipulated and declared that it shall be a condition precedent to any

right of action or suit upon this policy that award by such arbitrator/arbitrators of the amount

of the loss or damage shall be first obtained.

6.11 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.

6.12 All medical/surgical treatments under this policy shall have to be taken in approved hospitals in and outside Rajasthan and admissible claims thereof shall be payable in Indian currency. Payment of claim shall be made through TPA/GIF to the Hospital/Nursing Home or the Insured Person as the case may be. The list of approved hospitals is available at (Appendix 2).

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

6.14 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.

6.15 Pre existing diseases of the employee would not be covered in this policy except the parents of employee who are dependent of employee as per section 3.10.

6.16 Medical examination of the Nigam employee or any member of his family shall not be a

condition for issue of Mediclaim Poilicy.

6.17 A female employee can get the Mediclaim coverage either for her parents or Parents in law in case they are dependent on her and their monthly income is less than Rs. 2000/- and they are residing with her generally.

6.18 A master policy has been issued & copy of policy has been provided to all Drawing & Disbursing officer of RAJ. RAJYA VIDYUT PRASARAN NIGAM LTD., JAIPUR. It is required from every DDO that they would brought in notice of all the newly recruited employees regarding terms & condition of the policy. It is also expected that every newly recruited employee must have gone through the terms & conditions of the policy from their concerned DDOs.

7 HIGH CLAIMS RATIO LOADING (MALUS)

The total premium payable at the time of renewal of the Group Policy will be loaded at the following scale depending upon the incurred claims ratio for the entire group insured under the Group Mediclaim Insurance Policy for the preceding three completed years excluding the year immediately preceding the date of renewal, where the Group Mediclaim Policy has not been in force for the three completed years, such shorter periods of completed years, excluding the year immediately preceding the date of renewal will be taken into account.

8 Incured Claim ratio under the group policy Loading

Between 70% and 100% 25%

Between 101% and 125% 55%

Between 126% and 150% 90%

Between 151% and 175% 120%

Between 176 and 200 150%

Over 200% Cover to be reviewed

Note:

1 High Claim loading (Malus) will be applicable to the Premium at renewal of the Policy depending on the incurred claims Ratio for the entire Group Insured.

2 Incurred claim would mean claims paid plus claims outstanding in respect of the entire

group insured under the policy during the relevant period.

9 MATERNITY EXPENSES BENEFIT EXTENSION : (Wherever applicable)

9.1 The maximum benefit allowable under this clause will be upto Rs. 50,000/- per family per year restricted to two living children. This amount is including sum-assured of Rs. 1,00,000 per family per annum.

9.2 The Maternity benefits under this policy are categorized into three :

I Maximum limit under normal delivery : Rs. 10000/-

II Maximum limit under caesarean delivery : Rs. 20000/-

III Maximum limit under delivery related

complications(Including child care) : Rs. 50000/-

9.3 Special conditions applicable to Maternity expenses Benefit Extension :

I These Benefits are admissible only if the expenses are incurred in Hospital/Nursing

Home as in-patients in Rajasthan.

II A waiting period of 9 months is not applicable for payment of any claim relating to normal delivery or caesarean section or abdominal operation for extra uterine pregnancy. The waiting period may be relaxed only in case of delivery, miscarriage or abortion induced by accident or other medical emergency.

III Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured Person covered under the policy or any renewal thereof. Those Insured Persons who are already having two or more living children will not be eligible for this benefit.

IV Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of conception are not covered.

V Pre-natal and post natal expenses are not covered unless admitted in Hospital/Nursing Home and treatment is taken there.

VI Newly born child’s expenses will also be treated as Maternity Expenses.

10 PAYMENT OF CLAIM

10.1 The insured will submit the claim form through DDO to the TPA in the prescribed proforma (Appendix 4).

10.2 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.

10.3 No cashless facility will be provided if the identity cards have not been obtained by the policy holder.

10.4 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.

FILE : D:\POLICY\MEDI_VIDYUT\MEDI_VID_POL10


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Appendix : 1

List of Hospitals approved by the State Government for treatment outside Rajasthan

1. All India Institute of Medical Sciences, New Delhi.

2. Apollo Hospital, Madras.

3. Bombay Hospital, Bombay.

4. Cancer Institute, Adayar, Madras.

5. Christian Medical College & Hospital, Vallore.

6. Delhi Heart & Lung Institute, New Delhi.

7. Escort Heart Institute, New Delhi.

8. G.B. Pant Hospital, Delhi.

9. Gujarat State Cancer & Research Institute (M.P. Shah Cancer Hospital), Ahmadabad.

10. Irwin Hospital, New Delhi.

11. J.J. Hospital, Bombay.

12. Jaslok Hospital, Bombay.

13. K.E.M. Hospital, Bombay.

14. Lady Hardinge Medical College Hospital, New Delhi(for women and children).

15. N.M. Wadia Institute of Cardiology, Pune.

16. Post Graduate Institute, Chandigarh.

17. Rajiv Gandhi Cancer Institute & Research Center, Delhi.

18. Tata Memorial Hospital, Bombay.

19. The Gujarat Research & Medical Institute (Rajasthan Hospital), Ahmadabad


Appendix - 2

Approved Private Hospitals in Rajasthan

S.N.

Hospital Name

Multi Speciality Hospitals:

1

S.K.Soni Hospital, Jaipur

2

Gheesibai Memorial Mittal Hospital And Research Centre, Ajmer

3

Bhandari Hospital and Research Centre, Jaipur

4

Fortis Escorts Hospital, Jaipur

5

Mahatma Gandhi Medical College & Hospital, Jaipur

6

Tagore Hospital & Research Institute, Jaipur

7

Apex Hospital, Jaipur

8

Jaipur Hospital, Jaipur

9

NIIMS Hospital, Jaipur

10

Mittal Hospital, Alwar

11

Lifeline Hospital, Alwar

12

Ramsnehi Hospital and Research Centre, Bhilwara

13

Kothari Medical & Research Institute, Bikaner

14

Goyal Hospital & Research, Jodhpur

15

Bharat Vikas Parishad Hospital & Research Centre, Kota

16

Fortis Modi Hospital, Kota

17

Jaisawal Hospital & Neuro Institute, Kota

18

Sudha Hospital & Medical Research Centre, Kota

19

Geetanjali Medical College & Hospital, Udaipur

20

Maa Gayatri Hospital, Udaipur

21

Kalpana Nursing Home, Udaipur

22

GBH American Hospital, Udaipur

23

Global Hospital & Research Centre, Mount Abu

Only for Cardiology & City Surgery Super Speciality Hospitals:

24

Heart & General Hospital, Jaipur

25

Jaipur Heart Institue, Jaipur

Only for Neurosurgery Super Speciality Hospital:

26

Indowestern Brain & Spine Hospital, Jaipur

Only for Oncology Super Speciality Hospital:

27

Bhagwan Mahaveer Cancer Hospital & Research, Jaipur

Only for ophthalmology Super Speciality Hospital:

28

Anand Hospital and Eye Centre, Jaipur

29

Kshetrapal Eye Hospital & Lasic Laser Centre, Ajmer

Only for Cardiology Super Speciality Hospital:

30

Kota Heart Institute, Kota

Any change will be notified separately

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