RAJIV GANDHI SHILPI SWASTHYA BIMA YOJNA
Q1. What is the scheme all about?
A1. Rajiv Gandhi Shilpi Swasthya Bima Yojana provides health care facilities and covers death and disability due to accident to the artisans. The medical benefits are available to the insured artisan and his/her family comprising any three out of spouse, dependent parents and children. All Craft persons whether male or female, between the age group of one day to 80 years will be eligible to be covered under RGSSBY.
The artisans seeking enrollment under the scheme has to register with the Office of the Development Commissioner (Handicrafts) for issuance of Identity Card.
If not registered as yet, then the artisan can file an application for issuance of I. Card to the nearest Handicrafts Marketing & Service Extension Centre and can mention “Applied For” in the application for enrollment under the Scheme.
Q2. How much do I have to pay towards annual premium?
A2. For the current year 2009-10, the annual premium is Rs.879/-. The general category artisans shall contribute towards annual premium @ Rs.200/- and the artisans belonging to SC, ST, BPL and North Eastern Region shall contribute only Rs.100/- towards the annual premium. The balance of the annual premium and Service Tax on the total annual premium will be paid by Government of India.
Q3. What are the benefits of the scheme?
A3. The Scheme covers a total medical coverage of Rs.15,000/- per artisan family with sub limits for different treatments. The scheme also includes personal accident cover of Rs.1.00 lakh for covering death and permanent/partial disability.
The details may be seen on the Website: handicrafts.nic.in .
Q4. Is common cold Covered?
A4 Common ailments like Common cold, dysentery, malaria are covered under sub limits of OPD.
Q5 Is BP; Asthama; Diabetes covered?
A5 The Chronic diseases will be covered upto sublimit. The details may be seen in the scheme.
Q6. Are my Parents Covered?
A6 The family includes the insured artisan and any three out of spouse, dependent parents and children.
Q7. Is it possible to add or delete names in the Health Cards after initial enrollment?
A7. Yes, it can be done. The insured artisan has to submit a separate application either to the nearest Handicraft Marketing & Service Extension Centre of the Office of DC (Handicrafts) or to the nearest of ICICI Lombard General Insurance Company.
Q8. Is Homeo, Ayurvedic covered?
A8 Any form of treatment is covered under the scheme, provided that the doctor is a qualified practitioner & holds a registration number with the medical council. Treatment under Quacks is dangerous & will not be entertained
Q9. Is it mandatory to take the treatment from the network OPD/ IPD?
A9. No, Medical reimbursement is the alternative of cashless treatment
Q10. What is the Personal Accident Coverage?
A10. In case of Death due to accident - Sum Assured is Rs.1.00 lakh and in case of Total and irrecoverable loss of : any one limb by physical separation Sum assured Rs. 1 lakh ,Total and irrecoverable loss of : any one limb without physical separation Sum assured Rs. 1 lakh.
Q 11. Where should I drop the Claim application?
A 11. The Claims could be dropped off with the Handicraft Department or the Cluster-Coordinator or ICICI Lombard Offices.
Q12. When can I expect the re-reimbursement Cheque ?
A12. The Re-reimbursement cheque will be given upto a max of 30 days from the date of submission of the claim with all the documents.
Q13 What Documents need to submit at the time of claim?
A13 All Prescriptions & Bills have to be in original. In case of a Hospitalization, the discharge certificate needs to be attached in original.
Q14 What Documents to submit in case of Death?
A14 Claim Form, A Death Certificate, Post mortem Report, Police report where required, proper identification documents of the deceased.
Q15 Is it necessary that the main card holder should have a bank account?
A15 Yes, because the claim cheque is issued in favor of main card holder only.
Q16. Can the lost health card be reprinted?
A16 Yes, but the request letter has to be written first by the main card holder to the AD of the Handicrafts office or the Cluster Coordinator of ICICI mentioning the card details. The letter will then be forwarded to ICICI from AD for reprinting the card. The request letter should be accompanied with FIR & other documents.
Q17. Is it possible to avail the services under the Scheme after one year tenure of the Health Card is expired?
A17. Yes, it is possible. But the insured artisan has to apply a fresh for enrollment along with payment of prescribed annual contribution. However, if the artisan has already availed two renewals of the policy, 3rd renewal is not permissible under the scheme.