PREAMBLE
Handicrafts constitute an important segment of
the decentralized/unorganized sector of our economy. Originally, started as a part time activity
in rural areas, it has now transformed in flourishing economic activity due to
significant market demand over the year.
Handicrafts have big potential as they hold they key for sustaining not
only the existing set of millions of artisans spread over length and breadth of
the country, but also to increasingly large number of new entrants in the
crafts activity. Presently, handicrafts
are contributing substantially in employment generation, and export. The Handicrafts sector has suffered from
basic problems of being in the unorganized sector with additional constraints
like lack of education, capital, poor exposure to new technologies, absence of
market intelligence and poor institutional framework. These problems have been further aggravated
due to lack of proper care on the welfare of the artisans. In order to address
the welfare needs of artisan in terms of health & dwelling insurance, this
scheme has been envisaged.
OBJECTIVE
Rajiv Gandhi Shilpi Swasthya Bima Yojana aims
at financially enabling the artisans’ community to access to the best of
healthcare facilities in the country. This
scheme covers not only the artisans but his wife and two children also.
ELIGIBILITY TO GET THE COVERAGE
All Craft persons whether male or female,
between the age group of one day to 80
years will be eligible to be covered under the Rajiv Gandhi Shilpi
Swasthya Bima Yojana.
Other
Conditions:
a) One
artisan family will receive the benefit for 3 years
b) Primacy
would be given for renewals. Minimum 80% cases should be renewed.
c) The
Handicrafts Artisans Comprehensive Welfare Scheme will be implemented for a
period of 5 years. The Rajiv Gandhi Shilpi Swasthya Bima Yojana, for the first
2 years, i.e. for the year 2007-08 & 2008-09, will be implemented for all
categories of handicrafts artisans.
In terms of CCEA
approved scheme for the 11th Plan, the Rajiv Gandhi Shilpi Swasthya Bima Yojana
(RGSSBY) component of Handicrafts Artisans Compressive Welfare Scheme was to be
implemented for all categories of artisans in the first 2 years and thereafter,
on implementation of Health Insurance Scheme of Ministry of Labour for BPL
Workers, the RGSSBY was to be implemented, from 2009-10 to 2011-12, only for
Non BPL Handicrafts Artisans.
3. Since the Health Insurance Scheme of
Ministry of Labour for BPL Workers had not been fully implemented in the entire
country. Therefore, it was proposed that RGSSBY should be implemented in
2009-10 for BPL artisans as well so as to ensure the BPL artisans covered in
the first 2 years of the 11th plan do not get deprive of the
benefits available under RGSSBY in the 3rd year of the Plan. The matter was taken up with Ministries of
Labour and Finance and both
these Ministries have given their consent for implementing RGSSBY in 2009-10
for all categories of Artisans i.e. including artisans belongs to BPL families,
SALIENT FEATURES OF THE SCHEME.
FUNDING PATTERN
i. Contribution by the Govt. of India : Rs.697/- or Rs. 797/- per
annum
ii. Contribution by the handicrafts
artisans : Rs.200/- or Rs. 100/-per annum
The funding pattern would
be as following:
|
Contribution
by the Government of |
Rs.697/- or Rs.797/-
|
|
Contribution by the
Handicraft artisan |
Rs.200/- in case of
General Category Artisans and Rs.100/- from artisans belonging to North
Eastern Region and SC/ST communities/Below Poverty Line (BPL) families |
|
Total Premium |
Rs.897 /- |
Service tax on
total premium i. e. on Rs. 897/-
|
At applicable rates which at present is 10.30%
which works out to Rs. 92.40 |
The
artisan’s contribution shall be kept at 20% of the accepted bid, rounded off to
nearest Rs.50/- in case general artisans. The annual premium in respect of
artisans belonging to SC, ST, BPL families & NER, will be @ 50% of the
premium payable by general category artisans.
Release of funds:
i) The
for
coverage of artisans under the scheme in installments.
ii) Service
Tax at applicable rates, which at present is 10.30% over the annual insurance
premium will be borne by the Government of India.
iii) In
the event the claims ratio including all related costs is below 70%, with the
view to
incentives
the scheme, the surplus shall be rolled
over to the next policy period.
TARGET GROUP.
The scheme will cover the artisan's family of
four, comprising self, and any other three members of the family from amongst
the dependent parents, spouse and children. The scheme is to cover people
between age group of 1 day to 80 years.
THE COVERAGE.
The insurance company shall pay/reimburse
expenses incurred by the artisans in course of medical treatment availed of in
any hospital or nursing home within the country, subject to limits/sub-limits.
CASHLESS FACILITY.
The insurance company shall through its
authorized representatives (Third Party Administrator) provide a cashless
facility in empanelled hospitals/nursing homes in various states all over the
country. This would mean that a patient can avail of treatment in anyone of the
panel hospitals without actually having to pay the bills. In case a patient has
to go to a doctor or a clinic, not in the approved list, he can submit the
prescription and the vouchers for the medicines to the insurance company or its
authorized representative (TPA) who will ensure that full payment is made with
in 7 days after receipt of all the requisite documents and information.
PERIOD.
The Policy shall be valid for a period of 12
months, from the date of receipt of premium by the insurer.
BENEFITS
A.Personal Accident :-
Upto Rs.1.00 lakh
b)
Total and irrecoverable loss of : any one limb by physical separation
Sum assured Rs. 1,00,000/-
c) Total and irrecoverable loss of : any one
limb without physical separation
B. Medi-claim :-
|
Particulars |
Amount
(in Rs.) |
|
Annual Limit Per Family (1+3) |
15000/- |
|
Sub Limits per Family |
|
|
All pre-existing Diseases + New Diseases |
15,000/- |
|
Maternity Benefits (per child for the first two) |
2,500/- |
|
Dental treatment |
250/- |
|
Eye treatment |
75/- |
|
Spectacles |
250/- |
|
Domiciliary Hospitalization |
4,000/- |
|
Ayurvedic / Unani / Homeopathic / Siddha |
4,000/- |
|
Pre- Hospitalization & Post Hospitalization |
15,000/- |
|
Baby coverage |
500/- |
|
OPD |
7,500/- |
|
Limit per illness |
7,500/- |
EXCLUSIONS:
Corrective
cosmetic surgery or treatment, HIV,
AIDS, Sterility, Venereal diseases, Intentional self-injury, use of
intoxicating drug or alcohol. War riot Strike Terrorism acts & nuclear
risks.
OPERATIONAL MODALITIES:
CLAIM PROCEDURE:
Planned hospitalization
a) A patient can go to any empanelled hospital/nursing
homes of his/her choice. A list of such hospitals will be provided by insurance
company.
b) The name of the patient/policy No./nature of
ailment /the name of the hospital is to be communicated to insurance company or
its representatives by the concerned empanelled hospitals/nursing homes. A list
of insurance company's representatives (TPA)/ contact persons shall be provided
by the insurance company.
c)
ID Cards to the
artisans will be issued by the insurance company to the insured persons to
avail the cashless facility. The details of insurance company or its
representatives, phone numbers, help line numbers shall also be mentioned in
the I.D. cards for ease of reference. Additionally the empanelled hospitals
shall also fax an authorization form to the insurance company or its
representatives on their own. insurance company or its representatives would
give approval with 12 hours.
d) Patient would take the treatment, sign the bill and
get discharged. No payment is to be made.
Emergency hospitalization
a)
The patient can
be rushed to any empanelled hospital.
b)
ID card is to
be produced to the hospital and the patient can avail the treatment.
Simultaneously, the family can contact the of insurance company or its
representatives (TPA) over help line and submit the pre-authorization form. The
Insurance company or its authorized representatives (TPA) has to fax the
approval to the hospital immediately.
c)
Patient would
take the treatment, sign the bill and get discharged. No payment is to be made.
Reimbursement claims
a)
Patient can
avail treatment from a doctor or at a clinic in addition to the network/
empanelled hospitals.
b)
Can settle the
hospital bills directly by paying all the charge.
c)
Can
call/contact Insurance company, TPA office on Toll-free number 1800 222 555
which can be accessed from BSNL/MTNL land line phones.
d)
Can submit the
prescription and the vouchers for the medicines / claim form to the Insurance company or its
representatives.
e)
The claims have
to be settled immediately on receipt of all the documents/information.
Assistance.
a)
For any
assistance Toll-free numbers -----------------
which is accessible from BSNL, MTNL, Land lines, can be reached by anyone.
b)
Additionally
for any
c)
Besides giving
printed lists, Insurance Company shall also post full details of
hospitals/nursing homes, the TPAs and Insurance company on the web site of all
related government bodies.
ROLE OF INSURANCE COMPANY.
a)
Insurance company
or its authorized representatives (TPA) will furnish a list of medium class
hospitals/nursing homes for medical treatment to the handicrafts artisans, the
State Governments and Office of Development Commissioner for Handicrafts.
b)
Insurance
company should take all steps to make the scheme a success. The Insurance
company will get in touch with the field offices of O/o the DC(Handicrafts) for
taking preparatory steps like
identification of beneficiaries, furnishing forms, instructions etc.
immediately for coverage of artisans under the scheme.
c)
Insurance
company or its authorized representatives (TPA) will take all steps to
popularize the scheme among the handicrafts artisans through out the country by
various means including advertising in the media.
d)
Insurance
company will prepare information related to the scheme/beneficiaries in
vernacular languages.
e)
For
early settlement of medical bills of handicrafts artisans under the OPD cover,
the Insurance Company or its representatives will open offices in major
handicrafts clusters in the country.
f)
Insurance
company will send a monthly progress report on 1st of every month to the Office
of the Development Commissioner for Handicrafts every month indicating number
of people insured, funds utilized and the claims settled.
MONITORING AND EVALUATION.
The Office of the Development Commissioner for
Handicrafts will monitor the progress through its various field offices and by
convening meetings with the State Governments and Insurance company from time
to time. Further, officers from the Office of the Development Commissioner for
Handicrafts will also make periodical visits to the States from time to time
for physical inspection, to review the progress of implementation of the Rajiv
Gandhi Shilpi Swasthya Bima Yojana.
2. BIMA
YOJANA FOR HANDICRAFTS ARTISANS
Objective:
The
objective of “Bima Yojana For Handicrafts Artisans”
is to provide life insurance protection
to the Handicrafts Artisans, whether male or female, between the age group of
18-60 years.
Eligibility:
All crafts persons, whether male or female,
between the age group of 18- 60 years will be eligible to be covered under the
BIMA Yojana For Handicrafts ARTISANS.
Scheme
Contents:
JANSHREE BIMA YOJANA
i.
Life Insurance cover towards natural death
shall be a sum of Rs.30,000/- per member.
ii. For
accidental death or permanent totaL disability, the coverage shall be maximum
Rs.75,000/- per member and for permanent partial disability, the coverage shall
be maximum of Rs.37,500/- per member.
iii. Added
benefits in the form of, an associated scheme of LIC – “Siksha Sahyog Yojana”,
under which not more than 2 dependent children of the beneficiary studying in
the classes 9th to 12th are given Rs.300/- per quarter per child as educational
allowance for a maximum period of 4 years or till they complete XII standard,
which ever event occurs earlier.
Pattern of Financial Assistance:
1.
The annual premium rate per person under the
policy will be Rs.200/-
2.
The annual premium charged would be Rs.200/-
per annum, of which i.e. Rs.100/- is to be borne by Life Insurance Corporation
from its Social Security Fund, Rs.60/- is to be borne by the Government of
India in the Office of the DC (Handicrafts) and remaining Rs.40/- is to be
borne by the beneficiary.
It is estimated to cover 5 lakhs artisans under the insurance coverage
during the 11th Five Year Plan.
OPERATIONAL MODALITIES:
a) The
scheme shall be operative on year-to-year basis.
b) The
premium amount of artisan shall be paid one time for the whole year to the Life
Insurance Corporation of
c) The
Office of the Development Commissioner for Handicrafts (DC HC) Government of
India (GOI) in the Ministry of Textiles (MOT) shall release its share of the
premium as per annual target in scheme to the LIC.
d) A
prospective beneficiary shall be required to fill up an
application-cum-nomination form and submit the same to the implementing agency
alongwith his/her share of the premium. The format of the application form
shall be made available to the implementing agencies by the LIC. The implementing agencies shall be satisfied
with kind of proof of evidence provided as proof of age etc., by each member
for availing this scheme.
e) On
receipt of the above, the implementing agency shall scrutinize the application
and if found eligible, shall accept the premium amount and forward the lists on
such beneficiaries along with premium amount to the LIC.
f) On
receipt of the premium amount with the list of beneficiaries from the
implementing agencies, the LIC shall issue to the implementing agency, a group
policy certificate alongwith the list of names of individuals insured. Implementing agencies will arrange to inform
individual beneficiaries about the coverage.
g) In
the case of death or disability, the nominee/beneficiary concerned shall submit
his/her claim to the LIC through the implementing agency with required
documentary evidence such as death certificate/post-mortem examination
report/medical certificate/discharge certificate and other related documents,
as applicable. The implementing agency
shall forward the claim, to the LIC within 15 days of receipt of the
claim. LIC shall settle the claim within
one week from the date of receipt of the claim and pay the amount to the
beneficiary/nominee directly by AC/Payee Cheque (under intimation to the
Implementing Agency) or through the implementing agency.
h) In
the event of non-payment of the insurance premium for the next year by the
beneficiary, the insurance cover shall automatically cease. The beneficiary will however be free to
rejoin the scheme in any subsequent year on payment of required premium.
i) In
case a Handicrafts Artisans changes his membership during the period of
insurance from one Society/SHG to another, he/she, as the beneficiary of the
scheme, shall furnish intimation to the implementing agency.
j) The
State Government & the implementing agencies shall be actively associate in
implementation of the scheme by way of sensitizing the artisans to join the
scheme under the ambit of AHVY. The
performance of the scheme would be monitored as usual by three tier committees
constituted for monitoring the projects of AHVY.
ADDITIONAL BENEFITS:
a) The
Janshree Bima Yojana also provided scholarship to the children of parents who
are covered under it.
b) A
scholarship of Rs.300/- per quarter per child is to be paid to students
studying in standard IX to XII for a maximum period of four years or till they
complete XII standard whichever event occurs earlier. The scholarship will be for academic year
June to May.
c) The
benefit is restricted to two children of the member covered. Both the children will be covered for
scholarship.
d) If
a student fails and is detained in the same standard, he/she will not be
eligible for scholarship for the next year in the same standard.
e) Once
a person is admitted as a member under Janshree Bima Yojana, further proof of
income is not necessary at the time of selection of beneficiary under the
scheme.
f) No
Premium is charged either to the parent of the scholarship holder of to the
implementing agency. It is an additional
benefit given to the children of the parents covered under Janshree Bima
Yojana. If the premium under Janshree
Bima Yojana is not paid on annual
renewal date in such case, the child shall not eligible for scholarship.
g) The
beneficiaries has to be selected out of the members covered under Janshree Bima
Yojana. The targeted beneficiary
students of the State may be divided among the members covered under Janshree
Bima Yojana in proportion to the number of lives covered within the State. The
final selection shall be based on the criteria of poorest of the poor, as the
numbers of scholarship is limited.
h) The
members of Janshree Bima Yojana whose child is eligible for scholarship shall
fill up an application form (available with the implementing agency) and submit
to the implementing agency. The
application duly filled up and certified will be sent along with the list of
beneficiary students by the implementing agency to the concerned LIC P&GS
Unit for disbursement of scholarship.
The scholarship will be disbursed to the beneficiary students through
the concerned implementing agency.
i) LIC
will sent the Account Payee Cheque in the name of the implementing agency along
with list of beneficiary students who will pass on the scholarship to eligible
students. Implementing agency has to
maintain records and submit certificate of utilization periodically to LIC,
P&GS Unit.
j) On
introduction of Janshree Bima Yojana, the earlier Group Insurance Scheme stands
discontinued and no proposals for further renewal under this scheme will be
considered. The amount standing to the credit of the artisans in the savings
element of the earlier Group Saving Linked Insurance Scheme will be paid to him
by the LIC alongwith interest thereon on receipt of request for withdrawal
CLAIM PROCEDURE
The beneficiary of the deceased
member will be required to furnish the original death certificated to the
implementing agency who will arrange to forward the same alongwith the claim
papers to LIC i.e the Branch which has originally finalized the insurance
cover. LIC will settle the claim by
sending A/C Payee Cheque directly to the beneficiary however, intimation to
this effect has to be furnished to the concerned implementing agency. In the case of accidental claim, police
inquiry report will also be required to be submitted. The detailed procedure
will be mainly on the lines of the procedure of Social Security Group Scheme of
the LIC.
RELEASE OF FUNDS
The Nodal Agency/implementing Agency will collect the
beneficiary contribution, prepare a consolidated list of beneficiaries get it
certified form field office of DC(HC) and deposit the same with LIC’s concerned
P&GS Units.