Researched online on govt websites to find out more about the cover. No information on the state government website about the coverage, hospitals, or link to the scheme's website.
After some research effort, here are the details I could find.
2/n
This is *not* a new scheme. This insurance is on since 2012!
The scheme covers infectious diseases, critical care all these years - hence Covid19 was part of the cover.
The only change is the scheme now includes people in the higher economic class (white ration card)
3/n
The scheme is called Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)
The cover is as follows:
- Rs. 1.50 Lakh floater cover
- Covers all the members on the ration card.
- Pre-existing Disease cover
- Cashless treatment
- Treatment only through 1000 network hospitals.
4/n
The hospital network comprises of mostly Govt or Semi-govt hospitals - I couldn't find any big brands.
So you probably won't be able to use the scheme to get treatment at your preferred hospital.
Details of the TPA in the policy are not known.
The insurer is United India Assurance, but no information on their website. Couldn't connect to their toll-free.
If you want to avail this scheme, you need to visit the hospitals listed on the website and request for cashless.
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Patient hospitalized for 6 days
Insurer pays for 2 days - says no "active treatment" after 2nd day.
Doctor shares logic for the 6-day treatment.
Insurer still disagrees.
Should patients consult insurers before taking medical decisions?
Why do patients suffer for lack of medical regulations?
First, let's understand why this happens.
So, health insurance as per the contract will pay only in case when the hospitalization is
a) "Necessary" and
b) " requires active treatment"
Ok - so what is "Necessary" treatment?
It is when patient can only be treated at a hospital and not at home or in OPD.
For instance, say I meet with an accident, and break my hand.
Now, the doctor needs to apply plaster on my hand.
But say the doctor asks me to get hospitalized for a day - This won't be covered under health insurance.
"What if I skip Health Insurance and build a fund to cover my family’s healthcare."
Fine print + claim hassles have forced all of us to think in this line.
Before you go down that road, here’s a thread on what you need to know
👇🏻👇🏻
Health insurance, despite its flaws, offers some powerful benefits that you should understand before taking such calls.
Let’s break down these powerful benefits of health insurance:
⦿ Lifetime Hospitalization Cover
Once you clear the initial waiting periods, health insurance can practically cover all your hospitalization costs for a lifetime — yours and your family’s.
Regulation does not allow insurers to stop coverage, unless they prove a fraud.
Most of the changes are applicable from immediate effect - unless there is a specific target date mentioned for the change.
Thread time 👇🏻
INCLUSIVENESS:
IRDAI has asked insurers to make available products for 1. All age groups 2. People with medical conditions, including chronic. 3. All types of treatment - including OPD!! 4. All occupations, regions, categories.
All kinds of hospitals including affordable ones.
No denial of coverage in case of emergency situations.