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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Case of cashless claim approved first, then rejected.
Customer gets admitted to hospital, cashless is approved for 70K
Later the patient's health detoriates and he is shifted to ICU,
the bill shot up to 3.4L.
The insurer withdraws cashless, leaving the customer shocked.
Here’s how a Beshak Expert stepped in - and turned it all around 👇
A customer was hospitalized for angioplasty, and the insurer first approvied a cashless treatment of 70K.
The hospital stay seemed routine until things took a sudden turn.
Complications arose, and the patient needed urgent ICU care.
This led to a significant increase in the total hospital bill, raising it to 3.4L.
The hospital submitted a request to the insurer to approve the additional ICU treatment costs.
But the insurer rejected the change in cashless request.
They argued that ICU care wasn’t necessary for this procedure. And that ANY CHANGE in the line of treatment should’ve been communicated BEFORE the treatment was carried out.
🚨 Why a ₹1 Crore health cover may NOT be enough once you hit 30!
In 1999, my dad was proud owner of a bumper health insurance cover!
Cover of 2 Lakhs. He found it adequate.
In 2010, I felt ₹10L was a decent enough cover.
Today, ₹1Cr still seems a bit of a stretch. But is it?
Let’s break it down. 🧵👇
1. India’s private healthcare is only getting more expensive.
The government spends just 2.1% of GDP on healthcare - one of the lowest in the world. Public hospitals are struggling, and most middle-class families don’t prefer to go there.
That leaves us with private hospitals, and we all know how expensive they are.
Why?
Because the demand for quality healthcare far exceeds supply.
Just look at the top hospitals wherever you live - there’s always a rush.
Beds are perenially unavailable.
(Have seen the MD of a giant company waiting at Hinduja hospital, Mumbai, with their family member, late night, patiently negotiating for a vacant bed. )
India has only
- 1 doctor for every 1,500 people
- 1 hospital bed for every 1,000 people - far below WHO’s recommended standards.
Every year HR sends an "insurance" email most ignore.
You shouldn't.
The email usually has a deck that covers:
• The benefits you are entitled to.
• The process to enrol family members.
• The process to enrol and pay for parents’ covers and top up covers.
• The terms and conditions - which are a lot, believe me (this is ignored the most!)
Employer health insurance benefits are smoooooth!
👉 It is easy to enroll.
👉 It covers maternity benefits.
👉 It covers pre-existing diseases, damn it!
👉 It is even easy to claim.