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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🚨 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.
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.