General Introduction :
Mediclaim Insurance Policy – Government of Rajasthan : The state insurance and provident fund department was established in Rajasthan state as a well being measure for the employees with an aim of providing financial and social security and support to all the Government employees of Rajasthan state.
This applies to the State employee’s appointed on 1-1.2004 and thereafter. Under this, employees and their families are provided with the facility to be treated indoors till the maximum insurance coverage limit. From the date of joining the state service, the state worker becomes entitled to receive the benefit of this policy. All the benefits of Mediclaim Policy are payable to the State employee even during the probation period.
All the premiums for the State employees are borne by the State Government. For this, no monthly or annual premium is charged from the employee.
Insurance money :
At present, the maximum limit of Insurance money has been fixed in the mediclaim policy of the state employees. The insured can avail medical facility up to a maximum of Rs 3 lakh in a policy year for the treatment of self and their families.
The following are included in the definition of family of Mediclaim Policy –
1. State employee’s spouse
2. 2 unmarried children of 21 years of age
3. Dependent parents who usually live together at the place of posting of personnel and whose average monthly income is less than Rs.2000 / -.
Under Mediclaim Policy, employee can avail treatment facility in three types of hospitals –
- All Government hospitals in the state.
Approved hospitals outside the state.
- Approved private hospital.
Only those hospitals approved by the department under the policy are approved by the state government under the Civil Services Medical Attendance Rule 2013. Undertaking has been provided by all approved hospitals to the state government and department to provide medical facilities at CGHS package and rates. Hence they are obliged to provide medical facilities at CGHS rates. Updated information of approved hospitals is also available on the departmental website of the Finance Department.
Indoor Period :
To get the benefit of Mediclaim Policy, it is necessary to be hospitalized for a minimum of 24 hours. No refund amount will be payable for treatment done less than 24 hours.
Day-care facility :
There are some diseases which do not require to be admitted for 24 hours. Recharge facility is also available in what is known as day care. Such as dialysis, chemotherapy, radiotherapy, eye surgery, dental surgery, removal of kidney stone, D&C etc. in case of accident.
Employee Category :
|Pay scale according 7th pay||Entitlement of gov. hospital||Entitlement of approved private hospital||Maximum rate|
|A||64000 and Above||Deluxe||Private Ward||
RS 3000 per day
|36000 to 64000||Cottage||Semi private Ward||RS 2000 per day|
|C||Below 36000||General Ward||General Ward||
RS 1000 per day
∗Pay Scale means basic pay / fixed payment.
Rate of Recharge (FeedBack) :
The claim amount will be recharged to the insured employee at the CGHS package rates only. The CGHS rates of Jaipur city will be applicable on treatment in any approved private hospital in the state. The CGHS rates of the respective city will be applicable when treated outside the state. Because out-of-state CGHS rates are determined according to that state.
Cashless facility (cashless facility) :
Cashless facility means that the insured personnel do not have to pay any cash in the approved private hospital at the time of treatment. The treatment amount is paid directly by the department to the concerned hospital. This facility is limited to serious diseases under Mediclaim Policy. Under this, the following serious diseases are included –
- Caronary Artery Surgery
- Renal Failure i.e. Failure of Both Kidneys
- Multiple Sclerosis
- Major Organ Transplant likes kidney, Lung Pancreas, Bone marrow.
Pre – Hospitalization Facility :
This refers to the period in which an insured person undergoes outdoor treatment before being admitted. Recharge of outdoor treatment can be obtained up to 30 days before being admitted under this policy.
Post Hospitalization :
This is the period in which the insured can also get medical facility after being discharged from the hospital. In this mediclaim policy, the insured can get a recharge of treatment expenses up to 45 days after being discharged from the hospital.
Maternity Benefit :
Under this policy, the insured personnel can get maternity benefit up to a maximum of two living children. The maximum limit of maternity benefit has been fixed at Rs 50 thousand in a policy year. The maximum limit of maternity benefit is set as follows –
- Normal delivery – maximum Rs 10 thousand
- Caesarean delivery – maximum 20 thousand rupees
- Complicated deliveries – maximum Rs 50 thousand
(Child care has also been included in the limit of 50 thousand.)
Mediclaim related formats :
- Mediclaim new proposal form
- mediclaim new claim form
- Mediclaim appendix 5
- Mediclaim appendix 6
- SI Loan interest calculator
Go to SIPF Portal : Click Here
See Mediclaim related order : Click Here