The Rukhmani Charitable Trust

What is mediclaim insurance?

Mediclaim insurance was launched by Govt. of India in 1986 through 4 nationalized general Insurance Company for the benefit of individual and unorganized group. The Mediclaim insurance has undergone lot of changes since then in terms of sum insured and premium rating the benefits. Presently mediclaim policy covers the following:

Hospitalization expenses incurred as in patient for the treatment of disease and accident. It also covers domiciliary hospitalization expenses for taking hospitalized treatment at home if the patient’s condition is such that he cannot be removed to the hospital.
Sum insured is Rs.50,000 to Rs. 5,00,000 in multiple of Rs.25,000
Persons between the age of 90 days to 75 years can be covered under the policy

Their two types of policy

Individual policy with family discount for 10% and covering entire family and cumulate bonus as increase in sum insured by 5% for every claim free year up to maximum of 50% for every four claim free years you get free health check up for on amount up to 1% off capital sum insured.
Group Mediclaim policy is available to group of more than 100 people and it doesn’t have family discount, cumulative bonus and health checkup benefits enjoyed by individual policy holders.
This policy has a group discount of 2.5 % to 30% depending on size of the group. The policy the subject to preview for loading the premium or granting discount every year depending on the claim experience of earlier years.
As of today there are 8 million policy holders with a premium base of Rs. 1000 cores

What expenses are not payable?

Under the policy conditions the following services are not reimbursable

Registration/ Admission Fees
Telephone charges.
Visitor’s charges, attendant charges, ambulance charges.
Service charges
Diet charges, which are not part of the administered treatment.
Other non-medical charges

What is Cashless Hospitalization Facility?

The cashless hospitalization services enable the insured to obtain treatment at empanelled hospitals without payment, subject to the terms & condition of your policy. TPA will settle the hospital bills directly on his/ her behalf.

What is the insurance offered with Sampurna Arogya Health Plan?

Given today’s age of rising medical costs, its critical for you to have medical insurance. Choosing the right policy – one that suits your every need - is even more critical. Keeping this in mind, The Rukhmani Charitable Trust has tied up with the Insurance Company and introduced Sampurna Arogya plan, a unique simplified, cashless medical insurance policy that will make your life a lot easier.

What is Cashless Insurance Policy:

Sampurna Arogya and TPA Card is a cashless medical insurance policy. Now, you have to do is present your card! And the insurance company through its Third Party Administrator (TPA) will settle all bill directly with the partner hospitals across India, so you get the best possible care anywhere in the country.

Photo Identity cards:

Photo Identity cards and information booklets including services and list of hospitals will be provided to you for easy admission in Hospital.

What is Telephone guidance?

The TPA will provide 24 Hours, 7 Days a week telephone guidance on a TOLL FREE Telephone number for guidance to policy holders.

Does the Insurance cover pre-existing illness?

Sampurna Arogya Yojana covers your pre-existing diseases (provided you have opted for pre-existing disease coverage plan) that you have not claimed against the disease during the first 4 months when you take the policy for the first time of your Sampurna Arogya Yojana and that your health is otherwise stable. Other conditions apply. However declaring all the pre existing ailments and conditions is compulsory at the time of taking the first policy, un-declared pre-existing will not be covered. Under Sumpurna Arogya Yojana we are also covering members under standard insurance policy where pre-existing are not covered Presently no insurance company in India covers pre-existing diseases for individual and family. Providing true picture of medical history of each family member is also mandatory and beneficial to the members as it will help in proper diagnosis and treatment by your doctor.

Which pre-existing diseases are not covered?

Pre-existing cancer and terminal illness.
Replacement of artificial equipment/part or battery and other accessories.
Cost of pacemaker and other accessories.
Undeclared pre-existing diseases / conditions.

Are Pre and Post Hospitalization Expenses covered?

Sampurna Arogya also covers Pre-Hospitalization expenses up to 30 days prior to hospitalization; Post-Hospitalization expenses for up to 60 days provided these expenses are in line with the treatment for hospitalization.

Are all age groups covered under this Policy?

Sampurna Arogya Yojana insures you if your are anywhere between the ages of 5 and 75 and provides you maximum benefits, Children between the ages of 90 days and 5 years are also covered provided that one or both parents are covered concurrently.

What reimbursements can I expect if Sampurna Arogya covers me?

Devdoot provides reimbursements for the following hospitalization expenses:

Room and boarding expenses as provided by the hospital or nursing home to the patient.
Nursing expenses.
Fees to the surgeon, anesthetist, medical practitioner, consultant and specialist.
Expenses incurred for anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines & drugs, diagnostic material, x-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of organs and similar expenses.

What if my hospital is not a partner hospital of The Rukhmani Charitable Trust/ TPA?

In case your are admitted in a non-partner hospital, you will have to pay the hospital bills and TPA will assist you to get the same from the insurance company within 60 working days after receiving all the required and completed documentation and sorting out all the queries as raised by the insurance company.

Is it easy to get avail membership of Sampurna Arogya Yojana?

Yes, All you need to do is call us, and our representative will be at your doorstep with the necessary forms. The processing of the forms is equally quick. We will ensure that your membership card reaches you within 40 working days after receiving the completed proposal form and subject to realization of your cheque.

Do I need a medical report?

No, you don’t need any medical reports to become member of Sampurna Arogya Yojana. If you are opting for pre-existing disease coverage plan. However you have to declare all the pre-existing diseases so that they can be covered in the policy. In case of Mediclaim medical (when you are opting for standard policy without covering pre-existing disease) reports after the age of 50 have been made compulsory.

Note: That undeclared pre-existing diseases will not be covered. Here we fully relay upon you to give the correct picture of your health status.

Can I convert my other medical Insurance policy to Sampurna Arogya?

You can do better than just that. You can either convert your existing policy at the end of the cover period, or you can take a Sampurna Arogya as an additional policy and increase your overall cover. Existing claim free policyholders will be directly incorporated in the above scheme at renewal.

What if I forget to renew my policy?

That seems unlikely, twenty days prior to the expiry of your policy; you will receive a Premium Due Reminder. This will be followed by a phone call to ensure that your policy does not lapse without your knowledge. However in your own interest we request you to keep a track of your renewal and pay the premium 20 days in advance to keep the continuity of covered.

Does a single sum insure the entire family?

This is a family floater policy, so the entire family can be covered under one sum insured, which means substantial saving in premium. Maternity coverage plan with pre-existing disease cover is an individual plan. There are standard individual plans and standard family floater plans.

What sum insured can I select??

The policy amount can be chosen from Rs. 50,000 to Rs. 5,00,000 as per individual requirement as a family floater and as individual also.

Is Maternity covered?

Yes maternity expenses benefit is covered in our Plans. The waiting period for maternity in the first policy is 9 months. Other conditions apply. This is an individual plan with pre-existing. It is advisable to take this policy immediately after that marriage. Maternity expenses are covered upto 25% of the sum insured or Rs. 50,000 whichever is less, limited to delivery after 9 months. Newly born child shall be covered upto 3 months within the limits of hospitalization of mother as an inpatient in the hospital only. The congenital diseases of the newly born child shall be excluded. Other terms and conditions of maternity extension apply.

Is Personal Accident covered?

A separate Personal Accident policy is available at a concensional rate.

Is Out Patient Service (OPD) covered?

OPD Treatment shall have the meaning as under:

General Practitioner (GP) on the panel to whom the card-members are assigned will provide the out patient (OP) consultation, medicines, drugs and other medical disposables if provided by GP shall be charged to patient as per agreed payment schedule for one year without charging any consultations. Wherever GP is available in the hospital the GP consultation will be provided by such hospitals. Incase of GP services not available in particular hospital TRCT will arrange the GP attachment to such card-holders. The members are required to make the payment for medicines supplied by the GP immediately, OPD will also be available for Ayurved, Homeopathy, other forms of alternative medicine in your town of place of residence or nearest town, where ever such facilities are available. All such types of consultation will carry different terms and conditions which will be informed at the time of booking the membership. Diagnostic services, medicines and drugs wherever required shall be at discounted rates as agreed. Specialists out patient consultation will be at discounted rates.

What are the different OPD plans?

PLAN

Unlimited GP Consultation free for entire family.
Unlimited Specialist Consultation at a Discount between 5-20%.
Unlimited Path Lab, X-Ray, ECG at a Discount between 5-20%.
Discount of 5% on MRP for branded medicines purchased from Medical Shop.
All other diagnostic procedures not included above at 5-15% Discount.

N.B.: all the above facilities will be provided by the panel service providers only.

Is the Dental Treatment covered under the OPD Plan?

Yes, those who opt for the dental treatment will receive one oral dental checkup free for entire family from panel dentist, and 15% discount on treatment.

What is the procedure for availing OPD benefit?

For Discounted Services.

You have to produce Photo ID card of Sampurna Arogya Yojana to the panel Doctor / Service provider. He/She will examine you or provide the services available with him as per agreed terms with the Trust, i.e. discount benefits. He will enter the latest diagnosis and treatment details for updating the medical history on our database. The member will have to tender the cash at a discounted rate to Doctor / Service Provider and obtain receipt for the actual amount paid.

For Free Services.

You have to produce Photo ID card of Sampurna Arogya Yojana to the panel General Medical Practicenors where your card is attached, who will provide unlimited free consultation diagnosis and prescription for all the members covered under the Sampurna Arogya Yojana. Any medicines / injections given by the GP will be charged and the member should make immediate payment to the doctor.

Dental Treatment.

You have to produce Photo ID card of Sampurna Arogya Yojana to the panel Dentist where your card has been attached. Dentist will provide one free dental checkup for entire family members. If treatment is required it will be provided at 15% discount. Member should make the discounted fees to the doctor immediately