Aims and Objects of the Scheme
To provide financial assistance to the members and his/her spouse on the unfortunate events of hospitalization for Diagnosis, management of the following diseases.
a) Coronary Heart Disease : Angioplasty, by-pass surgery & valvular heart diseases surgery
b) Kidney failure : Haemodialysis, Renal Transplant
c) All malignant Diseases.
d) Management of brain Tumors
e) Joint Replacement : Surgery for knee and hip joints and major surgeries.
f) Spinal Stenosis and disc surgery
g) Cerebrovascular accidents.
h) Medical investigation for costing more than Rs.5000/.
i) Road Traffic accident and other accidents
.j) Other major illnesses requiring Hospitalisation approved by the scrutinizing committee.
Beneficiaries
Benefits of the Scheme shall be available only to the member and his/her spouse, if member has paid the annual membership subscription of his/her spouse. In the event of death of member, spouse, if he/she so desires can continue as a beneficiary member and has scheme as applicable to the members of the Scheme,provided the spouse was a life member of IMA. However such a beneficiary member shall not have any right to attend or vote in the general body meeting of scheme and shall not have any right to vote or contest for any post. If beneficiary is the life member of IMA at the time of demise of his/her spouse may become a regular member of the scheme as per the rules existing for admission to the scheme at that time, however no age bars shall be applied to such a beneficiary.
Eligibility of the Members.
a) Any member of IMA up to the age of 55 years at the time of joining is eligible to become member of the scheme.
c) The age will be calculated on the date of receipt of draft/cheque subject to its encashment.
Admission Fees :
Any member of IMA KSB willing to become a member of the scheme shall be enrolled on payment of admission fees as per scale below.
For member :
a) Below age of 35 years Rs. 750.00
b) Below age of 45 years Rs. 1250.00
But above 35 years
c) Below age of 55 years Rs. 1750.00
But above 45 years
Advance Financial Assistance Contribution (AFAC)
Every member shall have to pay initially Rs. 1500/- as advance financial assistance contribution along with the admission fees and membership fees. Advance financial assistance contribution will be adjusted as the amount paid to the beneficiary member in such a way that it does not exceed Rs. 50/- per beneficiary. At the beginning of the next year the amount used during the preceding year as financial assistance will be collected from the member/beneficiary member so as to make the balance of Advance Financial Assistance Contribution total Rs. 1500/-.
Annual Member Subscription
Every member/beneficiary member of the Scheme shall pay Rs. 200/- annual membership subscription.
How to apply?
Member shall submit their application in the prescribed application form along with their admission fees, membership fees and advance financial assistance contribution drawn in favour of the scheme "IMA Kerala Health Scheme " by A/c. payee draft or local cheque payable at Head Office at Secretary's office place Edappal with endorsement by Local Branch Secretary. Rs.40/- should be add as bank charges for out station cheques.No cash or money order will be accepted.
Contribution of member for Financial Assistance.
Every member or beneficiary member of the scheme shall continue financial assistance of maximum of Rs. 50/- per beneficiary up to the limit of Rs.1500/.(ie.A. F.A.C).
Benefits of the Scheme.
(a) This scheme is intended to be helpful to members to meet the heavy expenses for the management of serious illness.
Coronary Heart Disease : By-pass surgery and angioplasty required for the treatment of coronary heart disease and valvular heart disease surgery will be covered under the scheme. Upper limit will be Rs.One Lakh.
Kidney Failure: Regular haemodialysis or renal transplant required in the management of chronic irreversible failure of both the kidneys will be covered under the scheme. Upper limit will be Rs.1 Lakh.
Cancer : Surgical, Radiotherapy and Chemotherapy required for the treatment of all cancers will be covered under the scheme. Upper limit will be Rs.75000.
Management of Brain Tumours : Surgical, Radiotherapy and Chemotherapy required for the treatment of brain tumours will be covered under the scheme. Upper limit will be Rs.1 Lakh.
Major Surgeries : Surgery for knee and hip joints, Spinal Stenosis and disc surgery, or other major surgeries will be covered by the scheme with an upper limit of Rs.50000/- Any serious diseases, requiring hospitalisation ,will be covered with an upper limit of Rs.25000/-
Diagnosis and Treatment costing less than Rs.5000/ will not be covered under this scheme.
Investigation alone without any referance, positive findings or management will not be reimbursed.No charges will be given for the duplicate investigation .
b) Member have to submit original papers as well as photo copy of Treatment certificate, Break up of Bills-Professional charges, Medicines for treatment , investigations and other documents upon which a claim is based with in two month of discharge from Hospital . The member shall also give additional information and assistance as the scheme may be required in dealing wit the claim. If a claim be in any manner fraudulent or supported by any fraudulent means of device (whether by a member or any other person acting on his/her behalf), the scheme shall not be liable to make any payment. No charges will be given for the duplicate investigation. Original bills and papers will be given back to member after verification.
c) Permissible reimbursement will be disbursed within 90 days from the submission of the original papers, bills and other documents upon which the claim is based. After verifying all the facts as prescribed by the managing committee, all payments shall be made by A/c. payee check/bank draft only. Managing Committee will have discretion to pass/reject payment of bills in case, where they are not satisfied about the genuineness of the bills.
d) Members will be given reimbursement of 75% of total amount of the bill or fund collected from the members/beneficiary members' contribution up to the maximum limit of Rs. 50/- per case, whichever is less.
e) A member will get a maximum of benefit of Rs. 1 Lakh in one year.
f) Over and above all Government Modern Medicine Institutions in Kerala and treatment taken in empanelled private Modern Medicine Institutions in Kerala are recognized under this scheme. In exceptional cases treatment taken from Modern Medicine Institutions outside Kerala shall be considered. Private Hospitals have to apply for being included in the list of recognized institutions. The managing committee is empowered to add or alter or delete the name on the list of Institutes for management. It shall be communicated to all the members in advance. Members are requested to inform about the name of Institution for recognition.
g) No advance payment will be made to the member/beneficiary member
h) The managing Committee of the Scheme shall be empowered to decide about the claims of the above diseases. State Working Committee shall be the Appellate body . No disputes can be challenged in any court of Law.
i) Founder members will have the benefit of the scheme only after completion of 6 months of operation of the scheme . For all other members of the scheme, they will get benefit only after completion of one complete year of joining the scheme.
j) Charges of engaging a special nurse or attendant will not be reimbursed.
k) Expense incurred on travel or ambulance will not be reimbursed.
l) Food, laundry, room charges, and telephone bills will not be allowed.
m) Treatment in other systems other than Modern Medicine will not be allowed.
