IMA KERALA HEALTH SCHEME (IMA KHS)
Aims and Objects of the Scheme
To provide financial assistance to the members and his/her spouse, children and parents 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 : Hemodialysis, 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) Road Traffic accident and other accidents.
i) Other major illnesses requiring Hospitalisation approved by the scrutinizing committee.
Benefits of the Scheme shall be available only to the member and his/her spouse, children and parents, if the member has paid the membership subscriptions of his/her spouse, children and parents. In the event of death of the member, the spouse, children and parents, if desires can continue as a beneficiary member of the scheme provided the member 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.
Eligibility of the Members
a) Up to 30th November 2006 (First six months) any member of IMA of any age is eligible to become a member of scheme. He/she is considered as Founder Member.
b) After 30.11.2006 any member of IMA up to the age of 80 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 But above 45 years Rs. 1750.00
d) Below 60 years but above 55 years Rs. 5000.00
e) Below 65 years but above 60 years Rs. 6000.00
f) Below 70 years but above 65 years Rs. 7000.00
g) Below 75 years but above 70 years Rs. 8000.00
h) Below 80 years but above 75 years Rs. 10000.00
Advance Financial Assistance Contribution (AFAC)
Every member/spouse member who have joined below 55 years shall have to pay initially and yearly Rs. 2600/- as advance financial assistance contribution along with the admission fees and annual membership fees of Rs.100/-. Every child member shall have to pay initially Rs. 2100 as advance financial assistance contribution.
Members below 60 years but above 55 years, who join the scheme above the age of 55 years, shall contribute AFAC of Rs. 5000/- per year
Members below 65 years but above 60 years, who join the scheme above the age of 55 years, shall contribute AFAC of Rs. 7000/- per year.
Members below 70 years but above 65 years, who join the scheme above the age of 55 years, shall contribute AFAC of Rs. 8000/- per year.
Members below 80 years but above 70 years, who join the scheme above the age of 55 years, shall contribute AFAC of
Rs.10000/- per year.
Annual Member Subscription
Every member/beneficiary member of the Scheme shall pay Rs.100/- each as annual membership subscription
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 “IMA Kerala Health Scheme” by A/c. payee draft or local cheque payable at Head Office at Secretary’s office place with endorsement by Local Branch Secretary. No cash or money order will be accepted.
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. 2 Lakhs.
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.2 Lakhs.
Cancer: Surgical, Radiotherapy and Chemotherapy required for the treatment of all cancers will be covered under the scheme. Upper limit will be Rs. 2 Lakhs.
Management of Brain Tumors : Surgical, Radiotherapy and Chemotherapy required for the treatment of brain tumors will be covered under the scheme. Upper limit will be Rs.2 Lakhs.
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. 100000/-
Any serious diseases requiring hospitalisation, will be covered with an upper limit of Rs.40000/- Diagnosis and Treatment costing less than Rs.5000/- will not be covered under this scheme.
b) Members have to submit original papers as well as attested photo copy of Treatment certificates (Discharge summaries), Break up of Bills (Professional charges, Medicines, investigations) and other documents upon which a claim is based with in 60 days of discharge from the Hospital. The member shall also give additional information and assistance as the scheme may require in dealing with any 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. Original bills and papers will be given back to member after verification.
c) Permissible reimbursement will be disbursed/discharges within 3 months 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 / Net banking 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 not exceding the sum limited to each disease..
e) A member will get a maximum of benefit of Rs. 2 Lakhs in one year.
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.
f) No advance payment will be made to the member/beneficiary member.
g) 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.
h. i) 1. Founder member will have the benefit of the scheme only after completion of 6 months of joining of the scheme. For all other members of the scheme they will get benefit only after completion of 1 year of joining the scheme, except for those who join after completion of 60 years of age.
ii) The members who join after completion of 60 years of age will get benefit only after completion of 2 year of joining the scheme.
i) Charges of engaging a special nurse or attendant will not be reimbursed.
j) Expense incurred on travel or ambulance will not be reimbursed.
k) Food, laundry and telephone bills will not be allowed.
l) Treatment in other systems other than Modern Medicine will not be allowed.