IMA National Health Scheme
Constitution & Byelaws adopted on 27th December in the 75th meeting of Central Council of IMA at Ahmadabad, Gujarat.It came into force in January 2015, with an aim to help IMA members, those who join the scheme, to meet heavy expenses for the management of serious illnesses. It came in to As all of us know, in the current health scenario, the cost of investigations and treatment are bound to increase.
This scheme is intended to provide financial assistance to the members / beneficiary members to meet the expenses for the management of
- Heart diseases - Angioplasty, CABG, Valvular surgeries: Upper limit will be 3 lakh
- Kidney Diseases – Renal transplantation, Dialysis: Upper limit will be 3 lakh
- Malignancies, Brain tumours: Upper limit will be 3 lakh
- 4. Spinal Surgery, Other major surgeries, Joint replacement surgeries
- Cerebrovascular accidence:
- Road traffic and other accidents.
- Major illnesses requiring hospitalisation as approved by scrutinizing committee:
Scrutinizing committee of the scheme has the power of discretion to fix the upper limit of reimbursements for various medical conditions/ surgical/diagnostic procedures after considering the existing expenses of treatment in the territory.
Diagnosis and treatment costing less than Rs.5000 will not be covered under this scheme. Member has to submit original papers as well as attested photo copies of treatment certificate (discharge summary), break up of bills.(professional charges, cost of medicines and investigations etc.) and any other documents upon which a claim is based within 60 days of discharge from 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 the member after verification.
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 cheque / demand draft/ cash transfer only. Managing committee will have discretion to pass/ reject payment of bill in cases, where they are not satisfied about the genuineness of the bills. Members will be given reimbursement of 75% of total amount of the bill not exceeding the sum limited to each disease.
A member will get a maximum of benefit of Rs.3 Lakh in one year.
No advance payment will be made to the members
The managing committee of the scheme shall be empowered to decide about the claims on the above diseases. Central working committee of IMA shall be the Appellate body. No Disputes can be challenged in any court of law.
Medical Reimbursement can be claimed only after completion of 1 year Lock in Period for those in the age up to 55yrs at the time of joining, 2 year lock in Period for age group of 55age to 70 years age group at the time of joining and 3 year after 70 to 80 years age group at the time of joining.
Charges of engaging a special nurse or attendant will not be reimbursed.
CExpenses incurred on travel or ambulance will not be reimbursed
Food, laundry and telephone bills will not be allowed.
Treatment in Modern Medicine will only be reimbursed.Treatment in other systems will not be considered
Cost of cosmetic treatment including dental prosthesis, cost of external appliances like spectacles, hearing aids and exercise equipments etc will not be covered.
In case of demise of a member the claim shall be given to the nominee given in the records.
TO JOIN THE SCHEME
IMA members, Spouses, Parents and Children can join the scheme provided they are aged below 80 years at time of joining the scheme. IMA members shall be members and others shall be beneficiary members. Application form is available in this site. Download the form, take printout in legal size paper ie, 8.5 x 14 inch paper and send the duly filled form to the scheme office.
FEES STRUCTURE OF THE SCHEME
AF- Admission fees
AMS- Annual Membership Subscription
AFAC- Advance Financial Assistance Contribution
First Year (At the time of Enrolment)
| AGE | AF | AMS | AFAC | GST18% | TOTALRs. |
|---|---|---|---|---|---|
| Less than 25 | 1000 | 500 | 2500 | 720 | 4720 |
| Above 25 yrs below 35 yrs | 1000 | 500 | 3000 | 810 | 5310 |
| 35 yrs to below 45 yrs | 1250 | 500 | 3000 | 855 | 5605 |
| 45 yrs to below 55 yrs | 1750 | 500 | 3000 | 945 | 6195 |
| 55 yrs to below 60 yrs | 5000 | 500 | 5000 | 1890 | 12390 |
| AGE | AF | AMS | AFAC | GST18% | TOTAL |
|---|---|---|---|---|---|
| 60 yrs to below 65 yrs | 7000 | 500 | 7000 | 2610 | 17110 |
| 65 yrs to below 70 yrs | 8000 | 500 | 8000 | 2970 | 19470 |
| 70 yrs to below 80 yrs | 10000 | 500 | 10000 | 3690 | 24190 |
Next Year (Yearly Renewal)
| AGE | AMS | AFAC | GST 18% | TOTALRs. |
|---|---|---|---|---|
| Less than 25 | 500 | 2500 | 540 | 3540 |
| Above 25 yrs below 35 yrs | 500 | 3000 | 630 | 4130 |
| 35 yrs to below 45 yrs | 500 | 3000 | 630 | 4130 |
| 45 yrs to below 55 yrs | 500 | 3000 | 630 | 4130 |
| 55 yrs to below 60 yrs | 500 | 5000 | 990 | 6490 |
| AGE | AMS | AFAC | GST18% | TOTAL | |
|---|---|---|---|---|---|
| 60 yrs to below 65 yrs | 500 | 7000 | 1350 | 8850 | |
| 65 yrs to below 70 yrs | 500 | 8000 | 1530 | 10030 | |
| 70 yrs to below 80 yrs | 500 | 10000 | 1890 | 12390 | |
| AMS and AFAC have to be paid every year | |||||