All Beneficiaries of the Scheme shall have access to cashless and paperless services under the AB PM-JAY CMHIS up to the limit of their annual coverage.
Risk Cover for each Beneficiary Family Unit (BFU) shall include hospitalization and treatment expenses coverage including treatment for medical conditions and diseases requiring secondary and tertiary level of medical and surgical care treatment and including defined day care procedures (as applicable) and follow up care along with cost for pre- and post-hospitalisation treatment
Sum Insured: As on the date of commencement of the Policy Cover Period, the AB PM-JAY CMHIS Sum Insured in respect of the Risk Cover for each CMHIS (EP) BFU shall be :
1. Basic Cover of Rs. 5,00,000 (Rupees Five Lakhs Only) per family per annum on a family floater basis.
2. Top Up Cover, over and above the Sum Insured, of Rs. 5,00,000 (Rupees Five Lakhs Only) per family/ Rs. 15,00,000 (Rupees Fifteen Lakhs Only) per family per annum on a family floater basis.
(*this top up cover will be decided on 21st/22nd September 2022)
Risk cover to be provided on a family floater basis: Risk cover for each BFU shall be provided on a family floater basis covering all the members of the BFU including Senior Citizens, i.e., the Sum Insured including the Basic Cover and the Top Up Cover shall be available to any or all members of such BFU for one or more Claims during each Policy Cover Period.
Ward entitlement: Facility of private ward will be allowed to those drawing pay of Level 15 and equivalent or above or equivalent, semi-private ward to those drawing pay between Levels 10 to 14 and equivalent (both inclusive), and the remaining employees will be allowed general wards.
All pre-existing conditions/diseases to be covered.
OPD services and standalone diagnostics are not covered
*In exceptional circumstances, where the serving employee household has exhausted the sum insured and employee spends out of pocket for treatment beyond the sum insured, the employee shall be reimbursed on a case to case basis on recommendation of the State Medical Board.
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