National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation & Multiple Disabilities

Niramaya Scheme / contd...

Stop Loss
In case of total claims exceeding the total premium amount, the Insurance Company will cover the risk up to 120% of the
total premium amount i.e. the insurance company can have a stop loss at 120% of total premium amount. Similarly in
case of claims falling short of total premium amount, the Insurance Company shall pay back 90% of the savings, after
deducting 20% as administrative cost.
Implementation
The entire scheme may be implemented & monitored by the National Trust through registered organisation with the active
participation of the Local Level Committees (LLC). The registered organisation shall liaise with the Insurance Company,
health service providers, LLCs, State Nodal Agency Centres (SNAC) of the National Trust, State Govt. and all the
stakeholders concerned for awareness generation, enrolment as well as for the speedy settlement of claims.

ANNEXURE-A'NIRAMAYA'-Revised Benefit Chart

(On Reimbursement Basis only)
Section Sub Section
Detail Sub Limit
Over all Limit of Section
I Over all Limit of Hospitalization
1,00,000/- A Hospitalization 1,00,000/- B Corrective Surgeries for existing Disability including congenital disability 50,000/C Non- Surgical
15,000/- D Surgery to prevent further aggravation of disability 15,000/- IIOverall Limit for Out Patient Department
10,000/- A OPD treatment including the pathology, diagnostic tests
5,000/- B Regular Medical checkup for non-ailing disabled 5,000/- COngoing Therapies to reduce impact of disability,
disability and disability related complications
7,500/- D Dental Preventive Dentistry
7,500/- III Alternative Medicine(to be considered with in limit of IPD or OPD)
2,000/- IV Transportation costs (to be considered within limit of IPD or OPD)
150 per visit (for 3 visit)
450/- OVERALL LIMIT OF THE COVERAGE FOR A PERSON:Rs.1,00,000/Prev | 1 | 2 | 3

http://www.thenationaltrust.co.in/nt

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Generated: 9 August, 2014, 08:40