chapter viii wool & wollen textiles industry - Ministry of Textiles

annual report 2011-12
Table 10.6.
Enrolment and Claims settled under Health Insurance Scheme (upto Dec. 2011)
Policy Year Weavers’ enrolled No. of claims Settled Amount
(Rs. in Cr.)
2007-08 17,74,034 23,62,619 107.09
2008-09 18,78,334 39,50,281 118.04
2009-10 16,11,837 37,46,864 80.71
2010-11
17,97,513
2,61,632 7.08
(Policy period w.e.f.
Dec.,10 to Nov.,11)
(target)
Cumulative Total 70,61,718 1,03,21,396 312.92
2. The Service Provider has been
selected for a period of two policy
years, i.e., 2010-11 and 2011-12.
3. The Insurance Company has its
Cluster Coordinator/TPA in threefourth
of 692 clusters of the country.
4. Insurance Company has established
tie-up with OPD/IPD for cashless
facility in 90% of the handloom
clusters in each State.
5. For settlement of reimbursement
claims, the beneficiary has to submit
a claim within 60 days from the end
date of policy period.
6. The Insurance Company shall settle
such claims within 30 days from its
date of receipt.
7. In case of delay of settlement, of
valid claims, Insurance Company
pays interest on pro rata basis on
the amount @ which is 2% above the
bank rates prevalent at the beginning
of the financial year in the year in
which the claim was received by it.
8. Insurance Company provides web
based access, as far as possible,
to data relating to enrollment, MIS
reports, status of claims, balance
amount left in his account (as a
Statement of Treatment, on demand)
9. Insurance Company conduct health
camps periodically for grievance
redressal, awareness and collection
of claims.
10. Reimbursement claims can be
submitted by the beneficiary through
the Cluster Coordinator of Insurance
Company, TPA, through RPAD or
Courier.
11. A Grievance Redressal Committee
has been formed in all States having
more than 5000 health card holders.
This Committee will constitute of 3
members, will meet monthly to receive
and settle complaints/grievances and
to settle them within 60 days of the
complaint being filed. The cost of the
above Committee will be borne by
the Insurance Company
12. Insurance Company is responsible to
provide all information under RTI or
for Audit purposes to any authorized
Government agency or O/o DCHL,
as and when required.
2.2 Mahatma Gandhi Bunkar Bima
Yojana (MGBBY)
The MGBBY is being implemented
through the Life Insurance Corporation
of India. The contribution of the annual
premium of Rs.470/- per member under
the scheme is at table 10.7.
121