Tag Archives: health insurance

health insurance claims – covid

IRDAI circular dated 23rd april, 2021 advising health insurance companies to honour cashless covid claims.

1.  There are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having cashless arrangement with Insurers.

2.  In compliance with the provisions of Regulation 31of IRDAI ( Health Insurance ) Regulations, 2016, the Insurers, in case of “cashless claim” under a health insurance policy, are advised to ensure expeditious settlement of such claims on cashless basis in accordance to the Service Level Agreements ( SLAs) entered with hospitals.

3.  While reviewing cashless requests the Insurers are also advised to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable. Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers.

4.  In order to ensure that all network providers extend cashless services to policyholders and to address any issues causing inconvenience to policyholders while availing cashless service, the Insurers are advised to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders. Insurers are advised to report levying of excess charges or denial of cashless facility to the respective State Governments for appropriate action.

5.  All Insurers are directed to ensure that the “reimbursement claims “under a health insurance policy shall be settled as per the terms and conditions of the respective policy contract expeditiously. Insurers are advised to issue suitable guidelines on this to all TPAs.

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basic information to insured

IRDAI circular dated 1st March, 2021 laying down the basic information that should be provided on health insurance to policy holders at the time of issue of the policy and thereafter twice a year. Read on.

1.    Attention is drawn to the provisions of Regulation 12 of IRDAI (Protection of Policyholders’ interests) Regulations, 2017 specifying therein minimum information to be provided as part of health insurance policy. While the policy document is forwarded with relevant information, in order to continue the relationship with policyholders and to ensure information flow, it is considered important to periodically notify the policyholders certain relevant and key details relating to health insurance coverage available to the policyholders.

2.    In order to ensure flow of relevant information to policyholders the following norms are specified:

i)             All the general and health insurers as part of policy servicing, shall communicate the following basic information about the health insurance policy to the policyholders:

a.    Name of Product and policy number,

b.    Extent of coverage available by way of available Sum Insured and Cumulative Bonus,

c.    Number of insured people covered under policy,

d.    Policy period,

e.    Number and amount of claim settled (under relevant period), if any,

f.     Balance Sum Insured and Accrued cumulative bonus available, if any,

g.    Due date of renewal and premium payment frequency,

h.    Premium amount due on renewal (to be specified at the time of renewal)

i.      Grace Period (within 5 days after renewal due date)

j.      Contact details (for any query or other issues) of customer support service of Insurer, Toll Free No. or e-mail Id etc.

ii)            The above information shall be communicated by insurers to all the policyholders twice in a year, i.e, 6 months after issuance of policy and at least 1 month prior to the renewal due date. However, in case of a multiyear policy, the information can be shared with a frequency of 6 months from the date of issuance of policy.

iii)           In addition to the above, in the event settlement of any claim under a health insurance policy, the insurer shall also communicate the details of balance sum insured along with the cumulative bonus available, if any, to the policyholder. This shall be notified to the policyholders within 15 days of settlement of claim.

iv)           The insurer may choose any mode of communication (message, e-mail, letter etc) for the purpose of notifying the above referred information. The sample messages / communications that all the insurers to notify to the policyholders is placed at Annexure-1 for illustration purpose only. Insurers can improve on the same while refraining from making the message complex, unintelligible or too long with unnecessary information. These norms are applicable to all individual (both indemnity and benefit based) health insurance policies.

3.    All the insurance companies shall comply with the instructions issued in this circular at the earliest and not later than 1st June 2021.

https://www.irdai.gov.in/ADMINCMS/cms/Circulars_Layout.aspx?page=PageNo4384

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portability on health insurance policies

IRDAI circular dated 7th October, 2020 on the subject,

Re:  Additional Norms on portability under Health Insurance policies

  1. Reference is drawn to Chapter VIII of “Consolidated Guidelines on Product filing in Health Insurance Business” (Ref: IRDAI/ HLT/ REG/ CIR/ 194/07/2020 dated 22.07.2020) through which guidelines on migration and portability of health insurance policies were specified.
  2. Further to the above referred guidelines, for seamless coverage with continuity of benefits to the account holders of various banks who are provided health insurance coverage through group insurance schemes, the following guidelines are hereby issued.

a.    Members of an indemnity based group health insurance policy offered to account holders of a bank are allowed portability of their coverage to another indemnity based group health insurance policy offered by a different insurer to the account holders of the same bank.

b.   The portability will be offered subject to the option exercised by an individual member of the group policy.

c.    All other norms specified in Chapter VIII of the above referred guidelines are also applicable.

  1. These additional guidelines are issued in exercise of the powers vested under Regulation 17 of IRDAI (Health Insurance) Regulations, 2016 read with Section 34(1) of the Insurance Act, 1938 and will come into force with immediate effect.
  2. This has the approval of the competent authority.

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unauthorised entities selling health insurance

Public notice posted on IRDAI site. Public should take care and buy policies only from recognised & approved insurance companies.

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wellness features in insurance policies

IRDA circular dated 4th September 2020 on adding wellness features to life insurance polices by life, general & health insurance companies – what is allowed, what is not allowed, what approvals to be taken etc. Gist of circular follows:

Reference is invited to Chapter VII of the Consolidated Guidelines on Product Filing in Health Insurance Business issued vide Circular Ref: IRDAI/HLT/REG/CIR/194/07/2020 dated 22nd July, 2020 specifying norms on Wellness features. In supersession of these Guidelines on wellness features / benefits, under the provisions of Sec 34(1) of the Insurance Act 1938, read with Regulation 8(d) and 19 of IRDAI (Health Insurance) Regulations 2016, the following norms are prescribed:

a.    Any wellness and preventive feature shall be designed only with the objective of maintaining and improving good health, thereby enabling affordable health insurance.

b.    As part of promoting wellness and preventive regime, insurers may offer reward points to those policyholders who comply with or meet the set criteria of wellness and preventive features.

c.    No Wellness and preventive feature shall be offered without it being filed or incorporated as part of the product in terms of the Product Filing Guidelines. The methodology and criteria to be used for arriving at the reward points and corresponding reward points to be awarded need to be filed.

d.    Wellness and preventive features under a policy may also be offered either as optional or add-on cover.

e.    There shall be no discrimination in providing any of the wellness and preventive features offered and in granting the reward points thereunder to the same or similarly placed categories of policyholders of the underlying health insurance product. 

f.     Every Insurer shall assess the pricing impact of wellness and preventive features offered, if any, and the same shall be disclosed upfront in the File and Use or Use and File application, as may be the case, as specified in the Product Filing Guidelines.

g.    Based on criteria stipulated for wellness and fitness, insurers may endeavor promoting wellness amongst health insurance policyholders by offering the following services:

                     i)        Health specific services provided by Network providers or other empanelled hospitals / service providers for the following (in addition to any such benefits already offered):

a)    Outpatient consultations or treatments

b)    Pharmaceuticals

c)    Health check-ups/diagnostics

Including discounts on all the above.

                    ii)        Redeemable vouchers to obtain health supplements.

                   iii)        Redeemable vouchers for membership in:

a) Yoga centers

b) Gymnasiums

c) Sports clubs

d) Fitness centers for participating in fitness activities.

                   iv)        Discounts on premiums and/or increase in sum insured at the time of renewals based on wellness regime followed by policyholders in the preceding policy period; provided increase in sum insured shall be independent and shall not be linked to the cumulative bonus offered, if any.

                    v)        Coverage of cost of treatment of any admissible claim in respect of non-payable items that are specified under the terms and conditions of the base policy.

Provided, where more than one reward is offered, choice shall be given to the policyholder to choose as per his/her requirement or need.

h.    Insurers shall not publish the trade names or trade logos of third party merchandize in any of the insurance advertisements, but may refer the services in generic term. However, Insurers shall disclose the specific items of services in their website with necessary details and may provide a link to this in their insurance advertisement and policy contracts.

Provided insurers shall not promote products or services of any particular third party service provider.

Provided further, where multiple service providers are engaged by the insurers for providing benefits / services, the policyholders shall be allowed to choose a service provider of their choice for availing the wellness benefits / services.

i.      Insurers shall endeavour to engage multiple service providers for providing benefits / services under wellness and preventive features and the list of service providers may be constantly expanded by the Insurers. Insurers shall not accept any liability towards quality of the services made available by third parties and shall specify upfront that the said third party is responsible for providing the services stipulated under the wellness features and insurer is not liable for any defects or deficiencies on the part of the service provider. Insurers shall monitor the quality of service offered by service providers under wellness / preventive programs and ensure that they have put in place appropriate mechanism to discharge their obligations provided under wellness program of the applicable health insurance product.

j.      Other than the monetized value of the reward points redeemed by the policyholders, no payments shall be made by insurers to the third party merchants.

k.    Insurers shall not receive any consideration amount for offering the third party services.

l.      The operational costs, if any, for administering wellness and preventive features shall be factored into the pricing of the underlying health insurance product and costs factored shall be disclosed in the prospectus or sales literature (invitation to contract) wherever wellness and preventive features are offered.

m.  In case of Family Floater Plans, Insurers shall clearly define and disclose in policy document, the manner in which accrual and redemption of rewards is considered in respect of all members covered.

n.    Insurers shall clearly specify in the policy contract as to whether the accrued rewards can be carried forward or not when the policy is renewed with the Insurer and the period of validity of the accrued rewards under both the scenarios. In case of expiry of policy, the accrued rewards may be carried forward for a period not exceeding three months.

o.    The rewards accrued shall be at periodic intervals at rates/amounts declared upfront at the commencement of the policy and shall not be linked to any dynamic factor such as interest rate. The same shall be specified in the Policy Document.

p.    Insurer shall notify the rewards accrued to the credit of a Policyholder and entitlements of the policyholders under the wellness and preventive features at periodic intervals, at least once in a year.

q.    Insurer shall specify in the policy contract and prospectus, the mode of communication that the Insurer adopts for notification of various services offered under the wellness and preventive features.

r.     Insurers shall specify the manner of redeeming the rewards accrued under the wellness and preventive features in the prospectus, policy wordings and shall disclose updated information in their website.

s.    Insurer shall be responsible for any errors or omission in calculation of accrued rewards and shall address the same through their in-house Grievance Redressal Mechanism.

t.     Information gathered, if any, during the process of offering the wellness and preventive features of the policy, shall be kept confidential and shall not be used for purposes other than what it is meant for.

2.    The Authority reserves the right to reject wellness and preventive features proposed by the insurer if they are against policyholders’ interests and are not in line with fair market conduct notwithstanding the fact that they may broadly meet with the above guidelines.

3.    The Authority reserves the right to instruct the insurers to withdraw any wellness and preventive feature which is not in compliance with any regulations or guidelines issued by the Authority or which is found to be prejudicial to the interests of the policyholders or not in line with fair market conduct. The Authority also reserves the right in such cases to take appropriate action as deemed fit.

4.    Existing products may be modified either as per Clause (C) of Chapter III or Clause III (2) of Chapter IV of Consolidated Guidelines on Product Filing in Health Insurance Business (Ref. No: IRDAI/HLT/REG/CIR/194/07/2020 dated 22nd July, 2020) for offering wellness and preventive features in compliance to these guidelines.

5.    These Guidelines shall come into force with immediate effect.

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Telemedicine in health policies

IRDA has vide its circular dated 11th June, 2020 advised insurance companies to allow telemedicine wherever consultation with a medical practitioner is allowed within the terms of the insurance contract. Allowing telemedicine shall be part of the claims settlement of the insurers and they need not refer to the IRDA for modification. It has been ipso facto allowed without the need for health insurance companies to file a modification of their products.

Telemedicine allowed should of course be within the guidelines dated 25th March, 2020 issued by the Medical Council of India.

IRDA circular can be found https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=PageNo4155

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Health Insurance Policy contracts – standard terms & clauses

IRDA has issued a circular dated 11th June, 2020 wherein it has stipulated standardized terms & clauses in indemnity based health insurance policy contracts (except personal accident insurance and domestic / overseas travel policy). This comes into effect from 1st October 2020 and in case of renewals from 1st April, 2021 onwards.

https://www.irdai.gov.in/ADMINCMS/cms/Circulars_Layout.aspx?page=PageNo4157

Objective of this is to standardise the clauses in these contracts.

Gist of the standardized terms & clauses are given below

StandardGeneralTerms and Clauses:

1      Disclosure of Information

The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, misdescription or non-disclosure of any material fact by the policyholder.

(Explanation: “Material facts” for the purpose of this policy shall mean all relevant information sought by the company in the proposal form and other connected documents to enable it to take informed decision in the context of underwriting the risk)

2      Condition Precedent to Admission of Liability

The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any payment for claim(s) arising under the policy.

3      Claim Settlement (provision for Penal Interest)

             i.       The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.

            ii.       In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.

           iii.       However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle or reject the claim within 45 days from the date of receipt of last necessary document.

           iv.       In case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the policyholder at a rate 2% above the bank rate from the date of receipt of last necessary document to the date of payment of claim.

(Explanation: “Bank rate” shall mean the rate fixed by the Reserve Bank of India (RBI) at the beginning of the financial year in which claim has fallen due)

(Note to Insurers: The Clause shall be suitably modified by the insurer based on the amendment(s), if any to the relevant provisions of Protection of Policyholder’s Interests Regulations, 2017)

4      Complete Discharge

Any payment to the policyholder, insured person or his/ her nominees or his/ her legal representative or assignee or to the Hospital, as the case may be, for any benefit under the policy shall be a valid discharge towards payment of claim by the Company to the extent of that amount for the particular claim.

5      Multiple Policies

              i.    In case of multiple policies taken by an insured person during a period from one or more insurers toindemnify treatment costs, the insured person shall have the right to require a settlement of his/herclaim in terms of any of his/her policies. In all such cases the insurer chosen by the insured person shall be obliged to settle theclaim as long as the claim is within the limits of and according to the terms of the chosen policy.

             ii.    Insured person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other policy / policies even if the sum insured is not exhausted. Then the insurershall independently settle the claim subject to the terms and conditions of this policy.

            iii.    If the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose insurer from whomhe/she wants to claim the balance amount.

           iv.    Where an insured person has policies from more than one insurer to cover the same risk onindemnity basis, the insured person shall only be indemnified the treatment costs in accordancewith the terms and conditions of the chosen policy.

6      Fraud

If any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any fraudulent means or devices are used by the insured person or anyone acting on his/her behalf to obtain any benefit under this policy, all benefits under this policy and the premium paid shall be forfeited.

Any amount already paid against claims made under this policy but which are found fraudulent later shall be repaid by all recipient(s)/policyholder(s), who has made that particular claim,who shall be jointly and severally liable for such repayment to the insurer.

Forthepurposeofthisclause,theexpression”fraud”meansanyofthefollowingactscommittedbytheinsured personorbyhisagentor the hospital/doctor/any other party acting on behalf of the insured person, withintenttodeceivetheinsurerortoinducetheinsurertoissueaninsurancepolicy:

a)    the suggestion, as a fact of that whichisnottrueandwhichtheinsured persondoes not believetobetrue;

b)    theactive concealmentof afactbytheinsured personhavingknowledgeorbeliefofthefact;

c)    anyother act fitted to deceive; and

d)    anysuchactoromissionasthelawspeciallydeclarestobefraudulent

The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if the insured person / beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such misstatement of or suppression of material fact are within the knowledge of the insurer.

7      Cancellation

i.         The policyholder may cancel this policy by giving 15days’ written notice and in such an event, the Company shall refund premium for the unexpired policyperiod as detailed below.

(Note to Insurers: Insurer shall specify the method of refund calculation)

Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, anyclaim has been admitted or has been lodged or any benefit has been availed by the insured person under the policy.

(Note to insurers: Insurer may relax this condition as per the product design)

ii.       The Company may cancel thepolicy at any time on grounds of misrepresentation non-disclosure of material facts, fraud by the insured personby giving 15 days’ written notice. There would be no refund of premium on cancellation on grounds of misrepresentation, non-disclosure of material facts or fraud.

8      Migration

The insured person will have the option to migrate the policy to other health insurance products/plans offered by the company by applying for migration of the policyatleast30 days before the policy renewal date as per IRDAI guidelineson Migration. If such person is presently covered and has been continuously covered without any lapses under any health insurance product/plan offered by the company,the insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on migration.

For DetailedGuidelines on migration, kindly refer the link ………

(Note to Insurers: Insurer to provide link to the IRDAI guidelineson migration.Timelines for applying for migration may be relaxed by the insurer subject to product design)

9      Portability

The insured person will have the option to port the policy to other insurers by applying to suchinsurer to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.

For Detailed Guidelines on portability, kindly refer the link ………

(Note to Insurers: Insurer to provide link to the IRDAI guidelines related to portability.Timelines for applying for portability may be relaxed by the insurer subject to product design)

10   Renewal of Policy

The policy shall ordinarily be renewable except on grounds of fraud, misrepresentation by the insured person.

i.      The Company shall endeavor to give notice for renewal. However, the Company is not under obligation to give any notice for renewal.

ii.    Renewal shall not be denied on the ground that the insured person had made a claim or claims in the preceding policy years.

iii.    Request for renewal along with requisite premium shall be received by the Company before the end of the policy period.

iv.   At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of …… days (Note to insurers: Insurer to specify grace period as per product design) to maintain continuity of benefits withoutbreak in policy. Coverage is not available during the grace period.

v.    No loading shall apply on renewals based on individual claims experience.

11   Withdrawal of Policy

          i.       In the likelihood of this product being withdrawn in future, the Company will intimate the insured person about the same 90 days prior to expiry of the policy.

         ii.       Insured Person will have the option to migrate to similar health insurance product available with the Company at the time of renewal with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period. as per IRDAI guidelines, provided the policy has been maintained without a break.

12   Moratorium Period

After completion of eight continuous years under the policy no look back to be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently completion of 8 continuous years would be applicable from date of enhancement of sums insured only on the enhanced limits. After the expiry of Moratorium Period no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all limits, sub limits, co-payments, deductibles as per the policy contract.

13   Premium Payment in Instalments (Wherever applicable)

If the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly, as mentioned in the policy Schedule/Certificate of Insurance, the following Conditions shall apply (notwithstanding any terms contrary elsewhere in the policy)

i.         Grace Period of ___ (Note to Insurers: Insurer to specify grace period as per product design) days would be given to pay the instalment premium due for the policy.

ii.       During such grace period, coverage will not be available from the due date of instalment premium till the date of receipt of premium by Company.

iii.      The insured person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific Waiting Periods” in the event of payment of premium within the stipulated grace Period.

iv.     No interest will be charged If the instalment premium is not paid on due date.

v.       In case of instalment premium due not received within the grace period, the policy will get cancelled.

vi.     In the event of a claim, all subsequent premium instalments shall immediately become due and payable.

vii.    The company has the right to recover and deduct all the pending installments from the claim amount due under the policy.

14   Possibility of Revision of Terms of the Policy Including the Premium Rates

The Company, with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured person shall be notified three months before the changes are effected.

15   Free look period

The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of porting/migrating the policy.

The insured person shall be allowed free look period of fifteen days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.

If the insured has not made any claim during the Free Look Period, the insured shall be entitled to

i.      a refund of the premium paid less any expenses incurred by the Company on medical examination of the insured person and the stamp duty charges or

ii.    where the risk has already commenced and the option of return of the policy is exercised by the insured person, a deduction towards the proportionate risk premium for period of coveror

iii.   Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period;

(Note to insurers: Insurer may increase the free look period as per the product design)

16   Redressal of Grievance

In case of any grievance the insured person may contact the company through

Website:

Toll free:

E-mail:

Fax :

Courier:

Insured person may also approach the grievance cell at any of the company’s branches with the details of grievance

If Insured person is not satisfied with the redressalof grievance through one of the above methods, insured person may contact the grievance officerat ………….

For updated details of grievance officer, kindly refer the link……….

(Note to insurers: Address of the Grievance Officer and link having updated details of grievance officer on website to be specified by the insurer. Insurer to also specify separate contact details for senior citizens)

If Insured person is not satisfied with the redressalof grievance through above methodstheinsured person may also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievanceas per Insurance Ombudsman Rules 2017. (Note to insurers: Insurer to specify the latest contact details of offices of Insurance Ombudsman)

Grievance may also be lodged at IRDAI Integrated Grievance Management System – https://igms.irda.gov.in/

17   Nomination:

The policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under the policy in the event of death of the policyholder. Any change of nomination shall be communicated to the company in writing and such change shall be effective only when an endorsement on the policy is made. In the event of death of the policyholder, the Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, to the legal heirs or legal representatives of the policyholder whose discharge shall be treated as full and finaldischarge of its liability under the policy.

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Insurance – Covid relief

Govt. has given relief in case of motor vehicle 3rd party insurance policies and health insurance policies, if the renewal date falls between 25th March 2020 to 14th April, 2020, then they can make payment of their renewal policies upto 21st April, 2020.

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Covid economic relief

PIB press release dated 26th march, 2020

  • Insurance cover of Rs 50 Lakh per health worker fighting COVID-19 to be provided under Insurance Scheme
  • 80 crore poor people will to get 5 kg wheat or rice and 1 kg of preferred pulses for free every month for the next three months
  • 20 crore women Jan Dhan account holders to get Rs 500 per month for next three months
  • Increase in MNREGA wage to Rs 202 a day from Rs 182 to benefit 13.62 crore families
  • An ex-gratia of Rs 1,000 to 3 crore poor senior citizen, poor widows and poor disabled
  • Government to front-load Rs 2,000 paid to farmers in first week of April under existing PM Kisan Yojana to benefit 8.7 crore farmers
  • Central Government has given orders to State Governments to use Building and Construction Workers Welfare Fund to provide relief to Construction Workers

The Union Finance & Corporate Affairs Minister Smt. Niramla Sitharaman today announced Rs 1.70 Lakh Crore relief package under Pradhan Mantri Garib Kalyan Yojana for the poor to help them fight the battle against Corona Virus. While addressing the press conference here today, Smt. Sitharaman said “Today’s measures are intended at reaching out to the poorest of the poor, with food and money in hands, so that they do not face difficulties in buying essential supplies and meeting essential needs.”

The Minister of State for Finance & Corporate Affairs Shri Anurag Singh Thakur was also present besides Shri Atanu Chakraborty, Secretary, Department of Economic Affairs and Shri Debashish Panda, Secretary, Department of Financial Services. Following are the components of the Pradhan Mantri Garib Kalyan Package: —

PRADHAN MANTRI GARIB KALYAN PACKAGE

I. Insurance scheme for health workers fighting COVID-19 in Government Hospitals and Health Care Centres

  • Safai karamcharis, ward-boys, nurses, ASHA workers, paramedics, technicians, doctors and specialists and other health workers would be covered by a Special insurance Scheme.
  • Any health professional, who while treating Covid-19 patients, meet with some accident, then he/she would be compensated with an amount of Rs 50 lakh under the scheme.
  • All government health centres, wellness centres and hospitals of Centre as well as States would be covered under this scheme  approximately 22 lakh health workers would be provided insurance cover to fight this pandemic.

II.  PM Garib Kalyan Ann (अन्न) Yojana

  • Government of India would not allow anybody, especially any poor family, to suffer on account of non-availability of foodgrains due to disruption in the next three months.
  • 80 crore individuals, i.e, roughly two-thirds of India’s population would be covered under this scheme.
  • Each one of them would be provided double of their current entitlement over next three months.
  • This additionality would be free of cost.

Pulses:

  • To ensure adequate availability of protein to all the above mentioned individuals, 1 kg per family, would be provided pulses according to regional preferences for next three months.
  • These pulses would be provided free of cost by the Government of India.

III. Under Pradhan Mantri Garib Kalyan Yojana,

Benefit to farmers:

  • The first instalment of Rs 2,000 due in 2020-21 will be front-loaded and paid in April 2020 itself under the PM KISAN Yojana.
  • It would cover 8.7 crore farmers

IV. Cash transfers Under PM Garib Kalyan Yojana:

Help to Poor:

  • A total of 20.40 crores PMJDY women account-holders would be given an ex-gratia of Rs 500 per month for next three months.

Gas cylinders:

  • Under PM Garib Kalyan Yojanagas cylindersfree of cost, would be provided to 8 crore poor families for the next three months.

Help to low wage earners in organised sectors:

  • Wage-earners below Rs 15,000 per month in businesses having less than 100 workers are at risk of losing their employment.
  • Under this package, government proposes to pay 24 percent of their monthly wages into their PF accounts for next three months.
  • This would prevent disruption in their employment.

Support for senior citizens (above 60 years), widows and Divyang:

  • There are around 3 crore aged widows and people in Divyang category who are vulnerable due to economic disruption caused by COVID-19.
  • Government will give them Rs 1,000 to tide over difficulties during next three months.

MNREGA

  • Under PM Garib Kalyan Yojana, MNREGA wages would be increased by Rs 20 with effect from 1 April, 2020. Wage increase under MNREGA will provide an additional Rs 2,000 benefit annually to a worker.
  • This will benefit approximately 13.62 crore families.

V. Self-Help groups:

  • Women organised through 63 lakhs Self Help Groups (SHGs) support 6.85 crore households.
  1. Limit of collateral free lending would be increased from Rs 10 to Rs 20 lakhs.

VI. Other components of PM Garib Kalyan package

Organised sector:

  • Employees’ Provident Fund Regulations will be amended to include Pandemic as the reason to allow non-refundable advance of 75 percent of the amount or three months of the wages, whichever is lower, from their accounts.
  • Families of four crore workers registered under EPF can take benefit of this window.

Building and Other Construction Workers Welfare Fund:

  • Welfare Fund for Building and Other Constructions Workers has been created under a Central Government Act.
  • There are around 3.5 Crore registered workers in the Fund.
  • State Governments will be given directions to utilise this fund to provide assistance and support to these workers to protect them against economic disruptions.

District Mineral Fund

  • The State Government will be asked to utilise the funds available under District Mineral Fund (DMF) for supplementing and augmenting facilities of medical testing, screening and other requirements in connection with preventing the spread of CVID-19 pandemic as well as treating the patients affected with this pandemic.

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