GAISGUJ3

Group Accident Insurance Scheme under PMMSY: Medical Treatment - Gujarat

The scheme aims to provide financial assistance to fishermen/fishermen's families in case of death or injury. Through this scheme, insurance coverage for Medical Treatment is provided to eligible fishers.

राज्य नकद

राज्य / केंद्र शासित प्रदेश: गुजरात

नोडल विभाग: Agriculture, Farmers Welfare and Cooperation Department

योजना किसके लिए: Family

योजना प्रोफ़ाइल

डीबीटी (प्रत्यक्ष लाभ अंतरण): नहीं

श्रेणियाँ: कृषि, ग्रामीण व पर्यावरण, बैंकिंग, वित्तीय सेवाएँ और बीमा

उप-श्रेणियाँ: बीमा

लक्षित लाभार्थी: व्यक्तिगत

टैग: Accident, Fishermen, Medical Treatment, Insaurance, Injury

विवरण

The scheme "Group Accident Insurance Scheme under PMMSY" with a component "Permanent Partial Disability" is introduced by the Agriculture, Farmers Welfare and Co-operation Department, Government of Gujarat. Insurance of Fishers is one of the sub-components of the PMMSY, and it provides insurance coverage to fishers, which includes fishermen, fish workers, fish farmers, and other individuals directly involved in fishing and related activities. The sub scheme offers coverage for Medical Treatment. The National Fisheries Development Board (NFDB) and M/s Oriental Insurance Company Limited (OICL) implement the scheme. The premium cost is shared between the Central and State Governments, with no contribution from the beneficiary. The implementing agency of the scheme is the Commissioner of Fisheries.

Objective of scheme:

  • To financially assist the fisherman/fisherman's family in case of death/injury.

लाभ

  • Sr. No. Name of Component Standard of assistance 1. Medical Treatment₹25,000/- Mode of Disbursement:
  • The claim amount is deposited directly into the claimant& 39;s, nominee& 39;s, or legal heir& 39;s savings account via Direct Bank Transfer (DBT). Expected Time of Disbursement:
  • The insurance company will settle the claim within 15 working days of receiving the complete claim documentation. If a claim is not settled within this period, the insurance company will pay a simple interest of 10% on the admissible claim amount from the date of document submission until the payment date

**Sr. No.Name of ComponentStandard of assistance**1. Medical Treatment₹25,000/-

Mode of Disbursement:

  • The claim amount is deposited directly into the claimant's, nominee's, or legal heir's savings account via Direct Bank Transfer (DBT).

Expected Time of Disbursement:

  • The insurance company will settle the claim within 15 working days of receiving the complete claim documentation. If a claim is not settled within this period, the insurance company will pay a simple interest of 10% on the admissible claim amount from the date of document submission until the payment date.





पात्रता

  1. The applicant must be a fisher, which includes fishermen, fish workers, fish farmers, and any other person directly involved in fishing or fisheries-related activities.
  2. The applicant must be between 18 and 70 years old.
  3. The insured person should not have been 71 years of age on the date of the accident.
  4. The applicant must be approved by the State/Union Territory (UT) fisheries department.
  5. At the time of a claim, the claimant or insured fisher must be verified and certified by an "Appropriate Authority".
  6. The applicant should have registered himself in the concerned district office.

अपवर्जन

The scheme does not cover claims for death, injury, or disablement resulting from:

  • Suicide or attempted suicide.
  • Self-inflicted injury.
  • Pregnancy, childbirth, or related consequences.
  • Pre-existing physical or mental defects or infections.
  • Influence of intoxicating liquor or drugs.
  • Venereal diseases or insanity.
  • Engaging in aviation or ballooning, except as a passenger on a licensed aircraft.
  • Committing a breach of law with criminal intent.
  • Ionizing radiation or radioactive contamination from nuclear fuel or waste.
  • Nuclear weapons material.
  • Service in the armed forces.
  • Murder by an immediate beneficiary or nominee.
  • War, invasion, civil war, rebellion, or other hostilities.
  • Natural death.
  • Funeral or ambulance charges (except for accidental hospitalisation claims).
  • Weekly compensation or child education funds.

आवेदन प्रक्रिया

Offline

  1. Fishers or their legal heirs must submit the required documents to the concerned district office for assistance.
  2. The claim details must be intimated within 90 days of the accident via one of the following recognised communication methods:
  • Letter to the Insurance Company/NFDB Insurance Cell/Intermediary.
  • Email to support@pmmsygais.com.
  • Through the IT & ITES platforms provided by the intermediary.
  • Via the NFDB Toll-Free Number (1800-425-1660).
  • To the "Appropriate Authorities".

स्पष्टीकरण

myScheme पर प्रकाशित योजना सूचना से अतिरिक्त बिंदु (कानूनी सलाह नहीं)।

What is the Medical Treatment benefit under the Group Accident Insurance Scheme (GAIS)?
The Medical Treatment benefit provides financial assistance for the medical expenses of a fisher who is injured in an accident. <br>
What does the medical treatment benefit cover?
The benefit covers costs for medical treatment and hospitalisation resulting from an accident, including the cost of medicines, diagnostic tests, doctor&#39;s fees, and hospital charges. <br>
Who is eligible to claim the medical treatment benefit?
Any fisher between the ages of 18 and 70, who is registered under the scheme, is eligible for this benefit. The insured person must not have completed 71 years of age on the date of the accident. <br>
How is a claim for medical treatment initiated?
The claim must be intimated to the insurance company within 90 days from the date of the accident. <br>
What documents are required to file a claim for medical treatment?
You will need the Intimation Form, Claim Form, a cancelled cheque or bank passbook copy, Certification by the Appropriate Authority, and a government-issued ID. Additionally, you will need accident-specific documents. <br>
What additional documents are specifically required for a medical treatment claim?
You must provide the original consolidated hospital bill with a breakup of each item, original payment receipts, corresponding prescriptions, the treating doctor&#39;s certificate, a copy of the Medico Legal Certificate (MLC), and the original detailed discharge summary. <br>
Do I need to submit the original hospital bills?
Yes, you are required to submit original consolidated hospital bills and payment receipts. <br>
How long do I have to submit all the claim documents?
All claim documents for medical treatment must be submitted within 180 days of the accident. <br>
Is there a timeframe for the insurance company to settle a medical treatment claim?
Yes, the insurance company will settle the claim within 15 working days of receiving all complete documentation. <br>
Are ambulance charges covered under this benefit?
No, ambulance charges are not covered under the accidental hospitalisation claim. <br>
Does the medical treatment benefit cover pre-existing diseases?
No, the policy does not cover expenses for pre-existing physical or mental defects or illnesses. <br>

संदर्भ

आवेदन करें

अभी आवेदन करें

आधिकारिक आवेदन या कार्यक्रम पोर्टल नए टैब में खुलता है। संदेह हो तो मंत्रालय की साइट पर विवरण सत्यापित करें।

Documents Required for Government Schemes

Most government schemes require basic documents for verification. While the exact requirements vary, common documents include:

  • Aadhaar Card
  • Income Certificate
  • Caste Certificate (if applicable)
  • Residence Proof
  • Bank Account Details
  • Educational Certificates (for student schemes)

How to Apply for Government Schemes?

The application process for government schemes may be online or offline depending on the scheme. In most cases, you can follow these steps:

  1. Check eligibility criteria
  2. Collect required documents
  3. Fill the application form
  4. Submit the application online or at the relevant office
  5. Track application status