Department of Financial Services launched Paripoorna Mediclaim Ayush Bima scheme exclusively for beneficiaries of the Central Government Health Scheme (CGHS). The policy aims to supplement CGHS benefits by providing additional financial protection, wider hospital access, and modern treatment coverage.
Paripoorna Mediclaim Ayush Bima Overview
Paripoorna Mediclaim Ayush Bima is an indemnity-based health insurance policy designed specifically for CGHS beneficiaries. It provides in-patient hospitalisation coverage within India, cashless treatment facilities, and coverage for modern medical procedures and AYUSH treatments. The policy can cover up to six family members under a single family floater plan.
The scheme is offered as a retail health insurance product with no GST, ensuring affordability. It is available for purchase through offices and the online platform of New India Assurance Company Limited.
Objective and scope
The scheme is intended to complement existing CGHS facilities rather than replace them. Its objectives include:
- Providing additional financial security beyond CGHS limits
- Offering access to a wider network of hospitals across India
- Covering modern medical procedures and AYUSH treatments
- Ensuring a seamless, cashless hospitalisation experience
Coverage and eligibility
- Eligible persons: Serving and retired CGHS beneficiaries and their family members
- Maximum coverage: Up to six members under one policy (family floater)
- Coverage area: In-patient hospitalisation within India only
Sum insured options:
Beneficiaries can choose one of the following:
- ₹10 lakh
- ₹20 lakh
Co-payment structure
The policy includes a co-payment component, allowing beneficiaries to select:
- 70:30 co-payment (70% insurer, 30% subscriber)
- 50:50 co-payment (50% insurer, 50% subscriber)
Premium advantage
- 28% discount compared to regular policies under the 70:30 option
- 42% discount under the 50:50 option
- No GST applicable, further reducing premium burden
Hospitalisation and treatment benefits
- Room rent:
- Normal room: Up to 1% of sum insured per day
- ICU: Up to 2% of sum insured per day
- Pre-hospitalisation expenses: Covered up to 30 days
- Post-hospitalisation expenses: Covered up to 60 days
- AYUSH treatment: 100% of sum insured (in-patient only)
- Modern treatment: Covered up to 25% of sum insured (inbuilt)
- Optional modern treatment rider: Coverage enhanced up to 100% of sum insured with 15% additional premium
Claims conditions
- Claims payable only if hospitalisation exceeds 24 hours
- Exception for approved day-care procedures
- Emergency ambulance expenses covered up to 0.5% of sum insured per event
Specific covers
- Cataract surgery:
- ₹1 lakh per eye for ₹10 lakh SI
- ₹1.5 lakh per eye for ₹20 lakh SI
- Congenital diseases: Covered after 24 months of continuous coverage
- Day-care procedures: Covered as per approved list
Policy highlights
- Exclusive for CGHS beneficiaries
- Family floater covering up to six members
- Mid-term inclusion of newborn and spouse on pro-rata premium (CGHS proof required)
- Comprehensive coverage including diagnostics, dialysis, chemotherapy, surgeries
- Flexible co-pay options (70:30 or 50:50)
- Family discount:
- 5% for 2 members
- 10% for 3 members
- 15% for more than 3 members
Additional benefits
- Cumulative bonus: 10% of sum insured for every claim-free year, up to 100%
- Cashless hospitalisation through TPA network
- Lifetime renewability with no age limit
- Waiting periods:
- 30 days (general)
- 90 days for diabetes and hypertension
- 24 months for specified illnesses
- Pre-existing disease waiver may be considered on submission of a good health certificate with no hospitalisation in the past 24 months
- Grace period of 30 days for renewal (no claims admissible during grace period)
Purchase of the policy
CGHS beneficiaries can purchase the Paripoorna Mediclaim Ayush Bima policy through New India Assurance Company Limited’s physical offices and online platform.
About Central Government Health Scheme (CGHS)
CGHS provides comprehensive healthcare services to central government employees and pensioners. It offers:
- OPD treatment and medicines
- Indoor treatment at government and empanelled private hospitals
- Maternity, child health, and family welfare services
- AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, Homeopathy)
CGHS beneficiaries can choose treatment at any empanelled private hospital.
CGHS contribution (monthly deduction as per 7th Pay Commission)
- Pay Level 1–5: ₹250
- Pay Level 6: ₹450
- Pay Level 7–11: ₹650
- Pay Level 12 and above: ₹1,000