CMS

Micro Health Insurance

Vijay Development Resource Center

Vijaya Community Health Semi Insurance Program

This program will provide the following services and benefit package to its members.  These services and facilities are available only at the authorized hospital and pharmacy.  In case of any confusion, please contact the Office of VDRC.
Services Available:                                                  

1)    Normal check-up and consultation :
It includes all kinds of normal checkups or tests and re-inquiry.  The patient can benefit from all the services except the one defined as excluded by this insurance program (The same ticket has to be used for 10 days).

2)   Hospital admission :
For upto 5 days, this program will bear the hospital admission charges of the patient.  If the admitted days are more than five, then the member will have to bear it by him/her.
3)   Normal Delivery:
This includes the admission charges for normal delivery (normal bed) and pre and post delivery services.  But the expenses for the private cabin and pre-membership pregnancy won’t be provided by this program.
4)   Major Delivery:  
A normal bed to use and the services for major delivery case will be provided. But the expenses for separate room on cabin and pre-membership pregnancy won’t be provided by this program.
5)   Laboratory Tests:
      All sorts of laboratory tests (Pregnancy and HIV test) are included in the service package of this program.  But if the same check ups are done repeatedly and if, without any illness, a health checkup is done just for self satisfaction, the program won’t be bearing any expenses.
6)  Bone Fractures:
      In case of any fractures, this program will provide all the expenses except for the duplicate body parts or other appliances like spectacles, wheelchairs, crutches, belts etc.
7)   Radiology and other tests:
      This includes X-ray, ultrasound, endoscopy, ECG but not MRI and C.T scanning.
8)   Minor operations:
      All kinds of minor operations will be included but the expenses for surgery regarding pre-membership illness won be provided by this program.
9)    Major operations
      All kinds of operations (services available only in authorized hospitals) are included but not the expenses for the  surgery of pre membership illness.
10)   Normal Heart Problems:
      Normal heart problems are treated in the authorized hospitals.  Heart problems requiring special treatment are not included.
11)   Normal Dental problem:
      Tooth ache, tooth plucking and other simple treatments are included here.  Regular dental check ups, fill ups, scaling and replacement (tooth) are not included.
12)  Ambulance Service :
      This service is available only to transport the patient up to the authorized hospital.  But repeatedly for the same case, this service is unavailable.
13)   25% of the total cost of the medicine will be borne only if the medicines are prescribed and bought from the authorized hospital and pharmacy respectively.  But the medicines which has to be used for more than a month and the health tonics, vitamins, lotions and powders are not included.

Services which are not included by the health semi-insurance program
Treatment for the long lasting diseases like Asthma, Sugar, Cancer, AIDS, Paralysis is not included in this program. But the primary treatment for these kinds of diseases for up to one year from the date of disease identification is available through this program.

Treatment for the injuries and illness due to carelessness caused by using alcohol and drugs wont be included in this program.

The service to abort wont’ be available until and unless, it could affect the mother’s health and apart from it favoring the law, it should also be recommended by the doctor clearly.

No services will be provided in case of use of poison and un-prescribed medicines.

If in case, any argument arises on any decision has to be taken  regarding the programs decided by health semi insurance program and its services, the decision taken by VDIC will be the final one.  These services can be increased or decreased by the organization after re-observation in mind the durability of the program.
 
Insurance Premium:
The person on the family interested to be a member of this health semi-insurance program and use these services has to pay the premium of the following kind.  Sometimes, the organization could decide and bring in some different packages for the charge.
S.No.> Pattern of the family Premium rate/per head/per year
1) Family with maximum 5 members Rs.325
2) Family with maximum 10 members Rs.300
3) Family with maximum 11 members or more Rs.275
4) As a favour, an employee of any united organization can also be a member Rs.375

Note: If the number of the family increases after the card is made, the premium will be same as the previous one.

Limitations of the service and excess expense fulfillment:

1.     This program will provide an amount of Rs.15,000 at a time, totaling to Rs.30,000 (maximum) in a year to the insured members.
2.      If the insured members knowingly or unknowingly take more services than allowed, the excess amount has to be fulfilled to the organization.  If not done, the services to the member will be paused. And, in case of sickness during that period, no services will be provided.

Other Information about the Membership:
Just a person or some persons from a family couldn’t  be a member.  But the member, who are not here for most of the time, could be excluded.  In such case, the information should be given to the organization.

The 1st 30 days, from the membership issued date will be waiting period and the services will be provided to the member from the 31st day

I do hereby state that I have earnestly studied the information’s about the benefit package.  I promise solemnly to obey the rules and regulations and it abide by the same.
 

Contact us

College of Medical Sciences
  • Address: Chitwan, Nepal
  • Tel:  +977-56-521527 (Fax)
           +977-56-524203 (Hosp.)
           +977-56-523603 (Res.)