Paripoorna Mediclaim Ayush Bima

Why was Paripoorna Mediclaim Ayush Bima Introduced

Before the introduction of Paripoorna Mediclaim Ayush Bima, beneficiaries of the Central Government Health Scheme (CGHS), particularly families facing severe or sudden health crises, remained financially vulnerable when seeking high-cost in-patient hospitalisation and specialised treatments outside standard CGHS facilities, often resulting in significant out-of-pocket expenses for room rents, modern procedures, or holistic care.

In order to bridge this gap, the Department of Financial Services under the Ministry of Finance, in partnership with New India Assurance Company Limited, launched the Paripoorna Mediclaim Ayush Bima. The purpose of this optional health insurance scheme is to offer enhanced financial protection to CGHS beneficiaries and up to six family members by expanding medical coverage, providing cashless hospitalisation up to ₹10 lakh or ₹20 lakh.

Key Highlights- Paripoorna Mediclaim Ayush Bima

Eligibility to Apply for Paripoorna Mediclaim Ayush Bima

Paripoorna Mediclaim Ayush Bima is available exclusively to beneficiaries enrolled under the Central Government Health Scheme (CGHS). It is not open to the general public.

Primary Beneficiaries Eligible For The Scheme

• Central Government Employees: Currently enrolled in CGHS as active employees.
• Central Government Pensioners: Former central government employees enjoying the benefits of the CGHS scheme.

Eligible Dependents Of Family Members

• Covering Dependents: Includes spouse, dependent children, and eligible dependents as permitted by CGHS regulations.
• Maximum Coverage: Up to six members from the same family can be included in the family floater scheme.
• Mid-term Enrollment Facility: Provides a facility to add newborn infants and newly married couples in the post-enrollment period.

What Paripoorna Mediclaim Ayush Bima Covers

Paripoorna Mediclaim Ayush Bima provides hospitalisation coverage across India with sum insured options of ₹10 lakh or ₹20 lakh.

Primary Coverages

• Traditional (AYUSH) Treatments: Covers 100% of your total policy amount for hospital stays using traditional systems like Ayurveda, Yoga, Naturopathy, Unani, Siddha, or Homoeopathy.
• Modern Medical Treatments: The basic plan pays up to 25% of your total policy amount for standard modern (allopathic) hospital treatments, but you can upgrade this to 100% coverage by buying an extra add-on (rider).
• Pre and Post-Hospitalisation: Covers medical expenses incurred up to 30 days prior to hospital admission and 60 days following discharge.
• Cashless Treatment: Provides access to cashless hospitalisation across New India Assurance Company Limited's nationwide network of empanelled hospitals.
• Room Rent & ICU Charges: daily room charges are capped at 1% of your total policy amount for normal rooms, and 2% for ICU stays.
• Co-Payment Options: Lets you choose how to split your hospital bills with the insurance company, either 70:30 (insurance pays 70%, you pay 30%) or 50:50 (insurance pays 50%, you pay 50%)
• Cumulative Bonus: Increases your total policy amount by 10% for every year you don't make a claim, up to a maximum of 100% extra coverage.
• Day Care & Advanced Procedures: Covers procedures that take less than 24 hours (day care), associated costs like surgeon fees and chemotherapy, organ donor expenses, and emergency ambulance rides (up to 0.5% of your total policy amount).

Documents Needed for Paripoorna Mediclaim Ayush Bima

• Proof of CGHS (Compulsory): CGHS Card or Beneficiary Card of the current employee/pensioner with details of all the family members under that scheme.
• Proof of Identity and Proof of Address: Aadhaar Card, PAN Card, Passport, Utility Bills, Voter ID, and Official Government Quarters Allotment Letter.
• Proof of Age: Birth Certificate, Aadhaar Card, Passport, or Class 10th School Certificate (dependents/children).
• Proof of Relationship: Ration Card, CGHS Card (indicating family structure), Marriage Certificate (spouse), and Birth Certificate (children).
• Medical & Pre-Existing Disease (PED) Declaration:
  • Proposal Form: Complete the form properly, declaring any health issues you may be suffering from.
  • Good Health Certificate / Employer Certificate: Doctor’s note or an employer’s letter confirming you are in good health. This is needed only if you want to do away with or reduce the waiting period of the insurance coverage for pre-existing diseases.

How to Apply Step by Step

Step 1: Check for Eligibility and Collect Required Documents

Verify Eligibility: The applicant should be a current Central Government employee or a pensioner holding a CGHS card.

Documents Required:

• Active CGHS Card / Beneficiary ID Card of the primary applicant and 5 family members (maximum 6 members).
•  Proof of identity (Aadhaar Card, PAN Card) and proof of address.
•  Good Health Certificate / PED Waiver form (for waiver / reduction in waiting periods of pre-existing diseases).

Step 2: Select Mode of Application

• Online: Go to the website of New India Assurance (newindia.co.in) and go to the Paripoorna Mediclaim Ayush Bima page.
• Offline: Approach any local branch office of The New India Assurance Company Limited (NIACL).

Step 3: Fill in the Proposal Form and Select Policy Options

• Basic Details: Fill in the basic details of your name, contact details, and mandatory CGHS Beneficiary ID Nos.
• Select Sum Insured Amount: You can select ₹10 Lakh or ₹20 Lakh as the sum insured amount.
• Co-payment Plan: Select a co-payment plan, which is 70:30 (Premium Discount of 28%) or 50:50 (Premium Discount of 42%).
• Optional Rider Selection: if you want 100% Modern Treatment Rider(Base cover for this rider is 25%).
• Include Family Members: Up to 5 dependents can be included under the family floater scheme.

Step 4: Health Declaration and Upload Documents

• Medical History and Pre-Existing Conditions have to be declared on the proposal form correctly.
• Upload the scanned copy of the CGHS card, proof of identity, address and a good health certificate if available.

Step 5: Obtain a Quote and Pay the Premium Amount

• Review the calculated premium (premiums paid are exempt from GST).
• Pay using online payment gateway (UPI, Net banking, credit/debit card) or cash/DD at NIACL branch offices.

Step 6: Generate Policy

• Get an instant digital policy document via email/SMS or visit the NIACL branch and take the physical policy bond.

Helpline and Support

Other Government Health Schemes

• Central Government Health Scheme (CGHS): The base healthcare scheme providing comprehensive medical facilities for central government employees and pensioners.
• Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides up to ₹5 lakh per family per year for secondary and tertiary care hospitalization to eligible families.
• Employees' State Insurance Scheme (ESIS): Provides full medical care and socio-economic protection to workers in the organised sector.
• Pradhan Mantri Suraksha Bima Yojana (PMSBY): An accident insurance scheme offering accidental death and disability cover