IMA Kerala Health Scheme, started on 1st July 2006, is meant tohelp our members to meet the needs of hospitalisation andinvestigations. Rules andregulations are coined to suit the needs ofthe members, and are amenable if need arises. Now the upper limit ofreimbursement is Rs.3 lakhs for treatment of all diseases per memberper year. IMA KHS works on the principle of mutual benefit among ourmembers and family. The Scheme is not an insurance firm but our services are more prompt and incomparable and theyearly payment islowwhen compared to the insurance companies. All the major diseasesare included in the scheme and the scrutinisingcommittee andmanaging committee have the power to include more, as the needarises, from time to time.

IMA member, their spouse, parents and children can join thescheme provided they are below 65 yearsof age. Advance FinancialAssistance Contribution (AFAC) and Annual Subscription fees (AS) areto be paidevery year. Renewal Notice shall be sent in time every year.There will be no health screening for admission to the scheme.This is atailor made scheme for IMA Members and their families.

FEES STRUCTURE OF THE SCHEME

AF- Admission fees
AMS- Annual Membership Subscription
AFAC- Advance Financial Assistance Contribution

Renewal-Yearly Renewal

AGE	AF	AMS	AFAC	TOTAL	Renewal
Less than 25	800	100	2100	3000	2200
25 Up to 35	1000	100	3000	4100	3100
35 up to 45	1500	100	3500	5100	3600
45 up to 55	2000	100	4000	6100	4100
55 up to 60	5000	100	5000	10100	5100
60 up to 65	6000	100	7000	13100	7100
AMS and AFAC have to be paid every year.

SALIENT FEATURES OF THE SCHEME

(See by laws for details)

Individuals up to the age of 65 years are eligible for membershipin the scheme. Age is considered as on the date of receipt of duly filledapplicationalong with cheque/ DD (subject to encashment) at thescheme office. Bills above Rs 5000/- shall only be considered for reimbursement. Maximum amount that can be reimbursed isRs3,00,000/- per membership year as per conditions laid on. Benefitsof the scheme shall be given only to the members or beneficiarymembers (spouses, children and parents of an IMA member who havejoined in the scheme) provided their membership is active (ie. renewedevery year.)

Benefits of the Scheme .This scheme is entitled to be helpfulto the members /beneficiary members to meet the heavy expenses for the management of coronary heart disease and surgical managementof valvular heart diseases, management of renal failure, managementof cancer, brain tumors involving surgical treatment and jointreplacement surgery for hip and knee joints, spinal surgery, Traumaand all diseases requiring admission causing expenditure above Rs.5000.00

1. Coronary Heart Disease: - Bypass surgery and Angioplasty required for the treatment of coronary heart disease and Valvular heartdisease surgery will be covered under this scheme .Upper limit willbe Rs. 3 Lakhs/year.
2. Renal Failure: - Regular haemodialysis or renal transplantation required in the management of chronic irreversible failure of boththe kidneys will be covered under the scheme.Upper limit isRs. 3 lakhs/year.
3. Malignancy: - Surgery, Radiotherapy and chemotherapy required for the treatment of all cancers will be covered under the scheme.Upper limit will be Rs. 3 Lakhs/year.
4. Management of Brain Tumour: - Radiotherapy and chemotherapy required for the treatment of brain tumours will be covered underthe scheme. Upper limit will be Rs. 3 Lakhs/year
6. Major Surgeries: - Surgery for knee and hip joints, spinal stenosis and disc surgery or other major surgeries will be covered by thescheme with an upper limit of Rs 1 lakh.
7. Other diseases: - Any serious diseases requiring hospitalization will be covered with an upper limit of Rs 50,000/-.For multi systeminvolved diseases and those requiring ventilator support the upperlimit will be Rs. 1 Lakh.
8. A member will get a maximum of benefit of Rs. 3 Lakh in one year for all diseases.

PROCEDURE FOR CLAIM

1. It is mandatory that the member has to submit original papers as well as attested photo copies of treatment certificate,dischargesummary, breakup of bills, professional charges, cost ofmedicine and investigations and any other documents upon whicha claim is based within 60 days of bill date / discharge from thehospital. The member shall also give additional information as demanded by the scheme which may be required in dealing withany claim. If a claim in any manner is found fraudulent or supportedby false evidence, the scheme shall not be liable to make anypayment and may lead to termination of membership. Original billsand papers will be given back to the member after verification, if needed, and self-addressed, stamped (for Speed Post) envelopeshould be enclosed for the purpose.
2. Eligible amount will be paid within 90 days from the submission ofthe original bills, papers and other documents upon which the claimis based. After verifying all the facts as prescribed by the managingcommittee, all payment shall be made by A/c. payee cheque/DD. Managing committee will have the discretion to pass / rejectpayment of bill in cases where they are not satisfied about thegenuineness of the claim.
3. Members will be given reimbursement of 75% of total amountofthe bill (after eductions, if any) not exceeding the sum limited toeach diseases.
4. A member will get a maximum benefit of Rs.3 Lakhs in one year.
5. ) Diagnosis and treatment costing less than Rs.5000/ will not becovered under this scheme.
6. The managing committee is empowered to add or alter or deletethe name of the list of institutions for treatment.
7. However, cost of treatment of members/beneficiary members shall be reimbursed regardless of whether they are recognized or not,provided the managing committee has not debarred them underany circumstances for any fraudulent action made in the recordsgiven to members.
8. No advance payment will be made to the members.
9. Managing committee of the scheme shall decide about the claim.State Working Committee of IMA KSB shall be the appellate body.No disputes can be challenged in any court of law
10. New members of the scheme will get the benefit on completion ofone year term after joining the scheme.(Lock in period)
11. Charges of engaging a special nurse or attendant will not bereimbursed.
12. Expense incurred on travel or ambulance will not be allowed.
13. Food, laundry and telephone bills will not be reimbursed.
14. Claim for treatment in systems other than Modern Medicine willnot be allowed.
15. Claim on cosmetic treatment, dental procedures, externalappliances like spectacle, hearing aids etc will not be reimbursed.
16. Room rent up to Rs. 1000/- per day will only be considered forreimbursement