No.

1/1/2007-DCH/WW/HWCWS
GUIDELINES FOR IMPLEMENTATION OF
HEALTH INSURANCE SCHEME (HIS)" - A COMPONENT OF
HANDLOOMS WEAVERS COMPREHENSIVE WELFARE SCHEME
1. INTRODUCTION.
TIc Covcrnmcni of India was imlcmcniing a HcaliI Paclagc ScIcmc sincc
iIc ycar 1992-93 as a wclfarc mcasurc for iIc lcncfii of Iandloom wcavcrs.
TIc Covcrnmcni of India Iad iniroduccd iIc HcaliI Insurancc ScIcmc for
Handloom Wcavcrs in 2005-06 wIicI was imlcmcnicd iIrougI wiiI ICICI
Lomlard Ccncral Insurancc Comany Lid. TIis scIcmc will lc imlcmcnicd
in iIc rcviscd form in 2007-08 and 2008-09. TIc oljcciivc and oiIcr salicni
fcaiurcs of iIc HcaliI Insurancc ScIcmc arc givcn lclow.
1. OBJECTIVE:
TIc HcaliI Insurancc ScIcmc aims ai financially cnalling iIc wcavcr
communiiy io acccss iIc lcsi of IcaliIcarc faciliiics in iIc couniry. TIc
scIcmc is io covcr noi only iIc wcavcr lui Iis wifc and iwo cIildrcn, io
covcr all rc-cisiing discascs as wcll as ncw discascs and lccing
sulsianiial rovision for OPD. TIc ancillary Handlooms worlcrs lilc iIosc
cngagcd in waring, winding, dycing, riniing, finisIing, sizing, JIala
maling, Jacquard cuiiing cic. arc also cligillc io lc covcrcd. 3
. SALIENT FEATURES OF THE SCHEME
2.1 FUNDING PATTERN

i. Coniriluiion ly iIc . Fs.642.47/- cr annum
Covi. of India (Prcmium (Fs.556.50}
Scrvicc Ta Fs. 85.97.
( 12.3% (for iIc ycar 2007-08}
iii. Coniriluiion ly iIc . Fs.139.13/- cr annum
Handloom wcavcr/ siaic Covi.
TIc minimum coniriluiion ly iIc wcavcrs sIould lc Fs. 50/- cr family
cvcn in cascs wIcrc Siaic Covcrnmcnis arc maling coniriluiion on Iis lcIalf.
III. TotaI premIum : Rs.?S1.60J- per annum
(Including Scrvicc Ta}
. ReIease oI Iunds
1. TIc Ccniral Covi's. sIarc of rcmium will lc rclcascd io iIc ICICI
Lomlard dirccily for covcragc of wcavcrs undcr iIc scIcmc in
insialmcnis. An amouni cquivalcni io iIc Covcrnmcnis coniriluiion of
rcmium amouni and scrvicc ia io iIc cicni of 30% of iIc rcmium of
iIc ioial numlcr of wcavcrs io lc covcrcd will lc rclcascd io iIc
Comany. Ai any oini of iimc wIcn 66% of iIc alovc mcniioncd amouni
is uiiliscd iowards cnrolmcni of iIc wcavcrs, iIc comany sIall scnd a
rogrcss rcori io iIc Officc of iIc Dcvclomcni Commissioncr for
Handlooms indicaiing iIc numlcr of colc cnrollcd and funds uiiliscd
for iIc samc. On rcccii of rogrcss rcori, wIicI will lc corroloraicd
furiIcr ly a ccriificaic from iIc Siaic Covcrnmcni, Officc of iIc
Dcvclomcni Commissioncr for Handlooms will ialc sics io rclcasc iIc
nci insialmcni of 30% of iIc rcmium. FuriIcr rclcascs will lc madc in
iIc samc rooriion iill iIc figurc of 90% is rcacIcd. Oncc UCs Iavc
lccn rcccivcd for 90% iIcn only iIc rcmaining amouni of 10% will lc
rclcascd. 4
2. Scrvicc Ta, as alicallc, on iIc annual insurancc rcmium of
Fs.695.63/- will lc lornc ly iIc Covcrnmcni of India
3. ICICI Lomlard will roll ovcr io iIc nci olicy criod iIc surlus
amouni, if iIc claim aid, claims in roccss including IDNF and TPA
cIargcs is lcss iIan 70% of iIc annual rcmium arovcd.
. IMPLEMENTING AGENCIES
TIc scIcmc will lc imlcmcnicd ly iIc O/o DCHL iIrougI ICICI Lomlard
Ccncral Insurancc Comany Lid. TIc Siaic Dirccior of Handlooms/Dirccior of
Indusirics/in-cIargc of Handlooms will lc rcsonsillc for cnsuring cfficicni
imlcmcniaiion of iIc scIcmc in iIcir rcscciivc Siaics.
4. ELIGIBILITY.-
For availing iIc lcncfiis undcr iIc 'HcaliI Insurancc ScIcmc for Iandloom
wcavcrs', (Icrcinaficr iIc word wcavcr" sIall includc iIc ancillary Iandlooms
worlcrs lilc iIosc cngagcd in waring, winding, dycing, riniing, finisIing,
sizing, JIala maling, Jacquard cuiiing cic. TIc wcavcr sIould fulfill iIc
following condiiions.-
TIc wcavcr sIould lc carning ai lcasi 50% of Iis incomc from Iandloom
wcaving.
All wcavcrs, wIciIcr malc or fcmalc, arc cligillc io lc covcrcd undcr iIc
HcaliI Insurancc ScIcmc". TIc scIcmc will covcr iIc wcavcr's family of
four i.c. sclf, sousc and iwo cIildrcn. TIc scIcmc is io covcr colc
lciwccn agc grou of 1 day io 80 ycars.
5

Ii will lc iIc rcsonsililiiy of iIc Siaic Dirccior In cIargc and ICICI io
cnsurc iIai womcn wcavcrs, wcavcrs lclonging io minoriiics and wcavcrs
of NEF Siaics (ArunacIal PradcsI, Assam, Maniur, McgIalaya,
Mizoram, Nagaland, Triura and Sillim} arc givcn adcquaic
rcrcscniaiion wIilc imlcmcniing iIc scIcmc.
TIc wcavcrs lclonging io iIc Siaic Handloom Dcvclomcni
Cororaiions/Ac/Primary Handloom Wcavcrs' Coocraiivc Sociciics
will lc covcrcd undcr iIc ScIcmc. Wcavcrs ouisidc co-ocraiivcs can
also lc covcrcd undcr iIc scIcmc on a ccriificaic from iIc Siaic
Dirccioraic of Handlooms iIai iIcy arc fulfilling iIc cligililiiy condiiions.
Ii will lc iIc rcsonsililiiy of iIc Siaic Dirccior in cIargc of Handlooms
io vcrify iIc cligililiiy of iIc wcavcrs and ancillary worlcrs, wIo will lc
iIc lcncficiarics of iIc scIcmc.

. COVERAGE
TIc ICICI Lomlard sIall ay / rcimlursc ccnscs incurrcd ly iIc wcavcrs in
coursc of mcdical ircaimcni availcd of in any Iosiial or nursing Iomc wiiIin
iIc couniry, suljcci io limiis/sul-limiis.
6. CASHLESS FACILITY
TIc ICICI Lomlard sIall iIrougI iis auiIorizcd rcrcscniaiivcs (TIird Pariy
Adminisiraior} rovidc a casIlcss faciliiy in cmancllcd Iosiials / nursing
Iomcs in various siaics all ovcr iIc couniry. TIis would mcan iIai a aiicni
can avail of ircaimcni in any onc of iIc ancl Iosiials wiiIoui aciually Iaving
io ay iIc lills. In casc a aiicni Ias io go io a docior or a clinic, noi in iIc
arovcd lisi, Ic can sulmii iIc rcscriiion and iIc voucIcrs for iIc
mcdicincs io iIc 6
ICICI Lomlard or iis auiIorizcd rcrcscniaiivc (TPA} wIo will cnsurc iIai full
aymcni is madc wiiI in 15 days aficr rcccii of all iIc rcquisiic documcnis
and informaiion.
?. PERIOD
7.1 TIc Policy sIall lc valid for a criod of 12 moniIs, from iIc daic of rcccii
of rcmium ly iIc insurcr.
7.2 Onc wcavcr family would normally rcccivc iIc lcncfiis for onc ycar on
aymcni of Iis / Icr sIarc of iIc rcmium, wIicI will lc cligillc io lc
rcncwcd for onc morc ycar on aymcni of Iis/ Icr sIarc of iIc rcmium
cacI ycar.
7.3 Primacy sIould lc givcn for rcncwals. Minimum 80% of iIc cascs sIould lc
rcncwcd in iIc 2nd ycar. Failurc io acIicvc 80% rcncwals in iIc 2
nd
ycar
would rcsuli in dclarmcni of iIc comany.
S. BENEFITS
(In Rs.) AnnuaI LImIt per
IamIIy (1+)
1000J-
Sul Limiis cr Family.
All rc-cisiing Discascs + Ncw
Discascs
15,000/-
Maicrniiy Dcncfiis (cr cIild for
iIc firsi iwo}
2,500/-
Dcnial ircaimcni 250/-
Eyc ircaimcni 75/-
Scciaclcs 250/-
Domiciliary Hosiialisaiion 4,000/-
Ayurvcdic/Unani/HomcoaiIic/
SiddIa
4,000/-
Hosiialisaiion (including rc
and osi}
15,000/-
Daly covcragc 500/-
OPD 7,500/-