New Optional Health Insurance “Paripoorna Mediclaim Ayush Bima” Launched for CGHS Beneficiaries

In a major initiative to strengthen healthcare protection for Central Government employees and pensioners, the Department of Financial Services (DFS) under the Ministry of Finance has launched an optional health insurance scheme titled “Paripoorna Mediclaim Ayush Bima” exclusively for beneficiaries of the Central Government Health Scheme (CGHS).

The new policy is designed to supplement existing CGHS benefits by offering higher financial protection, wider hospital coverage, and inclusion of AYUSH and modern treatments at affordable premiums.

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Optional Insurance to Complement CGHS

Paripoorna Mediclaim Ayush Bima is not a replacement for CGHS but an additional, voluntary insurance cover that CGHS beneficiaries can opt for based on their healthcare needs. The scheme provides indemnity-based coverage for in-patient hospitalisation and will be available across India with cashless treatment facilities.

Each policy can cover up to six family members, making it suitable for both serving employees and pensioners.

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Coverage and Sum Insured Options

Beneficiaries can choose from two sum insured options:

• ₹10 lakh
• ₹20 lakh

The policy allows flexibility through co-payment options of 70:30 or 50:50 between the insurer and the beneficiary. Depending on the co-payment choice, policy premiums are discounted by 28% and 42% respectively, compared to standard health insurance products.

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Hospitalisation and Treatment Benefits

The scheme provides coverage for hospitalisation expenses with defined room rent limits. Room rent is capped at 1% of the sum insured per day, while ICU charges are capped at 2% of the sum insured per day.

In addition, the policy covers medical expenses incurred 30 days prior to hospitalisation and 60 days after discharge, ensuring continuity of care.

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AYUSH and Modern Treatment Coverage

A key feature of the policy is the inclusion of AYUSH treatments, which are covered up to 100% of the sum insured for in-patient care.

Coverage for modern medical treatments is available up to 25% of the sum insured, with an option to enhance this limit to 100% through an additional rider.

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Cumulative Bonus and Tax Relief

Policyholders will receive a 10% cumulative bonus on the sum insured for every claim-free year, subject to a maximum of 100% of the base sum insured.

To keep the policy affordable, no Goods and Services Tax (GST) will be levied on the premium amount.

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Availability and Implementation

Paripoorna Mediclaim Ayush Bima will be offered through New India Assurance Company Limited, both via its offices and online platforms. Detailed guidelines on enrollment, premium structure, and policy terms are expected to be released shortly.

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Significance for Government Employees and Pensioners

The launch of this scheme reflects the government’s continued effort to enhance healthcare security for its workforce and retirees. By providing higher coverage limits, broader treatment options, and cost-effective premiums, Paripoorna Mediclaim Ayush Bima is expected to reduce out-of-pocket medical expenses and offer greater peace of mind to CGHS beneficiaries.

Source: PIB