Tender Notice Dt - Department of Health , J&K

4. Unit of Enrolment:4.1. The unit of enrolment for this scheme is family. Coverage under thescheme would be provided identified beneficiaries and their families[up to a unit of five).4.2. This would comprise the Household Head, spouse, and up to threedependents. The dependents would include such members who arelisted as part of the family in the BPL data base and database of otherbeneficiaries (if applicable).4.3. Head of the household will need to identify three members (In caseswhere spouse is not present in the family details, four members canbe identified) who will be enrolled in the scheme. If the spouse is partof the identified beneficiary family list then it would be mandatory toenroll the spouse.5. Benefits:5.1. The Benefits within this scheme, to be provided on a cashless basis tothe Beneficiaries up to the limit of their annual coverage, packagecharges on specific procedures and subject to other terms andconditions outlined herein, are the following:a) The scheme shall provide coverage for meeting expenses ofhospitalization for medical and/or surgical procedures includingmaternity benefits, to the enrolled families up to Rs.30,000 perfamily per year subject to limits, in any of the network hospitals.The benefit to the family will be on floater basis, i.e., the totalreimbursement of Rs.30,000 can be availed of individually orcollectively by members of the family per year.b) Pre-existing conditions/diseases are to be covered from day one,subject to the exclusions given in Annexure 8.c) Coverage of health services related to surgical nature shall also beprovided on a day care basis.The Insurance Company shall provide coverage for the following daycare treatments/ procedures:i) Haemo-Dialysisii) Parenteral Chemotherapyiii) Radiotherapy6