Kerala Pathrapravathaka Arogya Pariraksha Padhathi.
The Scheme is implemented by the Kerala Union of Working Journalists (KUWJ) through the United India Insurance Co. Ltd.
What does this policy cover?
If you or any of the insured persons are hospitalized, either due to sickness or any accident, we will reimburse you the expenses incurred up to the sum insured as per the terms and conditions of the Policy. We do not cover any out patient treatment, except in certain specific cases.
You are also requested to go through the definition of the Hospital/Nursing Home to understand what we mean by the term. The Policy also covers the Journalist for a sum insured of 2.5 lakhs for compensation against accidental death.
Who is eligible to get enrolled in the scheme?
All the members of the KUWJ and all the staff of the Press Clubs in Kerala.
What are the benefits that are available under the scheme?
All the members (up to the age 60) are covered against personal accident for a sum of Rs. 2,50,000 and the member and his family of not more than five (including parents up to 75 years of age) against medical insurance for an insured sum of Rs. 65,000. The sum insured under medical reimbursement shall float among the six members of the family for a period of three years.
Who will pay the premium?
The scheme is being implemented with effect from April 1, 1999 with a government grant of Rs. 10 lakh and KUWJ’s contribution of Rs. Three lakh. The KUWJ will collect Rs. 750 from each member of the scheme at the rate of Rs. 250 per year during the three years. The amount so called will be to extend the scheme at the expiry of the third year. The same system will be followed to ensure continuity of the scheme.
How to Apply?
On the proposal form available with the Press Clubs affiliated to the KUWJ.
What is special about this scheme.?
The reimbursement limit is available for a family of 6 members by one or several incidents and persons. This provides wider cover at a lower cost to you.
What is the period of cover?
The period of cover is 3 years
How does one make a claim?
On the claim form available from any of the Press Clubs affiliated to KUWJ and its registered office at Kesari Memorial building in Thiruvanathapuram.
Can one submit the claim form at any of the insurance company’s offices?
No. The claim form has to be submitted along with the documents narrated in question 15 of this write-up to the secretary of the concerned Press Club in which the claimant is a member.
Who receives the claim cheque?
The UII will send the claim cheque to KUWJ which, in turn, will give it to the claimant.
Is there a minimum period of hospitalization?
No. Hospitalisation for even 24 hours stands covered. However, for specific treatments like Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, D&C etc. even if you are discharged on the same day, the policy would cover you.
However, we will not cover any expenses for Hospitalisation in the first 30 days of Policy (not applicable from second year onwards for continuous renewals) unless it is due to injury from an accident.
Do I have to produce a medical certificate for taking the policy?
Normally, No. But if you have any adverse medical history in your answers to question no. 12 & 13 in the proposal form, then you have to submit a medical certificate in the form given in the proposal form. If there is gap in the renewal also you might have to submit Medical Certificate. Further, if you want to cover persons above 75 years of age, then also we may need a medical certificate.
Do you pay all the expenses?
Any expenses reasonably and necessarily incurred under the following heads would be paid. Room, Boarding expenses as provided by the hospital, nursing expenses, surgeon, anesthetist, medical practitioner consultants, specialists fees, charges for anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines & drugs, diagnostic materials & X-Ray, Dialysis, Chemotherapy, cost of Pacemaker, artificial limbs & cost of organs and similar expenses are met by us.
We will not pay any food expense unless if forms part of the prescribed diet and supplied by the hospital. Cost of spectacles, contact lenses also are not paid. There are also some illness which we does not cover in the first year of policy (eg. Cataract), and also some which we will not pay at all. (eg. Venereal diseases). Please refer to “exclusions” for the details.
Do you cover existing illness?
No. If you are aware of any illness or other fitness problem that you have now, then you should declare it in the proposal form. Any expenses attributable to these conditions would be excluded from the policy by specific mention. In fact, even if you are not aware of it, if it is clear that the illness had developed prior to the inception of cover, it stands excluded. The policy is meant to cover any illness or injury contracted during the currency of the insurance. If you do not declare also, the effect would be the same. If, at the time of claim we feel that the illness would have been there at the time of taking the insurance, then we would go in for detailed investigation and claim would be denied. If we can find it was in existence then that family unit may be excluded form the scope of the policy on the ground of misrepresentation. Hence we request you to kindly declare your actual state of health.
‘What about expenses before hospitalization & after that for the same illness?
Relevant medical expenses relating to sickness requiring hospitalization incurred up to 30 days prior to hospitalization and 60 days after hospitalization would be covered. Any illness would be deemed to mean continuous period of illness and it includes relapse within 45 days from last consultation with the hospital.
How do I submit a claim under the policy.?
As soon as you are hospitalized, or suffer an injury needing hospitalization, you should immediately inform
Kerala Pathrapravarthaka Arogya Pariraksha Padhathi,
Kesari Buildings, Kesari Junction,
In any case, the intimation should be made within 15 days of such an event. We would either send you an claim form or you can collect the same form Press Clubs.Within 25 days of discharge, you should make a claim to the secretary of the concerned Press Club with completed claim form, a clear certificate of hospitalization, discharge card, medical certificate, prescription for medicines and investigations and the bills, all in originals. We may also ask you to produce the X-rays, ECG recordings etc. which you may take back after the verification by the insurance company. If there are post-hospitalisation charges also to be claimed, then you may submit the claim after 60 days of the discharge. But please keep us informed.
What are the exclusions?
The insurance company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any member in connection with or in respect of Such disease which have been in existence at the time of proposing this insurance. Pre-existing condition means any illness which existed prior to the effective date of this insurance. Pre-existing condition also means any sickness or its symptoms which existed prior to the effective date of this insurance, whether or not the insured person had knowledge that the symptoms were relating to the sickness. Complications arising from pre-existing disease will be considered part of that pre-existing condition.
Any hospitalization/domiciliary hospitalization expenses incurred in the first 30 days from the commencement date of insurance cover except in case of injury arising out of accident.During the first year of the operation of insurance cover the expenses on treatment of diseases such as Cataract, Benign Prostate Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital internal diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable.Injury or diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, warlike operations (whether war be declared or not).Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.The cost of spectacles and contact lenses, hearing aids.Dental treatment or surgery of any kind unless requiring hospitalization.Convalescence, general debility, “Run-down” condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, internal self-injury and use of intoxicating drugs/alcohol.
All expenses arising out of any condition directly or indirectly caused to or associated with Human T-cell Lymph tropic Virus type III (HTLV III) or Lymphadinopathy Associated Virus (LAV) or the mutants, derivatives or variations, deficiency syndrome or any condition of a similar kind commonly referred to as AIDS.Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and of the positive existence or presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home.Expenses on vitamins and tonics unless forming part of treatment for injury or disease certified by the attending physician.Injury or disease directly or indirectly caused by or contributed to by nuclear weapon/materials.Treatment arising from or traceable to pregnancy, childbirth including Caesarean section.Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception.Ayurvedic treatment Naturopathy treatment.
Definition of Hospital/Nursing home
This term means any institution in India established for indoor care and treatment of sickness and injuries and which either has been registered either as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner.Orshould comply with minimum criteria as underit should have at least 15 inpatient beds (in class C towns 10 beds)fully equipped operation theatre of its own wherever surgical operations are carried out.fully qualified nursing staff under its employment round the clock.fully qualified doctors should be in charge round the clock.
Whom to be contacted.
The members should not communicate with the Insurance Company directly. All the communication pertaining to the scheme should be addressed to
Kerala Pathrapravarthaka Arogya Pariraksha Padhathi(KUWJ)
Kesari Buildings, Kesari Junction,
Pulimoodu, Thiruvananthapuram – 1
(Telephone : 0471 – 2471909)
All correspondences to the Convener should be routed through the Secretary of the concerned Press Club.