The
Scheme is meant to provide medical treatment facility to the patients suffering
from serious ailments related to Kidney, Heart, Liver, Cancer and Brain or any
other life threatening diseases including Knee surgery and Spinal surgery to SC
persons whose annual family income is less than Rs.50,000/- p.a. and will be
implemented through the following Hospitals in addition to the existing 10
listed Hospitals.
(1) All
India Institute of Medical Sciences,
(2) Sanjay Gandhi Post Graduate Institute,
(3)
(4)
(5) B. Barua Cancer Institute,
(6) Birla Heart Foundation, Kolkata,
(7) Kalinga Hospital Ltd. Chandrashekharpur,
(8) Tata Cancer Research Institute, Mumbai,
(9) Nizam Institute of Medical Sciences,
(10) The Voluntary Health Services,
Chennai.
(11) All CGHS
approved Hospitals as revised from time to time by the Ministry of Health &
Family Welfare.
(12) All State
Government Medical Colleges attached Hospitals even if not included under CGHS
Scheme.
(13) All State Hospitals.
(14) All Hospitals recognized by State Government
(15) All Hospitals fully funded by either the
Central Government or the State Governments.
(16) All
Government Hospitals in District Headquarters/ major towns where surgery or
treatment facility for Kidney, Heart, Liver Cancer and Brain or any other life
threatening disease including knee surgery and spinal surgery is available.
(17) In exceptional cases where the Chairperson
is personally convinced of the genuineness and justification for the need of
any Hospital outside the approved list can be approached for eligible
treatment.
ELIGIBILITY
i The applicant shall belong to
Scheduled Caste Community.
ii Annual family income shall not exceed
Rs. 50,000/- per annum.
iii Those who
are suffering from major ailments which need surgery such as kidney heart,
liver, cancer, brain etc. or any other life threatening diseases including knee
surgery and spinal surgery.
The applicant shall apply for
medical aid through the prescribed application form, duly certified by the
Medical Superintendent of the concerned Hospitals. The application format is at
overleaf. The application must be submitted along with caste certificate,
income certificate, white ration card and estimated cost of the treatment duly
certified by the Medical Superintendent of the Hospital.
The
application shall be forwarded by a local sitting Member of Parliament (Lok
Sabha or Rajya Sabha) or by the District Magistrate & Collectors/Deputy
Commissioner of the concerned District/Secretaries incharge of Health &
Social Welfare Departments of States/UTs. The duly filled in form should reach
the Director, Dr. Ambedkar Foundation, 15, Janpath,
75% of
the total cost of the treatment will be released to the Hospital concerned
directly with maximum ceiling limit of Rs. 1,00,000/- in each case, in the form
of crossed cheque / DD, out of which 50% of the total estimated cost will be
paid as first installment in advance, directly to the Hospital before surgery.
The remaining amount will be released after the surgery and or on submission of
final bills duly certified by the Medical Superintendent of the concerned
Hospital. Further, Medical aid from the Foundation and other sources should not
exceed the total estimated cost of treatment.
A certificate in this regard should be obtained from the Medical
Superintendent of the concerned Hospital. The estimation certificate
accompanied with the proposal should contain the date fixed for surgical
operation.
A checklist for submission of
application form for getting medical aid under Dr. Ambedkar Medical Aid
Scheme:-
(i) The application form should be
accompanied with the following:-
(a)
Original
Estimation Certificate duly signed by the Medical Superintendent of concerned
hospital.
(b)
Original
or attested xerox copies of income, caste certificate and white ration card of
the patient.
(c)
The
application should be recommended/ forwarded either by a local sitting Member
of Parliament (Lok Sabha or Rajya Sabha) or by the District
Magistrate&Collectors/Deputy Commissioner of the concerned District,
Secretaries incharge of Health & Social Welfare Departments of States/UTs.
(d)
Medical
aid from the Foundation and other sources should not exceed the total estimated
cost of treatment. A certificate in
regard should be obtained from the Medical Superintendent of the concerned
Hospitals.
(e) The
Estimation Certificate accompanied with the proposal should contain the date
fixed for surgical operation as far as possible.
Application form for getting Medical Aid under
Dr. Ambedkar Medical Aid Scheme
1. Name of the patient
..
2. Father/Mother/Husband/Guardian
..
3. Caste
(Caste certificate to be attached)
4. Residential Address
.
..
5. Sex
6. Age
7. Nature of
disease
8. Name of the Hospital from where
treatment is sought and whether it is covered under the scheme
9. Financial assistance required (estimate
certificate in original from hospital named above to be
attached
)
10. Annual income of all adult members of
family from all sources (proof / certificate to be
attached
)
11. Whether the applicant has taken such
assistance from any other sources, if so give details
It is certified that the information
furnished above is true to the best of my knowledge and belief
and nothing has been concealed there from.
Signature of the applicant
(either self of legal guardian
in case of minor)
12. Forwarded
by_____________________________________________________________
(name,
signature and seal of sitting M.P/ D.M/D.C/ Health/ Social Welfare Secretary
who recommends the patient)