SSBY Objective:
To improve access of BPL families, other families having income below ` 1 Lakh per annum, pensioners and APL families coming under the scheme to quality medical care for treatment of diseases involving hospitalization and surgery through an identified network of health care providers.
1.1 The Benefits within this scheme, to be provided on a cashless basis to the Beneficiaries up to the limit of their annual coverage, package charges on Specific procedures and subject to other terms and Conditions outlined herein, are the following,

• The scheme shall provide coverage for meeting expenses of hospitalizationfor medical and/or surgical procedures, to the enrolled BPL families up to Rs.2,00,000/- per family per year subject to limits, in any of the network hospitals.The benefit to the family will be on floater basis, i.e., the total Reimbursement of Rs.2,00,000/- can be availed of individually or collectivelybyMembers of the family per year.

• Pre-existing conditions/diseases are to be covered from day one.,

• Coverage of health services related to surgical nature shall also be providedon a day care basis.,

• Pre and post hospitalization - Up to 1 day prior to hospitalization and up to 5 Days from the date of discharge from the hospital shall be part of the Package rates. Food Allowance to be included in the package rates.,

• Maternity and Newborn Child will be covered. If the newborn is sixth Member in the scheme then also she/he would be covered till discharge of the mother from the hospital.,

• Domiciliary treatment: Not required.

1.2 Personal Accident - Death Insurance which will include Accidental Death & Disability Benefit as under – • Insurance amount will be Rs.1,00,000/- per individual. This amount is not included in the Rs.2,00,000/- slab mentioned in Clause No 1.1 and will not be on floater basis.

• Disability Insurance will also be covered as follows:
a. Permanent Total Disability due to accident – Rs.1,00,000/- per individual.

b. Loss of One Eye or One Limb or One Hand in an accident –Rs.50,000/- Per individual

This amount is not included in the Rs.2,00,000/- slab mentioned in ClauseNo 1.1 and will not be on floater basis.

1.3 Cashless Access Service: Beneficiaries are provided with adequate facilities so that they do not have to pay any deposits at the commencement of the treatment or at the end treatment to the extent as the Services are covered under the Comprehensive Health Insurance Scheme (CHIS).

1.4 Package Rate
Liability for any medical or surgical treatment, procedure or intervention or listed day care procedure under the benefits package shall be no more than the Package Rates for that Medical or surgical treatment, procedure or intervention or listed day care procedure that is set out in Annexure-I. If hospitalization is due to a medical condition, a flat per day rate Will be paid depending on whether the Beneficiary is admitted in the General Ward or the Intensive Care Unit (ICU).These package rates (in case of surgical procedures or interventions or day care procedures) or flat per day rate (in case of medical treatments) Will include:
• Registration Charges
• Bed charges (General Ward),
• Nursing and Boarding charges,
• Surgeons, Anesthetists, Medical Practitioner, Consultants fees etc.
• Anesthesia, Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances etc.,
• Medicines and Drugs,
• Cost of Prosthetic Devices, implants,
• X-Ray and other Diagnostic Tests etc.,
• Expenses incurred for consultation, diagnostic test and medicines up to 1 day
• before the admission of the patient and cost of diagnostic test and medicine
• up to 5 days of the discharge from the hospital for the same ailment / surgery
• Any other expenses related to the treatment of the patient in the hospital.
• Food Allowances