The workers in the unorganized sector constitute about 93% of the total work force in the country. The Government has been implementing some social security measures for certain occupational groups but the coverage is miniscule. Majority of the workers are still without any social security coverage. Recognizing the need for providing social security to these workers, the Central Government has introduced a Bill in the Parliament.
One of the major insecurities for workers in the unorganized sector is the frequent incidences of illness and need for medical care and hospitalization of such workers and their family members. Despite the expansion in the health facilities, illness remains one of the most prevalent causes of human deprivation in India. It has been clearly recognized that health insurance is one way of providing protection to poor households against the risk of health spending leading to poverty. However, most efforts to provide health insurance in the past have faced difficulties in both design and implementation. The poor are unable or unwilling to take up health insurance because of its cost, or lack of perceived benefits. Organizing and administering health insurance, especially in rural areas, is also difficult.
Ministry of Finance, Government of India has approved the merger of Social Security Schemes viz., Aam Aadmi Bima Yojana (AABY) and Janashree Bima Yojana (JBY).
Details of the Scheme
1. Eligibility Criteria :
a. The members should be aged between 18 years completed and 59 years nearer birthday.
b. The member should normally be the head of the family or one earning member of the below poverty line family (BPL) or marginally above the poverty line under identified vocational group/rural landless household.
2. Nodal Agency
"Nodal Agency" shall mean the Central Ministerial Department/State Government / Union Territory of India/any other institutionalized arrangement/any registered NGO appointed to administer the Scheme as per the rules. In the case of "Rural Landless Households", the nodal agency will mean the State Government/Union Territory appointed to administer the Scheme.
3. Age Proof :
a) Ration Card
b) Extract from Birth Register
c) Extract from School Certificate
d) Voter's List
e) Identity card issued by reputed employer/Government Department
f) Unique Identification Card (Aadhar Card)
4. Premium :
The premium to be charged initially under the scheme will be Rs.200/- per annum per member for a cover of Rs.30,000/-, out of which 50% will be subsidized from the Social Security Fund . In case of Rural Landless Household (RLH) remaining 50 % premium shall be borne by the State Government/ Union Territory and in case of other occupational group the remaining 50% premium shall be borne by the Nodal Agency and/or Member and/or State Government/ Union Territory
Benefits of AABY
i) NATURAL DEATH
Upon death of a member, during the period of insurance cover the Sum Assured of Rs.30,000/- under assurance, then in force, shall become payable to the nominee.
ii) ACCIDENTAL DEATH / DISBILITY BENEFITS :
The following benefits are provided to members in case of accident, during the period of insurance cover
a) On death, due to accident Rs.75,000/-
b) Permanent Total Disability, due to accident Rs.75,000/-
i. Loss of 2 eyes or 2 limbs OR
ii. Loss of one eye & one limb, in an accident
c) Loss of one eye or one limb, in an accident Rs.37,500/-
iii) Scholarship Benefits
Scholarship as a Free Add-on benefit will be provided to a maximum of two children of the beneficiary studying between 9th to 12th Standard @ Rs.100/= per month for each child payable half yearly – on 1st July and on 1st January, each year.
Claim Procedure :
The death or disability claims under the scheme will be settled by the P&GS Unit of LIC by making direct payment to the beneficiaries through NEFT or where there is no NEFT facility available then in such cases directly to the bank account of beneficiaries with prior approval from Competent authority the A/C payee cheque or claim can be paid by any other mode as decided by LIC.
In the event of death of the member during the period of coverage and while the policy is in force, his/her nominee will have to make an application along with Death Certificate for payment of claim amount to the designated official of the Nodal Agency.
The designated official of the Nodal Agency shall verify the claim papers and submit the same along with the death certificate and a certificate that the deceased member was head /earning member of the family belonging to the BPL/Marginally above BPL family under the eligible occupations under the scheme.
Nodal Agency should submit along with the application, the following requirements:
a) Claim Form duly completed in all respects
b) Original death certificate along with a copy duly attested
In case of accident benefit claim the following additional requirements will have to be submitted along with the Death Registration Certificate:
i) Copy of FIR
ii) Post Mortem Report
iii) Police Inquest Report
iv) Police Conclusion Report / Final Report of Police.
Permanent Total Disability Benefit :
The claimant has to submit documentary evidence of the accident, as also the Medical certificate from a Government Civil Surgeon or qualified Government Orthopaedician certifying permanent total/ partial disability due to accident, stating loss of limb/s of the member covered under the scheme.
Every member shall appoint a nominee to receive the claim amount after his death. Nomination form is a part of the membership application form and it should include particulars of the nominee to receive the claim amount. It should be ensured that this procedure is followed without fail so that there is no difficulty at the time of settlement of death claims. The Nomination form will be kept in the custody of the Panchayat/ Nodal Agency and shall be forwarded to LIC along with the claim papers on the death of the member.
Claim Procedure for Scholarships :
1. The member whose child is eligible for scholarship shall fill up an application form half yearly and submit it to the Nodal Agency. The Nodal Agency will identify the students.
2.The Nodal Agency in turn will submit the list of beneficiary students to the concerned P&GS unit with full details such as name of the student, school's name, class, member's name, master policy no., membership no. and NEFT details for direct payment.
3. Every half year, for 1st July and 1st January, each year LIC will credit the scholarship payment to the Account of the beneficiary student, by NEFT.
4. Any other mode of payment of scholarships as decided by LIC/Government may be applicable in future.
Occupations/ Vocations Covered Under Aam Aadmi Bima Yojana
How To Join The Scheme
The Scheme is based on Nodal Agency Model. A Nodel Agency can be Panchayats, NGOs, Self Help Groups or any other Institutionalised arrangements. The Nodal Agency can contact the nearest Pension and Group Scheme office or any LIC Branch office.