Group Accident Insurance Scheme Under PMMSY: Medical Treatment

Group Accident Insurance Scheme under PMMSY: Medical Treatment provides vital financial support for eligible fishers and their families in Gujarat to cover treatment costs following accidental injuries. This scheme offers a fixed benefit of ₹25,000 for medical treatment so that those involved in fishing activities can access care without facing undue money strain. The scheme is part of Pradhan Mantri Matsya Sampada Yojana (PMMSY) and remains open for registered fishers in the state.

Group Accident Insurance Scheme under PMMSY: Medical Treatment serves as a supportive scheme by the Agriculture, Farmers Welfare and Co-operation Department, Government of Gujarat. It aims to provide financial security to the fishing community through insurance cover for medical treatment after an accident. It covers registered fishermen, fish workers, fish farmers, and other individuals actively involved in the fishing sector. National Fisheries Development Board (NFDB) and M/s Oriental Insurance Company Limited (OICL) manage this program. The government covers the entire premium cost, so nothing needs to be paid from the pocket. Commissioner of Fisheries oversees the implementation of this welfare mission.

Group Accident Insurance Scheme Under PMMSY: Medical Treatment - Introduction

The primary objective of this scheme is to offer a safety net for the family during difficult times caused by accidental injury or disability. Insurance of fishers is one of the sub-components of PMMSY, and the premium is shared between the central and state government as per the PMMSY funding pattern, so no beneficiary contribution is expected. The claim amount is paid directly into the savings account of the claimant, nominee, or legal heir through Direct Bank Transfer (DBT).

Key Information

Benefits

To support recovery, this scheme provides a standard medical treatment assistance amount. The cover is valid for a period of 12 months and the premium is paid annually by the government.

Mode of Payment: The insurance provider transfers the claim amount directly into the savings account of the claimant, nominee, or legal heir via Direct Bank Transfer (DBT).

Expected Time of Payment: A swift settlement can be expected within 15 working days after submitting all required documents. If the insurance company delays the payment beyond this period, a simple interest of 10% will be paid on the claim amount from the date of submission until the day the payment is released.

Eligibility

The following criteria should be met to qualify for benefits:

1. The person must be a fisher, including roles like fish worker, fish farmer, or anyone directly engaged in fishing activities.
2. The person should be between 18 and 70 years old.
3. The person must not have turned 71 on the date the accident occurred.
4. Registration must be approved by the State or Union Territory fisheries department.
5. A valid registration with the concerned district office is required.
6. At the time of filing, an Appropriate Authority must verify and certify the status of the person as an insured fisher.

Exclusions

This coverage does not apply to events such as:

• Suicide or intentional self-harm.
• Pregnancy, childbirth, or related medical issues.
• Pre-existing physical or mental conditions.
• Injuries sustained while under the influence of drugs or alcohol.
• Criminal activities or breaches of law.
• War, civil rebellion, or acts of hostility.
• Natural death.
• Costs like ambulance charges or funeral expenses.

Application Process

The claim process is offline and follows these steps. All claims must be intimated within 90 days of the accident and full documents submitted within 180 days.

STEP 1 - Collect all required documents and submit them to the nearest district fisheries office.

STEP 2 - Report the accident within 90 days of the incident through any recognised mode of communication.

STEP 3 - Submit the complete claim documents within 180 days from the date of the accident so that the claim is not rejected.

STEP 4 - Wait for the insurance company to settle the claim within 15 working days after receiving complete documentation.

Intimation can be given through a written letter to the Insurance Company, NFDB Insurance Cell, or intermediary, an email to support@pmmsygais.com, the registered IT & ITES platform, the NFDB Toll-Free Number at 1800-425-1660, or directly to the designated Appropriate Authorities.

Documents

To process a claim smoothly, the documents should be complete. A standard set of supporting papers is needed for all claims.

Common Documents:

1. A signed Intimation Form and Claim Form.
2. A copy of a cancelled cheque or the first page of the bank passbook (attested by a gazetted officer).
3. Certification from an Appropriate Authority.
4. A government-approved ID and address proof as per national standards.

Accident-Specific Documentation: Depending on the incident (for example Road Accident, Drowning, Fire, or Machinery), relevant reports such as the FIR, Spot Panchnama, Inquest Panchnama, Post Mortem Report, and Death Certificate may be required. Always submit certified true copies rather than original investigative reports.

Medical Treatment Claims: For hospitalisation, include the original consolidated hospital bill, payment receipts, doctor-prescribed medication bills, the treating physician's certificate, the Medico Legal Certificate (MLC), and the official discharge summary.

References

Official guidelines and further details can be found here:

• Official Scheme Guidelines
• Guidelines Issued by NFDB Hyderabad
• Official NFDB GAIS Portal
• Official PMMSY Portal

FAQ's

What is the Medical Treatment benefit under Group Accident Insurance Scheme?

This benefit offers financial help to cover hospital and treatment costs if a person is injured in an accident.

What does the medical treatment benefit cover?

It covers hospital bills, diagnostic tests, doctor consultation fees, and medicine costs.

Who is eligible to claim the medical treatment benefit?

Any registered fisher between 18 and 70 years old who meets the scheme criteria can file a claim.

How do I initiate a claim for medical treatment?

Submit an intimation of the accident to the insurance company within 90 days of the incident.

What documents are required to file a claim?

An Intimation Form, Claim Form, bank details, proof of identity, and specific documents related to the accident or medical treatment are needed.

Do I need to submit original hospital bills?

Yes, original itemized hospital bills and payment receipts should be submitted for the claim.

What is the deadline for submitting all claim documents?

Full documentation should be submitted within 180 days after the accident occurs.

How long will the insurance company take to settle my claim?

Once complete documentation is received, the company will process the settlement within 15 working days.

Are ambulance charges covered under this benefit?

No, the scheme does not cover ambulance or funeral charges.

Does this benefit cover pre-existing health conditions?

No, any pre-existing physical or mental defects are excluded from coverage.