IMA National Health Scheme

The Constitution & Byelaws of the IMA National Health Scheme were adopted on 27th December at the 75th meeting of the Central Council of the Indian Medical Association (IMA), held at Ahmedabad, Gujarat. The scheme came into force in January 2015.

The scheme was established with the objective of supporting IMA members who join the scheme in meeting the rising costs associated with the management of serious and life-threatening illnesses, in the context of increasing healthcare expenses.

Purpose of the Scheme

The scheme provides financial assistance to members / beneficiary members for expenses incurred in the management of the following conditions:

Medical Conditions Covered

• Heart diseases – Angioplasty, CABG, Valvular surgeries (up to ₹3 lakh)
• Kidney diseases – Renal transplantation, Dialysis (up to ₹3 lakh)
• Malignancies & Brain tumours (up to ₹3 lakh)
• Spinal surgery, major surgeries, joint replacement surgeries
• Cerebrovascular accidents
• Road traffic and other serious accidents
• Other major illnesses approved by the Scrutinizing Committee

Scrutiny & Reimbursement

The Scrutinizing Committee has discretionary powers to determine the upper limit of reimbursement for various medical conditions and procedures, considering prevailing treatment costs.

Diagnosis and treatment costing less than ₹5,000 are not covered under this scheme.

Members must submit original documents along with attested copies of discharge summaries, itemized bills (professional charges, medicines, investigations, etc.) and supporting documents within 60 days from hospital discharge.

Permissible reimbursements are disbursed within 90 days after verification and approval by the Managing Committee. Reimbursement is limited to 75% of the total bill, subject to disease-specific caps.

A member is eligible for a maximum benefit of ₹3 lakh per year. No advance payments are permitted.

Important Conditions

• Claims supported by fraudulent means will be rejected
• Payments are made only via cheque, demand draft, or bank transfer
• Expenses on travel, ambulance, food, laundry, telephone, attendants, or special nurses are not reimbursed
• Only treatment under modern medicine is eligible
• Cosmetic treatments, dental prosthesis, spectacles, hearing aids, and exercise equipment are excluded
• In case of demise, claims are payable to the registered nominee

Lock-In Period

• Up to 55 years – 1 year lock-in period
• 55 to 70 years – 2 years lock-in period
• 70 to 80 years – 3 years lock-in period

Eligibility & Enrollment

IMA members, their spouses, parents, and children can join the scheme, provided they are below 80 years at the time of enrollment. IMA members are registered as members, while others are beneficiary members.

Application forms are available on this website. Download, print on legal size paper (8.5 × 14 inches), complete the form, and submit it to the scheme office.

Fee Structure

AF – Admission Fee
AMS – Annual Membership Subscription
AFAC – Advance Financial Assistance Contribution

Detailed age-wise fee structures for enrollment and yearly renewal are provided in the Downloads section.

Fee Structure – First Year (Enrollment)

Fee Structure – Yearly Renewal

Important Notes

• Reimbursement limited to 75% of bill amount, subject to disease-wise caps
• Maximum benefit: ₹3 lakh per year
• No advance payment permitted
• Claims must be submitted within 60 days of discharge
• Payments made via cheque / DD / bank transfer only
• Central Working Committee of IMA is the appellate authority