NITF-Agrahara

Agrahara Insurance

Agrahara Insurance scheme was introduced by the Ministry of Public Administration Circular No: 5 /1997 and this scheme was under National Insurance Trust Fund from 1st of January 2006. Early stages we had a large number of claims, received from Sri Lanka Insurance and by now we have cleared the arrears and running smoothly.
The main idea of this "Agrahara" medical insurance scheme is to uplift the living standards of the public service and provincial public service and their families. Therefore we have taken steps to expedite all claims received by us as early as possible.

We have implemented a new system to expedite the claims as early as possible. If we receive any claim with all the necessary requirements arrangements have being made to Pay these Claims immediately.

To Whom:

The NITF cater to nearly Seven Hundred Thousand public servants and their dependents. We pay for all Medical(Hospitalizations, Childbirth, Various Operations, Bypass Operations, Spectacles and etc) , Accidents and Death claims submitted to us by them.

Beneficiaries :

Married Employees - Member, Spouse and Children (only if they are unmarried, unemployed and below 21years old).

Unmarried Employees - Member, Parents (only if the parents below 70 years old).

Agrahara members monthly remittance list format.

DOWNLOAD FROM HERE

Benefits:

Benefits are as per the circular published by Ministry of Public Administration and Home Affairs. DOWNLOAD THE CIRCULAR

Also you can visit the Ministry of Public Administration and Home Affairs website by: www.pubad.gov.lk

The list of benefits provided by Agrahara.

Type of Benefit	Max Amount (per case) Rs.	Duration	Rate (per case) Rs.	Limit (Per Year) Rs.
Private hospital room charges	30,000.00	10 days	3000.00	150,000.00
Gov. Hospital Room Charges	5,000.00	10 Days	500.00	150,000.00
Pvt Hospital Surgical &Medical Treatment	50,000.00	-	-	150,000.00
Consultation Fee	20,000.00	-	-	150,000.00
Medical Test	20,000.00	-	-	150,000.00
Cataract Operation	20,000.00	-	-	150,000.00
Paralysis Package	100,000.00	-	-	150,000.00
Heart Surgery Pkg bill for Family Member	100,000.00	-	-	150,000.00
Heart Surgery Detailed bill for Family Member	100,000.00	-	-	150,000.00
Cancer Insured Package	120,000.00	-	-	200,000.00
Total Knee Replacement Set	50,000.00	-	-	150,000.00
Total Hip Replacement Set	50,000.00	-	-	150,000.00
Spinal Fusion Set	50,000.00	-	-	150,000.00
Bone Metal Stents Family	50,000.00	-	-	150,000.00
Gov. Hospital Childbirth *	2,500.00	5 Days	500.00	2,500.00
Pvt Hospital Childbirth- Normal *	10,000.00	5 Days	2,000.00	10,000.00
Pvt Hospital Childbirth- Cesarean *	40,000.00	-	-	40,000.00
Spectacles **	3,500.00	-	-	3,500.00
Permenent Total Disablement	600,000.00	-	-	600,000.00
Permenent Partial Disablement	300,000.00	-	-	300,000.00
Temprory Partial Disablement	26,000.00	52 wks	500.00	26,000.00
Natural Death Insured	150,000.00	-	-	150,000.00
Accidental Death Insured	600,000.00	-	-	600,000.00
Kidney Insured Package	200,000.00	-	-	200,000.00
Pvt. Hospital Bypass for Member	500,000.00	-	-	500,000.00
Bare Metal Stents- Member	120,000.00	-	-	500,000.00
Drug Eluting Stent- Member	290,000.00	-	-	500,000.00
Dilatation Catheter- Member	36,000.00	-	-	500,000.00
PTCA Balloon- Member	39,500.00	-	-	500,000.00
Guide Wire- Member	12,500.00	-	-	500,000.00
Patent Ductus Arterious (PDA)	145,000.00	-	-	500,000.00
Atrial Spetal Defect (ASD)	293,000.00	-	-	500,000.00
Ventricular Spetal Defect (VSD)	293,000.00	-	-	500,000.00
Pace Maker (Singal)	136,000.00	-	-	500,000.00
Pace Maker (Dual)	272,000.00	-	-	500,000.00
PFO Occluder	293,000.00	-	-	500,000.00
Implantable Cardiovetor Defibrillator (ICD)	300,000.00	-	-	500,000.00
Radio Frequency Ablation (RF Ablation)	225,000.00	-	-	225,000.00

*Childbirth Claims can be made maximum 2 occurances in lifetime.
** Spectacle Claims can be made once in three years only.

Claim Procedure

Please click on the link to see the claim procedure of each category

Accidential Death

Accidents

Birth_Child

Cancer

Cardiac Guarantee

Cardiac

Death

Kidney

Paralysis

Spectacle

Agrahara Gold & Silver Package

Benefits:

Benefits are as per the circular published by Ministry of Public Administration and Home Affairs. DOWNLOAD THE CIRCULAR

DOWNLOAD THE REGISTRATION FORM (SINHALA)

DOWNLOAD THE CLAIM APPLICATION FORM

Benefits entitled to the members and dependent family members(for the family unit)	Maximum claim value (SILVER)	Benefits entitled to the members and dependent family members(for the family unit)	Maximum claim value (GOLD)
Hospitalization in a private hospital (Rs. 160,000 maximum for a single event) For room charges Rs.5000.00(per day) For medicine, operation theatre charges Rs. 60,000.00 For Doctor's fees Rs.35,000.00 For medical tests Rs.30,000.00	250,000.00 (per annum)	Hospitalization in a private hospital (Rs. 200,000 maximum for a single event) For room charges Rs.8000.00(per day) For medicine, operation theatre charges Rs. 80,000.00 For Doctor's fees Rs.50,000.00 For medical tests Rs.40,000.00	350,000.00 ( per annum )
For obtaining in-house treatment in a private Ayurvedic hospital subjective to above categories (private Ayurvedic hospital should be a registered entity under local subjective Ministry.)	160,000.00 ( per annum )	For obtaining in-house treatment in a private Ayurvedic hospital subjective to above categories (private Ayurvedic hospital should be a registered entity under local subjective Ministry.)	200,000.00 (per annum )
Hospitalization in a Government hospital For residing charges Rs.1000.00 (per day) For medicine Rs.60,000.00(only for the period hospitalized under specialist consultant's recommendation) For medical tests Rs.30,000.00(only for the period hospitalized under specialist consultant's recommendation)	10,000.00 (for maximum 10 days)	Hospitalization in a Government hospital For residing charges Rs.3000.00 (per day) For medicine Rs.80,000.00(only for the period hospitalized under specialist consultant's recommendation) For medical tests Rs.40,000.00(only for the period hospitalized under specialist consultant's recommendation)	30,000.00 (for maximum 10 days)
Hospitalization in a government Ayurvedic hospital For residing charges Rs.1000.00 (per day)	10,000.00 (for maximum 10 days)	Hospitalization in a government Ayurvedic hospital For residing charges Rs.3000.00 (per day)	30,000.00 (for maximum 10 days)
[Child births] Hospitalization in a private hospital Child birth with a cesarean surgery(only for the member/spouse) Natural child birth Hospitalization in a Government hospital Chid birth with a cesarean surgery ( 5 maximum days for a single hospitalization event) Natural child birth ( 5 maximum days for a single hospitalization event) Still-child birth & Miscarriage ( 5 maximum days for a single hospitalization event)	60,000.00 25,000.00 1500.00 (per day) 1500.00 (per day) 1500.00 (per day)	[Child births] Hospitalization in a private hospital Child birth with a cesarean surgery(only for the member/spouse) Natural child birth Hospitalization in a Government hospital Chid birth with a cesarean surgery ( 5 maximum days for a single hospitalization event) Natural child birth ( 5 maximum days for a single hospitalization event) Still-child birth & Miscarriage ( 5 maximum days for a single hospitalization event)	100,000.00 50,000.00 3000.00 (per day) 3000.00 (per day) 3000.00 (per day)
Heart related surgeries of family members	150,000.00	Heart related surgeries of family members	200,000.00

Benefits entitled only to members for major surgeries	Maximum claim value (SILVER)	Maximum claim value (GOLD)
For Heart surgeries For RF Ablation	800,000.00 350,000.00	1,000,000.00 500,000.00
For Kidney transplantations	800,000.00	1,200,000.00
For Brain surgeries	800,000.00	1,200,000.00
For Cancer diseases	400,000.00	600,000.00
For implantation of knees	150,000.00	250,000.00
For implantation of hip bones	150,000.00	250,000.00
For Hearing aids	75,000.00	100,000.00
For Spectacles	3500.00	5000.00
Personal accidents & Natural Death claims cover For Deaths caused by Accidents For Natural Deaths	1,000,000.00 400,000.00	2,000,000.00 700,000.00
Personal Accident cover	1,000,000.00	1,500,000.00

Click for more details about Gold & Silver Package >>

Agrahara Semi Government Gold & Silver Package

Benefits:

DOWNLOAD THE CLAIM APPLICATION FORM

Benefits entitled to the members and dependent family members(for the family unit)	Maximum claim value (SILVER)	Benefits entitled to the members and dependent family members(for the family unit)	Maximum claim value (GOLD)
Hospitalization in a private hospital (Rs. 160,000 maximum for a single event) For room charges Rs.5000.00(per day) For medicine, operation theatre charges Rs. 60,000.00 For Doctor's fees Rs.35,000.00 For medical tests Rs.30,000.00	250,000.00 (per annum)	Hospitalization in a private hospital (Rs. 200,000 maximum for a single event) For room charges Rs.8000.00(per day) For medicine, operation theatre charges Rs. 80,000.00 For Doctor's fees Rs.50,000.00 For medical tests Rs.40,000.00	350,000.00 ( per annum )
For obtaining in-house treatment in a private Ayurvedic hospital subjective to above categories (private Ayurvedic hospital should be a registered entity under local subjective Ministry.)	160,000.00 ( per annum )	For obtaining in-house treatment in a private Ayurvedic hospital subjective to above categories (private Ayurvedic hospital should be a registered entity under local subjective Ministry.)	200,000.00 (per annum )
Hospitalization in a Government hospital or Government Ayurvedic hospital For residing charges Rs.1000.00 (per day) maximum Rs.7000 for single event	21,000.00 (for maximum 21 days per annum)	Hospitalization in a Government hospital or Government Ayurvedic hospital For residing charges Rs.3000.00 (per day) maximum Rs.21000 for single event	63,000.00 (for maximum 21 days per annum)
[Child births] Hospitalization in a private hospital Child birth with a cesarean surgery(only for the member/spouse) Natural child birth Hospitalization in a Government hospital Chid birth with a cesarean surgery ( 5 maximum days for a single hospitalization event) Natural child birth ( 5 maximum days for a single hospitalization event)	60,000.00 25,000.00 1500.00 (per day) 1500.00 (per day)	[Child births] Hospitalization in a private hospital Child birth with a cesarean surgery(only for the member/spouse) Natural child birth Hospitalization in a Government hospital Chid birth with a cesarean surgery ( 5 maximum days for a single hospitalization event) Natural child birth ( 5 maximum days for a single hospitalization event)	100,000.00 50,000.00 3000.00 (per day) 3000.00 (per day)
Heart related surgeries of family members	150,000.00	Heart related surgeries of family members	200,000.00

Benefits entitled only to members for major surgeries	Maximum claim value (SILVER)	Maximum claim value (GOLD)
For Heart surgeries	800,000.00	1,000,000.00
For Kidney transplantations	800,000.00	1,200,000.00
For Brain surgeries	800,000.00	1,200,000.00
For Cancer diseases	400,000.00	600,000.00
For implantation of knees	150,000.00	250,000.00
For implantation of hip bones	150,000.00	250,000.00
For Hearing aids	75,000.00	100,000.00
For Contact Lenses	30000.00	50000.00
Personal accidents & Natural Death claims cover For Deaths caused by Accidents For Natural Deaths	1,000,000.00 400,000.00	2,000,000.00 700,000.00
Permenent Total Disablement caused by Accidents	1,000,000.00	1,500,000.00
Permenent Total Disablement caused by Disease	100,000.00	200,000.00