| Type of Benefit | Max Amount (per case) Rs. |
Duration | Rate (per Date) Rs. |
Limit (per Year) Rs. |
Limit (per lifetime) Rs. |
|---|---|---|---|---|---|
| Private Hospital Room Charges |
30,000.00 |
10 days |
3,000.00 |
150,000.00 |
- |
| Pvt Hospital Surgical & Medical Treatment |
50,000.00 |
- | - |
150,000.00 |
- |
| Private Hospital Consultation Fee |
20,000.00 |
- | - |
150,000.00 |
- |
| Private Hospital Medical Test |
20,000.00 |
- | - |
150,000.00 |
- |
| Gov. Hospital Room Charges |
5,000.00 |
10 days |
500.00 |
150,000.00 |
- |
| Cataract Operation |
20,000.00 |
- | - | - |
40,000.00 |
| Paralysis Package |
100,000.00 |
- | - | - |
100,000.00 |
| Heart Surgery Pkg bill for Family Member |
100,000.00 |
- | - | - | - |
| Heart Surgery Detailed bill for Family Member |
100,000.00 |
- | - | - | - |
| Cancer Insured Package |
120,000.00 |
- | - | - |
200,000.00 |
| Total Knee Replacement Set |
50,000.00 |
- | - | - |
50,000.00 |
| Total Hip Replacement Set |
50,000.00 |
- | - | - |
50,000.00 |
| Spinal Fusion Set |
50,000.00 |
- | - | - |
50,000.00 |
| Bone Metal Stents Family |
50,000.00 |
- | - | - |
50,000.00 |
| 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 |
- | - | - | - |
| 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 weeks |
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 |
| Type of Benefit | Max Amount (per case) Rs. |
Duration | Rate (per Date) Rs. |
Limit (per Year) Rs. |
Limit (per lifetime) Rs. |
|---|---|---|---|---|---|
| Private Hospital Room Charges |
160,000.00 |
10 days |
5,000.00 |
250,000.00 |
- |
| Pvt Hospital Surgical & Medical Treatment |
60,000.00 |
- | - |
250,000.00 |
- |
| Private Hospital Consultation Fee |
35,000.00 |
- | - |
250,000.00 |
- |
| Private Hospital Medical Test |
30,000.00 |
- | - |
250,000.00 |
- |
| 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 |
- |
| Gov. Hospital Room Charges |
10,000.00 |
10 days |
1,000.00 |
250,000.00 |
- |
| Gov. Ayurvedic Hospital Room Charges |
10,000.00 |
10 days |
1,000.00 |
10,000.00 |
- |
| Gov. Hospital Childbirth |
7,500.00 |
5 days |
1,500.00 |
- | - |
| Pvt Hospital Childbirth - Normal |
25,000.00 |
- | - |
25,000.00 |
- |
| Pvt Hospital Childbirth - Cesarean |
60,000.00 |
- | - |
60,000.00 |
- |
| Heart related surgeries for Family Member |
150,000.00 |
- | - | - |
150,000.00 |
| Heart Surgeries (Only for Member) | - | - | - | - |
800,000.00 |
| RF Ablation (Only for Member) | - | - | - | - |
350,000.00 |
| Cancer Insured Package (Only for Member) | - | - | - | - |
400,000.00 |
| Kidney transplantations (Only for Member) | - | - | - | - |
800,000.00 |
| Brain Surgeries (Only for Member) | - | - | - | - |
800,000.00 |
| Implantation of knees (Only for Member) | - | - | - | - |
150,000.00 |
| Implantation of hip bones (Only for Member) | - | - | - | - |
150,000.00 |
| Hearing aids (Only for Member) | - | - | - | - |
75,000.00 |
| Spectacles (Only for Member) |
3,500.00 |
- | - | - | - |
| Cataract Operation |
20,000.00 |
- | - | - |
40,000.00 |
| Paralysis Package | - | - | - | - |
100,000.00 |
| Natural Death Insured (Only for Member) |
400,000.00 |
- | - | - |
400,000.00 |
| Accidental Death Insured (Only for Member) |
1,000,000.00 |
- | - | - |
1,000,000.00 |
| Personal Accident Insured (Only for Member) |
1,000,000.00 |
- | - | - |
1,000,000.00 |
| Type of Benefit | Max Amount (per case) Rs. |
Duration | Rate (per Date) Rs. |
Limit (per Year) Rs. |
Limit (per lifetime) Rs. |
|---|---|---|---|---|---|
| Private Hospital Room Charges |
200,000.00 |
10 days |
8,000.00 |
350,000.00 |
- |
| Pvt Hospital Surgical & Medical Treatment |
80,000.00 |
- | - |
350,000.00 |
- |
| Private Hospital Consultation Fee |
50,000.00 |
- | - |
350,000.00 |
- |
| Private Hospital Medical Test |
40,000.00 |
- | - |
350,000.00 |
- |
| 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 |
- |
| Gov. Hospital Room Charges |
30,000.00 |
10 days |
3,000.00 |
350,000.00 |
- |
| Gov. Ayurvedic Hospital Room Charges |
30,000.00 |
10 days |
3,000.00 |
30,000.00 |
- |
| Gov. Hospital Childbirth |
15,000.00 |
5 days |
3,000.00 |
- | - |
| Pvt Hospital Childbirth - Normal |
50,000.00 |
- | - |
50,000.00 |
- |
| Pvt Hospital Childbirth - Cesarean |
100,000.00 |
- | - |
100,000.00 |
- |
| Heart related surgeries for Family Member |
200,000.00 |
- | - | - |
200,000.00 |
| Heart Surgeries (Only for Member) | - | - | - | - |
1,000,000.00 |
| RF Ablation (Only for Member) | - | - | - | - |
500,000.00 |
| Cancer Insured Package (Only for Member) | - | - | - | - |
600,000.00 |
| Kidney transplantations (Only for Member) | - | - | - | - |
1,200,000.00 |
| Brain Surgeries (Only for Member) | - | - | - | - |
1,200,000.00 |
| Implantation of knees (Only for Member) | - | - | - | - |
250,000.00 |
| Implantation of hip bones (Only for Member) | - | - | - | - |
250,000.00 |
| Hearing aids (Only for Member) | - | - | - | - |
100,000.00 |
| Spectacles (Only for Member) |
5,000.00 |
- | - | - | - |
| Cataract Operation |
20,000.00 |
- | - | - |
40,000.00 |
| Paralysis Package | - | - | - | - |
200,000.00 |
| Natural Death Insured (Only for Member) |
700,000.00 |
- | - | - |
700,000.00 |
| Accidental Death Insured (Only for Member) |
2,000,000.00 |
- | - | - |
2,000,000.00 |
| Personal Accident Insured (Only for Member) |
1,500,000.00 |
- | - | - |
1,500,000.00 |
| Type of Benefit | Max Amount (per case) Rs. |
Duration | Rate (per Date) Rs. |
Limit (per Year) Rs. |
Limit (per lifetime) Rs. |
|---|---|---|---|---|---|
| Private Hospital Room Charges |
250,000.00 |
10 days |
10,000.00 |
400,000.00 |
- |
| Pvt Hospital Surgical & Medical Treatment |
90,000.00 |
- | - |
400,000.00 |
- |
| Private Hospital Consultation Fee |
55,000.00 |
- | - |
400,000.00 |
- |
| Private Hospital Medical Test |
45,000.00 |
- | - |
400,000.00 |
- |
| 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.) | - | - | - |
250,000.00 |
- |
|
Gov. Hospital Room Charges Rs. 3000/- per day for a maximum of 21 days per year. (Maximum of 07 days per incident) |
- | - |
3,000.00 |
63,000.00 |
- |
|
Gov. Ayurvedic Hospital Room Charges Rs. 3000/- per day for a maximum of 21 days per year. (Maximum of 07 days per incident) |
- | - |
3,000.00 |
63,000.00 |
- |
| Gov. Hospital Childbirth |
15,000.00 |
5 days |
3,000.00 |
- | - |
| Pvt Hospital Childbirth - Normal |
50,000.00 |
- | - |
50,000.00 |
- |
| Pvt Hospital Childbirth - Cesarean |
125,000.00 |
- | - | - | - |
|
Heart related surgeries for Family Member ** One in lifetime for one member of the family unit ** |
- | - | - | - |
200,000.00 |
| Heart Surgeries (Only for Member) | - | - | - | - |
1,000,000.00 |
| Cancer Insured Package (Only for Member) | - | - | - | - |
600,000.00 |
| Kidney transplantations (Only for Member) | - | - | - | - |
1,200,000.00 |
| Brain Surgeries (Only for Member) | - | - | - | - |
1,200,000.00 |
| Implantation of knees (Only for Member) | - | - | - | - |
250,000.00 |
| Implantation of hip bones (Only for Member) | - | - | - | - |
250,000.00 |
|
Hearing aids (Family Member) ** One in lifetime for one member of the family unit ** |
- | - | - | - |
50,000.00 |
| Hearing aids (Only for Member) | - | - | - | - |
100,000.00 |
|
Cataract Surgery (Family Member) ** One in lifetime for one member of the family unit ** |
- | - | - | - |
20,000.00 |
| Cataract Surgery (Only for Member) ** Per eye ** |
50,000.00 |
- | - | - | - |
| Natural Death Insured (Only for Member) |
700,000.00 |
- | - | - |
700,000.00 |
| Accidental Death Insured (Only for Member) |
2,000,000.00 |
- | - | - |
2,000,000.00 |
| Total Permenent Disablement caused by Accidents (Only for Member) |
1,500,000.00 |
- | - | - |
1,500,000.00 |
| Total Permenent Disablement caused by Disease (Only for Member) |
200,000.00 |
- | - | - |
200,000.00 |
| Type of Benefit | Max Amount (per case) Rs. |
Duration | Rate (per Date) Rs. |
Limit (per Year) Rs. |
Limit (per lifetime) Rs. |
|---|---|---|---|---|---|
| Private Hospital Room Charges |
30,000.00 |
10 days |
3,000.00 |
- | - |
| Pvt Hospital Surgical & Medical Treatment | - | - | - |
50,000.00 |
- |
| Private Hospital Consultation Fee | - | - | - |
20,000.00 |
- |
| Private Hospital Medical Test | - | - | - |
20,000.00 |
- |
| 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.) | - | - | - |
120,000.00 |
- |
| Gov. Hospital Room Charges |
5,000.00 |
10 days |
500.00 |
- | - |
| Gov. Ayurvedic Hospital Room Charges |
5,000.00 |
10 days |
500.00 |
- | - |
| Heart Surgeries (Only for Member) | - | - | - | - |
500,000.00 |
| RF Ablation (Only for Member) | - | - | - | - |
225,000.00 |
| Cancer Insured Package (Only for Member) | - | - | - | - |
200,000.00 |
| Kidney transplantations (Only for Member) | - | - | - | - |
200,000.00 |
| Reanal Failure (Only for Member) | - | - | - | - |
150,000.00 |
| Paralysis (Only for Member) | - | - | - | - |
150,000.00 |
| Multiple Sclerosis (Only for Member) | - | - | - | - |
150,000.00 |
| Primary Pulmonary Arterial (Only for Member) | - | - | - | - |
150,000.00 |
| Fulminate Hepatitis (Only for Member) | - | - | - | - |
150,000.00 |
| Hearing aids (Only for Member) | - | - | - | - |
50,000.00 |
| Avastin Injection (Only for Member) | - | - | - | - |
25,000.00 |
| Natural Death Insured (Only for Member) |
150,000.00 |
- | - | - |
150,000.00 |
| Accidental Death Insured (Only for Member) |
600,000.00 |
- | - | - |
600,000.00 |
| Name | Address |
|---|---|
| NEW CHANDRA MOTORS | No.190, Dr.N.M.Perera Mawatha,Colombo 08 |
| LIYANAGE MOTORS | No.164/F,Main Street,Battaramulla |
| CHANDRASIRI MOTOR WORKS | No.125, Rajagiriya Road,Rajagiriya |
| NEW RANJITH MOTORS | No.197/5, Rajagiriya road,Rajagiriya |
| SANJEEWA MOTORS | No.1177/1, Kotte Road,Rajagiriya |
| ORIENTAL MOTOR GARAGE | No.135, D.R.Wijewardena Mawatha,Colombo 10 |
| POPULAR HOUSE | No.189, Colombo Road,Divulapitiya,Boralasgamuwa |
| AJITH AUTO ENGINEERING | No.122, Buthgamuwa Road, Rjagiriya |
| MATARA GARAGE | No.287/5, Highlevel Road,Kirillapona,Colombo 05 |
| SDH ENTERPRISE | No.18/6 A,Vidyakara Mawatha,Maharagama |
| DS MOTORS | No.206/4, Dehiwala Road,Maharagama |
| RATHNA MOTORS | No.128/4, Galwala Road,Katuwawala,Boralasgamuwa |
| JAYA MOTORS | No.194, Colombo Road,Divulpitiya,Boaralasgamuwa |
| UD MOTORS ENGINEERING | No.108/3, Pelenwatta, Pannipitiya |
| DULRAN MOTORS | No.286/3, Makumbura, Pannipitiya |
| RDS MOTORS | No.56/2, Thalawathugoda Road,Colombo |
| NEW SUSIL MOTORS | No.506/B,Anagarika Dharmapala Mawatha,Thalawathugoda |
| NEW NETHMINI MOTORS | No.12, Rajamalwatta Road,Battaramulla |
| AUTO FORCE | No.49/2, Sri Saranankara Road,Dehiwala |
| GRND AUTO –TECH | No.1/B/2,Horana Road,Kahathuduwa,polgasowita |
| HIRUSHI AUTO | Kidelpitiya,Wemilla Junction,Bandaragama |
| SAJITH MOTOR WORKS | No.61, Dibbedda Road,Panadura |
| WEST END MOTORS | No.144, Ward Place,Colombo 07 |
| KUMASARU AUTO MOBILE | No.32, Nawala Road,narahenpita,Colombo 05 |
| ASIRI MOTORS | No.25/5, Buwanekabahu Mawatha,Mirihana,Kotte |
| SISHAN MOTORS | No.253, Rajasinghe Mawatha,Kothalawala,Kaduwela |
| S.L.MOTORS | No.4/5, Walpola, Aggona, Angoda |
| CHAMUDINI MOTORS | No.510, Gamage Wtta,Gothatuwa |
| MR.PAINT | No.175, Vauxhall Street,Colombo 02 |
| EURO CAR MART | No.06, Staition Road,Colombo 02 |
| U.D.P.FERNANDO & CO.(PVT) LTD | No.265/2, Sri Saddharma Mawatha,Colombo 10 |
| 505 MOTORS | No.885, Danister De Silva Mawatha,P.O.Box 1862,Colombo 14 |
| CEYLON MOTOR WORKS | No.761/1, Kandy Road,Kelaniya |
| B M D ENGINEERING PVT LIMITED | No.69, Athurugiriya road,Homagama |
| Dissanayaka Motors | No.64/188, Santhananpitiya Rd,3rd step,Embuldeniya,Kelaniya |
| Shameera Garage | No.26/1 Malini Bulathsinhala Rd, Borelasgamuwa |
| Padmini Motors | No.120/D/6,Galwala Rd,Katuwawala,Boralesgamuwa |
| B.M.D Engineering Works (PVT.)Ltd | No.69,Athurugiriya Rd,Homagama |
| Samantha Motors Center | No .412/18/B,Pitipana North, Homagama |
| Reliable Motor Traders (Pvt) Ltd | No:94/1,Vijaya Kumaranatunga Mw,Polhengoda,Colombo 05 |
| Dayasri Auto Tech (PVT) Ltd | No.48/B,Kolamunna,Piliyandala |
| Jayantha Motors & Fiber Glass | 50,Jaya Mawatha,Battaramulla |
| New Perera Motors | 645,Subithipura Road,Battaramulla |
| Thilakarathna Motors | No.115A,Rabarwatta Rd,Gangodawila,Nugegoda |
| Goldway Motor Engineers | No.Horana Rd,Honnanthara,Kesbewa |
| Sriya Ananda Motors | No.252,High Level Rd,Kirulapona,Colombo 06 |
| Italian Thoroughbred Motor Company (pvt) Ltd | No.268B,Ariyasighala Mawatha,Kalapaluwawa,Rajagiriya |
| Preethi Motors | Galle Rd,Pambrana,Matara,sri Lanka |
| Matara Auto Tec | No.363A,Anagarika Dharmapala Rd,Nupe,Matara |
| Samrasinghe Motors (Pvt) Ltd | No.21,Dumriyapola Rd,Matara |
| Siri Motors | 512B,Maithripala senanayaka Mawatha,New Town,Anuradhapura |
| Wheel Masters Private Limited | No:514/A3A,Mithreepala Senanayaka Mawatha,Anuradhapura |
| New Jayasekera Automotors(PVT)Ltd | No.209,Wilgoda Circular Road,Yantampalawa,Kurunegala |
| Agrahara Member’s Insurance Claim Application Form for Hospitalization, Childbirth, Spectacles, Heart surgery, Cancer, and Other diseases and surgeries | English Sinhala Tamil |
| Agrahara Member’s Heart Surgery, Kidney Transplant Surgery, Brain Surgery Guarantee Application form | English Sinhala Tamil |
| Agrahara Member’s Accident Claim From | English Sinhala Tamil |
| Agrahara Member’s Accident Death or Natural Death Claim Form | English Sinhala Tamil |
| Agrahara Member’s Ten months Loan Guarantee Certificate Request From | English Sinhala Tamil |
IMPORTENT: Please note to obtain the payment of this death claim or any claim payment, you shall NOT require to pay any amount as tax, stamp duty or as document charges to National Insurance Trust Fund nor to any other institute or person and will be consider as a Bribe.
| Agrahara semi-goverment Member’s Insurance Claim Application Form for Hospitalization, Childbirth, Heart surgery, Cancer, and Other diseases and surgeries. | English Sinhala Tamil |
| Semi-goverment Member’s Heart Surgery, Kidney Transplant Surgery, Brain Surgery Guarantee Application form. | English Sinhala Tamil |
| Agrahara Semi-goverment Member’s Accident Claim Form. | English Sinhala Tamil |
| Agrahara Semi-goverment Member’s Accident Death or Natural Death Claim Form | English Sinhala Tamil |
IMPORTENT: Please note to obtain the payment of this death claim or any claim payment, you shall NOT require to pay any amount as tax, stamp duty or as document charges to National Insurance Trust Fund nor to any other institute or person and will be consider as a Bribe.
| Agrahara Pensioned Member’s Insurance Claim Application Form for Hospitalization, Heart surgery, Cancer, Kidney and Other diseases and surgeries. | English Sinhala Tamil |
| Pensioned Member’s Heart Surgery, Kidney Transplant Surgery, Brain Surgery Guarantee Application form. | English Sinhala Tamil |
| Agrahara Pensioned Member’s Accident Death or Natural Death Claim Form | English Sinhala Tamil |
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