What the Scheme Covers
The Tamil Nadu government launched a comprehensive New Health Insurance Scheme to protect state government employees, pensioners, and their eligible family members. From ₹4 lakh, the coverage now extends to ₹5 lakh per block of four years on a cashless floater basis, enabling medical treatment at empanelled government or private hospitals. Moreover, for specified diseases or surgeries, the government increased the maximum coverage to ₹10 lakh. This scheme covers 203 treatments and procedures, including complex surgeries and in-patient care. This Tamil Nadu New Health Insurance Scheme for Employees and Pensioners
Furthermore, the scheme allows emergency treatment even in non-network hospitals, where beneficiaries receive 75 % reimbursement of eligible medical expenses. It now empanels around 1,296 hospitals across Tamil Nadu, plus select facilities in cities such as Bengaluru, Puducherry, Thiruvananthapuram, and New Delhi. This enhanced flexibility ensures broader access to urgent medical care without financial stress.
Eligibility and Enrollment Process
The scheme covers all state government employees across departments, public sector units, statutory boards, local bodies, aided educational institutions, and their eligible dependents. Additionally, all pensioners drawing pension from the Consolidated Fund of Tamil Nadu including family pensioners are eligible. Ex‑gratia, provisional, and special pensioners also qualify, provided they receive pensions through recognized state treasuries
Enrollment became compulsory for both employees and pensioners. For employees, the scheme runs from July 1, 2021, to June 30, 2025. Pensioners join from July 1, 2022, to June 30, 2026. The government deducts a monthly contribution from employees’ salary (₹300/month) and pensioners’ pension amounts (₹497/month). Employees receive identity cards for treatment access. Beneficiaries may opt-out only if pensioners reside outside Tamil Nadu and submit a non-willingness letter within the stipulated period.
Features & Benefits of Government New Health Insurance Scheme
- Cashless hospitalization at empanelled hospitals, covering a wide range of procedures.
- For non-network hospital treatments, beneficiaries get 75 % reimbursement, even for emergency care.
- Assistance applies to both government and pay wards of private hospitals.
- The block coverage structure incentivizes moderation in claims and sustainable scheme financing.
Notably, the government reduced out-of-pocket expenses and ensured easier access across various districts. Hospitals also handle pre-authorisation requests swiftly; beneficiaries typically receive approval within 48 hours of admission, even in emergencies.
Financial Structure and Premium Details
To fund the policy:
- The government pays an annual premium of ₹3,240 per employee, plus applicable GST, for the block period (initially 2021‑2025).
- Employees contribute around ₹300/month, including ₹295 toward the scheme and ₹5 for the corpus fund.
- Pensioners pay ₹497/month from their pension.
- These contributions ensure the scheme remains sustainable while covering extensive healthcare costs.
For pensioners eligible for specified surgeries, the coverage increases up to ₹10 lakh. Since the implementation of the scheme, beneficiaries enjoy access to advanced treatments with minimal direct payment, especially in emergencies and elaborate procedures.
Empanelled Hospitals and Treatment Network
The scheme currently links around 1,296 hospitals across Tamil Nadu, including government-run institutions and private pay wards. It also covers major centres in Puducherry, Bengaluru, Thiruvananthapuram, and New Delhi, especially for complex cases or specialist treatments.
In empanelled hospitals, beneficiaries can access medical care without paying upfront, as long as the procedure is on the list of 203 covered treatments. Additionally, the scheme includes emergency treatment coverage in both empanelled and non-network hospitals, reducing delays during urgent medical needs.
Timeline and Modernisation
The scheme initially began in July 2021, replacing earlier health insurance systems. It continues through June 2025 for active employees and June 2026 for pensioners. The rollout included guidelines from the Tamil Nadu Health Department, with operational support from the United India Insurance Company, which handles pre-authorisation and claims management.
Officials ensure quick authorization through a streamlined TPA portal. Beneficiaries only require minimal documentation like identity cards, pre-authorisation letters, and hospital admission details to access benefits, even under emergency admission situations within 48 hours.
Real-World Impact
Since implementation, the scheme has covered thousands of treatments, reducing financial barriers for government employees and pensioners. Policyholders reported that the cashless system significantly lowers hospital bills, especially for surgeries and critical care. It also encourages families to rely on empanelled facilities, improving hospital cash flow and trust in the public system.
Health experts praised the scheme’s design: covering expensive procedures while allowing standardized premiums ensures long-term viability without burdening state finances. Overall, the initiative shifts healthcare reliance from out-of-pocket spending to structured insurance-based access.
Why It Matters
Firstly, the scheme brings financial protection against catastrophic health expenses, especially for middle-income government families. Secondly, by linking public and private hospitals, the state ensures quality care accessibility across districts. Most importantly, through cashless support and emergency coverage, the scheme promotes timely, stress-free access to healthcare.
Furthermore, the benefits of defined block coverage incentivize prudent use of medical resources, helping the state manage its insurance expenditure effectively. Employees and pensioners gain peace of mind knowing major illnesses and surgeries fall within the scope of assistance.
How to Enroll and File Claims
To join, employees register through their office HR or designated government portals, while pensioners enroll via pension administration channels. After registration, the system provides an Insurance ID card and access to empanelled hospitals. Before undergoing planned treatment, beneficiaries must obtain preauthorisation.
For emergencies, patients begin treatment immediately, then submit preauthorization documents within 48 hours. Meanwhile, the TPA ensures processing and reimbursement. If treated in non-network hospitals, applicants can claim 75 % of eligible costs with valid bills and medical proof
Stay Updated with Official Information
For complete scheme details, eligibility criteria, hospital lists, claim procedures, and FAQs, visit the Tamil Nadu New Health Insurance Scheme portal managed by the state’s Health Department. They frequently provide updates on treatment lists, coverage changes, and enrollment options. Access it here: Tamil Nadu Health Insurance Scheme – Official Portal
Special Features About Insurance Scheme:
| SI. No. | Employee’s Insurance Scheme | Pensioner’s Insurance Scheme |
| 1 | Cashless medical assistance | Cashless medical assistance |
| 2 | Quantum of assistance has enhanced from Rs.4 lakhs to Rs.5 lakhs for a block of four years | Medical treatment up to Rs.5 lakhs |
| 3 | Assistance for specified treatments has been enhanced from ₹7.5 lakh to ₹10 lakh | Assistance for specified treatment is up to ₹10 lakh |
| 4 | 1296 network of hospitals have been empanelled | 1294 network of hospitals have been empanelled |
| 5 | Monthly deduction of Rs.300/- from the salaries of the employee | Monthly deduction of Rs.497/- from the pension of the employee |
| 5 | About 203(listed) diseases and surgeries are treated under this scheme | About 203(listed) diseases and surgeries are treated under this scheme |
| 6 | Reimbursement of 75% of medical expenditure for the treatment taken in non-network hospitals. | Reimbursement of 75% of medical expenditure for the treatment taken in non-network hospitals. |
| 7 | Emergency care coverage have been extended to treatments in non-network hospitals also. | Emergency care coverage have been extended to treatments in non-network hospitals also. |
Summary Table
| Feature | Coverage Details |
|---|---|
| Block Coverage Duration | 4 years (Employees 2021–2025; Pensioners 2022–2026) |
| Standard Coverage | ₹5 lakh per family per block |
| Specified Treatments Coverage | Up to ₹10 lakh |
| Covered Procedures | 203 treatments & surgeries |
| Hospitals Empanelled | ~1,296 in TN + select national centers |
| Monthly Contribution | ₹300 (employees), ₹497 (pensioners) |
| Cashless Treatment | Available in empanelled hospitals |
| Non-Network Claims | 75 % reimbursement allowed |
| Emergency Approval Window | Within 48 hours |
The following employees shall be covered under the New Health Insurance Scheme:
Documents Required for Availing New Health Insurance Scheme for Tamil Nadu Government Employees and Pensioners
- Insurance ID card
- Employee’s/ Pensioner’s ID card
- Aadhaar card
- Preauthorization letter from the concerned authority
- Diagnosis letter from Doctor
How to get a claim through New Health Insurance Scheme
Along with preauthorization approval and other mandatory documents, the employee or the pensioner can proceed for the treatment in any of the empanelled hospitals.
In case of emergency, the treatment can be started immediately but preauthorization request with other mandatory documents should be submitted within 48 hours.
