The Health Department of Tamil Nadu has issued guidelines for implementation of the new health insurance scheme for State government employees and pensioners.
This scheme aims to provide health care assistance to the employees of State Government Organizations /Institutions and their eligible family members with provision to avail assistance up to Rupees Four Lakh for a block of four years.
This scheme also aims to provide health care assistance to the Pensioners (including spouse)/Family Pensioners on a CASHLESS basis, with provision to avail medical assistance up to Rupees Four lakh for a block period of four years.
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. |
Eligible Employees
The following employees shall be covered under the New Health Insurance Scheme:
- All the Employees of Government Departments, Public Sector Units, Co-operatives and Other Institutions / Organizations etc., and their eligible family members.
- The employees of Government Departments drawing pay in regular time scale of pay including Teaching and Non-Teaching Staff of Aided Educational Institutions.
- The employees of willing Organisations / Institutions registered under the Tamil Nadu Registration of Societies Act, 1975 are covered under the New Health Insurance Scheme .
- The employees of the Tamil Nadu Hindu Religious & Charitable Endowments Boards drawing pay in regular time scale of pay.
Eligible Pensioners
- All the Pensioners (including spouse) / Family Pensioners whose pension/family pension including provisional pension/family pension is paid out of the Consolidated Fund of Tamil Nadu and who draw their pension / family pension from the Pension Pay Office, Chennai / District Treasury / Sub-Treasury.
- State Civil Pensioners / Family Pensioners including Village Assistant Pensioners.
- Teacher Pensioners / Family Pensioners.
- Pensioners / Family Pensioners of All India Services belonging to the Tamil Nadu Cadre.
- Pensioners / Family Pensioners of the State Government Employees who had drawn lumpsum payment on absorption in Public Sector Undertakings / Autonomous Bodies/ Local Bodies / Co-operative Institutions and have become entitled to restoration of commuted portion of pension as well as revision of the restored amount.
- Divisible Family Pensioners where family pension is granted to more than one family members.
- Ex-Gratia Pensioners / Family Pensioners.
- Pensioners / Family Pensioners who are in receipt of Special Pension under Extraordinary Pension Rules, Tamil Nadu and Compassionate Allowance.
- Provisional Pensioners as provided in rules 60, 66, 69 and 69-B of Tamil Nadu Pension Rules, 1978.
- Pensioners / Family Pensioners of former Travancore-Cochin State who are drawing their pension on 1st November, 1956 in the Treasuries situated in the areas transferred to Tamil Nadu State on that date i.e. Kanniyakumari District and Senkottai Taluk of Tirunelveli District.
How to Enroll in New Health Insurance Scheme for Tamil Nadu Government Employees and Pensioners
The enrolment under New Health Insurance Scheme, 2024 shall be compulsory. Enrollment processes typically involve registration through designated government portals or through the human resources departments in government offices.
Note:
However, a pensioner or a family pensioner who resides outside the state of Tamil Nadu may opt to not to avail the benefit of the scheme, in that case, subscription shall not be deducted from such pensioner. It should be noted that these pensioner should submit the non-willingness letter to the concerned department before the stipulated time. The option once exercised shall be final.
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.
