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Guidelines on New Health Insurance Scheme Issued for Government Employees and Pensioners

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While medical science is making progress, the prices of quality healthcare facilities are skyrocketing. That’s why every person should have a health insurance policy to shield himself/herself financially when an ailment or injury leads to hospitalisation. One of the biggest perks for salaried employees is the health insurance policy offered by their employers. This holds true for professionals working both in the private and public sectors. In fact, the government released guidelines on a new health insurance scheme issued for government employees and pensioners. Let’s take a closer look at the increased coverage for treatments and other benefits the scheme offers.

Key Features of the New Health Insurance Scheme for Tamil Nadu Government Employees and Pensioners

The new health insurance scheme for government employees and pensioners of Tamil Nadu is a comprehensive healthcare scheme providing financial protection against a wide range of treatments. The key features of Tamil Nadu government employees new health insurance scheme are –

1. Empanelled Hospitals and Cashless Assistance:

Under this feature, beneficiaries can avail of cashless treatments in any of the empanelled hospitals across the state but the medical procedures or treatments must be covered under the scheme. As many as 1,296 hospitals have been empanelled. Before undergoing any treatment, the beneficiary must ensure that the treatment is covered and the hospital he/she chooses is empanelled under the scheme. In an empanelled or network hospital, the beneficiaries need not pay anything out of pocket. The hospitals covered under the scheme include pay wards of government and private hospitals.

2. Pensioner Benefits:

The scheme provides health insurance coverage of up to INR 5 lakhs to all government pensioners (including spouse)/family pensioners for four years, from July 1, 2022, to June 30, 2026. For specified treatments and surgeries, as listed in the policy, the sum insured has been enhanced from INR 7.5 lakhs to INR 10 lakhs. If those covered by the scheme get treated in a non-network hospital, they will receive reimbursement of 75% of the medical expenses incurred.

3. Implementation Guidelines:

The guidelines for implementing the new health insurance scheme have been issued by the State Health Department and are applicable to healthcare facilities under the control of the Director of Medical Education and Research and the Director of Medical and Rural Health Services.

4. Compulsory Enrolment:

The health insurance Tamil Nadu government scheme is mandatory for all serving government employees and pensioners.

5. Compulsory for new government employees:

All employees of Tamil Nadu government departments, statutory boards, State Public Sector Undertakings, Local Bodies, State Government Universities, etc., are eligible for health insurance coverage of up to INR 5 lakhs for four years from July 1, 2021, to June 30, 2025. For specified treatments and surgeries (as covered by the scheme), the beneficiary can claim up to INR 10 lakhs.

6. Coverage:

The scheme covers up to 203 treatments. However, there are some exclusions which one should be aware of.

Conclusion

In the wake of medical inflation, the cost of good healthcare facilities, especially in private hospitals, is out of reach for many people. To make quality healthcare accessible to all, the government of Tamil Nadu launched a new health insurance scheme for its employees and pensioners. However, in addition to the scheme, it is advisable to have individual health insurance or a family floater as backup plans.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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