New Health insurance Scheme for TN Govt Employees 2016 Copy of GO: 202, Dated : 30.06.2016 with complete details of – District Nodal Officers, Diseases / Procedures covered under the scheme , All approved Hospitasl list , Enrollment Form Download

FINANCE [Salaries] DEPARTMENT G.O.Ms.No.202 G.O.Ms.No.202,Dated 30th June 2016.

ABSTRACT MEDICAL AID – New Health Insurance Scheme, 2016 – Provision of Health Care Assistance to the Employees of Government Departments, Organisations covered under this Scheme and their eligible Family members through the United India Insurance Company Limited, Chennai - Implementation - Orders – Issued.

ORDER: In the Government Order read above, orders have been issued for the implementation of the New Health Insurance Scheme, 2016 to provide for health care assistance to the Employees of Government Departments, State Public Sector Undertakings, Statutory Boards, Local Bodies, State Government Universities and their eligible family members after the selection of a suitable Public Sector Insurance Company through National Competitive Bidding as in the case of New Health Insurance Scheme, 2012. 

2. Accordingly, the Notice Inviting Tender, dated 13-06-2016 has been issued. The Official Committee, which is the Tender Accepting Authority, after invoking due procedure as per the Tamil Nadu Transparency in Tenders Act, 1998 and the Tamil Nadu Transparency in Tenders Rules, 2000, submitted it’s report on 23-06-2016 to select the United India Insurance Company Limited, Chennai for implementing the New Health Insurance Scheme, 2016. 

3. The recommendation of the Tender Accepting Authority has been considered and the tender has been awarded to the United India Insurance Company Limited, Chennai. The said Company has executed an agreement with the Government of Tamil Nadu for the implementation of the New Health Insurance Scheme, 2016. 

4. The Government after careful consideration directs that:- 

(i) The New Health Insurance Scheme, 2016 (NHIS) sanctioned in the Government Order read above be implemented through the United India Insurance Company Limited, Chennai invoking the implementation procedures as detailed in the Annexure-I to this order;

(ii) The Director of Treasuries and Accounts shall be the administrator of the New Health Insurance Scheme, 2016; 

(iii) The enrolment under New Health Insurance Scheme, 2016 shall be compulsory to the employees and their eligible family members as detailed in para 2 and 4 of Annexure-I to this order;

(iv) The employees and their eligible family members covered under the scheme shall avail assistance upto the limit of Rupees Four Lakh in a block of four years commencing from 1-7-2016 as a CASHLESS model for the approved treatments/surgeries listed in the Annexure-II to this order, in the hospitals approved by the United India Insurance Company/Third Party Administrator and listed in the Annexure-III to this order; 

(a) However, the assistance shall be upto Rupees Seven Lakh and Fifty Thousand for illnesses listed out in Annexure II-A to the order; 
(b) The upper limit of medical assistance for cataract surgery shall be Rs.25,000/- per eye. In respect of Hysterectomy (uterus removal surgery) the upper limit of medical assistance shall be Rs.45,000/-. (c) The overall limit of assistance, in any case shall not exceed Rupees Seven Lakh and Fifty Thousand for a family in a block of four years under this scheme. 

(v) The coverage of medical assistance under the scheme shall be extended to accident cases where the patient got approved treatment/undergone surgery in a non-network hospital; 

(vi) The payment of premium shall be regulated as per the terms and conditions of the agreement between the United India Insurance Company and the Government. The annual premium payable by the Government to the United India Insurance Company Limited, shall be Rs. 2,100/- (plus Service Tax as applicable from time to time) per employee, per annum for the block period of four year from 01.07.2016 to 30-06-2020. 

(vii) The annual premium initially paid by the Government shall be recovered from the employee @ Rs.180/- per month by deduction in monthly salary from the month of July, 2016. 

(a) The excess of premium over and above the amount recovered shall be borne by the employer. In respect of Government employees and employees of Government aided educational institutions, the excess premium shall be borne by the Government.  

viii) Eventhough the legal spouse is covered under the term ‘Employee’, the total assistance for the Family will be limited to Rupees Four Lakh only in respect of diseases covered in Annexure-II and Rupees Seven Lakh and Fifty Thousand per family for specified illnesses listed in Annexure-II A. The overall limit of assistance shall not exceed Rupees Seven Lakh and Fifty Thousand per family in a block of four years. In such cases, the employee’s contribution shall be recovered from only one of the employees i.e. from the younger of the two.

Further details : http://tngda.org/media/pdf/3382578086_New_Health_Govt_Emp_2016.pdf 

Objective of New Health Insurance Scheme 2016

    The New Health Insurance Scheme will provide cashless health insurance coverage to the families of all the employees of Government of Tamil Nadu, State Public Sector Undertakings, Local Bodies in Tamil Nadu, State Government Universities and Statutory Boards under the control of the Government of Tamil Nadu.

MD India Implementing Agency (TPA)

Issue I.D Cards and Guide Book containing all the details of the Scheme, List of Network Hospitals and Contact details of the offices of TPA, to all the Beneficiaries.  Issue Authorization Letter (Approval letter) to the Network Hospital for cashless treatment of the beneficiary in the Network Hospital.  Establish 24 hrs functioning, dedicated BSNL Toll Free No./Help Line no.  Process and settle the claims of Network Hospitals.  Process and settle the reimbursement claims of beneficiaries who have taken treatment at the Government Hospitals.

New Health Insurance Scheme Rules, 2016

To extend the scope of assistance for medical treatments available under the existing Scheme. To cover more ailments and more hospitals including payment wards of Government Hospitals. To extend assistance for medical treatments to the employees of State Public Sector Undertakings, Local Bodies in Tamil Nadu, State Government Universities, Statutory Boards under the control of the Government of Tamil Nadu, the Noon Meal Workers, Anganwadi Helpers, Village Assistants, etc., State Government Organisations / Institutions registered under the Tamil Nadu Registration of Societies Act, 1975, Regular Employees of the Tamil Nadu Electricity Regulatory Commission and Tamil Nadu Institute of Labour Studies.  

To provide financial assistance upto Rupees Four lakhs per Family of the Employee for a block of four years. To provide the assistance through cashless model.

Enhanced Sum Insured will be applicable for Rs.3.5 Lakhs for the specified Procedures.

1. Surgery, Chemotherapy, Radiotherapy and Immunotherapy for all Malignancies including In­patient procedures for diagnosis. 
2. Liver, Kidney, Heart, Lungs and Bone Marrow Transplantation. 
3. Complex Open Heart Surgeries and Implants. 
4. Accident and Trauma cases involving Multiple Fractures. 
5. Heart valve replacements, Aneurysms and Angioplasties. 
6. Management of Burns.

The New Health Insurance Scheme for Tamil Nadu Government Pensioners - Policy Information

Policy Information
     The scheme shall be applied to the following categories of existing/future Pensioners / Family Pensioners whose pension / family pension is paid out of the Consolidated Fund of Tamil Nadu and who draw their pension / family pension either directly from the Pension Pay Office, Chennai / District Treasury / Sub-Treasury through Banks under Pension Pilot Scheme or directly from Banks under Public Sector Bank Scheme:- 

a. State Civil Pensioners / Family Pensioners. 
b. Teacher Pensioners / Family Pensioners. 
c. Pensioners / Family Pensioners of All India Services belonging to the Tamil Nadu Cadre. 
d. Pensioners / Family Pensioners of the State Government Employees who had drawn lump sum payment on absorption in Public Sector Undertakings / Autonomous Bodies / Local Bodies / Co-operative Institutions and have become entitled to restoration of 1/3rd commuted portion of pension as well as revision of the restored amount. 
e. Divisible Family Pensioners where family pension is granted to more than one family member. 
f. Ex-Gratia Pensioners / Family Pensioners. 
g. Pensioners / Family Pensioners who are in receipt of Special Pension under Extraordinary Pension Rules, Tamil Nadu and Compassionate Allowance. 
h. Provisional Pensioners as provided in rules 60, 66, 69 & 69-B of Tamil Nadu Pension Rules, 1978. i. Pensioners / Family Pensioners of former Travancore-Cochin State who are drawing their pension as on 1st November, 1956 in the Treasuries situated in the areas transferred to Tamil Nadu State on that date i.e. Kanniyakumari District and Shencottah Taluk of Tirunelveli District.

Please Note: This scheme is also applicable to the Government Pensioners / Family Pensioners of the above categories who are getting pension / family pension from the Treasuries / Sub-Treasuries and under the Public Sector Bank Scheme outside the State. 

Hospitals Covered under the scheme 

The Hospitals under the Scheme would include -- 
1. Pay wards of Government Hospitals 
2. Private Hospitals 

• A private hospital shall be qualified and tied up as a networked hospital by the insurance company only if it complies with the minimum criteria as under: 

a. It should have at least 15 inpatient beds in respect of ‘A’ class city (population exceeding 12 lakhs) and ‘B’ class city (population exceeding 5 lakhs but below 12 lakhs) and 10 inpatient beds in respect of ‘C’ class city (population below 5 lakhs ) as per the classification of cities by the Insurance Regulatory and Development Authority ; 
b. It should be equipped and engaged in providing medical and surgical facilities along with diagnostic facilities i.e Pathological tests, X-ray and other investigations like Electro Cardio Graph etc., for the care and treatment of injured or sick persons as inpatients; 
c. It should have a fully equipped operation theatre of its own wherever surgical operations are carried out; 
d. It should have fully equipped nursing staff under its employment round the clock; 
e. It should have qualified doctor(s) physically in charge round the clock; 
f. It should maintain complete records as required on day to day basis and be able to provide necessary records of the insured patient to the Insurer or his representative as and when required; 
g. It should have functioned with inpatient facility for a minimum period of one year.

• All the hospitals already accredited under the New Health Insurance Scheme for Government Employees 2012 as in AnnexureII to these Rules shall also automatically be deemed to be networked hospitals and the Insurance Company shall ensure that they have a tie-up with these hospitals before the commencement of the Scheme.
• At least three institutions (excluding Government Hospitals) each situated at Puducherry, Bengaluru, Thiruvananthapuram, Mumbai, Hyderabad and New Delhi shall also be covered. 
• The Insurance Company shall ensure the availability of a minimum of 6 networked hospitals in each district of the State and the availability of a minimum 50 networked hospitals excluding Government Hospitals in the areas under each district cluster as indicated below:
 ◦ Northern Cluster: Chennai, Tiruvallur, Kancheepuram, Vellore, Tiruvannamalai, Villupuram and Cuddalore 
◦ Central Cluster: Perambalur, Ariyalur, Nagapattinam, Tiruvarur, Tiruchirapalli, Thanjavur,Pudukottai and Karur 
◦ Western Cluster: Krishnagiri, Dharmapuri, Salem, Erode, Namakkal, Nilgiris, Coimbatore and Tiruppur 
◦ Southern Cluster: Madurai, Theni, Sivagangai, Virudhunagar, Dindigul, Ramanathapuram, Tirunelveli, Kanyakumari and Tuticorin

Medical Assistance
a. The Pensioners (including spouse) / Family Pensioners can avail medical assistance up to a limit of Rupees Two Lakhs in a block period of four years from 1-7-2014 to 30-6-2018 on a CASHLESS basis for the accredited treatments / surgeries in the hospitals approved by the United India Insurance Company / Third Party Administrator under this Scheme. 
b. The benefit will be on a floater basis with a total coverage upto Rupees Two Lakhs individually or collectively for Pensioner (including spouse) and Family Pensioners during the said block period of four years with no restriction on the number of times of availing the accredited treatments / surgeries in the hospitals approved by the United India Insurance Company / Third Party Administrator under this Scheme. 

The New Health Insurance Scheme for Tamil Nadu Government Pensioners (including Spouse) 2017

The New Health Insurance Scheme for Tamil Nadu Government Pensioners (including Spouse) / Family Pensioners will provide cashless health insurance coverage to all the Pensioners (including spouse) / Family Pensioners whose pension including provisional pension is paid out of the Consolidated Fund of Tamil Nadu and who draw their pension / family pension either directly from the Pension Pay Office, Chennai / District Treasury / Sub-Treasury through Banks under Pension Pilot Scheme or directly from Banks under Public Sector Bank Scheme.

TOLL FREE NO : 1800 233 5544

FURTHER DETAILS : https://tnnhis2014.com/TnHome.aspx

ACCIDENTAL DEATH/ DISABILITY - RELIEF SCHEME IN TAMILNADU GOVT

In exercise of the powers conferred by	section 4 of	the  Tamil Nadu
Manual Workers (Regulation of Employment and Conditions of Work) Act, 1982
(Tamil Nadu Act 33 of 1982), the Governor of	Tamil Nadu,	after consultation

with the Advisory Committee, hereby makes the following amendments to the Tamil Nadu Manual Workers (Construction Workers) Welfare Scheme 1994.

AMENDMENTS.

In the said Scheme, -

(1)  in clause 11, -

(i)   after sub-clause (2) (e), the following sub-clause shall be inserted,

namely: -

“(2-A) In case of disablement due to accident, the registered manual worker shall also be eligible to claim wheel chair or artificial limbs, in addition to the amount of compensation.”;

(ii)   in sub-clause (3) in item (e), for the expression “sanction the compensation to the claimant. ”, the expression “sanction the compensation

in addition to provide artificial limbs or wheel chair, to the claimant ” shall be substituted;

(2) in clause 15, in sub-clause (1), in THE TABLE,-

(i)  against Serial Number 7 in column (1),-

(a)   in column (4), for the expression “2000”, in two places where it occurs, the expression “4000” shall, respectively, be substituted;

(b)   in column (5), for the expression “3000”, in two places where it occurs, the expression “5000” shall, respectively, be substituted;

(ii) against  Serial Number 8 in column (1),-

(a) in column (4),	for	the expression	“2000”, in two places where it
occurs, the expression “4000” shall , respectively, be  substituted;
(b) in column (5),	for	the expression	“4000”, in two places where it
occurs, the expression “6000” shall, respectively,			be substituted;

(iii) against Serial Number 9 in column (1),-

(a) in column (4), for it occurs, the expression “6000”

the expression “4000”, in two places where shall, respectively, be substituted;

(b) in column (5), for the expression “6000”, in two places where it occurs, the expression “8000” shall, respectively, be substituted;

(3)   in SHEDULE II. in FORM – C,-

(i)    in the heading, for the expression “ACCIDENTAL DEATH/ DISABILITY”, the expression “ACCIDENTAL DEATH/DISABILITY/ PROVISION OF ARTIFICIAL LIMBS OR WHEEL CHAIR” shall be substituted,

(ii)  after item 9, the following item shall be inserted, namely:-

“9–A. In case of accidental disability, whether the claimant requires wheel chair/artificial limbs (strike out whichever is not applicable): ”;

(iii) under the heading “DECLARATION BY THE CLAIMANT”, for the expression “I hereby agree to refund in full the amount received as assistance “for accidental death / disability.’’, the expression “I hereby agree to refund the full amount of compensation and /or value of artificial limbs or wheel chair received.” shall be substituted;

(iv) under the heading “SANCTION”, for the expression “as assistance”, the expression “as compensation / provision of artificial limbs or / wheel chair” shall be substituted;

(v) under the heading “ACKNOWLEDGEMENT SLIP”, for the expression “accidental death / disability”, the expression “accidental death / disability/ provision of artificial limbs or / wheel chair” shall be substituted;.

Tamilnadu Governement Personal Accident Relief for the Accidents at Work Site 2016

Personal Accident Relief for the Accidents at Work Site.-

(1) All manual workers when met with an accident are eligible for Personal Accident Relief and where the accident results in death, their nominees are eligible for Personal Accident Relief.

Explanation.-

For the purpose of this clause, “accident” means any bodily injury or death or loss of limbs or loss of sight resulting to a manual worker solely and directly from accident arising out of and in the course of his employment but does not include any intentional self injury, suicide, attempted suicide, injury caused while under the influence of intoxicating liquor or drugs or caused by insanity or resulting from the commission of any breach of the law, or rules, regulations or instructions applicable, from time to time.

(2) The risk covered by the Personal Accident Relief scheme and the amount of compensation payable shall be as follows:-

(a)Death : Rs. 5,00,000

(b)Loss or actual physical separation of or total

and irrecoverable loss of use of:-

(i) both hands;

or

(ii) both feet ;

or

(iii) one hand and one foot ;

Or

(iv) total and irrecoverable loss of sight in both eyes.:

 Rs. 1,00,000

(c)Loss or actual physical separation of, or total

and irrecoverable loss of use of:-

(i) one hand ; or

(ii) one foot ; or

(iii) total and irrecoverable loss of sight of one eye: Rs. 50,000

(d)Permanent total disablement from injuries otherthan those specified in items (b) and ( c) above Rs. 1,00,000

(e)Permanent partial disablement as specified in column (1) of the Table below

At the rate specified in the corresponding entry in column ( 2 ) of the Table below:

(3) Claim.-

(a) Immediately upon the happening of any accident while  in pursuit of his employment resulting in death at work site, the employer shall send reports to the Labour Officer (Social Security Scheme), Assistant Director (Building and Other Construction Workers), Directorate of Industrial Safety and Health of the respective district and to the Police in Form B in Schedule II of such occurrence of the accident.

further details : http://cms.tn.gov.in/sites/default/files/go/labemp_e_65_2016_Ms.PDF