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
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