Tamilnadu Chief Minister's Comprehensive Health Insurance Scheme - SALIENT FEATURES OF THE SCHEME 2015

SALIENT FEATURES OF THE SCHEME

THE SCHEME

This is a lofty Insurance Scheme launched by the Tamil Nadu State Government through the United India Insurance Company Ltd (a Public Sector Insurer headquartered at Chennai) to provide free medical and surgical treatment in Government and Private hospitals to the members of any family whose annual family income is less than Rs.72,000/- (as certified by the Village Administrative Officers) .The Scheme provides coverage for meeting all expenses relating to hospitalization of beneficiary as defined in the Scope of the Scheme.

BENEFITS

The scheme seeks to provide cashless hospitalisation facility for certain specified ailments/ procedures. The scheme provides a coverage up to Rs.1,00,000/- per family per year on a floater basis for the ailments and procedures covered under the Annexure "C".
For certain specified ailments and procedures of critical nature, which are listed under Annexure "D" in the Scheme, the overall limit is increased from Rs.1,00,000/- to Rs.1,50,000/-

There are 2 other covers other than the hospitalisation benefits under Annexure "C" & "D" available under the Scheme. They are a) Follow-up Treatment as listed under Annexure "E"& b) Additional Diagnostic procedures listed under Annexure "F"

AVAILING THE BENEFITS

Free health camps / screening camps will be conducted by network hospitals as per the directions given by Project Director of Tamil Nadu Health Systems Society. Minimum of one camp per month per empanelled hospital will be held in the districts in each policy year. The persons who need treatment are identified in the Health camps. Such patients can approach the hospital in the network and follow the guidelines below:

1. A new Health Insurance identity card with biometrics is being issued to all those members who have been holding the smart cards in the earlier scheme. Till such time new cards are issued the public can use the earlier smart (Health) cards
2. This card should be shown at the Assistance Counter established at the empanelled hospital.
3. After due verification of the details and authenticating the identity of the patient by the Liaison Officer, the necessary Pre-authorisation request for cashless facility will be submitted by the DMO of the hospital.
4. The Project Office will approve the request on authentication of the identity and provided the procedure planned is within the Scheme

Even those patients who have the smart cards, though not identified through the Health Camps can also avail the benefit as above

HELPLINE

A 24 hour Call Centre has been set up at CMCHISTN Project Office with sufficient manpower with toll free help line. The Toll Free Number is 1800 425 3993. The Toll Free Line is competent to answer the query in Tamil.

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