tnnhis2014.com New Health Insurance Scheme For Pensioners 2014 : Tamil Nadu Government

Name of the Organization : Tamil Nadu Government
Type of Facility : New Health Insurance Scheme For Pensioners 2014
Location/State: Tamilnadu

Official Website : https://tnnhis2014.com/TnHome.aspx

New Health Insurance Scheme for Tamil Nadu Government Pensioners & Family Pensioners:
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.

Objective :
The main objectives of the Scheme are: –
a. To extend the scope of assistance for medical treatments available under the existing Scheme
b. To cover more ailments and more hospitals including payment wards of Government Hospitals
c. To provide financial assistance up to Rupees Two Lakhs per Pensioner (including spouse) / Family Pensioner for a block of four years
d. To provide the assistance on a cashless basis.

Scope of the Scheme :
a. To provide coverage for the eligible expenses incurred by the Pensioner on behalf of himself/herself or his or her legal spouse / Family Pensioners for the treatments and surgeries listed in Annexure-I to these Rules.
b. The coverage will include the cost of medicines, laparoscopic or open surgeries, doctor and attendant fees, room charges, diagnostic charges, dietary charges availed in the approved hospitals. Transport charges shall be excluded.
c. The coverage shall also include pre-existing illnesses which have been included in Annexure-I to these Rules, if any.

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 Annexure-II 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:
a. Northern Cluster: Chennai, Tiruvallur, Kancheepuram, Vellore, Tiruvannamalai, Villupuram and Cuddalore
b. Central Cluster: Perambalur, Ariyalur, Nagapattinam, Tiruvarur, Tiruchirapalli, Thanjavur,Pudukottai and Karur
c. Western Cluster: Krishnagiri, Dharmapuri, Salem, Erode, Namakkal, Nilgiris, Coimbatore and Tiruppur
d. 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.

Toll Free Number : 1800 233 5544