MEDICAL AID – New Health Insurance Scheme, 2021
Health Care Assistance to the Employees of Government Departments,
State Public Sector Undertakings, Statutory Boards, Local Bodies, State
Government Universities etc., and their eligible family members through
the United India Insurance Company Limited, Chennai - Implementation -
Orders – Issued
In the Government Order first read above, orders were issued for
implementation of New Health Insurance Scheme, 2016 to provide health care
assistance on a CASHLESS basis for employees of Government departments etc.,
and their eligible family members with a provision to avail assistance upto the
limit of Rs.4.00 lakh and in respect of specified illness the enhanced limit was
upto Rs.7.50 lakh for a block period of 4 years from 01-07-2016 to 30-06-2020
for the accredited treatments/surgeries in the hospitals approved by the United
India Insurance Company Limited.
2. In the Government Order second read above, orders were issued to
extend the New Health Insurance Scheme, 2016 for employees of the
Government departments etc., and their eligible family members beyond
30-06-2020, for a period of another one year from 01-07-2020 to 30-06-2021,
with assistance capped at Rs.4.00 lakh for families of all insured employees and
at Rs.7.50 lakh for specified illnesses, as per existing terms and conditions of
agreement made with the United India Insurance Company Limited.
3. The Government has examined the need for continuation of New Health
Insurance Scheme for the Employees of Government Departments, State Public
Sector Undertakings, Statutory Boards, Local Bodies, State Government
Universities etc., and their eligible family members and decided to continue the
same after selection of a suitable Public Sector Health Insurance Company
through National Competitive Bidding as in the case of New Health Insurance
Scheme, 2016. Accordingly, in the Government Order third read above, orders
have been issued for the implementation of the New Health Insurance
Scheme, 2021.
4. Based on the Government orders issued in reference third read above,
the Notice Inviting Tender, dated 26-02-2021 has been issued. The Tender
Scrutinizing Committee, i.e. the Principal Secretary to Government
[Expenditure], Finance (Salaries) Department, the Commissioner of Treasuries
and Accounts and the Director of Medical and Rural Health Services, after
following due procedure as per the Tamil Nadu Transparency in Tenders Act,
1998 and the Tamil Nadu Transparency in Tenders Rules, 2000, submitted its
report on 18-06-2021 to select the United India Insurance Company Limited,
Chennai for implementing the New Health Insurance Scheme, 2021 for the
Employees of Government Departments, State Public Sector Undertakings,
Statutory Boards, Local Bodies, State Government Universities etc., and their
eligible family members.
5. The recommendation of the Tender Scrutinising Committee has been
considered and the tender has been awarded to the United India Insurance
Company Limited, Chennai. The said Company shall execute an agreement with
the Government of Tamil Nadu for the implementation of the New Health
Insurance Scheme, 2021.
6. The Government after careful consideration directs that:-
(1) “New Health Insurance Scheme, 2021 for Employees of
Government Departments, State Public Sector Undertakings,
Statutory Boards, Local Bodies, State Government Universities
etc., and their eligible family members be implemented through
the United India Insurance Company Limited, Chennai as set
out in “The Guidelines for implementation of the New Health
Insurance Scheme, 2021 for Employees of Government
Departments, State Public Sector Undertakings, Statutory
Boards, Local Bodies, State Government Universities etc., and
their eligible family members appended to this order in
Annexure -A;
(2) The Commissioner of Treasuries and Accounts shall be the
administrator of the New Health Insurance Scheme, 2021;
(3)The enrolment under New Health Insurance Scheme, 2021 shall
be compulsory, which is a separate scheme for all the
employees irrespective of the fact that their spouse is a
Central Government Employee covered under Central
Government Health Insurance Scheme (CGHS) as detailed in
para 3 of Annexure-A to this order;
(4) The employees of Government Departments, State Public Sector
Undertakings, Statutory Boards, Local Bodies, State
Government Universities etc., and their eligible family members
covered under the scheme shall avail assistance upto the limit
of Rupees Five Lakh in a block of four years commencing from
01-07-2021 to 30-06-2025 as a CASHLESS model for the
approved treatments / surgeries listed in the Annexure-I to
this order, in the hospitals approved by the United India
Insurance Company / Third Party Administrator and listed in
the Annexure-II to this order;
(a) However, the assistance shall be upto Rupees
Ten Lakh for Specified illnesses listed out in
Annexure I-A to this order
(b) The upper limit of medical assistance for cataract
surgery shall be Rs.30,000/- per eye. In respect of
Hysterectomy (uterus removal surgery) the upper
limit of medical assistance shall be Rs.50,000/-.
(c) The overall limit of assistance, in any case shall not
exceed Rupees Ten Lakh for a family in a block of
four years under this scheme.
(d) The medical treatment taken by the employees of
Government Departments, Local Bodies, State Public
Sector Undertakings, Statutory Boards and State
Government Universities etc., and their eligible
family members in Non-Network hospital under
Non-Emergency situation shall also be covered on
reimbursement basis. However, since the quality of
treatment and facilities provided in a Non-network
Hospital is not known and the employee is
consciously choosing to avail treatment in such
hospital, the quantum of reimbursement in such
cases shall be restricted to 75% of the package rate of
similar procedure in the lowest grade Network
hospital.
(e) This scheme covers 203 approved treatments and
surgeries with 1,169 empanelled hospitals.
(f) The scheme is also extended to the parents of the
employee, in case of unmarried employee until the
employee gets married, in case of a divorced
employee not having children until such employee
gets re-married.
(g) The payment of annual premium shall be regulated
as per the terms and conditions of the agreement
between the Government of Tamil Nadu and the
United India Insurance Company Limited, Chennai;
(5) The annual premium payable by the Government to the United
India Insurance Company, Chennai shall be at the rate of Rs.3,240/- [plus
Goods and Services Tax as applicable from time to time] per Employee,
per annum for the block period of four years from 01-07-2021 to
30-06-2025;
(6) A sum of Rs.5/- per month shall be contributed separately by all
the employees along with the monthly Health Insurance premium for creating
a Corpus Fund (non-lapsable), with annual accrual of about Rs.5.60 crore for
meeting higher expenses in respect of rare illness and exceptional
circumstances, extending the total benefit upto Rs.20.00 lakh. These cases
shall be decided by the High Level Committee already formed in
G.O.Ms.No.202, Finance (Salaries) Department, dated 30-06-2016.
(7) The annual premium initially paid by the Government shall be
recovered from the employee at the rate of Rs.300/- per month [Rs.295/-
Subscription for NHIS + Rs.5/- contribution for corpus fund] by deduction
in monthly salary from the month of July, 2021.
(8) Eventhough the legal spouse is covered under the term ‘Employee’,
the total assistance to the Family will be limited to Rupees Five Lakh only in
respect of diseases covered in Annexure-I and Rupees Ten Lakh only per
family for specified illnesses listed in Annexure-IA. The overall limit of
assistance shall not exceed Rupees Ten Lakh only per family in a block of four
years.
(9) In case both the employee and spouse are State Government
employees, the employee’s contribution shall be recovered from only one of the
employees i.e. from the younger of the two.
(10) The employees appointed on (a) Consolidated Pay / Fixed Pay /
Honorarium, (b) Daily Wage, (c) Contract basis, (d) Re-employment,
(e) Temporary basis under Rule 10 (a) (i) of the Tamil Nadu State and
Subordinate Services through Employment Exchange and (f) Outsourcing are
not covered under this Scheme.
7. The Government also direct that the monthly subscription of Rs.295/-
towards New Health Insurance Scheme, 2021 for the Employees of Government
Departments shall be credited to the following Revenue Receipt Heads of
Account:
Government Employees in the Standard Scales of Pay
“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES
800. Other Receipts
BM. Subscription of Government Employees towards New
Health Insurance Scheme (NHIS)
224 Subscriptions
01 New Health Insurance Scheme- Employees
IFHRMS : (D.P.C. 0075 00 800 BM 22401)”
Employees drawing Pay under Special Time Scales of Pay
“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES
800. Other Receipts
BQ. Subscription of Employees in Non-Standard Scales of
Pay towards New Health Insurance Scheme (NHIS)
224 Subscriptions
01 New Health Insurance Scheme- Employees
IFHRMS : (D.P.C. 0075 00 800 BQ 22401)”
8. The Chief Executive Officers / Managing Directors of State Public
Sector Undertakings and Statutory Boards, Registrars of State Government
Universities, the Director of Rural Development, the Director of Municipal
Endowment Administration shall make necessary arrangements for recovery of
the employee contribution at Rs.295/- per month by deduction in the monthly
salary from July, 2021 and remittance of Annual Premium (including Goods and
Service Tax as applicable from time to time) to the following heads of account.
9. The employees of State Government Organisations / Institutions
registered under the Tamil Nadu Registration of Societies Act, 1975 which are
willing and capable of bearing the GST applicable on the contribution of the
employees to the Insurance scheme without financial liability befalling on the
State Budget may also be enrolled under the New Health Insurance Scheme,
2021.
10. The insurance premium on behalf of all the employees will be paid by
the Government as per the terms and conditions of the agreement based on the
proposals from the Commissioner of Treasuries and Accounts. The expenditure
on payment of insurance premium shall be debited to the following Head of
Account under Demand No.16. Finance Department [HoD Code 16-02]:
11. The Government direct that the monthly contribution of
Rs.5/- made by all the employees including State Public Sector Units etc.,
towards creation of Corpus Fund (Non-lapsable) for meeting higher expenses in
respect of rare illness and exceptional circumstances shall be credited to the
following Deposit Head of Account:
“K Deposits and Advances (b) Deposits not bearing interest
8443 00 Civil Deposits
800 Other Deposits
FB Creation of Corpus Fund (Non-lapsable) for meeting higher
expenses in respect of rare illness and exceptional
circumstances.
801 Receipts
02 Not Bearing Interest
802 Outgo
02 Not Bearing Interest
IFHRMS: (D.P.C. 8443 00 800 FB 80102) - Receipts
IFHRMS: : (D.P.C. 8443 00 800 FB 80202) - Outgo
12. All State Government departments/ Heads of Departments,
Chief Executive Officers / Managing Directors of State Public Sector
Undertakings and Statutory Boards, Registrars of State Government
Universities, the Director of Rural Development, the Commissioner of Municipal
Administration, the Commissioner of Hindu Religious and Charitable
Endowment Administration and willing State Government Organisations /
Institutions registered under Tamil Nadu Registration of Societies Act, 1975
shall make necessary arrangements for recovery of the employee contribution for
corpus fund at Rs.5/- per month by deduction in the monthly salary from July,
2021 and remit to head of account indicated in para-11 above.
The Commissioner of Treasuries and Accounts, Chennai-35 shall be the
Estimating, Reconciling and Controlling Authority for the above said new Head
of Account.
The Commissioner of Treasuries and Accounts, Chennai -35 is directed to
open the above new Head of Account in their books.
13. The Nodal Officers of the United India Insurance Company Limited
situated in the District Headquarters and Toll Free Helpline Number is listed in
the Annexure-V. The lists of approved treatments and surgeries, approved
hospitals and the addresses of the Offices situated in the District Headquarters
will be hosted in the websites of Government of Tamil Nadu in Finance
Department (www.tn.gov.in), Treasuries and Accounts Department
(www.tn.gov.in/karuvoolam) and the United India Insurance Company Limited,
Chennai / Third Party Administrator (www.mdindiaonline.com). The additional
list of approved hospitals treatments /surgeries to be included and the list of
deleted hospitals, treatments /surgeries if any covered in this Scheme will also be
updated and hosted in the above websites for ready reference from time to time,
based on the recommendation of the Accreditation Committee.
14. The Drawing and Disbursing Officers in Government Departments /
Pay Drawing Officers in the other Organisations shall furnish the details of the
employees and their eligible family members as per the Guidelines to this order.
15. The Commissioner of Treasuries and Accounts shall submit proposals
to Government for sanction of insurance premium at the appropriate time as per
the terms and conditions of the agreement.
16. The modalities on the operation of corpus fund will be issued
separately.
(BY ORDER OF THE GOVERNOR)
S.KRISHNAN
ADDITIONAL CHIEF SECRETARY TO GOVERNMENT
To
All Secretaries to Government, Chennai-600 009.
All Departments of Secretariat (OP/Bills), Chennai-600 009.
The Secretary, Legislative Assembly Secretariat, Chennai-600 009.
The Secretary to the Governor, Chennai-600 022.
The Comptroller, Governor’s Household, Raj Bhavan, Chennai-600 022.
The Governor’s Secretariat, Raj Bhavan, Guindy, Chennai-600 022.
All Heads of Departments.
All State Public Sector Undertakings and Statutory Boards.
All District Collectors / All District Judges / All Chief Judicial Magistrates.
The Accountant General (A&E) Chennai-600 018.
The Accountant General (Audit-I) Chennai-600 018.
The Accountant General (Audit-II) Chennai-600 018.
The Accountant General (CAB) Chennai-9 / Madurai.
The Commissioner of Treasuries and Accounts, Chennai-35.
 Department, dated: 26-02-2021.){kind=link}
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