The Hindu Business Line : New health insurance scheme for State Government employees

Coimbatore, Sept. 25 The Tamil Nadu Government has decided to launch a new health insurance scheme for its staff under which the assistance provided will be doubled from what the employees are able to receive under the existing insurance scheme.

The new scheme, while marginally increasing the monthly subscription the employees pay for the health insurance cover, will bring those employees receiving non-standard scales of pay and also employees of the local bodies, PSUs, statutory boards and state government universities under health insurance cover.

The Government has proposed to invite competitive bidding for selection of the health insurance provider.

An order issued by the Finance Secretary, Mr K. Gnanadesikan, said under the present Tamil Nadu Government Employees Health Fund Scheme providing coverage to the government employees and their family members, a monthly subscription of Rs 10 was collected and assistance to the extent of 75 per cent of the expenses or Rs 1 lakh whichever was less was granted to the eligible applicants.

It has been represented to the Government that the cap of Rs 1 lakh was insufficient to meet the medical expenses of major ailments such as cancer and congenital heart disease and the employees were deprived of getting further assistance under the scheme during the rest of their service after availing the maximum amount of Rs 1 lakh.

Employees also found it difficult to meet the cost of treatment themselves first before applying for reimbursement under the insurance scheme and in certain areas the employees/their dependents had to travel long distances for treatment due to lack of approved institutions nearby.

The existing insurance scheme also left out employees of PSUs, local bodies, state government universities and statutory boards and some major ailments were out of coverage.

Mr Gnanadesikan said the State Government has now decided to implement a new health insurance scheme to ‘provide for comprehensive healthcare assistance to the employees with a wider scope of coverage’. It would be extended to employees of government departments including those drawing pay under non-standard scales of pay like noon- meal workers, village assistance etc and would also cover employees of local bodies, PSUs, statutory boards and state government universities.

The monthly subscription has been increased to Rs 25 and if the premium payable to the insurance company for providing coverage to government employees is higher than the annual subscription collected from the employees, the Government would meet the entire additional cost. In respect of employees of PSUs, statutory boards, local bodies and state government universities, any difference in cost would be borne by the respective employer organisation.

The order said instead of assistance of Rs 1 lakh only once during the service period, employees could receive assistance up to Rs 2 lakh in a block period of four years. After this period, they will be again eligible for the same in the next block of four years and so on till retirement.

Cashless settlement

The Government, apart from expanding the list of ailments eligible for coverage, also said the treatment could be availed in hospitals spread throughout the State approved by the selected insurance provider. It would also be a cashless settlement in that the employees need not pay directly to the institutions for the treatment availed by them and the insurance company would take that responsibility.

For employees residing in districts bordering neighbouring States, the Government has decided to include some important hospitals in Thiruvananthapuram, Bangalore and Puducherry in the list of approved institutions. Similarly, for the benefit of employees of Tamil Nadu House in Delhi and those on central deputation, hospitals in New Delhi would be covered under the scheme.

The existing scheme would continue till the new one becomes operational.

More Stories on : General Insurance | Human Resources | Tamil Nadu

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