Guidelines on new health insurance scheme issued for government employees and pensioners

Updated - June 11, 2024 10:52 pm IST

Published - June 11, 2024 10:51 pm IST - CHENNAI 

The Health Department has issued guidelines for implementation of the new health insurance scheme for State government employees and pensioners. The guidelines would apply to healthcare facilities under the control of the Director of Medical Education and Research and the Director of Medical and Rural Health Services.  

The scheme covers employees from July 1, 2021 to June 30, 2025 and pensioners from July 1, 2022, to June 30, 2026. Under the scheme, 203 treatments are covered while the quantum of assistance for specified treatment has been enhanced from ₹7.5 lakh to ₹10 lakh and emergency care coverage has been extended to treatment in non-network hospitals as well. As many as 1,296 hospitals are empanelled and the quantum of cashless medical assistance has been enhanced from ₹4 lakh to ₹5 lakh. 

For pensioners, assistance is offered for specified diseases/treatments and 75% of medical expenditure at non-network hospitals will be reimbursed.  

The guidelines also give details of empanelment of hospitals and implementation of the new health insurance scheme in government hospitals. It also explains how government hospitals shall apportion the claims received.

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