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Benefits enhanced in newhealth insurance scheme



Chief Minister Jayalalithaa on Monday announced a new health insurance scheme, significantly enhancing benefits to patients, compared to the Chief Minister's Insurance Scheme of the previous Dravida Munnetra Kazhagam government.

A number of amendments have been made, upping the total health insurance cover for a family to Rs. 4 lakh for four years. In the yet-to-be-named scheme, each family gets cover of Rs. 1 lakh per annum for four years. In the case of certain diseases, this could go up to Rs. 1.50 lakh, Ms. Jayalalithaa said in a statement.

The other significant change is that the new scheme covers 950 medical conditions compared to 642 under the previous scheme. The DMK government had envisaged extending the scheme for newborns, but that was not implemented. The fresh scheme will not only include treatment for newborns, but also medical management, as against merely surgical interventions. Thereby, treatment costs will be covered for heart attack as well as angioplasty or open heart surgery.

The Chief Minister also announced that all the investigations done in connection with the treatment, as authorised by a government hospital, or government-run health camp, would be covered under the new scheme, even if surgery was not warranted at the end of it.

In case of hospital admissions, investigations and other charges incurred for five days would be reimbursed to the hospital. Under the earlier scheme, only investigations directly related to surgery would be covered. A certain amount would also be allocated for follow-up procedures.

One of the criticisms levelled against the previous health insurance scheme was that private hospitals were being promoted at the cost of government institutions. Trying to address this, the new scheme specifies that government hospitals would be paid the same rates as those in the private sector. Additionally, certain kinds of treatments would be permitted only in government hospitals. Special wards would be set up in the hospitals approved by the government under the new scheme.

Ms. Jayalalithaa added that people already enrolled under the old scheme and requiring emergency surgery could still avail treatment at approved hospitals. The government itself would compensate the hospitals for such expenses.

While fresh identity cards would have to be issued, the new scheme would use the existing database for beneficiaries.

The first State empowered committee meeting headed by the Chief Secretary would analyse the various issues and arrive at a decision to fix on the process of calling for tenders from bidders before this weekend, officials said.

Total cover for a family raised to Rs. 4 lakh for four years

New scheme covers 950 medical conditions against 642 earlier

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