G.O.Ms.No.160, New Health Insurance Scheme, 2021 (2021)
The Government of Tamil Nadu Finance (Salaries) Department issued G.O.Ms.No.160 on 29 June 2021 to implement the New Health Insurance Scheme, 2021 through the United India Insurance Company Limited, Chennai. The scheme provides health care assistance to covered employees and eligible family members from 1 July 2021 to 30 June 2025, and does not govern land, planning or property rights.
What the scheme governs
G.O.Ms.No.160 of the Government of Tamil Nadu Finance (Salaries) Department, dated 29 June 2021, implements the New Health Insurance Scheme, 2021. It covers eligible employees of Government departments, State Public Sector Undertakings, Statutory Boards, Local Bodies and State Government Universities, together with eligible family members.
The Commissioner of Treasuries and Accounts administers the scheme. The United India Insurance Company Limited, Chennai implements it under an agreement with the Government of Tamil Nadu.
The scheme concerns employee health insurance only. It does not contain provisions about land ownership, development, planning permission or property transactions.
Coverage and benefits
The New Health Insurance Scheme, 2021 applies for a four year block from 1 July 2021 to 30 June 2025. Key provisions include:
- Cashless assistance up to Rs.5 lakh per family for approved treatments and surgeries at approved hospitals.
- Assistance up to Rs.10 lakh for specified illnesses listed in Annexure I-A.
- An overall family limit of Rs.10 lakh during the four year block.
- A limit of Rs.30,000 per eye for cataract surgery and Rs.50,000 for hysterectomy.
- Coverage for 203 approved treatments and surgeries through 1,169 empanelled hospitals.
- Reimbursement for non-emergency treatment at a non-network hospital, restricted to 75 percent of the package rate for the same procedure in the lowest grade network hospital.
A separate non-lapsable corpus fund is intended for rare illnesses and exceptional circumstances. Cases approved by the High Level Committee may receive total benefits up to Rs.20 lakh.
Contributions and compulsory enrolment
Enrolment in the New Health Insurance Scheme, 2021 is compulsory for covered employees, even where an employee's spouse is a Central Government employee covered by the Central Government Health Insurance Scheme.
The Government pays an annual premium of Rs.3,240 per employee, plus applicable Goods and Services Tax. It recovers Rs.300 each month from salary, consisting of a Rs.295 scheme subscription and a Rs.5 corpus fund contribution. Where both spouses are State Government employees, recovery is made only from the younger employee.
Family eligibility and exclusions
The New Health Insurance Scheme, 2021 extends coverage to the parents of an unmarried employee until marriage. It also covers the parents of a divorced employee without children until that employee remarries.
Employees engaged on consolidated pay, fixed pay, honorarium, daily wages, contract, re-employment, specified temporary appointments or outsourcing are not covered.
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Common questions
Does G.O.Ms.No.160 affect my land or CMDA planning permission?
No. The Government of Tamil Nadu Finance (Salaries) Department order deals with employee health insurance and contains no land, planning permission or property provisions.
How much medical assistance can a covered family receive?
The regular limit is Rs.5 lakh per family for the four year block. Specified illnesses may receive up to Rs.10 lakh, while exceptional cases supported through the corpus fund may receive total benefits up to Rs.20 lakh with High Level Committee approval.
Can I claim for treatment at a non-network hospital?
Yes, non-emergency treatment at a non-network hospital may be reimbursed. Reimbursement is restricted to 75 percent of the package rate for the same procedure in the lowest grade network hospital.
Are contract and outsourced employees covered?
No. Employees appointed on contract, outsourcing, daily wages, consolidated or fixed pay, honorarium, re-employment and the specified temporary basis are excluded.
