G.O.Ms.No.202, New Health Insurance Scheme, 2016, Implementation Orders, 2016

What the document does

The Government of Tamil Nadu Finance [Salaries] Department issued G.O.Ms.No.202 on 30th June 2016. It appoints United India Insurance Company Limited, Chennai, to implement the New Health Insurance Scheme, 2016, and names the Director of Treasuries and Accounts as the scheme administrator.

The document concerns employee health insurance. It contains no provision changing land ownership, development rights, planning controls or property registration requirements. A property buyer or owner is affected only if they are also an employee or eligible family member covered by the scheme.

Who is covered

Enrolment under the New Health Insurance Scheme, 2016 is compulsory for covered employees and their eligible family members. The covered employment groups include:

• Government departments.
• State Public Sector Undertakings and Statutory Boards.
• Local bodies.
• State Government Universities.
• Government aided educational institutions.
• Willing State Government organisations or institutions registered under the Tamil Nadu Registration of Societies Act, 1975, subject to the stated conditions.

Where both legal spouses are employees, the contribution is recovered only from the younger employee. The assistance limit continues to apply to the family as a whole.

Medical assistance and contributions

Key provisions of the New Health Insurance Scheme, 2016 include:

• Cashless assistance up to Rs.4 lakh per family during the four year block from 1st July 2016 to 30th June 2020, for approved treatments or surgeries at approved hospitals.
• Assistance up to Rs.7.5 lakh for specified illnesses listed in Annexure II A.
• An overall family limit of Rs.7.5 lakh during the four year block.
• A limit of Rs.25,000 per eye for cataract surgery and Rs.45,000 for hysterectomy.
• Coverage for accident cases where approved treatment or surgery is received at a non-network hospital.
• An annual premium of Rs.2,100 per employee, plus applicable Service Tax.
• Recovery of Rs.180 per month from salary from July 2016. The employer bears the premium above the employee contribution.

Administration and information

Drawing and Disbursing Officers and Pay Drawing Officers must provide employee and eligible family details under the identity card guidelines. Lists of approved treatments, surgeries, hospitals, district nodal officers and helpline information are to be hosted on the websites of the Finance Department, Treasuries and Accounts Department, and United India Insurance Company Limited or its Third Party Administrator. Updated additions and deletions may also be published on those websites.