Policy Information

    The New Health Insurance Scheme will provide cashless health insurance coverage to the families of all the employees of Government of Tamil Nadu, State Public Sector Undertakings, Local Bodies in Tamil Nadu, State Government Universities and Statutory Boards under the control of the Government of Tamil Nadu.

Scope of the Scheme

The scope of the Scheme shall be to provide coverage for the eligible expenses incurred by the Employee on behalf of himself or any member of his or her family for the treatments and surgeries listed in Annexure I to these Rules. The coverage will include the cost of medicines, laproscopic or open surgeries, doctor and attendant fees, room charges, diagnostic charges, dietary charges availed in the approved hospitals. Transport charges shall be excluded. The coverage shall also include pre-existing illnesses which have been included in Annexure I to these Rules, if any.

Hospitals to be covered under the Scheme
The Hospitals under the Scheme would include --
  • Pay wards of Government Hospitals
  • Private Hospitals
  • A private hospital shall be qualified and tied up as a networked hospital by the insurance company only if it complies with the minimum criteria as under:
    • It should have at least 15 inpatient beds in respect of ‘A’ class city (population exceeding 12 lakhs) and ‘B’ class city (population exceeding 5 lakhs but 13 below 12 lakhs) and 10 inpatient beds in respect of ‘C’ class city (population below 5 lakhs ) as per the classification of cities by the Insurance Regulatory and Development Authority
    • It should be equipped and engaged in providing medical and surgical facilities along with diagnostic facilities i.e Pathological tests, X-ray and other investigations like Electro CardioGraph etc., for the care and treatment of injured or sick persons as in-patients
    • It should have a fully equipped operation theatre of its own wherever surgical operations are carried out
    • It should have fully equipped nursing staff under its employment round the clock; (e) It should have qualified doctor(s) physically in charge round the clock
    • It should maintain complete records as required on day to day basis and be able to provide necessary records of the insured patient to the Insurer or his representative as and when required
      It should have functioned as an inpatient facility for a minimum period of one year
  • All the hospitals already accredited under the Tamil Nadu Government Employees Health Fund Scheme as in Annexure II to these Rules shall automatically be deemed to be networked hospitals and the Insurance Company shall ensure that they have a tie-up with these hospitals before the commencement of the Scheme
  • At least three institutions (excluding Government Hospitals) each situated at Puducherry, Bengaluru, Thiruvananthapuram and New Delhi shall also be covered.
  • The Insurance Company shall ensure the availability of a minimum of 6 networked hospitals in each district of the State and the availability of a minimum 50 networked hospitals excluding Government Hospitals in the areas under each district cluster as indicated below:
    • Northern Cluster: Chennai, Tiruvallur, Kancheepuram, Vellore, Tiruvannamalai, Villupuram and Cuddalore
    • Central Cluster: Perambalur, Ariyalur, Nagapattinam, Tiruvarur, Tiruchirapalli, Thanjavur,Pudukottai and Karur
    • Western Cluster: Krishnagiri, Dharmapuri, Salem, Erode, Namakkal, Nilgiris, Coimbatore and Tiruppur
    • Southern Cluster: Madurai, Theni, Sivagangai, Virudhunagar, Dindigul, Ramanathapuram, Tirunelveli, Kanyakumari and Tuticorin If any district or cluster does not have the number of hospitals as specified above, the successful insurance company can seek specific exemption for that district or cluster and the same will be considered by the Government of Tamil Nadu after verification of the available qualified hospitals in that district or cluster.