FINANCE [Salaries] DEPARTMENT
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MANUSCRIPT SERIESGovernment of Tamil Nadu2016FINANCE [Salaries] DEPARTMENTG.O.Ms.No.202G.O.Ms.No.202,202, Dated 30th June 2016.(Thunmugi, Aani-16, Thiruvalluvar Aandu-2047)ABSTRACTMEDICAL AID – New Health Insurance Scheme, 2016 – Provision of HealthCare Assistance to the Employees of Government Departments,Organisations covered under this Scheme and their eligible Family membersthrough the United India Insurance Company Limited, Chennai Implementation - Orders – Issued.READ :G.O.Ms.No.169, Finance (Salaries) Department, dated 09-06-2016.-oOoORDER:In the Government Order read above, orders have been issued for theimplementation of the New Health Insurance Scheme, 2016 to provide forhealth care assistance to the Employees of Government Departments, StatePublic Sector Undertakings, Statutory Boards, Local Bodies, StateGovernment Universities and their eligible family members after theselection of a suitable Public Sector Insurance Company through NationalCompetitive Bidding as in the case of New Health Insurance Scheme, 2012.2. Accordingly, the Notice Inviting Tender, dated 13-06-2016 has beenissued. The Official Committee, which is the Tender Accepting Authority,after invoking due procedure as per the Tamil Nadu Transparency inTenders Act, 1998 and the Tamil Nadu Transparency in Tenders Rules,2000, submitted it’s report on 23-06-2016 to select the United IndiaInsurance Company Limited, Chennai for implementing the New HealthInsurance Scheme, 2016.3. The recommendation of the Tender Accepting Authority has beenconsidered and the tender has been awarded to the United India InsuranceCompany Limited, Chennai. The said Company has executed an agreementwith the Government of Tamil Nadu for the implementation of the NewHealth Insurance Scheme, 2016.4. The Government after careful consideration directs that:(i) The New Health Insurance Scheme, 2016 (NHIS) sanctionedin the Government Order read above be implementedthrough the United India Insurance Company Limited,Chennai invoking the implementation procedures asdetailed in the Annexure-I to this order;P.T.O.
:2:(ii) The Director of Treasuries and Accounts shall be theadministrator of the New Health Insurance Scheme, 2016;(iii) The enrolment under New Health Insurance Scheme, 2016shall be compulsory to the employees and their eligiblefamily members as detailed in para 2 and 4 of Annexure-I tothis order;(iv) The employees and their eligible family members coveredunder the scheme shall avail assistance upto the limit ofRupees Four Lakh in a block of four years commencingfrom 1-7-2016 as a CASHLESS model for the approvedtreatments/surgeries listed in the Annexure-II to this order,in the hospitals approved by the United India InsuranceCompany/Third Party Administrator and listed in theAnnexure-III to this order;(a) However, the assistance shall be upto Rupees SevenLakh and Fifty Thousand for illnesses listed out inAnnexure II-A to the order;(b) The upper limit of medical assistance for cataractsurgery shall be Rs.25,000/- per eye. In respect ofHysterectomy (uterus removal surgery) the upperlimit of medical assistance shall be Rs.45,000/-.(c) The overall limit of assistance, in any case shall notexceed Rupees Seven Lakh and Fifty Thousand fora family in a block of four years under this scheme.(v) The coverage of medical assistance under the scheme shallbe extended to accident cases where the patient gotapproved treatment/undergone surgery in a non-networkhospital;(vi) The payment of premium shall be regulated as per the termsand conditions of the agreement between the United IndiaInsurance Company and the Government. The annualpremium payable by the Government to the United IndiaInsurance Company Limited, shall be Rs. 2,100/- (plusService Tax as applicable from time to time) per employee,per annum for the block period of four year from01.07.2016 to 30-06-2020.(vii) The annual premium initially paid by the Government shallbe recovered from the employee @ Rs.180/- per month bydeduction in monthly salary from the month of July, 2016.(a) The excess of premium over and above the amountrecovered shall be borne by the employer. Inrespect of Government employees and employees ofGovernment aided educational institutions, theexcess premium shall be borne by the Government.
:3:(viii) Eventhough the legal spouse is covered under the term‘Employee’, the total assistance for the Family will belimited to Rupees Four Lakh only in respect of diseasescovered in Annexure-II and Rupees Seven Lakh and FiftyThousand per family for specified illnesses listed inAnnexure-II A. The overall limit of assistance shall notexceed Rupees Seven Lakh and Fifty Thousand per familyin a block of four years. In such cases, the employee’scontribution shall be recovered from only one of theemployees i.e. from the younger of the two.5. The Government also direct that the monthly subscription of theEmployees of Government Departmentsbe credited to the followingRevenue Receipt Heads of Account:Government Employees in the Standard Scales of Pay“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES800. Other ReceiptsBM. Subscription of Government Employees towardsNew Health Insurance Scheme (NHIS)(D.P.C. 0075 00 800 BM 0000)”Employees drawing Pay under Non-Standard Scales of Pay“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES800. Other ReceiptsBQ. Subscription of Employees in Non-StandardScales of Pay towards New Health InsuranceScheme (NHIS)(D.P.C. 0075 00 800 BQ 0008)”6. The Government further direct that the Annual Premium plusService Tax as applicable in respect of employees of the State Public SectorUndertakings, Statutory Boards, Local Bodies, State GovernmentUniversities, Willing State Government Organisations / Institutionsregistered under the Tamil Nadu Registration of Societies Act, 1975 and theTamil Nadu Hindu Religious and Charitable Endowments Board be remittedinto the State Government Account within one month from 1-7-2016 for thefirst year and before 31st July for the second, third and fourth year withoutfail. The excess of premium over and above the employee contribution shallbe borne by the respective organisation.7. The Chief Executive Officers / Managing Directors of State PublicSector Undertakings and Statutory Boards, Registrars of State GovernmentUniversities, the Director of Rural Development, the Director of MunicipalAdministration and the Commissioner of Hindu Religious and CharitableEndowment Administration shall make necessary arrangements for recoveryof the employee contribution at Rs.180/- per month by deduction in themonthly salary from July, 2016 and remittance of Annual Premium
:4:(including Service Tax as applicable from time to time) to the following headsof account at the appropriate time mentioned in para 6 above.Employees of State Public Sector Undertakings andStatutory Boards“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES800. Other ReceiptsBO. Subscription of Employees of Public SectorUndertakings and Statutory Boards towards NewHealth Insurance Scheme (NHIS)(D.P.C. 0075 00 800 BO 0004)”Employees of State Government Universities“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES800. Other ReceiptsBP. Subscription of Employees of State GovernmentUniversities towards New Health InsuranceScheme (NHIS)(D.P.C. 0075 00 800 BP 0006)”Employees of Local Bodies[Corporations, Municipalities, Town Panchayat, Panchayat Unions andVillage Panchayat, etc.]“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES800. Other ReceiptsBN. Subscription of Employees of Local Bodiestowards New Health Insurance Scheme (NHIS)(D.P.C. 0075 00 800 BN 0002)”State Government Organisations / Institutions registeredunder Tamil Nadu Registration of Societies Act, 1975“0075.00. OTHER MISCELLANEOUS GENERAL SERVICES800. Other ReceiptsBT. Subscription of Employees of Organisationsregistered under the Tamil Nadu Registration ofSocieties Act, 1975 towards New HealthInsurance Scheme (NHIS)(D.P.C. 0075 00 800 BT 0004)”8. The employees of State Government Organisations / Institutionsregistered under the Tamil Nadu Registration of Societies Act, 1975 whichare willing and capable of bearing the employer share of the premiumwithout financial liability befalling on the State Budget may also be enrolledunder the New Health Insurance Scheme, 2016, subject to adherence of theterms and conditions including the remittance of the annual premium to theGovernment at the appropriate time as mentioned in para 6 above. The
:5:orders to cover the willing State Government Organisations / Institutionsunder this scheme shall be issued by the Government in FinanceDepartment.9. The insurance premium on behalf of all the employees will be paidby the Government as per the terms and conditions of the agreement basedon the proposals from the Director of Treasuries and Accounts. Theexpenditure on payment of insurance premium shall be debited to thefollowing Head of Account under Demand No.16. Finance Department [HoDCode 1602]:“2075.00.MISCELLANEOUS GENERAL SERVICES800. Other ExpenditureHG. Payment of Premium to the Insurance Companyfor implementing New Health Insurance Scheme10. Contributions2. Insurance Premium(DPC 2075 00 800 HG 1029)”10. The Nodal Officers of the United India Insurance Company Limitedsituated in the District Headquarters and Toll Free Helpline Number arelisted in the Annexure-IV. The lists of approved treatments and surgeries,approved hospitals and the addresses of the Offices situated in the DistrictHeadquarters will be hosted in the websites of Government of Tamil Nadu inFinance Department (www.tn.gov.in/departments/finance.html), Treasuriesand Accounts Department (www.tn.gov.in/karuvoolam) and the United IndiaInsurance Company Limited, Chennai / Third Party Administrator(www.mdindiaonline.com). The additional list of approved hospitalstreatments /surgeries to be included and the list of deleted hospitals,treatments /surgeries if any covered in this Scheme will also be updated andhosted in the above websites for ready reference from time to time, based onthe recommendation of the Accreditation Committee.11. The Drawing and Disbursing Officers in GovernmentDepartments/Pay Drawing Officers in the other Organisations shall furnishthe details of the employees and their eligible family members as per theGuidelines Regarding Identity Cards in Annexure-V to this order.12. The Director of Treasuries and Accounts shall submit proposals toGovernment for sanction of insurance premium at the appropriate time asper the terms and conditions of the agreement.(BY ORDER OF THE GOVERNOR)K.SHANMUGAMADDITIONAL CHIEF SECRETARY TO GOVERNMENT.ToAll Secretaries to Government, Chennai-600 009.All Departments of Secretariat (OP/Bills), Chennai-600 009.The Secretary, Legislative Assembly Secretariat, Chennai-600 009.The Secretary to the Governor, Chennai-600 032.The Comptroller, Governor’s Household, Raj Bhavan, Chennai-600 032.
:6:The Governor’s Secretariat, Raj Bhavan, Guindy, Chennai-600 032.All Heads of Departments.All Public Sector Undertakings and Statutory Boards.All District Collectors / All District Judges / All Chief Judicial Magistrates.The Accountant General (A&E) Chennai-600 018.The Accountant General (Audit-I) Chennai-600 018.The Accountant General (Audit-II) Chennai-600 018.The Accountant General (CAB) Chennai-9 / Madurai.All Chief Educational Officers / All District Elementary Educational Officers.All Pay and Accounts Officers / All Treasury Officers / Sub-Treasury Officers.The Director of Treasuries and Accounts,Chennai-15.The Chief Internal Auditor and Chief Auditor of Statutory Boards,807, Chennai-2.The Secretary, Tamil Nadu Public Service Commission, Chennai-600 002.The Registrar General, High Court, Chennai-600 108.All Commissioners of Tribunal for Disciplinary Proceedings.The Registrars of all Universities.The Project Co-ordinator, Tamil Nadu Integrated Nutrition Project, Chennai.The Commissioners, Corporation of Chennai, Coimbatore, Madurai, Trichy,Tirunelveli, Salem, Tiruppur and Erode.All Municipalities. / The Tamil Nadu Science and Technology Centre, Chennai-25.The Anna Institute of Management, Chennai-600 028.The International Institute of Tamil Studies, Chennai-600 113.The Tamil Nadu Energy Development Agency, Chennai.The United India Insurance Company Limited, Divisional Office: 010600,PLA Rathna Towers, 5th Floor 212, Anna Salai, Chennai-600 006.The Managing Director, Tamil Nadu Road Sector Company Limited, Chennai-600 008.The Managing Director, IT Expressway Limited, Chennai-600 008.Copy to:The Secretary to the Chief Minister, Chennai-600 009.The Chief Minister’s Office, Chennai-600 009.The Private Secretary to the Chief Secretary to Government, Chennai-600 009.The Special Personal Assistant to Finance Minister, Chennai – 600 009.The Senior Private Secretary to the Additional Chief Secretary to Government,Finance Department, Chennai-600 009.All Officers in Finance Department, Chennai-600 009.All Sections in Finance Department, Chennai-600 009.All Recognised Associations.Stock File / Spare Copies.-/ Forwarded : By Order /-UNDER SECRETARY TO GOVERNMENT.
:7:Annexure-IIMPLEMENTATION PROCEDURES FORNEW HEALTH INSURANCE SCHEME, 2016.The New Health Insurance Scheme, 2016 shall be implemented by theDirector of Treasuries and Accounts, Chennai-15 through the United IndiaInsurance Company Limited, Chennai-600 006 / Third Party Administratorunder the control of United India Insurance Company Limited, Chennai fora block period of four years commencing from 1-7-2016.2. The following employees and their eligible family members arecovered under the New Health Insurance Scheme, 2016:(a) The employees of Government Departments drawing pay inregular time scale of pay including Teaching and Non-TeachingStaff of Aided Educational Institutions.(b) The employees of Local Bodies, State Public SectorUndertakings, Statutory Boards and State GovernmentUniversities, unless and otherwise specifically ordered to beexcluded from the coverage of the scheme.(c) The employees of willing Organisations / Institutions registeredunder the Tamil Nadu Registration of Societies Act, 1975 coveredunder the New Health Insurance Scheme 2012.(d) The employees of the Tamil Nadu Hindu Religious & CharitableEndowments Board drawing pay in regular time scale of pay.3. The employees appointed on (a) Consolidated Pay / Fixed Pay /Honorarium, (b) Daily Wage, (c) Contract basis, (d) Re-employment, (e)Temporary basis under Rule 10(a)(i) of the Tamil Nadu State andSubordinate Services through Employment Exchange and (f) Outsourcingare not covered under this Scheme.4. The following family members of the employee shall be coveredunder the New Health Insurance Scheme, 2016:(i)Legal Spouse of the Employee;(ii)Children of the Employee - till they get employedor married or attain the age of 25 years whicheveris earlier and dependent on the Employee;(iii)Parents of the Employee, in the case of unmarriedemployee until the Employee get married; and(iv)Physically Challenged and Mentally Retardedchildren of the employee without any agerestriction, subject to the minimum of thehandicap to the extent of 40% as certified by theDistrict Disability Welfare / Rehabilitation Officerand wholly dependent on the employee.5. (a) The Diseases, Treatments and Surgeries under the Broad BasedSpecialties approved under the New Health Insurance Scheme, 2016 arelisted in the Annexure-II and Annexure II-A to this order and the scope of
:8:the scheme shall be to provide coverage for the eligible expenses incurred bythe employee on behalf of himself / herself or any eligible his / her familymembers on such treatments and surgeries. The coverage will include thecost of medicines, laparoscopic or open surgeries, doctor and attendant fees,room charges, diagnostic charges, dietary charges availed in the approvedhospitals. The coverage shall also include pre-existing illnesses which havebeen included in the above said list. The Transport Charges shall beexcluded.(b) Claims relating to treatment / surgery included in the approved listundergone in non-network hospital consequent on accidents shall becovered under NHIS, 2016 and settlement made through a suitablemechanism.(c) Cap on ceiling of assistance in respect of cataract surgery shall notexceed Rs.25,000/- per eye and cap on ceiling of assistance in respect ofHysterectomy (uterus removal surgery) shall not exceed Rs.45,000/-.6. The hospitals already accredited for New Health InsuranceScheme, 2012 with the approval of the Insurance Company / Third PartyAdministrator and listed out in the Annexure-III to the Government Ordershall be applicable to the New Health Insurance Scheme, 2016. Theemployees and/or their family members eligible for assistance shall getadmitted in any one of the approved hospitals, by production of the IdentityCard issued by the Insurance Company or by production of the Certificateas in the Annexure-VI issued by the Drawing and Disbursing Officers inGovernment Department / Pay Drawing Officers in other Organisationscovered under this Scheme which will be valid till the New Identity Cards areissued by the Insurance Company. During the interim period of preparationand distribution of the New Identity Cards, the Insurance Company / ThirdParty Administrator shall authorise acceptance of the Identity Cards alreadyissued under the New Health Insurance Scheme, 2012.7. The additional lists of approved hospitals, treatments/surgeries to beincluded and deletion of approved hospitals, treatments/surgeries if any,shall be issued from time to time on report of the Accreditation Committee.The updated list of approved hospitals, treatments/surgeries may be verifiedwith the websites of the Government of Tamil Nadu in Finance Departmentand the United India Insurance Company Limited, Chennai / Third PartyAdministrator under the control of United India Insurance Company Limited,Chennai. The Accreditation Committee for empanelment of network hospitalsand to monitor the quality of treatment etc., constituted in G.O.Ms.No.309,Finance (Salaries) Department, dated 14-08-2012 for New Health InsuranceScheme, 2012 shall be continued for the implementation of New HealthInsurance Scheme, 2016.8. The Insurance Company / Third Party Administrator shall arrangeto issue the new Identity Cards to the employees covered under this schemewith the details of eligible family members within a period of 90 days from1-7-2016. The Insurance Company / Third Party Administrator shall alsoarrange to issue the Identity Cards to the employees newly recruited orabsorbed in service as the case may be as and when the details of theemployees are furnished to the Insurance Company / Third PartyAdministrator. The Drawing and Disbursing Officers in GovernmentDepartments / Pay Drawing Officers in other Organisations covered under
:9:this Scheme shall be responsible to arrange to furnish data in the prescribedformat well within the stipulated time and get Identity Cards for theiremployees. They shall also be responsible to surrender the Identity Cards tothe Insurance Company in respect of such employees who retire onsuperannuation, die in harness or otherwise cease to be in service. TheIdentity Cards in such cases shall be surrendered by the Employee or theirfamily member to the Drawing and Disbursing Officers in GovernmentDepartments and Pay Drawing Officers in other Organisations coveredunder this scheme.9. The Director of Treasuries and Accounts, Chennai-15 shall monitorthe progress of the work of the Insurance Company / Third PartyAdministrator for issuance of new Identity Cards to the employees. Theguidelines regarding Identity Cards as in the Annexure-V shall be followedby the employees, the Drawing and Disbursing Officers in GovernmentDepartments / Pay Drawing Officers in other Organisations covered underthis scheme, the Insurance Company/Third Party Administrator and theDirector of Treasuries and Accounts as the case may be. The InsuranceCompany / Third Party Administrator shall arrange to issue the IdentityCards to the employees within the stipulated time.10. The Insurance Company / Third Party Administrator shall ensurethat the patient i.e. employees and their family members who are eligibleunder this Scheme are given coverage for approved treatments / surgeriesincluding pre-existing illnesses in the approved hospitals for this purposeupto the limit of Rupees Four Lakh in respect of diseases covered inAnnexure-II and Rupees Seven lakh and Fifty Thousand in respect ofdiseases covered in Annexure-II-A over a period of four years commencingfrom 1-7-2016. The benefit will be on floater basis i.e. the total coverage, asapplicable can be availed of individually or collectively by the Employees andtheir eligible family members during the said block period with no restrictionon the number of times of availing. The over all limit of assistance in anycase shall not exceed Rupees Seven Lakh and Fifty Thousand for a familyduring the block period of four years from 1-7-2016.11. The employee and their eligible family members under thisscheme shall not be required to make any payment for the approved cost tothe hospitals upto the eligible limit. The hospitals approved by theInsurance Company / Third Party Administrator under this Scheme shallextend treatment to the employees and their eligible family members on aCASHLESS model.12. The procedure to be followed at the time of admitting employeesand / or their eligible family members for approved treatments/ surgeriesare as follows:(a) The hospitals approved by the Insurance Company/Third PartyAdministrator under this scheme alone should be approached foravailing assistance;(b) The approved Hospitals, the Liaison Officers of the United IndiaInsurance Company Limited / Third Party Administrator and theToll Free Helpline No.1800 233 5666 of Insurance Company /Third Party Administrator shall be informed for the approvedtreatments/surgeriestobeundertakensothat
: 10 :pre-authorisation is given by the Insurance Company / ThirdParty Administrator under the control of the United IndiaInsurance Company Limited, Chennai. In case of emergencyonly, the approval of the Insurance Company / Third PartyAdministrator for the accredited treatments / surgeriesundertaken in the approved hospitals shall be obtained forsettlement on CASHLESS basis during the period commencingfrom the date of admission in the approved hospitals asin-patient to the date before discharge from the hospital.(c) The Identity Card of the Employee issued by the InsuranceCompany / Third Party Administrator or the Certificate in lieu ofIdentity Card as in the Annexure-VI to this order shall beproduced to the approved hospitals for the approved treatments /surgeries. This arrangement of Certificate in lieu of Identity Cardwill be applicable only for such interim period, till the IdentityCards are issued. During the interim period of preparation anddistribution of the New Identity Cards, the Insurance Company/Third Party Administrator shall authorise acceptance of the existingIdentity Cards already issued under the New Health InsuranceScheme, 2012 for time being i.e. upto 30-09-2016.(d) This Scheme is on CASHLESS basis and no payment for approvedcost need to be made by the employee or their eligible familymembers to the approved Hospitals.(e) The eligible charges which are entitled to under this Schemeshould be ascertained for the approved treatments / surgeriesand the hospitals approved by the Insurance Company / ThirdParty Administrator shall not be allowed to charge any excessamount.(f) Any claim for reimbursement made in deviation of the aboveprocedure shall be rejected.(g) Information, Education, Communication (IEC) activities forcreation ofawareness among employees with reference toaddition and deletion of hospitals, specialties, etc., to be carriedout by Insurance Company.13. The Insurance Company shall submit Weekly / Monthly/ Quarterly / Annual report to the Government of Tamil Nadu withHead of Department / organization-wise details of the number subscribersenrolled, number
The Anna Institute of Management, Chennai-600 028. The International Institute of Tamil Studies, Chennai-600 113. The Tamil Nadu Energy Development Agency, Chennai. The United India Insurance Company Limited, Divisional Office: 010600, PLA Rathna Towers, 5 th
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