Tamil Nadu health insurance trust: chief ministers comprehensive health insurance scheme

Website: http://www.cmchistn.com/ It is reinstated kalaignar scheme Target : 1.34 crore BPL families of Tamil Nadu

Contact Information
The Project Director Tamil Nadu Health Systems Project (TNHSP) 3rd Floor, DMS Annex New Building 259 Anna Salai, Teynampet Chennai 600 006, Tamil Nadu INDIA Project office address : No 226, Om Shakti Towers, Kilpauk Garden Road, Kilpauk, CHENNAI - 10.Health Insurance : tnhealthinsurance@gmail.com Project Manager United India Insurance Co. Ltd, 24, Whites Road, Chennai 600014 Project Manager : Dr D Ramadoss Email :dramadoss@uiic.co.in Cell : 7373004391

CMO's 1. Common CMO Dr.Abhijit Sinha Roy Email : drroy@ttkhealthcareservices.com Cell : 7373004503 2. CMO of Claims Dr. Guru Maheswaran Cell :7373004366 3. CMO Dr Ajay Balaji Email :drajaybalaji@ttkhealthcareservices.com Cell :7373004648 cmchis@uiic.co.in and tncmchis@gmail.com

Introduction of the scheme

Launched on: January 11, 2012, aimed at benefiting 1.34 crore BPL population

Launched by: Tamil Nadu State Government through the United India Insurance
Company Ltd (a Public Sector Insurer headquartered at Chennai)

Aim: to provide free medical and surgical treatment in Government and Private hospitals to the members of any family whose annual family income is less than Rs.72,000/- (as certified by the Village Administrative Officers)

Coverage: all expenses relating to hospitalization of beneficiary Implemented by: Tamil Nadu Health Systems Society

Information about the scheme

Parameter Model of scheme Administration Responsibility Scheme implementation Unit of enrolment Nature of transaction Conditions covered Public Private Partnership (cost of scheme Rs. 200 crore per year) Insurance company and TPA Insurance Company Family Cashless Only tertiary care ,Surgical Procedures covered are 1127 and 23 Diagnostic procedures. 113 Follow up packages 1,00,000 per year per family with an buffer limit of additional 50,000 per year Entirely paid by Govt.

Follow up package Insurance Cover

Premium

Parameter Inclusions in package

Details Immediate Pre and post operative expenditure included in packages, so as to minimize the other financial expenses to the patient. Pre-existing diseases are covered from day one. 250 hospitals (Public and private)

Exclusions Network hospitals

Type of agreement with network hospitals Contractual agreement with network hospitals Total number of people registered Age Limitations Insurance Company 59,13,490 No United India Insurance Company.

Screening Camps
Minimum of one camp per month per empanelled hospital has to be conducted in

the districts in each policy year

Network hospital shall carry necessary screening equipments along with specialists (as suggested by the Tamil Nadu Health Systems Society) and other Para-medical staff Patients are Identified mostly through these camps and are referred for treatment

Health benefits provided under the scheme

The coverage will include bed charges in General ward, Nursing and boarding

charges,

Surgeons,

Anesthetists,

Medical

Practitioner,

Consultants

fees,

Anesthesia, Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances, Medicines and Drugs, Cost of Prosthetic Devices, implants, X-Ray and Diagnostic Tests, food to inpatient, transport cost etc., transport cost restricted to a maximum of Rs.1000/- per year. Expenses incurred for diagnostic test and medicines from 1 day before the admission of the patient upto 5 days after the discharge from the hospital

including transport expenses will also be the part of the package.

In addition to this, Primary Care is also provided through screening camps.

Follow up cover
The follow up packages covers the cost of a) consultation , b) medicines and c)

diagnosis test including all relevant investigations specified against each of the
procedures The follow up treatment starts on 6th day after discharge which is entirely cashless The packages are divided into four quarters. The first quarter being the higher amount and the remaining 3 quarters the amount of the packages are given equally The Hospital sends proof of follow-up services of patient for each quarter by uploading the following in the usual web portal used for claim processing. A) Details of consultation b) Details of Medicines given c) Investigation

Salient features
The new scheme also seeks to give priority to government hospitals over those in

the private sector

Certain types of treatments will be permitted only in government hospitals and special wards will be set up for this in hospitals approved by the government

Patient process flow

Patient or existing beneficiary under the old scheme

Heath camps conducted by NH

Health insurance identity card with biometrics is issued to the patients

Settlement of claims

Beneficiary having smart card under the old scheme

Processing of claims

Patient approaches the NH and submits the details at the assistance counter placed at the hospital

Cashless Treatment provided by NH or empanelled hospital

Approval of Pre- Authorization

Project office approves the request after authenticating id of patient and if the treatment required is part of the scheme Pre-Authorization request DMO of hospital submits Pre- Auth request for extending cashless facility

Verification of details and authentication of identity of patient by Liaison Officer