Monday, June 25, 2012

MEDICAL AID - New Health Insurance Scheme, 2012 for Employees of Government and their Family Members.

Government of Tamil Nadu
                2012

FINANCE [Salaries] DEPARTMENT

G.O.Ms.No.221, Dated 20th June 2012.

(Aani-6, Thiru valluvar Aandu-2043)

ABSTRACT

MEDICAL AID - New Health Insurance Scheme, 2012 for Employees of Government and their Family Members - Selection of a Public Sector Insurance Company for implementation - Interim Arrangements for providing health care assistance till implementation of New Health Insurance Scheme, 2012 - Orders Issued.

Read:-
G.O.Ms.No.139, Finance (Salaries) Department, dated 27-04-2012.

ORDER:-

   In the Government Order read above, orders have been issued for implementation of the New Health Insurance Scheme, 2012 beyond 10-06-2012 to provide for comprehensive health care assistance to the Employees of Government, etc. and their eligible Family Members with provision to avail assistance upto Rupees Four Lakh for the block period of four years after a suitable Public Sector Health Insurance Company selected through National Competitive Bidding as in the case of the Chief Minister’s Public Insurance Scheme.

   2. Accordingly, the Tender Inviting Authority has called for Open Tender by issue of Notice Inviting Tender on 27-04-2012. The Committee of Tender Accepting Authority to select a Public Sector Health Insurance Company has submitted its report to Finance Department on 06-06-2012 with its recommendation. The Government after careful consideration of the recommendations of the Committee has decided to accept the same. The United India Insurance Company Limited,  Chennai-600 006 has been selected for implementation of the New Health Insurance Scheme, 2012 with effect from 1-7-2012.

 

   3. The present New Health Insurance Scheme launched on 11-06-2008 for the block period of four years ended on 10-06-2012. As the New Health Insurance Scheme, 2012 will be launched from 1-7-2012 for further block period of four years, the reimbursement claims from the Government Employees for surgeries / treatments undergone during the period between 11-06-2012 and 30-06-2012 have to be settled.

   4. The Government hereby accords sanction for providing health care assistance to Government Employees and their eligible Family Members for the period from 11-06-2012 to 30-06-2012.

   5. The Government accordingly direct that the following arrangements be made for providing health care assistance by way of reimbursement to the Employees of Government and their eligible Family Members for the period from 11-06-2012 to 30-06-2012:-

   (i) Government delegate powers to the following authorities for sanctioning reimbursement claims from the Government Employees surgeries / treatments undergone during the interim period between 11-06-2012 and 30-06-2012 and designate them as Sanctioning Authority;

     (a) The Secretaries to Government in respect of employees in Secretariat Departments;

     (b) The Heads of Departments in respect of employees in Chennai District; and

     (c) The District Collectors in respect of employees other than Chennai District.

   (ii) The Government Employees shall submit claims for reimbursement of medical expenses for the approved surgeries / treatment through proper channel as per the format prescribed in the Annexure-I to this order along with Discharge Summary and Original Bills / Vouchers to the Sanctioning Authority mentioned in para 4(i) above.

   (iii) The Sanctioning Authority shall process the applications submitted by the employees and forward the same to Director of Medical Education in respect of employees in Chennai District and to Joint Directors of Health Services in districts in respect of employees other than Chennai District for obtaining remarks.

   (iv) On receipt of application from the Sanctioning Authority, the Director of Medical Education, Chennai / Joint Director of Medical Services in districts shall scrutinize the medical records and Bills/Vouchers with reference to the list of diseases, treatments / surgeries and hospitals which were already approved for the New Health Insurance Scheme for the block year 2008-2012 and the reimbursement provided for the same during the period 2008-2012 as per standard rates. Remarks as per the format prescribed in the Annexure-II to this order with the eligible quantity of reimbursement, countersign in the Bilis / Vouchers should be provided and the same shall be returned to the concerned Sanctioning Authority.

   (v) After obtaining the remarks of Director of Medical Education / Joint Director of Health Services as the case may be, the amount authorised by them shall be sanctioned by issuing necessary proceedings as per the format prescribed in the Annexure-III to this order by Sanctioning Authority.

   (vi) The Sanctioning Authority after issuing proceedings, send the sanctioned proceedings to the Pay and Accounts Officers concerned in Chennai District and Treasury Officers in districts in respect of other than Chennai District for preparation of the bill in the Miscellaneous Bill Form No.40 of T.N.T.C. and to draw and disburse reimbursement amount to the claimants as per the funds allotted by the Commissioner of Treasuries and Accounts, Chennai.

   (vii) The payment shall be made by cheques in favour of the Government Employee through the concerned Drawing and Disbursing Officer.

   (viii) The list of diseases, treatments / surgeries and hospitals which were already approved for the New Health Insurance Scheme for the block year 2008-2012 shall be adopted.

   (ix) The maximum coverage shall be allowed upto Rupees Two Lakh per employee and their eligible Family Members including the amount already availed under New Health Insurance Scheme for the block year 2008-2012 so that the total assistance under the scheme shall not exceed Rupees Two Lakh from 11-06-2008 till 30-06-2012. The eligibility of the Government Employee and their eligible Family Members and the claim status shall be verified through the existing database by the Director of Medical Education, Chennai / Joint Director of Health Services in districts concerned.

   6. The Government also sanction an initial Lumpsum amount of Rs.5,00,00,000/- (Rupees Five Crore Only) towards payment of health care assistance claims.

   7. The Commissioner of Treasuries and Accounts, Chennai-15 shall distribute the amount to the all Pay and Accounts Officers and Treasury Officers concern to incur the expenditure according to their requirements.

   8. The expenditure shall be debited to the following new Head of Account to be opened under Demand No.16. Finance Department:

2075.00. MISCELLANEOUS GENERAL SERVICES
800. Other Expenditure
I. Non-Plan
IC. Payment of Health Care Assistance to Government Employees till implementation of
New Health Insurance Scheme, 2012
09. Grants-in-Aid
3. Grants for Specific Schemes
(DPC 2075 00 800 IC 0938)

   9. The Commissioner of Treasuries and Accounts (HoD Code 1602), Chennai-15 shall be Estimating, Reconciling and Controlling authority in respect of the Heads of Account mentioned in para 8 above. The Pay and Accounts Officers / Treasury Officers concerned shall open the above Head of Account in their books of accounts.

   10. The expenditure sanctioned above shall constitute an item of “New Service” and the approval of the Legislature will be obtained in due course. Pending approval of the Legislature, the expenditure shall be initially met by an advance from the Contingency Fund, orders regarding which will be issued by the Government in Finance (BG-I) Department based on the application in the prescribed format along with a copy of this order.

   11. The Commissioner of Treasuries and Accounts, Chennai-15 shall apply for the required funds from Contingency Fund to the Finance (BG-I) Department in the prescribed format along with a copy of this order.

   12. The Commissioner of Treasuries and Accounts, Chennai-15 shall also send necessary Supplementary Notes for inclusion of the above expenditure in the Supplementary Estimates, 2012-2013 at the appropriate time.

   13. The Local Bodies, State Public Sector Undertaking and Statutory Boards, State Government Universities and State Organisations / Institutions already covered under the New Health Insurance Scheme 2008-2012 may extend this health care assistance to their employees during the interim period from 11-06-2012 to 30-06-2012 from their own funds.

   14. This order is issued with Additional Sanction Ledger No.453 (Four Hundred and Fifty Three).

(BY ORDER OF THE GOVERNOR)

K. SHANMUGAM
PRINCIPAL SECRETARY TO GOVERNMENT.

To View the Annexure I, II and III

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