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Wednesday, June 27, 2012

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


FINANCE (Salaries) DEPARTMENT

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

(Aani-6, Thiruvalluvar 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.
                                                          - oOo-
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 up to Rupees Four Lakh for the block period of four years after a suitable Public Sector Health Insurance Company selected throu7gh 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 of 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 11-0602998 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 
3-06-2012 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 30-06-2013.

         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/
                  treatment 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-1 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 the this order with the eligible quantity 
                   of reimbursement,Countersign in the Bills/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 authorized
                  by them shall be sanctioned by issuing necessary proceedings as per 
                  the format prescribe 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 Commissione 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 up to 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 lump sum 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
                         l.    Non-Plan
                        lC.   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-l) 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-l) 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 Organizations/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 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.




              

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