comprehensive Health Insurance Scheme (CMCHIS)

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Quality healthcare comes at a cost that is unaffordable for the economically weaker sections of society. One way to address this is to provide free healthcare in Government hospitals. But sometimes treatment is not possible at district and sub-district hospitals. Furthermore, the demand for advanced healthcare leads to long waitlists for emergency and life saving surgeries. To address these challenges and ensure availability of advanced healthcare, the Government of Tamilnadu introduced a scheme called the “Chief Minister Kalaignar Insurance Scheme for life saving treatments” on 23rd July 2009. This scheme is for the poorest of the poor/low income/unorganised groups who cannot afford costly treatment, as a supplementary facility for getting free treatment in empanelled Government and private hospitals for such serious ailments

Key Features

• Free surgical and medical treatments in private and government hospitals for economically backward classes are the sole aim of this scheme.
• Only certain specific treatments will get up to Rs 1.5 lakhs per year. Otherwise, with a total sum of Rs. 4 lakhs in 4 years, every single family is eligible for Rs. 1 lakh per year.Approximately 13.4 million people of Tamil Nadu State will be covered under this scheme.
• In short, this CMCHIS is a replacement to 2009 launched Kalaignar Insurance Scheme.

Eligibility

Any family whose annual income is Rs.72,000/- or less, members of unorganised labour welfare boards, and the spouse, children and dependent parents of such members in urban and rural areas are eligible. All Government servants, civil pensioners, ESI beneficiaries and families having an annual income of more than Rs. 72,000 /- but not members of any unorganised sectors welfare boards are not eligible under this scheme.

Needs Covered

Under the scheme, the sum assured for each family would be Rs.1 lakh every year for a total period of four years and for a total value of Rs. 4 lakh. In the case of certain procedures, the ceiling would be raised to Rs.1.5 lakh per annum. No fewer than 250 hospitals would be empanelled under the scheme. At least six hospitals in each district would be covered. There would be more hospitals in cities such as Chennai, Coimbatore and Madurai.

With an annual premium payment of Rs. 1,069 crores with United India Insurance Company contract has been renewed for four-year terms on conditions to provide more than 1,100 treatment conducts comprising the reports of congenital anomalies.

EMI and Mode of Payment

With or without interest, the state government will bear Equated monthly instalments (EMI) as per terms of the scheme. Besides, payments will directly be issued to assigned hospitals without the inclusion of any third party agent in between.

Coverage Details

To rectify low health quality treatment confrontations, back in 23rd July 2009, Tamil Nadu State Government also launched Chief Minister Kalaignar Insurance Scheme in addition to presently implemented Chief Minister’s Comprehensive Health Insurance Scheme.

Smart Card Use Download

To constitute a fine line of disengagement between eligible and non-eligible candidates for a scheme in the region, the state government has also introduced – SMART CARDS. 

To verify a range of treatment one is qualified for, at a referred hospital, help center will authenticate the Smart Cards. Depending upon requirements, a liaison officer at help centers will match identification particulars with those in Aadhar Card to Smart Card. 

Further assigned hospital’s DMO will send a pre-authorisation request to a cashless facility to received amount/ money associated with the scheme for proceedings.