This is a lofty Insurance Scheme launched by the Tamil Nadu State Government through the United India Insurance Company Ltd (a Public Sector Insurer headquartered at Chennai) 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) .The Scheme provides coverage for meeting all expenses relating to hospitalization of beneficiary as defined in the Scope of the Scheme.
The scheme seeks to provide cashless hospitalisation facility for certain specified ailments/ procedures. The scheme provides a coverage up to Rs.1,00,000/- per family per year on a floater basis for the various ailments and procedures .
For certain specified ailments and procedures of critical nature, the overall limit is increased from Rs.1,00,000/- to Rs.1,50,000/-
There are 2 other covers other than the hospitalisation benefits available under the Scheme. They are
- Follow-up Treatment &
- Additional Diagnostic procedures
Every member of a family whose annual family income is less than Rs.72,000/- as certified by Village Administrative Officer and such other person who may be declared to be eligible for coverage under the "Chief Minister's Comprehensive Health Insurance Scheme" by the Government will be "Eligible Persons" under the Scheme.
"Family" includes the eligible member, and the members of his or her family as detailed below:
- Legal spouse of the eligible person;
- Children of the eligible person till they get employed or married or attain the age of 25 years, whichever is earlier, and who are dependent on the eligible person;
- Dependent parents of the eligible person.
Provided that if any person, in any of the categories at (i), (ii) or (iii) above, finds place in the family ration card, then it shall be presumed that the person is member of the family, and no further confirmation would be required.
If any member of the family of an eligible person is eligible to have his/her name included in the family of an another eligible person, he/she would be eligible to have his/her name included in one health insurance identity card only and claim assistance under one card only.
Once the Children of the family head
- gets employed or
- married or
- attains the age of 25 years, whichever is earlier should obtain fresh smart cards after establishing the eligibility with the proof of the coverage in the Family Ration Card and the Smart Card as well as the Income Certificate from the VAO.
The new enrolment and issue of cards will be through district kiosk established by the insurance company at the District Collectorate.
| S.NO | SPECIALTY | PROCEDURES |
|---|---|---|
| 1 | ORTHOPEDIC TRAUMA | TN0314 : SURGICAL CORRECTION OF LONGBONE FRACTURE |
| ORTHOPEDIC TRAUMA | TN0314-A : FRACTURE NECK/ SHAFT OF FEMUR | |
| ORTHOPEDIC TRAUMA | TN0314-B : FRACTURE SHAFT OF OTHER LONG BONES (HUMERUS, BOTH BONES OF FORARM, BOTH BONES OF LEG) | |
| 2 | ORTHOPEDIC TRAUMA | TN0316-A : AMPUTATION OF AK / BK |
| ORTHOPEDIC TRAUMA | TN0316-B : AMPUTATION OF AE / BE | |
| ORTHOPEDIC TRAUMA | TN0316-C : AMPUTATION OF FORE-FOOT | |
| ORTHOPEDIC TRAUMA | TN0316-D : SYM'S AMPUTATION | |
| ORTHOPEDIC TRAUMA | TN0316-E : AMPUTATION OF TOES | |
| ORTHOPEDIC TRAUMA | TN0316-F : AMPUTATION OF FINGERS | |
| ORTHOPEDIC TRAUMA | TN0316-G : TRANS META-TARSAL AMPUTATION | |
| 3 | ORTHOPEDIC TRAUMA | TN0317 : SOFT TISSUE INJURY |
| 4 | ORTHOPEDIC TRAUMA | TN0321 : BONE GRAFTING AS EXCLUSIVE PROCEDURE |
| 5 | ORTHOPEDIC TRAUMA | TN0323 : OPEN REDUCTION & INTERNAL FIXATION OF FINGERS & TOES |
| 6 | ORTHOPEDIC TRAUMA | TN0324 : REDUCTION OF COMPOUND FRACTURES & EXTERNAL FIXATION |
| 7 | ORTHOPEDIC TRAUMA | TN0327 : OPEN REDUCTION OF DISLOCATIONS - DEEP |
| 8 | ORTHOPEDIC TRAUMA | TN0331 : AVASCULAR NECROSIS OF FEMORAL HEAD (CORE DECOMPRESSION) |
| 9 | ORTHOPEDIC TRAUMA | TN0332 : SOFT TISSUE RECONSTRUCTION PROCEDURES FOR JOINTS/OSTEOTOMY |
| 10 | POLY TRAUMA | TN0340 : GRADE-I & II |
| 11 | POLY TRAUMA | TN0341 : GRADE-III |
| 12 | POLY TRAUMA | TN0343 : SURGERY FOR PATELLA FRACTURE (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE) |
| 13 | POLY TRAUMA | TN0344 : SMALL BONE FRACTURES-K-WIRING (TO BE COVERED ALONG WITH OTHER INJURIES ONLY AND NOT AS EXCLUSIVE PROCEDURE) |
| 14 | ENT | TN0571 : MASTOIDECTOMY |
| 15 | ENT | TN0572 : STAPEDECTOMY - VEINGRAFT |
| 16 | ENT | TN0573 : TYMPANOPLASTY |
| 17 | ENT | TN0575 : FACIAL NERVE DECOMPRESSION |
| 18 | ENT | TN0579 : LARYNGO FISSURECTOMY |
| 19 | ENT | TN0580 : ADENOIDECTOMY - GROMET INSERTION |
| 20 | ENT | TN0584 : EXCISION OF BENIGN TUMOUR NOSE |
| 21 | ENT | TN0585 : ANGIOFIBROMA NOSE |
| 22 | ENT | TN0586 : ENDOSCOPIC DCR |
| 23 | ENT | TN0587 : ENDOSCOPIC SINUS SURGERY |
| 24 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0617 : RUPTURE UTERUS WITH TUBECTOMY |
| 25 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0618 : ECLAMPSIA WITH COMPLICATIONS REQUIRING VENTILATORY SUPPORT |
| 26 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0621 : VAGINAL HYSTERECTOMY WITH PELVIC FLOOR REPAIR |
| 27 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0623 : CYSTOCELE, RECTOCELE & PERINEORRAPHY |
| 28 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0636 : VAGINAL HYSTERECTOMY FOR BENIGN CONDITIONS |
| 29 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0637 : ABDOMINAL HYSTRECTOMY FOR BENIGN CONDITIONS |
| 30 | GYNAECOLOGY & OBSTETRIC SURGERY | TN0640 : DIAGNOSTIC HYSTERO- LAPROSCOPY |
| 31 | GENERAL SURGERY | TN0840 : BRANCHIAL CYST EXCISION |
| 32 | GENERAL SURGERY | TN0842 : CYSTIC HYGROMA EXCISION-EXTENSIVE |
| 33 | GENERAL SURGERY | TN0846 : REMOVAL OF SUBMANDIBULAR SALIVARY GLAND |
| 34 | GENERAL SURGERY | TN0849 : EXCISION OF THYROGLOSSAL CYST FISTULA |
| 35 | GENERAL SURGERY | TN0853 : HEMITHYROIDECTOMY |
| 36 | GENERAL SURGERY | TN0854 : ISTHMECTOMY |
| 37 | GENERAL SURGERY | TN0855 : PARTIAL THYROIDECTOMY |
| 38 | GENERAL SURGERY | TN0856 : RESECTION ENUCLEATION |
| 39 | GENERAL SURGERY | TN0857 : SUBTOTAL THYROIDECTOMY |
| 40 | GENERAL SURGERY | TN0858 : TOTAL THYROIDECTOMY |
| 41 | GENERAL SURGERY | TN0859 : SIMPLE MASTECTOMY(NM) |
| 42 | GENERAL SURGERY | TN0860 : MODIFIED RADICAL MASTECTOMY |
| 43 | GENERAL SURGERY | TN0861 : EPIGASTRIC HERNIA WITHOUT MESH |
| 44 | GENERAL SURGERY | TN0862 : EPIGASTRIC HERNIA WITH MESH |
| 45 | GENERAL SURGERY | TN0866 : UMBILICAL HERNIA WITHOUT MESH |
| 46 | GENERAL SURGERY | TN0867 : UMBILICAL HERNIA WITH MESH |
| 47 | GENERAL SURGERY | TN0868 : VENTRAL AND SCAR HERNIA WITHOUT MESH |
| 48 | GENERAL SURGERY | TN0869 : VENTRAL AND SCAR HERNIA WITH MESH |
| 49 | GENERAL SURGERY | TN0870 : LAP. APPENDICECTOMY |
| 50 | GENERAL SURGERY | TN0876 : PARTIAL/SUBTOTAL GASTRECTOMY FOR ULCER |
| 51 | GENERAL SURGERY | TN0883 : RESECTION & ANASTOMOSIS OF SMALL INTESTINE |
| 52 | GENERAL SURGERY | TN0886 : TOTAL COLECTOMY |
| 53 | GENERAL SURGERY | TN0887: COLOSTOMY |
| 54 | GENERAL SURGERY | TN0888 : COLOSTOMY CLOSURE |
| 55 | GENERAL SURGERY | TN0944 : BRONCHOSCOPY FOREIGN BODY REMOVAL |
| 56 | GENERAL SURGERY | TN0945 : FB CRICOPHARYNX, ESOPHAGUS |
Free health camps / screening camps will be conducted by network hospitals as per the directions given by Project Director of Tamil Nadu Health Systems Society. Minimum of one camp per month per empanelled hospital will be held in the districts in each policy year. The persons who need treatment are identified in the Health camps. Such patients can approach the hospital in the network and follow the guidelines below:
- A new Health Insurance identity card with biometrics is being issued to all those members who have been holding the smart cards in the earlier scheme. Till such time new cards are issued the public can use the earlier smart (Health) cards
- This card should be shown at the Assistance Counter established at the empanelled hospital.
- After due verification of the details and authenticating the identity of the patient by the Liaison Officer, the necessary Pre-authorisation request for cashless facility will be submitted by the DMO of the hospital.
- The Project Office will approve the request on authentication of the identity and provided the procedure planned is within the Scheme
Even those patients who have the smart cards, though not identified through the Health Camps can also avail the benefit as above.
HELPLINE:A 24 hour Call Centre has been set up at CMCHISTN Project Office with sufficient manpower with toll free help line. The Toll Free Number is 1800 425 3993. The Toll Free Line is competent to answer the query in Tamil.