FINANCE [Salaries] DEPARTMENT G.O.Ms.No.202

Transcription

1 Government of Tamil Nadu 2016 MANUSCRIPT SERIES FINANCE [Salaries] DEPARTMENT G.O.Ms.No , Dated 30 th June (Thunmugi, Aani-16, Thiruvalluvar Aandu-2047) ABSTRACT MEDICAL AID New Health Insurance Scheme, 2016 Provision of Health Care Assistance to the Employees of Government Departments, Organisations covered under this Scheme and their eligible Family members through the United India Insurance Company Limited, Chennai - Implementation - Orders Issued. READ : G.O.Ms.No.169, Finance (Salaries) Department, dated ooo- ORDER: In the Government Order read above, orders have been issued for the implementation of the New Health Insurance Scheme, 2016 to provide for health care assistance to the Employees of Government Departments, State Public Sector Undertakings, Statutory Boards, Local Bodies, State Government Universities and their eligible family members after the selection of a suitable Public Sector Insurance Company through National Competitive Bidding as in the case of New Health Insurance Scheme, Accordingly, the Notice Inviting Tender, dated has been issued. The Official Committee, which is the Tender Accepting Authority, after invoking due procedure as per the Tamil Nadu Transparency in Tenders Act, 1998 and the Tamil Nadu Transparency in Tenders Rules, 2000, submitted it s report on to select the United India Insurance Company Limited, Chennai for implementing the New Health Insurance Scheme, The recommendation of the Tender Accepting Authority has been considered and the tender has been awarded to the United India Insurance Company Limited, Chennai. The said Company has executed an agreement with the Government of Tamil Nadu for the implementation of the New Health Insurance Scheme, The Government after careful consideration directs that:- (i) The New Health Insurance Scheme, 2016 (NHIS) sanctioned in the Government Order read above be implemented through the United India Insurance Company Limited, Chennai invoking the implementation procedures as detailed in the Annexure-I to this order; P.T.O.

2 : 2 : (ii) The Director of Treasuries and Accounts shall be the administrator of the New Health Insurance Scheme, 2016; (iii) The enrolment under New Health Insurance Scheme, 2016 shall be compulsory to the employees and their eligible family members as detailed in para 2 and 4 of Annexure-I to this order; (iv) The employees and their eligible family members covered under the scheme shall avail assistance upto the limit of Rupees Four Lakh in a block of four years commencing from as a CASHLESS model for the approved treatments/surgeries listed in the Annexure-II to this order, in the hospitals approved by the United India Insurance Company/Third Party Administrator and listed in the Annexure-III to this order; (a) However, the assistance shall be upto Rupees Seven Lakh and Fifty Thousand for illnesses listed out in Annexure II-A to the order; (b) The upper limit of medical assistance for cataract surgery shall be Rs.25,000/- per eye. In respect of Hysterectomy (uterus removal surgery) the upper limit of medical assistance shall be Rs.45,000/-. (c) The overall limit of assistance, in any case shall not exceed Rupees Seven Lakh and Fifty Thousand for a family in a block of four years under this scheme. (v) The coverage of medical assistance under the scheme shall be extended to accident cases where the patient got approved treatment/undergone surgery in a non-network hospital; (vi) The payment of premium shall be regulated as per the terms and conditions of the agreement between the United India Insurance Company and the Government. The annual premium payable by the Government to the United India Insurance Company Limited, shall be Rs. 2,100/- (plus Service Tax as applicable from time to time) per employee, per annum for the block period of four year from to (vii) The annual premium initially paid by the Government shall be recovered from the Rs.180/- per month by deduction in monthly salary from the month of July, (a) The excess of premium over and above the amount recovered shall be borne by the employer. In respect of Government employees and employees of Government aided educational institutions, the excess premium shall be borne by the Government.

3 : 3 : (viii) Eventhough the legal spouse is covered under the term Employee, the total assistance for the Family will be limited to Rupees Four Lakh only in respect of diseases covered in Annexure-II and Rupees Seven Lakh and Fifty Thousand per family for specified illnesses listed in Annexure-II A. The overall limit of assistance shall not exceed Rupees Seven Lakh and Fifty Thousand per family in a block of four years. In such cases, the employee s contribution shall be recovered from only one of the employees i.e. from the younger of the two. 5. The Government also direct that the monthly subscription of the Employees of Government Departments be credited to the following Revenue Receipt Heads of Account: Government Employees in the Standard Scales of Pay OTHER MISCELLANEOUS GENERAL SERVICES 800. Other Receipts BM. Subscription of Government Employees towards New Health Insurance Scheme (NHIS) (D.P.C BM 0000) Employees drawing Pay under Non-Standard Scales of Pay OTHER MISCELLANEOUS GENERAL SERVICES 800. Other Receipts BQ. Subscription of Employees in Non-Standard Scales of Pay towards New Health Insurance Scheme (NHIS) (D.P.C BQ 0008) 6. The Government further direct that the Annual Premium plus Service Tax as applicable in respect of employees of the State Public Sector Undertakings, Statutory Boards, Local Bodies, State Government Universities, Willing State Government Organisations / Institutions registered under the Tamil Nadu Registration of Societies Act, 1975 and the Tamil Nadu Hindu Religious and Charitable Endowments Board be remitted into the State Government Account within one month from for the first year and before 31 st July for the second, third and fourth year without fail. The excess of premium over and above the employee contribution shall be borne by the respective organisation. 7. The Chief Executive Officers / Managing Directors of State Public Sector Undertakings and Statutory Boards, Registrars of State Government Universities, the Director of Rural Development, the Director of Municipal Administration and the Commissioner of Hindu Religious and Charitable Endowment Administration shall make necessary arrangements for recovery of the employee contribution at Rs.180/- per month by deduction in the monthly salary from July, 2016 and remittance of Annual Premium

4 : 4 : (including Service Tax as applicable from time to time) to the following heads of account at the appropriate time mentioned in para 6 above. Employees of State Public Sector Undertakings and Statutory Boards OTHER MISCELLANEOUS GENERAL SERVICES 800. Other Receipts BO. Subscription of Employees of Public Sector Undertakings and Statutory Boards towards New Health Insurance Scheme (NHIS) (D.P.C BO 0004) Employees of State Government Universities OTHER MISCELLANEOUS GENERAL SERVICES 800. Other Receipts BP. Subscription of Employees of State Government Universities towards New Health Insurance Scheme (NHIS) (D.P.C BP 0006) Employees of Local Bodies [Corporations, Municipalities, Town Panchayat, Panchayat Unions and Village Panchayat, etc.] OTHER MISCELLANEOUS GENERAL SERVICES 800. Other Receipts BN. Subscription of Employees of Local Bodies towards New Health Insurance Scheme (NHIS) (D.P.C BN 0002) State Government Organisations / Institutions registered under Tamil Nadu Registration of Societies Act, OTHER MISCELLANEOUS GENERAL SERVICES 800. Other Receipts BT. Subscription of Employees of Organisations registered under the Tamil Nadu Registration of Societies Act, 1975 towards New Health Insurance Scheme (NHIS) (D.P.C BT 0004) 8. The employees of State Government Organisations / Institutions registered under the Tamil Nadu Registration of Societies Act, 1975 which are willing and capable of bearing the employer share of the premium without financial liability befalling on the State Budget may also be enrolled under the New Health Insurance Scheme, 2016, subject to adherence of the terms and conditions including the remittance of the annual premium to the Government at the appropriate time as mentioned in para 6 above. The

5 : 5 : orders to cover the willing State Government Organisations / Institutions under this scheme shall be issued by the Government in Finance Department. 9. The insurance premium on behalf of all the employees will be paid by the Government as per the terms and conditions of the agreement based on the proposals from the Director of Treasuries and Accounts. The expenditure on payment of insurance premium shall be debited to the following Head of Account under Demand No.16. Finance Department [HoD Code 1602]: MISCELLANEOUS GENERAL SERVICES 800. Other Expenditure HG. Payment of Premium to the Insurance Company for implementing New Health Insurance Scheme 10. Contributions 2. Insurance Premium (DPC HG 1029) 10. The Nodal Officers of the United India Insurance Company Limited situated in the District Headquarters and Toll Free Helpline Number are listed in the Annexure-IV. The lists of approved treatments and surgeries, approved hospitals and the addresses of the Offices situated in the District Headquarters will be hosted in the websites of Government of Tamil Nadu in Finance Department ( Treasuries and Accounts Department ( and the United India Insurance Company Limited, Chennai / Third Party Administrator ( The additional list of approved hospitals treatments /surgeries to be included and the list of deleted hospitals, treatments /surgeries if any covered in this Scheme will also be updated and hosted in the above websites for ready reference from time to time, based on the recommendation of the Accreditation Committee. 11. The Drawing and Disbursing Officers in Government Departments/Pay Drawing Officers in the other Organisations shall furnish the details of the employees and their eligible family members as per the Guidelines Regarding Identity Cards in Annexure-V to this order. 12. The Director of Treasuries and Accounts shall submit proposals to Government for sanction of insurance premium at the appropriate time as per the terms and conditions of the agreement. (BY ORDER OF THE GOVERNOR) K.SHANMUGAM ADDITIONAL CHIEF SECRETARY TO GOVERNMENT. To All Secretaries to Government, Chennai All Departments of Secretariat (OP/Bills), Chennai The Secretary, Legislative Assembly Secretariat, Chennai The Secretary to the Governor, Chennai The Comptroller, Governor s Household, Raj Bhavan, Chennai

6 : 6 : The Governor s Secretariat, Raj Bhavan, Guindy, Chennai All Heads of Departments. All Public Sector Undertakings and Statutory Boards. All District Collectors / All District Judges / All Chief Judicial Magistrates. The Accountant General (A&E) Chennai The Accountant General (Audit-I) Chennai The Accountant General (Audit-II) Chennai The Accountant General (CAB) Chennai-9 / Madurai. All Chief Educational Officers / All District Elementary Educational Officers. All Pay and Accounts Officers / All Treasury Officers / Sub-Treasury Officers. The Director of Treasuries and Accounts,Chennai-15. The Chief Internal Auditor and Chief Auditor of Statutory Boards,807, Chennai-2. The Secretary, Tamil Nadu Public Service Commission, Chennai The Registrar General, High Court, Chennai All Commissioners of Tribunal for Disciplinary Proceedings. The Registrars of all Universities. The Project Co-ordinator, Tamil Nadu Integrated Nutrition Project, Chennai. The Commissioners, Corporation of Chennai, Coimbatore, Madurai, Trichy, Tirunelveli, Salem, Tiruppur and Erode. All Municipalities. / The Tamil Nadu Science and Technology Centre, Chennai-25. The Anna Institute of Management, Chennai The International Institute of Tamil Studies, Chennai The Tamil Nadu Energy Development Agency, Chennai. The United India Insurance Company Limited, Divisional Office: , PLA Rathna Towers, 5 th Floor 212, Anna Salai, Chennai The Managing Director, Tamil Nadu Road Sector Company Limited, Chennai The Managing Director, IT Expressway Limited, Chennai Copy to: The Secretary to the Chief Minister, Chennai The Chief Minister s Office, Chennai The Private Secretary to the Chief Secretary to Government, Chennai The Special Personal Assistant to Finance Minister, Chennai The Senior Private Secretary to the Additional Chief Secretary to Government, Finance Department, Chennai All Officers in Finance Department, Chennai All Sections in Finance Department, Chennai All Recognised Associations. Stock File / Spare Copies. -/ Forwarded : By Order /- UNDER SECRETARY TO GOVERNMENT.

7 : 7 : Annexure-I IMPLEMENTATION PROCEDURES FOR NEW HEALTH INSURANCE SCHEME, The New Health Insurance Scheme, 2016 shall be implemented by the Director of Treasuries and Accounts, Chennai-15 through the United India Insurance Company Limited, Chennai / Third Party Administrator under the control of United India Insurance Company Limited, Chennai for a block period of four years commencing from The following employees and their eligible family members are covered under the New Health Insurance Scheme, 2016:- (a) The employees of Government Departments drawing pay in regular time scale of pay including Teaching and Non-Teaching Staff of Aided Educational Institutions. (b) The employees of Local Bodies, State Public Sector Undertakings, Statutory Boards and State Government Universities, unless and otherwise specifically ordered to be excluded from the coverage of the scheme. (c) The employees of willing Organisations / Institutions registered under the Tamil Nadu Registration of Societies Act, 1975 covered under the New Health Insurance Scheme (d) The employees of the Tamil Nadu Hindu Religious & Charitable Endowments Board drawing pay in regular time scale of pay. 3. The employees appointed on (a) Consolidated Pay / Fixed Pay / Honorarium, (b) Daily Wage, (c) Contract basis, (d) Re-employment, (e) Temporary basis under Rule 10(a)(i) of the Tamil Nadu State and Subordinate Services through Employment Exchange and (f) Outsourcing are not covered under this Scheme. 4. The following family members of the employee shall be covered under the New Health Insurance Scheme, 2016: (i) Legal Spouse of the Employee; (ii) Children of the Employee - till they get employed or married or attain the age of 25 years whichever is earlier and dependent on the Employee; (iii) Parents of the Employee, in the case of unmarried employee until the Employee get married; and (iv) Physically Challenged and Mentally Retarded children of the employee without any age restriction, subject to the minimum of the handicap to the extent of 40% as certified by the District Disability Welfare / Rehabilitation Officer and wholly dependent on the employee. 5. (a) The Diseases, Treatments and Surgeries under the Broad Based Specialties approved under the New Health Insurance Scheme, 2016 are listed in the Annexure-II and Annexure II-A to this order and the scope of

8 : 8 : the scheme shall be to provide coverage for the eligible expenses incurred by the employee on behalf of himself / herself or any eligible his / her family members on such treatments and surgeries. The coverage will include the cost of medicines, laparoscopic or open surgeries, doctor and attendant fees, room charges, diagnostic charges, dietary charges availed in the approved hospitals. The coverage shall also include pre-existing illnesses which have been included in the above said list. The Transport Charges shall be excluded. (b) Claims relating to treatment / surgery included in the approved list undergone in non-network hospital consequent on accidents shall be covered under NHIS, 2016 and settlement made through a suitable mechanism. (c) Cap on ceiling of assistance in respect of cataract surgery shall not exceed Rs.25,000/- per eye and cap on ceiling of assistance in respect of Hysterectomy (uterus removal surgery) shall not exceed Rs.45,000/-. 6. The hospitals already accredited for New Health Insurance Scheme, 2012 with the approval of the Insurance Company / Third Party Administrator and listed out in the Annexure-III to the Government Order shall be applicable to the New Health Insurance Scheme, The employees and/or their family members eligible for assistance shall get admitted in any one of the approved hospitals, by production of the Identity Card issued by the Insurance Company or by production of the Certificate as in the Annexure-VI issued by the Drawing and Disbursing Officers in Government Department / Pay Drawing Officers in other Organisations covered under this Scheme which will be valid till the New Identity Cards are issued by the Insurance Company. During the interim period of preparation and distribution of the New Identity Cards, the Insurance Company / Third Party Administrator shall authorise acceptance of the Identity Cards already issued under the New Health Insurance Scheme, The additional lists of approved hospitals, treatments/surgeries to be included and deletion of approved hospitals, treatments/surgeries if any, shall be issued from time to time on report of the Accreditation Committee. The updated list of approved hospitals, treatments/surgeries may be verified with the websites of the Government of Tamil Nadu in Finance Department and the United India Insurance Company Limited, Chennai / Third Party Administrator under the control of United India Insurance Company Limited, Chennai. The Accreditation Committee for empanelment of network hospitals and to monitor the quality of treatment etc., constituted in G.O.Ms.No.309, Finance (Salaries) Department, dated for New Health Insurance Scheme, 2012 shall be continued for the implementation of New Health Insurance Scheme, The Insurance Company / Third Party Administrator shall arrange to issue the new Identity Cards to the employees covered under this scheme with the details of eligible family members within a period of 90 days from The Insurance Company / Third Party Administrator shall also arrange to issue the Identity Cards to the employees newly recruited or absorbed in service as the case may be as and when the details of the employees are furnished to the Insurance Company / Third Party Administrator. The Drawing and Disbursing Officers in Government Departments / Pay Drawing Officers in other Organisations covered under

9 : 9 : this Scheme shall be responsible to arrange to furnish data in the prescribed format well within the stipulated time and get Identity Cards for their employees. They shall also be responsible to surrender the Identity Cards to the Insurance Company in respect of such employees who retire on superannuation, die in harness or otherwise cease to be in service. The Identity Cards in such cases shall be surrendered by the Employee or their family member to the Drawing and Disbursing Officers in Government Departments and Pay Drawing Officers in other Organisations covered under this scheme. 9. The Director of Treasuries and Accounts, Chennai-15 shall monitor the progress of the work of the Insurance Company / Third Party Administrator for issuance of new Identity Cards to the employees. The guidelines regarding Identity Cards as in the Annexure-V shall be followed by the employees, the Drawing and Disbursing Officers in Government Departments / Pay Drawing Officers in other Organisations covered under this scheme, the Insurance Company/Third Party Administrator and the Director of Treasuries and Accounts as the case may be. The Insurance Company / Third Party Administrator shall arrange to issue the Identity Cards to the employees within the stipulated time. 10. The Insurance Company / Third Party Administrator shall ensure that the patient i.e. employees and their family members who are eligible under this Scheme are given coverage for approved treatments / surgeries including pre-existing illnesses in the approved hospitals for this purpose upto the limit of Rupees Four Lakh in respect of diseases covered in Annexure-II and Rupees Seven lakh and Fifty Thousand in respect of diseases covered in Annexure-II-A over a period of four years commencing from The benefit will be on floater basis i.e. the total coverage, as applicable can be availed of individually or collectively by the Employees and their eligible family members during the said block period with no restriction on the number of times of availing. The over all limit of assistance in any case shall not exceed Rupees Seven Lakh and Fifty Thousand for a family during the block period of four years from The employee and their eligible family members under this scheme shall not be required to make any payment for the approved cost to the hospitals upto the eligible limit. The hospitals approved by the Insurance Company / Third Party Administrator under this Scheme shall extend treatment to the employees and their eligible family members on a CASHLESS model. 12. The procedure to be followed at the time of admitting employees and / or their eligible family members for approved treatments/ surgeries are as follows: (a) The hospitals approved by the Insurance Company/Third Party Administrator under this scheme alone should be approached for availing assistance; (b) The approved Hospitals, the Liaison Officers of the United India Insurance Company Limited / Third Party Administrator and the Toll Free Helpline No of Insurance Company / Third Party Administrator shall be informed for the approved treatments / surgeries to be undertaken so that

10 : 10 : pre-authorisation is given by the Insurance Company / Third Party Administrator under the control of the United India Insurance Company Limited, Chennai. In case of emergency only, the approval of the Insurance Company / Third Party Administrator for the accredited treatments / surgeries undertaken in the approved hospitals shall be obtained for settlement on CASHLESS basis during the period commencing from the date of admission in the approved hospitals as in-patient to the date before discharge from the hospital. (c) The Identity Card of the Employee issued by the Insurance Company / Third Party Administrator or the Certificate in lieu of Identity Card as in the Annexure-VI to this order shall be produced to the approved hospitals for the approved treatments / surgeries. This arrangement of Certificate in lieu of Identity Card will be applicable only for such interim period, till the Identity Cards are issued. During the interim period of preparation and distribution of the New Identity Cards, the Insurance Company/ Third Party Administrator shall authorise acceptance of the existing Identity Cards already issued under the New Health Insurance Scheme, 2012 for time being i.e. upto (d) This Scheme is on CASHLESS basis and no payment for approved cost need to be made by the employee or their eligible family members to the approved Hospitals. (e) The eligible charges which are entitled to under this Scheme should be ascertained for the approved treatments / surgeries and the hospitals approved by the Insurance Company / Third Party Administrator shall not be allowed to charge any excess amount. (f) Any claim for reimbursement made in deviation of the above procedure shall be rejected. (g) Information, Education, Communication (IEC) activities for creation of awareness among employees with reference to addition and deletion of hospitals, specialties, etc., to be carried out by Insurance Company. 13. The Insurance Company shall submit Weekly / Monthly / Quarterly / Annual report to the Government of Tamil Nadu with Head of Department / organization-wise details of the number subscribers enrolled, number of claims received, and the total amount disbursed - diseases, treatments and surgeries-wise. Moreover, heads of department / organization-wise monthly report detailing the opening balance of number of employees of the month, additions and deletions during the month shall be furnished. Similarly, heads of department / organization - wise monthly report shall reveal the opening balance of number of Identity Cards, number of Identity Cards issued during the month and balance yet to be issued. 14. Eventhough the legal spouse is covered under the term Employee, the total financial assistance for the family will be limited to Rupees Four Lakh in respect of diseases, treatments and surgeries listed in the Annexure-II and Rupees Seven Lakh and Fifty Thousand in respect of

11 : 11 : diseases specified illnesses listed in the Annexure-II A. However, the total assistance per family shall not in any case exceed Rupees Seven Lakh and Fifty Thousand per four year block period. In such cases, the employee s contribution towards premium shall be recovered from the younger of the two. 15. Any grievance /complaint about difficulty in availing treatments, non-availability of facilities, availing of bogus treatment for ineligible individuals etc., shall be submitted to the Joint Director of Medical and Rural Health Services of the District concerned for placing before District Level Empowered Committee for redressal. The District Level Empowered Committee is headed by the District Collector, with the Joint Director of Medical and Rural Health Services, the District Treasury Officer and a representative of the Insurance Company as members. 16. An appeal against the decision of the District Level Empowered Committee may be preferred before the State Level Empowered Committee headed by the Director of Treasuries and Accounts with the Director of Medical and Rural Health Services as Member Secretary and an Official representative nominated by the Insurance Company as member. The appeals shall be filed with the Director of Medical and Rural Health Services, the Member Secretary of the State Level Committee who shall place the appeals for a decision of the said Committee. 17. Any grievance / dispute arising out of the implementation of the scheme remaining unresolved by the State Level Empowered Committee shall be referred within fifteen days to the High Level Committee, comprising of the Secretary to Government, Finance Department, Secretary to Government, Health and Family Welfare Department and a representative nominated by the Insurance Company. 18. The Civil Courts situated in Chennai shall have exclusive jurisdiction over any grievance / dispute, remaining unresolved after following the above said procedures and nothing aforesaid, shall prejudice the rights of the Government of Tamil Nadu to approach any other forum for dispute resolution permissible under Law. -/ True Copy /- UNDER SECRETARY TO GOVERNMENT.

12 : 12 : Annexure-II LIST OF DISEASES, TREATMENTS AND SURGERIES CLASSIFIED UNDER THE BROAD BASED SPECIALITIES Sl. No. Name of Diseases, Treatments and Surgeries I. CARDIOLOGY AND CARDIO THORACIC SURGERY Heart Surgery including 1. (a) Coronary By-Pass Surgery (CABG) 2. (b) Valve Replacement and Other Valvulo Plastics 3. (c) Correction of all Congenital Heart Diseases 4. (d) Angioplasty and PTCA Stent 5. (e) Baloon Valvuloplasty 6. (f) Permanent and Temporary Pacemaker Implantation 7. (g) Embolectomies for Peripheral Artery Embolism 8. (h) Surgeries for Repair of Aneurysm 9. (i) Enhanced External Counter Pulsation Therapy (EECP) II. ORTHOPAEDIC SURGERY 10. (a) Total Hip Replacement 11. (b) Total Knee Replacement 12. (c) Surgeries for Correction of Fractures of Bones and Joints 13. (d) Arthroscopic Repair of Ligaments III. NEPHROLOGY / UROLOGY 14. (a) Renal Transplantation 15. (b) Lithotripsy 16. (c) Surgeries for Prostrate Gland Problems 17. (d) Surgeries for Ureteric Problems 18. (e) Surgeries for Kidney Problems 19. (f) Surgeries for Urinary Bladder Problems IV. ONCOLOGY 20. (a) Surgical Management of all Malignant Tumors 21. (b) Laser or Radiation Treatment of Malignancy 22. (c) Chemotherapy for Treatment of Malignancy V. NEUROLOGY 23. (a) Emergency Life Saving Surgeries on Brain and Spinal Cord 24. (b) Advanced Specialized Surgeries on Brain and Spinal Cord such as Cerebrovascular Surgery (Aneurysm and Arteriovenous (Malformation), Surgeries

13 : 13 : Sl. No. Name of Diseases, Treatments and Surgeries involving base of the Skull and Synotactic Surgeries 25. (c) Surgery for Intractable Epilepsy 26. (d) Inter-vertebral Disc Prolapse related Surgeries 27. (e) Management of Cerebro-Vascular Accidents (Stroke) 28. (f) Surgery for all Congenital Malformations including Hydrocephalus 29. (g) Management of Guillian Barre Syndrome VI. OPTHALMOLOGY (i). Simple Surgery 30. (a) Any Cataract Surgery with or without Intra Ocular Lens (IOL) Implantation 31. (b) Surgery for Glaucoma (ii). Specialised Surgery 32. (a) Surgery and other procedures for Detachment of Retina. 33. (b) Vitrectomy 34. (c) Keratoplasty (Corneal Grafting) 35. (d) Laser treatment,-krypton Laser, Dye Laser, Argon Laser,Photo Coagulation. 36. (e) Liner Accelerator Theraphy (for Senile Macular Degeneration ). VII. VASCULAR SURGERY 37. Amputation of Legs, Arms, Toes and Foot VIII. GASTROENTEROLOGY 38. (a) Surgeries for various Gastro Intestinal Ulcers 39. (b) Gall Bladder and Liver Surgeries 40. (c) Surgery for Pancreatitis and Appendicitis 41. (d) Corrosive Strictures of GI Tract 42. (e) Laproscopic Cholecystectomy 43. (f) Surgeries for Perforation in GI Tract IX. PLASTIC AND FACIO MAXILLIARY 44. Treatment of Acute Burns X. E.N.T. 45. (a) Tonsillectomy 46. (b) Mastoidectomy 47. (c) Stapedectomy 48. (d) Injuries in Ear, Nose, Throat and Neck areas and its Management XI. GYNAECOLOGY 49. (a) Surgery for Removal of Uterus

14 : 14 : Sl. No. Name of Diseases, Treatments and Surgeries 50. (b) Surgery for Removal of Ovaries and Ovarian Cysts XII. THORACIC 51. Surgery for Lung Abscess, Pleural Effusion and Pneumothorax XIII. GENERAL: OTHER SURGERIES 52. (a) Thyroid Surgery 53. (b) Surgery for various Hernias 54. (c) Surgeries needed in Accident and Trauma 55. (d) Management of Coma, Meningitis and Encephalitis 56. (e) Piles and Fistula 57. (f) All surgeries for correction of congenital deformities and management of subsequent problems 58. (g) All Interventional Radiology Procedure for Vascular Problems 59. (h) All Interventional Radiology Procedures using Stents MEDICAL CARE (i). Critical Care 1. (a) Acute Respiratory Distress Syndrome (ARDS) 2. (b) ARDS with Multi Organ Failure 3. (c) ARDS plus DIC (Blood & Blood Products) 4. (d) OP Poisoning requiring Ventilator Assistance 5. (e) Septic Shock (ICU Management) 6. (f) Metabolic Coma requiring Ventilator Support (ii). Haematology 7. (a) Hemophilia 8. (b) Snake Bite requiring Ventilator Support 9. (c) Treatment for Sickle Cell Anemia 10. (d) Bone Marrow Transplantation 11. (e) Stem Cell Transplantation (iii). Pulmonology 12. Massive Hemoptysis (iv). Gastroenterology 13. (a) Acute Pancreatitis (severe) 14. (b) Obscure GI Bleed 15. (c) Cirrhosis with Hepatic Encephalopathy 16. (d) Cirrhosis with Hepato Renal Syndrome 17. (e) Corrosive Oesophageal Injury 18. (f) Acute Pancreatitis with Pseudocyst (Infected)

15 : 15 : Sl. No. Name of Diseases, Treatments and Surgeries 19. (g) Oesophageal Perforation 20. (h) Oesophageal Varices, Variceal Banding 21. (i) Oesophageal Varices, Sclerotherapy (v). Cardiology 22. (a) Acute MI (Conservative Management without Angiogram) 23. (b) Acute MI (Conservative Management with Angiogram) 24. (c) Acute MI with Cardiogenic Shock 25. (d) Acute MI requiring IABP Pump 26. (e) Refractory Cardiac Failure 27. (f) Complex Arrhythmias 28. (g) Simple Arrythmias 29. (h) Pericardial Effusion, Tamponade (vi). Nephrology 30. (a) Acute Renal Failure-(ARF) 31. (b) Nephrotic Syndrome 32. (c) Chronic Renal Failure 1 (CRF ) 33. (d) Hemodialysis/ Peritoneal Dialysis (vii). Neurology 34. (a) Neuropathies (GBS) 35. (b) Immunoglobulin Therapy IV 36. (c) Chronic Inflammatory Demyelinating Poly Neuropathy (CIDP) 37. (d) Hemorrhagic Stroke/Strokes 38. (e) Ischemic Strokes 39. (f) Neuromuscular (Myasthenia Gravis) 40. (g) Neuroinfections -Pyogenic Meningitis 41. (h) Tb Meningitis 42. (i) Neuroinfections -Viral Meningoencephalitis ( Including Herpes encephalitis) 43. (j) Management of COMA 44. (k) Cavernous Sinus Thrombosis 45. (l) Rhinocerebral Mucormycosis (viii). Rheumatology 46. (a) SLE (Systemic Lupus Erythematosis) 47. (b) Vasculitis (ix). Endocrinology 48. (a) Uncontrolled Diabetes mellitus with Infectious Emergencies.

16 : 16 : Sl. No. Name of Diseases, Treatments and Surgeries 49. (b) Hyper Osmolar Non Ketotic Coma 50. (c) Management of Endocrinal Disorders 51. (d) Hypopitutarism 52. (e) Pituitary Acromegaly 53. (f) Cushings Syndrome 54. (g) Delayed Puberty Hypogonadism (ex.turners synd, Kleinfelter synd) * * * -/ True Copy /- UNDER SECRETARY TO GOVERNMENT.

17 : 17 : Annexure-II-A LIST OF SPECIFIED ILLNESS FOR THE ENHANCED LIMIT OF RUPEES SEVEN LAKH AND FIFTY THOUSAND Sl. No. Name of Diseases, Treatments and Surgeries 1. Surgery, Chemotherapy, Radiotherapy and Immunotherapy for all Malignancies including inpatient procedures for diagnosis. 2. Liver, Kidney, Heart, Lungs and Bone Marrow Transplantation. 3. Complex Open Heart Surgeries and Implants. 4. Accident and Trauma cases involving Multiple Fractures. 5. Heart Valve Replacements, Aneurysms and Angioplasties. 6. Management of Burn Injuries. -/ True Copy /- UNDER SECRETARY TO GOVERNMENT.

18 : 18 : Annexure-III LIST OF APPROVED S UNDER NEW HEALTH INSURANCE SCHEME, I. ARIYALUR DISTRICT 1. A.S. NURSING HOME 27/E, Pattunoolkara Street, Ariyalur ARIYALUR GOLDEN (P) LTD. 81 A, Sendurai Road, Ariyalur EZHIL SURGICAL AND MATERNITY 44 A1/A2, Jayankondan, South Vellala Street, Ariyalur II. CHENNAI DISTRICT 4. A G EYE CARE 106, R.K Mutt Road, Mylapore, Chennai A V S 172, Solaiappan Street, Old Washermenpet, (Maharani Theater) Chennai ABHIJAY (P) LTD. 22/2, E S I Hospital Road Near TVK Nagar Junction, Peravallur [Perambur] Chennai ADITYA No.7, Barnaby Road, Kilpauk, Chennai AMRIT 310, Mint Street, Sowcarepet, Chennai APOLLO CHILDREN'S Shaffi Mohammed St, Thousand's Light, Chennai APOLLO FIRST MED S 154, P.H. Road, Chennai APOLLO AYYAMBAKKAM 64, Vanagaram to Ambattur Main Road, Ayyambakkam, Chennai APOLLO - SOWCARPET 134, Mint Street, (Opp. Ramar Kovil), Chennai APOLLO - TONDIARPET 645, T.H Road, Tondiarpet, Chennai APOLLO S ENTERPRISES LTD. 21, Greams Road,, Opp. to Greams Lane, Chennai Genito Urinary Surgery,, Nephrology, Orthopaedic Surgery Genito Urinary Surgery,, Orthopaedic Surgery , General Surgery,, Genito Urinary Surgery Ophthalmology General Surgery, Ophthalmology, , , Multi Speciality Multi Speciality. Uterus removal Excluded , , , Multi Speciality. Uterus removal Excluded. Multi Speciality. Uterus removal Excluded Multi Speciality. Uterus removal Excluded , , Multi Speciality. Uterus removal Excluded.

19 : 19 : 15. APOLLO SPECIALITY 320, Anna Salai, Nandanam,Padma Complex, Chennai APPASAMY 23, Friends Avenue, Arumbakkam, Chennai AROKYA 32, Pillaiyar Koil St., Nesapakkam, Chennai ASWENE SOUNDRA & RESEARCH CENTER 24, Kasturi Rangan Road, Teynampet, Chennai B M 36, 5th Main Road, Thillai Ganga Nagar, Nanganallur, Chennai B.M. SILVER JUBLIEE MULTI SPECIALITY 41, Durga Road, Pallavaram, Chennai BALAKRISHNA EYE & EYE RESEARCH CENTER 11/6, Sastri 1st Cross Street, Kaveri Road, Saidapet-PO, Chennai BHARATHI RAJAA SPECIALITY No.20, G N Chetty Road, T.Nagar, Chennai BILLROTH No.43, Lakshmi Talkies Road, Shenoy Nagar, Chennai CANCER INSTITUTE [W.I.A] Canal Bank Road, Adayar, Chennai CHENNAI EYE CARE No-6,12th Cross Street, Dhandeeswaram Nagar, Velachery (Near Tansi Nagar Bus Stop), Chennai CHETTINAD Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam CSI RAINY MULTISPECIALITY 45, G.A Road, Near Kalmandapam, Chennai DEEPAM EYE No:72, Medavakkam Tank Road, Kilpauk, Chennai DEEPAM (P) LTD. 327, Muthurangan Road, West Tambaram, Chennai Oncology. Uterus removal Excluded , /5947, Orthopaedic Surgery General Surgery, , Genito Urninary Surgery, Ophthalmology ,100 Cardiology, Cardiothoracic Surgery, General Surgery General Medicine-Medical Care, General Surgery,, Orthopaedic Surgery, Urology Cardiology, Cardio-Thoracic Surgery, ENT, Neuro Surgery, Nephrology , Oncology Ophthalmology , , , Cardiology, Cardiothoracic Surgery, ENT, Gastroenterology, Neurology, Plastic & Facio Maxilliary, Vascular Surgery General Surgery, , , Ophthalmology., Orthopaedic Surgery.

20 : 20 : 30. DEEPAM LTD. 30, Ayyasamy Street, Nehru Nagar, Chrompet, Chennai DOCTOR REX'S S 37, (Old No.19) Millers Road, Kilpauk, Chennai DR. AGARWAL'S EYE LTD. 19, Cathedral Road, Chennai DR. AGARWAL'S EYE 3, 1st, Floor, Main Road, Kamarajar Nagar, Avadi, Chennai DR. AGARWAL'S EYE 49, Arcot Road, Porur, Chennai DR. AGARWAL'S EYE AC-15, 2nd Avenue, Anna Nagar, Chennai DR. AGARWAL'S EYE No:27, 100 Feet Road, Baby Nagar, Velachery, Chennai DR. AGARWAL'S EYE No:729, T.H. Road, Old Tamil Nadu Theater, New Washermenpet, Chennai DR. AGARWAL'S EYE Old No.20, New No.33, 7th Avenue, Near G.R.T. School, Ashok Nagar, Chennai DR. AGARWAL'S EYE The Federation Square, B-63, Siva Elango Salai, (70 Feet Road), Periyar Nagar, Chennai DR. ARAVIND VISION CARE Old No:61, New No:3, Reddy Palayam Road, Mugappair West, Chennai DR. KAMAKSHI MEMORIAL 1, Radial Road, Pallikaranai, Chennai DR. RAI MEMORIAL MEDICAL CENTRE 562, Anna Salai, Century Plaza, Teynampet, Chennai DR. RAVISHANKAR'S EYE CLINIC & NURSING HOME 11, Hunters Road, Vepery, Chennai ESWARI NURSING HOME 1/255,10th Street, S.R.P.Colony, Chennai EYE RESEARCH FOUNDATION [VIJAYA] NSK Salai, Chennai Orthopaedic Surgery, Plastic & Facio Maxilliary / 2592 / 2358 / 3704/ /2592/2358/ 3704/ / 2592 / 2358 / 3704 / / 2592 / 2358 / 3704 / / 2592 / 2358 / 3704 / / 2592 / 2358 / 3704 / / 2592 / 2358 / 3704 / / 2592 / 2358 / 3704 / Ophthalmology. Ophthalmology. Ophthalmology. Ophthalmology. Ophthalmology. Ophthalmology. Ophthalmology. Ophthalmology Ophthalmology , Oncology, Cardiology, Cardiothoracic Surgery, ENT, Gastroenterology, Neurology, Vascular Surgery, Plastic & Facio Maxilliary Oncology , , , , Ophthalmology. General Surgery,. Ophthalmology.

21 : 21 : 46. FATHIMAH EYE CLINIC 23, Arulanandam Street, Santhome, Chennai Ophthalmology. 47. FORTIS MALAR 52, Gandhi Nagar, First Main Road, Chennai FOUSIYA New #119,Old # 56, Dr.Natesan Road, Triplicane, Chennai FRONTIER LIFELINE DR. K. M. CHERIAN HEART FOUNDATION R-30-C, Ambattur Industrial Estate Road, Mogappair, Chennai GAJANAN (P) LTD. 29, Kannan Street, West Tambaram, Chennai GLOBAL S & HEALTH CITY 439,Cheran Nagar, Perumbakkam, Chennai HALSTEAD SURGICAL CLINIC No:306, Poonamallee High Road, Kilpauk, Chennai HANDE 45,Lakshmi Talkies Road, Shenoy Nagar, Chennai HARIHARAN DIABETES AND HEART CARE S (P) LIMITEDNo.24 & 26, :SWATHI", 29th Street, Nanganallur, Chennai HARVEY HEALTHCARE LIMITED 542, T.T.K. Road, Alwarpet, Chennai K.J. PRIVATE LIMITED New No.182, Poonamallee High Road, Chennai K.K. EYE CARE AND RESEARCH CENTRE 34, Gandhi Road, West Tambaram, Chennai KAUVERY No.81, T.T.K. Road, Alwarpet, Chennai KHM AB-14, 6th Main Road, Anna Nagar, Chennai KKR ENT & RESEARCH INSTITUTE (P) LTD. 274, Poonamallee High Road, Kilpauk, Chennai , Cardiology General Surgery, Cardiology, Cardiothoracic Surgery , , Cardiology, Cardiothoracic Surgery, ENT, Gastroentrology, Neurology, Plastic & Facio Maxilliary, Vascular Surgery , General Surgery , , Surgical Gastroenterology. General Medicine-Medical Care, General Surgery, Cardiology, Cardio-Thoracic Surgery Cardiology, Cardiothoracic Surgery Care, General Surgery , Ophthalmology , Orthopaedic Surgery, Urology, Cardiology, Cardio-Thoracic Surgery, ENT, Neuro Surgery, Nephrology , Orthopaedic Surgery E.N.T.

22 : 22 : 61. KRISHNA EYE & ENT S 39, Burkit Road, T.Nagar, Chennai KUMARAN S PVT LTD. 214, P.H. Road, Kilpauk, Chennai LAKE VIEW 100 A, Kalpalayam, Red Hills Road, Chennai LAKSHMI 47, Govindan Road, West Mambalam, Chennai LASER AND LAPROSCOPIC New No-121, G N Chetty Road, T.Nagar, Chennai LIFELINE RIGID 47/3, New Avadi Road, Kilpauk, Chennai M.N. EYE 781, T.H. Road, Tondiarpet, Chennai MADRAS MEDICAL MISSION 4-A, Dr. J J Nagar, Mogappair, Chennai MAXIVISION EYE CARE MEDFORT S78/6, 3rd Avenue, Anna Nagar, Chennai MAXIVISION EYE CARE MEDFORT S No.116, Chamiers Road, Nandanam, Chennai MIOT S 4/112, Mount Poonamallee Road, Manapakam, Chennai NANTHINI 168, Chandra Sekaran Avenue, Thoraipakkam, Chennai NARAYANA 18,Tana Street, Purasawakam, Chennai NOBLE No.4, Audiappa Mudali Street, Purasawalkam, Chennai PARVATHY 241, G.S.T. Road, Chrompet, Chennai PATERSON CANCER CENTRE [VIJAYA] NSK Salai, Vadapalani, Chennai E.N.T. & Ophthalmology , Orthopaedic Surgery, Oncology General Surgery, , General Surgery, Surgical Gastroenterology , Surgical Gastroenterology Ophthalmology , Cardiology, Cardiothoracic Surgery Ophthalmology Ophthalmology Orthopaedic Surgery, Plastic & Facio Maxilliary, Cardiology, Cardiothoracic Surgery, Oncology General Surgery, General Surgery, General Orthopaedic Surgery, Gastro Enterology, Genitourinary Surgery , , 52,62,72. Orthopaedic Surgery, Plastic & Facio Maxilliary. Oncology.

23 : 23 : 77. R G STONE UROLOGY & LAPAROSCOPY HOSPITA 391/392, Anna Salai, Opp.New Bus Stand, Saidapet, Chennai RADHATRI NETHRALAYA EYE 12, Hindi Prachara Sabha Street, T.Nagar, Chennai RAJAN DENTAL INSTITUTE PVT LTD. No: 56, Dr.Radhakrishnan Salai, Mylapore, Chennai RAJAN EYE CARE (P) LTD. 5, Vidyodhaya East 2nd Street, T.Nagar, Chennai RAMANA EYE CENTRE 24, Venkatraman Street, T.Nagar, Chennai ROYAL BALAJI S No 7, Works Road, Chromepet, Chennai SAKTHI & RESEARCH CENTRE 175/86, Big Street, Tripilicane, Chennai SAMPAT NURSING HOME, Nachiappa Street, Mylapore, Chennai , , , , Urology. Ophthalmology Plastic & Facio Maxilliary , 0300 Ophthalmology Ophthalmology , , SANKARA EYE No.1, 3rd Cross Street, Sri Sankara Nagar, Pammal, Chennai SANKARA NETHRALAYA [MEDICAL RESEARCH FOUNDATION] 18, College Road, Chennai SANTHOSH No.1, 7th Avenue, Besant Nagar, Chennai SARASWATHY SPECIALITY 92/A,Bazaar Road, Sadasiva Nagar, Near Ram Nagar Bus Stop, Madipakkam, Chennai SATISH EYE 15 (New No: 57), Ormes Road, Kilpauk, Chennai SEN 18, Bunder Garden Street, Perambur, Chennai SOORIYA No 1, Arunachallam Road, Saligaramam, Chennai Ophthalmology , , Ophthalmology , Cardiology , , , , Ophthalmology. Cardiology, Cardiothoracic Surgery, Neurology, Orthopaedic Surgery.

24 : 24 : 92. SRI KUMARAN MULTI SPECIALITY No-532, Suriya Narayana Street, Royapuram, Chennai SRI RAMACHANDRA 1, Ramachandra Nagar, Porur, Chennai SRI VENKATESHWARA'S C.M. No:1, 47th Street, 5th Main Road, Nanganallur, Chennai SRINIVAS EYE 335, Thiruvallur Salai, Paneer Nagar, Mugappair, Chennai SRINIVAS PRIYA 106, Patel Road, Perambur, Chennai SUGAM 349, Thiruvottiyur High Road, Thiruvottiyur, Chennai TAMIL NADU GOVERNMENT MULTI SUPER SPECIALITY. Anna Salai, Triplicane, Chennai TAMIL NADU UROLOGICAL RESEARCH CENTRE PVT LTD. 76, Nelson Manickam Road, Aminjikarai, Chennai THE HEART INSTITUTE, VIJAYA HEALTH CENTER 323 and 434, NSK Salai, Vadapalani, Chennai TRUST No:122, Medavakam Tank Road, Ayanavaram, Chennai UDHI EYE S 9, Murrays Gate Road, Alwarpet, Chennai UMA EYE CLINIC PVT LTD. No:1957, 10th Main Road, Anna Nagar, Chennai V.S. 13, East Spurtank Road, Chetpet, Chennai VASAN EYE CARE 118, Bazaar Road, Saidapet, Chennai VASAN EYE CARE New No:976, Old No: 447, T.H Road, (Old Washermenpet) Tondiarpet, Chennai General Surgery, , , Multi Speciality Ophthalmology General Surgery, Genito Urninary Surgery, Multi Speciality , , , Urology. Cardiology, Cardiothoracic Surgery , Nephrology / Urology , , , , Ophthalmology. Ophthalmology. Oncology. Ophthalmology Ophthalmology.

25 : 25 : 107. VASAN EYE CARE No 77, 3rd Avenue, Opp K4 Police Station), Anna Nagar East, Chennai VASAN EYE CARE No. 100/101, Triplicane High Road, Triplicane, Chennai VASAN EYE CARE No. 115/1, Kamaraj Avenue, 2nd Street, Adyar, Chennai VASAN EYE CARE No. 201, GST Road, Opp. to Chrompet Bus Stop, Chrompet, Chennai VASAN EYE CARE No.310,TTK Road, Alwarpet, Chennai VASAN EYE CARE No.50, Arcot Road, Valasaravakkam, Chennai VEE CARE EYE A - 13, 2Nd Avenue, Roundtana Junction, Annanagar, Chennai VEE CARE 106, Jawaharlal Nehru Salai, Near Koyembedu Junction, Thirumangalam, Anna Nagar West, Chennai VEE CARE SUNDAR 186, Trunk Road, Poonamallee, Chennai VIJAYA GROUP OF S NSK Salai, Vadapalani, Chennai VIJAY'S NURSING HOME 39, West Road, West C.I.T. Nagar, Chennai VISHNU EYE CLINIC C-46, Second Avenue, Anna Nagar East, Chennai III. COIMBATORE DISTRICT 119. A S D NURSING HOME 91/1,Coimbatore Road, Pollachi ABINAND 237-F,Pollachi Main Road, Sundarapuram, Coimbatore ALVA 5,Kamarajar Street, Vettaikaran Pudur, Ambarampalayam, Pollachi Ophthalmology Ophthalmology Ophthalmology Ophthalmology Ophthalmology Ophthalmology Ophthalmology , Plastic & Facio Maxilliary, ENT, Orthopaedic Surgery General Surgery, , , General Medicine-Medical Care, General Surgery, Genito Urinary Surgery,, Nephrology, Orthopaedic Surgery, Neurology, Plastic & Facio Maxilliary, Gastroenterology, Neurosurgery, ENT, Cardiology. General Medicine-Medical Care, General Surgery,,Orthopaedic Surgery, Urology. Ophthalmology General Surgery, General General Surgery, General Surgery,.

26 : 26 : 122. ANURAG No.8, Krishna Nagar, Sowri Palayam, Coimbatore ARATHANA ORTHOPAEDIC SURGERY CENTRE 136, R C Polyclininc Building, Appar Street, Venkatesa Colony, Polachi ARTHY No:52, Nanjundapuram, Near Ramanathapuram Signal, Coimbatore ARUN 88, New Scheme Road, Pollachi ARVIND EYE & POSTGRADUATE INSTITUTE OF OPHTHALMOLOGY Avinashi Road, Coimbatore ASWIN No 1, Alamunagar Sathy Road, Coimbatore BETHEL (P) LTD. 223, Dr.Rajendra Prasad Road, 100 Feet Road, Coimbatore C.S.R.NURSING HOME 272, 7th Street Extn, Coimbatore CHINNIYAM PALAYAM 2/143 Avinashi Road, Coimbatore COIMBATORE BONE & JOINT FOUNDATION (P) LTD. 1091, Mettupalayam Road, North Coimbatore Bus Stop, Coimbatore COIMBATORE KIDNEY CENTER Puliakulam Road, Near Lakshmi Mills, Coimbatore G R No.30 Ram Gardens, Sowripalayam Road, Sowripalayam, Coimbatore GANGA MEDICAL CENTER & S LTD. 313, Mettupalayam Road, Coimbatore GEM INDIA PVT LTD. 45-A, Pankaja Mill Road, Ramanathapuram, Coimbatore H.S. Gandhinagar, Kavundampalayam, Coimbatore JOSEPH 10,1st Cross Street, Thirumalal Nagar, Peelamedu, Coimbatore K M , Palakad Road, Pollachi, Coimbatore General Medicine-Medical Care, General Surgery,, Orthopaedic Surgery, Urology , Orthopaedic Surgery, Plastic & Facio Maxilliary General Surgery, General , General Surgery, Ophthalmology General Surgery, General Surgery, General Surgery, General Surgery, Orthopaedic Surgery , , Nephrology/Urology General Surgery, General Orthopaedic Surgery, Plastic & Facio Maxilliary General Surgery, Surgical Gastroentrology General Surgery, General General Surgery, General Surgery,.