New Health Insurance Scheme, 2012 for Tamilnadu Government Employees

MANUSCRIPT SERIES

Government of Tamil Nadu
2012

FINANCE [Salaries] DEPARTMENT
G.O.Ms.No.309, Dated 14th August 2012.
(Aadi-30, Thiruvalluvar Aandu-2043)

ABSTRACT

MEDICAL AID – New Health Insurance Scheme, 2012 for Government Employees and Organisations covered under this Scheme – Implemented – Constitution of an Accreditation Committee for empanelment of hospitals and also to monitor the quality of treatment – Orders – Issued.

Read:-

1. G.O.Ms.No.139, Finance (Sal.) Department, dated 27-04-2012.
2. G.O.Ms.No.243, Finance (Sal.) Department, dated 29-06-2012.

ORDER:

In the Government Order first read above, orders have been issued for implementation of the New Health Insurance Scheme, 2012 to provide for health care assistance to the Employees of Government Departments and Organisations covered under this Scheme and their eligible Family Members with provision to avail assistance upto Rupees Four Lakh for a block of four years. In the Government Order second read above, orders have been issued for implementation of the New Health Insurance Scheme, 2012 through United India Insurance Company Limited, Chennai for a block period of four years commencing from 1-7-2012 to 30-6-2016.

2. During the review meeting on the implementation of the New Health Insurance Scheme, 2012 for Employees of Government Departments and Other Organisations covered under this scheme, the issues of monitoring quality of treatment and empanelment of hospitals as per the prescribed minimum qualifications were discussed. As per the tender conditions, the Insurance Company should have accredited hospital network in all districts of the State of Tamil Nadu and these hospitals should have the standards as prescribed under rule 6 of the New Health Insurance Scheme Rules, 2012 and this shall be adhered to by the Insurance Company / Third Party Administrator. After deliberation of the review meeting, it was decided that to ensure the standards prescribed in the New Health Insurance Scheme Rules, 2012, the Insurance Company / Third Party Administrator has to inspect the hospitals and ensure the standards prescribed under rule 6 of the New Health Insurance Scheme Rules, 2012. For the approval of such hospital accreditation, an Accreditation Committee may be
constituted.

3. Accordingly, the Government has decided to constitute an Accreditation Committee for empanelment of accredited hospitals and also to monitor the quality of treatment for the Employees of Government Department and Other Organisations covered under this Scheme. The
Committee consists of the following officers:

(a). Commissioner of Treasuries and Accounts.
(b). Director of Medical and Rural Health Services or his nominee and
(c). Representative of United India Insurance Company Limited, Chennai.

4. The Commissioner of Treasuries and Accounts is the head of the Accreditation Committee. The Committee shall review whether the accredited hospitals in all districts of the State of Tamil Nadu and outside the State have the standards as prescribed under rule 6 of the New Health Insurance Scheme Rules, 2012. The Committee will also monitor the quality of treatment for the Employees of Government Departments and Other Organisations covered under this Scheme periodically.

5. In addition, the standards prescribed in the New Health Insurance Scheme Rules, 2012 will also be applicable to the hospitals included in Annexure-III of Government Order second cited. Their inclusion in Annexure-III is only due to their pre-existing empanelment in Tamil Nadu Government Employees Health Fund Scheme and hence further accreditation under Tamil Nadu Government Employees New Health Insurance Scheme during 2012-2016 will be subject only to their fulfilling the minimum qualification prescribed in the New Health Insurance Scheme Rules, 2012. Hence, these hospitals have also to be inspected and verified that they fulfill the condition. Hence, the Accreditation Committee shall also review whether these hospitals have the standards as prescribed under rule 6 of the New Health Insurance Scheme Rules, 2012.

6. The Committee shall submit the report to the Government with specific recommendations for accreditation of hospitals for the implementation of New Health Insurance Scheme, 2012 within three months from the date of formation of the Committee.

7. The Accreditation Committee shall be declared as a first class committee and entitled for Travelling Allowance and Daily Allowance as per the rules in force.

(BY ORDER OF THE GOVERNOR)

K.SHANMUGAM
PRINCIPAL SECRETARY TO GOVERNMENT.

http://www.tn.gov.in/gosdb/gorders/finance/fin_e_309_2012.pdf

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