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TN G.O – New Health Insurance Scheme for Employees and Pensioners – Fixation of ceiling rates for COVID 19 Treatment

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Government of Tamil Nadu
2020

MANUSCRIPT SERIES

FINANCE [Salaries] DEPARTMENT
G.O.Ms.No.280, Dated 24th June 2020.
(Saarvari, Aani-10, Thiruvalluvar Aandu 2051)

ABSTRACT

NHIS – COVID-19 – Inclusion of New Packages for treatment of Critical and Non-Critical care for COVID-19 positive cases covered under New Health Insurance Scheme for Employees and Pensioners – Payment to the private hospitals – Fixation of ceiling rates – Orders – Issued.

Read the following :-

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1. G.O.(Ms).No.240, Health and Family Welfare (EAPI-1) Department, dated:5-6-2020.
2. G.O.(D) No.247, Finance (Salaries) Department, dated:15-6-2020.
3. From the Commissioner of Treasuries and Accounts, letter Rc.No.15357/NHIS-2/2020, dated 18-6-2020 and 22-6-2020.

-oOo-

ORDER:

In the Government Order first read above, due to the present pandemic caused by COVID-19, the Health and Family Welfare Department has issued an order for covering treatment of COVID-19 under Chief Minister Comprehensive Health Insurance Scheme (CMCHIS). The above Government Order also states that Finance Department is to fix the ceiling for treatment charges for COVID-19 positive cases, for New Health Insurance Scheme for Employees and Pensioners.

2. Consequently, in the Government Order second read above, an order was issued to form a committee to determine the ceiling rates for treatment of COVID-19 under the New Health Insurance Scheme for Employees and Pensioners with the following members:-

Chairman :

Dr. P.Umanath, IAS,
Managing Director,
Tamil Nadu Medical Services Corporation.

Members:

1. Thiru.C.Samayamoorthy, IAS,
Commissioner of Treasuries and Accounts.

2. Thiru. M. Arvind, IAS,
Joint Secretary to Government,
Finance Department.

3. Dr. T.S.Selvavinayagam,
Director of Public Health

3. Accordingly, a meeting was convened on 16-6-2020 under the Chairmanship of Managing Director, Tamil Nadu Medical Services Corporation and vide reference third cited, Committee recommended the ceiling rates for inclusion of new packages for treatment of COVID-19 under New Health Insurance Scheme for Employees and New Health Insurance Scheme for Pensioners.

Also Read : TN New Health Insurance Scheme – Inclusion of New Packages for treatment of Covid-19 for TN Pensioners

4. The Government after careful examination, have decided to accept the same and accordingly issue the following orders:-

i). With respect to Critical care, (ICU Ventilated & ICU Non Ventilated):

(a) The United India Insurance Company Limited shall make payments to all COVID positive cases that receive critical care as per the package rates for existing procedures covered under the New Health Insurance Scheme, subject to a ceiling of Rs.4 lakhs.

(b) In addition to the existing package rates, COVID-19 Management charges as prescribed for the Chief Minister Comprehensive Health Insurance Scheme (CMCHIS) in G.O.Ms.No.240, Health and Family Welfare (EAPI-I) Department, dated 05.06.2020 shall be provided by United India Insurance Company Limited as follows:-

CRITICAL CARE – COVID 19
ICU Non Ventilated ICU Ventilated
Without
Sepsis/MODS
With Sepsis /
MODS
Without
Sepsis/MODS
With Sepsis /
MODS
Rs.6500/-
per day
Rs.6500/-
per day
Rs.8500/-
per day
Rs.8500/-
per day

ii). With respect to Non-Critical COVID care, the Government has fixed the following as the ceiling for treatment cost of non-critical COVID cases in empanelled hospitals:

1. A1 and A2 Category Hospital
(for individual room)
Rs.9500/- per day +
Pharmacy charges
2. A3-A6 Category Hospitals
(for individual Room)
Rs.7500/- per day +
Pharmacy charges

iii). Payments to empanelled Hospitals:-

(a) For critical care, United India Insurance Company Limited shall make payments to empanelled hospitals as per the recommended rates in para 4 (i) above from the New Health Insurance Scheme account.

(b) For non-critical care, the Government has authorised the United India Insurance Company Limited to form two separate Corpus Funds – i.e. (1). Corpus Fund for COVID-19 treatment in empanelled hospitals under New Health Insurance Scheme for Employees – Rs.5 crore and (2). Corpus Fund for COVID-19 treatment in empanelled hospitals under New Health Insurance Scheme for Pensioners/ Family Pensioners – Rs.2.5 crore. The United India Insurance Company Limited shall make payments for COVID-19 treatment as per the above recommended rates in para 4 (ii) to the empanelled hospitals. Accordingly, the Government hereby sanction a sum of Rs.5 crore (Rupees Five Crore only) for New Health Insurance Scheme for Employees and Rs.2.5 crore (Rupees Two Crore and fifty lakh only) for New Health Insurance Scheme for Pensioners initially towards contribution to the two Corpus Funds. The Corpus Funds will be recouped from the Government as and when required.

iv) Payments to non-empanelled Hospitals:- United India Insurance Company Limited shall make payments as per the above rates as per para 4 (i) for critical care for COVID positive cases even in non-empanelled hospitals, as these treatments will come under the Emergency clause of the New Health Insurance Scheme, after getting orders from the District level Empowered Committee on appeal cases. With respect to non-critical care, Government employees and pensioners shall restrict their treatments to empanelled hospitals for the benefit of patient welfare.

Also Read : TN Govt Employees Health Insurance Scheme – Extension for another one year

v). The empanelled hospitals should not collect any amount in excess other than the amount as prescribed above in para 4 (i) and 4 (ii). United India Insurance Company Limited shall issue instructions to all the empanelled hospitals in this regard.

vi). Government Employees/Pensioners who have already taken treatment for Non-critical COVID care in empanelled Hospitals from 1.3.2020 to till date are directed to submit their claims for reimbursements by appealing to the Commissioner of Treasuries and Accounts, Chennai. The Commissioner of Treasuries and Accounts shall recommend to the United India Insurance Company Limited to reimburse the payment from the Corpus fund provided by the Government.

vii). United India Insurance Company Limited shall provide a statement to the Government on the utilization of the Corpus Fund at the end of each quarter.

5. The contribution of Rs.5 crore to Corpus Fund for New Health Insurance Scheme for Employees sanctioned in para 4 (iii) (b) above, shall be debited to the following head of account:-

“2075 00 MISCELLANEOUS GENERAL SERVICES
800: Other Expenditure
State’s Expenditure
JI : Corpus Fund for COVID-19 treatment in empanelled hospitals under New Health Insurance Scheme for Employees.
310 Contributions
01 : Contribution to Specific Fund
IFHRMS (D.P.C. 2075 00 800 JI 31001)
Old (D.P.C. 2075 00 800 JI 1014)”

6. Necessary funds will be provided in Revised Estimates / Final Modified Appropriation, 2020-21 to meet the expenditure sanctioned in para 4 (iii) (b) above. Pending provision of such funds, the Commissioner of Treasuries and Accounts, Chennai is authorized to incur the expenditure. However, the above expenditure shall be brought to the notice of the Legislative Assembly by a specific inclusion in the Supplementary Estimates for the year 2020-21. The Commissioner of Treasuries and Accounts is directed to include the above expenditure while sending the budget proposals for Revised Estimates / Final Modified Appropriation 2020-21 and also send draft explanatory notes for inclusion of this expenditure in the Supplementary Estimates 2020-21 to Finance (Public) Department at an appropriate time without fail.

7. The Commissioner of Treasuries and Accounts is the Estimating Reconciling and controlling authority for the above new head of account. The Pay and Account Officer/Treasury Officer concerned are directed to open the above new head of accounts in their books.

8. This order issues with the ASL No.160 (One hundred and sixty)

(BY ORDER OF THE GOVERNOR)

S.KRISHNAN
ADDITIONAL CHIEF SECRETARY TO GOVERNMENT

Signed Copy

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