Comprehensive Health Insurance Coverage Scheme by Central & TN State Government - Free Coverage Upto 5Lakhs

PRADHAN MANTRI JAN AROGYA YOJANA (PM-JAY)

 Central Government Health Insurance Scheme

Mission of PM-JAY:

PM-JAY aims to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services. PM-JAY is the world’s largest healthcare scheme, and it seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC).

Key features of PM-JAY:

Ø  Provides hospitalisation cover of up to Rs. 5,00,000 per entitled family per year.

Ø  More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country.

Ø  Entitlement based scheme. No formal enrolment process is required.

Ø  Poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) 2011 data, both rural and urban will be covered.

Ø  No cap on family size and age of members. All members of designated families get coverage; specifically, girl child and senior citizens.

Ø  Covers secondary and tertiary care hospitalization.

Ø  Free treatment available at all public and empanelled private hospitals.

Ø  Cashless and paperless access to quality health care services.

Ø  Benefits of national portability. Eligible beneficiaries can avail services across India.

Ø  1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics.

Ø  All pre-existing diseases covered.

To check eligibility, beneficiaries can contact the helpline (14555/1800111565), visit nearest Common Service Centres (CSC) or logon to https://mera.pmjay.gov.in. This can also be checked at empanelled hospitals.

CHIEF MINISTER’S COMPREHENSIVE HEALTH INSURANCE SCHEME

 Government of Tamil Nadu Health Insurance Scheme

Mission of CMCHIS:

Chief Ministers Comprehensive Health Insurance Scheme launched by the Government of Tamil Nadu through United India Insurance Company Ltd a Public Sector Insurance Company headquartered at (Chennai) The Scheme provides quality health care to the eligible persons through empanelled Government and Private hospitals and to reduce the financial hardship to the enrolled families and move towards universal health coverage by effectively linking with public health system.

The Scheme provides coverage for meeting all expenses relating to hospitalization of beneficiary as defined in the Scope of the Scheme.

Key Features of CMCHIS:

Ø  The scheme seeks to provide cashless hospitalization facility for certain specified ailments/ procedures.

Ø  The scheme provides coverage up to Rs.5, 00, 000/- per family per year on a floater basis for the ailments and procedures covered under the scheme.

Ø  List of Procedures is also available in the CMCHISTN website. The Scheme also grants cover for Follow-up Treatment as listed under Annexure "E” in addition to any other specific procedures listed in Annexure C and Diagnostic procedures listed under Annexure "F" in the website.

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.