CM Dr. Kalaignar Insurance Scheme

8/4/2019 CM Dr. Kalaignar Insurance Scheme

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chief minister kalaignar

insurance scheme for life saving treatments

insure to be securea journey with a million hearts


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Chief Minister KalaignarInsurance Scheme for life saving treatments

Quality healthcare which comes at a cost, many a time turns out to be an

unbearable burden for the economically weaker sections of the

society. One way to address this is to provide free healthcare in Government

hospitals. But what about treatments and diseases not feasible in district and

sub-district hospitals and also the long waitlisted situations for emergency and life

saving surgeries due to pile up of cases? How to ensure that economically weaker

sections are not deprived of required healthcare?

For addresing this situation the Government of Tamilnadu introduced a

massive welfare scheme called Chief Minister Kalaignar Insurance Scheme for life

saving treatments on 23rd July 2009, for the poorest of the poor / low income /

unorganised groups who cannot afford costly treatment, as a supplementary facility

for getting free treatment in empanelled Government and private hospitals for such

serious ailments.


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Eligibility

A

ny family whose annual income is Rs.72,000/- or less, members of

unorganised labour welfare boards,and the spouse, children and dependent

parents of such members in urban and rural areas are eligible.

All Government servants, civil pensioners, ESI beneciaries and families having an

annual income of more than Rs. 72,000 /- but not members of any unorganised

sectors welfare boards are not eligible under this scheme.

The sum insured is Rs. 1 lakh per family for a period of 4 years. With the entire

insurance premium borne by the Government of Tamilnadu, the scheme will benet

over one crore families in the State.


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What is covered

S

urgical procedures for various treatments which are covered under

this scheme include Cardiology & Cardiothoracic surgery, Vascular

surgery, Oncology, Nephrology, Neurology, Orthopaedic surgery,

Gastro-enterology, Plastic surgeries, Gynaecology, ENT and Haematology.

Expenses for investigations which help in the diagnosis of an ailment, cost

of medicine / conveyance before and after treatment are not covered in the

list.The coverage for the beneciaries started immediately on the date of

inauguration of the scheme. The entire process includes enrollment of the

eligible beneciares, empanelment of government and private hospitals.


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A liaison ofcer of Star Health will be stationed in all the network

hospitals. A dedicated kiosk shall be provided by the hospital to

facilitate service to the public. The liaison ofcer will help the

beneciaries in registration into the hospital.

Liaison Ofcer / Kiosk


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Enrollment

The entire database of various welfare boards was provided to the

insurance company. One thousand teams were sent throughout the

State to collect photometric and biometric data of all the eligible

individuals / families. Various camps were organized at the village / ward level to

facilitate easy enrolment of the beneciaries. Photos and biometric data of both

the individuals and families were collected and smart cards were issued.


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Enrollment Process

Upload

database of

welfare board

members

Collect

photometric and

biometric details

Issue smart

cards


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Empanelment

M/s Star Health and Allied Insurance Company Limited was contracted

to implement this scheme which has empanelled 592 network hospitals

inclusive of 42 Government Hospitals. According to the facilities

available in the hospitals, they are packaged into various categories for

reimbursement. The empanelled hospitals have to compulsoriy meet a

minimum criteria.


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ClaimsThe treatment under this policy will be available only in such empaneled

hospitals. The payment to hospitals for treatment shall be based on package rates

nalised with that hospital. The beneciary is not required to pay any amount to the

hospital for the treatment until the limit of one lakh is exhausted. (Cashless Treatment).

Pre-authorisation is provided on production of smart card, and claims are settled as per

procedures done and medical documents submitted.

The journey so far...

Till 30/4/2010, 83,991 patients have been treated for Rs. 238.03 crores


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Documents

CM Dr. Kalaignar Insurance Scheme