CM Dr. Kalaignar Insurance Scheme
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Transcript of 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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