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Friday, August 10, 2012

MEDICAL AID – New Health Insurance Scheme, 2012


TAMIL NADU GENERATION AND DISTRIBUTION CORPORATION LTD.

                                                    (ABSTRACT)               

MEDICAL AID New Health Insurance Scheme, 2012 - Provision of Health Care Assistance to the Employees of Government Departments, Organisations covered under this Scheme and their eligible Family Members through the United India Insurance Company Limited, Chennai - Implementation in Tamil Nadu Generation and Distribution Corporation Ltd. - Orders - Issued.                         
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     (SECRETARIAT BRANCH)

(Per.) CMD TANGEDCO  Proceedings No.194             Dated the 1st August 2012
                                                                                            Aadi-17,
                                                                                            Thiruvalluvar Aandu 2043.

                                                                                            READ

                     1)      (Per.) B.P. (Ch) No.89 (S.B.) dt. 21.5.2008.
                    2)      G.O.Ms. No.243,  Finance (Salaries) Department,
                             dt. 29.6.2012.
                3)      From Commissioner of Treasuries & Accounts Letter
                               Rc.No.17705/2012/NHIS  dated 09.07.2012.
                                                    -------   
PROCEEDINGS:

   Based on the orders of the Government, the Tamil Nadu Electricity Board introduced the New Health Insurance Scheme to provide health care assistance to the Tamil Nadu Electricity Board employees and their eligible family members with provision to avail assistance upto rupees two lakh with effect from 11.6.2008 and is in operation for the block period of four years upto 10-6-2012.

  2.   In the Government Order second cited, 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, Public Sector Undertakings, Statutory Boards, Local Bodies, State Government Universities, Willing State Government Organisations/Institutions and their eligible Family Members with provision to avail assistance upto Rupees Four lakh for a block of four years.   The United India Insurance Company Ltd., Chennai has executed an agreement with the  Government for  implementation of the New Health Insurance Scheme, 2012 for a block period of four years commencing from 1-7-2012 to          30-6-2016.

  3.  The Government also direct that the implementation of the New Health Insurance Scheme, 2012 shall be administered by the Commissioner of Treasuries and Accounts, Chennai-600 015.
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  4.   The Employees and their eligible Family Members covered under this Scheme shall avail assistance upto the limit of Rupees Four Lakh in a block period of four years commencing from 1-7-2012 to 30-06-2016 on a CASHLESS model for the approved treatments and surgeries in the hospitals approved by the Insurance Company/ Third Party Administrator under this Scheme. The benefit will be on a floater basis      i.e. the total coverage upto Rupees Four Lakh can be availed of individually or collectively by the Employees and their eligible Family Members during the said block period with no restriction on the number of times of availing.

  5.  The  employees in Tamil Nadu Generation and Distribution Corporation Ltd., drawing pay in regular time Scales of Pay and Special Time Scales of Pay and their eligible Family Members are covered under the New Health Insurance Scheme, 2012.   The Employees working on Consolidated Pay/Fixed Pay / Honorarium, Daily Wages, Contract basis, Re-employment, Temporary basis are not covered under this Scheme.

  6.  In the Government order cited, the Government have issued implementation procedure for New Health Insurance Scheme 2012 is outlined in Annexure–I.  The List of Diseases, treatments and surgeries under the broad based specialists approved under the New Health Insurance Scheme, 2012 are listed in  Annexure-II.  The List of hospitals approved by the United India Insurance Company Ltd./Third Party Administrator under the New Health Insurance  Scheme, 2012 are listed in      Annexure-III.  In addition to these hospitals, the employee families will be also eligible for treatment in other institutions to be approved by the Insurance Company and Third Party Administrator.  The List of Nodal Officers of the United India Insurance Company Ltd., situated in the District Headquarters and Toll free Helpline number are listed in the Annexure-IV.  The lists of approved treatments and surgeries, approved hospitals and the addresses of the Offices situated in the District Headquarters are also hosted on the websites of Government of Tamil Nadu in Finance Department (www.tn.gov.in/ departments/ finance.html), Treasuries and Accounts Department (www.tn.gov.in/ karuvoolam) and the United India Insurance Company Limited, Chennai / Third Party Administrator (www.mdindiaonline.com).   The additional list of hospitals included and list of deleted hospitals, if any covered in this Scheme will also be hosted in the above websites for ready reference from time to time on receipt of the same from the United India Insurance Company Limited / Third Party Administrator.   The guidelines regarding identity cards are listed in Annexure-V.  The certificate to be issued in Lieu of Identity card under the New Health Insurance Scheme, 2012 is furnished in      Annexure VI.   Form for furnishing Data of Employee and their eligible Family Members for insurance coverage under New Health Insurance Scheme, 2012 to Insurance Company/Third Party Administrator is in Annexure VII.

7.  Accordingly the following orders are issued: 
                    i.            The enrolment of the employees under the New Health Insurance Scheme, 2012 shall be compulsory.  The monthly subscription under the New Health Insurance Scheme, 2012 will be Rs.150/- per month and recovery shall commence from the salary for the month of July 2012 onwards.
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           ii.            The employees in Tamil Nadu Generation and Distribution Corporation Ltd., drawing pay in regular Time Scales of Pay and Special Time Scales of Pay and their eligible Family Members are covered under the New Health Insurance Scheme, 2012.

         iii.            The employees working on Consolidated Pay/Fixed Pay/Honorarium, Daily Wages, Contract basis, Re-employment etc. are not covered under this scheme.

          iv.            The following family members of the employee shall be covered under the New Health Insurance Scheme, 2012

(a)   legal spouse of the employee;

(b)  Children of the employee – till they get employed or   
      married or attain the age of 25 years whichever is earlier
      and dependent on the employee.

(c)  the parents of the Employee, in the case of unmarried  
      employee until the employee gets married.

             v.            Under the Scheme, in respect of legal spouse cases the total assistance for the Family will be limited to Rupees four lakhs only and the employee’s contribution shall be recovered either from Husband or from wife who is younger in age  i.e. younger of the two.

          vi.            The employees and their eligible family members shall avail assistance upto the limit of Rupees four lakh in a block of four years commencing from       1-7-2012  to 30-6-2016 on a CASHLESS model for the approved treatments and surgeries in the hospitals approved by the Insurance Company/Third Party Administrator under this scheme.  The benefit will be on a floater basis i.e. the total coverage upto Rupees Four Lakh can be availed of individually or collectively by the Employees and their eligible Family Members during the said block period with no restriction on the number of times of availing.

              vii.      The annual premium under the scheme shall be Rs.1,860/- per employee plus service tax @ 12.36% (i.e. the employee’s subscription of Rs.1800/- + the employer’s contribution of Rs.290/-) of Rs.2,090/- per employee shall be remitted within one month from 1-7-2012 and for Second, Third and Fourth years, the Annual premium including Service Tax as applicable shall also be remitted on or before 31st July of the respective year in the relevant head of account..   This amount should be paid by the Tamil Nadu Generation and Distribution Corporation Ltd. in Advance for the whole year. The additional expenditure over and above the subscription paid by employees drawing pay in regular time Scales will be borne by the respective employer organisation
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           viii.      The Pay Drawing Officers shall furnish the details of the Employees and their eligible Family Members as per the guidelines regarding Identity Cards in the Annexure-V to this order on or before 31-7-2012.

         ix.            The Identity Card of the Employee issued by the Insurance Company / Third Party Administrator or the Certificate in lieu of Identity Card as in the Annexure-VI to this order shall be produced to the approved hospitals for the approved treatments / surgeries. This arrangement of Certificate in lieu of Identity Card will be applicable only for such interim period, till the Identity Cards are made available. During the interim period of preparation and distribution of the New Identity Cards, the Insurance Company / Third Party Administrator shall authorise acceptance of the existing Identity Cards already issued under the Scheme for 2008-2012 for time being i.e. upto 30-09-2012.

  8.  The Chief Financial Controller will arrange for advance annual premium Rs.1860/- per employee plus service tax @ 12.36%, under the following head of account to the Government Account.


Employees of State Public Sector Undertakings and Statutory Boards
0075.00.
OTHER MISCELLANEOUS GENERAL SERVICES

800.
  Other Receipts

BO.
Subscription of Employees of Public Sector Undertakings and Statutory Boards towards New Health Insurance Scheme (NHIS)


(D.P.C. 0075 00 800 BO 0004)”






9)   The receipt of the TANGEDCO’s Proceedings shall be acknowledged.      

            (BY ORDER OF THE CHAIRMAN CUM MANAGING DIRECTOR)

A.S.PASUPATHI,
                                                                                                          SECRETARY.
To
All Chief Engineers. (w.e.)
The Director (Finance)/TANGEDCO. (w.e.)
The Director (Generation). (w.e.)
The Director (Distribution). (w.e.)
All Superintending Engineers. (w.e.)
The Secretary/TANGEDCO/Chennai-2. (w.e.)
The Chief Engineer/Personnel. (w.e.)
The Chief Financial Controller, General/Revenue, TANGEDCO. (w.e.)
The Industrial Relations Adviser. (w.e.)
Copy to:-
The Chairman cum Managing Director’s table.  (w.e.)
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The Managing Director/TANTRANSCO/Chennai. (w.e.)
All Directors/TANGEDCO. (w.e.)
All Directors/TANTRANSCO. (w.e.)
The Superintending Engineer/Chairman and Managing Director’s Office. (w.e.)
The Chief Medical Officer/TANGEDCO Dispensary, Chennai-2.
All Deputy Secretaries/Secretariat Branch. (w.e.)
The Deputy Chief Engineer/Administrative Branch. (w.e.)
The Chief Internal Audit Officer/Audit Branch/Chennai -2. (w.e.)
All Senior Personnel Officers/Administrative Branch. (w.e.)
The Under Secretary/Wage Revision/Secretariat Branch. (w.e.)
The Legal Adviser/TANGEDCO/Chennai -2. (w.e.)
The Industrial Relations Officer/TANGEDCO. (w.e.)
The Assistant Personnel Officer/Tamil Development for Publication
              in the TNEB Bulletin (2 copies). (w.e.)
All Officers and Sections / Secretariat Branch, TANGEDCO. (w.e.)
All Branches/TANGEDCO. (w.e.)
Tamil Nadu Electricity Workers' Federation. (w.e.)
Tamil Nadu Electricity Board Accounts & Executive  Staff Union. (w.e.)
Tamil Nadu Electricity Board Workers Progressive Union (LPF). (w.e.)
Central Organisation of Tamil Nadu Electricity Employees (COTEE). (w.e.)
Minsara Pirivu Anna Thozhir Sangam. (w.e.)
Tamil Nadu Minvariya Janatha Thozhilalar Sangam. (w.e.)
Tamil Nadu National Electricity Workers' Federation (2 Groups). (w.e.)
Tamil Nadu Electricity Board Engineers' Sangam. (w.e.)
Tamil Nadu Electricity Employees Congress. (w.e.)
Tamil Nadu Electricity Board Thozhilalar Aykiyya Sangam. (w.e.)
Tamil Nadu Electricity Board Engineers' Association. (w.e.)
Tamil Nadu Electricity Board Finance & Accounts Officers Association. (w.e.)
Bharathiya Electricity Employees Federation. (w.e.)
Tamil Nadu Electricity Board Card Billing Staff Unsion. (w.e.)
Tamil Nadu Electricity Board Dr.Ambedkar Employees Union. (w.e.)

                   //TRUE COPY//FORWARDED::BY ORDER//



SECTION OFFICER.

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