New Health Insurance Scheme for Pensioners 2018

The main objectives of the Scheme are: -

  1. To extend the scope of assistance for medical treatments available under the existing Scheme
  2. To cover more ailments and more hospitals including payment wards of Government Hospitals
  3. To provide financial assistance up to Rupees Two Lakhs per Pensioner (including spouse) / Family Pensioner for a block of four years
  4. To provide the assistance on a cashless basis.
Scope of the Scheme
  1. To provide coverage for the eligible expenses incurred by the Pensioner on behalf of himself/herself or his or her legal spouse / Family Pensioners for the treatments and surgeries listed in Annexure-I to these Rules.
  2. The coverage will include the cost of medicines, laparoscopic or open surgeries, doctor and attendant fees, room charges, diagnostic charges, dietary charges availed in the approved hospitals. Transport charges shall be excluded.
  3. The coverage shall also include pre-existing illnesses which have been included in Annexure-I to these Rules, if any.
  1. Issue ID cards and Guide book containing details of the scheme, List of Network Hospitals and Contact details of TPA in the state to all beneficiaries.
  2. Issue Authorization (AL) to the Network Hospital for cashless treatment of the beneficiary.
  3. Establish a dedicated toll free 24/7 to assist beneficiaries/hospitals.
  4. Process and settle claims of Network Hospitals.