Latest news with #NewHealthInsuranceScheme
The Hindu
25-06-2025
- Health
- The Hindu
T.N. government extends health insurance scheme for employees by another year
The Tamil Nadu government on Tuesday (June 24, 2025) extended the New Health Insurance Scheme, 2021, for its employees, which is set to expire on June 30 this year, by another year from July 1. It will have assistance capped at ₹5 lakh for families of all insured employees and additional ₹5 lakh for specified illnesses, as per existing terms and conditions of agreement with the United India Insurance Company Limited. However, P. Frederic Engels, State coordinator of the Contributory Pension Scheme (CPS) Abolition Movement, said the G.O. issued by the Finance (Health Insurance) department was not clear, as it said the insurance was being extended as per 'existing' terms of conditions of agreement. 'It is not clear if employees are eligible for an additional ₹5 lakh cover during the next one year if they have exhausted the original cover within the block period of four years,' he pointed out. Mr. Engels also contended that though the scheme was supposed to extend the cashless model for approved treatments and surgeries, almost all those who have claimed health insurance could not avail cashless treatment and had to incur a sizable sum of expenses by themselves. 'If the extended health insurance cover does not provide additional cover for one year, the employees are at a loss. They would be paying for a cover which they may not be able to benefit from.' As per the 2021 scheme, the annual premium payable by the government to the company was ₹3,240 + GST per employee per annum for a block period of four years. The annual premium initially paid by the government was recovered from the employee at ₹300 per month (₹295 subscription for NHIS + ₹5 contribution for corpus fund) by deduction in monthly salary. In December 2021, the government had also extended the cover to dependent children of government employees without any age restriction with an additional premium of ₹20 + GST per family per annum. Now, on the request of the Director of Treasuries and Accounts, the insurance company has agreed to extend the scheme for a period of one year from July 1, 2025, to June 30, 2026.
Time of India
22-06-2025
- Health
- Time of India
Consumer forum in Coimbatore directs insurance firm to settle denied medical claim
Coimbatore: The district consumer redressal commission recently directed a public sector undertaking (PSU) insurance firm to reimburse a customer's medical claim of Rs9.43 lakh, which was earlier denied citing that the treatment was not covered. According to an official source, the verdict was delivered on a petition submitted by P Nagarajan, a retired special sub-inspector of police, and his wife Nagaveni, of Singanallur, against the insurance firm that was responsible for disbursing medical benefits under the New Health Insurance Scheme (NHIS). In their petition, the couple said they were entitled to cashless treatment up to Rs20 lakh for specified procedures under the scheme. "Nagaveni was hospitalized on several occasions in 2022 for aneurysm-related treatment, incurring an expenditure of Rs16.98 lakh. However, only around Rs3.20 lakh was reimbursed. One of the claims was denied with a remark 'treatment not covered'," the source said. Since a significant portion of the expenses remained unpaid even after submitting all original bills and medical records through proper channels, the couple were forced to arrange funds through personal loans and general provident fund withdrawals to meet the medical expenses, the source said. The couple, in their petition, claimed that the insurance firm hadn't given them an opportunity for clarification before denying or reducing the claim amount. In their plea, they sought reimbursement of the medical expenses with 18% annual interest from February 24, 2022, along with a compensation for the mental agony they suffered. In its ruling, the commission, comprising president R Thangavel and members P Marimuthu and G Suguna, directed the insurance firm to reimburse the eligible medical expenses of Rs9.43 lakh. It was also ordered to pay a compensation of Rs10,000 and another Rs5,000 towards the cost of legal proceedings.
