Reimbursement in non-network hospitals allowed

The GO passed on Friday states that in case of emergency hospitalisation, for treatment or surgeries covered under the insurance scheme, in non-network hospital for approved treatments can be undertaken on reimbursement basis. The clause also covers eligible family membersunder the scheme.

However, the major change, introduced in the GO, is in the treatment or surgeries not covered under the New Health Insurance Scheme where the quantum of claim is decided based on Medical Attendance rules and on par with the expense incurred in governmenthospitals.

“In case, an employee or eligible family members undergo emergency treatment or surgeries not covered under this scheme in either network hospital or non-network hospitals, no claim can be filed under the New Health Insurance Scheme. However, they shall be eligible for claim to the extent permissible under the Tamil Nadu Medical Attendance Rules and in genuine cases of emergency, the claims will be restricted to the expenditure that would have been incurred had the patient taken treatment in a government hospital excepting diet charges,”read the GO.

For the purpose, state had sanctioned additional funds towards the premium and introduced new clause ‘emergency care’ under New Health Insurance Scheme, for government employees.

However, for government officials undergoing treatment or surgeries not covered under the scheme and in non-network hospitals, cashless treatment facility is not available.