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Govt. Employees Health Fund Scheme

 

Introduction

Government has been concerned at the distress caused to families of Govt.  Employees ,  when the employee is struck by a major ailment and the remedies are also very expensive, causing great hardship to the Govt. employees.  Hence the Govt. have decided to constitute a “Govt. Employees Health Fund” to provide financial assistance to Government employees to meet the expenses for certain advanced surgeries / treatment.  Accordingly the scheme was constituted in the G.O. Ms.No.18 Finance Department Dated 09.01.1992 and streamlined in G.O. Ms.No.400 Finance (salaries) Department Dated:- 29.08.2000. 

Salient Features 

  1. Employees can avail assistance as advance

  2. Employees can avail assistance as reimbursement of expenditure

  3. Employees can avail Loan facility

Applicability 

  1. Compulsory for all Government Employees

  2. Employees working under emergency provisions

  3. Officers of All India Service of the Tamil Nadu cadre

  4. Employees who are drawing Medical allowance

  5. All employees, irrespective of the pay are eligible for assistance

  6. Even a month’s subscription by an employee would make him entitled for availing the benefit

Sources 

The scheme is basically a self financing scheme and the source to meet out the expenditure for assistance are 

  1. Govt. Contribution Rs.40,00,000/- per annum

  2. Monthly subscription from the employees at Rs10/- p.m.  from December 1998 onwards. 

Admissibility of assistance 

The assistance is admissible for treatment / surgery for the disease mentioned in G.O. Ms.No.400 Finance (Salaries) Department Dated:- 29.08.2000 at the accredited private Hospital. GO.Ms. No. 377 dated 13th October 2005 (Updation in Ms. No 400 Finance (Salaries) Department Dated:- 29.08.2000 )

Quantum of assistance

  1. The maximum assistance admissible is Rs.1,00,000/- or 75% of the actual expenditure whichever is less (G.O. Ms.No.236 Finance Dated:- 30.03.1995)

  2. For cancer treatment assistance under this scheme may be allowed for any No. of times not exceeding maximum ceiling of Rs.1,00,000/-.

  3. In all other normal cases assistance can be availed twice, not exceeding the maximum ceiling of Rs.1,00,000/-

  4. In case of eye surgeries (Twice) maximum assistance is Rs.30,000/- not exceeding the overall ceiling of Rs1,00,000/-.

Loan facility 

The Loan Facility to a maximum of Rs.1,00,000/- is also allowed for the treatment in foreign countries.  This will bear  10% interest.

Procedure to receive the claim

Submission of Application; 

The employee shall prefer the claim to the sanctioning authority through his / her office in the prescribed format (vide Govt.Letter No.46490 Finance (Salaries) / 98 – 99 Dated:- 11.08.1999)  along with original vouchers, within 60 days from the date of discharge from the Hospital.

Sanctioning authority & format for sanction 

  1. The District Level Officers in the Pay Scale 15,600 – 39,100 + Grade Pay Rs. 6,600/- and above are empowered to sanction Assistance under Tamil Nadu Government Employees Health Fund Scheme.

  2. Sanction Order should be in the format prescribed by the Govt. in Letter No.46490 Finance (Salaries) / 98 – 99 Dated:- 11.08.1999  along with a annexure prescribed in Govt. Lr.No.70939 Finance (Salaries) Dept. Dated:- 02.03.2004

Forwarding of Sanction orders

The sanctioning authority shall forward the sanction orders to the O/o Special Commissioner of Treasuries and Accounts, Pannagal Buildings, Saidapet, Chennai.

Scrutiny of Sanction orders 

  1. The sanction proceedings along with the annexure prescribed in the format are scrutinized in light of the rules and regulations of the Tamil Nadu Government Employees Health Fund Scheme through Computer. 

  2. After scrutiny the payment will be made to the individual by way of Cheques in case of Chennai City Offices and Demand Draft in the case of other Districts in Tamil Nadu.  The Cheques or Demand Draft shall be sent to the sanctioning authority for disbursement to the individual in case of reimbursement.

  3. Advance payments are made directly to the accredited private Hospitals by means of Cheque / Demand draft through the sanctioning authority. 

  4. Sanction Proceedings with defects are returned to the sanctioning authority with Computer printouts containing audit objection for due rectification

New Health Insurance Scheme

          TNGEHF Scheme ceases to operate with effect from  10.6.2008 in lieu of a cashless scheme "New Health Insurance scheme" introduced for the Government Employees with effect from 11.6.2008 as per Govt. Letter No.10063/Finance (Salaries)/ 2009-1 Dated 7.3.2009.    However, the spill over medical reimbursement claims under TNGEHF Scheme sanctioned by the sanctioning authorities for the period of  treatment  taken upto 10.6.2008 are scrutinized and cheques are issued after scrutiny.