C.No.

8076/P&D/2024-25 I/3400/2025

C.No. 8076/P&D/2022-23 19-03-2025

All the Regional Joint Registrars and

Managing Directors of DCCBs

Sir,
Sub: New Health Insurance Scheme 2021 –
Procedure for Cashless and Reimbursement
Procedure – Clarifications to members of the
Scheme – Reg.
Ref: Our letter even No. dated 21.01.2023.

-:o:-

The New Health Insurance Scheme (NHIS) was introduced by Govt. of Tamil
Nadu through G.O. Ms. No.124 Cooperative Food and Consumer Protection
Department dated 18.08.2017.

United India Insurance Company is the third party Administrator for the
Insurance Scheme. (Block Years: 4 Years (2017-2021)).

The Govt. of Tamil Nadu vide its G.O. Ms. No.160 Finance (Salaries)
Department dated 29.06.2021 and G.O. Ms. No.112 Cooperative Food and
Consumer Protection Department dated 02.12.2021 renewed the New Health
Insurance Scheme for further period of 4 years from 2021 to 2025.

Of the premium collected, 95% is to be paid as Adhoc payment on the date

of commencement of the Scheme. Balance premium of 5% for the first year is
to be paid at the beginning of the second year based on the data provided by
the insurance Company.

The New insurance Scheme shall provide coverage to 203 Nos of treatment
and surgeries up to a maximum of Rupees Five lakh in a block of “4
Years”.

The financial assistance shall be enhanced up to Rupees Ten lakh for

specified treatments on cashless basis in any of the network hospitals and in
case of emergency care or accident in a non-network hospital on
reimbursement basis.
C.No.8076/P&D/2024-25 I/3400/2025

Premium remitted to United India Insurance Company from 2017-18 to

2024-25 is tabulated below:

No of Premium Paid to
Premium Amount
Sl.No Year Employees Insurance Company
(Rs.)
Covered Excl. GST (Rs.)
1. 2017-18 35864 2478 (2100+GST) 8,88,70,992.00
2. 2018-19 34696 2478 (2100+GST) 8,59,76,688.00
3. 2019-20 31906 2537 (2100+GST) 8,09,45,522.00
4. 2020-21 31089 2537 (2100+GST) 7,88,72,793.00
5. 2021-22 31081 3824 (3240+GST) 11,88,53,744.00
6. 2022-23 29254 3824 (3240+GST) 11,25,40,138.00
7. 2023-24 26797 3847 (3260+GST) 10,30,88,059.00
8. 2024-25* 27017 3847 (3260+GST) 9,87,37,680.00
TOTAL 76,78,85,616.00
*95% premium paid during 2024-25
In this connection, the Bank is receiving multiple enquiries and complaints
from the Societies regarding claim settlement and issue of NHIS card from
the United India Insurance Scheme.

In light of the above, the following instructions are provided for the
information of the Cooperative institutions.

The New Health Insurance Scheme 2021 has been implemented based
on the G.O.Ms.No.160 dated 29.06.2021 issued by the Finance
Department, Government of Tamil Nadu. All the members of the scheme
are advised to go through the above Government Order for reference.

Under the scheme, eligible family members and father and mother of
the employee in case of unmarried member and spouse of the member
and unmarried & unemployed 2 children without age restrictions in case
of married member of the scheme.

The New Health Insurance Scheme covers 203 treatments and

surgeries as listed in Annexure-I of the Guidelines mentioned in the
Government Order. The list of treatments provided under the Scheme is
enclosed hereunder for reference.

The Scheme shall provide medical care assistance upto a maximum of

Rs. Five Lakh to the members and their eligible family members of the
Scheme for a block of four years from 2021-2025. Further, the financial
C.No.8076/P&D/2024-25 I/3400/2025

assistance shall be enhanced upto Rs. Ten Lakhs for specified

treatments and surgeries mentioned in the Annexure-I A of the
Government Order.

The Scheme shall ordinarily provide medical assistance in any of the

Network Hospitals on CASHLESS Basis and in case of Emergency Care
or following an accident in a Non-Network Hospital on Reimbursement
Basis.

The members of the scheme must be aware of the details of the

Network Hospitals in the concerned District and specialized treatments
available in the Network Hospitals in Annexure-II. The members are
advised to undergo treatment for non-emergency care in the Network
Hospital in the district for higher reimbursement of the expenses.

For those employees, who do not have insurance ID Card, the insurance
company has advised the members of the scheme to obtain certificate
i n Annexure III from the concerned society with the signature of pay
disbursing officer with the acknowledgement by the concerned DCCBs in
lieu of identity card to avail medical assistance under the scheme.

Claims under the guidelines for reimbursement of payments made by

beneficiary to hospital for eligible medical expenses shall be submitted
by the member of the scheme directly to United India Insurance
Company within 30 days from the date of discharge along with
relevant documents and bills.

The members should submit the claim for reimbursement to insurance

company with mandatory covering letter from the concerned DCCB. The
members are advised to submit the correspondence address of the
employee with PINCODE and MOBILE Number in legible form. The model
covering letter is enclosed herewith for reference.

United India Insurance Company will receive the reimbursement claim

form with covering letter directly from the member of the scheme on
every Monday and Thursday at 10.30 AM to 02.30 PM at Division
Office:010600, 5th Floor, PLA Ratna Towers, Near Thousand Lights Metro
C.No.8076/P&D/2024-25 I/3400/2025

Station, 212 Anna Salai, Chennai – 600 006.

Steps to be followed for downloading the NHIS e-Card from the

insurance portal is mentioned below:
1. Go to the website tnnhis2018.in.

2. Go to quick links -> Employee E-cards

3. Select Co_operative_Society_2017 from the Employee E-CARDS

C.No.8076/P&D/2024-25 I/3400/2025

4. In the login page, enter the User ID (ID number provided by UIIC)
and Password (Date of Birth of the employee)

5. On submitting the requisite details, E-Card will be generated which

can be exported from the Export option available
C.No.8076/P&D/2024-25 I/3400/2025

6. E-Card will be downloaded which can be used when admitted in

the hospital and claim process.

All Regional Joint Registrars and the Managing Directors of the District
Central Cooperative Banks are advised to communicate the Scheme
Guidelines, List of approved treatments and Surgeries, List of specified
illness for the enhanced limit, List of approved hospitals under NHIS
2021 and the steps to download e-card to all the Cooperative institutions
under your control.
C.No.8076/P&D/2024-25 I/3400/2025

MANAGING DIRECTOR
Encl: As above