Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) Tamil Nadu: Cashless Healthcare ₹5 Lakh

On July 23, 2009, Tamil Nadu inaugurated the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), previously Kalaingar Kaappittu Thittam. Empanelled government and commercial institutions offer excellent treatment, decreasing financial burden for enrolled families. Linking to public healthcare advances universal health coverage.

United India Insurance Company runs the plan from January 2022 to 2027. It covers 1.37 crore households and comprises 1090 medical, 8 follow-up, and 52 diagnostic treatments as of January 2022. The state has 800 government and 900 private empanelled hospitals participating in the system.

The policy covers up to ₹5,00,000 per family per year for cashless hospitalization for selected diseases and treatments on a floater basis. While promoting excellent medical care, CMCHIS guarantees that underprivileged groups get appropriate healthcare without financial hardship.

Benefits

• • Extensive Medical Coverage: Financial protection against excessive medical expenditures while guaranteeing access to high-quality treatment.
  • A large network of empanelled institutions allows beneficiaries to access medical care in rural places.
    Comprehensive Treatment Coverage: Provides coverage for a variety of medical procedures and operations, lowering out-of-pocket costs.
  • High Sum Insured: Provides ₹5,00,000 per household yearly for minor and major healthcare services.
  • Additional Procedure Coverage: This includes follow-up treatments and diagnostic procedures, which provide cost assistance.

Eligibility

• • The applicant must be a resident of Tamil Nadu.
  • The applicant’s name must be present on the family card.
  • The annual family income should be less than ₹1,20,000 per annum.
  • Eligibility should be confirmed using:
    • Family card
    • Aadhaar card
    • Income certificate issued by VAO/Revenue Authorities
    • Self-declaration from the head of the family
  • Family members covered include:
    • Eligible member
    • Legal spouse
    • Children
    • Dependent parents

Exclusions

• • Non-residents of Tamil Nadu.
  • Families with an annual income above ₹1,20,000.
  • Individuals not listed in the ration card.
  • Non-Sri Lankan refugees without proof of citizenship.
  • Migrants from other states without migration certificates.
  • Orphans and rescued girl children not associated with registered organizations.

Application Process

Offline

Step 1: Obtain an income certificate from the Village Administrative Officer (VAO) or Revenue authorities.
Step 2: Gather necessary documents such as Aadhaar card, ration card, and income certificate.
Step 3: Visit the enrollment center and submit documents for verification.
Step 4: Provide biometric details (fingerprints, photograph, eye scan).
Step 5: After verification, the e-card will be issued.

Documents Required

• • Income certificate from VAO/Revenue authorities
  • Ration Card (original and photocopy)
  • Self-declaration from the head of the family
  • Proof of identity (Aadhaar, voter ID, PAN card, etc.)
  • Address proof (utility bill, voter ID, etc.)

Frequently Asked Questions

1. 1. Which family members are eligible to enroll under CMCHIS?
      The eligible family members include the applicant, legal spouse, dependent parents, and children listed on the family card.
   2. Can I file a claim online?
      No, CMCHIS operates as a cashless scheme, so beneficiaries do not need to file claims. Treatment expenses are directly settled between the hospital and the insurance provider.
   3. Till what age are children of the beneficiary included in the policy cover?
      Children of the beneficiary are covered under the scheme until they reach adulthood (18 years). However, if they remain dependent (unmarried, unemployed), they may continue to be covered.
   4. Are reimbursement claims allowed under CMCHIS health insurance?
      No, reimbursement claims are not allowed. The scheme provides cashless hospitalization, meaning the beneficiary does not need to pay out-of-pocket for covered procedures.
   5. What if the head of the family is not present at the time of enrollment?
      If the head of the family is unavailable, any adult family member listed in the ration card can complete the enrollment process.
   6. Are dental treatments included in CMCHIS?
      Basic dental procedures like extractions and minor surgeries are covered. However, cosmetic dental treatments are not included in the scheme.
   7. Is abdominal hysterectomy covered under CMCHIS?
      Yes, abdominal hysterectomy is covered under the scheme as part of the approved gynecological procedures.