Tamil Nadu CMCHIS Offers Rs 25 Lakh Health Insurance Cover; Insurer Liability Capped at Rs 5 Lakh

The Tamil Nadu government has proposed increasing annual treatment coverage under the Chief Minister`s Comprehensive Health Insurance Scheme (CMCHIS) to Rs 25 lakh per family, while capping the selected insurer`s liability at Rs 5 lakh. The State`s Corpus Fund will cover eligible treatment expenses exceeding the insurer`s limit, up to the overall coverage ceiling.

The latest tender issued by the Tamil Nadu Health Systems Society seeks to appoint a public sector insurance company to implement CMCHIS, integrated with the Pradhan Mantri Jan Arogya Yojana (PM-JAY), for a five-year term.

CMCHIS Coverage Increased to Rs 25 Lakh

Chief Minister C. Joseph Vijay announced in the Assembly on August 19 that the annual health insurance coverage would be increased five-fold, from Rs 5 lakh to Rs 25 lakh per family.

The 2027 guidelines incorporated into the tender provide for cashless treatment of up to Rs 25 lakh per family annually at empanelled hospitals.

However, the selected insurer`s financial liability will remain capped at Rs 5 lakh per family. Eligible claims exceeding this amount, up to the Rs 25-lakh limit, will be settled through the State`s Corpus Fund. The insurer will process these claims without charging an additional fee.

Corpus Fund Contributions for High-End Treatments

Private hospitals performing high-end medical procedures will be required to contribute 3% of the total package cost to the Corpus Fund.

Such procedures will require approval from a High-End Technical Committee constituted by the Tamil Nadu Health Systems Society.

The revised funding arrangement aims to support higher treatment coverage while distributing financial responsibility between the insurer and the State government.

CMCHIS Income Eligibility Limit Increased

The new guidelines also raise the annual family income eligibility ceiling from Rs 1.2 lakh to Rs 2.5 lakh, potentially allowing more families to access the scheme.

Under the outgoing arrangement, United India Insurance Company implemented CMCHIS for five years from January 2022, with an annual premium of Rs 849 per family and coverage capped at Rs 5 lakh.

Eligibility Requirements for Insurance Bidders

The latest tender requires participating insurers to meet the following conditions:

- Be a public sector insurance company.

- Have at least five years of experience in health insurance.

- Have a track record of covering at least five lakh families or individual policies.

- Establish an office in Chennai and coordinating offices in every district.

Consortium and joint-venture bids are not permitted.

The revised CMCHIS framework is expected to expand access to cashless healthcarere and provide greater financial protection to eligible families across Tamil Nadu.