1) Who are the beneficiaries:

• More than 1 Crore poor families in Tamil Nadu will be benefited under this scheme
• Any family whose annual income is Rs.72,000 and less
• All members of the following welfare boards and the spouse, children and the dependent parents of such members in urban and rural areas are eligible.

1. Tamil Nadu Agricultural Labour Welfare Board
2. Tamil Nadu Construction Workers Welfare Board
3. Tamil Nadu Manual Labours Welfare Board
4. Tamil Nadu Auto Rickshaw and Taxi Drivers Welfare Board
5. Tamil Nadu Washermen Welfare Board
6. Tamil Nadu Hair Dressers Welfare Board
7. Tamil Nadu Handicrafts Workers Welfare Board
8. Tamil Nadu Palm Tree Workers Welfare Board
9. Tamil Nadu Handlooms and Handloom Silk Weaving Welfare Board
10. Tamil Nadu Footwear and Leather Goods Manufacturing and Tannery Workers Welfare Board
11. Tamil Nadu Artists Welfare Board
12. Tamil Nadu Goldsmiths Welfare Board
13. Tamil Nadu Pottery Workers Welfare Board
14. Tamil Nadu Domestic Workers Welfare Board
15. Tamil Nadu Tribal Welfare Board
16. Tamil Nadu Scavengers Welfare Board
17. Tamil Nadu Denotified Communities Welfare Board
18. Tamil Nadu Narikuravars Welfare Board
19. Tamil Nadu Ulamas and Workers Welfare Board
20. Tamil Nadu Fishermen Welfare Board
21. Tamil Nadu Aravanis Welfare Board
22. Tamil Nadu Disabled Welfare Board
23. Tamil Nadu Grama Koil Poosaris’ Welfare Board
24. Tamil Nadu Folk Artists Welfare Board
25. Tamil Nadu Traders Welfare Board.

2) What is covered:

Surgical procedures for the following treatments are covered under the scheme
(Detailed list of diseases given in Annexure)

3) What is not covered:

(i) Expenses for investigation that results in the diagnosis of an ailment which is not covered in the Scheme.
(ii) Cost of medicine / conveyance, etc Before / After treatment.
(iii) Any other treatment cost not included in the list.

4) Sum insured:

(i) Rs. 1 lakh per family for a period of 4 years
(ii) The Insurance premium will be paid by the Government
(iii) The Government has earmarked Rs.517.307 crores for this scheme during the current year

5) Network Hospitals:

The insurance company will identify and enroll hospitals under this scheme. The hospitals so networked will be well publicized. The treatment under this policy will be available only in such network Hospitals. There shall be a minimum of 6 hospitals in each district and a minimum of 15 hospitals in major cities.

The payment to hospitals for treatment shall be based on package rates finalized with that hospital. The beneficiary is not required to pay any amount to the hospital for the treatment until the limit of Rs.1 lakh is exhausted.

6) Liaison Officer / Kiosk:

A liaison officer of Star Health will be stationed in all the network hospitals. A dedicated kiosk shall be provided by the hospital to facilitate service to the public. The liaison officer will help the beneficiaries in registration into the hospital.

7) Claims procedure:

(A) Registration:

1. The biometric smart card to be produced.
2. Till the smart cards are issued
   1. The head of the family can use the welfare board membership card.
   2. The rest of the family members, along with the welfare board card of the family head should also produce
      1. the concerned VAO’s photo identity certificate identifying the
         beneficiary in respect of rural areas and town panchayats / Bill
         collector’s certificate in respect of Municipalities and Municipal
         Corporations
         (or)
      2. Produce any other photo identity card issued by the Government
         A photocopy of Ration card shall also need to be produced.
   3. All others covered under the scheme, who are not members of any
      welfare board should produce the photo copy of the ration card and
      1. Certificate of the income for the house hold by the designated officer (VAO / any other official designated by the Government ) and
      2. the concerned VAO’s photo identity certificate identifying the
         beneficiary in respect of rural areas and town panchayats / Bill
         collector’s certificate in respect of Municipalities and Municipal
         Corporations
         (or)
         Produce any other photo identity card issued by the Government
   4. The treatment for the first time will be considered with the concerned VAO’s certificate or any other document listed above. But for future hospitalizations, the beneficiary has to be enrolled in the scheme and the smart card to be produced to avail any further benefit under the scheme.
      
      

(B) Medical Document required at admission:

Referral slips in a standard format which will be provided for the list of 51 diseases mentioned below from Government hospital or General practitioner (either Government or Private). However emergency cases shall be admitted directly in the networked hospitals and eligibility proof to be produced within 2 days.