TNNHIS2016

Tamil Nadu - Government New Health Insurance Scheme 2016

Private Hospitals

A private hospital shall be qualified and tied up as a networked hospital by the insurance company only if it complies with the minimum criteria as under:

It should have at least 15 inpatient beds in respect of ‘A’ class city (population exceeding 12 lakhs) and ‘B’ class city (population exceeding 5 lakhs but 13 below 12 lakhs) and 10 inpatient beds in respect of ‘C’ class city (population below 5 lakhs ) as per the classification of cities by the Insurance Regulatory and Development Authority

It should be equipped and engaged in providing medical and surgical facilities along with diagnostic facilities i.e Pathological tests, X-ray and other investigations like Electro CardioGraph etc., for the care and treatment of injured or sick persons as in-patients

It should have a fully equipped operation theatre of its own wherever surgical operations are carried out

It should have fully equipped nursing staff under its employment round the clock; (e) It should have qualified doctor(s) physically in charge round the clock

It should maintain complete records as required on day to day basis and be able to provide necessary records of the insured patient to the Insurer or his representative as and when required. It should have functioned as an inpatient facility for a minimum period of one year

All the hospitals already accredited under the Tamil Nadu Government Employees Health Fund Scheme as in Annexure II to these Rules shall automatically be deemed to be networked hospitals and the Insurance Company shall ensure that they have a tie-up with these hospitals before the commencement of the Scheme

At least three institutions (excluding Government Hospitals) each situated at Puducherry, Bengaluru, Thiruvananthapuram and New Delhi shall also be covered.

The Insurance Company shall ensure the availability of a minimum of 6 networked hospitals in each district of the State and the availability of a minimum 50 networked hospitals excluding Government Hospitals in the areas under each district cluster as indicated below:

Northern Cluster: Chennai, Tiruvallur, Kancheepuram, Vellore, Tiruvannamalai, Villupuram and Cuddalore

Central Cluster: Perambalur, Ariyalur, Nagapattinam, Tiruvarur, Tiruchirapalli, Thanjavur,Pudukottai and Karur

Western Cluster: Krishnagiri, Dharmapuri, Salem, Erode, Namakkal, Nilgiris, Coimbatore and Tiruppur

Southern Cluster: Madurai, Theni, Sivagangai, Virudhunagar, Dindigul, Ramanathapuram, Tirunelveli, Kanyakumari and Tuticorin If any district or cluster does not have the number of hospitals as specified above, the successful insurance company can seek specific exemption for that district or cluster and the same will be considered by the Government of Tamil Nadu after verification of the available qualified hospitals in that district or cluster.