CHENNAI: The Tamil Nadu government's latest tender for the Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) provides for annual treatment coverage of up to Rs 25 lakh per family, but retains the selected insurer's liability at Rs 5 lakh, with the State's Corpus Fund set to meet expenditure beyond that limit.

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

Chief Minister C Joseph Vijay had announced in the Assembly on August 19 that the annual coverage would be increased five-fold to Rs 25 lakh from Rs 5 lakh. The 2027 guidelines incorporated into the tender provide for cashless treatment up to Rs 25 lakh per family a year at empanelled hospitals. However, the insurer's liability is capped at Rs 5 lakh. Claims exceeding that amount and up to the Rs 25-lakh ceiling will be settled from the Corpus Fund. The insurer will process such claims without any additional fee.

Private hospitals performing high-end procedures will have to contribute three per cent of the total package cost to the Corpus Fund. Such procedures will require approval from a High-End Technical Committee constituted by the Society.

The guidelines also raise the annual family income eligibility ceiling from Rs 1.2 lakh to Rs 2.5 lakh. Under the outgoing arrangement, United India Insurance Company implemented the scheme for five years from January 2022 at an annual premium of Rs 849 per family, with coverage capped at Rs 5 lakh.

The new tender requires bidders to be public sector insurers with at least five years of health insurance experience and a record of covering at least five lakh families or individual policies. Consortium or joint-venture bids are not permitted. The selected insurer must establish an office in Chennai and coordinating offices in every district.