CHENNAI: The State government unveiled a revamped health insurance scheme for pensioners and family pensioners, substantially enhancing cashless medical coverage and extending the programme for another five years from July 1 to strengthen healthcare support for retired government employees and their dependants.
The New Health Insurance Scheme (NHIS), 2026, notified by the Finance (Health Insurance) Department through a GO, will remain in force until June 30, 2031. Following a competitive bidding process, the State has entrusted its implementation to United India Insurance Company., continuing the public sector insurer’s association with the programme.
Under the revised scheme, beneficiaries will be eligible for cashless treatment of up to Rs 7.5 lakh during the five-year block period, while coverage for specified critical illnesses has been enhanced to Rs 12 lakh. The overall assistance under the family floater model has also been capped at Rs 12 lakh for the block period.
The scheme covers 2,992 approved treatments and surgeries, including 46 specified procedures, and can be availed at 1,535 empanelled private hospitals as well as government hospitals brought under the network.
Treatment obtained at non-network hospitals under non-emergency conditions will be eligible for reimbursement, subject to the prescribed ceiling.
The annual premium has been fixed at Rs 7,728 per beneficiary. Beginning July 2026, a monthly subscription of Rs 644 will be recovered from the pension, family pension or interim payout of beneficiaries.
Any premium payable over and above the contribution collected from pensioners will be borne by the State in respect of government pensioners and by the respective organisations in the case of pensioners from local bodies, PSUs, statutory boards and universities.
Enrolment will be mandatory for pensioners, including retired employees covered under the Tamil Nadu Assured Pension Scheme (TAPS) and the Contributory Pension Scheme. Pensioners under the Special Time Scale, including sanitary workers, Anganwadi workers, noon meal workers, village assistants and other notified categories, will continue to receive medical coverage under the Chief Minister’s Comprehensive Health Insurance Scheme.
The government has appointed the Commissioner of Treasuries and Accounts as the administrator of the scheme. “The New Health Insurance Scheme, 2026 for Pensioners (including spouse) / Family Pensioners” will take effect from July 1 and remain operational for the next five years, the Government Order said.