Goa Mediclaim Scheme

Scheme Introduction: A Brief Overview

The Goa Mediclaim Scheme is a Government of Goa medical assistance scheme, which was introduced to help eligible residents meet the cost of specified super-speciality treatments. The scheme provides financial assistance when the required treatment is not available in the Government hospitals of Goa. Eligible beneficiaries can receive assistance for approved treatments at recognised hospitals in Goa and outside the state, subject to the prescribed conditions and authorization.

Under the latest amendment to the Goa Mediclaim Scheme, the family income limit has been increased to ₹8 lakh per year for eligible permanent residents of Goa. The applicant must have been residing in Goa for the last 15 years and must figure in the voters list. The scheme also covers eligible minor dependents. Retired State Government employees are eligible under the scheme and are exempt from the monetary income ceiling, subject to the other applicable conditions.

The scheme provides financial assistance for various approved super-speciality treatments that meet the scheme's eligibility conditions. The amount of assistance depends on the type of treatment and the applicable ceiling limit under the scheme.

The general sanction limit under the Goa Mediclaim scheme was enhanced from ₹1.50 lakh to ₹5 lakh through the 2024 amendment. The Directorate of Health Services' current Citizen's Charter lists a ceiling of up to ₹5 lakh for most major treatment categories, while bone marrow transplantation is covered up to ₹8 lakh. CAPD dialysis is also covered under the scheme with the prescribed dialysis limit. The actual assistance remains subject to the applicable treatment ceiling and scheme conditions.

Beneficiaries can avail of treatment through recognized hospitals in Goa and outside Goa. The Directorate of Health Services maintains separate lists of recognized hospitals where credit facility is available and hospitals where credit facility is not available. The scheme also provides specific flexibility for NICU, ventilatory support and kidney dialysis, for which an eligible beneficiary may choose an empanelled hospital even when the facility is available in a Government hospital.

To avail the Goa Mediclaim Scheme benefits, eligible applicants need to complete the prescribed application process and submit the required medical, income, residence and identity documents to the Mediclaim Cell of the Directorate of Health Services, Goa. Applicants may also need to provide their DDSSY-related documents, wherever applicable. Form C is used for self-treatment, while Form D is used when applying for a minor. The process also involves the prescribed medical and eligibility certificates before the competent authority issues authorization for the approved treatment.

Scheme Benefits

• The Goa Mediclaim Scheme provides financial assistance for specified super-speciality treatments that are not available in Government hospitals in Goa.
• The assistance is provided for approved treatment categories and remains subject to the applicable ceiling limit and scheme conditions.
• The general sanction limit was enhanced from ₹1.50 lakh to ₹5 lakh through the 2024 amendment to the Goa Mediclaim Scheme.
• Certain treatments have separate ceiling limits, including up to ₹8 lakh for bone marrow transplantation.
• Beneficiaries can receive treatment at recognized hospitals in Goa and outside the state, subject to the applicable conditions and authorization.
• The Directorate of Health Services separately lists recognized hospitals where credit facility is available and hospitals where credit facility is not available.

Treatment-wise Ceiling Limits

The Goa Mediclaim Scheme specifies financial limits for different categories of super-speciality treatment. The latest Directorate of Health Services Citizen's Charter provides the following treatment-wise limits:

Note: The Directorate of Health Services website still displays some older treatment ceilings, while the 2024 Citizen's Charter reflects the updated ₹5 lakh limits for most listed treatments. The 2024 Government Gazette also increased the general sanction limit to ₹5 lakh. Therefore, the latest notified limits should be used when describing the current scheme.

Eligibility Requirements

The Goa Mediclaim Scheme covers eligible permanent residents of Goa who meet the prescribed residence, voter-list and family-income conditions. The applicant must also require a treatment covered under the scheme and, in general, the required treatment should not be available at the concerned Government hospitals in Goa.

• The applicant must be a permanent resident of Goa.
• The applicant must have been residing in Goa for the last 15 years.
• The applicant must be included in the voters list.
• The applicant's family income must not exceed ₹8 lakh per year.
• Minor dependents of eligible permanent residents are also covered under the scheme.
• The required treatment should generally not be available in Government hospitals in Goa, including Goa Medical College and District Hospitals.
• The treatment must fall under the medical conditions or treatment categories covered by the scheme.
• The treatment must be taken at a hospital recognized under the Goa Mediclaim Scheme.
• For NICU, ventilatory support and kidney dialysis, eligible beneficiaries can choose an empanelled hospital even if the facility is available in a Government hospital.
• Retired State Government employees are eligible under the scheme and are exempt from the monetary family-income ceiling, subject to the other applicable conditions.

Required Documents

Applicants need to submit documents related to their medical treatment, residence, income and identity to apply for financial assistance under the Goa Mediclaim Scheme. The required documents may differ depending on whether the application is for self-treatment or for a minor.

• Form C – Application form for self-treatment.
• Form D – Application form for treatment of a minor.
• Medical Certificate – Medical certificate from the concerned Government hospital or prescribed medical authority.
• Family Income Certificate – Certificate issued by the Mamlatdar, wherever applicable.
• 15-Year Residence Certificate – Proof of residence in Goa for the required period.
• Pension Payment Order (PPO) – For retired State Government employees, wherever applicable.
• Mediclaim Certificate – Certificate issued through the prescribed medical verification process.
• Election Card/Voter ID – Proof of identity and residence.
• Permanent Ration Card – As prescribed under the scheme.
• Parent's Election Card – Required when applying on behalf of a minor.
• Aadhaar Card.
• DDSSY Card/Document, wherever applicable.
• Passport-size Photograph – Photograph on the prescribed application form.
• Declaration/Undertaking – Declaration regarding employment status, insurance coverage and previous benefits received under the Goa Mediclaim Scheme.

Note: The official scheme documents also require the prescribed medical, income/residence and other supporting certificates along with the application. Applicants should use the latest forms and document requirements issued by the Directorate of Health Services, Goa.

Steps to Apply

The Goa Mediclaim Scheme can be applied for offline only. There is no online application portal for the scheme. Applicants must approach the Directorate of Health Services with the prescribed form and supporting documents before availing treatment.

• Visit the concerned Government hospital or prescribed medical authority for examination and obtain the required medical certificate.
• Obtain the required income and residence certificates from the concerned authority, wherever applicable.
• Complete Form C for self-treatment or Form D for treatment of a minor.
• Attach the required documents, including identity proof, voter card, residence/income proof, medical certificate, photograph and prescribed declaration.
• Obtain the required Mediclaim Certificate through the prescribed process.
• Submit the completed application and documents to the Mediclaim Cell, Directorate of Health Services, Campal, Panaji, Goa.
• After verification, the competent authority issues the required authorization for treatment at a recognized hospital within the applicable limit.
• Take the approved treatment at the recognized hospital according to the authorization and scheme conditions.

Applying Without a Prior Referral

Patients who have already taken treatment at a recognised hospital without obtaining a Mediclaim Certificate can still apply for assistance.

• Apply directly to the Director of Health Services, Panaji, with all relevant papers.
• The Directorate scrutinises the case and submits it to the Government for approval in relaxation of the prescribed procedure.

Important Forms

• Goa Mediclaim Scheme Application Form C (Individuals)
• Goa Mediclaim Scheme Application Form D (For Minors)
• Goa Mediclaim Scheme Self Declaration Form.
• Goa Mediclaim Scheme Income and Medical Certificate

Relevant Links

• Goa Mediclaim Scheme Notification.
• Goa Mediclaim Scheme List of Recognised Hospitals
• Goa Mediclaim Scheme Sanction Limit Notice 1
• Goa Mediclaim Scheme Sanction Limit Notice 2
• Goa Mediclaim Scheme Gazette Notice
• Goa Directorate of Health Services Official Portal

Contact Information

• Goa DHS Contact Details