Tamil Nadu New Health Insurance Scheme

Scheme Introduction: A Brief Overview

Tamil Nadu government employees and pensioners now have a bigger health insurance cover under the New Health Insurance Scheme, 2026. The state government launched NHIS 2026 from 1 July 2026. This scheme replaces the earlier 2021 policy cycle. United India Insurance Company Limited continues as the insurer for this new five-year block. The block runs until 30 June 2031. NHIS 2026 offers cashless treatment on a package rate basis at empanelled hospitals across Tamil Nadu.

Under the NHIS 2026, the government raises the basic sum insured from Rs.5 lakh to Rs.7.50 lakh per family. Coverage for specified illnesses goes up from Rs.10 lakh to Rs.12 lakh. Government employees also get a separate Corpus Fund for rare and specified illnesses. This fund has increased from Rs.10 lakh to Rs.15 lakh. The Tamil Nadu Finance Minister confirmed these figures in the Budget Speech 2026-27 on 5 August 2026. The government has set aside Rs.838 crore to implement this health insurance scheme.

The scheme covers Tamil Nadu government department employees and their eligible family members. It also covers teaching and non-teaching staff of aided educational institutions. State government pensioners, family pensioners, and retired employees under the Contributory Pension Scheme or the Tamil Nadu Assured Pension Scheme are eligible too. Enrollment under NHIS 2026 is automatic and compulsory for most beneficiaries. There is no separate application form to fill for most people. Only a few special categories, such as All India Service pensioners, need to submit an option form.

NHIS 2026 is different from two other health insurance schemes the Tamil Nadu government runs. The Chief Minister's Comprehensive Health Insurance Scheme covers the general public across age groups, not just government employees and pensioners. The Chief Minister's Elderly Health Insurance Scheme is a newer scheme for senior citizens aged 70 and above, with no income ceiling. NHIS 2026 is meant only for government employees, aided institution staff, and pensioners. The scheme provides cashless treatment across 1,535 empanelled private hospitals. It also covers all government medical institutions already empanelled under the Chief Minister's Comprehensive Health Insurance Scheme. Beneficiaries can access 2,992 approved treatments and 46 specified illness procedures.

NHIS 2026 is already notified and in force. Premium deductions from salaries and pensions began in July 2026. The dedicated NHIS portal and e-identity cards are still being rolled out. Pensioners can use an interim certificate from their Pension Disbursing Officer until their e-card arrives.

Scheme Benefits

The New Health Insurance Scheme, 2026 provides enhanced health insurance coverage to eligible Government Employees, their family members, Pensioners and Family Pensioners. The major benefits include:

• Increases the basic sum insured from ₹5 lakh to ₹7.50 lakh.
• Increases coverage for specified illnesses from ₹10 lakh to ₹12 lakh.
• Enhances the Corpus Fund from ₹10 lakh to ₹15 lakh for employees requiring treatment for rare and specified illnesses.
• Covers 2,992 medical procedures under the scheme.
• Includes 46 specified illness procedures for enhanced coverage.
• Provides access to treatment through a network of 1,535 empanelled hospitals and Government Medical Institutions.
• Provides health insurance coverage to eligible family members of Government Employees.
• Covers eligible Pensioners, spouses and Family Pensioners under the pensioner component of the scheme.
• Operates for five years from 1 July 2026 to 30 June 2031.

Financial Benefits: Government Employees vs Pensioners

Note: The ₹15 lakh Corpus Fund is specifically provided for eligible Government Employees and should not be treated as an additional ₹15 lakh insurance cover for pensioners.

Eligibility Requirements

The New Health Insurance Scheme, 2026 covers eligible Government Employees and their family members, as well as Pensioners, including spouses, and Family Pensioners. The eligibility conditions differ for employees and pensioners.

Eligibility for Government Employees

• Employees of Government Departments on regular time scale of pay, including teaching and non-teaching staff of aided educational institutions.
• Special Time Scale Employees, including sweepers/sanitary workers, Anganwadi workers, Noon Meal workers, and Village Assistants, are covered under this scheme (unlike the pensioners' scheme, where these same categories are excluded and covered under CMCHIS instead).
• Legal spouse of the employee.
• Parents of an unmarried employee, until the employee marries; for a divorced employee with no children, until remarriage.
• Dependent children without age restriction, including those pursuing higher studies and not employed, and unmarried, widowed, or legally divorced dependent daughters.
• Persons with disability or intellectual disability who are wholly dependent on the employee.
• Employees of State PSUs, Statutory Boards and Corporations, Local Bodies, State Government Universities, and organisations registered under the Tamil Nadu Societies Registration Act, 1975, only where that organisation elects to adopt the scheme and bears the employer's premium share.

Eligibility for Pensioners

• Pensioners and Family Pensioners (including spouse) drawing pension from the Consolidated Fund of Tamil Nadu.
• State Civil Pensioners and Family Pensioners.
• Teacher Pensioners and Family Pensioners.
• All India Service Pensioners and Family Pensioners of the Tamil Nadu cadre.
• Disabled sons or daughters unable to earn a living even after age 25, until marriage.
• Unmarried, widowed, or divorced daughters past age 25, until marriage or until earning above ₹7,850/month.
• Dependents eligible for family pension under the Tamil Nadu Pension Rules, 1978.
• Pensioners entitled to restoration of commuted pension after lump-sum absorption in a PSU, Autonomous Body, Local Body, or Co-operative Institution.
• Divisible Family Pensioners, where family pension is split among more than one member.
• Pensioners receiving Special Pension under the Tamil Nadu Extraordinary Pension Rules.
• Provisional Pensioners under Rules 60, 66, 69, and 69-B of the Tamil Nadu Pension Rules, 1978.
• Pensioners of the former Travancore-Cochin State drawing pension in Kanniyakumari district and Shencottah Taluk, Tenkasi district.
• Retired CPS employees and TAPS-covered retirees, and their spouses, on payment of the prescribed premium.

Who is Not Eligible for NHIS 2026 (Employees)

• Staff engaged on consolidated pay, fixed pay, or honorarium.
• Daily-wage labour.
• Contract-basis staff.
• Re-employed staff.
• Temporary staff engaged under Rule 10(a)(1) of the Tamil Nadu State and Subordinate Services through Employment Exchange.
• Outsourced personnel.

Note: An employee who joined Tamil Nadu Government service after retiring from the Armed Forces, and who is covered under the Ex-Serviceman Health Scheme, may opt out of NHIS 2026. The option must be exercised within 15 days of the scheme's commencement or the employee's date of appointment, and is final once exercised.

Required Documents

Applicants should keep the required details and supporting documents ready while completing the New Health Insurance Scheme enrolment process. The documents and information vary for Government Employees and Pensioners/Family Pensioners, as specified in the respective forms.

For Government Employees

• NHIS ID Card details, if available.
• Employee Code / GPF / TPF / CPS Number, as applicable.
• Details of pay drawn and pay level.
• Details of the office, department and Head of Department (HOD) Code.
• Aadhaar Card details.
• Voter ID details.
• PAN details.
• Date of Birth details.
• Date of Appointment and Date of Retirement details.
• Details of eligible family members, including their date of birth, relationship, marital status and employment status.
• Passport-size photographs of the employee and eligible family members.
• Disability-related details for physically challenged or intellectually disabled children, wherever applicable.

For Pensioners and Family Pensioners

• Pension Payment Order (PPO) Number.
• Details of the Pension Disbursing Office / Treasury / Sub-Treasury / Pension Pay Office.
• Bank and branch details with the account number from which pension or family pension is drawn.
• Permanent address with District and PIN Code.
• Present address.
• Mobile number and other contact details.
• PAN details, if available.
• Details of the post held at the time of retirement.
• Details of the office or department from which the pensioner retired.
• Original pension, commuted amount, provisional pension or family pension details, as applicable.
• Date of Birth proof of the pensioner/family pensioner.
• Date of Birth proof of the spouse, where applicable.
• Date of Retirement details of the pensioner.
• Photograph of the Family Pensioner or joint photograph of the Pensioner and spouse, as applicable.
• Legal heir details, where applicable.

Additional Details for Pensioners Required to Exercise an Option

• AIS Pensioner details or AIS Family Pension details, wherever applicable.
• Spouse's name, office, designation and NHIS ID Card Number, where the spouse is a State Government employee.
• Spouse's name, PPO Number and pension subscription details, where both husband and wife are pensioners.
• Family Pensioner's PPO Number, Pension Disbursing Office, bank and account details, where a pensioner is also a Family Pensioner.
• Details of other pension where an individual draws more than one Family Pension.
• CPS Number, name of CPS retiree, spouse name, details of amount paid and district for CPS retirees and their spouses.

How to Enroll for the scheme

NHIS 2026 does not work like a typical scheme where beneficiaries submit an application form. Enrollment is automatic and compulsory for almost all eligible employees and pensioners, pulled directly from the IFHRMS database. What beneficiaries actually need to do depends on their situation, as explained below.

Enrollment (Automatic- No Action Needed for Most Beneficiaries)

1. Eligible employees and pensioners are enrolled automatically based on their IFHRMS records held by the Commissioner/Director of Treasuries and Accounts.
2. Monthly subscription is deducted directly from salary (employees) or pension/family pension (pensioners), starting from July 2026.
3. No enrollment form needs to be submitted unless you fall into one of the option-exercising categories listed under Eligibility above.

For Pensioners Required to Exercise an Option

1. Obtain the prescribed Annexure-III option form, appended to the official guideline.
2. Fill in the required category details, such as All India Service pensioner status, spouse's employment details, or family pension details, as applicable.
3. Submit the completed form to the authority concerned for your category. This is the Pension Pay Officer, Chennai for pensions drawn there, the District Treasury Officer or Assistant Treasury Officer for pensions drawn from a Treasury or Sub-Treasury, or the Commissioner/Director of Treasuries and Accounts for pensioners drawing their pension outside Tamil Nadu.
4. Submit the form within one month of the scheme's notification. If no option is submitted within this period, the pensioner is deemed to have opted in, and the option once exercised is final.
5. Pensioners who already exercised an option under the New Health Insurance Scheme, 2022 need not exercise it again for NHIS 2026, as confirmed under the current guideline.

How to Avail Cashless Treatment Under NHIS 2026?

Eligible beneficiaries should normally take treatment at a Network Hospital empanelled under NHIS 2026 to use the package-rate cashless facility. The following process applies for planned hospitalisation:

1. Check the list of NHIS 2026 Network Hospitals and approach an empanelled hospital for an approved treatment or surgery.
2. Visit the hospital's Insurance Desk that handles NHIS package-rate cashless treatment.
3. Produce the NHIS Electronic Identity Card (e-Card). Where applicable, the prescribed form or Employee ID Card containing the IFHRMS number can also be produced to establish eligibility.
4. The Network Hospital will verify the beneficiary's eligibility and register the beneficiary for the approved treatment.
5. The hospital will submit the required pre-authorisation request to the Insurance Company/Third Party Administrator (TPA).
6. The insurer/TPA will verify whether the beneficiary is eligible and whether the proposed treatment is covered under the NHIS package-rate system.
7. Once the treatment is authorised, the beneficiary can undergo the approved treatment on a cashless basis at the Network Hospital.
8. The beneficiary needs to pay only the non-payable or non-admissible expenses, if any, directly to the hospital.
9. At the time of discharge, the beneficiary should sign the required final authorisation/claim documents provided by the hospital.

How to Avail Treatment in a Medical Emergency

1. Call the insurer's toll-free number and inform them of the emergency and the hospital you plan to approach.
2. The call centre issues a Pre-Arrival Intimation to the hospital and an Emergency Intimation Number, allowing treatment to start immediately.
3. A 50% auto-approval of the eligible package rate is granted without waiting for routine pre-authorisation.
4. If admitted to a non-network hospital during an emergency, pay first and then file a reimbursement claim (see below).

How to File a Reimbursement Claim

1. Submit the claim, along with the required documents, to the Pension Disbursing Officer within 60 days of discharge (90 days for specified illnesses under Annexure I-A).
2. The Pension Disbursing Officer uploads the claim to the NHIS portal (or processes it manually until the portal is live) within 7 days.
3. The Grievance Redressal Officer examines the claim and forwards it, with a recommendation, to the District Level Empowered Committee within one month.
4. The District Level Empowered Committee approves eligible claims within one month; the insurer must then pay the beneficiary within one month of that approval.

What NHIS 2026 Does Not Cover

• Outpatient (OP) treatment of any kind is excluded – the scheme covers hospitalisation and day-care procedures only.
• Any treatment or surgery not listed in Annexure-I or Annexure I-A of the guidelines.
• Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) treatments.
• Hospitalisation purely for evaluation or diagnostic purposes, or investigations unrelated to the diagnosed condition.
• Expenses when the patient is diagnosed with HIV/AIDS, directly or indirectly.
• A long list of administrative and consumable items – including admission kits, documentation charges, luxury tax, television/AC charges, attendant charges, and routine consumables that are meant to be part of the hospital's own OT/ICU/room charges rather than separately billable.
• Ambulance charges and ambulance equipment.
• Private/special nursing charges after discharge (though nursing charges during hospitalisation are payable if supported by a prescription).

Important Forms

• Tamil Nadu New Health Insurance Scheme Employee Application Form
• Tamil Nadu New Health Insurance Scheme Pensioner Application Form

Relevant Links

• Tamil Nadu New Health Insurance Scheme for Employees (official PDF)
• Tamil Nadu Guidelines for Pensioners/Family Pensioners (official PDF)
• TN-HIS Portal
• Tamil Nadu Treasuries and Accounts Department (NHIS Info)
• Tamil Nadu New Health Insurance Scheme Hospital Network List
• Track Claim submitted under New Health Insurance Scheme

Contact Information

• Tamil Nadu New Health Insurance Scheme Toll Free Number
  • Employee: 18002335666
  • Pensioner: 18002335544
• For Login issues, contact 04440115088
• Tamil Nadu New Health Insurance Scheme Contact Details