DHARAMSHALA: Health Kalon Dr Tsering Wangchuk has appealed to Tibetans to enrol in Tibetan medicare system to avail the benefits of health care services, as the third year of the programme commences from 1 April.
In an exclusive interview with Tibet TV yesterday, Health Kalon said since the Tibetan medicare system was launched on 1 April 2012, it has been able to enrol 8,000 Tibetans in the first year and 10,000 in the second year. A total contribution of around Rs 79 lakh has been collected in the second year.
He said the health department has provided health care services to over 435 members enrolled in the second year and over 200 members need to be covered before the commencement of the next programme from 1 April 2014.
Health Kalon said the medicare system launched by the 14th Kashag is aimed at creating a more sustainable financing source for poor Tibetan families as well as those in need of urgent medical attention.
“More Tibetans need to join the medicare programme to reach the target of 20,000 members set by the health department,” health kalon said, adding, “the success of the health insurance depends solely on the participation of the general public.
“As many Tibetans are in different cities for the winter garment business before the third year of the medicare system starts from 1 April,” he said, “the health department will dispatch staff to these areas to raise awareness programme on medicare system and collect insurance fund from the enrolled members in January. Similar programmes will be organised in the Tibetan settlements and cluster areas from February till mid-March.”
“Therefore, we appeal to Tibetans to enrol in the medical system to avail an insured health care services when faced with urgent medical problem,” Health Kalon Dr. Tsering Wangchuk said.
Emphasising that Tibetans based overseas could a vital role in encouraging their family members and relatives living to enrol in the medicare system by providing financial assistance to them, health kalon requested the Offices of Tibet and Tibetan Associations to raise awareness programmes among the public.
The health kalon wished Tibetans good health in 2014.
Who are eligible to receive the benefits?
All Tibetan people in exile in India can enrol in the Tibetan Medicare System (TMS) and are eligible to receive the benefits.
How much to pay and what is covered?
For a family up to five, you would have to pay INR 3565 and INR 713 for each additional member on yearly basis as contribution, which will cover up the family floater for hospitalisation with reimbursement benefit up to INR 100,000. This includes the cost of the medicines prescribed and bought within one month of the discharge from the hospital. Individuals who are without a family can opt for individual coverage by paying a contribution of INR 950 for a year. For this contribution, an individual would get a reimbursement benefit up to INR 50,000 for hospitalisation expenses at referred hospitals. This includes the cost of the medicines prescribed and bought within one month of the discharge from the hospital.
How to enroll?
You can enroll at the hospital or the health care center of the Department of Health, CTA, in your settlement. If there is no health care center, enrollment can be done at the office of the Representative or Welfare Officer. A TMS member has the following responsibilities:• Attend meeting or get information on Tibetan Medicare System• Make a decision on enrollment• Fill the enrollment form with help of enrollment officer who could be any one of (Representative, Welfare officer, Doctor, Executive secretary, Health worker, camp leader etc.) • Submit the form with contribution amount and ID card charge to the enrollment officer• Verify the accuracy of the information given on your ID card and inform to the enrollment officer if there’s any mistake• Sign the “Received ID Card” sheet.
How to claim for benefits?
In case of sickness, approach the hospital or health care center of the Department of Health, CTA, or traditional Tibetan medical center in the settlement. If there is no health centers at the settlement, then go to a designated primary care provider In case there is a referral, take the referral slip from the first health care center or hospital and must go only to the referred hospital. After discharge from the hospital, all the original documents should be submitted to the Representative/Welfare officer/Executive secretary of the settlement for the reimbursement of the claim. The claim will be considered only to the enrolled patient who are hospitalised for more than 24 hours.
Claim will not be entertained in the following cases: 1. Submission of unnecessary or excess bills. 2. Any treatment related to alcohol and substance abuse. 3. Cost related to birth control or pregnancy prevention. 4. Vaccination (Included in primary health care services). 5. Cost of injuries related with fighting. 6. Treatment after attempting suicide. Any other health cost not covered under the TMS. 7. Treatment for cosmetic related surgeries.
Submit your name before 15 March 2014 to your Settlement Office or Hospital under the Department of Health.