It is a holistic secondary and tertiary health care (hospital care) coverage for all Tibetans living in exile under the responsibility of Tibetan Voluntary Health Association (TVHA), registered under the Societies Act 1860. The system is built on Public Private Partnership model and creates a health fund across the entire Tibetan exile community. It will provide equitable and comprehensive health care coverage on yearly basis designed to serve the health care needs of the entire Tibetan exile community by creating a more sustainable financing source.TMS is a nonprofit and charitable programme that improves public health and well-being of the Tibetan community in-exile significantly through access to quality secondary and tertiary healthcare in partnership with well-known health care providers, while reducing financial insecurity and hardship associated with treatment of catastrophic conditions and hospitalization. TMS will contribute towards a holistic preventive and curative system integrating both ‘SORIG’, the Tibetan traditional herbal medicine, and allopathic medicine system in order to deliver effective and efficient health care services tailored to the needs of the Tibetan community in-exile.Why do we need it?• It will provide financial security to the families and individuals when they face serious health problems• Tibetan Medicare System is a nonprofit and charitable programme intended to improve the health care services of the Tibetan community in-exile.• It will provide equitable and comprehensive health care coverage to families and individuals who are enrolled in this system• CTA will not provide any other subsidy for health after this scheme startsWho are eligible to receive the benefits? All Tibetan people in exile in India can enroll in the 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 hospitalization with cashless benefit upto 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 cashless benefit upto INR 50,000 for hospitalization expenses at selected 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” sheetHow 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.The cashless claim payment would be made to the empanelled or network hospitals on a regular basis for all the TMS member patients that they have provided the service to. But ensure that you carry your TMS ID card for the cashless transaction for the hospitalization. Claim reimbursement will be made only in case of emergencies, where an insured person is not able to reach a designated provider in time and goes to some other provider because of emergency. 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. . Once you are admitted to any of designated hospital;• Show your TMS ID card to prove that you are a member.• The management in the hospital will match your finger print.• The cashless transaction will start once the identification is matched.• Please ensure that the treatment you receive and the treatment billed by the hospital match. Inform your primary care provider or settlement officer if you have doubts.• The balance amount in the card will be shown either on the screen or in the written form after each usage.• During emergency, enrolled member can be admitted in the nearest non network hospital to save life. But one has to inform the concerned enrollment officer within 24 hours of admission in that hospital.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.
The department was first established in 1981. The first Kalon, Shewo L. Dhargay and first Secretary, Mrs. Kesang Y. Takla had joined their office on November 1988 and 1 December 1983 respectively. They and their teams and their successors had worked really hard to help the department and health status of the Tibetan people reached where they stand today.