TMS Frequently Asked Questions
Following are the short answers to the FAQs put forward by the settlers during the TMS awareness campaign. For further details, please go through TMS health plan document available at your hospitals and settlement offices.
Q 1. Will ID card be provided to all individuals?
Ans. Yes, ID card will be provided to all the members’ individually.
Q.2. Is there any special consideration with regard to the ward facility at the time of hospitalization?
Ans. The reimbursement towards room is limited to 1% of the yearly benefit (sum insured) amount, which amounts to Rs. 1000 per day of hospitalisation for Household Unit Plan and Rs. 500 per day of hospitalisation for Individual Unit Plan. These rent limits are doubled to 2% of the yearly benefit (sum insured) amount in case of hospitalisation in ICU/CCU.
Q.3. In case of migration of insured client abroad, can the same be replaced by another member of the same family?
Ans. No, all the family members have to enrol from the beginning if one family member is enrolling. Hence, no substitution is permitted.
Q.4. In monastery, many of monks are eager to join in individual category by paying Rs. 950/- per annum? Can they do it or not?
Ans. No, the Individual category provision is only meant for a family unit with single member. The monks staying in the monasteries should form a group of five to join a household/family unit provision.
Q.5. If someone has left for abroad after the registration, can he/she avail the same facility abroad?
Ans. The benefits under TMS are applicable only within India. Hence, anyone who has migrated abroad cannot avail the facility overseas. But, anyone moving within India can well avail all facilities from the nearest hospitals by intimating to the Settlement Office or TVHA hospital where he is currently staying.
Q.6. In case, an enrolled member faces an emergency during the sweater selling duration where there’s no TVHA hospitals around, where and how can I seek treatment?
Ans. Youwill have to get treated at any nearby hospital and send all the medical expenses related document to Department of Health through your enrolled Settlement Office or TVHA hospital. You should inform to your respective executive secretary or settlement officer within 48 hours of your admission.
Q.7. A family consisting of 7 members insures under this health plan by paying extra Rs. 713/- for the sixth and seventh member of the family? What is the benefit limit for such a family? Will it be only Rs. 1 lakh or more?
Ans. There is no change in the benefits which remains at Rs. 1 lakh because the risk cover for TMS increases.
Q.8. If a person enrols in TMS for more than 3 years and later discontinues, will he/she get some amount as refund later?
Ans. No (see entry and exit rules)
Q.9. Does the TMS cover a new born child?
Ans. Yes. A new-born child is covered from day one up to the end of the Health Plan period.
Q.10. Does the scheme also cover medical expenses related with eye and dental?
Ans. Medical expenses related to eye surgeries are covered as per package rates. Dental expenses are not covered, except those arising out of accidental injuries requiring a minimum of 24 hours of hospitalisation.
Q.11. Can we enrol as one family even if family members are staying in different places? For instance, I am living at Dharamsala and my parents live in Mussoorie. Can I enrol them at Dharamsala as one family?
Ans. Yes, provided you are legitimate family members as per the definition.
Q.12. What happens if the treatment expenses exceed the maximum benefit level?
Ans. In such a case, the concerned patient/member has to bear the extra costs.
Q.13. What will TMS do if the members consulted to their preferred hospital and get referral slip later?
Ans. TMS shall not be in a position to foot the bills for any of its member for consulting or getting treatment from hospitals of their preference in normal circumstances (see emergency rules).
Q.14. Can persons working in an educational institute or any other organisation enrol in TMS, when they are already covered under medical insurance provided by their organisation? Can they still enrol?
Ans. It is up to them if they want to have more than one health plan. However, getting double reimbursement is illegal and is subject to legal prosecution.
Q.15. Can a member who enrolled at Dharamsala is allowed to consult at hospital at Bangalore?
Ans. Yes, if he happens to be there at the time of hospitalization.
Q.16. Do the members get DA/TA while they are hospitalized?
Ans. No DA/TA is payable under TMS.
Q.17. Can extra members instead of joining the family provision form another unit?
Ans. No, no natural member(s) can form another family unit because this distorts the basic unit logic and effective preventive health care assumption.
Q.18. How will the TMS consider a situation where the scheme’s one year validity is over while one of the member is still in process of recovery at the hospital?
Ans. The TMS memberwill have to renew the membership without any lapse or else he will receive benefit only of period when he was a member.
Q.19. Who will get the benefit if a single enrolled member passes away in the middle of scheme’s financial year?
Ans. No One, as coverage lapses automatically on the member’s demise.
Q.20. Can the remaining benefits of previous financial year be carried forward to the subsequent year, in case no claim was made?
Ans. No, the benefits are on a year to year basis and lapse at the completion of the plan period.
Q.21. Can I enrol my family members who are staying in Nepal?
Ans. No, the scheme focuses only to the Tibetan refugees living in India at this stage.
Q.22. Does the TMS cover illness resulting from drinking excessive alcohol years ago?
Ans. Yes, such cases are covered since TMS do not bar any pre-existing diseases.
Q.23. Does the TMS bear expenses incurred for the delivery cases?
Ans. For such case, you should try to get the benefits provided under the ongoing MCH programme. If MCH programme is unable to cover the hospitalization than TMS will cover.
Q.24. Can one member in a family enrol if other members don’t want?
Ans. No. All members of the family have to enrol.
Q.25. Can member contribution paid is refundable on percentage base if a member has not fallen sick or not been hospitalized for many years?
Ans. No, because it must have been already used for other members of TMS.
Q.26. Can a non-Tibetan who has Green Book can enrol in this scheme?
Ans. No. Only Tibetans can enrol under this scheme.
Q27. Can I claim more than once during the period of the Health Plan?
Ans. Yes,you can claim more than once until your benefit limit is exhausted.