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.
Click on the question to see answer:
Yes, ID card will be provided to all the members’ individually.
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.
No, all the family members have to enroll from the beginning if one family member is enrolling. Hence, no substitution is permitted.
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.
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.
You will 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.
There is no change in the benefits which remains at Rs. 1 lakh because the risk cover for TMS increases.
No (see entry and exit rules)
Yes. A new-born child is covered from day one up to the end of the Health Plan period.
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.
Yes, provided you are legitimate family members as per the definition.
In such a case, the concerned patient/member has to bear the extra costs.
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).
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.
Yes, if he happens to be there at the time of hospitalization.
No DA/TA is payable under TMS.
No, no natural member(s) can form another family unit because this distorts the basic unit logic and effective preventive health care assumption.
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.
No one, as coverage lapses automatically on the member’s demise.
No, the benefits are on a year to year basis and lapse at the completion of the plan period.
No, the scheme focuses only to the Tibetan refugees living in India at this stage.
Yes, such cases are covered since TMS do not bar any pre-existing diseases.
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.
No. All members of the family have to enroll.
No, because it must have been already used for other members of TMS.
No. Only Tibetans can enrol under this scheme.
Yes, you can claim more than once until your benefit limit is exhausted.