Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS)

Why Was CMCHIS Needed?

A serious illness does not check your bank balance before arriving. But when it comes, it forces families to make a very unfair choice: sell what little they have, borrow from whoever will lend, or simply skip the treatment. In Tamil Nadu, low-income families in both rural and urban areas faced exactly this situation for years. While there were government hospitals, the complex procedures and surgeries, as well as specialist care, cost most families too much.

There has been considerable progress made in the field of public health in Tamil Nadu already. However, even the best infrastructure is not enough for a family that can't afford the surgery for their child. CMCHIS was created to fill that void. The scheme is currently implemented in around 1.37 crore families in the state of Tamil Nadu as of January 2022. It provides access to over 1,090 procedures, 52 diagnostic procedures and 8 follow-up treatments in over 800 government empanelled hospitals and 900 private empanelled hospitals. These are not numbers; these are people. There is a family standing behind each one that was given care they didn't have the funds for.

Who Is Eligible for CMCHIS?

The requirements for participation are well-stated:

• Should be a resident of Tamilnadu state on a permanent basis.
• Applicant's name must be mentioned in the family ration card.
• The total income of the family should be below ₹120000/- per annum.
• No annual income limit for refugees from Sri Lanka resident in Tamil Nadu who produce Migration Certificates.
• Persons from other states of India who are residing in Tamil Nadu for a period of at least 6 months with a valid migration certificate issued by an appropriate authority in the state of origin.
• Children are rescued (girls and orphans) from registered and unregistered institutions and covered.

For the purposes of the CMCHIS, the family is defined as the eligible member, their lawful spouse, dependent children under 25 years of age (or under marriage or employment) and dependent parents of both the member and their spouse.

Who is NOT eligible:

• Families whose annual income exceeds ₹1,20,000
• Residents of other states who do not meet the migration criteria
• Those already covered under separate central or state government health insurance schemes, where duplicate coverage is restricted.

Benefits and Coverage

This is what makes CMCHIS genuinely stand out. The coverage is not limited to basic hospitalisation.

• Health cover of ₹5 lakh per family per year on a floater basis, all family members share this limit.
• Over 1,090 medical procedures covered, including major surgeries, critical care, and complex treatments.
• 52 diagnostic procedures, encouraging early detection and reducing the need for additional out-of-pocket testing.
• 8 follow-up treatments, a feature most private insurance policies do not even offer.
• Pre-existing diseases covered from day one, no waiting period, no exclusions.
• Maternity and newborn care are covered as part of the scheme's comprehensive package.
• Cashless treatment at empanelled hospitals, the Third Party Administrator (TPA) settles bills directly with the hospital; the patient pays nothing at the counter.
• Ambulance and transport costs are included in the coverage.
• Dental treatments, certain dental procedures are covered under the scheme.
• Post-hospitalisation care and follow-up treatments are covered, reducing out-of-pocket costs after discharge.

Women avail of Janani Suraksha Yojana (JSY) benefits of incentive payment for institutional delivery and Pradhan Mantri Matru Vandana Yojana (PMMVY) for direct cash assistance during one of the most critical moments of their lives, thereby providing them with a multi-layered support system to benefit from the maternity care covered under CMCHIS. These women also receive ante natal services, which are part of Surakshit Matritva Aashwasan Yojana (SUMAN) under which specialist services are provided free of cost and also services for a dignified delivery are provided at public health institutions.

What is NOT covered:

• OPD consultation charges for conditions that do not lead to hospitalisation.
• Treatment at non-empanelled hospitals.
• Cosmetic and elective procedures not on the approved list.
• Reimbursement claims, CMCHIS works strictly on a cashless model; if you pay out of pocket at a non-empanelled hospital, CMCHIS does not reimburse.

Registration Process

Registration for CMCHIS is done offline through official enrollment centres. There is no end-to-end online registration currently available for new beneficiaries.

Step 1: Obtain an income certificate from the Village Administrative Officer (VAO) or Revenue Authorities.

Step 2: Visit the nearest CMCHIS enrollment centre with the required documents.

Step 3: The kiosk operator verifies your documents.

Step 4: The biometric process is completed, which includes your photograph, eye scan, and fingerprint capture.

Step 5: Once verified, you are assigned a CMCHIS e-card on the spot.

There is no premium to pay at enrollment. The entire cost is borne by the Tamil Nadu government.

Documents Required

Keep these ready before visiting the enrollment centre:

• Family Ration Card- to establish residency and family eligibility.
• Aadhaar Card- for identity proof and Aadhaar linking.
• Income Certificate- issued by the VAO or Revenue Authorities, confirming annual family income below ₹1,20,000.
• Self-declaration from the head of the family.
• Migration certificate- for migrants from other states or Sri Lankan refugees.
• Recent photographs of family members.

Card Download Process

Once enrolled, you can download your CMCHIS e-card online:

• Visit the official portal at cmchistn.com.
• Go to the "Enrollment" tab and click on "Member Search / e-Card".
• Enter your URN number from the smart card or your registered Aadhaar details.
• Select "Generate e-Card".
• Download and save the card.

The e-card can be linked to your Aadhaar for additional verification. Visit cmchistn.com, go to the "Beneficiary" section, and select "Link Aadhaar with URN" to complete the process.

Claim Process

CMCHIS works on a completely cashless model. There is no reimbursement route, which means you must use an empanelled hospital to access benefits.

• Visit any empanelled hospital with your CMCHIS e-card or smart card.
• The hospital verifies your identity through biometric details or card information.
• The hospital initiates the pre-authorisation process online; CMCHIS pre-authorisation is mandatory before treatment begins.
• Once pre-authorised, treatment proceeds. All costs are settled by the TPA directly with the hospital.
• Post-discharge, the beneficiary's e-health record is updated on the portal.

TB patients who receive treatment under CMCHIS hospitalisation should also be aware that they can additionally claim nutritional support through Nikshay Poshan Yojana, which provides ₹1,000 per month for the duration of TB treatment. For families facing extreme financial distress from life-threatening conditions beyond the ₹5 lakh CMCHIS limit, Rashtriya Arogya Nidhi (RAN) provides additional one-time financial assistance of up to ₹15 lakh at government super-specialty hospitals.

Special Provisions Worth Knowing

A few specific provisions of CMCHIS that are often missed:

• Children covered under Mission Vatsalya who are in institutional care and are Tamil Nadu residents can access CMCHIS hospitalisation benefits.
• Adolescent girls supported through the Scheme for Adolescent Girls (SAG) via Anganwadi Centres can transition into CMCHIS coverage as they grow older and their families qualify.
• Families with members having Autism, Cerebral Palsy, or Multiple Disabilities can additionally explore the Niramaya Health Insurance Scheme for specialised coverage that goes beyond what CMCHIS provides for this group.
• Medical camps are organised at empanelled hospitals at least once a month, giving enrolled families additional access to healthcare without having to wait for emergencies.

Helpline Details

If you face any issue at the hospital, during enrollment, or with your card:

• Toll-Free Helpline: 1800 425 3993- available 24 hours, 7 days a week, and can answer queries in Tamil.
• Phone Numbers: 044-24345992 / 044-24335993
• Official Portal: cmchistn.com, for beneficiary search, claim status, e-card download, and hospital list.
• Project Office: Chief Minister's Comprehensive Health Insurance Scheme, No. 226, Om Sakthi Towers, Kilpauk Garden Road, Kilpauk, Chennai, 600010, Tamil Nadu.
• TNHSP Office: 3rd Floor, DMS Annex New Building, 259 Anna Salai, Teynampet, Chennai, 600006, Tamil Nadu.

Any hospital that denies cashless service or demands out-of-pocket payment from a CMCHIS beneficiary must be reported to the helpline immediately.

Why CMCHIS Matters

This is not a small thing, but a health insurance scheme that covers more than 1.37 crore families, has no premium, provides cashless treatment for more than 1,090 procedures in over 1,700 empanelled hospitals and treats pre-existing diseases from day one.

The scheme has its drawbacks as well. Awareness is not consistent across all areas, even in those where cashless payments are accepted; it does not cover the costs of hospitals that are not part of the scheme, and some very vulnerable families still may be just above the income limit. CMCHIS is one of the most extensive state level health programmes in India, as a commitment from the state to ensure that no distinction is made between access to healthcare based on economic status.

If you are residing in Tamil Nadu and your family income is less than Rs.1,20,000/- per annum, then you need to visit your local enrollment centre or visit the cmchistn.com website, if you are a Sri Lankan refugee or a qualified migrant. The card is free, and the coverage is real, so it may be more important than you think.