Goa Mediclaim Scheme

Why Goa Mediclaim Scheme Introduced

Before the Goa Mediclaim Scheme was introduced, the population of Goa, especially the lower- and middle-class families, used to be financially vulnerable in cases of complicated emergencies and long-term critical illnesses. As the local government hospitals were not equipped with advanced equipment, patients were forced to get expensive private care, which put a heavy financial burden on families.

To overcome this problem, the Health Services Department of the Government of Goa launched the Goa Mediclaim Scheme in 1999. The purpose of this scheme is to offer financial support to permanent residents of Goa, enabling them to afford life-saving super-speciality treatment

Key Highlights: Goa Mediclaim Scheme

Eligibility to Apply for Goa Mediclaim

Residency & Identification

• Applicants must be permanent residents of the State of Goa for at least the last 15 continuous years.
• The applicant must be registered in the voters' list of Goa.
• The applicant must hold a valid permanent ration card issued in Goa.

Income Criteria

• The total annual family income must be less than ₹8 lakh per annum.
• Exemption: Retired State Government employees of Goa are fully entitled to the scheme and are exempted from the monetary income ceiling.

Medical Availability & Referral

• The required medical facility or super-speciality treatment must be certified as unavailable in state government hospitals, including Goa Medical College (Bambolim) and District Hospitals.
• Special Provision: Patients requiring Neonatal Intensive Care Unit (NICU) care, Ventilatory Support, or Kidney Dialysis may opt for any empanelled hospital, even if those specific facilities are available in government hospitals.

Hospital Recognition

• The treatment must be availed at a hospital recognised and empanelled under the Goa Mediclaim Scheme.

What the Goa Mediclaim Scheme Covers

The Goa Mediclaim Scheme provides financial support to eligible residents requiring specialised medical procedures not available in government hospitals. Coverage depends on the level of treatment category and income levels:

What Goa Mediclaim Scheme does not cover

Goa Mediclaim Scheme ensures the provision of assistance to those individuals who need specific medical treatments which cannot be performed at the government hospitals. This scheme is based on treatment categories and income groups:

• Routine hospitalisations due to minor illness or illness which can be taken care of by public hospitals in the state
• Super speciality treatments which are feasible in GMC/District Hospitals (Except NICU, Ventilatory Support, Kidney Dialysis)
• Treatment in unempanelled or unauthorised hospitals
• Treatments without any official certificate of referral by the state Medical Superintendents
• Experimental treatments, purely cosmetic surgeries and treatments done without prior authorisation from the empanelled network of providers

Document required to apply for Goa Mediclaim Scheme

• Official application form (Form C or Form D), complete with a recent passport-sized photograph of the patient
• Medical Certificate from the treating doctor at Goa Medical College (Bambolim), Hospicio Hospital (Margao), or Asilo Hospital (Mapusa)
• Mediclaim Certificate issued by the Medical Superintendent of Goa Medical College, Bambolim
• Income Certificate (Form 'B') issued by the concerned Mamlatdar (or a certified copy of the Pension Payment Order / PPO for retired state government employees)
• 15-year residence proof in Goa: Photocopy of the patient's Election Card (Voter ID) and permanent Ration Card (or parent's Voter ID if the patient is a minor)

How to Apply Step-by-Step

• Step 1: Get diagnosed by a government doctor at GMC Bambolim, Hospicio Hospital, or Asilo Hospital.
• Step 2: Obtain an official medical referral/certificate verifying that the required super-speciality treatment is unavailable in local government hospitals.
• Step 3: Secure the Mediclaim Certificate signed by the Medical Superintendent at Goa Medical College, Bambolim.
• Step 4: Obtain an Income Certificate in Form 'B' from your local Mamlatdar's office (skip this step if you are a retired state government employee with a PPO).
• Step 5: Fill out the Mediclaim application form (Form C/D) and attach all required document photocopies, photos, and ID cards.
• Step 6: Submit the completed physical application bundle to the Mediclaim Cell, Directorate of Health Services (DHS),Goa.

How to Check Application Status

• Visit the Mediclaim Cell in person at the Directorate of Health Services, Campal, Panaji.
• Contact the Joint Director of Accounts (Health) via phone at 0832-2225646 (Ext-214).
• Check with the treating empanelled hospital's desk for sanction update letters forwarded directly by the DHS.

Helpline and Support

Other Government Schemes

• DDSY Goa: is a state government health scheme which provides routine and secondary hospitalisation coverage on a cashless basis at empanelled hospitals for all Goa residents with 5+ years of residency
• Ayushman Bharat PM-JAY: A central government health scheme providing health coverage of up to ₹5 lakh per family per year to eligible economically weaker families.
• Central Government Health Scheme: Comprehensive OPD, IPD, and specialist healthcare coverage for central government employees, pensioners, and eligible dependents across India.