MADURAI: Retired government employees are frustrated over the prolonged delay in getting reimbursement of treatment costs availed under the New Health Insurance Scheme (NHIS) in Madurai especially if they had got admitted in a non-network hospital.
They claimed that private insurance claims are settled within one or two weeks, but they dragged for more than three months for pensioners of the state government.
Speaking to TNIE, Tamil Nadu Government All-Department Pensioners Association State secretary S Krishnan claimed more than 250 claims of government employees are currently pending in Madurai.
"The New Health Insurance Scheme for government employees in Tamil Nadu has many problems when it comes to settlement of claims. In the case of private mediclaims, the treatment cost is reimbursed within 2 to 10 days. But when government employees take treatment in a non-network hospital, the claim settlement takes more than three months."
A Govindarajan, the son of policyholder Balasaraswathy, narrated the delay he encountered in claim processing when his mother was diagnosed with cancer and was admitted to a private hospital in February 2025.
"Her condition turned severe and we moved to another private hospital for treatment in March 2025. The first treatment cost `1.25 lakh and the second cost `2.75 lakh as both the hospitals weren't listed in the network hospitals under the NHIS. We were asked to pay the total cost and later reclaim through medical claim procedure. I made the claim in April, but it is yet to be cleared."
Speaking to TNIE, K Sampath, a retired government sanitary staff, said, it took more than a year to get the reimbursement for his treatment for gastro problems in a private hospital in Madurai city last year.
"The surgery cost was around `3.15 lakh. As the private hospital wasn't listed in the network hospital, we paid the money and sought reimbursement. I got just `1.25 lakh, but even that took almost a year after the claim."
A top official from NHIS (Madurai) blamed procedural delay and assured to clear the pending claims soon. "It takes just a few weeks for the public sector insurance company for processing. But claims must get pre-approval at the District-Level Empowering Committee headed by the District Collector of Madurai. But in the months of April and May, there were some delays in organising the meeting. This created a backlog. Currently, all the claims have been approved and documents have been sent to the public sector insurer in Chennai. The issue will be resolved in a few weeks. In order to speed up the claims, entire documentations will be made online soon," the officer said.