• गोवा सरकार
    Government Of Goa
  • स्वास्थ्य एवं परिवार कल्याण मंत्रालय

A “Goa Mediclaim Scheme” has been introduced in Goa since 1989 wherein financial assistance is provided under Mediclaim Scheme to every permanent resident of the State of Goa for availing super speciality treatments that is not available in the Government Hospitals in the State of Goa.

The nature of sickness covered are CAPD Dialysis, Plastic surgery, ICU, NICU, PICU, Trauma Care, CABG/PTCA(Angiography & Angioplasty), Open Heart Surgery (Valve replacement, MVR, VSD, ASD), Kidney Transplantation, Neuro Surgery, Radio therapy/Chemotherapy(Cancer), Cochlear implant, Spastic child, Cerebral palsy, skeletal deformities and Bone Marrow Transplant

Super Specialty treatments are covered under the scheme:

Sr, No.Nature of SicknessPermitted ceiling limit for Treatment
(i)

CAPD

Dialysis                                                                                                                

15000 P.M

15600 P.M     [@] Rs.1300 per Dialysis for 12

dialysis

(ii)Plastic surgery.1.5  lakhs
(iii)ICU, NICU, PICU, Trauma Care1.5  lakhs
(iv)CABG/PTCA(Angiography & Angioplasty)1.5  lakhs
(v)Open Heart Surgery (Valve replacement, MVR, VSD, ASD)3.00 lakhs         or actual expenses
(vi)Kidney Transplantation3.00 lakhs           Whichever is the least.
(vii)Neuro Surgery3.00 lakhs
(viii)Radio therapy/Chemotherapy(Cancer)5.00 lakhs
(ix)Cochlear implant1.5 lakhs
(x)Spastic child, cerebral palsy, skeletal deformities1.5 lakhs
( xi)And Bone Marrow Transplant8.00 lakhs

** The amount of Dialysis has been increased from Rs.13000/- to Rs.15,600/- per month per patient w.e.f 30/6/15 with an increase in the number of dialysis per month from 10 to 12 dialysis [@] Rs. 1300/- per dialysis.

 HOSPITALS WHERE CREDIT FACILTY IS NOT AVAILABLE.

28Madras Medical  Mission Hospital, ChennaiCardiovascular surgery, Neurological disorders, Cardio-thoracic surgery, kidney transplantation. Plastic surgery, Radiotherapy, Total replacement of joints and other major disease / illnesses for which treatment facilities as certified by the Medical Superintendent, GMC are not available in the Govt. Hospital in the State of Goa.
29Jaslok Hospital, Mumbai-do-
30Wanless Hospital, Miraj-do-
31KEM Hospital, Mumbai-do-
32Bombay Hospital, Mumbai-do-
33P.D. Hinduja Hospital, Mumbai-do-
34Sion Hospital, MumbaiCardiovascular surgery, Neurological disorders, Cardio-thoracic surgery, kidney transplantation. Plastic surgery, Radiotherapy, Total replacement of joints and other major disease / illnesses for which treatment facilities as certified by the Medical Superintendent, GMC are not available in the Govt.Hospital in the State of Goa.
35Wadia Hospital, Mumbai-do-
36J.J. Hospital, Mumbai-do-
37Johari Nursing Home, MumbaiPaediatric facilities which are not available in Goa Medical College
38B.L. Kapur Memorial Hospital,  5, Pusa Road, New DelhiCardiology, Cardio thoracic and Vascular Surgery, Surgery, Nephrology, Neonatology, Paediatrics, Paediatric Surgery, Nuclear Medicine, Bone Marrow Transplant treatment.
39Wockhardt Hospital, MumbaiPediatric Cardiology, Pediatric Cardiac Surgery, Specialties in Ophthalmic surgery viz Cornea & Keratoplasty, Vitrioretinal Services & Glaucoma Services along with   General cardiology & Cardiothoracic Surgery
40Tata Memorial Hospital, MumbaiCancer treatment

Eligibility Criteria: Person should be permanent residents of Goa for last 15 years and figuring in the voters list and holding permanent ration card. Family Income should be less than 1.5 lacs per annum. Facilities not available in the Government hospital including Goa Medical College, Bambolim and District Hospitals (except for NICU, Ventilatory Support and Kidney Dialysis for which patient may opt for any empanelled hospital even if the facilities are available in Government hospital). Hospital should be recognized under Mediclaim Scheme. Retired State Government Employees shall also be entitled for the scheme. They are exempted from monetary income ceiling.

Required Documents to avail the Scheme:

In order to avail this facility, the concerned person/individual has to apply to the Director of Health Services, Panaji, Goa in the prescribed Form C & D (Annexure VII & VIII)  enclosing there with:

  1. Medical Certificate from Treating Doctor either from
  • Goa Medical College, Bambolim.

OR

  • Hospicio Hospital, Margao.

OR

  • Asilo Hospital, Mapusa.
  1. Income Certificate in prescribed Form ‘B’ from the

concerned   Mamlatdar in original or Certified copy of

the P.P.O.  Retired State Government Employee

(15 years Residence certificate).

  1. Mediclaim Certificate, from Medical Superintendent,

Goa Medical College, Bambolim alongwith Photo copy.

  1.     Affix passport size recent photograph of the patient on

Form ‘C’ or  Form ‘D’  alongwith  Declaration Form.

  1. Photocopy of the Election Card, Ration Card, DDSSY and Aadhaar card of the patient. If the patient is minor, photocopy of the election

card either of the parent.

Affix passport

size  recent

Photograph

of the patient

F   O   R   M   ‘C’

( Application for self for treatment under Mediclaim Scheme)

Name : …………………………………….

Address : …………………………………….

: …………………………………….

Dated : …………………………………….

Phone No. : …………………………………….

To,

The Directorate of Health Services,

Mediclaim Cell,

Campal, Panaji, Goa.

Sub: Treatment under the Mediclaim Scheme.

Sir,

I have to proceed to ………………………………………………….. (place) for medical  treatment at ……………………………………………………………… (name of hospital) as required under the scheme. I am submitting herewith the following certificates:-

  1. Certificate from the Medical Superintendent, Goa Medical College, the facilities for my treatment are not available in this State.
  1. Certificate from the Mamlatdar of …………………………… Certifying that the total income of my family does not exceed Rs. 1,50,000/- p.a. and that  I am registered in the Voters List.

OR

Certified copy of the P.P.O. bearing No. …………………………… confirming that the patient is a retired State Government employee.

I shall be obliged if a letter recommending me for medical treatment at …………………     …………………………………………………………………. (name of the hospital) be kindly issued to me immediately for admission in the hospital.

Yours faithfully,

                        Affix passport size

  recent Photograph of

    the patient

F   O   R   M   ‘D’

( Application for treatment under Mediclaim Scheme to be submitted on behalf of the patient as the patient is a minor)

Name : …………………………………….

Address : …………………………………….

: …………………………………….

Dated : …………………………………….

Phone No. : …………………………………….

To,

The Directorate of Health Services,

Mediclaim Cell,

Campal, Panaji, Goa.

Sir,

My  …………………………… (relationship) …………………………………………. (name of the patient) is to be taken to ……………………………………………………….                    (place) for medical  treatment at ……………………………………………………………… (name of hospital) as required under the scheme. The following certificates are submitted:-

  1. Certificate from the Medical Superintendent, Goa Medical College, that facilities for his/ her treatment are not available in this State.
  1. Certificate from the Mamlatdar of ……………………………  (taluka) that the total income of my/his family does not exceed Rs. 1,50,000/- p.a. and that he/she is registered in  the Voters List (not applicable, is minor).
  1. Shri/ Smt/ Kum. is a permanent resident of Goa residing for the last 15 (fifteen) years.

OR

Certified copy of the P.P.O. bearing No. …………………………… confirming that the patient is a retired State Government employee.

I shall be obliged if a letter recommending him/her for treatment at …………………………………………………………………………. (name of the hospital)  ……………………………………….. (place) is kindly issued to me immediately for admission in the hospital.

Yours faithfully,

Affix photograph

DECLARATION

  1. I, the undersigned Shri/Smt./Kum __________________________ aged _______ resident of _______________ hereby declare that I am in the employment/I am not in the employment * of State/Central Government/Autonomous Organisation/ESIS/Bank (indicate name of the organization with address).
  2. I, further declare that I have taken/not taken/provided* with insurance package to cover for the major ailment medical treatment from any Insurance Company (Indicate amount of cover and name of the Insurance Company).
  3. I, further declare that I had taken/not taken/availed* any medical benefits under Goa Mediclaim Scheme either for the same ailment or other ailment in the past (Indicate month and year in case of previous claim).

Place: _________________________

Signature of the patient/

Date:                                                                                                  Thumb Impression duly attested

Witnesses:

(1) Name with address:__________________________                       ___________________

__________________________           Signature

(2) Name with address:__________________________ ___________________

__________________________           Signature

* Strike out which ever is not applicable.

Note: In case any patient has gone to the recognized Institute for treatment which is not available in Government Hospitals in Goa, without Mediclaim certificate, he/she  shall apply directly to the Director of  Health Services alongwith the relevant papers. The Director of Health Services, after the required scrutiny shall submit such cases for the approval of the government in relaxation of the prescribed procedure.

Documents required for

Goa Mediclaim Scheme under Relaxation

  1. Application
  2. Original Income Certificate in Form ‘B’ from concerned Mamlatdar plus Xerox (Family income) OR Certified copy of the P.P.O. in case of Retired State  Government  Employee with 15 years Residence  certificate.
  3. Declaration Form (To be collected from this office) along  with Passport size Photo
  4. Discharge Summary Sheet [Xerox copy (3 sets) ]
  5. Original bills duly stamped and countersigned by the concerned hospital authorities ( Director/ Medical Superintendent) with hospital seal + photocopy 2 sets.
  6. Copies of Election, Aadhaar, Ration and DDSSY card.
  7. Reason for not taking referral letter from this office and also not availing DDSSY scheme.

Assistant Accounts Officer—1

Accountant—1

Clerical Staff—5

MTS—2

To look after the referral cases of Mediclaim, empanelment of hospitals, preparing of hospitals bills of the patients, ECS payment details of patients and hospitals, maintaining bill register and expenditure register, sanction order, RTI, LAQ’s, Court matter. Overall supervision and work related to Audit. To look after relaxation cases. Maintaining referral register and relaxation register. To look after ECS of all bills relating to Mediclaim Section. Attending to the public and any other work entrusted by the superiors.


Handling overall work of Deen Dayal Swasthya Seva Yojana and SABY typing work of self , attending public , remitting payment to private hospitals, keeping record such as maintaining cash book, bank reconciliation statement , Any other work entrusted by the superiors.

1) Goa Mediclaim Scheme

2) Deen Dayal Swasthya Seva Yojana

YEARWISE NUMBER OF PATIENTS INCLUDING RELAXATION 

ALLOTMENT & EXPENDITURE UNDER MEDICLAIM

Yearwise No. of patients Relaxation cases Total Number of patients Allotment Expenditure Rs. in Crores.
1998-1999 319 Nil 319
1999-2000 366 8 374 1.89 1.89
2000-2001 463 10 473 3.05 3.05
2001-2002 618 16 634 4.00 4.00
2002-2003 1002 58 1060 6.05 6.05
2003-2004 1080 26 1106 8.86 8.86
2004-2005 1395 47 1442 12.00 12.00
2005-2006 1559 182 1741 13.97 13.97
2006-2007 1475 159 1634 15.63 15.63
2007-2008 1891 143 2034 12.14 12.14
2008-2009  1399 239 1638 17.39 17.39
2009-2010 1405 122 1527 17.34 17.34
2010-2011  1308 153 1461 15.20 15.20
2011-2012  1307 155 1462 19.30 19.30
2012-2013 1317 108 1425 16.67 16.67
2013-2014 1255 206 1461 18.48
2014-2015  544 203 747 14.95 13.63
2015-2016 549 36 585 11.35 9.64
2016-2017 337 58 395 12.98 8.33
2017-2018 201 33 234 5.00 3.21
2018-2019            121 34 155 3.41 2.64
2019-2020 102 45 147 5.15 1.71

2020-2021

Up to September

21 16 37 5.65 0.33
DDSSY cards & Beneficiaries count
SrNo Policy Year                      (1st September to 31st August) Active cards No of beneficiaries
1 2016-17 218613 7106
2 2017-18 248172 10312
3 2018-19 235575 8724
4 2019-20  227874 8583
5 2020-21 till 30/09/2020) 215714 2526
DDSSY Yearwise Expenditure
2016-17    
Paid to Insurance Company 377500000 377500000
     
2017-18    
     
Paid to Insurance Company 721100000 721100000
     
2018-19    
     
Paid to Insurance company 106300000  
     
Paid to Empanelled Private hospitals 269946831  
     
Paid to TPA 6915029 383161860
     
2019-2020    
     
Paid to Empanelled Private hospitals 339977735  
     
Paid to TPA 25738725 365716460
     
     
2020-2021( up to Sept.’20)    
     
Paid to Empanelled Private hospitals 190858200  
     
Paid to TPA 442852 191301052

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