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:

** 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 [at] Rs. 1300/- per dialysis.

 HOSPITALS WHERE CREDIT FACILTY IS NOT AVAILABLE.

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.

2. 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).

3. Mediclaim Certificate, from Medical Superintendent,

Goa Medical College, Bambolim alongwith Photo copy.

4.     Affix passport size recent photograph of the patient on

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

5. 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