Quick Overview
- CMCHIS stands for Chief Minister’s Comprehensive Health Insurance Scheme, a flagship Tamil Nadu government health programme.
- It provides cashless hospitalisation for eligible residents at empanelled hospitals across the state.
- The scheme offers insurance coverage up to ₹5,00,000 per family per year on a floater basis.
- Coverage includes major surgeries, critical care, diagnostics and follow‑up treatments.
- It operates through a large network of government and private empanelled hospitals.
- Beneficiaries must be Tamil Nadu residents with an annual family income below the eligible threshold.
- A CMCHIS card (health insurance card) is issued for accessing cashless benefits.
- The scheme involves a preauthorisation (CMCHIS preauth) process to approve hospital treatments before admission.
Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) is a health insurance programme run by the Government of Tamil Nadu to provide cashless and quality medical treatment to eligible low‑income families in the state. It offers hospitalisation coverage for critical illnesses, surgeries, high‑end procedures, diagnostics and follow‑up care up to a substantial annual limit per family. The scheme works through a network of empanelled government and private hospitals, allowing beneficiaries to access healthcare services without paying at the point of care.
What is CMCHIS?
The CMCHIS scheme was launched on 23 July 2009 by the Government of Tamil Nadu as a welfare initiative to reduce financial hardship for families facing serious health issues. It is designed to offer comprehensive health insurance protection to households in the state with limited financial resources. The scheme is implemented in partnership with an insurance company and uses a systematic network of hospitals authorised to provide cashless treatment to eligible beneficiaries.
Objectives of the CMCHIS Scheme
- To provide financial protection to families who cannot afford high medical costs.
- To reduce out‑of‑pocket healthcare expenditures that push households into debt.
- To ensure access to quality secondary and tertiary medical care for low‑income residents.
- To support Tamil Nadu’s broader health coverage goals by linking public health infrastructure and empanelled healthcare providers.
- To simplify access to essential treatments and surgeries without upfront payment by beneficiaries.
Key Features of CMCHIS
- High Coverage Limit: Beneficiaries receive insurance coverage up to ₹5,00,000 per family per year on a floater basis.
- Cashless Hospitalisation: Treatment costs are directly settled by the insurance under CMCHIS, minimising financial burden.
- Wide Network of Hospitals: Both government and private empanelled hospitals across Tamil Nadu participate in the scheme.
- Extensive Treatment List: Over 1,000 medical procedures, diagnostic tests and follow‑up care are covered.
- Pre‑Authorisation Requirement (CMCHIS Preauth): Treatments must be authorised before hospitalisation to enable cashless benefits.
- Diagnostic and Follow‑Up Coverage: In addition to surgeries and major treatments, related diagnostics and follow‑ups are included.
- Family Floater Coverage: The insurance limit applies to the entire family, not individual members, providing flexibility in utilisation.
- 24/7 Helpline Support: A toll‑free helpline is available for queries and assistance.
Benefits of Chief Minister’s Comprehensive Health Insurance Scheme
Financial Protection Against Medical Expenses
CMCHIS offers significant financial protection for households that otherwise might be unable to afford treatment for serious illnesses. By covering hospitalisation costs, beneficiaries are shielded from catastrophic healthcare spending.
Coverage for Major Treatments and Surgeries
The scheme includes a wide variety of major surgical and medical treatments — such as cardiac procedures, cancer therapies, neurological surgeries, organ‑related treatments and other critical care — under its coverage list.
Reduced Out‑of‑Pocket Healthcare Costs
With a cashless treatment facility, beneficiaries do not have to pay at the time of hospitalisation. The insurance handles the billing directly with empanelled hospitals, greatly lowering the need for personal funds.
Access to Quality Healthcare Facilities
Through its extensive network of empanelled hospitals, CMCHIS enables beneficiaries to receive advanced medical care from both government and private institutions across Tamil Nadu.
Follow‑Up and Diagnostic Benefits
In addition to primary treatment, the scheme covers certain diagnostic tests and follow‑up procedures, further reducing the financial strain of ongoing medical care.
Eligibility Criteria for CMCHIS
Income‑Based Eligibility
To qualify for CMCHIS, a family must be resident in Tamil Nadu and meet the annual family income criteria specified by the scheme, which is determined based on government guidelines.
Residency Requirements in Tamil Nadu
Only individuals whose names appear on the Tamil Nadu family card (such as the ration card) are eligible for coverage. Some special provisions may include refugees with proper documentation, migrants with valid state residency proof, and orphans under recognised care.
Eligible Family Members
Eligible members typically include the claimant, their legal spouse, dependent children and dependent parents, provided they are listed on the family card and meet scheme conditions.
Coverage Under CMCHIS
Treatments and Diseases Covered
CMCHIS covers a wide range of secondary and tertiary treatments, including surgical procedures, critical care therapies, organ surgeries, oncology care (like chemotherapy and radiotherapy), cardiology, neurology, nephrology, trauma care and more as per the scheme’s approved list.
Hospitalisation Coverage Limits
Under CMCHIS, each family can receive coverage of up to ₹5,00,000 per year. This amount is applicable on a floater basis, meaning the total sum can be used by any eligible family member for treatment costs at empanelled hospitals.
Pre and Post‑Hospitalisation Benefits
The scheme typically includes pre‑hospitalisation investigations and certain post‑treatment follow‑ups as part of overall coverage when performed within the scope of approved procedures.
What is Not Covered Under CMCHIS
Excluded Medical Treatments
Routine outpatient consultations, minor ailments, cosmetic procedures and primary level care that do not involve hospitalisation are generally not covered under CMCHIS.
Non‑Medical Expenses
Costs such as travel, food for attendants, lodging outside the hospital or other non‑medical charges are not included in the scheme’s coverage.
Treatments Outside Scheme Scope
Treatments that are not part of the approved list of procedures or are conducted in non‑empanelled hospitals will not be covered. Only specified procedures at recognised network hospitals can be claimed under the scheme.
CMCHIS Preauth Process
What is CMCHIS Preauth?
CMCHIS pre-authorisation is the pre-authorisation that must be done prior to hospitalisation to receive treatment under the scheme. Preauthorisation guarantees that the given medical assistance will be reimbursed and will receive cashless benefits at the hospital.
Preauthorisation Steps
Treatment plans and patient details are provided to the CMCHIS authority by the beneficiaries or hospital liaison officers. On verification and confirmation of the procedure being listed in the scheme, the preauthorisation approval is issued, which allows admission to be made without cash.
Role of Hospitals in Pre-Approval
Empanelled hospitals can also be instrumental in making the required documentation and treatment plan and sending it to the insurance authority. Hospitals prepare and negotiate with the CMCHIS officials to acquire preauthorisation and facilitate a flawless admission process.
CMCHIS Card Details
What is a CMCHIS Card?
The CMCHIS card is the health insurance identification card that is used by qualified families. It also confirms the eligibility of a scheme and is swiped in at empanelled hospitals to obtain the cashless treatment benefits.
How to Download the CMCHIS Card Online
When their application has been registered and approved successfully, beneficiaries are often able to download their CMCHIS card online using the official scheme portal. This electronic card may be printed or stored in a mobile phone.
Using the CMCHIS Card for Cashless Treatment
Beneficiaries are required to show their CMCHIS card and identity proof during hospital registration. Under the scheme, the hospital confirms eligibility and continues with cashless treatment upon receiving preauthorisation for scheduled procedures.
How to Apply for the CMCHIS Scheme
CMCHIS Apply Online Process
By providing the card number of the family card and personal information, the applicants will be able to check their eligibility and apply on the official scheme site. Upon verification, the beneficiaries can be given instructions on how to obtain cards.
Offline Application Options
Interested families can also apply at specific government health offices, enrolment camps or help centres by filling in physical forms and by supplying needed documents.
Member ID Generation and Verification
Upon verification of the necessary documents and information, a CMCHIS member ID is created and attached to the family. The card is downloaded using this ID, and benefits are accessed in hospitals.
Documents Required for CMCHIS Application
Identity Proof
Government-issued documents like the Aadhaar card or other ID documents are needed to verify the identity of each beneficiary.
Income Certificate
The eligibility of the family is determined through the income limits by an income certificate issued by the Village Administrative Officer (VAO) or the revenue authority.
Address and Family Proof
The family card or ration card, which contains all the eligible members, is needed to verify the residency and family setup under the scheme.
How to File a CMCHIS Claim
The CMCHIS scheme mainly offers cashless treatment in the empanelled hospitals. There are, however, special circumstances where reimbursement claims can be done as well. The correct procedure will ensure that the claims are settled on time and will not be delayed.
Step 1: Verify Eligibility
- Before treatment is done, make sure that your family is eligible under CMCHIS.
- Make sure that your CMCHIS card is operational and your information (family members, income, residence) is properly registered in the scheme database.
- Only those residents of Tamil Nadu whose income is less than the given limit and who are included on the family card can apply.
Step 2: Identify an Empanelled Hospital
- The CMCHIS benefits are accessible in empanelled hospitals only.
- Go to the CMCHIS portal or mobile application to find out which government and non-government hospitals are approved by the scheme.
- Select a hospital where you will get the treatment or operation that you need.
Step 3: Obtain Preauthorisation (CMCHIS Preauth)
- CMCHIS preauthorisation is required in the case of major procedures or hospitalisation.
- The hospital employees create a treatment plan, diagnosis, proposed procedure, and estimated costs.
- The plan is presented to the CMCHIS authority, where it is approved.
- Upon granting preauthorisation, the hospital is able to do a cashless admission.
Step 4: Hospital Admission and Treatment
- When getting admitted to the hospital, bring your CMCHIS card and valid identity proof.
- Make sure that all the documentation, such as medical reports, past records and referral letters, should be submitted to the CMCHIS desk of the hospital.
- The hospital makes sure that the eligibility is done and that preauthorisation has been made.
- You are treated without any advance payments since the costs are charged directly between the hospital and CMCHIS authorities.
Step 5: Claim Submission by Hospital
- The empanelled hospital sends a claim package to the CMCHIS insurance authority after treatment.
- The package includes:
- Discharge summary and treatment report of the patient.
- Diagnostic reports and lab results
- Detailed hospital bills (included in CMCHIS).
- History of medications received in the hospital.
- The insurance authority vets the claim to make sure that it falls within the scheme limits and approved procedures.
Step 6: Reimbursement Claims (if applicable)
- Beneficiaries may choose to be reimbursed in uncommon instances where treatment is not available in cashless form.
- Give original bills, medical records, prescriptions and receipts to the CMCHIS authority.
- Carry a copy of your CMCHIS card and identity proof.
- The claim is authenticated, and the amount entitled is refunded straight into the bank account of the beneficiary.
Step 7: Claim Settlement
- After the claim has been proven and agreed upon, the hospital is directly paid by CMCHIS authorities in cashless claims.
- In the case of reimbursement claims, the payment is made to the beneficiary in his bank account.
- The cashless claim settlement is usually completed within a few days or a couple of weeks, based on the complexity of the treatment and the hospital documentation.
Step 8: Track Your Claim
- The status of the claim on CMCHIS can be accessed by the beneficiaries online by using the member ID or hospital reference number.
- The official CMCHIS portal will update on preauth approval, claim submission and settlement status.
Key Points to Remember
- Only treatments that are included in CMCHIS procedures and were carried out in empanelled hospitals can qualify.
- Never leave your CMCHIS card and identity proof at home whenever you visit the hospital.
- Get preauthorisation of any planned hospitalisations to prevent rejection of the claim.
- Always retain a copy of medical documents and hospital bills.
CMCHIS Hospital Network
Government Hospitals Covered
All major government hospitals across Tamil Nadu participate in the CMCHIS network, making essential treatments accessible within public healthcare infrastructure.
Empanelled Private Hospitals
A large number of private hospitals in the state are empanelled under the scheme, offering high‑quality care and enabling beneficiaries to choose where to receive treatment.
How to Check the Hospital List
The updated list of empanelled hospitals is available on the official CMCHIS portal and can be searched by district or procedure type to find suitable locations for treatment.
Importance of CMCHIS in Public Healthcare
Improving Access to Quality Healthcare
CMCHIS plays a crucial role in ensuring that economically vulnerable families can access advanced medical care without financial barriers.
Supporting Low‑Income Families
By providing a substantial insurance cover and cashless benefits, the scheme alleviates the burden of high hospital bills for low‑income households.
Strengthening Universal Health Coverage
CMCHIS contributes to broader public health goals by expanding coverage and linking citizens with essential healthcare services through a structured insurance model.
Why You Should Opt for ManipalCigna Health Insurance Along with CMCHIS
While CMCHIS provides significant coverage, a private health insurance plan like ManipalCigna can complement it by covering outpatient care, treatments outside empanelled hospitals, and additional benefits such as wellness services and broader geographical coverage.
FAQs on CMCHIS Scheme
What is CMCHIS and who can apply for it?
CMCHIS is the Chief Minister’s Comprehensive Health Insurance Scheme for Tamil Nadu residents with eligible annual income. Eligible families can apply using their family card, income proof and identity documents.
How can I check my CMCHIS member status online?
Beneficiaries can visit the official CMCHIS portal and enter their details or member ID to check their status.
What is the CMCHIS preauth process?
CMCHIS preauth is the pre‑authorisation approval required before treatment to ensure cashless benefits at empanelled hospitals.
How do I download my CMCHIS card?
Once the application and verification are complete, the beneficiary can download the CMCHIS card from the official portal using their member ID.
Is CMCHIS available for all Tamil Nadu residents?
CMCHIS is available only to eligible Tamil Nadu residents whose family income falls below the specified limit and who meet the scheme’s criteria
