By Tenzin Dharpo
DHARAMSHALA, Jan. 02: The Central Tibetan Administration’s Health Department on Saturday announced a considerable subsidy of 70 % cut in the premium for the Tibetan Medicare System. The subsidized balance of the TMS will be borne by the United States Agency for International Development (USAID), a US government agency responsible for administering civilian foreign aid.
Under the cover, most vulnerable sections of the Tibetan community will avail the benefit of the subsidized premium. The categories for those eligible for the benefit has been by the Health Dept.; economically weak individuals and families living in India including families of nyamthak (destitute), monks and nuns, new arrivals from Tibet since 1994, families with three or more children (third, fourth and so on children up to 18 years of age), old People Homes, family of people living with HIV AIDS (but not people living with HIV AIDS), family of people with disabilities (but not people with disabilities), widows and widowers; and their families, families of people with mental disorders (but not people with mental disorders), remote settlements in Ladakh’s Jangthang nomadic areas and Arunachal Pradesh and construction laborers and their families. People falling under these categories are exempt from paying Rs.2500 out of Rs.3565.
“The people with HIV AIDS, disabilities and mental disorders have not been included in the scheme as they avail specific benefits from the department like medical expenses and assistance under a separate cover more suited to their circumstances,” Tenzin Dolma, the TMS IT officer of DoH told Phayul.
The families of Tibetan Staffs employed by CTA and Non CTA Tibetan Institutions in India will also a onetime 50% subsidy for the same scheme.
The works for the revised TMS scheme was underway since the beginning of April this year. The amendments in the scheme, has led to many believing that the cover amount of one lakh has been reduced and that the deduction has diluted the effectiveness of the initiative. Nyima Gualtsen, the Program Coordinator of TMS while speaking to Phayul clarified, “The cover for the TMS remains one lakh, yet in the revised scheme, specific ceilings on various categories of ailments have been made. So a person will not be able to claim the maximum cover in one go but the remaining balance remains in his account for future usage within that year.
We have seen many people claiming exorbitant amount for simple procedures which could otherwise be done much more cheaply, hence the change is implemented. For instance, an eye treatment has been assigned lower cover amount and another higher depending on the general treatment approximation.”
When asked of the grievances from some policy holders that the reimbursement periods take as long as three to four months, Nyima responds, “Yes, That is true in some cases yet it is a very small percentage of clients that has to wait that long. Majority of the processing and reimbursements are completed within the first three weeks or a month. The reason why some cases take longer time is because some bills submitted are beyond any measure of verification and that takes repeated correspondence and time. And since there is monetary sum involved, we have to be accountable to a certain degree of careful verification and also reimbursement of larger amounts has to be sanctioned by the Health Kalon himself.”
He further adds that for the 19,650 current policy holders, only two staff members process and handle all the cases.
Since the TMS started, 49,000 Tibetans have enrolled in the TMS and more than 2000 have availed the benefits till date. The next TMS enrollment period will start from 20 January and ends on 29 February 2016.
