Goa Mediclaim Scheme

Description
“Goa Mediclaim Scheme” was launched by the Health Services Department, Government of Goa. The scheme applies to every permanent resident residing in Goa for 15 years. The objective of this scheme is to provide financial assistance to avail super-speciality treatments that are not available in the Government Hospitals of Goa, such as dialysis, plastic surgery, ICU care, angiography and angioplasty, open-heart surgery, kidney transplantation, neurosurgery, radiotherapy and chemotherapy for cancer, cochlear implants, and bone marrow transplants.

Benefits
• The Nature of Sickness along with its Permitted Ceiling Limit for the Super-Specialty Treatment is given below -
• Continuous Ambulatory Peritoneal Dialysis (CAPD) Treatment: ₹15,000/- per month
• Dialysis: ₹15,600/- per month @ ₹1,300/- per dialysis for 12 dialysis
• Plastic Surgery: ₹1,50,000/-
• Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), Trauma Care: ₹1,50,000/-
• Coronary Artery Bypass Grafting (CABG) / Percutaneous Transluminal Coronary Angioplasty (PTCA) (Angiography & Angioplasty) : ₹1,50,000/-
• Open Heart Surgery (Valve replacement, Mitral Valve Replacement (MVR), Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD): ₹3,00,000/-
• Kidney Transplantation: ₹3,00,000/-
• Neuro Surgery: ₹3,00,000/-
• Radiotherapy / Chemotherapy (Cancer): ₹5,00,000/-
• Cochlear Implant: ₹1,50,000/-
• Spastic Child, Cerebral Palsy, Skeletal Deformities: ₹1,50,000/-
• Bone Marrow Transplant: ₹8,00,000/-
• *The list of the hospitals recognized under this scheme, and the medical treatment covered under each hospital are provided in the scheme guidelines.
• *Either the Permitted Ceiling Limit Treatment or the Actual Expense of Treatment, whichever is the least will be considered.

Eligibility Criteria
1. - The applicant should be a permanent resident of Goa.
2. - The applicant should be residing in Goa for 15 years, figuring in the voters' list and holding a permanent ration card.
3. - The income of the applicant should be less than ₹1,50,000/- per annum. However, retired state government employees are eligible irrespective of their income.
4. - The applicant should require a facility that is not available in a Government Hospital of Goa (including Goa Medical College, Bambolim and District Hospitals). However, for NICU, Ventilatory Support and Kidney Dialysis, the patient may opt for any empanelled hospital even if the facilities are available in a Government hospital.
5. - The applicant should be suffering from a sickness/ailment that requires one of the following treatments - Continuous Ambulatory Peritoneal Dialysis (CAPD), Dialysis, Plastic Surgery, Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), Trauma Care, Coronary Artery Bypass Grafting (CABG) / Percutaneous Transluminal Coronary Angioplasty (PTCA) (Angiography & Angioplasty), Open Heart Surgery (Valve Replacement, Mitral Valve Replacement (MVR), Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD)), Kidney Transplantation, Neuro Surgery, Radiotherapy / Chemotherapy (Cancer), Cochlear Implant, Spastic Child, Cerebral Palsy, Skeletal Deformities, and Bone Marrow Transplant.

Application Process
Step 1: The interested individual should apply to the Director of Health Services, Panaji, Goa in the prescribed form, along with the required documents.
Officer to Be Contacted: Joint Director of Accounts (Health), Directorate of Health Services, Campal,…
Offline

The interested individual should apply to the Director of Health Services, Panaji, Goa in the prescribed form, along with the required documents.
Officer to Be Contacted: Joint Director of Accounts (Health), Directorate of Health Services, Campal, Panaji, Goa; Ph. No. 0832-2225646, Ext-214.
Detail of Office Where the Application to Be Submitted: Mediclaim Cell, S-37, Second Floor, Directorate of Health Services, Campal, Panaji-Goa.

Required Documents
• Medical Certificate From a Treating Doctor Either From the Goa Medical College, Bambolim, or Hospicio Hospital, Margao, or Asilo Hospital, Mapusa.
• Either the Income Certificate in the Prescribed Form ‘B’ From the Concerned Mamlatdar in the Original or Certified Copy of the Pension Payment Order (PPO) (in case the applicant is a Retired State Government Employee)
• Residence Certificate
• Mediclaim Certificate From the Medical Superintendent, Goa Medical College, Bambolim Along With Photocopy.
• Passport Size Recent Photograph of the Patient
• Declaration Form
• Photocopy of the Election Card / Ration Card of the Patient. if the Patient is a Minor, a Photocopy of the Election Card of Either Parent.
• Deen Dayal Swasthya Seva Yojana (DDSSY)
• Aadhaar Card

Frequently Asked Questions
Q: Are retired state government employees eligible for the scheme?
A: Yes, retired state government employees are eligible and are exempt from the income ceiling requirement.

Q: What types of treatments are covered under the scheme?
A: The scheme covers treatments like CAPD dialysis, plastic surgery, ICU care, open heart surgery, kidney transplantation, and cancer therapy, among others.

Q: Can applicants choose any hospital for treatment under the scheme?
A: No, applicants must choose from the list of recognized hospitals under the scheme for treatment.

Q: What is the role of the Medical Superintendent in the application process?
A: The Medical Superintendent of Goa Medical College must certify that the required treatment is not available in the state.

Q: Is there a specific form to be filled out for retired government employees?
A: Retired government employees must submit a certified copy of their P.P.O. along with the application form.

Q: What is the maximum financial assistance for cancer treatment under the scheme?
A: The maximum financial assistance for cancer treatment, including radiotherapy and chemotherapy, is 5 lakhs.

Q: What is the financial limit for open heart surgery under the scheme?
A: The financial limit for open heart surgery, including valve replacement, is 3 lakhs.

Q: Can applicants avail treatment for cochlear implants under the scheme?
A: Yes, cochlear implant surgery is covered under the scheme with a limit of 1.5 lakhs.

Q: Are there any specific treatments for children covered under the scheme?
A: Yes, treatments for spastic children, cerebral palsy, and skeletal deformities are covered with a limit of 1.5 lakhs.

Q: Can applicants avail treatment for neurological disorders under the scheme?
A: Yes, neurological disorders are covered under the scheme, with treatment available at recognized hospitals.

Q: What is the financial limit for bone marrow transplants under the scheme?
A: The financial limit for bone marrow transplants is 8 lakhs under the scheme.