P. RAVI Vs. DISTRICT LEVEL EMPOWERED COMMITTEE

JUDGEMENT

(1.) The petitioner is a Government Servant working as a Head Constable. In the year 2022, he underwent Aorto Bi-Iliac Bypass surgery with bifurcation grafting on 26/5/2022 in Velammal Medical College Hospital, Madurai.

(2.) The petitioner being a government servant, is covered under the New Health Insurance Scheme 2021 implemented by the government. The insurance scheme provides for cashless treatment to the government servants in the network hospitals for the listed diseases. Velammal Medical College Hospital, Madurai, wherein he has taken the treatment is a network hospital and the nature of illness is a listed disease as per the New Health Insurance Scheme - 2021, implemented vide GO.Ms.No.160 Finance Department, dtd. 29/6/2021. Though he is covered under this Insurance Scheme and the scheme provides cashless treatment, he was forced to pay a sum of Rs.2,73,494.00. The hospital has raised a bill for a sum of Rs.3,73,494.00, out of which, the 3rd respondent insurance company has sanctioned a sum of Rs.1,01,008.00 as the eligible amount. Aggrieved by this the petitioner has approached this court seeking a writ of mandamus directing the respondents 3 and 4 to reimburse the amount of Rs.2,73,494.00 incurred by him in a network hospital.

(3.) The learned counsel for the 3rd respondent insurance company admits that the petitioner is covered under the New Health Insurance Scheme of the government implemented vide GO.Ms.No.160 Finance Department, dtd. 29/6/2021 and that the petitioner underwent vascular surgery of Aorto Bi-Illac bypass surgery with bifurcation grafting on 26/5/2022 in Velammal Hospital, which is a network hospital and the illness is also a listed one. However according to him as per the scheme, the petitioner is entitled for a sum of Rs.1,01,088.00 for the treatment taken by him and the same has been paid.