CHAPTER I

1.1 INTRODUCTION OF THE STUDY

The Chief minister’s Health Insurance Scheme is a comprehensive healthcare initiative

introduced by various state governments to provide affordable and accessible medical coverage to
Tamilnadu public. Under this scheme, individuals can avail themselves of a range of healthcare
services, including hospitalization, outpatient care, and essential medical treatments. Aimed at
improving overall health outcomes, the CM Health Insurance Scheme plays a crucial role in ensuring
that citizens have financial protection against medical expenses, promoting a healthier and more secure
society.

1.2SCOPE OF THE STUDY

1.To provide cashless hospitalisation facility for certain specified ailments/ procedures.
2.To alleviating financial burdens for enrolled families and progressing towards universal health
coverage by establishing effective connections with the public health system .

1.3OBJECTIVE OF THE STYDY

•To study the Socio-economic factor of sample respondent .

• To assess the level of awareness about the health insurance scheme in rural areas of sulur
taluk.
• To identify the customer preference towards the health insurance policies.
• To analyze the customer level of satisfaction towards the service rendered by the health
insurance companies and the settlement of claims.
• To offer suitable Findings & suggestions about the health insurance scheme.

1.4 STATEMENT OF THE PROBLEM

The "Chief Minister Health Insurance Scheme " (CM Health Insurance) represents a pivotal
initiative in the domain of public health, aiming to provide comprehensive healthcare coverage. As
researchers dedicated to understanding and improving healthcare policies, our focus on the CM Health
Insurance Scheme prompts an exploration of key issues that Barriers to Enrollment and
Participation,Equity in Access and Coverage, Quality of Healthcare Services,Feedback Mechanisms
and Continuous Improvement.
1.5 RESEARCH METHODOLOGY
The current study is descriptive in nature and is based on primary and secondary data obtained
from a variety of sources, including books, journals, papers, and pertinent websites. The researcher
uses a questionnaire that was written for this study, and there was also an oral encounter. In this study,
the researcher employed the convenience sampling method. The acquired data was categorised and
coded before being transferred to master sheets. The data was tabulated, analysed, and interpreted once
it had been coded

. 1.6.1 RESEARCH DESIGN

A logical, methodical plan created for guiding a research project is known as a research design.
The researcher chose the descriptive design for the study from among several available designs. Studies
in which the goal is to describe something are known as descriptive research studies. qualities of a
specific person or group. Utilizing Descriptive Design, In sulur thaluk, Coimbatore's CM Health
insurance SCHEME, the researcher has planned to analyse beneficiary satisfaction.

1.6.2 AREA OF THE STUDY

The study has been conducted in sulur taluk, Coimbatore city, located in the southern Indian
state of Tamil Nadu
.
1.6.3 SOURCES OF THE DATA
The validity of any research is based on the data collected for the study. The present research is
based on primary data as well as secondary data.
1. PRIMARY DATA
Primary data are original data collected for the purpose of a particular study. In the present
study primary data have been collected by personal interview method with the help of questionnaire.
2. SECONDARY DATA
The secondary sources consist of existing available materials and already compiled statistical
statements. Secondary data for the present research collected the major sources from.
➢ Newspaper & Articles
➢ Business line
➢ Various websites
➢ Different marketing journal

1.6.4 SAMPLE SIZE

The study's sample size was 185 beneficiaries of the CM Health Insurance scheme in sulur
thaluk, Coimbatore.

1.6.5 SAMPLE TECHNIQUE

The process of selecting a group of persons from a statistical population in order to estimate the
demographics of the whole population is referred to as sampling in survey technique. The data
collection analyzes used for the current scenario was convenient sampling.

1.6.6 TOOLS FOR ANALYSIS

The study uses the following resources:
1. Simple percentage
2. Ranking
3. Weighted average
4. Corelation

1.6.7 LIMITATION OF THE STUDY

1. The study is restricted to 185 respondents beneficiaries only.
2. The results of the research depend only on the data extracted from respondents.
3. The study is restricted in sulur taluk.

1.6.8 CHAPTER SCHEME

1. The first chapter deals with Introduction of study.
2. The second chapter deals with Review of literature.
3. The third chapter deals with introduction to CM Health insurance.
4. The fourth chapter deals with Analysis and Interpretation of Statistical data
5. The fifth chapter deals with Finding, Suggestions and Conclusion.
 CHAPTER 2
2.1 REVIEW OF LITRATURE

The effectiveness of the study is greatly influenced by the literature review. It helps the
researcher in getting a better understanding of the chosen issue. It also offers guidance for structuring
the current investigation. This chapter serves as a record of the analysis of prior research in the area of
it workers. Here is a presentation of the reviewed studies.

Bigi Thomas, Dharmesh P. Raykundaliya, Sonal Bhatt, Ketal Vadhel (2023)

Study of awareness, enrolment, and utilization of Ayushman Bharat Pradhan Mantri Jan Arogya
Yojana in Gujarat, India. Ayushman Bharat-Pradhanmantri Jan Arogya Yojana (AB-PMJAY) envisages
complete financial protection for around 50 crores of identified poor and vulnerable Indian
beneficiaries against their catastrophic healthcare needs. Awareness is a pre-requisite that ensures
enrolment and utilization of any health insurance program. Beinga newly implemented scheme, very
few studies are reported on the level of awareness, enrolment, and utilization ofthe AB-PMJAY scheme
as well as the sources of information and support to the beneficiaries from Gujarat. So, thisstudy aims
to assess the current status of awareness, enrolment, and utilization of AB-PMJAY in
Gujarat.Conclusions:The reported utilization rate in this study was only 43.3%, despite having
impressive awareness and enrolment rates. The OOP costs must be reduced, and the issues that
prevented households from using the AB-PMJAY benefits despite their need must be addressed

M o n a l i s a S a h o o , H i m a n s h u S e k h a r R o u t , M i h a j l o J a k o v l j e v i (2023):
The study found that even though 56.70% of the sample households had heard about BSKY,
procedure-specific awareness was low. State government organised BSKY health insurance camp was
found to be a major source of knowledge among the sample. The regression model had an R of 0.414.
The Chi value showed that the model with predictor variables was a good. A majority (79.30%) of the
sample had the scheme card with them. However, only 12.60% of the cardholders used the card and
only 10.67%received benefits. Mean out-of-pocket expenditure (OOPE) faced by the beneficiaries is
Rs. 15743.59. Among the beneciaries,53.80% enhanced the OOPE from their savings, 38.50% by
borrowing, and 7.70% enhanced the OOPE by both means. Conclusion: The study found that
even though majority of people had heard about BSKY, they were not aware of its nature, features, and
operational procedures. The trend of low benet received and higher OOPE among the scheme
beneficiaries hampers the economic health of the poor. Finally, the study highlighted the need to
increase the magnitude of scheme coverage and administrative efficiency.

Arunima Saini, Monika Agarwal, Amit Kumar (2022)

The study on Health insurance: Uptake, perception and its determinants among health care
seekers at a tertiary care hospital.Health Insurance has come to the forefront of Public Health Policy
with the launch of Ayushman Bharat. Government spending on health is dismal compared to other
countries, even within the same income bracket, and health insurance is being proposed as the way out.
Though the majority (84.3%) of the participants had heard about the existence of health insurance
policies, only one-third (33.6%) of the participants were covered under health insurance policy.
Inadequate knowledge regarding benefits, low income, preference for other investments, and no felt
need were some of the barriers to subscription. Conclusions: Inadequate knowledge regarding
health insurance among health care seekers is a major road block in the government’s ambitious project
of Ayushman Bharat and other health insurance schemes. Emphasis should be given to educating the
people regarding their rights and the benefits of health insurance.
P N Roopalekha Jathanna, Professor, Januka Devi Dhamala, Student, (2021)
Health Information Administration, Department of Health Information Management, School of Allied
Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.10% Indians are
covered under different types of health insurance schemes, mostly inadequate. This low coverage might
be because of lack of awareness about health insurance or might be because of lack of financial
literacy. The aim of the present study was to investigate the awareness, and utilization of health
insurance in the selected population of State of Sikkim. A cross-sectional descriptive study was carried
out in north eastern region (NER) of India, which is considered as one of the backward regions of the
country. Sample unit was revisiting Central Referral Hospital Manipal, Gangtok Sikkim. It is suggested
that the issues related financial literacy can be taken up by insurance companies or the organizers by
conducting more and more awareness programs in identified regions of low and moderate enrolment
across the country.

Bhaskaran Unnikrishnan (2019)

Health insurance schemes: A cross-sectional study on levels of awareness bypatients attending a
tertiary care hospital of coastal south India.Health insurance (HI) is one of the ways by which Out-Of-
Pocket Expenditure canbe reduced. However, only 15% of the Indian population purchased some kind
of HI. Thus,we aimed to study the awareness, enrollment, and reasons for non-enrollment of HI among
patients attending public and private hospitals.The study shows that 74.4% of the patients were
aware of HI. The main sources of information were friends and Newspaper.71% had
purchased a HI. The foremost reason topurchase a HI was to cover medical expenditure
(84.6%), the surgical expenses. The most cited reason for non-enrollment in HI schemes was lack
of awareness.Conclusion: The awareness regarding HI was found to be high. However, not
all who wereaware had a HI.

Satakshi Chatterjee, Dr.Arunangshu Giri, Dr.S.N.Bandyopadhyay (2018),

Health insurance sector in India: A study. The study is descriptive and describes various health
insurance products offered in India. It attempts to analyze the insurance models of healthcare of
selected other countries as well. Non amalgamation between public and private companies is identified
as a major hindrance in development of the health insurance sector in the country. Health insurance is
regarded as an unsaturated market in India and the middle income group i.e. the targeted population of
this industry will definitely create a boom in health insurance in years to come. It is estimated that
overall insurance sector will value around USD 280 billion by the end of 2020. The health insurance
sector is required to be made universal irrespective of the income level and background of individual
and a family.

D Rajasekhar, Erlend Berg, Maitreesh Ghatak,R Manjula and Sanchari Roy(2013)

The National Health Insurance Scheme (Rashtriya Swasthya Bima Yojana, RSBY) aims to
improve poor people’s access to quality health care in India. This paper looks at the implementation of
the scheme in Karnataka, drawing on a large survey of eligible households and interviews with
empanelled hospitals in the state. Moreover, hospitals were not ready to treat RSBY patients. Surveyed
hospitals complained of a lack of training and delays in their imbursement of their expenses. Many
were refusing to treat patients under the scheme until the issues were resolved, and others were asking
cardholders to pay cash. As is typical for the implementation of a government scheme, many of the
problems discussed can be related to a misalignment of incentives.
Girija Gadre, Arti Bhargava (2017)
The age and affordability are the key factors for deciding the amount of treatment. Any delay in
renewing the health insurance policy or non-payment of the quality would mean discontinuation of the
plan. Further, he must review his lifestyle, his family ’ s and his own medical history to see if anyone
falls in a heritable high-risk category. Accordingly, a wider health coverage will be required,
irrespective of the age and prevailing health condition. So, is there any “ right” amount when allowing
for health insurance? Not really. It is an individual decision, to be taken after making an allowance for
several factors. Most importantly, it must not be a ‘do it, shut it, forget it’ decision.

Meeta Rajivlochan (2016)

In her article humanizing health care services at educed prices focused on: the key to improving
the quality of healthcare services in India and reducing costs at the same time can be found by enacting
legislation which lays down minimum standards of patient care. In the absence of such standards and
the reluctance of health insurance companies to standardize either price or quality, health care services
continue to be expensive and of doubtful quality. Developing standards of patient care by legislative
mandate and a change in the attitude of health insurers can change the equation in the favour of a
patient who is now at the mercy of the hospital. Further, similar studies (Gopinath, 2019) were
discussed on Customer Perception and socio demographic dimensions.

Chennappa (2015)
In his article - Health insurance in India was introduced in 1986 in the form of Mediclaim
policy by the Public Sector General Insurance Companies. Post liberalization, 4 Public, 22 Private and
4 Standalone insurance companies have entered this sector to provide superior health care at affordable
rates. As a result, the number of people covered (penetration) has developed from 0.69 million in 2001-
02 to 2.048 million in 2013-14, which amounts to only 0.16 percent of the total population.

Sarika Malhotra (2014)

In her article focused on why health care has become a preferred sector for private equity firms.
Health care is talented as a blue – eyed sector for investors, partly because of some big-ticket exits
newly. The healthcare sector has previously clocked 16 PE investments in the first quarter of 2014. The
few challenges, however, are unlikely to deter investors attracted by the recession-proof character of
the industry.

R.Venugopal (2013):
Was of the opinion that although the portability associated with Health insurance may not be the
panacea for all ills, it is bound to be a game-changer in the days to come. Till now the customer was
reluctant to change the Health insurer even though he/she was not satisfied with the services of the
insurer in view of the fear that the customer would lose all the present benefits of the health plan like
waiting period cover to the preexisting diseases like Diabetes, Heart ailment etc., and the ̳No Claim
Bonus ‘. But the portability clause approved by IRDA recognizes these issues, according to the
researcher.

Dr. N. Sivakumar (2013) :

Observed that for a sustained growth of the health insurance industry, the vision of the insurers
matters a great deal, although technology would be there to support this vision, in times of need. To
sustain visionary growth, the sector must realize that they are trustees of huge amounts of public
moneycollected in the form of premiums and hence insurance professionals must develop high level of
ethics and integrity. Also, firms must have social conscientiousness in all its strategies and action plans.
Mayur Trivedi and Indrani Gupta (2012)
Explored the HIV insurability in India tracing the early history and Current Status. They pointed
out that scheme like Yeshasvini Arogyasri covers all HIV positive people irrespective of economic
status. They stressed that a systematic analysis of all the existing schemes needs to be undertaken to
document the experience the experience of providing coverage for HIV related illness.

Sanjay Dutta (2012):

Traced the origin and the progressive metamorphosis that Health insurance recorded in India;
and hoped that a great deal can be achieved in the near future with co-operation from several
stakeholders. He forecasted that a combination of demographic and economic factors is expected to
bring about increased healthcare coverage in India which is expected to drive the growth of the sector.

Maumita Ghosh study on Awareness and Willingness to Pay for Health Insurance.(2011)
The present study is an effort to find out the response of the people of Darjeeling in the area of
health insurance. As firstly, this study examines the respondents who are aware or not aware about
health insurance as well as various sources of awareness; secondly, those who are aware have
subscribed for it or not; thirdly, those who have not subscribed what are the reasons behind the same;
and lastly are they willing to join and pay for it? If yes then what would be the possible amount? The
study was conducted in some selected villages in Darjeeling district and 200 questionnaires were
got filled from randomly selected general people. The results shown low level of awareness and
willingness to join and pay for health insurance scheme.

Thomas K.T. and R.Sakthi Vel (2011):

Evaluating emerging business models in Private health insurance in India, observed that the
biggest drawback of the industry is the lack of standard terminology and protocol in treatment and
billing of common illnesses. In many instances, different Hospital across the country use differing
terms and follow different treatment protocols and charges, for treating the same medical condition.

Ruchismita, Ahmed and Rai (2010) :

The highlighted the challenges in financing health in India and examined the role of health
insurance in addressing these challenges. The study provided with an operational framework for
development of sustainable health insurance model under National Rural Health Mission which will
respond to the contextual need of different states.

Ramani and Mavalankar (2010):

Examined the health system in India and showed that health and socio economic development
are so closely related that it is impossible to achieve one without other. The study found that no doubt
the economic development in India has been gaining momentum over the last decade, but the health
system is at cross roads today. The study concluded by identifying the role and responsibilities of
various stakeholders for building efficient and effective health system. REVIEW OF LITERATURE
Dr. NGPASC COIMBATORE | INDIA Nitya KalyaniK (2004): examined the coding systems and
standards to be followed as per the IRDA subgroup recommendations like Diagnosis Codes, Procedure
Codes, Service/Revenue Codes, Clinical Observation Codes and Explanation of Benefits Code.
 CHAPTER 3
3.1 INTRODUCTION OF THE CM HEALTH INSURANCE SCHEME

The Chief Minister Comprehensive Health Insurance Scheme, formerly known as Kalaingar
Kaappittu Thittam, was launched on 23rd July 2009, with the objective of providing quality healthcare
to eligible individuals through empanelled government and private hospitals, thereby reducing financial
hardship for enrolled families and moving towards universal health coverage by effectively linking
with the public health system. From January 2022 to 2027, the scheme is being implemented through
United India Insurance Company. As of January 2022, the scheme covers around 1.37 crore families. A
total of 1090 procedures, 8 follow-up procedures, and 52 diagnostic procedures are covered under
CMCHIS in 800 government and 900 private empanelled hospitals.
The scheme aims to provide cashless hospitalization for specific ailments/procedures and
provides coverage up to Rs. 5,00,000/- per family, per year on a floater basis for the ailments and
procedures covered under the scheme. The CMCHIS is a significant step towards ensuring that
vulnerable sections of society receive adequate healthcare without suffering financial distress, while
simultaneously promoting access to quality medical care.

WHO WILL BE BENEFICIARIES UNDER THIS SCHEME

The eligibility for participation in the Chief Minister's Comprehensive Health Insurance Scheme
is determined by the inclusion of the individual's name in the family card and a family annual income
below Rs. 1.2 lakh for residents of Tamil Nadu.
The scheme provides up to Rs 5 lakh insurance coverage through a network of private and
public hospitals. It provides cashless services aimed at ensuring universal health coverage in the state.
United India Insurance has partnered with the state's private and public hospitals for the service.

WHAT CHARACTERISTICS DOES CM HEALTH INSURANCE HOLD

You can avail cashless treatment at a wide range of empanelled network hospitals by showing
the Amma Kapitu Thittam Card issued to you at the time of enrollment. Since the CMCHIS claim
process is ideally cashless, you do not have to pay anything at the hospital from your pocket.
CMCHIS provides high coverage of 5 lakh rupees to each family for every policy year. This
amount of sum insured seems sufficient to avail most of the minor health treatments.

CM HEALTH INSURANCE SCHEME ENROMENT

Approach your village administration authorities for an income certificate (annual family
income must be less than ₹72,000). Along with the income certificate, submit the ration card, identity
and address proof, and self-declaration to the enrolment centre.
ACHIEVEMENTS OF CM HEALTH INSURANCE SCHEME

Chief Minister Comprehensive Health Insurance Scheme launched on 23.07. 2009 as kalaingar
Kaappittu Thittam.
Offered through United India Insurance Company Ltd, this scheme safeguards 1.37 Crore
families as of January 2022. Also known as Amma Health Insurance, it covers 1090 procedures, 8
follow-up procedures and 52 diagnostic procedures.

WHO IS ELIGIBLE FOR CM HEALTH INSURANCE SCHEME

The family must be a resident of Tamil Nadu and should have an annual income of less than
₹72,000. The family member should have a ration card or be mentioned in the ration card of the family.
Migrants of other states, if they carry a migration certificate, are eligible.
The minimum age to get health insurance for your child is 15 days, going all the way up to 18
years. For adults, the entry age is 18 years, and the maximum limit is 65 years.

NEEDS COVER IN CM HEALTH INSURANCE SCHEME

Under the scheme, the sum assured for each family would be Rs.1 lakh every year for a total
period of four years and for a total value of Rs. 4 lakh. In the case of certain procedures, the ceiling
would be raised to Rs.1.5 lakh per annum. No fewer than 250 hospitals would be empanelled under the
scheme. At least six hospitals in each district would be covered. There would be more hospitals in cities
such as Chennai, Coimbatore and Madurai.
The scheme would cover 1,016 procedures, 113 follow up procedures and 23 diagnostic
procedures. The cost of tests required for treatment would also be part of the insurance cover.

CM HEALTH INSURANCE SCHEME OVERVIEW AND OBJECTIVE

The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHISTN) was launched by
the Government of Tamil Nadu on 23rd October 2012. This ambitious scheme was implemented with
the objective of providing financial protection and comprehensive healthcare coverage to the
underprivileged sections of society. CMCHISTN was designed to ensure that individuals or families
could access necessary medical treatment without facing financial barriers or denials.
Primary Universal Health Coverage: The scheme aims to ensure that every eligible family in Tamil
Nadu has access to quality healthcare services without financial constraints. By providing cashless
treatment, it enables beneficiaries to seek necessary medical care without worrying about the expenses.
Financial Protection: CMCHISTN seeks to protect vulnerable families from the burden of
catastrophic health expenses. It provides financial coverage for various medical procedures,
hospitalization, surgeries, diagnostics, and follow-up treatments, among others.
Improved Healthcare Infrastructure: The scheme aims to strengthen healthcare infrastructure and
service delivery in both government and private hospitals. By empaneling hospitals and healthcare
providers, CMCHISTN contributes to the development of a robust healthcare system in Tamil Nadu.
Health Awareness and Prevention: CMCHISTN also focuses on promoting health awareness and
preventive measures among the beneficiaries. It aims to create a healthier society by encouraging
regular health check-ups, disease prevention, and health education.
BENIFITS OF CM HEALTH INSURANCE SCHEME

The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) offers a multitude of
benefits to its eligible beneficiaries. These benefits encompass a wide range of medical expenses and
provide financial security during times of healthcare need. Let’s explore the benefits of the scheme in
detail, including those mentioned and additional benefits:

Hospitalization Coverage:
CMCHIS provides coverage for expenses related to hospitalization, ensuring that beneficiaries
can receive necessary medical care without financial burden. This includes costs associated with room
charges, surgical procedures, medicines, and other hospital services.

Diagnostic Procedures:
The scheme covers the expenses of diagnostic procedures, enabling beneficiaries to undergo
necessary tests and investigations to diagnose and monitor their medical condition. This ensures timely
and accurate medical intervention.

Follow-up Treatments:
CMCHIS extends its coverage to follow-up treatments, ensuring that beneficiaries receive
continued medical care even after hospitalization. This includes consultations, medications, and other
essential treatments required for the recovery process

FinancialAssistance:
Beneficiaries who have made adequate CMCHISTN claims are assured an amount of Rs. 1 lakh
per year for a duration of four years. This financial support provides significant relief to families facing
the financial burden of medical expenses.

SchemeCard:
Eligible beneficiaries receive a CMCHIS scheme card, which serves as proof of their
enrollment and entitlement to the scheme’s benefits. This card allows easy identification and access to
cashless treatments at empaneled hospitals.

ExtendedCoverage:
The scheme provides coverage of up to Rs. 4 lakh over the four-year duration for eligible
beneficiaries. In cases where certain medical procedures cost more, the ceiling limit may be raised to
0.5 lakhs per annum, ensuring that individuals have sufficient financial coverage for their healthcare
needs.

ExtensiveHospitalNetwork:
CMCHIS has established tie-ups with a wide network of hospitals, including those in cities, to
provide quality healthcare services to beneficiaries.

CoverageofTests:
The insurance provided under CMCHIS also covers the cost of tests required for treatment,
even before the actual treatment commences. This provision is particularly beneficial for patients who
are undergoing diagnostic tests to determine their medical condition, ensuring that they can receive
accurate diagnoses and appropriate medical care.By exploring CMCHIS-TN online, individuals can
delve deeper into the scheme’s coverage, specific procedures, and hospital network, gaining a
comprehensive understanding of the benefits and opportunities it provides for healthcare assistance.
The Chief Minister’s Comprehensive Health Insurance Scheme continues to be a lifeline for
underprivileged families, offering financial protection, improved healthcare access, and peace of mind
during times of medical emergencies.

DOCUMENTS RERUIRED

To apply for CMCHISTN, applicants need to submit the following

documents:
1. Identity Proof: Aadhaar card, Voter ID, or any other government-issued identity document.
2. Address Proof:Recent utility bills, ration card, or any other valid address proof.
3. Income Certificate:A document verifying the annual income of the applicant and family members.
4. Photographs:Recent passport-sized photographs of the applicant and family members.
5. BPL Card or AAY Card:If applicable, provide a copy of the Below Poverty Line (BPL).