ORDER

This writ petition has been filed challenging the order passed by the second respondent dated 22.09.2021 thereby rejected the claim of reimbursement of medical expenses.

2. The petitioner's husband retired from Commercial Tax Department. After his retirement, he had been enrolled under New Health Insurance Scheme (hereinafter called as 'NHIS') for pensioners / family pensioners as per GO.Ms.No.222 dated 30.06.2018. Accordingly, it shall be implemented to United India Insurance Company Limited. The annual premium is Rs.3,800/- which will be recovered from the pensioners at the rate of Rs.350/- per month from their monthly pension. It is applicable to the categories of existing / future pensioners / family pensioners whose pension / family pension is paid out of the consolidated funds of Tamilnadu and who draw their pension from the Pension Pay Office. Accordingly, a pensioner (including spouse) has been eligible to the Insurance Coverage for Rs.4,00,000/- for treatment and surgeries. The petitioner had undergone right hip replacement surgery in the third week of January 2020. She had been taking treatment in Sundarapandian Bone and Joint Hospital, Anna Nagar, Chennai and as such the doctor recommended for medicine. However, she suffered unbearable and severe pain on 02.02.2020 in her right side hip since she was not even able to stand or sit. Immediately, she was taken to the said hospital and she was advised to go for surgery. It was an emergency and as such, she was admitted as in-patient for taking treatment from 02.02.2020 to 07.02.2020. On 03.02.2020, she had undergone surgery and her right hip was replaced. She incurred medical expenses to the tune of Rs.3,06,594/-.

2.1 After Covid-19, she submitted claim before the third respondent to reimburse medical expenses. However,the third respondent rejected her claim for the reason that the treatment was taken in a non-network hospital for non-emergency condition. Hence, the claim of the petitioner was not recommended. Aggrieved by the same, the petitioner preferred appeal before the second respondent for approval of her medical claim. However, it was not considered and as such she approached this Court in WP.No.17640 of 2021 and this Court directed to consider the appeal. However, the appeal filed by the petitioner was rejected on the ground that the petitioner had taken treatment in non network hospital for non emergency condition.

3. Heard, the learned counsel appearing on either side.

4. On perusal of the counter filed by the first respondent and on the submissions made by the learned counsel appearing on either side, revealed that the petitioner had taken treatment in Sundarapandian Bone and Joint Hospital, Chennai. It is non network hospital and not covered under NHIS. As per GO.Ms.No.222 Finance Department dated 30.06.2018, under NHIS medical assistance for approved surgery / treatments undergone in network private hospitals are available in cashless manner only and there is no provision for reimbursement of medical expenses under the said Insurance scheme. However, as per the Government order, the Government permits reimbursement of medical expenses for approved treatment undergone by pensioners in non network private hospitals in case of emergency or following an accident. For treatments undergone in non network hospitals under non emergency circumstances at the wilful option of the Government servant or pensioner, the expenditure is required to be met by the individual himself / herself and the Government is not obliged to compensate it to any extent either under the NHIS scheme or under the Tamilnadu Medical Attendance Rules. Further, the State Level Empowered Committee which was held on 11.08.2021 recommended the case under scenario III (Covered procedure taken in non network hospital on non emergency condition). Since the petitioner failed to submit relevant medical documents to the Committee and the first respondent requested to obtain those documents from the