O R D E R

Heard Mr. S.Balasubramanian, Learned Counsel for the Petitioner, Mr.

P.Balathandayutham, Learned Special Government Pleader appearing for the First to Third Respondents and Mr. M.B.Raghavan, Learned Counsel for the Fourth Respondent and perused the materials placed on record apart from the pleadings of the parties.

2. The Petitioner, who was working in the Education Department of the State Government, has availed the benefits of the New Health Insurance Scheme, 2008 of the Government of Tamil Nadu in G.O. Ms. No. 174, Finance (Salaries) Department dated 28.04.2008 by making periodical contributions towards insurance premia from his salary. According to the Petitioner, he had underwent surgery for Coronary Angiogram at G.Kuppusamy Naidu Memorial Hospital on 09.08.2010 and he had made an application for reimbursement of the medical expenses of Rs. 2,07,196/- incurred by him. The Fourth Respondent by Letter Ref. Tangenhis/R-3312 dated 20.10.2010 rejected the claim stating that the said Hospital where the Petitioner had undergone treatment had not been networked by it and the Petitioner was informed to submit a representation to the Second Respondent for the same. Subsequently, the Second Respondent reaffirmed it in the proceedings in Na. Ka. No. 1608/ Ka1/2010 dated 16.03.2011 on receipt of the representation dated 08.04.2011 from the Petitioner for the same. The Petitioner has filed this Writ Petition challenging the said order passed by the Second Respondent and has sought for consequential direction to reimburse the medical expenses of Rs. 2,07,196/- that had been incurred by him.

3. It is now trite as held by the Division Bench of this Court in Star Health and Allied Insurance Company Ltd. –vs- A.Chokkkar [(2010) 2 LW 90] that when the Insurance Company is not liable to reimburse the medical expenses under the New Health Insurance Scheme to the Government Servants/Pensioners, it would have to be processed under the Tamil Nadu Medical Attendance Rules by the Head of the Office with the concerned Department in which that employee had served and pay the eligible amount to him. In this context, it would also be useful to refer to clause 14(4) of the Guidelines for Implementation of New Health Insurance Scheme, 2018, for Pensioners (including Spouse)/Family Pensioners in the Appendix to G.O. Ms. No. 222, Finance (Pension) Department, dated 30.06.2018 issued by the Government of Tamil Nadu, which is extracted below:-

“14.(4) In case, a Pensioner/Family Pensioner undergoes emergency treatments/surgeries not covered under this Scheme in either Network Hospital or Non-Network Hospital, no claim can be filed under the Health Insurance Scheme. However, they shall be eligible for claim to the extent permissible under the Tamil Nadu Medical Attendance Rules and the G.O. Ms. No. 1023, Health and Family Welfare Department, dated 17.06.1980. It may be noted that the Tamil Nadu Medical Attendance Rules requires that treatment in private hospitals should not be resorted to except in case of emergencies. Clause 2(3) of the aforesaid Government Order states that in genuine cases of emergency, the claims will be restricted to the expenditure that would have been incurred had the patient taken treatment in a Government hospital excepting diet charges. For claims under Tamil Nadu Medical Attendance Rules, the Beneficiaries may apply to the authority in the department in which the Government employee last served who is competent to process and forward pension proposal to the Accountant General, Tamil Nadu. The Head of Office shall process the claims and pay the eligible claims under the Tamil Nadu Medical Attendance Rules.”

Though that Governmental Order has been issued after the claim has been made in this case, the aforesaid guidelines, which are based upon the instructions provided in the earlier Government orders and the Tamil Nadu Medical Attendance Rules, are obviously clarificatory in nature and would apply to past cases as well.

4. The