Goa Mediclaim Scheme, implemented by the Directorate of Health Services, Government of Goa, provides financial assistance for specialised medical treatments that are not available in Government hospitals within the state. Eligible beneficiaries can receive support of up to Rs. 5 lakh for approved procedures by applying through the Mediclaim Cell.
Goa Mediclaim Scheme Highlights | |
|---|---|
| Scheme Name | Mediclaim Scheme |
| Implementing Authority | Directorate of Health Services, Government of Goa |
| Objective | Financial assistance for specialised treatments unavailable in Government hospitals |
| Maximum Assistance | Up to Rs. 5 lakh for most approved treatments |
| Income Limit | Annual family income up to Rs. 8 lakh |
| Residency Requirement | Minimum 15 years of residence in Goa |
| Special Provision | Retired State Government employees are exempt from the income ceiling |
| Application Mode | Offline through the Mediclaim Cell, Directorate of Health Services |
| Covered Treatments | Open Heart Surgery, Kidney Transplant, Neurosurgery, Cancer Treatment, Trauma Care and other approved procedures |
| Contact Number | 0832-2225646 (Extension 214) |
| Official Website | dhs.goa.gov.in |
Introduction of Goa Mediclaim Scheme: A Brief Insight
When a patient requires highly specialised treatment, the biggest challenge is often not the diagnosis itself, but finding the right medical facility. In some cases, the required treatment may not be available in Goa’s Government hospitals, forcing families to seek care elsewhere at a significant cost.
To address this situation, the Directorate of Health Services, Government of Goa operates the Goa Mediclaim Scheme. The scheme provides financial assistance to eligible residents who need specialised medical procedures that are not available at Goa Medical College or District Hospitals.
Under the scheme, beneficiaries can receive financial support of up to Rs. 5 lakh for several high-cost treatments, including open heart surgery, kidney transplantation, neurosurgery, cancer treatment, trauma care, and other approved procedures. Certain treatments, such as Bone Marrow Transplant, may qualify for higher assistance as per applicable government notifications.
To avail the benefit, applicants must satisfy the prescribed residency and income conditions and obtain the required medical certification from authorised Government specialists. Retired State Government employees are also eligible and are exempt from the income ceiling prescribed under the scheme.
The application process is completely offline. Applicants need to collect the necessary documents, complete the prescribed form, and submit it to the Mediclaim Cell of the Directorate of Health Services. For assistance, beneficiaries can contact the Joint Director of Accounts (Health) at 0832-2225646.
Residents can also explore the broader Deendayal Swasthya Seva Yojana, which provides cashless hospitalisation benefits, while eligible senior citizens may also benefit from the Ayushman Bharat PM Jan Arogya Yojana and the Ayushman Bharat Vay Vandana Card Scheme.
Residents seeking healthcare support and those interested in other welfare initiatives offered by the state government can explore additional programmes available on our List of Welfare Schemes of Goa Government page.
Benefits Provided to Eligible Beneficiaries
Goa Government’s Mediclaim Scheme helps patients access specialised medical treatments that are not available in Government hospitals, ensuring financial support for high-cost procedures through approved hospitals within and outside the state.
Coverage by Treatment Type
- Plastic Surgery, ICU/NICU/PICU care, Trauma Care, CABG/PTCA (Angiography and Angioplasty), Open Heart Surgery, Kidney Transplantation, Neuro Surgery, and Radiotherapy/Chemotherapy are covered up to Rs. 5 lakh per case
- Bone Marrow Transplant attracts a higher assistance limit and is covered up to Rs. 8 lakh under certain notifications issued under the scheme
- CAPD Dialysis and regular Dialysis are supported through monthly assistance, generally ranging from Rs. 15,000 to Rs. 15,600 per month, depending on the number of sessions undertaken
- Cochlear Implant procedures, treatment for Spastic Children, Cerebral Palsy, and Skeletal Deformities are also included under the scheme’s coverage
A Major Enhancement in Recent Years
The Government has substantially increased both the income eligibility limit and the financial assistance available under the scheme. Earlier, assistance for many procedures ranged between Rs. 1.5 lakh and Rs. 3 lakh, while the income ceiling stood at only Rs. 1.5 lakh per annum. These limits have since been revised upward, allowing more families to benefit from the scheme.
Additional Benefit for Goa Medical College Patients
Patients undergoing treatment at Goa Medical College for Cancer, Total Hip Replacement, or Total Knee Replacement can also claim reimbursement towards the cost of medicines, drugs, and chemotherapy. The reimbursement is available up to 60% of the admissible amount under the scheme.
Eligibility Conditions Required to be Fulfilled
The Directorate of Health Services has prescribed specific residency, income, and treatment-related conditions for Mediclaim Scheme. Applicants should carefully review these requirements before submitting their application.
- Must be a permanent resident of Goa for at least 15 years
- Name must be included in the Voters List
- Must possess a Permanent Ration Card
- Annual family income should not exceed Rs. 8 lakh
- The required treatment should be for a medical facility or procedure not available in Government hospitals, including Goa Medical College and District Hospitals
- Treatment must be taken at a hospital that is recognised or empanelled under the Goa Mediclaim Scheme
An Important Exception Under the Scheme
Patients requiring NICU care, Ventilatory Support, or Kidney Dialysis can avail treatment at any empanelled hospital under the scheme, even if these services are available in Government healthcare institutions.
Special Provision for Retired Government Employees
Retired State Government employees are also eligible to receive assistance under the scheme and are exempt from the prescribed income ceiling.
Who Won’t Qualify
- Applicants who have not completed 15 years of residence in Goa
- Families with annual income exceeding Rs. 8 lakh, except retired State Government employees
- Patients seeking assistance for treatments that are already available in Government hospitals, other than the NICU, Ventilatory Support, and Dialysis exception
- Applicants receiving treatment at a hospital that is not recognised under the Goa Mediclaim Scheme
Documents Required to be Attached
Applying for Goa Government’s Mediclaim Scheme requires supporting documents related to your medical condition, income status, identity, and residency. Keeping all documents ready in advance can help ensure a smoother application process.
- Medical Certificate, issued by the treating doctor at Goa Medical College (Bambolim), Hospicio Hospital (Margao), or Asilo Hospital (Mapusa), certifying that the required treatment is not available within Goa
- Income Certificate, in prescribed Form ‘B’ issued by the concerned Mamlatdar, confirming that the annual family income does not exceed Rs. 8 lakh. Retired State Government employees may submit a certified copy of their P.P.O. instead
- Proof of 15 years’ residence in Goa
- Entry in the Electoral Roll/Voters List showing the applicant’s name
- Copy of the Permanent Ration Card
- Copy of the Aadhaar Card
- Recent passport-size photograph affixed to the application form
- Application Form ‘C’ for self-applications, or Form ‘D’ when the patient is a minor and the application is submitted through a guardian
How Beneficiaries Can Apply to Avail the Benefit of the Scheme
Applying for Goa Mediclaim Scheme is an offline process. You need to first obtain the required medical and income-related documents, and then submit your application to the Directorate of Health Services. Follow the steps below carefully.
Step 1: First, visit a specialist doctor at Goa Medical College (Bambolim), Hospicio Hospital (Margao), or Asilo Hospital (Mapusa). Explain your medical condition and obtain an official Medical Certificate stating that the required treatment facility is not available in any Government healthcare institution within Goa.
Step 2: Next, visit your local Mamlatdar Office and apply for an Income Certificate in prescribed Form ‘B’. If you are a retired State Government employee, keep a certified copy of your Pension Payment Order (P.P.O.) ready instead of the income certificate.
Step 3: After that, obtain the prescribed Form ‘C’ for self-applications or Form ‘D’ if the application is being submitted by a parent or guardian on behalf of a minor patient. These forms can be collected from the Directorate of Health Services.
Step 4: Fill in the application form carefully. Make sure all personal, medical, and contact details are entered correctly, and affix a recent passport-size photograph in the designated space.
Step 5: Now attach all the required supporting documents, including the Medical Certificate, Income Certificate, proof of 15 years’ residence in Goa, Voters List entry, Ration Card copy, Aadhaar Card, and any other document applicable to your case.
Step 6: Once your application is complete, submit it at the Mediclaim Cell, S-37, Second Floor, Directorate of Health Services, Campal, Panaji, Goa. Before submission, double-check that no document or signature has been missed.
Step 7: After receiving your application, the concerned authorities will verify the documents and assess your eligibility. If everything is found in order, the Director of Health Services will issue an authority letter mentioning the approved financial assistance amount and the empanelled hospital where treatment can be taken.
Step 8: After receiving the authority letter, proceed with your treatment at the authorised hospital. Depending on the approved case, assistance may be provided through reimbursement or other approved payment arrangements as specified in the authority letter.
Important: Complete Steps 1 and 2 before starting treatment whenever possible, as the Medical Certificate and income-related documents form the foundation of your application. If you need any assistance during the process, you may contact the Joint Director of Accounts (Health) or the Mediclaim Cell for guidance.
Important Links Available of the Scheme
- Directorate of Health Services, Goa Official Website
- Goa Mediclaim Scheme Official Guidelines PDF
- List of Recognised Hospitals Under Goa Mediclaim Scheme PDF
Contact Details in Case of Help Needed
- Implementing Authority: Directorate of Health Services, Government of Goa
- Mediclaim Cell Address: S-37, Second Floor, Directorate of Health Services, Campal, Panaji, Goa
- Concerned Officer: Joint Director of Accounts (Health)
- Phone Number: 0832-2225646
- Extension: 214
Frequently Asked Questions (FAQs)
Q. What is Goa Mediclaim Scheme?
Ans. Goa Mediclaim Scheme is a financial assistance programme implemented by the Directorate of Health Services, Government of Goa. It helps eligible residents receive support for specialised and high-cost medical treatments that are not available in Government hospitals within the state.
Q. Who can apply for Goa Mediclaim Scheme?
Ans. Individuals who have been permanent residents of Goa for at least 15 years, whose annual family income is below Rs. 8 lakh, and who require treatment that is not available in Government healthcare facilities can apply under the scheme.
Q. How much financial assistance is available under the scheme?
Ans. Financial assistance is available up to Rs. 5 lakh for most approved treatments. Certain procedures, such as Bone Marrow Transplant, may attract a higher assistance limit under applicable notifications, while dialysis assistance is provided through prescribed monthly limits.
Q. Are retired State Government employees eligible?
Ans. Yes. Retired State Government employees can avail benefits under the scheme and are exempt from the prescribed annual income ceiling.
Q. How can I apply for Goa Mediclaim Scheme?
Ans. Applicants must submit Form ‘C’ or Form ‘D’, along with all required supporting documents, at the Mediclaim Cell of the Directorate of Health Services, Campal, Panaji. The application process is completely offline.
Q. Is Goa Mediclaim Scheme different from DDSSY?
Ans. Yes. The Deen Dayal Swasthya Seva Yojana (DDSSY) functions as a health insurance scheme, whereas Goa Mediclaim Scheme specifically provides financial assistance for specialised treatments that are not available in Government hospitals.
Q. Can beneficiaries receive treatment outside Goa?
Ans. Yes. Eligible patients can avail treatment at recognised and empanelled hospitals located both within Goa and outside the state, subject to approval under the scheme.
Q. Is there any additional benefit for cancer and joint replacement patients?
Ans. Yes. Patients undergoing treatment at Goa Medical College for Cancer, Total Hip Replacement, or Total Knee Replacement can claim reimbursement towards medicines, drugs, and chemotherapy expenses up to 60% of the admissible amount.
Q. Which documents are required while applying?
Ans. Applicants need to submit a Medical Certificate issued by an authorised Government specialist, an Income Certificate, proof of residence, Voters List entry, Ration Card, Aadhaar Card, passport-size photograph, and the prescribed application form.
Q. Where can I check the list of recognised hospitals?
Ans. The updated list of recognised hospitals is available through the Directorate of Health Services and can also be accessed through the official hospital list published under the Goa Mediclaim Scheme.
Q. Where can I get assistance regarding my application or eligibility?
Ans. Applicants may contact the Joint Director of Accounts (Health), Directorate of Health Services, Campal, Panaji, on 0832-2225646 (Extension 214) for guidance related to the scheme.
Tabassum is a government schemes researcher and writer with 5 years of experience tracking Central and State welfare scheme programmes across India. She has covered 500+ schemes spanning agriculture, women welfare, education, and housing, helping lakhs of beneficiaries understand their entitlements in simple language.