| Q:- |
What are the options
for getting re-imbursement of medical claim? |
| Ans: |
There are three options
for getting the re-imbursement of medical
claim.
1. Fixed
Rs.125/-per month
2. Open Rs.1500/-
per annum
3. Chronic
Rs.6000/per annum |
| Q:- |
What are the conditions
imposed on obtaining the benefit of fixed,
open and chronic options? |
| Ans: |
- Only one option can
be availed at one point of time.
- Option can be changed in the month of April
not in between.
- Adhoc Employees can only get fixed medical
allowance since 1.1.1996. |
| Q:- |
Who will be consider
as dependent in case of obtaining reimbursement
of medical claim? |
| Ans: |
1.
Spouse:- (In case spouse is working
spouse) subject to the following conditions.
i. Working on regular basis.
ii. Husband/Wife not getting any fixed Medical
Allowance from any source.
iii. Furnishing of an Affidavit saying that
my wife/husband is employed and not getting
medical reimbursement
2. Unmarried Daughter
3. Unemployed son
4. Parents having income less than Rs.750/-
per mensum and residing with the claimant
at the address given in EC.
5. In-Laws if wife happens to be claimant
and husband non-working. |
| Q:- |
What are the conditions
to be fulfilled for Medical Reimbursement? |
| Ans: |
- Indoor and outdoor treatment
should be separately claimed.
- Medicine prescribed on the date of discharge
should not be included in the indoor treatment
as these are not reimbursable as
per Medical Claims Rules No.2/231/81-1HBIII
Dated 13.11.1986.
- Claims of Medicines/items be filled as under: |
| Sr.No. |
Name &
Qty. of Medicine (In capital words) |
OPD/ID NO.
& Date when prescribed |
Date which
actually purchased |
Price Rs.
Paisa |
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Claim should be signed by the claimant giving
his name, designation and complete address,
date and place.
- Reimbursement claim should be verified
and signed by AMA mentioning his name in
capital letters along with the seal.
- For indoor medical reimbursement
claim essentially certificate should
be signed and stamped by AMA on second page
of EC at appropriate place. |
| Q:- |
What is time period
for getting medical claim? |
| Ans: |
Medical reimbursement
claim should be submitted within 6 months
from the date of completion of treatment. |
| Q:- |
What are the circumstances
where Non-Availability Certificate is required? |
| Ans: |
- Must
be from Super Bazaar/Cooperative store.
- Not required if the medicine is purchased
in Emergency before opening/after closing
of super bazaar and AMA certifies on the
prescription that the medicines were essential
to be purchased in an emergency.
- Medicines not exceeding Rs.50/- can be
purchased from other than Super Bazaar in
a single day on one prescription or more
than one prescription.
- Medicines purchased from open market should
not exceed Rs.100/- in a calendar month
for the entire family, without NAC.
- Civil Surgeon/competent authority should
verify on the EC if Super Bazaar/ Cooperative
Store is not available at place. |
| Q:- |
Mentioned the
Institutes from where treatment can be taken? |
| Ans: |
a. GOVERNMENT
INSTITUTE RECOGNIZED FOR SPECIALIST TREATMENT
- PGIMS ROHTAK
- PGI CHANDIGARH
- AIIMS NEW DELHI
- All Districts Hospitals in Haryana
b. PRIVATE INSTITUTES RECOGNISED
FOR TREATMENT BY HARYANA GOVERNMENT
- EHIRC (ESCORTS), New Delhi
- Batra Hospital, Delhi
- Navedic Prosthetic Centre Daulat Singh
Wala, Ziarkpur
c. INSTITUTES CONDITIONALLY RECOGNISED
BY HARYANA GOVERNMENT
- Irwin Hospital, New Delhi
- Lady Harding Hospital, New Delhi
- St. Stephens Hospital, Delhi-Safdarjang
Hospital, Delhi
- Wellinton Hospital, Delhi
- G.B. Pant Hospital, Delhi
- Victoria Janana Hospital, Delhi
- Mrs. Girdhari Lal Maternity Hospital,
Delhi |
Note:-
Aforesaid Institutions are recognised for
Haryana Govt. employees and their dependants
who are stationed at Delhi or happen to
visit or pass through Delhi on official
Business/Tour. |
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d. INSTITUTES
RECOGNISED FOR TREATMENT IF THE TREATMENT
OF THAT
DISEASE IS NOT AVAILABLE IN THE STATE GOVT.
HOSPITAL
1. By pass Coronary Surgery
- Southern Railway Headquarter Hospital,
Perembur (Madras)
- K.E.M. Hospital, Bombay
- Christian Medical College and Hospital,
Vallore
- Jaslok Hospital, Bombay.
- Bombay Hospital, Bombay
- Kasturba Hospital, Bombay
- Sree Chitra Tirunal Institute of Medical
Sciences and Technology, Trivandrum.
- Apolo Hospital, Madras
2. Blood Cancer
- Tata Memorial Hospital, Bombay
- Cancer Institute, Adayar, Madras
3. Complicated Heart Surgery Cases
- Southern Railway Headquarter Hospital,
Perembur (Madras)
- K.E.M. Hospital, Bombay
- Christian Medical College and Hospital,
Vallore
- Bombay Hospital, Bombay
- Kasturba Hospital, Bombay
- Sree Chitra Tirunal Institute of Medical
Sciences and Technology, Trivandrum
- Samarian Hospital, Always (Kerala)
4. Kidney Transplant
Christian Medical College and Hospital,
Vallore |
| Note:-
Prior approval of the Civil Surgeon/DGHS is
mandatory for treatment in the aforesaid institution
and reimbursement will be made subject to
the satisfaction of reasons of treatment by
DGHS. |
| Q:- |
Q:- What are the
mandatory requirements for reimbursement of
medical claims for treatment in non-recognised
Institutions? |
| Ans: |
i. Relaxation can only
be accorded by FCHM.
ii. Relaxation requests of Health Employees
along with Civil Surgeon's recommendation
should only be forwarded to the Directorate
by Civil Surgeon.
iii. No request of employees other than health
should be forwarded by Civil Surgeons to Directorate
rather they should be asked to route their
requests through their administrative Heads
of FCHM.
iv. Bills exceeding Rs.300/- should be countersigned
by PMO/Civil Surgeon/DGHS/ Medical Superintendent
PGIMS Rohtak/Director Ayurveda depending upon
the treatment taken in various institutions. |
| Q:- |
Mention the competency
of competent authority for signing the medical
bills? |
| Ans: |
Competency of Head of
Office
Rs.1000/-
Head of the Department
Rs.2000/-
Administrative Secretary Above
Rs.2000/- |
| Q:- |
Mention the list
of the Chronic Disease? |
| Ans: |
i. Myocardial infarction.
ii. Angina Pectoris
iii. Chronic Heart Disease
iv. Rheumatic Heart Disease.
v. Chronic Renal Failure
vi. Rheumatic Arthritis
vii. Osteo-Arthritis
viii. Malignancy of different organs
ix. Chronic Pelvic Infection
x. Colic Diseases |
| Q:- |
How the Bill should
be scrutinized? |
| Ans: |
The bill should be scrutinized
on following items.
A. REIMBURSABLE ITEMS
- Medicines
- Consumables
- Rubber items
- Cotton/Bandages
- Disposable Syringes/needless
B. NON REIMBURSABLE ITEMS
- Admission Fee
- Diet Charges
- Tonic/Food/Vitamins
- Consultation Charges
- Talcum Powder
- Eudycolone
- Tooth paste & brush
- Toilet Soaps
- Mineral Water
- Attendant's room rent and diet charges.
- Deluxe room/single rooms
- Room Heater charges
- 75% Room charges in excess. |
| Note:-
Vitamins are reimbursable provided AMA certifies
that these were essential for the treatment
of the patient and were not used as food or
tonic. |
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C. CONDITIONALLY
REIMBURSABLE i AC Charges- if
recommended by AMA
ii. Ambulance charges-Refundable provided
the ambulance is used to carry patience
to the place of treatment or to carry patient
from one hospital to other for certain medical
examination.
Ambulance charges will not be
refundable in following cases.
1. Ambulance does not belong to Govt./Local
fund/social service organizations viz. Indian
Red Corss/Hospital where patient is admitted.
2. When patient is required to be transferred
to his residence.
iii. Taxi/Tonga/other conveyance charges
to shift the patient to the hospital is
not reimbursable.
iv. IOL (Intraocular Lens) Charges will
be reimbursed upto a minimum of Rs.800/-
once in life time provided the treatment
is taken from Govt./State Recognized Hospital.
|
| Q:- |
Who is the competent
authority for approval of specialist treatment
in Govt. approved hospitals ? |
| Ans: |
Civil Surgeon on recommendation
of Specialist. |
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