brief guidelines of medical expenses reimbursement …
TRANSCRIPT
1
Brief Guidelines of Medical Expenses Reimbursement Scheme of the Institute
The scheme obtaining at the Institute is similar to the Central Government Health Scheme
(CGHS) and its implementation at the Institute has been mostly in accordance with the
relevant guidelines issued from time to time covering the employees of the Central
Government.
Booklets detailing CGHS are available at the Clinic, Library and in all the group offices. Latest
booklets of these are being procured to replace these. The following guidelines relating to
reimbursement claims will be followed by the Institute effective June 1, 2012, until a
computerized system, which is being explored, is implemented.
1. The minimum claim per each reimbursement shall be least of Rs.1000/-, or medical
expenses incurred over a period of six months. It is mandatory to add a list of all the
medicines purchased for which bills are handwritten, in legible form, in the claim form.
This is not required if the bills for medicines are computer-generated. A single claim
form is enough for all the family members. Provide the names and other relevant
details are listed in the same form, or in an attached sheet.
2. The administration has been hitherto, on requests, condoning the delays in submitting
their claims. From now onwards, this discretionary decision will be exercised only in
rare exceptions. In case of delays beyond six months as indicated above, per every
month delay an amount equivalent to 5% of the reimbursable amount will be deducted
up to maximum of six months delay. No bills will be entertained which are more than
12 months.
3. Claims will generally be processed in about two-four weeks’ time. The claims ready
for disbursement will be notified on the notice board in the Clinic along with the time
and date for payment as well as on the website.
4. Reimbursements up to Rs.1,000/- will be made in cash. For reimbursements exceeding
Rs.1,000/-, reimbursement will be made by Account Payee Crossed cheque.
5. If any employee is aggrieved with any claimed expenses being disallowed, they may,
after verifying with the details listed in the CGHS booklets made available as above,
submit a note detailing the ground for their disagreement with the decision of the
administration. The administration on receipt such a note, will review its decision. Upon
such review if its earlier disallowance is reconfirmed, it will provide a note about it. On
receipt of such a reconfirmation from the Administration, if the concerned employee is
still aggrieved, such an employee may approach the following authority directly as some
of the employees are already doing so.
The Additional Director
CGHS, III Florr, E-Wing
Kendriya Sadan
Koramangala
Bangalore – 560 034.
2
Pattern of Reimbursement:
1 For Non-RRI Clinic Consultation:
General Physician
Upto Rs.100 per consultation
2 Specialist Consultation on written
referral to specialist
Rs. 100 to Rs.200 per consultation
3 Dental:
Extraction of Tooth including LA Rs. 100
Complicated Ext. per Tooth including LA Rs. 250
Flap Operation per Tooth Rs. 350
Gingivectomy per Tooth Rs. 200
Cyst under LA (Small) Rs. 250
Cyst under LA (Large) Rs. 450
Aposcectomy including LA Rs. 300
Implacated Molar including LA -
Fracture Wiring including LA Rs. 400
Intra Oral X-ray Rs. 50
Root Canal per Tooth Rs. 800
4. Medicines : As per CGHS norms - A book containing details of admissible medicines is
available at Library and Clinic.
5. X-rays, diagnostic tests, etc,: These services may be availed at any one of the
labs/hospitals listed in the attached file, who are recognized by CGHS. When you
approach them, please do mention that you are covered under a medical
reimbursement scheme of the Institute, and they normally charge for their
services at CGHS rates. If there are no such recognized hospitals/labs close to your
residence, please do let the Institute know about other places which are closer to you.
6. Annual Health Check-ups for Group A employees (self only) of the Institute who are
above 40 years of age, i.e. any employee whose is Pay Band 3 with grade pay of
Rs.5,400/- and above. The reimbursement will be on a financial year basis, and it is
limited to lease of the following rates or actuals incurred. This facility will be effective
from this year financial year (2012-13)
(i) Annual Medical Examination of the Men Officers - Rs. 2,000/-
(ii) Annual Medical Examination of the Women officers- Rs. 2,200/-
3
In-Patient treatment:
The reimbursement will be as per the norms laid down under CGHS.
This facility may be availed at any of the hospitals approved by CGHS, whose list is also given
in the enclosure. The Institute will, on request, provide authorization letters to these
hospitals to provide the required treatment and to send their bills directly to it for
payment. (Many of these hospitals have also offered out-patient treatment as well as
diagnostic facilities. Payment for these services will have to be made directly by the
employees.)
Employees may at their choice also get treatment at other hospitals (non-CGHS). For this,
the Institute has empaneled such hospitals which are also included in the attached list. It may
specifically be noted that these hospitals do not provide treatment at CGHS rates, and have
offered their services at credit, on formal referral by the Institute, and offer some
concessions as per their corporate policies.
If treatment at hospitals other than those approved by CGHS and/or empaneled one is
availed, please do ensure that they are approved by the Commissioner of Income Tax. If they
are not, reimbursement for such treatment availed will be subject to income tax as laid
down by the Income Tax Act, 1961.
4
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6
7
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