Complete processing of medical bills For Government Employees
Complete processing of medical bills For Government Employees
1. Claims for reimbursement of medical expenses - Procedure for drawal of -
The form of application and the various certificates prescribed for the Central Government servants under the Central Services (Medical Attendance) Rules, 1944, as amended by the Ministry of Health from time to time, shall, with necessary modifications, be used for claiming refund of medical expenses incurred in connection with medical attendance and/or treatment of members of the All India Services and their families.
[G.I. M.H.A. letter No.31/16/56-AIS (II), dated 17th November, 1956.]
2. Reimbursement of medical expenses - Preferring of claims -Fixing of time limits.-
The Government of India have decided that claims for reimbursement of medical expenses of Central Government servants should invariably be preferred within six months from the date of completion of treatment as shown in the essentiality certificate of the authorised medical attendant/medical officer concerned. The bills for reimbursement of charges on account of medical attendance and treatment should be countersigned by the controlling authorities, who are empowered to countersign the travelling allowance bills of the officers concerned. In the case of members of the Service who are their own controlling officers regard to travelling allowance bills, medical bills concerning them and members of their families shall be countersigned by the members themselves. Specific sanction to the reimbursement of medical charges is not ordinarily necessary. If, however, a claim for reimbursement of medical charges is not countersigned and preferred, within six months/one year of the date of completion of treatment should be subject to investigation by the Accountant General in accordance with the provisions of rules 123 and 124 of the General Financial Rules, Volume I, respectively. If a special sanction is accorded for reimbursement of any charges in relation of the rules that sanction should be deemed to be operative from the date of its issue and the period of six-months/one year will count from that date.
2. If the State Government has no objection, the same procedure and time limit may also be prescribed in the case of All India Service officers preferring claims under the All India Service (Medical Attendance) Rules, 1954.
[G.I. M.H.A. letter No. 31/3/57-AIS (i), dated 13th March, 1957 read with letter No. 6/6/59-AIS (III), dated 12th May, 1959 and 7/22/60-AIS (III), dated 25th October, 1960.]
3. Delegation of powers to Head of Departments.-
Letter No. 8/8/66-AIS (III), 14-07-1966 11023/5/75-AIS (III), 19th January, 1976, 11023/16/76 AIS(III), 14th Dec., 1977, 11023/5/76-AIS(II), 19th Aug., 1976. [Annexure-I]
4. Concessions regarding treatment of tuberculosis or leprosy.-
In exercises of the powers conferred under clause (ii) of rule 14 of the All India Services (Medical Attendance) Rule, 1954, the administrative Ministry in respect of All India Services officers working in connection with the affairs of the Union and the State Government in respect of officers working in connection with the affairs of the States, may reimburse expenses incurred by the officers in the following cases:-
(i) Post treatment check-up: a member of the Service who has suffered from tuberculosis or leprosy and who has obtained treatment in accordance with the relevant rules and orders will be entitled to reimbursement of fee for obtaining the certificate of fitness for return to duty. If he is required to undergo post-treatment check-up with specialist, he will also be entitled to reimbursement of fees for medical examinations during such periodical check-up as well as travelling allowance from his place of duty to the headquarters of the specialist and back. Post-treatment follow-up should, however, be done by a recognised T.B specialist/Institution, stationed at or nearest to the place of the ex-T.B. patient. The specialist if necessary may call for the complete records of the ex-patient from the institution where he was treated originally.
(ii) Ambulance charges: Reimbursement of ambulance charges will also be allowed even if the ambulance used belongs to a social service organisation such as the Red Cross Society.
[G.I. M.H.A. letter No. 6/1/58-AIS (III), dated 16th April, 1958, read with O.M. No. 6/1/58-AIS (III), dated 30th August, 1958.]
5. Medical attendance and treatment in the St. George’s Nursing Home Bombay - Reimbursement of charges.-
The Government of India have decided that the Nursing Home at the St. George’s Hospital, Bombay should be treated as a recognised institution for purpose of medical attendance and treatment of the All India Service officers serving in connection with the affairs of the Union and stationed in Bombay State, who are in receipt of a pay of over Rs.500 per mensem and the members of their families. In view, however, of the fact that the charges levied by the Nursing Home for the professional services rendered by the attending doctors are high, reimbursement of charges incurred by officers on their own treatment and/or on the treatment of members of their families in the Nursing Home will be allowed subject to the following conditions.
(i) The treatment should be received only at the hands of Government doctors of the hospitals and not at the hands of private doctors and private specialists who are allowed to treat patients at the Nursing Home.
(ii) The reimbursement of visiting fees of the doctors in the case of persons drawing a pay of Rs. 1,000 per mensem would be restricted to a maximum of Rs. 16 for the first visit and Rs. 10 for subsequent visit.
(iii) the reimbursement of anaesthetist’s charges would be restricted to a maximum of Rs. 50 for a minor operation and Rs. 100 for a major operation.
(iv) The reimbursement of operation charges would be made in full at the rates prescribed by the Government of Bombay.
(v) The reimbursement of surgeon’s charges would be restricted to a maximum of Rs. 500 in the case of a major operation and a maximum of Rs. 130 in the case of a minor operation. This will be in addition to the other usual hospital charges.
(2) The Government of Bombay may extend the above concession to All India Services officers serving in connection with the affairs of the State in exercise of the powers vested in them by rule 2(d) and rule 14(ii) of the All India Services (Medical Attendance) Rule, 1954.
[G.I. M.H.A. letter No. 7/3/60-AIS (II), dated 19th March, 1960.]
6. Reimbursement of fees paid to Honorary Specialists in the State of Bombay.-
The Government of India have decided that, since there are no Government specialists in the State of Bombay Honorary specialists attached to Government hospitals should be regarded as Government specialist in respect of All India Service Officers, serving in connection with the affairs of the Union and stationed in Bombay State, and the fees paid to them for consultations in their private consulting rooms reimbursed to the officers in accordance with the rates prescribed for Government specialists. The honorary specialists should, however, be consulted on the advise of the authorised medical attendant and with the prior approval of the Surgeon General with the Government of Bombay. The consultation with the honorary specialist at their private consulting rooms will be permissible only in emergent cases and in all other cases such consultation should be had at the hospitals without payment of any fees.
(2) The Government of Bombay may extend the above concessions to All India Services Officers serving in connection with the affairs of the State in exercise of the powers vested in them by the rule 2(d) and rule 14(ii) of the All India Service (Medical Attendance) Rules, 1954.
[G.I. M.H.A. letter No. 7/3/60-AIS (III), dated 19th March 1969.]
7. Concessions regarding treatment of members suffering from tuberculosis, cancer and poliomyelitis.-
The Government of India have decided that the following concessions which are admissible to the Central Government servants under the Central Services (Medical Attendance) Rules, 1944, should be extended to members of the All India Services serving in connection with the affairs of the Union. The State Government may extend these concessions to members of the All India Service serving in connection with the affairs of the State also.
TUBERCULOSIS
(i) Consultation: If a Government specialist in tuberculosis diseases is not available, consultation on the advise of the authorised medical attendant with a specialist in T.B. diseases recognised as such by the State Administrative Medical Officers concerned will be admissible. Where the authorised medical attendant proposes to advise a member to consult a specialist in T.B. diseases, the approval of the Chief Administrative Medical Officer of the State concerned shall be obtained. The specialist consulted should, as far as possible, be a medical officer equal in status to the authorised medical attendant and if such a specialist is in Government service, he should charge fees at the following rates:-
In respect of consultation with specialists, who are not in the service of the Government, the fees paid to them for consultations should be reimbursed to the members concerned to the extent of the rates indicated above.
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