All about BSNL Medical Reimbursement Scheme.
· this
scheme came into force from 24 th feb-2003 for the benefit of bsnl working
& retired employees
and their family members.
·
GENERAL GUIDELINES
·
all serving and
retired employees (including vrs) of
bsnl who had opted and retired from
bsnl are eligible.
·
non optee employees are not eligible for the scheme
·
on the death of bsnl
employee who was availing the facilities, the family pensioner shall continue
to avail the same facility.
·
OUT DOOR TREATMENT –
WITH VOUCHER:
·
the employee and his
eligible dependents are entitiled to
the reimbusement of actual expenses for
any branch of health care such as:
· allopathic,
· homeopathic,
· ayurvedic,
· naturopathy,
· yogic etc.,
·
in case of chronic
diseases as listed below, this limit of 25 days salary will be waived off in deserving cases.
·
cancer,
·
renel failure,
·
polimyeliltis,
·
cerebral
·
palsy & spastics,
·
t.b.
·
thalassemia major.
·
the claim form shall
be supported by the copies of prescriptions along with origional vouchers (in
duplicate) towards the expenses incurred.
·
the claim must be
submitted once in a month
·
out door treatment
with out voucher:
·
payment once in three
months for out patient treatment with out vourcher scheme was discontinued
from 1-10-2011
· all employees
are eligible , for with vouchers
scheme only
·
TREATMENT IN
RECOGNISED HOSPITALS:
·
serving and retired
employees including eligible family members
can take inpatient treatment in recognised hospitals as per the agreed
rates on credit basis.
·
for serving and
retired employees, dependents means and includes self, spouse, two dependent
children and dependent parents.
·
condition for two
dependent children will be for those
born after 16-04-2010. if twins are
born in second delivery, they are also
eligible.
·
criteria of
dependency shall be as defined under cghs and cs ma rules and as amended from time to time
·
female employees are
having option to include either their parents or in-laws as dependents
·
every april or on
crossing the above eligibility, mrs
card to be updated
ROOM / WARD ELIGIBILITY
·
group-d -- general ward
·
group-c -- semi private ward
·
gr-b & gr-a upto
sts –
·
gr-a jag and above
o
private ward with ac
TREATMENT IN NON
RECOGNISED HOSPITAL:
·
in emergency cases, the reimbursement will be
allowed for treatment in non recognised hospitals also with the approval of
cgm.
·
the amount will be restricted to rates applicable as
per cghs rates/ package charges.
·
DETAILED OPERATIVE
INSTRUCTIONS
·
all retired
officials have to exercise their option
for bsnl mrs.
·
option once exercised
can not be changed.
·
for treatment taken
in a non recognosied hospital in extreme emergency condition, the claim will be
restricted to cghs rates only.
·
in general, employee
to take indoor treatment at hospitals as applicable for his place of posting
and place of residence of his family.
·
but outstation
inpatient treatment will be allowed after approval of cgm.
·
at present cghs facility is not available to bsnl employee.
·
for undertaking
inpatient treatment, retired
officials are not eligible for advance .
·
WHO ARE THE
DEPENDENTS?
·
the term family for the purpose of the cs ma
rules-1944 shall mean a govt servant’s
·
wife or husband
·
parents (if getting income / pension
below rs. 3500 p.m.)
·
son below 25 years of
age and unemployed
·
daughter till gets
married
·
permanent ph wards.
·
those family
members should be wholly dependent upon the govt servant and
are normally residing them.
·
in case of the spouse employed in any other organisaion,
·
a certificate to be submitted by the spouse regarding non availing any medical facility from her office. .
·
the retired employee have the option to choose the
circle / ssa of their choice for availing the facility under bsnl mrs.
·
any change in the circle / ssa subsequently, will be changed on a request from the
retired employee under intimation to bsnl corporate office .
·
in case both husband and wife are bsnl employees,
only one of them will be allowed to
avail the medical benefits.
·
they should furnish a joint declaration as to who
will prefer the claim of medical expenses in respect of spouse and child.
·
SPECIAL
GUIDELINES FOR BSNL MRS
·
reimbursement of cost of appliances is within the
annual limit of outdoor treatment only.
·
cost of spectacles is not reimbursable
·
costmetic surgery shall not be allowed.
· payment
is restricted to revised cghs rates only
MEDICAL CARD
·
a medical card
containing photographs of all the eligible family members and dependents of the
employee will be issued to all bsnl mrs
optees by the administration.
·
in all cases of
extreme emergencies , the retired
employee has to de (mrs) soon after hospitalisation for indoor treatment.
·
in order to ensure
that the facility is used by the employee and his dependent family members
only, sde (mrs) or de (mrs) will visit the hospital and will verify the authenticity
of the beneficiary
·
procedure for
reimbursement for retired employees
·
the facilities under
the scheme will be withdrawn at any
time for misuse of the facility.
·
employees retired
after 1-1-2010 are
only eligible for bsnl mrs .
·
employees who are on
deputation to bsnl at the time of retirement,
and absorbed in bsnl subsequently, are
also eligible.
·
others are not
eligible for bsnl mrs card
·
procedure for
reimbursement
·
the medical card of the
pensioner will be revalidated every year in the month of april.
·
certificate to be
submitted that dependent members included in the card continue to satisfy the
eligibility conditions still.
·
for outpatient with
voucher scheme, to those who retired before 1-1-2007 will be 30 days
basic + da.
·
for outpatient with voucher scheme, to those who retired after 1-1-2007 will be 25 days basic + da.
·
out patient claim to
be submitted to zonal ao (p&a)
only.
·
inpatient treatment
bills to be submitted to a.o.
(mrs) at o/o dgm admn
·
INDOOR TREATMENT
·
indoor treatment
to be taken in bsnl mrs recognized hospital only. under extreme
emergency as listed below,
treatment can be taken in other non recgonised hospital also. .
·
the condition of
emergency are,
·
acute coronary
sydnromes (bye pass/ angioplasty)
unstable angina, paroxysmal. ventricular failure,
·
cardiac failure,
accelerated hyper tension, heart block, stoke
·
adam attack
·
acute limb inschemia,
sudden unconsciousness, head injury, respiratory failure , accute paralysis,
acute visual loss
·
acute abdomen
·
road traffic
accidents with injuries including fall
·
acute poisioning
·
acute renel failure
·
acute obstertrical
and gynecologial emergencies.
·
heat strokes.
·
avoid going to the
hospital with your own family
doctor’s prescription, because for
other doctors, hospital will charge you heavily which can
not be reimbursed.
·
package charges does
not include non medical items such as
diet, cosmetics, tonics advertised in mass media etc. such charges should be paid by the employee
only.
·
medicines prescribed on the date of discharge for
the future days follow up will not be reimbursed.
·
for surgery, only package charges will be paid. this includes fees such as admission room rent, operation charge, consultation/ investigation, lab tests, surgeon fee etc.,
·
where no cghs rates are prescribed on any indoor
treatment, rates notified by govt.
hospitals or aiims hospital will be taken into account for settlement.
·
treatments taken in ayurvedic, unani & naturopathy shall be considered as outdoor
treatment
·
reimbursement of cost of applainances such as cpap /
bpip machine , only 50% of the cost will be reimbursed. remaining 50% to be paid by the employee in out patient limit only.
·
maintenance of the machine will be by the employee
on his own cost only.
·
if the period of
inpatient stay is more than 12 days, insist the hospital to intimate the same to ao (mrs) with proper
justification for the prolonged stay and
for the treatment .
·
the implant charges
will be reimbursed as per actuals
except for the items where ceiling is defined.
·
if one or more
treatment procedures form part of major surgery, only 50% charges will be paid
for the minor surgery.
·
as per order
dated 2-9-2009, those who are having
mediclaim policies, can prefer his claims from both the sources.
·
reimbursement will be restricted only to the
admissible amount of cghs rates/ packages.
·
employees married after retirement can include
wife’s name in mrs card
·
if intimation for
inpatient is not given to de (mrs),
visit report can not be submitted and this will result in rejection of
claims.
·
for using stents, batch no, invoice copy for procurement
and outer pouch with sticker is
compulsory for bill settlement.
·
cost of stent and angioplasty is reduced by cghs.
