BSNL MRS was introduced in the year 2003. The original order of the corporate office alongwith various forms are given below
BHARAT SANCHAR NIGAM LIMITED
CORPORATE OFFICE
No. BSNL/ADMN/1 Dated:
22.4.2003
Office Order
Sub: BSNL Employees
Medical Reimbursement Scheme – Instructions for operation of the scheme.
Pursuant to the ‘BSNL Employees Medical Reimbursement Scheme’ (BSMRS)
issued vide this office letter of even no. dated 28.2.2003, the following
instructions are issued for operation of the scheme:
1.
The abbreviated form of
the scheme will be known as ‘BSNLMRS’ in place of ‘BSMRS’.
2. All serving and retired employees of BSNL will be
required to exercise their option for either CGHS or BSNLMRS by filling up the
prescribed proforma appended at ‘Annexure A’. Option, once exercised, can not
be changed. It may be noted in this connection that CGHS facility which is, in
general, not available for PSU employees, has been extended to BSNL employees
who have come en masse on deputation from DOT as a special case. The continuance of this facility is entirely
under discretion of the Ministry of Health, and can not be guaranteed by BSNL
Management. However, in case the CGHS
facility is subsequently withdrawn by the Ministry of Health, the optees of
CGHS will automatically have to switch over to BSNLMRS.
3. All serving and retired employees, who opt for BSNLMRS
as per para 2 above, are required to fill up a ‘Registration Form’ for
‘BSNLMRS’ as appended at ‘Annexure B’.
While registering for this scheme, the option regarding outdoor
treatment, viz. entitlement with voucher/without voucher/treatment from P&T
dispensary has to be exercised. Suitable Registration No. and Card will be
issued to all the beneficiaries under BSNLMRS.
4. All serving and retired employees registered under
BSNLMRS must present their claim for reimbursement of Medical Expenses in the
prescribed format which is appended herewith at ‘Annexure C’ (for
outdoor/domiciliary treatment) and ‘Annexure D’ (for Indoor treatment involving
hospitalization). It may be noted that
claim for outdoor treatment can be availed only under one of the three options
mentioned at paras 2.1.0, 2.1.1 & 2.1.2 of the ‘BSNLMRS’. These options are also indicated in the
Registration Form. Blank forms will be
made available by concerned sections of BSNL. The option regarding mode of
outdoor treatment once exercised cannot be changed during the financial year.
Contd../-
-2-
5. The Claim Form shall be supported by the copies of
prescriptions alongwith original vouchers ( in duplicate) towards the expenses
incurred.
6. The Claim Form along with supporting documents shall
be submitted to the sections dealing with Medical Claim. The competent authority for passing the
claims in the field units may be fixed up by the CGM concerned. In the Corporate Office, Sr.DDG(Pers) will
be the competent authority.
7. A register (preferably computerized) showing the
employee-wise detail of claim will be maintained by the section handling such
claims. In case of transfer of an
employee, the amount claimed towards medical-reimbursement and the balance of
entitlement as on date of transfer will be communicated to the new office
through LPC.
8. The claim papers duly checked and passed shall be sent
to Accounts Branch for payment.
9. Claim for outdoor treatment may be preferred once in a
month..
10.
List of recognized
hospitals shall be notified immediately by all the Heads of Territorial
Circles, as outlined in the BSNLMRS, taking into consideration the
infrastructure available, quality of service, standard rate of various
treatments vis-à-vis the CGHS approved rates etc. The guidelines for this purpose have already been issued vide
this office letter of even No. dated 27.2.2002. A further detailed guideline for empanelling of hospitals is
enclosed (Annexure-G).
11. As per para 2.2.3 of BSNLMRS, working employees may be
allowed advance towards expenses on hospitalization where long duration
treatment or major operation becomes necessary. A Performa for ‘Application for Medical Advance’ is appended at
‘Annexure E’.
12. As per para 2.2.2 of BSNLMRS, the reimbursement will
be allowed for treatment in non-recognized hospitals in emergency cases with
the approval of CGM for field office employee and concerned Director for C.O.
employees. The amount of reimbursement
will be restricted to the CGHS rates applicable at Delhi.
13. As per para 4.0 of BSNLMRS, the facility for Direct
payment to the Hospitals by the company (i.e. BSNL) has to be arranged. All CGMs of Territorial Circles may make
suitable arrangement with approved hospitals accordingly and notify to their
employees & C.O. In C.O. this is
presently being negotiated with approved hospitals.
14. An Employee should intimate regarding his/her serious
illness needing hospitalization to the sections dealing with Medical Policy
implementation. A letter of authorization shall be issued to the hospital
concerned so that necessary
Contd…/-
-3-
help
is extended by the hospital. A sample of such authorization letter is enclosed
for guidance (Annexure-F).
15. All claims for reimbursement should be submitted
latest by six months from the completion of the treatment. Claims submitted beyond this period are
liable to be rejected.
16. The existing arrangement of AMA will be discontinued
henceforth.
17. In case of any doubt regarding any provision of the
BSNLMRS, the matter may be referred to Corporate Office for clarification.
18. In case the spouse of any BSNL employee is employed in
any other organization, and the BSNL employee concerned wants to avail of
BSNLMRS facility for his/her spouse of other dependent family members, a
certificate has to be submitted by the spouse regarding non-availing of any
medical facility for self/family from his/her organization.
19. Any misuse of the BSNLMRS facility would attract
stringent action against employee(s) under the CCS(CCA) Rules or the rules
notified by BSNL from time to time..
20. CGMs in circle office are their own controlling
officer for the purpose of BSNLMRS.
21. The retired employees have the option to choose the
Circle/SSA of their choice for availing the facility under BSNLMRS. Any change
in the Circle/SSA subsequently will be changed on a request from the retired
employee by this office.
Hindi
version will follow.
(Amarjit Bhatia)
Encls: As above
Asstt. Dir. Gen.(Admn.)
Copy to
1.
All Chief General Managers, BSNL.
2.
PS to CMD , BSNL.
3.
PPS/PS to all Directors of BSNL Board.
4.
All Sr. DDsG/DDsG, BSNL CO.
5.
DG, P&T Audit.
6.
Admn. I/L&A/PAT/CSS Sections of BSNL CO.
7.
All recognized Associations/Unions of BSNL.
(Rajeev Kr. Jain)
Section Officer (Admn.I)
ANNEXURE – A
MEDICAL FACILITY FOR
BSNL EMPLOYEES
OPTION FORM
1. Name of
Employee:
2. Designation:
3. Place of
Posting:
4. Options for
availing Medical Policy:
i) CGHS
ii)
BSNLMRS
5. Details of
CGHS Card, if any
i) CGHS
Card No.:
I, do, hereby
certify that I have gone through the notification of BSNL Medical Reimbursement
Scheme and am exercising my option after satisfying myself about various
provisions under BSNLMRS.
(Signature of Employee)
ANNEXURE - B
BHARAT SANCHAR NIGAM LTD.
BSNL EMPLOYEES MEDICAL REIMBURSEMENT SCHEME
REGISTRATION FORM
1.
Name of Employee: 2. Designation:
3. Place of posting: 4.
Staff No.: 5. Basic Pay:
6. Telephone: (Office)------------------- (Residence) -----------------------
- Details of Family Members:
Sl. No.
|
Name
|
Date of Birth
|
Relationship with employee
|
Blood Group (If available)
|
8.
Details of chronic disease, if any: a)---------------------
b)---------------------
c)---------------------
d)---------------------
9. Options for
outdoor treatment (under BSNLMRS):-
(tick any one of i), ii)
or iii) )
i)
Outdoor/Domiciliary treatment from RMPs: Reimbursement against vouchers
(as per Para 2.1.0).
ii)
Outdoor/Domiciliary treatment: Entitlement without voucher(as per para
2.1.1)
iii) Outdoor/Domiciliary treatment
from P&T Dispensaries (as per Para 2.1.2)
Declaration:
I hereby
declare that above mentioned members of my family are fully dependent on me
i.e. their income from all sources does not exceed Rs. 1500/- per month. If the above information is found to be
false at any time, company can take action against me as per rules or as deemed
fit.
(Signature
of Employee)
FOR OFFICE USE ONLY
REIGSTRATION NO. ISSUED--------------------
CARD ISSUED : YES/NO on ----------------------
(Date of issue)
Signature of Issuing Authority
ANNEXURE - C
MEDICAL REIMBURSEMENT CLAIM FORM FOR OUTDOOR TREATMENT
1. Name
of Employee: 2. Designation:
3. Reg.
No.:
4. Salary
(Basic Pay + DA)/Pension (as on 01-04--------):
5. Place
of Duty: 6. Name of Patient:
7. Relationship
with Employee: 8. Age:
9. Reimbursement
claimed under:
(Tick
relevant box)
·
Treatment from RMP (as per Para 2.1.0)
·
Treatment from P&T Dispensary (as per Para 2.1.2)
10. Nature
of illness:
11. Name of Doctor/Hospital:
12.Details of claim:
(attach
prescription, vouchers, etc. in duplicate)
_________________________________________________________________________
Voucher No. Amount
·
Consultation:
·
Diagnostics/Tests:
·
Medicines:
·
Appliances:
·
Special treatment (e.g. Physiotherapy, Yoga etc.):
·
Others:
____________
Total:
(Rupees------------------------------------------------------)
__________________________________________________________________
Declaration:
I, hereby declare that the statements given
in application are true to the best of my knowledge and belief and that the
person for which medical expenses are incurred is wholly dependent on me.
(Signature of Employee)
ANNEXURE – D
MEDICAL REIMBURSEMENT CLAIM
FORM FOR INDOOR TREATMENT
1. Name of
Employee:
2. Designation:
3. Reg. No.:
4. Salary
(Basic Pay + DA)/Pension (as on 01-04--------):
5. Place of
Duty:
6. Name of
Patient:
7. Relationship
with Employee:
8. Age:
9. Nature of
illness:
10. Name of
Doctor/Hospital:
11. Period of
treatment: From ------------- To--------------------
(Certificate issued by the Medical
Officer in-charge of the hospital as per enclosed proforma is to be attached)
12. Details of
claim:
(attach prescription, vouchers,
etc. in duplicate)
_________________________________________________________________________
Voucher No. Amount
·
Consultation:
·
Diagnostics/Tests:
·
Medicines/Injections:
·
Appliances:
·
Room Rent:
·
Charges for Nurses:
·
Others:
___________________
Total:
(Rupees-------------------------------------------------------)
Declaration:
I, hereby declare that the statements given in
application are true to the best of my knowledge and belief and that the person
for which medical expenses are incurred is fully dependent on me.
(Signature of Employee)
Annex. D-I
CERTIFICATE FOR
HOSPITALIZATION
(To be completed in
the case of patients who are admitted to hospital for treatment)
Certificate
granted to Mrs./Mr./Miss ______________________ , husband /wife /son /daughter /mother /father of Mrs/Mr ____________________________ employed in
the office of______________________________,BSNL.
PART `A’
I, Dr.
_____________________________________________ hereby certify:
(a) that the patient was admitted to hospital on
________________________________.
(b) that the patient has been under
treatment at ___________________and that the under mentioned medicines
prescribed by me in this connection were essential for the recovery/prevention
of serious deterioration in the condition of the patient.
(c) that the patient is/was suffering from
_____________________and is/was under treatment from __________________to
____________________.
(d) that the X-ray, laboratory tests, etc.
for which an expenditure of Rs. ___________ was incurred were necessary and
were undertaken on my advice at ___________________ (name of hospital or
laboratory);
Signature and
Designation of the
Medical Officer
In-charge of the
case at the hospital
ANNEXURE – E
BHARAT SANCHAR NIGAM LTD.
APPLICATION FORM FOR
MEDICAL ADVANCE
1. Name of
Patient
2. Relationship
with Employee:
3. Age:
4. Name of
Disease (for which hospitalization is required):
5. Name of
Hospital:
6. Name of
Employee:
7. Designation:
8. Salary
(Basic + DA)/Pension:
9. Basic Pay:
10. Estimated
cost of treatment
(Enclose original copy of
hospital’s estimate)
11. Amount of
Advance required for treatment:
Signature:
Designation:
Section:
Tel. No.:
-----------
ANNEXURE - F
Bharat Sanchar Nigam Ltd.
(A Govt. of India
Enterprise)
Corporate Office
Statesman House, B-148
Barakhamba Road,
New Delhi - 110 001.
No.
Date:
AUTHORISATION
LETTER FOR TREATMENT IN HOSPITAL
This is to
certify that Sh./Smt.----------------------------------------------------(Name
of the patient),Age--------------- is the
Husband/Wife/Son/Daughter/Mother/Father of Sh./Smt.-----------------------,an
employee of BSNL. He/She may be
admitted in (Hospital’s Name) -----------------------------------------as per
his/her room entitlement, i.e. ------------------------------------------------.
He/She may be charged as per agreed rates
with BSNL.
Bills as per agreed rates may be
sent to this office for payment.
(Signature of the Competent Authority)
ANNEXURE – G
RELEVANT INFORMATION
FOR PROCESSING CASE FOR EMPANELMENT OF HOSPITALS
1. Name of
the Hospital
a) Whether the
hospital is recognized by the State Government for treatment of its employees and if so, a copy of the
order thereof.
2. Location/Address of the hospital
- Map of the city/town showing the exact
location of the hospital to be attached.
3. (i) Name (s) of Government hospital (s)/recognized hospital
(s) (within a radius of 4
Kms.).
(ii) Clinical facilities
available in the above hospitals.
4. Strength of BSNL employees and their
family members likely to be benefited.
5. INDOOR FACILITIES.
i) No. of beds in the
hospital – specialty-wise.
ii) General Wards
- Number
-
Size
- No. of beds in each ward
-
Amenities provided
- Rates
iii) Semi private Wards
- Number
-
Size
- Rates
iv) Private Wards
- Number
-
Size
- No. of beds in each ward
-
Amenities provided
- Rates
Contd…./-
-2-
v) Operation Theatres
- Number
-
Size
- Equipments
-
Rates
vi) Diagnostic Facilities
-
Pathological
- Radiological
-
Others
- Rates
vii) Details of the Blood
bank
viii) ICU & ICCU
Facilities
6. EMERGENCY AND TRAUMA SERVICES
i) No. of Ambulances
available
ii) No. of doctors
available with particular reference to
Emergency and Trauma Services
7. SPECIALISED SERVICES
i) Nature of Specialised
Services
ii) Name of specialists
with qualifications and field of specialisation
ii) Facilities of clinical
investigations
8. Facilities for Family Planning
Services
9. DOCTORS
i) List of doctors
available and their bio-date.
ii) Terms and conditions of
the employment of doctors with particular reference to
- Pay
-
Duration of the appointment whether part time or full time
iii) Private practice
whether allowed or not
iv) The names of hospitals
or clinical centers the said doctors are associated with
10. PARA – MEDICAL STAFF
Conditions of employment of para-medical personnel
-
Whole time/part time
- Pay
-
Duration for which appointed
11. Average O.P.D. attendance during
last one year.
Contd…/-
-3-
12. Schedule of
charges (Schedule of charges of nearby Govt. hospitals and one nearby
recognized hospital are to be furnished for comparison purpose).
13. Particulars of casualty services in
the hospital
14. Percentage of free treatment in OPD
and also reserved beds for poor patients.
15. Inventory of equipments
16. Residential physicians and
residential surgeons.
17. i) Doctors-patients
ratio
ii) Doctors-nurses ratio
iii) Nurses-patients ratio
iv) Bed occupancy rate at present.
18. i) Types of
operations carried out and their number, speciality-wise during last one year.
ii) Isolation Ward/bed for
communicable diseases like Diphtheria, Cholera, Measles, Chicken Pox,
Tuberculosis, Tetanus, Polio etc.
19. Apart from the
clinical amenities, availability of other amenities like the size of the rooms,
no. of beds in each room, no. of toilets available to each room, provision for
electrical amenities like fans/ACs/Coolers (in Private/Semi-Private &
General Wards)/lifts in the building etc.
20. i) Annual
Budget.
ii) Kind of drugs being
stored.
iii) Man-power.
*************
