Monday, 5 December 2016

G.O. Ms. No.68,Dated 28th March 2011. Pay Revision Commission Recommendations 2009 on Medical Reimbursement

    GOVERNMENT OF ANDHRA PRADESH                               ABSTRACT

Pay Revision Commission Recommendations 2009  on Medical Reimbursement  – Orders  Issued.

 HEALTH, MEDICAL & FAMILY WELFARE                         (K1) DEPARTMENT 
  G.O. Ms. No. 68    Dated 28th March 2011.   
Read the following:-

1.  G.O.Ms.No.74,  HM&FW (K1)  Department,  dated  15-3-2005.
2.  G.O.Ms.No.105,  HM&FW (K1)  Department,  dated  9-4-2007.
3.  G.O.Ms.No.397,  HM&FW (K1)  Department,  dated  14-11-2008.
4.  The Principal  Secretary  to  Government,  Finance Department,       D.O.Lr.No.243.B/16/PC.I/A2/2010, dt.6-4-2010.



1. Government have issued  Andhra  Pradesh Integrated  Medical Attendance  Rules  1972  for the benefit  of  all  state Government  employees and their  dependents, employees  of  local bodies, students of  medical colleges,  members  of  the State Legislature,  All India  Service (AIS)  Officers, A.P.  State  Higher  Judicial officers  etc. Several Private  Hospitals - both  within the State and  outside the State - have  been  recognized  by  the Government as referral  hospitals for providing health  care and treatment  for these category of persons on reimbursement basis.

2. In  the letter 4th  read above,  Finance  Department has forwarded the recommendations of  the  ninth Pay Revision  Commission  (9th  PRC)  relating to the  medical attendance  benefits for  the  employees  and pensioners  of  the state Government.  With  regard  to  medical  facilities,  the  9th  PRC observed that while ‘they  would  have  liked  to  see the new scheme adopted,  they  were aware  that it might  some  time  to  get it implemented and in  the  interregnum, they  have  made  the following  recommendations  in  respect  of  the existing scheme in  response  to  the representations received  by the Commission from different Associations’.

a)  Deletion  of  provision  relating  to  10%cut on  the  amount   admissible
   The  Commission, recommended  the  removal of  the  provision relating to  imposition  of  10%  cut on  the  amount admissible  where  treatment was obtained in the recognized hospitals.

b)  Recognition of  some Private Hospitals in semi  urban areas   as referral Hospitals
      Recommended  to  explore  the  possibility of  recognizing  some  more hospitals located in  semi-urban areas as referral hospitals,  where facilities for undergoing treatment are available.

c)  Entitlement of  wards  for the  in-patient  treatment
     Recommended  categorization  of  serving employees  and pensioners into  three categories  for purpose of  entitlement  of  wards  for inpatient treatment.
      However,  any  employee/  pensioner prefers  other than  the entitled ward,  his claim may be  restricted to  the charge  relating  to  the ward  to which she is eligible.

d)  Essentiality Certificate
Recommended  issuing instructions  to  all recognized  private  hospitals to  compulsorily  note  the  order  number  and  the  date  in  which  it  was recognized  and the  date  up  to  which  the  recognition  is  valid  on  the essentiality certificate itself.

e)  Medical reimbursement  to  the dependents  of  family   pensioners
The  Commission  was not in  favour  of  including  the  dependents of family   pensioners  for  purpose  of  eligibility  to  reimburse  the medical expenses  incurred by the  family  pensioners  towards their treatment.

f)  Dispensing  with  the  scrutiny  certificate  separately  in  cases where treatment  is obtained in NIMS/ SVIMS: 
Recommended  to dispense  with the  procedure  of insisting  on scrutiny certificate separately where treatment is obtained in NIMS/ SVIMS.

g)  Reimbursement of  the  cost  of  O.P.  treatment in  the   recognized private hospitals 
The O.P.  treatment  of  serious  diseases  is  already  covered  in  para 9(4) &  (5) of  the  G.O.  1st  read above  and hence  did not  recommend for change in the present position.

h) Delegation  of  enhanced  powers  of  Scrutiny  and Sanction
Recommended  delegation  of  the powers of scrutiny  of claims of medical  reimbursement  up  to  Rs.50,000/- to  District  Hospital Superintendents  /Superintendents  of  Teaching Hospitals  and for  the delegation  of  sanction  of claims  of  medical  reimbursement  up  to Rs.50,000/- to the District Level Officers (DCHS and DMHO).

i)  Master Health  Checkup for the Pensioners/Family Pensioners
The PRC recommended that it could not support the proposal.

j)  Treatment  of  all accident  cases and all emergent  cases in  the unrecognized private hospitals
    Recommended  deletion  of  the  word  ‘road’  occurring  in  para  9(9)  of G.O.Ms.No.74,  HM&FW (K1)  Department,  dated15-3-2005 and permitted

k)  Dispensing with  the essentiality certificate in certain cases
   Where tests,  medicines  or surgical  procedures  are prescribed  by  the concerned specialist doctor in the  Government hospital,  the requirement of further essentiality certificate may be dispensed with.

l)  Issue of  letter of  credit  in the case  of  pensioners
    The  PRC  recommend  that it  was unable  to  accept the  request of  the pensioners for issue of letter of credit.

m)Extension of  medical facilities  to  the staff of  aided  institutions/universities
   The  PRC  recommended  that  they  may be  brought  into  the  fold  of medical  benefits  when  the insurance scheme is  launched  by  the Government.

n) Payment  of  medical allowance                        Recommended  payment  of  Medical  Allowance of  Rs.200/- p.m.  to  the Pensioners/ Family  Pensioners. This  may be  disbursed along with  their monthly pension.

o)Removal /enhancement  of  ceiling limit 
    The PRC was  not  in  favour  of  either increase  in  the ceiling  limit  or to remove the ceiling limit.

p)Removal of  the  restriction of  three times in  the  entire  service  for the  treatment of  the  same  disease
     The  PRC recommended  that the  existing  position  referred  to  above  is quite adequate  and  the Commission  therefore recommended  to continue the same provision.

q)Dispensing with  the method  of  scrutiny by the Director  of        Medical education or  other officials of  the medical   department
    The PRC Declined to accept the request.

r)Extending the  facilities of  reimbursement  of  medical expenses        as applicable to the State Higher Judicial Officers 
    The  PRC stated  that  it was  proposed  by some  organizations that  the facilities  extended  to the Judicial  Officers  regarding  medical  treatment may be  extended  to  Government Servants and also  to  pensioners. The orders  issued  in  G.O.Ms.No.107 Law Department,  dated  14-72006,  are based  on  various  judgments  of  courts. The Govt. employees/pensioners  are   governed  by  A.P.  Integrated  Medical Attendance  Rules as  subsequently  modified  in G.O.Ms.No.74  HM & FW Dept.  Dt:15-3-2005,  and  are amended  from  time  to  time.  The Government has been  quite  liberal in extending medical facilities  to  its employees  and  pensioners.  PRC felt  that  the existing  facilities  are adequate  and if any  change  is required  it should be  in the  direction of moving away  from  Government led medical reimbursement to  a more refined and sophisticated system that provides for cashless facility.

s) Maximum limit  for dental treatment
     The commission felt  that the existing  scheme  is  adequate  and  requires no further relaxation.

t)  Medical  advance  to the  pensioners 
    The  commission was unable  to accept  this request for  the  reasons already referred to earlier.

3.   The Government  after careful  examination  of the matter has decided to  accept the  recommendations of  the  ninth Pay Revision  Commission  and accordingly hereby  order for adoption  of the same  to  all the eligible categories  of  employees  and pensioners  with  immediate  effect. All  Heads of Departments in  the  state  shall communicate  the  same  to all  Unit Offices under  their control for information, and implementation.

4. This order  issues  with the  concurrence  of  Finance  Department vide their U.O.No.29886/1168/A2/Expr.M&H.I/10, dt.22-10-2010


                        DR P.V.RAMESH

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