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
(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)
PRINCIPAL SECRETARY TO GOVERNMENT
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