कर्मचारी भविष्‍य निधि संगठन
Employees Provident Fund Organisation
श्रम एवं रोजगार मंत्रालय, भारत सरकार
Ministry of Labour & Employment, Government of India

HRM-8/V/12(18)2007/ UP/Vol-1

Dated: 31.05.2021
01 JUN 2021

To,

All Additional Central PF Commissioners (HQ),
All Additional Central PF Commissioners (Zones)/Addl. CPFC (ASD),
Director (PDNASS)
All RPFCc./OIC in-charge of Region

Sub: Medical advance without documentation in cases of emergency hospitalization on account of serious life threatening illnesses including Covid – reg.

Sir/Madam,

The procedure of getting an estimate for granting medical advance In cases of hosp1talizat1on on account of serious life-threatening illnesses including Covid has been revisited. In life-threatening diseases, many times it becomes imperative to get the patient Immediately admitted to the hospital on emergency to save his/her life and It is not possible to get the estimate from the hospital in such situations. A need is felt for streamlining the advance facility for such serious in-patient’s treatment in hospital wherever family members of employees are not able to manage estimate from the hospital concerned in which such patient has been admitted in an emergency Sometimes patient employee may be in ICU where the estimate is not known in advance. Hence the following procedure may be adopted to grant medical advance for emergency hospitalization on account of serious life­ threatening illnesses including Covid:

1. The patient is admitted for treatment in a Government/ PSU/ CGHS empanelled hospital. If the patient is admitted in an emergency in a private hospital and competent authority considers it a fit case to grant relaxation in rules for medical bills reimbursement, then. also advance specified below can be given.
2. A request letter is submitted by employee or any of the family member of the patient for providing medical advance without estimate along with details of the hospital and the patient.
3. A lump sum medical advance up to Rs 1 lakh may be granted by authority competent to grant medical advance by relaxing the formality of estimate from the hospital treating the employee  or for depositing advance with hospital for starting treatment. This advance be granted immediately preferably on the same day, If it Is a working  day else on Immediately succeeding woring day after the receipt of application of advancc without insisting for the estimate of expenditure from hospital /other documentation. Officer in charge of the concerned office (ACC-ASD for Head Office) should also ensure that this medical advance is granted by the next working day after the receipt of the application of advance.
4. After receipt of estimate for treatment subsequently but before discharge of patient from hospital, if entitlement of medical advance is more than one lakh as per rules then additional advance will be sanctioned equivalent to advance entitled as per rules reduced by one lakh already granted.
5. Medical advance amount may either be credited to the salary account of the employee or can be paid to the Hospital concerned directly as per request of family member of employee.
6. After discharge from hospital, employee should submit bill within 45 days from the date of discharge, The amount of aforesaid advance be adjusted from the final bill of the hospital permissible as per rules. Further action regarding reimbursement of medical bill or recovery of advance be taken as per rules while processing the medical bill of employee.

This circular is applicable to employees covered under CS(MA) rules as well as employees covered under CGHS.

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By SPEED POST

F.No.D-12015/06/ 2020-Ad.IX
Government of India
Ministry of Finance
Department of Revenue
Central Board of Direct Taxes

Room No.10, 5th Floor,
Jeevan Vihar Building,
Parliament Street, New Delhi – 110001

Dated : 28.10.2020

To

All Principal Chief Commissioner of Income Tax
All Director General of Income Tax (Inv.)

Sub : Streamlining of procedure to process of medical reimbursement claim.

Sir/Madam,

It has been observed that the medical reimbursement claims are being received in the Board, are incomplete and not subjected to any initial check. As a result a lot of time is spent on further communications resulting in delay in settlement of the claim.

2. It has therefore been decided that in future all medical claim are to be submitted to the Board on the basis of the attached Check List with proper referencing of the documents with page number and Annexure.

3. Offices of the Pr. CCIT and DGIT (lnv.) are requested for wide circulation of this advisory amongst the all subordinate offices under their control.

Yours Faithfully

Biswajit Guha
Under Secretary to the Govt. of India
Telefax: 011-23741823

Copy to : IFU/DT for information

Reimbursement of medical claims to pensioners residing in non-CGHS areas – DoT

CHECK LIST FOR PROCESSING MEDICAL CLAIM

Name & Designation of the Claimant: —————-

Office where working: —————-

Name of Patient & relationship with claimant: —————-

CHECK LIST FOR PROCESSING MEDICAL ADVANCE

Name & Designation of the Claimant:

Office where working:

Name of Patient & relationship with claimant:

Proforma for item-wise expenditure charged by the hospital vis-a-vis actual admissible amount as per CGHS rate/ CS(MA) Rules, duly authenticated by the HoD concerned

Name & Designation of the Claimant:

Office where working:

Name of Patient & relationship with claimant:

Name of the Hospital and address;

Duration of the Treatment:

Checked and verified by:

Signature with stamp

Certified and authenticated by HoD

Signature with stamp

Annexure

Proforma for Item-wise details

Name of item : Medicines

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CGHS

No: 4-35(01)/ 2019-PAT
Government of India
Ministry of Communications
Department of Telecommunications

20, Ashoka Road, 1120, Sanchar Bhawan
New Delhi-110001
Dated: 28/07/2020

OFFICE MEMORANDUM

Subject -: Reimbursement of medical claims to pensioners residing in non-CGHS areas-reg.

This refers to medical claims being received from pensioners residing in non-CGHS areas. In this respect. Ministry of Health and Family Welfare’s (MoH&FW) OM No. S. 14025/23/2013-MS.EHSS dated 29.09.2016 may be referred (copy enclosed). As per this OM, the pensions residing in non-CGHS have following options to avail medical facilities:

• (a) They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month or as revised from time to time. At present, vide OM 4/34/2017/P&PW(D) dated 19.07.2017. FMA is @ Rs. 1000/- per month.
• (b) They can also avail benefits of CGHS (OPD & IPD) by registering themselves In the nearest CGHS city after making the required subscription.
• (c) They also have the option to avail FMA for OPD treatment, and CGHS for IPD treatment after making the required subscriptions as per CGHS guidelines.

2. In addition, in accordance to MoH&FW’s OM No. 8.11011/11/2016 CGHS (P)/EHS dated 09.01.2017 (copy enclosed), pensioners have option to avail CGHS facilities by making contribution on an annual basis (1 year/12 months) or by making contribution for 10 (ten) years (120 months) for getting a pensioner CGHS card with life-time validity.

3. The undersigned is directed to request ail the Pr. CCA/CCAS and others concerned offices that the pensioners of this Department residing in non-CGHS areas may be intimated/ sensitized (more than once) by an appropriate means about the above options for medical facilities available to them as per MoH&FW OM dated 29.09.2016 and OM No. S.11011/11/2016 CGHS (P)/EHS dated 09.01.2017. They may be advised that for availing reimbursement of their medical bills, they have to mandatoryly register themselves with the nearest CGHS facility as per one of the options above. They may also be advised that if they fail to register themselves w.e.f. applicable date with the nearest CGHS facility for availing OPD/IPD treatment, their further medical bills may not be reimbursed by this Department.

4. Compliance report in respect of the above may be furnished to this office for appraisal of Secretary, DoT.

5. This issues with the approval of competent authority.

(A). Monthly Contributions for availing CGHS facility:

(B). Entitlement of words in private hospitals empanelled under CGHS

Pay slab for determining the entiltlement of a commodation in AIIMS, New Delhi.

The revised entitlement, as per the drawn the official, is as  follows:

(S.C. Karol)
Director (Estt.)
Phone. 23036500

To.
Pr. CCAs/ CCAS

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Nirman Bhawan, New Delhi
Dated the 17th October, 2016

OFFICE MEMORANDUM

Subject: Grant of 90% medical advance for all treatments (IPD and OPD) under CGHS and CS(MA) Rules, 1944.

The undersigned is directed to refer to O.M.NO.S. 14025/7/94-MS dated 15.05.1996, and OM No.S.12025/1/96-CGHS(P) dated 1305.1997 provisioning, inter-alia, grant of advance upto 90% in case of major illness like by-pass surgery, Kidney transplant, major cancer treatment, etc.

2. During the meeting held on 25.03.2015, National Council (Staff Side) requested this Ministry to make provisions for grant of 90% advance of the estimated cost for all treatments for serving Central Government employees, irrespective of major or minor diseases.

3. The matter was examined in the Ministry. Considering that the basic purpose of grant of advance for treatment of any disease is to provide relief to a Government employee from facing hardship, it has been decided with the approval of the competent authority that serving CS(MA) and CGHS beneficiaries may be granted 90% medical advance of the approved CGHS package rates for all indoor treatments, irrespective of major or minor diseases, on receipt of a certificate from the treating physician of a Government/recognized hospital as per the guidelines given in the OM No.S.14025/7/94-MS dated 15.05.1996 and OM No.S-11016/1/92-CGHS(P) dated 29.10.1992 for CS(MA) and CGHS beneficiaries respectively.

4. For out-door treatment, it has also been decided that advance may be limited to 90% of the total estimated expenditure of the treatment, subject to the condition that the advance for OPD treatment may only be granted when the total estimate of expenditure for OPD treatment including tests/investigations is more than Rs.10,000/-.

5. The advance should be released within 10 days on receipt of the request for advance by the administrative Department/Ministry/office in order to avoid inconvenience to the employees.

6. The OM No.S.12025/1/96-CGHS(P) dated 13.05.1997 stands withdrawn from the date of issue of this O.M.

(Sunil Kumar Gupta)
Under Secretary to the Govt. of India

Source : Confederationhq

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Abolishing 12 Interest free advances recommended by 7th CPC

The 7th Pay Commission has , in a casual manner, recommended that all interest free advances to be abolished. The impact of this recommendation is yet un noticed by the central government employees

There are 12 Interest free advances are listed in that table provided in the 7th CPC Report. When hearing the news that 7th cpc has recommended to abolish interest free advances , every body thought that some advances like festival advances only will be abolished. But if you read the names of advances recommended for abolishment, it will give you little bit shock.

In general opinion, the amount that is paid for government servants in some occasions and for specific purposes and the same will be recovered through monthly instalments are considered advances.

But the advance paid for Medical treatment and LTC are not supposed to be included this list, since it is reimbursable in nature and will not be recovered by Government.

The amount paid as advances to the Medical treatment and LTC are not recoverable by government if there is no any default in the claim. since the expenses incurred should be reimbursed to the Govt servants according to their entitlements, the amount paid in advance can be adjusted against the claim of reimbursement is sanctioned. So there is no need of repaying the advance to government in respect of Medical and LTC advances.These should not be included in the list of interest free advances.

Eventually abolishing these advances will make the central government employees not to avail LTC facility and medical treatment in Private hospital, since the amount of 90 % of the expenses paid in advance will not be available for them any more due to this recommendation. By availing this advances they were able to manage the Medical Expenses and by availing this advance only they were able to bye Air or Train Tickets to go on LTC.

Without these advances, the Group C and B employees cannot imagine availing of LTC to visit some places in India with their family.

The Central Government should not accept the proposal of Abolishing these advances.

Source: GServants.com

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