CS (MA) Rules, 1944 – Reimbursement of expenditure involved on emergent cases for the treatment taken at private nursing home/clinic – Regarding

Government of India
Ministry of Communications & IT
Department of Posts
Dak Bhavan, Sansad Marg
New Delhi – 110116

No. 6-1/2006-Medical
Dated – 27th October, 2010

To,
All recognized Unions/Associations of Department of Posts

Sub: - CS (MA) Rules, 1944 – Reimbursement of expenditure involved in emergent cases for the treatment taken at private nursing home/clinic – Delegation of powers – reg.

Sir,
I am directed to forward herewith a copy of Ministry of Health and Family Welfare, New Delhi O.M. No. S-14025/46/92-MS dated 4-2-1993 on the above subject for your information/guidelines and necessary action.

(Mahendra Kumar)
Assistant Director General (Medical)

No. S-14025/46/92-MS
Government of India
Ministry of Health and Family Welfare
Nirman Bhawan, New Delhi – 110011

Dated the 4th February, 1993

Office Memorandum

Subject – CS (MA) Rules, 1944 – Reimbursement of expenditure involved on emergent cases for the treatment taken at private nursing home/clinic – Delegation of powers – Regarding.

The undersigned is directed to say that under the CS (MA) Rules, 1944, vide Miscellaneous Important Decisions No. 5 under Section VII of the compilation of the CS (MA) Rules and further modified vide O.Ms. No. S-14012/9/75-MC (MS) dated 23.2.77, 7.5.79 and 18.6.82, powers have been delegated to the Heads of Departments to allow reimbursement of the medical claims in respect of the treatment obtained under emergency at private hospitals, as distinct from private nursing home/private clinic, subject to item-wise ceilings as per the rates prescribed in the Annexure to the O.Ms. referred to above without any financial limit on the total amount to be reimbursed.

2. However, although the broad guidelines provided in para 1 (iv) of the O.M. dated 18.6.82 referred to above are only indicative and not exhaustive, a large number of cases are being referred to this Ministry/Dte. G.H.S. for seeking relaxation of the rules stating that the hospital is not run on ‘No profit and No Loss Basis’, which otherwise could have been settled by the concerned Department under the delegated powers.

3. It has now been decided by the Government that in order to eliminate the confusion regarding distinction between the private hospital and a private nursing home Clinic, the delegated powers referred to above are applicable to all private medical institutions without making any distinction between a private hospital and a private nursing home/clinic.

4. the medical claims for specialized treatment for heart diseases, kidney transplantation, etc. may be settled as per the schedule of rates approved for the treatment of C.G.H.S beneficiaries from time to time at private recognized hospitals under that Scheme or the actual charges, whichever is less, and all other cases may be settled as per the item wise ceilings prescribed in the Annexure to the O.Ms. referred to above. No. references should be made to this Ministry/Dte. G.H.S. in the matter for further relaxation of the Rules and may be settled by the concerned Ministry/Department.

5. In this connection it may be reiterated that as already stated in para (iii) of the O.M. dated 18.6.82 referred to above, reimbursement of expenses incurred on treatment obtained in the private clinics/nursing homes of the Authorised Medical Attendants would not be admissible under the above provisions and also in relaxation of the CS(MA) Rules even in emergent cases.

6. All pending cases may be decided accordingly, However, the cases which are already settled or decided, may not be re-opened.

7. This issues with the concurrence of the Department of Pension and Pensioners’ Welfare vide their U.O. No. 272/92 P& PW (K) dated 19.10.1992 and the Ministry of Finance Deptt. Of Expenditure) vide their U.O. No. 1441/E.V/92 dated 17.11.1992.

8. In so far as persons serving in the Indian Audit and Accounts Deptts. are concerned, this issues with the concurrence of the office of the comptroller and Auditor General of India vide their U.O. No. 27-Audit-I/72-90, dated 25.1.1993.

Sd/-
(Braham Dev)
Under Secretary to the Govt. of India

Reimbursement of Medical claims in respect of service Officers/Personnel and their families for treatment in Civil Hospitals

No. AT/IV/4807/XVIII
Office of the C.G.D.A
Ulan Batar Road, Palam
Delhi Cantt – 10
Dated 18 Jun 2010

To
The PCDA / CDA

Sub: Reimbursement of Medical claims in respect of service Officers/Personnel and their families for treatment in Civil Hospitals.

Repeated references are received in HQrs office from Controllers as to the office which has to deal with the medical claims on account of treatment taken as indoor and OPD patients inspite of HQrs circular of even no dated 28-12-98 and subsequent clarifications issued on the subject. It is therefore once again clarified that medical claims of Service personnel and their families will be dealt as per the table appended below.

Sl.No.	Nature of Medical claims	PCDA/CDA/PAO	Authority
1.	Medical claims in respect of treatment taken as Indoor patient	Such claims are to be dealt with by Regional Controllers/PCDA (AF)/PCDA (Navy) under whose audit jurisdiction the service Hospitals nearest to The Civil Hospitals are situated.	Rule 55 FR Pt II
2.	Medical claims in respect of treatment taken as OPD patient	Such claims are to be processed by the respective CDA (O) / PCDA (Navy) / PCDA (AF) / PAOs of the concerned service personnel	Para 248 OM Pt-IX, Para 318-327 OM Pt VII, Items 18 & 27 of Annexure A to Chap VII of OM Pt III, and Chap 68 of OM Pt X
3.	Medical claims in respect of Clinical / Pathological test	If they are part of Indoor treatment the claims will be processed as per Sl. No.1 above otherwise claims on account of OPD treatment will be processed as per Sl no. 2 above	As above

Sr. Dy. CGDA (AT)

www.cgda.nic.in

MEDICAL FACILITIES FOR RETIRED EMPLOYEES

FACILITIES FOR RETIRED EMPLOYEES

'RETIRED EMPLOYEES CAN SUE GOVT FOR NEGLIGENCE UNDER CGHS'

The verdict, read with a ruling of the SC in 1995 that in-service Central Government employees are consumers under the Central Government Health Service Scheme, now catgorieses the entire working and retired work force as consumers, as far as health care is concerned under the scheme

Lakhs of retired central government employees can rejoice as the apex consumer forum has held them to be the sonsumers under the CGHS schme, thus conferring a right on them to sue the Centre for damage in case of deficiency in health care provided to them and their dependents.

This was unanimous decision of a full Bench of the National Consumer Disputes Redressal Commission (NCDRC) comprising its preseident Justice M.B.Shah, members Rajyalakshi Rao, B.K. Taimni, Justice K.S.Gupta, Justice S.N. Kapoor and P.D.Shenoy. This verdict, read with a ruling of the Supreme Court in 1995 that in-service central government employees are consumers under the Central Government Health Scheme (CGHS). now categorises the entire working and retired work force of the Central Goverment as consumers, as far as health are is concerned under the scheme.

The question before the NCDRC was "whether a pensioner and beneficiary of the CGHS would be a consumer under the provisions of Consumer Protection Act, 1986, for alleged deficiency in service by the CGHS Medical Officer".

Answering in the affirmative, NCDRC said medical treatment facilities extended to a retired under CGHS could not be termed as 'free service' as it was in consideration of service rendered by him to the government till the age of superannuation, which conferred a right on him to get pension as well as other benefits, including medical treatment presribed by various rules or the schemes framed by the Centre.

"Such employee would be a consumer as defined in Section 2(1)(d)(ii) of the Consumer Protection Act," said Justice Shah , writing for the Bench. Explaining the reason behind the conclusion that would make the retired employees feel less neglected, the NCDRC said service rendered by the government employees before retirement would be "consideration" for providing medical facilities to him or his family members.

"Hence, it cannot be said that the hospital which is subsidised by the government is rendering service free of charge," it said.

The NCDRC verdict came on a petition filed by retired employee Jagdish Kumar Bajpai, throgh advocate Nikhil Nayar, claiming that he was refused medicines for his wife by the CGHS dispensary in Kanpur. He also claimed damages to the tune of Rs. 4 lakh alleging that his wife died due to the negligence of the medical officer.

(The above news item appeared in Ahmedabad Edition ofTimes of India dated November 7, 2005 - Needless to say that this verdict is relevant to the working and retired employees of ONGC as the Central Government Medical Attednance Rules also apply on ONGC.)

Pensioners can claim Medical Reimbursement - Even without joining the Medical Scheme (CGHS)

Retired employees entitled to medical reimbursement - Even if not opted for Medical Scheme: Court

Ruling that all government employees, even those retired, are entitled for medical reimbursement, the Delhi High Court Tuesday asked the Delhi government to pay the medical bills of a man who retired from a government enterprise in 2002.

Justice Kailash Gambhir asked the government to pay the medical expenses of Suraj Bhan and said: 'The state has a constitutional obligation to bear the medical expenses of government employees while in service and also after they are retired. Clearly in the present case by taking a very inhuman approach, these officials have denied the grant of medical reimbursement to the petitioner forcing him to approach this court.'

Bhan had approached court seeking reimbursement of his medical bills.

In 2003, following a circular issued by the government, Bhan got enrolled for the medical scheme and paid the premium on regular basis though he had retired a year earlier. In 2007, a new scheme was introduced, but he was not aware of it.

Bhan was suffering from asthma and was under treatment at the Sir Ganga Ram Hospital from July 3 to July 9, 2004. When he moved an application for reimbursement of Rs.33,654 towards hospital bills it was rejected by the employment officer as Bhan was not part of the 2007 scheme.

'It is quite shocking that despite various directions from the courts, the government in utter defiance of the law has taken a position that the pensioner is not entitled to the grant of medical reimbursement since he did not opt to become a member of the said health scheme after his retirement,' the court said and imposed a law suit cost of Rs.10,000 on the government.

The government said that since Bhan had not opted for the new scheme in 2007, he was not entitled to reimbursement.

'The scheme is prospective in nature and the same would be effective once an employee becomes a member of the scheme and not otherwise,' counsel for the government said.

'It is a settled legal position that a government employee during his life time or after his retirement is entitled to get the benefit of medical facilities and no fetters can be placed on his rights on the pretext that he has not opted to become a member of the scheme or had paid the requisite subscription after having undergone the operation or any other medical treatment,' the court said.

Source: Indo Asian News Service

Retired employees to get medical reimbursement: Delhi High Court

Retired employees to get medical reimbursement: Court

Ruling that all government employees, even those retired, are entitled for medical reimbursement, the Delhi High Court Tuesday asked the Delhi government to pay the medical bills of a man who retired from a government enterprise in 2002.

Justice Kailash Gambhir asked the government to pay the medical expenses of Suraj Bhan and said: 'The state has a constitutional obligation to bear the medical expenses of government employees while in service and also after they are retired. Clearly in the present case by taking a very inhuman approach, these officials have denied the grant of medical reimbursement to the petitioner forcing him to approach this court.'

Bhan had approached court seeking reimbursement of his medical bills.

In 2003, following a circular issued by the government, Bhan got enrolled for the medical scheme and paid the premium on regular basis though he had retired a year earlier. In 2007, a new scheme was introduced, but he was not aware of it.

Bhan was suffering from asthma and was under treatment at the Sir Ganga Ram Hospital from July 3 to July 9, 2004. When he moved an application for reimbursement of Rs.33,654 towards hospital bills it was rejected by the employment officer as Bhan was not part of the 2007 scheme.

'It is quite shocking that despite various directions from the courts, the government in utter defiance of the law has taken a position that the pensioner is not entitled to the grant of medical reimbursement since he did not opt to become a member of the said health scheme after his retirement,' the court said and imposed a law suit cost of Rs.10,000 on the government.

The government said that since Bhan had not opted for the new scheme in 2007, he was not entitled to reimbursement.

'The scheme is prospective in nature and the same would be effective once an employee becomes a member of the scheme and not otherwise,' counsel for the government said.

'It is a settled legal position that a government employee during his life time or after his retirement is entitled to get the benefit of medical facilities and no fetters can be placed on his rights on the pretext that he has not opted to become a member of the scheme or had paid the requisite subscription after having undergone the operation or any other medical treatment,' the court said.
Source: Indo Asian News Service