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ASSOCIATION
(REGD) (Affiliated
to AIBOC)
On and from Ist May 2005, reimbursement of hospitalisation expenses under Regulation 24(1)(b)(i) of Officers' Service Regulations, 1979/1982, shall be in terms of the Hospitalisation Scheme laid down under Bipartite Settlement dated June 2, 2005, for workmen employees, (Please See Schedule - V at the bottom ) subject to following limits:-
Of Workmen Settlement Dated 02/06/2005
SCHEDULE
FOR REIMBURSEMENT OF HOSPITALISATION EXPENSES
1. Hospitalisation expenses will be reimbursed to workmen staff in the bank to the extent of 100 per cent in case of self and 75 per cent in case of dependent members of family subject to the procedure for reimbursement of hospitalization expenses as enumerated hereunder : a)
Hospitalisation charges to the extent stated above will be reimbursed in
case of all ailments and major accidents which require hospitalization. b)
A workman or his dependent family member(s) will be considered to have
been hospitalized only if they are admitted as indoor patient(s) in the hospital
in respect of diseases/ accidents as mentioned above in sub-para (a). however,
cases where the patient is admitted as an out-patient and discharged the same
day after surgical procedures involving advanced techniques may also be
considered for reimbursement of hospitalization expenses. c)
Medical expenses incurred for the hospitalization will be reimbursed on
the strength of bills/couchers to the extent of 100% in case of self and 75 % in
case of family members subject to the limits prescribed hereunder.
The expression `family’ of an employee shall mean the employee’s spouse, wholly dependent children including dependent step children and legally adopted children and parents wholly dependent on the employee and ordinarily residing with the employee. Notes
:- (i)
The term `wholly dependent
child / parent’ shall mean such relative having a monthly income not exceeding
Rs.2,550/- p.m. If the income of one of the parents exceeds Rs.2,550/- p.m. or
the aggregate income of both the parents exceeds Rs.2,550/- p.m., both the
parents shall not be considered as wholly dependent on the employee. (ii)
A married female employee may include her natural parents or
parents-in-law under the definition of family – but not both – provided that
the parents/parents-in-law are ordinarily residing with and wholly dependent on
her and satisfy the income criteria as stated above.
4. The workmen or members of their families (as the case may be) are expected to secure admission in a Governemnt/Medical Hospital or any `private’ hospital (i.e. hospitals under the management of a Trust, Charitable Trust, Charitable Institution or a religious mission) The reimbursement will be restricted to the percentage applicable to the workmen/dependent family member, i.e. 100% or 75% of the charges applicable to the lowest paying bed in such hospitals according to hospital rules or the maximum amounts mentioned above, whichever is lower. 5. Normally, the workman and members of family should avail of services of hospital as mentioned in paragraph 4 above. However, if he feels, that it is unavoidable to seek services of a private nursing home/hospital, he can do so in one of the hospitals/nursing homes, approved by the bank. Reimbursement in such cases will, however, be restricted to the extent of the amount which would have been reimbursable in case of admission to a public or private hospital as mentioned in paragraph 4 above. 6. Medical expenses incurred within 30 days of `pre’ and post-hospitalisation period on medical advice, on account of the ailment/disease for which the person was hospitalized, will be considered as hospitalization expenses for reimbursement purpose. However, in cases of hospitalization involving special or major operations, medical expenses incurred for a period not exceeding 45 days of post-hospitalisation will be considered for reimbursement, subject to medical advice. 7. Charges for engaging a nurse/attendant will not be reimbursed. However, nursing charges, if any, charged by hospital authorities in respect of days spent in ICU/CCU/neo-natal nursery may be considered for reimbursement on the basis of certificate issued by the hospital authorities and in consultation with bank’s Medical Officer. Reimbursement in such cases shall be 100% for workmen and 75% for family members of the actual charges. 8. Hospitalization charges in connection with maternity will not be reimbursable. However, the expenditure incurred by an employee in cases involving operative interference because of complicated labour and caesarean operation and subsequent hospitalization thereto will be reimbursed under the hospitalization scheme to the extent of expenditure incurred in excess of normal maternity charges and consequent hospitalization thereto subject to the condition that such reimbursement shall be 70% of the amount actually incurred or the limits as per Annexure II hereto, whichever is less. 9. The purchase of drugs/medicines will be restricted to approved chemists and arrangements will be made by banks wherever possible to make direct payments to the chemists. 10. Banks will have discretion to refuse payment of bills in cases where they are not satisfied about the genuineness of the bills. 11. Ambulance Charges Ambulance charges for removing the workman or his dependent family member from residence to the hospital / nursing home or from hospital / nursing home to residence on discharge or from one hospital / nursing home to another hospital / nursing home, within the urban agglomeration or municipal limits may be reimbursed in full. Actual expenses incurred on conveyance by mode other than ambulance shall be reimbursed subject to maximum as under : i) By public taxi - Actuals subject to maximum of Rs.150/- per trip ii) By autorickshaw - Actuals subject to maximum of Rs.75/- per trip In case the patient is to be moved to a hospital / nursing home outside the urban agglomeration/municipal limits, then the expenses incurred on conveyance may be reimbursed at the rate of Rs.5.00 per kilometer, with a maximum of Rs.1000/- per trip or the amount actually incurred, whichever is the least. Normally, services of an ambulance should be availed of. Where ambulance is not available or the facility of ambulance is not established, public mode of transport, i.e. taxi/autorickshaw could be used. The bank shall consider such claims on merits and facts. Abuse of the facility will be dealt with treating such claims as acts of gross misconduct. 12. Domiciliary Treatment Medical expenses incurred in respect of the following diseases which need domiciliary treatment as may be certified by the recognized hospital authorities and bank’s medical officer shall be deemed as hospitalization expenses and reimbursed to the extent of 100% in case of a workman and 75% in the case of his family. Cancer, Leukaemia, Thalassemia, Tuberculosis, Paralysis, Cardiac Ailment, Pleuresy, Leprosy, Kidney Ailment, Epilepsy, Parkinson’s disease, Psychiatric Disorder, Diabetes, Hepatitis-B, Hepatitis-C, Haemophilia, Myastheniagravis, Wilson’s disease, Ulcerative Colitis, Epidermolysis bullosa, Venous Throbosis ( not caused by smoking ), Aplastic Anaemia, Psoriasis and Third Degree Burns.
13. The medical aid and reimbursement of expenses under the hospitalization scheme under this Settlement will also be available for medical treatment under the recognized systems of medicines, viz. Ayurvedic, Unani, Homoeopathy and Naturopathy if such treatment is taken in a clinic/hospital recognised by the Central/State Government. Further, reimbursement shall be limited to such expenses within the prescribed ceilings as would have been reimbursable in case the treatment was taken in a Government/Municipal hospital, subject to the overall limits under the scheme, i.e. 100% of approved expenses for self and 75% in case of family. 14. Package Charges : Some hospitals are charging on the basis of `package’ for specialized treatment for diseases pertaining to heart, kidney, coronary, etc. These package charges generally include all charges pertaining to a particular treatment/procedure including admission charges, accommodation charges, ICU/ICCU charges, monitoring charges, operation charges, anaesthesia charges, operation theatre charges, procedural charges, Surgeon’s fee, cost of disposables, cost of consumables like catheters, guide wires, etc., surgical charges and cost of medicine used during hospitalization, related routine investigations, physiotherapy charges, etc. In the following cases, package charges will be reimbursed to the extent of 100% in the case of self and 75% in the case of dependent members of family, subject to the limits specified below :- (a) Coronary Bypass Surgery Rs.1,40,000/- (b) Coronary Angiography Rs. 15,000/- (c ) Angiplasty/Stentoplasty Rs. 70,000/- (d) Kidney Transplant Rs.1,60,000/- (e) Liver Transplant Rs.2,00,000/- Note :- (i) For the above ailments, workmen employees can claim either as per schedule of expenses prescribed or package whenever the treatment is taken under package charges scheme. (ii) In the case of stentoplasty, cost of medicated stent(s), wires/balloon, Implanted during surgery may be reimbursed at the rate of 75% for family members and 100% for workman himself at rates not exceeding the rates applicable to lowest paying bed of AIIMS, New Delhi, in addition to the package charges indicated above.
(iii) Liver transplant charges are not reimbursable in cases where damage to the liver has been caused by alcoholism. 15. Reimbursement of Hospitalisation Expenses incurred on Treatment Abroad : The procedure to be followed in respect of reimbursement of expenses incurred by the workmen and their families on treatment abroad shall be as laid down in Annexure-III hereto.
ANNEXURE
-- II OPERATION
CHARGES
ANNEXURE
- III SCHEME OF REIMBURSENMENT OF EXPENSES INCURRED BY
THE WORKMEN FOR
TREATMENT ABROAD 1.
As a rule, reimbursement of expenses incurred by workmen and their family
members on treatment abroad will not be allowed. 2. In exceptional cases necessitating treatment of a kind yet to be widely
established in the country, where workment on medical advice obtained in the
manner indicated below, chooses to go on their own for treatment abroad,
permission for treatment abroad may be granted by the Board of Directors of the
bank subject to conditions laid down hereinafter and limited to the expenditure
that would have been incurred had such treatment been received in India in a
governement hospital or a nursing home speciall recognized by the Director
General of Health Services of the Governement of India. 3. The reimbursement of expenses incurred on air passage for travel abroad
in connection with such treatment will not be reimbursed. 4. Foreign exchange may be released to the workmen for the purpose of
treatment abroad to the same extent as is permissible to private citizens. 5.
Hospitals and clinics indicated in paragraph 9 below have facility for
specialist treatment for which requests are generally received for treatment
abroad and in respect of which treatment facility in ordinary hospitals may be
availed of by the eligible workmen. In such cases, reimbursement may be allowed
subject to the authority sanctioning reimbursement being satisfied about
reasonableness of the claim. 6. The following ailments have been identified as ailments for which
treatment in India is not yet widely established : i)
Cadaver Kidney Transplant; ii)
Old Operated by-pass surgery cases (in which the initial operation was
done abroad) needing revascularisation; iii)
Bone Marrow Transplant; iv)
Operative Correction for high Myopia Cases; and v)
Complex Cyanote – Heart – Lesion and newly born infants suffering
from heart diseases. 7.
Reserve Bank of India (RBI) will constitute Medical Boards at Mumbai,
Delhi, Kolkata and Chennai and at such other centers as may be considered
necessary for the purpose of recommending
whether an employee would be covered under the scheme. The annual cost incurred
on meeting of the Board by way of sitting fees, etc., shall be shared on an
annual basis by such of the banks which avail of the services of the Medical
Boards of examining cases of their workmen needing treatment abroad, in a manner
as may be decided by the RBI. The Medical Board should make a specific
recommendation and also give reasons for recommending treatment abroad. The
Medical Board will submit its
report to RBI, which in turn, could pass it on to the concerned Bank. 8. For the purposes of reimbursement, as envisaged in the scheme, the
schedule of charges as applicable for private ward treatment at the All India
Institute of Medical Sciences, New Delhi, enforced from time-to-time, should be
adopted. 9.
The following institutions have been identified as having facilities for
specialized treatment :- ii. Christian Medical College and Hospital, Vellore. iii.
K.E.M.Hospital, Mumbai. iv. Jaslok Hospital, Mumbai. v.
Bombay Hospital, Mumbai. vi.
Kasturba Hospital, Bhopal. vii.Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum. (b) Kidney Transplant : i.
Christian Medical College & Hospital, Vellore. ii.
All India Institute of Medical Sciences, New Delhi. iii.
Post Graduate Institute, Chandigarh. iv.
Jaslok Hospital, Mumbai. (c)
Blood Cancer : i.
Tata Memorial Hospital, Mumbai. ii.
Cancer Institute, Adyar, Chennai. (d)
Complicated Heart Surgery Cases : i.
Southern Railway Headquarters Hospital, Perambur, Chennai ii. Christian Medical College and Hospital, Vellore. iii. K.E.M.Hospital, Mumbai. iv. All India Institute of Medical Sciences, New Delhi.. v. Bombay Hospital, Mumbai. vi. G.B. Pant Hospital, Delhi. vii.
Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum.
viii.
Post Graduate Institute, Chandigarh. ix.
S.S.K.M.Hospital, Kolkata. x. Samaritan Hospital, Alwaye ( Kerala). xi. Kasturba Hospital, Bhopal. xii.
N.M. Wadia Institute of Cardiology, Pune. *********
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