(1) All payments of .', medical expenses shall be made by the employee in the first instance. Claims for ~~ic reimbursement of medical expenses shall subsequently be submitted in the Form :.~c'iJ, annexed to these regulations duly supported by the prescription, bills, cash receipts and 'i ,.: ,.~ cash memos or any other relevant documents as may be specified by the Competent Authority from time to time.
(2) The claims for reimbursement of medical expenses should be submitted to the Competent Authority within three months from the day of completion of the treatment.
The time barred claims may be admitted beyond three months but within one year from ;::;: the date of completion of treatment if the Competent Authority Is ~tisfied in each case that ,the delay in submission of claims is for reasons beyond the control of employee.
\ (3) The Authority may reimburse charges in respect of medical attend~nce and I or treatment received by an employee or his family at a place other than his headquarters on the basi~ of satisfactory documentary proof in support of his claim provided that the ,! treatment is taken from an Authorised Medical Officer or Hospital under the control of 'I=-' the Central Government! State Government I Municipal Corporation I Municipal ;~ ':;: Committee and empanelled Nursing Homes as specified by the Authority from time to time.
(4) .The 'Competent Authority may at its sole discretion disallow claim for ~eimbursement. if it is not satisfied with the documentary proof produced by an employee In support of his or her claim..
:~...:t:.'fl' v';:'1~. 'U. j I 'No reimbursement shall be admissible in the following cases,- , .
(i) Diet Charges
(ii) Conveyance Charges, and
(iii) Charges incurred in respect ot an attendant at the hospital.
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.'~;i.. J,1.; i.~:;; , ,'-! , ~,;~t.q~,.; ,Ib ,1 ..18. -Medical benefit scheme for retired employees.-The employees shall be entitled for medi£al benefits for themselves and their spouse subsequent to their retirement on superannuation on contributory basis as per the terms and conditions of the Scheme. (Though the option once exercised shall be final, however the request to opt the medical benefits under th~ ~ulations) shall be decided on merit of each case if the son or daughter or spouse of the --' , ., t.. - , 17. Grant of advance for medical attendance and treatment and credit facilities.-
(1) The medical advance may be granted, if required, to the employees to meet the expenditure on medical attendance and treatment for themselves and the members of their families on the basis of .recommendation of the Authorised Medical Officer as per the limit and conditions from time to time.
t (2) The Medical advance is admissible for the following purpose, namely:-
(i) for in-patient treatment in a hospital/Nursing Home
(ii) as an out-patient in the cases of TB/Cancer / Chronic diseases; and
(iii) purchase, replacement, repair and adjustment of admissible artificial appliances.
;,(3) The Medical Advance may be granted on the following conditions, namely:-
(i) The duration and anticipated cost of treatment should be certified by the Medical Officer / Specialists;
(ii) .Advance can be paid in one or more installments for the same illness / injury subject to the limit prescribed from time to time;
(iii) .There is no limit with reference to number of advances payable;
(iv) In case of serious illness / accident where the employee is unable to apply for advance, the advance may be sanctioned on the application of wife or family members of the employee; a t; -(v) The advance shall be paid directly to the Hospital or Nursing Home concerned on .receipt of an estimate from the Physician or Medical Officer of Hospital or Nursing Home, as the case may be; 'and
(vi) In the case of artifidal appliances, the payment shall be made directly to the t c\') )r, supplying agency or Hospital which should supply such appliances.
., \.
;i (4) The medical ~dvance shall be adjusted in the following manner, namely:- f ,;: '1: ',Co:'
~~:1~...(1)".J I (;he advance shall be adjusted against the medical claim and the balance, if, any, from pay in one or more installments at the discretion of the Competent Authority;
(ii) , in prolonged treatment" reimbursement may continue till the concerned medical fl.'; ;:' 10 10:, officer gives the certificate that the patient no more requires treatment and advance ~)! ."'1:J;;! may be adjusted in final claim. ,
(iii) , if advance- is paid directly to Hospital, the final settlem~nt should be subml~ed by the employee within one month of discharge from hospital. Depa~r:nent of Flnanc~ ;.:;:1'~ ;~:.;ii and Accounts shall correspond with the hospital- for refund of unutllized advance, If ,\ -(iv):; ~nn~se, any negligence or default is fou~d in case ~f,adjus~m,e~t of me~ical claim, ...penal interest shall be imposed in defaulting cases besides disciplinary action.
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