A person who is in receipt of disablement benefit shall be entitled to medical benefit while he is in receipt of such benefit :
Provided that after the disablement has been declared as permanent disablement, the person shall not be entitled to medical benefit, if he is not otherwise entitled to such benefit, except in respect of any medical treatment which may be rendered necessary on account of the employment injury from which the disablement resulted.
103-A. Medical benefit after contribution ceases to be payable. — (1) A person on becoming an insured person for the first time shall be entitled to medical benefit for a period of 3 months provided that where such a person continues for 3 months or more to be an employee of a factory or establishment to which the Act applies, he shall be entitled to medical benefit till the beginning of the corresponding benefit period.
(2) The person in respect of whom contributions have been paid in a contribution period for not less than seventy-eight days in the said contribution period shall be entitled to medical benefit till the end of the corresponding benefit period :
Provided that in case of a person who becomes an employee within the meaning of the Act, for the first time, and for whom a shorter contribution period of less than 156 days is available, he shall be entitled to medical benefit till the end of the corresponding benefit period if the contributions in respect of him were payable for not less than half the number of days available for working in such contribution period :
Provided further that where a person suffering from any of the following diseases, before the commencement of the spell of sickness in which any such disease was diagnosed being in continuous service for a period of two years or more or where he did not have two years’ continuous service but by virtue of relaxation granted by the authority competent in this behalf, the insured person qualifies to claim extended sickness benefit, he shall be entitled to medical benefit till the end of the relevant extended benefit period :
I. INFECTITIOUS DISEASES
1. Tuberculosis
2. Leprosy
3. Chronic Empyema
4. Bronchiatesis
5. Intersitial Lung Disease
6. A.I.D.S.
II. NEOPLASMS
7. Malignant Diseases III. ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS
8. Diabetes Mellitus with proliferative retinopathy/diabetic foot/nephropathy.
IV. DISORDERS OF NERVOUS SYSTEM
9. Monoplegia
10. Hemiplegia
11. Paraplegia
12. Hemiparesis
13. Intracranial Space Occupying Lesion
14. Parkinson’s disease
15. Spinal Cord Compression
16. Myaesthenia Gravis/Neuromuscular Dystrophies V. DISEASES OF EYE
17. Immature Cataract with vision 6/60 or less
18. Detachment of Retina
19. Glaucoma VI. DISEASES OF CARDIOVASCULAR SYSTEM
20. Coronary Artery Disease
(a) Unstable Angina
(b) Myocardial infarction with ejection less than 45%
21. Congestive Heart Failure Left Right
22. Cardiac Valvular Diseases with Failure/complications
23. Cardiomyopathies
24. Heart Disease with Surgical intervention along with compli- cations.
VII. CHEST DISEASES
25. Chronic Obstructive Lung Disease (COPD) with congestive heart failure (Cor Pulmonale) VIII. DISEASES OF THE DIGESTIVE SYSTEM
26. Cirrhosis of liver with ascities/chronic active hepatitis IX. ORTHOPAEDIC DISEASES
27. Dislocation of vertebra/prolapse of intervertabral disc.
28. Non union or delayed union of fracture
29. Post Traumatic Surgical amputation of lower extremity
30. Compound fracture with chronic Osteomyelitis.
X. PSYCHOSIS
31. Sub groups under this are listed for clarification
(a) Schizophrenia
(b) Endogeneous depression
(c) Manic Depressive psychosis (MDF)
(d) Dementia XI. OTHERS
32. More than 20% burns with infection/complication
33. Chronic Renal Failure
34. Reynaud’s diseases/Burger’s disease.
(3) An insured person, whose title to medical benefit has ceased under this Regulation shall again be entitled to medical benefit from the date of his re-employment as an employee under the Act by a factory or establishment to which the Act applies, if he produces a certificate from the employer in the form which may be specified by the Director-General for the purpose. Such an insured person shall, unless he is covered by sub-regulation (2), be entitled to medical benefit till the commencement of the benefit period corresponding to the contribution period in which he is re-employed.
(4) An employer shall, on demand, issue the certificate referred to in sub-regulation (3) to an employee who has been employed by him after cessation of his previous insurable employment.
103-B. Medical Benefit to insured person who ceases to be in insurable employment on account of permanent disablement. — (1) An insured person who ceases to be in insurable employment on account of permanent disablement caused due to employment injury shall continue to receive medical benefit for himself and his/her spouse till the date on which he would have vacated the employment on attaining the age of superannuation had he not sustained such permanent disablement, if he produces a certificate from the employer/a declaration in the form which may be specified by the Director-General for the purpose.
(2) Medical benefit to retired insured persons. — An insured person who has attained the age of superannuation 4 [or retires under a Voluntary Retirement Scheme or takes premature retirement] shall be eligible to receive medical benefit for himself and his/her spouse, if he produces a certificate from the employer in the form which may be specified by the Director-General for the purpose.
(3) An employer shall, on demand, issue the certificate as referred to in sub-regulations (1) and
(2) to an employee who had been employed by him.