An insured person who wishes to claim medical benefit shall bring his identity card to the insurance dispensary, or other hospital, clinic, mobile dispensary post or any other medical institution to which he is allotted, and claims such benefit from the Insurance Medical Officer-in-charge of the Insurance dispensary or the Insurance Medical Officer of the hospital, clinic or other institution to which he is allotted;
Provided that in case of an emergency an insured person may claim medical benefit under these rules from any insurance Medical Officer whether he is allotted to him or not.
Provided further that where an insured person is unable to attend the State Insurance dispensary, hospital, clinic, mobile dispensary post or any other medical institution to which he is allotted, the Insurance Medical Officer wi ll, on intimation being received, visit him at his residence, if he is satisfied by interrogation or other wise that the insured person can not reasonably be expected to come to the medical institution to which he is allotted;
Provided further that if the insured person or his agent fails to produce his or the insured person's identity card, as the case may be as proof of the person claiming the benefit of being an insured person the medical benefit may be refused to him.
II. SCALE OF MEDICAL BENEFIT:- The medical benefit provided under these rules shall be according to the following sca!e:- ( 1) Out-patient treatment shall be provided at a State Insurance dispensary or in manner indicated in rule 4 and shall consists of all treatment, other than the treatment involving the application of special skill or experience and shall include:-
(i) Such preventive treatment as vaccination and inoculation:
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(ii) antenatal and postnatal treatment of insured women;
(iii) the free provision of all drugs and dressing that may be considered necessary; and
(iv) provision of ce11ificates free of cost in respect of sickness, maternity, employment injury and death, required under the Employees State Insurance (General) Regulation, 1950 or under the direction or instruction issued from time to time by the Corporation.
(2) An Insurance Medical Officer shall visit an insured person at his or her residence in accordance with the second proviso to rule I 0 and in addition to all cases of confinement or miscarriage, where the insured women or the registered midwife in attendance or any other reliable person reports that attendance by a small medical practitioner is desirable.
(3) Where in the case of serious emergency or otherwise in patient treatment in a hospital is considered necessary by the Insurance Medical Officer, the case shall be admitted to the nearest hospital, which is established or specified for the purpose by the State Government.
If accommodation is available and the treatment provided for the patient shall include free maintenance and such specialist and general treatment including treatment at confinement where necessary as may be available at the general wards of the hospital to which the insured is admitted as those special investigation which are considered desiJable and for which facilities exist at the hospital or at an associated laboratory.
(4) Facilities for removal free of charge of insured persons to hospital, where necessary shall be provided by an ambulance or otherwise:-
12.CONDITION OF SERVICES OR FULL TIME INSURANCE MEplCAL OFFICER.
(I) Subject to the provisions of the Act and the rules made there under, the State Government may, subject to such conditions as may be laid down by the Corporalion appoint a suitable Medical Officer already in its - 7 service or any person possessing such medical qualification as may be laid down by the State Government in consultation with the Corporation as an Insured Med1cal Officer.
(2) An Insurance Medical Officer shall receive such salary and Non practicing allowances as may be determined by the State Government with the consent of the Corporation.
(3) An Insurance Medical Officer shall receive such allowances and at such rates as may be sanctioned from time to time for med1cal officers of the State Government in similar grades in the localities in which they are stationed. An Insurance Medical Officer shall be entitled to leave and leave salary under the leave rules which may, from time to time applicable to other similar State Government Servant.
(4) An Insurance Medical Officer shall be entitled to traveling allowance for journeys performed on official duties on the scale laid down in the State Government rules applicable to medical officer of the State Government on similar grades.
(5) Full time Insurance Medical Officer shall not undertake private pracuce.
(6) An Insurance Medical Officer shall be subject to such other condition of service as may be fixed by the State Government in consultation with the Corporation.
(7) Notwithstanding anything contained in sub-rule (2) and (6) the pay, allowances and other condition of service of the State Government be such as may be detern1ined, with the consent of Corporation by the State Government by a general or special order.
I 3. ALLOWANCES FOR OTHER INSURA CE MEDICAL OFFICER AND STAFF.
Where the State Government appoints a par-time Insurance Medical Officer on contract or a Medical Officer in it's service in addition to his duties or any other medical practitioner such medical officer or medical practitioner shall be paid such allowances as may be fixed by the State Government, with the consent of the Corporation.
--- / 8 l4.STAFF TO BE PROVIDED AT HOSPITALS AND DISPE SARlES ETC.
Each State Insurance dispensary shall be m the charge of an Insurance Medical Officer.
Provided that in cases where the concentration of insured persons residing near a State Insurance dispensary so justifies, the State Government shall in accordance with such scale and subject to such condition as may be agreed upon between the State Government and Corporation. appoint two or more Insurance Medical Officer to such State Insurance dispensary.