Posts Tagged ‘medical claims’

Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Advertisement

Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS
Office of the Director, CGHS

No: Z.15025/38/2018 /DIR/CGHS

545-A Nirman Bhawan, New Delhi
Dated the 14th May, 2018

OFFICE MEMORANDUM

Subject :- Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries
With reference to the above subject the undersigned is directed to draw attention to the OM No Z 15025/79/1/DlR/CGHS dated the 5th October 2016 and to state that it has now been decided to review the timelines prescribed for processing and settlement of medical claims of pensioner CGHS beneficiaries in compliance of the directions of Hon’ble Supreme Court of India in their Judgement in the WP(CiviI) No 694 of 2015 between Shiva Kant Jha Vs UOI delivered on 13th April 2018 and in supersession of the earlier guidelines as per the details given under:

Medical Claims not requiring Special approvals

Pensioner CGHS beneficiaries shall submit the Medical claims to the CMO I/C of the CGHS Wellness Centre , where the CGHS Card is enrolled . CMO I/C of CGHS Wellness Centre issues Serial Number and sends the claim papers to the office of the Addl. Director, CGHS for processing. The Bills shall be processed by the Dealing Asstants and CMO and after the approval by the Additional Director, the bill for payment shall be sent to the Pay & Accounts Office for payment to the beneficiary by ECS. The payment shall be completed within 30 days of submission of the Medical claim papers at the CGHS Wellness Centre.

Medical claims reguiring approval of higher authorities

Total time within 45 days in Delhi
Total time within 60 days in other cities

Medical claims reguiring opinion of specialists

Total time 45 days

2. Chief Medical Officer in charge shall thoroughly check the papers initially for the completeness of the requisite documents before accepting the claim papers to ensure that the claim papers are not returned subsequently for want of some documents.

3. If approval of Directorate or Ministry is involved, the Addl. Directors shall submit only e-file with self-contained note and recommendation, enclosing only relevant scanned documents. Care shall be taken not to regret medical claims of pensioner CGHS beneficiaries on minor technical objections if , they fall under procedural lapses, which can be condoned.

Sd/-
(Dr.D.C.Joshi)
Director, CGHS

Source: cghs.gov.in

Download Central Government Employees News iOS App . Click here Cg News for iPhone, iPad & iPod Touch app to download in your device.
Stay updated on the go with CENTRAL GOVERNMENT NEWS App. Click here Cg news for Phones app to download it for your device.

Be the first to comment - What do you think?  Posted by admin - May 16, 2018 at 10:56 am

Categories: CGHS   Tags: , , , ,

Implementation of Medical Insurance scheme to Bank Retirees – IBA Circular

Implementation of Medical Insurance scheme to Bank Retirees – IBA Circular

 

Indian Banks’ Association

HR & INDUSTRIAL RELATIONS
No CIR/HR&IR/2015-16/XBPS/J/1413
October 1, 2015

To,
All Member Banks which are parties to the Bipartite Discussions

Dear Sir/ Madam,

 

Implementation of Medical Insurance scheme to Retirees as agreed vide Bipartite Settlement/ Joint Note Dated 25th May, 2015

We refer to our letter No CIR/HR&IR/2015-16/XBPS/961 dated the 29th June, 2015 in terms of which the member Banks parties to the Bipartite Discussions were advised that the medical Insurance Scheme will be extended to the existing retirees also, subject to payment of the agreed Insurance Premium by them. It was also advised to bring to the notice of the existing retirees, the contents of the said scheme and obtain their consent as to whether they are willing to join the Scheme and on receipt of their consent, the details were to be provided to the Lead Insurer i.e. United India Insurance Co. Ltd. appointed by IBA for the purpose.

2. We have been advised by M/s K.M. Dastur Reinsurance Brokers duly authorized by the Lead Insurance Company to collect the employees as well as retirees data from the Banks, that while the employees data has been received by them from the Banks, the retirees data is yet to be provided by the Banks to them. As such, the United India Insurance Co. Ltd. has calculated the premium in respect of the employees of the concerned Banks and has demanded to remit the premium accordingly to them so that Mediclaim Policy in respect of employees may be implemented preferably from 1st October, 2015.

3. In this connection, we advise that a separate Mediclaim Policy in respect of retirees will be issued on similar terms and conditions as is applicable to serving employees, once the data is provided by the Banks to United India Insurance Co. Ltd. through their authorized broker M/s K.M Dastur Reinsurance Brokers and Insurance Premium is remitted to the Insurance Co. The Insurance Premium for retirees is also same as is for serving Employees which is as under :

4. Participating Banks are therefore requested to obtain the consent of the retirees expeditiously and provide the details on prescribed format to M/s K.M Dastur Reinsurance Brokers to enable the Insurance Co. to calculate the Insurance Premium in respect of retirees of the concerned banks accordingly. To make the Mediclaim Insurance Policy operational w.e.f. 1st November, 2015 for retirees, it is suggested to inform the retirees to give their consent for joining the Scheme latest by 25th October, 2015. We have requested to Lead Insurer to allow a grace period of three months to such retirees who could not give their consent by stipulated date as suggested above to join the Scheme after Mediclaim Policy is made operational. In exceptional circumstances, to the satisfaction of the concerned Bank, the request of the retirees may be considered to join the scheme during the currency of the Policy. The Insurance company has agreed for the same.

5. It is pertinent to mention that United India Insurance Co. Ltd conducted workshops in the month of July in Mumbai, Delhi, Chennai and Bengaluru covering representatives from all participating Banks to disseminate the salient features of the Policy, benefits available to the employees/ retirees and to clear the doubts/queries raised by the participants.

6. Please, therefore, make all out efforts to operationalize. the MediclaimPolicy for retirees preferably from 1st November, 2015

Yours faithfully,

sd/-

K.Unnikrishnan

Deputy Chief Executive

Authority: www.iba.org.in

Click to view the circular

Be the first to comment - What do you think?  Posted by admin - October 9, 2015 at 11:26 am

Categories: General news   Tags: , , , , , ,

CGHS: Time limit for submission of final claims reimbursement of medical expenses

Revision of time limit for submission of final claims reimbursement of medical expenses under CS(MA) rules, 1944 – regarding.

No. S. 14025/19/2015-MS
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare

Nirman Bhagavan, New Delhi
Dated : 27th May, 2015.

OFFICE MEMORANDUM

Subject: Revision of time limit for submission of final claims reimbursement of medical expenses under CS(MA) rules, 1944 – regarding.

The undersigned is directed to refer to OM No. F. 29-40/68-MA dated 15.10.1968 in which it was laid down that submission of final claims for reimbursement of medical expenses of Central Government servants in respect of a particular spell of illness should ordinarily be preferred within 3 months from the date of completion of treatment.

2. A representation was received from National Council (Staff Side) to extend the time limit for submission of such medical bills from 3 months to 6 months. The matter was examined in the Ministry and it has been decided that the period of 3 month s for submission of medical claims be revised to 6 months. Henceforth, only the cases in which the bills are submitted after 6 months from the date of completion of medical treatment/discharge of the patient from the hospital are required to be taken up for condonation. The power of condonation of such delays and other terms and conditions woukld be same as enumerated in the OM No.S.14025/8/99/-MS dated 25.05.1999.

3. The issue with the approval of the competent authority.

(Sunil Kumar Gupta)

Under Secretary to the Govt. of India

Source : mohfw.nic.in

Be the first to comment - What do you think?  Posted by admin - June 17, 2015 at 9:46 am

Categories: CGHS   Tags: , , , , ,

BSNLMRS – guidelines for regulation of expenditure on indoor treatment – cases where no CGHS rates are prescribed for any treatment/procedure

BSNLMRS – guidelines for regulation of expenditure on indoor treatment – cases where no CG HS rates are prescribed for any treatment/procedure: BSNL Order

Admn. Section
Corporate Office
Bharat Sanchar Bhawan

BHARAT SANCHAR NIGAM LIMITED
(A Govt. of India Enterprise)

No. BSNL/Admn.I/15-3/11(Vol.II)

Dated: June 13th 2014

To
To All CGMS, BSNL
Sub: BSNLMRS – guidelines for regulation of expenditure on indoor treatment – cases where no CGHS rates are prescribed for any treatment/procedure.

Cases are referred to Corporate Office for settlement of medical claims where CGHS rates are not available. Where CGHS rates are not available, the cases are settled as per AIIMS rates. On seeking rates from AIIMS for various implants/devices and procedures, Administrative Office (H) of AIIMS has informed that the rate list of AIIMS is avaiiable on their website – www.aiims.edu I www.aiims.ac.in (link Hospital Zone-patient care service), wherever the rates of a particular disease are not available, the concerned Department/specialist doctor may be contacted [copy enclosed].
All the field units are requested to refer the rate list of AIIMS at their website and in case of non-availability of rates in the rate list they may directly refer their cases to concerned department of the AIIMS.

sd/-
(Raj Kumar Kushtwar)
Assistant General Manager (Admn.III]
Tel. No. 23037241 Fax No. 23734260

Source: bsnleuchq.com
[http://www.bsnleuchq.com/AIIMS%20rates%20(1).pdf]

Be the first to comment - What do you think?  Posted by admin - June 16, 2014 at 12:40 pm

Categories: CGHS, General news   Tags: , , , , ,