medical attendance rules · rcs(ma)rules.1970 problems no provision for rembursement for treatment...
TRANSCRIPT
![Page 1: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/1.jpg)
![Page 2: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/2.jpg)
EXISTING RULES RCS(MA)RULES,1970
RCS(MA)RULES,2008
RCS (MA) Rules, 2013
MEDICLAIM POLICY FOR EMPLOYEES APPOINTED AFTER 1-1-2004
RJO(MF) RULES 2008
AIS(MA) RULES 1954
![Page 3: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/3.jpg)
RCS(MA)RULES.1970PROBLEMS NO PROVISION FOR REMBURSEMENT FOR TREATMENT TAKEN
IN PRIVATE HOSPITAL WITHIN THE STATE.
NO PROVISION FOR REMBURSEMENT FOR TREATMENT TAKEN IN PRIVATE HOSPITAL OUTSIDE STATE THE STATE
REIMBURSEMENT OF IMPLANTS
REIMBURSEMENT OF CONSUMABLES
NO PROVISION OF TESTS & INVESTIGATIONS CARRIED OUT IN PRIVATE LABS.
![Page 4: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/4.jpg)
RCS (MA) RULES,2013 EFFECTIVE FROM 16-9-2013
APPLICABLE ON
all Government servants, appointed before 1st January, 2004
all Government servants on deputation from Central / other State Governments unless anything otherwise is provided in their terms of deputation
NOT APPLICABLE ON
Employees appointed after 1-1-2004
AIS service officers
Rajasthan Judicial service Officers
Contract employees
![Page 5: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/5.jpg)
Definations Authorised Medical Attendant1. MO of DMHS/ Approved hospital/ Referral Hospital
2. MO of attached hospital of RUHS
3. Aurved / Yunanni/ Homeopathik chikitsak of Govt, hospital attached to RAU Jodhpur & NIA jaipur
Approved hospital
Referral Hospital
Family1. Parents Max income 60001/ P.M.
2. Son Age 25
3. Daughter
Medical Attendance
Treatment
![Page 6: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/6.jpg)
Who decides
Can any body walk off
In Government Hospital
1. OPD
2. IPD
3. Investigations
4. Implants
5. consumables
![Page 7: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/7.jpg)
IMPORTANT RULES Rule 4 HBAC
RULE 5 - OPTION FOR MEDICLAIM
RULE 6
FREE MEDICAL ATTENDANCE IN GOVERNMENT HOSPITAL WITHIN THE STATE
REIMBURSEMENT OF:
ALLOPATHY DRUGS & MEDICINES (OTHER THAN NEGATIVE LIST)
AYURVEDIC &YUNAN DRUGS AS PER THE LIST
AMBULANCE CHARGES
BLOOD TRANSFUSION CHARGES
![Page 8: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/8.jpg)
HEARING AID & Other Implants
Cost wholly or partly of hearing aid or artificial limb (including cost of replacing a limb) or calipers. Cost of Implants other than specified in Appendix IX will be reimbursed as under: -
Cost of Hearing Aid Limit of reimbursement
(a) First Rs.5,000/- 100%
(b) Next Rs.5,000/- 80%
(c) Rest amount 50% of the remaining amount,subject to maximum of Rs.35,000/-
![Page 9: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/9.jpg)
• In case hearing aid equipment is required to be purchased again, in the opinion of the competent Authorised Medical Attendant or earlier equipment is beyond repairs, reimbursement would be limited to 50% of the amount as would have been admissible for first purchase as per rule (i) above.
• Consultation fee charged by the authorized medical attendant for treatment at residence of Government servant
• Auto financing scheme
• Actual cost of intra-ocular lens implantation and treatment thereto
• Cost of Subcutaneous Infusion Pump
• Cost of disposable surgical sundries used during surgical and other operations and which cannot be re-used including items of common surgical materials like gauge, I.V. Set, bandage, Leucoplast, Cotton, Crepe Bandage etc., if not supplied by the hospital.
![Page 10: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/10.jpg)
• Charges paid by the Government servants to the Rajasthan Medicare Relief Societies
• Charges paid by the Government servant to the private diagnostic centres / labs etc. installed in Government hospitals through Rajasthan Medicare Relief Societies for pathological, bacteriological and radiological tests, x-ray, MRI, CT-Scan etc., at the rates as may be approved by the Rajasthan Medicare Relief Society from time to time.
• Charges paid by the Government servant to the private diagnostic centres / labs etc. for the tests undertaken on advice of Authorised Medical Attendant, under conditions and to the extent as under: -
• (i) After obtaining NAC from Government hospital. -• (a) If the facility of that test exists in Government hospital• 100% of Government hospital rate• (b) If the facility does not exist in Government hospital• 70% of the incurred amount•
• (ii) Without obtaining NAC from Government hospital. -• (a) If the facility of that test exists in Government hospital• 80% of Government hospital rate• (b) If the facility does not exist in Government hospital• 50% of the incurred amount
![Page 11: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/11.jpg)
• Cost of implants including stents, valves, joints, pacemaker, ICD, Cochlear Implant etc., considered necessary to be implanted in the body of the patient and angioplasty / balloonplasty to the extent as may be prescribed by orders of the Government from time to time, on the advice of Medical Benefits Advisory Committee.
• Sums actually paid on account of medical attendance and treatment including charges for surgical operations.
![Page 12: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/12.jpg)
Ceilings of various Implants/ ProceduresS.No. Item Extent of Reimbursement
1 BIPAP Machine 50% of cost or Rs 40,000/ Whichever is less
2. Artificial limb 50% of cost or Rs 75,000/ Whichever is less
3. CRT-D Combo 50% of cost or Rs 3,50,000/ Whichever is less
4. Cochlear Implant 50% of cost or Rs 3,00,000/ Whichever is less
5. AICD Implant 50% of cost or Rs 2,00,000/ Whichever is less
6. CPAP Machine 50% of cost or Rs 25,000/ Whichever is less
7. MVR/AVR Rs. 95,000/-
8. Pace maker Rs. 65,000/-
9. TKR Rs.1,10,000/- each
10 CABG (on Pump) Rs. 55,000/-
11. CABG (Off Pump) Rs. 44,000/-
![Page 13: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/13.jpg)
StentsS.No. Item Extent of
Reimbursement
1. D.E. Stent 23,625/-
2. Bare metal Coronary stent 12,000/-
3. Bare metal SS Stent 10,000/-
4. Coronary angioplasty 50,000/-
5. Coronary angioplasty with baloon 55,000/-
![Page 14: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/14.jpg)
• RULE 7. Medical Attendance and Treatment to Government servant and his family in approved Hospitals, within the State.
• Rule 8 Medical Attendance and Treatment to Government servant and his family in PPP Hospitals, within the State.
• RULE 9. Medical attendance and treatment outside Rajasthan in Government hospitals: -
• RULE 10. Treatment, including specialised treatment, outside Rajasthan in hospitals other than Government hospitals
• Rule 11 Treatment in private unrecognized hospital within State.• RULE 12. Medical attendance and treatment, where both husband
and wife are employed in State Government / Autonomous Body / elsewhere, where procedure for medical reimbursement exists –
• 15. Grant of advance for medical attendance and treatment (outside/ within State): -
![Page 15: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/15.jpg)
Approved and PPP Hospital within State
OPD Registration
Medicines
Investigation - As per Appendix XVI
70% of actual
IPD Charge as per CGHS Package rates and reimbursement of 80% of the amount paid.
![Page 16: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/16.jpg)
Rule 7 Approved hospital within the StateS.No. Item Extent of Reimbursement
1 BIPAP Machine 50% of cost or Rs 40,000/ Whichever is less
2. Artificial limb 50% of cost or Rs 75,000/ Whichever is less
3. CRT-D Combo 50% of cost or Rs 3,50,000/ Whichever is less
4. Cochlear Implant 50% of cost or Rs 3,00,000/ Whichever is less
5. AICD Implant 50% of cost or Rs 2,00,000/ Whichever is less
6. CPAP Machine 50% of cost or Rs 25,000/ Whichever is less
7. MVR/AVR Rs. 95,000/-
8. Pace maker Rs. 65,000/-
9. D.E. Stent 23,625/-
10. Bare metal Coronary stent 12,000/-
11 Bare metal SS Stent 10,000/-
12 Coronary angioplasty 50,000/-
13 Coronary angioplasty with baloon. 55,000/-
![Page 17: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/17.jpg)
Other treatmentsS.No. Item Rate
1 Drugs & Medicine 90% of reimbursible drugs
2 Investigation As per Appendix XVI70% of actual
3 Operation Theater 50% Max 5,000/-
4 Anesthesia 50% Max 5,000/-
5 Doctor fees Rs. 400/- per day Max. 20,000/-
6 Room Charges As per appendix V
7 Blood Bank 75 % of appendix VI
8 Dialysis 75% ofappendix VI
9. ICU charges/ Ventilator charges Rs. 1200/- Per day
![Page 18: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/18.jpg)
Reimbursement in Unapproved Private hospital within and outside the State ( Rule 11)S.No. Item Rate
1 Drugs & Medicine 50% of reimbursible drugs
2 Investigation As per Appendix XVI50% of actual
3 Operation Theater 30% Max 3,000/-
4 Anesthesia 30% Max 3,000/-
5 Doctor fees Rs. 400/- per day Max. 20,000/-
6 Room Charges As per appendix V
7 Blood Bank 75 % of appendix VI
8 Dialysis 75% ofappendix VI
Cost of Implants As per the rates of approved hospitals
![Page 19: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/19.jpg)
Room chargesPay Slab Class of
AccommodationRate of reimbursement in Approved hospital and in PPP hospital
Rate of reimbursement in Un Approved hospital
Rs. 25000/- P.m. & above
1. Cottage Ward (AC)
2. Super Deluxe
1. 700/-2. 600/-
1. 5252. 450
Rs 14000/- to Rs.Rs.25000/-
1. Cottage ward 1. 350/- 1. 265
Rs 6600/- to Rs.Rs.14000/-
1. Rental ward of the lowest quality
1. 120 1. 90
![Page 20: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/20.jpg)
REIMBURSEMENT WILL BE LIMITED TO THE PACAGE RATES IRRESPECTIVE OF ACTUAL PAYMENT DONE BY THE EMPLOYEE / PENSIONER.
EXPENSES OF DRUGS OVER AND ABOVE THE PACKAGE WILL BE DONE. THE DRUGS USED DURING THE OPERATION ARE INCLUDED IN THE PACKAGE CEILING.
GOVERNMENT SERVANTS WILL PRESENT THEIR CLAIM TO HEAD OF OFFICE WHILE PENSIONERS WILL PRESENT THEIR CLAIM TO CONCERNING TREASURY OFFICFER FOR REIMBURSEMENT
![Page 21: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/21.jpg)
Rule 16 Purchase of Medicine
Rule 17 Claim from two sources
Rule 18 procedure to claim reimbursement – Referral cases, Above 2 lacs and above Rs 5 lacs.
Rule 19 TB and cancer
Rule 20 Govt power to issue guidelines
Rule 21 Saving clause
![Page 22: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/22.jpg)
Reimbursement claim when both Husband and wife are in Govt. Service Both appointed before 1-1-2004
One is appointed after 1-1-2004
Spouse in autonomous body
Spouse in Private organisation
![Page 23: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/23.jpg)
Admisibility of T.A. Medical attendance is not admissible at the
headquater of Govt Servant.
On reference of AMA for consultation with a specialist.
For specialised treatment in referral hospital on recommendation of Board.
T.A. to attendant
![Page 24: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/24.jpg)
Financial limitsS.No. Item Financial limit Competent Authority
1. Dependancy 6,000/- P.M. H.O.O
2. Advance to hospital
50,000/- HOO
2,00,000/- HOD
3,00,000/- Adm. Deptt.
3. Advance to Govt servant for OPD treatment
10,000/- HOO
4. Non Reimbursablemedicines
1000/- P.M. HOO
![Page 25: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/25.jpg)
Some case Studies One Government Servant was on leave. He went to
Mumbai with his family for excursion tour. He met an Road accident and was admitted to Tata Memorial hospital. An emergency operation was conducted and expenditure of Rs. 65,000/- was incurred. He came back to Jaipur after 15 days . He went to Mumbai twice for follow up check up and expenditure of 35,000/- was incurred . What will be the position of reimbursement?
![Page 26: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/26.jpg)
A Government Servant is only son of his old age parents. His father sffe5rs from cardiac arrest in a village in Sikar district. He is immediately rushed to SMS hospital. He is treated and CABG is performed. There is total Expenditure of Rs. 55,000/-. Can the Govt. Employee claim reimbursement
![Page 27: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/27.jpg)
Shri XYZ is a leading lawyer of Rajasthan High court. His annual income as per his IT return is Rs. 10 lacs. His wife is Joint Director in SIPF department. If Shri XYZ falls ill and takes treatment in Government / Approved hospital, can his wife claim reimbursement.
![Page 28: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/28.jpg)
A government employee is chronic patient of asthma. He takes regular treatment in Government hospital. One day there is sandstorm and this fellow suffers severe asthma attack. His son immediately takes him to nearest hospital i.e. Rungta hospital Malviya nagar. He is admitted and stays there for one day. The total expenditure is 17,000/-. What will be the position of reimbursement.
![Page 29: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/29.jpg)
A patient is admitted in Cardiology department in SMS. The PHOD examines him and writes on his ticket that the facility of treatment is not available in SMS hospital hence he is referred to Medanta Hospital Gurgaon. He writes a letter to Dr. Trehan for reference also. The patient is discharged and he goes to Medanta hospital. He is admitted there and treatment is done. The total expenditure is 3,50,000/-. What amount will be reimbursed.
![Page 30: MEDICAL ATTENDANCE RULES · rcs(ma)rules.1970 problems no provision for rembursement for treatment taken in private hospital within the state. no provision for rembursement for treatment](https://reader033.vdocuments.mx/reader033/viewer/2022041914/5e68d69a5ae7a743c656c1b3/html5/thumbnails/30.jpg)
Can the following be reimbursed:
Medical expenses of Son of Govt Employee studying in Nagpur for treatment taken in Govt. Hospital Nagpur
Medical Expenses of Daughter in law of Govt. Employee, if son is dependent on him.
Medical expenses of grand children who permanently reside with him.