MEDICAL REIMBURSEMENT SCHEME PROVIDING MEDICAL FACILITIES FOR SERIOUS AILMENTS / DISEASES (HOSPITALISATION)
SIIL EMPLOYEES MEDICAL ATTENDANCE , TREATMENT AND REIMBURSEMENT RULES.
1.0. SCOPE
These rules shall apply to all employees of the Sponge Iron India Limited and their family members including those on deputation or lien and other Company trainees, who are in whole time service of the Company but do not apply to (1) casual labourers (2) Contract labourers (3) persons appointed on contract basis (4) Apprentices under Apprenticeship Act
2.0. DEFINITIONS:
2.1 Family means:
a) The employee’s wife or husband, as the case may be
b) Dependent children only including -
i) Legitimate children and step –children or adopted children who are wholly dependent on the employee.
ii) Unmarried or widowed daughters wholly dependent on the employee (subject to (a) above).
iii) In case of children, the dependency ends with the taking up of employment by Son or Daughter or performance of her marriage which ever is earlier
NOTE: Employees are required to furnish a declaration regarding their family members dependent upon them at the time of their entry into service and also subsequent changes will have to be communicated in writing to the Management from time to time.
2.2 “Authorised Medical Attendant “ means chief Medical Officer of the Company ; where Chief Medical Officer of the Company is not available, a duly qualified registered medical practitioner including a Specialist/Super specialist specifically declared by the Company for the purpose, or Medical officer of the Government Hospital / Hospitals approved by SIIL, depending upon the place at which the patient falls ill.
2.3 “Qualified Registered Medical Practitioner” means –Doctors having a Bachelor’s Degree in the modern system of medicine recognised by the Indian Medical Council Act , 1956 and duly registered under the relevant law.
2.4 “Specialist “ means a Professor/Addl. Professor of a Govt. Medical College ; Civil Surgeon of the Government Hospital and such doctors as are specifically approved and notified by the Company from time to time.
2.4.1 “Super Specialist” means a Specialist with Doctorate in medicine or having the qualification of FRCS with MCH/MRCP or an American Board in respective speciality or such super specialists as are specifically approved and notified by the Company from time to time
2.5 “Medical Treatment” shall mean comprehensive medical coverage involving in – patient and specialized treatment or surgical treatment in the hospital /nursing home.
2.6 “Govt. Hospital “ includes a hospital maintained by a local authority and any other hospital with which Central /State Govt. has arrangement for treatment of Govt. Servants. Hospitals run by a railway administration, local fund authority and public sector undertakings are also covered by the definition of Govt. Hospital.
2.7 “Recognised Hospital” means all hospitals specified at 2.6 above and hospital (s) recognised by the by the Company at particular places from time to time.
2.8 “Approved Hospital “ means a hospital which the Company has approved and notified a tie-up arrangement with such hospitals for extending the medical treatment on a reference, and the bills of expenditure of such treatment shall be settled directly by the individual employee only.
2.9 “Recognised Nursing Home” means a Nursing Home/Hospital other than as indicated 2.7.,2.8 and approved by the Company only for primary level of treatment and emergency treatment.
2.10 “Referral Hospital” means a hospital where facilities are available for specialized treatment and patients are referred to such hospitals . This is subject to the condition that Chief Executive’s prior approval is to be obtained.
3.0 RATE OF REIMBURSEMENT:
3.1 Reimbursement of Medical Expenses on out-door treatment:
- Existing system of 100% reimbursement of Basic + DA per annum will be continued based on certification to meet Medical expenses for outdoor treatment, as per the existing rules.
4.0 HOSPITALISATION:
I) A committee consisting of Heads of P&A, Works, Finance and or their authorized representatives , Chief Medical Officer at Plant Office will review the cases and based on the recommendation of the Committee (which is further based on clinical investigation carried out), the cases shall be referred to recognised hospitals for specialized treatment as stated in clause 6.0 . In case of corporate office, a committee consisting of Heads of Departments of Finance, Personnel or their authorized representative and Authorised Medical consultant will review and recommend the cases for reference to recognised Hospitals.
II) The employees shall be entitled to hospitalization charges for self and family members for the following major diseases only in the Hospitals with whom SIIL has tie up.
Heart, Kidney, Cancer, Brain Tumor, Gastroenterology diseases involving surgery , treatment of eye (exclude cost of spectacles , contact lens), Ear, Orthopedic problems, Tuberculosis , Dental problems (excludes dentures , dental implant) limited to root canal and gums treatment only. Cost of pacemaker, hearing orthopedic appliances can also be reimbursed if the total reimbursement does not exceed Rs. 1.5.lakhs.
Reimbursement will also be allowed without hospitalization on case to case basis depending upon the recommendations of the Company’s Medical Consultant /Specialist Doctors and at the discretion of CMD in exceptional cases. Reimbursement can be permitted without surgery as well subject to special cases at the discretion of CMD in consultation with Medical consultant of the Company and term of specialist Doctor in exceptional cases.
III) Bed charges, food/diet charges in respect of inpatient treatment shall be borne by the concerned employee only.
IV) Operation, Medicine and investigation charges during hospitalization shall be reimbursed and the charges shall be restricted to that of NIMS, wherever NIMS Tariff is not available, Tariff is restricted to CGHS and further subject to the condition stipulated above.
V) The total expenditure on this account is limited to Rs. 1.5 lakh only (i.e. Operation , Medicine and investigation charges during hospitalization only) to be borne in full by the Company for extremely deserving and exceptional cases depending upon the recommendation on Medical Consultant of the Company specialist Doctors and at the discretion of the CMD.
5.0 LIST OF HOSPITALS:
The employees and their family members may get the in-patient treatment in the following Hospitals / Nursing Homes by the charges are restricted to those of NIMS:
1. NIMS
2. Medicity
3. Care Hospital
4. Mahavir Hospital, Red Hills, Hyderabad
5. Govt. Cancer Hospital, Red Hills , Hyderabad
6. Bibi Cancer Hospital , Malakpet
7. Singareni Collieries Co. Hospital, Kothagudem
8. Global Hospitals , Lakdikapool , Hyderabad.
Diagnostic charges before admitting the patients for inpatient treatment
should be borne by the concerned employees only.
6.0 GENERAL
6.1 The employee and their family members would be issued photo identity cards duly certified by the Sr. Mgr.(P&A) / AM(P&A) , corporate office as per the list of family members indicated by the employees in the personnel record. The cost of photo identity badges should be borne by the concerned employees only.
6.2.1 The employee and their family members advised in-patient treatment in the approved hospitals with whom SIIL has tie up must carry Admission Memo as at Annexure –1 duly signed by the Chief Medical Officer. In the absence of Chief Medical Officer, Asst. Manager (P&A) at Plant office and Asst. Manager (P&A) at Corporate Office are authorized to sign the same.
6.3. The Admission Memo shall be prepared in 6 copies . The first 2 copies will be sent to the Hospital . The third copy will be sent to Chief (F&A) , Finance Department, corporate office. Fourth copy to Administration, section at corporate office for co-ordination, fifth copy to General Manager (P&A) and the sixth copy will be retained with Chief Medical Officer
6.4. In case of emergencies and on holiday, the employee or a member of family will be admitted as in patient based on the production of photo identity badges issued for this Scheme and this will borne followed up by the Admission Memo on the next working day, to the hospital authorities .
6.5 The Hospital Authorities shall send back one copy of Admission Memo along with the proforma of the bill as in Annexure –II with the Admission Memo duly signed by the concerned employee.
6.6 Management may refer any claim to an investigation Board /Chief Vigilance officer. Till the investigation is completed, payment of such claim by the employees shall be held in abeyance . Subject to recommendations of the Board / Chief Vigilance Officer, such claim will be decided. Expenses incurred by the company in cases of misuse if any , would be recovered from the employees in one lumpsum immediately after the same is noticed.
6.7 In the event of misuse of the facilities provided under the scheme by any employee or member of his/her family the employee shall be liable for disciplinary action. Under SIIL Certified Standing Orders or SIIL conduct, Discipline & Appeal Rules, as the case may be.
6.8 In case of any doubt on any clauses in the scheme, the interpretation of the Chairman-cum-Managing Director of SIIL shall be final.
7.0 This scheme can be changed, altered, modified, amended or withdrawn by the Management at its discretion without assigning any reason subject to the approval of the Board.
7.1 The medical facilities covered by these rules are extended to the employees only as a welfare measures
7.2. Chairman-cum-Managing Director of the company is empowered to relax any of the conditions in special circumstances in deserving cases subject to such cases being informed to the Board in the subsequent meeting along with justification.
Ref. No. SI/RO/PERS/CMD/ / /2005 Dated
FROM
CHIEF MEDICAL OFFICER
SPONGE IRON INDIA
HYDERABAD
TO
THE MEDICLA SUPERINTENDENT
_____________ HOSPITAL
The patient whose particulars are given below may please be admitted in your Hospital immediately . The bill in respect of his/her hospitalization may be sent to Chief (F&A) SIIL, Khanij Bhawn, 6th Floor, Masab Tank, Hyderabad – 500 028 direct in duplicate as per annexure for payment along a copy of this Memo, after completing the details required on the reverse.
1. Name of the Patient :
2. Age of the Patient :
3. Relation with the Employee :
4. Brief details of disease and diagnosis :
5. Name of the SIIL Employee :
6. Emp. No. Division Department
7. Basic Pay of the Employee Rs.
8. Type of Accommodation :
9. Residential address of the employee:
Chief Medical Officer
Sponge Iron India Limited
Hyderabad / Paloncha
Annexure –I )(Contd…)
Annexure – (Contd…)
HOSPITAL SUPERINTENDENT,
________________ HOSPITAL,
TO
CHIEF (F&A)
SPONGE IRON INDIA LIMITED
KHANIJ BHAWAN , 6TH FLOOR
MASAB TANK
HYDERABAD – 500 028
The patient whose particulars are given on the reverse was admitted in this Hospital on __________________ and discharges on __________-. A bill for Rs. ________ (Rupees ________________ in duplicate is enclosed for payment within 15 days from today. The includes /excludes the diet charges and Medicines of food value of Rs. ________________ (Rupees ________________________________ only)
The certificate below from the SIIL employees having availed of the facilities in this hospital to which the bill relates has also been completed by him.
Signature of the Medical Supdt.
(with stamp)
Certified that I have availed of the hospital facilities in ______________Hospital from _________________ to _________________ for self /wife /son /daughter /whose name is included in family Identity card for which a bill of Rs. ________________ as stated. Certified that my Basic pay is Rs. ____________I further agree that in –admissible amount, if any, included in the bill shall be paid by me.
SIGNATURE :
NAME :
EMP. No.. :
DIVISION :
DATE :
HYDERABAD / PALONCHA
BILL FOR HOSPITALIZATION OF SILL EMPLOYEES OR THEIR FAMILY
1. Name of the Patient : Bill No.
2. Relationship to the Employee: Date:
3. Name of the SIIL Employee: Token No.
4. Emp. No. Regd.No.
5. Bed charges Ref.No.
(from __________ to _________)
6. Medicines:
7. Surgical Services
Name of the Operation
Whether Major / Minor
8. Laboratory Investigations:
9. Miscellaneous
10. Radiology
11. E.C.G.
12. Visiting charges
a) Visiting Doctor
b) Specialists
13. Diet charges and Medicines of food value:
Grand Total of :
a) Bed charges Rs.
b) Medicines Rs.
c) Surgical Services Rs.
d) Laboratory charges Rs.
e) Miscellaneous Rs.
f) Radiology Rs..
g) ECG Rs.
h) Visiting Charges Rs. ____________
_____________
Grand Total Rs. _____________ (Rupees ______________________) certified that the Medical facilities billed for ere actually extended to the beneficiary included in the bill.
Certified that I availed the certified Certified for Medical facilities
Medical facilities in ______ billed for were actually extended
Hospital from _________ to to the beneficiary enclosed in the bill
______ as shown in the bill
amounting to Rs. _______.
PATIENT SIGNATURE
(SIGNATURE)
SUPDT./SR. MEDICAL OFFICER /
ADMINISTRATOR
Passed for payment of Rs. ____________ (Rupees ______________ only)
Jr. Officer. Asst. Manager (A) Dy. Manager (Systems)