Delhi Electricity Regulatory Commission (Medical Attendance) Regulations, 2003

of \ GOVERNMENT OF INDIA REGISTERED No. D.L.-33002/99 \ \ EXTRAORDINARY PUBLISHED BY AUTHORITY 1l. 39 ] No.J9] '~, ~l f 12, 2003~ 21, 1924 PART IV '< VERNMENT OF THE NATIONAL CAPITAL TERRITORY OF DEWI 754 DG/2003 c ~I ?l(f)(11~ I co PART IV) DELHI GAZETTE. EXTRAORDINARY 15 Cfi. 7f. 'f.f. S. 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Short Title, Extent of Application and Commencement L These Regulations may be called the Delhi Electricity Regulatory Commission (Medical Attendance) Regulations, 2003. !I. They shall apply to all the employees of the Commission including contract employees if any, and their families but not to the Chairperson and Members of the Commission III These Regulations shall come into effect w e.f the date of publication in the official Gazette 2. Definitions In these Regulations, unless the context otherwise requires: - I. "Authorised Medical Attendant" means a medical officer/any registered medical practitioner having required minimum educational qualificatiol1s recognized as per relevant Acts/Rules ii "Commission" means Delhi Electricity Regulatory Commission III. "Controlling Officer" means Director (Administration) of the Commission or any other officer to whom such powers may be delegated by the Commission for the purpose of these Regulations iv. MFamily" means the employee's spouse, parents, unmarried sisters, minor brothers, widowed daughters, widowed sisters, children and step children (including legally adopted children) wholly dependent upon the employee as per provisions of CS (MA) Rules of Govt. of India as amended from time to time. v. "Patient" means an employee of the Commission or his family members to whom these Regulations apply and who are in need of medical attendance. vi. "Treabnent" means the use of all medical and surgical facilities available at the hospital in which the employee is treated and includes- a. The employment of such pathological, bacteriological, radiological or other methods as are considered necessary by the Authorised Medical Attendant; b. The supply of such medicines, vaccines, sera· or other therapeutic substances as are ordinarily available in the hospital and as are admissible under CS (MA) Rules; c. The supply of such medicines, vaccines, sera or other therapeutic substances not ordinarily so available as the Authorised Medical Attendant may certify in writing to be essential for recovery or for the prevention of serious deterioration in the condition of the employee except the preparations which are not medicines but are primarily foods, tonics, toilet preparations or disinfectants and expensive drugs, laxatives or other elegant and proprietory preparations as specified in the CS (MA) Rules of Govt. of India/CGHS as amer~ded from time to time; d. Such accommodation as is ordinarily provided in the hospital as per entitlement as laid down in Regulation 6; DELHI GAZETTE: EXTRAORDINARY ============================28 (PART IV e. Physiotherapy and other treatments associated with integrated system of medicine including Homoeopathy, Ayurvedic, Unani, and Sidha system; f. Such nursing as is ordinarily provided to in-patients by the hospital; and g. The specialist consultation described in these regulations but does not include diet or provisions at the request of the employee or accommodation superior to that described in Regulation 6. 3. Procedure for availing Outdoor treatment i) The officers and staff will be entitled to the reimbursement of medical expenses, for themselves and their family members including dependents with the following annual limits from April to March every financial year on production.of billslcash memos:- IS. No. Annual limitj (Rs) I Designation . I I Secretary and Directors 14,0001- I Ji. Director 11,0001- ! I Dy. Directors 9,0001- I I PO/Accounta"tiPS 6,5001- I PA, Steno, Cashier, Clerk, Driver 3,0001- ---i I ii) This annual limit is not inclusive of the expenses incurred on major tests such as MRI, CT Scan, Angiography etc. which will be reimbursable on actual basis or the limits laid down by CGHS, whichever is lower. iii) The annual ceiling amounts indicated above can be claimed on production of medical bills/cash memos as per proforma at IV) That if spouse of the employee is employed elsewhere the medical benefits for the spouse or members of the family shall be allowed only on production of a certificate by the employee from the employer of his/her spouse to the effect that no medical reimbursement is being availed by the spouse or the family members of the employee therefrom Such certificate shall be taken at the beginning of each financial year or whenever the need arises the employee shall record a certificate in this regard 4. Procedure for availing Indoor treatment i Employees ;,mdtheir dependants may take indoor treatment from the hospitals mentioned in Schedule I and the expenses incurred by the' employees In this regard will be paid by the Commission in favour of the Hospital or in case of reimbursement to the employee as the case may be, subject to admissibility and rates prescribed in the CGHS as amended from time to time. II. In case treatment ISobtained from any private hospital/nursing home (i e. other than hospitals mentioned in Schedule I) in emergency the reimbursement for such treatment will be limited to the rates prescribed in CGHS or actual expenses incurred, whichever is less 5. Advance for Medical Treatment i. The controlling officer may grant an advance to an employee to enable him/her initially to meet expenditure on Medical Attendance and treatment for himself/herself and members of his/her family in the following cases subject to production of a valid prescription and estimate by AMA: a} For indoor treatment at a recognized Hospital b} For OPD treatment in the case of TB/Cancer II The amount of advance shall not exceed 90% of the amount estimated by the treatmg AMA or demanded by such HospitaL II! The advance paid to the employee shall be adjusted against the mediC<31claim and balance, if any, shall be refunded forthwith IV. In case of following appliances, the controlling officer shall make the payment directly to the supplying agency and not to the employee a Heart Pace-Maker & replacement of the Pulse Generator b Replacement of diseased Heart-valves c Artificial Eiectronlc Larynx V. !n cases requiring prolonged Indoor treatment. the reimbursement of medical expenses may be allowed to the employees to the extent otherwise admiSSible under these Regulations and the advance already sanctioned in such cases may not be adjusted if the employee furnishes a certificate from the AMA to the effect that the patient is required to continue treatment and that the anticipated cost of future treatment will not be less than the amoun~ of advance already drawn 6. Accommodation Entitlement for various categories of officers/officials for indoor treatment will be as follows :- a Employees in the Basic Pay upto Rs. 7,500 : General Ward subject to a ceiling of Rs. 500/- per day b Employees in the Basic Pay of Rs. 7,501 to 10,5001- Semi Private Ward subject to a ceiling of Rs. 1,000/- per day c. Employees in the Basic Pay of Rs. 10,501 & above Private Ward subject to a ceiling of Rs 1.500/- per day d. Day-care (6-8 hours admission): Rs. 500/- per day (same for all categories) 7. Submission of Medical Claims The employees shall prefer final claims for reimbursement of Medical expenses in the form given at Annexure I to these Regulations within a month from the date of completion of indoor/outdoor treatment. The Doctor's Prescription, Chemist's Cash Memo, Doctors/Hospitals receipt in respect of consultations/medicines etc. (as required under these Regulations), shall be submitted alongwith the claim form; provided that the Controlling Officer may for reasons to be recorded in writing, condone the delay in submission of claims. 8. When both Husband and Wife are Government Servants In case where both husband and wife are Government Servants, they, as well as eligible dependants, may be allowed to avai~of the medical concessions according to his/her status. For this purpose, they should furnish to their respective authorities a joint declaration as to who will prefer the claim for reimbursement of medical expenses incurred on the Medical Attendance and treatment in respect of wife/husband and the children The above declaration should be submitted in duplicate and a copy of each shall be recorded in the personal file of each of them in their respective offices. This declaration shall remain in force till such time as it is revised on the express request in writing by both the husband and the wife, e g., in the event of promotion, transfer, resignation, etc., of either of the two. In the absence of such a joint declaration, the medical concessions shall be availed of by the wife and the children according to the status of husband 9. Cases where family stays outside Delhi I. Where the family of the employee does not reside at the same place where the employee is posted, they may avail of Medical treatment and the expenditure incurred on such treatment shall be reimbursed by the Commission subject to the ceilings prescribed in the Regulations. 32 DELHI GAZETIT : EXTRAORDINARY [PART IV !I. Employees or members of their families falling ill at a place other than his/her headquarters, or employees falling ill during official tours, are entitled to reimbursement of Medical expenses on the same basis as above 10 Treatment outside india I. /\n employee or dependant shall be eligible to obtain Medical treaiment outside India or as the case may be, to claim reimbursement of the cost of Medical treatment obtained outside India in accordance wittl the CS (MA) Rules/CGHS of the Govt of India II !t shall be competent for the Commission to authorise reimbursement of actual expenditure on Medical Insurance to an employee proceeding on official duty abroad as per Rules of the Gov! of India/Govi of NCT of Deihi 11. Specific cases of Reimbursement of charges I. Blood Transfusion Reimbursement of the cost of Blood and Blood Transfusion charges paid to a Gov! Institution or any other orga:lization recognised by the Gov! of India/Gov! of NCT of Delhi for s~jpoly of BloOd to patients in hospital shall be reimbursed The expenses incurred by the employees of the Commission in connection with the following type of Dental treatment obtained at Govt. hospitais/recognised/private hospitals may be reimbursed subject to the ceiling laid down in CS (MA) Rules/CGHS:- a) Extraction b) Scaling and gum treatment c) Filling of teeth (except with gold fining) d) Root Canal Treatment e) Dentures iii. Cost of Intra-Ocular Lens implantation charges a) The actual cost of Intra-Ocular Lens implantation and the treatment thereto excluding cost of spectacles shall be reimbursed to the employee. b) In the case of conventional operation for Cataract, the actual cost of spectacles, subject to ceiling as prescribed in the CGHS for correction of distant/near vision shall be admissible for reimbursement Replacement of such spectacles shall be admissible for reimbursement once in every three years provided the same is undertaken on the advice of the Authorised Medical Attendant/Specialist in the field in a Govt. Hospital. Provided that in othe( cases the cost of spectacles, contact lenses shall be reimbursed subject to the over all ceiling laid down in Regulation 3. Reimbursement of expenses for. purchase/ replacement/repair/ adjustment of '/arious artificial appliances will be made by the Commission directly to the supplying agencies in respect of the appliances as per Annexure II. Subject to the recommendations of the specialist in a Govt.!Recognised hospital for initial supply or replacement/repair the reimbj.Jrsementof cost of supply/replacement/repair of Heart Pace Maker, Pulse Generator, Artificial Heart Valves, Artificial Electronic Larynx, may be allowed subject to recommendations of AMA regarding technical specification of such device and also about periodicity of repJacementJrepair. The reimbursement will, however, be as per the specific orders of the Govt. of India/Govt. of NCT of Delhi issued from time to time. 754 D0/03-5 In the case of diseases like Poiio, where an appliance is fitted to a child, which has to be re-adjusted or replaced periodically as the child grows or the affected part improves, reimbursement of cost of boot (~hoe) in the case of such patients is permissible if certified as essential by a specialist in the concerned speciality in the hospitals Expenses incurred on the surgery and post-operative care of the donor of an organ for transplantation to an employee of the Commission or to a member of his family shall be reimbursed as per ceiling prescribed in these Regulations. 12. Ambulance Charges Ambulance charges for admission to the hospital in case of maternity or serious illness or injury shall be reimbursed In case public transport such as Taxi has been used to carry the patient in emergency or non-availability of Ambulance, actual charges paid shall be reimbursed. 13. Medical Termination of Pregnancy The expenditure incurred on medical termination of pregnancy shall be reimbursed in full provided it has been performed at Govt.lother hospitals recognized or approved under the Medical Termination of Pregnancy Act 14. Biennial Health check-up scheme Employees may at their option undergo a health check-up for self only once in two years from the recognised hospital including general health check-up, heart and other specialised consultation as may be needed. The expenditure on this will be reimbursed subject to the overall ceiling laid down in Regulation 15. Power to Review The power to review these Regu!ations shall vest with the Commission. 16. Interpretation If any question arises as to whether any service IS Included in Medical Attendance or Treatment under these Regulations as to the interpretation of these Regulations, it shall be referred to the Commission whose decision thereon shall be final. 17. Relaxation Where the Chairperson is of the view that it is necessary or expedient so to do, he may, for reasons to be recorded in writing, relax any of the provisions of these Regulations. 18. Review of the list of Hospitals The Commission may, from time to time, review the list of hospitals mentioned in Schedule I based on the performance of the hospitals and the requirement of the employees. Additions/deletions made by the CGHS will also automatically be included. 19. General a. The recognised Hospitals/Diagnostic centres will provide necessary medicines and all disposable sundries of standard quality and will not get them purchased through employees of this Commission. b. Any legal liability coming out of such service shall be dealt by the. Hospital/Diagnostic centre and it shall be their responsibility alone. c. For all matters which are not covered in these Regulations, the provisions laid 'down in the CS (MA) Rules/CGHS will be applicable. 36 DELHI GAZETIE : EXTRAORDINARY [PART IV Schedule I List of Recognized HospitalslDiagnostic Centres ~NO.I Name of the Hospital Purpose Purpose (including Cardiac &I Vascular Surgeries & Radiotherapy) CT, Colour I 4 I Col Pants Imaging Centre, A-22,I Green Paik, New Delhi Conventional Mammography, Doppler & Lab Radiology, USG & I Dr.' Anand Imaging & I : I Neurological Centre, F-24, Preet )i Vihar, Delhi r------tc--- __ --+---+- _ Greater Kailash Part-I, New,' I I, Delhi ! ,I I C r R d' I USG & If. oar ouna. : onvenlona a 10Ogy, I I 23-8, Pusa Road, New Ii i Centre, MammographyI I Delhi I I I II ! Dr. Savita Jain Arun Conventional Radiology, Centre, 0-29, Vivek Vihar, Delhi I Mammography I I i 13 Dr. Taneja Hospita! & Heart General purpose & diagnostic Centre, 113-A, New Colony, Gurgaon I Enclave, New Delhi Dharamshila Cancer Hospital & Research Centre, Vasundhara Enclave, New Delhi Diwan Chand Satyapal I : Aggarwal Imaging Research Centre, 10-8, Kasturba GandhiI Marg, New Delhi rs I USG & Mammography, Specialized Purpose-Cancer & Cancer related surgeries & I investigations, All Radiological Investigations & Nuclear Medicine I Conventional Radiology, CT & MR'I-/ i S. No. Name of the Hospital Purpose ----,, 14 Escorts Heart Institute & Specialized Purpose-Cardiology, I i Research Centre, Okhla Road, Cardiac & Vascular Surgery & related I i New Delhi - 25. diagnostic procedures , -II --- Neelam Chowk, Faridabad I-- 16 G.M.R. Institute & MRI Scan MRI I Centre, A-13, Green Park, New I Delhi 17 GMR Institute of Imaging & CT & MRI Research Centre, 35-B, Pusa Road, New Delhi 18 I Indian Spinal Injury Centre, 50-1 : Specialised & diagnostic (spinalI C, Vasant Kunj, New Delhi I injuries, diseases related to spines I and physiotherapy) 19 Indraprastha Apollo Hospital, General/all super specialty/Diagnostic i Sarita Vihar, New Delhi Purpose (except Radio Therapy) I,, I----, 20 Janta X-Ray Clinic, 48/5, Tilak Conventional Radiology, CT, MRI, Nagar, New Delhi - 18 Mammography, USG & Colour I Doppler & Lab 121 Jeevan Mala Hospital, 67/1, General & specialised purposes, New Rohtak Road, New Delhi - diagnostic (except cardiac surgery) 22 Kailash Hospital & Research General purpose & diagnostic, Non- Mehrauli Road, Gurgaon 24 Kesar Hospital, AH-II, Shalimar Specialised purpose minimum Bagh, Delhi invasive surgeries (Iaparoscopic) I 25 Mahajan Nuclear Medicine & Nuclear Medicine & Bone Bone Densitometry Centre (Sir Densitometry Ganga Ram Hospital) Rajinder . Nagar,· New Delhi i 26 Maharaja Agarsain Hospital, General & specialised purpose, , Road No. 35, West Punjabi dialysis, laparoscopic surgeries, non- Bagh, New Delhi - 26 invasive cardiac procedure etc., diagnostic (except cardiac surgery) 27 Majeeda Hospital, Jamia Diagnostic, Conventional Radiology & I Hamdard, Hamdard Nagar, New Lab Delhi 15--:- No~r-- Nameof the Hospita! i·: Purpose ~28 -·IMa-Ihotra Heart Institute and I-:·-rSpecialised purpose-cardiology, . i Medical Research Centre, 14, i i cwdiac & vascular surgery & related I Ring Road, Lajpat Nagar-IV, I i diagnostic I I New Delhi I I I i Janakpun, New Deihl . i purpose & dialysIs, non-invaSive· i I cardiac procedure, diagnostic (except : I I 'I cardiac surgery ) ! I I . I ! I Panchseel Park, New Delhi -: i Mammography, USG, Echo, Holter, : 17 i I PFT, Audiometry & Speech Therapy I I . I --.------+-:-----.----- ~--~ ..--j_---'--- ------ ---1 31 i Metro Health Care Centre (Tirath i: I CT ! I Ram Shah Hospital) Near Tis iii I Hazari, Battary Lan, New Delhi I I I l --- +---------.----.-.---.---1 --t- ..----.-~~-~--.- ~.-~-~-----ii 32 i Metro Hospital & Heart institute, I . I General & specialised purpose- I I I X-1, Sector-12, C-94, Sector-11, I i cardiology, cardiac surgery and II , Noida I I diagnostic procedures i I ! I I i ! 47, Pusa Road. New Delhi I! : 34 ! Modern Diagnostic & Research i I Conventional Radiology, CT & Lab i I Centre, 363/4, Jawahar Nagar, : i New Railway Road. Gurgaon, I: .. I i UU : I Ganga Ram Hospita! Marg, New' I I I i i Delhi I I I iii I i i i Centre (VIMHANS Campus) 1, i USG & Lab I I I Institutional i\rea, Nehru Nagar, I I I I New Delh: I ~I II ' I i Mohan Nagar, Ghaziabad i I including Non Invasive Cardiac i f ' I I' I Procedure & Diagnostic (except I Ll . I Cardiac Surgery) I I I Centre 17, NWA, Club Road, I I I Punjabi Bagh, New Delhi i I I I s. No.1 Name of the Hospital I,Purpose 39 I New Delhi Scan Institute (Sir I Ganga Ram Hospital) Rajinder I Nagar, New Delhi \' , NOIDA Diagnostic Centre, 0-41:- -+I-C-o-n-.vent~on-a-IR-a-d-io-'o-g-y&La-b--- North Delhi Path Clinic, 56-A, I : Kamla Nagar, Delhi I ---I I , North MR Scan Research MRI I Hospital) Rajinder Nagar, New I I Delhi , North Point Hospital (P) Ltd ,,3:-+-\ -L-it-ho-t-ri-p-sy------------------------- 357, Panchsheel Park, New I I Delhi I I Organ Imaging Research I :t'-C-I~&--M-R--I---------'---------- Centre, A-22, Green Park Main, ! New Delhi 41 NOIDA Medicare Centre, 16-C, Block-E, Sector - 30, Noida I CT I Diagnostic, Non Invasive o~:rdia~ \ Procedure Sant Parmanand Hospital, 18, I : Sham Nath Marg, Delhi Lab Specialised purpose for liver, renal & digestive diseases I Pushpawati Singhania Research Institute, Press Enclave Marg, Sheikh Sarai, New Delhi - 17. 48 Specialised purpose-cancer and cancer chemotherapy, radiotherapy 47 R.G. Stone, Urological Research i: Lithotripsy Institute, F-7, East of Kailash, ! New Delhi I j and I: - 5, I I 50 Santosh Medical & Dental,: General purpose & diagnostic College Hospital, 1, Ambedkar I Road, Ghaziabad I Rajiv Gandhi Cancer Research Centre, Sector Rohini, Delhi General & specialised purpose, diagnostic (except cardiac surgery) I Saral Advanced Diagnostic (P) Pitam Pura & 2, Shakti Vihar, Pitam Rura, Delhi Conventional Radiology, USG, CT, MRI & Lab I52 Satya Medical Centre, A-98/A, I: General purpose only Sector - 34, Noida I DELHI GAZETTE: EXTRAORDINARY [PART IV S.No. Name of the Hos ibU Purpose ,53, Shalimar Diagnostic Centre, AD- , 130A, Shalimar Bagh, Delhi I 54 Sidhartha Diagnostic centre,': I ' Sidharth Cat Scan Specialty, 2169, Shadi Kham Pur, Main I I Patel Road, West Patel Nagar, New Delhi , India S!')inal Injuries Centre; , ' Sector - C, Vasant Kunj, New I I 56 I Sri Ram Singh Hospital & Heart ! General purpose only I Institute B-25-26-26A, East I I 1 Krishna 'Nagar, Delhi . , I I' 57 I Thirth Ram Shah Hospital, Near I :I I Tis Hazan, Bottary Lane, Delhi I r-sa-T, Vasant Vision X-ray & Ultra : ,'conventional Radiology & USG -111 I Sound Clinic, F-9/4, Vasant I I I Vihar, New Delhi. i I I! Yashoda Hospital & Research General purpose & diagnostic I ,Centre, III-M: Nehru Nagar, I,ll Ghaziabad I , General purpose & diagnostic 1 60 I Sir Ganga Ram Hospital, I General/Specialized purpose, i 1 I Rajendra Nagar, New Delhi j' i Diagnostic (including Cardiac & II I I. I Vascular Surgeries)I ! Ii--16-1--+-! -S-u-n-d-e-r-L-al-J-a-i-n'-H-o-S-p-it-a-I,-A-S-h-O-k-lf--+-I-G-e-n-erai & Specialized purpose, I I I Vihar, Phase !!I, Delhi ,I ,! Diagnostic (except Cardiac Surgery) I Annexure-/ Delhi Electricity Regulatory Commission Reimbursement of Medical claim Name & Designation Name of the patient & reiationship Place at which patient fell ill Name of the Doctor/Hospital ! .. Consultation charges. I I No. & Dates of consultations I I No. & Dates of consultations I Cash Memo No.S No. Date I d. Cost of medicines hereby declare that the statements in the application are true to the best of my knowledge and belief and that the person for whom medical expenses were incurred is wholly dependent upon me. Signature of the Claimant List of Encls. Date