Medical attendance rules




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prior permission, the bills may be settled subject to scrutiny by

Director of Medical Educational about the entitlement.

 

18.  Medical Treatment of Government/Retired Employees and  their



dependants -Re-imbursement of Expenditure - Treatment in  Private

recognised Hospitals within and outside the State - Admissibility

of  Medical Expenditure, with 20% Cut on eligible amount  without

referral   from   Nizam's   Institute   of   Medical    Sciences,

Hyderabad/Sri   Venkateshwara  Institute  of  Medical   Sciences,

Tirupathi in cases of emergencies - Orders - Issued

 

    (G.O.Ms.No.  175, H.M. & F.W. (Kl) Dept., Dt. 28-5-1997)



 

Ref. :- 1.  G.O.Ms.No. 38, HM & FW, Dt. 23-1-1996.

 

        2.  G.O.Ms.No. 258, HM & FW, Dt. 15-6-1996.



 

        3.  From    the   President,   APNGO's    Association,

            Representation   dated 22-3-1996 and representation

            from  certain service Associations.

 

        4.  From Dir. of Medical Edn., Lr. No. (RC) 3773/MA.A/96,



            Dt. 9-10-1996.

 

Order  :-In the Government orders 1st and 2nd read  above  orders



were  issued  permitting  the State  Government  Employees,  both

serving  and  retired to secure treatment  in  Private  Hospitals

within and outside the State indicating therein that under Rule 7

of the Andhra Pradesh Integrated Medical Attendance Rules,  1972,

on a reference made by Nizam's Institute of Medical  Sciences/Sri

Venkateshwara Institute of Medical Sciences.

 

2.   In  the  reference 3rd read above the  Andhra  Pradesh  Non-



Gazetted Officer Association and some other Service  Associations

represented  that the orders issued in the Government Orders  1st

and 2nd read above are not beneficial to the employees because of

the  condition  that  the  employee  has  to  obtain  a  referral

certificate from Nizam's Institute of Medical Sciences, Tirupathi

to get treatment in Super Speciality Hospitals within or  outside

the State and requested that this stipulation be omitted.

 

3.   It  has  been  observed that a number  of  cases  are  being



referred  to  Government  for relaxation of  the  Andhra  Pradesh

Integrated Medical Attendance Rules, 1972 when the treatment  has

been obtained directly at the Private Hospitals without  referral

from   Nizam's  Institute  of  Medical  Sciences,   Hyderabad/Sri

Venkateshwara Institute of Medical Sciences, Tirupathi in view of

the serious nature of the patient and lack of sufficient time  to

obtain such referral letter from the hospitals stated above.

 

4.   After  careful consideration of this issue  in  consultation



with  the  Director  of Medical Education,  the  Government  have

decided to permit employees both serving and retired and also  to

their  dependants, to secure treatment in the  Private  Hospitals

recognised in the Government Orders 1 st and 2nd read above, when

the case is serious which required immediate treatment and  there

is  no  sufficient  time  to get  referral  letter  from  Nizam's

Institute   of  Medical  Sciences,   Hyderabad/Sri   Venkateswara

Institute  of  Medical  Sciences, Tirupathi.  All  the  competent

authorities are therefore permitted to sanction reimbursement  of

Medical   expenses  for  the  treatment  in   Private   Hospitals

recognised in the Government Orders 1st and 2nd read above  after

satisfying  themselves  that  the patient  was  admitted  in  the

hospital  in   a very serious condition and it was  an  emergency

case  and there was no sufficient time to obtain referral  letter

from   Nizam's  Institute  of  Medical  Sciences,   Hyderabad/Sri

Venkateswara   Institute  of  Medical  Sciences,  Tirupathi,   if

necessary after obtaining a certificate from the hospital to that

effect  and after obtaining copy of the case sheet. In  all  such

cases of the treatment without referral letter, a 20% cut has  to

be  imposed  on  the  eligible amount  after  getting  the  bills

scrutinised by the Director of Medical Education, Hyderabad.

 

5.   All  the  Departments  of  Secretariat  and  all  Heads   of



Departments are also informed that such cases covered under  para

4  above  need not be referred for relaxation and  the  authority

competent to sanction the medical reimbursement can sanction such

reimbursement  in the above cases also. In all other cases  where

the  competent  authority though not satisfied with  the  alleged

seriousness of the condition of the patient, but when the patient

has obtained treatment at a private hospital directly on his  own

choice  shall be referred to Government for relaxation  when  the

Heads  of  Departments consider that there is genuine  cause  for

anxiety and recommend for relaxation.

 

6.   All  Departments  of  the  Secretariat  and  all  Heads   of



Departments  are  informed that the rejected cases shall  not  be

reopened and the cases pending as on the date of this order  with

the  concerned  competent authorities may be disposed of  as  per

above order.

 

19. Medical Attendance to Government Employees/Retired  Employees



-Reimbursement  of treatment etc. incurred - Raising  of  maximum

ceiling from Rs. 50,000 to Rs. 75,000/- - Orders - Issued.

 

   (G.O. Ms. No. 161, H. M & F.W (Kl) Dept, dated 05-05-2000)



 

Ref. :- 1.  G.O. Ms. No. 170, M & H, Dept., dated 14-03-1985.

 

        2.   G.O. Ms. No. 281, H. M & F.W, Dept, dated 01-05-1989.



 

        3.   G.O. Ms. No. 184, H. M & F.W (Kl), Dept, dated  02-

             04-1992.

 

Order  :-Orders  were issued in the Government Order  third  read



above,  fixing  the maximum limit at Rs. 50,0007-  (Rupees  fifty

thousands only) to Government employees towards reimbursement  of

expenses  incurred by them on medical treatment, subject  to  the

conditions specified therein.

 

2.  The President, A.P. Retired Government Employees  Association



and  Andhra  Pradesh Non-Gazetted Officers Association  in  their

representations  fourth and fifth read above, have requested  the

Government  to  enhance  the ceiling from  Rs.  50,0007-  to  Rs.

1,50,000/-  since the cost of treatment is  invariably  exceeding

Rs. 50,000/-.

 

3.  The Pay Revision Commission, 1999 has recommended to  enhance



the  ceiling  limit  from  Rs.  50,000/-  to  Rs.  75,000/-   for

reimbursement  of  the  medical  expenses  to  State   Government

employees.

 

4.   Government  after careful examination of  the  matter,  have



decided that the maximum ceiling of Rs. 50,0007- reimbursable  to

Government  employees/  Retired employes  and  their  dependents,

towards reimbursement of medical expenditure shall be raised from

Rs. 50,0007- to Rs. 75,0007- (Rupees seventy five thousand  only)

subject to the conditions existing now. Any expenditure in excess

of  the enhanced ceiling limit of Rs. 75,0007- shall  however  be

borne  by  the Government employees/Retired Employees  and  their

dependents  themselves. However, the procedure of requirement  of

referral  letter  by  NIMS  or  SVIMS  to  obtain  treatment   in

recognised private hospitals shall be continued.

 

20.  Certain guidelines for referral of Insured Persons and their



beneficiaries  and  reimbursement  of medical bills  -  Orders  -

Issued.


 

  (G.O. Ms. No. 117, HM & FW(Q2) Department, dated 27-03-2000)

 

Note :-This Order is printed at page 237 of this book.



 

21.  Reimbursement  of expenditure for the treatment  at  private

recognised  hospitals  within  and  outside  the  State  and   at

Government  Hospitals  - Imposing of 20% cut  on  the  admissible

amount  - Scrutiny of bills by Director of Medical Education  and

by the Superintendents of Government Hospitals - Orders - Issued.

 

(G.O. Ms. No. 373, H. M. & F. W. (Kl) Dept., dated 20-10-2000)



 

Note :-This Order is printed at page 239 of this book.

 

22.  Recognition  of A.P. Super Speciality  Dental  Hospitals  as



Referral  Hospitals  for the treatment of  Government  employees,

retired  employees  and  their  dependents  -  Reimbursement   of

expenditure - Orders - Issued.

 

  (G.O. Ms. No. 38, H. M. & F. W. (Kl) Dept., dated 24-01-2001)



 

Note :-This Order is printed at page 240 of this book.

 

23. Nizam's Institute of Medical Sciences - Medical treatment  of



State   Government   Employees,  Retired  Employees   and   their

Dependents  -  Reimbursement  of  Expenditure  for  all  diseases

without referral letter, etc. - Orders - Issued.

 

   (G.O. Ms. No. 134, HM. & F.W. (Kl) Dept, dated 09-04-2001)



 

Note :-This Order is printed at page 241 of this book.



 

 

 
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