Govt. in Memo. No. 69/K1/89-1, HM&FW, dt. 14-3-89, the authorised
Medical Attendant to hospitals on outside Govt. Hospitals have
indiscriminately referred cases to hospitals outside the State
for treatment/Surgery without referring such case in the first
instance to the Govt. Hospitals, viz., Gandhi Hospital,
Secunderabad, Osmania General Hospital, Hyderabad where such
facilities are already available for such treatment or to Nizam's
Institute of Medical Sciences, Hyderabad which is a "REFERRAL"
Hospital. On account of this the department concerned have been
placed in embrassing situation, which lead to with unnecessary
correspondence with Government.
2. Government have examined the matter carefully and direct that
all the authorised Medical Attendants should refer the cases that
come to them for treatment/ surgery to Osmania Genl. Hospital,
Hyderabad, Gandhi Hospital, Secunderabad or Nizam's Institute of
Medical Sciences, Hyderabad, of serious nature in any case they
should not refer such cases to hospitals outside when facilities
are available for such treatment/surgery in these government
Hospitals of this State while issuing the letter of advice to
Nizam's Institute of Medical Sciences, Hyderabad, they should
certify that necessary facilities are not available in their
Institutions. They should refer a case for Treatment/surgery
outside the State only in consultation with Nizam's Institute of
Medical Sciences, Hyderabad, and on obtaining a certificate that
there are no facilities available in Nizam's Institute of Medical
3. All the Medical Officers of the Hospitals, and Dispensaries
in the State should adhere to the above orders scrupulously, any
deviation of these instructions will be viewed seriously.
9. Facilities of admission and treatment to the pensioners and
their family members in Super Specialities Hospitals -
Reimbursement of medical expenditure incurred thereon
[G.O.Ms.No. 401, HM & FW (Kl), Dt. 25-6-1991]
Ref. :- 1. G.O.Ms.No. 35, M&H, Dt. 26-1-1981.
2. G.O.Ms.No. 718, M&H, Dt. 26-11-1981.
3. From the Secretary, The Hyderabad Pensioner's Association,
Hyderabad, Ref. No. 28/B/89/HPA, Dt. 28-8-1989.
4. From the Director of Medical Education,
Lr.Rc.No.l6793/MA.C/89, Dt. 4-12-1989.
Order :- In the G.Os. first and second read above, it was ordered
among other that the retired Government Employees are entitled to
free medical treatment in all the Government Hospitals in the
State and that they are not eligible to claim reimbursement of
medical expenses and for medicines purchased in the open market,
if any, on the prescription of the Government Medical Officers.
2. In the reference third read above, Secretary, the Hyderabad
Pensioners Association, Hyderabad has represented that pensioners
are likely to fall sick frequently due to their old age and
require medical attention and that due to meagre pension they
cannot afford to spend huge amounts towards medical treatment. He
has therefore requested that free medical aid, in all General
Hospitals under the control of Government and Super Specialities
Hospitals including Nizam's Institute of Medical Sciences,
Hyderabad, may be provided and necessary orders will be issued in
3. After careful examination, the Government have decided to
provide medical treatment to all retired Government Employees and
their dependents on par with serving Government Employees. In
partial modification of the orders issued in the G.Os. first and
second read above, Government hereby direct that medical
treatment provided at Nizam's Institute of Medical Sciences,
Hyderabad to the retired Government Employees and their
dependents on par with serving Government Employees who suffer
with serious ailments of the Heart, Kidney, Brain Cancer or any
other disease or Surgery for which facilities are not available
in any of the teaching hospitals in the State and for
reimbursement of the cost of the treatment including consumable
and disposable and medicines direct to Nizam's Institute of
Medical Sciences, Hyderabad subject however to a maximum limit of
Rs. 40,0007- (Rupees Forty thousand only) or as fixed by
Government from time to time as in the case of serving Government
Employees. The reimbursement shall not however, be allowed if
they have obtained treatment in any other private hospitals. The
Nizam's Institute of Medical Sciences, Hyderabad shall take up
cases only on authorisation by Authorised Medical Attendant of
any teaching hospitals as in the case of serving Govt. Employees.
The Nizam's Institute of Medical Sciences, Hyderabad shall take
up treatment direct to the pensioners upto the limit fixed by
Government subject to scrutiny of the bills by Director of
Medical Education and claim reimbursement from Government.
4. The expenditure on this account shall be met from the
concerned Office/ Department from where the Pensioner worked last
and retired on attaining the age of superannuation and shall be
debited to the "Salaries Head" as in the case of regular Govt.
5. These orders shall come into force with effect from the date
of issue of orders.
10. Nizam's Institute of Medical Sciences - Medical treatment of
Govt. Employees and their dependents - Reimbursement of
expenditure - Simplification of procedure - Orders - Issued
[G.O.Ms.No. 445, HM&FW(E2), Dt. 19-7-1991]
Ref. :-G.O.Ms.No. 609, HM&FW, Dt. 21-11-1988.
Order :-1. The Government have, for sometime, been considering
simplification of the procedure for treatment of Government
Servants at the Nizam's Institute of Medical Sciences.
The procedure has been outlined in the G.O. cited. Presently the
Ni/am's Institute of Medical Sciences is regarded as referral
hospital subject to the following conditions :-
(a) The Nizam's Institute of Medical Sciences will be a
referral hospital other than for emergencies.
(b) Referral of patients to Nizam's Institute of Medical
Sciences should be from the teaching hospital with the approval
of the Head of the Departments/Speciality concerned.
(c) The referring hospital should ensure that facilities
available in that hospital are fully utilised in the first
instance ; and
(d) The referring hospitals should refer the cases with all
details including a referral summary.
2. Under the present procedure, the teaching hospitals in the
State are referring cases of Government Servants requiring
specialised treatment to the Nizam's Institute of Medical
Sciences whenever facilities are not available with them for
treatment of various ailments. The sanction of expenditure for
treatment incurred at Nizam's Institute of Medical Sciences is
being regulated in terms of the provisions of the Andhra Pradesh
Integrated Medical Attendance Rules, 1972. These rules require
that the bills of Nizam's Institute of Medical Sciences should be
scrutinised by the Director of Medical Education before sanction
is accorded for payment by the concerned Heads of Departments.
3. The above procedure has been found to be cumbersome and there
are some cases of delay in the referral of even emergency cases
to Nizam's Institute of Medical Sciences by the teaching
hospitals. The procedure of pre-scrutiny of bills by the Director
of Medical Education is also causing delays.
4. After due consideration, it has been decided that Government
Employees or their dependants can obtain treatment at Nizam's
Institute of Medical Sciences directly for the following ailments
("earmarked categories"). In respect of these cases, referral by
a teaching hospital will not be required.
(a) Acute Mycardial Infraction (Cardiology Department)
(b) Acute renal failure (Nephrology Department)
(c) Severe cases of head and spinal injury (Neuro-Surgery
(d) Cases of Coma (Neurology Department)
5. With regard to the above earmarked categories, the following
procedure shall be followed :-
(a) The Nizam's Institute of Medical Sciences need not insist
on advance payment by the Government Servants and may commence
treatment immediately taking into account the seriousness of the
(b) The Nizam's Institute of Medical Sciences should prepare an
estimate of the approximate expenditure for the treatment and
hand it over to the concerned Government Employee who, in turn
may apply for advance to the concerned Head of Department. The
estimate of expenditure shall be calculated only with respect to
items reimbursable under the Andhra Pradesh Integrated Medical
Attendance Rules. This has to be ensured by Nizam's Institute of
Medical Sciences. After the advance is sanctioned the amount of
advance shall be made over by the Head of Department directly to
Nizam's Institute of Medical Sciences. Normally, the Head of
Department should ensure that the amount sanctioned as advance
reaches Nizam's Institute of Medical Sciences within a period of
15 days. The amount of advances drawn shall be adjusted by
preferring claims by the respective departments with the
necessary certificates and vouchers.
(c) Orders delegating powers to Heads of Departments for
drawing of advances are being issued separately.
(d) It will no longer be necessary to get the bills scrutinsed
by the Director of Medical Education. The Nizam's Institute of
Medical Sciences shall take necessary steps to scrutinise the
bills in accordance with the Andhra Pradesh Integrated Medical
Attendance Rules and forward them for payment to the Head of the
Department concerned. The bills so sent must relate only to items
of expenditure admissible under the Andhra Pradesh Integrated
Medical Attendance Rules.
(e) The Nizam's Institute of Medical Sciences must make its own
arrangements with the Government Employee concerned for payment
with regard to items of expenditure in the bill which are
inadmissible under the Andhra Pradesh Integrated Medical
Attendance Rules. Likewise, the Nizam's Institute of Medical
Sciences must make its own arrangements with the Government
Employee concerned for payment of bills in excess of Rs. 40,000/-
which is the limit for reimbursement of medical expenses incured
by a Government Servant.
6. With regard to any matter not covered by the above procedure,
the provisions of the G.O. cited shall continue to apply. In
respect of the other cases, viz., cases not falling under any of
the above earmarked categories, the existing instructions issued
in the G.O. cited will continue to be in force.
11. NIMS - Medical treatment of Govt. employees and their
dependents -Reimbursement of expenditure - Simplification of
procedure - Regarding
(Letter No. 2706/K1/92-1, HM & FW Dept, Dt. 30-1-1992)
Ref. :- G.O.Ms.No. 445, HM & FW, Dt. 19-7-91.
Order :-In the G.O. cited, orders have been issued identifying
the earmarked ailments one each in the Departments of Cardiology,
Nephrology, Neuro-surgery and Neurology of Nizam's Institute of
Medical Sciences in which the Government employees and their
dependents have been permitted to approach the Nizam's Institute
of Medical Sciences directly for the treatment without reference
from teaching hospitals in the State. It is however noticed that
the cases received from other Departments for various other
ailments, the Government employees and their dependents are
directly approaching the Nizam's Institute of Medical Sciences
for treatment i.e., other than those identified as mentioned
above and others obtaining the estimates for the treatment and
approaching the government for sanction of advance to obtain
treatment or for reimbursement for the treatment already
obtained. In the Estimation Certificates/Bills issued by the
Nizam's Institute of Medical Sciences authorities, there is no
indication as to whether or not, the ailments for which treatment
is sought for or obtained are those identified for the treatment
in Nizam's Institute of Medical Sciences as provided in para 4 of
G.O.Ms.No. 445, H.M. & F.W., Dt. 19-7-1991. In the absence of
such information, it has become necessary to enter into
correspondence with the Departments and Nizam's Institute of
Medical Sciences tO Obtain the exact position in terms of the
aforesaid orders thereby resulting in delay in settlement of
medical claims of the employees consequently a subject of
2. With a view to avoid correspondence and consequential delay in
settlement of medical claims of the Government
employees/pensioners, I am directed to request you kindly to
incorporate in the estimation certificate to be sent or on the
medical bills to be given by Nizam's Institute of Medical
Sciences to the Government employees or retired Government
employees, as the case may be, a certificate whether or not the
case is covered by the orders issued in G.O.Ms.No. 445. H.M. &
F.W., dated 19-7-91 or whether it meets the requirement
prescribed in G.O.Ms.No. 609, H.M. & F.W. dated 21-11.1988 (i.e.,
reference to Nizam's Institute of Medical Sciences from a
12. Sanction of Medical Advance for Medical treatment of Govt.
Employees and their dependants in NIMS, Hyd. for certain serious
diseases - Delegation of powers to Heads of Departments for
sanction of Advance - Orders Issued.
[G.O.Ms.No. 86, F&P, Dt. 1-6-1992]
Ref. :- 1. G.O.Ms.No. 609, HM&FW (E2), Dt. 21-11-1988.
2. G.O.Ms.No. 445, HM&FW (E2), Dt. 19-7-1991.
3. G.O.Ms.No. 184, HM&FW (Kl), Dt. 2-4-1992.
Order :-In the G.O. 1st read above, Government have issued orders
declaring Nizam's Institute of Medical Sciences as referral
Hospital subject to the following conditions :-
1. The Nizam's Institute of Medical Sciences will be a referral
Hospital other than for emergencies.
2. Reference of patients to Nizam's Institute of Medical
Sciences should be from the Teaching Hospitals with the approval
of the Head of the Department/Speciality concerned.
3. The referring hospitals should ensure that facilities
available in that hospitals are fully utilised in the first
4. The referring hospitals should refer the cases with all
details including a referral summary.
5. The patients should be clearly informed that taking up of the
case by the Nizam's Institute of Medical Sciences is dependent on
the availability of accommodation and other facilities in the
Nizam's Institute of Medical Sciences.
2. In consideration of the difficulties being experienced by the
beneficiaries and also the delay involved in setting the medical
claims, it has been decided to delegated the powers to the
concerned Heads of Departments for sanction of Medical advances
to the employees working under their administrative control in
respect of the following diseases without referral by Authorised
Medical Attendant vide orders issued in G.O. 2nd read above.
(a) Acute Myocardial In Infraction (Cardiology Department)
(b) Acute renal failure (Nephrology Department)
(c) Severe cases of head and spinal injury (Neuro-Surgery
(d) Cases of Coma (Neurology Department)
3. The medical claims of State Government Employees covered by
A.P.I.M.A. Rules, 1972 can be broadly categorised into :
(i) Claims preferred against treatment in Govt.
Hospitals/Referral Hospitals/ Recognised Hospitals.
(ii) Claims preferred against treatment in unrecognised Private
(iii) Calims preferred against treatments in NIMS who were
admitted direct without reference by the A.M.A. under emergency
circumstances to undergo treatment for the diseases noted under
Para 2 above.
4. At present in respect of the claims noted against Items (i)
and (iii) under Para 3 above, Government is vested with the
powers of sanction of medical advances to Government Employees
and their dependents towards medical expenditure incurred while
undergoing treatment for certain diseases.
5. In respect of claims preferred by the individuals either for
sanction of advance or for reimbursement of medical expenditure
incurred for treatment undergone in unrecognised Private
Hospitals the Government would not entertain such claims
6. After due consideration, it has been decided to delegate the
powers to Heads of Departments concerned for sanction of medical
advance to Government Employees and their dependents and
settlement of final bills for undergoing treatment in NIMS in
respect of cases referred to under G.O.Ms.No. 445, HM&FW (E2)
Dept., Dt. 19-7-91 subject to the following conditions :-
(a) the maximum amount should not exceed Rs. 50,000/- and the
expenditure incurred over and above Rs. 50,000/- should be borne
by the individual.
(b) The Head of the Department should ensure that the amount
sanctioned as advance shall be paid to NIMS by means of
Cheque/Draft within 15 days from the date of receipt of
estimation of the expenditure from the NIMS.
(c) The advance drawn and paid to the NIMS shall be adjusted by
preferring claims by the concerned Head of the Department within
3 months from the date of drawal of advance with necessary
certificates and vouchers prescribed in A.P.I.M.A. Rules, 1972.
(d) The claim sent by the NIMS must relate only to the items of
expenditure admissible under the A.P.I.M.A. Rules, 1972.
(e) The bills need not be sent to the D.M.E. for scrutiny and
the claim be admitted based on the admissibility certificate
issued by NIMS.
7. If a Government Servant seeks admission in NIMS vide orders
issued in G.O.Ms.No. 609, H&M, Dt. 21-11-1988 the Head of the
Department is competent to sanction advances and also the final
bill following the conditions mentioned in Para 6 above. In
addition he shall ensure that the patient is preferred to NIMS,
Hyderabad by the Authorised Medical Attendant. The A.M.A. of the
Teaching Hospitals with the approval of the Heads of the
Departments/Specialists of the Hospital alone have to refer the
cases to NIMS. Other Heads of Departments of any
mofusall/Headquarters or City Hospitals who are not the Heads of
Departments/Specialists of the Teaching Hospitals would not be
reckoned as Authorised Medical Attendants, competent to refer the
cases to NIMS covered vide order issued in G.O.Ms.No. 609, M&H,
8. Where the authority referring the cases to NIMS is not deemed
as Authorised Medical Attendant, such cases are to be referred to
Government for relaxation of A.P.I.M.A. Rules, in HM & F.W.
Dept., and Finance and Planning (FW) Department for concurrence
and for relaxation of A.P.I.M.A. Rules. The Head of the
Department is not empowered to sanction advance if relaxation of
A.P.I.M.A. Rules is involved.
9. The Government extend the facility available for Central
Government Servant wherein a member of the family can also apply
and draw the advance when the Government Servant is critically
ill and hospitalised so as the avoid inconvenience. In such cases
the wife or a legal heir of the Government Employee shall submit
an application for sanction of advance to the Head of the
Department under whom the employee is working in case the
employee is critically ill and cannot sign the application. This
facility is available to all Government Servants who avail of the
facilities in the NIMS, Hyderabad under G.O.Ms.No. 445, H.M. &
F.W. (E2) Dept, dated 19-7-1991 and G.O.Ms.No.609, H.M. & F.W.
(E2) Department, dated 21-11-1988.
10. The advance sanctioned shall be debited to the Service Head
of Account to which the' pay and other allowances of the employee
are being debited.
13. Provision of Corrective Glasses and Hearing Aids - Fixation
of limit of expenditure for reimbursement - Orders - Issued
[G.O.Ms.No. 276, HM & FW (Kl), Dt. 11-5-1993]
Ref. :- 1. G.O.Ms.No.175, HM & FW, Dt. 7-3-1990.
2. Govt. Memo. No. 2118/K1/90-1, Dt. 28-4-1990.
3. From the Director of Medical Education, Lr.No. 14845/MA B/90,
Order :-In the Government Order 1st cited above orders have been