Post-Retirement Medical Benefit Facility

The officers who retire from the service of the Corporation are eligible, subject to rendering a minimum service of 15 years in IOC. Continuous service rendered in other Public Sector Organisations/ Govt. of India departments prior to joining IOC will also be considered if they have joined IOC without break in service. Prior to merger IBP was following different medical rules for their separated employees. Consequent upon merger of IBP with IOC, PRMAF Scheme of IOC(MD) will be made applicable to IBPD retired employees also w.e.f. 1.4.07. The Post-Retirement medical benefits shall however be allowed to Board level Executives (without any linkage to provision of 15 years of service) upon completion of their tenure or upon attaining the age of retirement, whichever is earlier. The scheme is on CONTRIBUTORY and VOLUNTARY basis.

1.1     Employee must fill in application in e Sambandh portal before separation.

1.2     Identity card:

          Members of the scheme will be issued Identity Cards for the purpose of undergoing treatment in nominated hospitals, separately, for self and each dependent.

A retired employee will also be issued an identity card to enable him/her to visit our office/ location.

Coverage:

        The Scheme covers the following:

• Self
• Spouse, irrespective of income. However, the retiring employee would have to submit a certificate that the spouse is not availing medical facility in cash or kind or both from any other source. However, the membership is restricted to either husband or wife where both are ex-employees of the Corporation.
• Dependent parents whose total monthly income does not exceed Rs 9000/- from various sources are considered dependent on the employee provided they stay with the employee under the same roof.
• Retired employees may be allowed to declare their parents as dependents even after retirement, provided the condition of dependency is established, as per the rules of the Corporation and after payment of contribution for additional beneficiary.
• It is mandatory to submit proof of income ceiling and proof of residing under the same roof with the employee, in respect of each parent.
• In case where option R-2A or R-3A has been exercised by the spouse, the special provision for coverage under PRMBF shall not be applicable in respect of those child(ren) who are not covered as dependent child under the scheme of PRMBF. The spouse shall, however, be eligible for medical coverage under the PRMBF Scheme upon opting for R2A/R3A rehabilitation option.
• In case of an employee who has been charge-sheeted for certain acts / omission / commission prior to the superannuation and the disciplinary proceedings is yet to commence or concluded at the time of superannuation, the employee would be allowed to be enrolled under the PRMAS at the time of superannuation. As regards the flow of medical benefits / reimbursement under PRMAS, the Disciplinary Authority after due consideration of charges, misconduct & contemplated punishment would be required to take a view, prior to the superannuation of concerned employee whether to withhold or not to withhold the PRMAS benefits or to permit only the hospitalization in case of accidents / serious sickness, as notified under the Scheme. In this connection, CO(HR)’s IOM No. DP/3/2/34 dated 20.4.04 should also be referred to while taking the decision.

Condition for dependency of children is mentioned below:   

1. a) Mentally retarded/spastic children provided it is a incurable congenital disease and is certified as incurable by a medical superintendent/CMO of a Government Hospital.

1. b) Children suffering from incurable congenital diseases with minimum 60% physical and mental disabilities and certified to be incurable by a medical superintendent/CMO of a Government Hospital. The incurable congenital diseases are listed below:

1. i) Heart / Brain damages from Birth
2. ii) A person of profound mental retardation since birth and having a mental        age below three/four years and generally being unable to learn connected speech or guard against common dangers.

iii)   Physical /mental disabilities from birth which have impaired      

      Hearing/speech/vision faculties.

1. v) AIDS by Birth

Post-Retirement Medical Benefit Facility (PRMBF) – eligibility for IOC executives appointed to Board level position in other PSUs

• As regards the case of Senior executives/Board executive of IOC who is appointed by Government to a Board level position in other PSU and the said executive superannuates from the other PSU within the lien period with IOC (maximum upto 5 years), the coverage under PRMBF scheme shall be regulated as under:

1. The executive may opt to avail post-retirement medical facilities after retirement either from IOC or from the other PSU in which he has been appointed. The option to avail IOC’s PRMBF Scheme should be received from the concerned executive within a period of six months of joining the other PSU otherwise it will be taken in irrevocable terms that the concerned has decided to opt out of IOC’s PRMBF scheme.

1. If he opts for continuing with the PRMBF scheme of IOC, then the other employer PSU (or alternatively the executive himself on behalf of the employer) must contribute the laid down percentage of his salary (BP+DA) to IOC’s PRMBF fund at the rate as prescribed by IOC from year to year for its own employees. However, if the executive decides for availing PRMBF from the other PSU, then the concerned executive shall no longer be eligible for enrolment under IOC’s PRMBF scheme.

1. The availing of the benefits under the IOC’s PRMBF scheme by the concerned executive, after his superannuation from other PSU, shall be as per the benefits /entitlement applicable to his equivalent grade in IOC (e.g. Board level of a Sch.-A PSU shall be equivalent to Board level of IOC; Director of a Sch.-B PSU shall be equivalent to ED of IOC; Managing Director of a Sch.-B PSU shall be equivalent to Director of IOC, etc.). However, in case the concerned executive reverts to IOC in his substantive post before completion of the lien period, then his benefits shall be regulated accordingly.

1. The above conditions on governing PRMBF shall also be applicable in the case of Senior executive/Board executive of IOC appointed by Government to a Board level position in other PSU and who is in continuation with the service in the other PSU even after completion of the maximum of 5 years lien period with IOC subject to the conditions laid down under (a), (b) & (c) above.

1. The coverage under the PRMBF Scheme of IOC would not be admissible if the concerned resigns from other PSU before the due date of superannuation or before the completion of tenure of the appointment in other PSU, or if termination takes place from other PSU out of any disciplinary action.

1.3          Contribution & Benefits:    

The rate of contribution (one time) and benefits w.e.f. 07.11.2012 are as under:   

Category-wise Revised One time Contribution Rates

Combined annual entitlement for members under ‘chronic option’

1.4    Additional Domiciliary entitlement for senior retired members:

1. The retired employee on crossing the age of 75 years shall be allowed additional domiciliary entitlement of 25% of the standard entitlement in their grade (rounded off to next Rs.100).

1. A further increase by 25% shall be admissible on the standard domiciliary ceiling in their grade (rounded off to next Rs.100) on crossing the age of 85 years.

1. The additional entitlement shall be made admissible from the financial year following the financial year in which the age of 75 years or 85 years is crossed by the retired member or by the spouse (in case of deceased member). The additional entitlement shall be straightway applicable for those who have already crossed the age of 75 years/ 85 years.

In case the retired employee expires after reaching 75 years / 85 years, the additional higher domicillary entitlement as was applicable shall continue in respect of the spouse and other eligible dependents.

However, if the retired employee expires before reaching 75 years / 85 years , the additional domicillary entitlement shall be applicable once the spouse or other eligible dependent of the member employee crosses the age of 75 years / 85 years.

1.5          Miscellaneous Expenses Reimbursement:

A lump-sum amount shall be admissible to the retired employees to meet their miscellaneous domiciliary treatment expenses on items like homeopathy treatment, cost of spectacles, hearing aids, travel for outstation reference, etc. as under:

Workmen   :   Rs.10,000/-  p.a.

Officers      :   Rs.15,000/-  p.a.

The above amount would be reimbursable on self-certification basis once in a financial year either in September or in March and it shall continue to be on pro-rata basis in the financial year in which the member is enrolled in the scheme.  

Self-certification :    

The domiciliary treatment expenses would be reimbursed on self-certification basis without any supporting documents twice in a financial year on completion of six months period i.e. first claim would be made after 30th September and second after 31st March in respect of each financial year. Each claim for six months period would in no case exceed 50 % of the entitled annual ceiling.

Note: In case of hospitalization at Nominated Hospitals please refer para 1.7.  

1. a) The domiciliary expenses are reimbursed based on vouchers upto the prescribed ceiling. For the purpose, the annual ceiling for domiciliary and hospitalization is combined, which operates on two FYs block basis.

1. b) The annual combined ceiling is available for domiciliary expenses, dental treatment, physiotherapy expenses, costly tests, hospitalization in nominated/non-nominated hospitals and health check up.

1. c) The carry forward and brought forward of annual combined ceiling within the block is permissible to the members. However, any un-availed combined ceiling amount in a block is allowed to be carried forward to be availed in the next block of 2 years but it should not exceed the hospitalization entitlement of previous block. Such carried forward amount shall get merged with the combined ceiling of domiciliary & hospitalization of the next block, and thereby the resultant combined ceiling is available for reimbursement against the medical expenses mentioned at (b) above.

1. d) Retired employees claiming domiciliary expenses reimbursement on self-certification basis can opt for switchover to claim the reimbursement on the basis of vouchers under the ‘chronic option’ if the retired employee, or their eligible dependants, is suffering from chronic ailment(s). The said option to switchover from ‘self-certification’ to ‘chronic-option’ or vice-versa are to be exercised on two FYs block basis (i.e. in the month of April of first FY of the two FYs block period).

With regard to the specific cases where retired employees claiming PRMBF under               self-certification category switch-over to chronic option, (on completion of two FYs block), the unutilized hospitalization entitlement of the previous block would be carried forward and get merged with the combined ceiling of domiciliary and hospitalization of the next block; and thus the said merged amount shall operate as combined ceiling available for the reimbursement against vouchers as admissible under chronic option (i.e. against medical expenses mentioned at (ii) (b) above)

The benefits under the Scheme (including combined ceiling in case of chronic option)  shall be admissible on pro-rata in the financial year in which the Officer / Workman become eligible for the Post Retirement Medical Attendance Facility.

The domiciliary treatment expenses would be reimbursed on self-certification basis without any supporting documents twice in a financial year on completion of six months period       (April-Sept.) i.e. first claim would be made after 30^th September and second (October-March) after 31^st March in respect of each financial year.  Each claim for six months period would in no case exceed 50 % of the entitled annual ceiling.

1.6          Chronic Ailments:

Patients who suffer from ailments like, Asthma, Diabetes, Parkinson’s   Syndrome/Paralysis of limbs, which are chronic in nature, are generally on medicines for long spells, involving substantial expenditure, which in some cases may go beyond their domiciliary entitlements.

                        No list of chronic ailments has been drawn. Whether an ailment is chronic in nature or otherwise, will be determined as per the certificate given by the Authorised Medical Attendant in the prescribed proforma.  

In order to give relief where the retired employee and/or eligible dependent beneficiaries enrolled under the scheme, is/are suffering from one of these ailments, which are certified .to be chronic in nature requiring long spells of continuous medical attendance, the retired employee at his option, may claim reimbursement of actual domiciliary medical expenses

duly supported by receipts/cash memos in lieu of the present practice of claiming on self-certification basis.

The claims under this provision shall be submitted once at the end of each quarter provided the claim amount is not less than   Rs. 500.

If domicillary medical claims of members who have opted for ‘chronic’ option, exceeds Rs.10,000/- (cumulatively) even before the end of quarter, the same is allowed to be claimed immediately, without waiting for the end of the quarter.

Any delay in submitting medical claims pertaining to any period of a financial year can be condoned only upto first quarter of the next financial year.  For example, if a claim of the first six months of the F.Y is not submitted by 31st December, delay can be condoned upto 30th June of the next year.  Thereafter, the validity of the claim will be deemed to have lapsed.

The “authority” to condone the delay shall be Unit/State Office/Regional Head or Divisional HR Head in Gd.H and above.  

 The procedure in this regard will be as under:

1. Once the retired employee has opted to avail relief under ‘Chronic Ailments’ for self and/or eligible dependent beneficiaries, the said option will remain valid for a block of two years from the date of exercising the option. In case of Chronic option the retired employee has to submit a Medical Certificate in original from an Authorised Medical Attendant (AMA) as per Medical Rules in the prescribed proforma. If the retired employee desires to change his option to reimbursement on self certification basis, he/she has to repeal the option by 30^th April of subsequent block year in order to claim reimbursement on self-certification basis. In other words, option would be exercised on 2-yearly block basis in all cases.

1. b) In case no option is received by 30^th April of the block year, the domiciliary entitlement shall continue to be regulated for reimbursement as per existing practice.

1. c) The medical claims for expenses on certified chronic ailment will be submitted through a separate claim form, indicating “chronic Ailment” on the top and shall not be combined with claims for other ailments. Subsequent changes/additions in the earlier prescribed medicine for chronic ailment would be processed for reimbursement, provided the revised prescription of medicine is with reference to the existing chronic ailment(s).

1. The claims for chronic ailment and/or other ailments shall be settled from the prescribed domiciliary entitlements mentioned in Para 1.3. After this entitlement is exhausted, the expenses on chronic ailments and other normal ailments shall be settled under balance available under Hospitalisation entitlement. This would be subject to the condition that reimbursement of expenses on normal ailments shall not exceed the annual ceiling laid down for domiciliary entitlement for the retired employee. Reimbursement of expenses only on treatment of certified chronic ailment (Consultation fee, prescribed diagnostics/investigations/ & prescribed medicines) shall continue to be reimbursed from the balance hospitaliation entitlement available for that financial year.  Expenses on Physiotherapy treatment as prescribed by the attending doctor would be admissible for reimbursement from out of the prescribed annual domiciliary ceiling for the treatments and limited to item-wise rates fixed for serving employees.

1. Where the retired employees have opted under the category chronic ailments, and have produced requisite certificate from the Medical Attendant, at the time of exercising their option, the prescription of the authorized Medical Attendant prescribing medicines upto a period of 6 months would be valid with permission to procure medicines upto a maximum of three months at one time, if prescribed so by the AMA. The procurement of medicines may be allowed upto a period of six months as a special dispensation in case the member is visiting abroad, if prescribed by AMA.

In cases where the retired employee visits abroad and the AMA prescribes medicines in his case for a period exceeding 3 months, the same would be allowed for reimbursement, subject to a maximum of six months.  In this regard it will be mandatory for the retired employee to enclose a copy of air ticket/boarding pass/copy of passport/visa showing the date of exit from India and the date of entry on return as a proof of having stayed abroad for the said period.

1. f) The prescribed limits on consultation fee, diagnostic / investigation charges etc. in respect of a serving employee of the same status shall be applicable in the case of retired employee.

Combined annual entitlements for members under ‘chronic option’- special provision:

1. In cases of retired employees who have opted for reimbursement of chronic ailment expenses on the basis of vouchers, the expenses on domiciliary treatment (including chronic ailment(s), dental treatment, physiotherapy expenses, costly investigations / tests, health check-up, hospitalization in non-nominated hospital would be settled against the combined entitlement (i.e. domiciliary plus hospitalization ceiling) of the retired employee.

 A table showing annual combined ceiling category-wise for retired employees (below 75 years) is shown at 1.3 for reference please.

14. In other words, the restriction that was existing on reimbursement of domiciliary expenses on normal ailments (i.e. other than chronic ailment(s) to the domiciliary ceiling, as was conveyed vide circular dated 14.7.2005, shall no more be applicable; and it will now be reimbursable within the overall combined entitlement of the block period.

1.7          Hospitalisation:                                                                                                

When admission in hospital and consequent stay is involved for treatment of sickness, the same will be treated as hospitalization.

In case the member / spouse is hospitalized it would be a pre-requisite to notify management at the earliest.

The claim for reimbursement of hospitalization expenses should be lodged within 3 months from the date of discharge from the hospital.

In respect of treatment in Nominated Hospitals :

For specified ailments: 100% reimbursement is permissible (for list of specified ailments refer point no.14)

For other than specified ailments:

All employees   :               85% of the total expenses.

(The above is only in case the expenditure exceeds the annual ceiling)

Any unavailed amount in the first year of the block can be carried forward to the next year in the same block. Similarly the amount spent in excess of financial limit during the first year be also adjusted against the combined ceilings for the first and second financial year of the two year block. 

The block years would be ending with even no. i.e. 2012-13 & 2013-14 etc. (financial year).

Any unavailed amount under hospitalization entitlement of a block can be carried forward to be availed in the next block.

All expenses on hospitalization in nominated or non nominated hospitals, domiciliary expenses on chronic ailment, costly investigation / tests / procedures, health check-up etc. are booked against the hospitalization entitlement of the employee in the order in which they are incurred/claimed.  However, hospitalization expenses in the nominated hospital  during the same year would be reimbursed / settled @ 85% for non-specified ailments and @ 100% for specified ailments.  At the end of the financial year, if any portion out of the prescribed hospitalization entitlement of that year remains unutilised, the same shall be utilized to pay the retired employee against his / her hospitalisation claim, if initially settled @ 85%.

Reimbursement for chronic ailments, costly investigations / tests / day care procedures and health check-up in a financial year shall not exceed the prescribed hospitalization annual limit of the individual.        

The post hospitalization follow-up domiciliary treatment in case of liver /kidney/bone marrow transplant/cancer and Brain Surgery treatment in a nominated hospital may be considered as hospitalization expenses for 100% reimbursement of the admissible claims without any restriction on the period of such treatment. Expenses on prospective legal donor towards prescribed tests / one time hospitalization in cases of liver / kidney / bone marrow transplantation are reimbursable within the hospitalization entitlement of the employee.  In case the hospitalization is in a nominated hospital, the expenses on prospective legal donor would be reimbursed as in the case of other than specified serious ailments / sicknesses ,i.e upto 85%.

Further, the outdoor treatment expenses in a nominated hospital for cancer treatment, not necessarily undertaken as a follow up of hospitalization/surgery, shall be kept outside the laid down domiciliary benefit ceilings without any restriction on the treatment period. Similarly, the treatment of Parkinson’s syndrome / disease, which involves prolonged continuous outdoor treatment, in a nominated hospital shall also be considered for reimbursement as in case of cancer treatment.

Follow-up treatment (including consultation fee) taken in case of Heart Surgery(including Angioplasty), in nominated hospitals may be considered as hospitalization instead of domiciliary treatment.  This facility will be available for a maximum period of 7 years from the date of discharge from hospital after first admission, as under:

In the event of repeat surgery/procedure in above cases the reimbursement of follow-up  domiciliary treatment would be admissible afresh.

The outdoor treatment expenses for Tuberculosis shall be admissible and treated at par with post-hospitalization follow up domiciliary medical attendance taken after Heart surgery in a nominated hospital. (i.e. ranging from 100% reimbursement in the first year to 60% from 4^th to 7^th year).

Any tests/investigations carried out as an outdoor patient within 30 days prior to the date of admission in a hospital and if directly connected with the surgery performed/treatment  taken subsequently, shall be considered as part of hospitalization expenses. Any consultation fee paid to the Attending Doctor while prescribing the investigations would also be considered as hospitalization charges alongwith diagnostic charges. The retired employee would, however, be required to submit along with his/her reimbursement claim, a certificate from the attending Doctor certifying that the tests/investigations carried out were directly linked with the hospitalization.               

The expense towards the test(s)/investigation(s) (inclusive of consultation fee) shall be treated as hospitalization as per the category (i.e. nominated or non-nominated hospital) wherever the surgery/treatment has been carried out.

The expense towards test(s)/investigation(s) (inclusive of consultation fee) will be considered as hospitalization but would be regulated as per provisions applicable as per the category of hospitals (i.e. nominated/non-nominated hospital) where the test(s)/investigation(s)(inclusive of consultation fee) has taken place; and

The subsequent surgery/treatment expenses shall be separately regulated as per provisions applicable as per the category of hospitals (i.e. nominated or non-nominated hospital) wherever the surgery/treatment has been carried out.

–      Post operation expenses on medicine/test/investigation prescribed by the Doctor on the discharge slip and undertaken within a period of 30 days would be considered as hospitalization expenses.       

Following provisions have been incorporated in order to regulate post hospitalization follow up domiciliary medical treatment for the ailments prescribed above :

1. Outdoor/domiciliary treatment expenses of a PRMBF member incurred in a nominated hospital on an ailment arising as consequent offshoot /side effect of one of the prescribed ailment(s), as covered above, is also to be considered as part of hospitalization expenses under the same provisions as laid down for the prescribed ailment, and regulated accordingly.

1. The attending doctor must certify that the side-effect (i.e. offshoot ailment) has arisen consequent to one of the ailments prescribed above under the extant provision of post hospitalization follow up domiciliary medical treatment.

• Above regulation shall however apply only in those cases where the retired employee has opted for claiming domiciliary treatment expenses against vouchers/bills (i.e. under chronic option) and not in respect of those who are claiming under self-certification basis.

                –      Since Dialysis requires prolonged attendance, under strict medical supervision in a hospital, it is to be treated as hospitalisation for the purpose of regulation of the medical facility.

                –      Considering the improved technique in Cataract Surgery involving insertion of Intra Ocular Lens, reimbursement of the cost of the intra-ocular lens inserted at actual not exceeding the ceiling as already defined for regular employees in the Medical Rules is allowed.

                In case of a separating employee, only hospitalisation in case of serious sicknesses as notified under the medical rules/accident is permitted till vacation of the Company owned/leased accommodation.

The following investigations/tests/procedures, if obtained as outdoor patient in a Nominated or Government Hospital, will be excluded from the domiciliary entitlement but reimbursed under hospitalization entitlement within the respective prescribed ceiling for each of them as per the existing rules:

–              Endoscopy

–              ERCP

–              Lithotripsy                                                                                                          

–              Laser Treatment*

–              Cataract

–              MRI

–              Thalium Scan

–              Colour Doppler

• Oxygen Therapy (not exceeding Rs.1500/- p.m.) Cost towards oxygen therapy and NOT expenses incurred on equipment / instrument purchased
• Diabetic Retinotherapy Procedure                                    

*Medical treatment of preventive or remedial in nature for curing the ailment and NOT cosmetic purposes (e.g. doing away spectacles/lenses or removal of scars etc.) through the use of Laser Technology will be considered for reimbursement in accordance with the provisions of PRMBF rules.

1. Health Check UP: is admissible once in a block of 2 years from out of the hospitalization entitlement of the retired employee.  The health check up will involve investigations as approved for serving officers during their initial health check up and certain other investigations considered essential due to old age and would be undertaken in any one of the nominated hospitals.  It also covers other beneficiaries enrolled under PRMBF.  However, at locations where a nominated hospital does not exist, the member shall be allowed to avail health check-up in a private hospital upto a maximum Rs.2000 per person once in the block of two years, which shall be debited from applicable hospitalization ceiling.

The list of investigations for health check has been specified separately.

MEDICAL CHECK-UP UNDER POST RETIREMENT MEDICAL BENEFIT FACILITY

1. Routine physical check-up
2. X-rays of the chest
3. Routine blood count
4. Routine blood examination
5. Routine urine examination
6. Blood sugar 2 hours after meals. A record of family history essential
7. Lipid Profile
8. Serum Creatinine
9. SGPT, SGOT & Alkaline Phosphatase
10. Electrocardiogram
11. Record of personal habits like smoking, consumption of alcohol, diet hours of work         
12. Examination of the eyes to be advised if necessary
13. Dental check up
14. Mammography (for female)
15. Pap Smear (for female)
16. Ultrasound for whole abdomen
17. Prostate Specific Antigen (PSA)
18. Hb1C (for diabetes)

The reimbursement claim would be submitted duly supported by Cash Memos/Receipt alongwith the list of investigations carried out under the Health Check up obtained from any one of the nominated hospitals.  Expenses on investigations outside the approved list (with charges) or treatment obtained on the basis of health check up will, however, be reimbursed under normal provisions, if the same is admissible.

In addition to the above a single test/investigation/procedure obtained as outdoor patient and costing Rs.1500/- and above will be excluded from the domiciliary entitlement but reimbursed against hospitalization entitlement within the prescribed ceiling for such test/investigation/procedure provided the same is undertaken in a Nominated or Government Hospital.  This being domiciliary expenditure in case of those who are claiming on self certification basis, the reimbursement is restricted to the cost of test/investigation and not on account of consultation fee paid to the Doctor who has prescribed for the same.

However, where the retired employee is claiming domiciliary medical expenses on the basis of cash receipts/vouchers, because of chronic ailment(s), tests/investigation costing above Rs.1500/- should necessarily be prescribed in one of the nominated hospitals for which admissible consultation charges shall also be reimbursable.  Consultation obtained from a Doctor outside the nominated hospital cannot be viewed as consultation from the nominated hospital.

 Any grouping of the tests/ investigations/procedures would not be admissible for this purpose.

The cost of artificial limbs/prosthesis in case of amputation will also be reimbursed as a part of hospitalization expenses within the prescribed hospitalization entitlement.

The above reimbursement is subject to the following conditions:

Whenever in a financial year the facility of hospitalization has been earlier availed in a hospital other than a Nominated Hospital, the financial limit as laid down applies unless the

member refunds the expenditure incurred during that financial year on hospitalisation in non-Nominated hospitals.

However, in case where urgent treatment is taken in emergency in a nominated for a specified ailment, in such case refund of reimbursement of expenditure incurred earlier during that financial year on hospitalization in non-nominated hospital(s) may not be insisted upon.  However, in order to regulate the said reimbursement made earlier on account of hospitalization expenses in non-nominated hospital(s) during that financial year, the same shall stand recoverable from the member, which may be recovered/adjusted from the future payments to the concerned.

If the treatment is taken in a non-nominated hospital, the rates will be restricted to Model Hospital rates.

Since the provision for refund of the hospitalization expenses incurred in a non-nominated hospital applies upon obtaining hospitalization in a nominated hospital in that financial year only, the retired employee would be entitled to obtain hospitalization in a nominated hospital in the second year of the Block without any refund by him of expenses reimbursed to him in the first year of the Block.  

Unutilised hospitalization entitlement brought forward or carried forward to the next year as per laid down provision, is admissible for hospitalization expenses  only and does not cover treatment obtained as outdoor patient, though they are reimbursed against hospitalization.

However, in cases of those members under ‘chronic option’, the hospitalization expenses incurred in a non-nominated hospital by a member under ‘chronic option’, irrespective of the ailment, shall not be needed to be refunded if the member is further hospitalized in a nominated hospital during the same financial year.

Note:

The benefit under the Scheme (other than hospitalization for serious sicknesses as notified under the medical rules/accident) shall be available only upon employee’s handing over peaceful possession of Corporation Accommodation.

Treatment in other than Nominated Hospitals:

Treatment in other than nominated hospitals is regulated as per the ceiling limits given under 1.3

1.8          Life Certificate:

Each retired employee shall be compulsorily required to submit a life certificate in the month of November every year on self certification basis in respect of self, spouse and any other dependent family member if availing benefit under PRMBF. In the event of death of the retired employee, his/her spouse would submit the life certificate. Life Certificate can be uploaded on e-Sambandh portal or can be submitted manuaaly in the attached format

Life Certificate is required in November every year before processing the reimbursement claims of PRMBF members.  In case medical bills pertaining to a block year / financial year is claimed for reimbursement in the subsequent financial year then the same shall be processed for payment only after submission of life certificate in the subsequent financial year.

ANNEXURE

LIFE CERTIFICATE

(Self Certification for Post Retirement Medical Benefit Facility)

(Life Certificate to be submitted in the month of April every year in respect of self, spouse and any other eligible dependant family member)

1. I am an ex-employee (Emp. No. __________) and I am a member of PRMBF.

2. I am     spouse     of     Late Mr./Mrs.___________________________ (Emp. No.___________) who was a member of PRMBF and request that the payment under PRMBF may be continued to be paid to me.

3. I, hereby certify that – (Please tick wherever applicable)

4. The details of my spouse/dependent family members are as under-

________________________

Name & Signature/Thumb Impression

of applicant

Address     :                   _________________________________________________

                                             _________________________________________________

                                             _________________________________________________

Telephone/Mobile No. :  __________________________________________________

email id :                          _________________________________________________