MASTER CIRCULAR ( 2004-05)
THE FOLLOWING AMENDMENTS/ INCLUSIONS WERE MADE TO THE MMTC MEDICAL SCHEME DURING THE YEAR 2004-05.
With the approval of the Competent Authority it was decided to amend the “MMTC EMPLOYEES’ MEDICAL ATTENDANCE AND TREATMENT RULES 1999”. The amendments are as follows:
1. The Medical Pad/ Reimbursement System for OPD presently operating ceases to exist with effect from 01/02/2004. All employees availing the Medical Pad system are required to surrender the same immediately.
2. The employees will henceforth get a lump sum towards OPD expenditure, in monthly instalments as applicable, along with their respective salary.
This reimbursement will be made on the basis of a certificate to be given by the employee on monthly basis.
3. In case of both husband and wife being employed in MMTC, the cash scheme can be availed of only by one spouse.
4. There will be no empanelled doctors(AMA’s/ Specialists) or chemists.
5. Employees will be free to seek treatment from any doctor/specialists of their choice.
6. However there would be cases, where the circumstances may warrant consideration for relaxation beyond the permissible limits- in respect of life threatening diseases requiring prolonged medication and post- operative medication for diseases like Cancer, Cardiac Bye pass/ Angioplasty, organ transplants etc. Such cases would be dealt with by a Medical Committee constituted for the purpose, consisting of the CGM(P&A)/GM(P), GM(A), GM(F) and the CMC.
Depending upon the case, the Committee may refer the case to a reputed Specialist of the field, preferably from a Govt./Empanelled Hospital, for his opinion regarding the essentiality and the likely duration of the treatment/medical expenditure, for which the relaxation is being sought, beyond the limit of lump sum payable per year. The Committee would forward the case along with their recommendations to CMD, whose decision in the matter would be final.
Persons falling in the above category should forward their cases by end March or by end September, to enable the above Committee to consider such cases every six months.
7. Officers retiring/resigning from the services of the Corporation will be paid proportionately.
8. The annual limits for cash reimbursement for MMTC employees will be as follows:
Sr.Mgr-Dy. Mgr. Rs.10,000/-
9. The employees were given an option to either avail the above mentioned CASH OPTION or the avail the OPD facility through the OPD of any Empanelled/ Government/ Recognized Hospital or through Registered Medical Practitioner holding at least MBBS or equivalent medical degree recognized by the Medical Council of India, up to a limit of Rs.15,000/- per year, and seek reimbursement of medical expenditure with proper prescription, chemist bill, clinical/ diagnostic reports etc.
The OPD Charges of the hospital / consultation charges of the doctor/ specialist will be paid as follows:
10. Purchase of medicines can be made from any chemist against prescription of the doctor. Medicines to be purchased for one month maximum against one prescription. This will be applicable for chronic diseases also.
11. The request for ‘change of option’ once exercised, can be entertained only at the beginning of the next financial year.
12. The hospitalisation will continue as per the provisions laid down in the MMTC Medical Rules, 1999 and the decisions of the Competent Authority from time to time, with respect to the same.
B. Inclusion of Day-Care Procedures under Hospitalization
The Competent Authority duly approved the inclusion of “Day Care” medical procedures under the hospitalisation facility.
Treatment under day care procedures will be subject to the following:
1. Day Care procedures will include all the surgical/medical procedures which involve a hospitalisation of less than 24 hours.
2. Admission/ hospitalisation for diagnostic purposes will not be considered as day care hospitalisation. This will be treated as OPD treatment only.
3. However diagnostic tests undertaken as part of the day care medical/surgical procedure for which admission has been taken, will be permissible.
4. Prior approval (in prescribed format) will be required to be taken for undergoing day care treatment, except in case of medical emergency. For such admission in case of medical emergency, the hospital will be required to certify the need for such admission.
5. Day care treatment in empanelled/ government hospital only will be considered under hospitalization. No relaxation will be allowed for day care treatment taken through a non empanelled hospital.