Accepting a major demand of the state employees, Haryana Government on Tuesday notified the policy for providing cashless medical services to its employees and pensioners with effect from November 30,
The scheme would be only for regular State Government employees and pensioners, said a spokesman of the Health Department,
Also, the spouses and dependents of regular Haryana Government employees and pensioners are not covered under this scheme. However, the spouse and dependents of employees and pensioners would be entitled for treatment as per the existing policy of reimbursement issued dated May 6, 2005.
A ceiling of Rs five lakh for limited cashless is fixed under the scheme.
Giving details, the spokesman said that this limited cashless medical facility would be applicable only for six life threatening conditions namely cardiac emergency, accidents, third and fourth stage of cancer, coma, brain haemorrhage and electrocution. This scheme would be applicable at all government medical colleges and government aided Medical Colleges in Haryana, all district hospitals, other health institutions of the state government and all private hospitals empanelled under the State Government.
All departments of the State Government would issue valid identity cards to their regular employees and pensioners to entitle them for availing limited cashless medical services. The pensioners would carry the Pension Payment Order (PPO) and these would be accepted as proof of identity by all the government or private empanelled health facilities for giving limited cashless service to them. Departments would link their identity cards to Aadhaar Numbers, he added.
He said that the National Informatics Centre would make available the data for identification of employees culled out from HRMS Data.
He said that a ceiling of Rs five lakh for limited cashless is fixed. If the cost of the treatment exceeds this amount, the excess amount would be paid by the employee or pensioner. This amount could later be got reimbursed from his or her department as per the entitlement and existing reimbursement policy.
The implant or device would be given in cashless mode only if the cost of the same has been fixed by the Haryana Government. The Central Government has notified the rates of cardiac stents and knee implants in 2017 and these rates would be applicable in place of Haryana Government rates, said the spokesman.
For implant or device whose cost has not been fixed by the Centre or the State Government, the employee or pensioner would make payment for the same and later get it reimbursed as per the existing reimbursement policy.
The spokesman said that it would be responsibility of the respective Head of the Department or Head of the Office to ensure payment or disposal of all the medical bills raised by the hospital providing cashless health service must be cleared within 60 days of the receipt of the bill.
In case any fake bill or duplication of claim is reported, the beneficiary or institution is liable to be penalized for major penalties under the Haryana Civil Services (Punishment and Appeal) Rules, as amended from time to time. In case any wrong bill or fake treatment is reported and confirmed, the hospital is liable for de-empanelment and it would be responsibility of the concerned department to send the case to the Health Department, added he.
For hospitals empanelled at PGI rates only, 50 per cent of treatment would be made cashless and 50 per cent of the final bill has to be paid by the beneficiary which later on may be submitted by the beneficiary to their concerned department for reimbursement under existing policy as per entitlement, he said.
The spokesman added that follow up services in OPD are not cashless. However, if there is another episode of similar life threatening conditions, the same would again qualify for cashless services.