UTTAR PRADESH GOVERNMENT SERVANTS (MEDICAL ATTENDANCE) (FIRST AMENDMENT) RULES, 2014

PREAMBLE

In exercise of the powers conferred by the proviso to Article 309 of the Constitution, the Governor is pleased to make the following rules with a view to amending the Uttar Pradesh Government Servants (Medical Attendance) Rules, 2011(2011-LLT-V-266[142]).

Rule 1. Short title and commencement.-

(1)     These rules may be called the Uttar Pradesh Government Servants (Medical Attendance) (First Amendment) Rules, 2014.

(2)     They shall come into force at once.

Rule 2. Amendment of Rule 3.-

In the Uttar Pradesh Government Servants (Medical Attendance) Rules, 2011, hereinafter referred to as the said rules, in Rule 3, for existing clauses (f) and (i) the following clauses shall be substituted, namely-

'(f) "family" means-

(i)       Husband or wife as the case may be, of the member of the service; and 

(ii)      The parents, children, step-children, unmarried/divorced/separated daughter, unmarried/divorced/separated sisters, minor brother(s) and step mother; who are wholly dependent on the Government Servant and are normally residing with the Government Servant

Note 1.-Such members of a family will be considered wholly dependent whose income from all sources does not exceed the sum of Rs. 3500 and the D.A. admissible on the basic pension of Rs. 3500 per month at the time of the commencement of the treatment.

Note 2.-The age limit for the dependents would be as follows:

(1)     Son - Till the time he is employed or attained the age of 25 years or till he is married, whichever is earlier.

(2)     Daughter- Till the time she is employed or she is married, whichever is earlier.

(3)     Son who is suffering from permanent mental or physical disability - Till lifetime.

(4)     Dependent and divorced/separated from husband/widow daughters and dependent unmarried/divorced/separated from husband/widow sisters - Till lifetime.

(5)     Minor brothers - Till he attains majority

(i)       (I) "Government Hospital" means a Hospital run either by State Government or Central Government or associated to any Government Medical College;

(ii)      "Authorized Contracted Hospitals" means such hospitals which are contracted by the State Government to provide treatment at par with the rates of the CGHS (Centralised Government Hospital Services);

Rule 3. Substitution of Rule 4.-

In the said rules, for existing Rule 4 the following rule shall be substituted, namely-

"4.   Entitlement of free medical services-All beneficiaries shall be entitled to free medical attendance and treatment in Government Hospital or Medical College or Authorised Contracted Hospitals. Ordinarily, this facility shall be provided at the place of residence or posting of the beneficiary. Registration fee and other prescribed fees for medical attendance and treatment shall be reimbursed fully by the Government. Ambulance shall also be provided free of charge in urgent/emergent cases, if the circumstances so require."

Rule 4. Amendment of Rule 6.-

In the said rules, in Rule 6 for existing sub-rule (a) the following sub-rule shall be substituted, namely-

"(a) Free medical treatment shall be available to a beneficiary only when he/she produces the proof of his/her identity through a numbered health card issued under the signature and seal of the Head of Office on pro forma given in Appendix A. The photograph on the card shall be so stamped with official seal that it covers the photographs and the card partially:

Provided that for a pensioner the designation, place of posting, basic pay and pay scale shall relate to his/her last posting before his/her retirements/death but the health card will be issued by the Head of the Office of his/her serving department located at the place from where he/she is drawing pension or residing.

In future the Government may stepwise issue U.P. Health Service Identity Card (Smart Card) in place of Health Certificate."

Rule 5. Amendment of Rule 7.-

In the said rules, in Rule 7, for existing sub-rule (a) the following sub-rule shall be substituted, namely-

"(a) In case of indoor treatment in a Government Hospital or Medical College or Authorised Contracted Hospitals all beneficiaries shall be provided the following accommodation free of cost:

Provided that last basic pay drawn by pensioner shall be taken as basic pay for determining entitlement. However, a pensioner shall be entitled for services not inferior to the ones that he/she has been getting just before retirement;

Provided further that in case a beneficiary is provided better accommodation facilities than the actual entitlement on request, he/she shall have to bear the additional expenses.

Note.-For indoor treatment in Authorised Contracted Hospitals the criteria for entitlement of ward would be based on the limits of the Basic Pay + Grade Pay as applicable to Government servants covered under the CGHS rates of Government of India in such hospitals."

Rule 6. Substitution of Rule 10.-

In the said rules, for existing Rule 10 the following rule shall be substituted, namely-

"10. Treatment in SGPGI/KGMU/Government Medical Colleges.-

Beneficiary on payment may get treatment in Sanjay Gandhi Post Graduate Institute of Medical Sciences and Research (SGPGIMS), Lucknow, K.G.M.U., Lucknow and Government Medical College without reference. The expenditure on medical attendance or treatment shall be wholly reimbursable on submission of claim in prescribed manner.

In addition to above, the treatment can be obtained with reference against payment from the Authorised Contracted Hospitals. The expenses incurred on medical care or treatment under the prescribed rules will be fully reimbursable on submission of the claim."

Rule 7. Substitution of long heading of Part III.-

In the said rules, after Rule 10, for the existing long heading "Part III Treatment in Emergency on Tour and Specialized Treatment", the long heading "Part III Treatment in Emergency and on Tour and Specialized Treatment" shall be substituted.

Rule 8. Substitution of Rule 11.-

In the said rules, for existing Rule 11, the following rule shall be substituted, namely-

"11. Treatment in Urgency/Emergency-A beneficiary is permitted to get treatment in a private hospital or authorised Contracted Hospitals in urgent/emergent condition or on tour within State or outside. The cost of treatment shall be reimbursable at the rates of Sanjay Gandhi Post Graduate Institute of Medical Sciences and Research (SGPGIMS), Lucknow in case of treatment within the State or All India Institute of Medical Sciences, New Delhi in case of treatment outside the State and in case of treatment in Authorised Contracted Hospitals, the cost of treatment shall be reimbursable at the rates of C.G.H.S. provided:

(a)      The treating doctor certifies the urgency/emergency.

(b)      The patient or his relative informs the Head of Office as soon as possible but not later than thirty days from the date of the commencement of treatment.

(c)      In case of emergency, the expenditure on air ambulance shall also be admissible for reimbursement."

Rule 9. Substitution of Rule 12.-

In the said rules, for existing Rule 12, the following rule shall be substituted, namely-

"12. Treatment on tour-The Government Servants on official duty or for personal work during tour to other states shall be entitled for medical attendance and treatment in the Government hospital or authorised contracted hospital of the concerned State and the actual expenses incurred thereon shall be wholly reimbursable:

Provided that the expenditure incurred on treatment in medical colleges, institutes or private hospitals shall be reimbursable at the rate of All India Institute of Medical Sciences (A.I.I.M.S.) and treatment in authorised contracted hospital shall be reimbursable at the CGHS rates.

It is expected from the Government servants that they should obtain the travel and health insurance police while on official tour to foreign country so that in case of requirement they can get the benefit of medical treatment during the foreign tour. The insurance premium on the travel and health insurance policy can be reimbursed in the TA bill along with the ticket but under no circumstances any medical reimbursement shall be sanctioned by the State Government separately. The cost of medical treatment would not be reimbursable on foreign tour for personal work."

Rule 10. Amendment of Rule 13.-

In the said rules, in Rule 13 for existing sub-rule (a) and (b) the following sub-rule shall be substituted, namely-

"(a)  For the treatment of complicated and serious ailments for which medical facilities are not available at the Government hospitals or referring institutions, the treating doctor not below the rank of Professor or Head of the Department of referring institution or Chief Medical Superintendent of the Government District Hospital or Chief Medical Officer of the District may refer the patient to a private hospital or institution recognized by the State or Central Government for specialized treatment and medical attendance.

(b)   The reimbursement of the expenditure on treatment in such private hospital or institution shall be limited on the actual expenditure or the rates of S.G.P.G.I.M.S., Lucknow for treatment within State or the rates of All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi for treatment outside the State, whichever is less.

The expenditure incurred on referral cases to authorized contracted hospitals shall be reimbursed at the CGHS rates."

Rule 11. Amendment of Rule 15.-

In the said rules, in Rule 15 for existing sub-rule (e) and (i) the following sub-rules shall be substituted, namely-

"(e) In case of continuous treatment of the disease, second advance may be sanctioned subject to the condition that the earlier sanctioned advance is adjusted by presenting a partial claim, taking into consideration the specific conditions, on the advice and recommendation of the attending doctor.

(i)       If the treatment has not started after sanction of the medical advance, the refund of such advance has to be made in three months and if the refund of such advance is not made within a period of three months, the punitive interest shall also be imposed which will be 2.5% more than the normal rate of interest as applicable in Provident Fund."

Rule 12. Amendment of Rule 19.-

In the said rules, in Rule 19 for existing sub-rule (a), the following sub-rule shall be substituted, namely-

"(a) Competent authority for technical examination shall be as follows:

Rule 13. Substitution of Rule 20.-

In the said rules, for existing Rule 20 the following rule shall be substituted, namely-

"20. Sanctioning authority-Authorities competent to sanction the reimbursement claim for treatment shall be as follows:

For working/retired Government Servant

Rule 14. Amendment of Rule 22.-

In the said rules, in Rule 22 for existing sub-rules (c) and (d) the following sub-rule shall be substituted, namely-

"(c)  The patient and the attendant if any, shall be entitled to traveling allowance for such journey from his/her residence to the place of the treatment and back by shortest rail route to the extent of entitlement of his official journey. However, no daily allowance would be permissible.

(d)   In case of critical illness, the journey by Aeroplane may be allowed by the Government on the written recommendation of the authorized medical attendant. However, no daily allowance would be permissible on such journey."

Rule 15. Substitution of Appendix "C".-

In the said rules, for existing Appendix "C" the following Appendix shall be substituted, namely-

APPENDIX "C"

(See Part V, Rules 16 and 18)

Name of Head of Office

Subject: Reimbursement of expenditure done on medical treatment

Sir,

I .................................................../my family members Name....................................... took treatment at (hospital name).......................................... for..................................... (disease name)........................................from (date)......................... to...................................My health Card No.............................. I am submitting the claim with following documents for reimbursement:

1.        Essentiality Certificate duly signed/countersigned by treating doctors/Superintendent of the Hospital.

2.        Original Cash memo, Bill, Vouchers duly signed and verified by treating doctor.

3.        It is certified that the above named family member is wholly dependent on me and normally resides with me.

Kindly do the needful for reimbursement of my claim after adjusting the advance of Rs. ................... sanctioned for my treatment vide letter no..........................dated.................of......................

Dated.......................

Name of Officer/Employee

Designation

Place of Posting