(* Approved by the 25th General Body in its meeting held on 16th February, 2021)
Title & Commencement
These Byelaws shall be referred to as NRIDA (Medical Attendance) Byelaws, 2020.
Scope
These Byelaws shall apply to:
- The whole time employees of the Agency and their families except the support staff;
- Those working on deputation with the Agency and their families, excepting those who specifically opt out of these Byelaws and choose to be governed by the facilities available to them in their parent cadres / organizations.
Definitions
For the purpose of these Byelaws:
i. ‘Agency’ means the National Rural Infrastructure Development Agency.
ii. ‘Authorized Medical Attendant’, means:
- A Medical Officer, whether or not under the employ of the Government of India, appointed as such by the Director General, National Rural Infrastructure Development Agency.
- In case of a Hospital, the Principal Medical Officer of a hospital notified by the Competent Authority to attend to the officers of the Agency.
iii. ‘Competent Authority’ – The Director General, National Rural Infrastructure Development Agency or such other authority to whom the powers in respect of these Byelaws may be delegated by the Director General.
iv. ‘Controlling Officer’ – The authority declared by the Competent Authority to be the Controlling Officer for each category of employees of the Agency.
v. ‘Employee’ – Any person who is serving in the Agency as a regularly appointed employee ( on deputation from the Government of India or a State Government / U.T. Administration or from any other autonomous or semi- Government organization). The persons working in the Agency as consultants or under any contract for outsourcing are specifically excluded from the purview of this definition and these Byelaws.
vi. ‘Family’ means the wife or husband of an employee, as the case may be, and parents, sisters, widowed sisters, widowed daughters, minor brothers, children, stepchildren, divorced / separated daughters and stepmother wholly dependent upon the employee and normally residing with the employee. The eligibility of the sons/daughters of an employee to be considered dependent upon him for the purpose of these Byelaws shall be subject to the following:
a. Son: Till he starts earning or attains the age of 25 years, whichever is earlier.
b. Daughter: Till she starts earning or gets married, whichever is earlier, irrespective of the age limit. c. Son suffering from any permanent disability of any kind (physical or mental): Irrespective of age limit.
Note.
1. – A member of the family is treated as dependant only if his/her income from all sources including pension etc. is less than Rs. 3,500 p.m. This condition shall not apply in the case of wife/husband of the employee.
Note.
2. – Family members may avail of the medical attendance and treatment even if they do not stay with the employee.
vii. Where both husband & wife are employed:
a) Spouse of an employee when serving in the Central /State Government etc. or in any other body financed totally or partially by the Central Govt./ State Govt. /private organizations which provide medical services to their employees, would be entitled to opt for either the medical facilities provided in the Agency, or those provided by the organization. In which she/he is employed.
b) When both the husband and wife are employed in the Agency they, as well as their eligible dependents, may be allowed to avail of the medical facilities according to his/her status. For this purpose they should furnish to their respective Controlling Authorities a joint declaration as to which of the two will prefer the claim for reimbursement of medical expenses incurred on the medical attendance and treatment in respect of wife/ husband and their dependants. This procedure may also be followed for those covered under (a) above.
c) If the spouses are governed by different medical Byelaws, and are stationed/ residing separately at their respective duty stations, the employee concerned may avail medical facilities under the Byelaws of Agency in respect of himself/ herself and the family members residing with him/her and covered under the Byelaws provided:
i. The spouse employed in the other organization is not in receipt of any fixed/monthly medical allowance; and ii. The employee produces a certificate from the employer of his/her spouse that he / she is not claiming medical facilities in respect of his/ her spouse and their family members.
Note.
1. Family members other than the spouse should be wholly dependant on the employee.
Note.
2. Every employee on his/her appointment or on joining the Agency shall submit a formal declaration:
- Specifying the members of his/her family dependant upon him/her. Any subsequent change in the dependants, during his/her employment with the Agency shall also be promptly intimated to the Controlling Officer.
- Indicating his/her option to be exercised in pursuance of clause (vii)(a) above.
- A joint declaration pursuant to clause (vii)(b) above, if applicable.
viii. 'Medical Attendance’ by the Authorized Medical Attendant shall include attendance in his/her consulting room or in the hospital to which he/she is attached or at the residence of the employee. It will also include -
a) All diagnostic tests or other methods of examination for the purpose of diagnosis as are available and are considered necessary by the Authorized Medical Attendant; and
b) Such consultation with a specialist or another medical officer as the Authorized Medical Attendant certifies to be necessary.
ix. ‘Patient’ – An employee or a member of his/her family to whom these Byelaws apply and who has fallen ill requiring medical attention.
x. 'Notified Hospital’ means such hospital(s), [Government/ Semi Government/ Private] as may be notified for the purpose of providing general or specialist medical facilities by the Competent Authority from time to time for treatment of employees of the Agency and their families. Health Care Organisations empanelled by M/o Health and Family Welfare Government of India under CGHS may be treated as notified hospitals.
xi. ‘Treatment’ - means the use of all medical and surgical facilities available at the Notified hospital(s) in which the employee is treated and includes:
- The employment of such pathological, bacteriological or other methods as may be considered necessary by the Authorized Medical Attendant.
- The supply of such medicines, vaccines, sera or other therapeutic substances as are ordinarily available in the Government or notified hospitals.
- Physiotherapy, speech therapy, psychiatric, anti-rabies treatment and such other treatment as may be considered necessary by the Authorized Medical Attendant.
- Such accommodation and diet as is ordinarily provided in the hospital and is suited to his/her status;
- Such nursing as is ordinarily provided to in-patients by the hospital;and
- Consultation with the Specialist.
But it shall not include provision of diet or accommodation superior to that described above at the request of the employee.
Any other terms used in these Byelaws but not defined hereinabove shall be construed to mean as defined under Rule 2 of Central Services (Medical Attendance) Rules, 1944.
Medical Benefits
a) An employee shall be entitled, free of charge, to medical attendance by the Authorized Medical Attendant. Any amount paid by him/her on account of such medical attendance shall, on production of an Essentiality Certificate (Annexure 3) in writing by the Authorized Medical Attendant in this behalf, be reimbursed to him/her by the Agency subject to the satisfaction of the Controlling Officer about genuineness of the claim.
b) Employees have to bear the expenditure incurred on diet charges, birth certificate etc. as these do not form part of the treatment. Besides, such of the items as fall within the definition of food value items are also not reimbursable to the employees. In case any diet restrictions have been imposed by Authorized Medical Attendant, the diet charges, including special diet charges paid to the notified hospitals by the employees and members of their families during the course of their indoor treatment may be reimbursed in full, at the discretion of the Competent Authority depending on merits of the case.
c) Controlling Officer may require production of original medical prescriptions by the claimants along with the claim papers, if considered necessary to enable him to verity the claim.
Consultation Fee
Consultation fee upto Rs. 400/- for first consultation and Rs. 250/- for each subsequent consultation charged by the Authorised Medical Attendant shall be reimbursed. The Competent Authority may, however, review these ceilings from time to time and revise them, if necessary.
Note:
a) For visits between 10.00 p.m. and 6.00 a.m. the fee reimbursable will be upto one and a half times the normal reimbursement ceiling.
b) In the case of domiciliary visits, the employee will have to get a certificate from the doctor to the effect that domiciliary visit was essential in view of the condition and the health of the patient.
c) The maximum number of consultations in respect of which reimbursement shall be permitted in respect of any one illness in any one spell shall be limited to three, except when the illness requires prolonged treatment in which case more than 3 consultations may be permitted if certified by the Authorized Medical Attendant.
Treatment at Residence
a) An employee may receive treatment at his/her residence if the Authorized Medical Attendant is of the opinion and certifies that owing to the absence or remoteness of a suitable hospital or the severity of the illness he/she cannot be given treatment in the hospital.
b) Cost of treatment so received, limited to the amount reimbursable, if he/ she had not been treated at his/her residence, shall then be reimbursed to him/her.
TA for medical attendance journeys
a) When the place at which a patient falls ill is more than eight kilometers by the shortest route from the consulting room of the Authorized Medical Attendant, the patient shall be entitled to Travelling Allowance for the journey to and from such consulting room.
b) If the patient is too ill to travel the Authorized Medical Attendant shall be entitled to travelling allowance for his/her journey to and from the place where the patient is to be treated.
c) A certificate issued in writing by the Authorized Medical Attendant stating that medical attendance was necessary and/or that the patient was too ill to travel shall accompany the claim for travelling allowance.
d) If the case of a patient is of such a serious or special nature as to require medical attendance by a Medical Officer other than Authorized Medical Attendant, he/she may:
-
Send the patient to the nearest Specialist or Medical officer by whom, in his/her opinion, medical attendance is required for the patient; or
-
If the patient is too ill to travel, summon such Specialist or Medical Practitioner to attend to the patient at his/her residence.
e) The employee shall intimate the facts and circumstances of the case to the Controlling Officer in writing / fax at the earliest opportunity. Travelling allowance for the journey/s involved shall be payable to the patient/specialist on a certificate to be issued by the Authorized Medical Attendant.
f) Claims for such treatment will be governed by provisions of Rule 12 below.
Dental Treatment
a) Dental treatment must be obtained only from the Hospitals notified for the purpose and not from any private institution.
b) The expenses incurred by an employee in connection with the following types of dental treatment obtained at hospitals so notified may be reimbursed:
i. Extraction;
ii. Scaling and gum treatment;
iii. Filling of teeth; iv. Root canal treatment.
c) Expenses incurred towards the treatment of Pyorrhea and Gingivitis may also be reimbursed under the rules as it is covered under the term “gum treatment”.
d) No private dentist shall be appointed as Authorized Medical Attendant.
Reimbursement for Complete Dentures
The essential expenditure incurred in providing a complete denture is reimbursable subject to a ceiling of Rs. 2000/- only for the complete denture and Rs. 1000/- for a denture of one jaw only provided that it has been advised and considered essential by the Dental Surgeon of a Notified Hospital.
An employee who may have opted in favour of medical facilities available in his/ her parent organization may be permitted by the concerned authority in his/her parent department for provision of dentures.
The reimbursement of complete / partial denture shall be permitted on one time basis only.
Choice of Authorized Medical Attendant
An employee is expected normally to consult an Authorized Medical Attendant nearest to his/her residence who should also be his/her nominated Authorized Medical Attendant. He/She may, however, consult any particular Authorized Medical Attendant of his/her choice provided he/she gives his/her option in writing to the Controlling Authority in advance who could thus keep a check on medical reimbursement bills submitted. No TA/DA shall, however, be paid to the employee for such consultation.
Choice of Treatment System
The employees or their families are not permitted to take treatment simultaneously under two or more systems of medicine for the same ailment. But there is no objection to the treatment being received simultaneously in different systems of medicine for different ailments if it is within the knowledge of attending doctor(s) of the other system(s) concerned.
Emergent Situations
In case of extreme emergencies or unforeseen circumstances, when an employee or the member of his/her family falls ill, he/she may take treatment from any other Medical Attendant even if he/she is not an Authorized Medical Attendant in terms of these Byelaws. Each such case shall, however, be considered on merits by the Controlling Authority who shall satisfy itself about the genuineness of the claim before it is allowed.
Medical Attendance while on Tour
In an employee needs any medical services while on tour to a place where there is no notified hospital, the Principal Medical Officer of the district appointed by the Government to attend to its officers in the District shall be considered to be his Authorized Medical Attendant for the purpose of these Byelaws.
Claims for Reimbursement
a) All payments for medical expenses will ordinarily be made by the employee in the first instance and reimbursement claimed. All claims for reimbursement shall be submitted in the form prescribed (Annexure 4).
b) A claim for reimbursement shall be supported by regular vouchers/cash memos and a copy of the prescription.
c) A claim for reimbursement presented after six months from the date of completion of treatment or where required intimation in writing / fax was not made at the earliest opportunity to the Controlling Officer will normally be rejected unless the Competent Authority is satisfied with the reasons given for delay to be recorded and examined in audit.
d) The cost of hospitalization will include pre- and post admission treatment, OPD charges and resultant cost of medicines subject to certification by the Notified Hospital that such OPD charges and pre/post admission treatment was part of the indoor treatment and was provided within a period of 3 months on either side.
e) Reimbursement of expenditure incurred on hospitalization from a notified hospital will be made with the sanction of the Competent Authority.
f) In case of an emergency where any notified hospital could not be reached and treatment had to be taken from another hospital, reimbursement will be made only on a certificate from the attending doctor of the (non-notified) hospital to the effect that the patient had to be admitted in emergency. The exact nature of the emergency shall also be stated in the certificate so issued.
g) The reimbursement on account of room rent for private wards in the notified hospitals/nursing homes shall be on the following basis:
Corresponding Basic Pay drawn by officer in 7th CPC per month |
Ward/ Room Entitlement |
| Up to Rs. 47,600/- | General |
| Rs. 47,601/- to Rs. 63,100/- | Semi Private |
| Rs. 63,101/- and above | Private Ward |
Pay slab for determining the entitlement of accommodation in AIIMS, New Delhi is as under :
Corresponding Basic Pay drawn by officer in 7th CPC per month |
Ward/ Room Entitlement |
| Up to Rs. 63,100/- | General |
| Rs. 63,100/- to Rs. 80,900/- | Semi Private |
| Rs. 80,901/- and above | Deluxe/Private |
Whenever a large amount is required to be deposited as an advance with a hospital, such payment will be made by the Agency directly to the hospital.
h) The status of an officer/employee of Agency for the purpose of medical attendance will be determined with reference to the actual pay he/she is drawing at the time he/she falls ill.
Cash memo and Essentiality Certificate
a) Cash memos for purchase of medicines must be obtained and got countersigned by the Authorised Medical Attendant. The Essentiality Certificate must contain the names of all the medicines prescribed and the amount incurred on purchase of each medicine. All Authorized Medical Attendants shall indicate clearly their designation and degree while signing reimbursement claim papers.
b) A certificate issued by the Authorised Medical Attendant that the patient is suffering from a chronic ailment needing prolonged treatment, shall be accepted as a certificate of Essentiality for that particular ailment. The Authorised Medical Attendant may prescribe medicines for up to 3 months at a time where necessary on the basis of the said certificate.
Eligible items for Reimbursement
a) The cost of medicines prescribed by Authorized Medical Attendant will be reimbursed.
b) Cost of indoor treatment / hospitalization in a notified hospital in the relevant specialization including pre and post admission treatment, OPD charges will be reimbursed.
c) All pathological, bacteriological, radiological and other tests conducted at a Notified Hospital will be reimbursed. When such tests are carried out elsewhere on the basis of recommendation of the treating Notified Hospital or during an emergent situation, the charges shall be limited to the rates prescribed in the Notified Hospital that prescribes such tests or the rates applicable in the Central Government Hospital, as the case may be.
d) The cost of items of food value and toiletries, even if prescribed by the doctor will not be reimbursable.
Miscellaneous
All situations and exigencies not covered under the Byelaws above shall be resolved with reference to corresponding provisions of Central Services (Medical Attendance) Rules 1944.
Interpretation and power to remove difficulties
a) The interpretation of the Director General NRIDA will be final in respect of any provisions of these Byelaws.
b) The power to remove difficulties in the application of these Byelaws shall vest in the Director General, NRIDA.
