REPORT OF CHSS REVIEW COMMITTEE

Transcription

1 Annex-II GOVERNMENT OF INDIA DEPARTMENT OF ATOMIC ENERGY (IR&W SECTION) REPORT OF CHSS REVIEW COMMITTEE

2 ( ) ई-म फ क स/Fax No & भ रत सरक र GOVERNMENT OF INDIA परम ण ऊर ज व भ ग DEPARTMENT OF ATOMIC ENERGY औ. स. ए क. अन भ ग IR&W SECTION अण शक त भवन Anushakti Bhavan, छ. क तश. म. म र ग C.S.M. Marg, म बई/Mumbai The CHSS Review Committee conducted its final meeting on The Committee has taken into consideration different issues and references made to it from time to time and has given the following recommendations to bring improvement and augment the Health Scheme of the Department : Sl. No Issues Considered Current Status Recommendations/Options Given by the Committee 1 Family Husband & Wife, Children and Parents 2 No. of Children Restricted to two children. Additional No. of children can be admitted on additional contribution for each child. 3 Age Limit for son 25 years or till he starts earning or gets married Recommended to restrict the definition of family to Husband/wife & Children. Parents will be admitted on additional payment. Further, if parents are not declared at the time of employment, subsequently they cannot be included in the scheme. Recommended to maintain status-quo. 21 years or till he starts earning or gets married, whichever is earlier. 4 Age Limit for Daughter / Facility for unmarried daughter(s) 5 Children suffering from permanent disability (either Physical/ mental) 25 years or till she starts earning or gets married No age limit Facility Allowed without age limit on case to case basis on the recommendations of Head of Unit 21 years or till she starts earning or gets married, whichever is earlier. No special consideration as in CGHS, wherein no age limit is prescribed. Medical facility may be allowed for life long for profoundly mentally retarded children only (not to their spouse), if so certified and not for Physically disabled / hardship cases.

3 6 Dependent Widowed/divorced /separated Daughters 7 Dependent Divorced/Abandon ed/separated/wid owed Sisters 8 Dependent and Minor Brother 9 Adopted Children/taken as Wards 10 Dependent children of widowed/ separated daughters CHSS facility not Allowed No exemption is recommended. Children upto the age of 21 are only allowed. Benefits are not Allowed Benefits are not Allowed Benefit is allowed with age limit of 25 years and dependency / marriage criterion in respect of adopted children Benefits may not be allowed. Benefits may not be allowed. Benefit may be allowed, limited to two children including biological children and the upper age limit as may be prescribed. Benefits are not Allowed Not recommended for inclusion to the benefit. 11 Parents staying away from Prime Beneficiary and dependency criterion 12 Dependency criterion for Children 13 Family Members- Residing away from the Prime Beneficiary Dependent parents (income should not be more than `8000) and should be residing with GS. No separate contribution is being made by the Prime Beneficiary Children whose income is less than ` 4000 per month are treated as dependent on Prime Beneficiary Family should reside with GS. Children allowed as sp. Case, staying away for short period for education purpose only. Both dependency and residency criteria may be removed. However, 1.25 % of revised normal rate of contribution has to be made for each parent. Maintain Status-quo. Maintain Status-quo. 14 Step Parents CHSS facility not Allowed Only one set of parents, either biological or step or adoptive. Option once exercised, at the time of issue of the card, cannot be altered. 15 Parents-In Law Not allowed in respect of male employee. In respect of female employee, option is given for either parent or parents-in-law and the option is final. Maintain Status-quo.

4 16 Registration of parents when both husband and wife are GS 17 Rate of Contribution 18 Contribution for retirees other than on superannuation Parents of both can be allowed. Both should contribute. 1% of Pay in pay band + Grade Pay + NPA (Max. `800/-) Voluntary Retirement Rate of Contribution as per years of Qualifying Service Compulsory Retirement Normal Medical Invalidation Normal Parents of both can be allowed. Both should make additional 1.25% per parent (5%/4=1.25%) While in Service 5% of Basic Pay+DA (Pay in Pay Band+GP+DA) while in service Family includes only Husband, wife and two Children. For one additional dependent member viz. Children and Parents additional 1.25% for each member. Max-No Ceiling After Retirement Contribution only on yearly basis Scrap life time registration Registration should be within a year of 5% of Basic Pension + DR as on 1 st January. No registration to be accepted after that period. Family includes self, spouse and children. For parents additional 2.5% for each parent. Voluntary Retirement Normal 5% (basic pension + D.R) Compulsory Retirement - Normal contribution in case, the service is 20 years or more. - 4 times the normal contribution on completion of 10 years but below 20 years of service. - No eligibility for CHSS, in case, the service is less than 10 years. Medical Invalidation Normal contribution irrespective of length of service.

5 19 Conversion of 10 years contribution (already paid) by retired employees as equal to lifetime contribution 20 Reimbursement of expenses in the cases of In-vitro Fertilization 21 Re-classification of entitlement of Hospital Accommodation Allowed Scrapping of life time contribution and replace with annual payment after retirement. The contribution may be 5% per month of total of basic pension and Dearness Relief as on 1 st January. Not Allowed a. 4 beds in a room with common toilet/bathroom whose pay in pay band is less than `15,000 b. 2 beds in a room with attached toilet / bathroom who pay is in the pay band is above `15,000 and below `67,000 c. Single bed AC accommodation whose pay in pay band is `67000 and above. In the past cases also, the amount of life time contribution paid will be 5% p.m. of basic pension + DR together. The amount paid at the time of retirement in the past cases, will be adjusted against the revised amount. The remaining amount to be paid, if any, will be recovered in lumpsum. In addition, annual contribution to be 5% p.m. on basic pension + DR together. May be allowed subject to inter-alia the following conditions laid down under CGHS Rules: a. Treatment based on the recommendation of Head, Department of Gynaecology and Obstetrics of Govt. Medical Institution. b. Maximum treatment for 3 cycles c. cost for each cycle restricted to `65,000 only. d. Age of women between 21 and 39 years. Recommended: a. To maintain status-quo. b. Refer to Consultant.

6 22 Annual Medical Exam No Annual Medical Check-up is carried-out except in the cases of Radiation workers as per AERB guidelines Recommended to cover all employees aged 40 and above. The committee expected a total cost of `5 crores may be needed for the purpose. Committee has recommended to hand over this issue to the Consultant. 23 Extension of CHSS to retirees absorbed in Govt. Institutes/AB/ PSU after serving DAE and its Constituent Units for more than 5 years Not Allowed Situation-I : DAE to DAE PSU / AB s May be re-admitted on a contribution of 5% of total of basic pension + D.R per month as applicable to DAE Pensioners. Situation-II : DAE to Non- DAE Units Recommended to continue the Membership at higher rate of contribution, as follows : - Normal contribution, if service is 30 years or more. - 2 times of normal contribution, if service is 25 years or more but less than 30 years. - 3 times of normal contribution, if service is 20 years or more but less than 25 years. - No eligibility for CHSS, in case service is less than 20 years.

7 24 Registration of family members under CHSS after the death of employee 25 Introduction of CHSS at all DAE locations including (a) Delhi (b) Nagpur (c) Jaipur (d) Shillong (e) Jamshedpur (f) Vizag (g) Bhubaneshwar (h) Allahabad 26 Definition of Mumbai 27 Loss of CHSS Identity Cards 28 Inpatient care for Honorary Consultants in DAE Hospital Not allowed Committee has recommended to extend the facility to the family of the deceased employee, only if, the employee dies while in service and family was outside the area covered under CHSS and then comes to settle at the place where CHSS is in operation and registration will be allowed only within one year of death. Contribution based on family 5% of Basic Pension + DR Family includes spouse & children Parents allowed with additional 2.5% for each parent Recommended for introduction of CHSS in all DAE stations. - DOS system can be adopted; (further study required) - Polyclinics / accredited hospitals to give quotations for a) OPD + Diagnostic care facility b) Inpatient on referral basis + reimbursement Refer to Consultant. -- No need to define Mumbai as CHSS will be extended to all Centres under DAE Compulsory to lodge Police complaint in case of loss of CHSS cards `100 is charged for issue of each duplicate card; `25 for each mutilated card if more than 5 yrs old & `50 if less than 5 years old. No need of lodging complaint. Recommended to charge `1000/- for all situations where duplicate identity card is required to be issued. Benefits are allowed Recommended medical facility for themselves alone in DAE Hospitals and no referrals to private hospitals. No family member to be included for benefits under the scheme.

8 29 Revision of rates for artificial dentures 30 Revision of rates of reimbursement for Spectacles 31 Revision of Maternity Charges for meeting confinement expenses at places other than DAE/ BARC Hospital 32 Reimbursement towards domiciliary confinement 33 CHSS to temporary employees 34 Revision of reimbursement charges for hiring Hearse 35 Enhancing the list of artificial appliances in line with CGHS 36 Enhancement of reimbursement under Liberalised Emergency Scheme (LES) Presently rates ranging from `5 to 400 are reimbursed towards cost of dentures. `100 is reimbursed in the cases where the pay does not exceed `7,000 per month CHSS provides the reimbursement of normal delivery charges of `1,050/- (`750/ + `300/- for stitching) Reimbursement of cost is 50% of `1050 or actual charges supported by bills whichever is less Benefits are allowed `200/- is reimbursed to the category A and B employee Supplied free of cost for the first time in the cases of diseases like polio, TB or Prostheses. 50% of cost is charged for replacement Reimbursable amount for outdoor and domiciliary treatment is `1500/- and inpatient treatment is `5000/- with Powers to Director, BARC to enhance reimbursement in deserving cases. Recommended -To find out CGHS rates -Total expenditure on Denture preparation limit to be calculated (Action: Head, Dental Division) Recommended to withdraw reimbursement Scrap existing proviso where CHSS provides facility, either at own hospital or referral hospitals. At other stations and in case of emergency, adopt CGHS rates. Recommended to scrap reimbursement. Recommended to scrap the system of extending the medical aid to temporary employees with an exception to JRF and SRF restricted to self alone. Recommended to maintain Status-quo Recommended to scrap the system of bearing the cost as it involves problems relating to variety of the appliances, cost for its maintenance etc. Employees may buy themselves the appliances and implants. Recommended to continue present system. No need for enhancement.

9 37 Reimbursement in the cases of Mediclaim Policy Holders 38 Ceilings on Higherend cost treatments 39 Reimbursement for OPD treatment to retired employees who stay outside CHSS area 40 Category of Drugs to be purchased Not Allowed Recommended to make eligible for CHSS membership the dependents with Mediclaim Policy with the following conditions: No ceiling in the cost a. No two claims on one hospitalization. b. Admission on approval of our doctor only in our Panel hospital. Recommended to contain the cost by adopting CGHS ceilings with no provision for relaxation by any authority. Not allowed Committee recommended continuation of the same status. -- Recommended to limit the reimbursement of cost to generic drugs 2. Following are the issues revised in CHSS Review Committee Report for assigning to Consultant : (a) (b) (c) (d) (e) (f) (g) Study over the need for Annual Medical check-up and the amount to be restricted for the same on par with recently issued order vide O.M. dated , for CGHS/CS(MA) beneficiaries for Group A Officers of the age 40 years and above. Adequacy of the services provided by hospitals and dispensaries functioning under DAE units. Criteria for Introduction of CHS Scheme in other units of DAE where CHSS is not in operation Cost analysis of starting our own hospital and dispensaries vis-à-vis outsourcing medical services to other hospitals/medical investigation centres etc. Comparison with other schemes in vogue in Government. Re-classification of entitlement of Hospital accommodation under CHSS Cost analysis of treatments/investigation procedures in DAE s referral Hospitals....