GOVERNMENT OF RAJASTHAN FINANCE DEPARTMENT (RULES DIVISION) Rajasthan Civil Services (Medical Attendance) Rules, 2013 (Updated upto 07-01-2016) This document is compilation of original orders and amendments. Inspite of due care having been taken, if any, errors or omissions have inadvertently remained and are detected in Rules, the same may also kindly be brought to the notice of Finance (Rules) Department. In case of any discrepancy, original Rules / Orders issued shall prevail.
GOVERNMENT OF RAJASTHAN FINANCE DEPARTMENT RULES DIVISION NOTIFICATION No.F.6(1) FD/Rules/2013 Jaipur, dated : 16-09-2013 Sub: Rajasthan Civil Services (Medical Attendance) Rules, 2013. In exercise of the powers conferred by the proviso to Article 309 of the Constitution, the Governor is pleased to make the following Rules in supersession of the existing "The Rajasthan Civil Services (Medical Attendance) Rules, 2008" and all notifications / orders / circulars thereunder : 1. Short Title & Commencement (1) These Rules may be called the Rajasthan Civil Services (Medical Attendance) Rules, 2013. (2) These shall come into force with immediate effect. 2. Extent of Application - (1) These Rules shall apply to: (i) all Government servants, appointed before 1 st January, 2004, including those on foreign service, and whose conditions of service are regulated or deemed to be regulated by the Rajasthan Service Rules; (ii) all Government servants on deputation from Central / other State Governments unless anything otherwise is provided in their terms of deputation; (2) These Rules shall not apply to: (i) Government servants governed or covered by the Employees State Insurance Act and Schemes framed there under; (ii) Government servants who are abroad either on leave or deputation; (iii) Work charged, casual and part-time employees, except where these Rules are specifically made applicable to them under their service Rules; (iv) persons appointed on contract basis; (v) officers of All India Services; (vi) officers of Rajasthan Higher Judicial Service / Rajasthan Judicial Service, when governed by specific Rules applicable to them. (3) Nothing contained in these Rules shall apply to the Government servants appointed to the civil services of the state on or after the 1 st day of January 2004. 1
3. Definitions In these Rules, unless otherwise provided, (1) Authorised Medical Attendant in respect of a Government servant or class of Government servants at a Station or area, means: (i) a Medical Officer of the Rajasthan Medical & Health Department/ Medical Education Department on duty; (ii) a Medical Officer of hospitals attached to Rajasthan University of Health Sciences, Jaipur on duty ; (iii) (iv) (v) (vi) (vii) (viii) an Ayurvedic / Unani / Homeopathic Chikitsak on Government duty; an Ayurved Chikitsak on duty in Ayurved Hospitals attached to Rajasthan Ayurved University, Jodhpur / National Institute of Ayurved, Jaipur; a Medical Officer on duty in a hospital approved under these Rules and enlisted in Appendix-I; a Medical Officer of the Hospital on duty run under Public Private Partnership arrangement under these Rules and enlisted in Appendix-II; a Medical Officer of Referral Hospital on duty and enlisted in Appendix-III ; a qualified Medical Officer, so Authorised, of the private or charitable hospital of Allopathy / Ayurved / Unani / Homeopathy, recognized under these Rules by the Government. Explanation- 1. "Authorised Medical Attendant" at a station outside Rajasthan shall mean an officer of Medical Department of Central or other State Government (as the case may be) on duty in a Government Hospital or Dispensary at that station. 2. Unless otherwise specified under these Rules, the term "Medical Officer" means an Allopathic Medical Officer. 3. An Authorised Medical Attendant for one spell of illness shall either be a Medical Officer or Ayurved / Unani / Homeopathic Chikitsak. (2) State means the State of Rajasthan. (3) Government means the Government of Rajasthan. (4) Government Hospital means an Allopathic / Ayurvedic / Unani or Homeopathic Hospital / Dispensary or Institution maintained / run by the Government of Rajasthan or any organization, owned or controlled by the Government of Rajasthan, for the purpose of Allopathic / Ayurvedic / Unani or Homeopathic treatment and shall also include hospitals attached to Rajasthan University of Health Sciences, Jaipur / National Institute of Ayurved, Jaipur / Rajasthan Ayurved University, Jodhpur/ [All India Institute of Medical Sciences, Jodhpur] 1 and any other hospital so specified by the Government. 1 Inserted vide FD Notification No. F. 6 (1) FD/Rules/2013 Pt. dated 18-03-2015 2
(5) Approved Hospital means a hospital enlisted in Appendix-I. (6) "Hospital under Public Private Partnership Arrangement" means a Allopathic / Ayurvedic / Unani or Homeopathic Hospital / Dispensary or institution run by a partner under a Public Private Partnership Arrangement as per terms and conditions regulated by related concession agreement and enlisted in Appendix II. (7) Referral Hospital means an Approved Hospital, in or outside Rajasthan enlisted in Appendix-III. (8) Health Benefit Empowered Committee means the Standing Committee constituted under Rule-4(1). (9) Family means Government servant s spouse, wholly dependent children, legally adopted children (including legally divorced / widowed daughter) and parents (excluding step parents) irrespective of where they reside. Explanation : for the purpose of this clause (i) Parents shall be deemed to be wholly dependent if their recurring total annual income from all sources does not exceed the limit as prescribed in Appendix- XIV. (ii) A declaration regarding income of parents and children shall be furnished by the Government servant in Annexure-I on the date of enforcement of these Rules and any change in income shall be intimated immediately. (iii) Any change in family shall be declared in Annexure-II by the Government servant within three months of the event. (iv) Dependent children shall mean and include : (a) Son Till gets married or starts earning income as prescribed in Appendix-XIV or attains the age of 25 years, whichever is earlier. (b) Daughter Till gets married or starts earning income as prescribed in Appendix-XIV whichever is earlier. Note : Son /daughter suffering from any permanent disability of any kind (physical or mental) shall be treated as dependent irrespective of his/her age or marital status. Government of Rajasthan Decision 2 Subject: - Clarification regarding inclusion of adoptive parents in the definition of family under the Rajasthan Civil Services (Medical Attendance) Rules, 2013. A question has been raised for clarification as to whether the legally adoptive parents of a Government servant, who are dependent on Government servant, irrespective of where they reside are covered in the definition of Family under sub-rule (9) of Rule 3 of Rajasthan Civil Services (Medical Attendance) Rules, 2013 or not? The matter has been examined and it is clarified that legally adoptive parents who are dependent on the Government servant, irrespective of where they reside, shall be member of family as parents as defined in sub-rule (9) of Rule 3 of Rajasthan Civil 2 Inserted vide FD Memo. No. F. 6 (2) FD/Rules/2013 Pt-II dated 22-06-2015 3
Services (Medical Attendance) Rules, 2013 provided that in any circumstances the real parents shall not be member of the family under the aforesaid rules. It is also clarified that if the adoptive father has legally more than one wife, only senior most will be adoptive mother and others being step mothers will not include in the definition of family as parents under the aforesaid rules. (10) Medical Attendance means attendance by an Authorised Medical Attendant in a Government / Approved / Public Private Partnership / Referral Hospital or at the residence of Government servant in case the patient is compelled to be confined to his/her residence, and includes: (i) (ii) employment of pathological, bacteriological, radiological or other methods of examination (tests / investigations) for the purpose of diagnosis that are considered necessary by the Authorised Medical Attendant ; consultation with any other medical officer as defined in Rule 3(1) to such extent and in such manner as certified by the Authorised Medical Attendant. (11) Patient means Government servant including family, as defined in Rule 3(9), who has fallen ill and to whom these Rules apply. (12) Treatment means administration of medicines / surgery / surgical facilities / vaccinations to cure, control and prevent any disease. (I) Treatment shall also include : (i) (ii) (iii) employment of pathological, bacteriological, radiological or any other method of examination (tests / investigations), as is considered necessary by the Authorised Medical Attendant ; use of medicines, vaccines, sera or other therapeutic substances excluding medicines or other consumables/ non consumables, which are regarded as food, toiletry preparations, tonics having more food value, disinfectants and other similar preparations ; dental treatment of major kind if the diagnosis of the pathological or other disease from which a patient is suffering indicates that the teeth are the real source of such disease. Dental treatment includes treatment of jaw bone disease, wholesale removal of teeth, surgical operation needed for removal of odontomes, impacted wisdom tooth, treatment of gum boils, extraction, scaling and gum treatment, filling of teeth, root canal treatment, pyorrhea and gingivitis. Cost of denture and treatment by private dentists or outside the hospital even on the advice of Authorised Medical Attendant shall not be reimbursed ; 4
(iv) Deleted 3 ; (v) implants and procedures of treatment specified and enumerated in Appendix-IX & Appendix-X ; (vi) Pre-natal and post-natal treatment ; (vii) Annual medical examination as per direction of State Government. (II) Treatment shall not include - (i) (ii) implants used for improvement of efficiency of any organ or part of the body, from its normal natural state, at the particular age of the government servant, other than those, which are specifically permitted under these Rules ; treatment taken for efficiency improvement like growth in height, cosmetic / plastic surgery to shape up some part of body / face, lippo-suction, weight reduction, dentures, use of spectacles/ contact lens etc. other than those, which are specifically permitted under these Rules. (13) Pay for the purpose of these Rules, means pay defined under Rule 7(24)(i) of Rajasthan Service Rules, 1951 or total of pay in running pay band and grade pay drawn as the case may be. 4. Health Benefit Empowered Committee - (1) There shall be a Standing Committee to be known as Health Benefit Empowered Committee, consisting of : (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) Additional Chief Secretary / Principal Secretary (Finance) Chairman Pr. Secretary/ Secretary, Medical Education - Member Secretary, Finance (Budget) - Member Principal, S.M.S. Medical College, Jaipur - Member Principal Medical College, Udaipur - Member Superintendent, S.M.S. Hospital, Jaipur - Member Director, Medical & Health Services - Member Director, Ayurved - Member Joint / Deputy Secretary (Rules) - Member Secretary (2) The Committee shall be empowered to recommend : (i) (ii) (iii) norms and procedure for approving hospitals/diagnostic centres; approval/deletion of private hospitals / diagnostic centres for the purpose of treatment; extent of reimbursement for treatment / cost of implants/ tests/procedure etc. undertaken in Government hospitals / 3 Deleted vide FD Notification No. F. 6 (1) FD/Rules/2013 Pt dated 01-09-2014 5
(iv) (v) (vii) (viii) (ix) Approved Hospitals/ Public Private Partnership Hospitals / Referral Hospitals or at approved diagnostic centers/ labs; category of ailments for which treatment in private hospitals within the State be allowed; negative list of allopathic drugs and medicines, which will not be eligible for reimbursement; classes or list of Ayurvedic, Unani and Homeopathic Drugs and Medicines and Pharmacies considered necessary for reimbursement; rates for various treatments / tests and investigations under these Rules ; on any other related issue referred to it or on its own motion. (3) The State Government in Finance Department may, on the recommendation of Health Benefit Empowered Committee, if consider necessary so to do, by order amend or modify all or any of the Appendix appended to these Rules and there upon the Appendix shall be deemed to have been amended accordingly. 5. Option of Mediclaim Insurance Coverage - In lieu of benefits under these Rules a Government servant may opt to avail medical facilities for him/herself and family, under Mediclaim Insurance Scheme, of any insurance provider regulated by the Insurance Regulatory & Development Authority (IRDA). Government will reimburse premium, as specified in Appendix-XIV. Such option shall be exercised in the form prescribed in Annexure-III, in writing to the Appointing Authority and shall be entered in service record. Such option once exercised shall be irrevocable and he /she shall not be entitled to avail facility of reimbursement of medical expenses under these Rules. 6. Medical Attendance and Treatment in a Government Hospital - (1) A Government servant and his/her family, except those who opt for mediclaim insurance, will be provided free medical attendance and treatment in a Government hospital, in accordance with provisions of these Rules. (2) Expenses incurred by a Government servant, while availing medical attendance and treatment in a Government hospital shall be reimbursed to him / her to the extent and in the manner prescribed as under: (a) (b) cost of allopathic drugs and medicines, vaccines, sera or other therapeutic substances not stocked and supplied by Government hospital, except allopathic drugs, medicines, included in Appendix- IV (Negative List) ; cost of Ayurvedic / Unani / Homeopathic drugs and medicines of approved preparations, as included in the list of drugs and 6
(c) (d) (e) (f) (g) (h) (i) (j) (k) (l) medicines in Appendix-V / VI / VII respectively, which are not available in a Government hospital ; cost of disposable surgical sundries, i.e. gauge, I.V. Set, bandage, Leucoplast, Cotton, Crepe Bandage etc., used during surgical and other operations, if not supplied by the hospital ; charges paid by a Government servants to the Rajasthan Medicare Relief Society or private diagnostic centres and labs etc. installed in Government hospitals through Rajasthan Medicare Relief Society, for pathological, bacteriological and radiological tests, x-ray, dialysis, investigations and procedures etc., which are considered necessary by the Authorised Medical Attendant, at the rates as per Appendix-XVI ; charges paid by a Government servant to approved private diagnostic centres / labs etc. for the tests undertaken on advice of Authorised Medical Attendant as per Appendix-VIII ; charges paid under auto finance scheme for pathological, bacteriological and radiological tests, X-ray, dialysis and investigations on prescription of Authorised Medical Attendant as per Appendix-XVI ; blood transfusion charges as per Appendix-XVI and cost of Subcutaneous Infusion Pump ; ambulance charges incurred to carry patient from place of illness to a government hospital, vice versa or from one government hospital to another for treatment or examination ; consultation fee charged by the Authorised Medical Attendant for treatment at residence of Government servant to the extent and as per scale prescribed in the Rajasthan Medical Officers and Nursing Staff Fees Rules, 2011 ; fee paid to compounder / nurse per visit for administering injectable at the residence of the Government servant as per the Rajasthan Medical Officers and Nursing Staff Fees Rules, 2011 ; cost of specific implants, to the extent indicated in Appendix-IX and specific procedure to the extent indicated in Appendix-X ; sums actually paid on account of medical attendance, nursing facilities and treatment including charges for surgical operations. 7. Indoor / Outdoor Medical Attendance and Treatment in approved Hospitals within the State - 7
Expenses incurred by a Government servant on account of medical attendance, treatment and implants shall be reimbursable to the extent indicated in Appendix-IX & Appendix-XI. 8. Medical Attendance and Treatment in Hospitals under Public Private Partnership Arrangement - A Government servant and the members of his/her family shall be entitled to medical attendance and treatment including cost of implants, in hospitals under Public Private Partnership Arrangement to the extent and as per conditions prescribed in related concession agreement. However, the reimbursement shall be limited to the extent as per Rule 7. 9. Medical Attendance and Treatment in Government Hospitals outside Rajasthan - (1) A Government servant, including his/her family members, who is on duty or on leave or otherwise at a station outside Rajasthan and within India, shall be entitled to medical attendance and treatment as an indoor or outdoor patient in any hospital maintained by the Central Government / other State Government on the scale and as per conditions applicable under these Rules, as if he/she has been on duty or on leave in Rajasthan. (2) Government servants posted at Delhi shall be reimbursed charges paid to the private hospitals / clinics listed in Appendix XII for tests and investigations which are considered necessary by medical officer of Government of Rajasthan posted in Delhi. 10. Treatment, including specialized treatment in Referral Hospitals outside Rajasthan - (1) A Government servant and the members of his/her family suffering from a disease for which treatment is not available in any Government Hospital/Approved Hospital/hospitals under Public Private Partnership Arrangement within the State, can be referred to a hospital specified in Appendix-III for medical attendance and treatment upon certification by the Principal of concerned Medical College, based on the opinion of the Medical Board to the effect that the treatment of a particular disease from which the patient is suffering, is not available within Rajasthan, and it is considered absolutely essential for the recovery of the patient to have treatment in the hospital so specified. Upon such reference and treatment being availed of, following charges/ expenses shall be reimbursable : (i) (ii) (iii) cost of Allopathic Drugs, Medicines, Vaccines, Sera or other therapeutic substances as reimbursable under these Rules ; sums actually paid to the Hospital / Institution on account of medical attendance and treatment including charges for surgical operations and nursing facilities ; expenses incurred on accommodation shall be reimbursed as per Appendix-XV according to the class he/she is entitled to ; 8
(iv) cost of specific Implants to the extent indicated in Appendix-IX ; (v) only one follow-up treatment on the advice of the treating doctor shall be allowed in cases where treatment has been undertaken in a referral hospital out side the State. (2) In case a Government servant takes treatment in the referral hospital without reference as per Sub-rule 10(1) above, the reimbursement shall be allowed to the extent prescribed in Appendix-IX and Appendix-XIII. 11. Indoor Treatment in a private unrecognised hospital within the State and out side the State in case of emergent circumstances - The reimbursement shall be allowed to the extent prescribed in Appendix- IX & Appendix-XIII for the charges paid by a Government servant on account of medical attendance and treatment as indoor patient in private unrecognized hospital within the State or out side the State in case of grave emergency for life threatening diseases or in case of accident. The emergent nature of hospitalization in private hospitals has to be established by an affidavit of the employee supported by a certificate of the treating doctor. No follow-up treatment shall be allowed in the cases where the treatment has been undertaken in emergent circumstances. 12. Medical attendance and treatment, where both husband and wife are employed in State Government / Autonomous Body / elsewhere, where procedure for medical reimbursement exists - (1) In case both husband and wife are eligible under these Rules, they shall be entitled to medical attendance and treatment according to status of any one of them. For this purpose they should furnish a joint declaration in Annexure-IV to their respective Head of Office as to who will prefer the claim for reimbursement of medical expenses. The above declaration should be submitted in duplicate and a copy shall be kept in the personal file of each of them. Such option can be revised only at the beginning of a financial year. In case of absence of such joint declaration, the claim shall be preferred by the husband. Both the spouses may prefer claims for their own medical expenses separately as well. In case of dependents each one has to declare in Annexure-IV, the names of family members he/she wants to claim reimbursement for. (2) In case the spouse of the Government servant is recruited in State Government service on or after 01-01-2004, his/her claims shall be regulated as per Rule 17. (3) If the spouse of the Government servant is employed in State Autonomous Body / PSU having prescribed procedures for reimbursement of medical expenses, he/she shall have option either to claim medical reimbursement under the Rules applicable on that body or under these Rules. For this 9
purpose Government servant will furnish a declaration in Annexure-V to his controlling authority as to who will prefer the claim for reimbursement of medical expenses. Such option can be revised only at the beginning of a financial year. (4) If the spouse of the Government servant is employed in other than Government organization where system of medical reimbursement exists and covered under any insurance scheme, his/her medical claims shall be reimbursed as per Rule 17. 13. Entitlement of accommodation in Hospital - (1) A Government servant and his/her family shall be entitled to free accommodation in the Government hospital as prescribed in Appendix XV subject to availability. (2) Expenses incurred on accommodation by a Government servant for treatment in Approved / PPP / Referral Hospital shall be reimbursed as per Appendix-XV according to the class of accommodation he/she is entitled to. 14. Admissibility of travelling allowance - (1) A Government servant is entitled for reimbursement of travelling expenses as on tour, excluding daily allowance admissible under the Rajasthan Travelling Allowance Rules, for any journey made for the purpose of medical attendance and treatment to the following extent : (i) (ii) (iii) (v) (vi) If medical attendance and treatment is not available at the headquarters of the Government servant then forward and return journey made by the patient to the nearest headquarters of Authorised Medical Attendant. Forward and return journey made by the patient to consult a specialist referred by the Authorised Medical Attendant on the condition of patient being so serious or of special nature and requires medical attendance by a specialist medical officer other than himself. Forward and return journey made by the patient for specialized treatment in referral hospital on the recommendation of competent authority as referred in Rule 10. Forward and return journey made by an attendant, if the Authorised Medical Attendant certifies in writing that it is unsafe for the patient to travel unattended and attendant is necessary to accompany the patient to the place of treatment. Forward and return journey made by an Authorised donor of kidney under the provisions of the Transplantation of Human Organs Act, 1994 and Rules 1995. (2) (i) Claim for Travelling Allowance under these Rules shall be drawn on TA Bill form and a certificate from the Authorised Medical Attendant, 10
as prescribed under Sub-rule (1) above should be attached with the claim. (ii) The bill shall be countersigned by the authority competent to sign the Travelling Allowance bill of the Government servant concerned. Explanation : The Authorised Medical Attendant for the purpose of this Rule means the Authorised Medical Attendant as referred in Rule 3(1)(i) to (iv) and (vii). 15. Grant of advance for medical attendance and treatment - (1) Medical advance Upto 75% of the estimated amount of reimbursable expenditure may be given to the hospital concerned for indoor treatment taken by the Government servant or his/her family members as per Appendix-XIV on the following conditions : (i) (ii) (iii) (iv) (v) (vi) (vii) The entire amount of advance shall be remitted through Demand Draft in favour of the hospital by the DDO on behalf of the Government servant. The advance shall be granted not earlier than 15 days of the actual date of operation/treatment as fixed by the Authorised Medical Attendant. Medical Advance shall be granted on the basis of certificate of the following: (a) (b) the Principal / Unit Head of a Medical College, in case the treatment is undertaken in a Government hospital of the State or in a referral hospital ; the Superintendent or Head of the Approved Hospital / Public Private Partnership Hospital where the treatment has been taken. The advance shall be drawn in the name of Government servant and debited to head of account of pay and allowances. Subsequent advance shall be granted only after the medical reimbursement claim(s) to the extent of previous advance has been submitted for adjustment. Government servant will have to submit medical reimbursement claim(s) within one month from the date of discharge of the patient from the hospital, and deposit unutilized amount of medical advance. In case of default, residual amount with 12% interest shall be deducted from his next salary bill(s). If the patient does not take treatment, he/she shall have to refund the entire amount advanced within 15 days. However, if the Authorised Medical Attendant reschedules treatment due to medical reasons, liability to refund shall accrue from the rescheduled date. 11
(viii) Non-compliance of the above conditions shall be treated as misconduct on the part of defaulter(s). (2) In case of outdoor treatment, Head of office can grant medical advance as per Appendix-XIV to a Government servant for purchase of drugs and medicines for treatment of Heart, Cancer and Kidney diseases on the recommendation of Authorised Medical Attendant. Government servant shall have to submit the reimbursement claim within one month and deposit the balance amount. In case of default, residual amount with 12% interest shall be deducted from his next salary bill(s). Subsequent advance can be granted subject to the adjustment of previous advance. 16. Purchase of medicines in case free supply is not provided - (1) Medicines prescribed by Authorised Medical Attendant shall be purchased by the Government servant from a shop run by CONFED / Upbhokta Sangh or shop authorised by the competent authority. In case medicines are not available at the shop, then the in-charge of the shop will issue Non Availability Certificate and medicines can be purchased from market on the basis of NAC. (2) In case of emergency or non-availability/closing of Co-operative Shop, medicines upto Rs 500/- can be purchased from private shops. (3) In case of indoor treatment, if facility of CONFED / Upbhokta Sangh or a shop authorised by the competent authority is not situated in the premises of Approved Hospital / Public Private Partnership hospital, then the medicines can be purchased from private shops. (4) Medicines prescribed by the Authorised Medical Attendant can also be purchased from the shops run by the Rajashan Medicare Relief Society. 17. Reimbursement of medical expenses from two sources - (1) A Government servant, who has subscribed / is subscribing to Medical Insurance Policies for himself/herself or his/her family, and is also eligible for availing medical facility under these Rules, may be allowed to claim reimbursement from both the sources. The claims in such cases shall be preferred as per procedure stated below : (i) (ii) The beneficiary will make the claim first to the insurance company and the residual claim if any, to the concerned Head of Office. Original vouchers/bills would be submitted to such insurance company along with claims. The company will retain such originals and issue certified copies clearly indicating amount met out or reimbursed on each bill/voucher in ink along with stamp and also issue certificate of total amount met out or reimbursed by it. 12
(iii) The beneficiary would then prefer his/her residual medical reimbursement claim to the Head of Office along with photocopies of vouchers / bills processed as prescribed in Sub-rule 1(ii) above. Note: The procedure mentioned above shall also apply to cases that fall under Rule 12(2 )&12(4). (2) Reimbursement from the Government shall be limited to the amount admissible as per provisions of these Rules absolutely and shall be over and above the amount met out by the insurance company. The reimbursement from both sources should not exceed total expenditure incurred by the beneficiary on the treatment. 18. Procedure for claiming reimbursement of medical expenses - (1) A Government servant shall present reimbursement claim to his/her Head of Office in duplicate, in the form prescribed in Annexure-VI and as per procedure stated below : (i) (ii) (iii) (iv) If the claim of medical expenses is upto Rs 500/- then in support of reimbursement claim, Government servant is required to attach prescription, relevant certificates, cash memo / bill for purchase of medicines and or other items. The prescription shall be signed by the Authorised Medical Attendant under his/her official stamp and shall bear OPD registration number and date of the hospital. If the claim of medical expenses is more than Rs. 500/-, then in support of reimbursement claim Government servant is required to attach Essentiality Certificate in duplicate, in the Form prescribed in Annexure-VII, cash memo / bill for purchase of medicines and other items, along with relevant certificates required under rules duly verified and signed by Authorised Medical Attendant under his/her official stamp. Consultation fee paid to Authorised Medical Attendant or/and fee paid to compounder / nurse per visit for administering injectables at residence of Government servant as per the Rajasthan Medical Officers and Nursing Staff Fees Rules, 2011 shall be claimed on the production of certificate prescribed in Annexure VIII. In case treatment is taken in referral hospital, a Government servant is required to attach Essentiality Certificate in duplicate in the Form prescribed in Annexure-VII, cash memo / bill for purchase of medicines and other items, relevant certificates required under rules duly verified and signed by doctor on duty of that hospital or countersigned by the Authorised Medical Attendant of Government hospital on whose advice the treatment outside the State was 13
taken, under his/her official stamp and self-attested copy of outdoor prescription slip in support of reimbursement claim. (v) If the total expenditure on drugs and medicines is more than Rs. 2 lacs, or on medical investigation more than Rs. 1 lac or total expenditure on medical attendance and treatment is more than Rs.5 lacs than the Head of Office will refer the case to the Principal of concerned Medical College to constitute a Medical Board to ascertain the genuineness of the claim. The reimbursement in such cases shall be governed as per opinion of the Medical Board. (vi) In case treatment continues over a long period, a Government servant can submit part claim once in a month, as per procedure prescribed under these rules, if reimbursable amount is more than Rs 1000/-. Note: Any tax paid by a Government servant on the purchase of items admissible under these Rules shall also be reimbursable to the extent and limit prescribed. (2) An Authorised Medical Attendant who verifies and signs the Essentiality Certificate shall maintain a register as prescribed in Annexure IX and shall mention the serial number with date of entry in such register on the Essentiality Certificate. District Medical & Health Officer or Superintendent of the Hospital or any other officer authorised by the Government may inspect and check the register without any prior notice. (3) Government servant shall submit the medical reimbursement claim at the place of his current posting within 2 years from the date of completion of treatment. But in case treatment was completed during deputation posting of the Government servant, then claim shall be preferred to borrowing authority. (4) Medical expenses shall be charged to salary budget head and shall be drawn in the pay bill form, duly countersigned by the authority competent to do so under Travelling Allowance Rules. (5) Head of the Department may refer any reimbursement claim of medical expenses for third party confirmation or confirmation by a team of doctors. Reimbursement in such cases shall be limited to the amount recommended by that body. 14
19. Special concessions to Government servants suffering from Tuberculosis and Cancer - A Government servant and members of his/her family suffering from Tuberculosis and Cancer shall be entitled for reimbursement of nonreimbursable medicines and cost of special diet as prescribed in Appendix-XIV. 20. Power of State Government - Notwithstanding any thing contained in these Rules, the Government may issue any direction / guidelines to regulate the purchase of medicines, the cost ceiling of implants, tests, treatments and approval of hospitals for treatment of State employees etc. and reimbursement procedure prescribed under these Rules. Provided that nothing in these Rules shall be deemed to entitle a Government servant for reimbursement of any cost incurred in respect of medical services obtained by him/her or for any journey performed by him/her otherwise than expressly provided under these Rules. Provided further that nothing in these Rules shall be deemed to prevent the Government from granting to a Government servant any concession relating to medical treatment or attendance or travelling allowance for any journey performed by him/her which is not Authorised under these Rules. Government of Rajasthan Decision 4 Sub: Ceiling Rates of reimbursement for Liver Transplantation Surgery under RCS (MA) Rules, 2013 In exercise of powers conferred under Rule 20 of RCS (MA) Rules, 2013 and as per the decision of the Health Benefit Empowered Committee, the State Government hereby decides the ceiling rates of reimbursement for liver transplant surgery in Government and approved private hospitals in the State, and in referral hospitals as follows: (a) The package rate for Liver Transplantation surgery involving live liver donor shall be as follows: Rs.11,50,000/- (Rupees Eleven lakh fifty thousand only) + pre transplant evaluation of donor and recipient, Rs.2,50,000/- (Rupees Two lakh fifty thousand only). (b) The package rate for Liver Transplantation surgery involving deceased liver donor shall be: Rs.11,00,000/- (Rupees Eleven lakh only. This includes the cost of consumables during the organ retrieval and the cost of preservative solution etc. 4 Inserted vide FD Order No. F. 6 (2) FD/Rules/2013 Pt. II dated 01-04-2015 15
(i) The package charges include the following: 1. 30 days stay of the recipient and 15 days for the donor starting one day prior to transplant surgery. 2. Charges for Medical and Surgical consumables, surgical and procedural charges, operation theatre charges, anesthesia charges, pharmacy, investigations and procedures during the above mentioned period. (ii) The package excludes: 1. Charges for drugs like Basiliximab/ Daclizumab, HBIG, and peg interferon. 2. Cross matching charges for Blood and Blood products. Note: 1. The medical reimbursement would be admissible as per the package rates mentioned above or the actual expenses, whichever is less. 2. The extra stay if any may be reimbursed after justification by the treating specialists for the reason of additional stay and only as per provisions/ rates under these rules, i.e., RCS (MA) Rules, 2013. 3. The drugs mentioned above and cross matching charges for blood and blood products shall be reimbursed as per relevant provisions of these rules, i.e., RCS (MA) Rules, 2013. 4. Liver transplant surgery shall be allowed only in Government Hospitals/ approved private hospitals/ Referral Hospitals, which are registered under the Transplantation of Human Organs Act, 1994, as amended from time to time. 5. As Liver Transplant Surgery is a planned surgery, prior permission of the Medical Board constituted under the Chairmanship of Head of Department, Gastroenterology, S. M. S. Medical College, Jaipur has to be obtained before the surgery is obtained. However, if for some reason it is done in emergency to save the life of the patient, the Medical Board shall consider the case referred to it for recommending grant of ex-post facto permission on a case to case basis. Detailed guidelines for the Medical Board, constituted for this purpose, selection criteria, documents required, submission of application etc. will be issued separately by the Medical Education Department, in concurrence of Finance Department. 5 Subject:- Rajasthan Civil Services (Medical Attendance) Rules, 2013 adoption of rates of CGHS, Jaipur as maximum chargeable rates for treatment in Approved Hospitals within the State. In exercise of powers vested in them under Rule 20 of the Rajasthan Civil Services (Medical Attendance) Rules, 2013 and after considering the recommendations made by the HBEC constituted under Rule 4 of the aforesaid rules, the Government has decided to adopt the rates of CGHS, Jaipur, as may be amended from time to time, as maximum chargeable rates for various treatments, investigations and implants etc. which can be charged by the Approved Hospitals within the State for treatment of Government servants appointed before 01-01-2004 and their family. Maximum chargeable rates for NABH/NABL and non NABH/ Non NABL Hospitals shall be as per the CGHS rates for these categories, respectively. The provisions of this order shall also be applicable to the pensioners and their family, who are availing medical facility under the Rajasthan State Pensioners Medical Concession Scheme, 2014. 5 Inserted vide FD Order No. F. 6 (2) FD/Rules/2013 Pt-III dated 27-06-2015 16
The rates of CGHS, Jaipur for various treatments, investigations and implants etc. are available on website http://cghsjaipur.nic.in/hospitals.html. The identification of Government employees and pensioners shall be done by the Approved Hospitals on the basis of the following:- (a) (b) (c) The identification certificate issued by the Drawing and Disbursing Officer to the Government Servant. Any identification issued by the competent authority in the State Government. This includes photocopy of Medical Diary or Pension Payment Order in the case of pensioner. Declaration by the employee/ pensioner himself at the time of admission, to be followed by (a) or (b) in reasonable time. The reimbursement of medical expenses to the Government servants and pensioners shall continue to be made as per the provisions of the Rajasthan Civil Services (Medical Attendance) Rules, 2013 and Rajasthan State Pensioners Medical Concession Scheme, 2014 respectively. This order shall come into force with effect from 1 st July, 2015. 21. Repeal and Savings - These Rules supercede the Rajasthan Civil Services (Medical Attendance) Rules, 2008 and all notifications / orders / circulars issued there under, and shall be applicable for the medical attendance and treatment taken on or after the date these Rules are issued. The pending cases and cases in which the treatment has been commenced prior to issuance of this notification shall be decided by the provisions of Rajasthan Civil Services (Medical Attendance) Rules, 2008 and all orders issued there under. 17
ANNEXURE - I Rule 3(9)(ii) FORMAT FOR DECLARATION OF DEPENDENCY OF PARENTS / CHILDREN I,... (Name of the Government employee),... (Designation and Officer / Department), hereby declare that following members of my family are wholly dependent on me and their monthly income is less than Rupees Six thousand per month : 1. 2. 3. 4. 5. I also declare that if there will be any increase in monthly income beyond Rs 6000 per month / or change in dependency then I will intimate accordingly. Date : Place : Signature of the Government Servant 18
Annexure - II Rule 3(9)(iii) FORMAT FOR CHANGE IN FAMILY UNDER THESE RULES 1. Name of the Government servant : 2. Post : 3. Office / Department : 4. Change in family : Sr. No. Name Relation Reason for change Date of change Date : Place : Signature of the Government Servant 19
ANNEXURE - III Rule 5 OPTION FORM FOR OPTING MEDICAL INSURANCE COVERAGE I... (Name)... (Post and Office), hereby declare that I opt to avail medical facilities under mediclaim insurance scheme of... (Name of Company). The insurance provider is regulated by the IRDA. The premium paid by me is Rs... per annum. I understand that once above option is exercised, I shall not be entitled for reimbursement of expenses incurred by me on medical attendance and treatment of myself and my family members under RCS (MA)Rules, 2013. Signature of government servant Name : Post : 20
ANNEXURE - IV Rule 12(1) Joint Declaration (in Duplicate) where Husband and Wife both are employed under State Government and covered under RCS (MA) Rules, 2013 We,... (Name, Post and Office) and... (Name, Post and Office) declare that we are spouses and also declare that reimbursement of medical expenses of our family shall be preferred by... (Name, Post and Office). Date : Place : Signature of Spouse Signature of the Government Servant who will prefer the medical claims Accepted by OR (Signature of Head of office with stamp) Declaration (in Duplicate) by each Government servant in absence of Joint Declaration I,... (Name, Post and Office) declare that reimbursement of medical expenses of myself and following dependent members of family (excluding spouse) shall be preferred by me : 1. 2. 3. Date : Place : Signature of the Government Servant Accepted by (Signature of Head of office with stamp) 21
Annexure - V Rule 12(3) Joint Declaration (in Duplicate) where one of the spouse is employed under State Government and covered under RCS (MA) Rules, 2013 and another employed under State Autonomous body / PSU having different facility for medical reimbursement We,... (Name, Post and Office) and... (Name, (Name, Post and Office)) declare that reimbursement of medical expenses of... (Name and Relationship) shall be preferred by... (Name, Post and Office)) or preferred separately by us through our respective offices. In case of dependent members of the family, medical expenses claim shall be preferred by... (Name, Post and Office). Date : Place : Signature of Spouse Signature of the Government Servant who preferred the medical claim Accepted by (Signature of Head of office with stamp) 22
Annexure - VI Rule 18(1) Form of Application for claiming reimbursement of Medical expenses incurred on Medical Attendance and Treatment of Government servants and their families. N.B. - Separate form should be used for each patient. 1. Name and Designation of the Government servant with Department (in Block letters). 2. Actual residential address. 3. Pay. 4. Place at which the patient fell ill. 5. Name of the patient and his/her relationship to the Government servant (in the case of children state age also.) 6. Amount of consultation fee charged by the Authorised Medical Attendant for treatment of the Government servant at residence under Rule 6(2)(i)(Mention name of the Doctor) and attach the prescribed certificate. (Annexure-VIII). 7. Fee paid to Compounder / Nurse for administering injectable at residence of Government servant (Attach prescribed certificate as per Annexure VIII). 8. Ambulance Charges. 9. Cost of the medicines purchased from the market. 10. Registration Fee / Consultation Fee (outdoor treatment). 11. Other charges admissible under Rules, if any. 12. Total amount claimed. 13. List of enclosures. Details of the medicines purchased from the market (Not required in case Essentiality Certificate is attached) S. No. Cash Memo No. & Date Name of the Shop Name of medicine 1 2 3 4 5 Amount Declaration to be signed by the Government servant I hereby declare that : (i) all statements in this application are true to the best of my knowledge and belief ; (ii) the person for whom medical expenses were incurred is wholly dependent upon me ; *(iii) the claim is for expenses incurred over and above the medical expenses covered under medical insurance scheme ; (iv) the claim for these medicines purchased by me has not been presented and drawn in the past; Date... Signature and Designation of the Government Servant and Office to which attached *Strike out if not applicable. 23
Annexure - VII Rule 18(1)(ii) &18(1)(iv) ESSENTIALITY CERTIFICATE I certify that Mrs./ Mr. / Miss... wife/ son/ daughter of Mr.... employed in the office... has been under treatment at the Hospital/ Indoor / Outdoor in my consulting room and that the under mentioned medicines prescribed by me in this connection are essential for the recovery / prevention of serious deterioration in the condition of the patient. These medicines are not stocked in the... for supply to private patients and do not include proprietary preparations for which cheaper substances of equal therapeutic value are available or preparations which are primarily foods, toilets or disinfectants. Cash Memo No. & Date Name of medicines Cost Rs. p. Signature and Designation of the Authorised Medical Attendant. Signature of the Medical Officer In-charge of the case in the Hospital 2. Certified that the patient is/ was suffering from... disease and is / was under my treatment from... to... It is further certified that the disease mentioned above does not fall under venereal disease, Delirium / Tremens. 3. The patient did not require / required hospitalization. The case is / was definitely not/ one of prolonged treatment. 4. Certified that the treatment is over / continuing. Entered at S. No.... in Hospital / Dispensary Register on... (Date). Signature of the Authorised Medical Attendant. Place... Date..... Signature of the Medical Officer I/c of the case in the Hospital 24
Annexure - VIII Rule 6(2)(i),6(2)(j)& 18(1)(iv) FORM 'A' CERTIFICATE It is Certified that Shri / Smt. / Kumari... Son/ wife/ daughter/ husband of Shri / Smt.... of the Department of... age... was suffering from... (disease) since... and was under my treatment. I paid visit / visits to his/her house on... at time... as his/her condition was serious and his/her removal to the hospital would have been dangerous or injurious to his/her life. I charged Rs... for my visits. Signature and Designation of the Authorised Medical Attendant Note: Medical Officer in receipt of non-practicing allowance are not allowed to undertake private practice and cannot charge consultation fee as Authorised Medical Attendant of Government servants under Finance Department Order No. F. 6(3)FD/Rules/2008 dated 12.09.2008 as amended from time to time. FORM 'B' Certify that Shri / Smt. / Kumari... Son/ wife/ daughter/ husband of Shri / Smt.... of the Department of... age... was suffering from... (disease) since... and I... paid visit / visits to his/her house on... at time... for administrating the injectable as prescribed by the Authorised Medical Attendant of... his/her Hospital / Dispensary and he / she was not in a position to attend the Hospital / Dispensary for the same. I charged Rs... as fee for injecting the injections. Signature and Designation of Compounder / Nurse Countersigned Signature & Designation of the Authorised Medical Attendant. 25
Annexure - IX Rule 18(2) Form of Register Date S. No. Name of the patient with Ailment / Disease designation and department 1 2 3 4 Prescription Fees charged for medical attendance including injectable etc. Total amount of Bills/ Cash Memo verified etc. Remarks 5 6 7 8 26
6 APPENDIX - I Rule 3(1)(v), 3(5) LIST OF APPROVED HOSPITALS FOR TREATMENT S. N. Name of Hospital A. Multispecialty Hospitals 1 1 Soni Manipal Hospital, Jaipur 2 2 Narayana Multispecialty Hospital, Jaipur 3 3 Porwal Hospital, Bhilwara 4 4 Solanki Hospital, Alwar 5 5 Krishna Hospital, Bhilwara 6 6 Aravali Hospital, Udaipur 7 7 Kamla Nagar Hospital, Jodhpur 8 8 Kailash Hospital, Behror (Alwar) 9 9 Dhanvantri Hospital and Research Centre, Jaipur 10 10 Gheesibai Memorial Mittal Hospital and Research Centre, Ajmer 11 11 Global Heart and General Hospital, Jaipur 12 12 Getwell Hospital and Research Centre, Sikar 13 13 Goyal Hospital and Emergency Care Centre, Baran 14 14 S.N. Pareek Memorial Hospital and Research Centre, Kota 15 15 Ravindra Hospital, Jhunjhunu 16 16 Sanjeevani Vyas Hospital Anusandhan Kendra, Jhalawar 17 17 M.N. Hospital and Research Centre, Bikaner 18 18 Anurag Nursing Home, Bundi 19 19 Imperial Hospital and Research Centre, Jaipur 20 20 Soni Hospital, Jaipur 21 21 Bhandari Hospital and Research Centre, Jaipur 22 22 Fortis Escorts Hospital, Jaipur 23 23 Mahatma Gandhi Medical College & Hospital, Jaipur 24 24 Tagore Hospital & Research Institute, Jaipur 25 25 Apex Hospital Pvt. Ltd., Malviya Nagar, Jaipur 26 26 Jaipur Hospital, Jaipur 27 27 NIMS Hospital, Jaipur 28 28 Jaiswal Hospital & Neuro Institute, Kota 29 29 Sudha Hospital & Medical Research Centre, Kota 30 30 Gitanjali Medical College and Hospital, Udaipur 6 Amended vide FD Orders No. F. 6(1) FD/Rules/2013 Pt dated 20-09-2013; No. F. 6(1) FD/Rules/2013 Pt dated 17-12-2013; No. F. 6(2) FD/Rules/2013 Pt-I dated 05-03-2014; No. F. 6(2) FD/Rules/2013 dated 09-05-2014; No. F. 6(2) FD/Rules/2013 Pt-II dated 07-08-2014; No. F. 6(2) FD/Rules/2013 Pt-II dated 09-09- 2014; No. F. 6(2) FD/Rules/2013 Pt-II dated 09-09-2014; No. F. 6(2) FD/Rules/2013 Pt-II dated 11-09- 2014; No. F. 6(2) FD/Rules/2013 dated 09-12-2014; No. F. 6(2) FD/Rules/2013 Pt-II dated 10-02-2015; No. F. 6(2) FD/Rules/2013 Pt-II dated 20-02-2015; No. F. 6(2) FD/Rules/2013 Pt-II dated 11-03-2015; No. F. 6(2) FD/Rules/2013 Pt-II dated 12-03-2015; No. F. 6(2) FD/Rules/2013 Pt-I dated 06-04-2015; No. F. 6(2) FD/Rules/2013 Pt-I dated 23-04-2015; No. F. 6(2) FD/Rules/2013 Pt dated 29-05-2015; No. F. 6(2) FD/Rules/2013 Pt dated 05-06-2015; No. F. 6 (2) FD/Rules/2013 Pt dated 06-07-2015; No. F. 6(2) FD/Rules/2013 Pt-I dated 30-07-2015; No. F. 6 (2) FD/Rules/2013 Pt-II dated 05-08-2015; No. F. 6(2) FD/Rules/2013 Pt-III dated 24-08-2015; No. F. 6 (2) FD/Rules/2013 Pt-II dated 25-08-2015; No. F. 6(2) FD/Rules/2013 dated 08-09-2015; No. F. 6 (2) FD/Rules/2013 Pt-II dated 16-10-2015; No. F. 6(2) FD/Rules/2013 Pt-II dated 16-10-2015; No. F. 6(2) FD/Rules/2013 Pt-II dated 23-12-2015 and No. F. 6(2) FD/Rules/2013 Pt-I dated 06-01-2016. 27