Chandigarh: Haryana Health Department has notified the policy for providing cashless medical services to the State Government employees and pensioners with effect from November 30, 2017.
Stating this, a spokesman of the Department said that the scheme would be only for regular State Government employees and pensioners.
He said spouses and dependents of regular Haryana Government employees and pensioners are not covered under this scheme. However, the spouse and dependents of employees and pensioners would be entitled for treatment as per the existing policy of reimbursement issued dated May 6, 2005.
He said this limited cashless medical facility would be applicable only for six life-threatening conditions namely cardiac emergency, accidents, third and fourth stage of cancer, coma, brain hemorrhage, and electrocution.
This scheme would be applicable to all government medical colleges and government aided Medical Colleges in Haryana, all district hospitals, other health institutions of the state government and all private hospitals empanelled under the State Government.
He said all departments of the state government would issue valid identity cards to their regular employees and pensioners to entitle them to availing limited cashless medical services. The pensioners would carry the Pension Payment Order (PPO) and these would be accepted as proof of identity by all the government or private empanelled health facilities for giving limited cashless service to them. Departments would link their identity cards to Aadhaar Numbers.
The spokesman said it would be the responsibility of the beneficiary to produce valid ID card or PPO Number to the hospital in order to establish his or her identity of regular employee or pensioner. Similarly, it would be the responsibility of the health institutions to ask for the identity cards or PPO’s from the employees or pensioners and to explain to them whether the condition or surgery or procedures or disease is covered under cashless medical facility or not.
He said the National Informatics Centre would make available the data for identification of employees culled out from HRMS Data. This data would be sent to Health Department who would upload this data on their official website. The database of the pensioners with PPO Numbers would also be made available to the Health Department by Finance Department and NIC.
This would also be uploaded on the official website of the Health Department and in case the hospital wants to verify the entitlement of the beneficiary, this would be done by counter-checking it on the website of the Health Department.
He said a ceiling of Rs five lakh for limited cashless is fixed. If the cost of the treatment exceeds this amount, the excess amount would be paid by the employee or pensioner.
This amount could later be got reimbursed from his or her department as per the entitlement and existing reimbursement policy.
He said that implant or device would be given in cashless mode only if the cost of the same has been fixed by the Haryana Government.
The Central Government has notified the rates of cardiac stents and knee implants in 2017 and these rates would be applicable in place of Haryana Government rates. For implant or device whose cost has not been fixed by the Centre or the State Government, the employee or pensioner would make payment for the same and later get it reimbursed as per the existing reimbursement policy.