Haryana

HARYANA NOTIFIED POLICY FOR PROVIDING CASHLESS MEDICAL SERVICES TO EMPLOYEES AND PENSIONERS

November 21, 2017 07:59 PM

Chandigarh (Face2News)

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.

While stating this here today, a spokesman of the Department said that the scheme would be only for regular State Government employees and pensioners. 

He said that 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 that 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 haemorrhage and electrocution. This scheme would be applicable at 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 that all departments of the state government would issue valid identity cards to their regular employees and pensioners to entitle them for 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, he added.

The spokesman said that 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 that 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 that 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.

The spokesman said that it would be responsibility of the respective Head of the Department or Head of the Office to ensure payment or disposal of all the medical bills raised by the hospital providing cashless health service must be cleared within 60 days of the receipt of the bill. He said that the cashless medical bills for cashless service given by the hospitals and sent to the respective department would be dealt in the office of Head of the concerned department and payment made to the hospital in time.

The Nodal Officer would be responsible in processing of bills, transfer of funds, to address any delay in payments and share grievances.He said that all the empanelled Government and private health facilities and all the Government Departments would appoint their respective nodal officers with a dedicated cell and share the contact details of the same on their official website and as well as send an e-mail to the Health Department. The Department would create a new page and would upload the detail of the nodal officers of all the departments, medical colleges and private empanelled hospitals on their website.
He said that this service being provided on public private partnership mode be given in cashless mode and would continue to be free for the state government employees and beneficiaries. These services would include the cathlab services too. The expenditure incurred would be fit charge under Mukhya Mantri Muft Ilaaj Yojana (MMIY).

He said that the expenditure incurred on providing cashless service to regular Haryana Government employees and pensioners in the above mentioned six categories of diseases by the Government Medical Colleges, Government aided Medical Colleges would be fit charge under MMIY.
The spokesman said that the rates for any package, procedure and surgery like organ transplant and devices or implant rates fixed by the state government from time to time would be applicable on all the government health facilities and empanelled private hospitals. These rates are displayed on the website of Health Department, he added. He said that in case any fake bill or duplication of claim is reported, the beneficiary or institution is liable to be penalized for major penalties under the Haryana Civil Services (Punishment and Appeal) Rules, as amended from time to time. In case any wrong bill or fake treatment is reported and confirmed, the hospital is liable for de-empanelment and it would be responsibility of the concerned department to send the case to the Health Department.
While referring to the private empanelled hospitals, he said that such hospitals would give 100 per cent cashless services for the treatment given under prescribed package rates of state government. If the beneficiary is treated for any conditions which is not covered by the prescribed package that is non-package then for hospitals empanelled at PGI rates plus 75 per cent of the balance amount, 80 per cent of the treatment would be made cashless and 20 per cent of the final bill has to be paid by the beneficiary which later on may be submitted by the beneficiary to their concerned department for reimbursement under existing policy as per entitlement.
He said that for hospitals empanelled at PGI rates only, 50 per cent of treatment would be made cashless and 50 per cent of the final bill has to be paid by the beneficiary which later on may be submitted by the beneficiary to their concerned department for reimbursement under existing policy as per entitlement. He said that in case of poly-trauma where multiple packages are invoked for treatment given in the same sitting or operative procedure then the reimbursement claimed by the private empanelled hospital would be as per the formula that is highest cost package to be reimbursed at the rate of 100 per cent of the package cost, second highest cost package at the rate of 50 per cent of the package cost and third highest cost package at the rate of 25 per cent of the package cost. All other subsequent cost packages at the rate of 25 per cent of the package cost, he added.

The spokesman said that follow up services in OPD are not cashless. However, if there is another episode of similar life threatening conditions, the same would again qualify for cashless services. He said that two hard copies of each and every bill have to be generated by the hospital, one for the concerned department and another for the patient. The bill in original along with the discharge summary would be submitted by the hospital to the nodal officer of the respective department within seven days of discharge through courier or speed post and a copy of the bill would also be handed over to the beneficiary at the time of discharge. This is in addition to the office copy retained by the hospital. After completion of treatment, the beneficiary would countersign the final bill raised by the hospital, he added.

He said that all empanelled hospitals would furnish their bank details like name of the bank, account number, IFSC Code, MICR Code and PAN Number with the bill to the concerned nodal officer of the department, for transfer of payment electronically. 

 

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