Organization : Delhi State Industrial & Infrastructure Development Corporation Ltd
Scheme Name : Post Retirement Medical Facilities Scheme (PRMFS) For Employees
State/ UT: Delhi
Official Website : http://dsiidc.org/
Scheme Details : https://www.statusin.in/uploads/8810-medical.doc
PRMFS For Employees
The Scheme is Titled as Post Retirement Contributory Medical Scheme aimed at providing reimbursement of hospitalization expenses to the retired employees of DSIIDC during their indoor hospitalization in Govt./CGHS approved Hospitals only.
Related / Similar Service : dsiidc.org Relocation Industry
This is purely a welfare / social security measure for providing them medical facility in their old age.
Eligibility:
Within the overall framework of the rules and regulations of the Medical Rules of the Corporation, the reimbursement of post-Retirement hospitalization expenses will be admissible to the following categories of officials on contributory and voluntary basis:-
(i) Those who retire from the service of the Corporation on reaching the age of superannuation subject to rendering minimum continuous service for 10 years in regular pay scale.
(ii) Those who are permitted to proceed on voluntary retirement and who have rendered minimum regular and continuous service of 10 years in the Corporation will be eligible for medical benefits only after reaching the notional age of superannuation.
(iii) Officials who are dismissed or whose services have been terminated by the Corporation as a measure of punishment for misconduct shall not be eligible for the benefits contemplated under this scheme. Similarly, officials unauthorisedly abandoning the service of the Corporation, shall also not be eligible for the benefit under the scheme.
(iv) This Scheme may also cover the spouses of the Retired Employees including their dependent family members as per definition of family defined in Medical Attendance Rules.
(v) The Retired Employees willing to join the scheme will be required to submit Dependency Certificate alongwith Photograph/Thumb Impression of his/her dependent family members on the prescribed performa (enclosed). Dependency Certificate / Undertaking shall be submitted along-with every claim.
(vi) In case of Death of the Retired Employees, his/her Spouse (including Dependents) shall continue to avail all the benefits under the Scheme subject to the condition contained in Point No.(iv) above and continue to meet other terms & conditions of the scheme.
Contribution:
(i) For taking membership of this medical scheme, all the Retired Employees of the following categories shall have to contribute the amount mentioned below against their category, as one time contribution: –
One Time Contribution :
Category ‘A’ – Rs.10,000/-
Category ‘B’ – Rs.7,000/-
Category ‘C’ – Rs.5,000/-
Category ‘D’ – Rs.3,000/-
(ii) Contribution shall be payable by all Retired Employees in advance, i.e. three months prior to the date of retirement from the service of the Corporation and those who have already Retired may pay their contribution within one month from the date of issue of the Circular, along-with willingness and Dependency Certificate, on the prescribed proforma.
(iii) Contribution once paid in this regard shall not be refunded even if the beneficiary opts out of this scheme at any stage.
(iv) The Membership of the Scheme will be restricted to either Husband or wife and in those cases where both are Ex-employees of the Corporation, as may be opted by them.
(v) Where both Husband & Wife are the employees of the Corporation, the contribution towards Membership under the scheme would be payable by any one of them only. In that case, even upon superannuation, the Spouse who retires later would not be enrolled under the scheme independently. The Medical benefits would be restricted to the prescribed ceilings for the member and his dependents. However, in case it is considered beneficial, option may be exercised jointly by both ex-employees (husband and wife) and the differential amount paid, at the time of superannation of the later, to convert the existing membership in the name of the one who has superannuated last. In all other cases option once exercised will not change.
Medical expenses qualifying for reimbursement:
All the expenses incurred by an employee which are connected with and are incidental to indoor hospitalization for medical treatment and are incurred during the period of hospitalization except as provided otherwise elsewhere on this scheme will qualify for reimbursement Expenses incurred in connection with availing of OPD service will not be admitted for reimbursement.
The medical expenses qualifying for reimbursement will include:-
(i) Charges for Hospital Accommodations.
(ii) All Charges connected with surgery.
(iii) All charges connected with tests / investigations such as pathological tests, X-ray charges, radiological charges etc.
(iv) Expenses incurred by way of consultation fee/visiting charges during the period of Indoor Hospitalization.
(v) Cost of medicines provided by the Hospitals and paid by the applicant and/or purchased from outside on the prescription of the Hospital Physician.
(vi) Any other expenses charged by the hospital which are directly connected with and are incidental to medical treatment during the period of hospitalization.
Benefits:
(i) The reimbursable ceiling limit for the hospitalization expenditure shall be 90% of the total expenditure as admissible under para-4.
(ii) No Medical Advance shall be provided to the Retired Employees for Hospitalization purposes.
(iii) This facility of Reimbursement will be restricted to CGHS rates and to those Retired Employees whose treatment has taken-place at any of the Govt./CGHS approved hospitals only. The list of such hospitals is enclosed for reference of all concerned. No reimbursement will be allowed, if treatment takes place at non-recognised hospital.
(iv) In the event of the Death of Retired Employee, the benefit will continue to apply to the spouse and his/her dependents so long as they fall under the category of Dependents.
(v) In case the member or any of his dependent is hospitalized, it would be a pre-requisite to intimate Personnel Division immediately alongwith Hospital’s recommendation in writing or by e.mail/fax .
(vi) Medical expenses incurred for treatment outside the country shall not be admissible for reimbursement under this Scheme.
(vii) Normally only those claims where hospitalization took place for more than 24 hours will be considered for reimbursement.
(viii) The entitlement of Retired Employees to various types of Hospital Accommodation/charges will be worked out on the basis of their rank at the time of retirement.
(ix) MD shall have the discretion to allow treatment in non-notified hospitals /Nursing Homes keeping in view the urgency/seriousness of illness.
The Category-wise Entitlement of Retired Employees to various types of Hospital Accommodation will be as under:-
Nursing Home Basic Pay more than Rs.12,000/- p.m.
Semi-nursing Home Rs.8,000-12,000/- p.m.
Semi-paying Rs.5,000-8,000/-
Economy ward. Less than Rs.5,000/-
In case any member takes treatment in the upper category he will be entitled for the 90% of eligible amount of his category only calculated on the rates of Sir Ganga Ram Hospital as applicable to serving employees of DSIIDC.
Claim:
The retired employees will be required to submit their medical claims in Personnel Division of DSIIDC within 3 months from the date of discharge. These claims will be processed and payment released by cheque from Central A/cs Section of DSIIDC as per C.G.H.S. rates. All efforts will be mde to clear the bill within 30 days.
General Conditions:
(i) The Corporation may at its sole discretion decide to terminate the Membership of any member or any of his/her Dependents in case Corporation is satisfied on the basis of evidence on record that benefits/facilities under the scheme are being misused/abused by a member, apart from taking other action as Corporation may deem fit.
(ii) The Scheme and or the benefits shall be liable to be withdrawn and made inoperative at any time for any other reason whatsoever. The Scheme and or benefits there under shall not be deemed to be a matter of right of contract or terms & condition of Employment.
Saving:
Matters not specifically covered in this scheme, shall be decided by the Managing Director, which shall be final.