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    Post Retirement Medical Benefits

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    Testhdj
    The document outlines guidelines for post-retirement medical benefits for hospitalization for retiring employees of a company. It details that [1] employees retiring after May 2006 and their spouses are eligible for up to Rs. 5 lacs annual coverage for hospital expenses. [2] Reimbursement will be provided for hospitalization, day procedures, and expenses from approved hospitals up to the specified limits. [3] Prior approval must be obtained for planned treatment and estimates, except for emergencies or tied hospitals.

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    Post Retirement Medical Benefits

    Uploaded by

    Testhdj
    68 views4 pages
    The document outlines guidelines for post-retirement medical benefits for hospitalization for retiring employees of a company. It details that [1] employees retiring after May 2006 and their spouses are eligible for up to Rs. 5 lacs annual coverage for hospital expenses. [2] Reimbursement will be provided for hospitalization, day procedures, and expenses from approved hospitals up to the specified limits. [3] Prior approval must be obtained for planned treatment and estimates, except for emergencies or tied hospitals.

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    The document outlines guidelines for post-retirement medical benefits for hospitalization for retiring employees of a company. It details that [1] employees retiring after May 2006 and their spouses are eligible for up to Rs. 5 lacs annual coverage for hospital expenses. [2] Reimbursement will be provided for hospitalization, day procedures, and expenses from approved hospitals up to the specified limits. [3] Prior approval must be obtained for planned treatment and estimates, except for emergencies or tied hospitals.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    68 views4 pages

    Post Retirement Medical Benefits

    Uploaded by

    Testhdj
    The document outlines guidelines for post-retirement medical benefits for hospitalization for retiring employees of a company. It details that [1] employees retiring after May 2006 and their spouses are eligible for up to Rs. 5 lacs annual coverage for hospital expenses. [2] Reimbursement will be provided for hospitalization, day procedures, and expenses from approved hospitals up to the specified limits. [3] Prior approval must be obtained for planned treatment and estimates, except for emergencies or tied hospitals.

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    POST RETIREMENT MEDICAL BENEFITS FOR HOSPITALISATION

    (Revised w.e.f. 8.10.2014)

    The broad guidelines for Post retirement Medical Benefits Scheme for
    Hospitalisation for retiring employees is enumerated below:

    1. The employee retiring after May 2006 and his/her spouse only will be eligible to
    get the medical facilities for hospitalisation.

    2. The maximum eligible amount during the financial year will be Rs 5 lacs per
    annum with a cap of Rs 3 lacs per ailment per person. The employee
    retiring in between in the financial year will be eligible to get the proportionate
    amount (inclusive of the Hospitalisation expenses of spouse) for that financial
    year

    3. The expenses for hospitalisation treatment including day care procedures viz.
    Cataract, Laparoscopy & Laser surgeries(non cosmetic) etc. will be reimbursed
    after scrutiny of reimbursement claim for the reasonability of various charges
    like room charges, operation charges, visit charges, nursing charges, etc. The
    entitlement of these charges shall be as per the ceiling specified at para no. 8
    and the expenses for Ayurved/Homeopathy hospitalisation treatment shall be
    reimbursed subject to the maximum eligible amount as specified at para no. 2.
    No incidental charges, if any, shall be reimbursed. The expenses for
    hospitalisation treatment taken at Narmadanagar Hospital shall be debited from
    the maximum eligible amount as specified at para no.2.

    4. The list of tie-up hospitals in various cities prepared by our Narmadanagar


    Hospital is enclosed herewith for kind information where cashless
    hospitalisation treatment can be taken.

    5. The medicards of yourself and your spouse are placed in the folder and the
    same is required to be presented at the time of hospitalisation.

    6. The retired employees are required to take prior permission from the
    Company’s doctor before undergoing hospitalisation treatment. In order to
    provide proper medical treatment and guidance as also to expedite the process
    of medical reimbursement claims for the planned surgery / hospitalisation
    treatment taken, the concerned retired employee is required to obtain an
    estimate from the treating doctor / hospital and get it approved by Sr.Manager
    (Dr.SMP) in advance. However, this procedure of obtaining the estimate for
    medical treatment during hospitalisation in respect of tie-up hospitals is not
    required. The concerned retired employee has to obtain a reference letter for
    taking treatment in these tie-up hospitals. In case of emergency, verbal
    guidance/approval from the Company’s doctor should be obtained and written
    approval can be obtained subsequently, but prior to submission of medical
    claim.

    1
    7. The Medical claims for reimbursement shall be supported by vouchers,
    receipts, cash-memos, copy of reference letter if any etc. and shall be certified
    by the authorised Medical Practitioner and submitted in the prescribed form
    (placed in the folder) to the Sr.Manager(Dr.SMP) for certification before the
    payment. The retired employee shall submit his/her medical reimbursement
    claim form with the supporting documents not later than 30 days from the date
    of discharge from the hospital.

    8. The following ceiling for various charges shall be considered subject to the
    overall maximum eligible amount as specified at para no. 2 above.

    A. Room Charges ceiling ( Rs. per day):

    Type of city Max. ceiling in Rs.


    For Staff For Officer For CM & For GM,
    employees in O-5 & AGM on CGM, ED on
    below on the date of the date of
    the date of retirement retirement
    retirement
    Metro cities outside 4,750 5,400 7,200 10,800
    Gujarat (Delhi,
    Mumbai, Kolkata,
    Chennai, Hyderabad,
    Bangalore) & Pune
    Ahmedabad (many 3,200 3,600 4,500 6,000
    cashless tie up
    hospitals available at
    discounted rates)
    State Capitals and 1,900 1,980 2,475 3,575
    cities with population of
    10 lacs & above.
    Cities with population 1050 1,320 1,980 2,420
    of more than 1 lac but
    less than 10 lacs
    Towns with population 625 990 1,650 2,200
    of less than 1 lac

    In case of cities like Ahmedabad and other places, where many cashless
    hospitals are available, other hospitals should be rarely preferred and there
    should some justification for ignoring the approved cashless hospitals.

    The room charges will be reimbursed as actuals within the ceiling specified
    above. However, in serious cases where ICU or Spl. Room treatment is
    necessitated as per the medical requirement, it may be considered on case to
    case basis on its merits.

    2
    The limit of room charges as aforesaid will be applicable to all and it will apply
    to Corporate, Multispecialty & Trust Hospitals also besides Private and other
    Hospitals.

    B. Visit Charges:

    Visit charges of treating doctor at his/her own hospital will be reimbursed up


    to maximum limit of Rs. 200 per day/visit during the period of hospitalisation.
    Charges for the specialist or super specialist doctors, if invited by the
    hospital for the treatment shall be reimbursed on actual basis.

    C. Nursing Charges:

    Nursing charges shall be reimbursed up to the maximum limit of Rs.150/-


    per day.

    D. Assistant Charges:

    Assistant charges for assisting Surgeon during the operation will be


    reimbursed only in case of Polyclinics and Corporate Hospitals excluding
    Private hospitals.

    E. Operation Charges:

    Operation charges will be reimbursed at the maximum rates negotiated for


    the tie up hospitals in the same city or town or the nearby City / Town in
    Gujarat.

    F. Operation Theatre Charges:

    Operation theatre charges will be reimbursed upto max. limit of 20% of


    operation charges in case of private hospitals. In case of Trust’s hospitals, it
    will be reimbursed as actuals.

    G. Surgical Charges:

    The Surgical charges for non tie up hospitals shall be reimbursed upto the
    extent of maximum rates negotiated for tie up hospitals in the same city /
    town. However, if there is no tie-up arrangement made in any hospital in the
    same city/town; then the maximum Surgical charges finalized with tie-up
    hospital in the nearest city/town shall become payable. However, for Metro
    Cities having no tie-up hospitals, the maximum ceiling of surgical charges,
    as aforesaid, will be increased by 25%.

    H. File / Admission Charges:

    These are reimbursed only in cases where patient is hospitalised in


    Charitable Hospital or Corporate Hospital or Polyclinics.

    3
    I. In case of the following operations, the hospitalisation for 24 hrs. is not
    required for claiming reimbursement for pre and post-hospitalisation
    expenses:

    A) Eye operation for Cataract & glaucoma


    B) Laproscopy
    C) Laser Surgery.

    J. The expenses for pre and post medical treatment up to seven days prior to
    the hospitalisation and thirty days after the discharge of the patient from the
    hospital shall be considered, if the period of hospitalisation shall be min.
    seven days except in case of para I above.

    9. The consultation charges of Company’s regular Doctors will not be charged to


    the retired employees and their spouse in Narmadanagar Hospital No extra
    amount of 10% will be charged for the medicines dispensed at the prescription
    of Company’s doctors from Narmadanagar Hospital for the retired employees
    and their spouse.

    10. In case, the information provided earlier by you to HR Dept. get changed, you
    are requested to provide us the latest details and send us the same either by
    post or by an email to “kcprajapati@gnfc.in”.

    11. Any dispute with regard to interpretation of any of the medical rules etc., MD’s
    decision shall be final and binding to all.

    -----

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