EXISTING RULES RCS(MA)RULES,1970

RCS(MA)RULES,2008

RCS (MA) Rules, 2013

MEDICLAIM POLICY FOR EMPLOYEES APPOINTED AFTER 1-1-2004

RJO(MF) RULES 2008

AIS(MA) RULES 1954

RCS(MA)RULES.1970PROBLEMS NO PROVISION FOR REMBURSEMENT FOR TREATMENT TAKEN

IN PRIVATE HOSPITAL WITHIN THE STATE.

NO PROVISION FOR REMBURSEMENT FOR TREATMENT TAKEN IN PRIVATE HOSPITAL OUTSIDE STATE THE STATE

REIMBURSEMENT OF IMPLANTS

REIMBURSEMENT OF CONSUMABLES

NO PROVISION OF TESTS & INVESTIGATIONS CARRIED OUT IN PRIVATE LABS.

RCS (MA) RULES,2013 EFFECTIVE FROM 16-9-2013

APPLICABLE ON

all Government servants, appointed before 1st January, 2004

all Government servants on deputation from Central / other State Governments unless anything otherwise is provided in their terms of deputation

NOT APPLICABLE ON

Employees appointed after 1-1-2004

AIS service officers

Rajasthan Judicial service Officers

Contract employees

Definations Authorised Medical Attendant1. MO of DMHS/ Approved hospital/ Referral Hospital

2. MO of attached hospital of RUHS

3. Aurved / Yunanni/ Homeopathik chikitsak of Govt, hospital attached to RAU Jodhpur & NIA jaipur

Approved hospital

Referral Hospital

Family1. Parents

2. Son

3. Daughter

Medical Attendance

Treatment

Who decides

Can any body walk off

In Government Hospital

1. OPD

2. IPD

3. Investigations

4. Implants

5. consumables

IMPORTANT RULES Rule 4 HBAC

RULE 5 - OPTION FOR MEDICLAIM

RULE 6

FREE MEDICAL ATTENDANCE IN GOVERNMENT HOSPITAL WITHIN THE STATE

REIMBURSEMENT OF:

ALLOPATHY DRUGS & MEDICINES (OTHER THAN NEGATIVE LIST)

AYURVEDIC &YUNAN DRUGS AS PER THE LIST

AMBULANCE CHARGES

BLOOD TRANSFUSION CHARGES

HEARING AID & Other Implants

Cost wholly or partly of hearing aid or artificial limb (including cost of replacing a limb) or calipers. Cost of Implants other than specified in Appendix IX will be reimbursed as under: -

Cost of Hearing Aid Limit of reimbursement

(a) First Rs.5,000/- 100%

(b) Next Rs.5,000/- 80%

(c) Rest amount 50% of the remaining amount,subject to maximum of Rs.35,000/-

• In case hearing aid equipment is required to be purchased again, in the opinion of the competent Authorised Medical Attendant or earlier equipment is beyond repairs, reimbursement would be limited to 50% of the amount as would have been admissible for first purchase as per rule (i) above.

• Consultation fee charged by the authorized medical attendant for treatment at residence of Government servant

• Auto financing scheme

• Actual cost of intra-ocular lens implantation and treatment thereto

• Cost of Subcutaneous Infusion Pump

• Cost of disposable surgical sundries used during surgical and other operations and which cannot be re-used including items of common surgical materials like gauge, I.V. Set, bandage, Leucoplast, Cotton, Crepe Bandage etc., if not supplied by the hospital.

• Charges paid by the Government servants to the Rajasthan Medicare Relief Societies

• Charges paid by the Government servant to the private diagnostic centres / labs etc. installed in Government hospitals through Rajasthan Medicare Relief Societies for pathological, bacteriological and radiological tests, x-ray, MRI, CT-Scan etc., at the rates as may be approved by the Rajasthan Medicare Relief Society from time to time.

• Charges paid by the Government servant to the private diagnostic centres / labs etc. for the tests undertaken on advice of Authorised Medical Attendant, under conditions and to the extent as under: -

• (i) After obtaining NAC from Government hospital. -• (a) If the facility of that test exists in Government hospital• 100% of Government hospital rate• (b) If the facility does not exist in Government hospital• 70% of the incurred amount•

• (ii) Without obtaining NAC from Government hospital. -• (a) If the facility of that test exists in Government hospital• 80% of Government hospital rate• (b) If the facility does not exist in Government hospital• 50% of the incurred amount

• Cost of implants including stents, valves, joints, pacemaker, ICD, Cochlear Implant etc., considered necessary to be implanted in the body of the patient and angioplasty / balloonplasty to the extent as may be prescribed by orders of the Government from time to time, on the advice of Medical Benefits Advisory Committee.

• Sums actually paid on account of medical attendance and treatment including charges for surgical operations.

• RULE 7. Medical Attendance and Treatment to Government servant and his family in approved Hospitals, within the State.

• Rule 8 Medical Attendance and Treatment to Government servant and his family in PPP Hospitals, within the State.

• RULE 9. Medical attendance and treatment outside Rajasthan in Government hospitals: -

• RULE 10. Treatment, including specialised treatment, outside Rajasthan in hospitals other than Government hospitals

• Rule 11 Treatment in private unrecognised hospital within State.• RULE 12. Medical attendance and treatment, where both husband

and wife are employed in State Government / Autonomous Body / elsewhere, where procedure for medical reimbursement exists –

• 15. Grant of advance for medical attendance and treatment (outside/ within State): -

Rule 16 Purchase of Medicine

Rule 17 Claim from two sources

Rule 18 procedure to claim reimbursement

Rule 19 TB and cancer

Rule 20 Govt power to issue guidelines

Rule 21 Saving clause

IMPORTANT CIRCULARS DATED 6-2-2009

DATED 20-2-2009

DATED 27-11-2009

DATED 16-12-2009

DATED 4-2-2010

DATED 15-2-2010

DATED 1-6-2010

DATED 6-7-2010

DATED 10-9-2010 (2 ORDERS)

Dated 12-11-2010

REIMBURSEMENT IN APPROVED HOSPITALS OPD

50/- REIMBURSEMENT FOR REGISTRATION / DOCTOR’S FEES

DRUGS TO BE PURCHASED FROM CONFED SHOP

AFTER NAC FROM CONFED CAN BE PURCHASED FROM HOSPITAL SHOP

INVESTIGATIONS CAN BE DONE IN APPROVED HOSPITAL

REIMBURSEMENT WILL BE 70% OF APPROVED HOSPITAL RATE OR SMS RATES WHICHEVER IS LESS

IPD PATIENT CAN BE DIRECTLY ADMITTED IN APPROVED HOSPITAL

WITHOUT ANY REFERNCE FROM GOVERNMENT HOSPITAL

As per CGHS rates

Reimbursement in Unapproved Private hospitalS.No. Item Rate

1 Drugs & Medicine 50% of reimbursible drugs

2 Investigation As per Appendix XVI50% of actual

3 Operation Theater 30% Max 3,000/-

4 Anesthesia 30% Max 3,000/-

5 Doctor fees 40% Max 3,000/-

6 Room Charges As per appendix V

7 Blood Bank 75 % of appendix VI

8 Dialysis 75% ofappendix VI

Room chargesPay Slab Class of

AccommodationRate of reimbursement in Approved hospital and in PPP hospital

Rate of reimbursement in Un Approved hospital

Rs. 25000/- P.m. & above

1. Cottage Ward (AC)

2. Super Deluxe

1. 700/-2. 600/-

1. 5252. 450

Rs 14000/- to Rs.Rs.25000/-

1. Cottage ward 1. 350/- 1. 265

Rs 6600/- to Rs.Rs.14000/-

1. Rental ward of the lowest quality

1. 120 1. 90

REIMBURSEMENT WILL BE LIMITED TO THE PACAGE RATES IRRESPECTIVE OF ACTUAL PAYMENT DONE BY THE EMPLOYEE / PENSIONER.

EXPENSES OF DRUGS OVER AND ABOVE THE PACKAGE WILL BE DONE. THE DRUGS USED DURING THE OPERATION ARE INCLUDED IN THE PACKAGE CEILING.

GOVERNMENT SERVANTS WILL PRESENT THEIR CLAIM TO HEAD OF OFFICE WHILE PENSIONERS WILL PRESENT THEIR CLAIM TO CONCERNING TREASURY OFFICFER FOR REIMBURSEMENT

Some case Studies One Government Servant was on leave. He went to

Mumbai with his family for excursion tour. He met an Road accident and was admitted to Tata Memorial hospital. An emergency operation was conducted and expenditure of Rs. 65,000/- was incurred. He came back to Jaipur after 15 days . He went to Mumbai twice for follow up check up and expenditure of 35,000/- was incurred . What will be the position of reimbursement?

A Government Servant is only son of his old age parents. His father sffe5rs from cardiac arrest in a village in Sikar district. He is immediately rushed to SMS hospital. He is treated and CABG is performed. There is total Expenditure of Rs. 55,000/-. Can the Govt. Employee claim reimbursement

Shri XYZ is a leading lawyer of Rajasthan High court. His annual income as per his IT return is Rs. 10 lacs. His wife is Joint Director in SIPF department. If Shri XYZ falls ill and takes treatment in Government / Approved hospital, can his wife claim reimbursement.

A government employee is chronic patient of asthma. He takes regular treatment in Government hospital. One day there is sandstorm and this fellow suffers severe asthma attack. His son immediately takes him to nearest hospital i.e. Rungta hospital Malviya nagar. He is admitted and stays there for one day. The total expenditure is 17,000/-. What will be the position of reimbursement.

A patient is admitted in Cardiology department in SMS. The PHOD examines him and writes on his ticket that the facility of treatment is not available in SMS hospital hence he is referred to Medanta Hospital Gurgaon. He writes a letter to Dr. Trehan for reference also. The patient is discharged and he goes to Medanta hospital. He is admitted there and treatment is done. The total expenditure is 3,50,000/-. What amount will be reimbursed.

Can the following be reimbursed:

Medical expenses of Son of Govt Employee studying in Nagpur for treatment taken in Govt. Hospital Nagpur

Medical Expenses of Daughter in law of Govt. Employee, if son is dependent on him.

Medical expenses of grand children who permanently reside with him.