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THE SIKKIM SERVICES (MEDICAL FACILITIES) RULES, ------------------------------------------------------------------------------------------------------------------------------------------- I. INTRODUCTORY AND DEFINITIONS.
1. Short title and commencement.- (1) These Rules may be called the Sikkim Services (Medical Facilities) Rules.
(2) They shall come into force with effect from 1st April, 1981.
2. Extent of application.- (1) These rules shall apply to all employees of the Sikkim Government (except the officers belonging to the India Administrative Service, Indian Police Service or such other Services of All India Cadre), appointed against regular post with the time scale of pay, who have rendered a minimum continuous service of one year and members of their families and also to any person in respect of whose services, pay and allowances or any of them, special provisions have been made by an agreement made with him by the Government.
(2) Notwithstanding anything contained in sub-rule (1), a Central Government servant or a Government Servant of any other State while on deputation to the Government of Sikkim shall also be governed by these rules in regard to medical facilities.
3. Definitions.- In these rules, unless the context otherwise requires, (1) “Authorised Medical Attendant” means a Medical Officer. Amji, Homeopath or a Vaidya under the employment of the Government of Sikkim or Government of India and includes a doctor working at the Ayurvedic Research Centre at Tadong and Homeopathy Centre at Gangtok under the Government of India.
(2) “Family” means a Government Servant’s wife or husband, as the case may be, parents, unmarried sister, minor brothers, 1[widowed sister, unemployed major brothers] and children wholly dependent upon the Government Servant.
Explanation 1.- For the purpose of this rule, the parents shall be regarded as “wholly dependent” upon the Government Servant if they reside with the Government Servant and their total monthly income from all sources does not exceed Rs.12500/-].
Explanation 2.- The term “Family” does not include any other dependent relation such as major brother, major or minor married sisters and the term "parent" does not include step parents.
Explanation 3.- The term “children” includes children adopted legally.
Explanation 4.- A female Government Servant may have a choice to include either her parents or her parents-in-law, wholly dependent on her and residing with her.
Note.- Every Government Servant who intends to avail of the facilities under these rules shall furnish a declaration regarding income and residence of the parents to the Head of his Department at the beginning of his service and wherever there is any change.
(3) “Medical Attendance” means attendance in a Government Hospital or Amji Clinic or Homeopathic Centre or Ayurvedic Centre of the State Government or of Government of India or at the residence of the Government Servant by the authorised medical attendant and includes -
(i) such pathological, bacteriological, radiological or other methods of examination for the purpose of diagnosis as are available in the Government hospital and are considered necessary by the authorised ------------------------------------------------------------------------------------------------------------------------------------------- 1[ ] Inserted with effective from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007. 2[ ] Substituted for “500” with effect from 5/11/2007 vide ibid.
medical attendant or subject to the provisions of rule 18(1), in a selected Government hospital or institution outside Sikkim.
(ii) Such consultation with any other Medical Officer or Specialist as may be considered necessary by the authorised Medical Officer.
(4) “Patient” means a Government Servant or other person to whom these rules apply and who has fallen ill.
(5) “Treatment” means use of all medical and surgical facilities available at a Government hospital or Amji Clinic or Ayurvedic Clinic or Homeopathic Centre of the State Government or the Government of India in which patient is treated and includes -
(i) Medical Examination, (ii) Consultation with Specialist; and (iii) Supply of medicines, drugs, vaccine, sera and other therapeutic substances as considered necessary by the authorised medical attendant but does not include provision for Spectacles and Dentures.
(6) “Medical Board” means the Board of Specialist constituted by the State Government at STNM Hospital and elsewhere to examine selected medical, surgical and other cases and to refer for treatment outside Sikkim.
3[Note.- The treatment shall include provision for prosthetics, hearing aids and spectacles: Provided that the spectacles shall be made under the prescription of an Ophthalmologist and the reimbursement in case of spectacles shall be limited to Rs. 2500/-, for hearing aids and prosthetics, the limit of reimbursement shall be Rs. 4000/-] ------------------------------------------------------------------------------------------------------------------------------------------- 3[ ] Substituted with effect from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment rules, 2007 published in the Extra Ordinary Gazette No.49B dated 5/11/2007.
11. TREATMENT WITHIN SIKKIM 4. Treatment at Government Hospital.- A Government Servant and the members of his family shall be entitled to free medical attendance and treatment tree of charge at any Government Hospital, Amji Clinic/Homeopathic Centre/Ayurvedic Institution of the State Government or the Government of India.
5. Treatment at the residence.- A Government Servant and the members of his family shall be entitled to free medical attendance and treatment at his own residence in the event of serious illness or incapacity rendering it harmful for the patient to travel to the nearest Government Hospital.
6. Free Medical Treatment.- (i) Free Medical Attendance and treatment includes all medicines available from the Government Hospital as are considered by the Authorised Medical Attendant.
(ii) A Government Servant and the members of his family receiving treatment as in-patients in a Government Hospital shall be entitled to beds free of charge in the General Wards of Hospital.
(iii) A Class IV Government Servant and the members of his family receiving treatment as in-patients in Government Hospital shall be entitled to free diet from the hospital.
7. Reimbursement of expenses.- (1) If any medicine prescribed by an Authorised Medical Attendant is not available in a Government Hospital, Amji Clinic, Homeopathic Centre or Ayurvedic Institution of the State Government or the Government of India, the case of such medicines purchases by the patient from the market shall be reimbursed by the Government on production of an essentiality certificate and prescription card of Government Hospital, Medical Institution or Clinic.
Note.- Reimbursement of the cost of preparations, which are not medicines but are primarily foods, tonics, toilet preparations or disinfectant is not admissible under these rules. Prescription of expensive drugs, laxative or other elegant and proprietary preparations for the use of the Government servant and the members of their families when drugs of equal therapeutic values are available in the Hospital is prohibited.
(2) Pathological, bacteriological, radiological or other methods of examination for the purpose of diagnosis should be carried out only at a Government Hospital or a Government Laboratory. At the time of claiming reimbursement of expenses incurred on this account, the Government Servant concerned should produce a certificate from the Authorised Medical Attendant that such examination were considered necessary by him.
(3) Gazetted Government Servants and the members of their families receiving treatment as in-patients in a Government Hospital shall be entitled to accommodation in the paying ward in the Hospital. In such cases, they shall be entitled to reimbursement of actual bed/room rent charged by the Hospital.
(3a) A non-gazetted Government Servant and the members of his family may be allowed accommodation in the paying wards, provided it can be certified by the Medical Superintendent of the Hospital or Institution concerned
(i) that accommodation in the General Ward was not available at the time of admission of the patient;
(ii) the admission of the patient into the Hospital or Medical Intuition count not be delayed without danger to the health of the patient until accommodation in the General Wards becomes available.
(4) The claim for reimbursement of medical expenses shall be preferred in the form prescribed in Appendix I or Appendix 2 according as the treatment is obtained as out-patient or in-patient in the Hospital, respectively, supported by Essentiality Certificate, Cash Memos, Money Receipts, etc.
(5) Reimbursement for claim in respect of Hospitalisation charges at the rate prescribed in the Intensive Cardiac Care Unit shall be entertained for all categories of Government Servants and their family subject to the production of certificate from the Cardiologist for treatment within Sikkim.
4[(6) Reimbursement of claim in respect of vaccines shall be allowed except for the vaccines used for routine immunization of children:
Provided that the vaccination has been prescribed by the treating medical practitioner.] ------------------------------------------------------------------------------------------------------------------------------------------- 4[ ] Inserted with effect from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007.
III. TREATMENT OUTSIDE SIKKIM 8. Conditions for treatment outside Sikkim.- (1) A Government Servant is entitled to reimbursement of medical expenses incurred by him for his own treatment and for the treatment of the members of his family at a place outside Sikkim provided that the Medical Board certifies that patient has contracted a disease or has reached a stage of the disease for which no further treatment is possible within Sikkim and recommends with the concurrence of the Health Department, treatment at a hospital or any other institution outside Sikkim. In case of illness or a Government Servant or members of their family at – place outside Sikkim if treatment is obtained at a Government hospital or institution, such cases may be considered by the Medical Board on its own merit ex-post facto.
Explanation.- The term “outside Sikkim” does not include any place Outside India.
(2) The following types of cases may normally be considered by the Director of Health Services for recommending treatment outside Sikkim:- (a) Selected surgical cases; (b) selected medical cases; (c) cancer cases; (d) leprosy and selected skin disease cases; (e) selected eye and ENT cases; (f) cases needing artificial limbs; (g) mental disease cases; (h) selected gynaecological cases; (i) tuberculosis cases; (j) selected dental cases; (k) cases referred by an Amji or Vaidya or Homeopath working under the Government of Sikkim or Government of India or any other recognised Society.
9. Hospital/Institution where treatment is to be obtained.- Arrangement for treatment of the above types of cases shall be made at selected Government Hospital/Any other Institution. Under no circumstances shall a Government Servant or a member of his family be permitted to select his/her own doctor or place of hospitalisation.
Government of Sikkim's decision.- 1. It is hereby notified for information of all employees working under the Government of Sikkim that the State Government has empanelled various reputed Multi-speciality and Super-speciality Hospitals located at several places in the country for treatment of employees and their dependants referred outside the State by the State Medical Board.
2. The treatment in these empanelled hospitals will be on cashless basis for the convenience of the referred patient. And henceforth, all employees entitled to avail medical treatment facilities as per Sikkim Services (Medical Facilities) Amendment Rules, 2007, will have to avail treatment facilities in these empanel led hospitals only. No reimbursement claims shall be entertained by the Government for treatment availed in hospitals other than the empanel led ones and claims submitted without Referral Certificate issued by the State Medical Board. [Health Care, Human Services' and Family Welfare Department Notification No. 55/HCHS&FW dated 17/09/1010.]
[Editor's note.- The following hospitals have been empanelled by the State Government for cashless treatment of the Government employees and their dependants. The list is subject to change from time to time depending on the validity of the agreement with the Hospital:-
(A) SILIGURI 1. North Bengal Neuro Research Centre (for Neurological cases only), 2. Dr Chhang’s Super Speciality Hospital (for Neurological cases only).
(B) DELHI & ITS SURROUNDING AREAS (NCR) (1) Fortis Escorts Heart Institute & Research Centre Ltd. (2) Indraprastha Apollo Hospital (3) Primus Super speciality Hospital (4) Dr. Soni’s Dental Clinic (5) The Clinic (Dr. Bela S. Jain’s Dental Clinic) (6) Delhi Centre for Sight (7) Medanta -The Medicity (Gurgaon)
(C) KOLKATA (1) Apollo Gleneagles Hospital
(D) DURGAPUR (1) The Mission Hospital
(E) AGREEMENTY NOT SIGNED BUT PATIENTS CAN BE J REFERRED TO. All India Institute of Medical Sciences, New Delhi.]
10. Travelling Allowance for journey for treatment outside Sikkim.- The Travelling Allowance for journey to obtain medical treatment outside Sikkim shall be regulated under Rule 54 and 55 of the Sikkim Travelling Allowance Rules.
11. Accommodation in Government Hospital/Institution.- (1) A Government Servant and the members of his family receiving treatment as in-patients in a Government Hospital/Institution outside Sikkim shall be entitled to beds free of charge in General Wards in common with other members of the general public.
(2) A Gazetted Government Servant and the members of his family receiving treatment as in-patient in Government Hospital/Institution outside Sikkim shall be entitled to accommodation in the paying wards. In such cases they shall be entitled to reimbursement of actual bed/room rent charged by the Hospital or Institution or 5[Rs.500/-] per day, whichever is less.
(3) A non-gazetted Government Servant and the members of his family be allowe3d accommodation in the paying ward provided it can be certified by the Medical Superintendent of the Hospital/Institution concerned-
(a) that accommodation in the General Ward was not available at the time of admissible of the patient, and
(b) the admissible of the patient into the Hospital/Institution could not be delayed without danger to the health of the patient until accommodation in the General Ward became available. ------------------------------------------------------------------------------------------------------------------------------------------- 5[ ] Substituted for the figure “200” with effect from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007.
Note.- In such cases, they shall be entitled to reimbursement of actual bed/room rent charged by the hospital/institution or Rs.200/- per day, whichever is less.
12. Reimoursement of medical expenses.- (1) The actual expenditure incurred on purchase of prescribed medicines will be reimbursed in full. Cost of medicine and other shall be reimbursable as per the list of admissible/inadmissible medicines appended to Central Services (Medical Attendance) Rules as amended from time to time. The maximum amount of medical reimbursement for anyone reference shall not exceed 6[Rs. 15,000/-]:
Provided that the maximum limit fixed under sub-rule (1) shall not be applicable to the following diseases, namely,-
(i) Cancer; (ii) Organ Transplant Surgeries; (iii) Bye-pass surgeries; (iv) Selected neuro-surgical cases; 7[(v) All terminally ill cases as certified by the State Medical Board’ (vi) Patients who expire during treatment; (vii) Dialysis; (viii) Cirrhosis of Liver; (ix) Gall stones requiring laparotomy; (x) Grievous gunshot injuries.] Full reimbursement of expenditure incurred on the above categories of referral cases shall, however, be governed as per rates fixed by the Government Hospitals.
(2) Diet charges, if any paid to the Hospital/Institution by a Class IV Government Servant and the members of his family receiving treatment as in-patients will be reimbursed in full.
(3) The claims for reimbursement should be submitted in the form prescribed in Appendix 2 duly supported by Essentiality Certificate to be obtained from the Medical Attendant or the Hospital/Institution or concerned Specialist of STNM Hospital along with the prescription card: ------------------------------------------------------------------------------------------------------------------------------------------- 6[ ] Substituted for the figure "10,000" with effect from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007
7[ ] Inserted with effect from 5/11/2007 vide ibid.
Provided that the Government Servant falling sick outside the State while on tour, training or on vacation, provisions of rule 13 and 14 shall apply.
(4) The claim for reimbursement should be accompanied by cash memos and money receipts in support of the expenditure.
IV. MEDICAL FACILITIES FOR GOVERNMENT SERVANTS POSTED OUTSIDE SIKKIM.
13. Facilities.- The Government Servants posted outside Sikkim ad the members of their families shall be entitled to the following facilities for Medical attendance and treatment;
(a) Medical attendance from private registered medical practitioners and reimbursement of consultation fees;
(b) consultation with Specialists and reimbursement of consultation fees;
(c) reimbursement of the cost of medicines;
(d) reimbursement of the cost of test and investigation for diagnosis.
14. Treatment at hospital.- (1) The Government Servants and the members of their families will be admitted to the State Hospitals in common with other members of the general public on the advice of their doctors. While under treatment at such hospital, they shall be entitled to the following facilities at Government expenses:-
(i) the use of all medical and surgical facilities available at the hospital in which the patient is treated;
(ii) the employment of such pathological, radiological or other methods as are considered necessary by the hospital authorities;
(iii) the supply of such medicines, vaccines, sera or other therapeutic substances as are ordinarily available in the hospital;
(iv) the supply of such medicines, vaccines, sera or other therapeutic substances not ordinarily stocked in Government hospital as the doctor-in-charge of the case may certify in writing to be essential for the recovery or the prevention of serious deterioration in the condition of the patient;
(v) such accommodation as is ordinarily provided in hospital.
Note.- Reimbursement of bed/room rent for paying ward shall be regulated under Rule II (2) or II (3), as the case may be.
(vi) such consultation with a Specialist as the hospital authorities consider necessary; and
(vii) such nursing as is ordinarily provided to in-patients by the hospital.
(2) The claims for reimbursement should be preferred in the form prescribed in Appendix 2 supported by Cash Memos, Money Receipts and Essentiality Certificate.
(3) The claim for reimbursement for medical attendance/treatment obtained from a private medical practitioner should be preferred in the form prescribed in Appendix 3” supported by cash memos, money receipts and Essentiality Certificate.
(4) The Maximum amount reimbursable shall not exceed the limit laid down in rule 12.
V. GENERAL 8[15. Treatment in a Private Hospital/Nursing Home.- Treatment in a private hospital/nursing home shall be admissible if the required facility is not available or the bed is not available at the time of emergency in the referred Institute provided that the Superintendent or the attending physician of the referred Institute certifies to the effect under seal and signature.]
16. Special Nursing.- If, during treatment in a Government hospital, nursing becomes necessary, a Government Servant or a member of his family will be entitled to such nursing as may be deemed essential for the recovery or for the prevention of serious deterioration of the condition of the patient having regard to the nature of the disease. For this purpose, a certificate from the Medical Officer- in-charge of the case in the Hospital duly countersigned from the Medical Superintendent of the Hospital should be procured in form prescribed in Appendix 4. The amount to be reimbursed to a Government Servant in respect of such special Nursing shall be limited to 30% of the actual charges paid on this account. ------------------------------------------------------------------------------------------------------------------------------------------- 8[ ] Substituted with effect from 5/11/2007 vide Sikkim Services {Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007.
17. When both husband and wife are employed.- (1) In case where both husband and wife are State Government Servants, they, as well as eligible dependants, may be allowed to avail of the medical concessions according to his/her status. For this purpose they should furnish to their respective Head of Department a joint declaration as to who will prefer the claim for reimbursement of medical expenses incurred on the medical attendance and treatment in respect of wife/husband and their children. The above declaration should be submitted in duplicate one copy of which shall be recorded in the personal file of each of them, the other copy being forwarded to the Chief Pay & Accounts Officer.
(2) The husband or wife of a Government Servant, as the case may be, employed in a Central Government Department or a Corporation, Autonomous Body, financed partly or wholly by the State Government, which provide medical facilitie4s, would be entitled to choose either the facilities under these rules or medical facilities provided by the organisation in which he/she is employed. The procedure for making the choice should be as laid down in sub-rule (1) of this rule.
18. Cash Memos and Essentiality Certificate,- (1) Cash Memos for purchase of medicines must be countersigned by the doctor prescribing the medicines and the Essentiality Certificate must contain the names of all medicines prescribed and the amount incurred in the purchase of each medicine.
(2) The prescription should invariably bear the name of the patient and the dated signature of concerned Medical Officer.
19. Cash Memos need not be stamped or receipted.- Cash Memos submitted in support of the claims for reimbursement of the cost of medicine purchased from the open market need not be stamped or acknowledged by the supplier. Cash Memos must, however, show the name of the Government Servant or the patient as per prescription.
19A. Procedure for claiming medical reimbursement for treatment outside Sikkim.- (1) The claim by the Government Servant for medical reimbursement for treatment done outside Sikkim shall be submitted in the prescribed form to Administrative Head of Office or Head of Department in which they are working.
(2) The Head of Office or Head of Department, as the case may be, shall forward the claim to the Director of Health Services. The Health Department is empowered to scrutinise, concur and recommend for sanction and payment of claim wholly or in part 0 the Head of Department concerned. The decision of the Director of Health Services shall be final in the matter.
(3) The procedure laid down in sub-rule (2) and (3) of rule 14 shall apply to the Government Servants posted outside Sikkim.
20. Grant of advance.- (1) A Head of Department may with the concurrence of the Director of Health Services 9[or Additional Director of Health Services as specially notified by the Health Department], grant an advance to a Government Servant to enable him initially to meet the expenditure of medical attendance and treatment when he or a member of his family is treated in a Government Hospital/Institution outside Sikkim. (2) The application for advance should be supported by a referral certificate issued by the State Medical Board.
(3) The advance, in each case, may be limited to 10[Rs.50,000] only. However, in exceptional case second advance will be considered only after settlement of first advance.
(4) Ordinarily not more than one advance should be granted in respect of the same illness.
(5) The amount of advance should b& adjusted against the claim for reimbursement of expenditure as admissible under these rules and the balance, if any, recovered from the pay of the Government Servant concerned in 11[ten] equal monthly instalments.
Note.- No separate advance should be admissible on account of Travelling Allowance for journeys to obtain the treatment. ------------------------------------------------------------------------------------------------------------------------------------------- 9[ ] Inserted with effect from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007. 10[ ] Substituted for the figure “5000” with effect from 5/11/2007 vide ibid. 11[ ] Substituted for the figure “four” with effect from 5/11/2007 vide Sikkim Services (Medical Facilities) Amendment Rules, 2007 published in Extra Ordinary Gazette No. 498 dated 5/11/2007.
VI. CONTROLLING OFFICER 21. Duties of Controlling Officer.- (1) All claims for charges on account of Medical Attendance and treatment should be countersigned by the Controlling Officers who are empowered to countersign the Travelling Allowance bills of the Government Servant concerned.
(2) It is the duty of the Controlling Officer to scrutinise carefully before countersigning a claim in respect of medical expenses that the claim genuine and is covered by the rules and that the charges claimed are supported by necessary Cash Memos, Money Receipts, Certificates etc. They are empowered to disallow claims, which do not satisfy these conditions.
Note.- Production of original prescriptions, by the claimants along with the claim papers may be insisted upon by the Controlling Officer in order to satisfy themselves about the genuineness of the claims. The original prescriptions may be returned to the claimant, if desired, after countersigning the claim.
22. Time limit for medical claims.- The claims for reimbursement of medical expenses in 'respect of a particular spell of illness should be preferred within three months from the date of completion of treatment as shown in the Essentiality Certificate issued by the concerned Medical Officer. The Controlling Officer shall be empowered not to entertain a medical claim not preferred by a Government Servant within three months of the completion of the treatment where he is not satisfied with the reasons put forth by the Government Servant for late submission of the medical claim where the claim is prima facie incomplete.
23. Classification of expenditure.- (1) The expenditure involved in reimbursement of medical claims is debitable to the Head of Account to which the Pay and Allowances of the Government Servant concerned are debited.
(2) The expenditure involved in reimbursement of medical claim should be drawn I pay bill form.
VII. REMOVAL OF DOUBTS
24. Removal of doubts.- Where a doubt arises as to the interpretation of any of the provisions of these rules or when a particular case is not covered by the provisions of these rules, the matter shall be referred to the Health Department for decision.
25. Repeal.- All rules, orders or notifications which were in force before the commencement of these rules and applicable to Government Servants to whom these rules apply are hereby repealed.
APPENDIX -I FORM OF APPLICATION FOR MEDICAL CLAIMS [See rule 7(4)]
Form of application for claiming reimbursement of medical expenses incurred in connection with Medical Attendance/Treatment of Sikkim Government Servants and members of their families as outpatients in the hospitals.
[N.B: Separate form should used for each patient.]
DECLARA TION TO BE SIGNED BY THE GOVERNMENT SERVANT
I hereby declare that the statements in this application are true to the best of my knowledge and belief and that the person for whom medical expenses were incurred is wholly dependent upon me.
Signature of the Government Servant and name of the office to which attached. Dated……..
ESSENTIALITY CERETIFICATE
I, Dr……….. …………… hereby certify that the patient is/was suffering from … andis/was under my treatment from … to … and that the under mentioned medicines prescribed by me in this connection were essential for the treatment of the patient. These medicines do not include proprietary preparations for which cheaper substances of equal therapeutic value are available nor preparations which are primarily foods, toilets preparations, or disinfectants. The medicines are not stocked in the ………(Name of the Hospital). I also certify that the tests and examinations for which claims have been made were necessary for the purpose of diagnosis of the disease.
Signature and designation of Medical Officer And name of Hospital/Institute/concerned Specialist.
CERTIFICATE OF CONTROLLING OFFICER Certified that I have, after scrutiny of the claim as required under; Rule 21, satisfied myself that the claim is, to the best of my knowledge and belief, correct.
Signature and designation of Controlling Officer Dated……
---------------------------------------------------------------------------------------------------------------------------------------------------------------------- APPENDIX-2
FORM OF APPLICATION FOR MEDICAL CLAIMS I [See Rule 7(4), 12(3)… 14(2)] Form of application for claiming reimbursement of medical expenses incurred in connection with medical attendance/treatment of Sikkim Government Servants and members of their families as inpatients in the hospitals.
DECLARA TION TO BE SIGNED BY THE GOVERNMENT SERVANT
I hereby declare that the statements in this application are true to the best of my knowledge and belief and that the person for whom medical expenses were incurred is wholly dependent upon me.
Signature of the Government Servant and name of the office to which attached. Dated………….
ESSENTIALLY CERETIFICATE
I, Dr ……….. hereby certify that the patient is/was suffering from ….. and is/was under my treatment from … to … and that the under mentioned medicines prescribed by me in this connection were essential for the treatment of the patient. These medicines do not include proprietary preparations for which cheaper substances of equal therapeutic value are available nor preparations which are primarily foods, toilets preparations, or disinfectants. The medicines are not stocked in the ….. (Name of the Hospital). I also certify that the tests and examinations for which claims have been made were necessary for the purpose of diagnosis of the disease.
Signature and designation of Medical Officer And name of Hospital/Institute/concerned Specialist.
CERTIFICA TE OF CONTROLLING OFFICER
Certified that I have, after scrutiny of the claim as required under Rule 21, satisfied myself that the claim is, to the best of my knowledge and belief, correct.
Signature and designation of Controlling Officer Dated...
FORM OF APPLICATION FOR MEDICAL CLAIMS [See rule 14(3)]
Form of application for claiming reimbursement of medical expenses incurred in connection with Medical Attendance/Treatment of Sikkim Government Servants posted outside Sikkim and members of their families as outpatients in the hospitals.
[N.H: Separate form should used/or each patient]
DECLARATION TO BE SIGNED BY THE GOVERNMENT SERVANT
I hereby declare that the statements in this application are true to the best of my knowledge and belief and that the person for whom medical expenses were incurred is wholly dependent upon me.
Signature of the Government Servant and name of the office to which attached Dated………..
ESSENTIALITY CERETIFICATE
I, Dr ………. hereby certify that the patient is/was suffering from ……. and is/was under my treatment from ….. to ….. and that the under mentioned medicines prescribed by me in this connection were essential for the treatment of the patient. These medicines do not include proprietary preparations for which cheaper substances of equal therapeutic value are available nor preparations which are primarily foods, toilets preparations, or disinfectants. The medicines are not stocked in the ….. (Name of the Hospital). I also certify that the tests and examinations for which claims have been made were necessary for the purpose of diagnosis of the disease.
Signature and designation of Medical Officer And name of Hospital/Institute/concerned Specialist.
CERTIFICATE OF CONTROLLING OFFICER Certified that I have, after scrutiny of the claim as required under Rule 21, satisfied myself that the claim is, to the best of my knowledge and belief, correct.
Signature and designation of Controlling Officer Dated…
APPENDIX -4
FORM OF CERTIFICATE FOR SPECIAL NURSING [See rule 16]
Certified that Shri/Shrimati/Kumari …………wife/son/daughter/father/mother of Shri….. …employed in … has been under my treatment for……… (disease) at the…..… hospital and that the- services of the special nurses for which an expenditure of Rs ……..… (Rupees…………………….…) was incurred vide bills and receipts attached, was essential for the recovery/prevention of serious deterioration in the condition of the patient.
Signature of the Medical Officer-in-Charge Of the case at the Hospital Dated…………
Countersigned Medical Superintendent ……………..... Hospital
Government of Sikkim's instructions.
1.1 Health Department, Government of Sikkim has been empowered to settle all the Medical Reimbursement claims of Government employees of all departments for treatment inside and outside the State.
1.2 All payments will be subject to scrutiny and verification by the Director of Health Services. Reimbursement of individual claims will have to be made to the Director of Health Services through the respective Head of Department/Office.
1.3 Government has decided to have only one Medical Board created at Gangtok. For treatment outside the State, cases will now be referred only at Calcutta and Delhi.
1.4 These shall come into force with effect from 1st April, 1990. [Finance Department Circular No.34/Fin/Acctts. dated 31.3. 1990.]
2.1 In supersession of this Office Circular No.34/Fin/Acctts dated 31st March 1990, in regard to the settlement of medical reimbursement of State Government employees and the payment of advance for treatment outside Sikkim, the following procedure for payment is hereby prescribed which shall come into force with effect from 151 April, 1990.
(1) The claims by the Government Servants for medical reimbursement shall be submitted in the prescribed form to the Heads of Offices/Heads of the Departments concerned in which they are working.
(2) The Heads of Offices/Departments concerned shall forward the claim to the Director of Health Services. The Health Department is empowered to scrutinise, concur and recommend for the sanction and payment of claims wholly or in pat to the Department concerned. The decision of the Director of Health Services will be final on the matter.
(3) The cases of advance payment and medical reimbursement to the general public shall be submitted to the Director of Health Services directly for scrutiny and payment. The drawal of advance for such cases should, however, be made with the concurrence of the Finance Department.
2.2 The Government has decided to have only one Medical Board in the State located at Gangtok for treatment outside the State. Cases will now be referred only at Calcutta and Delhi and total medical reimbursement will be restricted to Rs.10,000/- (Rupees ten thousand). [Finance Department Circular No.1/Fin dated 7.4.1990.]
3.1 In view of the representation submitted by the Sikkim Teachers’ Association to the Government of the financial powers for concurrence of medical reimbursement of the District Officials for treatment within the State is hereby delegated to Chief Medical Officers of the District.
3.2 Henceforth, all the medical claims of the District Officials for treatment within the State will be concurred by the Chief Medical Officers of the respective District. 3.3 This Notification is issued with the concurrence of the Finance Department. [Health & Family Welfare Department Notification No.402/H&F dated 19.9.1994.]
4.1 The Governor of Sikkim is pleased to review the charges for various Investigations/Tests in the S. T .N.M. Hospital, Gangtok, as under, with immediate effect:-
(1) E.C.G. ... Rs.20/- per case. (2) Echocardiogram ... Rs.200/- per case. (3) I.M.T. ... Rs.200/- per case. (4) Endoscopy ... Rs.100/- per case. (5) X-Ray ... Rs. 15/- per case. (6) Haltor ... Rs.200/- per case. (7) Ultra Sound ... Rs.100/- per case.
4.2 All Indoor Patients except those staying in Paying Wards are, however, exempted from payment of charges for above Tests/Investigations.
4.3 The Outdoor Local Patients may also be exempted from payment of above charges at the discretion of the Medical Superintendent, STNM Hospital on verification of their bona fides.
4.4 All Class IV employees of the State Government are also exempted from payment of above charges.
4.5 All other categories of patients shall continue to pay the charges of nvestigations/Tests as above.
4.6 The previous Notifications/Circulars already issued on the subject shall stand modified to the extent relevant. [Health & Family Welfare Department Notification dated 28.11./995.]
5.1 In supersession of Notification No.625/H&FW/94-95 dated 24.5.1994, the Government of Sikkim has been pleased to review and sanction an outright one time grant of Rs.5000/- by Director of Health Services as partial assistance for any illness to the member of general public for treatment of special cases referred by the Medical Board of Sikkim subject to verification of bona fide of the claimant by the Health Department. The claimant is required to give a declaration in the prescribed form meant for the purpose that he/she is not a regular employee or dependent under the Government of Sikkim.
5.2 A minimum outright one time grant up to Rs.10,000/- as partial assistance may be sanctioned by the Secretary, Health Department on the recommendation of the Medical Board for the following selected diseases:-
(1) cancer (2) Organ Transplant Surgery, (3) Bye Pass Surgery, (4) Selected Neuro Surgery Cases.
5.3 However, Chief Minister and Minister, Health may, at their discretion, in exceptional cases, sanction up to Rs.20,000/- and Rs.15,000/- respectively as one time grant. [Health & Family Welfare Department Notification No.164M dated 15.9.1995.]
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