MEDICAL AID & HOSPITALISATION EXPENSES

DEFINITION OF FAMILY:

a.  In substitution of Clause 18 of the Bipartite Settlement dated 2nd June 2005, for the purpose of medical facilities and for the purpose of leave fare concession, the expression ‘family’ of an employee shall mean the employee’s spouse, wholly dependent unmarried children (including step children and legally adopted children), wholly dependent physically challenged brother / sister with 40% or more disability, as also parents ordinarily residing with and wholly dependent on the employee.  

b.  The term wholly dependent child/parent, physically challenged brother/sister shall mean such member of the family having a monthly income not exceeding Rs.3500/- p.m.   If the income of one of the parents exceeds Rs.3,500/- p.m. or the aggregate income of both the parents exceeds Rs.3,500/- p.m., both the parents shall not be considered as wholly dependent on the employee.

c.  A married female employee may include her natural parents or parents-in-law under the definition of family – but not both – provided that the parents/parents-in-law are ordinarily residing with and wholly dependent on her.

(Para18 of BPS dated 27.04.2009)

 

In partial modification of the Sastry Award paragraph 450(9) and paragraph 11.20 of the Desai Award and Clause 15.1(b) of the First Bipartite Settlement dated 19th October 1966, reimbursement of medical expenses of a workman and his family may be made on the strength of the concerned workman’s certificate of having incurred such expenses duly supported by a Statement of accounts for the amounts claimed.

 (Para XII.2 of BPS dated 17.09.1984)

 

The amount of total expenses from January to December of each calendar year will be allowed to be accumulated so as not to exceed at any time three times the maximum amount provided under this settlement.

 (Para XII.1 of BPS dated 17.09.1984)

 

It is agreed that permanent part-time workmen whose normal total hours of work per week are 6 hours or more will be granted full medical aid with effect from 01-01-1972.

 (Para XI (c) of BPS dated 08.01.1973)

 Permanent part-time employees drawing scale wages are eligible for leave, medical aid & uniforms.

 (Para 18.2 (a) of BPS dated 10.04.1989)

MEDICAL AID

In substitution of Clause 17 of the Bipartite Settlement dated 2nd June 2005, with effect from 1st November 2007, the reimbursement of medical expenses under medical aid scheme shall be restricted to an amount of Rs.2,000/- per annum. For the year 2007, the reimbursement of medical expenses under the medical aid scheme shall be enhanced proportionately for two months i.e. November and December 2007.

 (Para 17 of BPS dated 27.04.2010)

HOSPITALISATION EXPENSES

In substitution of Clause 20 of the Bipartite Settlement dated 2nd June 2005, with effect from the 1st May 2010, the reimbursement of hospitalisation expenses shall be as detailed in Schedule V to this Settlement.

 (Para 20 of BPS dated 27.04.2010)

 

Wherever existing facilities in any bank or banks are superior to the provisions hereinafter made, such facilities should be continued. Wherever possible, banks should appoint or nominate a whole time or part-time medical practitioner (hereinafter called “authorised doctor”) who shall be available for consultation and for treatment at stated hours either in his dispensary or in the premises made available to him by the bank. An employee claiming the benefit of these facilities shall go to an authorised doctor or such other doctor as he may recommend in writing, providing that where there is no such authorised doctor appointed by the bank for any place, the employee can choose any registered medical practitioner practicing in the locality or nearby. Except where an authorised doctor treats the workman, all medical bills shall, in the first instance, be paid by the workman. He can thereafter recover whatever amounts are permissible from the bank. Bills of authorised doctor shall be paid by the bank itself. Banks are at liberty to have the bills for treatment submitted by other medical practitioner where authorised doctor’s are not available for scrutiny and approval by the banks’ doctors and only the amounts so recommended by them need be paid. Every workman shall during illness (whether he is on duty or on leave) be entitled free of charge and up to the limits (provided) to attendance and treatment by the bank’s authorised doctor or where there is no such doctor, by a registered medical practitioner of his choice as stated above. 8) All bills submitted for payment shall be accompanies by a certificate from the doctor concerned for the treatment.

 (Para 450 of Sastry Award)

 

It was urged that provisions relating to medical aid and expenses should be available not merely when a workman falls ill but also when he meets with any accident. In order to avoid any controversy on the subject, I direct that the provisions of this award in connection with medical aid and expenses will extend to cases where a workman meets with an accident and is in need of medical aid.

 (Para 11.1 of Desai Award)

 

Employee shall submit the Bills, etc., against which medical aid is claimed within 6 weeks of the expenses being incurred or the workman’s return to duty from sickness which ever is later. Banks shall make payment of the Bills, if otherwise in order and within the workman’s entitlement within four weeks of their presentation to the Bank.

 (Para 15.1(b) of BPS dated 19-10-1966)

 

Employees on suspension will be entitled to reimbursement of medical expenses under medical aid scheme.

 (Para 18 (iii) of BPS dated 31.10.1979)

 

In partial modification of Clause 18.2 of the Bipartite Settlement dated 10th April, 1989, with effect from 1st November, 1999, Part Time employees drawing scale wages shall also be eligible for reimbursement of Hospitalisation Expenses on pro-rata basis.

 (Para 20 (ii) of BPS dated 27.03.2000)

 

Cost of Kidney paid to the donor by the employee is not reimbursable. As regards expenses on hospitalisation of the donor, the same may be considered only if the donor is a member of the employee’s family as per the definition of the term family in the Settlement. However, in exceptional cases, the bank may consider reimbursement of hospitalisation expenses of donor even if he is not covered by the definition to the extent the same would be reimbursable in case the donor is a family member.

 (IBA clarification).

 

It would be in order to consider reimbursement of expenses incurred on tests required to be carried out at pre-post hospitalisation stage under the hospitalisation scheme.

 (IBA clarification)

 

SCHEDULE FOR REIMBURSEMENT OF HOSPITALISATION EXPENSES

 1.  Hospitalisation expenses will be reimbursed to workmen staff in the bank to the extent of 100 per cent in case of self and 75 per cent in case of dependent members of family subject to the procedure for reimbursement of hospitalisation expenses as enumerated hereunder:

 

(a)   Hospitalisation charges to the extent stated above will be reimbursed in case of all ailments and major accidents which require hospitalisation.

 

(b)    A workman or his dependent family member(s) will be considered to have been hospitalised only if they are admitted as indoor patient(s) in the hospital in respect of diseases/accidents as mentioned above in sub-para (a).  However, cases where the patient is admitted as an out-patient and discharged the same day after surgical procedures involving advanced techniques may also be considered for reimbursement of hospitalisation expenses.

 

(c)   Medical expenses incurred for the hospitalisation will be reimbursed on the strength of bills/vouchers to the extent of 100% in case of self and 75% in case of family members subject to limits prescribed hereunder.

 

2.     For the purpose of medical facilities :

The expression ‘family’ of an employee shall mean the employee’s spouse, wholly dependent unmarried children (including step children and legally adopted children), wholly dependent physically challenged brother/sister with 40% or more disability, as also parents ordinarily residing with and wholly dependent on the employee.  

      (a)    The term wholly dependent child/parent, wholly dependent brother/sister shall mean such member of the family having a monthly income not exceeding Rs.3500/- p.m.  If the income of one of the parents exceeds Rs.3,500/- p.m. or the aggregate income of both the parents exceeds Rs.3,500/- p.m., both the parents shall not be considered as wholly dependent on the employee.

      (b)    A married female employee may include her natural parents or parents-in-law under the definition of family – but not both – provided that the parents/parents-in-law are ordinarily residing with and wholly dependent on her.


3.         The reimbursement of hospitalisation expenses will be restricted to the following charges:

Sr. No.

Details

Extent of reimbursement

3.1

(a)     Hospital Registration Fees

100% for self and 75% for dependent family members of the amount actually incurred or Rs.220/-  whichever is lower.

 

(b)     Surcharge/tax on hospital bills

Proportionate to the extent of the bill passed by the bank

3.2

Charges for bed per day (excluding boarding charges)

100% for self and 75% for dependent family members of the amount actually incurred or Rs.450/-  whichever is lower.

3.3

ICU/CCU/Neo-natal Nursery

100% for self and 75% for dependent family members of the amount actually incurred or Rs.550/- per day,  whichever is lower.  This is in addition to bed charges.

 3.4

Diagnostic material charges, X-rays, Pathological tests, ECGs, etc.

As per Annexure I hereto

3.5

Medicines, drugs, injections (including disposable syringes), bandage and dressing materials, etc. except tonics/vitamins. (However, tonics/vitamins which are prescribed by the attending doctor and certified as essential for the period of hospitalisation, may be considered for reimbursement.)

100% or 75% as the case may be of actual expenses.

3.6

Operation charges, etc.

As per Annexure-II hereto

 

3.7         Physician’s and Consultant’s fees per visit:

 

100% for self and 75% for dependent family members of the amount actually incurred or the amount as mentioned below against each item, whichever is lower

Major ‘A’ Class cities viz. Mumbai, Chennai, Delhi, Kolkata, Ahmedabad, Bangalore & Hyderabad

Other Places

             Rs. per visit

         Rs. per visit

VISIT AT THE CHAMBER

First Consultation

                 220/-

             130/-

Subsequent Consultations

                   85/-

               70/-

VISIT AT RESIDENCE

In case of emergency leading to Hospitalisation

                 330/-

             210/-

Second Consultation

                 250/-

             165/-

Subsequent Consultations

                165/-

             110/-

VISIT MADE BY SPECIALISTS AT THE HOSPITAL:- SPECIAL VISIT

During the day time

               140/-

              95/-

During the night time

               330/-

            165/-

Routine visits

               140/-

             95/-

 

4.             The workmen or members of their families (as the case may be) are expected to secure admission in a Government/Municipal Hospital or any ‘private’ hospital (i.e., hospitals under the management of a Trust, Charitable Institution or a religious mission).   The reimbursement will be restricted to the percentage applicable to the workman / dependent family member, i.e. 100% or 75% of the charges applicable to the lowest paying bed in such hospitals according to hospital rules or the maximum amounts mentioned above, whichever is lower.

 

5.             Normally, the workman and members of family should avail of services of hospital as mentioned in paragraph 4 above. However, if he feels, that it is unavoidable to seek services of a private nursing home/hospital, he can do so in one of the hospitals/nursing homes, approved by the bank. Reimbursement in such cases will, however, be restricted to the extent of the amount which would have been reimbursable in case of admission to a public or private hospital as mentioned in paragraph 4 above.

 

6.             Medical expenses incurred within 30 days of ‘pre’ and post-hospitalisation period on medical advice, on account of the ailment/disease for which the person was hospitalised, will be considered as hospitalisation expenses for reimbursement purpose.  However, in cases of hospitalisation involving special or major operations, medical expenses incurred for a period not exceeding 45 days of post-hospitalisation will be considered for reimbursement, subject to medical advice.

 

7.             Charges for engaging a nurse/attendant will not be reimbursed. However, nursing charges, if any, charged by hospital authorities in respect of days spent in ICU / CCU/ neo-natal nursery may be considered for reimbursement on the basis of certificate issued by the hospital authorities and in consultation with bank’s Medical Officer.  Reimbursement in such cases shall be 100% for workmen and 75% for family members of the actual charges.

 

8.             Hospitalisation charges in connection with maternity will not be reimbursable.  However, the expenditure incurred by an employee in cases involving operative interference because of complicated labour and caesarean operation and subsequent hospitalisation thereto will be reimbursed under the hospitalisation scheme to the extent of expenditure incurred in excess of normal maternity charges and consequent hospitalisation thereto subject to the condition that such reimbursement shall be 70%  of the amount actually incurred or the limits as per Annexure II hereto, whichever is less. 

 

9.             The purchase of drugs/medicines will be restricted to approved chemists and arrangements will be made by banks wherever possible to make direct payments to the chemists.

 

10.         Banks will have discretion to refuse payment of bills in cases where they are not satisfied about the genuineness of the bills.

 

11.         Ambulance Charges

Ambulance charges for removing the workman or his dependent family member from residence to the hospital/nursing home or from hospital/nursing home to residence on discharge or from one hospital/nursing home to another hospital/nursing home, within the urban agglomeration or municipal limits may be reimbursed in full.Actual expenses incurred on conveyance by mode other than ambulance shall be reimbursed subject to the maximum as under:

 

(i)

By public taxi

-

Actuals subject to maximum of Rs.165/- per trip

(ii)

By autorickshaw

-

Actuals subject to maximum of Rs.85/- per trip

                 

In case the patient is to be moved to a hospital/nursing home outside the urban agglomeration/municipal limits, then the expenses incurred on conveyance may be reimbursed at the rate of Rs.6.00 per kilometer, with a maximum of Rs.1100/- per trip or the amount actually incurred, whichever is the least.

Normally, services of an ambulance should be availed of. Where ambulance is not available or the facility of ambulance is not established, public mode of transport i.e. taxi/ auto rickshaw could be used. The bank shall consider such claims on merits and facts. Abuse of the facility will be dealt with treating such claims as acts of gross misconduct.

 

12.         Domiciliary Treatment

Medical Expenses incurred in respect of the following diseases which need domiciliary treatment a may be certified by the recognised hospital authorities and bank’s medical officer shall be deemed as hospitalisation expenses and reimbursed to the extent of 100% in case of a workman and 75% in the case of his family.

 

Cancer, Leukaemia, Thalassemia, Tuberculosis, Paralysis, Cardiac Ailment, Pleuresy, Leprosy, Kidney ailment, Epilepsy, Parkinson’s Disease, Psychiatric disorder, Diabetes, Hepatitis-B, Hepatitis-C, Haemophilia, Myastheniagravis, Wilson’s disease, Ulcerative Colitis, Epidermolysis bullosa, Venous Thrombosis (not caused by smoking), Aplastic Anaemia, Psoriasis, Third Degree Burns, Rheumatoid Arthritis, Hypothyroidism and Hyperthyroidism.

 

Note:- 

(i)      The cost of medicines etc. in respect of domiciliary treatment shall be reimbursed for the period stated in the Specialist’s prescription.  If no period is stated, the prescription for the purpose of reimbursement shall be valid for a period not exceeding 90 days.

 

(ii)     Expenses incurred on radiotherapy and chemotherapy in the treatment of cancer and leukaemia shall be considered for reimbursement under domiciliary treatment to the extent of 100% in case of a workman and 75% in the case of his family.

 

13.     The medical aid and reimbursement of expenses under the hospitalisation scheme under this Settlement will also be available for medical treatment  under  the  recognised  systems of medicines, viz., Ayurvedic, Unani, Sidha, Homeopathy and Naturopathy if such treatment is taken in a clinic/hospital recognised by the Central/State Government.  Further, reimbursement shall be limited to such expenses within the prescribed ceilings as would have been reimbursable in case the treatment was taken in a Government/Municipal hospital, subject to the overall limits under the scheme, i.e., 100% of approved expenses for self and 75% in case of family.

  

14.               Package Charges

Some hospitals are charging on the basis of ‘package’ for specialised treatment for diseases pertaining to heart, kidney, coronary, etc.  These package charges generally include all charges pertaining to a particular treatment/procedure including admission charges, accommodation charges, ICU/ICCU charges, monitoring charges, operation charges, anesthesia charges, operation theater charges, procedural charges/ Surgeon’s fee, cost of disposables, cost of consumables like catheters, guide wires, etc., surgical charges and cost of medicine used during hospitalisation, related routine investigations, physiotheraphy charges etc. In the following cases, package charges will be reimbursed to the extent of 100% in the case of self and 75% in the case of dependent members of family, subject to the limits specified below:-

 

(a)    Coronary Bypass Surgery

Rs.1,60,000/-

(b)    Coronary Angiography

Rs.  16,500/-

(c)    Angioplasty/Stentoplasty

Rs.  80,000/-

(d)    Kidney Transplant

Rs.1,80,000/-

(e)    Liver Transplant

Rs.2,20,000/-

   Note:-

(i)      For the above ailments, workmen employees can claim either as per schedule of expenses prescribed or package charges whenever the treatment is taken under package charges scheme.

 

(ii)    In the case of stentoplasty, cost of medicated stent(s), wires/balloon, implanted during surgery may be reimbursed at the rate of 75% for family members and 100% for workman himself at rates not exceeding the rates applicable to lowest paying bed of AIIMS, New Delhi, in addition to the package charges indicated above.

 

(iii)   Liver transplant charges are not reimbursable in cases where damage to the liver has been caused by alcoholism.

                                                                                                                                                                                          

                                                                                                                                                                                               Annexure I

 SCHEDULE FOR REIMBURSEMENT OF CHARGES INCURRED

BY WORKMEN FOR PATHOLOGICAL ETC. INVESTIGATIONS

 


 

NAME OF PROCEDURE

100% for self and 75% for dependent family members of the amount actually incurred or the amount as mentioned below against each item, whichever is lower (Rupees)

CLINICAL PATHOLOGY

Urine Routine

45

Urine for Albumin

45

Urine for 17 Ketosteroids

400

Urine Culture

125

Urine for Column Count Test

125

Sensitivity Test

165

Urine for Acid Fast Bacilli (T B Culture)

115

Urine Bile Pigment and Salt

45

Urine Urobilinogen

45

Urine Occult Blood

45

Urine Total Proteins

90

Urine Sodium

90

Urine Chloride

90

Bence Jones Protein

55

Stool Routine

45

Stool Occult Blood

45

Smear Analysis

65

Body Fluids-C.S.F./Plural/Ascitic, etc. Chemistry, Sugar, Protein, etc

185

Malignant Cells

150

HAEMATOLOGY

Blood Count with Indices (Hb, TLC, DLC)

80

Blood Count without Indices (Hb, TLC, DLC)

75

RBC and Hb with Indices

80

RBC and Hb without Indices

60

Total WBC and Differential Count (TC/DC)

60

Blood Smears for parasites (MP, etc.)

45

Peripheral smear examination

50

Blood for Microfilaria

110

Platelet Count

80

Bleeding and Coagulation time (BT CT)

75

Clot Retraction Time

75

Prothrombin Time

85

Erythrocytes Sedimentation Rate (Westergren’s method)

35

Sedimentation Rate (Both Methods) ESR

35

Hb, TLC,DLC, ESR

95

Blood Culture

175

Clot Culture

175

Glucose Phosphate Dehydrogenase (G&PD)

165

Reticulocyte Count

50

Absolute Eosinophil Count

45

Packed CellVolume (PCV)

45

R.B.C. Fragility Test

80

L.E. Cell

105

Haemogram

95

Bone Marrow Smear Examination

225

Partial Thromboplastin

150

BLOOD BANK

Coomb’s Test direct (for coating antibodies)

165

Coomb’s Test (for complete and incomplete indirect antibodies)

220

Blood Grouping and Rh Factor only (not for matching) for Non-maternity Cases

75

Blood Transfusion per Bottle and Donor’s fees (including Pathologist’s attendance and cross-matching)

400

Packed Cell Preparation

280

BIOCHEMISTRY

Blood Urea/Calcium/Phosphorus/Phosphatase/ Sodium/Potassium each

110

Blood Urea Nitrogen

110

Urea Clearance Test

190

Creatinine Clearance Test

190

Serum Proteins or Plasma Proteins

110

Serum Proteins Electrophoresis

220

Blood for Fibrinogen

120

Blood for Creatinine

85

Blood Uric Acid

110

Blood Sugar Curve (Glucose Tolerance Test) GTC or GTT

310

CO2 Combining Power of Plasma

145

Blood Cholesterol

85

Blood Protein Bound Iodine (PBI)

330

Blood Chlorides  (S Cl)

110

Serum Sodium (S Na)

95

Serum Potassium (S K)

95

Serum Iron (S Fe)

145

Serum Iron Studies

240

Serum Calcium (S Ca)

95

Serum Phosphorous (S.P.)

95

Serum Alkaline Phosphatase

85

Serum Acid Phosphatase

150

Serum Glutamic Oxalic Transaminase (SG OT)

85

Serum Lipase

145

Serum Glutamic Pyruvic Transaminase  (SG PT)

85

Serum Anylase

215

C P K

345

Glucose 6 Phosphate Dehydrogenase

185

Serum Lactic Dehydrogenase(LDH)

160

Serum Lactic Dehydrogenase with Isoenzyme

415

SMA 12-2 (14 Blood Chemistry)

690

BACTERIOLOGY & SEROLOGY

Brucella Agglutination Test*

145

Cold Agglutination Test for Virus Pneumonia

145

Paul Bunnel Test

165

C Reactive Proteins**

150

Smear Gram-Strain Examination

55

Sputum Smear A.F.B. Stain

55

V.D.R.L.

85

Widal Test

85

R.A.Test

110

Culture & Sensitivity (other specimens)

165

Vibro Cholera Culture

145

Conjunctival Swab for Microscopic and Culture Examination

155

Smear Examination for Micro Organisms

105

Fluids or Exudates for Malignant Cells

155

*   For hospitalised patients only

** For Rheumatic disease to be reimbursed  for hospitalised patient

X-RAY

Fluroscopy Chest

135

Abdomen AP Erect (One Film)

150

Abdomen Lateral View (One Film)

150

Abdomen for Pregnancy

150

Chest PA View (One Film)

150

Chest Oblique or Lateral (One Film)

150

Mastoids

150

Extremities, Bones and Joints (One Film)

150

Pelvis (One Film)

150

Paranasal Sinuses (One Film)

150

T.M. Joints (One Film)

150

Abdomen & Pelvis for K.U.B.

250

Skull A.P. & Lateral

250

Spine AP & Lateral

250

Barium Swallow

580

Sinography/Sialography

660

Cystography/Urethrography

990

Arthrography

745

Retrograde Pyelography

825

Oral or I.V. Cholecystography

825

Barium Enema

1075

Barium Meal Upper or Lower

1075

Bronchography

1155

I.V. Urography

1155

Myelography

1320

Pneumo Encephalography

990

Barium Meal Complete

1320

Cerebral/Femoral Angiography

1570

C T SCAN/MRI

CT Scan

2750

CT Scan (with contrast)

4400

MRI

5500

MRI (with contrast)

7200

ULTRA SONOGRAPHY AND ECHOCARDIOGRAPHY

Electro Cardiogram (ECG)

150

Indual Test

155

U C G (Phono-cardiography, Telemetry C, Cardiac Ex Test, Stress Test)

760

Echo Cardiography

870

Cardio Version

560

Ultra Sonography

435

US Guided Biopsy

580

SKIN

Tuberculin Test (Mantaux) TT or MT

115

Scraping for Fungus

60

Skin Clipping & smear for Leprosy

115

Nasal smear for leprosy

95

LIVER FUNCTION TESTS

Thymol Turbidity Test

100

Cephalin Cholesterol Floculation Test

100

Vanden Berghn Reaction and Icterus Index (Quantitative Bilirubin)

165

Takata Ara Reaction

110

Bromsulphalein Excretion Test (Excluding injection charges)

240

PLEURAL AND PERICARDIAL AND ASCITIC FLUIDS

Pleural Fluid for Routine Examination

155

Pleural Fluid for Cultural Pericardial and Ascitic Fluids

155

SPUTUM EXAMINATION

 

Sputum Routine

100

Sputum for Acid Fast Bacilli only (Sputum AF B)

100

Sputum for Culture (Culture for TB)

155

CSF for Diptheria

140

Culture for Diptheria

115

GASTRIC ANALYSIS

Gastric Contents for Routine Analysis (Gastric Analysis or Fractional Test Meal)

240

Sternal Marrow Routine Cytology (Bone Marrow)

310

Basal Metabolic Rate (BMR)

275

Lung Function Test

275

PSYCHIATRY TEST

ECT

150

CO2

90

Psychology Testing

150

R I A

 

TSH, LH, FSH, Prolactin (for each test)

180

Testosterone

470

Parathyroid

470

Estrogen (Total)

470

ACTH

470

HBsAg by RIA or EIA

550

FOR SURGICAL INVESTIGATION &TREATMENT OF CANCER

Scopies and Biopsies

550

Chemotherapy:

 

Single Drug Therapy per day

1100

Multiple Drug Therapy per day

2200

Infusional Chemotheraphy

3300

OXYGEN CHARGES

Oxygen charges shall be reimbursed at the rate of Rs.40/- per hour subject to a maximum of Rs.400/- per day .

 

Note: Any test/investigation prescribed by the Hospital/Doctor but not included in the Schedule may be reimbursed at 100%/75% of the cost of such tests or the rates of CGHS, whichever is lower.

Annexure II

OPERATION CHARGES

 

 

100% for self and 75% for dependent family members of the amount actually incurred or the amount as mentioned below against each item, whichever is lower

 

Rs.

Rs.

Rs

 

Special Operation

Major Operation

Minor Operation

(a)    Operation Theatre Charges

3,300/-

2,200/-

715/-

(b)    Anaesthetist’s Charges

3,300/-

2,200/-

715/-

(c)    Surgeon’s Fees for Operation (including Fees for Assistants)

11,000/-

7,150/-

2,310/-

(d) Expenses for dialysis, blood transfusion, Heart valve replacement, angiography, implanted  items during surgery wherever they do not form part of package charges and pace-maker may be reimbursed at the rate of 75% for family members and 100% for workman himself at rates not exceeding the rates applicable to lowest paying bed of AIIMS, New Delhi.

 

Indicative list of Special, Major and Minor operations is appended below:

 

SPECIAL OPERATIONS :

Cardiac including By-Pass Surgery, Brain, Lung and Cancer Operations, Kidney/Liver Transplantation Operation, Bone Marrow transplant and Multiple Fractures

                                                                                           (time taken is more than 3 hours).

 MAJOR OPERATIONS :

Kidney Stone (including lithotripsy), Prostate, Thyroid, Caesarean Delivery, Gastrectomy, Hysterectomy, Fractures, Amputations, S.P.Nailing, Discoidectomy, Retina Detachment, Liver & Gall Bladder, Plastic Surgery (not for beautification), Cataract(wih IOL), Hernia subject to Bank’s discretion                                                                     (Time taken approximately 1 to 3 hours).

 

MINOR OPERATIONS :

D & C, Fissure, Circumcision, Small Hydrocele, Dilatation, Vasectomy, Abscess, Bilat, Hydrocele, Appendix, Tubectomy, Piles, Fistula, Minor Operations of the Eye, Nose and Ear

                                                                        (Time taken approximately 60 minutes or less).

 Note:-

Operative interference done using state-of-the-art medical techniques taking less than the time indicated as above will not alter the nature of the operations.

 (Schedule V of BPS dated 27.04.2010)

ANNEXURE  III - TREATMENT ABROAD

1. As a rule, reimbursement of expenses incurred by workmen and their family members on treatment abroad will not be allowed.

 

2. In exceptional cases necessitating treatment of a kind yet to be widely established in the country, where workmen on medical advice obtained in the manner indicated below, choose to go on their own for treatment abroad, permission for treatment abroad may be granted by the board of directors of the bank subject to conditions laid down hereinafter and limited to the expenditure that would have been incurred had such treatment been received in India in a government hospital or a nursing home specially recognised by the Director General of Health Services of the Government of India.

 

3. The reimbursement of expenses incurred on air passage for travel abroad in connection with such treatment will not be reimbursed.

 

4. Foreign exchange may be released to the workmen for the purpose of treatment abroad to the same extent as is permissible to private citizens.

 

5. Hospitals and clinics indicated in paragraph 9 below have facility for specialist’s treatment for which requests are generally received for treatment abroad and in respect of which treatment facility in ordinary hospitals are still inadequate. The services provided by these hospitals may be availed of by the eligible workmen. In such cases, reimbursement may be allowed subject to the authority sanctioning reimbursement being satisfied about reasonableness of the claim.

 

6. The following ailments have been identified as ailments for which treatment in India is not yet widely established:

 

 (i)    Cadaver Kidney Transplant;

 

 (ii)   Old operated by-pass surgery cases (in which the initial operation was done abroad needing revascularization;

 

(iii)   Bone marrow transplant;

 

(iv)   Operative correction for high myopia cases; and

 

 v)    Complex Cyanote - Heart-Lesion and newly born infants suffering from heart diseases.

 

7. Reserve Bank of India (RBI) will constitute Medical Boards at Mumbai, Delhi, Kolkata and Chennai and at such other centers as may be considered necessary for the purpose of recommending whether an employee would be covered under the Scheme. The annual cost incurred on meeting of the Board by way of sitting fees, etc., shall be shared on an annual basis by such of the banks which avail of the services of the Medical Boards of examining cases of their workmen needing treatment abroad, in a manner as may be decided by the Reserve Bank of India. The Medical Board should make a specific recommendation and also give reasons for recommending treatment abroad. The Medical Board will submit its report to RBI, which in turn, could pass it on to the concerned bank.

 

8. For the purposes of reimbursement, as envisaged in the scheme, the schedule of charges as applicable for private ward treatment at the All India Institute of Medical Sciences, New Delhi, enforced from time-to-time, should be adopted.

 

9. The following institutions have been identified as having facilities for specialised treatment:

 

(a)   Bypass Coronary Surgery:

 

(i) Southern Railways Headquarters Hospital, Perambur, Chennai. (ii) Christian Medical College and Hospital, Vellore. (iii) K.E.M. Hospital, Mumbai. (iv) Jaslok Hospital, Mumbai. (v) Bombay Hospital, Mumbai. (vi) Kasturba Hospital, Bhopal. (vii) Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum.

(b)   Kidney Transplant:

 

(i) Christian Medical College and Hospital Vellore. (ii) All India Institute of Medical Sciences, New Delhi. (iii) Post Graduate Institute, Chandigarh. (iv) Jaslok Hospital, Mumbai.

 

(c)   Blood Cancer:

       (i) Tata Memorial Hospital, Mumbai. (ii) Cancer Institute, Adyar, Chennai.

 

(d)   Complicated Heart Surgery Cases:

 

(i) Southern Railway Headquarters Hospital, Perambur, Chennai. (ii) Christian Medical College and Hospital, Vellore. (iii) K.E.M. Hospital, Mumbai. (iv) All India Institute of Medical Sciences, New Delhi. (v) Bombay Hospital, Mumbai. (vi) G.B. Pant Hospital, Delhi. (vii) Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum. (viii) Post Graduate Institute, Chandigarh. (ix) S.S.K.M. Hospital, Kolkata. (x) Samaritan Hospital, Alwaye (Kerala). (xi) Kasturba Hospital, Bhopal (BHEL). (xii) N.M. Wadia Institute of Cardiology, Pune.

(Schedule V of BPS dated 02.06.2005)

 

NOTE ON CERTAIN DECEASES UNDER DOMICILE TREATMENT

Wilson’s disease causes the body to retain copper. The liver of a person who has Wilson’s disease does not release copper into bile, as it should. Bile is a liquid produced by the liver that helps with digestion. As the intestines absorb copper from food, the copper builds up in the liver and injures liver tissue. Eventually, the damage causes the liver to release the copper directly into the bloodstream, which carries the copper throughout the body. The copper buildup leads to damage in the kidneys, brain and eyes. If not treated, Wilson’s disease can cause severe brain damage, liver failure, and death. Wilson’s disease is hereditary. Symptoms usually appear between the ages of 6 and 20 years, but can begin as late as age 40. The most characteristic sign is the Kayser-Fleischer ring-a rusty brown ring around the cornea of the eye that can be seen only through an eye exam. Ulcerative colitis is a relatively uncommon, chronic, recurrent inflammatory disease of the colon or rectal mucosa. Often a lifelone illness, the condition has profound emotional and social impact on the affected individual. Ulcerative colitis is defined as continuous idiopathic inflammation of the colonic or rectal mucosa. The rectum is involved in more than 95% of cases. Some authorities believe that the rectum is always involved in an untreated patient. Partial healing may occur in a patient treated with topical therapy, creating diagnostic confusion. In the US, the annual incidence of ulcerative colitis is 10, 4-12 cases per 100,000 people. The prevalence rate is 35-100 cases per 100,000 people. Epidermolysis bullosa (EB) is a rare group of inherited disorders that manifests itself as blistering or erosion of the skin, and in some cases, the epithelial lining or other organs in response to little or no apparent trauma. Venous thromboembolic (VTE) disease the syndrome in which blood clots form in the deep veins and often break loose to travel to the lungs, is one of the most difficult and serious problems in modern medicine. Early recognition and appropriate treatment of deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) can save many lives. Aplastic anaemia: The bone marrow is the soft fatty tissue found in the cavities of our bones. Basically it is the “factory” where most of our blood cells - red cells, platelets and white cells - are made. Aplastic anaemia (or bone marrow failure) is a serious rare disease that develops when the bone marrow fails to produce these blood cells. The symptoms of aplastic anaemia are Patients may have symptoms of anaemia such as paleness, fatigue, shortness of breath on exertion and rapid heart rate (caused by low red cells); excessive bleeding and a tendency to bruise easily (low platelets) and a high susceptibility to infection (lack of white cells).