Payment/ reimbursement of medical expenses from two sources viz, from insurance agencies and under Rajasthan Civil Services (Medical Attendance) Rules, 2008.

GOVERNMENT OF RAJASTHAN
FINANCE DEPARTMENT
(RULES DEVISION)

ORDER

No. F.6(5)FD/Rules/2010- Pt.

Jaipur, dated :14th June 2012.

Sub:- Payment/ reimbursement of medical expenses from two sources viz, from insurance agencies and under Rajasthan Civil Services (Medical Attendance) Rules, 2008.

   Government servants appointed before 01.01.2004 are entitled to Medical facility under the Rajasthan Civil Service (Medical Attendance) Rules, 2008. As per provisions contained in Rule 5 of these rules a Government servant, who is entitled to avail medical attendance and treatment facilities and reimbursement thereof under these rules, can opt out of the benefits under these rules and avail medical facilities under any medi claim insurance Scheme, of any insurance provider regulated by the Insurance Regulatory & Development Authority (IRDA). The option once exercised is final and irrevocable and such Government servant is not entitled to avail facility of medical attendance and treatment and reimbursement thereof, under these rules.

   In accordance with the above provisions, those who do not opt for Medi claim Insurance Scheme are entitled to avail facility of medical attendance and treatment and reimbursement thereof.

   As per existing provisions contained in the Rajasthan Civil Service (Medical Attendance) Rules, 2008 reimbursement of Medical claim is allowed on production of original bills. Those who obtain payment of Medical claim through insurance policy are not entitled to reimbursement under Rajasthan Civil Service (Medical Attendance) Rules, 2008 for the remaining amount of the same treatment.

   The matter has been considered and the Governor is pleased to order that Government servants who have subscribed / are subscribing to Medical Insurance Policies and are also eligible for availing Medical Facility under Rajasthan Civil Services (Medical Attendance) Rules, 2008, may be allowed to claim reimbursement from both the sources subject to the conditions that the reimbursement from such
sources should not exceed the total expenditure incurred by the beneficiary on the treatment.

   The beneficiary will make the first claim to the insurance company and the second claim to the concerned Head of Office. The medical claim against the original vouchers/ bills would be raised by the beneficiary first on the insurance company, which would issue a certificate indicating the amount reimbursed to the concerned Head of Office. The insurance company concerned will retain the original vouchers/bills in such cases.

   The beneficiary would then prefer his/her medical claim along with photocopies of vouchers/bills duly certified, in ink, along with stamp of the insurance company on the reverse of the vouchers/bills to the concerned Head of Office. Reimbursement from Government will be restricted only to the admissible amount as per provisions contained in Rajasthan Civil Service (Medical Attendance) Rules, 2008 /including approved package rates subject to the conditions that the total amount reimbursed does not exceed the total expenditure incurred by the beneficiary.

   The provisions of this order shall also be applicable to the pensioner / family pensioner who are availing medical facility under the Rajasthan State Pensioners’ Medical Concession Scheme, 2009.

   This order shall take effect from the date of issue and past cases are not to be reopened.

By order of the Governor,

sd/-
(Akhil Arora)
Secretary to the Government,
Finance (Budget)

Source:http://finance.rajasthan.gov.in/RULES/F6(5)-2010-14-06-2012.pdf