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Acceptance of Medical Reimbursement for Treatment in Private Non-Referral Hospitals in Emergency Cases and COVID 19

Acceptance of Medical Reimbursement for Treatment in Private Non-Referral Hospitals in Emergency Cases and COVID 19

Acceptance of Medical Reimbursement for Treatment in Private Non-Referral Hospitals in Emergency Cases and COVID 19

Medical Reimbursement accepted in Private Non-Referral Hospitals in Emergency Cases and COVID 19

Lr. No. Dr. YSR AHCT/MR/2268/2021. dated: 29.04.2021. 

Sub: Dr. YSR CT - Medical Reimbursement - Acceptance Medical Reimbursement - Claims of School Education Department - Employees and their dependents Reimbursement of expenditure in Private Non referral Hospitals within and Outside the State - Reg

Ref:

1.GO.MS No 74 HM&W (KI) Department, dated 15.03.2005
2.GO.Ms. No 105 HM & FW (K1) Dept dt 09.04.2007 
3. GO.Ms NO 68 HM & FW (KI) Depl. dt.28-03-2011 
4.GO.Ms.No. 159 HM &FW (11) Department, dated 22.12.2014 
5.GO.Rt. No. 30 HM & FW (11] Department, dated 29.01.2021 
6. Lr.No 5/2021, dated: 06.04.2021.

During the management committee meeting held on dated 15.03 2021 under the Chairmanship of CEO, Dr. YSR Aarogyasri Health Care Trust some of the members at requested to send clarification to commissioner of School Education Department regarding

a) Acceptance of treatment of the employees of Chittoor, Ananthapur & Nellore Districts. As per G.O.Ms. No. 159 TM & FW  Department, dated 22.12.2014

b) Acceptance al Medical Reimbursement bills of Employees & Pensioners of School Education Department in case if they get treatment in non-referral hospitals

Dr. YSR Aarogyasri Health Care Trust has thoroughly examined the request made by the Members of the Management Committee and representation by MLC, Shaik Sabjee vide Lr No 5/2021.dated: 06.04.2021. 

In regard to (a), it is to note that vide G.O.Ms No. 159 HM & FW (II) Department, dated: 22.12.2014 in para 3 clause VII & VIII, the Government clearly says as follows:

"VII. Even in the case of Employees/pensioners who are having "Health Cards they avail treatment in Non-empaneled hospitals, in Emergency, they may be allowed reimbursement, as per the package rates of Employees Health Scheme

VIII. Employees working in Nellore, Chittoor & Anantapur having health cards, and seek treatment in the Super Specialty Hospitals in Chennai, Vellore & Bengaluru respectively, especially in case of complicated diseases will be allowed reimbursement as per the package rates of Employee Health Scheme".

The above guideline is followed by all the departments with regard non referral Hospitals, hence same also may be followed by School Education Department

In regard to Point (b) Dr. YSR Aarogyasri Health Care Trust has been following guidelines and instructions laid down in GO Ms No 68 HM & FW Department Dated 28.3.2011 under para (2) in clause J

J. The treatment for all accident cases and all emergency cases in the unrecognized private hospitals is permitted

The above guidelines are followed by all the departments with regard to non-referral Hospitals, hence same also may he followed by school education department

Mr Shaik Sabjeee, MLC has requested clarification applicability of Medical Reimbursement for COVID-19 treatment in Non-referral Hospitals. In this regard as per GO. Rt. No. 30 HM & FW Department, dated 29.01.2021  treatment of COVID 19 under Medical Reimbursement scheme within the state and outside the state, Hyderabad Chennai, Bengaluru subject to ceiling amount upto 2 lakhs.

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