Bharat Sanchar Nigam Limited

(A Government of Indian Enterprises)

Corporate Office

No. BSNL/Admn.I/15-4/05 dated : January 13. 2006

Sub: Publishing of a compendium of Medical Rules framed by BSNL

It has been felt for sometime that all the orders issued under BSNLMRS be
compiled in a form of compendium. According, an attempt is made in this direction and
the entire information is place on our intranet. Web pages have been designed for
quick glance through the current provisions of BSNLMRS. Compendium on
BSNLMRS can be downloaded from the intranet. Any suggestions for improvement of
the content and design of the website can be sent to the Jt DDG(Admn).BSNLMRS is
accessible on the home page of Admin Branch under Director (HRD) and a link
provided left side of the intranet pages.

(Sd/-)
(P.K Misra)
JT.DDG (Admn)

Chapter I- Policy

1.0 Commencement and Scope

This scheme shall come in to force from 24th February 2003
1.1 Interpretation
Management shall be the sole authority for the interpretation of all or any of the
Provisions of this scheme and its decision thereon shall be final and binding on
all.
1.2 Alteration/relaxation of the provisions under this Scheme
The management shall at any time be entitled to replace , alter, amend or/and add
to this scheme. The management shall have full authority to consider relaxation of
the scheme on case to case basis on merits.

1.4. Definitions
i) Board means Board of Directors of Company
ii) The company means Bharat Sanchar Nigam Limited(BSNL)
having it registered office at Sanchar Bhavan New Delhi.
iii) Dependent means and includes members of family as defined
under Civil Service (Medical Attendance) Rules as amended by the
Central Government from time to time.
iv) Employee means any person employed by the company.
v) Management means the Board of Directors of the Company,
Managing Director or any other officer of the ccompany nominated
by the board for this purpose.
 vi) Scheme means BSNL employees Medical Reimbursement
Scheme
vii) Salary means Basic Pay and Dearness Allowance
viii) Pension means Basic Pension and Dearness Allowance.
ix) Retired Employee means an employee who has retired on
superannuation while serving in BSNL, who was either directly
recruited by BSNL or absorbed from DoT/DTS in BSNL.

1.5 Eligibility
1.5.1 All serving and retired employees (including voluntarily retired) of BSNL
including deputationist will be eligible for this scheme. However, the employees
in order to avail of this scheme have to opt for this scheme whereby they will not
be allowed the facility under CGHS Scheme.

1.5.2 Clarifications on eligibility of retired employees

No. Category Eligibility

i. An employee who has retired after October 2000 and has not Not
opted for BSNL (though option was offered & date-deadline eligible
for opting has passed)
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ii An employee who has retired from BSNL but option to opt Eligible
for DOT or BSNL was not offered to him viz. Group A
officers.
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iii. An employee who opted for DOT but was serving in BSNL Not
at the time of his retirement eligible
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iv. An employee who opted for DOT and retired from DOT Not
eligible
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v An employee who opted for BSNL and retired from BSNL Eligible
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1.5.3. Eligibility of family/dependents of expired employees

On the death of BSNL employee who was availing BSNLMRS facilities,
spouse/children who become family pensioners shall continue to avail
the same facility, as was being availed by the employee prior to his/her
death. However, the dependents shall not be entitled to change any option.

1.6. Taxability
All medical benefits will be subjected to Income Tax Rules as applicable from
time to time.
2.0 Benefits under BSNLMRS Scheme
2.1.0 Outdoor/domiciliary treatment from RMPs: Reimbursement
against vouchers
The employees and his dependent shall be entitled to the reimbursement
of actual expenses not exceeding the limit prescribed under this scheme
incurred for domiciliary treatment and medical attendance by any
Registered Medical Practitioner, including cost of medicines, appliance,
diagnostic and pathological tests.. The treatment would include treatment
for immunizing and prophylactic purposes also. The Registered Medical
Practitioner can be of any branch of health care e.g. Allopathic,
Homeopathic, Ayurvedic, Naturopathy, Yogic etc. The total annual limit
for reimbursement of expenses for such treatment (including that under
22.0 excepting hospitalization) for self and dependant family members
would be one months salary (i.e Basic +DA).The annual limit will be
fixed for a financial year and salary for the first month of the Financial
Year will considered. For the retired employee this be limited to last
month salary drawn before retirement (Basic + DA) per annum.

2.1.1. Outdoor/Domiciliary treatment: Entitlement without vouchers

Alternatively, 50% of the admissible amount (as mentioned in para 2.1.0
above, i.e. one months Basic + DA) will be paid to the working
employees without production of any vouchers. Such payments limited to
50% of one months salary will be paid in four equal installments at the
end of each quarter. This amount would be taxable .Similar facility for
payment without vouchers will be available to the retired employees also.
2.1.2 Omitted
2.1.3 Waiver of outdoor treatment limit for specified chronic diseases
In case of chronic diseases as listed below, Circle Heads are empowered
to waive this limit in deserving cases.
i) Cancer
ii) Renal failure
iii) Polimyelitis, Cerebral Palsy & spastics
iv) T.B.
v) Thalassemia Major
2.2.0 Treatment in recognized hospitals/nursing homes etc.
An employee (including retired employee) and his/her dependants shall
be entitled to the reimbursement of expenses at the approved rates at all
hospitals recognized from time to time by the management .Till such time
as approved rates in recognized hospitals are not notified by BSNL
management, the reimbursement will be as per actual expenses basis.
Entitlement under this clause will be separate and distinct from the ceiling
amount prescribed in para 2.1.0 and 2.1.1 under domiciliary/out door
treatment. All expenditure incurred in connection with the treatment will
 be reimbursable subject to a limit on the room rent which will be as per
entitlement.

2.2.1. List of recognized hospitals/nursing homes etc.

List of recognized hospital/nursing homes will be notified by the
management from time to time. For Delhi this will be done by BSNL
C.O. The CGMs of territorial circles in consultation with BSNL C.O. will
notify list of recognized hospital/nursing homes in places under their
jurisdiction. Employees of hospitals/nursing homes in place under their
jurisdiction. Employees of Project/Maintenance/T&D/Q.A circles etc. will
follow lists so prepared by the territorial circles. Until such list are
prepared and notified, all hospitals recognized under CGHS and CS(MA)
Rules or by State Governments will be deemed to have been recognized
for the purpose of this scheme. List of such hospitals etc. will be notified
by BSNL C.O./all CGMs of territorial Circles immediately on
commencement of this scheme by suitable administrative order.

2.2.2. Treatment in non-recognized hospitals

In emergency cases, the reimbursement will be allowed for treatment in
non-recognized hospital with the approval of CGM for field office
employees and concerned Director of BSNL Board for C.O. employees.
The amount will be restricted to rates applicable for a particular
recognized hospital to be notified by CGM/BSNL C.O.

2.2.3 Advance for medical treatment in hospital

Working Employees may be allowed advance towards expenses on
hospitalization where long duration treatment of major operation becomes
necessary. Advance shall be paid to the employees, based on estimates to
be from the hospitals as per CGHS scheme or Central Government.
3.0 Procedure for reimbursement of claim
All claims for reimbursement of medical expenses shall be made in
prescribed proforma supported by necessary bills, vouchers, certificates
and prescriptions etc. and shall be subject to the procedure lid down by
the management from time to time.

4.0 Direct Payment to Hospitals.

Arrangement will be made with the recognized Hospital so that individual
employees(including retired employees) does not require to make any
payment to the hospitals for their treatment. Instead, on proper
establishment of their identity, they will be provided all necessary indoor
treatment by the recognized hospital at approved rates and Bill will be
forwarded to BSNL for releasing the payment. Till such arrangement is
made, payment will be made as per para 2.2.0
 Entitlement of Room/Bed for Indoor Treatment

Sl..No. Employees Group Eligibility

1 Group D General Ward

2 Group C Semi- Pvt Ward
3 Group B&Group A (upto STS) Pvt Ward (Non AC)
4 Group A JAG and above Pvt Ward (AC)

5 CMD & Board of Directors Delux room with AC

(Full Time)
Further classification of Employees group in PSU will be added as
and when the same are notified

Note; ICU/ICCU as per the empanelled hospitals rates

Chapter II Detailed Operative Instructions

Pursuant to the BSNL Employees Medical Reimbursement

Scheme (BSNLMRS) issued vide letter dated 28 th February 2003,the
following instructions are issued for the operation of Scheme.
1. The abbreviated form of the scheme will be known as
BSNLMRS in places of BSMRS.
2. All serving and retired employees of BSNL will be required
to exercise their option for either CGHS or BSNLMRS by
filling up the prescribed proforma appended at Annexure A.
Option once exercised, can not be changed. It maybe noted in
this connection that CGHS facility which is, in general, not
available for PSU employees, has been extended to BSNL
employees who have come en masse on deputation from DoT
as a special case. The continuance of this facility is entirely
under of the Ministry of Health, the optees of CGHS will
automatically have to switch over to BSNLMRS.
3. All serving and retired employees, who opt for BSNLMRS as
per para 2 above , are required to fill up a Registration Form
for BSNLMRS as appended at Annexure-B while
registering for this scheme, the option regarding outdoor
treatment, viz. entitlement with voucher/without
voucher/treatment from P& T dispensary has to be exercised.
Suitable Registration No. and Card will be issued to all the
beneficiaries under BSNLMRS.
4. All serving and retired employees registered under
BSNLMRS must present their claim for reimbursement of
Medical Expenses in the prescribed format which is appended
herewith at Annexure C( for outdoor/domiciliary treatment )
and Annexure D (for Indoor treatment involving
hospitalization).It may be noted that claim for outdoor
treatment can be availed only under one of the three options
mentioned at paras 2.2.0,2.1.1 &2.1.2 of the BSNLMRS.
These options are also indicated in the Registration Form,
Blank forms will be made available by concerned sections of
BSNL. The option regarding mode of outdoor treatment once
exercised cannot be changed during the financial year.
5. The claim form shall be supported by the copies of
prescription along with original vouchers (in duplicate)
towards the expenses incurred.
6. The claim Form along with supporting documents shall be
submitted to the sections dealing with Medical Claim. The
competent authority passing the claims in the field units may
be fixed up by CGM concerned. In the Corporate Office.
7. A register (preferably computerized) showing the employee-
wise details of claim will be maintained by the section
handing such claims. In case of transfer of an employee, the
amount claimed towards medical reimbursement and the
balance of entitlement as one date of transfer will be
communicated to the new office through LPC.
8. The claim papers duly checked and passed shall be sent to
Accounts Branch for payment.
9. Claim for outdoor treatment may be preferred once in a month.
10. List of recognized hospitals shall be notified immediately by
all the Heads of Territorial Circles, as outlined in the
BSNLMRS, taking into consideration the infrastructure
available, quality of service, standard rate of various
treatments vis-a-vis the CGHS approved rates etc.. The
Guidelines for this purpose have already been issued vide this
office letter of even No. dated 27th February 2002. A further
detailed guidelines for empanelling of hospitals is enclosed
(Annexure G).
11. As per para 2.2.3 of BSNMRS, working employees may be
allowed advance towards expenses on hospitalization where
long duration treatment or major operation becomes necessary.
A proforma for Application for Medical Advance is
appended at Annexure E.
12. As per para 2.2.2. of BSNLMRS the reimbursement will be
allowed for treatment in non-recognised hospital in
emergency cases with the approval of CGM for field office
employee and concerned Director for C.O employees. The
 amount of reimbursement will be restricted to the CGHS rates
applicable at Delhi.

13. As per para 4.0 of BSNLMRS, the facility for Direct payment
to the Hospitals by the company (i.e. BSNL) has to be
arranged. All CGMs of Territorial Circles may make suitable
arrangement with approved hospitals accordingly and notify to
their employees & C.O. This is presently being negotiated
with approved hospitals.
14. An employee should intimate regarding his/her serious illness
needing hospitalization to the sections dealing with Medical
Policy implementation.A letter of authorization shall be issued
to the hospital concerned so that necessary help is extended
by the hospital. A sample of such of such authorization letter
is enclosed for guidance (Annexure F)
15. All claims for reimbursement should be submitted latest by
Six months from the completion of the treatment. Claims
submitted beyond this period are liable to be rejected.
16. The existing arrangement of AMA will be discontinued
henceforth.
17. In case of any doubt regarding any provision of the
BSNLMRS, the matter may be referred to Corporate Office
for clarification.
18. In case of the spouse of any BSNL employee is employed in
any other organization, and the BSNL employee concerned
wants to avail of BSNLMRS facility for his/her spouse or
other dependent family members, a certificate has to be
submitted by the spouse regarding non-availing of any medical
facility for self/family from his/her organization.
19. Any misuse of the BSNLRS facility would attract stringent
action against employee(s) under the CCS(CCA) Rules
notified by BSNL from time to time.
20. CGMs in circle office are their own controlling officer for the
purpose of BSNLMRS.
21. The retired employees have the option to choose the
Circle/SSA of their choice for availing the facility under
BSNLMRS. Any change in the Circle/SSA subsequently will
be changed on a request from the retired employee by this
office.

Chapter III-Special Guidelines for Reimbursement

1. Reimbursement of cost of medicines

 Reimbursement of cost all medicines are allowed as per the ordrs
dated 28.02.03
2. Reimbursement of cost of appliances
Cost of appliances is reimbursable within the annual limit of
outdoor treatment i.e. one months salary, as per 2.2.0 of
BSNLMRS. Appliances covered under CGHS Rules hall only be
considered for the reimbursement within the limit of outdoor
treatment.
Cost of spectacles is not reimbursable
3 Correcting of deformity Cosmetic Surgery

Cosmetic Surgery shall not be allowed.

4 Claims for treatment in non-empanelled hospitals

As per BSNLMRS, in emergency cases, the employees are
allowed to take indoor treatment from non-empanelled hospital,
with the approval of concerned CGM for the field office
employees and concerned Director for Corporate Office
employees.

Chapter IV Guidelines for expenditure Regulation/monitoring:

Guidelines to monitor the expenditure on indoor treatment :
i) In case the cumulative expenditure in any financial year claimed
for reimbursement under indoor treatment is more that two
months basic + DA of the employee concerned, the reimbursement
shall have to be approved by respective CGM.

Delegation of powers to CGMs

1 CGMs shall have full powers to approve the expenditure incurred on the
the treatment taken in Govt. Hospitals
2 In respect of Indoor treatment taken in empanelled hospital CGMs shall have
full powers to settle the claims, where at least 90% of the total expenditure are
covered under the rate list prescribed by CGHS for specialized and general
purpose treatment and diagnostic procedure.

3 In case of treatment taken in non-empanelled hospitals in emergency condition

with approval of competent authority, CGMs shall have full powers to settle the
claim by restricting it to CGHS rates.
4. The financial powers shall not be sub-delegated by CGM.

5 In all cases involving hospitalization of two or more than two days, a

Designated officer of BSNL shall visit the hospital and give certificate as
Enclosed format. The Certificate shall be attached to the claim while
forwarding the same to CGMs office for approval.
 The instruction regarding attaching a certificate by concerned doctor identifying
the patient in the copy of BSNLMRS Card as conveyed by this office OM No.

Guidelines to monitor overall expenditure

i. All the Circles shall submit a quarterly report indicating the expenditure
During the quarter as per Proforma given in Annexure I. The report shall
positively be sent to Jt. DDG (Admn) in Corporate Officer by 15th
July/October/January/April.
ii. Expenditure per employee for all SSAs within a Circle may be monitored at
the Circle level. A team from the Circle office may check the procedure for
sanction of medical expenses in respect of 15% of the constituent units
subject to a minimum of one unit, whose average expenditure per
employee is the highest in the Circle. This exercise must be done at
least once a year and a detailed report indicating misuse ,if any detected
along with corrective action and suggestion for improvement may be sent
to Corporate Office ,positively before end of 1st quarter of the financial
year.

iii. Each month , SSA Head should get 1% of the paid bills (subject to min.
of 5 & max of 10) with the highest expenditure in respect of indoor
treatment specially checked and send a detailed report of such checking
to the Circle Office. Similarly, action may also be taken for 1% of the
highest cumulative accepted claims in the six monthly period ending
30th September and 31st March each year(subject to min. of 2 and max
of 5)

Chapter V Miscellaneous Guidelines:

1.0 Treatment from Hospitals outside the jurisdiction of the Circle.
i) In general, employee and his/her dependant family members shall be
allowed to take indoor treatment at hospitals as applicable for his/her place
of posting and as applicable for the place of residence of his /her family.
ii) Taking indoor treatment in any hospitals other that those as above, shall be
permissible only for taking specialized treatment, for which certificate
from the local hospital stating that such facility is not available in the
place of posting or the headquarter of the employee or the place of
residence of the family, as the case may be.

1.1. Medical Card

A Medical card containing photographs of all the family members and
dependent of concerned employee shall be issued to all BSNLMRS
optees immediately. The medical/hospitalization claim should be duly
certified by the Doctor along with photograph of the person give indoor
treatment.
1.2 Emergency Hospitalization
 In all cases of extreme emergencies, the employee concerned shall have
to inform the SSA Head or his controlling officer soon after
hospitalization for indoor treatment. In order to ensure that the facility is
used by the employee and his dependent family members only, a
designated officer of BSNL may visit the hospital and verify the
authenticity of the beneficiary

1.3. Both Husband and wife are BSNL employees:

In case where both husband and wife are BSNL employees, only one of
them may be allowed to avail of the medical benefits according to his/her
status. For this purpose ,they should furnish to their respective authorities
a joint declaration as to who will prefer the claim for reimbursement of
medical expenses incurred on the medical attendance and the treatment in
respect of spouse and children. The above declaration should be
submitted in duplicate and copy shall be recorded in the personal file of
each of them in their respective offices. This declaration shall remain in
force till such time as it is revised on the express request of writing by
both the husband and the wife e.g. in the event of promotion, transfer,
resignation etc. of either of the two. In the absence of such a joint
declaration, the medical benefits shall be availed of by the wife and the
children according to the status of husband.
1.4. Change of option from CGHS to BSNLMRS
Beneficiaries of CGHS facility are allowed to exercise their option to
move over to BSNLMRS. The option can be registered any time during
a financial year after surrendering the CGHS Card.

1.4. Provision of TA for outstation treatment:

Travelling allowance may be allowed for the journeys undertaken (both
sides) for medical treatment taken with the approval of competent
authority to the station other that the place of posting as per Rules. The
persons covered shall be as follows:

1) Traveling allowance may be allowed to the patient for the

journeys undertaken for taking medical treatment at the outstation.
ii). Attendant or escort who is required to travel along with the
patient, if the Medical Authority attending the patient has certified
in writing that it is unsafe for the patient to travel alone and a
attendant/escort is necessary to accompany him.

iii). Donor of Kidney who is required to travel for donating the kidney
to BSNL employee or his family member

The TA is admissible as per the entitlement.