Medical-Attendance-Rules Tamil Nadu
Medical-Attendance-Rules Tamil Nadu
Medical-Attendance-Rules Tamil Nadu
Chapter XIV(8)
1. SHORT TITLE
These rules may be called GAIL (INDIA) LIMITED Medical Attendance Rules (hereinafter
called the Rules).
2. OBJECTIVE
The objective of the Rules is to provide free medical facilities to the regular employees of
the Company and their dependent family members.
3. APPLICABILITY
3.1 These Rules will be applicable to all employees in the regular pay scales of the
Company and their dependent family members and will include the following:
a) Deputationists whose terms of deputation provide so.
b) Trainees under Company’s own training Scheme (for self only).
c) Ad-hoc employees on regular scales of pay (for self only)
d) Any other category of employees whose employment conditions specifically
so provide.
4. DEFINITIONS
In these Rules, unless the context otherwise requires:
a) ‘Company’ means the GAIL (INDIA) LIMITED including the Projects / Units under its
management.
b) ‘Authorised Medical Attendant (AMA)/ Practitioner’ means a registered medical
practitioner qualified in modern system of medicine (Allopathic) with a minimum
qualification of M.B.B.S. In smaller town/places where M.B.B.S. or higher qualified
Doctors are not available, the employee may get treatment from the Registered
Medical Practitioner with Licentiate in Medicine in Allopathy.
c) ‘Government Hospital’ includes a Military Hospital, a Hospital maintained by a local
authority and any Hospital with which Central/State Government has arrangements
for treatment of Government Servants.
NOTE:
Hospitals run by Railway Administration and other Public Sector Undertakings may
also be covered under the definition of ‘Government Hospitals’. Thus medical
expenses incurred in connection with treatment taken at railway Hospitals and
Hospitals run by other Public Sector Companies can be reimbursed to the employees
under GAIL Medical Attendance Rules.
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d) ‘Family’ means the employee’s wife or husband, as the case may be, wholly
dependent parents residing with the employee, children and step-children (including
legally adopted children) wholly dependent upon the employee.
NOTE:
(i) The parent will be considered as wholly dependent on an employee if the
monthly income of the parent or the combined monthly income of both parents
(if both parents are alive) does not exceed Rs.6000/-. It may not be necessary
for dependent parents to reside with the employee at his/her place of posting.
[No.CO/Pers/Pol/P-38, dated 22.10.91; No.Co/HR/Pol/P-41, dated 8.2.2002;
No.CO/Pers/Pol/P-38 dated 27.3.2002; and No.CO/HR/Pol/P-172, dated 27.12.2004]]
(ii) A family member (excluding his / her spouse) will be deemed to be dependent
upon the employee if his/ her income from all sources is not more Rs.3000/- per
month.
(iii) Sons and daughters who are not employed or where employed, their individual
income from all sources is less than Rs. 3000/- p.m. will be treated as
dependent on the employee subject to the condition that the employer where
the concerned son/ daughter is employed, does not provide medical facility/
allowance.
EXPLANATION – I
a) The term ‘family’ does not include any other dependent relations such as brother,
sister, widowed sister etc. The term ‘Parents’ does not include ‘Step-parents’.
b) The term ‘Children’ will include children adopted legally.
c) An adopted child shall be deemed to be the child of his adoptive parents for all
purpose and the ties of the child in the family of his birth are severed and
replaced by those created by the adoption in the adoptive family.
Accordingly:
i) the term ’family’ for the purpose of these Rules shall include adoptive
parents who are wholly/ mainly dependent on the employee subject to the
condition of dependence and residence laid down;
ii) In the case of adoptive parents, if the adoptive father has more than one
wife living, and the adoption has been made with the consent of more than
one wife, only the senior most among them in marriage will be deemed to
be the adoptive mother for the purpose of eligibility to the concession under
these Rules and the other will be treated as stepmother and as such will not
be eligible to the concession as under these Rules, the term parent does not
include stepmother.
iii) At remote GAIL work centres (i.e. Vijaipur, Jhabua, Pata, Dibiyapur, Lakwa,
Agartala and Samakhiali only), it is has been decided that in individual cases,
where the employee’s parents are certified as suffering from serious
diseases, the condition for retaining the dependent parents with the
employees for at least 240 days in a year can be relaxed and such
employees may be accorded permission for retaining their parents at a
location other that their place of posting. Such cases for obtaining prior
permission shall be required to be forwarded to Corporate HR department
for processing/specific approval of Director (HR).
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EXPLANATION – II
A female employee shall have the choice to include either her parents or her parents-
in-law, for the purpose of availing of the benefits of the medical concession subject
to the condition of dependence and residence.
i) Every female employee should, immediately after her marriage, give a
declaration as to whether she would like to include her parents or parents-in-
law for the purpose of availing of the benefit of medical concessions. She can
change her option only once during the entire period of her service.
ii) In case where the husband or wife of the employee, as the case may be, is
employed in Central Government/ State Government/other Public Sector
Undertakings etc. which provide medical facilities, he/she would be entitled to
choose either the facilities under these Rules or the medical facilities provided
by the organization in which he/she is employed. For this purpose, the
employee should furnish a declaration as to who will prefer the claim for
reimbursement of medical expenses incurred on the medical attendance and
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f) ‘Patient’ means a GAIL employee or a member of his family to whom these Rules
apply.
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NOTE:
a) Tonic will not be considered essential for treatment and, therefore, cost
thereof would not be reimbursed.
b) The cost of vitamins in various combinations and in the form of Capsules /
tablets (also in Liquid form if prescribed for children below the age of 10
years) may be reimbursed:
i) when prescribed along with Antibiotics
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ii) for a maximum period of four weeks in other cases, where vitamins are
considered essential for proper treatment.
iii) For a period exceeding four weeks, on request in respect of patients
suffering from Tuberculosis, Diabetes and Malignancy.
c) If the attending Doctor does not specify the quantity or number of days for
which medicines are required, the medicines will be allowed for 3 days or up
to the minimum sized packages / bottles.
d) Medicines prescribed but not purchased with 3 days from the date of
prescription shall not be normally reimbursed.
CLARIFICATION
The AMA should prescribe medicines normally upto a period not exceeding 30
(thirty) days at a time which can be repeated, if required.
[No.CO/HR/Pol/P-42, dated 8.8.2001]
6.4.3 If the AMA dispenses medicines, the dispensation by him shall be for not
more than 5 days at a time for each sickness both in normal as well as in
emergency cases.
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6.4.4 The AMA may repeat medicines if the situation demands it. The number of
consultations will, normally be restricted to three within a period of 21
days. However, depending on the nature of sickness, a higher number not
exceeding five may be allowed with the specific approval of the competent
authority and subject to certification by the Attending Medical Attendant
that the progress of the case required more frequent monitoring.
6.4.5 Whenever the AMA dispenses medicines, such dispensation should indicate
the name and quantity of medicine together with the cost thereof, disease
treated, consultation fee etc.
6.4.6 In case of chronic ailments, the Medical Attendant may prescribe
medicines for a longer period but not more than one month at a time.
However for such longer treatment an essentiality certificate from the AMA
has to attached with the claim.
CLARIFICATION
However, for such longer treatment on advice from the AMA duly approved by
company doctor/HR Deptt.
[No.CO/HR/Pol/P-42, dated 8.8.2001]
6.4.7 The cash voucher of the druggist should indicate name and address of the
patient, name of the doctor, batch of medicines purchased etc
6.4.8 Where too frequent medical attendance is required or excessive
medication is found to be administered to an employee and/or member of
his family by an AMA, such cases may be referred by the Management to a
recognized or Govt. hospital or to a Medical Board that may be constituted
for such purpose or to the Company’s visiting/retainer Medical practitioner
for check up and advice.
6.4.9 If the AMA prescribes X-Ray, Pathological tests etc., the same may be got
done by the employee within the existing cost limit prescribed and
reimbursement shall be allowed to the employees within the limits
prescribed under these Rules.
6.4.10 Expenditure incurred by an employee in obtaining medical attendance in
India will be reimbursed by the Company subject to the provisions
indicated in these rules.
7. INJECTIONS
7.1 Fees for administering injections (other than the cost of medicine which is
reimbursed separately) will be reimbursed upto the following ceilings for all
grades of employees:
a) Intravenous injections/ infusions : Rs.5/- per injection
b) Intramascular and subcutaneous injections : Rs.3/- per injection
7.2 The number of injections for which injection fee will be reimbursable will be
limited to 10 (Ten).
7.3 For I.V. Transfusion, cost of disposable I.V. Set shall be admissible.
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8. The names of Doctors and specialists to be taken on the approved list for various offices
including Corporate Office may be notified from time to time. The company may add or
delete from such list any name (s) as may be considered necessary at any time.
8.1 Similarly, the names of hospitals to be taken on the approved list of the Company
for different offices including Corporate Office will be notified by the Company from
time to time. The Company may add or delete from such list any Hospital(s) as may
be considered necessary at any time.
8.2 In case of hospitalization, employees are required to go to the Government
Hospitals and/or Hospitals on the approved list of the Company and reimbursement
of the charges levied by such hospitals will be made as per the employee’s
entitlement.
8.3 If at the place of posting Company’s panel hospitals are in existence and the
employee and/or his dependent family member(s) takes indoor treatment from a
non-panel hospital, reimbursement of medical expenses in such cases will be as per
the scales mentioned in Rule 12.3 (i)(b) below subject to the condition that the
employee has taken prior permission from the Company.
9.2 Not more than 4, consultations will be allowed for the same ailment.
9.3 When medicines are supplied by the attending physician, no separate consultation
charges would be paid and the reimbursement will be restricted to the amount
calculated at the rate of Rs. 5/- per day for the period of treatment as indicated by
the attending Doctor.
CLARIFICATION
When medicines are supplied by the attending physician, no separate consultation
charges would be paid and the reimbursement will be restricted to the amount
calculated at the rate of Rs. 8/- per day for the period of treatment as indicated by the
attending Physician.
[No.CO/Pers/Pol/P-41, dated 27.10.1995]
9.4 Reimbursement of medicines would be confined to the medicines listed as general
medicines in the Central Services (Medical Attendance) Rules.
9.5 Duration of treatment in one spell shall not exceed 20 days.
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Certificate Form
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12.3 When an employee takes treatment at out-station , medical claims in such cases
will be regulated as under:
i) (a) At an out-station where the Company’s panel/ hospitals/
doctors/specialists are in existence, the employee should normally
consult such doctors or take indoor treatment from such empanelled
hospitals and reimbursement will be allowed provided in the case of
indoor treatment accommodation etc. is/are as per entitlement.
CLARIFICATION
An employee availing medical treatment in an outstation location based on
prior approval, he shall be reimbursed medical expenses towards treatment at
the rates of the hospital empanelled by the company at place of outstation
treatment or with reference to the rates of the reference hospital specified for
the said station, if treatment is taken in a non paneled hospital.
[CO/Pers/Pol/P-41, dated 29.6.1998]
i) (b) If, in such cases, indoor treatment is taken from non-panel hospital, rate
of reimbursement will be restricted to AIIMS rates or the rates of an
empanelled hospital, if existing at the place of posting, whichever is
higher, subject to actuals. Where there is more than one empanelled
hospital, the Office concerned will decide and notify a particular
empanelled hospital which may be taken as reference for this purpose.
CLARIFICATION
Where more than one hospital has been empanelled for referral purposes in any
of the location, reimbursement for the medical expenses for treatment in a
hospital would be at the rates prevalent at the empanelled/ Reference State
hospital as under at 12.5.
[No.CO/Pers/Pol/P-41, dated 28.6.1998]
Amongst all empanelled hospitals, Sir Ganga Ram Hospital, New Delhi is
recognized as company level Reference Hospital. As such, if any admissible
treatment is taken at Sir Ganga Ram Hospital, New Delhi as an Outdoor Patient,
same is to be allowed as per actuals. In other words, admissible treatment as
availed at Private OPD of Sir Ganga Ram Hospital, New Delhi may be
reimbursed as per actuals. However, cases where treatment is taken from a
non-empanelled hospital, reimbursement of the same is restricted to the extant
rates for Private OPD in respect of State Referral Hospital/ Sir Ganga Ram
Hospital, New Delhi as the case may be, subject to actuals.
[No.CO/Pers/Pol/P-42, dated 24.8.2006]
i) (c) Similarly, if outdoor treatment is taken from non-panel doctor/hospital,
reimbursement will be restricted to the charges as payable at the place
of posting or actuals whichever is lower.
CLARIFICATION
In case the prescription of medicines by an empanelled Hospital/Doctor for
outdoor treatment exceeds 30 days, the cost of same may be reimbursed as per
actuals subject to Rules/admissibility i.e. with prior approval for outstation
journey to empanelled Hospital/Doctor.
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ii) (a) If at the out-station, Company’s panel hospital/doctor does not exist and
an employee takes indoor treatment from a hospital other than a Govt.
hospital, reimbursement will be restricted to AIIMS rates or the rates for
a panel hospital, if existing at the place of posting whichever is higher
subject to actuals.
ii) (b) Similarly, for out-door treatment, reimbursement will be restricted to the
rates as payable at the location of treatment.
CLARIFICATION
a. In event that an employee takes medical treatment at the work station from a non-
empanelled nursing home, the reimbursement of medical expenses shall be
regulated as per the Company’s medical assistance rules and be limited to actuals
or the rates of the empanelled nursing home, whichever is lower.
b. In event the outdoor medical treatment is obtained from a qualified doctor
possessing a MBBS degree, he will not be treated at par with a specialist and his
professional consultation fee will be limited to actual or limited to consultation fee
of an MBBS doctor in an empanelled nursing home, whichever is lower.
c. If the AMA (specialist or otherwise) makes an outstation reference in respect of an
ailment for which specialist treatment is available at place of posting, then in that
case the concerned local specialist shall necessarily be referred to in first instance.
In case the said specialist further refers the case for outstation treatment then in
that event prior approval of the OIC/HR incahrge may be accorded for the same.
Reimbursement, however, shall be regulated as per rules.
[No.CO/HR/Pol/P-41, dated 18.9.2001]
12.4 Reimbursement of medical expenses in respect of dependent family members
staying away from the employee shall be allowed if the employee obtains prior
permission of the Management for availing the reimbursement facility of such
members of family. In such cases, however, reimbursement of medical
expenditure will be regulated as per the provisions mentioned above.
12.5 Outstation Medical Treatment
(i) In order to streamline and rationalise the system of reimbursement of
medical expenses for Indoor/Outdoor outstation treatment, it has been
decided to modify the extant provisions and empanel the following
hospitals in various states as per the details mentioned below:
States Hospital on Panel Reference Hospital
(a) Andhra (i) Apolllo Hospital, Hyderabad Medwin Hospital Hyderabad
Pradesh (ii) Medwin Hospital, Hyderabad
(b) Tamil Nadu (i) Apollo Hospital, Chennai Vijaya Hospital Chennai
(ii) Vijaya Hospital, Chennai
(iii) Tamil Nadu Hospital Corp. Chennai
(c) Karnataka (i) Mallya Hospital, Banglore Mallya Hospital Banglore
(d) Gujarat (i) Mayo Hospital, Baroda Rajasthan Hospital Ahmedabad
(ii) Rajasthan Hospital Ahmedabad
(e) Madhya (i) Chaith Ram Hospital, Indore Apollo Hospital Indore
Pradesh (ii) Gokuldas Hospital , Indore
(iii) Apollo Hospital, Indore
(f) West Bengal (i) CMRI Hospital, Kolkata Wood Land Hospital Calcutta
(ii) Wood Land Hospital, Kolkata
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For purpose of sanction of advances for medical treatment the extant provision
would continue upto the ceiling as prescribed from time to time. However, a
higher amount than the prescribed limit, if the case merits, will be considered
subject to the specific approval of the Competent Authority only in cases where
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the treatment is taken in an empanelled hospital and in case credit facility is not
available
[No.CO/PERS/POL/P-41, dated 14.9.1998]
13.7 CISF personnel deployed in the company are entitled to medical facilities as
admissible to the regular GAIL employees. However as far as practicable CISF
personal are to be discouraged to avail facilities in a non empanelled hospital in
normal circumstances. In accidental or emergent cases or the places/cities
where no empanelled hospital is existing, the employees can avail in non-
empanelled hospital. In the event, employee seeks to go to an non-empanelled
hospital, the reimbursement is restricted to the index hospital of the state.
Where no index hospital is earmarked, the reimbursement is restricted to Sir
Gangaram Hospital of New Delhi. However, no advance in such cases will be
sanctioned to the employee.
[No.Co/HR/Pol/P-42, dated 5.6.2003]
13.8 Advance for medical treatment will be required to be settled within three month
from the date of drawal of advance or 30 days from discharge/completion of
Medical Test, whichever is earlier. Whenever treatment is of longer duration,
settlement from time to time is to be made. In the event of delay in settlement
of advance(s) beyond the aforesaid limits, employees will be liable for recovery
of penal interest/token penalty in terms of the following provisions:
a) In case advance amount is not utilised by the employee within the
stipulated period, penal interest @ 15% per annum will be charged from the
employee for the period of default on the total amount.
b) In case advance amount is utilised by the employee within the stipulated
period but he has failed to settle the same within the stipulated period due
to various reasons, a token penalty @ 2% of the advance amount will be
levied provided the employee gives justified reasons for such delay in
settlement.
c) In case advance amount is partially utilised by the employee within the
stipulated period, penal interest @ 15% per annum on the utilised amount
will be charged (in the with Sub-Para (a) above) and token penalty @ 2%
on the utilised amount of the advance will be charged (in terms with Sub-
Para (b) above).
[No.CO/HR/POL/P-208, dated 23.1.2004]
14. OTHER FACILITIES
14.1 TESTING OF EYE SIGHT
Employee and member of their families may have their eye sight tested for
glasses at a Govt./recognised Hospitals, once in every three years. This three
years condition may, however, be relaxed on the advice of the AMA. Fee paid
to the specialists for such services will be reimbursed according to the
Scheduled rates prescribed by the Company.
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value attention and consultation about cardiac conditions via a beeper which
will be made available in GAIL hospitals.
[No.GAIL/ND/TELEMED/98, dated 18.3.1998]
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14.6 Immunisation expenses for Hepatitits ‘A’ and Chicken pox is not admissible.
[No.CO/HR/Pol/P-41, dated 1.10.2002]
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fee and cost of medicines etc. in the manner as may be prescribed by the
Company from time to time.
16.3 Cost of such medicines which are not reimbursable under the Central Service
(Medical Attendance) Rules and also charges for treatment of such diseases/
ailments/ deformities, which are not reimbursable under the Central Service
(Medical Attendance) Rules, shall not be reimbursed.
NOTE:
i) ‘Pay’ would mean Basic Pay plus Special Pay, Personal Pay (on stagnation), Special
Pay (on redesignation), NPA, or such other emoluments which may be classified as
Pay by the orders of the Company
ii) ‘Deluxe Room’ will mean and include air-conditioned room provided the empanelled
hospital categorised such an air-conditioned room as ‘Deluxe Room’.
iii) In case room charges include charges for diet, the same will be deducted from the
medical claim.
CLARIFICATION
Hospitalisation Entitlement
(Pay ranges effective from 13.10.2000 for executives)
Pay Range/ Grade Entitled Description
Accommodation
Executives with B.Pay of 18170 & D Deluxe Room
above
Executives with B.Pay of 12435 to C Room
18169
Executives with B.Pay of 10750 to B Cubicle (3-bed or 4-bed ward)
12434
S-3 to S-7 B Cubicle (3-bed or 4-bed ward)
S-2 & below A General Ward
[No.CO/HR/Pol/WR-13, dated 13.10.2000]
CLARIFICATION
Hospitalisation Entitlement ( Empanelment of Hospitals in and around Delhi/NCR)
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20 A. GENERAL
a) Employees have been advised not to adopt any unhealthy practice while
availing various benefits under the Medical Scheme of the Company, as the
same may amount to ‘misconduct’ compelling disciplinary action under the
Employees’ (Conduct, Discipline & Appeal) Rules, 1986.
[No. CO/Pers/Pol/P-41, dated 20.10.1992]
21. INTERPRETATION
Where any doubt arises about the interpretation of any clause of the Rules, the matter
shall be referred to the Corporate HR Department for clarification.
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Total (1) :
(B) Medicines, Injections, Dressings & Other Charges
Patient Date Cash Particulars Amount (Rs.)
S.No. Memo No. Claimed Passed
Total (2) :
(C) Pathological, Bacteriological and Radiological Tests etc.
Patient Date Cash Name of Clinic/ Lab Particulars of Recommended Amount (Rs.)
S.No. Memo No. tests (Yes/ No) Claimed Passed
Total (3) :
(D) Hospitalisation Charges
Patient Date Name of the Hospital Recommended Amount (Rs.)
S.No. From To (Yes/ No) Claimed Passed
Total (4) :
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Total (5) :
* : Please enclose a copy of the permission obtained for Outstation Medical Treatment
Total Claim :
Total Amount Claimed (1) to (5), Rs. :
Less Advance Taken (if any), Rs. :
Net Amount Claimed, Rs. :
Certified that :
a) My wife/ husband is not employed anywhere.
b) My wife/ husband for whom Medical reimbursement is claimed by me is employed in
_______________, which provide Medical facilities but she/he is not preferring any
claim in this regard to her/his employer.
c) (i) My son** has neither started earning nor attained the age of 25 years.
(ii) My daughter** has neither started earning nor is married.
** : no age limit prescribed in case of physically/ mentally challenged son and
daughter till she gets married
d) My parents are residing at _______________.
e) My parent(s) is/are wholly dependent on me. The income of my parents from all
sources is not more than Rs.6000/- per month.
f) My child/ children who are wholly dependent on me, is/ are residing in Hostels for
pursuing studies.
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