GOVERNMENT 0F ANDHRA PRADESH

A B S T R A C T

MEDICAL ATTENDANCE – MedicalTreatment of Government/Retired Employees and their dependents – Reimbursement ofExpenditure – Treatment in Private recognised Hospitals within and outside the State– Admissibility of Medical Expenditure with 20% cut on eligible amount withoutreferral from Nizam's Institute of Medical Sciences, Hyderabad/Sri Venkateswara Instituteof Medical Sciences, Tirupati in cases of emergencies – Orders – Issued.

HEALTH MEDICAL & FAMILY WELFARE (K1)DEPARTMENT

G.O.Ms.No. 175                                                                                                            Dated :29.05.1997

Read the following:

G.O.Ms.No. 38, HM&FM (K1) Dept., dt. 23.1.1996

G.O.Ms.No.258, HM & FW, dated : 15.6.1996

From the President, APNGOs Association, Representationdated : 22.3.1996 and representation from certain service Associations.

From the Director of Medical Education,Lr.Rc.No.3773/MA.A/96, dated : 9.10.1996.

* * *

 

O R D E R:

In the Government Orders 1st and 2nd readabove, orders were issued permitting the State Government Employees, both serving andretired to secure treatment in Private Hospitals within and outside the State indicatedtherein that under Rule 7 of the Andhra Pradesh Integrated Medical Attendance Rules, 1972,on a reference made by Nizam's Institute of Medical Sciences/Sri Venkateswara Institute ofMedical Sciences.

2. In the reference 3rd read above, theAndhra Pradesh Non-Gazetted Officers Association and some other service Associationsrepresented that the orders issued in the Government Orders 1st and 2nd read above are notbeneficial to the employees because of the condition that the employee has to obtain areferral certificate from Nizam's Institute of Medical Sciences, Hyderabad/SriVenkateswara Institute of Medical Sciences, Tirupati to get treatment in Super SpecialityHospitals within or outside the State and requested that this stipulation be omitted.

3. It has been observed that a number ofcases are being referred to Government for relaxation of the Andhra Pradesh IntegratedMedical Attendance Rules, 1972 when the treatment has been obtained directly at thePrivate Hospitals without referral from Nizam's Institute of Medical Sciences, Hyderabad /Sri Venkateswara Institute of Medical Sciences, Tirupati in view of the serious nature ofthe patient and lack of sufficient time to obtain such referral letter from the hospitalsstated above.

4. After careful consideration of thisissue in consultation with the Director of Medical Education, the Government have decidedto permit employees, both serving and retired and also to their dependants, to securetreatment in the Private Hospitals recognised in the Government Orders 1st and 2nd readabove, when the case is serious which requires immediate treatment and there is nosufficient time to get referral letter from Nizam's Institute of Medical Sciences,Hyderabad / Sri Venkateswara Institute of Medical Sciences, Tirupati. All the competentauthorities are therefore permitted to sanction reimbursement of Medical expenses for thetreatment at Private Hospitals recognised in the Government Orders 1st and 2nd read aboveafter satisfying themselves that the patient was admitted in the hospital in a veryserious condition and it was an emergency case and there was no sufficient time to obtainreferral letter from Nizam's Institute of Medical Sciences, Hyderabad / Sri VenkateswaraInstitute of Medical Sciences, Tirupati if necessary after obtaining a certificate fromthe hospital to that effect and after obtaining copy of the case sheet. In all such casesof the treatment without referral letter, a 20% cut has to be imposed on the eligibleamount after getting the bills scrutinised by the Director of Medical Education,Hyderabad.

5. All the Departments of Secretariat andall Heads of Departments are also informed that such cases covered under para 4 above neednot be referred for relaxation and the authority competent to sanction the medicalreimbursement can sanction such reimbursement in the above cases also. In all other caseswhere the competent authority though not satisfied with the alleged seriousness of thecondition of the patient, but when the patients has obtained treatment at a privatehospital directly on his own choice shall be referred to Government for relaxation whenthe Heads of Departments consider that there is genuine cause for anxiety and recommendfor relaxation.

6. All Departments of the Secretariat andall Heads of Departments are informed that the rejected cases shall not be reopened andthe cases pending as on the date of this order with the concerned competent authoritiesmay be disposed of as per above order.

7. This order issues with the concurrenceof Finance and Planning (Fin.EBS.VIII) Department vide theirU.O.No.2579/Fin.&Plg.(Expr.)/97, dated 3.5.1997.

 

(BY ORDER AND IN THE NAME OF THE GOVERNOROF ANDHRA PRADESH)

 

C. ARJUNA RAO

PRINCIPAL SECRETARY TO GOVERNMENT.

 

 

// True Copy //

 

SECTION OFFICER

 

GOVERNMENT of andhra pradesh

home (op.i) department

 

eNDT. nO.21651/OP.I/97-1 Dated:9-7-1997

Copy communicated to Officers / StaffMembers in Home Department for information.

 

 

 

R. MARKONDAIAH

ASSISTANT SECRETARY TO GOVT.

To

All Officers & Staff members in

Home Department.

 

//forwarded by order//

 

SECTION OFFICER