VASANDI'S BLOG

THE ALL INDIA SERVICES (MEDICAL ATTENDANCE) RULES, 1954

MISCELLANEOUS EXECUTIVE INSTRUCTION/ORDERS ISSUED BY THE GOVERNMENT OF INDIA UNDER THE ALL INDIA SERVICES (MEDICAL ATTENDANCE) RULES, 1954

1. Claims for reimbursement of medical expenses - Procedure for drawal of -

The form of application and the various certificates prescribed for the Central Government servants under the Central Services (Medical Attendance) Rules, 1944, as amended by the Ministry of Health from time to time, shall, with necessary modifications, be used for claiming refund of medical expenses incurred in connection with medical attendance and/or treatment of members of the All India Services and their families.

[G.I. M.H.A. letter No.31/16/56-AIS (II), dated 17th November, 1956.]

2. Reimbursement of medical expenses - Preferring of claims -Fixing of time limits.-

The Government of India have decided that claims for reimbursement of medical expenses of Central Government servants should invariably be preferred within six months from the date of completion of treatment as shown in the essentiality certificate of the authorised medical attendant/medical officer concerned. The bills for reimbursement of charges on account of medical attendance and treatment should be countersigned by the controlling authorities, who are empowered to countersign the travelling allowance bills of the officers concerned. In the case of members of the Service who are their own controlling officers regard to travelling allowance bills, medical bills concerning them and members of their families shall be countersigned by the members themselves. Specific sanction to the reimbursement of medical charges is not ordinarily necessary. If, however, a claim for reimbursement of medical charges is not countersigned and preferred, within six months/one year of the date of completion of treatment should be subject to investigation by the Accountant General in accordance with the provisions of rules 123 and 124 of the General Financial Rules, Volume I, respectively. If a special sanction is accorded for reimbursement of any charges in relation of the rules that sanction should be deemed to be operative from the date of its issue and the period of six-months/one year will count from that date.

2. If the State Government has no objection, the same procedure and time limit may also be prescribed in the case of All India Service officers preferring claims under the All India Service (Medical Attendance) Rules, 1954.

[G.I. M.H.A. letter No. 31/3/57-AIS (i), dated 13th March, 1957 read with letter No. 6/6/59-AIS (III), dated 12th May, 1959 and 7/22/60-AIS (III), dated 25th October, 1960.]

3. Delegation of powers to Head of Departments.-

Letter No. 8/8/66-AIS (III), 14-07-1966 11023/5/75-AIS (III), 19th January, 1976, 11023/16/76 AIS(III), 14th Dec., 1977, 11023/5/76-AIS(II), 19th Aug., 1976. [Annexure-I]

4. Concessions regarding treatment of tuberculosis or leprosy.-

In exercises of the powers conferred under clause (ii) of rule 14 of the All India Services (Medical Attendance) Rule, 1954, the administrative Ministry in respect of All India Services officers working in connection with the affairs of the Union and the State Government in respect of officers working in connection with the affairs of the States, may reimburse expenses incurred by the officers in the following cases:-

(i) Post treatment check-up: a member of the Service who has suffered from tuberculosis or leprosy and who has obtained treatment in accordance with the relevant rules and orders will be entitled to reimbursement of fee for obtaining the certificate of fitness for return to duty. If he is required to undergo post-treatment check-up with specialist, he will also be entitled to reimbursement of fees for medical examinations during such periodical check-up as well as travelling allowance from his place of duty to the headquarters of the specialist and back. Post-treatment follow-up should, however, be done by a recognised T.B specialist/Institution, stationed at or nearest to the place of the ex-T.B. patient. The specialist if necessary may call for the complete records of the ex-patient from the institution where he was treated originally.

(ii) Ambulance charges: Reimbursement of ambulance charges will also be allowed even if the ambulance used belongs to a social service organisation such as the Red Cross Society.

[G.I. M.H.A. letter No. 6/1/58-AIS (III), dated 16th April, 1958, read with O.M. No. 6/1/58-AIS (III), dated 30th August, 1958.]

5. Medical attendance and treatment in the St. George’s Nursing Home Bombay - Reimbursement of charges.-

The Government of India have decided that the Nursing Home at the St. George’s Hospital, Bombay should be treated as a recognised institution for purpose of medical attendance and treatment of the All India Service officers serving in connection with the affairs of the Union and stationed in Bombay State, who are in receipt of a pay of over Rs.500 per mensem and the members of their families. In view, however, of the fact that the charges levied by the Nursing Home for the professional services rendered by the attending doctors are high, reimbursement of charges incurred by officers on their own treatment and/or on the treatment of members of their families in the Nursing Home will be allowed subject to the following conditions.

(i) The treatment should be received only at the hands of Government doctors of the hospitals and not at the hands of private doctors and private specialists who are allowed to treat patients at the Nursing Home.

(ii) The reimbursement of visiting fees of the doctors in the case of persons drawing a pay of Rs. 1,000 per mensem would be restricted to a maximum of Rs. 16 for the first visit and Rs. 10 for subsequent visit.

(iii) the reimbursement of anaesthetist’s charges would be restricted to a maximum of Rs. 50 for a minor operation and Rs. 100 for a major operation.

(iv) The reimbursement of operation charges would be made in full at the rates prescribed by the Government of Bombay.

(v) The reimbursement of surgeon’s charges would be restricted to a maximum of Rs. 500 in the case of a major operation and a maximum of Rs. 130 in the case of a minor operation. This will be in addition to the other usual hospital charges.

(2) The Government of Bombay may extend the above concession to All India Services officers serving in connection with the affairs of the State in exercise of the powers vested in them by rule 2(d) and rule 14(ii) of the All India Services (Medical Attendance) Rule, 1954.

[G.I. M.H.A. letter No. 7/3/60-AIS (II), dated 19th March, 1960.]

6. Reimbursement of fees paid to Honorary Specialists in the State of Bombay.-

The Government of India have decided that, since there are no Government specialists in the State of Bombay Honorary specialists attached to Government hospitals should be regarded as Government specialist in respect of All India Service Officers, serving in connection with the affairs of the Union and stationed in Bombay State, and the fees paid to them for consultations in their private consulting rooms reimbursed to the officers in accordance with the rates prescribed for Government specialists. The honorary specialists should, however, be consulted on the advise of the authorised medical attendant and with the prior approval of the Surgeon General with the Government of Bombay. The consultation with the honorary specialist at their private consulting rooms will be permissible only in emergent cases and in all other cases such consultation should be had at the hospitals without payment of any fees.

(2) The Government of Bombay may extend the above concessions to All India Services Officers serving in connection with the affairs of the State in exercise of the powers vested in them by the rule 2(d) and rule 14(ii) of the All India Service (Medical Attendance) Rules, 1954.

[G.I. M.H.A. letter No. 7/3/60-AIS (III), dated 19th March 1969.]

7. Concessions regarding treatment of members suffering from tuberculosis, cancer and poliomyelitis.-

The Government of India have decided that the following concessions which are admissible to the Central Government servants under the Central Services (Medical Attendance) Rules, 1944, should be extended to members of the All India Services serving in connection with the affairs of the Union. The State Government may extend these concessions to members of the All India Service serving in connection with the affairs of the State also.

TUBERCULOSIS

(i) Consultation: If a Government specialist in tuberculosis diseases is not available, consultation on the advise of the authorised medical attendant with a specialist in T.B. diseases recognised as such by the State Administrative Medical Officers concerned will be admissible. Where the authorised medical attendant proposes to advise a member to consult a specialist in T.B. diseases, the approval of the Chief Administrative Medical Officer of the State concerned shall be obtained. The specialist consulted should, as far as possible, be a medical officer equal in status to the authorised medical attendant and if such a specialist is in Government service, he should charge fees at the following rates:-

In respect of consultation with specialists, who are not in the service of the Government, the fees paid to them for consultations should be reimbursed to the members concerned to the extent of the rates indicated above.

(ii) Treatment in a Sanatorium: If the specialist in T.B. diseases certifies that treatment in a T.B. Sanatorium is necessary, the member concerned will be entitled to treatment at a recognised sanatorium, located at or nearest to the place of duty, which can, in the opinion of the T.B. specialist, provide the necessary and suitable treatment and where accommodation for him is available. A list of T.B. institutions recognised for the purpose is given in Appendix I. Where in the opinion of the T.B. Specialist, the member concerned does not require treatment in a T.B. Sanatorium; he will be entitled to receive treatment in a hospital in the State, which can provided the necessary treatment. These concessions are admissible to members of their families also.

Members of the Service and the members of their families, who fail to get accommodation in a recognised T.B. institution or for whom treatment as an in-patient in a Government hospital and/or a recognised T.B. institution is not considered necessary, may, on the advise of the authorised medical attendant, be allowed to receive treatment at the outpatient department of a Government hospital and/or a recognised T.B. institution at or near the place where they fall ill or at the consulting room of a T.B. specialist, subject to the following conditions:-

(i) that a certificate signed by the authorised medical attendant or the government recognised specialist is submitted to the effect that the patient was advised to receive treatment as an out-door patient at the consulting room of the T.B. Specialist, as they failed to get necessary accommodation at the recognised T.B. institution or treatment as in patient in a recognised T.B. institution was not considered necessary; and

(ii) that a certificate from the authorised medical attendant and/or the Government recognised T.B. specialist is submitted to the effect that the patient had reasonable chances of recovery if treated otherwise than as an inpatient in a recognised T.B. institution.

Reimbursement of consultation fees paid to the authorised medical attendant and for a Government recognised specialist for treatment at his consulting room will be allowed in full at the prescribed rates for the first consultation and at two-thirds for each subsequent consultation. The cost of medicines, which will include the cost of drugs injected but not with professional fees for administering the injections, will be reimbursable in full, if otherwise admissible under the Rules.

(iii) Travelling allowance: A member of the Service and the members of his family sent to a recognised sanatorium for treatment under the advice of the authorised medical attendant or the T. B. Specialist consulted, will be entitled to travelling allowance for the journeys performed by rail and road to and from the place of treatment.

Travelling allowance will not be admissible for journeys performed by air. If the T.B. Specialist consulted certifies in writing that it is unsafe for the patient to travel unattended and that an attendant is necessary to accompany him to the place of treatment, then the attendant may draw T.A for the outward and return journeys.

A member of the Service will be entitled to travelling allowance at tour rate for the rail and road journey; but no halting allowance will be paid.

A member of his family referred for treatment, will be entitled to the actual single railway fare for the class of accommodation to which the member of the Service is entitled, or of any lower class, by which the patient travels for the rail journey and actual cost of transit not exceeding the travelling allowance admissible to the member of the Service for journey by road. An attendant accompanying a patient will be granted actual single railway fare for the appropriate class in which the patient travels, or by a lower class, by which the attendant actually travels, for the rail journey, and actual cost of the transit not exceeding the travelling allowance admissible to the member concerned for journey by road.

The outward journey will be deemed to have commenced from the headquarters of the member of the Service or from the place, from which the patient actually travels, whichever is nearer to the sanatorium. Likewise, the return journey will be deemed to have ended at the headquarters or at the place, to which the patient actually travels, whichever is nearer.

For purpose of reimbursement of travelling allowance for the return journey, a certificate testifying to the actual performance of the journey from the Medical Superintendent of the sanatorium or any other doctor-in-charge of the case in the sanatorium, who for all practical purposes is the authorised medical attendant of the patient while at the sanatorium, will be acceptable.

CANCER

(i) Treatment: A member of the Service or a member of his family may receive treatment for cancer at the nearest recognised hospitals providing such treatment, subject to the conditions that such treatment is recommended by the authorised medical attendant and that the prior approval of the State Administrative Medical officer concerned is obtained. A list of the hospitals recognised for this purpose is given in Appendix II. If the Medical Superintendent of the recognised hospital to whom the patient was sent for treatment by the authorised medical attendant considers that special treatment is necessary, he may refer the patient to the Tata Memorial Hospital, Bombay or the Cancer Institute, Madras.

(ii) Travelling Allowance: A member of the Service and the members of his family sent to a recognised hospital for treatment of cancer under the advise of the authorised medical attendant will be entitled to travelling allowance for the journeys performed by rail and road to and from the place of treatment. Travelling allowance will not be admissible for journeys performed by air or by Air-conditioned accommodation on trains.

If the authorised medical attendant certifies in writing that it is unsafe for the patient to travel unattendant and that attendant is necessary to accompany him to the place of treatment he may draw travelling allowance for the onward and return journeys.

A member of the Service will be entitled to travelling allowance at tour rates for the rail and road journey but no halting allowance will be paid. A member of his family, referred for treatment will be entitled to the actual single railway fare for the class of accommodation to which the member of the Service entitled, or of any lower class, by which the patient travels for the rail journey, and cost of transit not exceeding the travelling allowance admissible to the member of the Service for journey by road.

An attendant accompanying the patient will be granted actual single railway fare of the appropriate class by which the patient travels or by a lower class by which the attendant actually travels for the rail journey and actual cost of transit not exceeding the travelling allowance admissible to the member concerned for journey by road.

The outward journey will be deemed to have commenced from the headquarters of the Government servant or from the place, from which the patient actually travels, whichever is nearer to the hospital. Likewise, the return journey will be deemed to have ended at the headquarters at the place, to which the patient actually travels, whichever is nearer.

(iii) Post-treatment check-up: A member of the Service, who has suffered from cancer and who has obtained treatment in accordance with the relevant rules and orders, will be entitled to reimbursement of fees for obtaining the certificate of fitness for return to duty. If he is required to undergo post-treatment check-up with a specialist, he will be entitled to reimbursement of fees for medical examinations during such periodical check-up as well as travelling allowance by rail and road from his place of duty to the headquarters of the specialist and back. Post treatment follow up should however, be done by a recognised cancer specialist/institution stationed at or nearest to the place of duty of the ex-patient. The Specialist, if necessary, may call for the complete records of the ex-patient from the institution where he was treated originally.

(iv) Ambulance charges: Reimbursement of ambulance charges will also be allowed even if the ambulance used belongs to a social service organisation such as the Red Cross Society etc.

POLIOMYELITIS:

(i) Treatment: A member of the Service or a member of his family may receive treatment for poliomyelitis at the nearest recognised hospital providing such treatment, subject to the conditions that such treatment is recommended by the authorised medical attendant and that the prior approval of the State Administrative Medical Officer concerned is obtained. A list of hospitals recognised for this purpose is given in Appendix III.

(ii) Travelling Allowance: A member of the Service and the members of his family sent to a recognised hospital for treatment of poliomyelitis under the advise of the authorised medical attendant will be entitled to travelling allowance for the journeys performed by rail and road to and from the place of treatment. Travelling allowance will not be admissible for journeys performed by air or by Air-conditioned accommodation on trains.

If the authorised medical attendant certifies in writing that it is unsafe for the patient to travel unattended and that an attendant is necessary to accompany him to the place of treatment, he may draw travelling allowance for the onward and return journey.

A member of the Service will be entitled to travelling allowance at tour rates for the rail and road journey, but no halting allowance will be paid.

A member of his family, referred for treatment will be entitled to the actual single railway fare for the class of accommodation to which the member of the Service is entitled or of any lower class by which the patient travels, for the rail journey and actual cost of transit not exceeding the travelling allowance admissible to the member of the Service for journey by road.

An attendant accompanying the patient will be granted actual single railway fare of the appropriate class by which the patient travels, or by a lower class, by which the attendant actually travels, for the rail travelling allowance admissible to the member concerned for journey by road.

The out ward journey will be deemed to have commenced from the headquarters of the Government servant or from the place from which the patient actually travels whichever is nearer to the hospital. Likewise, the return journey will be deemed to have ended at the headquarters or at the place to which the patient actually travels, whichever is nearer.

MENTAL DISEASES:

(i) Treatment: A member of the Service may receive consultation and/or treatment for mental disease in the nearest Government Recognised Mental Hospital on the advise of the authorised medical attendant and with the prior approval of the Chief Administrative Medical Officer of the State, subject to the condition that the duration of the treatment, for which reimbursement of medical expenses will be admissible to the member concerned, should not exceed six months unless the Medical Superintendent of the Mental Hospital concerned certifies that treatment for a reasonable period upto six months beyond the six-month limit is likely to lead to complete recovery of the patient. A list of recognised mental hospitals is given in Appendix IV.

(ii) Travelling Allowance: A member of the Service suffering from mental disease will be entitled to travelling allowance (by rail and road and not by air) for the outward and return journeys in the manner indicated below when sent for consultation/treatment in a Mental Hospital.

(a) for the rail journeys in question, actual fare for the entitled or lower, class by which the patient may actually travel; and

(b) for the road portion of the journey or for journeys between stations connected by road only travelling allowance at half the rate of the road mileage admissible under the All India Services (Travelling Allowance) Rules, 1954.

If the authorised medical attendant certifies in writing that it is unsafe for the patient to travel unattended and that an attendant is necessary to accompany him to the place of consultation/treatment, the attendant accompanying the patient will be entitled to actual single railway fare, both ways, of the appropriate class, in which the patient is entitled to travel or of a lower class, by which the attendant actually travels.

Journey by air or by Air-Conditioned accommodation on trains are not permissible.

The outward journey should be deemed to have commenced from the headquarters of the members of the Service or from the place, from which the patient actually travels, whichever is nearer to the place of consultation/treatment. Likewise, the return journey will be deemed to have ended at the headquarters or at the place, at which the patient actually travels, whichever is nearer.

For the road portion of the journey, the attendant will be allowed the actual cost of transit not exceeding the travelling allowance admissible to the member of the Service concerned:

(iii) The concessions mentioned in (i) and (ii) above will also be admissible to the members of the family of a member of the Service provided the treatment for such diseases is taken in a Government Mental Hospital.

8. Reimbursement of expenses on purchase/replacement/repair/adjustment of Hearing Aid instrument:-

The undersigned is directed to invite attention to this Ministry’s O.M. No. 14025/32/83-MS dated 5th March 1984 according to which the reimbursement of cost of Hearing Aid to Central Govt. Employees and members of their families is admissible on the recommendations of the Director General of Health Services. Representations are being received in this Ministry for the reimbursement of expenses for the purchase of Hearing Aid to the Central Govt. employees and members of their families under the CS (MA) Rules, 1944. After careful consideration, it has now been decided that the reimbursement of cost of Hearing Aid to Central Govt. employees and their family members, will be made on the recommendation of the ENT Specialist of Govt./recognized hospital and on the basis of the Audiogram given by him/her, identifying the degree and the nature of the deafness. The payment would be made by the Administrative Authority direct to the Supplying Agency and not to the Govt. Servant concerned.

2. In view of the procedure indicated above, it is no more necessary to obtain the concurrence of the Director General of Health Services for the reimbursement of expenditure incurred by the Deptt./Office concerned for their employees.

3. This issues with the concurrence of the Deptt. of Pension & P.W. vide their U.O. PPW No. 570/87 P&PW dated 31.08.1987.

4. In so far as persons serving in the Indian Audit and Accounts Departments are concerned, there orders issue after consultation with the Comptroller and Auditor General of India.

5. These orders also apply to the Central Govt. employees who are beneficiaries of Central Govt. Health Scheme. The payment will be made from the ‘Service Head’ of the beneficiary.

[G.I. MH & FW O.M. No. 14025/48/96-MS dated 20.11.1987 read with DP&T Circular letter No.11023/6/92-AIS(III) dated 11.11.1994.]

APPENDIX I
APPENDIX II
APPENDIX III
APPENDIX IV
9. Instructions of the Ministry of Finance Govt. of India regarding reimbursement of medical claims of Central Government Officers in emergent circumstances not conversed under the Central rules: Instruction to the State Government for adoption:-

Instructions have been issued by M/O Finance vide OM. No. F. 49(15)- EV/59 dated 21-05-1959 and 21(2)-EV(B)/62, dated 17-04-1963 regarding reimbursement of medical expenses incurred by the Central Government servants and the All India Services Officers serving in connection with the affairs of the Union, on having medical attendance/treatment in emergent circumstances from sources other than those from when it is permissible under the relevant Medical Attendance Rules. The State Govt. may adopt these orders in respect of All India Services Officers serving in connection with the affairs of State delegating the powers of allowing the State Govt. The medical attendance and treatment will include the cost of all facilities mentioned in clause (f) and (k) of rule 2 of the AIS (M.A.) Rules, 1954 including cost of medicines, fees for administration of injections and visiting fees, charged by the Medical Officers and Private Practitioners who are not authorised Medical Attendants of the officers in question.

[No. 8/8/66-AIS (III), dated 14th July, 1966.]

(i) Copy of Min. of Finance (Exp.) O.M. No. F. 49(15)-EV/59, dated 21st May, 1959.

1. At present all cases where Central Government servants & members of their families receive medical attendance/treatment in emergent circumstances from sources other than those from whom it is permissible under the relevant Medical Attendance Rules, are referred to the Ministries of Finance/Health for allowing reimbursement of the Medical expenses by special sanction. Such cases are referred to the Ministries of Finance/Health irrespective of the amount involved. In the past it has been noticed that in the majority of such cases medical attendance and/or treatment were received either from Railway/Military/Factory/Local Board (District and Municipal Boards, Local Funds and Panchayats) hospital or from doctors attached thereto, or from private practitioners, due to the non-existence of any Government/recognised hospital within a reasonable distance from the place where the patient fell ill. With a view to cutting out delays in the settlement of such cases caused by frequent references to the Ministries of Finance and Health, the President has been pleased to delegate powers to all Ministries/Head of Departments to allow refund of medical expenses upto a maximum limit of Rs. 50/- in each case where they are satisfied that although refund is not permissible under the strict application of the various Medical Attendance Rules, the circumstances of the case warranted medical attendance/treatment being had from hospitals and doctors mentioned above, in the absence of Government/recognised hospital or doctors within a reasonable distance from the place where the patient fell ill. The reasonableness of the distance may be determined with reference to the nature and severity of the ailment in each case. Further, refunds as above may be allowed only to the extent admissible under the relevant Medical Attendance Rules and subject to the general spirit of those rules being observed. Doubtful cases should continue to be referred to the Ministries of Finance/Health.

(ii) Copy of Min. of Finance (Exp.) O.M. No. F. 21(2) EV (B)/62, dated 17th April, 1963.

1. In modification of the orders contained in this Ministry’s Office Memorandum No. F.49 (15)-EV/59 dated 21st May, 1959 (Copy enclosed for ready reference) on the above subject, the President has been pleased to decided that the existing limit of Rs. 50/- laid down in the above orders shall be raised to Rs. 100/- in each case.

2. Ministries and Head of Departments may henceforth allow refund of medical expenses upto Rs. 100/- in each case in relaxation of the relevant Medical Attendance Rules subject to the consideration and conditions set out in the aforesaid orders.

3. The powers referred to above may also be exercised in cases where medical attendance and treatment is received in a private hospital, as a result of serious accident, or on the advice of the Authorised Medical Attendant.

4. These powers can also be exercised in cases where medical attendance and treatment is received from Government doctors other than the Authorised Medical Attendant, or in Government recognised hospitals or institutions without following the prescribed procedure of obtaining prior approval of the Authorised Medical Attendant, Chief Administrative Medical Officer of the State etc. and in cases where medical tests like X-ray, Blood examination etc. are got done in private clinics due to absence of facilities in Government hospitals/institutions or due to severity of ailment which confines the patient to bed.

5. Doubtful cases should, however, be referred to the Ministry of Health for their advice, who would consult the Ministry of Finance, if necessary.

6. It has also been decided that in the types of cases referred to above, where the amount exceeds Rs. 100 refund may be allowed by the Ministries and Head of Departments in relaxation of various Medical Attendance Rules and orders issued thereunder in consultation with the Ministry of Health only. (That Ministry will be free to consult the Ministry of Finance in cases of doubt).

7. It has further been decided that:

(a) in cases where medical attendance/treatment is received in State/State-aided hospital in Calcutta, which has not been specifically recognised by the Government of India for medical attendance/treatment of Central Government employees and members of their families i.e. in respect of which Schedule of Charges has not been published by the Ministry of Health, reimbursement of medical expenses to the extent otherwise admissible may be allowed by the Ministries/Heads of Departments, where necessary and justified, in direct consultation with the Director of Health Services, West Bengal, Calcutta. The Director of Health Services, West Bengal will be deemed to be the final authority to decide whether the charges on account of accommodation and other expenses recovered from a Central Government employee in such a hospital are reasonable and suited to the status of the Government servant concerned. The same procedure may be adopted in the case of hospitals in respect of which the Schedules of Charges have been published by the Government of India but such Schedules have undergone changes, till such charges are communicated to all concerned by the Government of India, Ministry of Health.

Such cases need not be referred to the Ministries of Health and Finance.

(b) in cases where artificial appliances have to be purchased (e.g. for diseases like polio, T.B. etc. or in cases requiring surgical operations etc.) reimbursement of expenses incurred in connection with the procurement of such artificial appliances (e.g. travelling expenses, hospitalisation charges etc. if any) including the actual cost of appliance, may, where necessary and justified, be allowed by the Ministries/Heads of Departments, in consultation with the Ministry of Health direct. Such cases need not be referred to the Ministry of Finance.

8. The powers referred to in these orders shall not be exercised by the Heads of the Departments in their own cases. In such cases sanction of the higher authority should be obtained.

9. These orders also apply to Central Government employees who are beneficiaries of the Contributory Health Service Scheme mutatis mutandis.

10. Pending cases may be decided in the light of these orders.

11. In their application to persons serving in the Indian Audit and Accounts Department, these orders issue after consultation with the Comptroller and Auditor General of India.

10. Instructions of the Ministry of Finance Govt. of India regarding reimbursement of indoor medical treatment in private hospitals Central Government: Instruction to the State Government for adoption:-

I am directed to refer to the Ministry of Home Affairs letter No. 8/8/66-AIS(III), dated the 14th July, 1966 and forward herewith a copy of a Ministry of Finance O.M. No. F. 26 (10)-EV(B)/74 dated the 16th July, 1974. It is requested that the State Government may adopt the orders contained therein in respect of members of the All India Services working under them.

[DP & AR Letter No. 11023/5/75-AIS(III), dated 19th January, 1976.]

(i) Copy of Min. of Finance (Exp.) O.M.26(10)EV-B/74 of 16-07-1974.

1. The question of reimbursement of indoor medical treatment in private hospitals was raised by the staff in the National Council of the J.C.M. and on the basis of the decision taken in the National Council; the President is pleased to decide that in partial modification of the orders contained in Finance Ministry’s Office Memorandum No. F. 21(2)E.V.(B) 62 dated the 17th April, 1963 the ceiling of Rs. 100/- upto which Ministries/Heads of departments were at present delegated powers for sanctioning reimbursement in each case where treatment was received in private hospitals as a result of serious accidents or on the advise of the authorised medical attendants mentioned therein, would be raised to Rs. 250/- where Ministries and Heads of departments consider claims in respect of their own staff and to Rs. 500/- where they consider claims in respect of the employees of their subordinate and lower formations. In other cases as at present, the claims in respect of reimbursement for treatment in private hospitals would be examined on merits by the Ministry of Health.

2. The other conditions mentioned in this Ministry’s Office Memorandum No. F. 49 (15)/59 dated 21st May, 1959 and Office Memorandum No. F. 21(2)-E.V.(B)/62 dated the 17th April, 1963 will, however, continue to be observed.

3. In their application to the persons serving in the Indian Audit and Accounts Department, these orders issue after consultation with Comptroller and Auditor General of India.

(ii) Copy of DP & AR letter No. 11023/16/76-AIS(III), dated 14th December, 1977.

1. I am directed to enclose a copy of the Ministry of Finance (Department of Expenditure) Office Memorandum No. 22(3)-EV(B)/76, dated the 18th June, 1976 regarding reimbursement of the cost of Heart Pace Maker and its replacement. In accordance with these orders, the reimbursement of the cost of Heart Pace Maker and the replacement of its pulse generator has been brought within the purview of the delegated powers in terms of their earlier Office Memorandum No. F. 21(2)-EV(B)/62 dated the 17th April, 1963.

2. Attention in this connection is invited to the Ministry of Home Affairs letter No.8/8/66-AIS(III), dated the 14th July, 1966 (copy enclosed with its enclosures) under which the instructions contained in the Ministry of Finance (Deptt. of Exp.) O.M. dated 17th April, 1963 were adopted in respect of All India Services Officers serving in connection with Affairs of the State, directing further that powers allowing refund in such cases may be delegated to the Heads of Departments under the State Government.

3. It has also been decided that the orders contained in the Ministry of Finance (Department of Exp.) O.M. No. F.22(3)-EV(B)/76, dated the 18th June, 1976 may also be adopted in respect of the members of All India Services and the powers of reimbursement of the cost of Heart Pace Maker and the replacement of its pulse generator may also be delegated to the Heads of Departments of the State Government.

The initial supply of the Heart Pace Maker as well as the replacement of the pulse generator will in all cases be made only on the recommendation of the Department of Health of the State concerned.

4. Wherever the supply is approved by the Department of Health of the State concerned, the administrative authority would make payment direct to the supplying agency and not direct to the member of the All India Service concerned.

5. These orders also apply to the members of the All India Services serving in connection with the affairs of the Union and who are beneficiaries of Central Government Health Scheme.

(iii) Copy of Ministry of Finance (Exp.) O.M. No. F. 22(3)-EV(B), dated 18th June, 1976.

1. The undersigned is directed to say that a question has been raised whether the reimbursement of the expenses incurred on the purchase of Heart Pace Maker or its replacement is covered by the power delegated to Ministries/Heads of Departments in terms of para 7(b) of this Ministry’s Office Memorandum No. F.21(2)-EV(B)/62, dated 17th April, 1963. The matter has been considered carefully and the President has been pleased to decide that the reimbursement of the cost of Heart Pace Maker and the replacement of its pulse generator should also be brought within the purview of the delegated powers in terms of the above mentioned para 7(b). But the initial supply of the Heart Pace Maker as well as the replacement of the pulse generator will in all cases be made only on the recommendation of the Director General of Health Services and not as a matter of course.

2. Wherever the supply is approved by DGHS, the administrative authority would make the payment direct to the supplying agency and not direct to the Government servant concerned.

3. These orders also apply to Central Government employees who are beneficiaries of Central Government Health Scheme.

4. In so far as persons serving in the Indian Audit and Accounts Department are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.

11. Sanctioning authorities of medical reimbursement in respect of member of Service serving at the headquarters and places outside the headquarters in the State Government: -

A question was raised as to who would be the sanctioning authority for allowing medical reimbursement of Rs. 250/- and Rs. 500/- to members of the All India Services serving at the headquarters of the State Governments and those serving at places outside the State Governments Hqrs. The matter has been considered in consultation with the Ministry of Finance and the position is clarified as under:-

(i) In respect of All India Services officer serving at the headquarters in the Ministries/Departments of the State Governments viz., State Government’s Capital such as Bombay, Calcutta, Lucknow etc., the Heads of Departments viz., Secretary, Special Secretary, Chairman, Board of Revenue, Commissioner and Secretary and the other officers of equivalent status who are Heads of the Ministries/Departments would be empowered to sanction amounts upto Rs. 250/- in each case; and

(ii) In respect of members of the All India Services serving outside the State Government’s headquarters viz., outside the capital of the State Governments the Heads of Departments viz., Secretary, Special Secretary, Chairman, Board of Revenue, Commissioner and Secretary and other officers of equivalent status who are Heads of Ministries/Departments would be empowered to sanction amounts upto Rs. 500/- in each case.

2. In case the amounts mentioned at (i) and (ii) above are exceeded, the matter shall be decided by the cadre authority (e.g. Appointment department, Department of Personnel etc.) in consultation with the Health Department of the State Government concerned.

(This disposes Government of Rajasthan letter No. 3/8/(1)-1/68, dated the 10th March, 1976).

[DP & AR letter No. 11023/5/76-AIS (III), dated 19th August 1976.]

12. Instructions of the Ministry of Finance Govt. of India regarding the reimbursement of the cost of replacement of diseased heart valves: Delegation of powers: Instruction to the State Government for adoption:-

I am directed to enclose a copy of the Ministry of Finance (Department of Expenditure) O.M. No. F. 23(5)-EV(B)/77 dated the 18th Sept., 1978, regarding the reimbursement of the cost of replacement of diseased heart valves. In accordance with these orders, the reimbursement of the cost of heart valves has been brought within the purview of the delegated powers of their earlier O.M. No. F. 21(2)-EV/(B)/62 dated 17th April, 1963, a copy of which is attached to this Department’s letter No. 11023/16/76-AIS(III), dated 14th December, 1977.

2. It has been decided that the orders contained in the Ministry of Finance O.M. No. F. 23(5)-EV(B)/77 dated 18th Sept., 1978 may be adopted in respect of member of All India Services and the powers of reimbursement of the Cost of replacement of diseased heart valves may be delegated to the Heads of Department of the State Government.

The initial supply of the heart valves will, however, in all cases be made only on the recommendation of the Department of Health of the State concerned.

3. Wherever the supply is approved by the Deptt. of Health of the State concerned, the administrative authority would make payment direct to the supplying agency and not direct to the member of the All India Service, concerned. These orders also apply to the members of the All India Services serving in connection with the affairs of the Union and who are beneficiaries of the Central Government Health Scheme.

[DP & AR letter No. 11023/14/78-AIS(III), dated 6th January, 1979.]

(i) Copy of Ministry of Finance (Exp.) O.M. No. F.23(5)EV (B)/77 Dated 18.09.1978.

1. The undersigned is directed to say that a question has been raised whether the reimbursement of the cost of the replacement of diseased Heart Valves is covered by the powers delegated to the Ministries/Heads of Departments in terms of para 7(b) of this Ministry’s Office Memorandum No. F.21(2)EV(B)/62 dated the 17th April, 1963. The matter has been considered carefully and the President has been pleased to decide that the reimbursement of the cost of replacement of diseased Heart Valves should also be brought within the purview of the delegated powers in terms of the above mentioned para 7(b). The initial supply of the Heart Valves will, however, in all cases be made only on the recommendation of the Director General of Health Services.

2. Wherever the supply is approved by D.G.H.S. the Administrative authorities would make the payment direct to the supplying agency and not direct to the Government servant concerned.

3. These orders also apply to Central Government employees who are beneficiaries of Central Government Health Scheme.

4. In so far as persons serving in the Indian Audit and Accounts Department are concerned these orders have been issued after consultation with the Comptroller and Auditor General of India.

[Copy of letter No. 11023/4/76-AIS(III), dated 21st January, 1977.]

13. Instruction of the Ministry of Health, Govt. of India on the procedure to be followed regarding medical treatment under Indian System of Medicine and Homoeopathy in respect of Central Government servants: Instructions to the State Governments for adoption: -

I am directed to say that in accordance with the Government of India decision No. 13 below Rule 2 of the All India Services (Medical Attendance) Rules, 1954, the State Governments are competent to recognise Unani or Ayurvedic Hospitals for the purpose of treatment of All India Services Officers serving in connection with the Affairs of the State. The Government of India (Ministry of Health and Family Planning) have issued orders/instructions regarding the procedure to be followed regarding medical treatment under Indian System of Medicine and Homoeopathy in respect of Central Government servants vide their O.M. No.29/16/71-MA dated 14-09-1972 (copy enclosed).

2. It has been decided that the provisions contained in the Deptt. of Health’s O.M. referred to in para 1 above may also be adopted in respect of the members of All India Services.

3. The authorised Medical Attendant in respect of members of the AIS will have the same meaning as mentioned in para 2(i) (a) of the Ministry of Health and Family Planning O.M. No. 29-16/71-MA, dated 14-09-1972, referred to in para 1 above, and also under rule 2(a) of the AIS (Medical Attendance) Rules, 1954.

4. I am to request that the contents of this letter may be brought to the notice of the members of the Service working under the State Government.

(i) Copy of Deptt. of Health letter No. 29-16/71MA, dated 14th September, 1972.

1. Reference is invited to this Ministry’s Office Memorandum No.F. 28-26/61-HI, dated the 6th November, 1961 reproduced as Government of India decision No. 5 at page 11 of the Compilation of Central Services (Medical Attendance) Rules, 1944 and orders (1964 edition). It was clarified under para 2 that under the Medical Attendance Rules, modern system of medicine only is recognised and other systems of medicines such as Ayurvedic, Unani, Homoeopathy amount covered by these rules, and that Ayurvedic etc., hospitals are not recognised for the purpose of aforesaid orders even though some of the State Governments have recognised such hospitals for the treatment of their own employees. This decision was based on the policy of Government according to which Allopathic (Modern) scientific medicine should continue to be the basis for the development of the National Health Services in the country. The above mentioned policy decision has recently undergone modification according to which the Union and State Governments have been directed that Allopathic, Indian and Homoeopathic Systems of medicine should contribute towards the development of the National Health Services in the country.

2. The question of giving effect to the aforesaid revised policy decision in so far as medical attendance and treatment of Central Government servants and members of their families are concerned under the provisions of the Central Services (Medical Attendance) Rules have been under the consideration of the Government for some time past. It has now been decided as follows:-

(i) Authorised medical attendant for the purposes of these orders within the meaning of Rule 2 of the Central Services (Medical Attendance) Rules, 1944, will mean -

(a) In respect of a Government servant who belongs to a Central Service Class I, or whose pay is not less than Rs. 500 per mensem, Class I officers belonging to Ayurveda, Unani, Sidha and Homoeopathic Medical Services of the State/or Central Government or any other qualified medical officer, appointed by the Government, to attend its officers in the district;

(b) In respect of a Government servant not belonging to a Central Service, Class I whose pay is less than Rs. 500 per mensem, but more than Rs. 150/- per mensem, a Class II Gazetted Officer of the Department of Indian Medicine or Homoeopathy of a State or Central Government, or any other qualified Medical Officer, appointed by the Government to attend its officers in the station;

(c) In respect of any other Government servant, the physicians-in-charge of Government, Government aided Municipal and Panchayati dispensaries of Ayurveda, Sidha, Unani and Homoeopathic systems of medicines and/or any other qualified medical officer, similarly appointed.

N.B.: The term ‘qualified’ would mean in the case of Ayurveda, Unani and Sidha, persons possessing recognised medical qualifications as included in the II, III and IV Schedules of the Indian Medicines Central Council Act, 1970. As far as Homoeopathy is concerned, it would include the recognised medical qualifications as notified in the II Schedule of the Homoeopathy Central Council Bill, 1971.

(ii) Rates of fees for purposes of re-imbursement:

(a) Class I Officers belonging to Ayurveda, Unani, Sidha and Homoeopathic Medical Services of the State or Central Government of any other medical officers of equivalent status appointed by the Government....................Rs. 16

(b) Class II Officers of the Departments of Indian Medicine and Homoeopathy of a State or Central Government or any other medical officer of an equivalent status appointed by the Government........... Rs. 3.

Provided that in respect of medical officers of State Governments who are not allowed to receive any payment, no fees would be reimbursable.

NOTE:- The fees prescribed in clause (a) and (b) above will be payable for consultation at the consulting room of the authorised medical attendant or at the residence of the patient.

(iii) List of admissible medicines for the purpose of reimbursement: Ayurveda, Sidha, Unani and Homeopathy.

The list of medicines in these systems approved for the purposes of reimbursement with indication of maximum prices against each medicine is given in Annexure I. In this Annexure, lists of medicines have been drawn up in three categories viz.

(a) Costly medicines and treatment like panchakarma therapy which may be prescribed only by class I officers or a doctor of equivalent rank;

(b) General medicines which may be prescribed by all authorized medical attendants, and

For General Information