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Handbook on Medical Services

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Handbook on Medical Services Handbook on Medical Services Oil and Natural Gas Corporation Ltd., Chennai 044 – 28574761, 25874762, 28574763, 28574769 F o r e w o r d There have been many amendments and introduction of new policies made in medical services of ONGC which may not be known to our employees/ beneficiaries, especially our retired veterans. Therefore, an effort is being made to compile the relevant circulars / office orders / guidelines through this Hand Book which may serve as a handy reference and help in settlement of claims. However, suggestions are invited from users for improving this booklet. Dr.G.Basumatari General Manager (MS) Medical Services, Chennai Medical Scheme 1. ONGC provides the best medical facility to its employees viz., a) Regular, their dependent family members. b) Retired employee and his/her spouse for life, on joining the Scheme by making lump sum contribution as per Rules. c) Family members of deceased employee who died while in service. Norms to avail the medical facility: i) Regular employee : His/her dependent spouse, children and parents Son : Up to 30 years of age or till he gets job whichever is earlier Daughter : Till marriage or employment, whichever is earlier. (Up to three children to those employees joined prior 01.06.87 and up to two children to those who joined after the above date) ii) Retired employee : Employee and spouse for life. iii) Those who lost their lives : Medical facility to dependent parents till while in service the period of normal retirement age of the deceased, spouse for life and to his/ her children as mentioned in (i) above iv) Permanently disabled : Medical facility for life of these children. children of Regular / A Certificate stating that they are unable to Retired and of those who earn their living be produced to Medical lost their lives while Section, Chennai. in service/on duty/VRS How to avail medical facility i) Regular employee : Should produce Medical Photo Identity Card issued by ONGC to ONGC Hospitals/ empanelled hospitals for availing indoor/ Outpatient treatment. The card must be surrendered to ONGC on retirement/transfer/VRS/resignation/ dismissal. ii) Retired employee : ONGC issues Medical Card to them which has to be produced to the empanelled Hospitals / Clinics for availing indoor/outdoor treatment iii) Employees keeping families : Medical token cards are issued by respective at a place other than HR Section to enable the employee’s dependents place of posting avail medical treatment. This card is valid for one year. Periodical Medical Check-up For early detection of occupational diseases, regular employees are sent for periodical medical check up. Other medical facilities namely, spectacles, artificial appliances, hearing aid etc are explained in detail in following pages. Credit facilities Procedure for Indoor Treatment An advice indicating the nature of treatment / disease from concerned Specialist of the Hospital for admission should be obtained for approval of the Head of Medical Services. Subsequently, Medical Section will issue Credit Authorization letter based on the approval of Head of Medical Services. In case of emergency and on holidays, employees and their dependents / retired employees and their spouse can get themselves admitted to empanelled hospitals on production of Medical Photo Identity Card. The in- patient treatment thus availed, will have to be regularized with the aforesaid formalities, on the next working day. The employee / patient / dependent should sign on the original bill of the hospital at the time of discharge. Procedure for Outdoor Treatment Employees on reference from outside Region are allowed Out Patient Credit (OPD) facilities. OPD credit facility is also allowed for costly investigations advised by Specialist of a panel hospital for Chennai based employees / medical token card holders and Retired employees . For Retired Employees Declaration Non-working certificate be submitted every year to I/C HR-ER duly witnessed by either ONGC Executive or by any Executive of nationalized bank/PSU. PAN Card Submission of a copy of PAN card to Medical Section as per instructions of Ministry of Finance TTA Eligible for medical facility at a place for which TTA was drawn. Any change in station for availing this facility shall be allowed after completion of 3 years. Change of Medical Section should be intimated with the change of residence Residence Reimbursement of Limited to 7 months emoluments of pay in 12 consecutive months. med. Expenses. Beyond this, approval of concerned Director is required. (Outpatient treatment) Reimbursement of As per actuals subjected to admissibility. med. expenses (In- patient treatment) CONTRIBUTION BY RETIRED EMPLOYEES FOR JOINING THE SCHEME (O.O.No.ONGC/ER/CP/MED/009 dtd. 18.02.2010) Retired Executive employees are required to pay a lump-sum one time contribution by Cheque in favour of “ Finance & Accounts Officer, ONGC, Chennai” for availing post-retirement medical facility, as per the level and amount mentioned against each. Level of Pay scale (Rs) Lumpsum Executives Contribution (Rs) E-0 20,600 – 46,500 10,300 E-1 24,900 – 50,500 12,450 E-2 29,100 – 54,500 14,550 E-3 32,900 – 58,000 16,450 E-4 36,600 – 62,000 18,300 E-5 43,200 – 66,000 21,600 E-6 51300– 73,000 25,650 E-7 & E-8 51,300 – 73,000 25,650 E-9 62,000 – 80,000 31,000 Director 75,000 – 1,00,000 37,500 CMD 80,000 – 1,25,000 40,000 Contribution payable by unionized category of employee for availing post retirement medical facility shall be as under w.e.f. 01.12.2010 (Ref: OO(81/2010) No.ONGC/ER/CP/MED/009 dtd.01st December, 2010: Scale Pay scale (Rs) Lumpsum Code Contribution (Rs) I 10,000-18,000/- 5000/- II 10,500-21,000/- 5250/- III 11,000-24,000/- 5500/- IV 12,000-27,000/- 6000/- V 13,500-31,000/- 6750/- VI 15,000-35,000/- 7500/- VII 16,000-36,000/- 8000/- S-I/W-VII 20,000-45,000/- 10,000/- S-II 24,000-48,500/- 12,000/- S-III 28,000-52,500/- 14,000/- S-IV 32,000-56,000/- 16,000/- General All Govt. Hospitals/ESI/ Govt. Health Centers are approved, in addition to the approved panel Hospitals of ONGC, for availing medical treatment by the employees / retired employees. For in-patient/out-patient treatment in non-paneled hospitals, General treatment. reimbursement will be at par with rates of KEM Hospital, Pune. Dental treatment. For dental treatment availed in non-paneled clinics, hospitals, reimbursement will be as per the rates of Ganga Ram Hospital, New Delhi. Treatment cycle Normally the treatment cycle for a single disease is 21days. HUMAN INSULIN Patients using Human Insulin (analogue) in cartridge form, will have to bear the cost of PEN and NEEDLES from their own sources for utilizing the Inj. Human Insulin (analogue) in catridge form. (O.O.No: ONGC/ER/CP/MED/011 dated 15.03.2010) Artificial appliances (Prosthesis) and Wheel Chair (O.O.No:ONGC/ER/CP/MED/008 dated 03.12.2009 – With effect from 03.12.2009) Category of appliances Cost ceiling Norms (Rs) Above Elbow prostheses 4,80,000 These appliances have to be Below Elbow prostheses 2,50,000 prescribed, physically verified and Above knee prostheses 4,80,000 certified as essential by an in-house Below knee prostheses 1,50,000 orthopedic or empanelled orthopedic Shoulder Disarticulation 1,00,000 surgeon Hip Disarticulation 1,50,000 Type of Recommended user Cost ceiling (Rs) Norms wheel chair Ordinary Elderly/invalid person who stays Rs.6000/- wheel chair indoor and is taken care by family members Prescribed by in-house Folding Dependent Individual who has to Rs.15,000/- orthopedic or wheel chair commute in public transport or empanelled orthopedic personal vehicle surgeon. Power wheel Working individual/young Rs.1,80,000/-. Only on specific chair individual recommendation of Medical Board consisting of I/C Medical Services (not below E-5) in-house orthopedic surgeon/treating doctor and empanelled orthopedic surgeon) Life norms for artificial appliances : Category Life norm Sanctioning Payment authority Regular employee & Once in ten years (maximum on his/her dependents three occasions) Less than Once in five years upto the age Rs.25,000/- Dependent children (upto of 12 and thereafter once in ten would be 12 years) years upto the permissible age reimbursed and of dependency L – I if more than Retired employee & Once after retirement/death of Rs.25,000/-, spouse of retired employee directly to the employee/deceased supplying employee who die while agency. in service Maintenance charges for artificial appliances : 5 % of the actual cost of artificial appliance will be reimbursed to the user in prescribed claim format, after completion of one year Hearing Aid (O.O.No: ONGC/ER/CP/ MED/ 011 dt 29.08.2008 & NO.OHSS/1/1/2010 DTD.29.09.2010) Employees / retired employees and their dependents will be eligible (only twice after retirement) for reimbursement of cost of hearing aid in the prescribed format for : Type of Recommended by Limit Hearing Aid Conventional Incharge, Medical Services at the Rs.10,000/- (for one side) and bilateral Work Centre or empanelled ENT Life : 5 years hearing aid specialist supported by audiometric evidences. Digital Two ENT Specialists, supported Rs.30,000/-( for one side) hearing aid by audiometric evidences & three Life : 5 years . Second hearing aid will nos. quotations and final be allowed only after condemnation recommendations by CMS, DDN. certificate issued by ENT specialist Spectacles : (O.O.No: ONGC/ER/CP/MED/011 dated 30.12.2006) All employees with at least one year of service rendered in ONGC shall be eligible for reimbursement of spectacles/contact lenses.
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