Haryana notifies cashless medical service

Accepting a major demand of the state employees, Haryana Government on Tuesday notified the policy for providing cashless medical services to its employees and pensioners with effect from November 30, 2018.

Highlights of the scheme :

• Health Minister Anil Vij launched the much-awaited cashless medical facility for its employees on Haryana Day.
• The decision to launch the facility in the state follows a long-standing demand by the 'Sarv Karamchari Sangh', an organisation representing Haryana government employees.
• The scheme would be only for regular State Government employees and pensioners.
• Also, the spouses and dependents of regular Haryana Government employees and pensioners are not covered under this scheme. However, the spouse and dependents of employees and pensioners would be entitled for treatment as per the existing policy of reimbursement issued dated May 6, 2005.
• Accordingly, under this scheme govt. will provide cashless treatment to a ceiling of up to Rs 5 lakh to its employees. In case the cost of treatment exceeds this amount, then the employee or pensioner will have to bear the excess amount. However, state govt. will reimburse the excess amount as per the existing reimbursement policy.
• The implant or device would be given in cashless mode only if the cost of the same has been fixed by the Haryana Government. The Central Government has notified the rates of cardiac stents and knee implants in 2017 and these rates would be applicable in place of Haryana Government rates.
• Haryana state govt. will identify employees on the basis of HRMS Data and pensioners on the basis of report from Finance Department & NIC.
• All the departments of Haryana govt. will issue valid Identity Cards (linked with Aadhar) to the regular employees and pensioners. Moreover, the pensioners should carry Pension Payment Order (PPO) as Identity Proof to avail the benefits of Cashless Treatment.
• Henceforth, health institution will ask for identity card (PPO Number) and will tell them whether the disease is covered or not under the Haryana Cashless Treatment Scheme.
• The cashless treatment scheme would be applicable only for six life threatening conditions such as cardiac, brain hemorrhage, electric shock, Coma, accidents and 3rd and 4th stage of cancer. This would also include important facilities like CT scan, MRI, dialysis and Cardiac cath lab.
• Accordingly, govt. will implement this scheme at all govt. / govt. aided / district hospitals / private em-paneled hospitals under the state government.
• Private empanelled hospitals would have to appoint a separate help centers and a nodal officer, who would exchange the patient bills in the concerned departments. These hospitals will be paid in 60 days of receipt of bills.
• In case any fake bill or duplication of claim is reported, the beneficiary or institution is liable to be penalized for major penalties under the Haryana Civil Services (Punishment and Appeal) Rules, as amended from time to time.
• In case any wrong bill or fake treatment is reported and confirmed, the hospital is liable for de-empanelment and it would be responsibility of the concerned department to send the case to the Health Department.
• For hospitals empanelled at PGI rates only, 50 per cent of treatment would be made cashless and 50 per cent of the final bill has to be paid by the beneficiary which later on may be submitted by the beneficiary to their concerned department for reimbursement under existing policy as per entitlement.
• Notably, follow up services in OPD are not cashless. However, if there is another episode of similar life threatening conditions, the same would again qualify for cashless services.

By: Harman Sandhu