POST RETIREMENT MEDICAL FACILITIES SCHEME (PRMFS)

FOR EMPLOYEES OF D.S.I.I.DC. LTD.

1. TITLE

The Scheme is Titled as Post Retirement Contributory Medical Scheme aimed at

providing reimbursement of hospitalization expenses to the retired employees of DSIIDC
during their indoor hospitalization in Govt./CGHS approved Hospitals only. This is
purely a welfare / social security measure for providing them medical facility in their old
age.

2. ELIGIBILITY

Within the overall framework of the rules and regulations of the Medical Rules of the
Corporation, the reimbursement of post-Retirement hospitalization expenses will be
admissible to the following categories of officials on contributory and voluntary basis:-

(i) Those who retire from the service of the Corporation on reaching the age of
superannuation subject to rendering minimum continuous service for 10 years in regular
pay scale.

(ii) Those who are permitted to proceed on voluntary retirement and who have rendered
minimum regular and continuous service of 10 years in the Corporation will be eligible
for medical benefits only after reaching the notional age of superannuation.

(iii) Officials who are dismissed or whose services have been terminated by the
Corporation as a measure of punishment for misconduct shall not be eligible for the
benefits contemplated under this scheme. Similarly, officials unauthorisedly abandoning
the service of the Corporation, shall also not be eligible for the benefit under the scheme.

(iv) This Scheme may also cover the spouses of the Retired Employees including their
dependent family members as per definition of family defined in Medical Attendance
Rules.

(v) The Retired Employees willing to join the scheme will be required to submit
Dependency Certificate alongwith Photograph/Thumb Impression of his/her dependent
family members on the prescribed performa (enclosed). Dependency Certificate /
Undertaking shall be submitted along-with every claim.

(vi) In case of Death of the Retired Employees, his/her Spouse (including Dependents)
shall continue to avail all the benefits under the Scheme subject to the condition
contained in Point No.(iv) above and continue to meet other terms & conditions of the
scheme.

1
3. CONTRIBUTION

(i) For taking membership of this medical scheme, all the Retired Employees of the
following categories shall have to contribute the amount mentioned below against their
category, as one time contribution: -

Category * One Time Contribution

‘A’ Rs.10,000/-
‘B’ Rs.7,000/-
‘C’ Rs.5,000/-
‘D’ Rs.3,000/-

[* as per last pay scale]

(ii) Contribution shall be payable by all Retired Employees in advance, i.e. three months
prior to the date of retirement from the service of the Corporation and those who
have already Retired may pay their contribution within one month from the date of
issue of the Circular, along-with willingness and Dependency Certificate, on the
prescribed proforma.

(iii) Contribution once paid in this regard shall not be refunded even if the beneficiary
opts out of this scheme at any stage.

(iv) The Membership of the Scheme will be restricted to either Husband or wife and in
those cases where both are Ex-employees of the Corporation, as may be opted by them.

(v) Where both Husband & Wife are the employees of the Corporation, the contribution
towards Membership under the scheme would be payable by any one of them only. In
that case, even upon superannuation, the Spouse who retires later would not be enrolled
under the scheme independently. The Medical benefits would be restricted to the
prescribed ceilings for the member and his dependents. However, in case it is considered
beneficial, option may be exercised jointly by both ex-employees (husband and wife) and
the differential amount paid, at the time of superannation of the later, to convert the
existing membership in the name of the one who has superannuated last. In all other
cases option once exercised will not change.
4. Medical expenses qualifying for reimbursement:

All the expenses incurred by an employee which are connected with and are incidental to
indoor hospitalization for medical treatment and are incurred during the period of
hospitalization except as provided otherwise elsewhere on this scheme will qualify for
reimbursement Expenses incurred in connection with availing of OPD service will not be
admitted for reimbursement. The medical expenses qualifying for reimbursement will
include:-

(i) Charges for Hospital Accommodations.

(ii) All Charges connected with surgery.

2
 (iii) All charges connected with tests / investigations such as pathological tests, X-ray
charges, radiological charges etc.

(iv) Expenses incurred by way of consultation fee/visiting charges during the period of
Indoor Hospitalization.

(v) Cost of medicines provided by the Hospitals and paid by the applicant and/or
purchased from outside on the prescription of the Hospital Physician.

(vi) Any other expenses charged by the hospital which are directly connected with and
are incidental to medical treatment during the period of hospitalization.

5. BENEFITS:

(i) The reimbursable ceiling limit for the hospitalization expenditure

shall be 90% of the total expenditure as admissible under para-4.

(ii) No Medical Advance shall be provided to the Retired Employees for

Hospitalization purposes.

(iii) This facility of Reimbursement will be restricted to CGHS rates and

to those Retired Employees whose treatment has taken-place at any of the Govt./CGHS
approved hospitals only. The list of such hospitals is enclosed for reference of all
concerned. No reimbursement will be allowed, if treatment takes place at non-
recognised hospital.

(iv) In the event of the Death of Retired Employee, the benefit will
continue to apply to the spouse and his/her dependents so long as they fall under the
category of Dependents.

(v) In case the member or any of his dependent is hospitalized, it would

be a pre-requisite to intimate Personnel Division immediately alongwith Hospital’s
recommendation in writing or by e.mail/fax .

(vi) Medical expenses incurred for treatment outside the country shall not
be admissible for reimbursement under this Scheme.

(vii) Normally only those claims where hospitalization took place for
more than 24 hours will be considered for reimbursement.

(viii) The entitlement of Retired Employees to various types of Hospital

Accommodation/charges will be worked out on the basis of their rank at the time of
retirement.

(ix) MD shall have the discretion to allow treatment in non-notified

hospitals /Nursing Homes keeping in view the urgency/seriousness of illness.

3
 The Category-wise Entitlement of Retired Employees to various types of Hospital
Accommodation will be as under:-

Category of Employee Entitlement

Basic Pay more than Rs.12,000/- p.m. Nursing Home

Rs.8,000-12,000/- p.m. Semi-nursing Home
Rs.5,000-8,000/- Semi-paying
Less than Rs.5,000/- Economy ward.

In case any member takes treatment in the upper category he will be entitled for the 90%
of eligible amount of his category only calculated on the rates of Sir Ganga Ram Hospital
as applicable to serving employees of DSIIDC.

6. CLAIM

The retired employees will be required to submit their medical claims in Personnel
Division of DSIIDC within 3 months from the date of discharge. These claims will be
processed and payment released by cheque from Central A/cs Section of DSIIDC as per
C.G.H.S. rates. All efforts will be mde to clear the bill within 30 days.

7. GENERAL CONDITIONS

(i) The Corporation may at its sole discretion decide to terminate the
Membership of any member or any of his/her Dependents in case Corporation is satisfied
on the basis of evidence on record that benefits/facilities under the scheme are being
misused/abused by a member, apart from taking other action as Corporation may deem
fit.

(ii) The Scheme and or the benefits shall be liable to be withdrawn and
made inoperative at any time for any other reason whatsoever. The Scheme and or
benefits there under shall not be deemed to be a matter of right of contract or terms &
condition of Employment.

8. SAVING

Matters not specifically covered in this scheme, shall be decided by the Managing
Director, which shall be final.

Chief Manager (Personnel)