Monday, April 9, 2018

AP Certain amendments order to fix ceiling limit for the dental treatment as per G.o.No:105

APIMA Rules 1972 Certain amendments order to fix up the ceiling limit for the dental treatment Dental treatment, Rs.20,000/- may be fixed as ceiling limit and three times to each of employees and their dependents certain procedures and by taking advantage of these rates, most of the Dental bills are presented with maximum rates between Rs.15,000/- and Rs.24,500/- as per GO.Ms.No.105 Dated:09-04-2007
HEALTH, MEDICAL AND FAMILY WELFARE  DEPARTMENT APIMA Rules 1972 Certain amendments order to fix up the ceiling limit for the dental treatment Dental treatment, Rs.20,000/- may be fixed as ceiling limit and three times to each of employees and their dependents certain procedures and by taking advantage of these rates, most of the Dental bills are presented with maximum rates between Rs.15,000/- and Rs.24,500/- as per GO.Ms.No.105 Dated:09-04-2007

  • G.O.Ms.No.74, HMNFW (K1) Deptt., dated 15-3-2005.
  • G.O.Ms.No.180, HMEtFW (K1) Dept., dt.11-5-2006. 
  • Representation from the Progressive Teachers Union, AP, Hyderabad Letter No.49/2006, dt.22-3-2006. 
  • Representation from the President/ Secretary, A.P.Secretariat Association, Hyderabad dt.18-4-2006.
  • Representation from the General Secretary, A.P.State Govt. Retired Employees Association, Sultan Bazar, Hyderabad, dated 22-4-2006. 
  • Representation from the APNGOS Association, District Branch, Ananthapur through CMP No.10482/CMP/2006, dt.16-10-2006.
  • From the DME, A.P., Hyderabad Rc. No. 20866/MA(I)A/2006 dated 16-4-200b and 9-11-2006.
  • From the DME Lr. No. 1797/LC-B/2006 dated 6-10-2006. 
  • Representation from President/General Secretary, A.P. NGOs Association letter dated 27.11.2006.


AP To fix up the ceiling limit for the dental treatment As per GO.Ms.No.105 Dated:09-04-2007.


Government have issued Andhra Pradesh Integrated Medical Attendance Rules, 1972, applicable to State Government employees and their dependents, employees of local bodies, students of Medical Colleges, members of State Legislature, Officers, A.P. State Higher Judicial Officers etc. Many Private Hospitals both in the State and out side the State have been recognized by the Government as referral hospitals, for the purpose of treatment for the above category of persons on reimbursement basis.

Government have constituted a Committee under the Chairmanship of the Director of Medical Education for review of rules and submission of recommendations. Accordingly, the said committee has submitted the report. Based on the said report, orders have been issued liberalizing the scheme vide G.O.Ms.Na.74, HMEtEW (K1) Department, dated 15-3-2005.

Government have conducted a review meeting on 28-1-2006 with the officials of Finance and Health Medical Health Family Welfare Department and the Director of Medical Education on the subject of medical reimbursement and reviewed the matter

fix up the ceiling limit for the dental treatment including the following points.


  • To fix up the ceiling limit on Central Government Health Scheme (CGHS) Package rates;
  • To fix up the ceiling limit for the dental treatment.
  • It has also been brought to the notice of the Government that the dental rates prescribed in the said G.O. are high for certain procedures and by taking advantage of these rates, most of the Dental bills are presented with maximum rates between Rs.15,000/- and Rs.24,500/- In some cases one procedure is done, but high rates are being claimed mentioning other procedures.
  • The matter has been referred to the Director of Medical Education.


The A.P. Secretariat Employees Coordination Association has also submitted a representation for discussions with officers committee's meeting constituted vide G.O.Rt.No.2272, G.A. (SW-II) Department, dated 2-5-2006. Similarly, A.P. Secretariat, Association has also represented.


They have requested for issue of orders on the following:




For Dental treatment, Rs.20,000/- may be fixed as ceiling limit and three times to each of employees and their dependents separately in the entire service or life.
Credit facility for health checkup.
Issue of net admissible certificate by NIMS at the time of discharge.

Credit letter should be accepted by all private recognised hospitats/NIMS/SVIMS issued by departments for any emergency treatment.

One month time may be prescribed for clearing medical bills by scrutiny authority.
In the G.O. second read above, Ceiling limit of Rs.1,70,000/- has been fixed for the treatment obtained in private hospitals in respect of diseases for which no packages rates of CGHS are available.

The Pay Revision Commission, 2005 has made recommendations for enhancement of ceiling Limit for medical reimbursement to Rs. 2.00 Lakhs for serving employees and Rs. 1.00 Lakh for retired persons.

After careful examination of the matter and with a view to rationalize the medical reimbursement procedure, keeping in view the recommendations of PRC, 2005 and with a view to prevent misuse of facilities, the Government have decided to amend the orders issued in G.Os first and second read above. Accordingly, Government hereby issue the https://drive.google.com/file/d/lWQdfqaa
PDF GO Ms No 105.

following amendments to G.O.Ms.No.74, HM & FW (K1) Department, dated: 15-3-2005 read with G.O.Ms.No.180, HM & FW (K1) Department, dated: 11-5-2006.

AMENDMENTS

In sub-para (1) of para 9 of G.O. Ms. No. 74, HM & FW (K1) Department dated 15-3-2005,as amended in G.O.Ms.No.180,HM & FW (81) Department, dt. 11-5-2006, the following shall be substituted, namely: -

The rates prescribed in the Central Government Health Scheme (C.G.H.S.) package by Government of India, Ministry of Health and Family Welfare Affairs, New Delhi for Central Government Health Scheme, Hyderabad are adopted in the State for the purpose of reimbursement of medical expenditure incurred by the State Government employees both in service/ retired and their dependents; family pensioners, M.L.As and their family members and all other eligible categories who are entitled for free medical treatment as mentioned in Andhra Pradesh Integrated Medical Attendance Rules, 1972, when the treatment was taken in the private hospitals recognised by the State Government within the State.

If medical treatment is taken outside the State, the rates of Central Government Health Scheme, Delhi shall be applicable. b) The maximum ceiling limit of Rs.2.00 lakhs (Rupees two lakhs only) is fixed for the major ailments of Bypass Heart surgery, CABG5, Double valve replacement, Open Heart procedure, aortic valve replacement, Kidney Transplantation, Cancer and Neuro-Surgery to Brain irrespective of package rates of CGHS for the treatment obtained in private hospitals, and also for the treatment obtained in NIMS, Hyderabad and SVIMS, Tirupati or actual cost which ever is less.

This ceiling limit of Rs. 2.00 lakhs is applicable to the serving employees and their dependents. In respect of retired employees, their dependents and family pensioners, the ceiling limit is Rs.1.00 lakh (Rupees one lakh only) for these ailments, as per the recommendations of P.R.C. 2005.

In the conditions, procedures, surgeries where CONS package rates are available, the CGHS tariff is the ceiling limit and shall be followed for the treatment obtained in Private Hospitals except for the major ailments mentioned in point 1(b) above.

The Private hospitals recognised as referral hospitals should abide and follow CGHS package rates and Government orders while giving treatment to the employee and their dependents as per APIMA Rules. They shall not charge excess amount over the package rates mentioned in CGHS package rates.



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