GOVERNMENT OF RAJASTHAN
No. F.1(4)FD/Rules/2021 Jaipur, dated : 15 APR 2021
Sub: Scheme for grant of medical concession to State Government Pensioners.
The matter regarding revision of the “Rajasthan State Pensioners’ Medical Concession Scheme” for grant of medical concession to State Government pensioners has been under consideration after introduction of a cashless health benefit Scheme referred as Rajasthan Government Health Scheme (RGHS). Accordingly, after due consideration the existing Scheme for providing medical concessions to State pensioners is being revised as here under.
2. The Scheme shall be called “Rajasthan State Pensioners’ Medical Concession Scheme, 2021”.
3. Definition: In this Scheme, the terms used shall have the meaning as defined in Rule 3 of Rajasthan Civil Services (Medical Attendance) Rules 2013 except as hereinafter explained:
(1) “Scheme” means Rajasthan State Pensioners’ Medical Concession Scheme, 2021.
(2) “Pensioner” means retired Government servant and also employee of Panchayat Samiti and Zila Parishad who is granted pension under the Rajasthan Civil Services (Pension) Rules, 1996 or is retired on the Contributory Provident Fund benefits, and also includes retired judicial service officers governed under Rajasthan Judicial officers (Medical Facility) Rules, 2008 and All India Service (AIS) Officers born on State cadre. AIS officers also eligible to become members of Central Government Health Scheme shall exercise their option to take treatment either under Central Government Health Scheme or Rajasthan Pensioners’ Medical Concession Scheme subject to the condition that the claim for the treatment taken under Central Government Health Scheme would not be entertained under this Scheme. The term “Pensioner” shall also include “Family Pensioner”.
(3) “Family” means pensioner’s wife/ husband, if wholly dependent upon the pensioner. Wife/ Husband will be regarded as wholly dependent upon the pensioner if she/ he normally resides with the pensioner. In case the pensioner has son(s) or unmarried daughter(s) suffering from any disorder or disability of mind or is physically crippled or disabled so as to render him or her unable to earn a living, he or she will be regarded as a member of family for the purpose of medical facility available under the Scheme.
(4) “Authorised Shops” means shops recognized under this Scheme for the purpose of free supply of medicines to the pensioners.
(5) “Head of Office/Department” means authority declare as such by the Government or any other authority under Government.
(6) “RGHS” means Rajasthan Government Health Scheme.
(7) “Fund” means Rajasthan Government Health Scheme Fund.
4-Medical Attendance and Treatment:
A pensioner and his family shall be provided free medical attendance and treatment at Government hospitals (within and outside the State), Approved Hospitals within State, Hospitals under PPP arrangement, Referral Hospitals, indoor treatment in a private unrecognized hospital within an outside the State in case of emergent circumstances as admissible to State Government servant under Rajasthan Civil Services (Medical Attendance) Rules, 2013 subject to following limits:
(1) Allopathic drugs, medicines, vaccines, sera, other therapeutic substances not ordinarily available in Government Hospitals free of charge can be taken from medical shop/store recognized for the Scheme in case of outdoor treatment up to the cost ceiling of Rs. 20,000/- per annum. The tests (pathological, bacteriological, radiological and other) can be taken up to Rs 5000/- per annum, after NAC from Government hospital.
Provided that medicines to the indoor patient shall be made available irrespective of the cost ceiling.
Note: The pensioner/family pensioner shall be eligible for the free accommodation in Government Hospitals on the basis of last pay drawn by Government Servant at the time of retirement or on the date of death while in service, as the case may be. The class of free accommodation and reimbursement in present scheme shall be as per RCS (MA) Rules, 2013. The Government Servant retired on Contributory Provident Fund benefits shall also be entitled for free accommodation in Government Hospitals on the basis of pay last drawn by them immediately before retirement. This facility shall be subject to availability of accommodation in Government Hospitals. The provisions regarding entitlement of free accommodation in Government Hospitals from time to time before present scheme has also been compiled and appended as Form-1.
5. Relaxation in cost ceiling:
The issue of procedure of extension of cost ceiling of drugs and medicines in case of out-door treatment above Rs 20,000/- per annum and tests charges above Rs 5000/- per annum will be decided in due course.
6. RGHS card:
RGHS card will be issued to the pensioners free of cost as per RGHS. The procedure for issuance of RGHS card and related issues can be seen on RGHS website www.rghs.gov.in
7. Procedure for claiming Medical Reimbursement:
(1) All the medical facilities as per Rajasthan State Pensioners’ Medical Concession Scheme, 2021 will be admissible under RGHS. As RGHS is cashless health benefit scheme, therefore, no reimbursement will be allowed to RGHS card-holder, where cashless treatment is available. Reimbursement will be admissible to the RGHS Card holder in grave emergency in un-approved hospital, medicines purchased from outside for outdoor treatment and other exceptional circumstances. In such circumstances, the claim will be reimbursed only after submitting the claim online through RGHS portal.
(2) Claim of retired Judicial Officers shall be submitted online as per their entitlement under Rajasthan Judicial Officers (Medical Facilities) Rules, 2008.
(3) If a pensioner is subscribing / has subscribed to medical insurance policy for him or his family, and is also eligible for availing medical facilities under this Scheme, the claim will be settled as per procedure laid down in RGHS.
8. Reimbursement of Medical Claims in case of death of a pensioner:
The arrears of Medical Claim of a deceased pensioner may be paid to the heirs of the deceased as per procedure laid down in RGHS.
9. Fixed Medical Allowance to Pensioner / Family Pensioner for those drawing pension in other States:
(1) In case a pensioner / family pensioner is drawing his / her pension in other State, a fixed medical allowance @ Rs. 300/- per month shall be payable to him/her provided that he / she is not availing the medical facility under the Scheme.
(2) The amount of fixed Medical Allowance shall be disbursed through direct benefit transfer (DBT) to the pensioner/family pensioner every month by e-payment. Receipt of amount of earlier payment should be ensured before disbursing the next payment.
(3) The pensioner/ family pensioner shall submit an application in the Form-2, as the case may be, appended to the Memorandum online. through IT platform of RGHS.
10. Recovery of subscription from monthly pay bills:
(1) Subscription to the RGHS Fund shall be made by the serving Government Servants appointed to the Civil services of the State before 01-01-2004 at the rates, as may be prescribed by the State Government from time to time.
(2) Recovery of the subscription at the prescribed rates shall be made from the monthly pay bill by each head of Office/Department for crediting to the RGHS Fund. The details of the recoveries made from the Government servants shall be indicated in the Form-3 which shall accompany every monthly pay bill. The recovery of the subscription from employees of Panchayat Samitis and Zila Parishads shall be through RGHS portal.
(3) Subscription of RPMF from Government servants by way of deduction from pay bills before issuing this Memorandum shall be transferred to respective receipt head of RGHS fund.
11. Supply of medicines to the pensioners:
(1) All Cooperative Medical Stores/ Jan Aushadi Kendra organized and run by Rajasthan Sahakari Upbhokta Bhandar and Drug Distribution Centres under Mukhya Mantri Nishulka dava Yojana shall be authorised shops for supply of medicines to the pensioners on the basis of prescription by authorised medical attendant under this scheme as per prescribed in RGHS Scheme. Also, E-pharma Stores will be authorised for supply of medicines to the pensioners.
(2) RGHS shall create an internet-based medicines issuance system from authorized shops. Pensioners will be required to submit only original/ copy of the prescription along with RGHS Card to these authorized shops for supply of medicines.
12. Issuance of Non-Availability Certificate to the pensioners in respect of medicines not available at Authorised Cooperative Medical shops and its reimbursement.
(1) In respect of medicines not available at Authorised Cooperative Medical shops, the in-charge of the shop shall issue a Non-availability Certificate to the RGHS Card Holder
(2) The RGHS Card Holder shall purchase the medicines from the licensed medical shop / e-pharma stores.
(3) The detailed procedure regarding supply of medicines and issuance of NAC shall be issued under RGHS.
13. Functions of Treasury Officer under the Scheme:
(1) The Treasury Officer will ensure that deductions at the prescribed rates of subscription are made from monthly pay bill of each Government. servant, and a recovery schedule in support of the deductions so made is attached to each monthly pay bill.
(2) The recovery schedule attached to monthly pay bill shall be detached by the Treasury staff and it shall be sent to the Director, Treasuries and Accounts, Rajasthan, Jaipur with a covering list. The covering list shall be prepared in duplicate, one copy of which shall be retained by the Treasury for its record.
(3) Each Treasury Officer shall send a monthly statement of Accounts at the close of each month to the Director, Treasuries & Accounts, Rajasthan, Jaipur and the and Director, SI&PF Department by the 7th. of the following month as per procedure.
14. The Finance (1&P) Department of the Government shall be the Administrative Department of the Scheme.
15. In cases where it is found that a pensioner has abused or misused any of the concessions allowed under the Scheme, he shall be permanently debarred from availing of the concessions under this Scheme. Appeal shall lie against his order to the competent level in RGHS.
16. Repeal and Savings :
(1) This Scheme shall supersede the Rajasthan State Pensioners’ Medical Concession Scheme, 2014 and all Memorandums / orders / circulars issued thereunder, and shall be applicable for the medical attendance and treatment taken on or after the date this Scheme is issued.
(2) The pending cases and cases in which the treatment has been commenced prior to issuance of this Memorandum shall be decided by the provisions of Rajasthan State Pensioners’ Medical Concession Scheme, 2014 and all orders issued there under.
(3) The provisions laid down under Rajasthan State Pensioners’ Medical Concession Scheme, 2014 shall be continued till RGHS card is issued. After issuance of RGHS Card to the pensioner, medical attendance and treatment will be admissible under this Scheme of 2021.
By order of the Governor,
Finance Secretary (Budget)