1.0 Scope :
1.1 The SJVN Medical Attendance Rules will apply to all regular employees and Trainees (other than Act Apprentices) and their families and also Deputationists unless it is specified otherwise in the terms and conditions of their deputation. Act Apprentices, Workcharged and Temporary / Daily rated employees working in SJVN (not their families) are entitled only to emergency treatment for injuries sustained during and in the course of their duty / training as the case may be.

2.0 Definitions:
2.1 “Authorised Medical Attendant” (AMA) means the Doctor appointed by the Company, who is a Company’s employee or one who is authorised under these rules to attend on the employees of the Company or the GM/Project Incharge.

2.2 “Government Hospital” includes a Military Hospital, a Hospital maintained by a local authority and any other hospital with which Central / State Government / SJVN’s Management have arrangements for treatment of its employees.

Note: Hospitals run by Railway Administration and other Public Sector Undertakings may also be covered under the definition of “Government Hospital”. Thus, medical expenses incurred in connection with treatment taken at Railway Hospitals and Hospitals run by other Public Sector companies can be reimbursed to the employees under SJVN Medical Attendance Rules.

2.3 “Employees” means whole-time regular employees of SJVN, including deputationists and trainees and Apprentices (other than Act Apprentices) and Casual employees on daily rated / workcharged.

2.4 “Family” means

• employees’ spouse,
• children and step-children (including legally adopted children); parents wholly dependent.
• Minor brothers (below the age of 21 years) and unmarried sisters wholly dependent and residing with the employee only if the parents are (a) not alive or (b) wholly dependent

Notes :
a) The parents will be considered as wholly dependent upon an employee only if the monthly income of the parent or the combined monthly income of parents (if both parents are alive) is less than Rs. 2500/-.

b) Family of the employee is entitled to the medical facilities in case residing at places other than the headquarter of the employee

c) Children shall be considered dependent on the employee in the following situations.

1. Children who are pursuing studies.

2. Children who are physically/ mentally disabled, incapable of doing any work and unmarried/ widowed daughters

3. Children who are gainfully employed and including those who are in part time/ daily rated employment but their monthly income from such employment does not exceed Rs. 2500/-

4. Children taken as ‘wards’ by the employer under the “Guardian and Wards Act, 1890” provided such a ward lives with the employee and is treated as a member of family and provided the employee through special will has given such a ward the same status as that of a natural born child.

2.5 “Medical Attendance” means attendance in registered hospital or at the residence of the employees, including such consultation, pathological, bacteriological, radiological or other methods of examination, for the purpose of diagnosis as are available at the Company’s hospital or failing that in any Government Hospital /empanelled Hospitals/ Laboratory or in any registered private hospital / Laboratory.

2.6 “Patient” means a SJVN employee or a member of his family to whom these rules apply and such others as are provided for in these rules and who require medical attention.

2.7 “Treatment” means the use of all medical and surgical facilities essential for the recovery or for prevention of deterioration in the condition of the patient.

Notes :
1.  In the case of female employees and families of male employees, treatment includes confinement at the Hospital of the Company or at a Government Hospital / Maternity Centre as well as a pre-natal or post-natal treatment or in any private hospital subject to the condition that reimbursement of charges for confinement be restricted as per clause 4.1.

2.  Dental treatment.

1. Dental treatment can be obtained from Govt./empanelled Hospitals.
2. If treatment is taken from empanelled hospitals, actual charges as agreed by the Hospitals shall be reimbursed.
3. In case dental treatment is taken from other Private Registered Medical Practitioner, in such cases reimbursement will be restricted to maximum rate of empanelled hospitals at that station.
4. When treatment is taken from a station where no empanelled hospital is available in such cases reimbursement shall be allowed as per Annexure-I.

3.  Reimbursement of expenditure incurred on contact lenses upto a maximum of Rs. 2,000/- (per pair) in respect of employee or his family members is allowed provided it has been recommended by an Ophthalmologist and has been prescribed on Therapeutic grounds and not for cosmetic reasons as duly certified by the AMA and subject to the conditions mentioned below :

• The patient has been examined by two Eye Specialists.
• The power of Myopia / Hypermetropia is not less than 4.00 D. The periodicity for reimbursing the cost of contact lenses will be once in three years.
• Cost of semi-soft or soft type of lenses, which have better gas permeability, will be reimbursed subject to the above prescribed limit.

4.  Reimbursement of charges incurred on account of fitting of “Intra Ocular Lens” for each eye once in a lifetime is admissible to employees and their dependants. Where employees / their dependant family members are admitted in hospitals / nursing homes for implantation of the Intra-Ocular Lens, expenditure incurred on the cost of IOL. Kit shall be reimbursed as per actual limited to Rs. 1750/-. However, in cases where patients are admitted in the company’s empanelled hospitals or local authority hospitals and where IOL Kits are supplied by the hospitals concerned, full reimbursement of charges shall be made as per entitlements.

5.  Treatment for immunising and prophylactic purposes :

Reimbursement of charges incurred on treatment of the employees and their families for immunising and prophylactic purpose will be permitted only in the case of communicable diseases viz.

6.  Vaccinations, Inoculations, etc.

The cost of vaccinations, inoculations and injections taken by the employee, his family and servants for prophylactic and immunising purposes to secure health certificates under International Travel Regulations before commencement of such travel will be reimbursed by the Company provided the journey is undertaken at the cost of the Company.

7.  Treatment of Mental diseases / psychiatric treatment.

Reimbursement of expenditure incurred on psychiatric treatment can be considered when a reference is made through the A.M.A. for such treatment and prior permission of the competent authority (including the approximate expenditure likely to be incurred on the treatment) is obtained. The ceiling rates for such reimbursement will be rates prescribed by the Local Government or Company’s empanelled hospitals.

8.  Reimbursement of expenditure upto Rs. 5,000/- in respect of purchase of hearing aids shall be admissible to the employees on the recommendation of the ENT Specialist of a Government / empanelled hospitals by identifying the degree and the nature of the deafness.

The average life of hearing aid shall be 5 years, a replacement may be permitted on the basis of a condemnation certificate from a technical expert and on approval of a ENT Specialist/AM A.

9.  The Human Mixtard Penfil and Blood Sugar Monitoring Strips will be admissible in the following circumstances.

1. If employee has already purchased the Novapen-3, in such circumstances Human Mixtard Penfil may be reimbursed.

2. If an employee who has purchased Glucometer, in such circumstances the Glucotred-2 (Blood Sugar Monitoring Strips) may be reimbursed as per prescription upto 20 strips per month.

3. No imbursement will be made against Glucometer/Novapen-3.

4. Where employee has been allowed for reimbursement of Human Mixtard Penfil & Glucotred-2 (Blood Sugar Monitoring Strips) in such cases no reimbursement will allowed on account of cost of Syringe for administration of insulin and pathological test of Sugar level from Pathological Lab.

2.8 “Management” means the Board of Directors, CMD/ Director (Personnel) or any other Officer so authorised.

2.9 “Empanelled Hospitals” means the Hospitals other than Govt. Hospitals notified from time to time.

3.0 Treatment at the Dispensary / Hospital of the Company :
All employees and their families are entitled to free medical attendance and treatment in SJVN dispensary / hospital. Patients will not ordinarily be treated at their residence except when the A.M.A. considers movement of the patient injurious to his recovery. Patients requiring hospitalisation will be admitted to the Company’s hospital and will be entitled to the following facilities at Company’s expenses.

1. Use of all medical and surgical facilities available at the hospitals;

2. The employment of such pathological, bacteriological, radiological or other methods as are considered necessary by the A.M.A.

3. Supply of such medicines, vaccines, sera or other therapeutic substances as are ordinarily available in the hospital. Cost of medicines etc. prescribed by the A.M.A. but not available at the hospital will be reimbursed.

4. Such consultations with a Specialist as the A.M.A. may consider necessary.

5. Such accommodation and nursing as are ordinarily provided at the hospital to the patients.

3.1 Rates for the cost of diet to be charged will be published from time to time by the Management as and when Company hospital makes arrangement for supply of diet. However, this will not be obligatory for the Management nor can this be claimed as a matter of right by employees.

4.0 Treatment as Indoor Patients at other Hospitals:
4.1 Where a Company Hospital does not exist at the station of duty of the employee or arrangements for the requisite treatment do not exist at the Company’s Hospital and the A.M.A. of the Company refers the case for admission to another hospital, or the employee is residing at a distance of more than 15 kilometers from the Company Hospital, the employee and his family members who require hospitalization, can be admitted to the Government/empanelled hospital. The list of Empanelled Hospitals is given at Annexure–II. Also employee and his family members can take treatment in SJVN non empanelled hospitals and reimbursement will be limited to the specified percentage of rates of Holy Family Hospital, New Delhi as under:

In cases where certain diagnostic tests and procedure/treatment are not available in Holy Family Hospital, in such cases the reimbursement will be restricted to the rates of Sir Ganga Ram Hospital.

4.1.1. The credit facilities for taking indoor treatment is also arranged with the hospitals as given in Annexure-III. The procedure for availing treatment on credit basis by employees is given in Annexure–IV. If an employee is found misusing credit facility he will be liable for punishment under Company’s Rule and other law of the land besides deduction of total amount paid to the hospital.

4.2 While under treatment in such hospitals, the employee will be entitled at Company’s expenses to the same facilities as are mentioned under Rule 3 above. The entitlement of accommodation shall be as under: -

* i.e. One level above the free of charge accommodation, if any free accommodation available in the Hospital.

If the medical Superintendent of the Hospital certifies that such accommodation was not available and his admission to hospital could not be delayed without danger, accommodation of next higher class may be allotted but, if such higher accommodation is allotted only at the request of the employee he will himself have to bear the additional expenses.

4.3 Charges for any special nursing will be borne by the employee unless it is especially directed by the A.M.A. or the Medical Superintendent of the Hospital.

4.4 Transportation charges for admission to the Government Hospital/empanelled Hospital if recommended by A.M.A. would be reimbursed.

4.5 Reference:
4.5.1 Reference to Government Hospitals/ empanelled Hospitals shall be made only by AMA as notified from time to time.

4.5.2 The AMA while referring the case shall satisfy himself that such reference is absolutely necessary and the treatment is not possible at the station and reference Hospital is the nearest Hospital where the treatment is possible. However, patients may be referred to a Hospital on the request of the employee with the approval of the head of concerned P&A department. In such cases TA will be admissible to the nearest referral Hospital.

4.5.3 The conditions as stipulated under Clause 4.5.2, shall not apply in case of accident causing serious bodily injury and acute cardiac ailment where medical intervention is absolute necessary to save the lives in such cases AMA may refer the patient to empanelled/other hospitals as deemed fit.

4.5.4 After the patient consults the referral Hospital he will report the case to AMA for further advice, if any.

4.5.5 Employee cannot insist AMA to make reference to empanelled hospitals in case medical treatment/facilities are available at the stations.

4.5.6 If referral Hospital further refer the case to a other Hospital, the reimbursement of treatment will be as per clause 4.1.

4.6 For the medical treatment of the employees and their dependants in empanelled Hospitals, reimbursement for accommodation will be as per entitlement under clause 4.2 and expenditure on account of medicines, laboratory tests, investigations and operation etc. shall be reimbursed in actual.

4.7 DELIVERY CASES:
Due to the inadequacy / non-availability of prenatal, natal and postnatal facilities at project(s), employees can take their spouses for deliveries at other places, till such time the requisite medical facilities are established by SJVN / the Govt. at or near the project site. In such cases, reimbursement of medical expenditure would be restricted to the rates as per clause 4.1.

5.0 Outdoor treatment from Private Medical Practitioners:
Where there is no A.M.A. of the Company at the station of duty of the employee or the employee is not residing in the township and residence is beyond 15 kms or is on leave or on tour at another station, he and his family members may receive medical attendance and treatment from private Registered Medical Practitioners (not less than MBBS) of their choice at their residence or at the residence of the Doctor or at the Latter’s consulting room. The reimbursement of consultation fee will be restricted to the consultation fee of the Private OPD of specified percentage rates of Holy family Hospital, New Delhi depending upon classification of cities (100%, 80% & 60% for A, B1& B2 class and unclassified cities.

5.1 Consultation fee including other tests / injection charges will be fully reimbursable in the event of OPD treatment taken in the SJVN Empanelled hospitals.

5.2 Where management feels that any employee or his family members are misusing outdoor treatment facility, the employee will be directed to take treatment from the Company’s hospital or other specified Doctor / Government Hospital including supply/ purchase of medicine from a specified source.

6.0 Reimbursement of medical expenses and the procedure therefore :
6.1 The cost of medicines which are required and recommended by Registered Medical Practitioner (not below MBBS) will be reimbursed on submission of a claim (Form B1 & Form B2) as hereinafter prescribed.

6.2 The cost of the following medicines is not reimbursable :

• Medicines which are of food value;
• Medicines in the nature of toiletries;
• Medicines which are of a prophylactic nature except to the extent specifically provided for in these rules.

Notes :
1) When cheaper substitutes of equal therapeutic value are available, the less expensive ones should be used as far as possible.

2) The list of medicines not reimbursable is given in the Annexure-V. This will be modified from time to time.

6.3 All pathological, bacteriological, radiological and other tests should be conducted at the Company’s Hospital / dispensary or at Government Hospitals / Institution. Any charges payable in Government Hospital / Institutions will be reimbursed. Where company hospital does not exist at place of duty of the employee or the employee is residing at a distance of more than 15 km from company hospital and the employee gets such tests done through private hospitals / laboratory, the following shall apply:

• In case of outdoor treatment, reimbursement for such tests will be made at the rate of 100%, 80% & 60% for “A”, “B1 & B2” & Unclassified” class of city (As per CCA) of Holy Family Hospital New Delhi.
• In case of indoor treatment, reimbursement for such tests will be governed as per clause 4.1.

6.4 All payments of medical expenses should be made by the employee in the first instance. Claims for refund of medical expenses should subsequently be submitted on the prescribed Form B1, B2 accompanied by bills, cash receipts/ cash memos (in original). The claims on receipt should be checked with reference to the rules and countersigned for the admissible amount by the Controlling Officer of the employee before being forwarded to the Accounts Department for final check and payment.

6.5 Claims for refund of medical expenses should be submitted within three months of the date of completion of the treatment.

Time barred claims may be admitted beyond 3 months but within one year from the date of completion of the treatment provided that the Controlling Officer is satisfied in each case for reasons to be recorded by him that the delay in submission of the claims is beyond the employee’s control.

6.6 Reimbursement of expenses on artificial limbs / appliances
Expenses incurred by the employee towards purchase / replacement / repair / adjustment of artificial appliances for self and / or dependent family member(s) may be reimbursed only for such items as are included in the Annexure-VI.

The reimbursement as above will be made to the concerned employees on the recommendations of and in consultation with the authorised medical attendant. Expenses incurred on items will be regulated in accordance with the rates charged by AIIMS or the local Municipal Hospital at the place where the employee is undertaking treatment.

7.0 Medical treatment in respect of employee’s families under special circumstances
7.1 The families of employees who are deputed / posted by the Company abroad for training or any other purposes will continue to be entitled for free medical attendance and treatment at the cost of the Company in terms of these rules, if they do not accompany the employee abroad, irrespective of the place they may be residing at in India.

7.2 Similar concessions in respect of the family of an employee transferred to another station of the Company in India will be admissible for a period an employee is allowed to retain his family at the station as per separate rules made on this subject.

7.3 Reimbursement of medical expenses incurred at outstation will also be allowed if the employee goes on regular and sanctioned leave including casual leave to outstation and falls sick there. The following conditions shall apply :

1. In respect of indoor treatment, reimbursement to employees and their families will be allowed as per entitlements as applicable in that particular location, irrespective of place of posting and will be governed as per clause 4.1.

2. In respect of outdoor treatment, the reimbursement for consultation / pathological and radiological charges will be regulated as 100%, 80% and 60% for “A”, “B1 & B2” & “C/Unclassified class of city (As per CCA) of Holy Family Hospital.

8.0 Travelling Allowance
Employee and their families will be entitled to the payment of travelling allowance in terms of T.A. Rules of the Company when directed by the A.M.A. as stipulated under para 4.5 for medical attendance or treatment to another M.O. / Specialist or hospital outside the station at which the employee is posted. T.A. for one attendant / escort will also be allowed if it is certified by the A.M.A. that it is unsafe for the patient to travel unattended.

Employee may be allowed TA for the same station, if employee visits the Empanelled/Govt. Hospitals instead of referred Hospital at the same station.

9.0 Grant of Advances for Medical Treatment
9.1 Under these rules, whenever an employee is hospitalised in outside hospital, Competent Authority may grant advance direct to the empanelled hospital under these Rules for treatment based on estimated expenditure made by A.M.A. or concerned hospital. Such advance can also be given in case of protracted diseases like Cancer, T.B., Polio, mental diseases, etc. even if treatment is received at outpatient. In such case the advance will be sanctioned as per the relevant clause of DOP. Such advance should be applied on Form ‘A’.

Medical advance shall not be admissible for out-door consultations, pre-natal treatment, pathological / other medical tests etc.

9.2 The advance will be adjusted against the admissible medical reimbursement claims. Second advance will not be allowed unless first advance is cleared. Balance unspent advance should be deposited by the employee immediately on discharge from the hospital failing which the recovery will be made from the pay besides this will be treated an act of misconduct.

10.0 Reimbursement of Medical Expenses incurred in emergencies :
Refund of medical expenses upto Rs. 500/- in each case incurred in emergencies may be allowed by the General Manager / Project Incharge in relaxation of these rules on the recommendation of the A.M.A. of the Company.

11.0 Medical Treatment for outsiders at dispensaries / hospitals of the Company :
11.1 Non-employees like Contractors, Contractors employees, employees relatives, other outsiders will not be entitled to receive any treatment in the hospital except in accident cases or in case where question of life and death is involved. In such cases, emergency treatment can be given on charge. For the purpose, charges for indoor and outdoor treatment will be announced in consultation with Finance by the hospital from time to time.

11.2 Employees of Project, Schools, CISF, Post & Telegraph office, local Police will be entitled to medical treatment as per contract entered with them by the Competent Authority.

12.0 Medical Certificates and Private Practice:
12.1 No Company Doctor will issue any certificate other than what they are required to do under Company’s rules.

12.2 No Company Doctor will engage himself in private practice while in service of SJVN. This will be treated as a misconduct and infringement of contract of employment.

13.0 Ambulance Rules
13.1 Ambulance service wherever made available will be provided free of charge to cases eligible for free treatment requiring admission as in patients only.

13.2 Dangerously or seriously ill cases will be given priority for providing ambulance facilities. Employees are required to indicate, wherever feasible, the nature of the illness and its seriousness when requests for ambulance are made. Requests for ambulance will be complied with subject to availability and / or prior bookings and seriousness of cases.

13.3 The ambulance will be used only over motorable roads. The use of ambulance will be limited to a radius of 20 kilometers from the Company’s hospital.

13.4 In case of patients eligible for free treatment other than those requiring admission as in-patients, ambulance service may be provided free of charge if in the opinion of the attending doctor, it is necessary to transport the patient by an ambulance on medical grounds, such as inability to walk on account of fracture in leg or blindness or very old age or mental illness or other infirmity.

13.5 If, after arrival at the hospital, the doctor finds that the use of the ambulance was not warranted on any of the grounds mentioned in paras 13.1 to 13.4 above, the ambulance charges will be recovered from the employee and the employee will be liable for disciplinary action for false representation.

13.6 Ambulance service will not be made available for dropping patients at their homes or at other places after out-patient treatment. They will be required to make their own arrangements for returning from the hospital. However, in exceptional cases, non-ambulant patients will be permitted the use of the ambulance under instruction from the Chief medical Officer or the Medical Superintendent or one of the Medical Officers, in the absence of any one of them, this discretion will be used by attending Doctor.

13.7 Ambulance service will be provided free of charge to drop the discharged in-patients at their residence within a distance of 20 kilometers, if in the opinion of the doctor of not less than the rank of Medical Officer, the ambulance service is necessary in that case. If the residence is beyond these limits but within 30 kilometers, chief Medical Officer’s permission will be required.

13.8 Requests for ambulance to bring paying cases who are residing within the township will be complied with subject to availability of the ambulance. In other cases, the employees will have to make their own arrangements. The only exception will be cases arising out of accidents for which the Chief Medical Officer’s approval will be required. After arrival at the Hospital, if it is found that incorrect or misleading information has been furnished in addition to recovering the ambulance charges, disciplinary action may also be taken against the employee.

13.9 Use of ambulance for medico-legal cases connected with employees or their dependant eligible for free treatment will be charged for except when in the opinion of the attending doctor it is necessary to transport the patient by ambulance on medical grounds.

13.10 In cases of accidents while on duty, ambulance will be provided free of charge.

13.11 The user of the ambulance will ensure that :

• for incoming cases the Doctor or the Nurse of the Maternity Ward of the Casualty certifies the use of ambulance as free or paid; and

• for outgoing cases an ambulance slip issued by the doctor treating the case should be obtained and presented to the casualty nurse.

13.12 When a patient eligible for free treatment is referred to the Government Headquarters hospital, ambulance will be provided only if a doctor of not less than the rank of a Medical Officer Incharge certifies that is not safe for the patient to travel by any other transport.

13.13 All cases brought by ambulance should present themselves at the casualty room and not at the out-patient department (except in cases of confinement where the patient will be taken directly to the Maternity Ward) and then directed to the Medical Officer in the out-patient department after registering their names in the ambulance register. Likewise, all patients to be dropped should present themselves at the casualty room with the necessary authorisation of the Medical Officer for registration before getting into the ambulance. In all paying cases, casualty Nurse will record “TO PAY” in the Ambulance Register and in the ambulance trip sheet.

13.14 The charges for ambulance trip will be as fixed by the Management from time to time.

13.15 The ambulance will not be used for transporting dead bodies.

13.16 Any matter regarding the use of the ambulance not covered by these rules will be referred to the General Manager.

14.0 Check list for Medical Refund/Claim :
Before forwarding the medical bills to the Accounts Department, the Controlling Officer should check :

1. The claim is submitted within three months from the date of completion of treatment.

2. The bill is signed by the employee and countersigned by his Controlling Officer as per Delegation of Powers.

3. The declaration in the application is signed by the employee and in the case the claim is in respect of dependent parents, the following certificate is added :
   “Certified that the parents are wholly dependent upon me”

4. The claim is to be preferred in the form prescribed (Form B1, B2).

5. The prescription granted by the Doctor contains name of disease and period of treatment, date of consultation and dates of administration of injection, if any.

6. The claim for cost of medicines is supported by cash bills from the shops if medicines purchased from outside.

7. In the case of employees living in the Township, if the treatment is undergone in other than Company’s hospital the employee should be on leave at an outstation. The nature and period of leave is specified by the employee in the application and the same verified.

8. The rates charged by hospital for room rent is as per entitlement of the employee and approved rates.

9. Rates charged for procedures/treatment is as per agreed rates and terms.

10. Claims are not admitted when treatment for sterility / venereal diseases is undergone with the Private Registered Medical Practitioner.

14.1 Checklist for employees availing Credit Facility for treatment.
All employees availing Credit Facility for Indoor Treatment for self and their dependents in empanelled hospitals shall verify the bills with respect to the following.

1. Date of admission and discharge.
2. Date of visiting consultants during hospitalization.
3. Medicines, Administered injections, Pathological Tests etc. as per the enclosed bills of the hospital.
4. Accommodation availed as per entitlement.
5. Whether Package treatment availed or the stay/treatment exceeded the package charge.
6. Any deviation must be reported with reasons.
7. Verifications of inadmissible foods, tonics, toilets and medicines, if any.
8. Relationship and dependency of patient with employee.

15.0 Compulsory medical check-up of executives
Considering the executive stress, its medical hazards and as a preventive health measure, all executives above 45 years of age shall undergo medical check-up once in a year at Company’s cost.

The following guidelines are issued :

1. The medical check-up shall, inter alia, include History and full general physical examination, Routine Urine and Stool examination, Eye examination – ophthatmology assessment, X-ray Chest (P.A. view), Resting Electro Cardiogram, Haemotology (HB-TLC-DLC-ESR & Blood Group), Bio-chemistry (Blood sugar, Fasting & PP Cholesterol, Triglycerides, Uric acid, Urea, Creatinine & Gamma G.T.) and for ladies, Gynae check-up with Pap Smear. In case, there is suggestion of any abnormality, the employee shall be subjected to further detailed investigation and treatment, as considered necessary.

2. In case of Executives posted at Projects, where Company Hospitals / Dispensaries exists, medical check-up will be done by these hospitals / Dispensaries; and the Health Card of the concerned Executive maintained and monitored by the CMO / Incharge of the Hospitals / Dispensaries.

3. For the Executives posted at places where full fledged Company Hospitals / Dispensaries do not exist, management may tie up arrangements with a hospital having complete facilities for thorough medical check-up. The responsibility of maintaining and monitoring the health status of the Executive concerned shall be with the respective Personnel Department in this case.

16.0 Import of medicines
In case of necessity when some medicines in the nature of life saving ones are required to be imported, the same can be got through a local chemist by the employee concerned for self or the eligible members of his family. Based on receipts / certificates issued by the chemist concerned, reimbursement can be allowed to the employee concerned supported by a valid medical prescription in each individual cases by A.M.A. / hospital.

17.0 Homeopathic and Ayurvedic / Unani Treatment
Employees / their dependent members will be entitled for reimbursement of charges for treatment undertaken under Homeopathic and Ayurvedic / Unani systems of medicines, as under:

1. Consultation charges (if medicines prescribed by Doctor)
   First Consultation Rs. 10/-
   Subsequent Consultation Rs. 5/- (Maximum of 3 consultations for the same ailment)
    
2. Medicines
   a) When nedicines are supplied by the Doctor, no separate consultation charges would be paid and reimbursement will be restricted

Allopathic Medicines prescribed by Doctors qualified in Ayurvedic, Homeopathy & Unani system of Medicines are not reimbursable.

18.0 Interpretation

• In case of any doubt regarding interpretation of these rules, it should be referred to Director (Personnel) / CMD and his decision in the matter will be final.

• Management reserves the right to modify, cancel, withdraw, add or amend any of the above rules at any time without giving any notice or assigning any reason therefor.

II Contributory Scheme for Post Retirement Medical Facilities

1.0 Coverage
The scheme is framed with a view to provide medical benefits to the regular employees of SJVN and their spouses subsequent to their retirement, on contributory basis, subject to the provisions, as detailed hereunder.

2.0 Eligibility
2.1 The Scheme will apply to the following categories of SJVN employees:

1. Employees who separate from the Company on account of retirement on attaining the age of superannuation or are separated by the Company on medical grounds, provided that the concerned employees have completed a minimum qualifying period of ten years of continuous service in Central/ State Government / Public Sector Undertaking, out of which a minimum of 5 years shall be in SJVN, provided that their applications for employment in SJVN were forwarded through proper channel; and

2. Board level appointees, on completion of their tenure. 
   However, in cases where any board level appointee has completed his initial tenure of appointment or during his tenure is appointed as board level executive in another Public Sector Enterprise, on leaving the corporation in either case, his tenure will be deemed to have been completed and he will become entitled for the benefits under the Scheme.

3. Spouse (only one) of employees who dies while in service except when 
   a) Spouse of the deceased employee re-marries or becomes dependant on his/her son/daughter. 
   
   OR/AND

4. he/she is employed in Central/State Govt./Public Sector Undertaking or in receipt of medical facilities elsewhere.

2.2 In case of death of the retired employee who has been availing of the benefits under the Scheme, his/her spouse will continue to avail the benefits under the Scheme subject to his/her continuing to meet the terms and conditions of the scheme.

2.3 The benefits under the scheme would be available to the concerned employee only if the employee concerned and his/her spouse is not availing of any medical facilities from or through the Central/State Government/Public Sector Undertaking/Quasi-Government Body.

3.0 Benefits
The medical benefits to the retired employees and their spouses under the Scheme will be admissible for the treatment taken only in India and would be as under:

3.1 The retired employees residing at places where the Company has its own hospital/full-fledged dispensaries would be allowed medical treatment facilities, including medicines as available in such hospitals/dispensaries only.

3.2 In respect of such retired employees who reside at places where the Company does not have its own hospital/full-fledged dispensaries, reimbursement of medical expenses incurred shall be regulated as under :

3.2.1 Indoor Treatment
Reimbursement of medical expenses incurred for indoor treatment will be allowed, subject to the condition that the treatment is obtained in Government Hospitals or hospitals empanelled by the Company.

3.2.2 Out Patient / Domiciliary Treatment
For outpatient / domiciliary treatment, reimbursement of medical expenses shall be allowed as per Company’s Medical Attendance and Treatment Rules for serving employees. The annual ceiling for reimbursement of expenditure incurred for outpatient / Domiciliary treatment would be equivalent to the maximum of the Pay Scale of a serving employee of equivalent status / rank, on the last day of the relevant financial year. The maximum ceiling for the employees who are enrolled for the benefits under the scheme, for the first year after their retirement will, however, be proportionate to the number of months for which the benefits will be availed of after retirement upto 31st March, of that Financial Year.

.3.2.3 If the treatment is obtained from the Company hospital or empanelled hospitals and also buy medicines from these authorised hospitals or authorised shops of these hospitals / super bazaar, Government Stores, the expenditure will not be counted against one month’s ceiling and they will be allowed reimbursement as in the case of regular employees.

3.3 The entitlement of medical benefits for the retired employees, as above, shall be the same as admissible to serving employees of equivalent status / rank and shall be allowed as per Company’s Medical Attendance and Treatment Rules as applicable for serving employee within India.

4.0 Contribution
4.1 Eligible retired employees who intend to avail of benefits under the Scheme shall be required to pay contribution at the following rates :

This is subject to revision from time to time.

In the event of death of the employee after retirement, the spouse may continue to avail the facility at his / her option on paying the contribution as above.

4.2 The contribution, as above, shall be payable in advance on yearly basis for each financial year commencing from the 1st day of April. The first installment of contribution for the employees, who become eligible for the benefits under the Scheme will, however, be proportionate to the number of months for which the benefit will be availed after retirement upto 31st March of that financial year plus contribution for the following financial year.

4.3 Contribution once paid shall not be refundable even if the benefits under the scheme are not availed by the beneficiary or in the event of death of beneficiary / beneficiaries before the expiry of the term for which the contributions have been paid.

4.4 Where a retired employee does not become a member of the scheme or / and pay his contribution, he cannot seek any advantage by making contribution for the past.

5.0 Procedure
5.1 An eligible employee who intends to avail of medical benefits under the scheme shall apply for this purpose to the Head of the Project / Office from where he has retired, indicating, inter-alia, the SJVN Project / Office where he wants to register himself for availing of the facilities giving his residential address. In the event the employee wants to change the place from where he wants to avail of the benefits, he will have to approach the Project / office from where he is availing of the facilities for the change.

5.2 The Personnel Department of the Project / Office will, after scrutiny of the application and verification of the eligibility conditions as mentioned in para 2.0 above, issue an Office Order permitting the beneficiary / beneficiaries to avail of the benefits with copies to the Personnel Department and Finance Department of the concerned office / Project where the retired employee is to be registered.

5.3 The Project / Office where the retired employee is to be registered shall duly register the retired employee concerned and issue a Medical Card to him in the form prescribed as Form C, after receipt of the prescribed amount of contribution from the retired employee. The amount will be payable to the Project / office by cash or Demand Draft in favour of SJVN drawn on any branch at that place. A copy of the medical card shall also be sent to the concerned Finance and Accounts Department.

5.4 The Medical Card will be valid for a period for which the prescribed contributions have been paid. The Medical Card shall be issued/renewed for period of three/five/ten years on payment of the prescribed contribution. However, intermittent or broken period membership shall not be permitted.

5.5 The Medical Card will become invalid from the date any of the eligibility conditions ceases to be fulfilled by the beneficiaries and in that case, the contribution paid for the unexpired period if any will not be refundable.

6.0 Claim
6.1 For claiming reimbursement of medical expenditure incurred by the beneficiaries covered under para 3.2 above, the retired employee shall prefer claim not more than once in a month to the Accounts Department of the Project / Office concerned in the form prescribed as Form D.

6.2 The claim will be processed and reimbursed to the retired employee by the concerned Accounts Department after verifying the validity of the Medical Card and the benefits admissible to the retired employee concerned under the scheme.

7.0 General
7.1 In case any doubt arises regarding the genuineness or otherwise of the claims preferred by the retired employee, the Company reserves the right to direct the beneficiary to present himself before a Medical Board and that no reimbursement will be made till the recommendations of the Medical Board are received in this regard.

7.2 If, on reasonable belief or on the basis of recommendations of the Medical Board, it is found that there is misuse of the benefits under the scheme by any beneficiary, he may be summarily debarred from the benefits under the scheme.

7.3 The Company reserves the right to amend, modify or discontinue the Scheme, in part or full.

7.4 In respect of any matter not covered herein, specific reference will be considered by Corporate Personnel Division for decision.

Admission Slip for Indoor Medical Treatment
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