Section 5 in Jammu and Kashmir Civil Services (Medical Attendance-Cum-Allowance) Rules, 1990
5. Medical Attendance within the State
(1)Every Government servant shall be allowed reimbursement of the amount, if any, charged by the hospital authorities, including cost of drugs purchased from the market during the period of hospitalisation in Government Hospital within the State of the employee himself or any ember of his family, wholly dependent on him.(2)Reimbursement of the expenses in the manner indicated in sub-rule (1) above shall also be allowed in respect of hospitalisation in non-Government hospitals within the State provided the following conditions are fulfilled,-(a)Where it is recommended by the Principal, Medical College or Director Health Services [or Director SKIMS] [Inserted vide SRO 142, dated 8-5-1998.] that the treatment is not available in the Government Hospitals and can be had in a private hospital in the State.OR(b)If the concerned authority (Principal Medical College or Director Health Services 1. Inserted vide SRO 142, dated 8-5-1998.[or director SKIMS]) is of the opinion that regardless of the availability of the treatment in a Government Hospital within the State the nature of surgery is such as require sophisticated theatre and as congenial surgical atmosphere for the prevention of infection in respect of operations of heart, lungs and brain and can be had in private hospital within the State.(c)Expenditure incurred in such cases shall be reimbursable as under:(i)Charges for operation and drugs and other expenses like room rent etc. excluding diet as may be charged from the beneficiary by the hospital authorities.(ii)The beneficiary shall be allowed 50% of the estimated cost of the hospital charges as advance,(3)Where in any case a Government servant or his beneficiary during hospitalisation in any Government Hospital within the State including the Institute of Medical Sciences, Srinagar has to undergo replacement of a diseased heart valve or fitting of a heart pace maker [or intra occular lense] [Inserted vide SRO 80 dated 3-4-1995] the reimbursement of the cost thereof shall be admissible as part of hospitalisation expenses. The payment of the cost of these appliances will on the advice of the Medical Superintendent of the Hospital/Institute be made by the concerned Drawing and Disbursing Officer direct to the supplying agency and not to the Government servant or his beneficiary.(4)Notwithstanding anything contained in sub-rule 3 of this rule, the cost of the appliances etc., prescribed by the concerned Head of Department of the Government Medical College/Hospital including Sher-I-Kashmir Medical Institute, Soura, Srinagar shall be made in advance to the beneficiary if he requests for the same, This is, however, subject to the condition that after the equipment is fitted, a certificate of the concerned Head of Department of the Medical Institute/Hospital that the equipment has been fitted to the beneficiary, will be furnished within one month, by the beneficiary to the Drawing and Disbursing Officer who has given an advance to him.(4A)[ If a Government Servant himself/herself or any member of his/her family dependent upon him/her is suffering from heart ailments, Renal Failure, Cancer or any other disease/life consuming disease and needs hospital treatment, the treatment may be taken in Acharya Shri Chander College of Medical Sciences and Hospital, Jammu:Provided that the reimbursement shall be levelled on the admissible items with that of the Government Medical College Hospital Jammu/Srinagar whichever is less:Provided further that in the event, such a treatment facility is not available in the Government Medical College Hospital Jammu/Srinagar but is available in Sher-I-Kashmir Institute of Medical Sciences Soura, Srinagar, the reimbursement charges in that case be restricted to the rates prevalent in SKIMS, Soura, Srinagar or Acharya Shri Chander College of Medical Sciences and Hospital, Jammu whichever is less.] [Inserted vide SRO 353 dated 30-12-2005.](5)In case a Government servant or any member of his family wholly dependent upon him is suffering from Cancer or any other disease which is certified by the Director Health Services or Principal Medical College as life consuming or from Tuberculosis, Leprosy, Mental illness, he shall be entitled to the reimbursement of Medical expenses incurred by him for treatment of said diseases even outside the Hospital. The reimbursement will be subject to the certificate of competent Medical authority that the beneficiary is suffering from any one of the said diseases and would be in need of home treatment for a long time and further subject to the verification of the connected vouchers by the Head of Department of the concerned discipline of the concerned Institute.[Note.- The government in the Administrative Department may sanction an advance, not exceeding 75% of the estimated amount of expenses, in such a manner as it may deem proper on the certificate and recommendation of Director Health Services or Director SKIMS or Principal Medical College as the case may be, to a government servant for treatment of any terminal or life consuming disease or where a prolonged treatment is required under rule 5(5) above, subject to the fulfilment of the conditions laid down in rule 14.29-A of Financial Code Vol. I.] [Inserted by SRO 54 dated 31-01-1997.]Pending cases as on the date of the issue of this order shall be decided accordingly.(6)[ The cost of vaccines to be used for treatment of dog bites, shall be reimbursed on the recommendations of Chief Medical Officer/Medical Superintendent of Government Hospitals on whose advise the injunction have been administered.] [Sub-rule (6) inserted vide SRO 142 dated 8-5-1998.][5-A(1)Government servants covered under these rules are also entitled to the benefits of "Government Employee Mediclaim Policy" introduced by the government to facilitate the employees to avail medical facility on hospitalisation in or outside the State on cash less basis. [Rule 5-A inserted by SRO 236 dated 21-07-2003.]The government servant and his/her three dependent family members shall be covered up to the age of 58 years for Rs 3 lacs for an annual premium to be determined by the government from time to time under the aforesaid scheme:Provided that the government servants have an option to increase the size of family unit from four family members up to maximum of 8 members on payment of additional 30% of premium. The government servants may also include their dependents beyond the age of 58 years but below 80 years of age on payment of additional 50% premium annually:Provided further that the government servant and his or her dependents will be entitled to take treatment in any of the accredited hospital as per "Government employees Mediclaim Policy" and the insurer/TPA shall reimburse the expense to the hospital within the sum assured on floater basis.(2)Reimbursement claims on account of medical expenses beyond Rs 3 Lacs in any single case relating to government servant or his/her dependant shall be dealt with by the government as per existing rules.(3)The government servant, may choose to opt out of the "Government employees Mediclaim Policy" in writing to his DDO, such option shall be exercised within 7 days from the date of issue of notification. Government servant on leave or under suspension shall exercise such option within seven days of rejoining of service and in case of fresh appointees within 7 days from the date of joining of service. Option once exercised shall be final.
