Income limit for dependent family members set at Rs 9,000 plus DA; reimbursement ceilings fixed for medical devices
Jammu, Oct 23 : The Jammu and Kashmir government has amended its medical attendance and allowance rules for government employees, raising the income limit for dependent family members and capping reimbursement for treatment at select private hospitals at the rates applicable at AIIMS, New Delhi.
The amendments to the Jammu and Kashmir Civil Services (Medical Attendance and Allowance) Rules, 1990, also expand the definition of family to include dependent divorced or separated daughters and stepmothers, besides prescribing fixed reimbursement ceilings for medical devices and artificial appliances.
According to a notification issued by the Finance Department accessed The Web Story/The Varmul Post a family member will be considered wholly dependent on a government employee if they ordinarily reside with the employee and their monthly income does not exceed Rs 9,000 plus dearness allowance.
The revised definition of family includes spouses, parents, sisters, widowed sisters, daughters, minor brothers, children and stepchildren, subject to prescribed conditions. Dependent brothers, divorced or separated daughters and stepmothers have also been explicitly included.
In a move to regulate expenditure on high-cost medical treatment, reimbursement for procedures performed at select private hospitals will be restricted to the rates applicable for the same procedures at AIIMS, New Delhi.
The provision covers Apollo hospitals in Delhi, Chennai, Hyderabad, Bengaluru and Kolkata, the Escort Heart Institute in Delhi, the Institute of Liver and Biliary Sciences in New Delhi and Jaslok Hospital in Mumbai.
The government has also expanded the list of reimbursable medical equipment to include cardiac devices, continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) machines, and oxygen concentrators, besides intraocular lenses.
The amended rules prescribe maximum reimbursement limits for various medical devices, including heart valves, pacemakers, implantable cardioverter defibrillators, hearing aids, cochlear implants and prosthetic limbs.
Under the revised schedule, reimbursement for double valve replacement has been capped at Rs 1,10,500, while mitral or aortic valve replacement has a ceiling of Rs 45,050.
The maximum reimbursement for a dual-chamber pacemaker has been fixed at Rs 83,200 plus GST, while that for a bi-ventricular pacemaker has been capped at Rs 1.95 lakh plus GST. Combo devices used in cardiac resynchronisation therapy with defibrillation have a ceiling of Rs 4.90 lakh plus GST.
For respiratory equipment, oxygen concentrators and CPAP machines have been capped at Rs 45,000 plus GST each. Bi-level CPAP machines have a ceiling of Rs 68,000 plus GST, while bi-level ventilatory systems have been capped at Rs 1.05 lakh plus GST.
The revised schedule also sets reimbursement limits for artificial limbs according to the type of prosthesis, age group and specifications. High-end externally powered upper-limb prostheses have been capped at Rs 1,29,500 for below-elbow devices and Rs 1,76,500 for above-elbow devices.
For hearing aids, the reimbursement ceiling has been fixed at Rs 8,000 for digital behind-the-ear devices and Rs 9,000 for digital in-the-canal or completely-in-the-canal devices. Cochlear implants have been capped at Rs 5.35 lakh.
The amendments have been issued under the proviso to Article 309 of the Constitution. The Government Press has been directed to publish the notification in the official gazette.
The changes seek to clarify eligibility criteria for dependents, standardise reimbursement claims and establish fixed limits for high-cost medical equipment and treatment under the 1990 rules.
