1 (On Stamp Paper of Rs.100/-) AGREEMENT The ... - UGC

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‘Entitlement’ refers to the room charges to which a retired employee is entitled to avail in case of hospitalization. As per prevailing norms, based on salary structure, the following entitlements are approved by the CGHS and opted by the UGC for their Pensioners/Family Pensioners. (as per 5 th Pay Commission’s recommendations) S.No. Ward entitlement Basic Pay 1. General ward : Upto Rs.7,500/- 2. Semi-private ward : Rs.7,501/- to 10,500 /- 3. Private ward Rs.10,501/- and above (as per 6 th Pay Commission’s recommendations) S.No. Ward entitlement Pay drawn in pay Band (excluding Grade Pay) 1. General ward : Upto Rs.13,950/- 2. Semi-private ward : Rs.13,960/- to 19,530/- 3. Private ward Rs.19,540/- and above If the patients on their own opt for a higher category than what he/she is entitled, the excess cost will be the responsibility of the patient for which the patient will have to make prior arrangements with the Provider Hospital. UGC’s commitment will be restricted to the actual entitlement only. In case of the deceased Pensioners/Family Pensioners, the following clause shall be the part of the agreement. IN CASE OF DEATH OF Pensioners/Family Pensioners/dependent Provided that in case of death of the Pensioners/Family Pensioners, the spouse and dependents will continue to enjoy the facilities in terms of the scheme for which amount has been deducted by UGC. 2. OBJECT The UGC has approached the provider Hospital to extend medical facilities and treatment to the Pensioners/Family Pensioners and the provider hospital has agreed for the same on the terms and conditions hereinafter stipulated. 3. PERIOD This agreement shall remain in force vis-a-vis the concerned hospital, until the concerned hospital remains enlisted in the CGHS approved list of hospitals and this agreement shall be deemed to have been terminated automatically vis-à-vis the hospital which gets de-recognized and excluded from CGHS approved list of hospital or does not appear in the CGHS approved list of hospital. 2
4. EXTENT OF COVERAGE (i) (ii) (iii) (iv) (v) (vi) The Provider Hospital shall extend only inpatient hospitalization to the Pensioners/Family Pensioners/dependent under this agreement and claims will be settled directly by the UGC under ‘CASHLESS FACILITY’. For the out patient treatment’ the UGC retired employee shall take such treatment on the agreed rates on cash basis and UGC shall not be responsible for any such medical expenditure on this account under ‘CASHLESS FACILITY’. The Provider Hospital will extend service on prevailing CGHS rates only both for IPD and OPD treatment. If the Hospital normally charges rates for various procedures which are lower than the negotiated rates, the reimbursement would be at the actual rates charged by the Hospital. The Provider Hospital shall ensure that each time Pensioners/Family Pensioners/dependents avail service envisaged in this agreement, the expenses are regulated strictly with reference to the eligibility and monetary limits fixed with reference to the entitlement status, as indicated in O.M. No.S.11011/2/2008-CGHS(P) dated 20 th May, 2009. The Hospital shall ensure that the benefits are made available to the member strictly as per terms of this agreement and no benefit outside the terms of this agreement shall be allowed without prior approval unless the same is essential for the recovery of Pensioners/Family Pensioners/dependents. UGC shall not be liable to make any payment on account of claims which are in the opinion of UGC fraudulent or are as a result of fabricated claims. 5. OBLIGATIONS OF PROVIDER (i) (ii) The Provider Hospital shall admit the patient only on production of a valid Identity Card with photographs of the beneficiary issued by the UGC. The empanelled hospital shall not demand any advance from the beneficiary and shall provide credit facilities to the concerned patient. The Provider Hospital shall ensure that all members are admitted and treatment in the Institution/Hospital on priority basis. Priority basis in this context means making available to the member services like on-the-post admission/treatment beds on an urgent basis and the like. In case there is no accommodation either in the ward or in the operation theatre or the patient requires specialized treatment which is not available in the Hospital, the provider Hospital shall make all attempts through its good offices to accommodate and admit the Pensioners/Family Pensioners/dependent to other CGHS approved empanelled/super-specialty Hospital, subject to concurrence from the concerned Pensioners/Family Pensioners/dependent and in intimation as to the cross reference shall be made to the UGC within 24 hours of such referral. 3
Page 1: (On Stamp Paper of Rs.100/-) AGREEM
Page 5 and 6: (xii) (xiii) (xiv) (xv) (xvi) (xvii
Page 7: In case of termination, either by U

1 (On Stamp Paper of Rs.100/-) AGREEMENT The ... - UGC

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