Annexure - Delhi Transco Limited

• The medical card holder should sign the credit letter with full name andemployee no. with date at the time of discharge.• Medical beneficiary, if desire to receive treatment from premier hospitals, incase a particular treatment is not being available in any empanelled hospitals orotherwise, prior permission from Medical Adviser (CMO). Pension Trust is to beobtained.Instruction to Hospitals:• The panel hospitals shall honour letter of credit issued by the Medical Adviser(CMO), Pension Trust, RPH.• It is the responsibility of the hospital authorities to ensure and verify admissionthrough photo affixed on his/her Medical Prescription Card.• The hospital shall charge hospital rates/revised CGHS rates, whichever is less.In case there are no CGHS prescribed rates for any test/procedure then AIIMSrates are applicable, as provided in the CSMA Rules. If there are no AIIMS ratesthen the hospitals rates will prevail. The implants/stents shall be charged as peractuals except for the items where ceiling is defined and follow relevant CGHSguidelines/CSMA Rules.• The hospital authorities shall inform "intimation of admission'' of eachretiree/dependant by fax No.23245619 within 24 hrs. of such admission.• A separate MOU shall be signed between Hospital and Pension Trust in thisregard.• In case the patient wants to avail treatment, cost of which is beyond CGHS rates,the difference in cost is to be obtained from the patient directly by the hospitaland the same should not be included in the bill which may be presented toPension Trust for release of payment.INSTRUCTIONS FOR AUTHORISED MEDICAL ATTENDANTS ANDMEPICAL BENEFICIARIES.1. AMA shall ensure that he/she is attending to a right medical beneficiarythrough photo affixed on the MPC.2. Signature of the AMA should be supported with rubber stamp, indicatingname, designation and organization on each prescription/verification of bills.3. Referral should be made only to a panel hospital and purpose for suchreferral is to be recorded on MPC.

4. Bill submitted from non-panel hospitals/diagnostic centers should not be verified unlessrelaxation is granted by the competent authority.5. Inadmissible items/medicines are neither be prescribed nor be verified.6. Utmost economy should be exercised while prescribing medicines where less expensivemedicines of equal therapeutic value are available.7. MOs and Sr. MOs of dispensary shall not advise special investigation. On I) specialists frompanel hospitals are allowed to advise special investigations.8. Diagnostic investigations i.e. advice should be specific to the case presented or to the provisionaldiagnosis.( ). All relevant columns in the MPC are to be clearly filled with clinicalfindings and purpose for the referral.10. Advice for purchase of medicines in chronic illness should not exceed for more than 30 days in asingle instance.11. Utmost care should be taken while verifying claims submitted by beneficiaries (both A&Bforms). Any deviation from existing guidelines/procedures is to be examined and clarificationshall be obtained from the hospital wherever necessary, before verifying the claims. PensionTrust shall be processing verified claims after applying applicable rules.12. Due referral with Registration number should be obtained before visiting panel hospitals except inemergency where the registration number should be obtained from the dispensary within threeworking days.13. Doctor's advice for purchase of medicines/to carry out investigation/to attend hospital afterreferral shall be valid only for three days from the date of such advice. In case any delay beyondthree days, re-consultation shall be required for further advice.14. Each prescription shall be treated as a spell of treatment. Medical bills after due verificationshould be submitted to Accounts Section within 90 days after completion of such spell oftreatment.15. Medicines should be purchased either from panel hospital pharmacy or from panel chemists.Medicines purchased from elsewhere shall be considered only if the competent authority grantsrelaxation.16. For in-patients and for out-patients (in emergencies) medicines/surgical items are allowed to bepurchased within the premises of the panel hospital.

17. Special or routine investigations above the ceiling limit of Rs.1000/- and above are to be carriedout only from panel hospitals or from panel diagnostic centers.18. Reimbursement is allowed only at admissible/applicable: CGHS rates only.19. Empty strips/wrapper/vial/phial/tube etc should be submitted at CMO office if the cost of thesingle medicines is more than Rs.400/-20. Verification & scrutiny of OPD medical bills at concerned CMO Office is required in thefollowing cases:i) Claims exceeding Rs.400/- for a single medicine (prior to discountoffered by the panel chemist).ii) Claims of a MPC Card holder exceeding Rs.1000/- in a single day(claims of self & dependants all inclusive), iii) Claims of a MPC Card holderexceeding Rs.2500/- in a particularmonth (claims of self & dependants all inclusive).