MEDICAL RULES Document No.

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INDEX

[Link]. Content Page No.

Part I
1.0 Title And Commencement 3
2.0 Applicability 3
3.0 Membership - Eligibility And Procedure 3
4.0 Rates of Contribution 6
5.0 Places Where Medical Coverage Available 6
6.0 Outdoor Treatment 8
7.0 Indoor Treatment 13
8.0 Day Care Treatment 17
9.0 Miscellaneous 18
10.0 Special Provisions 23
Indian, Homoeopathic, Chinese & Tibetan Systems Of
11.0 28
Medicines
12.0 Periodic Medical Check-Up Of Employee 29
13.0 Medical Examination For Appointment 30
14.0 Medical Examination For Visit Abroad 30
15.0 Medical Examination For Other Purposes 31
16.0 Health Check-Up For Site Personnel 31
17.0 Prevention of Misuse of Medical Facility 32
18.0 Claims Procedure 33
19.0 Modification To And Relaxation Of Rules 34
References 35
Annexures 36-161
Part II
Chapter–I: Contributory Post-Retirement Medical
Coverage Scheme
1.0 Introduction 162
2.0 Eligibility 162
3.0 Coverage Facilities 163
4.0 Operation Of The Scheme 165
5.0 Procedure For Claim 166
Chapter II - Scheme For Medical Coverage For Spouse Of Employee
Dying In Harness
6.0 Introduction 167
7.0 Eligibility 167
8.0 Contribution 167
9.0 Benefits 167
A References 168
B Annexures 169-176

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PART I
CHAPTER I

1.0 TITLE AND COMMENCEMENT

1.1 These Rules shall be called Engineers India Limited Medical Rules.

1.2 Under these rules, the Company will reimburse medical expenses actually incurred by the
employees to the extent of ceilings laid down. Full reimbursement of all expenses is not
envisaged.

Note: (a) Employees and eligible member of their family will generally be allowed
reimbursement of medical expenses under any one system of treatment
at a time; and

(b) Any interpretation or clarification of the rules will be issued by the

Company's HR Welfare Dept., New Delhi.

2.0 APPLICABILITY

2.1 These Rules shall apply to all the regular employees of the Company and their families,
other than those:

(a) Engaged on daily wages;

(b) engaged as Apprentices/Trainees;

(c) On deputation to the Company and governed by the Rules of their parent
organization;

(d) on deputation from the Company to an organization in or outside India, unless the
terms of deputation specifically provide for an option to the employees to elect
these Rules. In such cases, the entire liability for medical reimbursement will be
that of the borrowing organization;

(e) on leave outside India. The family of the employee staying in India, while the
employee is on leave outside India, will, however, be governed by these Rules;
and

(f) on contract appointment.

2.2 The provisions of these Rules are to be applied within India only.

2.3 Employees (including members of the family, if any,) on study leave will not be entitled
to any benefit under these Rules during the period of such leave.

3.0 MEMBERSHIP - ELIGIBILITY AND PROCEDURE

3.1 Benefits under these Rules will be available to only those employees and their families, if
any, who elect to become members by applying in the prescribed manner.

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3.2 For the purpose of these Rules, "Family" in respect of employees on Industrial DA pay
scales and those on Central DA pay scales, who are governed by HPPC, will be as under:-

(i) Employees on Industrial DA pay scales

(a) employee's wife/husband;

(b) wholly-dependent children/step children/legally adopted children

(unmarried/unemployed sons and daughters); and

(c) wholly-dependent parents of the employee residing with the employee.

However, for employees posted on construction and infrastructure sites in
India, whose parents do not reside, either with them at their place of
posting or with other member of the family (for employee on single status)
are provided with the relaxation in specified residency criteria to
determine dependency of parents for medical benefits. [35]

(ii) Employees on Central DA pay scales governed by HPPC Report as modified from
time to time.

(a) employee's wife/husband;

(b) employee's wholly dependent children/step children/legally adopted

children(sons and daughters); and

(c) the following other members of family, who are wholly dependent on
the employee and are also residing with the employee:-
- employee's parents
- employee's unmarried sisters
- employee's widowed sisters
- employee's widowed daughters
- employee's minor brothers ('Minor' means less than 18 years of age).

Note:
(i) Dependent children shall be covered provided they do not exceed 30 years in age.
However spastics, schizophrenic and children with disabilities as are specifically
approved by the Management only will be extended medical coverage beyond the
age of 30 years.

(ii) Unmarried daughters above 30 years of age and female wards legally
separated/divorced/widowed and otherwise meeting the dependency criteria will
be treated as dependent with the approval of the competent authority.

3.3 A member of the family will be deemed to be wholly/ entirely dependent on the
employee if he/ she (the member) is not in receipt of average total income exceeding Rs.
5000/- per month (or Rs. 60000/- per annum) from all sources whatsoever including, but
not limited to, the following:
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(i) Pension including temporary increase and pension equivalent of death – cum –
retirement gratuity benefits;
(ii) Income from house/ agricultural property or other investments;
(iii) Salary from employment/ re-employment;
(iv) Stipend as apprentice/ trainee, whether under the Apprentice Act, 1961, or
otherwise;
(v) Fellowship/Teaching Assistantship; and
(vi) Internship/ fellowship/ scholarship/ stipend received during course of education
pursued abroad.

Note:

(i) Internship/scholarship/ stipend received during course of education pursued in

India shall not be considered as part of total income of the dependent for the above
purpose.

(ii) Whether any income from a source other than those mentioned above will be
treated as income for this purpose will be decided by the Company and its decision
will be final. “Average total income” will mean the average of total income of the
member concerned during the 12-month period preceding the date of claim.

(iii) Employee’s son/daughter shall be excluded from dependency status once he/ she
is employed irrespective of what he/she earns. He/she shall not be allowed to
revert to dependency status thereafter even if the member is below the age of 30
years.[8] However employee’s daughter may be allowed to revert to dependency
status if she becomes unemployed, remain unmarried and otherwise meets the
dependency criteria as elucidated in clause 3.2 above. [20]

(iv) If spouse is employed in any other organization and is claiming medical benefits
from his/her organization then he/she will not be entitled to claim medical benefits
from EIL. [13]

3.4 The Company will have the right to satisfy itself with regard to the dependency of
employee's parents, children, or other members of the family and the employee may be
required to provide such reasonable proof in this regard as the Company may demand.

3.5 An employee will be admitted as a member of the Medical Scheme only after he has been
examined in connection with his appointment and found medically fit.

3.6 If both husband and wife are employees of the Company, each may become member of
the scheme independently or one of them may become member covering the other as
member of his/her family.

3.7 Medical benefits under the Company's scheme are not available to the employee's
parents-in-law. However, where both the husband and the wife are employees of the

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Company, each can obtain medical coverage for his/her parents (subject to their fulfilling
the conditions regarding dependency and residence.

3.8 An employee whose spouse is employed in an organization providing medical facilities

in any form will have the option of receiving medical benefits either from the company
or from the spouse's organization but not from both. If the employee chooses to
receive medical facilities for spouse from the Company, he will furnish the prescribed
declaration.

(a) Employees who are members of the existing Medical Scheme will continue to be
members under the revised scheme subject to these rules, unless they opt to
discontinue their membership.

(b) Persons joining the Company’s service after the publication of these rules will
have the option of becoming members within 30 days of joining.

(c) For enrolment as member or discontinuance of membership, application will be

made on the form at Annexure-I.

4.0 RATES OF CONTRIBUTION

4.1 Employees on IDA pay scales and corresponding level of CDA pay scales who become
members of the scheme are required to pay monthly contribution as under:
Level Rate of monthly contribution (Rs)

19 and Above 1000

15 - 18 650
10 - 14 450
1-9 250 [25]
4.2 When promotion to higher level takes effect from a retrospective date and increase
in pay due to such reclassification/grant of increment takes the employee to a higher
level/gradation, the same will be reckoned from the date of notification of
reclassification/grant of increment.

Provided that when an increment is due on satisfactory completion of probation of one

year, the higher level/ gradation will be reckoned from the date of notification of
completion of probation (copy of notification will be endorsed to Accounts
Department) or from the date of accrual of increment, whichever is later.

4.3 Irrespective of the day of the month on which the employee joins the scheme or moves
to higher level/gradation, contribution will be payable for the full month.

5.0 PLACES WHERE MEDICAL COVERAGE AVAILABLE

Medical coverage under these rules will be available as under:

5.1 For employee

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Wherever located in India.

5.2 For spouse and wholly dependent children

Wherever kept in India for the time being.

5.3 For other dependent members of the family

At the station where the employee is posted, provided they are residing with him.

5.3.1 When medical coverage for the employee's parents/unmarried sisters/widowed sisters/
widowed daughters/ minor brothers, wholly dependent on the employee, is desired at a
station in India other than that where the employee is posted, the employee will make
a written request to that effect indicating, inter alia, the reasons for such request and
the period for which such coverage is desired for consideration by Management.

If medical expenditure of dependent parents (both OPD and IPD) is incurred either away
from place of posting or family location (for employees on single status) of the employee,
75% of the total expenditure which would have been payable/reimbursable shall be
borne/reimbursed by the company. This shall be applicable to the employees who have
either availed the relaxation in rules regarding residency criterion (under clause no. 3.2
(i) (c)-for employees posted at construction sites/infrastructure sites) or where prior
permission for keeping dependent parents away from posting/family location, as the case
may be, has been taken in line with the DoP in force (for all regular employees). However,
this restriction of 75% shall not be applicable to employees posted at Pipelines Projects
for whom the relaxation of keeping dependent parents at locations other than
posting/family location (for employees on single status) is available in the present rules.
[35]

5.3.2 Medical coverage for parents/unmarried sisters/ widowed sisters/widowed

daughters/minor brothers, wholly dependent on the employee will also be available in
various contingencies, as under:

Contingency Where medical coverage will be available for

dependent parents/unmarried sisters/widowed
sisters /widowed daughters/minor brothers,
wholly dependent on the employee

(a) Employee availing of At the station where LTC/LFA is being availed of:
LTC/LFA
(i) For the period the employee avails of leave for
the purpose of availing of LTC/LFA for self only;
and

(ii) For a period of stay not exceeding 6

months, provided the spouse and/or children
of the employee are also availing of LTC/LFA
and staying at that station.
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(b) Employee on transfer to new At old HQ for a period of stay not exceeding 6
HQ and parents / unmarried months.
sisters / widowed sisters/ Provided that where an employee has spouse
widowed daughters/ minor and/or children, the medical coverage to
brothers, wholly dependent dependent parents / unmarried sisters/ widowed
on the employee at old HQ sisters/widowed daughters/minor brothers,
wholly dependent on the employee at old HQ will
be subject to the condition that the parents, etc;
stay with spouse and/or children of the employee.
(c) Employees on tour at an Any station for the duration of tour provided the
outstation in India for duration spouse and/or children of the employee, if any,
over one month. are also staying at that station.
(d) Employee on leave At the station(s) where the leave is spent.

5.4 Employee on tour/training/posting/assignment abroad will not be covered under the

provisions of these Rules. However, medical coverage for his family in India (including
wholly-dependent parents/unmarried sisters/ widowed sisters/widowed daughters/minor
brothers, wholly dependent on the employee in accordance with these rules) will continue
to be available at the station where the family is located.

Provided however that when an employee is sent abroad on tour/training/posting

/assignment, the terms of assignment/posting will indicate the manner in which medical
coverage will be available for self and family during the period of assignment/posting etc.

CHAPTER II: MEDICAL CONSULTATION AND TREATMENT UNDER ALLOPATHIC SYSTEM

6.0 OUTDOOR TREATMENT

6.1 Consultation

6.1.1 Members will be free to consult/receive treatment from any registered medical
practitioner of the allopathic system of medicine.

6.1.2 For consulting the doctor at his clinic, actual consultation fee paid will be reimbursed
subject to a ceiling of Rs. 200/- for each consultation to all levels/grades of employees.
There will be full reimbursement as per agreed rates as per nomination arrangement with
the hospitals. [9]

6.1.3 Members will, as a rule, consult the doctors at their clinic, except in an emergency when
the doctor can be called at the patient's residence. The attending doctor will be certified
whether a call at the residence was necessitated by emergency.

6.1.4 For consultation with a private doctor or the Company's doctor at the patient's
residence in an emergency, consultation fees actually paid will be reimbursed upto the
ceiling of -
-Rs. 300/- day time per visit- General Physician’s visit at residence
-Rs. 500/- night time per visit- General Physician’s visit at residence (between

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10.00 PM to 6.00 AM) [9]

on production of a certificate as prescribed in Rule 6.1.3.

6.1.5 Fees for consultation with a specialist will be reimbursed upto a ceiling of Rs. 500[9]for
each consultation for the same patient/disease for all levels/grades of employees on
production of the specialist's receipt, in cases where such consultation was obtained at
the clinic or the residence of the specialist.

6.1.6 Where specialist consultation becomes essential at the patient's residence, the fees for
consultation with the specialist will be reimbursed subject to a ceiling of Rs.500 per visit
and not exceeding Rs.1500 [9] per calendar day on production of the specialist's receipt
along with a certificate by the specialist indicating that the call at the patient's residence
was necessitated by emergency.[2]

6.1.7 The reimbursement for charges for tele/web/online consultation shall be made as per
actuals limited to Rs. 500/- per tele consultation in nominated as well as non-nominated
hospitals/clinic.[37]

6.1.8 In case the employee/ex-employee or their dependent family member is required to visit
nominated hospital in odd hours, gets admitted through emergency ward and is being
discharged without further hospitalization, the actual consultation fees charged for the
treatment by the nominated hospital shall be reimbursed.[33]

Note 1: The expression "Specialist" in these rules connotes a consulting physician/surgeon,

etc; having post-graduate qualification(s) in the respective discipline related to
disease(s)/ailment(s) for which consultation/ treatment is obtained or referred by general
medical practitioner.

6.2 Medicines

6.2.1 The attending doctor will normally prescribe medicines and the employee will
purchase the same from chemists. In exceptional cases, the attending doctor may
supply the medicines costing not more than Rs.50.

6.2.2 The cost of medicines prescribed and purchased will be reimbursed except in respect
of the "inadmissible" medicines listed in Annexure-II to these rules, which may be
amended from time to time by the Managing Director in consultation with the
Administrative Medical Consultant at New Delhi.

6.2.3 Over-the-Counter (OTC) medicines up to Rs 300 per quarter and not exceeding Rs 1200
per annum will be reimbursed without prescription, on production of cash receipt(s) from
the chemist. OTC amount will not be carried forward from one quarter to next quarter.
Claims with a separate code number on the existing claim format shall be made within
respective quarter of the financial year.

Medicines like pain killers, antipyretics, anti-emetics, oral electrolytes, OTC medicines

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under homeopathy (Bio combinations) for the ailments of colic, cough, cold, tonsils,
fevers, pain killers (excluding tonics)[23], personal hygiene products like, hand sanitizers,
face-mask, hand gloves etc.[32] shall be included in the category of OTC medicines.
However, medicines like anti-depressants, antibiotics, sleeping pills, antitursive which
require the prescription of doctors shall not be included in the category of OTC medicines.

6.2.4 Reimbursement of cost of medicines for chronic ailments like arthritis, asthma, diabetes,
Parkinson’s syndrome, hypertension, thyroid etc. and such other diseases as may be
specified from time to time requiring medicines for long spell involving substantial
expenditure and do not need hospitalization, will be made subject to a maximum of one
year without insisting on fresh prescription. However claim for reimbursement will be
submitted maximum in six months. [26]

6.2.5 The cost of items which are primarily food, tonic, disinfectant or toilet preparations, is
not to be reimbursed even though a particular item falling under any of these
categories may not find a place in the published list of "inadmissible" medicines.
However, cost of vitamins in various combinations may be reimbursed -

(a) when prescribed along with antibiotics;

(b) for a maximum period of 4 weeks in other cases where vitamins are considered
essential for proper prosecution of treatment;

(c) for a period exceeding 4 weeks, on special request, in respect of patient's

suffering from Tuberculosis, Diabetes and Malignancy.

6.2.6 Sometimes the attending doctor does not specify the quantity or number of days for
which medicines are required. In such cases, the medicines may be allowed for three
days or the minimum sized packages/bottles.

6.2.7 Medicines prescribed but not purchased within ten days from the date of prescription
shall not be reimbursed.

6.3 Clinical Procedures, Investigation, Laboratory & Surgical Charges

6.3.1 Expenses relating to clinical procedures, investigation, laboratory & surgical charges etc.
will be reimbursed as per following: [2]

 At nominated hospitals on actual as per agreed rates.

 At other than nominated hospitals reimbursement will be as per rates in the EIL’s
Schedule of charges (Annexure III), if rates are not given in EIL Schedule of charges
(Annexure III), reimbursement will be made on actual basis or limited to the rates of
‘nodal hospital’ whichever is less. Following hospitals will be ‘nodal hospital’ in four
metros.

1. Sir Ganga Ram Hospital, Delhi for Northern region.

2. Bombay Hospital & Medical Research Centre, Mumbai for Western Region.
3. Apollo hospital, Chennai for Southern Region.
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4. Calcutta MRI Hospital, Kolkata for Eastern Region.

 If rates for any clinical procedures etc. are not covered above, the same will be
reimbursed on actual basis.

6.3.2 EIL Schedule of charges will be as per CGHS NABH / NABL – Delhi schedule of charges on
mutatis-mutandis basis, as modified by Government from time to time for various
procedures / Surgeries, investigations / diagnostic tests, hospitalization cases etc.
Prevailing CGHS rates are CGHS-2014 which are given in Annexure III.[25]

For physiotherapy the reimbursement will be at the rate of Rs. 150/- per sitting per
physiotherapy. The reimbursement will be for physiotherapy as recommended by
attending doctor. [25]

6.3.3 The cost of disposable syringes and needles both for intra-venous and intra-muscular
infusions, used in administering injections will be reimbursed at actuals on the basis of
cash memo from a Chemist. However, in case the disposable syringe and needle is
supplied by the doctor, extra charges not exceeding Rs.5 per set of syringe and needle
may be reimbursed for all places including Metros if actually paid to the doctor. For I.V.
Transfusion, cost of disposable I.V. set will be reimbursable.

6.4 Company Doctor

6.4.1 Members may also consult/receive treatment from the Company's doctor.

6.4.2 No consultation fee will be payable by employees for consulting the Company's doctor at
his clinic in respect of the employee himself. For consulting the Company's doctor at his
clinic in respect of the employee's family, usual consultation fee as charged by the doctor
will, however, be payable and reimbursement will be made as per Rule.

6.4.3 No consultation fee will be payable by employees for consulting the Company's doctor
during his periodic visit to the office in respect of the employee himself, or the employee's
family.

6.4.4 No fee will be payable by the employees to the Company's Doctor for administering
injections at his clinic to the employee himself. For administering injections to the
member of an employee's family, at his clinic, usual fee for administering injections as
charged by the doctor will, however, be payable and reimbursement will be subject to
prescribed ceiling limits.

6.4.5 No fee will be payable by employees to the Company's Doctor for administering
injections to the employee himself or employee's family, during his periodic visit to
the office.

6.5 Outdoor Treatment Ceiling

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6.5.1 For employees joining after 1st August 2005, annual ceiling on reimbursement for Outdoor
treatment will be limited to the maximum of the IDA Scale corresponding to the level of
the employee as on 1st April of the financial year.

Exclusions:
i. Expenditure incurred on dialysis and chemotherapy will be treated as deemed
hospitalization and accordingly the same will not be counted towards ceiling laid
down for Outdoor treatment.

ii. Reimbursement of CPAP/BIPAP/Oxygen Concentrator Machines for domiciliary

use, artificial appliances, hearing aid charges will be over and above the annual
ceiling for Outdoor treatment. [27][29]

iii. Cost of OPD medicines and expenses w.r.t. consultation, investigations and
essential supplementary medicines (if prescribed by doctor as necessary for
treatment) will be considered under the category “Exclusions” i.e. over and above
the annual ceiling for outdoor treatment for the following diseases: [25]

(A) For following Post-Operative treatments:

(a) Post operative cases of major Cardiac Surgery/ Cardiology.

(b) Oncology cases.
(c) Post operative organ transplant cases.
(d) Post operative joint replacement cases.
(e) Post operative major Neurosurgical/ Neurology cases including
cerebral stroke etc.

(B) Additionally, following chronic diseases will be considered under exclusions:

- Diabetes Mellitus Type I and/or Diabetes Mellitus Type 2. [11]

- Parkinson’s Syndrome.
- Oncology (including tests/ diagnostics for cancer evaluation). [9]
- Systemic Lupus Erythematosus (Lupus). [14]
- Neurological Treatment (other than post-operative), Alzheimer’s disease and
dementia.
- Chronic Asthma/Bronchitis.
- BP / hypertension, cardiac resulted from diabetics and requiring long terms
treatment.
- Chronic Kidney Disease (CKD).
- Chronic Liver Disease / Pancreato-Biliary diseases.[25]

The expenses under ‘Exclusion’ category, as mentioned above, shall not form part of the
annual ceiling of OPD treatment for the employees who joined after 01/08/2005, instead
two separate heads will run concurrently – one claim under General Ailments and other
under ‘Exclusions’.[22]

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7.0 INDOOR TREATMENT

7.1 In cases where hospitalization/nursing home treatment is considered necessary by the

attending doctor/specialist, the employee will be entitled to obtain such treatment
subject to limits prescribed by the Company.

(a) in a Government hospital anywhere in India;

(b) in a nominated hospital/nursing home; and
(d) in a private hospital/nursing home,

Provided, however, that the requirement of advice of the attending Doctor may not be
necessary in the following cases:

(i) Hospitalization on account of –

(a) Maternity (b) Accident

(ii) Admission to I.C.U/ I.C.C.U. in an emergency.

7.2 All Government hospitals in the country and such other private hospitals as are notified
from time to time are categorized as nominated hospitals for treatment of the employees
and eligible members of their family under allopathic system only. Nominated hospitals
will be categorized as under: [18]

i.) Nominated Specialised hospital: Nominated specialised hospitals will deal with the
diseases/specialties indicated in Annexure IV.

ii.) Nominated Referral hospitals: Nominated referral hospitals will deal with the cases
referred by other nominated hospitals or Company’s medical consultant. However no
reference will be required in accidental and emergency cases and for treatment of any
specialised diseases i.e. cardiac, cancer, lungs’ surgery, kidney, orthopedics,
ophthalmology, neurology, obstetrics & gynaecology, urology surgeries and such other
diseases/specialties as may be included from time to time [4] & [9]

7.3 List of hospitals presently nominated under each category for Delhi/NCR is indicated in
Annexure-IV. The categorization of nominated hospitals at outstation locations (outside
Delhi / NCR) shall be under category of “Nominated Specialised” for all specializations [25].
Management will have the sole right to add to or delete any hospital(s) at any time.

7.4 Procedure for admission in nominated hospital

7.4.1 Authority letter for admission in General purpose and Specialised hospitals will be issued
on the advice of the attending doctor. Employee will have to apply for issue of authority
letter in the prescribed application form (Annexure -V) indicating expected period of
hospitalization and estimated expenditure duly certified by the attending Doctor and
other required documents.

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7.4.2 Authority letter for admission in Referral hospitals except for accidental and emergency
cases and for treatment of any specialised diseases mentioned in 7.2(ii), will be issued
only on advice of attending Doctor in a nominated hospital where the patient is taking
treatment for the time being as in-patient or Company Doctor and approval by HR
Division. Employee will have to apply for issue of authority letter in the prescribed
application form (Annexure-V) indicating expected period of hospitalization and
estimated expenditure (duly supported by documents as required).

7.5 Room Entitlement

7.5.1 Nominated Hospitals

For medical treatment as an in-patient in a nominated hospital, room type entitlement of

employees for self and members of the family shall be as under:-

Level Type of room [3]

1-4 Single bed in 4 or more bedded room
5-9 Single bed in a 2 or 3 bedded room
10-14* Single bed in a 2 or 3 bedded room
15 -20 Private Ward (Single Room)
21-22 Single Room (Deluxe)
* Regular employees at level 14 who are at top of the pay scale at the time of
hospitalization and the ex-employees who retired at level 14 after reaching the top of the
pay scale will be entitled for Private Ward (Single Room) [25]. Employees in level 14 upon
reaching the basic pay of Rs. 146410/- (in the scale of Rs. 80000 – 220000) and ex-
employees at level 14 superannuated after 01-01-2017 with basic pay of Rs. 146410/- &
above shall also be eligible for private ward (single room) in case of hospitalization.[33]

Note: In case diet charges do not form part of room rent, to the extent these are
reasonable, will be reimbursed.

7.5.2 Other than nominated Hospitals

Rent of accommodation in Hospitals/ Nursing Homes (other than nominated

hospitals) including diet charges, nursing charges, medical care/medical attention
charges, if any, will be reimbursed upto the following ceilings:

Level Type of room Room rent rate (in Rs.)[25]

1-4 Single bed in 4 or more bedded room Rs 1000
5-9 Single bed in a 2 or 3 bedded room Rs 2000
10-14* Single bed in a 2 or 3 bedded room Rs 2000
15 -20 Private Ward (Single Room) Rs 3000
21-22 Single Room (Deluxe) As per actual
Day Care Rs 1000

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* Regular employees at level 14 who are at top of the pay scale at the time of
hospitalization and the ex-employees who retired at level 14 after reaching the top of the
pay scale will be entitled for Private Ward (Single Room) [25] Employees in level 14 upon
reaching the basic pay of Rs. 146410/- (in the scale of Rs. 80000 – 220000) and ex-
employees at level 14 superannuated after 01-01-2017 with basic pay of Rs. 146410/- &
above shall also be eligible for private ward (single room) in case of hospitalization.[33]

7.5.3 Entire cost of treatment of an employee for an injury arising out of accident while
performing official duties shall be borne by the Company. Such treatment should as far
as possible be arranged by the Company.[2]

In case of accident while on official duty, TA to employee & one attendant (if essential),
as per entitled class of travel of employee will be admissible.[9]

In the event of death of an employee, while on tour/posted at Company’s office location

on single status, cost of transportation of the body at employee’s native place/ residence
and fare for journey of one escort shall be borne by the Company.[9]

7.5.4 Reimbursement for medical treatment (surgeries / tests) in non-nominated hospitals /

nursing homes in cases of accidents requiring hospitalisation will be made subject to the
ceiling at ‘nodal hospital’. However consultations / rent of accommodation will continue
to be regulated as per EIL rates. In the case of accident including life saving situations, for
indoor treatment in non-nominated/ Government hospital, advance up to 75% of the
estimated expenses be released. Payment of advance will be directly made to the hospital
and settled against bills raised on the employee.[2]&[9]

7.5.5 Indoor Treatment- At office locations where there is no nominated Hospital [9]

For any specialized indoor treatment, reimbursement to be made as under:

-Surgery, investigation as per actual or of nodal hospital of the region whichever is lower.

7.5.6 Reimbursement for medical treatment in case of life threatening emergency situations /
diseases in specialties like cardiac, cancer, kidney, Lung surgeries, Neurology (Certified
by the treating Doctor) in non-nominated hospitals / nursing homes at the locations
where there is no nominated hospitals, shall be made as per the rates of ‘Nodal
Hospital’, Sir Ganga Ram Hospital, New Delhi, subject to the following ceilings :

Treatment in cities classified as “X” – at the rates of 100 % of Nodal hospital rates

Treatment in cities classified as “Y” – at the rates of 75 % of Nodal hospital rates

Treatment in cities classified as “Z” – at the rates of 50 % of Nodal hospital rates

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Cities/Towns are classified as “X”, “Y”, and “Z” for above purpose of reimbursement as
enumerated in the Annexure XVI.

The above provision shall also be applicable for CPRMCS beneficiaries. [25]

Reimbursement for treatment in non-nominated hospital for the cases not covered above
shall be as per EIL Schedule of charges as specified in EIL Medical Rules and as amended
from time to time. [25]

7.6 ICCU/ICU Charges

ICCU/ICU charges in respect of procedures under package deals will not be reimbursed
separately. In case of admission to ICCU/ICU in other than nominated hospitals the actual
ICCU/ICU charges upto Rs.400/-per day in addition to room/bed charges will be
reimbursed. In case an employee or a member of his family is admitted to ICCU/ICU in an
emergency in a nominated hospital, actual charges will be reimbursed.

7.7 Surgical Procedures, Laboratory, Clinical And Radiological Charges

7.7.1 In Nominated Hospitals Charges in respect of surgical procedures, Laboratory, Clinical

and Radiological charges will be reimbursed as per the rates agreed with the respective
hospital except where indicated otherwise.

7.7.2 In Other than nominated Hospitals Charges in respect of surgical procedures, Laboratory,
Clinical etc. will be reimbursed subject to ceiling laid down in Annexure-III. If rates are not
given in EIL schedule of charges, reimbursement will be made on actual basis or limited
to the rates of ‘nodal hospital’ whichever is less.[2]

However, reimbursable amount in cases of maternity related procedures (normal delivery

/ C-section delivery) in Non-Nominated for all locations hospitals would be:

Normal Delivery : Actual expenditure subject to maximum Rs. 30000/-

C- Section Delivery : Actual expenditure subject to maximum Rs. 40000/-

Any treatment charges of new borne baby (if required) shall be considered over and
above the rates mentioned above.[25]

7.7.3 Rates for reimbursement of indoor treatment expenses for various treatments/tests
under package deal have also been specified in the Annexure-III. The rates given in
Annexure-III are for 2 or 3 bedded room and all inclusive package charges. For Private
Ward there will be an increase of 15% and for 4 or more bedded room there will be a
decrease of 10% in the rates indicated in the Annexure-III. If one or more minor treatment
procedures form part of a major procedure, package charges will be made against major
procedure and half the actual charges for the minor procedure would be added to the
package charges of the first major procedure.

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7.7.4 Package deal rate includes all charges pertaining to a particular treatment/ procedure
including admission charges, accommodation charges, ICU/ ICCU charges, monitoring
charges, operation charges, anesthesia charges, operation theater charges, procedural
charges/surgeon’s fee, cost of disposable, surgical charges, cost of medicines used during
hospitalization, related routine investigations, physiotherapy charges etc..

7.7.5 The package rate does not include telephone charges, TV charges and cost of cosmetics,
toiletry, tonics and medicines advertised in mass media. Cost of these items will be
realized from the employee and are not to be included in the package charges.

7.7.6 Package rate envisages duration of indoor treatment as follows:

 12 days for specialised procedure
 7-8 days for other procedures
 3 days for laproscopic surgery
 1 day for day care/minor procedure (OPD)

7.7.7 Where stay in the hospital exceeds the days envisaged in the package rate, additional
reimbursement will be limited to room rent as per entitlement, cost of prescribed
medicine and investigations, doctors’ visits (not more than two times a day) for the
additional days of stay involved.

7.8 Consultation Charges

Charges of specialist consultation in other than nominated hospital will be reimbursed

subject to ceiling laid down under clause 6.1.7. However, consultation charges in respect
of procedures under package deals will not be reimbursed separately.

7.9 Payment of percentage of Indoor treatment expenses by the employee/ex-

employee/beneficiaries[25]

Employees / ex-employees / beneficiaries shall bear 5% of total hospitalization bill in the

cases where billing amount exceeds Rs. 5 lakhs per instance, which needs to be settled
by them at the time of discharge from the hospital.

In case of emergency like accident, 5% loading, as above, will not be applicable. [25]

8.0 DAY CARE TREATMENT

8.1 Procedure like dialysis, radiotherapy, chemotherapy and cataract will ordinarily be done
as day care cases and regular admission as in-patient will be permitted on the basis of the
specific recommendation of attending doctor. Employee will have to apply for issue of
authority letter in the prescribed application form (Annexure-V).

9.0 MISCELLANEOUS

Notwithstanding any other provision in these rules, reimbursement on account of the

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following will be regulated as under:

9.1 Pre-natal medical care

In case the Hospital/Nursing Home charges a lump-sum registration fee towards pre-natal
medical care, the fee actually paid by the employee, subject to a maximum of Rs.500 for
all pre-natal check-ups, will be reimbursed. Accordingly, no consultation fee for any
subsequent pre-natal check-ups shall be reimbursable.

9.2 Special Nursing

If during treatment in a hospital/nursing home, etc., special nursing is deemed

essential by the attending doctor/doctor performing the operation, for the recovery
or the prevention of serious deterioration in the condition of the patient, having regard
to the nature of the disease, an employee or a member of his family will be entitled to
such special nursing as may be advised by the doctor subject to the provisions of Rules
9.2.1and 9.2.2 below.

9.2.1 The amount to be reimbursed to an employee in respect of such special nursing shall
be limited to ceiling rate as indicated below for the period for which special nursing was
advised/availed of by the employee concerned:

Type of special nursing

Advised Engaged Applicable ceiling rate

i) for day only for day only Rs. 200

ii) for night only for night only Rs. 200

Note1: If special nursing is necessary for both day and night, separate nurses will be
engaged for day and for night, and reimbursement will be admissible as above.

Note 2: Various rates prescribed for special nursing shall apply to treatment taken in
Metros i.e. Delhi, Calcutta, Mumbai and Chennai including urban agglomerations. In all
other places the rates would be restricted to 75% of the rates prescribed for metros.

9.2.2 The medical reimbursement claim should be duly supported by a receipt from the nurse
engaged, indicating the period, rate and the amount paid, and a certificate in the
proforma prescribed in Annexure-VI to these rules from the doctor concerned and
countersigned by the Medical Superintendent of the Hospital/Nursing Home in case the
treatment is taken at a nominated Hospital/Nursing Home, or the Administrative Medical
Consultant of the Company in all other cases.

Note: The charges for special nursing in respect of treatment as an in-patient in a

nominated hospital shall not be reimbursable in full in cases where these are more than
existing rates prescribed vide Rule 9.2.1. Reimbursement of charges for special nursing in
all cases, irrespective of whether the treatment is taken in a nominated Hospital or other
than nominated Hospital/Nursing Home, will be regulated as per Rule 9.2.1.
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9.2.3 Special nursing to employees/retired employees and their dependents at residence in

very emergent condition on specific advice of attending doctor of company’s nominated
hospital shall be allowed for reimbursement on production of payment receipt @ Rs
1000 per shift (12 Hrs Day / Night) i.e. Rs 2000/- per day maximum.

The nursing services shall be allowed limited to the days prescribed by the doctor but
not for more than 30 days in first instance. If required, extension of the service shall be
allowed further with recommendation of attending doctor of company’s nominated
hospital and company’s medical consultant, for not more than 30 days per
instance. [24]

9.3 General Debility and Secondary Anaemia

Charges for treatment of 'General Debility' and 'Secondary Anaemia' will be reimbursed
as in the case of any other disease.

9.4 Anti-Rabic Treatment

Charges for anti-rabic treatment received in Government hospitals/National Institute

of Communicable Diseases/Nominated Hospitals/Private Doctors, will be reimbursable.
However, the cost of Human Diploid Vaccine will be reimbursable only if it is purchased
from the market with proper receipt and not from the doctor administering it.

9.5 Treatment for immunizing and prophylactic purposes

Actual charges on account of treatment for immunising and prophylactic purposes in

the case of communicable diseases, viz., Cholera, Typhoid group of fevers(TAB), Plague
Diphtheria, Whooping Cough, Tetanus, Poliomyelitis, Measles, etc will be reimbursed
subject to the following ceiling limits.[26]

Vaccination Charges [17][30]

[Link]. Vaccine Rate in Rs.

1. Triple Antigen/DPT 50/-
2. Polio 230/-
3. Measles 168/-
4. M.M.R. 250/-
5. Meningitis 3801/-
6. Hepatitis B 350/-
7. Junior 1139/-
Hepatitis A
Adult 1799/-
8. Typhoid 1821/-
9. HIB Junior 325/-
Adult 500/-

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10. BCG 109/-

11. Chicken Pox/Vericella 1850/-
12. Pneumococcal/PCV 3801/-
13. Rabies 351/-
14. HPV (Human Papillomavirus 3250/-
Vaccine)
15. Influenza Vaccine/Flu 1539/-
Vaccine
16. Meningococcal 4950/-
17 Pentavalent 395/-
18 Rotavirus 1770/-
19 Rubella 94/-
20 Japanese Encephalitis (JE) 665/-

Cost of above vaccines shall be reimbursed at actual just like cost of medicines, if
purchased from nominated hospitals/pharmacies.[21]

9.6 Blood Transfusion

Where blood transfusion becomes necessary, actual charges thereof as paid to the Blood
Bank will be reimbursed on production of the receipt for the same duly verified by the
attending doctor. The charges for cross‑matching and transfusion, if charged separately,
will also be admissible.

9.7 Dental Treatment

Charges for filling of teeth with gold or silver and Orthodontia treatment on account of
cosmetics will not be reimbursable. However, for other Orthodontia treatment or for
surgical operations required as a result of an accident, reimbursement will be made in
accordance with the ceilings prescribed in Annexure-VII[25] of these rules. The rates of
dental treatment which are not covered under Annexure –VII but covered under CGHS
rate list (Annexure III) shall be made as per ceiling mentioned in latter.

9.8 Reimbursement of Spectacle expenses

Cost of spectacles and contact lenses including eye-testing charges will be reimbursed to
every employee and dependent family members (including CPRMCS beneficiaries)
subject to a ceiling of Rs. 5000/- (for regular employees; within the OPD ceiling limit) and
Rs. 2000/- (for CPRMCS beneficiaries; over and above the OPD ceiling limit) in a financial
year /-. [9][29]

Multiple claims by the employee for self and dependents, subject to overall ceiling in a
financial year are allowed for the above purpose. [12]

9.9 Family Planning Methods

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Actual charges incurred on Family Planning methods such as insertion of Copper-T, etc.,
subject to a maximum of Rs.400, will be reimbursed. However, no reimbursement
shall be admissible if the employee has claimed similar expenses from Government
Family Planning Department, or elsewhere.

9.10 Cancer

(a) Treatment for cancer in respect of the employees or family may be had on the
advice of the attending doctor in an institution having facilities, recognized for
the purpose.

(b) In respect of the employees, actual expenses incurred (including diet

charges), to the extent certified by the Cancer Specialist as reasonable and
necessary, will be reimbursed in full.

(c) In respect of the employee's family, expenses incurred on cancer treatment

will be reimbursed as admissible under these rules.

9.11 Poliomyelitis

An employee or a member of his/her family suffering from poliomyelitis may receive

treatment from a Government/ Government recognized hospitals providing such
treatment, either as indoor or outdoor patient. Actual expenses (including diet charges)
to the extent certified by the attending doctor as reasonable and necessary will be
reimbursed in full.

9.12 Diabetes

Consultation and tests, anti-diabetes drugs and vitamin B complex regularly

administered/given will be permissible. The expenditure on administration of injections
like insulin etc. and the cost of Bendix Solution or paper strips for carrying out test at
home will also be reimbursed till the attending doctor considers necessary. Cost of Gluco
Strips would also be reimbursible subject to monthly ceiling of Rs.450 and Rs.800 in case
of diabetic and juvenile diabetic patients respectively against prescription of attending
doctor.

9.13 Ambulance Charges

Ambulance charges for emergency evacuation of employees and members of their family
from residence to hospital, hospital to hospital and hospital to residence shall be
reimbursed as per actuals.

9.14 Bariatric Surgery [19]

Procedure of Bariatric Surgery is allowed limited to CGHS rates. Bariatric Surgery for
morbid obesity shall be permissible with prior approval in respect of EIL medical
beneficiaries as per guidelines outlined below:-
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Guidelines for Bariatric Surgery

A. Selection Criteria

Factor Criteria
Weight (Adults) a) Body Mass Index (BMI) ≥ 40 with no co-morbidities
b) Body Mass Index (BMI) ≥ 35 with obesity associated co-
morbidity

B. Exclusion Criteria

Factor Criteria
Exclusion a) Reversible endocrine or other disorder that can cause
obesity
b) Current drug or alcohol abuse.
c) Uncontrolled, severe psychiatric illness
d) Lack of comprehension of risks, benefits, expected
outcomes, alternatives and lifestyle changes required
with bariatric surgery.

C. Types of Bariatric Surgery Procedures Permitted

i). Laparoscopic Gastric Banding Surgery

ii). Laparoscopic Sleeve Gastrectomy
iii). Laparoscopic Gastric Bypass (GBP)
iv). Other cases – as per examination and recommendation of a panel of
medical specialist / consultants.

D. Permission for Bariatric Surgery

Bariatric Surgery procedures are planned / elective procedures and hence not regarded
as emergency procedures. The requests shall be entertained on a case to case basis after
the person intending to go for the bariatric surgery has exhausted all other options of
weight reduction. Request for the same shall be taken up for examination by a panel of
medical specialist and company medical consultants. On the basis of recommendation
given by panel of specialists / company medical consultant proposal shall be put up to
Director (HR) & Director (Finance) for prior approval before the surgery is undertaken. No
ex-post facto approval for reimbursement shall be given.

E. List of documents required for seeking permission / reimbursement

i) Recommendation by attending doctor / specialist.

ii) BMI report.
iii) Reports documenting obesity associated co-morbidities certified by the
attending doctor / specialist.
iv) Reports of tests for endocrine disorder and relevant reversible conditions
that can cause obesity.
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v) Documentary evidence in support of the fact that other means of weight

reduction have been exhausted.

F. Ceiling rates for reimbursement of Bariatric Surgery Procedures

The ceiling / package rate for all Bariatric Surgery procedures as listed in (C) above shall
be Rs.225000/- (Rupees Two Lakh Twenty Five Thousand only) or actual whichever is
lower, for single bed in 2 or 3 bedded room eligibility. (The package rate is to be
increased by 15% in case of private ward or reduced by 10% in case of single bed in 4 or
more bedded room entitlements). The package rates as amended from time to time by
CGHS shall be adopted as EIL schedule of charges for Bariatric Surgery.

10.0 SPECIAL PROVISIONS

10.1 Implants

The implants for which no ceiling has been laid down in the rules will be reimbursed at
actual. However for such implants exceeding Rs. 2 Lakhs reimbursement will be allowed
with the prior approval of competent authority.

10.2 Reimbursement for Cardiology Implantation Devices:

(i) The cost of Coronary Stents, Rotablator, Single /Dual Chamber Pacemaker shall be
reimbursed as under:

Name of the Item Maximum Ceiling Rate Prescribed

a) Coronary Stent Rs. 60,000 per stent (subject to
maximum of two stents in a patient) or
the actual cost cost, whichever is less.
b) Rotablator Rs. 50,000 or the actual cost, whichever
is less.
c) Pacemaker (Single Chamber)
- Without rate response Rs. 37,000 or the actual cost, whichever
is less.
- With rate response Rs. 65,000 or the actual cost, whichever
is less.
d) Pacemaker(Dual Chamber) Rs. 1,15,500 or the actual cost,
whichever is less.

(ii) The facility of above devices is permitted to the members of the scheme subject to the
recommendation of Cardiologist of the hospital.

(iii) The cost of coronary stents is admissible in addition to the cost of Angioplasty.

(iv) The number of stents in a patient should not exceed two. However, in exceptional
circumstances, when the use of more than two stents becomes necessary to bail out
the patient, approval of the Company is to be obtained.

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(v) The cost of Rotablator is permissible in addition to the charges of Balloon Angioplasty.

10.3 Reimbursement/ Permission for Cypher Stent & TAXUS Stent

(i). Reimbursement/ permission for the use of Cypher Stent (Serolimus Eluding Coronary
stents) and TAXUS stent (Paclitaxul Eluding Stent) would be made where restenosis
involves/would involve high risk to the patient’s life in the following cases:

a) Osteal/ Proximal LAD lesions

b) Stenosis of a Coronary Artery, which is giving collaterals to another, blocked artery, thus
supplying large area of myocardium.

c) Stenting of restenotic lesions after previous angioplasty.

(ii) Permission for a maximum of two Cypher/ TAXUS Stents will be granted based on the advice
of the Cardiologist and Medical Superintendent of the Hospital. However, in exceptional
cases, more than two stents may be allowed with the approval of the competent authority.
Reasons for the requirement of additional stent are to be recorded by the concerned
cardiologist.

(iii) Reimbursement shall be subject to a maximum of Rs.1,31,000/- for one Cypher Stent or
actual expenditure, whichever is less and Rs 90,000/- for TAXUS stent or actual expenditure,
whichever is less.

(iv) It is essential for the hospital to quote the batch number when a coronary stent of any type
(ordinary stent/Cyper stent/TAXUS stent) is implanted.

10.4 Reimbursement of Charges for Coronary By-pass Surgery/Angiography/Angioplasty/

Other Investigations:

a) In nominated hospitals, The rates for CABG, Coronary Angiography and other
investigations will be regulated on package deal basis as per agreed rates.

b) In non- nominated hospitals, reimbursement in respect of these will be made at the rates
mentioned in Annexure-III or the rates charges by the hospitals, whichever is less.

10.5 Conventional Operation (for Cataract Patients)

a) In case of conventional operation for cataract, the actual cost of spectacles for correction
of distance/ near vision subject to a maximum of Rs. 200/- shall be reimbursed.

10.6 Rates for Phaco Surgery and Intra Ocular Lens (IOL)

(a) Cost of Extra Capsular Cataract Extraction (ECCE) will be as per rates given in Annexure
III.
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(b) Rates for non-foldable IOL and foldable IOL will be Rs 1000 and Rs 5000 respectively or
actual expenditure whichever is less.[2]

10.7 Reimbursement of Cost of Knee and Hip Implants

The cost of Knee and hip implants shall be reimbursed subject to the prescribed ceiling
rate, provided in the Annexure-III.

a) The implant shall be purchased on the recommendation of the orthopaedic specialist.

b) The treating orthopaedic specialist shall issue a certificate to the effect that the implant
has been implanted successfully and is functioning satisfactorily.

10.8 Reimbursement of Cost of Various Artificial Appliances

The cost of various artificial appliances shall be reimbursed as under:

a) In case where prosthetic (artificial limbs) appliances have to be purchased on the advice
of hospital/company doctor, the reasonable initial cost of such artificial appliance will be
borne by the company. Any cost incurred subsequent to the initial purchase or
replacement or repair etc. will be reimbursed to the extent of 75% of the cost on the
recommendation of company doctor. subject to the following conditions: [9]

(i) For items costing below Rs. 2000/- can be purchased without any quotation.

(ii) Items costing Rs. 2000/- and above, prior approval should be obtained from the
competent authority

b) The artificial appliances should be purchased from Govt. Hospital/ Govt.

Undertaking/Authorised Dealers of ALIMCO/ Peripheral Limb Fitting Centre/NGOs
approved by Ministry of Welfare. The items can also be purchased from private
manufacturers subject to certification by Govt. Orthopaedic Surgeon/ Govt.
Rehabilitation Specialist to the effect that the appliances are as per the requisite
specification.

c) Replacement of appliances is allowed once in two years for adults and once in every year
for children below 18 years. In case of tricycle and wheel chairs, the replacement shall
be allowed every two years for all age groups.

10.9 Reimbursement for CPAP/ BIPAP/Oxygen Concentrator Machines [27]

a) Individual request for permission/ ex-post facto approval for provision of CPAP/ BIPAP/
Oxygen Concentrator machine for domiciliary use of patient (employee/ employee’s
family member) shall be considered by the competent authority in consultation with the
company Doctor.

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b) Request should be accompanied by copies of Sleep Lab Report or other relevant

investigations (in case sleep Lab Report is not applicable, i.e. disease other than sleeping
disorder) and all other basic investigation report.

c) The reimbursement shall be subject to the following ceilings:

(i) CPAP Machine : Rs. 50,000

(ii) BIPAP Machine : Rs. 1,00,000
(iii) Oxygen concentrator : Rs. 60,000

d) The procedure laid down for procuring artificial appliances should be followed.

e) The machines (CPAP, BIPAP & Oxygen Concentrators) shall be allowed to be replaced
again after a period of five years subject to a certificate by a service engineer regarding
the un-serviceability/condemnation of earlier machine provided under these rules and
recommendation of attending doctor/company’s medical consultant.

f) Responsibility of maintenance of machine shall be of the employee and expenditure

incurred in this regard shall be borne by him.

10.10 Reimbursement of CAPD Fluids and Related items:

The reimbursement of expenditure incurred on procurement of CAPD Fluids

and related items which include Y- Set, Transfer Set, Mini-Cap etc. is allowed
subject to the following conditions:

a) Required items will be purchased on advice of the specialist.

b) The employee should purchase the items for one month at a time and claim
reimbursement for the same.

c) The employee should submit a utilization certificate from his treating doctor certifying
that the CAPD Fluids, etc. have been fully utilized while requesting to procure the same
items for the use of subsequent months.

10.11 Reimbursement of the cost of the Disposable Surgical Sundries

Employees are entitled to reimbursement of cost of disposable surgical sundries

subject to the following conditions:

a) Treating specialist/ doctor should certify that the Disposable Surgical Sundries were
essential as a part of treatment.

b) Cost of disposable items like syringes, needles, electrodes, catheters, urine-bag; and
implants such as nailing, steel-rod, disc, bone-plate, etc. which are essential for proper
treatment, shall be reimbursed.

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c) No reimbursement is allowed for the items of common surgical materials like gauze,
bandages, leucoplast, cotton, crepe bandage etc. which are supplied from the hospitals.
However Cost of Venor Plaster and Berdyex Plastic Bandages (required for the treatment
of fractured bones) shall be reimbursed.

d) Cost of Neck support, calipat, shunt, etc; shall not be reimbursed.

Note: The term “Surgical Sundries” includes those surgical subsidiaries as are used in surgical
and other operations and which cannot be reused.

10.12 Reimbursement for Nebulizer

a) Actual cost of Nebulizer or Rs. 3000/- whichever is less, shall be reimbursed.

b) Permission for use of Nebulizer/ ex-post-facto approval may be given only on the advice
of Sr. Physician or Medical Specialist of a Nominated hospital.

c) Cost of maintenance shall be borne by the employee.

d) Replacement may be permitted only after 5 years from the date of initial purchase, on
the basis of a certificate of condemnation from the treating physician/ specialist.

10.13 Reimbursement of Cost of Hearing Aid

(a) An amount not exceeding Rs 7000/- shall be reimbursed by the company towards the
hearing aid for employee and employee’s spouse (including CPRMCS beneficiaries). [9]

(b) Reimbursement will be made only upon prescription of an ENT specialist giving detailed
specifications of the machine required.

(c) Employees using hearing aids shall be allowed reimbursement of Rs 7000/- [9] for
replacement of hearing aid, after a period of 5 years from date of procurement of the
hearing aid.

10.14 Reimbursement of Surgical/Treatment Charges of the Kidney Donor

Reimbursement is allowed in respect of expenditure incurred on surgery and post-

operative care of a donor of kidney to an employee or a member of his family, for
transplantation as per the entitlement applicable to the employee.

10.15 Treatment of infertility/Drug Abuse/Alcoholism (self inflicted Disease),

reimbursement of expenses incurred on plastic surgery [9]

(a) Reimbursement of cost of treatment of infertility/treatment of drug

abuse/alcoholism (self inflicted disease) for self and eligible family members shall
not be admissible for reimbursement.

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(b) Expenses incurred on cosmetic plastic surgery shall not be admissible for
reimbursement.

CHAPTER III: INDIAN, HOMOEOPATHIC, CHINESE & TIBETAN SYSTEMS OF MEDICINES

11.0 HOMOEOPATHIC, CHINESE & TIBETAN SYSTEMS OF MEDICINES

11.1 Consultation

Consultation can be obtained only from Medical practitioners who are registered
under the various Indian and Homoeopathic Systems of Medicines

Maximum amount reimbursable for consultation would be Rs. 100 for each
consultation.[2]&[9]

11.2 Medicines

When medicines are supplied by the attending physician, no separate consultation

charges would be paid and the reimbursement will be restricted to the amount
calculated at the rate of Rs.50/- per day [21] for the period of treatment, as indicated
by the attending doctor.

Reimbursement would be confined to the medicines listed as general medicines in the

Central Services Medical Attendance Rules. List of the medicines under Indian systems
so approved is included in Annexure-IX, X & XI. For Homoeopathic system all
medicines except those indicated in Annexure-XII are to be treated as general
medicines.

(a) Ayurvedic, Unani and Sidha systems of medicines

Only those medicines will be reimbursed as listed in Annexure-IX, X & XI, against
a proper prescription. [25][26]

(b) Homoeopathic system of medicine

The cost of medicines purchased from any dealer or pharmacy shall be

reimbursable. However, in case of prolonged treatment/expensive medicines,
employees shall have to purchase the medicines from the authorized
pharmacies/dealers as given in Annexure-XIII. A list of inadmissible medicines is
given in Annexure-XII.

11.3 Laboratory, Clinical and Radiological procedures/investigations

In respect of Laboratory, Clinical and Radiological procedures/Investigations prescribed

by the attending doctor, charges actually paid will be reimbursed subject to the ceilings
laid down in Annexure-III.

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CHAPTER IV :

12.0 PERIODIC MEDICAL CHECK-UP OF EMPLOYEE

12.1 Employees and their spouses may have themselves medically examined by suitable
doctors to assess their state of health so as to initiate corrective/preventive action, where
necessary. The periodicity of medical check-up will be as per following schedule:

Age bands in years Employee Spouse

40 to 50 Once in three years Once in five years
Above 50 to 55 Once in two year Once in two years
Above 55 Once every year Once in two years

The duration listed in the table above is the time interval between consecutive health
check-ups. First health check-up in the next band will be allowed after completion of the
minimum interval required in the previous age band.

12.2 According to competent medical advice, the scope of such medical examination should
be as per Annexure XVII:

12.3 Employees undergoing medical check-up should obtain from the examining doctor his
findings about their state of health; and, where necessary, his advice regarding any
corrective/preventive action. Such findings/advice should accompany the medical report.
It will, however, be for the concerned employee to take necessary action, if any, advised
by the doctor.

12.4 To ensure that employees are able to secure competent consultation, it has been decided
that for physical examination evaluation of the medical reports and advice under this
scheme, employees will be reimbursed actual fee paid to the examining doctor, subject
to a maximum of the amount of consultation fee prescribed for specialist under these
rules

12.5 Cost of the medical examination will be reimbursed by the Company at the rates
prescribed in these rules on the employee's preferring necessary claim on the
prescribed form duly supported by the receipts for payments made and the complete
medical examination report. After retaining in his dossier, a brief record of the date of
check-up, name and address of the examining doctor and his findings/advice, the relative
medical reports shall be returned to the employee concerned.

13.0 MEDICAL EXAMINATION FOR APPOINTMENT

13.1 Persons selected for appointment in the Company are required to undergo medical
examination (including the following tests) by the Company's Administrative Medical
Consultant or a Civil Surgeon and produce medical certificate of fitness, in the form at
Annexure-XV, at the time of joining:

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(1) Urine Analysis

(2) Blood Examination (Hb%,TLC,DLC,ESR)
(3) Stool Examination
(4) Testing of Vision
(5) Chest X-Ray PA View

13.2 Actual expenses in connection with the medical examination will be reimbursed on
production of necessary vouchers, subject to the following ceilings:

Ceiling

(1) Examining Doctor's fee Rs.100

(2) Charges for various tests as laid down in Annexure-III

When a consolidated amount is claimed covering the doctor's fee and the cost of all the
prescribed tests on the basis of a consolidated receipt, actual expenses but not
exceeding Rs.400 will be reimbursed.

When the doctor's fee is claimed separately on the basis of the doctor's receipt and
the cost of the tests is claimed as a consolidated amount on the basis of one receipt
for all the tests, actual amount paid to the doctor but not exceeding Rs.100 and the
actual amount paid for the tests but not exceeding Rs.300 will be reimbursed.

14.0 MEDICAL EXAMINATION FOR VISIT ABROAD

14.1 Employees who are nominated for being sent abroad on (1) assignment, or (2)
posting or (3) training for a period exceeding 3 months, are required to undergo
medical examination (including the tests prescribed in Rule 13.2 above) by the
Company's Administrative Medical Consultant or a Civil Surgeon and produce a
medical certificate of fitness in the form at Annexure XV before proceeding abroad:

Provided that medical examination, as above, will not be necessary, if the date of
commencement of visit abroad falls within 3 months from the date of submission of
certificate of fitness in connection with appointment in the Company.

14.2 Reimbursement of expenses on medical examination for employees who are nominated
for being sent abroad will be made at actual against documentary evidence. [1]

15.0 MEDICAL EXAMINATION FOR OTHER PURPOSES

15.1 Where the Company has reasons to believe that an employee, who continues to attend
to his duties, is suffering from a communicable disease, or from an ailment which affects
adequate performance of his normal official duties, the Company may, at its discretion,
require him to undergo medical examination by a medical practitioner nominated by it,
who will, taking into account the employee's state of health, give in the medical report
his opinion as to the desirability or otherwise of the employee attending to his duties.
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Fees for the medical examination will be borne by the Company.

15.2 Where the Company has reasons to doubt the genuineness of a claim/ claims
for reimbursement of medical expenses preferred by an employee in respect of himself
or a member of his family, the Company may, at its discretion, require that the
employee or that member of the family undergo medical examination by a medical
practitioner/Medical Board nominated by it, who will give his opinion as to the
status/facts of the person's illness and the prescribed course of treatment in relation
to the claim(s) in question. Fees for the medical examination will be borne by the
Company.

15.3 Where the Company considers necessary, it may require an employee, to appear
before a nominated Doctor/Medical Board.

16.0 HEALTH CHECK-UP FOR SITE PERSONNEL [28]

16.1 Coverage:

All regular employees posted at construction site are covered under the scheme. The
employees deputed at construction sites on tour shall also be covered under subject
scheme with the approval of RCM/site in charge considering the client/project
requirement.

16.2 Periodicity:

The periodicity of health check-up shall be as per the client requirement (which shall
generally be once in a year). In case the interval between two health check-ups for an
employee is less than one year, approval of RCM/Head of the office (not below the level
of CGM/Level 19) shall be obtained recording the specific reason for the same.

16.3 Tests/Examination covered:

The test/examination shall be covered as per Annexure XVIII.

16.4 General provisions:

16.4.1 The subject health check-up shall be in addition to the periodic health check-up already
covered under medical rules.
16.4.2 The tests shall be conducted in the nominated hospitals/ laboratories/ investigation
centers and the cost of health check-up shall be reimbursed to the concerned employee.
16.4.3 In case of the office locations where there is no nominated hospital, the reimbursement
for health check-up shall be made as per actuals, limited to Rs.2550/-

16.4.4 for the cases falling under point 4.3 above where the cost of health check-up (as per the
prescribed format) is more than Rs. 2550/-, the actual cost shall be reimbursed with the
specific approval of ED (Construction).

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16.4.5 The reimbursement under subject scheme shall be the covered under ‘Exclusions’ i.e.
over and above the OPD ceiling limit for regular employees.

17.0 Prevention of Misuse of Medical Facility: [9]

(a) The management, at its discretion shall have the right to demand the employee to show
the medicines for physical verification. The Management would also have the right to go
to the residence of the employee to have the physical verification of the medicines
purchased in doubtful cases

(b) The Management shall have the right to refer medical expenses claims including asking
the patient for examination by Doctor-in-attendance/ by any other doctor nominated by
the Management to find out the genuineness of the claim. The Doctor’s opinion shall be
binding on the employee.

(c) In case the employee or his eligible family member is hospitalized in non-nominated
hospital, the employee should immediately notify the Management. In doubtful cases,
the Management can verify the genuineness of the hospitalization.

(d) In cases where the medical reimbursement bills are considered to be of not genuine
nature, such bills along with prescription shall be referred to AMA/nominated doctor of
EIL for a second opinion and if a claim is found to be inflated or not of genuine nature by
the AMA/ nominated doctor, the claim shall be rejected in its entirety apart from initiating
such action as the Management may deem fit.

(e) If bills for reimbursement are too frequently received from an employee or if bills are of
large amounts, such bills shall be subject to investigation by the Management followed
by necessary further action as deemed fit by the Management.

(f) At any point of time in any particular case, the Management shall have the right under
the Medical Rules to insist on the employee to obtain medicines from a specific chemist
shop.

(g) In case the Management feels that the reimbursement claimed by a particular employee
for treatment taken from a particular doctor was not of genuine nature, the
Management, at any point of time, shall have the right to insist on the employee
concerned to take medical treatment only from a doctor nominated by the Management.

(h) In case of claims of dependent parents, EIL shall have the right to verify the bonafides
even including physical verification/ visiting the residence of the employee.

(i) Management may also consider appointing a panel of doctors/chemists at different

locations for purpose of Medical treatment/purchase of medicines by the employees of
that location.

(j) Where in the course of scrutiny, instances of employees who appear to be availing
themselves of the facility of reimbursement fraudulently come to notice such case should
be dealt with as under:
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(i) Petty cases may be dealt with departmentally.

(ii) Where there are grounds to suspect that false claims are being submitted
habitually or which are otherwise considered of special significance, such cases
may be referred for investigation to the Vigilance Department.

(k) In cases where the guilt of any employee is proved, the disciplinary authority is expected
to impose deterrent upon the erring employee as deemed fit.

18.0 CLAIMS PROCEDURE

18.1 Claims for reimbursement of medical expenses will be preferred in specified formats by
employees in IDA and CDA scales of pay.

The form should be carefully completed in all respects and duly supported by original
prescription and receipts for all payments made including cash memoranda.
Prescriptions must indicate, besides the patient's name and the medicines, etc.,
prescribed, his/her age and the doctor's diagnosis of the ailment.

In the case of treatment under the allopathic system, even where the medicines are
supplied by the attending doctor, prescription should be obtained and furnished for all
medicines, other than mixtures. A list of medicines in block capitals should accompany
the claim.

Note: Where the prescription does not indicate the doctor's diagnosis, the employee need
not go to the doctor for getting the diagnosis written, but may himself indicate the
nature of ailment (for example cold, fever, diarrhoea, nausea, etc.)

In cases when doctor do not issue cash memo/bills and instead indicate the amount
received on the letterhead, the same may be accepted.

In case of online/web/tele consultation, scanned copy of doctor’s prescription on the

letterhead may be submitted and reimbursement for cost of lab tests/purchase of
medicines through online/tele mode as per doctor’s prescription shall also be reimbursed
on the basis of online generated documents. Proof of payment made through electronic
mode or a copy of cash receipt, having unique number shall be required to be submitted
along with such claim.[37]

18.2 Claims for reimbursement of medical expenses should be preferred soon after the
completion of treatment, but in no case later than three months from the date of such
completion. In the case of prolonged treatment, claims may be preferred fortnightly.

18.3 The Company may, at its discretion, refer any claim(s) to its Authorized Medical
Consultant for an opinion, and depending upon his advice, such claim(s) may Be
accepted/ rejected, without prejudice to such further action against the employee as
may be deemed appropriate.

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19.0 MODIFICATION TO AND RELAXATION OF RULES

The Managing Director is empowered to make modifications to and allow

relaxations of these rules which are not of a major nature.

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REFERENCES:

[1] Circular No. 11/2006 [2] Circular No. 46/2006

[3] Circular No. 10/2007 [4] Circular No. 50/2007
[5] Circular No. 07/2009 [6] Circular No. 16/2010
[7] Circular No. 19/2010 [8] Circular No. 38/2010
[9] Circular No. 29/2011 [10] Circular No. 15/2012
[11] Circular No. 31/2012 [12] Circular No. 38/2012
[13] Circular No. 29/2013 [14] Circular No. 39/2013
[15] Circular No. 08/2014 [16] Circular No. 20/2014
[17] Circular No. 22/2014 [18] Circular No. 43/2015
[19] Circular No. 54/2015 [20] Circular No. 01/2016
[21] Circular No. 14/2016 [22] Circular No. 40/2013
[23] Circular No. 04/2012 [24] Circular No. 03/2017
[25] Circular No. 43/2017 [26] Circular No. 42/2018
[27] Circular No. 20/2019 [28] Circular No. 48/2019
[29] Circular No. 49/2019 [30] Circular No. 14/2020
[31] Circular No. 43/2020 [32] Circular No. 53/2020
[33] Circular No. 61/2020 [34] Circular No. 63/2020
[35] Circular No. 74/2020 [36] Circular No. 78/2020
[37] Circular No. 80/2020

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SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

42 Scleral grafting or conjunctival flap for corneal perforation 2300 2645

43 Keratoconus correction with therapeutic contact lenses 1200 1380

44 UV radiation for cross-linking for keratoconus 1800 2070
45 EDTA for band shaped keratopathy 863 992
46 Arcuate keratotomy for astigmatism 2800 3220
47 Re-suturing (Primary suturing) of corneal wound 1150 1323
48 Penetrating keratoplasty ---- with glaucoma surgery 12144 13966
49 Penetrating keratoplasty --- with vitrectomy 12144 13966
50 Penetrating keratoplasty ---- with IOL implantation 13656 15703
51 DALK- Deep anterior lamellar keratoplasty 17250 19838
52 Keratoprosthesis stage I and II 11500 13225
53 DSAEK- Descemet’s stripping automated endothelial 16675 19176
keratoplasty
54 ALTK- Automated lamellar therapeutic keratoplasty 16500 18975
55 Probing and Syringing of lacrimal sac- in one eye 69 79
56 Probing and Syringing of lacrimal sac- in both eye 138 159
57 Dacryocystorhinostomy—Plain 2875 3306
58 Dacryocystorhinostomy—Plain with intubation and/or with 9750 11213
lacrimal implants
59 Dacryocystorhinostomy—conjunctival with implant 9200 10580
60 Caliculoplasty 2300 2645
61 Dacryocystectomy 1725 1984
62 Punctal plugs for dry eyes 130 150
63 Refraction 40 46
64 Indirect Ophthalmoscopy 67 77
65 Orthoptic check-up- with synoptophore 44 51
66 Lees’ charting or Hess’ charting 100 115
67 Orthoptic exercises 50 58
68 Pleoptic exercises 50 58
69 Perimetry/field test—Goldman 144 166
70 Perimetry/field test— automated 144 166
71 Fluorescein angiography for fundus or iris 920 1058
72 Ultrasound A- Scan 863 992
73 Ultrasound B- Scan 230 265
74 Fundus Photo Test 200 230
75 Indocyanin green angiography 920 1058
76 Corneal endothelial cell count with specular microscopy 230 265
77 Corneal topography 331 381
78 Corneal pachymetry 230 265
79 Auto-refraction 35 40
80 Macular function tests 44 51
81 Potential acuity metry 100 115
82 Laser interferometry 173 199
83 OCT-Optical coherence tomography 2125 2500
84 HRT- Heidelberg’s retinal tomogram 150 173
85 GDX--- Nerve fibre layer analyzer 88 101

40
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

86 UBM- Ultrasound bio microscopy 150 173
87 Non Contact tonometry 50 58
88 IOP measurement with schiotz 30 35
89 IOP measurement with applation tonometry 50 58
90 Three mirror examination for reti 58 67
91 90 D lens examination 50 58
92 Gonioscopy 58 67
93 Chalazion incision and curettage in one eye 400 460
94 Chalazion incision and curettage in both eyes 431 496
95 Ptosis surgery with fasanella servat procedure 2300 2645
96 Ptosis surgery with LPS resection one lid 5500 6325
97 Ptosis surgery with Sling surgery one lid 6670 7671
98 Ectropion surgery- one lid 1400 1610
99 Ectropion surgery- both lids 2500 2875
100 Epicanthus correction 1550 1783
101 Cantholysis and canthotomy 575 662
102 Entropion surgery- one lid 1380 1587
103 Entropion surgery- both lids 2000 2300
104 Tarsorraphy 650 748
105 Suturing of lid lacerations 1150 1323
106 Lid retraction repair 1700 1955
107 Concretions removal 115 132
108 Bucket handle procedure for lid tumors 345 397
109 Cheek rotation flap for lid tumors 6900 7935
110 Orbitotomy 8050 9258
111 Enucleation 3000 3450
112 Enucleation with orbital implants and artificial prosthesis 3000 3450
113 Evisceration 3450 3968
114 Evisceration with orbital implants and artificial prosthesis 5693 6547

115 Telecanthus correction 5175 5951

116 Orbital decompression 5750 6613
117 Exenteration 5750 6613
118 Exenteration with skin grafting 6900 7935
119 Fracture orbital repair 9200 10580
120 Retinal laser procedures 1500 1725
121 Retinal detachment surgery 11500 13225
122 Retinal detachment surgery with scleral buckling 13800 15870
123 Buckle removal 1150 1323
124 Silicone oil removal 2800 3220
125 Anterior retinal cryopexy 1162 1336
126 Squint correction for one eye 5000 5750
127 Squint correction for both eyes 7500 8625
128 Trabeculectomy 6900 7935
129 Trabeculotomy 6900 7935
130 Trabeculectomy with Trabeculotomy 10350 11903
131 Trephition 2300 2645

41
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

132 Goniotomy 345 397
133 Glaucoma surgery with Glaucoma valves 6900+valve 7935 +valve
134 Cyclocryotherapy 1150 1323
135 YAG laser iridotomy 1500 1725
136 YAG laser capsulotomy 1093 1257
137 ALT-Argon laser trabeculoplasty 1495 1719
138 PDT-Photodymic therapy 3450 3968
139 TTT- Transpupillary thermal therapy 3000 3450
140 PTK- Phototherapeutic keratectomy 7500 8625
141 Argon/diode laser for retinal detatchment 1150 1323
142 Intralase application for keratoconus 5750 6613
143 EOG- electro-oculogram 900 1035
144 ERG- Electro-retinogram 794 913
145 VEP- visually evoked potential 800 920
146 Vitrectomy- pars plana 11500 13225
147 Intravitreal injections- of antibiotics 1150 1323
148 Intravitreal injections- of lucentis excluding cost of drug 3000 3450
149 X- Ray orbit 115 132
150 CT-orbit and brain 1600 1840
151 MRI- Orbit and brain 3450 3968
152 Dacryocystography 340 391
153 Orbital angio-graphical studies 1500 1725
154 ECCE with IOL 3450 3968
155 SICS with IOL 5000 5750
156 Phaco with foldable IOL (silicone and acrylic)/PMMA IOL 10781 12398

157 Pars plana lensectomy with/without IOL 10350 11903

158 Secondary IOL implantation- AC IOL PC IOL or scleral 6900 7935
fixated IOL
159 Cataract extraction with IOL with capsular tension rings 13500 15525
(Cionni’s ring)
160 Optic nerve sheathotomy 7500 8625
161 Iridodialysis repair or papillary reconstruction 5000 5750
162 Iris cyst removal 850 978
163 Lid Abscess incision and Drainage 1700 1955
164 Orbital Abscess incision and Drainage 3000 3450
165 Biopsy 460 529
166 Paracentesis 230 265
167 Scleral graft for scleral melting or perforation 2800 3220
168 Amniotic membrane grafting 1100 1265
169 Cyclodiathermy 2300 2645
170 Intraocular foreign body removal 187 215
171 Electrolysis 230 265
172 Perforating injury repair 4500 5175
173 Botulinum injection for blepharospasm or squint 2500 2875
TREATMENT PROCEDURE DENTAL PROCEDURES

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SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

174 Flap Operation per quadrant 360 414
175 Gingivectomy per quadrant 234 269
176 Reduction & immobilization of fracture- Maxilla Under LA 900 1035

177 Reduction & immobilization of fracture-Mandible Under LA 3500 4025

178 splints/Cirucum mandibular wiring under LA 510 587

179 splints/Cirucum mandibular wiring under GA 990 1139
180 Internal wire fixation/plate fixation of Maxilla under LA 3000 3450
181 Internal wire fixation/plate fixation of Maxilla under GA 4000 4600
182 Internal wire fixation/plate fixation of Mandible under LA 3500 4025

183 Internal wire fixation/plate fixation of Mandible under GA 4250 4888

184 Extraction per tooth under LA 80 92

185 Complicated Ext. per Tooth under LA 100 115
186 Extraction of impacted tooth under LA 160 184
187 Extraction in mentally retarded/patients with systemic 939 1080
diseases/patient with special needs under short term GA
188 Cyst & tumour of Maxilla /mandible by enucleation/ 244 281
excision/ marsupalisation upto 4 cms under LA
189 Cyst & tumour of Maxilla/mandible by enucleation/ 406 467

excision/ marsupalisation size more than 4 cms under LA

190 Cyst & tumour of Maxilla/mandible by 1000 1150
enucleation/excision/marsupalisation size more than 4 cms
under GA
191 TM joint ankylosis- under GA 7500 8625
192 Biopsy Intraoral-Soft tissue 374 430
193 Biopsy Intraoral-Bone 374 430
194 Hemi-mandibulectomy with graft 21000 24150
195 Hemi-mandibulectomy without graft 21000 24150
196 Segmental-mandibulectomy with graft 3400 3910
197 Segmental-mandibulectomy without graft 990 1139
198 Maxillectomy- Total with graft 2500 2875
199 Maxillectomy- Total without graft 1950 2243
200 Maxillectomy- partial with graft 3000 3450
201 Maxillectomy- partial without graft 2500 2875
202 Release of fibrous bands & grafting -in (OSMF) treatment 1500 1725
under GA
203 Pre-prosthetic surgery- Alveoloplasty 500 575
204 Pre-prosthetic surgery - ridge augmentation 1200 1380
205 Root canal Treatment(RCT) Anterior teeth(per tooth) 500 575
206 Root canal Treatment(RCT) Posterior teeth (per tooth) 700 805
207 Apicoectomy- Single root 500 575
208 Apicoectomy-Multiple roots 650 748
209 Metal Crown-per unit 500 575

43
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

210 Metal Crown with Acrylic facing per unit 700 805
211 Complete single denture-metal based 1500 1725
212 Complete denture- acrylic based per arch 950 1093
213 Removable partial denture-Metal based-upto 3 teeth 700 805
214 Removable partial denture-Metal based-more than 3 teeth 900 1035

215 Removable partial denture-Acrylic based-upto 3 teeth 500 575

216 Removable partial denture-Acrylic based-more than 3 teeth 264 304

217 Amalgum restoration-per tooth 200 230

218 Composite Restoration-per tooth-anterior tooth 250 288
219 Glas Ionomer-per tooth 200 230
220 Scaling & polishing 300 345
221 Removable Orthodontics appliance- per Arch 700 805
222 Fixed Orhtodontics-per Arch 1150 1323
223 Space maintainers-Fixed 500 575
224 Habit breaking appliances-removable 800 920
225 Habit breaking appliances-Fixed 1500 1725
226 Expansion plate 1000 1150
227 Feeding appliance for cleft palate 1500 1725
228 Maxillo-facial prosthesis (sal/auricular/orbital/facial lost 3500 4025
part)
229 Functional orthodentic appliances 3000 3450
230 Obturator (Maxillo-facial) 1500 1725
231 Occlusal night guard(splint) 800 920
TREATMENT PROCEDURE ENT
232 Pure Tone Audiogram 172 198
233 Impedence with stepedeal reflex 230 265
234 SISI Tone Decay 132 152
235 Multiple hearing assessment test to Adults 115 132
236 Speech Discrimination Score 90 103
237 Speech Assessment 120 138
238 Speech therapy per session of 30-40 minutes 131 151
239 Cold Calorie Test for Vestibular function 172 198
240 Removal of foreign body From Nose 345 397
241 Removal of foreign body From Ear 230 265
242 Syringing (Ear) 166 191
243 Polyp removal under LA 575 661
244 Polyp removal under GA 850 978
245 Peritonsillar abscess Drainage under LA 1449 1666
246 Myringoplasty 6900 7935
247 Staepedectomy 9200 10580
248 Myringotomy with Grommet insertion 4600 5290
249 Tympanotomy 8625 9919
250 Tympanoplasty 13800 15870
251 Mastoidectomy 14950 17193
252 Otoplasty 16100 18515

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SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

253 Labyrinthectomy 13800 15870
254 Skull Base surgery 25000 28750
255 Facial Nerve Decompression 17250 19838
256 Septoplasty 5750 6613
257 Submucous Resection 7314 8411
258 Septo-rhinoplasty 16100 18515
259 Rhinoplasty- Non-cosmetic 11500 13225
260 Fracture Reduction 4250 5000
261 Intra nasal Diathermy 1150 1323
262 Turbinectomy 5750 6613
263 Endoscopic DCR 13000 14950
264 Endoscopic Surgery 13800 15870
265 Septal Perforation Repair 13800 15870
266 Antrum Puncture 950 1093
267 Lateral Rhinotomy 1000 1150
268 Cranio-facial resection 25500 29325
269 Caldwell Luc Surgery 10626 12220
270 Angiofibroma Excision 17000 19550
271 Endoscopic Hypophysectomy 21500 24725
272 Endoscopic Optic Nerve Decompression 32775 37691
273 Decompression of Orbit 25500 29325
274 Punch/Wedge biopsy 674 775
275 Tonsillectomy 5000 5750
276 Uvulo-palatoplasty 15000 17250
277 FESS for antrochoal polyp 5750 6613
278 FESS for ethmoidal polyp 5750 6613
279 Polyp removal ear 748 860
280 Polyp removal Nose(Septal polyp) 748 860
281 Mastoidectomy plus Ossciculoplasty including TORP or 2415 2777
PORP
282 Endolymphatic sac decompression 2875 3306
283 Diagnostic endoscopy under GA 2300 2645
284 Yonges operation for Atrophic rhinitis 6900 7935
285 Vidian neurectomy for vasomotor Rhinitis 10350 11903
286 Nasal Packing-anterior 345 397
287 Nasal Packing-posterior 805 926
288 Ranula Excision 6843 7869
289 Tongue Tie excision 1500 1725
290 Sub Mandibular Duct Lithotomy 269 309
291 Adenoidectomy 5640 6486
292 Palatopharyngoplasty 8165 9390
293 Pharyngoplasty 17193 19772
294 Styloidectomy 9200 10580
295 Direct laryngoscopy including Biopsy under GA 5000 5750
296 Oesophagoscopy/foreign body removal from 1800 2070
297 Bronchoscopy with [Link] 2438 2804
298 Other Major Surgery 15000 17250

45
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

299 Other Minor Surgery 8500 10000
TREATMENT PROCEDURE FOR HEAD AND NECK

300 Ear Lobe Repair one side 500 575

301 Excision of Pinna for Growth (Squamous/Basal/ Injuries) 4000 4600
Skin Only
302 Excision of Pinna for Growth (Squamous/Basal/ Injuries) 3800 4370
Skin and Cartilage
303 Partial Amputation of Pinna 4500 5175
304 Total Amputation of Pinna 6200 7130
305 Total Amputation & Excision of External Auditory Meatus 1500 1725

306 Excision of Cystic Hygroma 5175 5951

307 Excision of Cystic Hygroma Extensive 7452 8570
308 Excision of Branchial Cyst 10350 11903
309 Excision of Branchial Sinus 10350 11903
310 Excision of Pharyngeal Diverticulum 10580 12167
311 Excision of Carotid Body-Tumours 11615 13357
312 Operation for Cervical Rib 12500 14375
313 Block Dissection of Cervical Lymph Nodes 15000 17250
314 Pharyngectomy & Reconstruction 15000 17250
315 Operation for Carcinoma Lip - Wedge-Excision 8050 9258
316 Operation for Carcinoma Lip - Vermilionectomy 5758 6622
317 Operation for Carcinoma Lip - Wedge Excision and 9292 10686
Vermilonectomy
318 Estlander Operation 7475 8596
319 Abbe Operation 9800 11270
320 Cheek Advancement 9775 11241
321 Excision of the Maxilla 19320 22218
322 Excision of mandible-segmental 15525 17854
323 Mandibulectomy 21000 24150
324 Partial Glossectomy 5520 6348
325 Hemiglossectomy 7000 8050
326 Total Glossectomy 22885 26318
327 Commondo Operation 22000 25300
328 Parotidectomy - Superficial 12075 13886
329 Parotidectomy - Total 15000 17250
330 Parotidectomy - Radical 19550 22483
331 Repair of Parotid Duct 11500 13225
332 Removal of Submandibular Salivary gland 8625 9919
333 Hemithyroidectomy 9500 10925
334 Partial Thyroidectomy (lobectomy) 11500 13225
335 Subtotal Thyroidectomy 13053 15011
336 Total Thyroidectomy 19000 21850
337 Resection Enucleation of thyroid Adenoma 10580 12167
338 Total Thyroidectomy and Block Dissection 26450 30418
339 Excision of Lingual Thyroid 16882 19414

46
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

340 Excision of Thyroglossal Cyst/Fistula 13225 15209
341 Excision of Parathyroid Adenoma/Carcinoma 21275 24466
342 Laryngectomy 17825 20499
343 Laryngo Pharyngectomy 30000 34500
344 Hyoid Suspension 10350 11903
345 Genioplasty 12000 13800
346 Direct Laryngoscopy including biopsy under GA 5175 5951
347 Phonosurgery 13800 15870
348 Fibroptic examition of Larynx under LA 1725 1984
349 Microlaryngeal Surgery 10350 11903
350 Laryngofissure 17250 19838
351 Tracheal Stenosis Excision 19780 22747
Head and neck cancer
352 Excisional Biopsies 5750 6613
353 Benign Tumour Excisions 9500 10925
354 Temporal Bone subtotal resection 20700 23805
355 Modified Radical Neck Dissection 25300 29095
356 Carotid Body Excision 26000 29900
357 Total Laryngectomy 39192 45071
358 Flap Reconstructive Surgery 41400 47610
359 Parapharyngeal Tumour Excision 39330 45230
360 Other Major Surgery 21250 25000
361 Other Minor Surgery 5000 5750
TREATMENT PROCEDURE BREAST
362 Drainage of abscess 6000 6900
363 Excision of lumps 6969 8014
364 Local mastectomy-simple 12650 14548
365 Radical mastectomy-formal or modified. 28750 33063
366 Excision of mammary fistula 15525 17854
367 Segmental resection of breast 16100 18515
368 Other Major Surgery 25000 28750
369 Other Minor Surgery 5000 5750
TREATMENT PROCEDURE GENERAL SURGERY

370 Injury Of Superficial Soft Tissues 425 500

371 Suturing of small wounds 269 309
372 Secondary suture of wounds 3400 4000
373 Debridement of wounds 450 518
374 Removal Of Foreign Bodies 300 345
Biopsies
375 Excision of Cervical Lymph Node 1725 1984
376 Excision of Axillary Lymph Node 2277 2619
377 Excision of Inguinal Lymph Node 2277 2619
378 Excision Biopsy of Ulcers 1470 1691
379 Excision Biopsy of Superficial Lumps 3220 3703
380 Incision Biopsy of Growths/Ulcers 1470 1691
381 Trucut Needle Biopsy 1550 1783

47
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

382 Percutaneous Kidney Biopsy 1470 1691
383 Marrow Biopsy (Open) 1060 1219
384 Muscle Biopsy 1470 1691
385 Scalene Node Biopsy 1350 1553
386 Excision of Sebaceous Cysts 1242 1428
387 Excision of Superficial Lipoma 1932 2222
388 Excision of Superficial Neurofibroma 2500 2875
389 Excision of Dermoid Cysts 2277 2619
390 Haemorrhoidectomy 20720 24375
391 Stappler haemorrhoidectomy 38000 43700
392 keloid excision 1150 1323
393 Vericose vein surgery;Tendelenburg operation with suturing 10000 11500
or ligation.
TREATMENT PROCEDURE OESOPHAGUS
394 Atresia of Oesophagus and Tracheo Oesophageal Fistula 28750 33063

395 Operations for Replacement of Oesophagus by Colon 25000 28750

396 Oesophagectomy for Carcinoma Easophagus 25000 28750
397 Oesophageal Intubation (Mausseau Barbin Tube) 11500 13225
398 Achalasia Cardia Transthoracic 14950 17193
399 Achalasia Cardia Abdominal 12650 14548
400 Oesophago Gastrectomy for mid 1/3 lesion 24495 28169
401 Heller’s Operation 19750 22713
402 Colon-Inter position or Replacement of Oesophagus 22540 25921
403 Oesophago Gastrectomy – Lower Corringers procedure 21390 24599
404 Other Major Surgery 27625 32500
405 Other Minor Surgery 5000 5750
TREATMENT PROCEDURE ABDOMEN / GI SURGERY

406 Gastroscopy 1725 1984

407 Gastric & Duodenal Biopsy (Endoscopic) 1950 2243
408 Pyloromyotomy 2800 3220
409 Gastrostomy 8625 9919
410 Simple Closure of Perforated peptic Ulcer 9775 11241
411 Vagotomy Pyleroplasty / Gastro Jejunostomy 13800 15870
412 Duodenojejunostomy 18950 21793
413 Partial/Subtotal Gastrectomy for Carcinoma 23000 26450
414 Partial/Subtotal Gastrectomy for Ulcer 22425 25789
415 Operation for Bleeding Peptic Ulcer 20976 24122
416 Operation for Gastrojejunal Ulcer 19780 22747
417 Total Gastrectomy for Cancer 22368 25723
418 Highly Selective Vagotomy 18630 21425
419 Selective Vagotomy & Drainage 18630 21425
420 Congenital Diaphragmatic Hernia 18975 21821
421 Hiatus Hernia Repair- Abdominal 14490 16664
422 Hiatus Hernia Repair- Transthoracic 16100 18515
423 Exploratory Laparotomy 12650 14548

48
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

424 Epigastric Hernia Repair 11385 13093
425 Umbilical Hernia Repair 11385 13093
426 Ventral /incisional Hernia Repair 10293 11837
427 Inguinal Hernia Herniorraphy 14835 17060
428 Inguinal Hernia - Hernioplasty 16500 18975
429 Femoral Hernia Repair 18285 21028
430 Rare Hernias Repair (Spigalion, Obturator, Lumbar, Sciatic) 18975 21821

431 Splenectomy - For Trauma 18975 21821

432 Splenectomy - For Hypersplenism 14490 16664
433 Splenorenal Anastomosis 23000 26450
434 Portocaval Anastomosis 28750 33063
435 Direct Operation on Oesophagus for Portal Hypertension 22885 26318

436 Mesentericocaval Anastomosis 25450 29268

437 Warren Shunt 28750 33063
438 Pancerato Duodenectomy 21735 24995
439 By Pass Procedure for Inoperable Carcinoma of Pancreas 23000 26450

440 Cystojejunostomy or Cystogastrostomy 14490 16664

441 Cholecystectomy 10292 11836
442 Cholecystectomy & Exploration of CBD 14375 16531
443 Repair of CBD 13600 16000
444 Operation for Hydatid Cyst of Liver 11902 13687
445 Cholecystostomy 10292 11836
446 Hepatic Resections (Lobectomy /Hepatectomy) 14375 16531
447 Operation on Adrenal Glands - Bilateral 26105 30021
448 Operation on Adrenal Glands - Unilateral 13800 15870
449 Appendicectomy 8108 9324
450 Appendicular Abscess – Drainage 9775 11241
451 Mesenteric Cyst- Excision 11040 12696
452 Peritonioscopy/Laparoscopy 4600 5290
453 Jejunostomy 5750 6613
454 Ileostomy 15410 17722
455 Resection & Anastomosis of Small Intestine 20700 23805
456 Duodenal Diverticulum 18400 21160
457 Operation for Intestinal Obstruction 10350 11903
458 Operation for Intestinal perforation 38000 43700
459 Benign Tumours of Small Intestine 19550 22483
460 Excision of Small Intestine Fistula 19550 22483
461 Operations for GI Bleed 16000 18400
462 Operations for Haemorrhage of Small Intestines 19550 22483
463 Operations of the Duplication of the Intestines 17825 20499
464 Operations for Recurrent Intestinal Obstruction (Noble 23000 26450
Plication & Other Operations for Adhesions)
465 Ilieosigmoidostomy and related resection 16790 19309
466 Ilieotransverse Colostomy and related resection 16790 19309

49
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

467 Caecostomy 3903 4488
468 Loop Colostomy Transverse Sigmoid 13110 15077
469 Terminal Colostomy 17250 19838
470 Closure of Colostomy 17480 20102
471 Right Hemi-Colectomy 13800 15870
472 Left Hemi-Colectomy 13800 15870
473 Total Colectomy 17250 19838
474 Operations for Volvulus of Large Bowel 24920 28658
475 Operations for Sigmoid Diverticulitis 18630 21425
476 Fissure in Ano with Internal sphinctrectomy with 13800 15870
fissurectomy.
477 Fissure in Ano - Fissurectomy 13800 15870
478 Rectal Polyp-Excision 5658 6507
479 Fistula in Ano - High Fistulectomy 16780 19297
480 Fistula in Ano - Low Fistulectomy 9867 11347
481 Prolapse Rectum - Theirch Wiring 10350 11903
482 Prolapse Rectum - Rectopexy 5750 6613
483 Prolapse Rectum - Grahams Operation 18400 21160
484 Operations for Hirschsprungs Disease 14260 16399
485 Excision of Pilonidal Sinus (open) 11500 13225
486 Excision of Pilonidal Sinus with closure 11500 13225
487 Abdomino-Perineal Excision of Rectum 18300 21045
488 Anterior Resection of rectum 21850 25128
489 Pull Through Abdominal Resection 17170 19746
490 Retro Peritoneal Tumor Removal 18000 20700
491 Radio ablation of varicose veins 1800 2070
492 Laser ablation of varicose veins 17250 19838
493 Laproscopic Fundoplication 19300 22195
494 Laproscopic Spleenectomy 25000 28750
495 Laproscopic Removal of hydatid cyst 18000 20700
496 Laproscopic treatment of Pseudo Pancreatic cyst 18000 20700
497 Laproscopic whipples operation 20000 23000
498 Laproscopic GI bypass operation 22000 25300
499 Laproscopic Total Colectomy 25000 28750
500 Laproscopic Hemi Colectomy 23000 26450
501 Laproscopic Anterior Resection 23000 26450
502 Laproscopic Cholecystetomy 18975 21821
503 Laproscopic Appedicectomy 18000 20700
504 Laproscopic Hernia inguinal repair 18000 20700
505 Laproscopic ventral Hernia Repair 17500 20125
506 Laproscopic Paraumblical Hernia Repair 17500 20125
507 Laproscopic Adrenelectomy 12000 13800
508 Laproscopic Nephrectomy 22000 25300
509 Other Major Surgery 38000 43700
510 Other Minor Surgery 6000 6900
TREATMENT PROCEDURE ICU/CCU PROCEDURES
(SPECIAL CARE CASES)

50
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

511 Coronary Care with Cardiac Monitoring (Room Rent extra) 750 863

512 Compressed air / piped oxygen /per hour 50 58

513 Ventilator charges (Per day) 531 611
514 Paediatric care for New born (Per day) 186 214
515 Incubator charges (Per day) 345 397
516 Neonatal ICU charges (Per day) 391 450
517 Resuscitation 184 212
518 Exchange Transfusion 265 305
519 Pneupack ventilator in Nursery (Per day) 575 661
TREATMENT PROCEDURE CARDIOVASCULAR AND

CARDIAC SURGERY & INVESTIGATIONS

520 ASD Closure 51808 59579
521 VSD with graft 51808 59579
522 TOF/TAPVC/TCPC/REV/RSOV repair 127075 146136
523 [Link]/Left atrium myxoma 80750 95000
524 Senning/ASO with graft 122188 140516
525 DSO 103615 119157
526 AV Canal repair 161000 185150
527 Fonten 169000 194350
528 Conduit repair 169000 194350
529 CABG 127075 146136
530 CABG + IABP 169000 194350
531 CABG + Valve. 169000 194350
532 CABG without bypass. 140000 161000
533 Ascending aorta replacement 130000 149500
534 DVR 155422 178735
535 MVR/AVR 103615 119157
536 MV repair + AV repair 103615 119157
537 Aorta femoral bypass 52000 59800
538 B.T Shunt/Coaractation 51980 59777
539 [Link] septostomy 51980 59777
540 Pericardectomy 42320 48668
541 CMV/PDA 51980 59777
542 Gunshot injury 51980 59777
543 Heart transplant 276000 317400
544 Balloon coronary angioplasty/PTCA with VCD 80600 92690
545 Balloon coronary angioplasty/PTCA without VCD 80000 92000
546 Rotablation 48875 56206
547 balloon valvotomy/PTMC 10264 11804
548 CATH 10000 11500
549 Arch Replacement 10350 11903
550 Aortic Dissection 12650 14548
551 Thoraco Abdominal Aneurism Repair 15000 17250
552 Embolectomy 21000 24150
553 Vascular Repair 36000 41400

51
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

554 Bentall Repair with Prosthetic Valve 30000 34500
555 Bentall Repair with Biologic Valve 127500 150000
556 Coaractation dilatation 14500 16675
557 Coaractation dilatation with Stenting 18500 21275
558 TPI Single Chamber 7500 8625
559 TPI Dual Chamber 8160 9600
560 Permanent pacemaker implantation- Single Chamber 13800 15870
561 Permanent pacemaker implantation- Dual Chamber 19320 22218
562 Permanent pacemaker implantation Biventricular 34500 39675
563 AICD implantation Single Chamber 28750 33063
564 AICD implantation Dual Chamber 40000 46000
565 Combo device implantation 40000 46000
566 Diagnostic Electrophysiological studies conventional 4550 5233
567 Ambulatory BP monitoring 587 690
568 External Loop/event recording 2848 3350
569 RF Ablation conventional 35000 40250
570 RF Ablation Atrial Tachycardia/Carto 45000 51750
571 Endomyocardial biopsy 10000 11500
572 IABP 7820 8993
573 Intra vascular coils 46000 52900
574 Septostomy- Balloon 16150 19000
575 Septostomy- Blade 19550 22483
576 AVBD/PVBD 48300 55545
577 Digital subtraction angiography-Peripheral artery 11500 13225
578 Digital subtraction angiography- venogram 11500 13225
579 C.T Guided biopsy 1265 1455
580 Sinogram 863 992
581 Peripheral Angioplasty with VCD 11500 13225
582 Peripheral Angioplasty without VCD 11500 13225
583 Renal Angioplasty 60350 71000
584 IVUS 25000 28750
585 FFR 12750 15000
586 Holter analysis 850 1000
587 Aortic stent grafting for aortic aneurysm 78500 90275
588 IVC Filter implantation 16129 18548
589 ASD/VSD/PDA device closure 36225 41659
590 ECG 50 58
591 HUTT 2200 2530
592 2 D echocardiography 1200 1380
593 3 D echocardiography 1403 1650
594 Fetal Echo 1400 1610
595 2DTEE 1403 1650
596 3 D TEE(Transoesophageal echo ) 1403 1650
597 Stress Echo- exercise 1500 1725
598 Stress Echo- pharmacological 2500 2875
599 Stress MPI- exercise 1955 2300
600 Stress MPI - pharmacological 2500 2875

52
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

601 Coronary angiography 11500 13225
602 CT coronary angiography 6030 6935
603 Cardiac CT scan 2272 2613
604 Cardiac MRI 2444 2811
605 Stress Cardiac MRI 3000 3450
606 MR angiography. 5635 6480
607 Cardiac PET 1500 1725
608 Pericardiocentesis 3500 4025
609 Other Major Surgery 20000 23000
610 Other Minor Surgery 4250 5000
TREATMENT PROCEDURE OBSTETRICS AND
GYNAECOLOGY
611 Normal delivery with or without Episiotomy & P. repair 8000 9200
612 vacuum delivery 8625 9919
613 Forceps Delivery 9200 10580
614 Cesarean Section 14050 16158
615 Cesarean Hysterectomy 18975 21821
616 Rupture Uterus closure & repair with Tubal Ligation 17250 19838
617 Perforation of Uterus after D/E Laparotomy & Closure 13800 15870
618 Laparotomy for Ectopic pregnancy 13800 15870
619 Laparotomy-peritonitis Lavage and Drainage 11500 13225
620 Salphingo-Oophorectomy/ Oophorectomy Laproscopic 10000 11500
621 Ovarian Cystectomy-laparoscopic. 10350 11903
622 Ovarian Cystectomy -laparotomy. 13800 15870
623 Salpingo-Oophorectomy-laparotomy 11520 13248
624 Laproscopic Broad Ligament Hematoma Drainage with 6900 7935
repair
625 Exploration of perineal Haematoma & Repair 8000 9200
626 Exploration of abdominal Haematoma (after laparotomy + 8050 9258
LSCS)
627 Manual Removal of Placenta 3450 3968
628 Examination under anesthesia (EUA) 1000 1150
629 Burst-abdomen Repair 10000 11500
630 Gaping Perineal Wound Secondary Suturing 1656 1904
631 Gaping abdominal wound Secondary Suturing 3450 3968
632 Complete perineal tear-repair 2128 2447
633 Exploration of PPH-tear repair 3500 4025
634 Suction evacuation vesicular mole 5000 5750
635 Suction evacuation Missed abortion/ incomplete abortion 5175 5951

636 Colpotomy 3450 3968

637 Repair of post-coital tear/ perineal injury 3508 4034
638 Excision of urethral caruncle 3450 3968
639 Shirodhkar/ Mc. Donald’s stitch 3220 3703
640 Abdominal Hysterectomy with or without salpingo- 17250 19838
oophorectomy
641 Vaginal Hysterectomy (NDVH) 17250 19838

53
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

642 Vaginal Hysterectomy with repairs (UV Prolapse) 17250 19838
643 Myomectomy -laparotomy 14000 16100
644 Myomectomy -laparoscopic 6325 7274
645 Vaginoplasty 14950 17193
646 Vulvectomy -Simple 9200 10580
647 Vulvectomy-Radical 9200 10580
648 RVF Repair 18975 21821
649 Manchester Operation 15000 17250
650 Shirodkar’s sling Operation or other sling operations for 3450 3968
prolapse uterus
651 Laparoscopic sling operations for prolapse uterus 28000 32200
652 Diagnostic Curettage 2484 2857
653 Cervical Biopsy 1800 2070
654 Polypectomy 1518 1746
655 Other-Minor Operation Endometrial 2300 2645
656 Excision Vaginal Cyst/Bartholin Cyst 3450 3968
657 Excision Vaginal Septum 4600 5290
658 Laparoscopy -Diagnostic with chromopertubation and or 4025 4629
adhesiolysis and drilling
659 Laparoscopy Sterilization 3450 3968
660 LAVH 25243 29029
661 Balloon Temponade for PPH 2800 3220
662 Total laparoscopic hysterectomy 25243 29029
663 Laparoscopic treatment of Ectopic pregnancy- 9775 11241
salpingectomy/salpinostomy conservative
664 Conisation of cervix 4025 4629
665 Trachhelectomy of cervix for early CA cervix 5500 6325
666 Hysteroscopic cannulation 2875 3306
667 Laparotomy recannalization of Fallopian tubes- 22425 25789
(Tubuloplasty)
668 Laparoscopic recannalization of Fallopian tubes- 19500 22425
(Tubuloplasty)
669 Colposcopy 958 1102
670 Inversion of Uterus – Vaginal Reposition 2500 2875
671 Inversion of Uterus – Abdominal Reposition 2500 2875
672 Laparoscopic VVF Repair 28000 32200
673 Abdominal VVF Repair 28000 32200
674 Vaginal VVF Repair 28000 32200
675 Interventional Ultrasonography (CVS) 880 1012
676 Amniocentesis 880 1012
677 Karyotyping 800 920
678 Thermal balloon ablation. 11500 13225
679 Ultrasonographic myolysis 10293 11837
680 Vaginal Myomectomy 10000 11500
681 Intra Uterine Inseminition 920 1058
682 ICSI 11500 13225
683 Laparotomy abdominal sacro-colpopexy 15000 17250

54
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

684 Vaginal Colpopexy 22000 25300
685 Laparoscopic abdominal sacro-colpopexy 20000 23000
686 Laparotomy pelvic Lymphadenectomy 1200 1380
687 Laparoscopic pelvic Lymphadenectomy 3500 4025
688 Endometrial aspiration cytology/biopsy 570 656
689 Transvaginal sonography (TVS for Follicular monitioring 460 529
/aspiration)
690 laparoscopic treatment for stress incontinence 15000 17250
691 Transvaginal tapes for Stress incontinence 15000 17250
692 trans-obturator tapes for Stress incontinence 12000 13800
693 Interventional radiographic arterial embolization 18000 20700
694 Diagnostic cystoscopy 2875 3306
695 Staging laparotomy surgery for CA Ovary 6325 7274
696 Internal Iliac ligation 3393 3902
697 stepwise devascularisation 9200 10580
698 Assisted breech delivery 10925 12564
699 Intra-uterine fetal blood transfusion 21275 24466
700 Hysteroscopy TCRE 8500 9775
701 Hysteroscopy Removal of IUCD 7500 8625
702 Hysteroscopy Removal of Septum 11000 12650
703 Hysteroscopy Diagnostic 7500 8625
704 Radical Hysterectomy for Cancer cervix with pelvic 8500 9775
lymphadenectomy
705 Radical Hysterectomy for Cancer endometrium extending 8500 9775

to cervix with pelvic and para aortic lymphadenectomy

706 Sterilization Post partum (minilap) 3750 4313
707 Sterilization interval (minilap) 3750 4313
708 Ultrasonography Level II scan/Anomaly Scan 500 575
709 Fetal nuchal Translucency 300 345
710 Fetal Doppler/Umblical Doppler/Uterine Vessel Doppler 850 978
711 MTP- 1st Trimester 3000 3450
712 MTP - 2nd Trimester 4370 5026
713 Quadruple test 2000 2300
714 Biophysical score 600 690
715 Other Major Surgery 28000 32200
716 Other Minor Surgery 5000 5750
TREATMENT PROCEDURE NEPHROLOGY AND
UROLOGY
717 Partial Nephrectomy -open 16215 18647
718 Partial Nephrectomy-laproscopic/endoscopic 14490 16664
719 Nephrolithomy -open 12000 13800
720 Nephrolithomy -laproscopic/endoscopic 14000 16100
721 Pyelolithotomy-open 13000 14950
722 Pyelolithotomy -laproscopic/endoscopic 10580 12167
723 Operations for Hydronephrosis -pyeloplasty open 18400 21160

55
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

724 Operations for Hydronephrosis -pyeloplasty Lap/endoscopic 19000 21850

725 Operations for Hydronephrosis Endoplyelotomy antegrade 20000 23000

726 Operations for Hydronephrosis Endoplyelotomy retrograde 20000 23000

727 Operations for Hydronephrosis -ureterocalicostomy 18000 20700

728 Operations for Hydronephrosis-Ileal ureter 18000 20700
729 Open Drainage of Perinephric Abscess 8000 9200
730 Percutaneous Drainage of Perinephric Abscess -Ultrasound 5750
guided
731 Cavernostomy 9775 11500
732 Operations for Cyst of the Kidney -open 11960 13754
733 Operations for Cyst of the Kidney -Lap/endoscopic 14030 16135
734 Ureterolithotomy -open 13248 15235
735 Ureterolithotomy-Lap/Endoscopic 10000 11500
736 Nephroureterectomy open 16100 18515
737 Nephroureterectomy -Lap/Endoscopic 16100 18515
738 Operations for Ureter for -Double Ureters 19000 21850
739 Operations for Ureter -for Ectopia of Single Ureter 18000 20700
740 Operations for Vesico- ureteric Reflux -Open 18000 20700
741 Operations for Vesico- ureteric Reflux-Lap/Endoscopic 18000 20700
742 Operations for Vesico- ureteric Reflux/ Urinary incontinence 20700 23805
with bulking agents
743 Ureterostomy - Cutaneous 12000 13800
744 Uretero-Colic anastomosis 16000 18400
745 Formation of an Ileal Conduit 17250 19838
746 Ureteric Catheterisation 8278 10950
747 Biopsy of Bladder (Cystoscopic) 2300 2645
748 Cysto-Litholapaxy 10925 12564
749 Operations for Injuries of the Bladder 10000 11500
750 Suprapubic Drainage (Cystostomy/vesicostomy) 6000 6900
751 Simple Cystectomy 17250 19838
752 Diverticulectomy -open 16000 18400
753 Diverticulectomy- Lap/Endoscopic 18400 21160
754 Diverticulectomy -Endoscopic incision of neck 1725 1984
755 Augmentation Cystoplasty 6670 7671
756 Operations for Extrophy of the Bladder- Single stage repair 22300 25645

757 Operations for Extrophy of the Bladder- Multistage repair 20815 23937

758 Operations for Extrophy of the Bladder- simple cystectomy 22500 25875
with urinary diversion
759 Repair of Ureterocoel -Open 13800 15870
760 Repair of Ureterocoel -Lap/Endoscopic 14375 16531
761 Repair of Ureterocoel -Endoscopic incision 13000 14950
762 Open Suprapubic Prostatectomy 20700 23805

56
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

763 Open Retropubic Prostatectomy 20125 23144
764 Transurethral Resection of Prostate (TURP) 18630 21425
765 Urethroscopy/ Cystopanendoscopy 4600 5290
766 Internal urethrotomy -optical 5750 6613
767 Internal urethrotomy -Core through urethroplasty 11040 12696
768 Urethral Reconstruction -End to end ansatamosis 3450 3968
769 Urethral Reconstruction - substitution urethroplasty 19550 22483
(Transpubic urethroplasty
770 Abdomino Perineal urethroplasty 14000 16100
771 Posterior Urethral Valve fulguration. 11270 12961
772 Operations for Incontinence of Urine - Male -Open 17250 19838
773 Operations for Incontinence of Urine - Male -Sling 18400 21160
774 Operations for Incontinence of Urine - Male-Bulking agent 19435 22350

775 Operations for Incontinence of Urine - Female -Open 17250 19838

776 Operations for Incontinence of Urine - Female-Sling 18400 21160
777 Operations for Incontinence of Urine - Female-Bulking agent 19435 22350

778 Reduction of Paraphimosis 1725 1984

779 Circumcision 3000 3450
780 Meatotomy 2346 2698
781 Meatoplasty 3220 3703
782 Operations for Hypospadias + Chordee Correction 9200 10580
783 Operations for Hypospadias - Second Stage 15000 17250
784 Operations for Hypospadias - One Stage Repair 9200 10580
785 Operations for Crippled Hypospadias 11500 13225
786 Operations for Epispadias _primary repair 12593 14482
787 Operations for Epispadias-crippled epispadias 11385 13093
788 Partial Amputation of the Penis 10764 12379
789 Total amputation of the Penis 12000 13800
790 Orchidectomy-Simple 9775 11241
791 Orchidectomy -Radical 12075 13886
792 Post Radical Orchidectomy retroperitoneal lymph node 14000 16100
dissection.
793 Epididymectomy 15938 18750
794 Adreneclectomy Unilateral/Bilateral for Tumour/For 25300 29095
Carcinoma- Open
795 Adreneclectomy Unilateral/Bilateral for Tumour/For 14375 16531
Carcinoma -Lap/Endoscopic
796 Operations for Hydrocele - Unilateral 5865 6745
797 Operations for Hydrocele - Bilateral 8556 9839
798 Operation for Torsion of Testis 11500 13225
799 Micro-surgical Vasovasostomy /Vaso epidedymal 11040 12696
ansatamosis.
800 Operations for Varicocele Unilateral-Microsurgical 7705 8861
801 Operations for Varicocele Palomo’s Unilateral - Lap 9200 10580
802 Operations for Varicocele Bilateral --Microsurgical 12650 14548

57
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

803 Operations for Varicocele Bilateral – Lap/ Palomo 14950 17193
804 Block Dissection of ilio-inguinal Nodes - One Side (For Ca- 6325 7274
Penis)
805 Block Dissection of ilio-inguinal Nodes - Both Sides (For Ca- 23000 26450
Penis)
806 Excision of Filarial Scrotum 11500 13225
807 Kidney Transplantation (related) 200000 230000
808 Kidney Transplantation (Spousal/ unrelated) Including 300000 345000
immunosuppressant therapy
809 ABO incompatible Transplantation 490000 563500
810 Swap Transplantation 388000 446200
811 Kidney Transplant Graft Nephrectomy 59500 70000
812 Donor Nephrectomy (open) 28750 33063
813 Donor Nephrectomy (Laproscopic) 46000 52900
814 Cadaver Transplantation 83300 95795
815 Kidney Transplant with Native Kidney Nephrectomy 28000 32200
(Related)/ Unilateral
816 Kidney Transplant with Native Kidney Nephrectomy 85000 97750
(Related)/ Bilateral
817 Kidney Transplant with Native Kidney Nephrectomy 85000 97750
(Spousal/ Unrelated) Unilateral
818 Kidney Transplant with Native Kidney Nephrectomy 85000 97750
(Spousal/ Unrelated) Bilateral
819 Post-Transplant Collection drainage for Lymphocele (open) 6800 8000

820 Post-Transplant Collection drainage for Lymphocele 6800 8000

(percutaneous)
821 Post-Transplant Collection drainage for Lymphocele 7650 9000
(Laproscopic)
822 Arteriovenous Fistula for Haemodialysis 2300 2645
823 Arteriovenous Shunt for Haemodialysis 3500 4025
824 Jugular Catheterization for Haemodialysis 1500 1725
825 Subclavian Catheterization for Haemodialysis 2250 2588
826 One sided (single Lumen) Femoral Catheterization for 1000 1150
Haemodialysis
827 Bilateral (single Lumen) Femoral Catheterization for 1500 1725
Haemodialysis
828 Double Lumen Femoral Catheterization for Haemodialysis 1850 2128

829 Permcath Insertion 2800 3220

830 Arterio venous Prosthetic Graft 1850 2128
831 Single lumen Jugular Catheterization 1500 1725
832 Single lumen Subclavian Catheterization 1700 2000
833 Plasma Exchange/ Plasma phresis 1725 1984
834 Open method CAPD catheter insertion 3500 4025
835 Schlendinger method CAPD catheter insertion 3500 4025
836 Sustained low efficiency hemodialysis 1250 1438

58
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

837 Continuous Veno venous/Arteriovenous Hemofilteration 2250 2588
838 Hemodialysis for Sero negative cases 1400 1610
839 Hemodialysis for Sero Positive cases 1650 1898
840 Acute Peritoneal Dialysis 1450 1668
841 Fistologram for Arteriovenous Fistula 2500 2875
842 Ultrasound guided kidney Biopsy 850 978
843 Fistula stenosis dilation 3000 3450
844 Slow continuous Ultrafilteration 2500 2875
845 PCNL - Unilateral 20000 23000
846 PCNL - Bilateral 25000 28750
847 Endoscopic Bulking agent Inject 4500 5175
848 Testicular Biopsy 1955 2248
849 Radical Nephrectomy -Open 17250 19838
850 Radical Nephrectomy -Lap/Endoscopic 20700 23805
851 Radical Nephrectomy plus IV thrombus 23000 26450
852 Radical Nephrectomy plus IV thrombus plus cardiac bypass. 23000 26450

853 Vesico Vaginal Fistula Repair (Open) 16000 18400

854 Vesico Vaginal Fistula Repair (Laproscopic) 22000 25300
855 Radical Cystectomy -Ileal conduit 17000 20000
856 Radical Cystectomy - continent diversion. 15000 17250
857 Radical Cystectomy – Neo bladder 18500 21275
858 Nephrectomy Simple -Open 10074 11585
859 Nephrectomy Simple-lap/Endoscopic 12593 14482
860 Nephrostomy -Open 10000 11500
861 Nephrostomy -Lap/Endoscopic 10704 12593
862 Ureteric Re- implant for Megaureter/Vesicoureteric reflex/ 10494 12068
uterocele (open)
863 Ureteric Re -implant for Megaureter/Vesicoureteric reflex/ 10494 12068
uterocele (Laproscopic)
864 Partial Cystectomy 13800 15870
865 TURP & TUR Bladder Tumour 17250 19838
866 TURP with Cystolithotripsy 17000 19550
867 Closure of Urethral Fistula 11000 12650
868 Orchidopexy - Unilateral -Open 9867 11347
869 Orchidopexy - Unilateral- Lap/Endoscopic 12334 14184
870 Orchidopexy - Bilateral -Open 12282 14124
871 Orchidopexy - Bilateral -Lap/Endoscopic 14500 16675
872 Cystolithotomy -Suprapubic 9775 11241
873 Endoscopic Removal of Stone in Bladder 3450 3968
874 Resection Bladder Neck Endoscopic /Bladder neck 10925 12564
incision/transurethral incision on prostrate
875 Ureteroscopic Surgery 10350 11903
876 Urethroplasty 1st Stage 10925 12564
877 Scrotal Exploration 8556 9839
878 Perineal Urethrostomy 4715 5422
879 Dilatation of Stricture Urethra under G.A. 2000 2300

59
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

880 Dilatation of Stricture Urethra under LA 1725 1984
881 Laproscopic Nephrectomy 33350 38353
882 Laproscopic partial Nephrectomy 10000 11500
883 Laproscopic pyelolithotomy 12650 14548
884 Laproscopic Pyeloplasty 9775 11241
885 Laproscopic surgery for Renal cyst 9775 11241
886 Laproscopic ureterolithotomy 11500 13225
887 Laproscopic Nephro ureterotectomy 13225 15209
888 Lithotripsy Extra corporeal shock wave. 19550 22483
889 Uroflow Study (Uroflometry) 450 518
890 Urodynamic Study (Cystometry) 480 552
891 Cystoscopy with Retrograde Catheter -Unilateral /RGP 2803 3223
892 Cystoscopy with Retrograde Catheter - Bilateral /RGP 4675 5500
893 Cystoscopy with Bladder Biopsy (Cold Cup Biopsy) 3381 3888
894 Voiding-cysto-urethrogram and retrograde urethrogram 414 476
(Nephrostogram)
895 Radical prostatectomy-Open 17825 20499
896 Radical prostatectomy-Laproscopic 20125 23144
897 Radical prostatectomy- Robotic (Robotic Partial 20125 23144
Nephrectomy)
898 Hollmium YAG Prostate Surgery 15000 17250
899 Hollmium YAG OIU 4600 5290
900 Hollmium YAG Core Through 17250 19838
901 Hollmium YAG Stone Lithotripsy 10200 12000
902 Green Light laser for prostate 17250 19838
903 RIRS/ Flexible Ureteroscopy 6800 7820
904 Microscopic VEA/ Vaso-Vasostomy (for Infertility) 13500 15525
905 Cystoscopic Botulinum Toxin Injection ( Over active 6800 7820
bladder/ Neurogenic bladder)
906 Peyronie’s disease – Plaque excision with grafting 3400 4000
907 High Intensity Focus Ultrasound (HIFU) (Robotic) for 4600 5290
Carcinoma prostrate and renal cell carcinoma
908 Prosthetic surgery for urinary incontinence 2300 2645
909 TRUS guided prostate biopsy 575 661
910 Ultra sound guided PCN 720 828
911 Other Major Surgery 15000 17250
912 Other Minor Surgery 6800 7820
TREATMENT PROCEDURE NEURO-SURGERY
913 Craniotomy and Evacuation of Haematoma -Subdural 50715 58322
914 Craniotomy and Evacuation of Haematoma -Extradural 50000 57500
915 Evacuation /Excision of Brain Abscess by craniotomy 40000 46000
916 Excision of Lobe (Frontal Temporal Cerebellum etc.) 41000 47150
917 Excision of Brain Tumours -Supratentorial 39123 44991
918 Excision of Brain Tumours -Infratentorial 45000 51750
919 Surgery of spinal Cord Tumours 45000 51750
920 Ventriculoatrial /Ventriculoperitoneal Shunt 25000 28750
921 Twist Drill Craniostomy 4250 5000

60
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

922 Subdural Tapping 2456 2824
923 Ventricular Tapping 2967 3412
924 Abscess Tapping 2875 3306
925 Placement of ICP Monitor - 2875 3306
926 Skull Traction Application 2300 2645
927 Lumber Pressure Monitoring 4250 5000
928 Vascular Malformations 22000 25300
929 Meningo Encephalocoele excision and repair 15000 17250
930 Meningomyelocoel Repair 24995 28744
931 C.S.F. Rhinorrhaea Repair 28750 33063
932 Cranioplasty 24150 27773
933 Anterior Cervical Dissectomy 16600 19090
934 Brachial Plexus Exploration and neurotization 15525 17854
935 Median Nerve Decompression 14000 16100
936 Peripheral Nerve Surgery – Major 17250 19838
937 Peripheral Nerve Surgery Minor 8280 9522
938 Ventriculo-Atrial Shunt 11615 13357
939 Nerve Biopsy 6900 7935
940 Brain Biopsy 5808 6679
941 Anterior Cervical Spine Surgery with fusion 32200 37030
942 Anterio Lateral Decompression of spine 28750 33063
943 Brain Mapping 837 963
944 Cervical or Dorsal or Lumbar Laminectomy 23000 26450
945 Combined Trans-oral Surgery & CV Junction Fusion 34500 39675
946 C.V. Junction Fusion procedures 30000 34500
947 Depressed Fracture Elevation 25000 28750
948 Lumbar Discectomy 27600 31740
949 Endarterectomy (Carotid) 20000 23000
950 R.F. Lesion for Trigeminal Neuralgia 11500 13225
951 Spasticity Surgery - 39675 45626
952 Spinal Fusion Procedure 30000 34500
953 Spinal Intra Medullary Tumours 34500 39675
954 Spinal Bifida Surgery Major 18975 21821
955 Spinal Bifida Surgery Minor 15000 17250
956 Stereotaxic Procedures- biopsy/aspiration of cyst 23000 26450
957 Trans Sphenoidal Surgery 30000 34500
958 Trans Oral Surgery 30000 34500
959 Implantation of DBS -One electrode 34500 39675
960 Implantation of DBS -two electrodes 40250 46288
961 Endoscopic aqueductoplasty 15000 17250
962 Facial nerve reconstruction 30000 34500
963 Carotid stenting 42263 48602
964 Cervical disc arthroplasty 27600 31740
965 Lumbar disc arthroplasty 13800 15870
966 Corpus callostomy for Epilepsy 35000 40250
967 Hemishpherotomy for Epilepsy 32200 37030
968 Endoscopic CSF rhinorrhea repair 30000 34500

61
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

969 Burr hole evacuation of chronic subdural haematoma 24150 27773
970 Epilepsy surgery 36225 41659
971 RF lesion for facet joint pain syndrome 17250 19838
972 Cervical laminoplasty 32000 36800
973 Lateral mass C1-C2 screw fixation 23000 26450
974 Microsurgical decompression for Trigeminal nerve 38000 43700
975 Microsurgical decompression for hemifacial spasm 4646 5343
976 IC EC bypass procedures 32000 36800
977 Image guided craniotomy 28980 33327
978 Baclofen pump implantation 39000 44850
979 Programmable VP shunt 25000 28750
980 Endoscopic sympathectomy 17107 19673
981 Lumber puncture 207 238
982 External ventricular drainage (EVD) 4600 5290
983 Endoscopic 3rd ventriculostomy 40000 46000
984 Endoscopic cranial surgery/Biopsy/aspiration 31536 36266
985 Endoscopic discectomy (Lumbar, Cervical) 35621 40964
986 Aneurysm coiling (Endovascular) 34400 39560
987 Surgery for skull fractures 40000 46000
988 Carpel Tunnel decompression 15000 17250
989 Clipping of intracranial aneurysm 24150 27773
990 Surgery for intracranial Arteriovenous malformarions(AVM) 40000 46000

991 Foramen magnum decompression for Chari Malformation 93750 107813

992 Dorsal column stimulation for backache in failed back 28750 33063
syndrome
993 Surgery for recurrent disc prolapse/epidural fibrosis 32200 37030
994 Surgery for brain stem tumours 43988 50586
995 Decompressive craniotomy for hemishpherical acute 40000 46000
subdural haematoma/brain swelling/large infarct
996 Intra-arterial thrombolysis with TPA (for ischemic stroke ) 4600 5290

997 Steriotactic aspiration of intracerebral haematoma 32545 37427

998 Endoscopic aspiration of intracerebellar haematoma 40000 46000
999 Steriotactic Radiosurgery for brain pathology(X 27560 31694
knife/Gamma ) - ONE session
1000 Steriotactic Radiosurgery for brain pathology(X knife / 57500 66125
Gamma knife -Two or more sessions
1001 Chemotheraphy wafers for malignant brain tumors 14450 16618
1002 Battery Placement for DBS 22000 25300
1003 Baclofen pump implantation for spasticity 17330 19930
1004 Peripheral Nerve tumor surgery 24000 27600
1005 Surgery Intra Cranial Meningioma 20000 23000
1006 Surgery for Intracranial Schwannoma 35000 40250
1007 Surgery for Gliomas 45000 51750
1008 Surgery for Orbital tumors 40000 46000

62
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1009 Surgery for Cranial (Skull) tumors 38500 44275
1010 Surgery for Scalp AVM’s 25000 28750
1011 Kyphoplasty 40000 46000
1012 Balloon Kyphoplasty 40000 46000
1013 Lesioning procedures for Parkinson’s disease, Dystonia etc. 35000 40250

1014 Other Major Surgery 42500 50000

1015 Other Minor Surgery 17000 20000
TREATMENT PROCEDURE PAEDIATRIC SURGERY

1016 Excision of thyroglossal Duct/Cyst 16000 18400

1017 Diaphragmatic Hernia Repair (Thoracic or Abdominal 17250 19838
Approach)
1018 Tracheo Oesophageal Fistula (Correction Surgery) 23000 26450
1019 Colon Replacement of Oesophagus 23000 26450
1020 Omphalo Mesenteric Cyst Excision 17250 19838
1021 Omphalo Mesenteric Duct- Excision 15525 17854
1022 Meckels Diverticulectomy 3347 3849
1023 Omphalocele 1st Stage (Hernia Repair) 15525 17854
1024 Omphalocele 2nd Stge (Hernia Repair) 17250 19838
1025 Gastrochisis Repair 16100 18515
1026 Inguinal Herniotomy 12558 14442
1027 Congenital Hydrocele 12000 13800
1028 Hydrocele of Cord 12000 13800
1029 Torsion Testis Operation 15000 17250
1030 Congenital Pyloric Stenosis- operation 13938 16029
1031 Duodenal- Atresia Operation 14000 16100
1032 Pancreatic Ring Operation 22425 25789
1033 Meconium Ileus Operation 14500 16675
1034 Malrotation of Intestines Operation 13000 14950
1035 Rectal Biopsy (Megacolon) 9736 11196
1036 Colostomy Transverse 15000 17250
1037 Colostomy Left Iliac 15000 17250
1038 Abdominal Perineal Pull Through (Hirschaprugis Disease) 19000 21850

1039 Imperforate Anus Low Anomaly -Cut Back Operation 10235 11770
1040 Imperforate Anus Low Anomaly - Perineal Anoplasty 12000 13800
1041 Imperforate Anus High Anomaly -Sacroabdomino Perineal 12500 14375
Pull Through
1042 Imperforate Anus High Anomaly - Closure of Colostomy 8625 9919

1043 Intususception Operation 20700 23805

1044 Choledochoduodenostomy for Atresia of Extra Hepatic 15000 17250
Billiary Duct
1045 Operation of Choledochal Cyst 16000 18400
1046 Nephrectomy for -Pyonephrosis 17000 19550
1047 Nephrectomy for - Hydronephrosis 15000 17250

63
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1048 Nephrectomy for -Wilms Tumour 15000 17250
1049 Paraortic Lymphadenoctomy with Nephrectomy for Wilms 20000 23000
Tumour
1050 Sacro-Coccygeal Teratoma Excision 14000 16100
1051 Neuroblastoma Debulking 16000 18400
1052 Neuroblastoma Total Excision 20700 23805
1053 Rhabdomyosarcoma wide Excision 15000 17250
1054 Congenital Atresia & Stenosis of Small Intestine 19000 21850
1055 Muconium ileus 16000 18400
1056 Mal-rotation & Volvulus of the Midgut 15000 17250
1057 Excision of Meckle’s Deverticulum 12000 13800
1058 Other Major Surgery 27000 31050
1059 Other Minor Surgery 11050 13000
TREATMENT PROCEDURE BURNS AND PLASTIC
SURGERY
1060 Primary Suturing of Wound 300 345
1061 Injection of Keloids - Ganglion 1099 1264
1062 Injection of Keloids - Haemangioma 1150 1323
1063 Free Grafts - Wolfe Grafts 1725 1984
1064 Free Grafts - Theirech- Small Area 5% 7475 8596
1065 Free Grafts - Large Area 10% 8000 9200
1066 Free Grafts - Very Large Area 20% and above. 10350 11903
1067 Skin Flaps - Rotation Flaps 8970 10316
1068 Skin Flaps - Advancement Flaps 12500 14375
1069 Skin Flaps - Direct- cross Leg Flaps- Cross Arm Flap 12500 14375
1070 Skin Flaps - Cross Finger 12500 14375
1071 Skin Flaps - Abdominal 9350 11000
1072 Skin Flaps - Thoracic 9350 11000
1073 Skin Flaps - Arm Etc. 11000 12650
1074 Subcutaneous Pedicle Flaps Raising 6900 7935
1075 Subcutaneous Pedicle Flaps Delay 5950 7000
1076 Subcutaneous Pedicle Flaps Transfer 5950 7000
1077 Cartilage Grafting 8625 9919
1078 Reduction of Facial Fractures of Nose 1380 1587
1079 Reduction of Facial Fractures of Maxilla 8000 9200
1080 Reduction of Fractures of Mandible & Maxilla - Eye Let 7475 8596
Splinting
1081 Reduction of Fractures of Mandible & Maxilla - Cast Netal 6900 7935
Splints
1082 Reduction of Fractures of Mandible & Maxilla - Gumming 7500 8625
Splints
1083 Internal Wire Fixation of Mandible & Maxilla 11500 13225
1084 Cleft Lip - repair. 11500 13225
1085 Cleft Palate Repair 12650 14548
1086 Primary Bone Grafting for alveolar cleft in Cleft Lip 11500 13225
1087 Secondary Surgery for Cleft Lip Deformity 10000 11500
1088 Secondary Surgery for Cleft Palate 12650 14548

64
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1089 Reconstruction of Eyelid Defects - Minor 6325 7274
1090 Reconstruction of Eyelid Defects - Major 8500 9775
1091 Plastic Surgery of Different Regions of the Ear - Minor 8050 9258
1092 Plastic Surgery of Different Regions of the Ear - Major 10350 11903
1093 Plastic Surgery of the Nose - Minor 8050 9258
1094 Plastic Surgery of the Nose - Major 9500 10925
1095 Plastic Surgery for Facial Paralysis (Support with 16100 18515
Reanimation)
1096 Pendulous Breast - Mammoplasty 13000 14950
1097 Underdeveloped Breast Mammoplasty 12000 13800
1098 After Mastectomy (Reconstruction)Mammoplasty 12000 13800
1099 Syndactyly Repair 12750 15000
1100 Dermabrasion Face 13225 15209
1101 upto 30% Burns 1st Dressing 152 175
1102 upto 30% Burns Subsequent Dressing 124 143
1103 30% to 50% Burns 1st Dressing 193 222
1104 30% to 50% Burns Subsequent Dressing 152 175
1105 Extensive Burn -above 50% Frist Dressing 276 317
1106 Extensive Burn -above 50% Subsequent dressing 193 222
TREATMENT PROCEDURE ORTHOPEDICS
1107 Plaster Work 255 300
1108 Fingers (post slab) 259 298
1109 Fingers full plaster 259 298
1110 Colles Fracture - Below elbow 978 1125
1111 Colles Fracture - Full plaster 994 1143
1112 Colles fracture Ant. Or post. slab 400 460
1113 Above elbow full plaster 173 199
1114 Above Knee post-slab 575 288
1115 Below Knee full plaster 173 199
1116 Below Knee post-slab 718 826
1117 Tube Plaster (or plaster cylinder) 800 920
1118 Above knee full plaster 1265 1455
1119 Above knee full slab 1158 1332
1120 Minerva Jacket 2415 2777
1121 Plaster Jacket 2185 2513
1122 Shoulder spica 1955 2248
1123 Single Hip spica 2243 2579
1124 Double Hip spica 2760 3174
1125 Strapping of Finger 179 206
1126 Strapping of Toes 180 207
1127 Strapping of Wrist 230 265
1128 Strapping of Elbow 262 301
1129 Strapping of Knee 345 397
1130 Strapping of Ankle 345 397
1131 Strapping of Chest 460 529
1132 Strapping of Shoulder 518 596
1133 Figure of 8 bandage 518 596

65
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1134 Collar and cuff sling 255 300
1135 Ball bandage 400 460
1136 Application of P.O.P Casts for Upper & Lower Limbs 633 728
1137 Application of Functiol Cast Brace 1350 1553
1138 Application of Skin Traction 690 794
1139 Application of Skeletal Tractions 949 1091
1140 Bandage & Strappings for Fractures 552 635
1141 Aspiration & Intra Articular Injections 575 661
1142 Application of P.O.P Spices & Jackets 2473 2844
1143 Close Reduction of Fractures of Limb & P.O.P 2600 2990
1144 Reduction of Compound Fractures 2760 3174
1145 Open Reduction & Internal Fixation of Fingurs & Toes 5175 5951
1146 Open Reduction offracture of Long Bones of Upper / Lower 8050 9258
Limb -iling & Exterl Fixation
1147 Open Reduction of fracture of Long Bones of Upper / Lower 9660 11109
Limb -AO Procedures
1148 Tension Band Wirings 5658 6507
1149 Bone Grafting 6601 7591
1150 Excision of Bone Tumours 6900 7935
1151 Excision or other Operations for Scaphoid Fractures 7188 8266
1152 Sequestrectomy & Saucerisation 6900 7935
1153 Sequestrectomy & Saucerizations -Arthrotomy 9971 11467
1154 Multiple Pinning Fracture Neck Femur 11500 13225
1155 Plate Fixations for Fracture Neck Femur 13500 15525
1156 [Link] Procedures for Fracture Neck Femur 16560 19044
1157 Open Reduction of Fracture Neck Femur Muscle Pedicle 19500 22425
Graft and Internal Fixations
1158 Close Reduction of Dislocations 3174 3650
1159 Open Reduction of Dislocations 3439 3955
1160 Open Reduction of Fracture Dislocation & Internal Fixation 13500 15525

1161 Neurolysis/Nerve repair 13800 15870

1162 Nerve Repair with Grafting 16675 19176
1163 Tendon with Transplant or Graft 10350 11903
1164 Tendon Lengthening/Tendon repair 8050 9258
1165 Tendon Transfer 3105 3571
1166 Laminectomy Excision Disc and Tumours 4830 5555
1167 Spil Ostectomy and Internal Fixations 24150 27773
1168 Anterolateral decompression for tuberculosis/ Costo- 3450 3968
Transversectomy
1169 Antereolateral Decompression and Spil Fusion 19350 22253
1170 Corrective Ostectomy & Internal Fixation - short bones 13800 15870
1171 Corrective Ostectomy & Internal Fixation - long bones 11040 12696
1172 Arthrodesis of - Minor Joints 10350 11903
1173 Arthrodesis of - Major Joints 10000 11500
1174 Soft Tissue Operations for C.T.E.V. 8050 9258
1175 Soft Tissue Operations for Polio 6900 7935

66
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1176 Hemiarthroplasty- Hip 20000 23000
1177 Hemiarthroplasty- Shoulder 20000 23000
1178 Operations for Brachial Plexus & Cervical Rib 24150 27773
1179 Amputations - Below Knee 6900 7935
1180 Amputations - Below Elbow 6843 7869
1181 Amputations - Above Knee 8050 9258
1182 Amputations - Above Elbow 6843 7869
1183 Amputations - Forequarter 13225 15209
1184 Amputations -Hind Quarter and Hemipelvectomy 18400 21160
1185 Disarticulations - Major joint 20700 23805
1186 Disarticulations - Minor joint 12650 14548
1187 Arthrography 9200 10580
1188 Arthroscopy - Diagnostic 8568 9853
1189 Arthroscopy-therapeutic: without implant 10000 11500
1190 Arthroscopy-therapeutic: with implant 17250 19838
1191 Soft Tissue Operation on JOINTS -SMALL 6900 7935
1192 Soft Tissue Operation on JOINTS -LARGE 13500 15525
1193 Myocutaneous and Fasciocutaneous Flap Procedures for 18630 21425
Limbs
1194 Removal of Wires & Screw 1760 2024
1195 Removal of Plates 4140 4761
1196 Total Hip Replacement 79000 90850
1197 Total Ankle Joint Replacement 95400 109710
1198 Total Knee Joint Replacement 110000 126500
1199 Total Shoulder Joint Replacement 79000 90850
1200 Total Elbow Joint Replacement 79000 90850
1201 Total Wrist Joint Replacement 100000 115000
1202 Total finger joint replacement 20000 23000
1203 Tubular external fixator 4600 5290
1204 Ilizarov's external fixator 7763 8927
1205 Pelvi-acetebular fracture -Internal fixation 8625 9919
1206 Meniscectomy 12000 13800
1207 Meniscus Repair 10000 11500
1208 ACL Reconstruction 8500 9775
1209 PCL Reconstruction 13500 15525
1210 Knee Collateral Ligament Reconstruction 12500 14375
1211 Bencarf Repair Shoulder 13200 15180
1212 RC Repair 1500 1725
1213 Biceps tenodesis 14000 16100
1214 Distal biceps tendon repair 10380 11937
1215 Arthrolysis of knee 12500 14375
1216 Capsulotomy of Shoulder 15800 18170
1217 Conservative Pop 1200 1380
1218 Application for CTEV per sitting 1200 1380
1219 Total Hip Replacement Revision Stage-I 17000 19550
1220 Total Hip Replacement Revision Stage-II 50000 57500
1221 Total Knee Replacement Revision Stage-I 35000 40250

67
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1222 Total Knee Replacement Revision Stage-II 35000 40250
1223 Illizarov/ external fixation for limb lengthening/ deformity 12500 14375
correction
1224 Discectomy/ Micro Discectomy 12500 14375
1225 Laminectomy 4646 5343
1226 Spinal Fixation Cervical/dorsolumbar/ lumbosacral 16000 18400
1227 Fusion Surgery Cervical/ Lumbar Spine upto 2 Level 22000 25300
1228 More than 2 Level 12000 13800
1229 Scoliosis Surgery/ Deformity Correction of Spine 25000 28750
1230 Vertebroplasty 12000 13800
1231 Spinal Injections 450 518
1232 DHS for Fracture Neck Femur 15000 17250
1233 Proximal Femoral Nail (PFN for IT Fracture) 14000 16100
1234 Spinal Osteotomy 1434 1649
1235 Illizarov’s / External Fixation for Trauma 13000 14950
1236 Soft Tissue Operations for Polio/ Cerebral Palsy 10557 12420
1237 Mini Fixator for Hand/Foot 9000 10350
1238 Other Major Surgery 38250 45000
1239 Other Minor Surgery 11883 13980
TREATMENT PROCEDURE PHYSIOTHERAPY
1240 Ultrasonic therapy 78 90
1241 S.W. Diathermy 78 90
1242 Electrical stimulation (therapeutic) 78 90
1243 Muscle testing and diagnostic 71 82
1244 Infra red 78 90
1245 U.V. Therapeutic dose 58 67
1246 Intermittent Lumbar Traction 78 90
1247 Intermittent Cervical traction 75 86
1248 Wax bath 75 86
1249 Hot pack 78 90
1250 Breathing Exercises & Postural Drainage 50 58
1251 Cerebral Palsy – exercise 50 58
1252 Post – polio exercise 50 58
NUCLEAR MEDICINE / RADIOTHERAPY AND
CHEMOTHERAPY
1253 Cobalt 60 therapy
1254 Radical therapy 68425 78689
1255 Palliative therapy 24438 28104
1256 Linear accelerator
1257 Radical therapy 58650 67448
1258 Palliative therapy 34213 39345
1259 3 D Planning 4888 5621
1260 2 D Planing 4888 5621
1261 IMRT(Intensity Modulated radiotherapy) 100878 116010
1262 SRT (Stereotactic radiotherapy) 60996 70145
1263 SRS(Stereotactic radio surgery) 80546 92628
1264 IGRT(Image guided radiotherapy) 147016 169068

68
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1265 Respiratory Gating-alongwith Linear accelerator planning 110000 126500

1266 Electron beam with Linear accelerator 67473 79380

1267 Tomotherapy 79400 91310
NUCLEAR MEDICINE / BRACHYTHERAPY- HIGH
DOSE RADIATION
1268 Intracavitory 11730 13490
1269 Interstitial 58650 67448
1270 Intraluminal 9775 11241
1271 Surface mould 4644 5341
1272 GLIADAL WAFER 93900 107985
NUCLEAR MEDICINE / CHEMOTHARAPY
1273 Neoadjuvant 863 992
1274 Adjuvant 863 992
1275 Concurrent-chemoadiation 920 1058
1276 Single drug 552 635
1277 Multiple drugs 897 1032
1278 Targeted therapy 920 1058
1279 Chemoport facility 920 1058
1280 PICC line (peripherally inserted Central canulisation) 920 1058
LIST OF PROCEDURES/ TESTS IN

GASTROENTEROLOGY / ENDOSCOPIC PROCEDURES

1281 Upper G.I. Endoscopy + Lower G.I. Endoscopy 1725 1984
1282 Diagnostic endoscopy 250 288
1283 Endoscopic biopsy 345 397
1284 Endoscopic mucosal resection 1543 1815
1285 Oesophageal stricture dilatation 1725 1984
1286 Balloon dilatation of achalasia cardia 2875 3306
1287 Foreign body removal 1725 1984
1288 Oesophageal stenting 3000 3450
1289 Band ligation of oesophageal varices 2500 2875
1290 Sclerotherapy of oesophageal varices 2500 2875
1291 Glue injection of varices 2500 2875
1292 Argon plasma coagulation 4025 4629
1293 Pyloric balloon dilatation 2415 2777
1294 Enteranal stenting 3680 4232
1295 Duodenal stricture dilation 990 1139
1296 Single balloon enterocopy 4000 4600
1297 Double balloon enteroscopy 3500 4025
1298 Capsule endoscopy 4950 5693
1299 Piles banding 1099 1264
1300 Colonic stricture dilatation 2737 3148
1301 Hot biopsy forceps procedures 3000 3450
1302 Colonic stenting 2737 3148
1303 Junction biopsy 2000 2300
1304 Conjugal microscopy 4000 4600

69
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1305 Endoscopic sphincterotomy 2415 2777
1306 CBD stone extraction 2415 2777
1307 CBD stricture dilatation 6500 7475
1308 Biliary stenting (plastic and metallic) 4830 5555
1309 Mechanical lithotripsy of CBD stones 8000 9200
1310 Pancreatic sphincterotomy 6375 7500
1311 Pancreatic stricture dilatation 5750 6613
1312 Pancreatic stone extraction 10098 11613
1313 Mechanical lithotripsy of pancreatic stones 11385 13093
1314 Endoscopic cysto gastrostomy 8050 9258
1315 Balloon dilatation of papilla 6900 7935
1316 Ultrasound guided FNAC 575 661
1317 Ultrasound guided abscess Drainage 720 828
1318 PTBD 1150 1323
1319 Diagnostic angiography 2000 2300
1320 Vascular embolization 15100 17365
1321 TIPS 5400 6210
1322 IVC graphy + hepatic veinography 34212 39344
1323 Muscular stenting 97750 112413
1324 BRTO 57500 66125
1325 Portal haemodymic studies 1913 2250
1326 Manometry and PH metry 1612 1897
1327 Oesophageal PH metry 5000 5750
1328 Oesophageal manometry 5000 5750
1329 Small bowel manometry 6800 8000
1330 Anorectal manometry 6800 8000
1331 Colonic manometry 7650 9000
1332 Biliary manometry 7650 9000
1333 Sengstaken blackenesse tube tempode 2875 3306
1334 Lintas machles tube tempode 2875 3306
1335 Fecal fat test/ fecal chymotrypsin/ fecal elastase 350 403
1336 Breath tests 300 345
1337 Extra corporeal shortwave lithotripsy 41400 47610
1338 Liver biopsy 1380 1587
NAME OF INVESTIGATION / DENTAL
1339 Dental IOPA X-ray 50 58
1340 Occlusal X-ray 78 90
1341 OPG X-ray 196 225
NAME OF INVESTIGATION / PULMONARY
1342 Lung Ventilation & Perfusion Scan (V/Q Scan) 3600 4140
1343 Lung Perfusion Scan 2000 2300
NAME OF INVESTIGATION / OSTEOLOGY
1344 Whole Body Bone Scan with SPECT. 3421 3934
1345 Three phase whole body Bone Scan 3421 3934
NAME OF INVESTIGATION / NEUROSCIENCES
1346 Brain Perfusion SPECT Scan with Technetium 99m 9775 11241
radiopharmaceuticals.

70
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1347 Radionuclide Cisternography for CSF leak 3740 4400
NAME OF INVESTIGATION / GASTRO AND
HEPATOBILIARY
1348 Gastro esophageal Reflux Study (G.E.R. Study) 1955 2248
1349 Gastro intestinal Bleed (GloB.) Study with Technetium 99m 3421 3934
labeled RBCs.
1350 Hepatobiliary Scintigraphy. 2444 2811
1351 Meckel's Scan 1955 2248
1352 Hepatosplenic scintigraphy with Technetium-99m 1870 2200
radiopharmaceuticals
1353 Gastric emptying 1275 1466
NAME OF INVESTIGATION / GENITOURINARY
1354 Renal Cortical Scintigraphy with Technetium 99m D.M.S.A. 3421 3934

1355 Dynamic Renography. 3421 3934

1356 Dynamic Renography with Diuretic. 3421 3934
1357 Dynamic Renography with Captopril 1960 2254
1358 Testicular Scan 1466 1686
NAME OF INVESTIGATION / ENDOCRINOLOGY
1359 Thyroid Uptake measurements with 131-Iodine. 1564 1799
1360 Thyroid Scan with Technetium 99m Pertechnetate. 1466 1686
1361 Lodine-131 Whole Body Scan. 2933 3373
1362 Whole Body Scan with M.I.B.G. 17595 20234
1363 Parathyroid Scan 4888 5621
NAME OF INVESTIGATION / RADIO-ISOTOPE
THERAPY
1364 131-lodine Therapy 1530 1800
1365 131-lodine Therapy <15mCi 3854 4432
1366 131-lodine Therapy 15-50mCi 4956 5699
1367 131-lodine Therapy 51-100mCi 12000 13800
1368 131-lodine Therapy >100mCi 15000 17250
1369 Phosphorus-32 therapy for metastatic bone pain palliation 5000 5750

1370 Samarium-153 therapy for metastatic bone pain palliation 10450 12018

1371 Radiosynovectomy with Yttrium 21250 25000

NAME OF INVESTIGATION / CARDIOLOGY
1372 Stress thallium / Myocardial Perfusion Scintigraphy 9450 10868
1373 Rest thallium / Myocardial Perfusion Scintigraphy 8000 9200
1374 Venography 3300 3795
1375 TMT 489 562
1376 TEE 489 562
1377 Lymph angiography 1613 1855
NAME OF INVESTIGATION / TUMOUR IMAGING

1378 Scintimammography. 4800 5520

1379 Indium lableled octeriotide Scan. 73313 84310

71
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

NAME OF INVESTIGATION / PET SCAN
1380 FDG Whole body PET / CT Scan 20528 23607
1381 Brain I Heart FDG PET / CTScan, 14663 16862
1382 Gallium-68 Peptide PET / CT imaging for Neuroendocrine 15000 17250
Tumor
LABORATORY MEDICINE / CLINICAL PATHOLOGY

1383 Urine routine- pH, Specific gravity, sugar, protein and 35 40

microscopy
1384 Urine-Microalbumin 70 81
1385 Stool routine 35 40
1386 Stool occult blood 24 28
1387 Post coital smear examination 30 35
1388 Semen analysis 35 40
LABORATORY MEDICINE / HAEMATOLOGY
1389 Haemoglobin (Hb) 18 21
1390 Total Leucocytic Count (TLC) 31 36
1391 Differential Leucocytic Count (DLC) 31 36
1392 E.S.R. 25 29
1393 Total Red Cell count with MCV,MCH,MCHC,DRW 32 37
1394 Complete Haemogram/CBC, Hb,RBC count and indices, 135 155

TLC, DLC, Platelet, ESR, Peripheral smear examination

1395 Platelet count 48 55
1396 Reticulocyte count 48 55
1397 Absolute Eosinophil count 48 55
1398 Packed Cell Volume (PCV) 13 15
1399 Peripheral Smear Examination 43 49
1400 Smear for Malaria parasite 41 47
1401 Bleeding Time 35 40
1402 Osmotic fragility Test 50 58
1403 Bone Marrow Smear Examination 70 81
1404 Bone Marrow Smear Examination with iron stain 250 288
1405 Bone Marrow Smear Examination and cytochemistry 440 506
1406 Activated partial ThromboplastinTime (APTT) 102 117
1407 Rapid test for malaria(card test) 44 51
1408 WBC cytochemistry for leukemia -Complete panel 110 127
1409 Bleeding Disorder panel- PT, APTT, Thrombin Time 400 460
Fibrinogen, D-Dimer/ FDP
1410 Factor Assays-Factor VIII 720 828
1411 Factor Assays-Factor IX 680 782
1412 Platelet Function test 50 58
1413 Tests for hypercoagulable states- Protein C, Protein S, 400 460
Antithrombin
1414 Tests for lupus anticoagulant 150 173
1415 Tests for Antiphospholipid antibody IgG, IgM ( for 500 575
cardiolipin and B2 Glycoprotein 1)

72
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1416 Thalassemia studies (Red Cell indices and Hb HPLC) 560 644
1417 Tests for Sickling / Hb HPLC) 77 89
LABORATORY MEDICINE / BLOOD BANK
1418 Blood Group & RH Type 30 35
1419 Cross match 50 58
1420 Coomb’s Test Direct 90 104
1421 Coomb’s Test Indirect 100 115
1422 3 cell panel- antibody screening for pregnant female 170 200
1423 11 cells panel for antibody identification 170 200
1424 HBs Ag 102 120
1425 HCV 128 150
1426 HIV I and II 150 173
1427 VDRL 43 50
1428 RH Antibody titer 80 92
1429 Platelet Concentrate 56 64
1430 Random Donor Platelet(RDP) 128 150
1431 Single Donor Platelet (SDP- Aphresis) 150 173
LABORATORY MEDICINE / HISTOPATHOLOGY
1432 Routine-H & E 90 104
1433 special stain 65 75
1434 Immunohistochemistry(IHC) 750 863
1435 Frozen section 780 897
1436 Paraffin section 343 394
LABORATORY MEDICINE / CYTOLOGY
1437 Pap Smear 150 173
1438 Body fluid for Malignant cells 150 173
1439 FNAC 200 230
NAME OF INVESTIGATION / FLOW CYTOMETRY

1440 Leukemia panel /Lymphoma panel 1536 1766

1441 PNH Panel-CD55,CD59 1000 1150
LABORATORY MEDICINE / CYTOGENETIC STUDIES

1442 Karyotyping 1539 1770

1443 FISH 500 575
LABORATORY MEDICINE / BIO-CHEMISTRY
1444 Blood Glucose Random 24 28
1445 24 hrs urine for Proteins,Sodium, creatinine 50 58
1446 Blood Urea Nitrogen 54 62
1447 Serum Creatinine 55 63
1448 Urine Bile Pigment and Salt 25 29
1449 Urine Urobilinogen 20 23
1450 Urine Ketones 30 35
1451 Urine Occult Blood 35 40
1452 Urine total proteins 18 21
1453 Rheumatoid Factor test 100 115
1454 Bence Jones protein 47 54

73
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1455 Serum Uric Acid 55 63
1456 Serum Bilirubin total & direct 80 92
1457 Serum Iron 90 104
1458 C.R.P. 100 115
1459 C.R.P Quantitative 160 184
1460 Body fluid (CSF/Ascitic Fluid etc.)Sugar, Protein etc. 90 104
1461 Albumin. 18 21
1462 Creatinine clearance. 80 92
1463 Serum Cholesterol 62 71
1464 Total Iron Binding Capacity 80 92
1465 Glucose (Fasting & PP) 47 54
1466 Serum Calcium –Total 60 69
1467 Serum Calcium –Ionic 44 51
1468 Serum Phosphorus 60 69
1469 Total Protein Alb/Glo Ratio 50 58
1470 IgG. 250 288
1471 IgM. 250 288
1472 IgA. 250 288
1473 ANA. 200 230
1474 Ds DNA. 350 403
1475 S.G.P.T. 55 63
1476 S.G.O.T. 55 63
1477 Serum amylase 117 135
1478 Serum Lipase 130 150
1479 Serum Lactate 72 83
1480 Serum Magnesium 100 115
1481 Serum Sodium 50 58
1482 Serum Potassium 50 58
1483 Serum Ammonia 100 115
1484 Anemia Profile 204 240
1485 Serum Testosterone 150 173
1486 Imprint Smear From Endoscopy 240 276
1487 Triglyceride 75 86
1488 Glucose Tolerance Test (GTT) 90 104
1489 Triple Marker. 800 920
1490 C.P.K. 100 115
1491 Foetal Haemoglobin (HbF) 85 100
1492 Prothrombin Time (P.T.) 110 127
1493 L.D.H. 100 115
1494 Alkaline Phosphatase 60 69
1495 Acid Phosphatase 78 90
1496 CK MB 190 219
1497 CK MB Mass 140 161
1498 Troponin I 100 115
1499 Troponin T 600 690
1500 Glucose Phosphate Dehydrogenase (G, 6PD) 100 115
1501 Lithium. 130 150

74
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1502 Dilantin (phenytoin). 400 460
1503 Carbamazepine. 400 460
1504 Valproic acid. 300 345
1505 Feritin. 250 288
1506 Blood gas analysis 120 138
1507 Blood gas analysis with electrolytes 460 529
1508 Urine pregnancy test 65 75
1509 Tests for Antiphospholipid antibodies syndrome. 280 322
1510 Hb A1 C 130 150
1511 Hb Electrophoresis/ Hb HPLC 100 115
1512 Kidney Function Test. 225 259
1513 Liver Function Test. 225 259
1514 Lipid Profile.( Total cholesterol,LDL,HDL,treigylcerides) 200 230

Nutritional Markers
1515 Serum Iron 90 104
1516 Total Iron Binding Capacity 90 104
1517 Serum Ferritin 100 115
1518 Vitamin B12 assay. 250 288
1519 Folic Acid assay. 300 345
1520 Extended Lipid Profile.( Total 595 684

cholesterol,LDL,HDL,treigylcerides,Apo A1,Apo B,Lp(a) )

1521 Apo A1. 200 230
1522 Apo B. 199 229
1523 Lp (a). 445 512
1524 CD 3,4 and 8 counts 170 200
1525 CD 3,4 and 8 percentage 170 200
1526 LDL. 62 71
1527 Homocysteine. 400 460
1528 HB Electrophoresis. 440 506
1529 Serum Electrophoresis. 220 253
1530 Fibrinogen. 165 190
1531 Chloride. 60 69
1532 Magnesium. 150 173
1533 GGTP. 90 104
1534 Lipase. 239 275
1535 Fructosamine. 200 230
1536 β2 microglobulin 90 104
1537 Catecholamines. 1050 1208
1538 Creatinine clearance. 120 138
NAME OF INVESTIGATION / TUMOUR MARKERS

1539 PSA- Total. 312 359

1540 PSA- Free. 375 431
1541 AFP. 300 345
1542 HCG. 289 332

75
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1543 CA. 125. 391 450
1544 CA 19,9. 616 708
1545 CA 15.3. 560 644
1546 Vinyl Mandelic Acid 350 403
1547 Calcitonin 500 575
1548 Carcioembryonic antigen(CEA) 340 391
OTHERS
1549 Immunofluorescence 150 173
1550 Direct(Skin and kidney Disease) 425 500
1551 Indirect (antids DNA Anti Smith ANCA) 425 500
1552 VitD3 assay 550 633
1553 Serum Protein electrophoresis with 300 345
immunofixationelectrophoresis (IFE)
1554 BETA-2 Microglobulin assay 100 115
1555 Anti cycliocitrullinated peptide (Anti CCP) 450 518
1556 Anti tissuetransglutaminase antibody 425 500
1557 Serum Erythropoetin 425 500
1558 ACTH 500 575
HARMONES
1559 T3, T4, TSH 200 230
1560 T3 64 75
1561 T4 64 75
1562 TSH 90 104
1563 LH 150 173
1564 FSH 150 173
1565 Prolactin 150 173
1566 Cortisol 250 288
1567 PTH(Paratharmone) 500 575
1568 C-Peptide. 330 380
1569 Insulin. 150 173
1570 Progesterone. 225 259
1571 17-DH Progesterone. 440 506
1572 DHEAS. 440 506
1573 Androstendione. 600 690
1574 Growth Hormone. 340 391
1575 TPO. 300 345
1576 Throglobulin. 300 345
1577 Hydatic Serology. 318 374
1578 Anti Sperm Antibodies. 380 437
1579 HBV DNA Qualitative 2000 2300
1580 HBV DNA Quantitative. 1500 1725
1581 HCV RNA Qualitative. 1691 1945
1582 HPV serology 218 251
1583 Rota Virus serology 130 150
1584 PCR for TB 900 1035
1585 PCR for HIV 600 690
1586 Chlamydae antigen 850 978

76
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1587 chlamydae antibody 238 280
1588 Brucella serology 230 265
1589 Influenza A serology 943 1084
USG, X-RAY , CT, MRI, BONE DENSITOMETRY
1590 USG for Obstetrics - Anomalies scan 770 886
1591 Abdomen USG 323 380
1592 Pelvic USG ( prostate, gynae, infertility etc) 255 300
1593 Small parts USG ( scrotum, thyroid , parathyroid etc) 349 410
1594 Neonatal head (Tranfontanellar) 425 489
1595 Neonatal spine 500 575
1596 Contrast enhanced USG 900 1035
1597 USG Breast 349 410
1598 USG Hystero-Salpaingography (HSG) 255 300
1599 Carotid Doppler 850 1000
1600 Arterial Colour Doppler 706 830
1601 Venous Colour Doppler 706 830
1602 Colour Doppler, renal arteries/any other organ 800 920
1603 USG guided intervention- FNAC 490 564
1604 USG guided intervention - biopsy 720 828
1605 USG guided intervention - nephrostomy 800 920
X-Ray
1606 Abdomen AP Supine or Erect (One film) 128 150
1607 Abdomen Lateral view (one film) 128 150
1608 Chest PA view (one film) 60 70
1609 Chest Lateral (one film) 60 70
1610 Mastoids: Towne view, oblique views (3 films) 250 288
1611 Extremities, bones & Joints AP & Lateral views (Two films) 255 300

1612 Pelvis A.P (one film) 110 127

1613 T. M. Joints (one film) 110 127
1614 Abdomen & Pelvis for K. U. B. 128 150
1615 Skull A. P. & Lateral (2 films) 255 300
1616 Spine A. P. & Lateral (2 films) 250 288
1617 PNS view (1 film) 110 127
X RAY CONTRAST STUDIES
1618 Barium Swallow 510 600
1619 Barium Upper GI study 800 920
1620 Barium Upper GI study (Double contrast) 935 1100
1621 Barium Meal follow through 935 1100
1622 Barium Enema (Single contrast/double contrast) 850 1000
1623 Small bowel enteroclysis 1020 1200
1624 ERCP (Endoscopic Retrograde Cholangio – 2500 2875
Pancreatography)
1625 General :Fistulography 638 750
/Sinography/Sialography/Dacrocystography/ T-Tube
cholangiogram/Nephrostogram
1626 Percutaneous transhepatic cholangiography (PTC) 1440 1656

77
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1627 Intravenous Pyelography (IVP) 1190 1400
1628 Micturating Cystourethrography (MCU) 680 800
1629 Retrograde Urethrography (RGU) 680 800
1630 Contrast Hystero-Salpingography (HSG) 1020 1200
1631 X ray - Arthrography 700 805
1632 Cephalography 150 173
1633 Myelography 2750 3163
1634 Diagnostic Digital Subtraction Angiography (DSA) 1749 2011
MAMMOGRAPHY
1635 X-ray Mammography 315 370
1636 MRI Mammography 2550 3000
CT
1637 CT Head-Without Contrast 900 1035
1638 CT Head- with Contrast (+/- CT angiography) 1350 1553
1639 C. T. Chest - without contrast (for lungs) 1700 2000
1640 C. T. Scan Lower Abdomen(incl. Pelvis) With Contrast 1700 1955
1641 C. T. Scan Lower Abdomen( Incl. Pelvis) Without Contrast 1500 1725

1642 C. T. Scan Whole Abdomen Without Contrast 3000 3450

1643 C. T. Scan Whole Abdomen With Contrast 4500 5175
1644 Triple Phase CT abdomen 4500 5175
1645 CT angiography abdomen/ Chest 4500 5175
1646 CT Enteroclysis 6000 6900
1647 C. T. Scan Neck – Without Contrast 1500 1725
1648 C. T. Scan Neck – With Contrast 1870 2200
1649 C. T. Scan Orbits - Without Contrast 1190 1400
1650 C. T. Scan Orbits - With Contrast 1615 1900
1651 C. T. Scan of Para Nasal Sinuses- Without Contrast 900 1035
1652 C. T. Scan of Para Nasal Sinuses - With Contrast 1600 1840
1653 C. T. Spine (Cervical, Dorsal, Lumbar, Sacral)–without 1500 1725
contrast
1654 CT Temporal bone – without contrast 893 1050
1655 CT - Dental 1275 1500
1656 C. T. Scan Limbs -Without Contrast 1700 2000
1657 C. T. Scan Limbs -With Contrast including CT angiography 2253 2650

1658 C.T. Guided intervention –FNAC 1200 1380

1659 C.T. Guided Trucut Biopsy 1200 1380
1660 C. T. Guided intervention -percutaneous catheter drainage / 1305 1535
tube placement
MRI
1661 MRI Head – Without Contrast 1998 2350
1662 MRI Head – With Contrast 2848 3350
1663 MRI Orbits – Without Contrast 1445 1700
1664 MRI Orbits – With Contrast 2000 2300
1665 MRI Nasopharynx and PNS – Without Contrast 2450 2818
1666 MRI Nasopharynx and PNS – With Contrast 3500 4025

78
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1667 MR for Salivary Glands with Sialography 3000 3450
1668 MRI Neck - Without Contrast 3000 3450
1669 MRI Neck- with contrast 5000 5750
1670 MRI Shoulder – Without contrast 2000 2300
1671 MRI Shoulder – With conntrast 2600 3000
1672 MRI shoulder both Joints - Without contrast 3000 3450
1673 MRI Shoulder both joints – With contrast 4000 4600
1674 MRI Wrist Single joint - Without contrast 2125 2500
1675 MRI Wrist Single joint - With contrast 4000 4600
1676 MRI Wrist both joints - Without contrast 2125 2500
1677 MRI Wrist Both joints - With contrast 5000 5750
1678 MRI knee Single joint - Without contrast 2125 2500
1679 MRI knee Single joint - With contrast 5000 5750
1680 MRI knee both joints - Without contrast 2125 2500
1681 MRI knee both joints - With contrast 5000 5750
1682 MRI Ankle Single joint - Without contrast 2125 2500
1683 MRI Ankle single joint - With contrast 5000 5750
1684 MRI Ankle both joints - With contrast 5000 5750
1685 MRI Ankle both joints - Without contrast 2500 2875
1686 MRI Hip - With contrast 2500 2875
1687 MRI Hip – without contrast 2125 2500
1688 MRI Pelvis – Without Contrast 2125 2500
1689 MRI Pelvis – with contrast 5000 5750
1690 MRI Extremities - With contrast 5000 5750
1691 MRI Extremities - Without contrast 2125 2500
1692 MRI Temporomandibular – B/L - With contrast 4000 4600
1693 MRI Temporomandibular – B/L - Without contrast 2125 2500
1694 MR Temporal Bone/ Inner ear with contrast 4000 4600
1695 MR Temporal Bone/ Inner ear without contrast 2500 2875
1696 MRI Abdomen – Without Contrast 2125 2500
1697 MRI Abdomen – With Contrast 5000 5750
1698 MRI Breast - With Contrast 4250 5000
1699 MRI Breast - Without Contrast 2125 2500
1700 MRI Spine Screening - Without Contrast 1000 1150
1701 MRI Chest – Without Contrast 2125 2500
1702 MRI Chest – With Contrast 4000 4600
1703 MRI Cervical/Cervico Dorsal Spine – Without Contrast 2125 2500
1704 MRI Cervical/ Cervico Dorsal Spine – With Contrast 4000 4600
1705 MRI Dorsal/ Dorso Lumbar Spine - Without Contrast 2125 2500
1706 MRI Dorsal/ Dorso Lumbar Spine – With Contrast 4000 4600
1707 MRI Lumbar/ Lumbo-Sacral Spine – Without Contrast 2125 2500
1708 MRI Lumbar/ Lumbo-Sacral Spine – With Contrast 5000 5750
1709 Whole body MRI (For oncological workup) 5100 6000
1710 MR cholecysto-pancreatography. 5500 6325
1711 MRI Angiography - with contrast 5000 5750
1712 MR Enteroclysis 2125 2500
BONE DENSITOMETRY (DEXA SCAN)

79
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1713 Dexa Scan Bone Densitometry - Two sites 1500 1725
1714 Dexa Scan Bone Densitometry - Three sites (Spine, Hip & 2000 2300
extremity)
1715 Dexa Scan Bone Densitometry Whole body 2450 2818
NEUROLOGICAL INVESTIGATIONS AND
PROCEDURES
1716 EEG/Video EEG 298 350
1717 EMG (Electro myography) 638 750
1718 Nerve condition velocity (at least 2 limbs) 638 750
1719 Decremental response (before and after neo stigmine) 595 700
1720 Incremental response 595 700
1721 SSEP (Somato sensory evoked potentials) 638 750
1722 Poly somnography 638 750
1723 Brachial plexus study 638 750
1724 Muscle biopsy 383 450
1725 ACHR anti body titre 1848 2125
1726 Anti MUSK body titre 2340 2691
1727 Serum COPPER 500 575
1728 Serum ceruloplasmin 450 518
1729 Urinary copper 500 575
1730 Serum homocystine 450 518
1731 Serum valproate level 315 362
1732 Serum phenol barbitone level 350 403
1733 Coagulation profile 553 636
1734 Protein C, S anti thrombine – III 2400 2760
1735 Serum lactate level 450 518
CSF
1736 Basic studies including cell count, protein, sugar, gram stain, 240 276
India Ink preparation and smear for AFP
1737 Special studies 1000 1150
1738 PCR for tuberculosis/ Herpes simplex 1200 1380
1739 Bacterial culture and sensitivity 200 230
1740 Mycobacterial culture and sensitivity 200 230
1741 Fungal culture 128 150
1742 Malignant cells 64 75
1743 Anti measles antibody titre (with serum antibody titre) 890 1024
1744 Viral culture 255 300
1745 Antibody titre (Herpes simplex, cytomegalo virus, flavivirus, 760 874
zoster varicella virus)
1746 Oligoclonal band 1200 1380
1747 Myelin Basic protein 1871 2152
1748 Lactate 298 350
1749 Crypto coccal antigen 1138 1309
TESTS IN GASTRO-ENTEROLOGY
1750 D-xylase test 850 1000
1751 Fecal fat test/ fecal chymotrypsin/ fecal elastase 850 1000
1752 Breath tests 1300 1495

80
SR. NO. CGHS TREATMENT NON- NABH/NON- NABH/NABL

PROCEDURE/INVESTIGATION LIST (DELHI/NCR) NABL RATES RATES

1753 H pylori serology for ciliac disease 500 725
1754 HBV genotyping 2500 2875
1755 HCV genotyping 4875 5606
TESTS IN ENDOCRINOLOGY ( IN ADDITION TO
THOSE INCLUDED UNDER HARMONES)
1756 Urinary VMA 1500 1725
1757 Urinary metanephrine/Normetanephrine 1138 1309
1758 Urinary free catecholamine 1690 1944
1759 Serum catecholamine 3400 3910
1760 Serum aldosterone 1125 1294
1761 24 Hr urinary aldosterone 920 1058
1762 Plasma renin activity 1000 1150
1763 Serum aldosterone/renin ratio 1200 1380
1764 Osmolality urine 128 150
1765 Osmolality serum 128 150
1766 Urinary sodium 80 94
1767 Urinary Chloride 43 50
1768 Urinary potassium 80 94
1769 Urinary calcium 80 94
1770 Thyroid binding globulin 510 600
1771 24 hr. urinary free cotisole 200 230
1772 Islet cell antebody 750 863
1773 GAD antibody 1330 1530
1774 Insulin associated antibody 449 516
1775 IGF-1 1500 1725
1776 IGF-BP3 1650 1898
1777 Sex hormone binding globulin 1333 1533
1778 USG guided FNAC thyroid gland 387 455
1779 E2 208 245
1780 Thyro globulin antibody 587 675

81
Contd...Annexure-III

82
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94
95
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Contd...Annexure-III

100
101
102
Contd...Annexure-III

103
104
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 Annexure IV

Nominated Hospitals (Delhi/NCR)

Nominated Specialized Hospitals

[Link]. HOSPITAL NAME HOSPITAL ADDRESS
1 Aakash Healthcare Super specialty Hospital, Sector 3, Dwarka, New Delhi
2 Action Cancer Hospital B19 H-2/FC-34 A-4 Paschim Vihar, New delhi
3 Artemis Health Institute Sector-51, Gurugram
4 Artemis Hospitals Plot No.14, Sector-20, Dwarka, New Delhi
5 Asian Institute of Medical Sciences Badkal Flyover Road Sector-21A, Faridabad
6 Atlanta Hospital NH-01, Sector-14, Atal Chowk, Vasundhara, Ghaziabad
7 Ayushman Hospital Sector XII, Dwarka, New Delhi
8 Bharati Eye Hospital 1/3, East Patel Nagar, New Delhi
9 BL Kapur Memorial Hospital Pusa Road, Delhi
10 Center for Sight B- 5/24, Safdarjung Enclave, Delhi
11 Centre for Sight F-19, Main Vikas Marg, Preet Vihar, Delhi
12 Columbia Asia Block-F, Near Gol Chakkar, Palam Vihar, Gurugram
13 Cygnus Orthocare Hospital C5/29, Opp. IIT Main Gate Safdarjung Development Area Hauz
Khas, New Delhi
14 C K Birla Hospital for Women Block J, Mayfield Garden, Sector 51, Gurugram
15 Delhi Heart and Lung Institute 3mm-II, Panchkuian Road, New Delhi
16 Dharamshila Cancer Hospital & Research Centre Dharamshila Marg, Vasundhara Enclave, Delhi
17 Eye-Q Super Speciality Eye Hospitals i) C/o- Sheetla Hospital, New Railway Road,
Sector 8, Gurugram
(ii) Plot No. 522, Sector 27, Gurugram
18 Fortis Escorts Heart Institute. Okhla Road, New Delhi
19 Goyal Eye Hospital 1/10 East Patel Nagar, Opp. Metro Pillar No.176, Delhi
20 Holy Family Hospital Okhla Road, New Delhi
21 Indian Spinal Injuries Centre Sector-C, Vasant Kunj, Delhi
22 Jaypee Hospital, Sector 128, Noida, UP
23 Kailash Hospitals Ltd 23, KP 1 Greater Noida
24 Maharaja Agrasen Hospital Punjabi Bagh, New Delhi
25 Manipal Hospital (HCMCT Manipal Hospitals) Adjoining MTNL Building, Sec 6
Dwarka, New Delhi

26 Mata Channan Devi Hospital C-1, Janak Puri, New Delhi

27 Mayom Hospital South City-1, D-Block, Sector-30, Gurugram
28 Medeor (formely Rockland) Hospital B-33,34 Qutab Institutional Area, New Delhi
29 Medeor (formely Rockland) Hospital Limited Dwarka, Sector-12, Plot HAF-B, New Delhi
30 Medeor (formely Rockland) Hospital Manesar, Gurugram
31 Metro Hospitals & Heart Instt. 14, Ring Road, Lajpat Nagar, New Delhi
32 Metro Hospitals and Heart Institute X- I, Sector-12, Noida, UP
33 Metro Group of Hospital RLKC Hospital Metro Heart Naraina Road, Pandav Nagar, New Delhi
Institutes (A Unit of Dr. R L Khera Charitable trust)

34 Metro Hospital & Cancer Institute (A Unit of Metro 21, Community Center, Preet Vihar, Delhi – 110092
Medical Sciences Ltd)
35 Metro Hospital and Heart institute (A unit of Umkal H Block, Palam Vihar, Gurugram
Healthcare Pvt. Ltd),
36 Mohan Eye Institute 11-B, Sir Ganga Ram Hospital Marg,
37 Narayana Superspeciality Hospital Plot No. 3201, Block V, DLF PH III, Sec 24, Gurugram
38 Narinder Mohan Hospital & Heart Centre Mohan Nagar, Ghaziabad, UP
39 National Heart Institute 49-50, Community Centre, East of Kailash, New Delhi
40 Neo Hospital (A Unit of Muskan Medical Centre Pvt. D-170A, Sector- 50, Noida-201301
Ltd.)
41 Noida Medicare Centre Ltd. 16 C, Block-E, Sector-30, Noida
42 Paras Hospital C-1, Sushant Lok, Phase-1, Gurugram
43 Primus Hospital Chankya Puri, New Delhi
44 Pushpawati Singhania Research Instt. Prerss Enclave Marg, Sheikh Sarai Phase-II, New Delhi
45 QRG Health City Hospital Sector 16, Faridabad
46 Rajiv Gandhi Cancer Instt. and Research Centre Sector- V, Rohini, New Delhi
47 RG Stone Urological & Laproscopy Hospital F-12, East of Kailash, New Delhi

119
48 RG Stone Urology & Laparoscopy Hospital B-1, Vishal Enclave ,Opp. Police Station, Rajouri Garden, New
Delhi
49 RG Stone Urology & Laparoscopy Hospital 18, Gagan Vihar, New Delhi
50 RG Urology and Leproscopy Hospital 195, Depali Chowk, Pritam Pura, New Delhi
51 Saroj Hospital Sector-14, Extension, Institutional Area, Madhban Chowk, Rohini,
New Delhi
52 Sarvodaya Hospital & Research Centre YMCA Road, Sector-8, New Delhi
53 Sheetla Hospital and Eye Institute New Railway Road, New Delhi
54 Shanti Gopal Hospital Indira Puram, New Delhi
55 Sharp Sight Centre Pitampura & various branches -
56 Shroff Eye Hospital 1. A-9, Kailash Colony, New Delhi
2. 105, Surya Kiran Building, Ist Flr19, KG Marg, New Delhi
3. 110, Commerical Plaza, Radisson Suites, B-Block, Sushant Lok,
Phase-I, sector-27, Gurugram
57 Sukhmani Hospital B-7 Extn.126A, Safdarjung Enclave
58 Sunder Lal Jain Charitable Hospital New Delhi
59 Sunflag Hospital and Research Centre Sector- 16 A, Faridabad
60 St. Stephen’s Hospital Tis Hazari, New Delhi
61 Tirath Ram Shah Hospital 2, RBL Isher Das Sawhney Marg, Rajpur Road, New Delhi
62 Umkal Hospital and MP Heart Research Institute A-520, Sushant Lok- I, Gurugram
63 Vasan Eye Care 1) Parvtesh Tower , 36-B, Pusa Road, Opp. Pillar No.125, New
Delhi
2) A-1/20, Janakpuri, Opp. Metro Pillar No.634, New Delhi
64 Venu Eye Instt. and Research Centre 1/31, Sheikh Sarai [Link] Phase II, New Delhi
65 Vidyasagar Institute of Mental Health & 1, Institutional Area, Nehru Nagar, New Delhi
Neurosciences
66 Yashoda Super Speciality Hospital, H-1, 26, 27, Kaushambi, Near Metro Station, Ghaziabad
67 Yatharth Hospital Sector-110, Noida
68 Yatharth Welness Hospital and Trauma Centre Sector Omega - 1, Greater Noida
69 W Pratiksha Hospital (A unit of North East Health Golf Course Extension Road,
Care Pvt. Ltd) Sector 56, Sushant Lok II,Gurgaon,Haryana
Nominated Referal Hospitals in Delhi NCR
70 Batra Hospital and Medical Research Centre 1, Tguhlakabad Instl. Area, Mehrauli Badarpur Road, New Delhi-
110062
71 Fortis Hospital B-22, Sector-62, NOIDA, UP
72 Fortis Hospital Neelam Bata Road, Opp. Neelam Cinema, Faridabad
73 Fortis Flt Lt Rajan Dhal Sector -B Pocket 1,Vasant Kunj, New Delhi
74 Fortis Hospital Shalimar Bagh, New Delhi
75 Fortis Memorial Research Institute Sector 44, (Opp. HUDA City Center Metro Station), Gurugram

76 Indraprastha Apollo Hospital Sarita Vihar, Delhi-Mathura Road, New Delhi

77 Jaipur Golden Hospital 2, Institutional Area, Rohini, New Delhi- 110085
78 Kailash Hospital and Research Centre Ltd. H- 33, Sector-27, Noida- 201301, UP
79 Max Balaji Hospital 108-A, Indraprastha Extension, [Link] Apts., Patparganj
Ganj, New Delhi
80 Max Super Speciality Hospital(East Block & West 1 & 2, Press Enclave Road,Saket, New Delhi
Block)
81 Max Super Speciality Hospital Shalimar Bagh, New Delhi
82 Max smart Super Speciality (Formaly GM Modi Press Enclave Road, Saket, New Delhi
Hospital)
83 Max Vaishali (Formaly Pushpanjali Crosslay Hospital) W-3, Sector-1, Vaishali, Ghaziabad

84 Max Hospital (A unit of Alps Hospital Ltd), B Block, Sushant Lok Phase 1, Gurgaon, Haryana
85 Max Multi Speciality Center, Max Healthcare Institute N-110, Panchsheel Park, New Delhi
Ltd
86 Max Hospital– Pitampura, Pitampura, New Delhi
87 Medanta(The Medicity Hospital) Sector-38, Gurgaon-122001
88 Shri Mool Chand Khairati Ram Hospital & Ayurvedic Lajpat Nagar III, New Delhi - 110024
Research Ins
89 Sir Ganga Ram Hospital Sir Ganga Ram Hospital Marg, Old Rajendra Nagar, New Delhi-
10060
90 Venkateshwar Hospital Sec 18A, Dwarka, New Delhi

120
SL. HOSPITAL NAME LOCATION
1 Sterling Hospitals Ahmedabad
2 Kusum Dhirajlal Hospital (K D Hospital), Ahmedabad
3 Delhi Heart Institute & Multispecialty Hospital Bathinda
4 Sunshine Hospital Bharuch
5 Mallaya Hospital Bengaluru
Narayana Hrydalaya – with extension counters
6 (i) MS Rahaiah Memorial Hospital Bengaluru
(ii) Chinmaya Narayana Hrydalaya
7 Aster Hospital Bengaluru
8 Vikram Hospital Bengaluru
9 Kalinga Hospital Bhubaneswar
10 Care Hospital, Chandrasekharpur Bhubaneswar
11 Apollo Hospital, Samantapuri Bhubaneswar
12 AMRI Hospital Bhubaneswar
13 Lower Assam Hospital and Research Center Bongaigaon
14 Frontier Lifeline Hospital Chennai
15 MIOT Hospitals Chennai
16 Apollo Hospitals, Greams Road Chennai
17 Apollo Specialty Hospitals, OMR Chennai
Mehta Multi Speciality Hospitals (Two Hospitals at locations: Chetpet &
18 Velappanchavadi) Chennai
19 MGM Health Care Pvt Ltd (Aminjikarai -Chennai) Chennai
20 Dr Kamakshi Memorial Hospital Pvt Ltd (Pallikaranai -Chennai) Chennai
21 Aditya Diagnostics & Hospitals Dibrugarh
22 Down Town Hospital (in abeyabnce) Guwahati
23 Apollo Hospital, Jubilee Hills Hyderabad
24 Apollo Hospital, Hyderguda Hyderabad
25 Goyal Hospital & Research Center Jodhpur (for HRRL Barmer)
26 Regency Hospital Limited Kanpur
27 Apollo Reach Hospital Karimnagar, Telangana
28 Amritdhara Hospital Karnal Karnal
29 Medical Trust Hospital Kochi
30 CMRI Kolkata
31 Fortis Hospital Kolkata
32 Apollo Gleneagles Hospital Kolkata
33 BM Birla Heart Research Centre - 1/1 National Library Avenue Kolkata
34 MEDICA Superspecialty Hospital – 127, Mukundapur, EM Bypass Kolkata

Shankar Nethralaya (A unit of Medical research foundation,

35 Chennai) 147, Mukundapur, Purba Jadavpur, Kolkata-700099 Kolkata
36 Father Muller Charitable Institutions Mangalore
37 Apollo Hospitals, Belapur, Navi Mumbai Mumbai
38 Bombay Hospital & Research Centre Mumbai
39 Holy Hospital & Research Centre Mumbai
40 Balabhai Nanavati Hospital Mumbai
41 MGM New Bombay Hospital Mumbai

121
42 Jupiter Hospital Mumbai
43 RG Stone Urology & Laparoscopic Hospital Mumbai
44 RG Stone Urology & Laparoscopic Hospital Mumbai
45 Park Hospital Panipat
46 Grant Medical Foundation, Ruby Hall Clinic Pune
47 Sunshine Hospital Surat
48 Sterling Hospital Vadodara Vadodara
49 Bankers Heart Hospital Vadodara
50 Sunshine Hospital Vadodara
51 Tricolour Hospital Vadodara
52 Apollo Hospital Vizag
53 Seven Hills Vizag
54 Care Hospital Vizag

122
 ANNEXURE V

HEAD (Pers)
Engineers India Limited
New Delhi

Sub: Request for Authority letter for Admission

(See Rule 7.4.1)

Dear Sir,

Kindly issue me an authority letter for admission in the following hospital.

Name of Hospital:

Category ( ): General Purpose Hospital/ Referral Hospital/ Specialized Hospital/ Treatment in Day Care

I am a member of the Company's Medical Reimbursement Scheme. The person for whom admission is
sought is a member of my family as defined in the Medical Rules.

The requisite particulars are given below:

Name of the employee

2. Emp. No.

3. Designation & Level

4. Deptt./Location

5. Name of the patient, age &

relationship with the employee

6. Nature of treatment for which admission is

sought Delivery Case/Any other (Specify) :

7. Date of admission

8. Referred by (Name of Doctor)*

(Enclose photo copy of prescription)

"Attach Format A.

I understand that the authority letter issued under this request will be valid only for Allopathic treatment
excluding Dental treatment, cosmetic plastic surgery and treatment relating to infertility.

I understand that issue of authority letter is subject to the provisions of the Company Medical Rules, and
any medical expenses that are not admissible as per the Company's Rules will be recovered from my
salary or I will tender it on demand.

I undertake to abide by the terms and conditions of the issue of authority letter, and comply with all
requirements of the Company Medical Rules as are modified from time to time.

I shall also verify & sign the bills raised by the hospital at the time of discharge from the hospital.

I understand that the expenditure incurred for indoor medical treatment is subject to the provisions of Rule3A(2) of
Income Tax Rules, 1962 (for details see overleaf) and such medical expenses as are not covered under the said rules
will be taxable and appropriate tax will be deducted from my salary or I will tender the amount on demand.

Date : / Signature
120
Place: Intercom No. 123
 Prescribed Diseases Enlisted Under Rule3A (2) of Income Tax Rules, 1962

(a) Cancer;
(b) Tuberculosis;
(c) Acquired immunity deficiency syndrome;
(d) Disease or ailment of the heart, blood, lymph, glands, bone marrow, respiratory system
and other body systems requiring surgical operation.
(e) Ailment or disease of the eye, ear, nose or throat, requiring surgical operation.
(f) Fracture of skeletal system requiring surgical operation or orthopedic treatment.
(g) Gynecological or obstetric ailment or disease requiring surgical operation.
(h) Ailment or disease of the organs mentioned at (d), requiring medical treatment in a
hospital for at least three continuous days;
(i) Gynecological or obstetric ailment or disease requiring medical treatment in a hospital
for at least three continuous days.
(j) Burn injuries requiring medical treatment in a hospital for at least three continuous days;
(k) Mental disorder - neurotic or psychotic - requiring medical treatment in a hospital for at
least three continuous days;
(1) Drug addiction requiring medical treatment in a hospital for at least seven continuous days;
(m) Anaphylactic shocks including insulin shocks, drug reactions and other allergic
manifestations requiring medical treatment in a hospital for at least three continuous days.

Explanation: For the purpose of this rule: -

"Surgical Operations" includes treatment by modern methodology such as angioplasty,

dialysis, lithotripsy, laser or cryo-surgery.

124
-•

FORMAT A

FORMAT FOR INDOOR TREATMENT

1. Name of the employee Emp. No.

2. Name of Patient Relationship

3. Date of Admission

4. Provisional Diagnosis

5. Name of treating Doctor

6. Operations/Procedures including investigations:

7. Approximate no. of days of hospitalization

8. Estimated Expenditure

Date: Consultant's Signature with seal

[Link].

125
 FORMAT B

FORMAT FOR INDOOR TREATMENT IN REFERRAL HOSPITAL

1. Name of the employee: Emp. No. :

2. Name of Patient: Relationship:

3. Date of Admission:

4. Provisional Diagnosis:

5. Name of treating Doctor:

6. Operations/Procedures including investigations:

7. Approximate no. of days of hospitalization:

8. Estimated Expenditure:

Date: Consultant's Signature with seal

[Link].

For Referral Cases (To be referred by the attending Doctor in a nominated hospital or Company Doctor)

1. Hospital where presently under

treatment: Referred by:

Consultant's Signature with seal

[Link].

2. In case referred by Company Doctor

Co. Docotor's Signature

For Use in HR Department

ADMISSION ALLOWED/ NOT ALLOWED

AUTHORITY LETTER NO.:

DATE:

126
 ANNEXURE-VI

MEDICAL REIMBURSEMENT CLAIM FOR SPECIAL NURSING

(Refer Rule 9.2)

I certify :

(i ) that (name of the patient) has been under treatment for (name
of the disease) at (name of the hospital/nursing home, etc.);

(ii) that special nursing was deemed essential for the recovery/prevention of serious
deterioration in the condition of the patient having regard to the nature of the disease;
(date);
(iii) that special nursing was necessary for the period from (date) to
(iv) that special nursing was advised -

*(a) during day only

*(b) during night only
*(c) during day and night

(v) that the particulars relating to the special nursing availed of are as under:

(a) Name of the nurse

(b) Period of engagement

(c) Type of engagement *For night only

*For day only
*For day and night

(d) Rate Rs.

(e) Amount paid Rs.

(Rupees only)

Place

Date Signature of the Doctor

Registration number

*Score out whichever inapplicable

127
 Annexure VII
Dental Treatment Charges

[Link]. Head Rates (in Rs.)

I. Consultation 200
II. Filling
a) One Surface 450
b) Two Surface 600
III. Minor Operations
[Link] per tooth 600
[Link] 700
[Link] Currettage 700
[Link] 700
[Link] 700
[Link] Incision 700
[Link] per segmention 1000
[Link] 1000
[Link] 1000
[Link] 1000
[Link] removal 1000
[Link] Closure 1000
[Link] 1000
[Link] Planning 1000
IV. Major- I
[Link] of Impaction-Apecectomy 1700
[Link] amputation 1700
[Link] 1700
[Link] 1700
[Link] 1700
[Link] 1700
[Link] 1700
V. Major- II
[Link] of Fracture of jaw 4500
[Link] extractions in one jaw 4000
[Link]-Full Mouth 4000
[Link] neurectomy 4000
VI. Major-III
[Link] extractions 5000
[Link] Resection of jaw 5000
[Link] 5000
[Link] 5000
VII. Special Procedures
[Link] of jaw 15000
VIII. X-ray(single plate)per tooth 200
IX. X-ray(full mouth) 750
X. Root Canal Treatment(per tooth)
[Link] Rooted 3000
[Link] Rooted 2200
XI Dental crown/capping 2500

128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
 LIST OF INADMISSIBLE HOMOEOPATHIC MEDICINES
(See Rule 11.2(b))
[Link]. Name of the drug

1. Aranes Diaderna

2. Astorias Rub

3. Crocus Sativa

4. Dolichos Pur

5. Drosera rotun

6. Ginsong

7. Justicia Adhatoda

8. Mephitis
9. Moschus

10. Moschus Tunquin

11. Myristica Sebifera

12. Micromeria

13. Vesicaria corn.

14. Yohimbinum

Annexure-XIII - Deleted
Annexure-XIV - Deleted

150
 ANNEXURE-XV

ENGINEERS INDIA LIMITED

NEW DELHI

FORM OF MEDICAL CERTIFICATE FOR APPOINTMENT AND VISIT ABROAD

(See Rule 13.1)

The candidate must make the statements required -below prior to his/her medical examination and must sign
the declaration appended hereto:

1. State your name in full (in block letters)

2. State your age, date of birth and place of birth

3. Have you ever had smallpox,intermittent or any other fever, enlargement or suppuration of glands, spitting
of blood, asthma, heart disease, lung disease, fainting attacks, rheumatism, appendicitis, any other disease
or accident requiring confinement to bed and medical/surgical treatment? If so, give details.

4. When were you last vaccinated?

5. Have you or any of your near relations been afflicted with consumption, scrofula, gout, asthma, fits,
epilepsy or insanity?
6. Have you suffered from any form of nervousness due to over-work or any other cause?

7. Have you been medically examined and declared unfit for

service within the last three years.
8. Furnish the following particulars concerning your family:

Father's age if Father's age at Number of brothers Number of brothers

living & state death and cause living, their ages . dead, their ages at death
of health of death and state of health and cause of death

Mother' age if Mother's age at Number of sisters Number of

living & state death and cause living(married/ sisters dead, their
of health of death unmarried) their age ages and cause of
and state of health death

151
 hereby declare that,to the best of my knowledge and belief, all the above answers are true and correct.

also solemnly affirm that I have not received a disability pension on account of any disease or other condition.

Candidate's signature
signed in my presence
Date:
Signature of examining Doctor
Date:

Note 1: The employee will be held responsible for the accuracy of the above statement. By wilfully
suppressing any information he/she will•render himself/herself liable for disciplinary action.

Note 2: The reports on Urine Analysis, Blood, Stool and Eye-sight tests and X-Ray examination of the chef,
etc. must be brought along with the medical certificate.

CERTIFICATE BY THE EXAMIMNG DOCTOR

I hereby certify that I have examined employed as in the Engineers India Limited, who has been selected for
being sent abroad, having taken into account his/her (1) Urine Analysis, (2) Blood Test, (3) Stool Test, (4)
Eye-sight Test and (5) X-Ray examination of the chest, etc. (the reports are enclosed), and cannot discover
that he/she has any disease (communicable or otherwise), constitutionai weakness, or bodily infirmity except

I do not/do consider this a disqualification for visit abroad.

Station: Signature of the examining Doctor and seal

Date:
Registration No.

152
 ANNEXURE - XVI

LIST OF CITIES / TOWNS CLASSIFIED FO R REIMBRSEMENT OF MEDICAL TREATMENT

IN NON NOMINATE D HOSPITAL/NURSING HOMES IN CASE OF LIFE THREATENING
EMERGENCY SITUATIONS/DISEASES AT LOCATIONS WHERE THERE IS NO EIL’S
NOMINATED HOSPITAL

SL. STATES / UNION CITIES CLLASSIFIED CITIES CLLASSIFIED AS

TERRIROTIRES AS “X: “Y”
1 Andman & Nicobar Island – Port Blair
2 Andhra Pradesh / Hyderabad Vijayawada, Warangal, Geater
Telangana Visakhapatnam, Guntur,
Nellore
3 Arunachal Pradesh – –
4 Assam – Guwahati
5 Bihar – Patna
6 Chandigarh – Chandigarh
7 Chhattisgarh – Durg-Bhilai Nagar , Raipur
8 Dadra & Nagar Haveli – –
9 Daman & Diu – –
10 Delhi Delhi NCR* –
11 Goa – Goa
12 Gujarat Ahmadabad Rajkot, Jamnagar, Bhavnagar,
Vadodara, Surat
13 Haryana – Panchkula
14 Himachal Pradesh – –
15 Jammu & Kashmir – Srinagar, Jammu
16 Jharkhand – Jamshedpur, Dhanbad, Ranchi,
Bokaro Steel City
17 Karnataka Bengaluru Belgaum, Hubli-Dharwad
Mangalore, Mysore, Gulbarga
18 Kerala – Kozhikode, Kochi Thiruvana-
thapuram, Thrissur,
Malappuram, Kannur, Kollam
19 Lakshadweep –
20 Madhya Pradesh – Gwalior, Indore, Bhopal,
Jabalpur, Ujjain
21 Maharashtra Greater Mumbai / Pune Amravati, Nagpur,
Aurangabad, Nasik, Bhiwandi
Solapur, Kolhapur, Vasai-Virar
City, Malgaon, N anded-
Waghala, Sangli
22 Manipur –
23 Meghalaya – Shillong
24 Mizoram –
25 Nagaland –
26 Odisha – Cuttack, Bhubaneswar,
Raurkela
27 Puducherry (Pondicherry) – Puducherry / Pondicherry ,
28 Punjab – Amritsar, Jalandhar, Ludhiana

153
SL. STATES / UNION CITIES CLLASSIFIED CITIES CLLASSIFIED AS “Y”
TERRIROTIRES AS “X:
29 Rajasthan – Bikaner, Jaipur, Jodhpur, Kota,
Ajmer
30 Sikkim –
31 Tamilnadu Chennai Salem, Tiruppur, Coimbatore,
Tiruchirappalli, Madurai, Erode
32 Tripura –
33 Uttar Pradesh – Moradabad, Meerut, Aligarh
Agra, Bareilly, Lucknow, Kanpur,
Allahabad, Gorakhpur, Varanasi,
Saharanpur, Firozabad, Jhansi
34 Uttarakhand – Dehradun
35 West Bengal Kolkata Asansol, Siliguri, Durgapur

* Includes Faridabad, Ghaziabad, NOIDA and Gurgaon

Note: The remaining cities / towns in various Sates /UTs which are not covere d by classification
as “X” or “Y” are classified as “Z” for above purpose.

154
 B

LIST OF TESTS/ PROFORMA FOR HEALTH CHECK UP REPORT:

(For GMs & EDs)
Date:___________

Name: Age: Sex: M/F

Employee No.:
Name of the Post held:
Brief clinical history, if any:

A: Examination
Physical Systemic

Investigations:
Haemogram
Hb%
TLC
DLC
Peripheral Smear
Blood Sugar
F
P.P
Lipid Profile
Total Cholesterol
HDL Cholesterol
LDL Cholesterol
VLDL Cholesterol
Triglyceride

Liver Function Test

Total Bilirubin
Direct Bilirubin
Indirect Bilirubin
SGOT
SGPT
ALK Phosphates

Kidney function Test

Urea
Creatinine
Uric Acid
Electrolytes
Na+
K
Calcium
Inorganic Phosphates

____________________________________________________________________________________________________________________

Template No.5-0000-0001-T2 Rev.1 Copyrights EIL – All rights reserved

156
 B

:2:

Cardiac Profile
CPK
CK-MB
LDH
SGOT

Urine
Routine Microscopic
Sugar
Albumin
E.C.G.

X-Ray

Ultra Sound Abdomen

Any other Investigation

Advice

B. Medical Report of the Officer

1. Haemoglobin level of the officer Normal/Low
2. Blood Sugar level Satisfactory/Normal/High/Low
3. Cholesterol level of the officer Normal/High/Low
4. Liver functioning Satisfactory/Normal/Dysfunctional
5. Kidney status Normal/Both-One Kidney not functional
optimally
6. Cardiac Status Normal/Enlarged/Blocked/Not normal

C. Summary of Medical Report

1. Overall Health of the officer
2. Any other remarks based on the health
check up of the officer
3. Health profile grading

Signature of Medical Authority

Date: Designation

____________________________________________________________________________________________________________________

Template No.5-0000-0001-T2 Rev.1 Copyrights EIL – All rights reserved

157
 C

List of Tests/Proforma for Health check up Report: For Directors and C&MD

Date:

Name: Age: Sex: M/F

Employee No.:
Name of the Post held:
Brief clinical history, if any:

A: Examination
Physical Systemic

Investigations:
Haemogram
Hb%
TLC
DLC
Peripheral Smear
Blood Sugar
F
P.P
Lipid Profile
Total Cholesterol
HDL Cholesterol
LDL Cholesterol
VLDL Cholesterol
Triglyceride

Liver Function Test

Total Bilirubin
Direct Bilirubin
Indirect Bilirubin
SGOT
SGPT
ALK Phosphatase
Kidney function Test
Urea
Creatinine
Uric Acid
Electrolytes
Na+
K
Calcium
Inorganic Phosphates

____________________________________________________________________________________________________________________

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Cardiac Profile:
C
CPK
CK-MB
LDH
SGOT

Urine
Routine Microscopic
Sugar
Albumin
E.C.G.

X-Ray

Ultra Sound Abdomen

Any other Investigation

Advice

B. Medical Report of the Officer

1. Haemoglobin level of the officer Normal/Low
2. Blood Sugar level Satisfactory/Normal/High/Low
3. Cholesterol level of the officer Normal/High/Low
4. Liver functioning Satisfactory/Normal/Dysfunctional
5. Kidney status Normal/Both-One Kidney not functional
optimally
6. Cardiac Status Normal/Enlarged/Blocked/Not normal

C. Summary of Medical Report

1. Overall Health of the officer
2. Any other remarks based on the health
check up of the officer
3. Health profile grading

Signature of Medical Authority

Date: Designation Additionally, following tests may be conducted on the advice of
attending doctor:
VDRL
Hbs AG
PSA Test
TMT
PFT
ECHO
Serum Electrolyte

____________________________________________________________________________________________________________________

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 D

Health check-up package for spouse of Directors & C&MD:

  
Doctor's Consultation and Full Medical Examination
  
Blood Test
  
Complete Haemogram (Hb, TLC, DLC ESR, Haematorit, Peripheral Smear)
  
SGOT
  
SGPT
  
Blood Sugar (Fasting & Post Prandial)
  
Blood Urea
  
Serum Uric Acid
  
Serum Creatinine
  
Lipid Profile
  
Urine Examination
  
X-Ray Chest PA
  
ECG
  
Stress Screening by Psychologist
  
Eye Examination
  
Post Check Up Consultation
 
Pap Semar Test (only for ladies)

In addition to the basic package, following tests may be conducted as may be

prescribed by the doctor:
  
VDRL
  
LPA
  
Hbs AG
  
G6PD
  
Serum Electrolytes
  
Liver Function Test
  
PSA Test
  
TMT
  
PFT
  
Ultrasound-whole abdomen
  
ECHO
 
IMT

____________________________________________________________________________________________________________________

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161
 MEDICAL RULES Document No.
1.89.44.0001.02.00

PART – II

CHAPTER–I: CONTRIBUTORY POST-RETIREMENT MEDICAL COVERAGE SCHEME

1.0 INTRODUCTION

The scheme has been introduced entirely as a welfare measure and does not confer any
right or benefit on the retiring employee nor imposes any obligation or liability
whatsoever on the Company and shall not be deemed to be any contract or condition of
service between the Company and any such employee. The Company reserves to itself
the right to alter partly or wholly or amend or withdraw the scheme at any time without
assigning any reason and without any notice.

2.0 ELIGIBILITY

2.1 The retiring employee, to become entitled to the benefits under the scheme, shall have
put in a minimum of 10 years’ service in the Company. In case of employees who join
EIL from other public sector organisations through proper channel, the retiring
employee should have put in at least 5 years’ service in the Company and the balance in
any other public undertaking/Government, immediately preceding employment in EIL.

Provided that the requirement of minimum 5 years service in EIL in respect of Board
level appointees shall also include full time service at the Board level in other public
sector undertaking(s) immediately preceding employment in EIL.

Provided that Board level appointees, when cease to be in the service of the Company,
on expiry of the period of tenure including any extension thereof, or otherwise before
reaching the age of superannuation, except by way of resignation or in consequence of
any disciplinary action, will be allowed the benefits under the scheme provided the
incumbent has attained 55 years of age and completed, at least, 20 years of service in
the Company at the time of cessation of service. For the purpose of these rules, the
period of 20 years of service in the Company shall include the period of service spent in
any other Central PSEs/ Central/State Government.

Employees joining after 26.11.2008 shall become eligible to be member of PRMCS only
after putting in a minimum of 15 years of service in the Company (including the service
rendered in any other CPSEs immediately preceding employment in EIL), before retiring
[7]
on attaining the age of superannuation.

Effective from the financial year 2010-11, members of PRMCS shall be allowed to avail
Medical health Check Up facility (which includes tests as per laid down package for
regular employees) for self and spouse once a year (without doctor’s advice), at any of
the hospitals notified for the purpose at the same rate as applicable to the regular
employee. However, the above expenses shall be within the overall ceiling for
domiciliary treatment and the member shall be required to make the payment directly
[7]
to the hospital and claim reimbursement from the Company.

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2.2 Ethical code of conduct as per Annexure VI of CPRMCS Schemes shall be applicable to all
[10]
employees including Board level appointees post superannuation

2.4 The Scheme will be voluntary.

2.5 The retired employee hereinafter referred to as ‘member of the scheme’ and his/her
spouse will be covered provided both the retired employee and spouse is generally
living together under one roof. Spastic/Mentally Retarded/Schizophrenic
[9]
child(ren), parents who are dependent at the time of retirement of the
[16]
employee are also covered under PRMCS including for OPD treatment, within the
[9]&[16]
overall OPD ceiling.

2.6 The retiring employee desirous of enrolling as a member of the scheme are required to
deposit 10 years’ contribution at the applicable rate in advance at the time of
retirement in which case benefits under the scheme will be allowed to be availed of, as
per rules, throughout the life of the members. Those who retired prior to 19.7.1988, will
have the option to make payment of the lump-sum 10 years’ contribution, but the
amount of contribution(s) paid prior to 19.7.1988 will not be adjusted against the lump-
sum amount payable under this sub-rule. In case an existing member employee wishes
to continue as a member by making annual payment of membership fee, medical claims
shall be liable to rejection in case he does not make the necessary contribution in
st [25]
advance before 31 March for the year starting 1st April following.

2.7 With reference to point 2.6 above, in case of the death of the member of the scheme
where the surviving spouse becomes eligible for the medical coverage under this
scheme and wishes to avail of the same, the surviving spouse shall intimate the
Company accordingly. In such an event, it shall be the duty of the surviving spouse to
remit the subscription to the Company as above.

Note: Applicable rate refers to the amount of monthly contribution corresponding

to the level of the retiring employee in force at the time of retirement.

3.0 COVERAGE FACILITIES

3.1 Members under this scheme will be free to consult/receive treatment from any
Registered Medical Practitioner of the Allopathic/Ayurvedic/Unani/Sidha/ Homeopathic
Systems of medicines, as per the Medical Rules of the Company.

3.2 The coverage will include domiciliary treatment as well as hospitalization. In respect of
domiciliary treatment the annual amount admissible for reimbursement will not exceed
[25]
the ceiling laid down in Annexure I . The amount of reimbursement in the year of
retirement/ superannuation of the employee shall be allowed on pro-rata basis for
remaining months of the financial year following the month in which the employee
retired.

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 MEDICAL RULES Document No.
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Exclusions which will be over and above the annual ceiling limit for domiciliary
treatment will be as under:

i. Expenditure incurred on dialysis and chemotherapy will be treated as deemed

hospitalization and accordingly the same will not be counted towards ceiling laid
own for Outdoor treatment.

ii. Reimbursement of CPAP/BIPAP/Oxygen Concentrator Machines for domiciliary

use, spectacle reimbursement, artificial appliances, will be over and above the
annual ceiling for Outdoor treatment.

iii. Cost of OPD medicines and expenses w.r.t. consultation, investigations and
essential supplementary medicines (if prescribed by doctor as necessary for
treatment) will be considered under the category “Exclusions” i.e. over and
[25]
above the annual ceiling for outdoor treatment for the following diseases:

(A) For following Post-Operative treatments:

(a) Post operative cases of major Cardiac Surgery/ Cardiology.

(b) Oncology cases.
(c) Post operative organ transplant cases.
(d) Post operative joint replacement cases.
(e) Post operative major Neurosurgical/ Neurology cases
including cerebral stroke etc.

(B) Additionally, following chronic diseases will be considered under exclusions:

[11]
- Diabetes Mellitus Type I and/or Diabetes Mellitus Type 2.
- Parkinson’s Syndrome.
[9]
- Oncology (including tests/ diagnostics for cancer evaluation).
[14]
- Systemic Lupus Erythematosus (Lupus).
- Neurological Treatment (other than post-operative), Alzheimer’s disease
and dementia.
- Chronic Asthma/Bronchitis.
- BP / hypertension, cardiac resulted from diabetics and requiring long
terms treatment.
- Chronic Kidney Disease (CKD).
[25]
- Chronic Liver Disease / Pancreato-Biliary diseases.

The expenses under ‘Exclusion’ category, as mentioned above, shall not form part of the
annual ceiling of OPD treatment for the superannuated employees who are members of
PRMCS, instead two separate heads will run concurrently – one claim under General
[22]
Ailments and other under ‘Exclusions’.

3.3 There will be no reimbursement of domiciliary treatment in respect of retired

employees as long as they are having regular/full time/gainful employment. For this

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purpose, all retired employees, covered under the scheme, having monthly income (all
inclusive) from post retirement employment, more than 50% of the maximum of the
[25]
prevailing pay scale of the corresponding level from which the employee has retired ,
will be deemed to be in regular/full time/gainful employment. All retired employees will
be required to make annual declaration containing the details of post retirement
employment and disclose income from post retirement employment as per prescribed
pro-forma at Annexure V.

3.4 In respect of hospitalisation, reimbursement will be regulated as that applicable to

regular employees of the comparable status/grade according to Medical Rules, in force
from time to time applicable at that time. Reimbursement of charges in respect of
hospitalisation will be in addition to the amount admissible for domiciliary treatment as
mentioned above. Company will issue authority letter for self and spouse on request
being made by such employee/spouse for admission in any of the nominated hospitals
as per the prescribed performa provided in Part I of these rules and the payment of bills
for such treatment will be made directly by the company. In case any amount is
inadmissible out of such bills, the retired employee will be informed suitably to pay the
said amount to the company or if the amount is very small the same can be adjusted
from the medical bills that the retired employee submits for reimbursement.

3.5 The facility will be available only to those members of the scheme who do not receive
any medical assistance from any other organisation as dependent of their wards etc.
Similarly, where the spouse of the member of the scheme is serving after the employee
himself has retired and is receiving medical coverage from the organisation of the
spouse, he/she will not be covered under this scheme.

3.6 The coverage will also be admissible on request to the surviving spouse till his/her
death.

4.0 OPERATION OF THE SCHEME

4.1 The members covered under this scheme shall not be eligible for any medical advance.

4.2 Retiring employees, who are eligible for coverage under the above scheme may apply
for membership of the scheme in the enclosed proforma (Annexure II) alongwith the
remittance as per para 2.6 above. In the event of death of the member of the scheme
where the surviving spouse wishes to avail of the coverage under the scheme, the
application may be made in the form at Annexure III.

4.3 In accordance with these rules, it is well within the rights of the company to refuse the
membership to a retiring employee or terminate the same at any time; without notice
or assigning any reason. Without the prejudice to the right’s of the company,
membership may be suspended/ terminated under following circumstances also:

(i) Where Company discovers any outstanding due from a retired employee and the
employee is advised in writing to refund the excess amount so given in
settlement of the final dues but does not do so in reasonable time, the Company
may suspend the membership in the PRMCS forthwith.
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(ii) Where it comes to the notice that the retired employee admitted to the Scheme
misuses/abuses the facility of PRMCS by way of fraudulent/wrongful claim, etc.
or a retired employee so admitted is found to have committed any fraudulent
action during service or otherwise connected with the Company, the Company
may terminate his/her membership. However, membership shall not be
terminated for any reason without such person being afforded an opportunity of
being heard and no order of termination of membership shall be issued without
obtaining prior approval of the competent authority.

(iii) For the purpose of the above, competent authority shall be as under:

Category of Official Competent Authority

Functional Directors including the

Chief Executive, EDs & CGMs Board

GMs/DGMs/AGMs C&MD

Sr. Managers & below A Committee of Director

(Personnel)/Director (Finance) and
concerned Director (wherever
applicable)

4.4 In case of any dispute decision of the Managing Director shall be final and binding.

5.0 PROCEDURE FOR CLAIM

5.1 The medical claim for reimbursement under this scheme will be made in the enclosed
proforma at Annexure IV or claim format generated from online portal after online
filing of medical claims. Along which every claim, Member will have to give a
declaration regarding post retirement employment that he is/was employed on
regular/full time employment/gainful employment and his monthly income (all
inclusive) from post retirement employment is / was not more than 50% of the
maximum of the prevailing pay scale of the corresponding level from which he retired
OR that he was not employed on regular/full time employment/gainful employment
during the month this medical claim is being made.

5.2 In case the member of the scheme desires that the amount reimbursable to him may be
credited to his bank account in Delhi (the bank account should be in a bank where it is
possible for the Company to make credits in the account of the member of the scheme
concerned), he may advise the Accounts Department accordingly, indicating his Bank
Account Number in the medical claim form. In other cases, the amount will be remitted
by Cheque. In the case of surviving spouse, the claim can be preferred by him/her and
the amount will be remitted as above.

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 MEDICAL RULES Document No.
1.89.44.0001.02.00

CHAPTER II: SCHEME FOR MEDICAL COVERAGE FOR SPOUSE OF EMPLOYEE DYING IN
HARNESS

6.0 INTRODUCTION

6.1 Medical cover to spouse of employee dying in harness will be extended on the same
scale as applicable to the retiring employees of comparable level and subject to the
same conditions as are applicable under the Post Retirement Medical Coverage Scheme.
The medical benefits to the children & parents will also be extended if they are
dependent at time of death of the employee. They will continue to get the medical
benefit till the employee’s notional date of retirement or till they meet the condition of
[15]
dependency under the EIL medical rules, whichever is earlier.
6.2 The scheme being introduced entirely as a welfare measure shall not confer any right or
benefit on the recipients under the scheme nor impose any obligation or liability
whatsoever on the Company and shall not be deemed to be any contract or condition of
service between them. The Company has the right to alter partly or wholly or amend or
withdraw the scheme at any time without assigning any reason and without any notice.

6.3 The scheme shall be voluntary

7.0 ELIGIBILITY

7.1 The Scheme shall cover the spouse of an employee, who has put in 10 years of service at
the time of death out of which 5 years shall be in the Company and the balance may be
in any of the PSUs/Govt. immediately preceding employment in EIL. Service in previous
PSUs/Govt. will be considered only if he/she has applied through proper channel. In
case of tenure appointments made by the Government at Board level where the
condition of minimum 5 years service in EIL is not satisfied, the benefit of the scheme
shall be allowed provided the total service rendered in EIL at Board level and the full
time service at the Board level in other Public Sector Undertaking(s) immediately
preceding employment in EIL is 5 years.

8.0 CONTRIBUTION

8.1 Such of the surviving spouse desirous of obtaining cover under this scheme is required
to apply in the prescribed format and pay 10 years' contribution in advance at the rates
applicable under the post retirement medical coverage scheme. The Basic Pay Range
and level/Gradation will be as applicable at the time of death of the employee.

9.0 BENEFITS

9.1 The coverage which includes domiciliary treatment/hospitalization shall be available for
life time of surviving spouse.

9.2 In respect of domiciliary treatment the annual amount admissible for reimbursement
will not exceed the ceiling laid down in Annexure I, corresponding to the level/ grade of
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 MEDICAL RULES Document No.
1.89.44.0001.02.00

the employee at the time of his demise. Exclusions which will be over and above the
annual ceiling limit for domiciliary treatment will be as provided under medical rules of
the company. The reimbursement shall, however, be regulated as per the Medical
Rules.

9.3 In respect of hospitalization reimbursement will be regulated as per the Medical Rules
as amended from time to time.

9.4 Medical coverage will be available to the surviving spouse only if he/she is not eligible
for any medical assistance from any other organisation.

10.0 Any other provisions not specifically provided herein will be governed by the
Contributory post-retirement medical coverage scheme, mutatis mutandis.

REFERENCES:

[1] Circular No. 11/2006 [2] Circular No. 46/2006

[3] Circular No. 10/2007 [4] Circular No. 50/2007
[5] Circular No. 07/2009 [6] Circular No. 16/2010
[7] Circular No. 19/2010 [8] Circular No. 38/2010
[9] Circular No. 29/2011 [10] Circular No. 15/2012
[11] Circular No. 31/2012 [12] Circular No. 38/2012
[13] Circular No. 29/2013 [14] Circular No. 39/2013
[15] Circular No. 08/2014 [16] Circular No. 20/2014
[17] Circular No. 22/2014 [18] Circular No. 43/2015
[19] Circular No. 54/2015 [20] Circular No. 01/2016
[21] Circular No. 14/2016 [22] Circular No. 40/2013
[23] Circular No. 04/2012 [24] Circular No. 03/2017
[25] Circular No. 43/2017 [26] Circular No. 42/2018
[27] Circular No. 20/2019 [28] Circular No. 48/2019
[29] Circular No. 49/2019 [30] Circular No. 14/2020
[31] Circular No. 43/2020 [32] Circular No. 53/2020
[33] Circular No. 61/2020 [34] Circular No. 63/2020
[35] Circular No. 74/2020 [36] Circular No. 78/2020
[37] Circular No. 80/2020

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 Annexure I

OPD Ceiling Limit under CPRMCS

Level of Retiring Ceiling Amt (in Rs.)

Employee
1 16000
2 16000
3 16000
4 16000
5 21000
6 21000
7 21000
8 24000
9 24000
10 32000
11 32000
12 32000
13 32000
14 39000
15 39000
16 39000
17 48000
18 48000
19 48000
20 53000
21 68000
22 75000

169
 Annexure II

Application form for enrolment as member under the

Company's Contributory Post Retirement Medical Coverage Scheme
(To be submitted in Triplicate)
(Refer Rule 4.2 of Part II)

The Chairman & Managing Director

Engineers India Limited,
New Delhi

Sir,

1. I am retiring/have retired on attaining the age of superannuating/am

voluntarily retiring/have voluntarily retired/have retired under pre-mature
retirement on medical grounds scheme from the services of EIL on and
would like to join the Company's Contributory Post
Retirement Medical Coverage Scheme with effect from

2. I request the medical coverage be extended to me and to my spouse named

below:-

Name of the Spouse Age Specimen signatures of

the spouse

3. I certify that my spouse is not employed.

4. I declare that my spouse is employed in

(Name & address of the organization)
but I opt to receive medical
coverage both for self and my spouse from EIL. I further declare that my
spouse and I are not in receipt of and will not receive so long as we are
beneficiaries of EIL's Contributory Post Retirement Medical Coverage
Scheme medical benefits in my form from any other organization.

Note: This does not debar free medical treatment from Government Hospitals
or other institutions.

5. I undertake to no - - fy to the Company any change in the above particulars

as soon as it oc-u7s.

170
 6. Subscription equal to ten years contribution is enclosed vide Cheuqe No.
dated drawn in favour of EIL on
Bank/has been paid in cash vide Receipt No.
dated issued from enclosed against life
for medical coverage for me and my spouse.

7. a) After retirement I will be residing at

, I certify that my spouse is
generally living with me. I undertake to notify the change in my
residential address, if any, as soon as it occurs.

b) I may be allowed the facility of reimbursement of medical expenses as per

Company rules through Company's Headquarters Office at New
Delhi/Regional Offices at Mumbai/Kolkata/Vadodara/Chennai (Tick the
place where reimbursement facility is desired).

8. The reimbursement of medical claims submitted by me from time to time,

as may be admissible to me, may be remitted to me by cheque/deposited in
my bank account No. in the (full address of the bank).

9. I fully understand that Company may refuse/terminate my membership

under this scheme at any time without any notice and without assigning any
reason.

Yours Faithfully,

Signature
Name
Ex-Emp. No.
Designation at the time of retirement
Category of entitlement at the time of
retirement (Al, AB, C or D)
Deptt. at the time of retirement
Location at the time of retirement
Level at the time of retirement
Telephone No. (Res.)

171
 Annexure-III
Company's Post Retirement Medical Coverage Scheme
For spouse of employees dying in harness
(Refer Rule 4.2 of Part II)

The Chairman & Managing Director

Engineers India Limited, New Delhi

Sir,

1. My spouse, who was an Ell employee and whose particulars are given below, expired on
(date). I wish to avail of the facilities provided under the ELL's
Contributory Post Retirement Medical. Coverage Scheme from (date).

a) Name of the applicant

b) Employee No. of the Spouse
c) Designation of the spouse at the time of death

2. Subscription equal to ten years contribution is enclosed vide Cheuqe No.

dated drawn in favour of EIL on Bank/has been paid in
cash vide Receipt No. dated issued from enclosed
against life for medical coverage for me and my spouse.

3. At present, I am residing at
(Address).

4. The reimbursement of medical claims submitted by me from time to time, as may be

admissible to me, may be remitted to me by cheque/deposited in my bank account
No. in the (full address of the bank).

5. I declare that I am not in receipt of, and will not receive so long as I am the
beneficiary of EIL Post Retirement Medical Coverage Scheme, medical benefits in
any form from any other organization. (Note: This does not debar free medical
treatment from Government hospitals or other institutions).

6. I undertake to notify to the Company:-

a) Any change in my residential address, if any, as soon as it occurs.

b) Any change in my marital status immediately after remarriage. I fully understand

that in such an event, the Company shall have the discretion to determine
continuance of my membership of the scheme.

c) Any change in the above particulars as soon as it occurs.

7. I fully understand that the Company may refuse/terminate my membership under

this scheme at any time without any notice and without assigning any reason.

Yours faithfully,

Signature:
Place: Name:
Date: Date of birth:

172
 Annexure-IV

Application for Reimbursement of Expenses incurred in Medical

Consultant/Treatment under the Company's Contributory Post Retirement
Medical Coverage Scheme
(Refer Rule 5.1 of Part II)

N.B. Separate claim should be preferred for each patient and each spell of indoor/outdoor treatment

Name of the claimant

2 Ex-employee No.

3 i) Designation & Level

ii) Annual Ceiling

iii) Date of retirement

4 Residential Address
(With telephone number and email id)

5 Place at which the patient fell ill

6 If 4&5 are different stations,

Specific reasons

7 Name of the Medical Officer Consulted &

his Registration No.
8 System of medicine Allopathic/Ayurvedic/Unani Sidha/ Homeopathic

9 Amount claimed Rs.

Encl:

(FOR USE IN ACCOUNTS DEPARTMENT)

Admitted for Rs. (Rupees

only)

(Authorized Officer)

173
 :2:

DETAILS OF THE AMOUNT CLAIMED:

Amount Amount
Claimed Admitted
(Rs.) (Rs.)
(1) Consultation Charges
Date Number Place of Consultation

2) Injection Charges: Date Number & Rate

3) Charges for X-ray Name of the Receipt No.

Pathological and Test & date
Other test (receipt
to be attached)
4) Cost of Medicines :
i) Supplied by Dr. w.e.f. to @ Rs
purchased from C.M. No. Date Rs.
Market prescri-
Ption & Cash Memo
together with a list of
Medicines in block letters

5 Any other charges

(Attach Proof)
Total Amount Rs.
DECLARATION BY THE CLAIMANT

6. I hereby declare that: -

1) The statement made in the claim are true to the best of my knowledge and belief.
2) I am a beneficiary of Company's Contributory Post Retirement Medical Coverage Scheme.
3) The Medical expenses are incurred for self/my spouse.
4) I fully understand that the Company may refuse/terminate my membership of the scheme
at any time without any notice and without assigning any reason.
5) I am not working anywhere in violation of EIL PRMS (for Level 16 & above).
6) Please tick which is applicable:-
a) I certify that I am/was employed on regular/full time employment/gainful employment
and my monthly income (all inclusive) from post retirement employment is/was not
more that 50% of the maximum of my pay scale from which I retired.
OR
b) I certify that I was not employed on regular/full time employment/gainful employment
during the month this medical claim is being made.

Signature:
Name:
Ex. Emp. No.
Note: Please ensure to attach receipts from the attending - tlysician and Chemist/Medicine
Docto supplier.

174
 Annexure V
of Part II

Annual Declaration By Retired Employee For

OPD Treatment

1. Name of retired employee

2. Ex Employee No Level Designation

3. Date of Superannuation

4. Ceiling of medical reimbursement

5. Whether on regular/full time/gainful employment : Yes/No

6. If 'Yes'

(a) Name of Employer

(b) Address of Employer

Tele No
Email id

(c) Date of employment

(d) Monthly Income
(e) Place & Address of Posting

7. Whether getting medical facility/benefits from employer : Yes/No

8 Name of the spouse

9. Is the spouse beneficiary of EIL's medical facility : Yes/No

Signature

Telephone No Address for Correspondence:

Email id

Date :

175
 Annexure VI
ETHICAL CODE OF CONDUCT UNDER POST RETIREMENT MEDICAL COVERAGE SCHEME

(Circular No. 15/2012)

(Refer Rule 202 of Part II (CPRMCS))

1. Management will have full right in respect of member/other beneficiaries, in a particular case of doubtful
nature to:

(i) insist upon taking medical treatment only from a doctor nominated by Management;

(ii) insist upon purchasing medicines from a chemist nominated by the Company;

(iii) to refer the patient and/or the claim/bills received, to Company's AMC/ Attending Doctor/ any
other doctor nominated by Management for expert opinion; and

(iv) to reject a claim in its entirety.

2. Management may decide to terminate [Link] of any member in case it is satisfied that the
benefits/facilities under the scheme are being misused/abused by a member/spouse, apart from taking
such other action as Management may deem fit.

3. The membership of a member may be terminated and benefits under the scheme withdrawn after giving
him due opportunity by issuing time bound show-cause notice to explain his action, if it is established
that the member is working against the interest of the Company; or a misconduct committed by an
employee during active service is detected after his retirement and the Competent Authority, as under, is
satisfied that the said misconduct was committed by the member:

Position before superannuation Disciplinary Authority Appellate Authority

Below Board Level employees Director (HR) C&MD

Board Level employees C&MD Board of Directors

C&MD Board of Directors -

4. The scheme shall not be deemed to be a matter of right or contract or condition of employment; and shall
be liable to be withdrawn at any time for misuse or abuse of the benefits under the scheme or for any
reason whatsoever.
***

176
Note: Any amendments/changes in Medical Rules or CPRMCS after issuance of this
document shall be notified through issuance of Circulars and such circulars will be made
available on EIL connect and Ex- employee’s portal as and when issued.