WAJAHAT SHABIR
SRINAGAR: The Jammu and Kashmir Government has amended the Jammu and Kashmir Civil Services (Medical Attendance and Allowance) Rules, 1990, revising the definition of family members eligible for medical benefits and prescribing maximum reimbursement limits for artificial limbs, cardiac devices, hearing aids and other medical appliances.
According to a notification issued by the Finance Department (Codes Division) under S.O. 276 dated October 23, the amendments have been made under Article 309 of the Constitution of India.
Under the revised rules, the definition of “family” includes a husband or wife, parents, sisters, widowed sisters, widowed daughters, minor brothers, children and stepchildren ordinarily residing with the government servant and wholly dependent on them. The definition also covers dependent brothers, dependent divorced or separated daughters and stepmothers.
The government has also revised the criteria for determining financial dependency. Family members will be considered wholly dependent on a government employee if they ordinarily reside with the employee and their total monthly income does not exceed Rs 9,000, plus dearness allowance applicable on the date of consideration.
The notification also expands the list of medical appliances covered under the rules. References to intraocular lenses, cardiac devices, CPAP/BiPAP equipment and oxygen concentrators have been incorporated into the relevant provisions, while a new annexure specifies the maximum admissible reimbursement limits for artificial appliances.
Under the prescribed rates, double valve replacement has a reimbursement ceiling of Rs 1,10,500, while mitral or aortic valve replacement has been capped at Rs 45,050.
For cardiac devices, the maximum prescribed rate for a single-chamber cardiac pacemaker without rate response is Rs 34,840 plus GST, while a single-chamber pacemaker with rate response is capped at Rs 44,928 plus GST. The ceiling for a dual-chamber cardiac pacemaker is Rs 83,200 plus GST, and that for a bi-ventricular cardiac pacemaker is Rs 1.95 lakh plus GST.
The schedule also fixes reimbursement limits for other cardiac devices, including implantable cardioverter defibrillators, combo devices and aortic stent grafts.
For respiratory support equipment, the prescribed ceiling for an oxygen concentrator and CPAP is Rs 45,000 each, plus GST. Bi-level CPAP has been capped at Rs 68,000 plus GST, while the ceiling for a bi-level ventilatory system is Rs 1.05 lakh plus GST.
The notification also specifies rates for hearing aids, including Rs 8,000 for a digital behind-the-ear device and Rs 9,000 for a digital in-the-canal or completely-in-canal device. The prescribed rate for a cochlear implant is Rs 5.35 lakh.
Detailed reimbursement ceilings have also been laid down for artificial limbs and prostheses, with different rates for adults and children in the age groups of 7–12 years and 0–6 years. The schedule covers below-knee and above-knee prostheses, foot prostheses, upper-limb prostheses and advanced externally powered devices.
For adult beneficiaries, the prescribed rate for a standard below-knee prosthesis is Rs 20,000, while a standard above-knee prosthesis is capped at Rs 40,840. Rates vary according to the type of prosthesis and additional features, including silicone or polyurethane liners and locking mechanisms.
The amended rules further provide that reimbursement for treatment undertaken at specified Apollo Group hospitals, Escorts Heart Institute, the Institute of Liver and Biliary Sciences, Hospital New Delhi and Jaslok Hospital, Mumbai, will be restricted to the amount payable for the corresponding procedures at AIIMS, New Delhi.
The notification has been issued by order of the Lieutenant Governor and signed by Financial Commissioner (Additional Chief Secretary), Finance Department, Shailendra Kumar, IAS. The amendments form part of the revised framework governing medical attendance and reimbursement benefits for Jammu and Kashmir government employees under the 1990 rules.
