Policy for Retired Chief Justice and Retired Judges of Punjab and Haryana High Court

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Published by Authority

No.49] CHANDIGARH, FRIDAY, DECEMBER 6, 2024 (AGRAHAYANA 15, 1946 SAKA)

CONTENTS

Pages PART I—Punjab Government Notifications and Orders

.. 835-970 PART I-A—Notifications by Local Government

.. Nil PART I-B—Notifications by Commissioners and Deputy Commissioners .. Nil PART II—Statutory Notifications and Republications from Gazette of India/Punjab .. Nil PART III—Notification by High Court, Labour Commissioner ; Advertisements ; .. 523-537 Director of Lotteries, Punjab and Notices etc.

PART III-A—Notifications by Universities

.. Nil PART III-B—Court Notices

.. Nil PART IV—Acts and Bills

.. Nil PART V—Notification by Punjab State Legislature

.. Nil SUPPLEMENT PART I—Statistical

.. Nil SUPPLEMENT PART II—General

.. Nil LEGISLATIVE SUPPLEMENT—Contents

.. xix Ditto PART I—Acts

.. Nil Ditto PART II—Ordinances

.. Nil Ditto PART III—Delegated Legislation

.. 121 Ditto PART IV—Correction slips, Republications and Replacements .. NilPART I] PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) 835

Published by Authority

No.49] CHANDIGARH, FRIDAY, DECEMBER 6, 2024 (AGRAHAYANA 15, 1946 SAKA)

PART I

Punjab Government Notifications and Orders

GOVERNMENT OF PUNJAB

DEPARTMENT OF HOME AFFAIRS AND JUSTICE

(JUDICIAL-1 BRANCH)

DRAFT NOTIFICATION

The 14th October, 2024

No. HOME-JD-10CC/4/2024-3JUD1-Part(3)/736.-

Sub:- Policy for Retired Chief Justice and Retired Judges of Punjab and Haryana High Court

State Government has decided to implement Cashless Health Care Scheme for all retired Chief justices and retired Judges of Punjab and Haryana High Court and their families.

The objective of the Health Care Scheme is to provide cashless quality medical care without financial burden, more efficient, seamless, hassle free at CGHS rates.

Cashless Health Care Scheme is a cashless Health scheme to provide treatment to all retired Chief justices and retired Judges of State of Punjab and their family members in empanelled hospitals.

PART-I

1. Short title, commencement and application:-

i. The scheme shall be known as the "Cashless Health Care Scheme (CHCS)" for retired Chief justices and retired Judges and their family members of State of Punjab, residing in Punjab/Tri-City or settled outside Punjab but coming to Punjab for availing treatment.

ii. This Scheme shall come into force with effect from the date of its publication in the Official Gazette.

iii. Applicable to all Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab, residing in Punjab/Tri-City or settled outside Punjab but coming to Punjab for availing treatment.

(835)836 PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) PART I] 2. Definitions:

i. "CHCS" shall refer to Health Care Scheme of Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab, residing in Punjab/Tri-city or settled outside Punjab but coming to Punjab for availing treatment. The Scheme shall be implemented by Office of Registrar Punjab and Haryana High Court with the objective of reducing out of Pocket Expenditure of treatment for all Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab, residing in Punjab/Tri-City or settled outside Punjab but coming to Punjab for availing treatment through a network of Empanelled Health Care Providers and cashless investigations through empanelled laboratories and Diagnostic Centers.

ii. "Beneficiary" means the Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab, residing in Punjab/Tri-City or settled outside Punjab but coming to Punjab for availing treatment. Family means husband or wife as the case may be, children (unmarried son up to the age of 25 years, unmarried daughter and widowed daughter (no age limit) and a special child as defined in The Rights of persons with Disabilities Act, 2016.

iii. "Medical Package" shall refer to the package that the beneficiary would be entitled to receive under the scheme for any of the day care procedure/ indoor treatment /chronic illness within the fixed package rate, as per the use of standardized codes for procedure packages covered under CGHS. However in case of any customization is required as per needs, the state will review the same.

Treatment shall be provided from the package of CGHS procedure list enclosed to this notification as Annexure 1.

PGI rates will be followed at PGIMER and Tata Memorial Center will work at their own rates (Annexure 2).

In case of Non-availability of Packages in CGHS, PGI rates will be followed.

iv. "Cashless" means the benefits drawn by the beneficiary in any empanelled hospital as per his/her entitlement shall be completely cashless. The beneficiary shall not pay any amount to any empanelled hospital for any covered treatment within his/ her entitlement limits.

v. "Day care" means indoor stay in Hospital for less than 24hrs which is duly certified by concerned Hospital.

vi. Chronic Illness means the already notified chronic illnesses by the government. These are subjected to revision from time to time as decided by government.

vii. "Empanelled Healthcare Provider (EHCP)"shall refer to health care provider duly recognized and empanelled by Department of Health and Family Welfare/ Implementing Agency to impart heath care services to the beneficiaries under the scheme. The EHCPs shall include both empanelled private and public health institutions

viii. "Empanelled laboratories / Diagnostics centers shall refer to laboratories / Diagnostics centers duly recognized and empanelled by Implementing Agency to provide investigatory services to the beneficiaries under the scheme. The EHCPs shall include both empanelled private and public health institutions.

ix. "Fraud" under the scheme shall mean any intentional deception, manipulation of facts and/or documents or misrepresentation made by the EHCP or by any person or organization appointed/ employed / contractedPART I] PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) 837 by the EHCP with the knowledge that the deception could result in unauthorized financial or other benefit to herself/himself or some other person or the organization itself. This also includes any such act by the employee/retiree/beneficiary under the scheme. It includes any act that may constitute fraud under any applicable law in India.

In addition to the above, any act (indicative list below) that is recognised by different provisions of law as fraud shall be deemed to be fraud under the CHCS: a. Impersonation b. Counterfeiting c. Misappropriation d. Criminal breach of trust e. Cheating f. Forgery g. Falsification h. Concealment

x. "I-Card" means the valid I-card/e-card generated/issued by the Registrar of Punjab and Haryana High Court to Retired Chief Justices and Retired Judges and their family members as the case may be to entitle them for availing medical treatments in empanelled hospitals, laboratories and Diagnostic Centers.

xi. JCI means the hospital possessing accreditation certificate of Joint Commission International.

xii. "NABH" means hospitals possessing accreditation certificate of National Accreditation Board for Hospitals & Healthcare Providers.

xiii. "Package Rate" means a lump sum amount charged by the empanelled hospital for packages/ procedures.

This includes all charges pertaining to a particular treatment/ procedure including admission charges, visit fee/ consultation fee, patient's diet, monitoring charges, preoperative investigation charges, investigation charges, operation charges, anesthesia charges, operation theatre charges, procedural charges/ surgeon's fee, anesthetist's fee, cost of surgical disposals and all surgeries used during hospitalization, consumables, gas charges, surgical charges/Operation Theater (OT) assistant charges, cost of medicine used during hospitalization, physiotherapy charges, nursing care charges for its services, routine post operative stay in Intensive Care Unit (ICU), blood transfusion (blood grouping, cross matching, blood or component, transfusion) and medicines for a period as permissible in CGHS. There are approx. 1853 procedures included in CGHS package master, and these 1853 procedure caters to cover most of OPD, Day Care and Indoor treatments.PGI rates at PGIMER and rates followed by Tata memorial Center (TMC) for Cancer related treatment through empanelled healthcare facilities.

xiv. "Scheme" means the cashless Health Care Scheme for Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab, residing in Punjab/Tri- City or settled outside Punjab but coming to Punjab for availing treatment. Under the scheme all the above-mentioned beneficiaries shall be eligible for treatment in any of the empanelled hospitals and investigation through empanelled laboratories and diagnostic centers as per CGHS guidelines, that may be upgraded from time to time.

xv. "Implementing Agency" refers to the agency/body set up by the State Government/Registrar Punjab and Haryana High Court for the purpose of coordinating and implementing the CHCS.

PART-II

3. Objective of the Scheme

i. The objective of the Health Care Scheme is to provide cashless quality medical care without financial burden, more efficient, seamless, hassle free at CGHS rates.

ii. The Scheme will be implemented through Office of Registrar Punjab and Haryana High Court with the objective of providing reducing out of Pocket Expenditure of treatment for all Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab,838 PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) PART I] residing in Punjab/Tri-City or settled outside Punjab but coming to Punjab for availing treatment through a network of Empanelled Health Care Providers and cashless investigations through empanelled laboratories and Diagnostic Centers.

iii. Reimbursement in case of treatment in non-empanelled hospitals, and for OPD treatment shall be at CGHS rates, as per existing system of reimbursement.

iv. All the Stakeholders like empanelled hospitals and beneficiaries shall be benefitted as the scheme shall be cashless for all the listed procedures, for getting their claims cleared within a specified time frame.

v. The scheme shall be cashless for all Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their family members in the state of Punjab, residing in Punjab and/or settled outside Punjab but coming to Punjab for availing treatment for all hospitalizations and day care procedures in EHCPs as per the guidelines, except in cases where the beneficiary opts for superior services other than the guidelines, the beneficiary shall bear the additional cost in such cases.

4. Nodal Agency for implementation of the Scheme:-

Office of Registrar Punjab and Haryana High Court

5. Mechanism Of Implementation:

i. Database of eligible beneficiary: Available as per authenticity of the department for the purpose of confirmation and verification of beneficiary.

ii. Eligibility: All Retired Chief Justices and Retired Judges of Punjab and Haryana High Court and their families, as per the database shared by Registrar of Punjab and Haryana High Court. Beneficiaries with existing private insurance schemes may choose to use their private insurance for treatment, if they prefer.

However, under no circumstances will a beneficiary be entitled to benefits under both schemes, this scheme and any other insurance scheme simultaneously.

iii. I-Card Generation: I-card will be generated/issued by the Registrar of Punjab and Haryana High Court to all Retired Chief Justices and Retired Judges of High Court in the State of Punjab, residing in Punjab/ Tri-City and others coming to Punjab for their treatment and their family members as the case may be for availing facility under the scheme.

iv. Empanelment of hospitals / laboratories /Diagnostics Centers will be done through the Department of Health and Family Welfare as per guidelines framed under the scheme, after consent and advise of Registrar of High Court, which may be revised from time to time, however, rates of reimbursement will be CGHS rates or O/o Registrar, Punjab and Haryana High Court may empanel the hospital of their own.

v. Bill Submission: After complete treatment and discharge of patient, hospital will raise bill through the portal to the Office of Registrar of Punjab and Haryana High Court for release of payment against the claim.

vi. Grievance Redressal:

If any dispute arises in the implementation or operationalization of the scheme, there shall be a Grievance Redress mechanism to resolve the conflicts. The Implementing Agency shall prepare the SOPs.

vii. Fraud Handling: In case any fake bill or duplication of claim is reported, the beneficiary is liable to be penalised for major penalties as applicable under law that may be revised from time to time. If any EHCP is found involved in fraudulent activities, as reference from Registrar Punjab and Haryana High Court, the action as under rules shall be prescribed by Health Department/ Director Health Services (DHS), whichPART I] PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) 839 includes show cause notice, suspension, de-empanelment and imposition of penalties or action may be taken at the end of O/o Registrar Punjab and Haryana High Court.

6. Procedure of Treatment :

No permission is required for getting listed investigations/ Treatment Procedures done at the CGHS empanelled Diagnostic Centre/Hospitals/Laboraties, if prescribed by the concerned Specialist.

7. Facilities available under CHCS

i. Indoor Treatment at Government and Empanelled Hospitals.

ii. Investigations at Government and Empanelled Diagnostic centers.

iii. Cashless facility available for treatment in empanelled hospitals and diagnostic centers for beneficiaries and their family members.

iv. Family Welfare, Maternity and Child Health Services.

v. Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha system of medicines (AYUSH).

vi. Benefits against all packages as in CGHS package master can be availed under the scheme, however, for unlisted procedures (Not listed in CGHS package master) following is proposed:

• PGI and other public hospitals of UT Chandigarh will continue its working as per PGI rate list and at Tata memorial their own rate list will applicable.

• In case unlisted procedure exists in PGI package list, hospitals will be reimbursed as per PGI rates, available at PGIMER website.

• In case unlisted procedure relates to oncology and same exists in Tata Memorial package list, hospitals will be reimbursed as per Tata Memorial rates. Tata memorial rates annexed at Annexure 2.

• In case, unlisted procedure does not exist in any of the above list, then, final decision shall be taken by Department of Health and Family Welfare, Punjab.

PART-III

8. Hospital Empanelment

i. The empanelled hospitals can be Public/ Private/ Non-Government Organisation (NGO)/ Charitable Hospital.

ii. The criteria for hospital empanelment will be consent based, hospitals willing to work for said scheme on CGHS rates.

iii. The empanelment of Public and Private Hospitals shall be done in consonance with Registrar of Punjab and Haryana High Court, which may be revised from time to time.

9. Reimbursement to the empanelled hospitals. –

A) The hospitals shall be reimbursed for the expenditure incurred on treatment / investigation as per CGHS rates. However, such expenditure shall be reimbursed to the hospital as per terms and conditions of the scheme.

B) Reimbursement in case of treatment in non-empanelled and OPD treatment will be at CGHS rates as per existing Guidelines.

10. Determination of package rates to be charged by the hospitals:-

The reimbursement of the treatment cost to a hospital shall be made as per CGHS rates for selected package, provided that if a treatment is not covered in the CGHS rate list, in such exceptional circumstances,840 PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) PART I] the Hospital can treat the patient and raise the demand under unspecified package. The Implementing Agency shall immediately examine such demand and can approve a special package for the treatment as per guidelines framed under scheme.

PART-IV

11. Funding for Scheme:

The State Government shall make necessary budgetary provisions in the appropriate head of account for funding this Scheme. As the schemes pertain to provide Health Care benefits to the Retired Judges of High Court with their family members, it shall be 100% financed by the State Government. It will be on non-contributory basis meaning there by that the beneficiary will not be making any contribution towards the payment of their claim.

12. Penalties:

If any of the Hospital, empanelled for providing treatment to beneficiaries, denies to provide treatment or charges any amount from the beneficiary or any of his relatives or friends or any person, he shall be liable for penalties/action. The Implementing Agency shall prepare the SOP for imposing penalties.

13. Grievance Redress Mechanism:

If any dispute arises in the implementation or operationalization of the scheme, there shall be a Grievance Redress mechanism to resolve the conflicts. The Implementing Agency shall prepare the SOPs.

14. Interpreting Authority:

In case of any doubt with regard to the interpretation of any of the provisions of this policy, the Principal Secretary to the Government of Punjab, Department of Health and Family Welfare / Registrar of High Court, can interpret this policy for the avoidance of any doubts or can issue clarifications.

ALOK SHEKHAR,

Additional Chief Secretary to Government of Punjab,

Department of JusticePART I] PUNJAB GOVT. GAZ., DECEMBER 6, 2024 (AGHN 15, 1946 SAKA) 841

3257$ 12-2024/Pb. Govt. Press, S.A.S. Nagar