Ex-gratia payment and medical assistance
Dated : May 30, 2003
Subject:- Grant of Financial Assistance/Ex-gratia Financial Assistance from the Welfare Fund - review of existing guidelines and issue of fresh consolidated guidelines - regd.
The Governing Body of the Customs & Central Excise Welfare Fund in its meeting held on 28.04.03 reviewed the existing guidelines for Grant of Financial Assistance/Ex-gratia Financial Assistance from the Welfare Fund.
2. The consolidated guidelines, as approved by the Governing Body, are enclosed in Annexure I (for grant of Financial Assistance on non reimbursable medical expenses), and Annexure II (for grant of Ex-gratia Financial Assistance on death/injury of officials) Requisite Certificates/Proforma which has to invariably accompany the proposals for grant of financial assistance for non reimbursable medical expenses is enclosed as Annexure III.
3. You are requested to circulate these guidelines amongst all the formations under your charge.
CONSOLIDATED GUIDELINES FOR GRANT OF FINANCIAL ASSISTANCE IN RESPECT OF MEDICAL EXPENSES
I. Only claims necessitated by emergency or where treatment was not available at approved Dispensary / Hospital are to be forwarded by the Commissioners duly certified by them that the treatment was taken in a private hospital due to emergent circumstances.
II. The time limit for requesting for financial assistance by the individual and for forwarding the proposal by the Commissioner has to be strictly observed. The individual has to request within 6 months of treatment if the entire amount is non reimbursable and within 3 months of settlement of claims when part of the claim is settled under CS(MA)/CGHS rules. The Commissioners are to forward the proposal within a period of one month of receipt of the request.
III. In cases of continuous treatment only one time financial assistance should be considered and normally no subsequent request should be entertained unless there are extreme compassionate grounds.
IV. Financial assistance is admissible only to the officer / staff, his unemployed spouse and dependent children.
V. In case of dependent children and spouse the officer / staff is entitled to financial assistance with a maximum overall cap of Rs. 5 lakhs in the entire career.
VI. No maternity / termination of pregnancy expenses would be admissible to officer/staff having two or more surviving children.
VII. No sundry expenses are to be reimbursed.
VIII. Only 50% of the non-reimbursable room charges are to be paid as financial assistance in cases of treatment in private hospital.
In case of package deal cases where nothing has been reimbursed, Rs. 1,000/- per day is to be deducted. However, in cases of partial reimbursement, a sum of Rs.500/- per day is to be deducted from the claim.
IX. After deductions on account of the non reimbursable room charges and sundry charges, a further deduction of 25% of the remaining non reimbursable expenses should be made to arrive at the final amount admissible for payment from the Welfare Fund.
X. The following minimum amounts of financial assistance to be proposed for sanction have been fixed:
Group'A' : Rs.
10,000/- Group 'C : Rs. 3,000/-
XI. No financial assistance is to be granted to retired officers / staff.
XII. Proforma (Annexure-III) has been prescribed which is to accompany proposals showing split up of amount spent, amount reimbursed and amount non-reimbursable category wise (cost of treatment etc, room charges and sundry charges).
XIII. To monitor the maximum overall cap of Rs. 5 lakh, entries in the Service Book of the officer / staff of the financial assistances for medical expenses from the Welfare Fund are required to be made. To computerize / monitor the details by the Directorate of Logistics, the Commissioner while forwarding the proposal shall certify that the name of the officer is as per the Service Book and also give details regarding change of name, if any.
XIV. The Commissioner while forwarding the requests of financial assistance for medical expenses shall send the details of financial assistance hitherto granted to the officer / staff in his entire career as per the Service Book and details of proposals in respect of that officer if any pending with the Directorate. The Commissioner should also enclose certificate to this effect from the officer / staff.
XV. Each proposal should be scrutinized by the Advisory Committee, comprising of Commissioner/Director and one representative each of Group 'A' to 'D' services, constituted for sponsoring proposals under the rules and duly recommended before it is sent to the Directorate of Logistics. The proposals received without recommendation of the Advisory Committee would not be placed before the Governing Body.
CONSOLIDATED GUIDELINES FOR GRANT OF EX-GRATIA FINANCIAL ASSISTANCE FROM THE WELFARE FUND
1) (i) When the value of terminal benefits and immovable assets of the deceased official both put together is less than Rupees 5 lakhs, the family will be paid ex-gratia assistance of Rs. One lakh.
(ii) When the value of terminal benefits and immovable assets put together of the deceased official is more than Rupees 5 lakhs but less than Rupees 10 lakhs, the family will be paid an ex-gratia assistance of Rs. 75,000/-.
(iii) When the value of terminal benefits and immovable assets put together of the deceased official is more than 10 lakhs, no ex-gratia assistance shall be paid
2) Since there is a graded system for sanction of Ex-gratia financial assistance an inquiry report should be sent with the proposal showing the financial condition of the family giving full details of value of immoveable properties, amount available with the Banks (savings/fixed deposits) LIC payments, total terminal benefits paid, monthly pension being paid and whether any of the family members are employed may be sent.
3) A sum of Rs. One lakh is to be sanctioned as Ex-gratia financial assistance to officials / staff who sustain permanent injury or disability during the performance of Gbvt. duties.
4) For the officials / staff who die while performing anti-smuggling / anti-evasion/ anti-narcotics duties, a sum of Rs. 5 lakhs be paid as ex-gratia assistance in addition to any assistance which may be sanctioned from the Consolidated Fund of India in terms of Department of Pension & Pensioner's O.M. No. 45/55/97-P&PW(C) dated 11.9.98. In view of condition No. 12 contained in the Annexure to the afore-mentioned O.M. which provides that ex-gratia assistance paid from different sources should not epxceed Rs. 10 lakhs in each individual case, the amount paid out of the Welfare Fund will be in addition to the relief, if any, received from the Consolidated Fund of India in terms of the aforementioned O.M. However, the ex-gratia assistance out of the Welfare Fund will be paid only if the death of the official is directly attributable to the actual performance of anti-smuggling / anti-evasion and anti-narcotics duties. The Commissioners while forwarding proposals in this respect would critically examine and report the circumstances of death of the subject official.
5) The decision regarding grant of ex-gratia financial assistance shall be delinked from the appointment on compassionate grounds of a family member of the deceased official.
6) Proposal for ex-gratia finanical assistance from Welfare Fund may be sent to the Directorate of Logistics as early as possible after the death of the official but not later than two year after his death.
7) If for some reasons, a proposal for ex-gratia financial assistance could not be sent in the prescribed time limit of 2 years after the death of an employee, but survivor of the deceased deserve ex-gratia financial asistance on merit of the case, the same may be sent for consideration of the Governing Body giving full justification and reasons for not been able to forward the proposal within prescribed time limit of 2 years after the death of the employee.
CERTIFICATES to be submitted with the proposal for grant of Financial Assistance on non reimbursable medical claims
1. Certified that the proposal for financial assistance has been recommended by the Advisory Committee constituted in this office for this purpose.
2. Certified that a sum of Rs. -------------- has been earlier sanctioned to the individual as Financial Assistance from the Welfare Fund for medical expenses for spouse and dependent children and the details thereof have been entered in the individual's service book. Further, ------------- number of proposals of Financial Assistance are pending (give details) with Directorate of Logistics.
Note => The amount of financial assistance to staff/employee should not be included in above certificate
3. Certified that the name of the officer is as per the service book (in case of change of name, details may be given.)
4. Certified that the number of surviving children are less then two.
Note => This certificates required only in cases of grant of Financial Assistance on the non reimbursable expenses on the maternity expenses or termination of pregnancy.
5. Certified that the spouse of employee/officer is non working.
Note => This certificate is required only where financial assistance is sought for medical expenses of spouse.
6. Details of medical expenses reimbursed and not reimbursed are as under :
No. of days for which room rent paid for stay in other than ICU/CCU ----------