Govt clears medical insurance benefit rules for employees

SIKKIM EMPLOYEES STATE INSURANCE [MEDICAL BENEFIT] RULES COMES INTO FORCE 12 YEARS AFTER IT WAS DRAFTED
GANGTOK, 03 Dec: Finally, after a lapse of almost 12 years, the State government has decided to go ahead with the Sikkim Employees State Insurance (Medical Benefit) Rules 2012. The initial draft rules had been issued in the year 1996. This will definitely bring some cheer for the government employees who are largely dependent on the government for medical benefits.
Now that the government has decided to go ahead with this insurance cover for its employees, State Insurance dispensaries will be established for medical treatment of insured persons. However people living in remote areas may not see much benefit in this as such dispensaries will be set up where the population concentration is not less than 1,000 insured persons.
However as per the rules, arrangement has also to be made for insured persons where there are no such dispensaries but within reasonable distance. This can be by a mobile dispensary or by delegating an Insurance Medical Officer to visit any specified dispensary in the areas or arranging for treatment of insured persons by the medical officer. The state may also make arrangement for provision of treatment in government or private hospitals.
Other options available with the government are either to establish a separate hospital for insured persons or reserve separate beds for exclusive use of insured persons in hospitals under it or a private hospital.
Insured persons have the right to indicate which hospital or dispensary where arrangement for provision of medical benefit has been made. A person is required to bring along his identity card to claim medical benefit.
In case of an emergency an insured person may claim medical benefit under these rules from any Insurance medical Officer whether he is allotted to him or not. Medical benefit will be refused in case the person fails to produce the identity card.
As for the range of treatment that an insured person can receive, it has been stated that these will include out patient treatment which shall consist of all treatment other than those involving special skill or experience. The range of treatment includes vaccination, inoculation, antenatal and postnatal treatment, free drugs and dressing and also provision of certificates in respect to sickness, maternity, employment injury and death.
The Insurance Medical Officer will also visit the insured person at his residence and also visit women suffering miscarriages. More serious persons requiring hospitalization shall be admitted at the nearest hospital by ambulance.
It has been further directed by the state that full time Insurance Medical Officers are not to undertake private practice. Such officers will be subject to other conditions of service as fixed by the government.
All State Insurance dispensaries, hospitals, clinics, mobile dispensaries and other medical institutions specified for the purpose of providing medical benefits to insured persons shall be subject to administrative control and superintendence of the Director of Health Services.