Nust Medical Policy 2015

NUST MEDICAL POLICY 2015

1. Title. The document will be called “NUST MEDICAL POLICY 2015” and will come into force with effect from 1 November 2015.

2. Scope. It will be applicable to NUST employees, serving at Main Office and its institutions, to the extent explained in the succeeding paras.

3. Definitions. For the purpose of this policy, the pertinent terms are explained as under:-

a. Family. Includes spouse, sons, daughters and parents of the employee provided that:-

(1) Sons will be taken as part of the family till the age of 18 years or till get married, whichever is earlier.

(2) Daughters will be taken as part of the family till they get married.

(3) Parents will be taken as part of the family if both of them are not in any service or business and their entitlement will be ascertained as under:-

(a) If the employee has other siblings, the parents will be assumed to be dependent on his / her elder brothers, primarily.

(b) On the employee, if being the only son / daughter.

(d) If more than one child is serving as employees, the parents will be assumed to be dependent on one employee only, with higher pay scale.

b. Medical Authority. Means “Director Medical Sciences” or any officer authorized by the competent authority as his representative at Main Office NUST and its institutions.

4. Execution. The extent and methodology for the provision of medical services are explained as under:-

a. Emergency Medical Services. All NUST employees, their families and students will be entitled to free emergency treatment at H-12 campus / MI Room at its institutions.

b. Faculty & Officers (EBPS 17 & Above) on Contract on Lump Sum Pay Package and their Families Less Parents

(1) For their Indoor / Outdoor health care needs, they will be offered “Health Insurance Package” on 60:40 premium sharing basis between the employee and NUST except during the probation period when they will not be entitled to it. The package may be offered to fresh faculty members / officers as and when and to the extent as deemed appropriate.

(2) For the members opting for the package, premium deduction and the processing of reimbursement cases will be undertaken by Finance Directorate.

(3) For the Faculty members and Officers who decline the package offer, NUST will bear no responsibility what so ever towards their / their families’ health care needs which will be managed at their own except as specified in para 4a ante.

c. Officers (BPS 17 & Above) on Regular Basis & NG Staff

(1) The employees will be entitled to medical allowance as per NUST rules.

(2) The employees and their families will be entitled to Outdoor (other than hospitalization) medical services in the manner specified below:-

(a) H-12 Medical Centre / MI room at institutions will act as filter clinics to attend to the emergencies and routine sick report and patients will be provided with consultation and emergency treatment for a maximum of 5 days in a case.

(b) Except emergencies, which may report at any time, employees seeking medical assistance will report to the Medical Centre at dedicated sick report time along with sick report, to be initiated by an officer of that office. The sick report will be endorsed by Medical Officer (MO) with the diagnosis / disposal of the patient as under:-

(i) Medicine & Duty - M&D

(ii) Medicine & Rest - M&R

(iii) M&R will be restricted to a maximum of 03 days, beyond which hospitalization should be considered. Bed rest without the need of hospitalization will be counted towards medical / sick leave, on the recommendation of Medical Authority.

(c) Except emergencies, which may report at any time, the employees’ families will report to the Medical Centre / MI Rooms at sick report stipulated time with their updated family treatment card. The specimen of the card will be prepared by NUST Medical Centre which will undergo bulk printing while based on the available data; the cards will be prepared by the respective Directorates / Institutions.

(d) Cases requiring opinion of specialists will be referred as under:-

(i) For the Directorates / Institutions at H-12 Campus, by MOs of NUST Medical Centre

(ii) For other Institutions, by MO of respective MI Room

(iii) In principle, the cases will be referred to Government / Armed Forces hospitals or any other hospital, deemed appropriate by the medical authority if the required expertise and capabilities do not exist in Government / Armed Forces hospitals.

(e) The expenditure on the treatment and investigations advised by specialist without hospitalization will initially be borne by the employee with filing of reimbursement claim subsequently (on specified form) with supporting medical documents.

(f) Medicines advised by specialist after first visit of the patient or any new medicine advised subsequently, as part of long term treatment, will be purchased by the employee, initially for a maximum duration of one week and subject to its tolerance by the patient, the same may be purchased for a maximum duration of two weeks at a time, till changed by the specialist. Reimbursement cases will be considered accordingly.

(g) Except in emergency which will be ascertained by Medical Authority, expenditure incurred on the treatment / investigations in hospitals / clinics other than Government / Armed Forces hospitals will not be reimbursed. If a justification for getting treatment / undertaking investigations from a hospital other than Government / Armed Forces hospitals exists, the non-existence of the consultative / treatment / diagnostic capabilities will be required to be certified by the Medical Superintendent of the Government / administrator / concerned consultant of the Armed Forces hospital and verified by Medical Authority.

(h) Cases requiring day care operative procedures and sophisticated investigations like CT scan, MRI, Echocardiography, Angiography, all other scanning procedures, Hysterosalpingography, all biopsies etc. will seek prior written approval of Medical Authority along with complete medical documents and financial effects.

(j) To cater for the outdoor reimbursement provisions, they will be entitled to an outdoor consultation / treatment / procedure / investigations expenditure ceiling on reimbursement basis, as under:-

(i) BPS 1 – 5 / equivalent - Rs 4,000 / family member

(ii) BPS 6 – 10 / equivalent - Rs 5,000 / family member

(iii) BPS 11 – 16 / equivalent - Rs 6,000 / family member

(iv) BPS 17 – 18 / equivalent - Rs 7,000 / family member

(v) BPS 19 / equivalent - Rs 9,000 / family member

(vi) BPS 20 / equivalent - Rs 12,000 / family member

(k) Day Care Procedures like cataract, minor surgical and gynaecological procedures, endoscopies, scanning etc. are disposed of in hospitals within a couple of hours and therefore hospitalization is not justified in such cases. All such procedures, in principle, will be accounted for against Outdoor medical expenditure ceiling unless considered otherwise by Medical Authority.

(l) No medical expenditure ceiling will be entitled to NG staff employed on contract, during the probation period.

(3) For Indoor (hospitalization associated) health care needs of the employees and their families, the following will apply:-

(a) Except in emergency, hospitalization / operative or any other procedure will strictly be on the discretion / approval of NUST Medical Authority and the opinion of any specialist will not be a binding on NUST.

(b) Except for emergencies, all cases requiring hospitalization / surgical intervention / sophisticated investigations like CT and other scans, MRI, Angiography etc, will require prior approval of Medical Authority. For NUST H-12 Campus Main Office / Directorates / Institutions, these will be processed with Director Medical Sciences through NUST Medical Centre while for the other Institutions; it will be sought through respective Medical Officer. However, such cases pertaining to Institutions other than H- 12 Campus requiring medical expenditure over Rs 15,000/- (Rupees Fifteen Thousand Only) will also be processed with Director Medical Sciences for prior approval. In emergencies, where prior approval could not be sought, case will be regularized by seeking ex-post-facto sanction.

(c) Hospitalization associated health care delivery will, in principle, is through Government / Armed Forces hospitals, where applicable. Hospitalization may be undertaken in other hospitals with prior approval of Medical Authority, if the required expertise and capabilities do not exist in Government / Armed Forces hospitals. The non-existence of the required consultative / treatment / diagnostic capabilities will be required to be certified by the Medical Superintendent of the Government / administrator / concerned consultant of the Armed Forces hospital and verified by NUST Medical Authority.

(d) The expenditure during hospitalization will initially be borne by the employee with filing of reimbursement claim subsequently (on specified form) with supporting medical documents.

(e) For the purpose of reimbursement, as a rule, the rates of Armed Forces / Government hospitals for room rents / investigations / procedures / operations will be taken as reference. Any expenditure incurred over and above to those, when treatment undertaken in other hospitals in emergency and that too vetted by NUST Medical Authority, will be borne by the employee.

(f) Unless necessitated by the condition of the patient for placing him / her at another place, in principle, the employees will be entitled to the following hospital accommodation:-

(i) BPS 1-16 / equivalent - General ward

(ii) BPS 17-19 / equivalent - Semi-private room

(iii) BPS 20 / equivalent - Private room

(g) No hospitalization associated services will be entitled to NG staff employed on contract, during the probation period.

(4) For the dental treatment, the employees and their families will be entitled to consultation and treatment of common gum diseases and extraction of carious / impacted tooth. All fillings / root canal treatment / orthodontic / prosthodontic / cosmetic procedures / crowning / bridging / scaling / dentures / elective maxillo-facial surgery etc. will not be covered towards entitlement. NG staff employed on contract will not be entitled to dental treatment, during the probation period.

d. Serving Armed Forces Officers /JCOs/Soldiers. All serving Armed Forces officers / JCOs / soldiers and their families will be entitled to free emergency services at NUST Medical Center / MI Room of institutions. However, they will get long term treatment for themselves and their families from respective Armed Forces hospitals.

e. Retired Armed Forces Officers. All retired Armed Forces officers employed on contract and their families will be entitled to free emergency services at NUST Medical Center / MI Room of institutions. However, they will get long term treatment for themselves and their families from respective Armed Forces Hospitals. If they want extended coverage, may join Health Insurance Policy as explained in para 4 b ante.

f. Retired Armed Forces JCOs / Soldiers.

(1) They will be entitled to medical allowance as per NUST rules.

(2) The employees employed on contract and their families will be entitled to free emergency services at NUST Medical Center / MI Room of institutions. However, they will get long term treatment for themselves and their families from respective Armed Forces Hospitals.

(3) Cases requiring opinion of specialists / hospitalization will be referred by Medical officer of NUST Medical Centre / MI Room of institutions to respective Armed Forces hospitals.

g. Students.

(1) Each student will subscribe Rs 100/- pm as “Medical Treatment Subscription”.

(2) Will be entitled to free emergency treatment at H-12 Medical Centre / MI Rooms at institutions for common ailments, to the extent of consultation and available medicines.

(3) Will not be entitled to any medical / surgical / dental / cosmetic treatment / procedure / investigation not forming part of an emergency.

(4) In case of emergencies occurring at NUST campuses, for which management is beyond the capabilities of NUST Medical Centre / MI Rooms, they will be referred to Government / Armed Forces hospitals, in principle, for consultation / treatment / admission / investigations / operative procedure as deemed appropriate. In the best interest of the patient and subject to the decision of NUST Medical Authority, such emergencies may also be referred to other hospitals at the station. The authorization of medical expenditure, incurred in such cases will rest entirely with the competent authority at NUST.

(5) They will be entitled to admission to a general ward, unless nature of emergency demands placing the patient at another place.

(6) Will not be entitled to the treatment / investigations of any cold medical / surgical condition that either existed before joining or appeared during stay at NUST except for that presenting as an emergency.

(7) Will be entitled to the reimbursement of medical expenditure incurred on the treatment / investigations, advised by NUST Medical Officers / specialists at various hospitals where they were referred in emergency by NUST Medical Officers. The reimbursement claim will be entertained only with the supporting documents.

(8) Will not be entitled to reimbursement of medical expenditure incurred on the treatment of emergencies occurring out-campus like on leave / weekend etc.

5. Financial Powers.

a. For the regularization of medical expenditure, the following financial power will be exercised:-

(1) Head of Institutions - Rs 15,000/-

(2) Director Medical Sciences - Rs 150,000/-

(3) Pro-Rector (P&R) - Rs 300,000/-

(4) Rector - As deemed appropriate

b. Medical expenditure incurred in emergency and approved by an office beyond its financial power, will be regularized by seeking ex-post-facto approval from the appropriate higher office in chain.

6. Exclusions. Any modality of medical treatment / investigation / procedure other than proven and recommended by allopathic system of health care delivery, will not be covered towards the entitlement. Besides that, the following aspects and the like will also be part of exclusion network for the purpose of entitlement:-

a. Cosmetics, termed as medicines.

b. Food supplements and fancy Vitamin preparations.

c. Baby milk formulae.

d. Scientifically un-proved products / procedures.

e. Elective tubal ligation / vasectomy.