Executive Summary:
This notification concerns the Employees State Insurance Corporation's (ESIC) implementation of the Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2010, in conjunction with the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (ABPMJAY). It outlines user charges and details for ABPMJAY beneficiaries availing medical services in underutilized ESIC hospitals, as approved by the Central Government. Objections or suggestions regarding this notification must be submitted within 30 days of its publication.
Key Points / Main Content:
* **Authority and Context:**
* The notification is issued under the authority of sub-clause 1 of clause 6 of The Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2010.
* It follows a Memorandum of Understanding between the ESIC and the National Health Authority for providing services under ABPMJAY.
* **User Charges and Medical Services:**
* ABPMJAY beneficiaries can avail medical services in underutilized ESIC/ESIS hospitals.
* Inpatient Department care will be as per ABPMJAY packaged rates.
* **Definition of Underutilized Hospital:**
* An underutilized hospital is defined as one with bed occupancy less than 60% during the last two financial years.
* **Operational Modalities:**
* The Director General of ESIC will specify the names of underutilized hospitals and their operational modalities for ABPMJAY.
* **Objections and Suggestions:**
* Objections or suggestions regarding the notification will be considered if received within 30 days of publication.
* These can be addressed to Shri S Biswas, Insurance Commissioner P D, at the provided address or email.
Impact Analysis:
* **Employees State Insurance Corporation:**
* *Impact:* Responsible for implementing the scheme and defining operational modalities for underutilized hospitals. Must consider suggestions/objections.
* *Action Required:* Specify underutilized hospitals and their operational modalities. Review and consider objections/suggestions received.
* **Ayushman Bharat Pradhan Mantri Jan Arogya Yojna Beneficiaries:**
* *Impact:* Gain access to medical services at underutilized ESIC/ESIS hospitals at ABPMJAY rates.
* *Action Required:* May need to familiarize themselves with the list of designated hospitals and applicable procedures.
* **Employees State Insurance Scheme Hospitals:**
* *Impact:* Underutilized hospitals may see an increase in patient load and revenue.
* *Action Required:* Prepare to provide services to ABPMJAY beneficiaries as per the defined operational modalities.
* **General Public:**
* *Impact:* Opportunity to provide feedback and suggestions on the notification.
* *Action Required:* Submit any objections or suggestions within 30 days of the notification's publication.
Key Entities Referenced
Employees State Insurance Corporation: An Indian government organisation responsible for providing social security and health insurance to employees.
National Health Authority: An Indian government body responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojna.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojna: A centrally sponsored scheme of the Indian government to provide free access to healthcare for low income earners.
The Other Beneficiaries and Members of their Families Medical Facilities Scheme, 2010: A scheme related to medical facilities for beneficiaries and their families, administered by the Employees State Insurance Corporation.
New Delhi: The location where the draft notification was issued.
Shri S Biswas: Insurance Commissioner P D, Employees State Insurance Corporation, to whom objections and suggestions regarding the notification may be addressed.
Panchdeep Bhawan, Comrade Indrajit Gupta Marg, New Delhi110002: The address of the Employees State Insurance Corporation where Shri S Biswas is located.
Employees State Insurance Scheme hospitals: Hospitals operated under the Employees State Insurance Scheme.
रजजस्ट्री ु.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99
xxxGIDHxxx
सी.जी.-डी.एलxx.x-GअI.D-E0x3x1x 12020-222936
CG-DL-E-03112020-222936
अुाधारण
EXTRAORDINARY
भाग III—खण्ड 4
PART III—Section 4
प्राजधकार ु ेप्रकाजित
PUBLISHED BY AUTHORITY
ु.ं 465] नई ददल्ली, र्गं लाार, ना्ीर 3, 2020/का्तक 12, 1942
No. 465] NEW DELHI, TUESDAY, NOVEMBER 3, 2020/KARTIKA 12, 1942
कर्चम ारी राज्य ीीर्ा जनगर्
र्ुौदा अजधुचू ना
नई ददल् ली, 19 अक्त ूीर, 2020
ु.ं य-ू 11/13/2/2019 जचदकत्ु ा I.—जीदक कर्मचारी राज्य ीीर्ा जनगर् न े ‘‘अन् य लाभाथथी तथा उनके रिराार
के ुदस्ट् यों को जचदकत् ुा ुिजाधाएं योजना, 2010’’ को कायामजन्ात करने के प्रयोजन ुे कर्मचारी राज्य ीीर्ा जनगर् ्ारा
आयिष् र्ान भारत/प्रधानर्ंरी-जन आरोग्य योजना (आ.भा./प्र.र्-ं ज.आ.यो) के अतं गतम ुेााएं प्रदान करन े ूते ि राष्र ीय
स्ट् ाास्ट् ् य प्राजधकरण, भारत ुरकार के ुाथ ुर्झौता ज्ञारन दकया ू।ै
अत: जीएुआर 654(ई), ददनांक 04 अगस्ट्त , 2010 के र्ाध् यर् ुे भारत का राजरर (अुाधारण), धारा 3, उर-
धारा (i) का भाग ।। र्ें अजधुूजचत की गई ‘‘अन् य लाभाथथी तथा उनके रिराार के ुदस्ट् यों को जचदकत् ुा ुिजाधाएं योजना,
2010’’ के रैराग्राफ 7 के ुाथ रिित ररै ाग्राफ 6 ्ारा प्रदत्त िजियों का प्रयोग करत े हुए र्ूाजनदेिक, कर्मचारी राज्य
ीीर्ा जनगर् न े उक्त ‘‘अन् य लाभाथथी तथा उनके रिर ाार के ुदस्ट् यों को जचदकत् ुा ुिजाधाएं योजना, 2010’’ के अंतगमत
आयिष् र्ान भारत/प्रधानर्ंरी – जन आरोग् य योजना के लाभा्थयों को अन् य लाभा्थयों के ूपर र् ें कर्मचारी राज्य ीीर्ा
जनगर् या कर्मचारी राज्य ीीर्ा योजना के अल् र उरयोगी अस्ट् रतालों र्ें जचदकत् ुा ुिजाधाएं प्रा त करन े ूते ि केन् रीय ुरकार
्ारा यथा अनिर्ोदद त प्रयोक्त ा ििल् क तथा अन् य जाारणों को जन्न जलजखत ितामधीन अजधुूजचत दकया ू,ै यथा :-
i. अंत:रोगी जाभाग देखभाल, आयिष् र्ान भारत/प्रधानर्ंरी-जन आरोग् य योजना रैकेज दरों की र्ौजूदा दरों के
अनिुार ूोगी;
ii. इु अजधुूचना के प्रयोजन के जलए क.रा.ीी.जनगर् अथाा क.रा.ीी.योजना के अल् र उरयोगी अस्ट् रताल ूोंग,े
जूां जरछल ेदो जात्तीय ाीों र् ेंजीस्ट् तर अजधभोग 60 ु ेकर् रूा ू;ै
iii. आयिष् र्ान भारत/प्रधानर्ंरी-जन आरोग् य योजना के ुंींध र् ें अल्र उरयोगी अस्ट्र तालों के नार् एां उनकी
रिरचालन काय-म रीजतयााँ र्ूाजनदेिक, क.रा.ीी.जनगर् ्ारा ुर्य-ुर्य रर अजधिाुी जनदेिों के र्ाध् यर् ु े
जनर्ददष् ट दकए जाएंगे।
5377 GI/2020 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC. 4]
2. इु अजधुूचना के ुंींध र्ें प्रकािन की जतजथ ुे तीु ददनों के भीतर दकुी व् यजि ुे कोई आरजत्त या ुिझाा, प्रा त
ूोने रर क.रा.ीी.जनगर् ्ारा जा चार दकया जाएगा। आ रजत्तयां या ुिझाा, यदद कोई ूों, को श्री एु. जीश् ााु,
ीीर्ा आयिक् त (योजना एा ं जाकाु), कर्चम ारी राज्य ीीर्ा जनगर्, रंचदीर भान, कार्रेड इंरजीत गि ता र्ाग,म
नई ददल् ली-110002 (ई-र्ेल : med-comm@esic.nic.in) को भेजा जाए।
एु जीस्ट्ााु, ीीर्ा आयिक् त (योजना एां जाकाु)
[जाज्ञारन-III/4/अुा./324/2020-21]
EMPLOYEES’ STATE INSURANCE CORPORATION
DRAFT NOTIFICATION
New Delhi, the 19th October, 2020
No U-11/13/2/2019 Medical I.—whereas the Employees’ State Insurance Corporation has entered
into a Memorandum of Understanding with National Health Authority, Government of India for providing
services under Ayushman Bharat/ Pradhan Mantri – Jan Arogya Yojna (AB/PM-JAY) by Employees’ State
Insurance Corporation for the purpose to implement ―The Other Beneficiaries and Member of their
Families Medical Facilities Scheme, 2010‖.
Therefore, in exercise of the powers conferred by sub-clause (1) of clause 6 of ―The Other
Beneficiaries and Members of their Families Medical Facilities Scheme, 2010‖ notified vide G.S.R 654(E),
dated 04th August, 2010 published in the Gazette of India (Extraordinary), part II Section 3, Sub-section (1)
read with paragraph 7 thereof, the Director General, Employees’ State Insurance Corporation, hereby
notifies the rate of user charges and other details, as the Central Government has approved for availing the
medical services in the underutilised Employees’ State Insurance Corporation or Employees’ State
Insurance Scheme hospitals by Ayushman Bharat/Pradhan Mantri – Jan Arogya Yojna beneficiaries, as
other beneficiaries, under the said ―The Other Beneficiaries and Members of their Families Medical
Facilities Scheme, 2010‖, subject to the following conditions, namely:-
i. Inpatient Department care shall be as per the extant rates of Ayushman Bharat/Pradhan Mantri
– Jan Arogya Yojna packaged rates;
ii. An underutilised hospital for the purpose of this notification shall be the Employees’ State
Insurance Corporation Hospital or Employees’ State Insurance Scheme Hospital where the bed
occupancy is less than 60% during the last two financial years;
iii. Name of the underutilised hospitals and their operational modalities regarding Ayushman
Bharat/ Pradhan Mantri – Jan Arogya Yojna shall be as specified by the Director General,
Employees’ State Insurance Corporation, from time to time, through executive instructions.
2. Any objection or suggestion, which may be received from any person in respect of this notification
within a period of thirty days from the date of publication, will be considered by the Employees’ State
Insurance Corporation. The objections and suggestions, if any, may be addressed to Shri S Biswas,
Insurance Commissioner (P & D), Employees’ State Insurance Corporation, Panchdeep Bhawan, Comrade
Indrajit Gupta Marg, New Delhi-110002. (e-mail: med-comm@esic.nic.in).
S. BISWAS, Insurance Commissioner (P & D)
[ADVT.-III/4/Exty./324/2020-21]
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
and Published by the Controller of Publications, Delhi-110054.