DEPARTMENT OF ATOMIC ENERGY HOSPITAL, KALPAKKAM 603 102

INFORMATION BROCHURE ON MEDICAL FACILITIES AVAILABLE FOR RETIRED EMPLOYEES UNDER CONTRIBUTORY HEALTH SERVICES SCHEME (CHSS) OF DAE AT KALPAKKAM/CHENNAI

A) Extension of the Scheme:

Kalpakkam - Retired employees enrolled under CHSS are eligible to get CHSS facilities at Kalpakkam.

Chennai - Retired employees enrolled under CHSS and settled in Chennai  are eligible for CHSS facilities at Chennai.

B) Eligibility:

- Retired employees of the Department who have put in a minimum of five years of service in the Department before their retirement and opted for the benefits of the Scheme and members of their families. (Para 2.1.10(i))

- Employees who had already retired from DAE/NPC Units in Kalpakkam/Chennai before introduction of CHSS i.e. those retired before 1.8.1993.(DAE Note No.22/10/92-CHSS/IR&W/189 dated 4.8.1994)

- Employees retired from places of DAE Units where CHSS is not available and settled down in a place where CHSS is available. (Para 2.1.10(vi))

- The benefits of the Scheme will continue to be made available to the members of the families of the retired employees who are covered by the definition of "Family" and covered under the CHSS, i.e. Spouse, dependent parents whose monthly income is less than Rs.4000/- p.m. and unmarried/unemployed children not completed 25 years of age, even after the death of retired employees subject to payment of appropriate contribution and fulfillment of other conditions.

- If life long registration is not done, it is obligatory on the part of the retired employee to revalidate the registration every year after submission of a declaration to the effect that they do not avail medical facility from any other sources.  In case, the retired employees do not renew CHSS cards in time, they are not eligible for any medical treatment and reimbursement the non-renewal period. (DAE ID Note No.7/14/98/CHSS-IR&W/165 dated 19.5.1998)

- Retired employees should pay the prescribed CHSS contribution without any break from the date of retirement/registration under CHSS.

- Person who is receiving or is eligible to receive medical aid/facility/cash subsidy, cash allowance or reimbursement for medical care from any source other than this Scheme, shall not be admitted to the Scheme. (Para 4.2)

C) Application for Admission to the Scheme:

Application for registration under CHSS shall be submitted in the prescribed form (Annexure-1) forwarded by the Administration concerned with a stamp-size photo of each beneficiary to the Assistant Personnel Officer (CHSS), DAE Hospital, Kalpakkam 603 102. 

In case, an employee retired from DAE Unit outside Kalpakkam/Chennai wishes to avail the CHSS facility at Kalpakkam/Chennai, he/she may submit  a filled up application form along with a certificate issued by the concerned Unit containing following details or forward the application form through Administration of the Unit in which he/she last served:

1. Name of the retired employee :

2. Designation/Post held at the time of retirement :

3. Unit & Place from which retired :

4. Date of birth :

5. Date of joining in service (in DAE) :

6. Date of retirement :

7. Whether presently covered under the CHSS : Yes / No

8. Details of family members eligible for medical facilities at the time of retirement:   

                                Name              Date of birth       Relationship 

9. Details of CHSS contribution paid if any:

      a) period up to which paid            :

      b) Amount & Rate of contribution   :

Retired employees of the Department who opted for the  benefits of the Scheme should pay the contribution @ 1% of the basic pay last drawn per month in advance for a minimum period of one calendar year.  For LIFE TIME registration, retired employees shall pay one time contribution for ten years even if he/she opts for it at a later date.

Employees retired prior to 1.1.1986, have to pay 2% of last basic pay drawn subject to maximum of Rs.30/- as monthly contribution.

Employees retired after 1.1.86 but before 1.2.98 have to pay 1% of basic pay drawn (pre-revised) subject to maximum of Rs.50/- per month.

Employees retired from 1.2.98 have to pay 1% of basic pay last drawn at the time of retirement.

Employees who retired voluntarily with less than 25 years of qualifying service, are eligible for registration under the Scheme provided they pay an enhanced contribution at the rate of three times of the normal rate.  However, the voluntarily retired employees with 30 years of qualifying service need to pay contribution at normal rate and those with less than 30 years but more than 25 years of service at double the normal rate. (DAE OM No.1/7/99/IR&W/200 dated 27.7.2000)

Payment towards CHSS contribution should be made by demand draft to be drawn in favour of "Accounts Officer, GSO" payable at State Bank of India or Canara Bank at Kalpakkam.  Local Bank Cheque at Kalpakkam is also accepted.

D) Facilities available under CHSS :

i) At Kalpakkam:

All retired employees and their family members possessing valid CHSS cards, are eligible to avail medical facilities at DAE Hospital, Kalpakkam.  They are eligible to get reimbursement for the medicines not available in the Hospital and prescribed by the DAE Hospital Doctors. They are eligible to get treatment/investigations at recognised Hospitals/Centres under CHSS based on the referral letters issued for them including treatment under Indian System of Medicines.  Retired employees and their family members, who are referred to recognised Hospitals/Centres outside Kalpakkam, will be entitled to claim travelling allowance from Kalpakkam as per rules.

ii) At Chennai:

Retired employees settled down at Chennai may avail medical treatment from one of the Authorised Medical Attendants (AMA) nominated under the CHSS in Chennai. Medicines prescribed by the AMA, should be purchased within 10 days or before the date of completion of treatment as shown in the essentiality certificate whichever is earlier. 

AMAs at Chennai are authorised to refer the beneficiaries to the following recognised private Centres/Hospital in addition to Government Hospitals/Centres at Chennai, if required:

1. MEDISCAN SYSTEMS,
197, (Old No.92), Doctor Natesan Road, (Near Chennai City Centre), Mylapore, CHENNAI 600004.     (New address)  Ph.No.24663232  Fax:24988226
Ultra sonogram tests
2. ARMA CLINICAL SERVICES,
34, First Main Road, Gandhi Nagar, Adyar,
CHENNAI 600 020 (Ph:24910704/24415995)
All investigations
3. EHRLICH LABORATORY
19, Masilamani Road, Royapettah,
CHENNAI 600 014 (Ph:28130514/28130460)
Lab tests only
4. LISTER METROPOLIS LABORATORY
3, Jagannathan Road, Nungambakkam,
CHENNAI 600 034           (Ph: 42055555)
Lab tests only
5. ST. ISABEL HOSPITAL
18, Oliver Road, Mylapore,
CHENNAI 600 004 (Ph:24991081/82/83)
Specialist consultation/other treatment as considered necessary

The patient shall be admitted only in the entitled bed class at the St. Isabel Hospital.  In cases where the required specialised treatment is not available at the Hospital, the patient should report to the DAE Hospital, Kalpakkam for further medical advice.

A Medical Officer from DAE Hospital, Kalpakkam is visiting NPC Office, No.51, Montieth Road, Egmore, Chennai 600 008 on every Tuesday between 10.00 and 12.00 hours and patients requiring any advice/consultation for medical treatment (including treatment for major ailments) may approach the Medical Officer for further treatment.

For availing treatment under Indian System of Medicines, CHSS beneficiaries may contact the above deputed Medical Officer at NPC Office, Chennai for getting referrals.

Reimbursement claims should be submitted in the prescribed form alongwith original bills/essentiality certificates (Form A) etc. duly signed by the AMAs to the NPC Office, Chennai within a month of completion of treatment.  Cost of items like toiletries, disinfectants, equivalent to food, appliances and similar items, are not admissible even if prescribed by the AMAs.  Referral letter form to be issued by AMAs is available at NPC Office, Chennai.

Treatment for purely aesthetic reasons will not be covered under the CHSS.

iii) Outside Kalpakkam/Chennai:

Retired employees have an option for claiming reimbursement following the pattern of CS(MA) Rules only for the in-door medical treatment availed of by them and their family members provided he/she was a member of CHSS at the time of availing treatment.  Such reimbursement shall be allowed only for the treatment availed of through the following:

a) Government hospitals and medical institutions of the local authorities such as District Hospitals, Medical Colleges, Municipal Hospitals etc.

b) Private Hospitals as recognised by the Ministry of Health & Family Welfare, New Delhi

c) Hospitals recognised under CGHS

d) Hospitals recognised by DAE for treatment under CHSS/CS(MA) Rules.

e) Hospitals recognised by the State Governments, other Central Government Departments and Public Sector Undertakings under the control of DAE.

For OP treatment, beneficiary is eligible for medical attendance/ treatment from any Authorised Medical Attendants.  The entitlement will be regulated under CS(MA) Rules, 1944.

E) Treatment under medical emergency:

In medical emergencies, beneficiaries under the Scheme may receive, as a concessional measure, medical attendance and treatment from any private medical practitioner or hospital (where the emergency arises) and the reimbursement for such expenditure will be limited as per rules of the CHS Scheme.

For the purpose of this Scheme, the term "emergency" shall mean a situation or contingency when but for the immediate medical aid sought, there would have been, on the basis of the medical and attendant considerations, a serious danger or hazard or severe or deleterious consequence to the health of the patient.  The accessibility/ availability or otherwise of the facilities under the Scheme in the context of the severity of medical emergency/ailment at the time of emergency will also be taken into consideration.  The opinion of the Medical Superintendent, DAE Hospital shall be final as to what constitutes an emergency treatment, notwithstanding any medical certificate to the contrary produced from a private doctor or hospital.

DAE Hospital, Kalpakkam shall determine whether a claim should be reimbursed or not and also the extent to which the reimbursement should be allowed from the point of view of medical necessity etc., e.g.,

a) whether it was a case of medical emergency

b) whether the intimation regarding emergency was given as required

c) whether the items included in the claim were medically necessary &

d) whether the charges/prices are reasonable

The treatment when availed under medical emergency should be reported to the DAE Hospital, Kalpakkam within 4 days from the date of commencement of the treatment.

F) Categorisation of retired employees under CHSS:

Category Pay as per Third Pay Commission
(upto Dec.1985)
Pay as per Fourth Pay Commission
(Jan.1986 to Dec.1995)
Pay as per Fifth Pay Commission
(From Jan.1996)
A Upto Rs.400 Upto Rs.1350 Upto Rs.4590
B Rs.400 to 800 Rs.1351 to 2360 Rs.4591 to 7999
C Rs.801 to 1500 Rs.2361 to 3500 Rs.8000 to 11500
D Rs.1501 & above Rs.3501 & above Rs.11501 & above

DAE vide their Note No.7/8/2009-IR&W dated 26.03.2010 have reclassified the entitlement of Hospital accommodation at Panel Hospitals recognized under CHSS as follows:

Sr.No. Category of Employees (as per revised pay w.e.f. 01.01.2006) Equivalent for employees retired prior to 01.01.2006 Class of Accommodation
1. Employees drawing pay in the pay band of less than Rs.15000/- per month or the equivalent pay in the pre-revised scale

(Grade pay not to be included)

Employees retired with basic pay in the pre-revised scale below Rs.8000/- per month

(Upto Rs.2360/- for employees retired prior to 01.01.1996 and upto Rs.800/- for employees retired prior to 01.01.1986)

Four beds in a room with common toilet/bathroom
2. Employees drawing pay in the pay band of Rs.15000/- and above but below Rs.67000/- per month or the equivalent pay in the pre-revised scale

(Grade pay not to be included)

Employees retired with basic pay in the pre-revised scale of Rs.8000/- and above per month

(Rs.2361/- and above for employees retired prior to 01.01.1996 and Rs.801/- and above for employees retired prior to 01.01.1986)

Two beds in a room with attached toilet/ bathroom
3. Employees drawing pay in the pay band Rs.67000/- per month and above or equivalent pay in the pre-revised scale

(Newly approved bed class)

Scientific Officers (OS) and above Single bed AC accommodation as per availability in the referral hospital with attached toilet/ bathroom

G) Annual Declaration:

For children above 18 years and parents issued with CHSS cards, an annual declaration of their dependency should be submitted to the CHSS Office, DAE Hospital, Kalpakkam 603 102 in January every year for renewing their CHSS cards.  Unemployed and unmarried children are eligible for CHSS facility upto 25 years of age only.  Mentally retarded/physically handicapped children shall be eligible for the benefits till such a time they are dependent on prime beneficiaries, provided that the disability exceeds 40%.

H) Contact Phone Numbers:

Medical Superintendent, DAE Hospital, Kalpakkam                        (044) 27481228  

DAE Hospital Fax Number                                                         -  (044) 27481253    

CHSS Office, DAE Hospital, Kalpakkam                                        -  (044) 27488228

NPC Office, No.51,Montieth Road, Egmore, Chennai  600 008          -  (044) 28585052

All correspondences relating to CHSS should be sent to:

     Assistant Personnel Officer,
     CHSS Office, DAE Hospital, Kalpakkam 603 102.

All claims should be submitted along with a Pre-receipt (as per the format given below):

Pre-Receipt

Received an amount of Rs._________ (Rupees ________________________) from Pay & Accounts Officer, GSO, Kalpakkam 603 102 towards medical reimbursement claim.

                                                                                                                             *Signature:_____________

Address to which payment is to be sent:

Name         :___________________________________

Full address :___________________________________

                  ___________________________________

                  ___________________________________

Place        :  __________________________    Pin code: ______________

*NOTE: Affix Re.1/- revenue stamp in case the amount claimed exceeds Rs.5000/- and sign on the stamp.