EPFO allows medical advance without documentation for life threatening illnesses

कर्मचारी भविष्‍य निधि संगठन
Employees Provident Fund Organisation
श्रम एवं रोजगार मंत्रालय, भारत सरकार
Ministry of Labour & Employment, Government of India

HRM-8/V/12(18)2007/UP/Vol-1

Dated: 31-05-202101 JUN 2021

To,

All Additional Central PF Commissioners (HQ),
All Additional Central PF Commissioners (Zones)/Addl. CPFC (ASD),
Director (PDNASS)
All RPFCc./OIC in-charge of Region

Sub:-     Medical advance without documentation in cases of emergency hospitalization on account of serious life threatening illnesses including Covid – reg.
Sir/Madam,

Procedure of getting estimate for granting medical advance In cases of hosp1talizat1on on account of serious lire-threatening illnesses including Cov1d has been revisited. In life-threatening diseases, many times it becomes imperative to get the patient Immediately admitted In hospital on emergency to save his/her life and It is not possible to get the estimate from hospital in such situations. A need is felt for streamlining the advance facility for   such serious in-patient’s treatment in hospital wherever family members of employees are not able to manage estimate from hospital concerned in which such patient has been admitted in emergency Sometimes patient employee may be in ICU where estimate is not known in advance. Hence the following procedure may be adopted to grant medical advance for emergency hospitalization on account of serious life­ threatening illnesses including Covid:

1. Patient is admitted for treatment in a Government/PSU/CGHS empanelled hospital. If patient is admitted in emergency in private hospital and competent authority considers it a fit case to grant relaxation in rules for medical bills reimbursement, then. also advance specified below can be given. 
    
2. A request letter is submitted by employee or any of the family member of the patient for providing medical advance without estimate along with details of the hospital and the patient. 
    
3. A lump sum medical advance up to Rs 1 lakh may be granted by authority competent to grant medical advance by relaxing the formality of estimate from the hospital treating the employee  or for depositing advance with hospital for starting treatment. This advance be granted immediately preferably on the same day, If it Is a working  day else on Immediately succeeding woring day after the receipt of application of advancc without insisting for the estimate of expenditure from hospital /other documentation. Officer in charge of the concerned offuce (ACC-ASD for Head Office) should also ensure that this medical advance is granted by the next working day after the receipt of application of advance. 
    
4. After receipt of estimate for treatment subsequently but before discharge of patient from hospital, if entitlement of medical advance is more than one lakh as per rules then additional advance will be sanctioned equivalent to advance entitled as per rules reduced by one lakh aleady granted. 
    
5. Medical advance amount may either be credited to the salary account of the employee or can be paid to the Hospital concerned directly as per request of family member of employee. 
    
6. After discharge from hospital, employee should submit bill within 45 days from the date of discharge, The amount of aforesaid advance be adjusted from the final bill of the hospital permissible as per rules. Further action regarding reimbursement of medical bill or recovery of advance be taken as per rules while processing the medical bill of employee.

This  circular is  applicable to employees  covered under CS(MA) rules as well as employees covered under CGHS.

(This issue with the approval of competent authority)

(Brijesh K Mishra)
Regional P.F. Commissioner (HRM)