BRIEF ON RAILWAY HEALTH CARE POLICY INSTRUCTIONS (RHPI)-& RAILWAY HOSPITAL MANAGEMENT INFORMATION SYSTEM (HMIS)
RAILWAY
HOSPITAL MANAGEMENT INFORMATION SYSTEM (HMIS)
BRIEF
ON RAILWAY HEALTH CARE POLICY INSTRUCTIONS (RHPI)
REF:
- No.2024/I &
Trans. Cell/Healthcare / P dated 29.08.24 by Ministry of Railways /Railway
Board
- Gov. Ministry of
Health & FW, OM No.Z 15025 /105 /2017 /DIR / CGHS/EHS dated
09.11.2017.
- Gazette
notification No.R-12013/01/2022/Ethics of 02.08.2023
- RB Lr. No.2018/Tran
cell/Health/Medical issues of 24.01.2019.
- RB Lr.
No.2021/H-1/10/MOU of 20.11.2023
- RB Lr.
No.2009/H/6-4/Policy of 09.04.2015
- RB Lr.
No.2018/Transcell/Health/CGHS(eOFF.No.3270783) of 16.06.2021
IR’s
Digital Health Infrastructure (HMIS)
The
railway serving employees, pensioners, and their dependent beneficiaries coming
under RELHS and having UMID cards:
- a. Are entitled to
medical treatment, services, and medicines at RHs/RHUs.
- b. If not having a
UMID card, their UMID card number would be generated at the first
opportunity with reference to PPO and Aadhar when they approach RH/RHU for
treatment, but they should not be denied treatment.
Remaining
details/fields in UMID cards would be verified and filled up in the HMIS
Database.
Additional
Provision:
- a. The servants,
attendants, or non-dependents who are temporarily staying with the railway
employee or pensioner, if needing medical attention, could avail
treatment/services/medicines at RHs/RHUs as private patients on PAYMENT
at city-specific CGHS rates or as prescribed by Railways wherever CGHS
rates are not available.
- b. Such treatment
for non-dependents shall be limited to the jurisdiction of RHs/RHUs where
the employee or pensioner resides.
- c. This
jurisdiction will be mentioned in HMIS, and for all other RHs/RHUs, such
usage is prohibited and the system to those other RHs/RHUs would be
blocked.
- d. All transaction
slips in HRMS with respect to treatment for such non-dependents as private
patients shall capture the name, relationship, Aadhar card of the patient
along with OTP-based confirmation by the primary UMID cardholder and
payment.
- e. All such
transactions will reflect in the HMIS profile of the primary cardholder.
Pan-IR
UMID card:
For serving staff, pensioners, and dependent beneficiaries. A QR-based Pan-IR
UMID card will be issued, on request, through HMIS at Rs.100/card.
e-UMID: All UMID cards, as
'issued Document' will be in Digi-Locker of the Primary cardholder (pensioner)
and available in the 'Beneficiary Profile' on the HMIS app.
Special instructions for the Primary UMID card holder
(PCH)
- UMID
card is non-transferable.
- Misuse
of the UMID card shall be liable for proceedings under DAR/Civil/Criminal
proceedings.
- Card to
be kept in safe custody and used scrupulously.
- Changes
or updates are the responsibility of the PCH.
- When a
fresh card is required due to any changes in HMIS, the card shall be
blocked, and a fresh card shall be applied for.
- Loss/Theft
of the card shall be immediately reported by the PCH to the Medical
Officer/CMS along with an FIR copy, and the card will be blocked in HMIS.
Pan-IR UMID validity
- UMID
card is valid on IR-based, at any RH/RHU & IR Empanelled Health Care
Organizations (HCOs) like Private Hospitals, Diagnostics, specialists,
etc.
Treatment with referral or without referral in
EMERGENCY
- LIVE
DIRECTORY in HMIS app has lists of IR empanelled HCOs.
- Patients
can see the list of empanelled hospitals/HCOs, which includes 2 lists:
- A List
– for CASHLESS treatment on referral & in EMERGENCY.
- B List
– for NON-CASHLESS treatment on referral (mentioned as 'CARE').
- All
Zonal railways shall recognize all empanelled HCOs with which they have
MOUs and shall incorporate them in all existing empanelled HCOs.
Referral not required
For treatment at:
- Institutes
of National Importance (INIs) like PGIMER-Chandigarh, JIPMER-Puducherry,
NIMHANS-Bengaluru, and other 25 AIIMS.
- OPD /
IPD / Investigations / Diagnostics / Tests.
- Medicines
& follow-up medicines prescribed at INIs can be obtained at RHs/RHUs
in OPD.
- For IPD
treatment, until the time the patient is admitted in these INIs,
medicines, tests, and diagnostics will be covered in the expenses during
the treatment.
- Dental
implants are not allowed, and dental treatments are excluded.
- Reimbursement
for treatment at these INIs shall be as per actuals or city-specific CGHS
rates, whichever is lower.
Simplified REFERRAL
- Referral
can be obtained through a Railway doctor at RH or through HMIS as an
e-referral.
- Referral
shall not be in favor of any particular empanelled hospital or HCO by
name, as per Ministry of Health & FW, CGHS instructions regarding the
regulation on professional conduct & ethics.
- Any
violations could invite vigilance scrutiny, and the erring doctor may be
liable for conduct rule violations.
- All
employees, pensioners, and dependents are entitled to avail
treatment/services at any IR empanelled HCOs, regardless of the Zonal
Railway that empanelled the HCO.
- The
referral will be valid for treatment at any IR empanelled HCOs on IR.
- The
validity of treatment is 15/30 days, and the type of treatment will be
mentioned. Further extensions of referrals will be subject to revalidation
by the same referring RH/Doctor.
NON EMPANELLED PRIVATE Hospital
- If
patient, even with UMID card, availed treatment/services from the HCO from
List B of IR Empanelled HCOS or at any Non-empanelled private hospital.
- Patient
NOT obtained any REFERRAL from RH.
- Situation
is NOT AN EMERGENCY as declared by the HCO or hospital.
- Patient
has to pay the bills on his/her own.
- Reimbursement
could not be claimed - NOT ELIGIBLE.
- If
treatment taken from the IR empanelled List B HCO, rates for
treatment/tests/diagnosis/OPD/IPD will be at CGHS rates with UMID CARD.
- If
treated at Non-IR Empanelled private Hospital, treatment rates at the
Hospital rates.
STANDARDISED FORMAT OF PAN-IR UMID
CARD
On card of Primary card Holder and dependents, the following details will be
displayed:
On the front side of the card:
- QR code
- UMID No.
/ Masked Aadhaar
- Type of
card SELF/Dependent
- Validity
up to --/--/----
- Valid at
all RHs/RHUs on IR
- Referral
or Emergency cases are entitled to cashless treatment at any IR Empanelled
hospitals shown in HMIS directory.
- At INIs,
NO referral is required and is reimbursable as eligible.
- Name of
cardholder
On the rear side of the card:
- Name of
PCH/card number
- Designation
at the time of retirement
- HRMS ID
- Masked
cell Number
- PPO No.
- Jurisdictional
RH/RHU ---/--- DIV_RLY__
- Special
instructions
- Signature
of issuing authority
Note: In the
present issued UMID card through umiddigitalir, some details and validity over
IR not available. But the procedure to apply and get a fresh UMID card through
HMIS app is not specified. To be ascertained.
Note: This brief
is prepared on the basis of RB Lr. No.2024/I & Trans.Cell/Healthcare/P
dated 29.08.2024. For any clarification, please refer to the original letter.
- The eligible
Reimbursement claim will be credited within prescribed time limit (now 60
days - from the date of submission of claim) to the Bank account of PCH as
indicated.
EMERGENCY
CASE - NO REFERRAL - for REIMBURSEMENT
- When the patient
needs treatment at an EMERGENCY SITUATION (as per defined in RB letter
REF. No.7)
- Patient can choose
the HCO from list A or B of IR empanelled HCO from HMIS Directory.
- IR empanelled HCO
would have an OTP based login access to verify the patient’s UMID card and
tick the EMERGENCY TREATMENT - ‘RED FLAG’ shown against the UMID card.
- HMIS system would
trigger an SMS-SOS based message and the SMS would be sent to the
concerned RH in charge (CMS) of the jurisdiction unit of PCH and also to
Zonal Central Railway hospital (PCMD).
- The bills in
ORIGINAL attested by the treating doctor of HCO, along with other required
documents (like covering letter to CMS, Application for reimbursement,
Emergency admission & Essentiality certificate from HCO with signature
and seal, original discharge summary, original medicines, lab tests, etc.,
bills with signature and stamp, copies of UMID card, PPO, bank pass book
first page, declaration regarding insurance claim, patient dependency
certificate, if required, PCH declaration certificate), would be submitted
to the DESIGNATED JURISDICTIONAL RH/RHU of the Primary Card Holder to
CMS/RH for having availed the treatment with reference to the EMERGENCY
TREATMENT within 6 months from the date of discharge.
Note: List of documents & check list for
reimbursement can be obtained from the concerned CMS office.
- The eligible
Reimbursement claim will be credited within prescribed time limit (now 60
days from the date of submission of claim) to the Bank account of PCH as
indicated.
Additional
Benefit of Reimbursement of Medical Expenses from 2 sources (Insurance &
Railways)
- Patient can avail
the benefit of PRIVATE INSURANCE of self or dependent for paying the bills
at IR empanelled HCO from list B.
- Total bill claimed
less paid by insurance subjected to admissible amount @ CGHS rates REF
No.6.
- Total bill
Rs.1,00,000. Paid from Insurance company Rs.40,000. Amount approved by
Railways Rs.70,000. Reimbursement eligible is Rs.60,000 since lesser than
Rs.70,000 (1,00,000 - 40,000 = 60,000).
- Total bill
Rs.1,00,000. Paid from Insurance company Rs.20,000. Amount approved by
Railways Rs.70,000. Reimbursement eligible is Rs.70,000 since lesser than
Rs.80,000 (1,00,000 - 20,000 = 80,000).
·
*
UMID card holder can choose empanelled hospital/HCOs from the list A - CASHLESS
and LIST B-NON-CASHLESS and get referral.
·
·
*
The RH/RHU would be duty bound to render all assistance/guidance to the patient
in making his/her decision about choice from that list of IR empanelled HCOs.
·
·
*
If an employee/pensioner/beneficiary needs a Medical pass, then the choice
would be exercised by PCH in writing.
·
·
*
In all referral cases, a referral authentication TOKEN, along with a DIGITAL
REFERRAL LETTER, in HMIS would be generated by the RH/RHU that has referred the
patient.
·
·
*
The concerned empanelled HCO, wherever the patient chooses to avail the
referral treatment/facility, would use its own - HCO specific login ID to
accept the referral token available against the UMID card details in HMIS App.
·
·
*
In EMERGENCY CASES, the empanelled HCO would use its login ID to verify that
UMID and tick on RED-FLAG. An SMs (SOS) message in HMIS against that UMID would
be sent to the concerned RH/RHU incharge (CMS) of UNIT of the PCH and Zonal
railway administrator (PCMD).
·
·
ON-LINE
HMIS INTEGRATED PAYMENT GATEWAY
·
·
For
payments relating to treatment services including medicines at RH/RHU has been
provided in HMIS.
·
·
ON
REFERRAL BY RAILWAY DOCTOR FOR TREATMENT AT IR EMPANELLED HCOs:
·
Patient,
with UMID card, is issued with a Referral letter for 15/30 days to any IR
empanelled hospital without mentioning the name of the empanelled HCO.
·
·
CASHLESS
TREATMENT FROM HCO in LIST A:
·
•
Patient verifies the location/Rating/services/specialization offered by the IR
Empanelled HCO from lists A & B from HMIS Directory.
·
•
Chooses CASHLESS treatment from the IR empanelled HCO from list A.
·
•
IR empanelled HCO would have an OTP-based login access to verify the patient’s
UMID card and tick the UNIQUE REFERRAL TOKEN - shown against the UMID card and
acknowledge the Digital Referral Letter issued by the doctor of any RH.
·
•
Patient would be admitted as In-patient and get treatment.
·
•
Bills will be paid by Railways - CASHLESS TREATMENT.
·
·
NON-CASHLESS
TREATMENT FROM HCO IN LIST B:
·
•
Patient verifies the location/Rating/services/specialization offered by the IR
Empanelled HCO from lists A & B from HMIS Directory.
·
•
Chooses NON-CASHLESS treatment from the IR empanelled HCO from list B, since
he/she found that HCO is suitable and convenient.
·
•
IR empanelled HCO would have an OTP-based login access to verify the patient’s
UMID card and tick the UNIQUE REFERRAL TOKEN - shown against the UMID card and
acknowledge the Digital Referral Letter issued by the doctor of any RH.
·
•
Patient would be admitted as In-patient and get treatment.
·
•
Patient avails treatment as In-patient as per Railway referral.
·
•
Payment will be made by the patient himself/herself @ CGHS rates.
·
•
The bills in ORIGINAL attested by the treating doctor of HCO, along with other
required documents like discharge summary, tests conducted, reports, etc.,
would be submitted to the DESIGNATED JURISDICTIONAL RH/RHU of the Primary Card
Holder to CMS/RH for having availed the treatment.
- UMID
card holder can choose empanelled hospital/HCOs from the list A - CASHLESS
and LIST B - NON-CASHLESS and get referral.
- The
RH/RHU would be duty-bound to render all assistance/guidance to the
patient in making his/her decision about choice from that list of IR
empanelled HCOs.
- If an
employee/pensioner/beneficiary needs a Medical pass, then the choice would
be exercised by PCH in writing.
- In all
referral cases, a referral authentication TOKEN, along with a DIGITAL
REFERRAL LETTER, in HMIS would be generated by the RH/RHU that has
referred the patient.
- The
concerned empanelled HCO, wherever the patient chooses to avail the
referral treatment/facility, would use its own - HCO specific login ID to
accept the referral token available against the UMID card details in the
HMIS App.
- In
EMERGENCY CASES, the empanelled HCO would use its login ID to verify that
UMID and tick on RED-FLAG. An SMS (SOS) message in HMIS against that UMID
would be sent to the concerned RH/RHU in charge (CMS) of the unit of the
PCH and Zonal railway administrator (PCMD).
ON-LINE HMIS INTEGRATED PAYMENT
GATEWAY
For payments relating to treatment
services, including medicines at RH/RHU, have been provided in HMIS.
ON REFERRAL BY RAILWAY DOCTOR FOR
TREATMENT AT IR EMPANELLED HCOs
- Patient,
with a UMID card, is issued a referral letter for 15/30 days to any IR
empanelled hospital without mentioning the name of the empanelled HCO.
CASHLESS TREATMENT FROM HCO IN LIST A
- Patient
verifies the location/rating/services/specialisation offered by the IR
Empanelled HCO from lists A & B from the HMIS Directory.
- Chooses
CASHLESS treatment from the IR empanelled HCO from list A.
- IR
empanelled HCO would have an OTP-based login access to verify the
patient’s UMID card and tick the UNIQUE REFERRAL TOKEN shown against the
UMID card and acknowledge the Digital Referral Letter issued by the doctor
of any RH.
- The
patient would be admitted as an in-patient and receive treatment.
- Bills
will be paid by Railways - CASHLESS TREATMENT.
NON-CASHLESS TREATMENT FROM HCO IN
LIST B
- Patient
verifies the location/rating/services/specialisation offered by the IR
Empanelled HCO from lists A & B from the HMIS Directory.
- Chooses
NON-CASHLESS treatment from the IR empanelled HCO from list B, since they
found that the HCO is suitable and convenient.
- IR
empanelled HCO would have an OTP-based login access to verify the
patient’s UMID card and tick the UNIQUE REFERRAL TOKEN shown against the
UMID card and acknowledge the Digital Referral Letter issued by the doctor
of any RH.
- The
patient would be admitted as an in-patient and receive treatment.
- The
patient avails treatment as an in-patient as per the Railway referral.
- Payment
will be made by the patient himself/herself at CGHS rates.
- The
bills, in ORIGINAL, attested by the treating doctor of the HCO, along with
other required documents like discharge summary, tests conducted, reports,
etc., would be submitted to the DESIGNATED JURISDICTIONAL RH/RHU of the
Primary Card Holder to CMS/RH for having availed the treatment.
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