Monthly Income Ceiling for Dependent Family Members Fixed at ₹9,000 Plus DA; Revised Rates Prescribed for Cardiac Devices, Artificial Limbs, Hearing Aids
Nadeem Nadu
Srinagar/Jammu, Oct 23 :
The Jammu and Kashmir Government has amended the Jammu and Kashmir Civil Services (Medical Attendance and Allowance) Rules, 1990, expanding the definition of eligible dependent family members and prescribing reimbursement ceilings for various medical devices, artificial limbs and specialised treatment procedures.
The amendments have been notified by the Finance Department through S.O. 276 under the powers conferred by the proviso to Article 309 of the Constitution of India, a copy of which lies with news agency Kashmir News Corner.
Under the revised provisions, dependent divorced or separated daughters and stepmothers have been included in the definition of family, in addition to the members already covered under the rules.
The notification further provides that family members will be considered wholly dependent on a government employee if they ordinarily reside with the employee and their total monthly income does not exceed ₹9,000 plus applicable Dearness Allowance (DA).
The amended rules also introduce prescribed reimbursement ceilings for cardiac devices, intraocular lenses, CPAP/BiPAP equipment, oxygen concentrators, hearing aids, cochlear implants and artificial limbs, as detailed in the newly added Annexure F.
CARDIAC DEVICES: REVISED REIMBURSEMENT CEILINGS
The amended schedule prescribes reimbursement ceilings for various cardiac devices, with GST payable additionally wherever specified. A single-chamber cardiac pacemaker without rate response has a ceiling of ₹34,840 plus GST, while a single-chamber cardiac pacemaker with rate response is capped at ₹44,928 plus GST. The ceiling for a dual-chamber cardiac pacemaker is ₹83,200 plus GST, while a bi-ventricular cardiac pacemaker carries a ceiling of ₹1,95,000 plus GST.
An implantable cardioverter defibrillator (single chamber) has a prescribed ceiling of ₹1,75,786 plus GST, while the dual-chamber variant is capped at ₹3,75,000 plus GST. The ceiling for a combo device (CRT-D) is ₹4,90,000 plus GST. An aortic stent graft, including the delivery system, carries a ceiling of ₹4,40,960 plus GST. The prescribed rates for a Rotablator with advancer and a Rotablator burr are ₹49,920 plus GST and ₹23,920 plus GST, respectively.
HEART VALVE PROCEDURES AND INTRAOCULAR LENSES
The notification specifies reimbursement rates for selected heart valve procedures. Double valve replacement (DVR) has a prescribed rate of ₹1,10,500, while mitral valve replacement/aortic valve replacement (MVR/AVR) carries a rate of ₹45,050.
For intraocular lens-related procedures, cataract extraction with an IOL and Cionni’s capsular tension ring has a prescribed rate of ₹12,000. Extracapsular cataract extraction (ECCE) with IOL is capped at ₹5,000, while pars plana lensectomy, with or without IOL, carries a rate of ₹10,000. Penetrating keratoplasty with IOL implantation has a prescribed rate of ₹3,000, phaco with foldable IOL ₹9,375, secondary IOL implantation ₹6,000, and small-incision cataract surgery (SICS) with IOL ₹714.
The intraocular lens procedure rates are listed under the non-NABH CGHS rates section of the annexure.
CPAP, BiPAP AND OXYGEN EQUIPMENT
The amended schedule prescribes reimbursement ceilings for respiratory support equipment, including an oxygen concentrator at ₹45,000 plus GST and CPAP equipment at ₹45,000 plus GST. The ceiling for Bi-Level CPAP is ₹68,000 plus GST, while a Bi-Level Ventilatory System carries a ceiling of ₹1,05,000 plus GST.
These provisions cover specified equipment used for oxygen support and respiratory assistance, subject to the applicable rules and claim conditions.
HEARING AIDS AND COCHLEAR IMPLANTS
The revised schedule also specifies reimbursement rates for hearing-related devices. A digital behind-the-ear (BTE) hearing aid has a prescribed rate of ₹8,000, while a digital in-the-canal (ITC) or completely-in-canal (CIC) hearing aid is capped at ₹9,000. The prescribed rate for a cochlear implant is ₹5,35,000.
ARTIFICIAL LIMBS: REIMBURSEMENT RATES FOR ADULTS
The notification lays down separate reimbursement ceilings for artificial limbs, depending on the type of prosthesis and the components included.
For below-knee prostheses, a standard transtibial prosthesis carries a ceiling of ₹20,000, while a below-knee prosthesis with a silicone/PU liner is capped at ₹37,000. The ceiling rises to ₹45,500 for a below-knee prosthesis fitted with a silicone/PU liner and shuttle-lock mechanism. A Symes prosthesis has a prescribed rate of ₹19,300, while a partial-foot prosthesis with shoe and filler is capped at ₹7,000.
For above-knee and other lower-limb prostheses, a standard transfemoral prosthesis carries a ceiling of ₹40,840. An above-knee prosthesis with a suction valve is capped at ₹44,640, while one fitted with a silicone/PU liner carries a ceiling of ₹61,140. The ceiling for an above-knee prosthesis with a silicone/PU liner and shuttle-lock mechanism is ₹69,640. A knee disarticulation prosthesis has a prescribed rate of ₹51,940, while a hip disarticulation prosthesis is capped at ₹60,300.
For high-end lower-limb prosthetics, the notification lists a transtibial prosthesis with a dynamic-response foot at ₹26,700. Other high-end models carry separate prescribed ceilings according to their specifications.
ARTIFICIAL LIMBS FOR CHILDREN
The amended schedule provides separate reimbursement rates for children aged 7–12 years and those aged 0–6 years for specified prostheses.
A below-knee prosthesis for children aged 7–12 years carries a ceiling of ₹18,140, while the rate for children aged 0–6 years is ₹5,000. A below-knee prosthesis with a silicone/PU liner for children aged 7–12 years is capped at ₹35,140, while a model fitted with a silicone/PU liner and shuttle-lock mechanism carries a ceiling of ₹43,640 for the same age group.
A Symes prosthesis for children aged 7–12 years has a prescribed rate of ₹19,300, compared with ₹5,000 for children aged 0–6 years. A partial-foot prosthesis with shoe and filler is capped at ₹4,000 for children aged 7–12 years and ₹1,500 for those aged 0–6 years.
For above-knee prostheses, the prescribed ceiling is ₹49,980 for children aged 7–12 years and ₹12,000 for children aged 0–6 years.
Additional rates apply to selected models fitted with suction valves, silicone/PU liners and shuttle-lock mechanisms. The detailed annexure specifies the applicable age groups and instances where reimbursement is not admissible for a particular age category.
UPPER-LIMB PROSTHESES: PASSIVE, BODY-POWERED AND ELECTRIC MODELS
The government has also specified reimbursement ceilings for artificial arms, hands and related prosthetic components, with rates varying according to the type of prosthesis and the beneficiary’s age.
A trans-radial or below-elbow/wrist disarticulation passive prosthesis carries a ceiling of ₹10,000 for persons above 12 years, ₹5,000 for children aged 7–12 years and ₹2,000 for children aged 0–6 years. A body-powered below-elbow prosthesis is capped at ₹17,000 for persons above 12 years and ₹12,000 for children aged 7–12 years.
A trans-humeral or above-elbow passive prosthesis has a prescribed ceiling of ₹20,000 for persons above 12 years, ₹10,000 for children aged 7–12 years and ₹5,000 for children aged 0–6 years. A body-powered above-elbow prosthesis is capped at ₹28,000 for persons above 12 years and ₹22,000 for children aged 7–12 years.
A passive shoulder disarticulation prosthesis carries a ceiling of ₹30,000 for adults, ₹20,000 for children aged 7–12 years and ₹10,000 for children aged 0–6 years. The prescribed rate for a body-powered shoulder disarticulation prosthesis is ₹37,000 for adults and ₹28,000 for children aged 7–12 years.
For high-end upper-limb prostheses, an externally powered below-elbow/wrist disarticulation prosthesis carries a ceiling of ₹1,29,500 for persons above 12 years, while an externally powered above-elbow/elbow disarticulation prosthesis is capped at ₹1,76,500 for the same age group.
A silicone finger prosthesis is capped at ₹7,000 per finger for adults and ₹5,000 for children aged 7–12 years. A silicone thumb prosthesis carries a ceiling of ₹8,000 for adults and ₹6,000 for children aged 7–12 years. A silicone partial-hand prosthesis is capped at ₹35,000 for adults, ₹25,000 for children aged 7–12 years and ₹10,000 for children aged 0–6 years.
The externally powered systems include specified components such as batteries, electrodes, wrist units, chargers, cables, connectors, gloves, liners and sockets, as detailed in the notification.
REIMBURSEMENT FOR TREATMENT AT SPECIFIED PRIVATE HOSPITALS
The amendments also revise the provisions governing treatment obtained at certain designated private hospitals.
Under the revised rule, reimbursement for treatment at hospitals belonging to the Apollo Group in Delhi, Chennai, Hyderabad, Bengaluru and Kolkata, as well as Escorts Heart Institute, Delhi; the Institute of Liver and Biliary Sciences (ILBS), New Delhi; and Jaslok Hospital, Mumbai, will be restricted to the amount payable for the relevant procedures at AIIMS, New Delhi.
The provision establishes a benchmark for determining admissible reimbursement for treatment obtained at the specified institutions and may affect the amount payable against claims arising from treatment at these hospitals.
FINANCE DEPARTMENT NOTIFIES AMENDMENTS
The amendments have been issued by the Jammu and Kashmir Government’s Finance Department under the authority of the Lieutenant Governor, revising the existing medical attendance rules and adding Annexure F, which contains prescribed reimbursement ceilings for artificial appliances and other medical equipment.
The revised provisions are relevant to government employees and eligible dependants seeking medical assistance, particularly those requiring specialised cardiac devices, hearing equipment, respiratory support systems, artificial limbs and other prescribed medical appliances.
Eligible beneficiaries are advised to check the applicable rules, prescribed reimbursement ceilings and departmental procedures before submitting claims, as reimbursement will remain subject to the conditions laid down in the notification. (KNC)