TRF Medical Benefit Rules Aug 2011

Objective:

 To define benefits and guidelines of medical facilities

admissible to TRF employees.

 The medical service is meant to provide assistance for illness,

injury or other ailments related to primary health care as well
as treatment through hospitalization, as applicable to TRF
employees as well as for employee’s dependent family members.
Applicability:

 Medical facilities are provided by the Company to all permanent

employees at Jamshedpur, regional offices and construction sites.

 These facilities are also provided to the eligible members of

their family.
Family members include:

 Spouse,

 Sons up to the age of 21 years,

 Unmarried daughters,

 Parents; provided they are dependent on/and residing with the

employee at the place of posting/work,

 Legally adopted sons and daughters.

 In case of trade apprentices medical facility is provided to the

trainee only and not to
their family members.

 Limited medical facility ( OPD facility at company dispensaries

only) is also extended to sons up to 25 years/retired employees,
who have superannuated on or after April 1, 2004, at Jamshedpur
only and their spouse.

 Earning wife/husband/daughter – They are not eligible for

medical assistance from the company. If, however, they do not
get any medical benefit (monetary or otherwise) from their
employer, then they will be considered for medical facilities by
the Company. The earning spouse has to forego his/her claim of
medical facility provided by their employer and submit a
declaration regarding this to the company, through the employee.

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 TRF Medical Benefit Rules Aug 2011

 Medical facility to family members not residing with the

employee at the place of posting – Such family members are not
eligible for medical assistance from the company. If however,
they stay with the employee at the place of his/her posting
then, they will get the full medical facility as per company’s
medical rule. Also, the family of an employee posted at site,
stays back in Head Office (Jamshedpur), will get medical
benefits as per rules for employees posted at Jamshedpur.

 Medical facilities to the employees while on leave / tour -

o The company reimburses the medical expenses incurred by an
employee who is away from the Headquarter / place of posting on
company’s business.
o The company provides medical benefits /reimburses medical
expenses incurred by an employee in connection with treatment while
on leave, provided he or she does not leave the place of posting.
o However, if an outstation employee visits Jamshedpur, while
on leave, then he/ she is extended the Company’s medical benefits.
 Medical services at Jamshedpur - For any level of treatment in a
hospital/clinic, in Jamshedpur approval of company’s medical
authority is essential.

 Process

o At the time of joining, employees are required to provide

family details in prescribed format along with a photograph to
HR department / Personnel department for preparing the Medical
book. Any new arrival of family member (new born child or
legal adaptation, spouse after marriage) must be brought to
notice of HR/ Personnel department for correction of records.
o Medical books will be issued to the employee by the Personnel
department within 10 days of submission of document.
o Employee / family members need to bring their medical book for
all treatment including general ailments and chronic
treatment.

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 TRF Medical Benefit Rules Aug 2011

o Medical department dispenses medicines. However, In case they

are not available then it ensures that the medicine is
procured and provided to the employee.

o Ambulance service is extended to all permanent employees and

their family members for attending OPD as well as indoor
admission and discharge from hospital.
o Non-reimbursable services/ aids/ supplies/medicines – Cost of
pacemaker, spectacles, contact lenses, dentures, orthodontic
treatments, Phaeco surgery, medicines with herbal
constituents, un-established experimental medicines, medicated
soaps, toothpaste, shampoo, minoxidil lotions, medicines being
marketed by public media, dietary supplements, health foods
are not reimbursable. Procurement of any medical appliance
must be made with the prior authorization of Chief Medical
Officer (CMO). Authority to take decision on revising list of
non-reimbursable medicines lies with Chief Medical Officer of
company only. CMO is only authority to pass any bill for
reimbursement.
o Cosmetic treatment – Cost of any treatment, which is cosmetic
in nature, is not reimbursed by the Company.

 Primary level care (for general ailments, routine treatment) –

Modes for primary care are through TRF’s dispensaries, centers
of domiciliary services, empanelled dentists, Tata Steel’s
homeopathic centers.

o TRF dispensaries – Medical department runs two dispensaries,

one in work’s premises another at TRF Nagar. Any eligible
patient with company’s medical service book can consult
Company’s doctor during working hours. All medicines and
investigations prescribed by the doctor are provided either
at dispensary itself or through empanelled medicine shops
and empanelled radiologists/ pathologists.

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 TRF Medical Benefit Rules Aug 2011

Production of medical service book is essential for visit to

doctor for treatment.

 Domiciliary service – Company provides domiciliary medical

service for the benefit of its employees. Patient with
company’s medical service book can call on company’s doctor at
any center of domiciliary service during the time fixed for
that center. The details of locations and
timing of domiciliary service centers is available with the
medical department. Any medicines / investigations advised by
company’s doctor are provided either through panel medicine
shop and panel radiologist / pathologist. For treatment of
dependent family members, a part of professional fees of
company’s doctor is deducted from employee’s salary /as per
company’s policy.

 Empanelled dentists –The Company has dentists on its panel.

Employees and their dependents can avail treatment on advice
of Company’s medical officers at their clinics.

 First confinement of married daughters – This facility is

given to a married daughter from the sixth month onward till
delivery. Primary and secondary level treatment is provided by
the company on application by employee for the same.

No cash transaction for investigations or procurement of

medicines is allowed except in some specific cases with prior
permission of Chief Medical Officer (CMO).

 Secondary level care (for specialized care & indoor treatment)

– Patients can be referred to any local empanelled hospital,
depending upon required treatment of ailment as decided by
company’s medical officer. However in case of sudden illness
or injury, patient can go to the casualty ward any of the
empanelled hospital and may inform the medical department once
the treatment starts. Medicine of a particular brand
prescribed by specialist may changed by the company’s doctor
who will ensure that there is no compromise the composition,
quality and line of treatment on the basis of available

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 TRF Medical Benefit Rules Aug 2011

pharmacopoeia of the medical department , which is reviewed

from time to time. Indoor treatment is free of cost in general
ward, in case the employee is availing cabin facility. Cabin
charges will be recovered from employee’s salary at the rate
of 25% per month in case of self and 50% per month in case of
dependent family members.

 Tertiary level care (for super specialized care or treatment not

available in Jamshedpur)
o An employee, dependent spouse, unmarried daughter, sons up to 21
years of age can be referred to empanelled referral centers
outside Jamshedpur for tertiary level of treatment after
obtaining referral from Tata Main Hospital & Jamshedpur Eye
Hospital (JEH).
o Apart from the cost of treatment at higher center, Company also
reimburses the expenses of to & fro train fare of patient along
with one escort (both parents incase of children below five
years of age) as per company rule. Also a certain daily
allowance is reimbursed by the company for the period of outdoor
treatment at the higher center.
o Management’s special approval (For cases not routed through
referral board) - On recommendation of CMO, a patient may be
referred for super specialized treatment. In such cases, cost
of medicines, investigations are reimbursed on actual basis
while bed and surgery charges are reimbursed at the rate
prevalent at Tinplate Hospital/ JEH. However, expenses incurred
towards journey, boarding, and daily allowances are not
reimbursed.

Dependent parents are not entitled to referral treatment outside

Jamshedpur.

 Alternate medicine – Employees and their family members are

eligible for the treatment at all the homeopathic centers of
Tata Steel located in different parts of Jamshedpur.

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 TRF Medical Benefit Rules Aug 2011

 Medical rules for sites (BMH) - Employees posted at sites are

eligible for medical benefit for the treatment undertaken at the
place of posting or at Jamshedpur. These facilities are:

 OPD Treatment –
 at Jamshedpur - as per medical service at Jamshedpur (see
2)
 At site (on reimbursable basis only) – Employee may visit
medical center, local hospitals, clinics, nursing homes at
sites. Actual cost of medicines, investigations are
reimbursed, and consultation fees are limited to Rs-150 /-
for General and Rs- 250 /- for specialist. Transport and
daily allowance are not reimbursable.
 Homeopathic treatment is not reimbursable

 Eye Treatment – Employee may visit client’s hospital if

available at site, or nearest medical
center.
 Charges reimbursed at JEH rate,
 Transport and daily allowance are not reimbursable
 Actual cost of medicines, investigations are reimbursed
and
 Phaeco surgery for cataract is nor reimbursable.

 Dental Treatment – Employee may visit client’s hospital if

available at site, or nearest dental center.
 Charges are reimbursed at TMH rate
 Transport and daily allowance are not reimbursable
 Actual cost of medicines, investigations are reimbursed
and
 Cost of denture/orthodontic treatment is not
reimbursable.

 Indoor Treatment -
 At Jamshedpur - As per medical service at Jamshedpur (see 2)
 At site (on reimbursable) – Employee may visit client’s
hospital(s) if available at site, or nearest medical center.

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 TRF Medical Benefit Rules Aug 2011

 Cabin charges are reimbursed at TMH rate (as applicable

at head office),
 Transport and daily allowance are not reimbursable and
o Actual cost of medicines, investigations are reimbursed
while bed and surgery charges are reimbursed at TMH rates.

 Specialized Treatment - With the prior permission of the CMO and

the reimbursement of
expenses is made at TMH rates.
 Cabin charges are reimbursed at TMH rate(as applicable in
head office),
 Transport and daily allowance are not reimbursable and
 Actual cost of medicines, investigations are reimbursed
while bed charge and operation charges are made at TMH
rate.

 Super specialized treatment - This is allowed with due

permission of company’s Chief
Medical Officer, if the treating specialist recommends super
specialized treatment. The reimbursement of such treatment is
made on the basis of actual.
 Cabin charges are reimbursed at TMH rate(as applicable in
head office) and
 Transport and daily allowances are reimbursed at fixed
rate decided by management.
 Dependent parents can not be referred for super
specialized treatment.

 Medical facilities for regional offices - Medical facilities are

provided to employees and their family members at the place of
posting only. Others rules are same as that of medical rules
for sites (BMH) {see 3)

 Process
 At the time of joining, employees are required to provide family
details in prescribed format along with a photograph to HR
department / Personnel department. Any new arrival of family
member (new born child or legal adaptation, spouse after
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 TRF Medical Benefit Rules Aug 2011

marriage, parents on becoming dependent) must be brought to

notice of HR/ Personnel department in writing for correction of
records.
 Employee posted at sites and regional offices are required to
submit the original documents of all expenses along-with the
Doctor’s prescription and case papers for reimbursement of
expenses. All medical bills are to be approved by CMO.
 Non-reimbursable services/ aids/ supplies/medicines – Cost of
Pacemaker, spectacles, contact lenses, Prosthesis, dentures,
orthodontic treatments, Phaeco surgery, medicines with herbal
constituents, un-established experimental medicines, medicated
soaps, toothpaste, shampoo, minoxidil lotions, sunscreen lotions,
medicines being marketed by public media, dietary supplements,
health foods are not reimbursable. Procurement of any medical
appliances must be authorized by CMO beforehand. Authority to
take decision on revising the list of non reimbursable medicines
lies with Chief medical officer of company only. CMO is only
authority to pass any bill for reimbursement.

Cosmetic treatment – Cost of any treatment, which is cosmetic in

nature, is not reimbursed by the Company.

 Medical facilities at Kolkata based divisions are provided to

those employees of the Company whose terms of employment stipulate
reimbursement of medical expenses up to stipulated limit for
domiciliary treatment and health insurance policy to cover
hospitalization charges.

 PROCEDURE TO CLAIM REIMBURSEMENT IN CASE OF OPD TREATMENT-

An employee can claim reimbursement up to the stipulated limit in
a financial year calculated on the basis of period of service
rendered by the employee. In case of any change in consolidated
salary during the financial year the limit of entitlement for
reimbursement will also change accordingly from the date of
change in consolidated salary.

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 TRF Medical Benefit Rules Aug 2011

The stipulated amount for domiciliary treatment as fixed by the

management or part there of will not be carried forward in the
next financial year and will lapse automatically if not availed
during a given financial year.
Employees and their family will be eligible to domiciliary
treatment / investigations including dental and eye treatment.
Domiciliary treatment will cover allopathic/ homeopathic
treatment.

Expenses on account of following will not be reimbursed:

 Spectacles/Optical Lens / contact lens
 Tonics, unless they form part of treatment and
 Dentures/any cosmetic surgery related to dental treatment

Reimbursement is made on monthly basis. Employees claiming

reimbursement of medical expenses should submit the bills to
accounts along with supporting prescriptions from registered
medical practitioners, cash memos and receipts in original
required for reimbursement.

 INDOOR TREATMENT / HOSPITALISATION –

o Indoor treatment is provided under a group medical insurance

policy (that includes dependant
family members also).

o Health Insurance Policy taken by the Company for the amount as

fixed by the management on
case-to-case / level basis for employees and their family members.

o The reimbursement of medical claim is as per the laid down rules

of the health insurance
policy.

 Employees not covered under above scheme are covered under ESI
scheme.

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