Mission Directorate

National Health Mission. Odisha

••
Department of Health & Family Welfare.
Government of Odisha.
Letter No: OSH&FWS/ II DC( H2017 Date: 2f) .09 2n l1=
From
!Lier /~otr
Shalini Pandlt, lAS
Mission Director. NHM. Odisha
To
All CDMO-cum-District Mission Director.
Odisha

Sub: Guideline on NHM Employees' Welfare Fund.

Madam/ Sir.

With reference to the subject cited above, I am to say that Government in H & FW
Department has been pleased to introduce the NHM Employees' Welfare Fund with effect
from 01.04.2017. Under the scheme, following package of compensation will be provided to
the employees and their families:

• One time compensation package up to Rs. 6 lakhs for death and permanent
disability
• One time compensation of an amount of Rs. 2.5 lakhs in case of partial disability
between 61%-80% disability and Rs. 2 lakhs in case of partial disability between
40% -60%.
• Reimbursement of medical expenses up to Rs. 3 lakhs in a year for critical health
conditions, only in case where expenses total exceeds 40% of annual remuneration
for concerned staff for a single event year.
• Maximum provision of Rs. 1000/- per employee per annum for annual Health
Check up of all contractual employees who are of 40 years of age.

You are therefore, requested to ensure effective implementation of' the NHM
Employees' Welfare Fund as per detailed guideline attached herewith.

Yours flll Y,

Mission
NHM.Odisha
6~:~
I(}
Memo No. /10 9~
Copy submitted to Commissioner-cum-Secretary
kind information.
to Govt.
H&FW =r
Date. 26'07,
for
2P0-

MiSSid Director
NHM,Odisha

Annex Building ofSIH&FW, Unit-8, Nayapalli, Bhubaneswar-751012

Tel-0674-2392480/88 E-mail: missiondirector(Q)nic.in.Web: www.nrhmorissa.gov.in
 Mission Directorate
National Health Mission, Odisha
Department of Health & Family Welfare,
Government of Odisha.

Memo No. [10 j =1 Date.2G Cf. /1- I

Copy forwarded to Managing Director, OSMCL, Odisha for information and

necessary action.

Miss~llor
NHM,Odisha
Memo No. r I r e>O Date. 2. 6,(Jr· ,.=}-
Copy forwarded to all Directors, Health & Family Welfare Department, Govt. of
Odisha for information.

Memo No. II J C) I
NHM,Odisha
Date. 'LG,
.t I:j- 9'
Copy forwarded to Directors, Capital Hospital / RGH, Rourkela for information and
necessary action.

Missiotrector
NHM,Odisha

Memo No. t II ()2. Date. 2.£. 7· / T-

Copy forwarded to ADMO (PH)-cum-Nodal Officer, NUHM of Bhula eswar,
Cuttack, Rourkela, Berhampur & Sambalpur for information and necessary action.

Missio Director
NHM,Odisha
Memo No. 111 ~tJ Date. 26" Cj. 1:)--
Copy forwarded to Superintendent of Govt. Medical Colleges & Hospitals,
MKCGMCH / SCBMCH/ VIMSAR / Director, AHRCC, Cuttack / Superintendent, SVPPGIP,
Cuttack, Principal College of Nursing, Berhampur/ Project Coordinator, Odisha Sickle Cell
Project, VIMSAR, Burla for information and necessary action.

.i.
NHM,Odisha

Memo No. I J J tJ 4 Date. 2_b. r~1:;-

Copy forwarded to all DPMs for information and necessary action.

.i:
NHM,Odisha

Annex Building of SIH&FW, Unit-S, NayapalJi, Bhubaneswar-751012

Tel-0674-2392480/88 E-mail: missiondirector@nic.in.Web: www.llrhmorissa.gov.in
 Guideline on NHM Employees' Welfare Fund.

1. Background: Under NHM, more than 15,000 employees are working as

contractual staff without having any social security benefits. As a result, many
employees & their families face severe financial difficulties in the event of death,
disability or critical health conditions. Keeping in view to the critical situation as
well as to extend some kind of social security benefits to the employees and
their families, Govt in H& FW Deptt have been pleased to create corpus fund of
sum of Rs. 1 Cr under NHM Employees' welfare fund, maintained at the State
level. The employee's contribution would be Rs.100/- per annum, which would
by the employees as per the modalities to be communicated separately. The
scheme is in effect from 01.04.2017.

2. Key features of the Scheme :

i) Compensation in case of death or permanent disability (more than 80%
disability) while being in service under the Society.
o One time assured compensation of Rs. 3.00 lakh for all employees.
o Plus, one time additional compensation up to Rs. 3.00 lakh to be
calculated by multiplying completed years of service under the Society
with the last base remuneration of the employee.
o Thus for the purpose, an employee shall be entitled for a maximum
compensation of Rs. 6.00 lakh.

ii) Compensation in case of partial disability (40-60% & 61-80%) while being in
service under the Society.

o One time compensation of an amount of Rs 2.5 lakh to the employee

in-case of partial disability between 60-80% & Rs 2.00 lakh to the
employee in case of partial disability between 40-60%.

iii) Compensation in shape of reimbursement cost of medical expenses.

o Compensation in shape of reimbursement cost of medical expenses

(at CGHS rates) up to Rs. 3 lakh in a year for critical health conditions,
only in-case where total expenses exceeds 400/0 of annual
remuneration (Excluding PI) of concerned staff for a single event in
a year.
iv) Compensation in shape of reimbursement cost of annual Health check up

o Maximum provision of Rs. 1000/- per employee per annum for

annual Health Check up of all contractual employees who are of 40
years of age.

A Statement illustrating a few cases from each category is attached at

Annexure-1 for better understanding.
11
------" "-

3. Modalities for application & processing:

In order to avail the benefit under the scheme, following process shall be
adopted:

• An application in the prescribed format along with enclosures duly certified &
recommended by appropriate authority must be submitted to the Mission
Director, NHM, Odisha. Application format for critical health conditions
(Annexure-A) death and disability attached at (Annexure- B).
• Necessary process for submission of application will be done by DPM at
district level and CPM at the city level and through proper channel in case of
other implementing agency.
• The Admin & HR section will initiate necessary process sanction & release of
compensation after due verification of each case.
• Each individual case will be subject to scrutiny by a Committee consisting of
Joint Director (Tech.), NHM, Joint CEO (Tech.), State Health Assurance
Society and a Specialist in related field.
• In case of annual health check up, each employee above 40 years of age are
to submit medical reports in the prescribed format ( Annexure-C) along with
money receipt for reimbursement of such charges as per actual not exceeding
Rs. 1000/-.
• The compensation cost will be transferred to account of the employee / legal
heir through Direct Benefit Transfer (DBT).
 Annexure-1
A Statement illustrating a few cases from each category for calculation of payment of ex-gratia in case of death / compensation for
permanent disability / partial disability occurred while in service and also the provision for reimbursement of medical expenses in case
of critical health conditions
a. Calculation of payment of ex-gratia in case of death / compensation for permanent disability of more than 80%

Component 1= Minimum
SI.No Name of the Position
No.of completed assured amount of
Monthly Component 2= no. of Total compensation ( TC ) =
years of service Remuneration (MR) completed years of service MAS+ (MR x CY) Subject to
compensation (MAS)
( in Rs.) (CY) x MR ( in Rs.) Maximum of Rs. 6 lakh
( in Rs.)
1 DPM 1 0 300000.00 46200.00 0.00 300000.00
2 DPM 2 2 300000.00 46200.00 92400.00 392400.00
3 DPM 3 7 300000.00 46200.00 323400.00 600000.00
4 DEO1 0 300000.00 12180.00 0.00 300000.00
5 DEO2 2 300000.00 12180.00 24360.00 324360.00
6 DEO3 7 300000.00 12180.00 85260.00 385260.00

b. Compensation in-case of partial disability between 40-80%

SI.No Name of the Position Amount of Compensation
Total compensation
1 DPM 1 fixed amount of Rs.2.5 lakh in case of partial disability between 60-80%
250000.00
2 DPM 2 fixed amount of Rs.2 lakh in caseof partial disability between 40-60%
1 200000.00
DEO1 fixed amount of Rs.2.5 lakh in case of partial disability between 60-80%
2 250000.00
DEO2 fixed amount of Rs.2.5 lakh in case of partial disability between 40-60% 200000.00

c. Compensation in shape of reimbursement cost of medical expenses (at CGHSrates) upto Rs. 3 lakh in a year for critical health
conditions, only in-case where total expenses exceeds 40% of annual remuneration of the concerned staff for a single event in a year
SI.No Name of the Position Amount of Compensation
Total compensation
when the annual remuneration is 554400.00 and actual expense is 275000.00 and 40% of annual
1 DPM remuneration is 221760 then he will get the compensation of the medical expenses as the medical
Actual at CGHSrates
expense exceeds 40% of his yearly remuneration
when the annual remuneration is 146160.00 and actual expense is 50000.00 and 40% of annual
, 2 DEO
remuneration is 58464.00 then he will get a compensation of the medical expense is lessthan 40% of Actual at CGHS rates
t. the annual remuneration
 Annexure-A

NHM Employee Welfare Fund

(Application for Medical Reimbursement for Critical Health Conditions)

1. Background Information of Employee

1.1 Name of the Employee
1.2 Designation
1.3 Placeof posting
1.4 Date of JOiningin OSHFWS
1.5 Total BaseRemuneration drawn
1.6 Contact Address & Mobile No
2. Applicant Details, if other than employee
2.1 Name of the Applicant
2.2 Relationship with the Employee
2.3 Contact Address & Mobile No
3. Treatment details
3.1 Name of the Disease/ Conditions for which
treatment was sought
3.2 Name of the Hospital
3.3 Type of Hospital Public/ Private
3.4 If private, whether empanelled under any
scheme of Health & Family Welfare
department, Govt. Of Odisha or CGHS
3.5 Whether referral made from public facility or
not
3.6 If Yes,name of the public facility
3.7 Period of treatment
3.8 Total cost of treatment
3.9 Amount claimed for reimbursement
4. Bank Details for transfer of reimbursement cost
Name of the account holder
4.1 Name ofthe Bank/Branch
4.2 Bank Account Number
4.3 Bank IFSCCode No
Declaration

I hereby declare that the statements made in the application are true to the best of my knowledge
and belief. I agree for the reimbursement as is admissible under the rules.

Date:

Place: Signature of the Employee/ Applicant

 Documents to be attached

1. Recommendation Letter from appropriate authority ( CDMO in caseof district level/MD in

caseof State level employee)
2. Copy of referral slip from public health facility
3. Copy of discharge certificate with detailed description about the type of treatment,
diagnosis done, drugs, and other consumables prescribed.
4. In case of implants invoice number along with sticker with sl no of the implant to be
attached.
5. In case of coronary Stents, outer pouch of stents is to be enclosed.
6. In case of replacement of pacemaker / ICD etc. Copy of the warranty certificate of earlier
pacemaker / ICDmay be enclosed.
7. Original Bills & Vouchers for the Reimbursement amount claimed

Note:

Misuse of reimbursement of medical expenses is a criminal offence. Penal action including

termination of service from the OSHFWSwill be done in case of wilful suppression of facts or
submission of false statement. Suitable disciplinary action shall be taken in case of serving
employees.
 Annexure-B
NHM Employee Welfare Fund

(Application for compensation for Death/Disability)

1. Background Information of Employee
1.1 Name of the Employee
1.2 Designation
1.3 Placeof posting
1.4 Date of JOiningin OSHFWS
1.5 Total BaseRemuneration drawn
1.6 Contact Address & Mobile No
2. Applicant Details, if other than employee
2.1 Name of the Applicant
2.2 Relationship with the Employee
2.3 Contact Address & Mobile No
3. Disability Details
3.1 Types of disability
3.2 Percentage of disability
3.3 Causesof disability
4. Death Details if any
4.1 Date of death
4.2 Placeof death
4.3 Causesof death
5. Details of Legal heir
5.1 Name of the legal heir
5.2 Age
5.3 Relationship with the employee
5.4 Name of the local guardian in case of minor
5. Bank Details for transfer of the compensation
6.1 Name of the account holder
6.2 Name of the Bank/Branch
6.3 Bank Account Number
6.4 Bank IFSCCode No

Declaration

I hereby declare that the statements made in the application are true to the best of my knowledge
and belief. I agree for the reimbursement as is admissible under the rules.

Date:

Place:
Signature of the Employee/ Applicant
Documents to be attached

1. Recommendation Letter from appropriate authority ( COMO in case of district level/MD in

caseof State level employee)
2. Copy of the disability certificate from competent authority
3. Copy of the death certificate in caseof death
4. Copy of legal heir certificate

Note:

Misuse of reimbursement of medical expenses is a criminal offence. Penal action including

termination of service from the OSHFWSwill be done in case of wilful suppression of facts or
submission of false statement. Suitable disciplinary action shall be taken in case of serving
employees.
 Annexure-C
NHM Employee Welfare Fund

(Proforma for health check up of NHM employees above 40 years of age)

Name Age Sex: M/F

Designation District Date

Brief clinical history, if any:

A: Examination

Physical Systemic

Investigation:

Peripheral Smear

Blood Sugar

FBS

P.P

Lipid Profile

Total Cholesterol

HDLCholesterol

LDLCholesterol

VLDLCholesterol

Triglyceride

Liver Function Test

Total Bilirubin

Direct Bilirubin

Indirect Bilirubin

SGOT

SGPT

ALKPhosphatase
Kidney Function Test

Urea

Creatinine

Uric Acid

Cardiac Profile

CPK

CK-MB

LDH

E.C.G.

X-ray Chest

Urine

Routine Microscopic

Sugar

Albumin

Any other Investigation

Advise

B: Medical Report of the Officer

1. Haemoglobin level of the officer Normal/Low

2. Blood Sugar level Satisfactory/Normal/ High/ Low
3. Cholesterol level of the officer Normal/ High/ Low
4. Liver functioning Satisfactory/normal/dysfunctioning
5. Kidney Status Normal/ Both-one kidney not functional optimally
6. Cardiac Status Normal/ enlarged/ blocked/ not normal

C: SUMMARY OF MEDICALREPORT(ONLYCOPYOFTHISPARTISTO BEATIATCHEDTO PAR)

1. Overall Health of the officer

2. Any other remarks based on the health medical
check up of the officer
3. Health profile grading

Date
Signature of Medical Authority
Designation