CASHLESS TREATMENT SCHEME IN EMERGENCY (CTSE) For RELHS Beneficiaries in Indian Railways

Posted10/10/2022

Updated10/10/2022

DigSource

Topic: Cashless Treatment Scheme in Emergency (CTSE) for Railway employees in Indian Railway

Railways provide Comprehensive Health Care Facilities to its beneficiaries through its health Institutions (Hospitals) along with referrals to recognized hospitals whenever necessary. The beneficiaries, among others, include retired employees and their dependent family members.

A large number of Retired Railway healthcare beneficiaries live in the newly developed suburbs of various cities throughout India. These parts of the city are often far away from the established Railway Health Institutions. In this scenario the RELHS beneficiaries coming to Railway Health Institutions routine is acceptable. However, in emergency situations, precious time is lost in travel to the railway hospital.
To overcome this problem, Railway Board has decided to roll out a “Cashless Treatment Scheme” (CTSE) in empanelled hospitals for retired railway employees and their dependent family members in emergency situations. The empanelled hospital shall give necessary treatment in emergencies and raise the bill directly to Railway authorities; provided the identity and eligibility of the patient are established as a CTSE beneficiary and an emergency is certified by the designated Railway Medical Authority (RMA).

Implementation of the CTSE Scheme and How to Apply

M/s. UTIITSL (https://www.railctse.utiitsl.com/ClaimantPortal/) developed a Web application to enable RELHS beneficiaries to apply for a new ‘CTSE Card’ at the website. All RELHS beneficiaries can apply online.
Note: For the benefit of those RELHS beneficiaries who are not comfortable with the online form, an offline process for obtaining the card has also been designed.

How to Apply CTSE in Railway:

After filling up the form, the printout of the completed form will be submitted by the retired Railway employee to the concerned Personnel Department (Division/Zone/PU/Other Units) along with a Self-attested photocopy of the Aadhar Card, RELHS Card, PPO and any other documentary proof of the claims made in the application form.

The fee, to join CTSE per family (comprising all eligible members as per RELHS Card) shall be as follows:
1. Those entitled to Pvt Ward – Rs.30,000/-
2. Those entitled to Semi-Pvt Ward – Rs.15,000/-
3. Those entitled to General Ward – Rs.6,000/-

**These Rates are as per VII CPC and are at the time of publishing this article. The fee may change from time to time.

Rules and Procedures:

Ward entitlement is dependent upon the last salary drawn and shall be displayed on the website while filling out the form.
All the existing facilities are even otherwise available to the RELHS beneficiaries. However, to avail of cashless treatment in a recognized hospital (the new facility), they will have to get the new CTSE Card.
One card to each beneficiary will be issued on payment of Rs.200/-. The CTSE Card shall also serve the purpose of the RELHS Identity card, for these beneficiaries. However, vice versa will not be true.
The Personnel Department will authenticate the bonafide of the beneficiaries (from the RELHS Card etc.) Personnel Department shall duly authenticate the application and authorize M/s.UTIITSL to make a “CTSE Photo-identity Card” which will be issued to the beneficiary.
M/s UTIITSL shall use the updated database at ARPAN/UTI website for printing the new CTSE card. This way there will be 100% conformity between the database and the new CTSE Card.
The Medical Department of zonal railways will empanel private hospitals (located within its geographical limits) recognized by CGHS at the same rates (CGHS empanelled hospitals which are not lying in the jurisdiction of any Zone/PU shall be empanelled by the zone which has jurisdiction in some part of that district/state).
Information about any railway patient admitted to an empanelled hospital will be communicated by the empanelled hospital to the Railway Health Institution (Hospital). Authorization for treatment will be given by Railway Health Institution (Hospital) (through its designated Railway Medical Officers) based on clinical parameters communicated by the hospital within 24 hrs. The communication will be normally through the website/SMS, however, if the situation demands other means of communication may also be employed.
If the authorization is not forthcoming from the designated doctor within 24 hours period, then at the end of 24 hours period, the concerned MD/CMS/CMO shall automatically receive an alert, to make a decision and communicate it to the hospital. Likewise, there will be an automatic alert to the concerned CMD at 36 hrs and AGM at 47 hours period. If Railway fails to respond within 48 hrs, then that case shall be considered an emergency and the cost of the entire treatment shall be borne by Railway.
A list of all cases, in which no decision could be made about an emergency within 48 hrs period, despite the private hospital submitting all the details, shall be put up to GM every month.
If emergency authorization is declined, the patient shall be apprised through SMS by the system and the patient will be transported to Railway Hospital by the empanelled hospital in its own ambulance or the patient may be asked to report to Railway hospital for treatment at a convenient hour.
The Railway will bear the expenses till the emergency authorization is declined by a positive act. If the patient or his/her representative refuses Railway Medical Services and opts to continue treatment in the non-railway facility, the cost of such treatment will be borne by the patient or his / her representative without any further reimbursement from Railway.
In line with provisions of the MoA signed between MoHFW and CGHS empanelled hospitals, such bills by the hospital shall however be at CGHS rates as per terms and conditions of Railway MoA with the hospital and payments will be made by the patient or his representative. Railway Beneficiaries shall be required to give an undertaking to this effect at the time of applying for a CTSE Card and for such balance treatment Railway will not be liable for payment in any way and the entire liability will be borne by the patient or his/her representative.
The hospital shall raise the bill online to M/s.UTIITSL (within 7 days of discharge of the patient) will exercise checks and get it corrected from the concerned hospital if required. Thereafter a physical copy of the corrected bill shall be submitted by the hospital to M/s UTIITSL.
M/s.UTIITSL shall process the bill as per the extant rules and applicable rates as per MoA, and thereafter submit it to MD/CMS/CMO office both online and offline (within 15 days of submission of corrected bills by the hospital).
After approval of MD/CMS/CMO, the office shall submit the bill to the associate Accounts Department (within 15 days of submission of corrected bills by M/s.UTIITSL). The accounts Department will pass the bills and make the payment to the hospital and M/s.UTIITSL (within 15 days of submission of approved bills).
M/s.UTIITSL fee is 2% of the amount of the bill raised by the hospital subject to a minimum of Rs. 12.50 and a maximum of Rs. 750) plus Re.1/- for the SMS service. The M/s.UTIITSL fee is not in addition to the hospital bill, rather this amount shall be subtracted from the hospital bill money.
In case the patient belongs to some other Railway Zone, then the debit shall be raised to the concerned zone at a later stage as per the extant codal provisions, but the bill shall be passed by the local accounts only.

ENTITLEMENTS FOR VARIOUS TYPES OF WARDS

CTSE beneficiaries are entitled to facilities of private, semi-private or general wards depending on their pay drawn in pay band/pension. These entitlements are amended from time to time and the latest order in this regard needs to be followed.

The entitlement at present as per the 7th CPC Basic Pay drawn is as follows:

Basic Pay up to Rs.47,600/- – General Ward
Basic Pay from Rs.47,601/- to 63,100/- – Semi-Private Ward
Basic Pay Rs.63,101/- and above – Private Ward

The CTSE Identity Card will have the entitlement of the patient endorsed. The website shall also be indicating the entitlement at the time of reporting the admission to the Railway and M/s.UTIITSL.
a. Private ward is defined as a hospital room where a single patient is accommodated and which has an attached toilet (lavatory and bath). The room should have furnishings like a wardrobe, dressing table, bedside table, sofa set, carpet, etc. as well as a bed for the attendant. The room has to be air-conditioned.
b. Semi Private Ward is defined as a hospital room where two to three patients are accommodated and which has attached toilet facilities and necessary furnishings.
c. General ward is defined as a hall that accommodates four to ten patients

MODE OF PAYMENT FOR TREATMENT OF BENEFICIARIES

There shall be three classes of patients:

CTSE Beneficiaries report to empanelled Hospital directly.
Railway Beneficiaries are referred by Railway Hospitals to the empanelled hospital.
Railway Beneficiaries (other than CTSE members) reporting to the Hospital directly

In respect of the CTSE beneficiaries for emergency authorized or otherwise, treatment/procedures the services shall be undertaken /provided on credit: No payment shall be sought from them (except for the initial deposit as advised by the Railway from time to time) and the bills should be submitted to the BCA (Bill Clearing Agency) and Office of the CMS/Ms-in-charge/MD/CMO of the concerned city.
For the railway beneficiaries referred by Railway Hospitals to the empanelled hospital, the bill shall be processed through M/s.UTIITSL only, only the online identification and ‘online authorization’ shall not be required.
Railway Beneficiaries (other than CTSE members) reporting to the hospital directly, without any referral letter from Railway, shall be clearing their bills with the hospital themselves; Railway shall not be liable in any way for these bills. However, the hospital agrees and undertakes to make the bill as per the CGHS rate or hospital rate, whichever is lower.
Web portal: www.railctse.utiitsl.com – For Online registration, to download.