Under the new Provident Fund (PF) rules, employees registered with the Employees’ Provident Fund Organisation (EPFO) are eligible for a Rs 1 lakh in funds as a medical advance. Though they have to link Aadhaar Card with PF UAN (universal account number) to get PF contributions from the employers and other benefits before September 1, 2021.
The medical advance can only be taken out against their accumulated corpus for emergency medical treatment or hospitalisation. Apart from this, prior to withdrawing the funds the employees need to not give any estimate as to the cost of said hospitalisation or procedure.
The new circular by EPFO was issued after a revisit by the organisation to the matter of granting medical advance in case of medical emergencies for employees under the PF scheme.
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The new circular outlines the treatment conditions under which it will be given and defines the ambit within which the medical advance falls. Covid-19 related treatments has recently been included in the list.
The EPFO circular clearly mentions that the advance will only be applicable to the the employees covered under the Central Services Medical Attendant (CS(MA)) rules and for those who fall under the coverage of the Central Government Health Scheme (CGHS).
“In life-threatening diseases, many times it becomes imperative to get the patient immediately admitted in hospital on emergency to save his/her life and it is not possible to get the estimate from hospital in such situations. A need is felt for streamlining the advance facility for such serious in-patient’s treatment in hospital whenever family members of employees are not able to manage estimate from hospital concerned in which such patient has been admitted in emergency," the circular says.
"Sometimes patient employee maybe in ICU where estimate is not known in advance. Hence the following procedure may be adopted to grant medical advance for emergency hospitalisation on account of serious life threatening illness including Covid,” the circular added.
Steps to obtain the medical advance:
1) As per the rules, the patient must be admitted for treatment in a Government/PSU/CGHS empanelled hospital. For those admitted to a to a private hospital due to an emergency, need to make an appeal to the relevant authority to consider their case for reimbursement. The advance can be given to private hospitals as well in those cases.
2) For claiming the advance, the employee or a family member has to submit a letter on patient's behalf. The letter should include details of the hospital and the patient.
3) The medical advance of up to Rs 1 lakh can be directly deposited to the hospital’s accounts for beginning the treatment process or to the patient or family member by the concerned authority.
4) In case of treatment costs exceed the Rs 1 lakh advance, then an additional advance is possible as long as it falls under the rules of withdrawal of the EPFO. But that can only take place after the receipt of the estimate for treatment that is to come and before the patient is discharged from the hospital.
5) The employee or family member needs to submit the hospital bill within 45 days after being discharged. The advance would be adjusted to fit the final bill of the hospital as per the EPF rules.6)
Last but not the least, the money that can be withdrawn is the least a 6 months’ basic wages and dearness allowance (DA) of the member or to the member’s share of contribution with interest.