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SUPER SPECIALITY TREATMENT

What are the eligibility conditions for availing the super specialty treatment ?

The eligibility conditions are as follows:

  • An insured person who is eligible for medical treatment is entitled to avail Super Speciality treatment, for self and his/her family
  • A newly registered employee is entitled to avail super speciality treatment for self, on completion of three months of service in insurable employment and contribution should have been paid/payable for not less than 39 days during that period.
  • A newly registered employee ‘s dependents are entitled to super speciality treatment on completion of six months of service in insurable employment and contribution should have been paid/payable for not less than 78 days during that period.

The concepts of contribution period and benefit period will not apply while deciding the eligibility of an IP for Super specialty treatment.

Whether a beneficiary can avail the super specialty treatment in a state different from that of the state in which the IP is registered ?

Yes. The procedure for the same is as follows:

  • The referring hospital/dispensary shall send a copy of the reference slip to the SSMC/SMC of the referring and the referred state from where the patient wants to avail, the required super-speciality treatment.
  • SSMC/SMC of the state from where the patient wants to take treatment, shall intimate the network/tie-up hospital for providing necessary/required treatment. Thereafter, the bill for payment may be sent to the SSMC/SMC of the state from where he was referred on completion of treatment.