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Medical benefit council - Employees State Insurance Act(1936), Industrial Laws Video Lecture | Industrial Laws - B Com
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FAQs on Medical benefit council - Employees State Insurance Act(1936), Industrial Laws Video Lecture - Industrial Laws - B Com
| 1. What is the role of the Medical Benefit Council under the Employees State Insurance Act (1936)? |  |
Ans. The Medical Benefit Council is responsible for implementing and overseeing the medical benefits provided under the Employees State Insurance Act (1936). It ensures the provision of quality medical care to insured employees and their dependents by empaneling hospitals, clinics, and dispensaries. The council also reviews and approves medical reimbursement claims and monitors the overall healthcare services provided to the beneficiaries.
| 2. How does the Medical Benefit Council determine the empanelment of hospitals and clinics? | |
Ans. The Medical Benefit Council evaluates hospitals and clinics based on various criteria such as infrastructure, availability of qualified medical staff, quality of healthcare services, and proximity to the insured population. These facilities need to meet the prescribed standards set by the council to be empaneled. The empanelment process involves a thorough assessment and periodic inspections to ensure the continuous provision of high-quality medical care to the insured individuals.
| 3. Can an insured employee choose any hospital or clinic for medical treatment under the Employees State Insurance Act? | |
Ans. No, insured employees and their dependents can only seek medical treatment from the hospitals and clinics empaneled by the Medical Benefit Council. The act ensures that the beneficiaries receive healthcare services from authorized and quality healthcare providers. This restriction is in place to maintain the standard of medical care and prevent any misuse of the medical benefits provided under the act.
| 4. How are medical reimbursement claims processed by the Medical Benefit Council? | |
Ans. To claim medical reimbursement, insured employees need to submit the necessary documents, including medical bills, prescriptions, and diagnostic reports, to the Medical Benefit Council. The council reviews the claims and verifies the authenticity of the documents. If the claim is found to be valid and as per the provisions of the Employees State Insurance Act, the council approves the reimbursement and processes the payment accordingly.
| 5. What measures does the Medical Benefit Council take to monitor the healthcare services provided to the insured employees and their dependents? | |
Ans. The Medical Benefit Council conducts regular inspections and audits of the empaneled hospitals, clinics, and dispensaries to ensure that they adhere to the prescribed standards of medical care. The council also reviews feedback and complaints from the insured individuals regarding the quality of healthcare services provided. If any discrepancies or violations are found, the council takes appropriate action, which may include warning, suspension, or removal of the healthcare facility from the empanelment list. This monitoring mechanism aims to safeguard the interests of the insured employees and maintain the overall quality of healthcare services.
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Dec 23, 2024 Last updated |
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