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GOVERNMENT OF INDIA (3fR'O 'tHCfi"C)

MINISTRY OF RAILWAYS (t<;r tH:;iiIt>t:tl)
(RAILWAY BOARD)

No. 2014/H /28/1/smart card/Part A Dated: +

I .07.2016

General Manager,
All Indian Railways,
New Delhi,

GM/CAO/DG
All Production Units, NAIR & RDSO

Sub: Policy letter on cashless treatment scheme in emergency (CTSE)in empanelled hospitals for
retired employees and their dependent family members.

Railway provides Comprehensive Health Care Facilities to its beneficiaries through its

health Institutions along with referrals to recognized hospitals whenever necessary. The

beneficiaries, among others, include retired employees and their dependent family members.

Large no. of retired 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 in

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 in empanelled hospitals for retired employees and their dependent family members in

emergency situations" (CTSE). The em panelled hospital shall give necessary treatment in

emergencies (defined in the draft agreement or DA) and raise the bill directly to Railway

authorities; provided the identity and eligibility of the patient is established as CTSEbeneficiary

and emergency is certified by designated Railway Medical Authority (RMA). To implement this

scheme on the ground, a system will have to be developed with provisions which are

summarized as follows:-

Page 1 of 13
 (i) It should be possible for the retired employee/dependant family member to

establish their identity and eligibility under the scheme, reasonably beyond

doubt to the private/referral hospital.

(ii) The hospital should be able to communicate to the local Railway medical

authorities sufficient medical data through internet/phone to establish the

emergency, to get an authorization to treat the patient on railway account.

(iii) The bills raised by hospitals should be as per the mutually agreed rates.

(iv) This scheme should work seamlessly on pan India basis, i.e. any retired

beneficiarv retiring from anywhere, settling in any city or moving from place to

place, should be able to get emergency medical facility anywhere in India, in any

of the recognized hospitals without the need of formal referral from the local

railway medical authorities.

Note: To gain experience and smoothen out the possible hiccups, initially the scheme

shall be launched in four metro cities; Delhi Urban Agglomeration (UA) or Delhi NCR,

Mumbai (UA), Kolkata(UA) and Chennai (UA) as a pilot scheme for one year. The term

'Urban Agglomerate' includes the metro city and its suburbs, not necessarily

restricting to municipal limits of the metro concerned.

To achieve the above objectives, it has been decided to issue such RELHSbeneficiaries

(retired employees and their dependent eligible family members, registered in these four cities

at present) who are willing to become member of the new scheme, individual 'CTSE Plastic

Photo Identity Card' (CTSE Card). This new CTSE card and scheme will have the following

features:-

(a) The new CTSEcard should have relevant demographic detail of the beneficiary,

i.e. name, date of birth, date of retirement of the ex-employee, photograph,

address, PPO number, last pay drawn, designation at the time of retirement,

Office from which retired, health unit/hospital at which RELHScard is registered,

relation to the ex- employee etc. Since identification of beneficiary can be

established quickly in real time by Aadhar No. , it should also have Aadhar no. of

Page2 of 13
 · the beneficiary. Accordingly, RELHSbeneficiaries wishing to join eTSE shall be

required to provide Aadhar Number as in absence of Aadhar Number

establishing identity may consume precious time. To protect confidentiality of

the beneficiary only certain part of this entire information (to the extent

required) shall be printed in language. The remaining part shall be available in

barcode/QR code which will be printed on the card.

(b) The hospital should be able to communicate with the Railway authorities on real

time basis. M/s UTIITSL has been authorized to develop a website to facilitate

this. Address of the website shall be communicated in due course.

(c) The new eTSE card shall be valid throughout the country and the website shall

also be accessible from every part of the country.

(d) The list of referral hospital shall be available on website and should be updated

regularly by zonal railways and should be visible to all beneficiaries.

(e) It is also to be noted here that eTSE is a new and additional scheme; even

without the new eTSE Identity card, all the existing facilities will continue to be

available to the RELHSbeneficiaries as before.

(f) The prerequisite to join eTSE shall be the membership of RELHS.For this purpose

the option to join RELHSnow, for the already retired employees, is again thrown

open. Such retired employees will have to complete all the formalities and

deposit required fees with concerned personnel department office.

The outline of the eTSE scheme -is as follows:-

The website will be maintained by the M/s UTIITSL, which will be operational round the

clock, throughout the year. The website will have various modules:

(i) List of recognized hospitals, zone, state, city and area wise, along with

information on the services/ specialties for which the hospital is recognized.

Medical Department, at every zonal HQ shall provide the list of recognized

hospital within their jurisdiction to the agency maintaining the site online.

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(ii) The authorized persons from the Railway administration shall be able to log on

to the site with unique id and password and perform various functions like

updating the list of hospitals, type of treatments for which the hospital is

recognised, authorize treatment, correspond with MiS UTIITSLand communicate

with hospitals etc.

(iii) The recognized hospitals will also be having access to the site with a unique id

and password to establish the identity and eligibility of the patient reporting to

them, communicate with the Railway medical authorities, correspond with MIS

UTIITSL,raise bills etc.

(iv) MIS UTIITSLshall enter into an MoU with Unique Identification Authorityof India

(UIDAI). At the backend the website shall verify the identity of the patient by

matching the biometrics (primarily fingerprint only and retinal scan if and when

required) with the biometrics stored at the UID website through Aadhar no.

(v) The basic data, with Aadhar number being the key and the unique CTSE

registration nos., of all beneficiaries, shall be stored at the website. Ideally, the

initial identification of the beneficiary at the time of presenting to the hospital

should be through comparison of the patient's fingerprints (at the hospital's

finger print reader) to the UIDAI website stored biometric parameters itself.

However, though there may be times when this is not possible, in such cases also

the hospital can start the treatment. However, it will be the duty of the hospital

to establish the identity of the patient through the biometrics (as described

above) or otherwise before discharge. In absence of this verification, it will not

be considered authorized treatment by Railways. In these cases it will be

incumbent upon hospital to prove the emergency and get authorization of

Medical Emergency from RMA.

(vi) In every case, the hospital will take the fingerprint of the patient treated in the

case sheet, so that random checks may be conducted by Railway, whenever

required.

(vii) The data base of the beneficiaries shall be provided to MIS UTIITSL by the

Personnel Department. It is envisaged that all the Sr. DPOs shall be updating the
Page4 of 13
 data base at ARPAN and the data base at MIS UTIITSL shall be updated and

matched daily (or at a frequency as decided by railway) with ARPAN, at a fixed

time, online. The updating of the data base of ARPAN shall be done by railway

with help of MiS UTIITSL as spelled out in detail in 'Online and Offline mode of

CTSEID Card Application and Issue'.

(viii) . MIS UTIITSL shall maintain the website on a 24 hour basis for at least the next 5

years, with above mentioned functions, extendable on usual terms and

conditions. The software, source code, etc. shall be the property of railways.

(ix) MIS UTIITSL may have to make a few modifications when the system starts

working as per the experience gained from the working of the system.

How to Implement the CTSEScheme along with responsibilities of various departments

a. Mis UTIITSL will develop an application to enable RELHS beneficiary to apply for new

'CTSE Card' at the website. Advertisements will be issued in the national, regional and

local newspapers by NR, WR, CR, ER, SER,SR, Metro Railway and ICF advising all RELHS

beneficiaries registered in the four metro cities (UA) to apply online for CTSE. - Action

by Personnel Department

Note: For the benefit of those RELHS beneficiaries who are not comfortable with the

online form, an offline process of obtaining the card has also been designed, please see

the annexes.
b. After filling up the form, the .print out of the completed form will be submitted by the

retired Railway employee to the concerned Personnel Department

(Division/Zone/PU/Other Units) along with Self attested photocopy of Aadhar Card,

RELHSCard, PPO and any other documentary proof on the claims made in application

form. The fee, to join CTSEper family (comprising of all eligible members as per RELHS

Card) shall be as follows:

Those entitled to Pvt Ward Rs.50,0001- (fifty thousand)

Those entitled to Semi-Pvt Ward Rs.25,0001- (twenty five thousand)
Those entitled to General Ward Rs.l 0 ,000 I - (ten thousand)
Ward entitlement is dependent upon last salary drawn and shall be displayed at
the website while filling the form. - Action by Personnel Department

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 Note:- All the existing facilities are even otherwise available to the RELHS beneficiaries. However to avail

cashless treatment in recognized hospital (the new facility) they will have to get the new aSE Card.

Personnel Department shall enter into an MOU with M/S UTIITSL for issuing the plastic aSE card. One

card to each beneficiary will be issued on payment of Rs200/-. Additional cards (in case of loss, mutilation

etc.) can be issued after payment of Rs.200/- by the beneficiary. The aSE Card shall also serve the purpose

of RELHSIdentity card, for these beneficiaries; however the vice versa will not be true.

The amounts received (one time aSE joining fee and aSE Card cost) shall be credited to sundry earning,

detailed head no. 657 as below:

Minor Head Sub-head Detailed Head

600 Miscellaneous 657 Other Unclassified receipts 657 Receipts on account of recovery towards cost

Of Cashless Card and one time recovery for

subscription under CTSE

c. The Personnel Department will authenticate the bonafide of the beneficiaries (from the

RELHS Card etc.) New/additional information as mentioned in application form, duly

verified by personnel department would also get incorporated in the data base for each

and every application (within a reasonable time frame). Personnel Department shall

duly authenticate application and authorize MIS UTIITSL to make "CTSE Photo-identity

Card" which will be issued to the beneficiary. MiS UTIITSL shall use the updated

database at ARPAN/UTI website for printing the new CTSEcard. This way there will be

100% conformity between the data base and the new CTSECard.- Action by Personnel

Department and W Railway i~ respect of ARPAN

Note: - Since there are different practices in different zones for maintaining the service records every

zone will devise its own methodology for verification of the application forms. For smooth

implementation of the scheme it would be advisable to issue a Joint Procedure order duly signed by CPO,

FA&CAO,CMD and PHOD/CHODof concerned Department (wherever other Departments maintain their

employees's service records separately); the requirements for manpower and other resources may be

taken care of in the JPO.

d. After commencement of the scheme, the newly retired personnel intending to settle in

the four metros can apply to become member of CTSEin addition to RELHS.Personnel

department shall issue CTSEcards to them with the help of M/S UTIITSL (till the time

Page 6 of 13
 ·.

scheme is extended to the other regions this shall be restricted to those retiring persons

who are settling in four metros (UA). - Action by Personnel Department

Note: -The points given herein above at (a) to (d), will take care of both the groups of retirees; those who

have already retired and those who will be retiring in future. In any case the exercise of issuing the CTSE

Cards shall be a continuous one. Those persons who are not comfortable with online application shall be

able to obtain CTSEcard by complete offline mode. Detailed process flows are attached as Annexes.

e. Medical Department of zonal railways will empanel private hospitals (located in 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). Model MoA to be followed, is

attached along with this letter as Draft Agreement (DA).' The MoA has been vetted by

the Finance directorate and Legal Directorate of Railway Board and as such there is no

need to get it vetted again at Zonal/Divisional level. The concerned MD/CMS/CMO can

enter into MoA with the CGHS em panelled hospital located, within jurisdiction of the

hospital, with concurrence of the associate finance. If there is no CGHS em panelled

hospital at a place and a need is felt for an em panelled hospital, then Railways will

recognise suitable hospital(s} as per the already existing procedure. All the zonal HQs

will be communicating the list of empanelled Hospitals online to M/s UTIITSL who are

maintaining the site on real time basis. Initially only the CGHS recognized hospitals shall

be empanelled by Railway, but eventually the objective is to have at least one suitable

hospital empanelled by railway in every district. The list of civil districts distributed

amongst railway divisions for the purpose shall be distributed separately later. - Action

by Medical Department

Note: All the CGHS empanelled Hospitals shall be approached by concerned CMS/MD

and if willing every hospital in CGHS list, providing emergency treatment, shall be

empanelled by Railway. There shall be 2 annexes with the prescribed MoA. First

Annexure will be the relevant city specific CGHS rate list and the second set of

Annexes will be the different process flows attached with this letter as annexes.

f. Every year 5% cases of every hospital shall be audited. - Action by Medical Department

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 , .

g. Each em panelled hospital will be allotted to a particular Railway Health institution which
"-
is nearest/ suitable as decided by the divislonal/zonal authorities. For every

administrative function e.g. authorization of emergency, bill submission, bill payment

etc. the em panelled hospital will have to communicate with that particular Railway

Health ·Institution or the concerned CMS/MD/CMO office only. The CMS/

MD/CMO/ ACMs-in-charge will have to make a roster so that at least one medical officer

is always available to authorize treatment at each em panelled hospital daily. -Action by

Medical Department

Note: In earlier system, hospital recognition used to be for the treatment of patients

of that particular division/unit only. In this new scheme, any railway patient belonging

to any Zone/unit may be treated at any recognized hospital but the bill shall be

processed by the local medical and account department only. If need be, a debit note

shall be raised later by this local unit on to the concerned zone/PU.

h. A CTSE beneficiary in an emergency situation can go to any of the nearby private

em panelled hospital (list accessible at the M/S UTIITSLwebsite). At time of admission in

Private Hospital the beneficiary will have to make a deposit at following rate:

Those who are entitled to Private Ward Rs. 10,000/-

Those who are entitled to Semi-Private Ward Rs. 5000/-

Those who are entitled to General Ward Rs. 2000/-

If the medical condition turns out to be an emergency then the hospital shall refund t~e

deposited amount (to the CTSEbeneficiary) within 48 hrs of authorization otherwise this

deposit shall be adjusted towards the bill payment of the treatment/investigations

undertaken till the time emergency authorization is declined by Railway. In such cases,

where condition is not found to be an emergency, the balance part of payment (after

adjustment of initial deposit by the beneflciarv) shall be borne by Railway, only till the

time emergency was declined. - Action by Medical Department

i. Information about any railway patient admitted to an empanelled hospital will be

communicated by the empanelled hospital to the Railway Health Institution which

signed the MoA (described in detail in process flows attached to this document).

Authorization for treatment will be given by Railway Health Institution (through its
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 ·.

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. - Action by Medical Department

j. If the authorization is not forthcoming from the designated doctor within 24 hours

period then at the end of 24hr period the concerned MD/CMS/CMO shall automatically

receive an alert, to make a decision and communicate it to hospital. Likewise there will

be an automatic alert to the concerned CMD at 36 hrs and AGM at 47 hour period. If

Railway fails to respond within 48 hrs, then that case shall be considered an emergency

and the cost of entire treatment shall be borne by Railway. List of all cases, in which no

decision could be made about emergency within 48 hrs period, despite private hospital

submitting all the details, shall be put up to GM every month.

k. 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 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 MoA signed between MoHFW and CGHS empanelled hospitals, such bills by the

hospital shall however be at CGHSrates as per terms and condition 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 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. - Action by Medical and Personnel Department

I. The hospital shall raise the bill online to M/S UTIITSL (within 7 days of discharge of the

patient) which will exercise checks and get it corrected from concerned hospital, if

Page 9 of 13
\.-

required. Thereafter a physical copy of the corrected bill shall be submitted by the

hospital to Mis UTIITSL. - Action by Medical Department

m. MiS 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).

n. After approval of MD/CMS/CMO the office shall submit the bill to associate Accounts

Department (within 15 days of submission of corrected bills by Mis UTIITSL). Account

Department will pass the bills and make the payment to the hospital and MIS UTIITSL
(within 15 days of submission of approved bills). MIS UTIITSLfee 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.l/- for the SMS service. The MIS UTIITSL fee is not in addition to the
hospital bill, rather this amount shall be subtracted from the hospital bill money. The

money paid on account of this scheme shall be debited to the heads as per the note

below. The 2% fee of Mis UTIITSL has been fixed at the same level as CGHS is paying
them, this may go upward or lower revision as per the CGHS action in this regard and

such changes shall be advised by Railway Board. - Action by Accounts Department on

Zones and Health Directorate of Railway Board

Note: - The process flow charts in various situations and backend are attached as

annexes 1.1 to 1.7. Detailed accounting head, under minor head 200 and subhead 240,

have been modified/ created for debiting the cost as follows:

Minor Sub-Heads Detailed Heads

Heads

200 240 Payment 241 Reimbursement to serving railway officials for emergency
Medical to non-Railway medical treatment and assistanceat non- railway
Services Hospitals, institutions/hospitals. (Non-referred caseswhere beneficiary pays
(Existing) reimbursement first and then claim reimbursement later)
of Medical 242 Reimbursement to retired railway officials for emergency
expenses and medical treatment and assistanceat non- railway
miscellaneous institutions/hospitals. (Non-referred caseswhere beneficiary pays
first and then claim reimbursement later).
243 Payment to non-railway institutions/hospitals for medical
treatment of serving railway official in casesreferred by Railway
Medical Dept. (Referred cases).

Page10 of 13
 '.

Minor Sub-Heads Detailed Heads

Heads

244 Payment to non-railway institutions/hospitals for medical

treatment of retired railway officials in casesreferred by Railway
Medical Dept. (Referred cases).
245 Payment to non-Railway institutions/hospitals for treatment
of retired railway subscribers to CashlessTreatment Scheme in
Emergency (CTSE)declared as emergency by RMA.
246 Payment to non-Railway institutions/hospitals for medical
treatment of retired railway subscriber to CashlessTreatment
Scheme (CTSE)in caseswhich are not declared as Emergency.
247 Payment of fees to outsourced mediating agency (M/s
UTIITSL)under CashlessEmergencyTreatment Scheme.
248 Cost of TB treatment in Sanatoria.
249 Other expenses.

o. 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.- Action by Accounts Department

The whole exercise will require creation of additional infrastructure like space, computers,

printers, scanners, other associated equipments, furniture etc to be created in offices.

responsible for running the schemes that is health units, hospital, Sr DPO office, Sr DFM office.

This requirement needs to be worked out by the respective branch officers. As far as purchase

of new PCs, printers etc. is concerned, the same is left to the discretion of the DRM and this

requirement would be over and above the normal powers given to DRM for purchase of new

PCs.

FA & CAO, CMD and CPO of these 8 zonal RailwaysjPU (NR, WR, CR, ER, SER, Metro railway,

SR and ICF) may nominate one deputy FA & CAO, deputy CMD and one deputy CPO as nodal

officers of these units to implement the cashless treatment scheme and for authorization of

various activities for CTSEscheme.

Page11 of 13
 An effort has been made to foresee all the situations and give solutions to them. However,

a new work of this magnitude will throw up new challenges as we go along. Those challenges

will have to be met with the underlying philosophy that this scheme is to give social security to

one of the most vulnerable group of society i.e. the elderly group of people who had served

Railways in their youth, hence, innovative solutions may have to be found many a times. Having

said this, it is also imperative to state that enough safeguards and precautions are always

exercised to ensure that the provisions ofthe scheme are not misused.

M/S UTIITSL shall be conducting coaching cum interactive sessions for the empanelled

hospital staff and the railway staff of Medical, Personnel and Accounts Department to

familiarize them with the working of the website and different procedures to be followed (The

.period of one year of pilot scheme shall start only after the website starts working and not from
,
the date of issue of this letter). All the zones/PUs are advised to nominate and get their staff

members, who will be working for implementation of the scheme, trained in these sessions.

The Railway shall be implementing this scheme in coordination with M/S UTIITSL, hence it is

desirable that the concerned officials should be in touch with the local M/S UTIITSL officials so

that any problem that crop up can be sorted out swiftly. A list of contact persons of M/S

UTIITSLwill be circulated in due course of time.

These documents are very comprehensive and contain a lot of information; it may be read

in its entirety, for proper understanding of the scheme. In case of any difficulty/clarification the

respective directorate (viz. Health, Finance or Personnel) official may be contacted at a

convenient time.

Page12 of 13
 This letter is issued with approval of Railway Board. The draft agreement attached with this

letter is also vetted by the finance and legal directorate of the Railway Board. This issues

with the concurrence of Finance Directorate of the Board.

co~-c«
=ss=»:
(DR. GAJENDRA KUMAR)
Adviser Health
Railway Board
No. 2014/H /28/1/smart card/Part A Dated: .07.2016

Annexes:
1. Process Flows as Annexure-1.1 to 1.7
2. The Draft Agreement (DA) as Annexure-2.
3. Declaration to be given by RELHS member while applying to become a member of
CTSE as annexure-3.
4. Process Flows for Online and Offline mode of application and making of CTSE
Card as annexure-4.1 to 4.2.
5. Numbering system for CTSE and RELHS cards as Annexure-S.

Copyto:-
1. CMDs,All Indian Railways.
2. CMOs,All Production Units including RDSO
3. FA&CAO,All Indian Railways including PUs & RDSO
4. Sr. Professor Health Management, NAIR,Vadodara

Copy forwarded to:-

1. CPOs, All Indian Railways including PUs & RDSO
2. Directors, All CTIs
3. Mr. Punit Saxena, MD & CEO,M/s UTIITSL, CBDBelapur, Navi Mumb

f· 7·11.,.
( AJIV KISHORE)
EDIERP
Railway Board
No. 2014/H /28/1/smart card/Part A Dated: .07.2016

Copy Forwarded to:-

1. The Principal Director of Audit, All Indian Railways.
2. The Dy. Comptroller & Auditor General of India (Railways), Room No. 224, Rail
Bhavan, New Delhi.

~~
No. 2014/H /28/1/smart card/Part A
o b·1, ")/0/ t
For Financial Commissioner Railways

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