To get the EPFO medical advance the Patient must be admitted for treatment in a Government/PSU/CGHS empanelled hospital as per the rules of the circular.
Employees that are registered for their Employee Provident Fund (EPF), are eligible to for a Rs 1 lakh in funds as a medical advance. This can be taken out against their accumulated corpus for emergency medical treatment or hospitalisation. Employees also need not give any estimate as to the cost of said hospitalisation or procedure prior to withdrawing the funds. This information comes in light of a circular that was circulated by the Employees’ Provident Fund Organisation (EPFO). The circular was a revisit by the organisation to the matter of granting medical advance in the event of medical emergencies for employees under the PF scheme.
The revisited and streamlined circular outlines the ambit within which the medical advance falls and even the treatment conditions under which it will be given. One of the additions to the parameters was the inclusion of Covid-19 related treatments.
According to the circular, this advance is applicable to the employees covered under the Central Services Medical Attendant (CS(MA)) rules as well as 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. Sometimes patient employee maybe in ICU where estimate is not known in advance. Hence the following procedure may be adpted to grant medical advance for emergency hospitalisation on account of serious life threatening illness including Covid,” said the circular.
Step-by-step Process to Obtain the Medical Advance
1) The Patient must be admitted for treatment in a Government/PSU/CGHS empanelled hospital as per the rules. In the event that the patient is admitted to a private hospital due to an emergency then they can appeal to the relevant authority to consider their case as fit to grant relaxation in rules so that the medical bills can be reimbursed. In such a case the advance can be given to private hospitals as well.
2) The employee or a family member has to submit a letter on behalf of the patient for claiming the advance. It need not have an estimate of the cost, but it does need to have the details of the hospital and the patient.
3) The medical advance of up to Rs 1 lakh can then be granted by the concerned authority to the patient or family member or can be directly deposited to the hospital’s accounts for beginning the treatment process. This advance should be granted immediately, preferably on the same working day. If not, it should be given on the following working day after the receipt of the application. It should also be given without insistence for the estimate of expenditure from the hospital or any other documentation. This responsibility falls to the concerned office (ACC-ASD for the Head Office).
4) In the event that 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. This advance will only be granted after the receipt of the estimate for treatment that is to come and before the patient is discharged from the hospital. The additional advance will be given, minus the amount that was initially given.
5) The employee or family member needs to submit the hospital bill within 45 days after being discharged. The medical advance will be adjusted to fit the final bill of the hospital as per the EPF rules. Any further reimbursement or recovery of advance needs to happen while the medical bill is being processed.
What are the Withdrawal Conditions of EPFO?
The money that can be withdrawn is the least a 6 months’ basic wages and dearness allowance of the member or to the member’s share of contribution with interest.
