Health Component of Labour Welfare Scheme

The scheme namely Health Component of the Labour Welfare Scheme was launched by the Ministry of Labour and Employment, Government of India. The scheme aims to provide accessible free, and quality healthcare services to the bonafide Beedi workers, Cine workers & non-coal mine workers and their dependents with a network of 258 Dispensaries and 11 Hospitals located across the Country. The scheme also provides reimbursement of the expenditure at the prescribed rates incurred for specialized treatment in the recognized Hospitals in case of critical diseases i.e. Cancer, Tuberculosis, Heart Diseases, Kidney Transplantation, Hernia, Appendectomy, Ulcer, Gynaecological diseases, Prostate diseases and other Minor diseases to the beneficiaries.

Objectives

The Scheme contemplates to Provide accessible, affordable, and quality healthcare services and also reimbursement of the expenditure to the bonafide workers and their dependents for their treatment of the Cancer, Kidney Diseases, Heart Diseases, Tuberculosis, Hernia, Appendectomy, Ulcer, Gynaecological diseases, Prostrate diseases, Cataract and other Minor diseases including diagnostic test/ investigation.

Target Beneficiaries

• Beedi workers including Gharkhhata workers
• Cine workers
• Non-Coal Mines Workers {i.e. Iron Ore Mines, Manganese Ore & Chrome Ore
• Mines (IOMC) workers, Limestone & Dolomite Mines (LSDM) workers and
• Mica Mines workers

Scheme Components

• Comprehensive health care services for workers and their immediate dependents.
• Outpatient Care: Free Consultations, diagnostics and Medicines provide through Labour Welfare's Dispensaries and Central Hospitals located across the Country,
• Inpatient Care: OPD/IPD Services provide to workers and their family members through Labour Welfare's Central Hospitals located across the Country.
• Mobile Medical Units (MMUs), an on-site health clinic for workers at underserved rural/remote areas.
• Reimbursement Of expenditure for following specialized treatment under the recognized Impaneled Government/Private Hospital in case of critical diseases, as under

Financial Benefits:

S. No. Critical DiseaseNature of Assistance1.CancerRe-imbursement of expenditure up to ₹7,50,000/- on treatment, medicines and diet charges incurred by workers, and their dependents. 2.Heart DiseasesRe-imbursement of expenditure up to ₹2,00,000/- on treatment, medicines and diet charges incurred by workers and their dependents. 3.Kidney Diseases Re-imbursement of expenditure up to ₹3,00,000/- on treatment, medicines and diet charges incurred by workers and their dependents including charges for dialysis.4.Minor diseases like Tuberculosis, Hernia, Appendectomy, Ulcer Gynaecological diseases, Prostrate diseases, Cataract and other Minor diseases including diagnostic test/investigation.Re-imbursement of expenditure up-to ₹40,000/- on treatment, medicines and diet charges incurred for each disease to workers and their dependents.

• The actual expenditure on the above items as charged by the hospital authorities in respect beds in General ward should be computed by the welfare organization for the purpose of deterring.

Eligibility Criteria for LWS beneficiaries for availing reimbursement facilities.

1. The total income of worker from all sources not exceeding ₹21,000/- per month or ₹2,52,000/- per annum and up-to the age of 60 Years.
2. The worker, who has completed minimum of six months of continuous service in Beedi/Cine/Non-Coal Mines industries on the date of reports with diseases to medical officer of Labour Welfare Organization shall be eligible for the reimbursement of the expenditure incurred on the above-mentioned diseases.
3. The dependents of the workers will be allowed for the reimbursement of the expenditure incurred on their treatment on the above-mentioned diseases, if the worker who has completed minimum of One years of continuous service in Beedi/Cine/Non-Coal Mines industries on the date reports with diseases of his/her dependents to Medical officer of Labour Welfare Organization.
4. The workers who are eligible for re-imbursement from their employers or from any other government's health schemes shall not be eligible for re-imbursement under this scheme and every claim for reimbursement shall be accompanied by a certificate form the employer or self-declaration from worker that the claimant is not eligible for re-imbursement from the employer or from any Other Government's Health Schemes.
5. For the purposes of this Scheme worker's family means,

• Wife/Husband;
• dependent and unmarried Child/Children up-to the age of 21 years;
• dependent father/mother.

NOTE: The term dependency means that family member's income from all sources, including pension, cannot exceed Rs. 9,000 plus the applicable Dearness Relief (DR) on it at the time of consideration. This applies to various dependent family members, including parents, children (including divorced/separated daughters), and siblings except spouse(s).

Offline

Application Process

Step 1: The attending Labour Welfare Organization's medical officer identifies a need for referral to the empanelled hospital based on:-

• Unavailability of necessary diagnostic or therapeutic services.
• Requirement for specialized care not available at the Labour Welfare's Dispensary or Hospital.
• Patient's request, if LWO's Medical Officer satisfied himself/herself.
• Emergency situations requiring higher-level care.

Step 2: Workers and their dependent who undergoes specialized treatment in a recognized/Impaneled hospital shall seek permission form the concerned Welfare Commissioner through Medical Officer, LWO before getting admitted or test in the hospital by submitting the recommendation of the Doctors/Medical Officers of recognized/empanelled hospital to the Labour Welfare Organization certifying that the patient required specialized treatment in a hospital (to be specified).
Step 3: The permission must be given to the beneficiary within 07 days of submission.
Step 4: The reimbursement claim of the expenditure for specialized treatment in a recognized/empanelled hospital shall be submitted with the Welfare Commissioner within 06 Months from Discharge for Hospital or from the date of Test/investigation.
Step 5: The Welfare Commissioner shall settle the claim up to his/her delegated financial powers within 30 days from the date of submission.
Step 6: The permission request from the worker should be submitted in Form A and the request for reimbursement of treatment charges and subsistence allowance etc. should be submitted in Form B.

Beneficiary Enrolment & Identification

• Dedicated Portal for Beneficiary database linked to Aadhaar/unique identification number for the workers for Health cards with QR code and biometric authentication, based on workers data and existing registered databases i.e. e-Shram Portal.
• Centralized digital health management system with Mobile and online enrolment facilities, OPD/IPD Registration, E-claims processing and digital medical records via Next Gen e-Hospital.

• Valid Identity Card of the Worker.
• Medical Prescription or Treatment Recommendation Letter (Required for Surgeries, Tuberculosis, Cancer, Heart, Kidney, Mental Diseases, Leprosy, and Spectacles).
• Original Bills and Receipts of Medical Expenditure (Required for Treatment Reimbursement Claims).
• Prior Approval Letter from the Welfare Commissioner (Required for Heart Ailments, Kidney Treatment, and Cancer Treatments).