(1) A person on becoming an insured person for the first time shall be entitled to medical benefit for a period of 3 months provided that where such a person continues for 3 months or more to be an employee of a factory or establishment to which the Act applies, he shall be entitled to medical benefit till the beginning of the corresponding benefit period.
(2) The person in respect of whom contributions have been paid in a contribution period for not less than half the number of days in the said contribution period shall be entitled to medical benefit till the end of the corresponding benefit period.
Provided that in case of a person who becomes an employee within the meaning of the Act, for the first time, and for whom a shorter contribution period of less than 156 days is available, he shall be entitled to medical benefit till the end of the corresponding benefit period if the contributions in respect of him were payable for not less than half the number of days available for working in such contribution period"
Provided further that where a person suffering from any of the following diseases before the commencement of the spell of sickness in which any such disease was diagnosed being a continuos service for a period of two years or more or where he did not have two years continuous service but by virtue of relaxation granted by the authority competent in this behalf, the insured person qualifies to claim extended sickness benefit, he shall be entitled to medical benefit till the end of the relevant extended benefit period:
I. INFECTIOUS DISEASES
1. Tuberculosis
2. Leprosy
3. Chronic Empyema
4. Bronchiectasis
5. Interstitial Lung Disease
6. AIDS
II. NEOPLASMS
7. Malignant Diseases
III. ENDOCRINE NUTRITIONAL AND METABOLIC DESIRES
8. Diabetes mellitus and proliferative retinopathy/diabetic foot/nephropathy
IV. DISORDERS OF NERVOUS SYSTEM
9. Monoplegia
10. Hemiplegia
11. Paraplegia
12. Hemiparesis
13. Intracranial Space Occupying Lesion
14. Parkinsons Disease
15. Spinal Cord Compression
16. Myasthenia Gravis/Neuromuscular Dystrophies
V. DISEASES OF THE EYE
17. Immature Cataract with vision 6/6 or less
18. Detachment of Retina
19. Glaucoma
VI. DISEASES OF THE CARDIOVASCULAR SYSTEM
20. Coronary Artery Disease
(a) Unstable Angina
(b) Myocardial infraction with ejection less than 45%
21. Congestive Heart Failure:
Left
Right
22. Cardiac Valvular Diseases with failure/complications
23. Cardiomyopathies
24. Heart Diseases with Surgical Intervention along with complications
VII. CHEST DISEASES
25. Chronic Obstructive Lung Disease (COPD) with congestive heart failure
VIII. DISEASES OF THE DIGESTIVE SYSTEM
26. Cirrhosis of liver with ascities/chronic active hepatitis
IX. ORTHOPAEDIC DISEASES
27. Dislocation of vertebra/prolapse of intervertebral disc
28. Non-union or delayed union of fracture
29. Post Traumatic Surgical amputation of lower extremity
30. Compound Fracture with chronic ostemyelitis
X. PSYCHOSES
31. Sub-groups under this are listed for clarification
(a) Schizophrenia
(b) Endogenous Depression
(c) Manic Depressive psychosis
(d) Dementia
XI. OTHERS
32. More than 20% burns with infection/complication
33. Chronic Renal Failure
34. Reynauds Disease/Burgers Disease
(3) An insured person, whose title to medical benefit has ceased under this regulation shall again be entitled to medical benefit from the date of his re-employment as an employee under the Act by a factory or establishment to which the Act applies, if he produces a certificate from the employer in the form
which may be specified by the Director General for the purpose. Such an insured person shall, unless he is covered by sub-regulation (2), be entitled to medical benefit till the commencement of the benefit period corresponding to the contribution period in which he is re-employed.
(4) An employer shall, on demand, issue the certificate referred to in sub-regulation (3) to an employee who has been employed by him after cessation of his previous insurable employment.
