[(2) the person in respect of whom contributions have been paid in a contribution period for not less than seventy-eight 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 in continuous 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)
Bronchiactesis
(5)
Interstitial Lung Disease
(6)
Aids
(II) Neoplasma
(III) Endocrine Nutritional and Metabolic Disorders
(IV) Disorders of Nervous System
(V) Diseases of Eye
(VI) Diseases of Cardiovascular System
(VII) Chest Diseases
(VIII) Diseases of the Digestive System
(IX) Orthopaedic Diseases
(X) Psychoses(XI) Others
(7)
Malignant Diseases
(8)
Diabetes mellitus with proliferative retinopathy/diabetic foot/nephropathy
(9)
Monoplegia
(10)
Hemiplegia
(11)
Paraplegia
(12)
Hemiparesis
(13)
Intracranial Space Occupying Lesion
(14)
Parkinson's disease
(15)
Spinal Cord Compression
(16)
Myaesthenia Gravis/Neuromuscular Dystrophies
(17)
Immature Cataract with vision 6/6 or less
(18)
Detachment of Retina
(19)
Glaucoma
(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 Disease with Surgical Intervention along with complications
(25)
Chronic Obstructive Lung Disease (COPD) with congestive heart failure (Cor Pulmonale)
(26)
Cirrhosis of liver with ascities/chronic active hepatitis
(27)
Dislocation of vertebra/prolapse of intervertebral disc
(28)
Non-union or delayed union of fracture
(29)
Post-Traumatic Surgical amputations of lower extremity
(30)
Compound fracture with chronic osteomyelitis
(31)
Sub-groups under this are listed for clarification(a) Schizophrenia
(b) Endogenous depression
(c) Manic Depressive psychosis (MDF)
(d) Dementia
(32)
More than 20% burns with infection/complication
(33)
Chronic Renal Failure
(34)
Reynaud's disease/Burger's 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.
97 [ 103B Medical benefit to insured person who ceases to be in insurable employment on account of permanent disablement. -(1) An insured person who ceases to be in insurable employment on account of permanent disablement caused due to employment injury shall continue to receive medical benefit for himself and his/her spouse till the date on which he would have vacated the employment on attaining the age of superannuation had he not sustained such permanent disablement, if produces a certificate from the employer/a declaration in the form which may be specified by the Director-General for the purpose.
(2)
Medical benefit to retired insured persons. -An insured person who has attained the age of superannuation shall be eligible to receive medical benefit for himself and his/her spouse, if he produces a certificate from the employer in the form which may be specified by the Director-General for the purpose.
(3)
An employer shall, on demand, issue the certificate as referred to in sub-regulations (1) and (2) to an employee who had been employed by him.]