Specialized Treatment and Medical Assistance Scheme (Puducherry Building and Other Construction Workers Welfare Board)

What is the Specialized Treatment and Medical Assistance Scheme?

The Specialized Treatment and Medical Assistance Scheme is a welfare benefit of the Puducherry Building and Other Construction Workers Welfare Board, which functions under the Labour Department, Government of Puducherry. The Board was constituted in 2002 under the Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996, and is funded by the cess collected on construction works in the Union Territory.

According to the Labour Department, Government of Puducherry, the Board extends medical assistance up to Rs 2 lakh for specialised treatment taken in hospitals having a tie-up with the Government General Hospitals at Puducherry, Karaikal, Mahe and Yanam, for diseases such as TB, lung disease, neurological conditions and accident cases, with a referral letter duly obtained from the Health Department, Government of Puducherry by the beneficiary.

Three conditions are built into that single sentence, and every rejected claim usually fails on one of them:

1. The worker must be a registered beneficiary of the Board.
2. The treatment must be at a tie-up hospital, not any hospital of the worker's choice.
3. There must be a referral letter from the Health Department before the treatment.

Rs 2,00,000 is a substantial ceiling by the standards of construction worker welfare boards in India, and it is aimed squarely at the kind of illness that otherwise pushes a daily-wage household into debt, a neurosurgical case, a long course of TB treatment, or the aftermath of a serious accident.

Who is eligible for the specialised treatment assistance?

You can claim if:

• You are a construction worker registered as a beneficiary of the Puducherry Building and Other Construction Workers Welfare Board.
• Your beneficiary status is live: subscription paid up, registration current.
• You have obtained a referral letter from the Health Department, Government of Puducherry.
• The treatment is taken at a hospital having a tie-up with the Government General Hospital at Puducherry, Karaikal, Mahe or Yanam.
• The condition is one for which specialised treatment is needed, the Board names TB, lung disease, neurological conditions and accident cases among them.

You are not eligible if:

• You are not registered with the Board. This is the single largest reason construction workers in Puducherry miss out on benefits. Registration is the gateway to every one of the Board's schemes, and it cannot be done after the illness.
• Your registration has lapsed or subscription is in arrears.
• You took treatment without a Health Department referral letter.
• You took treatment at a hospital that has no tie-up with the Government General Hospitals of the Union Territory.
• You are a construction worker in another state, or a worker in a trade outside the 53 categories of construction work that the Board has enlisted for enrolment.

What documents are required?

How to apply for the specialised treatment medical assistance

1. Confirm your registration is live. Check with the Labour Department or the Board office that your beneficiary registration is current and that no subscription is outstanding. Clear any arrears before you claim.
2. Get the referral letter first. Approach the Health Department, Government of Puducherry, through the Government General Hospital treating you, and obtain the referral letter for specialised treatment. This must come before the treatment, not after, a claim built on a retrospective letter is the commonest kind of dispute.
3. Confirm the hospital has a tie-up with the Government General Hospital at Puducherry, Karaikal, Mahe or Yanam before admission. Ask the Board office or the referring hospital for the current tie-up list.
4. Take the treatment and keep every bill, receipt, prescription, investigation report and the discharge summary.
5. Obtain and fill the claim form from the Office of the Puducherry Building and Other Construction Workers Welfare Board. The Board's application forms are supplied free of cost, and claims are made offline.
6. Submit the claim with the referral letter, registration card, bills, discharge summary, bank passbook copy and Aadhaar card, at the Board office in your region — Puducherry, Karaikal, Mahe or Yanam.
7. Keep the acknowledgement and follow up with the Board on the sanction. The assistance is released to your bank account.

How to register with the Board first

If you are not yet a registered beneficiary, that is the step to take today rather than when illness strikes.

1. Check that you qualify. The worker should have completed 18 years of age and should not have completed 60 years, and should have worked in construction during the preceding 12 months.
2. Check that your trade is on the list. The Board has enlisted 53 categories of construction workers for enrolment, masons, carpenters, bar benders, painters, plumbers, electricians on construction sites and so on.
3. Apply to the Labour Department, Government of Puducherry, with proof of age, proof of residence, proof of engagement in construction work, photographs and bank details, and pay the registration fee and subscription.
4. Keep the subscription current. A lapsed registration takes a worker outside every scheme the Board runs, including this one. The Board separately operates a refund of subscription fee benefit.

What else the Board provides

A worker claiming specialised treatment assistance should know what else the same registration entitles the household to. The Labour Department lists the Board's benefits as:

1. Maternity benefit: Rs 5,000 to a woman beneficiary, and to the spouse of a male beneficiary.
2. Medical assistance, including the specialised treatment assistance up to Rs 2,00,000 described here.
3. Scholarship to the wards of registered workers.
4. Deepavali gift.
5. Death benefit for natural death and accident death.
6. Funeral assistance.
7. Insurance premium to LIC, fresh and renewal.
8. Marriage assistance.
9. Accident medical benefit, the Board may sanction Rs 1,500 per month to a worker who sustains a fracture, until a government doctor certifies fitness to resume normal work.
10. Refund of subscription fee.

Why claims are rejected, and how to avoid it

• No referral letter. The Board's condition is explicit. Get it from the Health Department before treatment.
• Hospital not on the tie-up list. Verify before admission, not after discharge.
• Registration lapsed. Subscriptions in arrears take the worker outside the scheme on the date of treatment.
• Bills not in the worker's name, or informal receipts rather than proper hospital bills.
• No discharge summary, so the Board cannot establish what was treated.
• Claim for a condition unconnected to specialised treatment. Routine outpatient care goes under the Board's general medical assistance rather than this head.
• Bank details wrong or account dormant, so the release fails.

Where to apply and how to raise a grievance

Claims and enquiries go to the Office of the Puducherry Building and Other Construction Workers Welfare Board, Labour Department, Government of Puducherry, which has offices covering the Puducherry, Karaikal, Mahe and Yanam regions. The Labour Department publishes the Board's constitution, benefits and notices at labour.py.gov.in.

If a claim is delayed or rejected, take it up first with the Board's Secretary through the Labour Department, and thereafter through the Centralised Public Grievance Redress and Monitoring System (CPGRAMS) against the Government of Puducherry.

Application forms are supplied free of cost by the Board, and no fee is payable to any person for filing a claim or securing a sanction.