Section 39: Medical benefit

Finin2min analysis — what the section actually does

Full statutory text — Section 39

39. Medical benefit.—(1) An Insured Person or (where such medical benefit is extended to his family)
a member of his family whose condition requires medical treatment and attendance shall be entitled to
receive medical benefit.
     (2) Such medical benefit may be given either in the form of out-patient treatment and attendance in a
hospital or dispensary, clinic or other institution or by visits to the home of the Insured Person or treatment
as in-patient in a hospital or other institution.
     (3) The qualification of an Insured Person and (where such medical benefit is extended to his family)
his family, to claim medical benefit and the conditions subject to which such benefit may be given, the scale
and period thereof shall be such as may be prescribed by the Central Government:
    Provided that a person in respect of whom contribution ceases to be payable under this Chapter may be
allowed medical benefit for such period and of such nature as may be provided by the regulations:
     Provided further that an Insured Person who has attained the age of superannuation, a person who retires
under a Voluntary Retirement Scheme or takes premature retirement, and his spouse shall be eligible to
receive medical benefits subject to payment of contribution and such other conditions as may be specified
in the regulations:
    Provided also that 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 benefits, subject
to payment of contribution and other conditions as may be prescribed by the Central Government:
    Provided also that the conditions for grant of medical benefits to the Insured Person during employment
injury shall be as specified in the regulations.
    (4) (a) The Corporation may establish medical education institutions, including colleges, dental
colleges, nursing colleges and the training institutes for its officers and staff with a view to improve the
quality of their services.
   (b) The medical education institutions referred to in clause (a) shall require its students to furnish a
bond for serving the Corporation for such time and in such manner, as may be specified in the regulations.
    (5) The medical education institutions and training institutes referred to in sub-section (4) may be run
by the Corporation itself or on the request of the Corporation, by the Central Government, any State
Government, Public Sector Undertaking of the Central Government or the State Government or any other
body notified by the Central Government.
     Explanation.—For the purposes of this sub-section, the expression “other body” means any such
organisation of persons which the Central Government considers capable to run colleges and training
institutions referred to in sub-section (4).

    (6) The Corporation may, in order to take preventive and curative measures for welfare of the Insured
Persons, carry out such occupational and epidemiological surveys and studies for assessment of health and
working conditions of Insured Persons in such manner as may be specified in the regulations.

How to apply this provision

1. Primary statutory test — (1) An Insured Person or (where such medical benefit is extended to his family) a member of his family whose condition requires medical treatment and attendance shall be entitled to receive medical benefit.
2. Additional operative limb — (2) Such medical benefit may be given either in the form of out-patient treatment and attendance in a hospital or dispensary, clinic or other institution or by visits to the home of the Insured Person or treatment as in-patient in a hospital or other institution.
3. Qualification / exception to test — Provided that a person in respect of whom contribution ceases to be payable under this Chapter may be allowed medical benefit for such period and of such nature as may be provided by the regulations:
4. Central Rule mapping — 25. Read the mapped provision together with this text rather than treating the concordance as a substitute for it.
5. Evidence file — retain facts and records proving the role/status of: Central Government, State Government, Corporation / EPFO / Board.

Rules, forms and cross-references

A direct concordance is not exhaustive. Central/State jurisdiction, schemes, authority appointments, saved instruments and later notifications may change the practical route without changing the section wording.

Worked example

Q&A — Section 39

Source & verification trail