Reimbursement of medical claims to pensioners residing in non-CGHS areas
No: 4-35(01)/2019-PAT
Government of India
Ministry of Communications
Department of Telecommunications
20, Ashoka Road, 1120, Sanchar Bhawan
New Delhi-110001
Dated: 28/07/2020
OFFICE MEMORANDUM
Subject -: Reimbursement of medical claims to pensioners residing in non-CGHS areas-reg.
This refers to medical claims being received from pensioners residing in non-CGHS areas. In this respect. Ministry of Health and Family Welfare’s (MoH&FW) OM No. S. 14025/23/2013-MS.EHSS dated 29.09.2016 may be referred (copy enclosed). As per this OM, the pensions residing in non-CGHS have following options to avail medical facilities:
(a) They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month or as revised from time to time. At present, vide OM 4/34/2017/P&PW(D) dated 19.07.2017. FMA is @ Rs. 1000/- per month.
(b) They can also avail benefits of CGHS (OPD & IPD) by registering themselves In the nearest CGHS city after making the required subscription.
(c) They also have the option to avail FMA for OPD treatment, and CGHS for IPD treatment after making the required subscriptions as per CGHS guidelines.
2. In addition, in accordance to MoH&FW’s OM No. 8.11011/11/2016 CGHS (P)/EHS dated 09.01.2017 (copy enclosed), pensioners have option to avail CGHS facilities by making contribution on an annual basis (1 year/12 months) or by making contribution for 10 (ten) years (120 months) for getting a pensioner CGHS card with life-time validity.
3. The undersigned is directed to request ail the Pr. CCA/CCAS and others concerned offices that the pensioners of this Department residing in non-CGHS areas may be intimated/sensitized (more than once) by an appropriate means about the above options for medical facilities available to them as per MoH&FW OM dated 29.09.2016 and OM No. S.11011/11/2016 CGHS (P)/EHS dated 09.01.2017. They may be advised that for availing reimbursement of their medical bills, they have to mandatoryly register themselves with the nearest CGHS facility as per one of the options above. They may also be advised that if they fail to register themselves w.e.f. applicable date with the nearest CGHS facility for availing OPD/IPD treatment, their further medical bills may not be reimbursed by this Department.
4. Compliance report in respect of the above may be furnished to this office for appraisal of Secretary, DoT.
5. This issues with the approval of competent authority.
(S.C. Karol)
Director (Estt.)
Phone. 23036500
To.
Pr. CCAs/CCAS
No. S.14025/23/2013-MS EHSS
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare
Nirman Bhavan, New De
Dated the 29 September, 2016
OFFICE MEMORANDUM
Sub:- Reimbursement of medical claims to Pensioners under CS (MA) Rules, 1844 as directed by various CATS/Courts – Regarding.
 The undersigned is directed to state that various references are being received in Ministry of Health and Family Welfare on the above mentioned subject. It is hereby clarified that CS (MA) Rules, 1944 are not applicable to pensioners till date
2. It is further informed that the following options to avail medical facilities are available to Central Government pensioners:
Pensioners residing in CGHS covered ares:
1) They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD facilities.
2) Pensioners residing in CGHS areas cannot opt out of CGHS and avail any other medical facility (i.e. Fixed Medical Allowance). Such Pensioners, if they do not choose to avail CGHS facility by depositing the required cantributions, cannot be granted Fixed Medical allowance in lieu of CGHS.
b) Pensioners residing in non -CGHs areas:
1) They can avail Fixed Medical Allowance (EMA @ Rs.500/- per month.
2) They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.
3) They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGS guidelines.
3. In view of the above, reimbursement of medical claims to Pensioners under CS (MA) Rules, 1944 as directed by various CATs/Courts, need not be referred to Ministry of Health and Family Welfare. The respective administrative Department/Ministry may take their own decision in this regard.
4. Further, all Departments/Ministries are requested to intimate their employees proceeding fer retirement regarding the above options for medical facilities available to the Central Government pensioners.
5. This issues with the approval of competent authority.
SUNIL KUMAR GUPTA)
UNDER SECRETARY TO THE GOVT. OF INDIA
To
All Ministries/Departments
No. S.11011/11/2016- CGHS (P)/EHS
Government of India
Ministry of Health and Family Welfare
EHS Section
***
Nirman Bhawan, New Delhi
Dated the 9th January, 2017
OFFICE MEMORANDUM
Sub: Revision of rates of subscription under Central Government Health Scheme due to revision of pay and allowances of Central Government employees and revision of pension/ family pension on account of implementation of recommendations of the Seventh Central Pay Commission.
 The undersigned is directed to refer to this Ministry’s OM No. s.11011/2/2008-CGHS(P) dated 20th May, 2009 vide which orders were issued revising the rates of monthly subscription for availing CGHS facility, as also the entitlement for free diet, entitlement of accommodation in private empanelled hospitals under CGHS, etc.
2. Consequent upon revision of pay on the basis of the implementation of the recommendations of the 7™ Central Pay Commission, it has been decided to revise the rates of subscriptions, to be made by employees / pensioners, for availing benefits under the CGHS, with effect from at January, 2017. It has also been decided to revise the monetary ceiling limits for various entitlements of the beneficiaries for availing CGHS facilities.
3. In suppression of all earlier instructions, the following revisions are having made. in so far as it relates to the facilities mentioned below:
(A). Monthly Contributions for availing CGHS facility:
| Sl. No. | Corresponding levels in the Pay Matrix as per 7th CPC | Contribution (Rs. Per month) |
| 1. | Level: 1 to 5 | 250 |
| 2. | Level: 6 | 450 |
| 3. | Level: 7 to 11 | 650 |
| 4. | Level: 12 & above | 1000 |
(B). Entitlement of words in private hospitals empanelled under CGHS
| Sl. No. | Corresponding Basic Pay drawn by the officer in 7th CPC per month | Ward entitlement |
| 1. | Up to Rs. 47,600/- | General |
| 2. | Rs. 47,601/- to Rs. 63,100/- | Semi-Private |
| 3. | Rs. 63,101/- and above | Private |
(C). Monetory Ceilling for Free Diet:
The monetary ceiling for free diet for CGHS beneficiaries is revised to pay/ pension / family pension of Rs. 44,900/- per month.
(D) Monetary ceiling for free diet for beneficiaries suffering from TB or mental) disease):
The monetary celling for free diet in case of beneficiary suffering from TB or Mental disease is revised to pay / pension / family pension of Rs. 69,700/- per month.
(E) Pay slab for determining the entitlement of Nursing Home facilities in Government State Government / Municipal Hospitals:
The monetary ceiling for determining the entitlement of nursing in Central Government / State Government / Municipals Hospital is revised to pay / pension / family pension Rs. 47,60 month and above.
(F) Monetary Ceiling for direct consultation with Speciolists in Central Government /State Government / Municipal Hospitals:
The monetary ceiling for determining the entitlement for direct consultation with Specialists in Central Government / State Government / Municipal Hospitals will continue at the existing rates until revision of the same after consultation with Ministry of Finance.
(G) Pay slab for determining the entiltlement of a commodation in AIIMS, New Delhi.
The revised entitlement, as per the drawn the official, is as follows:
| Sl. No. | Corresponding Basic Pay drawn by the officer in 7th CPC pre month | Ward entitlement |
| 1. | Up to Rs. 63,100/- | General |
| 2. | Rs. 63, 101/- to Rs. 80,900/- | Private |
| 3. | Rs. 80, 901/- and above | Deluxe/Private |
4. It is clarified that the reference to pay in this order relates to the pay drawn in the level of pay.
5. Pensioners have an option to get their CGHS pensioner card made by either making CGHS contribution on an annual basis (twelve months) or by making contribution for 10 (ten) years {120 (one hundred and twenty) months} for getting a pensioner CGHS card with life-time validity. It is clarified that:
(i). Contribution to be made by pensioners / family pensioners would be the amount that they were subscribing at the time of their retirement or at the time of death of the Government servant;
(ii). Pensioner beneficiaries, who have already obtained CGHS card with life time validity by paying a lump sum amount equivalent to 10 years’ contribution, will not be required to pay any additional amount as a result of the revision in the rates of contribution for availing CGHS facility;
(iii). Entitlement of pensioners / family pensioners, who have already deposited their contribution for life time CGHS facility, will not be changed.
(iv). Pensioners / family pensioners who are contributing to the CGHS on an annual basis and wish to continue to avail CGHS benefits will have to contribute at the revised rates up to the time of contribution needed to cover a period of a total of ten years from the time pensioner CGHS card was issued for the first time to them. The revised rate of contribution for the remaining period would be with reference to the level of pay that he / she would have drawn in the post held by him / her (at the time of his / her retirement / death) had he / she continued to be in service now but for his / her retirement/ death; and
(v). Any pensioner / family pensioner who is entitled to facility has not so far got his / her pensioner CGHS card made, the rate of contribution in such cases will be with reference to the level of pay that he / she would have drawn in the post held by him (at the time of his / her retirement / death) had he / she continued to be in service now but for his/ her retirement /death.
6.This issues with the concurrence of the Department of Expenditure vide their I.D. Note No. 18(1)/EV/2016, dated 24/11/2016.
7. Hindi version will follow.
(Sunil Kumar Gupta)
Under Secretary te the Government of india
Tel. 23061986
To
- All Ministries/Departmenis, Government of india
- Â Director, CGHS, Nirman Bhawan, New Dethi
- Addl. DDG(HQ), CGHS, MoHFW, Nirman Bhawan, New Delhi
- AD(HQ), CGHS, R.K.Puram, Sector-12, New Delhi
- All Addl. Directors/Joint Directors of CGHS cities outside Delhi
- Additional Director (SZ)/(CZ)/(EZ\/(NZ)MSD), MCTC CGHS, New Delhi
- JD(HQ), JD (Grievance)/JD {R&H), CGHS, Delhi
- DDG(M) /CMO(SRA), Dte.GHS, MoHFW, Nirman Bhawan, New Delhi
- Rajya Sabha/Lok Sabha Secretariat, New Delhi
- Registrar, Supreme Court of India, New Delhi
- U.P.S.C. Dholpur House, New Delhi
- Office of the Comptroller & Auditor General of India, Bahadur Shah
- Director, Department of Pension & Pensioners Welfare, Lok Nayak Bhawan, Khan Market, New Delhi
- PPS to Secretary (H&FW)/Secretary (AYUSH]/Secretary
(HR)/Secretary (AIDS Control}, Ministry of Health & Family Welfare - PPS to DGHS/AS&DG (CGHS)/AS&FA/AS&IVID, NRHIVi/AS(H), MoHFW, New Delhi
- MS Section, MoHFW, Nirman Bhawan, New Delhi
- MG-II Section, Dte.GHS, Nirman Bhawan, New Delhi
- Hospital Empanelment Cell, CGHS, MoHFW, Nirmen Bhawan, New Delhi
- CGHS-III/II/IV, Die. Gen of CGHS, MoHFW, Nirman Bhawan, New Delhi
- Estt.l/Esttl/Estt.i/Estt.lV Section, MoHFW, Nirman Bhavan, New Delhi
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