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CGHS Benefits for Pensioners

It has been seen that due to lack of adequate information about the rules and procedures governing CGHS the beneficiaries of this scheme, particularly pensioners are at a disadvantage. To over come this, Ministry of Personnel, Public Grievances and Pensions, Department of Pensions and Pensioners Welfare, in consultation with the Department of Health had brought out a Brochure on this subject which was circulated to all the Ministries vide O.M.No. 12/165/90-Co-Ord, dated 21-1-1991. Over a period of time, the scheme has undergone many changes. The difficulties of the pensioners etc. however, still exist primarily on account of lack of knowledge about the scheme. In the following paragraphs we have attempted to give a brief position of salient features regarding facilities of CGHS available to pensioners, based on the Brochure of Department of Pension referred to above:- 1. Eligibility All Central Government pensioners (except Railway Pensioners and Armed Forces pensioners) who were eligible for availing CGHS facilities while in service are eligible for availing CGHS facilities after retirement. The scheme is also applicable to Central Government employees who retired with Contributory Provident Fund benefits. Similarly families of Central Government employees in receipt of family pension are also eligible to avail facilities while in service. 2. Cities where CGHS Facilities are Available / Registration The facilities are available at 27 Stations all over India (see Sec. I). The Pensioners have the option to get their name registered with any of the dispensaries in the above mentioned cities irrespective of the fact as to whether they are residing in that city or not. In the event of visit to another station, which is covered by CGHS they can avail the service of the CGHS dispensary in that city on the authority of their CGHS Card which has their photograph and no seprate temporary permit is required for this purpose. The detailed instruction are available in the M/H & FW letter dated 10-6-1991, in Section-II of this Manual. 3. Rates of Contribution The pensioners have an option to pay contribution based on the last pay drawn at the time of retirement and avail of the facilities available to serving Government employees earning the same emoluments or to pay contribution based on the amount of pension Similarly the pensioners also have an option to pay contribution based on the last pay drawn by the decreased employees or based on the amount of family pension. Details about revised rates of CGHS subscription w.e.f. 1-5-1998 and other related matters can be seen in M/H & FW No. S. 11011/18/99-Desk, I/CGHS (P) Date 3-7-2000 in Section II of this Manual. A retired Central Government employee who does not join the CGHS Scheme immediately after retirement is not required to pay the arrears of the contribution for the intervening period from the date of his retirement to the month of jointing CGHS Scheme. In such cases he will, however, be required to pay admission fee of Rs. 30. Similarly, if a pensioner after having become a CGHS beneficiary discontinues his membership of CGHS for some reasons and wants to be re-admitted to CGHS later on, he will not be required to pay the contribution for the intervening period from the month of cessation of the membership of CGHS to the month of rejoining the CGSH. In these cases also he will be required to pay readmission fee of Rs. 30 in addition to the prescribed contribution. 4. Issue of New CGHS Card CGHS Card can be obtained by pensioners from specified office of the CGHS at each of the places where CGSH dispensaries are functioning. A list of these authorities inter alia indicating full address is given in Appendices. The pensioners desirous of availing of CGHS facilities may make an application to the concerned authorities in the prescribed proforma given in Appendices. 5. Facilities Available to the Pensioners: 1. Outdoor treatment through dispensaries / polyclinic / hospital, maternity Center, etc. 2. Supply Centre, etc. 3. Lab. and X-Ray investigations. 4. Domiciliary visits (provided the pensioner resides within 3 km of the CGHS dispensary) 5. Specialist consultation in selected centres and Polyclinics / Hospitals, etc. 6. Hospital services at Government hospitals and selected hospital recognised under CGSH. It includes OPD, hospitalization, specialised investigations and treatment, etc. 7. Specialised treatment in Specialised hospitals for diseases like Cancer, TB, Polio and Mental diseases. 8. Super specialty treatment, e.g. Kidney Transplant and Coronary Artery By-Pass Graft (CABG), etc. 9. Facilities for Dental treatment are also available. Facilities not permissible to the pensioners: 1. Treatment in Non-recognised hospital except I Emergency. 2. Private nursing Home. 3. Treatment outside India 4. Administration of routine injections at one’ residence. 5. Dressing of wound at residence. 6. Supply of artificial appliances, e.g., dentures, spectacles, contact lens, etc. 7. Ortodontic treatment 8. Treatment for obeseity due to inogenous factors. Fixed Medical Allowance for Pensioners 1. Pensioners/Family Pensioners residing in an area not covered by CGHS (or corresponding health scheme of other Ministries/Departments), and who have specifically opted for not availing of outdoor facilities from the nearest CGSH dispensary, are entitled for a fixed medical allowance of Rs. 100 p.m. for meeting day-to-day medical expenses that do not require hospitalization. 2. Pensioners who have opted for availing Rs. 100 p. m. as medical allowance, but also desire to avail CGSH facilities for indoor hospitalization treatment from the nearest CGSH covered city, can be issued CGHS cards bearing stamp “NOT VALID FOR OPD TREATMENT”. Extension of CS (MA) Rules, 1944 to Pensioners residing in areas not covered under CGSH. 1. Central Government pensioners residing in non-CGHS areas may opt for being covered under CS (MA) Rules or under CGHS. 2. In case of pensioners opting for medical facilities under CS (MA) Rules, their claims shall be scrutinized and paid by the parent office as in case of serving employees. 3. Such pensioners shall be entitled to avail of hospitalization facilities as provided under CS (MA) Rules.