BHARAT PENSIONERS’ SAMAJ
(All India Federation of Pensioner’s Association)
(Registered No. 2023 of 1962-63)

No.BPS/ BDPA (I)/ Fixed-Med/ Enhancement/ 2023

Dated 26th April, 2023

To:

Hon’ble Smt. Nirmala Sitaraman,
Finance Minister, Govt. of India,
15, Safdarjung Road,
New Delhi

Sub: A request to expedite decision for enhancing Fixed Medical Allowance from Rs. 1000/- Per Month to Rs. 3000/- PM.

1. That the Parliamentary committee on Pensioner’s Grievance has submitted its 110th report on 10.12.2021; wherein it has been recommended the enhancement vide para3.14, sub Para (iii) “Fixed Medical Allowance may be enhanced from Rs 1000 to Rs 3000 per month since most pensioners are suffering from different diseases at old age and are unable to manage with meager pension as CGHS hospital is not available in every town”.

2. As per Para 2.21 of 120th Action Taken Report, “DoP&PW has taken-up the issue of enhancement of FMA with the Finance Ministry.

3. Now, as we understand the GOI Min of Personnel, Public Grievance& Pensions, DoP&PW F. No. 4/34/2017-P&PW (D dated 31-01-2018 has forwarded the said proposal to your Minister for further decision in the matter.

4. That GOI Min of Personnel, Public Grievance& Pensions, DoP&PW F. No. 4/34/2017-P&PW (D) dated 31-01-2018 had increased it from Rs.500/- to Rs.1000/- per month in the year 2018 to meet the day-to-day expenses on medicines for those retired Central Govt. pensioners who are residing beyond 2.5 KMs from any CGHS dispensary or any other health unit corresponding Health unit administered by other Ministries/ Departments. In turn BSNL Corporate Office had also implemented the same for the BSNL Pensioners.

5. For your information, EPFO pensioners get Rs. 2000/- PM since 01.03.2013.

6. Since 2018 till date the FMA is paid per month on the above rates whereas it is established fact that during these six years price index is increased resulting in to rise in prices of medicines which are required by the age pensioners to maintain up their health.

In light of above factual reasons, we request you to kindly expedite decision to enhance Fixed Medical Allowance from Rs 1000 to Rs 3000 per month since most pensioners are suffering from different diseases at old age and are unable to manage with paltry sum of Rs. 1000/- per month.

Your ministry will be aware of the fact that now a day’s our Hon’ble Prime Minister Shri Narendrabhai is also reiterating the stand of govt. showing its concern for Senior citizens. Your sympathetic consideration of the issue will be a boon to all the Pensioners fraternity.

We therefore look forward to your august office for early sympathetic decision in the matter.

With Regards,

Yours Sincerely,

(D.D. MISTRY)
Secretary BSNL/PSU

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S-11011/09/2019/ Addl.DDG(HQ)/CGHS
Government of India
Ministry of Health & Family Welfare
Directorate General of CGHS

Nirman Bhawan, New Delhi
Dated the 11th February , 2021.

OFFICE MEMORANDUM

Sub: CGHS Rates for 21 Treatment procedures/ Investigations in continuation of 2014 CGHS rates.

With reference to the above-mentioned subject, the undersigned is directed to draw attention to the Office Memoranda No S- 11011/09/2019/ Addl.DDG(HQ)/ CGHS dated 14.01.2020 and 03.06.2020 vide which CGHS rates have been notified by the Government for 15 and 25 investigations and procedures respectively for treatment at CGHS empanelled Health Care Organizations (HCOs) and to state that it is now decided to notify CGHS package rates for another 21 investigations/ treatment procedures as per the details given under and shall be treated as part of CGHS package Rates 2014.

2. The rates for investigations from S.No 1 to S.No 21 are for NABL/ NABH Accredited The rates for non-NABL/ non-NABH Accredited HCOs shall be 15% less.

CGHS Package Rates for 15 Investigations under CGHS

3. The rates shall come into force from the date of issue of O.M.

5. This issues with the concurrence of Integrated Finance Division, MoHFW vide CD No 2643 dt 08.02.2021.

sd/-
(Dr. G.D. Palia)
Addl. DDG(HQ), CGHS

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INDIAN RAILWAYS TECHNICAL SUPERVISORS ASSOCIATION
(Estd. 1965, Regd. No.1329, Website http://irtsa.net)

M. Shanmugam,
Central President, IRTSA
# 4, Sixth Street, TVS Nagar, Padi,
Chennai – 600050.
Email- cpirtsa@yahoo.com
Mob:09443140817

Harchandan Singh,
General Secretary, IRTSA,
C.Hq. 32, Phase 6, Mohali,
Chandigarh-160055.
Email gsirtsa@ yahoo.com
(Ph: 0172-2228306, 9316131598)

No: IRTSA/CHQ/Memo .2020-13

Date: 27.11.2020

DIRECTOR GENERAL (HR)
Railway Board
New Delhi

Sub: PROPOSAL OF MEDICAL INSURANCE SCHEME FOR RAILWAY EMPLOYEES.

Ref: 1) Railway Board letter No.E(W)2020/Misc/ Dashboard-GIS, dated 27.10.2020
2) Railway Board order No.ERB-1I/2020/23/30, dated 20.10.2020.

1) Ministry of Railways constituted a committee to examine and tender their recommendations to bring all Railway Employees under the Medical Insurance Scheme for obtaining treatment in private hospitals. IRTSA submits the following for the kind consideration of Railway Board,

2) Indian Railways Medical Service (IRMS) is spread across the length and breadth of the country. IRMS is having 125 hospitals and 586 dispensaries, manned by 33,300 medical staff catering to approximately 66 lakh beneficiaries including 12.27 lakh serving employees. In the year 2018-19 Railway Hospitals treated 2.01 crore OPD patients, 5.08 lakh in-patients and performed 1.02 lakh major and specialty surgeries.

7th CPC Transport Allowance and DA granted for Indian Railway Medical Service (IRMS) officers drawing Grade Pay of Rs.10,000/- under DACP Scheme

3) Railway Hospitals performed pre-placement medical examination for 38,000 candidates and carried out periodical medical examination for 1.14 lakh employees. They also examined 12.51 lakh food and water samples.

4) Indian Railways total medical services expenses for the year 2018-19 including cost of medical staff is Rs. 6888.34 crore. That makes average medical expense per beneficiary as Rs.10,500.

5) No medical insurance company in India handles 66 lakh beneficiaries. Medical Insurance doesn’t cover OPD. Since Railway is catering 2.01 crore OPD patients in a year, it may not be possible to include huge OPD beneficiaries in private managed medical insurance.

6) In existing Railway medical system all medical services like OPD, diagnosing, medicines, Surgeries, in-patient care, major treatment/surgeries carried out in referral private/ CGHS hospitals and follow-up checking are part of employees’ welfare scheme offered to employees and their dependents. It is a part of service condition. For retired employees and their dependents who opted for RELHS on onetime payment, same medical services are extended.

7) In the Railway Medical system, no cost ceiling is fixed for entitlement of any required treatment. On the other hand, medical insurance cover is basically extended to in-patient treatments and for surgeries with a ceiling based on the premium paid.

8) For example, United India Insurance Company Limited offers Rs.10 lakh sum insured at premium rate per member Rs.12,386 in age group 41-45. If all 66 lakh Railway beneficiaries are covered under above premium Rs.8370.78 crore will be paid as total premium. Whereas total medical expense of Indian Railways for the year 2018-19 is Rs. 6888.34 crore which is for diverse services given in the Annexure.

9) In the same time there is a need for addition of more private empanelled hospitals in Indian Railways Medical Services with seamless cashless treatment, since large number of serving and retired health care beneficiaries live in the newly developed suburbs of various cities throughout India. It is pertinent to note that in case of emergency, beneficiaries first require to approach Railway Hospital, then they are referred to private hospitals and in many cases precious golden hours are lost in mere formalities endangering the life.

10) Beneficiaries living in faraway places from Railway Hospitals also find it difficult to get their regular treatments and minor treatments occasionally, since they are required to travel long distance to reach Railway Hospitals. These beneficiaries will be benefited if cashless treatment is extended to them in the hospitals available near their living place.

11) Hence it is requested that,

a. Existing Indian Railways Medical Service facilities may please be continued.

b. The proposal for Medical Insurance Scheme for Railway employees / Pensioners and their depended may please be made as additionally facility to the beneficiaries to get their regular treatments including OPD & IPD in empaneled private hospitals, premium thereof may please be borne by Railways.

Thanking You

Yours faithfully,
(Harchandan Singh),
General Secretary, IRTSA

Annexure

List of diverse services performed by Indian Railways Medical Service (IRMS)

1) Attending Railway accidents and similar incidents;
2) Emergency medical treatment for sick passengers;
3) Pre-employment medical examination for prospective employees;
4) Periodical medical examination for employees;
5) Medical boards and other medical certification for employees;
6) Safe water supply at Railway stations;
7) Safe food supply at Railway stations;
8) Running medical first-aid posts for IR factories under the Factories Act;
9) Certification of dead bodies;
10) Certification of perishable goods;
11) Curative healthcare; and
12) Preventive healthcare.

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No.S.11011/29/ 2019-EHS
Government of India
Ministry Of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi – 110 108
Dated: the 13th September,2019

OFFICE MEMORANDUM

Subject: Emergency treatment in CGHS empanelled Hospitals

The extant instructions under CGHS provide that under emergency conditions, a CGHS beneficiary can get admission in any CGHS empanelled Hospital without any prior permission. It has, however, been brought to the notice that the Hospitals deny admission or insist on referral memo from CGHS Wellness Centre even in emergency conditions.

2. In accordance with the Memorandum of Agreement between the CGHS empanelled Hospital and the Government of India, refusal to provide treatment to bonafied CGHS beneficiaries in emergency cases and other eligible categories of beneficiaries on credit basis, without valid ground, would attract disqualification for continuation of empanelment.

Also check:  CGHS medical facilities reimbursement to Central Government pensioners

3. It is, therefore reiterated that in emergency the empanelled hospitals will not refuse admission or demand an advance payment from the CGHS beneficiary or his family member and will provide credit facilities to the patient.

(Rajeev Attri)
Under Secretary to the Govt. of India
(Tel.011 – 2306 1883)

Source – CGHS

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The   norms   for   establishment   of   new   Wellness   Centre   under   CGHS   are   as   under:-

I. In an existing CGHS City:-

For opening of a new CGHS Wellness Centre in an existing CGHS  City,  there  has  to  be  a  minimum  of  2000  Card  holders  (serving  employees  of Central Government and Central Civil Pensioners).

Also check: NPS covered pensioners allowed to use CGHS facilities without any bar of minimum qualification service

II. Extension of CGHS to a new City:-

For extension of CGHS to a new City, there has to be a minimum of 6000 Card holders.

At present, there is no such proposal. Opening of new CGHS Wellness Centre is considered as per the extant norms in this regard, subject to availability of resources.

The Minister of State (Health and Family Welfare), Sh Ashwini Kumar Choubey stated this in a written reply in the Lok Sabha here today.

Source: PIB

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Annual Health Check-up at Hospitals empanelled under CGHS in respect of CGHS Pensioner beneficiaries aged 75 years and above

Z 15025/ 36/2019/ DIR/CGHS/ CGHS(P)pt
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated, the 19th August, 2019

OFFICE MEMORANDUM

Subject: Annual Health Check-up at Hospitals empanelled under CGHS in respect of CGHS Pensioner beneficiaries (Primary card holders) aged 75 years and above- regarding

With reference to the above mentioned subject, the undersigned is directed to state that the matter relating to Annual Health Check-up at private hospitals empanelled under CGHS in respect of elderly CGHS beneficiaries was under consideration at this Ministry and it has now bean decided that hereinafter, CGHS Pensioner beneficiaries {Primary Card holders) aged 75 years and above shall be permitted to undergo ‘Annual Health Check-up’ at CGHS empanelled hospitals.

Permission in respect of CGHS Pensioner beneficiaries (Primary Card holders) aged 75 years and above shall be granted by CMO in charge of CGHS Wellness Centre.

The private hospitals empanelled under CGHS shall perform the Annual Health Check-up at CGHS rates and extend cashless facility for the same in respect of CGHS Pensioner beneficiaries (Primary Card holders) aged 75 years and above.

(Rajeev Attri)
Under Secretary to Government of India

Source: CGHS

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Post-operative Follow-up treatment from Hospitals empanelled under CGHS in respect of critically ill CGHS beneficiaries

Z.15025/35/2019/DIR/CGHS/ CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 29th May , 2019.

OFFICE MEMORANDUM

Sub: Post-operative Follow-up treatment from Hospitals empanelled under CGHS in respect of critically ill CGHS beneficiaries-regarding

With reference to the above mentioned subject the undersigned is directed to state that in view of the difficulties being faced by critically ill CGHS beneficiaries in getting post-operative follow-up treatment at CGHS empanelled hospitals, the matter was reviewed and it has now been decided that critically ill CGHS beneficiaries shall be permitted for follow up treatment in CGHS empanelled hospitals as per the details given under:

i. Permission for post-operative follow-up treatment in respect of the following post – operative conditions requiring frequent Consultations from Specialists at private hospitals empanelled under CGHS, need not be re validated from time to time and follow-up treatment may be under taken at CGHS rates without time limit.

ii. The consultation /investigations are permitted under these follow-up cases. The conditions covered are:

a. Post Cardiac Surgery Cases including Coronary Angioplasty
b. Post Organ Transplant Cases (Liver, Kidney, Heart, etc.,)
c. Post Neuro Surgery Cases/Post Brain Stroke cases requiring regular follow-up treatment
d. End Stage Renal Disease/follow up cases of Liver Failure
e. Cancer treatment
f. Auto-immune disorders like Rheumatoid Arthritis requiring regular follow-up
g. Neurological disorders like Dementia, Alzheimer’s disease, Parkinsonism, etc.,

Medicines prescribed are to be procured from CGHS Wellness Centre.

iii. The beneficiaries shall have to submit a self-attested photo copy of the permission letter to the hospital to enable the hospitals to provide credit facility in respect of pensioners and other categories of CGHS beneficiaries entitled for credit facility. Serving employees (and their dependents) who may not be entitled for cashless facilities shall enclose a self-attested photo copy of permission letter to claim reimbursement from the concerned Ministry /Department. Permission in respect of Pensioner CGHS beneficiaries, Ex-MPs (and other categories of CGHS beneficiaries, whose medical expenditure is borne by CGHS) etc., shall be granted by CGHS. Permission in respect of Hon’ble Members of Parliament shall be granted by Rajya Sabha Secretariat/Lok Sabha Secretariat as the case may and by concerned Ministry /Department in respect of serving beneficiaries and by concerned Autonomous Body / Statutory Body in respect of serving /pensioner beneficiaries

iv. However, if any non-listed investigations / procedures are advised permission from competent Authority shall be required, except in emergency.

These orders are in supersession of the earlier guidelines on the subject.

Sd/-
(Dr. Manai Jain)
Addl. DDG(HQ), CGHS

Source: CGHS

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CGHS Facilities to Retired Employees of KVS

Kendriya Vidyalaya Sangathan
18, Institutional Area, Shaheed Jeet Singh Marg
New Delhi 110 016

F.11086/01/2012-KVS(HQ)/Admn.II/291-338

Dated: 13-03-2019

OFFICE MEMORANDUM

Subject: Extension of CGHS facilities to the retired employees of Kendriya Vidyalaya Sangathan (KVS) – matter regarding.

Ministry of HRD, vide letter No.F3-5/2011-UT-2 dated:13-03-2019 has conveyed the approval of the Ministry of Health & Family Welfare O.M.No.S.11016/8/2015-CGHS (P) dated 06.03.2019 vide which Ministry of Health & Family Welfare has extended the implementation of CGHS facilities to all the retired employees of KVS, who were having CGHS cards while in service, in all CGHS covered Cities, on the same terms and conditions on which retired employees of KVS were extended CGHS facilities in Delhi/NCR vide Ministry of Health & Family Welfare OM dated 29.05.2015.

Other terms and conditions of MoH&FW OM dated 29.05.2015 circulated vide KVS (HQ) OM No.11086/01/2012-KVS HQ (Admn.II) 793/805 dated 21.08.2015 will remain unchanged.

sd/-
(Dr. Shashi Kant)
Joint Commissioner (Pers.)

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CGHS Chennai Hospitals and Diagnostic Centres Updated List Nov 2018

The Central Government Health Scheme (CGHS) under Ministry of Health and Family Welfare, Chennai Division has published the latest list of empanelled hospitals as on November 2018.

CGHS Hospitals (16), Exclusive Eye Centres(14), Exclusive Dental Clinics (3) and Diagnostic Centres (5)

Name of Hospital, Address & Contact Numbers, Name of Nodal Officer, NABH or Non NABH and Treatment available…

EXCLUSIVE EYE CENTRES

EXCLUSIVE DENTAL CLINICS

DIAGNOSTIC CENTRES

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GOVERNMENT OF INDIA
MINISTRY OF RAILWAYS
(RAILWAY BOARD)

No.2016/H-1/11/58/Policy

New Delhi, dated 25.4.2018

The General Managers,

All Indian Railways & Production Units,

Sub: Comprehensive procedure, guidelines and check list for empanelment of private hospitals.

Ref:- SER’s letter no.CMD/SER/Hosp. Tie-up/2303 Dated 14.11.2017.

PCMD/SER vide their letter under reference had sought necessary guidelines to be followed while empanelling private hospitals in consequence of powers delegated to the GMs for empanelment of private hospitals vide Railway Board letter no. 2017/Trans/01/Policy dated 18/10/17 and to the DRM’s for divisions and CWMs for workshops vide letter no.2017/Trans/01/Policy/Pt 1 dated 30/11/17. Such powers are to be exercised by the delegated officers in person and shall not be delegated below. Hence now no proposal for empanelment is required to be sent to Railway Board.

A comprehensive guideline for procedure and checklist to be followed while empanelling private hospitals are being issued as per Annexure enclosed. Any new guidelines issued from MoH & FW as and when issued shall be duly incorporated and advised.

This is in surprise of all earlier guidelines issued from Railway Board on this subject.

This issues with the concurrence of the Finance Directorate of the Ministry of Railways.

(Mrs. H.K. Sanhotra)

Joint Director-II/Health

Comprehensive Procedure Guideline & Check List For Empanelment of Private Hospitals

The empanelled hospitals have been broadly categorised into two groups:-

A. CGHS / E$l / ECHS empanelled hospitals and Government of India / Public Sector Undertaking hospitals like of SAIL, BHEL, Coal India, etc.

B. Other private hospitals which are neither empanelled by CGHS, ECHS & ESI nor are run by Government of India Public Sector Unit. (PSU).

The following guide lines and check list are to be kept in consideration while empanelling hospitals by Railways. The point common to both these types of hospitals are given below:-

1. Justification for the proposal mentioning the present status of Railway Hospital i.e. number of Doctors & Paramedical on roll vis. a vis. sanctioned strength, services provided by it, any future plan for expansion, no. of Honorary Consultants/Visiting Specialists (specialty wise) & CMPs and despite existing facilities why referral services are still required.

2. Justification for empanelment with technical aspect i.e. number of beds/ facilities/specialties/services offered/medical set up etc. at the proposed hospital.

3. Total number of Railway beneficiaries catered by the Railway Hospital.

4. In the Specialties Specialties for which Railway hospital do not have facilities if there are any reputed Government Hospitals rendering services in those specialties.

5. In CGHS covered states/cities, hospitals should be empanelled only at CGHS rates (in case of Government of India, PSU hospital their own rate) or even lower or some discount etc offered by them. Names of the hospital empanelled by CGHS / ECHS /ESI can be obtained from respective website. Even in places not covered by CGHS, all out efforts should be made to empanel hospital on CGHS (city-specific) rates only. In case of any deviation from CGHS rates, justification to be given by MD / CMS / CMO in charge, duly concurred by Associate Finance before being approved by Competent Authority.

6. Comparative statement of package rates as well as diagnostic charges of the proposed hospital with (i) other empanelled hospitals in the city and (ii) the CGHS rates of that city or the nearest city in tabulated form.

7. Two copies of rate list of hospital duly verified by competent authority. After approval, one copy along with sanction letter to be sent to HQ for uploading on Zonal website.

8. Concurrence of the Associate Finance as applicable along with their verbatim comments

9. Proposal to be sent for approval of GM /DG (RDSO) /DRM /CAO /CWM as the case may be (both for the first time and as well as further renewals).

10. Validity of empanelment will be two years or till it is empanelled or revoked by CGHS / ECHS /.ESI whichever is earlier and for Government of India PSU hospitals too it will be for two years, Same for non CGHS / ECHS / ESI hospitals too. Overall performance of the hospital, patient’s feedback etc. to be kept in mind while extension

11. Further extension may be done with mutual consent of both parties, arid will be sanctioned by GM /DG (RDSO) /DRM /CAO /CWM as the case may be (also see para

A((a) & B(d)).

A. CGHS / ESI/ ECHS empanelled hospitals and Government of India / Public Sector Undertaking hospitals like of SAIL’ 3HEL, Coal India, etc. –

(a) In case of CGHS / ECHS / ESI empanelled & Government of India/PSU run hospitals, a letter of willingness from the hospital be obtained and can be empanelled any time Rates as and when revised by CGHS can be agreed to.

B. Other private hospitals which are neither empanelled by CGHS, ECHS & ESI

a) An open advertisement should be floated once a year or as per requirement for empanelment of private hospitals.

b) Empanelment of such hospitals should be considered only if there is no other CGHS/ ECHS / ESI nor any hospital run by Government of India – Public Sector Undertaking like SAIL, BHEL, Coal India etc. empanelled hospital, preferably within a vicinity of 5kms from the hospital already empanelled.

c) Search committee should be constituted by MD / CMS / CMO, consisting of 3 doctors of at least JAG level and they may co-opt another doctor of particular speciality when required. They will visit the hospitals and give clear justification for approving this hospital.

d) For any increase in rates, at the time of extension same should be justified by MD/CMS/CMO and concurred by Associated Finance and accepted by the concerned competent authority. If such increase in rates is more than 5%, the proposal duly justified by medical in charge and vetted by associate finance and approval of DRM /CWM in case of Division and workshops to be sent to Headquarters for sanction of General Manger. In case of headquarter controlled Central hospitals and Pus, General Manager / DG*(RDSO) will approve such proposals. However, no enhancement in rate is permissible during that period of recognition of two years.

Source: http://www.cghs.gov.in/

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