The undersigned is directed to state that in accordance with the definition of ‘family’ mentioned in Ministry of Health Memo. No. F.6(1) 1-54-H, dated the Ist May, 1954 the family of a beneficiary for the purpose of CGHS scheme includes husband/wife of the CGHS card-holder, as the case may be, wholly dependent children or step-children and parents, who are mainly dependent on and residing with the Government Servant. While it is incumbent upon the card issuing. Authorities, i.e. various departments and offices participating in the scheme, to ensure that the names of only genuine and eligible persons are included in the CGHS token cards, it is the responsibility of the employees concerned to apply for a deletion of the name of the dependent from the CGHS card, when the ward is no more entitled to the benefit eligible under the scheme. The failure on the part of a cardholder to get the name of a child deleted from the CGHS token-card when he is no more dependent on him is a good and sufficient reason for initiating disciplinary proceedings against him in terms of the CCS (CCA) Rules, 1965.

All Ministers/Departments of the Government of India are requested kindly to ensure that the above said provisions are complied with fully. These instructions may also be brought to the notice of all employees concerned.

Opting out of the C.G.H. Scheme

Spouse employed outside Central Government and availing Medical Facilities provided by his/her Employer

Central Government Servants covered under Central Govt. Health Scheme and whose spouse is employed in Defence or Railway Services, State Government or Corporations or Bodies financed partly or wholly by the Central or State Government, Local Bodies and private organizations which provide medical facilities to the employees and their family members, can opt out of the CGH Scheme and avail medical facilities so provided by the above mentioned organizations.

It is to be ensured that neither of the two nor their family members avail medical facilities from both the sources at the same time and for this purpose, the concerned Central Government employee shall give an undertaking to the authority issuing the CGHS Card.

Re-admission under CGHS after ‘opting out’

Such Government Servants, who have opted out of CGHS, may apply for readmission and avail the benefit of CGHS in case their spouse dies or resigns or is dismissed from the office/organization, which provided medical facilities.

Availability of ‘Opting Out’ Facility

The facility of opting out of CGHS can only be availed twice during the whole service career of the employee. Administrative Ministry/Department shall record the same by making an entry in the employee’s Service Book.

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New Delhi: In a move that could benefit more than 50 lakh central government employees and 56 lakh pensioners, the Seventh Pay commission is planning to propose to introduce health insurance scheme to replace Central Government Health Scheme (CGHS) at highly subsidized rates.

The pay panel has already held detailed discussions about this with various stakeholders, including organisations, federations, groups representing civil employees as well as Defence services.

The pay panel will ask the central government to urge the insurance industry to come up with feasible health insurance solution for the central government employees and pensioners. The IRDA, the insurance regulatory body of India, will be compelled to ask the health insurance companies to offer a basic insurance to every central government employee and pensioner, regardless of age or medical condition and are not allowed to make a profit off this basic insurance.

The serving central government employees in non-CGHS areas are provided healthcare facilities under the CS(MA) Rules, 1994, but pensioners are not covered under these rules.

The pensioners are, however, entitled to a fixed medical allowance of Rs 500 per month. The pensioners residing in non-CGHS areas have the option to become a CGHS member in any CGHS-covered city of their choice to avail the medical facilities under the CGHS Scheme.

Health insurance would be available for central government employees and pensioners till death, with the insured employees and pensioners will have to pay 50% of the premium from their salaries and pensions and the remaining 50% premium may be paid by the central government.

The health insurance would cover a family of six the employee and pensioner himself or herself, the spouse, two children and two parents. The maximum sum assured for family in a year could up to Rs 5 lakh.

Under the CGHS, the annual per capita expenditure is more than Rs 5,000. In contrast, the National Rural Health Mission (NRHM), which caters to the rural masses, spends just Rs 180 per head.

The CGHS is financed mainly through the Centre’s tax revenues. Though beneficiaries do contribute a share of their wages towards premium, ranging from Rs 600 to Rs 6,000 a year depending on their pay scale, this accounts for just about 5 per cent of the total expenditure. The government shells out the remaining 95 per cent.

So, the central government also wanted for ending the CGHS in its current form and to move to an insurance-based health scheme to cut costs.

TST

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