File No.S.14028 /30/2022 -EHS
S.14028/30/2022 -EHS
Government of India
Ministry of Health & Family Welfare
EHS Section

Nirman Bhawan, New Delhi
Dated 12th September, 2022

OFFICE MEMORANDUM

Subject: Reimbursement of medical claims to pensioners under CS(MA) Rules, 1944 as directed by various CATs/Courts-reg.

The undersigned is directed to say that as per Note-2 below Rule-2 of CS(MA) Rules, 1944, Retired Government officials are not covered thereunder. However, as per extent CGHS guidelines, Central Government Pensioners residing in non-CGHS areas have the following options:

• They can avail Fixed Medal Allowance (FMA) in lieu of OPD facilities under CGHS.
• They can also avail benefits of CGHS (OPO & IPD) by registering themselves in the nearby CGHS covered city after making the required subscription.
• They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGHS guidelines.

2. All Ministries/ Departments of Government of India are requested to bring the contents of this OM to the notice of organization(s) under their administrate control for guidance and compliance thereof. Also, retiring Central Government employees may be made aware of the above rule position.

3. Court CATs cases filed by pensioners may be defended by Ministries/ Departments in the light of above rule position. No reference in this regard needs to be made to Ministry of Health & Family Welfare for comments/ clarifications etc, thereon.

4. This issues with the approval of Competent Authority.

Digitally Signed by Guite
Elsy Thang Biak Lun
Date: 12-09-2022 15:52:01
Reason: Approved
(Guite Elsy Thang Blak Lun)
Under Secretary to the Government of India

To

All the Ministries/ Departments, Govt of India.

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CGHS medical facilities reimbursement to Central Government pensioners

CGDA, Ulan Batar Road, Palam, Delhi Cantt.-110010
(Ph.011-25665714,25665560/ Fax-011-25674806/ Email: admin14.cgda@nic.in)

IMPORTANT CIRCULAR

No.AN/XIV/19015/ Govt. Orders/TA /DA/LTC/ Medical

To,
All PCsDA/ CsDA/ PCA (Fys.)
(Through website)

Dated: 29/11/2019

Subject: Reimbursement of medical claims to Pensioners under CS(MA) Rules 1944 – guidelines issued by Ministry of Health & Family

Ministry of Health and Family Welfare vide its OM No. S.14025/23/2013-MS.EHSS dated 29th September 2016 has clarified that CS (MA) Rules 1944 are not applicable to pensioners till date. The Ministry has issued the following guidelines for medical facilities to Central Government pensioners:-

Also check: CGHS – Central Government Health Scheme

a) Pensioners residing in CGHS covered areas:

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 contributions, cannot be granted Fixed Medical allowance in lieu of CGHS.

b) Pensioners residing in non-CGHS areas:

1. They can avail Fixed Medical Allowance (FMA) © Rs. 500/- per month revised to Rs. 10001- from 01.07.2017.

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 CGHS guidelines.

All retired/ retiring Officers/ Staff of the Defence Accounts Department may please be advised to adhere to the above provisions and subscribe to CGHS facility by depositing the required contributions for availing medical facilities after retirement.

This issues with the approval of Sr. Jt. CGDA (AN).

(Rajeev Ranjan Kumar)
Dy. CGDA (AN)

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Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS
Office of the Director, CGHS

No: S-11011/29/2018-CGHS(HEC)/ DIR/CGHS

Nirman Bhawan, New Delhi
Dated the 6th August, 2018

OFFICE MEMORANDUM

Subject:- Revision of ceiling rates for reimbursement of the cost of Cardiac pacemaker, AlCD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS(MA) Rules.

With reference to the above subject attention is drawn to the OM No 12034/02/2014/Misc./- CGHS D.lll dated 22nd July 2014 vide which ceiling rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS (MA) Rules were prescribed and to state that the matter has been reviewed by the Ministry and it is decided to revise the ceiling rates as per the details given under:

2. Other terms and conditions prescribed under OM No 12034/02/2014/Misc./-CGHS D.III dated 22nd July 2014 shall remain unchanged.

3. These rates shall remain valid till the rates for the above devices are notified by National Pharmaceutical Pricing Authority (NPPA).

4. Issued with the concurrence of SS&FA, Ministry of Health & Family Welfare vide CD – No.1295 dated 25.07.2018.

(Dr. Atul Prakash)
Director, CGHS

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CGHS

No. Misc.12014/2005/CGHS(R&H)

Nirman Bhawan, New Delhi
Dated the 9th July, 2018

OFFICE MEMORANDUM

Subject:- Permission /Approval for reimbursement of cost of Neuro-implants, viz., Deep Brain Stimulation implants, Intra-thecal Baclofen Pump, lntra-thecal Morphine Pump and Spinal Cord stimulators for CGHS/CS(MA) beneficiaries

With reference to the above subject the undersigned is directed to draw attention to the Office Memoranda of even Number dated 23/06/2006 and 4/12/2008 and OM No.S.3849/09/CGHS(R&H)-CGHS(P) dated 8/12/2014 vide which the rates and guidelines for Permission /Approval for reimbursement of cost of Neuro-implants, viz., Deep Brain Stimulation implants, Intra-thecal Baclofen Pump, Intra-thecal Morphine Pump and Spinal Cord stimulators for CGHS/CS(MA) beneficiaries were notified and to convey the approval of competent authority to allow reimbursement of cost of the above mentioned neuro-implants under CGHS/CS(MA) Rules at the same ceiling rates and guidelines and conditions till the rates for the above mentioned implants are notified by National Pharmaceutical Pricing Authority (NPPA).

sd/-
(Bindu Tewari)
Director (EHS)

Source: https://cghs.gov.in/

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Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS
Nirman Bhawan, Maulana Azad Road
New Delhi 110 011

No. C 14012/02/2018/CGHS-III/DIR
Dated: 6th April, 2018

OFFICE MEMORANDUM

Subject:- Clarification regarding demarcation of CGHS covered areas under CGHS Wellness Centre

With reference to the above subject the undersigned is directed to state that in some of the CGHS Cities the areas covered under CGHS were not specified resulting in inconvenience to the beneficiaries. The matter has been reviewed and it is now decided that hereinafter the coverage of CGHS shall be limited to the areas within 5 km (approx.) radius of the CGHS Wellness Centres , in all CGHS covered Cities , where such demarcations were not specified. The Additional Director, CGHS concerned City shall notify such areas covered under CGHS Wellness Centres.

The serving Central government employees residing outside the CGHS covered areas shall be covered under CS(MA) Rules. However, in all CGHS covered cities the serving Central government employees residing within the Municipal limits of the city, shall be given a onetime choice to opt for CGHS (instead of CS(MA) Rules) from the nearest CGHS Wellness Centre.

S/d,
(Dr.D.C.Joshi)
Director, CGHS

Signed copy

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No. 5.14025/23/2013-MS.EHSS
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare

Nirman Bhavan, New Delhi
Dated the 29 September, 2016

OFFICE MEMORANDUM

Sub:- Reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 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:

a) Pensioners residing in CGHS covered areas:

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 optout cf CGHS and avail anyother medical facility {i.e. Fixed Medical Allowance). Such pensioners, if they do not choose to avail CGHS facility by depositing the required contributions, cannot be granted Fixed Medical allowance in lieu of CGHS.

b) Pensioners residing in non – CGHS areas:

1). They can avail Fixed Medical Allowance (FMA) @ 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 CG HS for IPD treatments after making the required subscriptions as per CGHS 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 the 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 for 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

Source: [CGHS.GOV.IN]

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No. S-11012/2/2016-CGHS-P
Government of India
Ministry of Health and Family Welfare
(CGHS-P Section)

Nirman Bhawan, New Delhi
Dated the 8th November, 2016

OFFICE MEMORANDUM

Sub: Revision of Income limit for dependency for the purpose of providing Central Government Health Scheme (CGHS) coverage to family members of the CGHS covered employees subsequent to implementation of recommendation of the seventh Central pay commission-regarding
The undersigned is directed to say that subsequent to the implementation of the recommendations of the 6th CPC, the income limit for dependency for the purpose of extending CGHS coverage to “family” members of the CGHS covered Central Government employees was enhanced to Rs. 3500/-per month plus the amount of dearness relief on the basic pension of Rs. 3500/- as on the date of consideration.

2. With the implementation of the recommendations of the 7th Central pay commission, the issue of revision of income limit for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered Central Government employees and pensioner CGHS beneficiaries was under consideration keeping In view the amount of minimum pension/family pension fixed by the 7th Central pay commission.

3. On the basis of the recommendations of the 7th CPC, the Department of Pension and Pensioners’ Welfare under Para 5.2 of their OM No. 38/37/2016-P&PW (A)(i) dated 4/8/2016 , has fixed the amount of minimum pension a~ Rs. 9,000/- per month and under para 7.1 of this OM the amount of family pension has been fixed as 30% of the basic pay In revised pay structure and shall be subject to a minimum of Rs. 9,000/- per month and maximum of 30% of the highest pay in the Government. Vide Para 7.3 of the aforesaid O.M, It has been mentioned that there will be no other change in the provisions regulating family pension.

4. It has been decided, In consultation with the Department of Expenditure, to revise the income limit for the purpose of providing CGHS coverage to the family members of the CGHS covered Central Government employees to Rs. 9,000/- plus the amount of dearness relief on basic pension of Rs. 9,000/- as on the date of consideration.

5. As such, all the orders related to the CGHS Rules stand amended to the extent that the Income limit for Rs. 3500/- per month from all sources including pension/and family pension stands amended to an Income of Rs. 9000/- plus amount of the dearness relief on the basic pension of Rs. 9000/- as on the date of consideration. The amount of dearness relief, as indicated in the Income limit stands for the amount of dearness relief drawn by a pensioner/family pensioner on the date of consideration and not the amount of dearness relief due on the date of consideration.

6. The Income limit for dependency of “Rs.9000/- plus amount of the dearness relief on the basic pension of Rs. 9000/- as on the date of consideration”, shall also be applicable for the cases covered under CS(MA) Rules, 1944 for the purpose of examining eligibility of family members of the Central Government employee for medical facilities under the Rules.

7. The order shall be effective from the date of Issue of Instructions of this O.M.

8. This issues with the concurrence of Department of Expenditure vide their I.D. No.204/E-V/2016 dated 19/10/2016.

(Sunil Kumar Gupta)
Under Secretary to the Govt. of India

Source: www.cghs.gov.in

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No. 1-1/13/Hospital Cell/R&H/CGHS (Pt.I)/CGHS (P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhavan, Maulana Azad Road
New Delhi- 110 108

Dated : 23rd February, 2015

OFFICE MEMORANDUM

Subject:- Cancer Treatment under CGHS/CS(MA) Rules, 1944

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum of even number dated 2nd September, 2008 and to state that in view of empanelment of several Cancer hospitals under CGHS the matter was re-examined, and it has now been decided to modify the Office Memorandum as follows:

i) CGHS beneficiaries and beneficiaries covered under CS(MA)Rules, 1944 shall be permitted to get themselves treated from any of the under mentioned 27 (Twenty seven) hospitals recognized by the Ministry of Health & Family Welfare under the National Cancer Control Programmes that are funded by the Government of India, subject to the condition that the reimbursement will be as per the rates fixed in the Regional Cancer Centers under Central Government, if any or as per actual, whichever may be less.

1. Andhra Pradesh – M.N.J. institute of Oncology & Regional Cancer Centre, Hyderabad.
2. Assam – Dr. B. Borooah Cancer institute, Guwahati.
3. Bihar – Indira Gandhi institute of Medical Sciences, Patna
4. Chandigarh – Post Graduate institute Medical Education Research, Chandigarh.
5. Chhattisgarh – Pt. ,i.J.N Medical College & Dr. BR. Ambedkar Memorial Hospital, Raipur.
6. Delhi – Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi.
7. Gujarat– Gujarat Cancer Research Institute, Ah medabad, Gujarat.
8. Haryana – Post Graduate Institute of Medical Sciences, Rohtak.
9. Himachal Pradesh– Indira Gandhi Medical College, Shimla.
10. Jammu & Kashmir– Sher-i- Kashmir Institute of Medical Sciences, Srinagar.
11. Jammu & Kashmir- Government Medical College -Jammu.
12. Karnataka – Kidwai Memorial Institute of Oncology, Bangalore.
13. Kerala – Regional Cancer Centre, Thiruvananthapuram.
14. Madhya Pradesh – Cancer Hospital & Research Institute, Gwalior.
15. Maharashtra – Rashtrasant Tukdoji Regional Cancer Hospital Research Centre, Nagpur.
16. Maharashtra -Tata Memorial Hospital, Mumbai.
17. Manipur– Regional Institute of Medical Sciences, Imphal.
18. Mizoram – Civil Hospital, Aizwal.
19. Odisha – Acharya Harihar Regional Cancer Centre, Cuttack.
20. Puducherry – Jawaharlal Institute of Postgraduate Medical Education & Research.
21. Rajasthan – Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner.
22. Tamil Nadu – Govt. Arignar Anna Memorial Cancer Research Institute & Hospital, Kancheepuram.
23. Tamil Nadu – Cancer Institute (WIA), Adyar, Chennai.
24. Tripura – Civil Hospital, Agartala.
25. Uttar Pradesh – Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.
26. Uttar Pradesh – Kamla Nehru Memorial Hospital, Allahabad.
27. West Bengal – Chittaranjan National Cancer Institute, Kolkata.

ii) In cities where there are no facilities for cancer treatment in any of the empanelled private hospitals powers are hereby delegated to the Addl. Directors of CGHS of the concerned cities in respect of CGHS and to HOD/ Head of Office in respect of serving employees covered under CS(MA) Rules, 1944 for grant of permission for undergoing treatment at any hospital that provides treatment to cancer patients, subject to the condition that the reimbursement shall be limited to the prevalent CGHS rates or actual expenditure – whichever may be lower. Permission shall however be granted for the specific treatment procedures as advised by a Government specialist.

iii) Powers are also hereby delegated to the Additional Directors of CGHS of the concerned cities in respect of CGHS and to HOD/ Head of Office in respect of serving employees covered under CS(I\/IA) Rules, 1944 for grant of permission for post-operative follow up treatment from the same centre, where permission has been granted earlier for cancer treatment as per the terms and conditions of OM dated 10.04.2001 regarding Post-operative follow up treatment.

2. These orders shall be in force till further orders.

3. This issues with the concurrence of Integrated Finance Division vide CD No. 115650 /2015 dated 15-01-2015.

sd/-
(RAVI KANT)
UNDER SECRETARY TO THE GOVT. OF INDIA

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File963.pdf

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Subject: Revision of Income limit for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered employees subsequent to implementation of recommendations of the VI CPC-Clarification regarding.

The undersigned is directed to refer to the above mentioned subject and to state as follow:

(MS Section),Nirman Bhavan,
New Delhi.

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List of Private Hospitals in India (Recognised under CS(MA) Rules, 1944) Central Government Employees and Pensioners belonging to Non-CGHS places are covered by Central Services Medical Attendance Rules 1944 as far as reimbursement of medical expenses Out-Patient and In-Patient treatment are concerned.

Ministry of Health and Family Welfare has approved following private hospitals under CS(MA) Rules, for reimbursing package rates when Central Government Employees and Pensioners taking medical treatment in these hospitals…

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