12 JUL 2019

The Sixth Central Pay Commission in its report had recommended the introduction of a Health Insurance Scheme for central government employees and pensioners and their dependent family members on pan India basis. Ministry of Health & Family Welfare has framed the draft health Insurance Scheme. OPD facilities are not covered under the proposed scheme. The draft scheme has been sent to the Department of Expenditure, Government of India, for appraisal and approval of the financial feasibility of the scheme.

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

PIB

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GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND EMPLOYMENT
LOK SABHA

UNSTARRED QUESTION NO: 875
ANSWERED ON: 21.11.2016

ESIC Employees

YOGI ADITYANATH
Y. S. AVINASH REDDY
KOTHA PRABHAKAR REDDY

Will the Minister of LABOUR AND EMPLOYMENT be pleased to state:-

(a) whether the Government has stopped/proposes to stop the cashless treatment of ESIC Employees;

(b)if so, the details thereof and the reasons therefor;

(c)the steps being taken by the government to alleviate problems of ESIC employees in this regard;

(d)whether the Health Insurance Scheme run by the Government provides guarantee of income which is necessary for livelihood and if so, the details thereof; and

(e)if not, whether the Government proposes to implement such schemes in future?

ANSWER

MINISTER OF STATE (IC) FOR LABOUR AND EMPLOYMENT (SHRI BANDARU DATTATREYA)

(a) & (c): No, Madam. The employees under ESI Scheme are eligible for cashless treatment in the ESI Hospitals and tie up hospitals. In case of emergency treatment outside the ESI network, the employees are reimbursed on CGHS rates or respective state rates.

(b): Not applicable in view of answer at (a) above.

(d): Yes, Madam. Under ESI Scheme, cash compensation for loss of wages is paid as under:

1. Sickness Leave – For 91 days @ 70% of wages

2. Temporary disablement – Till the spell of sickness lasts @ 90% of wages

3. Maternity leave – For 12 weeks (under revision to 26 weeks) @ 100% of wages

4. Unemployment allowance- @50% for first year and 25% for second year.

(e): Not applicable.
Source: Loksabha.nic.in

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Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110108

No: Z.15025/79/2/DIR/CGHS
Dated the 5th October, 2016

OFFICE MEMORANDUM

Subject: Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner CGHS beneficiaries, etc.
With reference to the above subject the undersigned is directed to state that that the matter has been reviewed by the Ministry in view of the difficulties faced by the CGHS pensioner beneficiaries Therefore, with a view to streamline and to simplify the procedures. it has now been decided to further delegate powers to the Addl. Directors of CGHS Cities / Zones in respect of CGHS pensioner beneficiaries. etc. as under:

i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs /Imaging Centre:

Requests for permission ex-post facto approval for elective treatment / investigations in non-empanelled hospitals / diagnostic centres in respect of Pensioners/ex-MF’s/freedom Fighters, etc. shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less

ii) Permission / ex-post facto approval in cases involving procedural lapse:

Requests for approval of elective treatment l investigations in empanelled hospitals / diagnostic centres without recommendation of Govt. Specialist or CMO and without prior permission in respect of Pensioners/ex-MPs/freedom Fighters, etc, shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS rates or actual expenditure whichever is less.

iii) Delegation of Powers for Settlement of Medical Reimbursement Claims (at approved rates) of Individual Pensioner Beneficiary. etc,

		Revised Delegated Powers
a)	Additional Director, CGHS of City/Zone	Rs. 7,00,000/-
b)	Director, CGHS	Rs. 15,00,000/-
c)	Addl. Secretary & DG, CGHS	Rs. 25,00,000/-

iv) Delegation of Powers for settlement of Hospital Bills (at approved rates) for the Treatment given to Pensioner Beneficiaries, etc,

		Revised Delegated Powers
a)	Additional Director, CGHS of City/Zone	Rs. 7,00,000/-
b)	Director, CGHS	Rs. 15,00,000/-
c)	Addl. Secretary & DG, CGHS	Rs. 25,00,000/-

v) Delegation of Powers for Permission / ex-post facto Approval / Settlement of Medical Reimbursement Claims of Individual Beneficiaries / Hospital Bills in respect of Unlisted procedures / Implants (no CGHS rates)

If there is no CGHS package rate for treatment I CGHS Ceiling rate for implant approval shall be granted as per AIIMS package rate (if only procedural charge. it shall not be considered as package rates)/ AIIMS rate for implant and if there is no CGHS/AIIMS rate approval shall be granted as per actual rate.

		Revised Delegated Powers
a)	Additional Director, CGHS of City/Zone	Rs. 7,00,000/-
b)	Director, CGHS	Rs. 15,00,000/-
c)	Addl. Secretary & DG, CGHS	Rs. 25,00,000/-

2. The revised delegations mentioned above will be subject to the conditions that it will not include any case involving relaxation of rules, irrespective of the amount involved. Further, cases where the amounts exceed the monetary limits prescribed above will have to be referred to the Ministry of Health & Family Welfare for obtaining the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare.

3. The above delegations are in supersession of all the earlier instructions in the matter in respect of the delegations now being conveyed.

This issues with the concurrence of Integrated Finance Division, Ministry of Health & Family Welfare, vide Dy. No C- 3373 dt. 20.09.2016

sd/-
(Dr.D.C.Joshi)
Director, CGHS

Source: www.cghs.nic.in

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Government is working on a cashless health insurance scheme for senior citizens which may be announced in the upcoming Union Budget 2016-17.

Around Rs 10,000 crore – lying unclaimed in banks and insurance companies, EPFO and small savings schemes — would be utilised for providing the health insurance cover to the elderly, sources said.

Senior citizens are often dependent on their children or extended families for healthcare, they said, adding that the proposed scheme will help in meeting secondary and tertiary health care needs.

The quantum of insurance cover would be more than Rs 50,000 for person over 60 years.

Finance Minister Arun Jaitley will present the central budget for the next financial year on February 29.

The proposed scheme will be administered by the Department of Financial Services under the Finance Ministry.

The government proposes to link this scheme to bank accounts of beneficiaries to directly transfer the subsidised amount to the accounts. As per the proposal, the government would subsidise the premium for those below poverty line by up to 90 per cent through cash transfers to their bank accounts.

It’s not that the government will forfeit these unclaimed funds, sources said, adding that if claimants come forward they will be paid because the fund would be revolving in nature, sources said.

Health insurance scheme for senior citizen would be a logical extension of the ongoing low premium life insurance (Pradhan Mantri Jeevan Jyoti Bima Yojana), general insurance (Pradhan Mantri Suraksha Bima Yojana) and pension plan (Atal Pension Yojana) of the government, sources said.

The Pradhan Mantri Jeevan Jyoti Bima Yojana offers a renewable one-year life cover of Rs 2 lakh to all savings bank account holders in the age group of 18-50 years, covering death due to any reason, for a premium of Rs 330 per annum.

The Pradhan Mantri Suraksha Bima Yojana offers a renewable one-year accidental death-cum-disability cover of Rs 2 lakh for partial/permanent disability to all savings bank account holders in the age group of 18-70 years for a premium of Rs 12 per annum per subscriber.

The Atal Pension Yojana focuses on the unorganised sector and provide subscribers a fixed minimum pension of Rs 1,000, Rs 2,000, Rs 3,000, Rs 4,000 or Rs 5,000 per month, starting at the age of 60 years, depending on the contribution option exercised on entering at an age between 18 and 40 years.

PTI

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