CGHS

No: 4-35(01)/ 2019-PAT
Government of India
Ministry of Communications
Department of Telecommunications

20, Ashoka Road, 1120, Sanchar Bhawan
New Delhi-110001
Dated: 28/07/2020

OFFICE MEMORANDUM

Subject -: Reimbursement of medical claims to pensioners residing in non-CGHS areas-reg.

This refers to medical claims being received from pensioners residing in non-CGHS areas. In this respect. Ministry of Health and Family Welfare’s (MoH&FW) OM No. S. 14025/23/2013-MS.EHSS dated 29.09.2016 may be referred (copy enclosed). As per this OM, the pensions residing in non-CGHS have following options to avail medical facilities:

• (a) They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month or as revised from time to time. At present, vide OM 4/34/2017/P&PW(D) dated 19.07.2017. FMA is @ Rs. 1000/- per month.
• (b) They can also avail benefits of CGHS (OPD & IPD) by registering themselves In the nearest CGHS city after making the required subscription.
• (c) They also have the option to avail FMA for OPD treatment, and CGHS for IPD treatment after making the required subscriptions as per CGHS guidelines.

2. In addition, in accordance to MoH&FW’s OM No. 8.11011/11/2016 CGHS (P)/EHS dated 09.01.2017 (copy enclosed), pensioners have option to avail CGHS facilities by making contribution on an annual basis (1 year/12 months) or by making contribution for 10 (ten) years (120 months) for getting a pensioner CGHS card with life-time validity.

3. The undersigned is directed to request ail the Pr. CCA/CCAS and others concerned offices that the pensioners of this Department residing in non-CGHS areas may be intimated/ sensitized (more than once) by an appropriate means about the above options for medical facilities available to them as per MoH&FW OM dated 29.09.2016 and OM No. S.11011/11/2016 CGHS (P)/EHS dated 09.01.2017. They may be advised that for availing reimbursement of their medical bills, they have to mandatoryly register themselves with the nearest CGHS facility as per one of the options above. They may also be advised that if they fail to register themselves w.e.f. applicable date with the nearest CGHS facility for availing OPD/IPD treatment, their further medical bills may not be reimbursed by this Department.

4. Compliance report in respect of the above may be furnished to this office for appraisal of Secretary, DoT.

5. This issues with the approval of competent authority.

(A). Monthly Contributions for availing CGHS facility:

(B). Entitlement of words in private hospitals empanelled under CGHS

Pay slab for determining the entiltlement of a commodation in AIIMS, New Delhi.

The revised entitlement, as per the drawn the official, is as  follows:

(S.C. Karol)
Director (Estt.)
Phone. 23036500

To.
Pr. CCAs/ CCAS

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KENDRIYA VIDYALAY SANGATHAN
18 Industrial Area, Shaheed Jeet Singh Marg,
New Delhi – 110 016

The Deputy Commissioner/Director
Kendriya Vidyalaya Sangathan
All Regional Offices / ZIETs

Subject:- Guidelines to implement O.M. dated 13.03.2019 for extension of CGHS facilities to the retired employees of Kendriya Vidyalaya Sangathan – regarding.

Sir/Madam,

In continuation of KVS Office Memorandum of even no. dated 13.03.2019 vide which the approval of the Competent Authority of KVS for extension of CGHS facility to the retired employees of KVS who were having CGHS card while in service and residing in CGHS covered cities was conveyed. In this connection, the following guidelines may be kept in mind while processing the requests made for making of new CGHS card by the retired employees:-

A. A retired employee of KVS who was having CGHS card while in service and is residing in CGHS covered areas can opt for CGHS facility by submitting his / her application along with relevant documents and CGHS contribution to the concerned Pension Sanctioning Authority (PSA) which has released his / her pensionary benefits. As per 7th CPC, the revised monthly subscriptions, as decided by Ministry of Health & Family Welfare vide their O.M .No. 5.11011/11/2016-CGHS(P)/EHS dated 09.01.2017, to be made by employees/ pensioners for availing CGHS facilities are as under:-

B. On receipt of application from the retired official, the concerned Pension Sanctioning Authority i.e. Regional Office (R.O)/ZIETs/ Kendriya Vidyalaya Sangathan (HQ) will verify the particulars filled in the application form and enclosed documents as required by CGHS Authority i.e. self-attested photocopy of the LPC, PPO, Aadhar Card, CGHS card while in service, employee contribution as per 7th CPC as applicable to the concerned employee in accordance to his / her pay level at the time of retirement. Thereafter, PSA will write a letter for discontinuation of payment of fixed medical allowance (FMA) to the Pension Disbursing Authority (PDA) i.e. State Bank of India, Parliament Street, New Delhi. The PSA will forward the application form along with Cheque / draft for the amount as per the CGHS rate applicable with reference to residential address of the official concerned to the Deputy Commissioner concerned of the Regional Office having jurisdiction over the CGHS city wherein the official is residing.

Illustration

A Deputy Commissioner or Assistant Commissioner or Administrative Officer is retired from Mumbai Region having CGHS card while in service & residing in Lucknow i.e. CGHS covered area. He / she will submit his / her application (along with his employee-contribution as per 7th CPC in favour of, KVS, HQ and documents stated in para B) to the PSA (KVS, HQ). The PSA will verify the application form and forwarded the same to KVS, RO Lucknow along with the Cheque/DD (amount as applicable for CGHS Centre at Lucknow). Since the Deputy Commissioner, KVS RO Lucknow is having jurisdiction over CGHS Centre at Lucknow the application form will be countersigned by the Deputy Commissioner, RO Lucknow and submitted to CGHS Centre at Lucknow along with Cheque/DD and other necessary documents for preparation of CGHS card. The Deputy Commissioner RO Lucknow will also maintain a register depicting the name of the employee and family members, CGHS card no., validity of the card and the details of the pension sanction authority along with particular of Kendriya Vidyalaya or Regional office from where the official is retired. Further, Deputy Commissioner, KVS RO Lucknow, will also keep a copy of CGHS card (Index Card) issued by CGHS. All medical claims in respect of the Deputy Commissioner/ Assistant Commissioner/ Administrative Officer retired from Mumbai, will be reimbursed by Regional Office Lucknow.

C. The concerned Deputy Commissioner will forward the application to the CGHS center, along with all necessary documents including Cheque or Demand Draft after countersigning the application form, for issue of CGHS card. If the retired official is residing in the city having CGHS Centre which falls under the jurisdiction of Pension Sanctioning Authority, then the Pension Sanctioning Authority will forward the application to the concerned CGHS Centre. The Deputy Commissioner concerned will countersign the form and send it to the CGHS authority for preparation of CGHS card under intimation to the retired official as well as the Pension Sanctioning Authority.

D. The Deputy Commissioner of the RO, who has forwarded the application form to the CGHS Centre for issue of card, will maintainthe proper records and make necessary entries in CGHS card issuing register which will carry the details of Name of the employee and family members, CGHS card, validity of the card and the details of the Pension Sanctioning Authority along with particulars of Kendriya Vidyalaya/Regional Office/ZIETs from where the official retired.

E. Existing Rates of CGHS yearly contributions payable by KVS, as circulated by Directorate General of Health Services (DGHS), Nirman Bhawan, New delhi vide their Circular No. Z.22025/4/2007-CGHS (Stats. Cell) dated 02.03.2010 are given below. The concerned PSA will calculate KVS share by deducting the employee contribution as mentioned in para ‘A’ from yearly contribution as indicated below. The PSA will then forward the total amount (KVS share & employee contribution) to the respective Deputy Commissioner where the retired official is residing.

(Figures in Rs.)

*(These rates have not been revised after 2009-10 by DGHS, Nirman Bhawan, New Delhi)

F. Medical claims, if any, will be reimbursed by the Kendriya Vidyalaya/ Regional Office/ ZIETs where the official is residing. The copy of CGHS card (Index Card) issued by CGHS has to be kept for record.

Yours faithfully,
sd/-
(Dr. Shachi Kant)
Joint Commissioner (Pers.)

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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: Z.15025/38/2018 /DIR/CGHS

545-A Nirman Bhawan, New Delhi
Dated the 14th May, 2018

OFFICE MEMORANDUM

Subject :- Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries
With reference to the above subject the undersigned is directed to draw attention to the OM No Z 15025/79/1/DlR/CGHS dated the 5th October 2016 and to state that it has now been decided to review the timelines prescribed for processing and settlement of medical claims of pensioner CGHS beneficiaries in compliance of the directions of Hon’ble Supreme Court of India in their Judgement in the WP(CiviI) No 694 of 2015 between Shiva Kant Jha Vs UOI delivered on 13th April 2018 and in supersession of the earlier guidelines as per the details given under:

Medical Claims not requiring Special approvals

Pensioner CGHS beneficiaries shall submit the Medical claims to the CMO I/C of the CGHS Wellness Centre , where the CGHS Card is enrolled . CMO I/C of CGHS Wellness Centre issues Serial Number and sends the claim papers to the office of the Addl. Director, CGHS for processing. The Bills shall be processed by the Dealing Asstants and CMO and after the approval by the Additional Director, the bill for payment shall be sent to the Pay & Accounts Office for payment to the beneficiary by ECS. The payment shall be completed within 30 days of submission of the Medical claim papers at the CGHS Wellness Centre.

Medical claims reguiring approval of higher authorities

Total time within 45 days in Delhi
Total time within 60 days in other cities

Medical claims reguiring opinion of specialists

Total time 45 days

2. Chief Medical Officer in charge shall thoroughly check the papers initially for the completeness of the requisite documents before accepting the claim papers to ensure that the claim papers are not returned subsequently for want of some documents.

3. If approval of Directorate or Ministry is involved, the Addl. Directors shall submit only e-file with self-contained note and recommendation, enclosing only relevant scanned documents. Care shall be taken not to regret medical claims of pensioner CGHS beneficiaries on minor technical objections if , they fall under procedural lapses, which can be condoned.

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

Source: cghs.gov.in

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Indian Banks’ Association

HR & INDUSTRIAL RELATIONS
No CIR/HR&IR/2015-16/XBPS/J/1413
October 1, 2015

To,
All Member Banks which are parties to the Bipartite Discussions

Dear Sir/ Madam,

Implementation of Medical Insurance scheme to Retirees as agreed vide Bipartite Settlement/ Joint Note Dated 25th May, 2015

We refer to our letter No CIR/HR&IR/2015-16/XBPS/961 dated the 29th June, 2015 in terms of which the member Banks parties to the Bipartite Discussions were advised that the medical Insurance Scheme will be extended to the existing retirees also, subject to payment of the agreed Insurance Premium by them. It was also advised to bring to the notice of the existing retirees, the contents of the said scheme and obtain their consent as to whether they are willing to join the Scheme and on receipt of their consent, the details were to be provided to the Lead Insurer i.e. United India Insurance Co. Ltd. appointed by IBA for the purpose.

2. We have been advised by M/s K.M. Dastur Reinsurance Brokers duly authorized by the Lead Insurance Company to collect the employees as well as retirees data from the Banks, that while the employees data has been received by them from the Banks, the retirees data is yet to be provided by the Banks to them. As such, the United India Insurance Co. Ltd. has calculated the premium in respect of the employees of the concerned Banks and has demanded to remit the premium accordingly to them so that Mediclaim Policy in respect of employees may be implemented preferably from 1st October, 2015.

3. In this connection, we advise that a separate Mediclaim Policy in respect of retirees will be issued on similar terms and conditions as is applicable to serving employees, once the data is provided by the Banks to United India Insurance Co. Ltd. through their authorized broker M/s K.M Dastur Reinsurance Brokers and Insurance Premium is remitted to the Insurance Co. The Insurance Premium for retirees is also same as is for serving Employees which is as under :

4. Participating Banks are therefore requested to obtain the consent of the retirees expeditiously and provide the details on prescribed format to M/s K.M Dastur Reinsurance Brokers to enable the Insurance Co. to calculate the Insurance Premium in respect of retirees of the concerned banks accordingly. To make the Mediclaim Insurance Policy operational w.e.f. 1st November, 2015 for retirees, it is suggested to inform the retirees to give their consent for joining the Scheme latest by 25th October, 2015. We have requested to Lead Insurer to allow a grace period of three months to such retirees who could not give their consent by stipulated date as suggested above to join the Scheme after Mediclaim Policy is made operational. In exceptional circumstances, to the satisfaction of the concerned Bank, the request of the retirees may be considered to join the scheme during the currency of the Policy. The Insurance company has agreed for the same.

5. It is pertinent to mention that United India Insurance Co. Ltd conducted workshops in the month of July in Mumbai, Delhi, Chennai and Bengaluru covering representatives from all participating Banks to disseminate the salient features of the Policy, benefits available to the employees/ retirees and to clear the doubts/queries raised by the participants.

6. Please, therefore, make all out efforts to operationalize. the MediclaimPolicy for retirees preferably from 1st November, 2015

Yours faithfully,

sd/-

K.Unnikrishnan

Deputy Chief Executive

Authority: www.iba.org.in

Click to view the circular

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No. S. 14025/19/2015-MS
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare

Nirman Bhagavan, New Delhi
Dated : 27th May, 2015.

OFFICE MEMORANDUM

Subject: Revision of time limit for submission of final claims reimbursement of medical expenses under CS(MA) rules, 1944 – regarding.

The undersigned is directed to refer to OM No. F. 29-40/68-MA dated 15.10.1968 in which it was laid down that submission of final claims for reimbursement of medical expenses of Central Government servants in respect of a particular spell of illness should ordinarily be preferred within 3 months from the date of completion of treatment.

2. A representation was received from National Council (Staff Side) to extend the time limit for submission of such medical bills from 3 months to 6 months. The matter was examined in the Ministry and it has been decided that the period of 3 month s for submission of medical claims be revised to 6 months. Henceforth, only the cases in which the bills are submitted after 6 months from the date of completion of medical treatment/discharge of the patient from the hospital are required to be taken up for condonation. The power of condonation of such delays and other terms and conditions woukld be same as enumerated in the OM No.S.14025/8/99/-MS dated 25.05.1999.

3. The issue with the approval of the competent authority.

(Sunil Kumar Gupta)

Under Secretary to the Govt. of India

Source : mohfw.nic.in

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Admn. Section
Corporate Office
Bharat Sanchar Bhawan

BHARAT SANCHAR NIGAM LIMITED
(A Govt. of India Enterprise)

No. BSNL/Admn.I/15-3/11(Vol.II)

Dated: June 13th 2014

To
To All CGMS, BSNL
Sub: BSNLMRS – guidelines for regulation of expenditure on indoor treatment – cases where no CGHS rates are prescribed for any treatment/procedure.

Cases are referred to Corporate Office for settlement of medical claims where CGHS rates are not available. Where CGHS rates are not available, the cases are settled as per AIIMS rates. On seeking rates from AIIMS for various implants/devices and procedures, Administrative Office (H) of AIIMS has informed that the rate list of AIIMS is avaiiable on their website – www.aiims.edu I www.aiims.ac.in (link Hospital Zone-patient care service), wherever the rates of a particular disease are not available, the concerned Department/specialist doctor may be contacted [copy enclosed].
All the field units are requested to refer the rate list of AIIMS at their website and in case of non-availability of rates in the rate list they may directly refer their cases to concerned department of the AIIMS.

sd/-
(Raj Kumar Kushtwar)
Assistant General Manager (Admn.III]
Tel. No. 23037241 Fax No. 23734260

Source: bsnleuchq.com
[http://www.bsnleuchq.com/AIIMS%20rates%20(1).pdf]

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