Reimbursement of medical claims to pensioners residing in non-CGHS areas-DOT
No: 4-35(01)12019-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 pensioners 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. S.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 all 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 mandatorily 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.
(S.C. Karol)
Director (Estt.)
Phone. 23036500
RAJESH says
Dear Team,
This is Rajesh, i would like to know about CGHS facility. In state govt of Andhrapradesh maximum government employees avail their health cards even they are far from govt employees treatment available hospitals, but in Central government system not giving any health cards above 20 kms far from CGHS approved hospitals, The Central government system is bigger than and profitable than any state government departments, still reimbursement procedure is going on, but in this lot of complications are there, while claiming reimalbursment they have to submit government doctor refering slip and then they went to Town or city there also they require government doctor refering slip if there is no facility for treating the patient in that hospital, if the patient went to private hospital again Department ask for The hospital should have permission for Central government employees treatment facility document who has given permission from the central government.
Here we consider one point sir/madam how can do these things when employee got emergency?
In central government departments like Central water commission lot of sites are residing near to river banks and even telephone signals are not there at present. Lot of people struggling while claiming reimbursement, and even loss lot of amount for not submitting required documents. In emergency situation no one get any idea about these procedures.
Please consider my request and please look in to this issue, lot of people are struggling even they don’t know how to rise the voice about this issue.
Please help in this regard and save many people’s life and money.
Thanking you,