DOP&PW – 5th Pay Commission fixed Medical Allowance @ Rs.100/- P.F. to Central Govt, Pensioners residing in areas not covered under CGHS

(i)               In the case of those pensioners who are in receipt of two pension’s viz., service pension and another family pension and military pension and another Civil pension, to which category of pension, medical allowance of Rs.100/- shall be
allocated.

(i)               If any pensioner or family pensioner receives two pensions, only single medical allowance @ Rs.100/- p.m. id admissible, if he/she does not avail of the medical facilities provided by the respective organisations. As regards, pensioner who gets both military pension and civil pension, if the pensioner avails of the medical facilities provided by one of the civil or military organisations, he is not entitled to medical allowance and if the does not avail medical facilities from any of the organisations, he is entitled to medical allowances for only one of
the two pensions.

(ii)             In case of family pension is being shared by two family pensioners i.e. two windows, whether the fixed medical allowance permissible should be granted @ Rs. 50/- to each of the two windows.

(ii)            Where the family pension is shared by two windows, same criteria may be adopted as in the case of dearness relief is adopted.

(iii)            Are the re-employed pensioners/employed family pensioners, who are claiming re-reimbursement of medical expenses under CGHS rules, entitled to medical allowance or
not.

(iii)           Re-employed pensioners/employed family pensioners are not entitled to medical facilities are provided by his/her organisation.

(iv)            Whether beneficiaries of ex-gratia pension are entitled to medical allowance or
not.

(iv)           The beneficiaries of ex-gratia are not entitled to medical allowance, as they are not treated as Central Govt. Pensioners/family pensioners.

(v)              Whether the Pensioners who are getting their pension from the places covered by CGHS and are residing at other places not covered by CGHS are entitled to medical allowance or not.

(v)             The medical allowance should be granted to the pensioner on the basic of the declaration given by him.

(vi)           This scheme is applicable to those who are residing in areas not covered by CGHS etc., but as per para 3 of the O.M. an option is to be obtained from future retires as to whether they want to avail of medical facilities under CGHS etc., or they want to claim fixed medical allowance of Rs.100/- . This seems to be contradictory because those residing in CGHS areas would not be entitled for the medical allowance whether they opt or do not opt and on the other hand, those who are residing in areas not covered by CGHS, have no option to avail the CGHS facilities and the only way for them is to accept medical allowance. Therefore,
obtaining any option from either category of pensioners would not be required. The address on the PPO would be the deciding factor to ascertain the area.

(vi)           Only those pensioners who are residing in an area not covered by CFGS, and specifically opt for not availing of out-door facilities in the nearest CGHS dispensary, are entitled to receive medical allowance. It is, therefore, essential to obtain a specific option from them that they do not wish to avail of OPD facilities in the nearest CGHS dispensary.

(vii)          Even though the subject matter of the O.M. Stipulates grant of medical allowance to Central Govt. pensioners residing in areas not covered under CGHS, the provision of para 3 and 4 of the said O.M. entitles a pensioner for the fixed medical allowance even if he is residing in an area covered under CGHS or other similar scheme but he will not be entitled for out-door facilities provided by CGHS. The CGHS card in such cases need to be endorsed suitably in order to restrict availing facilities of out-door and in-door as the case may be. Suitable entries in this regard should also be made by the PDA in the
PPO/PC.

(vii)         Clarified against item (VI) above. The provision for endorsing the cards has been prescribed to prevent his use of the CGHS card.

(viii)        As per para 3 of the O.M. an option is to be exercised once for all. For this an annual undertaking is required to be furnished by thee pensioners to his PDA to regulate payment of monthly allowance or otherwise, situation may arise when a pensioner residing in CGHS area and was availing facilities thereof, changes his residence and resides in an area not covered under CGHS or similar other Scheme of the Govt. He would then be required to surrender his PPO/PC to his new PDA for regulating payment of allowance or otherwise. Similarly, when a pensioner residing in an area not covered under CGHS and thus a recipient of medical allowance, changes his residence and resides in an area covered under CGHS, discontinuance of the allowance will have to be suitably endorsed in the PPO/PC by the PDA. A fresh option /undertaking shall have to be given by the pensioner for payment /discontinuance of the allowance. It is felt that one time option will not be a fruitful proposition.

(viii)        To prevent miss-use of claiming medical allowance, the provision for exercising one time option at the time of retirement has been prescribed. The frequent changes in residential address by a pensioner from CGHS covered area and vice-versa would cause hardships to the pension disbursing authority. Only one change in option in the life-time of a pensioner shall be allowed.