Sunday, August 2, 2020

Reimbursement of medical claims to pensioners residing in non-CGHS areas - DoT



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


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:
Sl. No.Corresponding levels in the Pay Matrix as per 7th CPCContribution (Rs. Per month)
1.Level: 1 to 5250
2.Level: 6450
3.Level: 7 to 11650
4.Level: 12 & above1000
(B). Entitlement of words in private hospitals empanelled under CGHS
Sl. No.Corresponding Basic Pay drawn by the officer in 7th CPC per monthWard entitlement
1.Up to Rs. 47,600/-General
2.Rs. 47,601/- to Rs. 63,100/-Semi-Private
3.Rs. 63,101/- and abovePrivate
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:
Sl. No.Corresponding Basic Pay drawn by the officer in 7th CPC pre monthWard entitlement
1.Up to Rs. 63,100/-General
2.Rs. 63, 101/- to Rs. 80,900/-Private
3.Rs. 80, 901/- and aboveDeluxe/Private
(S.C. Karol)
Director (Estt.)
Phone. 23036500



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