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

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:

Sl. No.	Corresponding levels in the Pay Matrix as per 7th CPC	Contribution (Rs. Per month)
1.	Level: 1 to 5	250
2.	Level: 6	450
3.	Level: 7 to 11	650
4.	Level: 12 & above	1000

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

Sl. No.	Corresponding Basic Pay drawn by the officer in 7th CPC per month	Ward entitlement
1.	Up to Rs. 47,600/-	General
2.	Rs. 47,601/- to Rs. 63,100/-	Semi-Private
3.	Rs. 63,101/- and above	Private

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 month	Ward entitlement
1.	Up to Rs. 63,100/-	General
2.	Rs. 63, 101/- to Rs. 80,900/-	Private
3.	Rs. 80, 901/- and above	Deluxe/Private

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

To.
Pr. CCAs/ CCAS

Grant of 90% medical advance for all treatments (IPD and OPD) under CGHS and CS(MA) Rules, 1944

No.S. 14025/18/2015-MS/EHSS
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 17th October, 2016

OFFICE MEMORANDUM

Subject: Grant of 90% medical advance for all treatments (IPD and OPD) under CGHS and CS(MA) Rules, 1944.

The undersigned is directed to refer to O.M.NO.S. 14025/7/94-MS dated 15.05.1996, and OM No.S.12025/1/96-CGHS(P) dated 1305.1997 provisioning, inter-alia, grant of advance upto 90% in case of major illness like by-pass surgery, Kidney transplant, major cancer treatment, etc.

2. During the meeting held on 25.03.2015, National Council (Staff Side) requested this Ministry to make provisions for grant of 90% advance of the estimated cost for all treatments for serving Central Government employees, irrespective of major or minor diseases.

3. The matter was examined in the Ministry. Considering that the basic purpose of grant of advance for treatment of any disease is to provide relief to a Government employee from facing hardship, it has been decided with the approval of the competent authority that serving CS(MA) and CGHS beneficiaries may be granted 90% medical advance of the approved CGHS package rates for all indoor treatments, irrespective of major or minor diseases, on receipt of a certificate from the treating physician of a Government/recognized hospital as per the guidelines given in the OM No.S.14025/7/94-MS dated 15.05.1996 and OM No.S-11016/1/92-CGHS(P) dated 29.10.1992 for CS(MA) and CGHS beneficiaries respectively.

4. For out-door treatment, it has also been decided that advance may be limited to 90% of the total estimated expenditure of the treatment, subject to the condition that the advance for OPD treatment may only be granted when the total estimate of expenditure for OPD treatment including tests/investigations is more than Rs.10,000/-.

5. The advance should be released within 10 days on receipt of the request for advance by the administrative Department/Ministry/office in order to avoid inconvenience to the employees.

6. The OM No.S.12025/1/96-CGHS(P) dated 13.05.1997 stands withdrawn from the date of issue of this O.M.

(Sunil Kumar Gupta)
Under Secretary to the Govt. of India

Source : Confederationhq

Abolishing 12 Interest free advances including LTC Advance recommended by 7th CPC

7th Pay Commission recommendations on LTC advance and Medical Advance

Abolishing 12 Interest free advances recommended by 7th CPC

The 7th Pay Commission has , in a casual manner, recommended that all interest free advances to be abolished. The impact of this recommendation is yet un noticed by the central government employees
There are 12 Interest free advances are listed in that table provided in the 7th CPC Report. When hearing the news that 7th cpc has recommended to abolish interest free advances , every body thought that some advances like festival advances only will be abolished. But if you read the names of advances recommended for abolishment, it will give you little bit shock.

In general opinion, the amount that is paid for government servants in some occasions and for specific purposes and the same will be recovered through monthly instalments are considered advances.

But the advance paid for Medical treatment and LTC are not supposed to be included this list, since it is reimbursable in nature and will not be recovered by Government.

The amount paid as advances to the Medical treatment and LTC are not recoverable by government if there is no any default in the claim. since the expenses incurred should be reimbursed to the Govt servants according to their entitlements, the amount paid in advance can be adjusted against the claim of reimbursement is sanctioned. So there is no need of repaying the advance to government in respect of Medical and LTC advances.These should not be included in the list of interest free advances.

Eventually abolishing these advances will make the central government employees not to avail LTC facility and medical treatment in Private hospital, since the amount of 90 % of the expenses paid in advance will not be available for them any more due to this recommendation. By availing this advances they were able to manage the Medical Expenses and by availing this advance only they were able to bye Air or Train Tickets to go on LTC.

Without these advances, the Group C and B employees cannot imagine availing of LTC to visit some places in India with their family.

The Central Government should not accept the proposal of Abolishing these advances.

Source: GServants.com