Reimbursement of Medical Claims to Pensioners Residing in Non-CGHS Areas | How do I Claim Medical Reimbursement for Pensioners

Reimbursement of Medical Claims to Pensioners Residing in Non-CGHS Areas

Pensioners residing in non -CGHS areas:

They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month.
They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.

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.

Also Read: Central Government Pensioners CGHS Medical Reimbursement

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.

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(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.

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

No. S.14025/23/2013-MS EHSS
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare

Nirman Bhavan, New Delhi
Dated the 29 September, 2016

OFFICE MEMORANDUM

Sub:- Reimbursement of medical claims to Pensioners under CS (MA) Rules, 1844 as directed by various CATS/Courts – Regarding.

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The undersigned is directed to state that various references are being received in Ministry of Health and Family Welfare on the above mentioned subject. It is hereby clarified that CS (MA) Rules, 1944 are not applicable to pensioners till date

2. It is further informed that the following options to avail medical facilities are available to Central Government pensioners:

Pensioners residing in CGHS covered ares:

Also Read: Payment of CGHS Contribution through Bharatkosh portal

1) They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD facilities.

2) Pensioners residing in CGHS areas cannot opt out of CGHS and avail any other medical facility (i.e. Fixed Medical Allowance). Such Pensioners, if they do not choose to avail CGHS facility by depositing the required cantributions, cannot be granted Fixed Medical allowance in lieu of CGHS.

b) Pensioners residing in non -CGHs areas:

1) They can avail Fixed Medical Allowance (EMA @ Rs.500/- per month.

2) They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.

3) They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGS guidelines.

3. In view of the above, reimbursement of medical claims to Pensioners under CS (MA) Rules, 1944 as directed by various CATs/Courts, need not be referred to Ministry of Health and Family Welfare. The respective administrative Department/Ministry may take their own decision in this regard.

4. Further, all Departments/Ministries are requested to intimate their employees proceeding fer retirement regarding the above options for medical facilities available to the Central Government pensioners.

5. This issues with the approval of competent authority.

SUNIL KUMAR GUPTA
UNDER SECRETARY TO THE GOVT. OF INDIA

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