Health Ministry implements New Health Insurance for Central Government Employees and Pensioners

Health Ministry implements New Health Insurance for Central Government Employees and Pensioners

Details of the meeting held between members of the National Council (JCM) and the Health Ministry regarding CGEPHIS.

On 14-07-2010, a meeting was held between Staff Side members of National Council (JCM) and the Ministry of Health regarding the new proposed Health Insurance Scheme for Central Government Employees and Pensioners.

The Joint Secretary (Regulation) Shri. Vinet Chawdhry presided over the meeting.

The Staff Side members
Shri. S.K.Vyas (Audit),
Shri. C.Srikumar (AIDEF),
Shri. Shiv Gopal Mishra (AIRF) and
Shri. Guman Singh (NFIR) attended the meeting.

The chairman welcomed the Staff Side National Council members to the meeting to discuss the proposed Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS). He further explained the benefits arising out of the new proposed scheme in detailed and the Union Government is eager to implement this scheme as soon as possible, as recommended in the 6th CPC and to directions of Committee of Secretaries (COS).

After the detailed speech by the Chairman, members also expressed their own views. The explained the discrepancies of this new Health Insurance scheme and also requested the ministry to expand the existing Central Government Health Scheme. They also insisted that some points in the CS (MA) Rules should be withdrawn and it should be useful for the serving employees as well as pensioners.

As some news sources said that, finally the members concluded that they were against the new Health Insurance Scheme and they further opined that the proposed Health Scheme will also deprive the existing benefits available to the employees and pensioners viz. OPD facilities, coverage to all dependent family members etc. Extension to all CS(MA) Rules, 1944 to all pensioners living in Non CGHS areas is their long pending demand.

Source: Government Employees News

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STATE WISE CENTRAL GOVERNMENT PENSIOERS DETAILS

Health insurance plan for govt staff takes off

The Ministry of Health and Family Welfare has got cracking on the Sixth Pay Commission’s plan to introduce health insurance scheme for central government employees that would dramatically increase the number of locations and hospitals where they can access medical facilities.

The ministry has invited quotes for premium payments from non-life/health insurance companies, while an expert group advising the ministry on the scheme’s contours has met several times.

The insurance plan substantially adds to the current Central Government Health Scheme that covers only 24 districts and that too only for outpatients. It has a cumbersome system under which a CGHS-empanelled doctor can prescribe hospitalisation.

The introduction of Central Government Employee and Pensioners Health Insurance Scheme (CGEPHIS) will change all that.

“We have already floated the request for quotes from insurers on February 28. We expect the scheme to be finalised soon. The employee and his family will be covered for hospitalisation and surgical procedures for an amount of Rs 5 lakh,” said a ministry official close to the development.

There are an estimated 1.7 million families of serving employees and 700,000 retired employees under the CGHS. Sanjay Pande, managing director, Amicus Advisory said, employees will now have access to 3,000 hospitals and nursing homes under the new scheme.

The new scheme is being made compulsory for new entrants as well as those who retire after the launch of the planned scheme. It is optional for those retiring before the scheme is launched.
Source: Hindustantimes

Appendix-E

STATE WISE DETAILS OF CENTRAL GOVERNMENT
PENSIONERS

S.No.	Name of State	No. of Pensioners
1.	Assam	19,034
2.	Delhi	1,57,937
3.	Jharkhand	12,361
4.	Goa	1,959
5.	Maharashtra	72,475
6.	Tamilnadu	35,324
7.	West Bengal	74,140
8.	Bihar	26,907
9.	Gujarat	16,139
10.	Karnataka	23,308
11.	Rajasthan	33,758
12.	Uttar Pradesh	56,352
13.	Andhra Pradesh	33,763
14.	Kerala	40,033
15.	Uttranchal	34,378
16.	Himachal Pradesh	23,117
17.	Madhya Pradesh	20,849
18.	Daman & Diu	4
19.	Jammu & Kashmir	10,603
20.	Manipur	3,301
21.	Orissa	9,458
22.	Chattirgarh	2,100
23.	Nepal	7,514
24.	Tripura	4,893
25.	Andaman & Nicobar	12,909
26.	Meghalaya	3,087
27.	Chandigarh	9,506
28.	Haryana	40,219
29.	Mizoram	344
30.	Pondicherry	1,405
31.	Sikkim	624
32.	Arunachal Pradesh	2,451
33.	Nagaland	1,979
34.	Punjab	32,754
	Total	8,24,958

(Source: Central Pension Accounting Office)
Note: CGHS Card Holders (Pensioners): 2,53,868 (as on 31.3.08)

Appendix-D

City wise CGHS package rates applicable on States

S.No.	CGHS Rates	State
1.		A&N Islands
2.	Hyderabad	Andhra Pradesh
3.	Guwahati	Arunachal Pradesh
4.	Guwahati	Assam
5.	Patan	Bihar
6.	Chandigarh	Chandigarh
7.	Bhopal	Chattishgarh
8.	Ahmadabad	Dadra & Nagar Haveli
9.	Ahmadabad	Daman & Diu
10.	Delhi	Delhi & Diu
11.	Pune	Goa
12.	Ahmadabad	Gujarat
13.	Chandigarh	Haryana
14.	Chandigarh	Himachal Pradesh
15.	Chandigarh	Jammu & Kashmir
16.	Randhi	Jharkhand
17.	Bangalore	Karnataka
18.	Thiruvanthapuram	Kerala
19.	Thiruvanthapuram	Lakshadweep
20.	Bhopal	Madhya Pradesh
21.	Mumbai	Mumbai including Navi Mumbai
	Pune	Rest of Maharashtra
22.	Guwhati	Manipur
23.	Guwhati	Meghalaya
24.	Guwhati	Mizoram
25.	Guwhati	Nagaland
26.	Bhubaneswar	Orissa
27.	Chennai	Pondicherry
28.	Chandigarh	Punjab
29.	Janipur	Rajasthan
30.	Guwahati	Sikkim
31.	Chennai	Tamilnadu
32.	Guwahati	Tripura
33.	Lucknow	Uttar Pradesh
34.	Deharadoon	Uttarkhand
35.	Kolkata	West Bengal

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Government introduce a new Medical Scheme for Central Government Employees and Pensioners

Government introduce a new Medical Scheme for Central Government Employees and Pensioners as in the name of Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS). In all over India, pensioners are getting meager amount of Rs.100 as Medical Allowance (except CGHS beneficiaries). It is estimated that approximately 17 lakh serving employees and 7 lakh pensioners shall be offered this Scheme and Government plan to enroll all serving employees and pensioners on compulsory / optional basis.

Some key points regarding the scheme:-

CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME (CGEPHIS)

BENEFICIARIES:
CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the Health Insurance Scheme.

CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.

CGEPHIS would be available on voluntary basis for the following:
Existing Central Government Employees and Pensioners who are already CGHS beneficiaries. In this case they have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total insurance premium has to be borne by the member.

Existing Central Government Employees and Pensioners who are not CGHS beneficiaries but are covered under CS (MA)

INSURANCE COVERAGE:
In-patient benefits – The Insurance Scheme shall pay all expenses incurred in course of medical treatment availed of by the beneficiaries in an Empanelled Hospitals/ Nursing Homes (24 hours admission clause) within the country, arising out of either illness/disease/injury and or sickness.

NOTE: In case of organ transplant, the expenses incurred for the Donor are also payable under the scheme.

Pre & Post hospitalization benefit: Benefit up to 30 days Pre Hospitalization & up to 60 days Post Hospitalization respectively which would cover all expenses related to treatment of the sickness for which hospitalization was done.

FAMILY SIZE:
Serving/Retired Employees: Self, Spouse, Two dependent children and up to Two Dependent Parents. New born shall be considered insured from day one till the expiry of the current policy irrespective of the number of members covered subject to eligibility under maternity benefit.

Any additional dependent member in addition to above [Sr. No. 5 (1)] can be covered under the Scheme by paying the fixed amount of premium. This additional full premium shall be borne by the beneficiary.

IDENTIFICATION OF FAMILY:
Beneficiaries shall be identified by a “Photo Smart Card” issued by the insurer to all beneficiaries which would have all personal details, medical history, policy limits etc. of the CGEPHIS members. This card would be used across the country to access Health Insurance Benefits. The photograph embedded in the chip of the Smart Card will be taken as the proof for determining the eligibility of the beneficiaries.

SUM INSURED AND BUFFER / CORPORATE SUM INSURED
SUM INSURED:
The Scheme shall provide coverage for meeting all expenses relating to hospitalization of beneficiary members up to Rs. 5, 00,000/- per family per year in any of the Empanelled Hospital/Nursing Home/Day Care Unit subject to stated limits on cashless basis through smart cards. The benefit shall be available to each and every member of the family on floater basis i.e. the total reimbursement of Rs. 5.00 lakh can be availed by one individual or collectively by all members of the family.

Entitlements for various types of wards: CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their pay drawn in pay band / pension. These entitlements are amended from time to time and the latest order in this regards needs to be followed. The entitlement is as follows:-

Pay drawn in pay band/Basic Pension - Entitlement
Rs. 13,950/-(up to)……………………………… General Ward
Rs. 13,960/- to 19,530/- …………………… Semi-Private Ward
Rs. 19,540/- and above ……………………… Private Ward

CASHLESS ACCESS SERVICE:
The Insurer has to ensure that all CGEPHIS members are provided with adequate facilities so that they do not have to pay any deposits at the commencement of the treatment or at the end of treatment to the extent as the Services are covered under the Scheme. The service provided by the Insurer along with subject to responsibilities of the Insurer as detailed in this clause is collectively referred to as the “Cashless Access Service.”

The services have to be provided by the Empanelled Hospitals/Nursing Homes/Day Care Clinics to the beneficiary based on Photo Smart Card authentication only without any delay. The beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/sub-limits of defined package rates and sum insured, i.e., not specifically excluded under the scheme.
ENROLMENT PROCESS
The process of enrolment shall be as under:
Serving Employees:
1. Departments and offices will call for options from employees to join voluntary CGEPHIS with or without existing CGHS/CS (MA) benefits.

2. Head of Department of the Administrative Ministry/Department would be the contact point for the Insurance Companies.

3. Enrolment forms giving details about self and family and authorization to the department for recovery of premium on a monthly basis would be consolidated by the Administrative Ministry / Department. The data of the beneficiary and dependent members to be covered along with 2 recent passport size photo and copy of enrolment form will be forwarded to Insurance Company on monthly basis.

4. Insurance Company will issue Smart Cards on the basis of information received of the beneficiaries for enrolment.

5. Such Smart Cards along with the enrollment kit shall be sent by the insurers directly to the insured persons at their respective mailing addresses at insurer’s cost within 7 days.

Insurance Premium:-
The beneficiary will have to pay an annual premium which will be determined after the formal introduction of the Scheme. It will vary according to the grade pay of the officer. The estimated annual premium for a standard family size will be in the range of Rs.8000 to Rs.12000 p.a. It is however proposed to be subsidized by the Government to a considerable extent.

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Government have proposed to introduce a new "Central Government Employees & Pensioners Health Insurance Scheme" for all serving & retired employees

Ministry of Health & Family Welfare, Government of India have proposed to introduce a new "Central Government Employees & Pensioners Health Insurance Scheme" (CGEPHIS) for all serving employees and pensioners.

Central Government Health Scheme (CGHS) is a scheme for providing health care to serving Central Government employees and their dependant family members. Over the years, the scheme has been extended to cover central government pensioners, their dependant family members and certain other categories like members of parliament and ex-members of parliament, freedom fighters etc. Employees of some select autonomous bodies as also PIB accredited journalists have also been extended CGHS facilities on cost-to-cost basis in Delhi. Central Government Health Scheme is available in 25 cities [Delhi (including Noida, Gurgaon, Faridabad, and Ghaziabad), Ahemdabad, Allahabad, Bangalore, Bhopal, Bhubaneshwar, Chandigarh, Chennai, Dehradun, Guwahati, Hyderabad, Jabalpur, Jaipur, Jammu, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong and Thiruvanthapuram]. Central Government Employees living outside the CGHS areas are entitled to reimbursement for medical attendance and treatment under the Central Services (Medical Attendance) Rules [CS(MA) Rules]. Pensioners of the Central Government are not covered under these rules. At present, Central Government Pensioners living in non-CGHS areas are paid a sum of Rs. 100 p.m. for meeting their medical expenditure. Consequently, there has been a long standing demand from Central Govt. pensioners residing in non CGHS areas for medical services at par with those available to Central Govt. pensioners in CGHS areas. The VIth Pay Commission has recommended the introduction of a health insurance scheme in lieu of the CGHS.
Government of India, therefore, proposes to provide inpatient health care services to their all personnel of the Central Government including All India Service officers, serving and retired, and others who are covered under the existing CGHS (Central Government Health Services) and under CS (MA) Rules [Central services (Medical attendance) Rules] through a Health Insurance Scheme catering to their health care requirements. The proposed scheme shall be on voluntary basis for current set of employees & pensioners but compulsory for future employees & pensioners. The existing CGHS beneficiaries will have an option to avail CGHS facilities for OPD requirements and the insurance scheme for inpatient treatment.
With the introduction of health insurance scheme, the Central Government Employee (existing/ retired) will have the choice to select the best available health facilities for meeting their health care and can get best available treatment in areas in the close proximity.
Ministry of Health & Family Welfare, Government of India invites Expressions of Interest from Insurers and Health Insurance consultants for the proposed scheme.
NAME OF THE SCHEME
The name of the proposed scheme is Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS).
BENEFICIARIES
All personnel of the Central Government including All India Service officers, serving, newly recruited, retired and retiring and others who are covered under the existing CGHS(Central Government Health Services) and under CS (MA) [Central Services (Medical Attendance) Rules] Rules shall be offered Health Insurance Scheme on voluntary or on compulsorily basis . This could be:
CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the health Insurance Scheme.
CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.
CGEPHIS would be available on voluntary basis for the existing Central Government Employees and pensioners serving in CGHS area/ covered by CGHS. In this case such serving Central Government Employees and Central Government existing Pensioners shall have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total premium has to be born by the beneficiary.
CGEPHIS would also be available on voluntary basis for the existing serving employees and pensioners in non-CGHS areas not covered by CGHS. In this case such serving Central Government Employees and existing Pensioners (who have opted for CGHS facility) shall have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total premium has to be born by the beneficiary.
More detail... Click the link...
http://mohfw.nic.in/AA-CGEPHIS.doc

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