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Recommendations of Sixth Pay Commission, provided for implementing an alternative health insurance scheme in the place of existing CGHS. Of course, the existing CGHS requires to be revamped for the very reason that it caters to minority of Government employees.
While Central Government employees community are posted knook and corner of the country, the existing CGHS is limited only to 26 cities. As we all know, the rest of places are covered by Central services (Medical Attendance) Rules, which seldom serve the real purpose.
In this scenario, the present contemplation of the Government in bringing a new Health Insurance Scheme in the place of existing CGHS, and medical treatment under Central services (Medical Attendance) Rules, is positive and welcome one.
We provide here the official documents released by the Government (which is available in Ministry of health and family welfare) for assessing the willingness of the CG employees to join in the proposed health insurance Scheme. This documentation is named as Demand Survey.
We request all the Gconnect readers to go through the document and apply in the given format in case they are willing to join as beneficiary in the proposed health insurance scheme.
Some of our friends pointed out the documentation is slightly vague in the sense that whether the proposed scheme is applicable for non-CGHS centers as the filled up applications were required to be furnished at the CGHS centers available in 26 cities mentioned in the said documentation.
However, we feel that as per the wordings of the demand survey document as well as earlier proposals of the government the scheme has been proposed for non-CGHS centers also and the employees belonging to non-CGHS centers can send the willingness to the Deputy Director, Ministry of Health and Family Welfare directly (address mentioned in the document survey)
Government of India
Ministry of Health & Family welfare
Department of Health & Family welfare
Nirman Bhavan, New Delhi
CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME (CGEPHIS)
OBJECT OF DEMAND SURVEY – Government of India is contemplating introduction of a Health Insurance Scheme for Central Government Employees and Pensioners and their dependent family members all over India. Ministry of Health & Family Welfare intends to assess the demand for the above Scheme from the prospective beneficiaries through this survey for taking further steps in this direction.
WHO CAN JOIN THE SCHEME – All the 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 Scheme) and under CS(MA)Rules [Central services (Medical Attendance) Rules] Can join the Scheme. The Scheme is proposed to be implemented on voluntary basis for existing employees and pensioners and compulsorily for future employees and pensioners.
INSURANCE COVERAGE – The scheme shall provide coverage for meeting expenses of hospitalization and surgical procedures for beneficiary members up to Rs.5.00 lakh per family per year subject to limits, in any of the network hospitals. The benefit to the family will be on floater basis i.e. the total reimbursement of Rs.5.00 lakh can be availed of individually or collectively by members of the family.
Coverage of Pre-existing diseases: All diseases under the proposed scheme shall be covered from day one.
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.8,000 to Rs.12,000 p.a. It is however proposed to be subsidized by the Government to a considerable extent. The amount of premium shall be decided by the transparent process of bidding amongst the Insurance companies participating in the Scheme. In case of serving employees, the premium would be deducted by the Drawing & Disbursing Officer. In the case of pensioners, they would be required to authorize the Band branch from which they are drawing their pension, to deduct the insurance premium.
a) In case of serving employees, self, spouse, two dependent children and dependent parents would be covered. New born will be covered as a part of insured family member during the currency of the policy.
b) In case of retired employees, self, spouse, two dependent children and dependent parents would be covered.
1. Additional dependent family member can be covered under the scheme by paying an additional premium per additional family member. The premium shall be borne by the beneficiary and there would be no govt. subsidy for the same.
2. The definition of dependent shall be as per guidelines issued by Central Government from time to time.
Serving Central Government employees and Central Government pensioners, if interested in becoming a member of the proposed insurance scheme may send their details as per the format given below, to the Additional Director / Joint Director in the following cities nearest to his place, where CGHS is presently functioning, not later than 15th Feb. 2010.
Ahmedabad – Guwahati – Mumbai
Allahabad – Hyderabad – Nagpur
Bangalore – Jaipur – Patna
Bhubaneshwar – Jabalpur – Pune
Bhopal – Jammu – Ranchi
Chandigarh – Kanpur – Shillong
Chennai – Kolkata – Trivandraum
Delhi – Lucknow – Jammu
Dehradun – Meerut
Alternatively they can also send their details at the following address:
Ministry of Health & Family Welfare
Room No.529-A, Nirman Bhawan
New Delhi-110 108
E mail : firstname.lastname@example.org
FORMAT OF DEMAND SURVEY FOR THE CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME (CGEPHIS)
1. Name :
2. Designation :
3. Office Address :
4. Mailing Address :
5. e-mail id (if available) :
6. Date of Birth :
7. Age as on 01.01.2010 :
8. Date of Retirement :
9. Whether CGHS beneficiary :
(Yes / No)
10. Nearest CGHS location :
11. Family size :
(Details including gender & age)
I am interested in joining the Health Insurance Scheme as and when it becomes operational.