Reimbursement of Medical Claims to Pensioners under CS(MA) Rules 1944 as directed by various CATs and Courts

Reimbursement of Medical Claims to Pensioners under CS(MA) Rules 1944 as directed by various CATs and Courts

No. 5.14025/23/2013-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, 1944 as directed by various CATS/Courts - Regarding.

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:

a) Pensioners residing in CGHS covered areas:
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 optout cf CGHS and avail anyother medical facility {i.e. Fixed Medical Allowance). Such pensioners, if they do not choose to avail CGHS facility by depositing the required contributions, cannot be granted Fixed Medical allowance in lieu of CGHS.

b) Pensioners residing in non - CGHS areas:
1). They can avail Fixed Medical Allowance (FMA) @ 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 CG HS for IPD treatments after making the required subscriptions as per CGHS 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 the 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 for 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

Source: [CGHS.GOV.IN]

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CS(MA) Rules 1944 are not applicable to pensioners – Health Ministry

CS(MA) Rules 1944 are not applicable to pensioners – Health Ministry

Medical Facilities to Government employees

Central Government Health Scheme provides medical care to its beneficiaries which include serving as well as retired Central Government employees. The CGHS provides its services through a network of CGHS Wellness Centers which are in operation presently in 25 major cities of the country. Expenditure on medical reimbursement in respect of pensioners is borne by CGHS and in respect of serving employees it is borne by concerned Ministry/ department/office. The pensioner beneficiaries are eligible for credit facility for treatment in CGHS empanelled hospitals.

Central Services (Medical Attendance) Rules, 1944 are applicable to serving Central Government employees only who are residing in non-CGHS covered areas. Medical attendance is provided by the Authorized Medical Attendant appointed by concerned department. The CS(MA) Rules 1944 are not applicable to pensioners. As per these Rules, there is no provision for issue of medicines and medical reimbursement claims are to be settled by the concerned department/ Ministry.

The Health Minister stated this in a written reply in the LokSabha here today.

Source: PIB

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Criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary

Criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary

 

The below information is tabled to a question in Lok Sabha on 11th July 2014 by the Minister of Helath and Family Welfare Shri Harsh Vardhan as follows…

 

The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area are as under:-

(i) In an existing CGHS city:- For opening of a new Allopathic CGHS dispensary in an existing CGHS city, there has to be a minimum of 2000 Card holders (serving employees of Central Government and Central Civil pensioners).

(ii) Extension of CGHS to a new City:- For extension of CGHS to a new city, there has to be a minimum of 6,000 Card holders. However, due to financial and other resource constraints it is not always possible to adhere to the above criteria.

(b): The details about number of CGHS allopathic/AYUSH dispensaries and Hospitals in the country, State/UT-wise are at Annexure.

 

Keeping in view the financial and other resource constraints, a decision has been taken not to expand CGHS to cover new cities/ areas. There are some States and UTs which do not have the presence of CGHS as yet. Accordingly, the Ministry has mooted a proposal to open at least one CGHS dispensary in the capital city of such States/UT’s namely, Himachal Pradesh, Chhattisgarh, Goa, Arunachal Pradesh, Tripura, Manipur, Mizoram, Sikkim, Nagaland, Gujarat and Pudduchery.

 

In addition, there is also a proposal to open one CGHS dispensary in Indore in compliance of the High Court’s directions.

 

ANNEXURE

STATEMENT SHOWING DETAILS OF CGHS HOSPITALS/WELLNESS CENTRES

S.No.	City	ALLOPATHY	POLYCLINIC	AYUSH	CGHS HOSPITALS
1	AHMEDABAD	8	1	2	0
2	ALLAHABAD	7	1	2	0
3	BANGALORE	10	1	4	0
4	BHOPAL	2	0	0	0
5	BHUNESHWAR	3	0	1	0
6	CHANAI	14	2	4	0
7	CHANDIGARH	1	0	0	0
8	DEHRADOON	2	0	0	0
9	GUWAHATI	5	0	1	0
10	HYDERABAD	13	2	6	0
11	JAMMU	2	0	0	0
12	JAIPUR	7	1	2	0
13	JABALPUR	4	0	0	0
14	KANPUR	9	0	3	0
15	KOLKATA	18	1	4	0
16	LUCKNOW	9	1	3	0
17	MEERUT	6	0	2	0
18	MUMBAI	26	2	5	0
19	NAGPUR	11	1	3	0
20	PATNA	5	1	3	0
21	PUNE	9	1	3	0
22	RANCHI	3	0	0	0
23	SHILLONG	2	0	0	0
24	TRIVENDRUM	3	0	2	0
25	DELHI	94	4	36	4
	TOTAL	273	19	85	4

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Dental Clinics in CGHS Dispensaries

Dental Clinics in CGHS Dispensaries

The dental services in CGHS Delhi have been outsourced in 13 Wellness centres (5 under Central Zone and 8 under South Zone) for 22 dental procedures. The location wise details are at Annexure-A.

The details of payments made to the service provider in respect of these clinics from the starting of the services till July, 2013 are at Annexure-B.

No specific complaint has been reported about irregularities committed by the dental clinics in connivance of CGHS officials. However, deficiency in services has been reported from the beneficiaries. An Inspection Committee has been constituted for regular inspection of the dental units to ensure proper delivery of services as per the terms and conditions of the agreement.

This information was given by the Union Minister of Health & Family Welfare ShriGhulamNabi Azadin written reply to a question in the LokSabha yesterday.
ANNEXURE -A
Details of  CGHS Wellness Centers where the Dental Care Services have been  outsourced

Central Zone: New Delhi

S.No.	Wellness Centers Name	Address
1	Dr. Z.H. Road (D44)	CGHS Building , Dr. Z.H. Road, New Delhi.
2	Chitra Gupta Road (D51)	CGHS Building, Near Aram Bagh. New Delhi.
3	Aliganj, Lodi Road 1(D9)	CGHS Building , Near Lodhi Road, New Delhi.
4	Kali Bari (D76)	CGHS Building, Kali Bari Marg, DIZ Area, New Delhi.
5	CGHS Dispensary Chanakyapuri	CGHS Dispensary Chanakyapuri. New Delhi.

South Zone : New Delhi

S.No.	Wellness Centers Name	Address
1	Sadiq Nagar (D63)	CGHS Dispy., Behind Siri Fort Road, Near G.K.-I, New Delhi.
2	SriniwasPuri	CGHS own Building, Sriniwaspuri, New Delhi.
3	PushpVihar (D78)	A-B/125, 126, 127 – Sector-IV, PushpVihar, New Delhi.
4	R.K. Puram-V (57)	CGHS Dispensary Building, Sector-XII, R.K. Puram.
5	MotiBagh (D16)	CGHS own Building near Begum Zaidi Market, MotiBagh, New Delhi.
6	Kidwai Nagar (D12)	CGHS Own Building, 61-63, Kidwai Nagar.
7	Kalkaji-I (D42)	CGHS Maternity Centre &Dispy., Kalkaji.
8	Faridabad (D70)	CGHS Dispensary Building, NH-4, Faridabad.

ANNEXURE –B

Details of Expenditure on Outsourced Dental  Units in CGHS Delhi

(Figures in Rs)

Sr.No	Month	Central Zone	South Zone	Total
1	Oct-11	448956	-	448956
2	Nov-11	497881	-	497881
3	Dec-11	4043711	-	4043711
4	Jan-12	-	-	-
5	Feb-12	-	-	-
6	Mar-12	176163	-	176163
7	Apr-12	1179142	2586424	3765566
8	May-12	13006909	-	13006909
9	Jun-12	1303705	5290870	6594575
10	Jul-12	484770	1928530	2413300
11	Aug-12	3552947	7443269	10996216
12	Sep-12	2663951	941197	3605148
13	Oct-12	2425373	-	2425373
14	Nov-12	3272900	-	3272900
15	Dec-12	2359883	-	2359883
16	Jan-13	1740479	2075111	3815590
17	Feb-13	298461	2490650	2789111
18	Mar-13	6519138	14361771	20880909
19	Apr-13	2582860	2586424	5169284
20	May-13	5579933	3251084	8831017
21	Jun-13	2628854	12823634	15452488
22	Jul-13	4296128	7420154	11716282

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