Health Insurance Scheme for CGHS Beneficiaries

Ministry of Health and Family Welfare

Health Insurance Scheme for CGHS Beneficiaries

12 JUL 2019

The Sixth Central Pay Commission in its report had recommended the introduction of a Health Insurance Scheme for central government employees and pensioners and their dependent family members on pan India basis. Ministry of Health & Family Welfare has framed the draft health Insurance Scheme. OPD facilities are not covered under the proposed scheme. The draft scheme has been sent to the Department of Expenditure, Government of India, for appraisal and approval of the financial feasibility of the scheme.

The Minister of State (Health and Family Welfare), Sh Ashwini Kumar Choubey stated this in a written reply in the Lok Sabha here today.

PIB

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Cashless treatment of ESIC Employees and cash compensation for loss of wages: Loksabha Q&A

Cashless treatment of ESIC Employees and cash compensation for loss of wages: Loksabha Q&A

GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND EMPLOYMENT
LOK SABHA

UNSTARRED QUESTION NO: 875
ANSWERED ON: 21.11.2016

ESIC Employees

YOGI ADITYANATH
Y. S. AVINASH REDDY
KOTHA PRABHAKAR REDDY

Will the Minister of LABOUR AND EMPLOYMENT be pleased to state:-

(a) whether the Government has stopped/proposes to stop the cashless treatment of ESIC Employees;
(b)if so, the details thereof and the reasons therefor;
(c)the steps being taken by the government to alleviate problems of ESIC employees in this regard;
(d)whether the Health Insurance Scheme run by the Government provides guarantee of income which is necessary for livelihood and if so, the details thereof; and
(e)if not, whether the Government proposes to implement such schemes in future?

ANSWER

MINISTER OF STATE (IC) FOR LABOUR AND EMPLOYMENT (SHRI BANDARU DATTATREYA)

(a) & (c): No, Madam. The employees under ESI Scheme are eligible for cashless treatment in the ESI Hospitals and tie up hospitals. In case of emergency treatment outside the ESI network, the employees are reimbursed on CGHS rates or respective state rates.

(b): Not applicable in view of answer at (a) above.
(d): Yes, Madam. Under ESI Scheme, cash compensation for loss of wages is paid as under:

1. Sickness Leave - For 91 days @ 70% of wages
2. Temporary disablement - Till the spell of sickness lasts @ 90% of wages
3. Maternity leave - For 12 weeks (under revision to 26 weeks) @ 100% of wages
4. Unemployment allowance- @50% for first year and 25% for second year.

(e): Not applicable.

Source: Loksabha.nic.in

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Cashless health insurance for elderly likely in Budget

Cashless health insurance for elderly likely in Budget

Government is working on a cashless health insurance scheme for senior citizens which may be announced in the upcoming Union Budget 2016-17.

Around Rs 10,000 crore – lying unclaimed in banks and insurance companies, EPFO and small savings schemes — would be utilised for providing the health insurance cover to the elderly, sources said.

Senior citizens are often dependent on their children or extended families for healthcare, they said, adding that the proposed scheme will help in meeting secondary and tertiary health care needs.

The quantum of insurance cover would be more than Rs 50,000 for person over 60 years.

Finance Minister Arun Jaitley will present the central budget for the next financial year on February 29.
The proposed scheme will be administered by the Department of Financial Services under the Finance Ministry.

The government proposes to link this scheme to bank accounts of beneficiaries to directly transfer the subsidised amount to the accounts. As per the proposal, the government would subsidise the premium for those below poverty line by up to 90 per cent through cash transfers to their bank accounts.

It’s not that the government will forfeit these unclaimed funds, sources said, adding that if claimants come forward they will be paid because the fund would be revolving in nature, sources said.

Health insurance scheme for senior citizen would be a logical extension of the ongoing low premium life insurance (Pradhan Mantri Jeevan Jyoti Bima Yojana), general insurance (Pradhan Mantri Suraksha Bima Yojana) and pension plan (Atal Pension Yojana) of the government, sources said.

The Pradhan Mantri Jeevan Jyoti Bima Yojana offers a renewable one-year life cover of Rs 2 lakh to all savings bank account holders in the age group of 18-50 years, covering death due to any reason, for a premium of Rs 330 per annum.

The Pradhan Mantri Suraksha Bima Yojana offers a renewable one-year accidental death-cum-disability cover of Rs 2 lakh for partial/permanent disability to all savings bank account holders in the age group of 18-70 years for a premium of Rs 12 per annum per subscriber.

The Atal Pension Yojana focuses on the unorganised sector and provide subscribers a fixed minimum pension of Rs 1,000, Rs 2,000, Rs 3,000, Rs 4,000 or Rs 5,000 per month, starting at the age of 60 years, depending on the contribution option exercised on entering at an age between 18 and 40 years.

PTI

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Pension – Medical Aid – New Health Insurance Scheme for Pensioners (including spouse) / Family Pensioners – Implementation of the Scheme- Orders – Issued

Pension – Medical Aid – New Health Insurance Scheme for Pensioners (including spouse) / Family Pensioners – Implementation of the Scheme- Orders – Issued

GOVERNMENT OF TAMILNADU
2013

FINANCE (PENSION) DEPARTMENT
G.O.No.462, Dated: 27th December, 2013
(Vijaya, Margazhi-12, Thiruvalluvar Aandu-2044)

Pension – Medical Aid – New Health Insurance Scheme for Pensioners (including spouse) / Family Pensioners – Implementation of the Scheme- Orders – Issued.

Read the following:-

1. G.O.Ms.No.562, Finance (Pension) Department, dated: 11.07.1995.
2. G.O.Ms.No.378, Finance (Pension) Department, dated: 13.10.2005.
3. G.O.Ms.No.128, Finance (Pension) Department, dated: 12.04.2007.
4. G.O.Ms.No.50, Finance (Pension) Department, dated: 19.02.2008.
5. G.O.Ms.No.423, Finance (Pension) Department, dated: 25.11.2010.
6. G.O.Ms.No.188, Finance (Pension) Department, dated: 9.05.2008.
7. G.O.Ms.No.7, Finance (Pension) Department, dated: 6.1.2012.
8. G.O.Ms.No.474, Finance (Pension) Department, dated: 30.09.2009.
9. G.O.Ms.No.475, Finance (Pension) Department, dated: 30.09.2009.

ORDER:-

In the Government Order first read above, the Government have constituted a fund called Tamil Nadu Government Pensioners Health Fund with effect from 1.7.1995 to provide financial assistance to pensioners for undergoing specialized treatment/ surgery when they are affected by major ailments and the maximum limit entitled for the pensioner is Rs.1.00 lakh or 75% of the actual cost of the treatment whichever is less. Subsequently, the above concession was extended to the spouse of the Pensioner with effect from 17.2.2009.

2. In the Budget Speech 2013-2014, the Hon’ble Minister for Finance has announced in the floor of the House to launch a separate Health Insurance Scheme in line with the Government Servants Health Insurance Scheme to reduce the burden of the health related expenses of the pensioners.

3. The Government after careful examination has decided to launch the New Health Insurance Scheme for the Pensioners (including spouse) / Family Pensioners. Accordingly, the Government direct that New Health Insurance Scheme for the Pensioners (including spouse) / Family Pensioners shall be formulated on the following basis:-

i) the New Health Insurance Scheme shall operate on a CASHLESS basis and it shall be made compulsory to all the Pensioners (including spouse) / Family Pensioners.

ii) the quantum of assistance shall be fixed as Rs.2.00 lakh for both Pensioners (including spouse) and Family Pensioners for a block period of four years from the date of the launch of the scheme.

iii) if the spouse of the pensioners is also a pensioner, the recovery of subscription shall be effected from one person only, based on the option exercised by them.

iv) the New Health Insurance Scheme shall be implemented by the Insurance provider finalised from among the Public Sector Insurance provider by following due tender procedure.

v) the New Health Insurance Scheme shall be implemented through the Commissioner of Treasuries and Accounts as is being done in the case of New Health Insurance Scheme for the Government Employees.

vi) the amount of the Pensioners contribution to the scheme will be decided after the selection of the Insurance Company and finalisation of the costs.

4. Further modalities / terms and conditions for the New Health Insurance Scheme for the Pensioners (including spouse) / Family pensioners will be issued separately.

(BY ORDER OF THE GOVERNOR)

K. SHANMUGAM,
PRINCIPAL SECRETARY TO GOVERNMENT.

Source:http://www.tn.gov.in/go_view/dept/9

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