New Health Insurance Scheme for Government Employees under Consideration
There is a proposal for introduction of a health insurance scheme for the central government employees and pensioners on pan-India basis, with special focus on pensioners living in non-CGHS areas. The proposal is to make this scheme voluntary cum contributory for serving employees & pensioners. However, it is proposed to be made compulsory for the new entrants in Government service.
The salient features of the proposed Health Insurance Scheme are as under;
· Optional for serving Central Government employees and pensioners including future pensioners,
· Compulsory for new recruits,
· Covers all the members of family as per CGHS norms,
· Sum insured – Rs. 5 lakh per year on a family floater basis,
· Corporate buffer of Rs 25 Crore to take care of cases exceeding Rs. 5 lakh,
· All pre existing diseases covered from the day one,
· Pre and post hospitalisation benefits available,
· Domiciliary Hospitalisation benefit,
· Maternity benefit upto two living children,
· OPD not covered however OPD consultations will be free,
· Payment of FMA for meeting OPD needs,
· Cashless treatment facility,
· Govt. to subsidise significantly the payment of premium,
· Employees / pensioners to contribute 20 to 30 percent of the premium,
· Identification of beneficiaries through a Smart Card.
The proposed scheme will be an alternative to the CGHS and it will provide an option to the serving employees and pensioners to choose a scheme as per his/her convenience.
The Scheme will have special focus on the pensioners living in non-CGHS areas who are getting Fixed Medical Allowance at the rate of Rs.300/- only per month to take care of their medical needs and have been demanding extension of CGHS or CS (MA) Rules to cover their OPD and Inpatient medical needs which is not feasible due to resource constraints. The Health Insurance Scheme seems to be a viable alternative. It will have additional implications, due to coverage of pensioners living in non-CGHS areas and not covered under any Government Scheme.
The proposal for inclusion of the Health Insurance Scheme for the Central Government employees and pensioners in the 12th Plan has been moved by the Ministry for consideration of the Steering Committee on Health in the Planning Commission. On receipt of approval of Planning Commission, the proposal would be placed before the Expenditure Finance Committee and finally before the Cabinet for approval of the scheme. No strict time frame can be given in this regard.
This information was given by the Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad in reply to a Starred question in Lok Sabha today
Tags: CGHS, pension, FINANCE, HEALTH, CGHS, New Health Insurance Scheme
sir,
It is really good news.Whether is it applicable to Railways.as such Railways is practicing worst type of treatment especially for group C and D.Though they are unable to treat.they will not send you out to a good hospital.either we have to take treatment in their hospital or with whom they are having contract.And those hospitals are miles apart from the place of working/residence.why can’t in a hospital nearer to the place of working by medial insurance.
Sir,
My residential address was at Kolkata and I am a CGHS card holder. At present I myself and my wife are residing at my daughter’s house at Agartala, as no body of us to lookafter. Practically we are suffering various old age deceases. In such a situation Whether I can be able to avail the said scheme at Agartala.
sir,
it is a good one
we have a question: we are working in esic hospital,and availing medical services and benefits from it
if the new scheme is introduced then we can avail the esic facility or not?
The scheme if implemented would really be a boon to central govt.pensioners staying in areas not covered by CGHS.With exhorbitant mediacal procedures/investigations it is very difficult to avail the treatment in nearby hospitals orelse one has to go all the way to cghs authorities,obtain ncy.permissions,many times first spend from one’s pocket and then follow up the reimb with cghs.Most of this will be a matter of past if the proposed scheme is planned genuinely with a view to help govt employees/pensioners to get quality mediacal services near their residences.