ELIGIBILITY FOR CGHS CARD

 

ELIGIBILITY & NON ELIGIBILITY FOR CGHS CARD

Residence’ alone (and not the Headquarters) is the criterion for determining eligibility of a Central Government servant for availing medical facilities under the Central Government Health Scheme. Thus, Central Government employees and their family members etc. residing in any of the 28 notified cities are covered under the Scheme.

Persons Eligible under the C.G.H. Scheme

          The following list of persons eligible to avail medical facilities under the Central Government Health Scheme has been compiled as per MH & FW Information Booklet on CGHS, 2000 Edition and various orders issued from time to time. Readers are requested that before acting upon, on the basis of this list, they must ascertain their eligibility from the Ministry:

(i)   All Central Government employees paid from the Civil Estimates

(Except Railways and Delhi Administration),including their families.

(ii)   Pensioners of Central Government (except pensioners belonging to Railways and the Armed Forces) and their families.

(iii)  Pensioners retiring with Contributory Provident Fund benefits and their families.

(iv) Widows of Central Government pensioners, getting family pension.

(v)   Delhi Police personnel and their families, in Delhi only.

(vi) Railway Board employees.

(vii)  Civilian employees of Defense paid from Defense Service Estimates

(Except at Mumbai where the scheme is in operation).

(viii)   Child drawing pension on death of Central Government employee including minor brother and sister of such child.

(ix)     Ex- Governors and Lt. Governors and their families.

(x)       Ex-Vice Presidents and their families.

(xi)     Central Government employees on leave preparatory to retirement.

(xii)    Central Government servants who are deputed to semi-government  and autonomous bodies receiving substantial grant from, or financed by, the Central Government.

(xiii)   Military officers while on deputation to civil department and getting their emoluments from Civil Estimates.

(xiv)  Families of ‘CGHS covered government servants’ who are on temporary transfer outside Delhi/CGHS centers for a maximum period up to six months provided they deposit six months contribution in advance.

(xv)    Families of Government servants transferred to a non –CGHS area ,for a maximum period of six months on deposit of CGHS contribution

(For the period of six months) in advance.

(xvi)  Families of IAS Officers of North-Eastern Cadre, who continue to stay back in Delhi even after repatriation of the IAS Officer to the North-Eastern Cadre, till they continue to occupy Government accommodation in Delhi/New Delhi , on the deposit of CGHS contribution in advance on an yearly basis. The same also applies to families of IAS Officers of J & K Cadre.

(xvii)       Pensioners visiting CGHS covered cities and Staying at a place falling in CGHS covered cities.

(xviii)      Employees of CGHS not residing in the CGHS covered cities.

(xix)        Ministers/Deputy Ministers of the Central Government/State Governments and their families.

(xx)          Parliamentary Secretaries of the Central Government and their families.

(xxi)        Members of Parliament and their families.

(xxii)       Ex-Members of parliament, including those who are not in receipt of any pension.

(xxiii)      Sitting and retired judges of the Supreme Court and High Court residing in CGHS covered areas besides Delhi/New Delhi.

(xxiv)     Work Charged and Industrial Staff working in establishments run by various Ministries/Department of Central Government, immediately from the date of their joining the service.

(xxv)       Employees of Kendriya Vidyalaya Sangathan Stationed at Calcutta, Madras and Bombay.

(xxvi)     Employees of Ordnance Factory Board Headquarters, Calcutta & Ordnance Factory Board Headquarters, Kanpur.

(xxvii)    Ad-hoc employees of CGHS organizations outside Delhi

(xxviii)    All India Service pensioners who retire while serving under the State at their option.

(xxix)     Freedom Fighters and members of their family receiving Central Pension under the Swatantrata Sainik samman Pension Scheme.

(xxx)       Family members of the deceased EX-Members of Parliament.

(xxxi)     Pensioners of Ordnance factories.

(xxxii)    Members of Staff Side of the National Council of the Joint Consultative Machinery , even though not serving as Central Government employees.

(xxxiii)   Persons employed in semi-government and autonomous bodies who are permitted to join the CGH scheme.

(xxxiv)  An Accredited Journalist who produces a certificate from the press Council of India stating that he is a member of the press Association ,New Delhi (for OPD and at RML Hospital).

(xxxv)    Retired employees of Indian Council Of Agricultural Research.

(xxxvi)  Employees of statutory canteens in CGHS covered cities, if not covered under any other medical scheme.

(xxxvii) Employees of the Central Council of Indian Medicine.

(xxxviii)    Retired Divisional Accountants of the Indian Audit and Accounts Department and those whose pay and pension are entirely borne by the State Government.

(xxxix)  PSU absorbees who had commuted 100% of their pension and have been restored 1/3rd portion of their pension after 15 years.

(xl)           Absorbees of Statutory Bodies/Autonomous Bodies of central Govt., (including those who proceeded on deputation initially or were on demand deputation and then absorbed), who are in receipt of Central Civil Pension.

(xli)          Serving and retired Railway Audit Staff.

(xlii)         Serving and retired Divisional Accounts Officers and Divisional Accountants posted in the Office of Accountant Generals in States.

(xliii)       CISF personnel (and their families) and CAPF (Central Armed Police Forces) personnel posted in CGHS cities.

(xliv)       Employees of Supreme Court Legal Services Committee.

(xlv)        Employees of India Pharmacopoeia Commission, and their families

(xlvi)       Family and dependent members of a Central Govt. employee (a CGHS beneficiary) who stay back in CGHS covered area after posting of the employee to N.E. region (including Sikkim),

Andaman & Nicobar, Laksadweep or Ladakh region on payment of annual CGHS contribution in advance.

Persons Not Eligible under CGH Scheme

                 The following categories of persons are not  entitled to avail CGHS facilities :-

(a)         Family members who are no longer dependent upon the government servant though staying with him/her.

(b)         Independent brothers or sister, even if minor.

(c)         Married (but not separated ) daughter staying with her parents.

(d)        Government servant and their family members staying in an area not covered under CGHS.

(e)         Government servant transferred to a State Government or an ineligible department or are deputed to a foreign service.  However, their families may be issued temporary permits for availing CGHS facilities on pre-payment of prescribed charges.

(f)          Families of Central Govt. servants on deputation to semi-Govt./autonomous bodies.

(g)        Pensioners of Deptt. Of P & T (except those who were members of CGHS while in service).

 

PLASTIC CARDS----procedure for acquiring plastic cards:

1.   Fill up the application form  either online or offline. If you fill online then take a printout of the form. The filled form or printout should be submitted to the CGHS office along with the following documents:

For serving patients:

a.    Address proof

b.    Pay slip – latest

c.    Proof of residence of dependants

d.   Proof of age of son or brother if any

e.    Photographs- two joint and two separate

f.     Dependency certificate.

 

2.   For pensioners:

a.    address proof

b.    last pay certificate

c.    PPO

d.   Proof of age of son or brother if any.

e.    Demand draft of the applicable amount.

f.     Photographs- two joint and two separate

g.   Dependency certificate.

Application form for Plastic card: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File434.pdf

Pensioners :-

          Once card is issued at the time of retirement as per Last basic pay – entitlement  - it cannot be changed.

 

P & T and DOT :-

          If at The time of retirement, They  do not hold a CGHS card, They are not entitled for CGHS facility after retirement  as per O.M No. S.11011/2/2000 – CGHS/O.I

 

BSNL & MTNL :-

          It is learnt that BSNL and MTNL have introduced distinct medical care schemes for their serving and retired employees. The BSNL / MTNL absorbees

are entitled to avail the medical facilities under the same. It would not be possible to extend them the CGHS facilities during their service period. However, the absorbees who have opted for pro-rata pension from Central Civil Estimates of Government of India, after their retirement from BSNL / MTNL, will be eligible for CGHS facilities subject to the condition that they are in receipt of central civil pension from Government of India.

 

          In view of the above, it is clarified that BSNL and MTNL officers and employees including the officers on deemed deputation /deployment to BSNL/ MTNL and drawing their salary from the above organization are not entitled for CGHS facilities.

 

Pensioners having permanent plastic card can avail CGHS facility anywhere in India having CGHS facility. 

 

CONTRIBUTION FOR CGHS CARD IS AS FOLLOWS :-

Serving :-

Grade pay

Rate of Monthly Contribution

a)   Up to Rs. 1650.

Rs. 50/-

b)   Rs. 1800, 1900, 2000, 2400 and Rs. 2800.

Rs. 125/-

c)   Rs. 4200

Rs. 225/-

d)   Rs. 4600, 4800, 5400, 6600.

Rs. 325/-

e)   Rs. 7600 and above.

Rs.500/-

 

Pensioner :-

          Contribution as above depending on the Last grade pay at the time of retirement.

 

VALIDITY

 Serving  -  upto 5 years. Renewable after every 5 years.

Pensioner - Choice is with the individual. One can apply for Life time card by paying 10 years contribution together or one can apply for one year, two years etc. by paying for that applicable period.

 

ENTITLEMENT :-

          Ward Entitlement for hospitalization depends on your present basic pay without grade pay for serving and the last basic pay before retirement for pensioner.

 

Pay

Entitlement

Upto Rs. 13950

General Ward

13960 - 19530

Semi - private

Above 19540

Private ward

 

Nursing Home facilities in Govt./State Govt./Municipal Hospitals for those drawing basic pay  of Rs. 13950 and above.

DIRECT CONSULTATION :-

          Officers drawing pay of Rs. 19540 and above may, if they so desire, consult a specialist directly. However, it is wellness Centre first who is their family physician.

 

DEFINITION OF FAMILY :-

Meaning of Family

The term ‘Family’ means and includes:-

1.   Husband/wife, including more than one wife and a judicially separated wife.

2.   Parent (excluding step parents), subject to the following :

a)   In case of adoption, adoptive parents and not real parents;

b)   If adoptive father has more than one wife , only the first wife; and

c)   In case of female employees , parents or parents-in-law, at her option , subject to the conditions of dependency and residence etc. being satisfied.

Note: - Option to include either her parents or parents –in-law is not available  to a female family pensioner.

 

3.   Children, including step children , legally adopted children , children taken as wards by the Government servant under the Guardians and Ward  Act, 1980, provided that  such a ward lives with him, treated as a family member and is given the status of natural –born child through a special will executed by that Government servant.

Notes:-  (i) Son is eligible till he starts earning or attains the age of 25 years

                        or get married , whichever is earlier.

               (ii) Daughter is eligible till she starts earning, or gets married        

                      Whichever is earlier. (irrespective of age)

 

4.   Sons suffering from permanent disability either physically or mentally without any age-limit.

Notes:- (i) Disability means blindness , low vision, leprosy-cured ,hearing    

                      impairment ,locomotor disability , mental retardation, mental  

                      illness (includes schizophrenia), autism, cerebral palsy or a

                      combination of any two or more of such conditions and includes a

                      person suffering from several multiple disability.

              (ii) ‘Permanent disability’ means a person with 40% or more of one or      

                      more disabilities.

 

5.   Dependent divorced/abandoned  or separated from their husband/widowed daughters (irrespective of age).

 

 

DEPENDENCY CRITERION:-

          The Income limit per month for dependant from all sources including pension / Family pension and pension equivalent of DCRG is Rs. 3500 plus the amount of Dearness Relief thereon.

 

 

TRANSFER:-

(a)     On transfer of a Govt.  servant to an area which is not covered by CGHS, the facility for his family at the old station is admissible only for six months provided they deposit six months contribution in advance except  when transferred to North east, Andaman & Nicobar islands, Lakshadweep, Ladakh .

 

(b)     If an employee is transferred to another CGHS station or goes to serve abroad leaving his family at the old station, may continue to pay the contribution, in which case his family can continue to receive the benefits at the old station for that duration. Surrender card at the old station and make a new plastic card at the new station. If an employee or his family goes to another CGHS station and requires emergency treatment, they can avail treatment from the city.

 

The plastic card is valid all over the country.

    

 SURRENDER OF CGHS CARD :-

          The card should be surrendered in the following events :-

Following events :-

a)   Retirement / Resignation

b)   Death of Govt. Servan-t Grace period 3months for conversion to family pensioner cards.

c)   Transfer-- surrender the card in the city and apply for a new card at the new CGHS station.

d)   The plastic card-holder becomes ineligible for any reason

 

LOSS OF  CARD :-

          The owners should immediately inform the concerned Police station and inform CGHS office about the loss along with the FIR and apply for a new plastic card along with postal order of Rs. 50/- In case of plastic card and Rs. 5 In case of paper card.

 

RENEWAL OF CARD :-

          Application form along with the existing card to be submitted to the CGHS office along with the contribution as demand draft as applicable for pensioners (if not applied for permanent card)

 

Serving :-

With the latest pay slip, address proof  and forwarding letter from  office and all document as before

 

ADDITION / DELETION OF NAME:-

Serving beneficiaries :- Fill up the form for addition of name and forward through their HOD along with proof of birth or proof of dependency and dependency certificate as the case may be, and also with photographs.

Pensioner :- Submit the documents as stated above to CGHS office along with photographs.

Deletion :- Fill up the form and forward through HOD, in case of serving, along with death certificate in case of death or marriage certificate in case of daughters. In case of sons, their names areautomatically  deleted by the system (software) when they attain the age of 25yers and brothers if 18 yrs old. If the son or daughter starts working, the onus lies on the card holder to inform the CGHS authorities and get their names deleted.

          Only sons with permanent disability (more than 40%) physical or mental can continue to avail the facility on producing disability certificate from Hospital. Which should be within 5 years.   

 

Nomination facility under CGHS for claiming medical reimbursement in the event of death of the principal CGHS cardholder – reg.

 

Nomination facility whereby a person duly nominated by the principal CGHS cardholder can claim the reimbursement of expenses incurred on the medical treatment of the beneficiary in the event of unfortunate death of the principal card holder. He matter has been examined in this Ministry in the context of difficulties being faced by the family members of a deceased CGHS cardholder in completing the prescribed formalities for claiming reimbursement of medical expenses. Accordingly, it has been decided with approval a of the competent authority to simplify the procedure and provide an option to the principal CGHS cardholder beneficiary to nominate a person to claim reimbursement of medical expenses in the event of his/her unfortunate death.

 

The nomination facility shall be subject to the following conditions:-

a)   The nomination facility shall be available only to the CGHS pensioner card holders.

b)   Beneficiaries who wish to exercise this option shall submit their declaration of nomination in the prescribed ‘Nomination From’ duly filled up and complete in all respect, to the CMO In-charge of the CGHS Wellness Centre where the beneficiary is enrolled

c)   CMO In-charge shall maintain a separate register – ‘ Nomination Register’ to record the particulars of the nomination submitted by the CGHS beneficiary in exercise of this option. Once the nomination details are recorded, the CMO In-charge shall forward the ‘Nomination Form ‘ to the card issuing authority, i.e, Additional Director (HQ), CGHS in the case of Delhi and respective Additional/Joint Director, CGHS in the case of other CGHS covered cities for making necessary entries in the CGHS database after due scrutiny and approval of Additional Director, CGHS concerned.

d)   The nomination shall be treated as valid only if it has been entered in the CGHS database.

e)   Only one person shall be allowed to be nominated as the original nominee or first nominee. In addition, another person can also be nominated as alternate nominee or second nominee’ who can claim reimbursement in   case of unfortunate death of the first nominee.

f)    The principal CGHS cardholder beneficiary can nominate any natural or juristic person as his/her nominee for this purpose, whether related or unrelated to him her.

g)   This option can be exercised only twice in the lifetime of the pensioner card holder.

h)   In case, no option has been exercised during the life time of the CGHS pensioner beneficiary, the existing  CGHS provision for claiming reimbursement of medical expenses, requiring submission of Affidavit by the claimant and NOCs from other legal heirs shall continue to apply.