Monday, June 15, 2009

New Insurance Scheme for Central Govt Employees.

As per the recommendations of the sixth CPC, the Misnistry of Health and family Welfare, Govt. of India has come up with a detailed plan of a health insurance scheme in lieu of the CGHS.
Government of India, therefore, proposes to provide inpatient health care services to their all 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 Services) and under CS (MA) Rules [Central services (Medical attendance) Rules] through a Health Insurance Scheme catering to their health care requirements. The proposed scheme shall be on voluntary basis for current set of employees & pensioners but compulsory for future employees & pensioners. The existing CGHS beneficiaries will have an option to avail CGHS facilities for OPD requirements and the insurance scheme for inpatient treatment.
With the introduction of health insurance scheme, the Central Government Employee (existing/ retired) will have the choice to select the best available health facilities for meeting their health care and can get best available treatment in areas in the close proximity.
All personnel of the Central Government including All India Service officers, serving, newly recruited, retired and retiring and others who are covered under the existing CGHS(Central Government Health Services) and under CS (MA) [Central Services (Medical Attendance) Rules] Rules shall be offered Health Insurance Scheme on voluntary or on compulsorily basis . This could be:
1. CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the health Insurance Scheme.
2. CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.
3. CGEPHIS would be available on voluntary basis for the existing Central Government Employees and pensioners serving in CGHS area/ covered by CGHS. In this case such serving Central Government Employees and Central Government existing Pensioners shall have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total premium has to be born by the beneficiary.
4. CGEPHIS would also be available on voluntary basis for the existing serving employees and pensioners in non-CGHS areas not covered by CGHS. In this case such serving Central Government Employees and existing Pensioners (who have opted for CGHS facility) shall have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total premium has to be born by the beneficiary.
The scheme shall provide coverage for meeting all expenses relating to hospitalization of beneficiary members up to Rs. 500,000/- per family per year subject to stated limits on cashless basis through smart cards. The benefit shall be available to each and every member of the family on floater basis i.e. the total reimbursement of Rs. 5 .00 lac can be availed by one individual or all members of the family. The sub-limits mentioned herein form part of the overall annual, family limit.

See details here.

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