Proposal for introducing cashless health insurance facilities for pensioners in nearby Private Health Centers in lieu of FMA on voluntary basis

Proposal for introducing cashless health insurance facilities for pensioners in nearby Private Health Centers in lieu of FMA on voluntary basis: Action Taken Report on recommendation of DRPSC

PARLIAMENT OF INDIA
RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON
PERSONNEL, PUBLIC GRIEVANCES, LAW AND JUSTICE
Rajya Sabha Secretariat, New Delhi
December, 2022 / Agrahayana, 1944 (Saka)

ONE HUNDRED TWENTIETH REPORT
ON
ACTION TAKEN ON ONE HUNDRED TENTH REPORT OF THE COMMITTEE ON
“PENSIONER’S GRIEVANCES – IMPACT OF PENSION ADALATS AND CENTRALIZED
PENSION GRIEVANCES REDRESS AND MONITORING SYSTEM (CPENGRAMS)”
PERTAINING TO
THE DEPARTMENT OF PENSION & PENSIONERS’ WELFARE
(MINISTRY OF PERSONNEL, PUBLIC GRIEVANCES & PENSIONS)
(Presented to the Rajya Sabha on 8th December, 2022)
(Laid on the Table of the Lok Sabha on 8th December, 2022)

RECOMMENDATIONS/OBSERVATIONS WHICH HAVE BEEN ACCEPTED BY THE MINISTRY

GRIEVANCES PERTAINING TO PENSION POLICY, PENSION STRUCTURE AND OTHER RETIREMENT BENEFITS

Proposal for introducing cashless health insurance facilities for pensioners in nearby Private Health Centers in lieu of FMA on voluntary basis

Recommendation/Observation

1.6 The Committee notes that the Central Government provides health care facilities for both, serving as well as, retired employees. However, the Committee observes that serving employees of central government are covered under the Central Service (Medical Attendance) Rules, 1944 (CS (MA) Rules), which provides facilities for availing medical facilities outside CGHS covered areas. However, these Rules are not applicable to pensioners, and instead pensioners residing outside CGHS covered area are entitled to Fixed Medical Allowance (FMA). The Committee is of the view that non-applicability of CS (MA) Rules to pensioners residing outside CGHS areas has placed them at disadvantaged position vis-à-vis serving employees. Accordingly, the Committee feels that either the provisions for medical facilities available to serving employees also needs to be extended to pensioners or instead of increasing FMA year after year, DoPPW may moot a proposal for introducing cashless health insurance facilities for such pensioners in nearby Private Health Centers in lieu of FMA on voluntary basis. (3.23)

Action Taken

1.7 Ministry of Health & Family Welfare is the administrative Department concerned with providing health and medical facilities to the serving Government servants as well as pensioner retired from Central Civil service. Therefore, the matter was taken up with that Ministry.

1.8 Ministry of Health & Family Welfare has informed that Central Government pensioners, not residing in a CGHS city have the option to avail the CGHS facility for both IPD (indoor) and OPD (outdoor) treatment by paying the required CGHS contributions. The pensioners availing the CGHS facility for both IPD (indoor) and OPD (outdoor) treatment can have OPD treatment from a CGHS dispensary in a nearby city and indoor medical treatment in any Government hospital and empanelled private hospitals in the cities covered by CGHS. They can also get indoor medical treatment in any private hospital in emergent circumstances.

1.9 Alternatively, Central Government pensioners not residing in a CGHS city can avail CGHS facility for IPD (indoor) treatment by paying the required CGHS contributions and also receive Fixed Medical Allowance in lieu of the OPD (outdoor) treatment.

1.10 Those pensioners who are residing in a non-CGHS area and do not choose to avail CGHS facility by paying the required CGHS contributions are entitled to receive monthly Fixed Medical Allowance. At present, the amount of Fixed Medical Allowance is Rs. 1000/- per month. Department of Pension & Pensioners’ Welfare has separately mooted a proposal for increasing the amount of Fixed Medical Allowance in pursuance of the recommendation No.3.21 in the 110th Report of the Parliamentary Standing Committee.

1.11 Thus, the pensioners have the option to avail CGHS facility while residing in a non CGHS area. Since serving Government servants residing in non-CGHS areas do not have the option to avail CGHS facility, they are covered by CS (MA) Rules.

Further observation

1.12 The Committee takes note of the reply.

***

Source: Rajya Sabha