Reimbursement of medical expenses to Pensioners

No. 4/4/2013 -P&PW-(D)

Government of India

Ministry of Personnel, Public Grievances & Pensions

Department of Pension & Pensioners Welfare

Lok Nayak Bhavan, Khan Market,

New Delhi,

Dated the 6th December, 2013

OFFICE MEMORANDUM

Sub:- Reimbursement of medical expenses pensioners where payment of FMA is allowed to staff working in the interior where AMA not available – request of Shri Mukesh Singh.

The undersigned is directed to forward herewith a representation dated 27.62013 of Shri Mukesh Singh in original received through Deptt. of Expenditure vide letter No.164/EV/2013- Hindi dated 7.10.2013 for considering the grievances raised therein expeditiously in accordance with the extant rules/instructions under intimation to the representationist to whom a copy of this communication is also being endorsed.

(Deepa Anand)

Under Secretary to the Govt„ of India

Dated: 27.06.2013

Subject: Reimbursement of Medical Expenses where Payment of Fixed Medical Allowance is allowed to staff working in the interior where AMA not available.

 With due regards, it is submitted that this Federation has raised the subject matter before the Secretary, MOH&FW and Min of Defence on 05.07.2011 and reminded from time to time that Fourth Central Pay Commission (04th CPC) recommended in Para 16.9 as under;

“We recognize that employees covered by Medical Reimbursement Scheme (MRS) under the Central Services (Medical Attendance) Rules, 1944 are experiencing difficulties as regards the treatment andreimbursement of expenses incurred by them. There is also considerable administrative and accounting work involved in the settlement of claims. Various kinds of malpractices in the scheme have also brought to our notice. We, therefore, recommend grant of a Fixed Medical Allowance of Rs. 25/- per month for outdoor treatment to all employees covered by MRS. The expenses incurred on special diseases (cancer, diabetes, mental diseases, poliomyelitis, tubercular diseases and leprosy) and hospitalization may continue to be reimbursed to all employees as at present under the scheme”.

 Thereupon Govt issued instructions vide G.O.I., M.H., O.M. No. S-14020/1/88-MS, dated 17th  July, 1990, 28th  Sep, 1991, that quantum of medical allowance of Rs. 25/- per month per employee working in interior may be granted where no Authorized Medical Attendant is available within a radius of 05 km, and if available, he is not willing to be appointed as AMA.

It is worth to mention here that the reimbursement of medical expenses for indoor treatment were allowed by the concerned authorities though the employee was drawing Rs. 25/- per month FMA.

Subsequently, Fifth Central Pay Commission (5thCPC) also recommended in Para 114.24 on the subject matter as under;

“We are in favour of a greater freedom of choice in obtaining medical aid and advice, where Central Government is unable to organize its own facilities for employees. Such a freedom, while aiming at development of employees within their own responsibilities, will reduce much of clerical work involved in medical reimbursement claims for day-to-day need. For serious ailments and hospitalizations, however, we still do not see any justification for removal of restrictions. Accordingly, we recommend that in areas presently covered by Medical reimbursement Scheme for outpatient purposes a medical allowance of Rs. 100/- per month per employee may be granted only for outpatient facilities, not provided by either CGHS or any departmental medical facilities.”

 Thereupon Govt issued instructions to enhance the quantum of FMA to Rs. 100/- from Rs. 25/- per month per employee vide G.O.I., M.H., O.M. No. S-14020/1/88-MS, dated 18th  Jan, 1999, for employee working in interior where no Authorized Medical Attendant is available within a radius of 05 km, and if available, he is not willing to be appointed as AMA.

Simultaneously, on the recommendation of 5th CPC, Govt introduced Fixed Medical Allowance of Rs. 100/- per month from 01.12.1997 to Central Government Pensioners/family Pensioners not covered under CGHS vide DOP&PW, O.M. No. 45/57/97-P&PW, dated 19.12.1997. According to this scheme, a pensioner/family pensioner may opt either CGHS facility or Fixed Medical Allowance of Rs. 100/ which has been enhanced to Rs. 300/- vide your O.M. No. 390/2010-MS, Dated 14th  July, 2010. Since the issuance of the O.M. dated 19.12.1997 the medical reimbursement of the Govt employee and their family members has been discontinued. 

The employee residing in the interior area has no option to avail outpatient medical facility from any source of Central Government/State Government/Local Municipality/Private Medical practitioner appointed as Authorized Medical within a radius 05 km, hence he has been compelled/granted by Central Government to accept Rs. 25/- or 100/- as FMA and whenever such medical facility will be provided to him, this FMA will be discontinued forthwith.