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16/06/2009

Central Government Employees & Pensioners Health Insurance Scheme

New “Central Government Employees & Pensioners Health Insurance Scheme” for serving & retired employees proposed

Ministry of Health & Family Welfare, Government of India have proposed to introduce a new “Central Government Employees & Pensioners Health Insurance Scheme” (CGEPHIS) for all serving employees and pensioners.

Central Government Health Scheme (CGHS) is a scheme for providing health care to serving Central Government employees and their dependant family members. Over the years, the scheme has been extended to cover central government pensioners, their dependant family members and certain other categories like members of parliament and ex-members of parliament, freedom fighters etc. Employees of some select autonomous bodies as also PIB accredited journalists have also been extended CGHS facilities on cost-to-cost basis in Delhi. Central Government Health Scheme is available in 25 cities [Delhi (including Noida, Gurgaon, Faridabad, and Ghaziabad), Ahemdabad, Allahabad, Bangalore, Bhopal, Bhubaneshwar, Chandigarh, Chennai, Dehradun, Guwahati, Hyderabad, Jabalpur, Jaipur, Jammu, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong and Thiruvanthapuram]. Central Government Employees living outside the CGHS areas are entitled to reimbursement for medical attendance and treatment under the Central Services (Medical Attendance) Rules [CS(MA) Rules]. Pensioners of the Central Government are not covered under these rules. At present, Central Government Pensioners living in non-CGHS areas are paid a sum of Rs. 100 p.m. for meeting their medical expenditure. Consequently, there has been a long standing demand from Central Govt. pensioners residing in non CGHS areas for medical services at par with those available to Central Govt. pensioners in CGHS areas. The VIth Pay Commission has recommended the introduction 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.
Ministry of Health & Family Welfare, Government of India invites Expressions of Interest from Insurers and Health Insurance consultants for the proposed scheme.
NAME OF THE SCHEME
The name of the proposed scheme is Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS).
BENEFICIARIES
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:
CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the health Insurance Scheme.
CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.
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.
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.

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PME Due Date

Master Circular No. 25



Copy of Railway Board’s letter No. 69/H/3/11 dated 06.12.1974



Subject: Implementation of the Recommendations of the Visual Sub-Committee.



6. Periodical re-examination of serving Railway Employees:



6.l. In order to ensure the continued ability of Railway employees in Classes A l, A 2, A 3, B l and B 2 to discharge their duties with safety, they will be required to appear for re-examination at the following stated intervals throughout their service as indicated below:



6.1.1. Classes A l, A 2 and A 3 —At the termination of every period of three years, calculated from the date of appointment until they attain the age of 45 years, and thereafter annually until the conclusion of their service.



Note: (l) The staff in categories A l, A 2 and A 3 should be sent for special medical examination in the interest of safety under the following circumstances unless they have been under the treatment of a Railway Medical Officer.



(a) Having undergone any treatment or operation for eye trouble irrespective of the duration of sickness.



(b) Absence from duty for a period in excess of 90 days.



(2) If any employee in medical category A has been periodically medically examined at any time within one year prior to his attaining the age of 45, his next medical examination should be held one year from the due date of the last medical examination and subsequent medical examination annually thereafter.



If, however, such an employee has been medically examined, at any time earlier, than one year prior to his attaining the age of 45, his next medical examination should be held on the date he attains the age of 45 and subsequent medical examination annually thereafter.




Ammendment: It was ammended in 1993 as below



Age Group PME Due



Age 00-45 every 4yrs



Age 45-55 every 2yrs



Age 55-60 every year
Details:-
As per Rly Bd's Guideline of Medical Exam issued vide LNo. 88/H/5/12 dated 24-01-1993

a) PME would be done at the termination of every period of 4 years from date of appointment / Initial medical Exam till the date of attainment of age of 45 years, every 2 years upto 55 years & there after annual till retirement.
b) Employees who has been periodically examined at any time within 2years prior to his attaining the age of 45years would be examined after 2years from the date of last PME & subsequent PME for every 2years upto 55years age.Of

NRMU 4 you
SMLokhande





6.1.2. Classes B-1 and B-2—On attaining the age of 45 years, and thereafter at the termination of every period of five years.