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7th CPC: Revised entitlement of wards in Railway empanelled Hospital for Railway Medical beneficiaries - Railway Board Order

7th CPC: Revised entitlement of wards in Railway empanelled Hospital for Railway Medical beneficiaries - Railway Board Order
Government of India
Ministry of Railways
Railway Board

No. 2016/H-1/11/69/Hospital Recognition
New Delhi, Dated 08.05.2018

The General Managers,
All Indian Railways & Production Units.

Sub: Entitlement of Hospital Wards for Railway Medical beneficiaries in Railway empanelled Hospitals.

The issue of revision of entitlement of wards in railway empanelled hospitals for railway medical beneficiaries as contained in para 5 of Memorandum of Understanding (MOU) circulated as an annexure to Board’s letter of even number dated 23.12.2016 has been under consideration of this Ministry.

2. Keeping in view the guidelines circulated by M/o Health & Family Welfare pursuant to acceptance of 7th Central Pay Commission (CPC), the matter has been examined in consultation with Finance Directorate of this Ministry and it has been decided that revised criteria for entitlement of wards in railway empanelled hospital for railway medical beneficiaries will be as under:

S. No. Corresponding basic pay drawn by the officer in
7th CPC per month Entitlement
1 Upto Rs. 47,600/- General ward
2 Rs. 47,601/- to Rs. 63,100/- Semi-private ward
3 Rs. 63,101/- and above Private ward

3. This issues with the concurrence of the Finance Directorate of the Ministry of Railways (Railway Board).

(This disposes of Southern Railway’s letter No. MD.34/I/Referral Hospital dated 21.02.2018).

(Mrs. H. K. Sanhotra)
Joint Director-II/ Health

Pension Procedure Latest updates PENSION PROCEDURE

Pension Procedure Latest updates
PENSION PROCEDURE
(1) What is the meaning of the following terms?
(a) Pension Disbursing Authority
(b) Pension Sanctioning Authority
(c) PPO Issuing Authority

(2) What should a Government servant do to claim his pension?
During service each Govt. servant should satisfy himself that service is being verified and recorded so in the service book and that there are no gaps in this. He should also ensure that nomination for all payments due to him are current and valid.
Six months prior to the retirement date, a Government servant is required to furnish certain information (e.g. joint photo with spouse, family details, name of the branch of the authorized bank through which he desires to draw his pension etc.) to his Head of Office in the prescribed Form No. 5.
The Head of Office is required to undertake the work of preparation of pension papers in Form No. 7 one year before the date on which a Government servant is due to retire on superannuation. After complying with the requirements of CCS Pension Rules 59 & 60, the Head of Office has to forward to the Pay & Accounts Officer Form 5 and Form 7 duly completed with a covering letter in Form 8 along with service book of the Government servant duly completed up-to-date and any other documents relied upon for the verification of service, not later than six months before the date of retirement of the Government servant.
(3) Who is to authorize the pension?
On receipt of pension papers from Head of Office, the Pay & Accounts Officer concerned will, after applying requisite checks, assess the amount of pension and issue the Pension Payment Order (both halves of Pension Payment Order, i.e. disburser’s portion and pensioner’s portion) not later than one month in advance of the date of retirement of the Government servant with forwarding authority letter, duly ink signed and embossed, to Central Pension Accounting Office (CPAO) who in turn will generate on computer a Special Seal Authority on the basis of details given in the Pension Payment Order and authority letter of the Pay & Accounts Officer and forward disburser’s half of PPO with Special Seal Authority to the Central Pension Processing Centre (CPPC) of the concerned authorized Bank. The Pay & Accounts officer after ascertaining that the special seal of authority has been issued shall send pensioners’ half of PPO to be handed over to the retiring employee. However, if the employee opts to take the PPO from bank, both halves shall be sent to CPAO. All records will be maintained in the CPPC and the disbursing branch, will make the payments to the pensioner on authorization of payment of pension by the CPPC. The CPPC however is only the back office for processing pensions, all pension related problems/grievances of the pensioners will continue to be handled by the concerned paying branch as before.
(4) What is to be done in case the pension has not been fixed correctly?
The Pay & Accounts Officer while issuing the pension authorization will forward one copy of the pension calculation sheet (out of three received by him from the Head of Office) as certified by the Head of Office and countersigned by him (Pay & Accounts Officer) to the pensioner along with the intimation of his having sent the pension payment authority/PPO to the CPAO. In case it is found from the pension calculation sheet that pension has been fixed incorrectly, the matter may be taken-up with the Head of Office. PAO concerned, if necessary, will issue an amendment authority letter to Central Pension Accounting Office for onward transmission to the CPPC to carry out
necessary amendments in both halves of PPO.

Fixed Medical Allowance and Amount
What is Fixed Medical Allowance and its Amount is the first question answered in the FAQ issued by DoPPW which was updated on 18-4-2018.
FIXED MEDICAL ALLOWANCE (FMA)
1. What is the Fixed Medical Allowance for pensioners? What is it’s amount?
Fixed Medical Allowance is granted to the pensioners residing in areas not covered by CGHS, if they are not using CGHS facility for OPD treatment from a CGHS dispensary in the nearest city. The amount of Fixed Medical Allowance has been increased from Rs. 500/- per month to Rs. 1000/- per month w.e.f. 01.07.2017.
2. Are the Government Pensioners who have not applied for CGHS card in spite of residing in areas covered by CGHS, also eligible for Fixed Medical Allowance?
In accordance with Office Memorandum No. 45/57/97-P&PW(C) dated 19.12.1997, Central Government pensioners/ family pensioners residing in areas not covered by Central Government Health Scheme administered by Ministry of Health and Family Welfare and corresponding Health Schemes administered by other Ministries/ Departments for their retired employees are entitled to Fixed Medical Allowance (FMA) for meeting expenditure on day-to-day medical expenses that do not require hospitalization. Government pensioners/ family pensioners residing in CGHS covered areas are eligible to avail medical facility under CGHS for both indoor as well as outpatient treatment on payment of CGHS contributions. Those pensioners/ family pensioners residing in CGHS areas who do not opt to avail CGHS facility are not eligible to receive FMA. Government pensioners/ family pensioners residing in Non CGHS area are also entitled to avail CGHS facility from the nearest city covered by CGHS for the both Indoor and OPD treatment on payment of CGHS contributions. If they do not avail CGHS facility, they are eligible for FMA. Government pensioners/ family pensioners not residing in CGHS area have an option to avail CGHS facility from the nearest CGHS city for Indoor treatment only (on payment of CGHS contribution) and to get monthly FMA in lieu of OPD facility.
3. In the case of those Pensioners who are in receipt of two pensions viz., service pension and family pension OR military pension and another civil pension to which category of pension, medical allowance shall be allocated.
If any pensioner or family pensioner receives two pensions, Fixed Medical Allowance is admissible from only one of the two organizations. As regards, pensioner who gets both military pension and civil pension, if the pensioner avails of the medical facilities provided by one of the civil or military organisations, he is not entitled to Fixed Medical Allowance and if he does not avail medical facilities from any of the organizations, he is entitled to Fixed Medical Allowance for only one of the two organizations
Commutation of Pension Latest FAQ
A pensioner can opt to commute up to 40% of the pension admissible at the time of retirement.
11. COMMUTATION OF PENSION
(11.1) How much of the pension can be commuted?
A pensioner can opt to commute up to 40% of the pension admissible at the time of retirement.
(11.2) Is there any restriction on commutation of pension?
Yes. No Government servant against whom departmental or judicial proceedings as referred to in Rule 9 of the Pension Rules, have been instituted before the date of his retirement or the pensioner against whom such proceedings are instituted after the date of retirement, shall be eligible to commute a fraction of his provisional pension authorised under Rule 69 of the Pension Rules or the pension, as the case may be, during the pendency of such proceedings.
(11.3) Whether the family can be given the benefit of 40 per cent commutation if a pensioner dies before exercising option?
No, since the commutation does not become absolute in such cases the benefit cannot be given to the family.
(11.4) What will be the effective date of reduced pension if,
a) The applicant is drawing pension from PAO?
b) The applicant is drawing pension from a branch of Public Sector Bank?
c) A Government servant who retired on superannuation and commutation applied in Form 1-A of CCS(Commutation of Pension) Rules before the date of retirement and commutation paid through Head of Office within the first month of retirement ?
(a) The reduction in the amount of pension on account of the commutation shall be operative from the date of receipt of the commuted value of pension or at the end of three months after issue of authority by the PAO for the payment of commuted value of pension, whichever is earlier.
(b) The reduction in the amount of pension on account of commutation shall be operative from the date on which the commuted value of pension is credited by the bank to the applicant’s account to which pension is being credited.
(c) The reduction in the amount of pension on account of commutation shall be operative from its inception. The commuted value is paid in two stages as such the reduction in the amount of pension shall be made from the respective dates of the payment as per (a) or (b) above, as the case may be.
(11.5) How does the period of 15 years for restoration of commuted portion of pension reckon?
The 15-year period for restoration may be reckoned from the date of retirement itself only in case where the payment of commuted value of pension was/is made during the first month of retirement leading to appropriate reduction on account of commutation in the first pension itself. In all other cases, where the commutation of pension led/leads to a reduction in the second or subsequent month, the 15-year period will be reckoned from the date on which reduction in pension became/ becomes effective.
(11.6) Is any authorization for restoration of commuted portion of pension after 15 years required from PAO/CPAO?
No, Restoration of commuted portion of pension after 15 years (from the date of crediting of commuted value) or as fixed by the Government from time to time is to be made automatically by bank. In cases where the date of commutation is not readily available in the PPO, the bank will obtain the information from the concerned PAO who issued the PPO through CPAO before restoring the commuted portion of pension.
(11.7) What has the pensioner to do for restoration of commuted portion of pension? From what date is it restored?
Commuted portion of pension is to be restored after 15 years from the date of commutation. This restoration was introduced w.e.f 01.04.1985. The commuted amount of pension shall be restored on completion of fifteen years from the date the reduction of pension on account of commutation becomes operative in accordance with Rule 6 of CCS (Commutation of Pension) Rules provided that when the commutation amount was paid on more than one occasion on account of upward revision of pension, the respective commuted amount of pension shall be restored on completion on fifteen years from the respective date(s).
(11.8) What is reduce/residual/residuary pension?
Reduce/residual/residuary pension is the part of pension which is payable after deducting commuted portion of the pension.
(11.9) What would be the age to be used for commutation of additional commutable pension and which factor would be used for such additional commuted value of pension?
The age reckoned for calculation of commuted value of pension at the time of original application for commutation of pension will apply for calculation of commutation value of additional commutable pension. However, as mentioned in the OM dated 04.08.2016, the commutation factor in the revised Table of Commutation Value for Pension will be used for the commutation of the additional amount of pension that has become commutable on account of retrospective revision of pay/pension.
(11.10) From which date the reduction in pension on account of additional commutation of pension will take effect?
Reduction in pension on account of additional commutation of pension will be in two or more stages as per the provisions contained in Rule 6 and Rule 10 of the CCS(Commutation of Pension) Rules,1981.
(11.11) What will be the date of restoration of additional commutation of pension?
The commuted portion of pension shall be restored after 15 years from the respective dates of commutation as provided in Government of India decision No.1 under the Rule 10 of CCS(Commutation of Pension) Rules,1981. Necessary endorsement should be made on PPO.
(11.12) A person with D.O.B. on first of month retires in the previous month. What will be the value to be taken for calculation from commutation table ?
The commutation of pension become absolute on the date following the date of his retirement. The commutation value taken will be Age on 61st Birthday (i.e. 8.194) in the present commutation table, if he has retired on attaining the age of 60 years.
(11.13) Whether a person who has commuted some percentage of his pension, can commute remaining part up to maximum of 40% afterwards( e.g if a person have commuted 20% of his pension on retirement and the same was duly authorized, whether he can commute the remaining 20% of his pension)?
There is no provision for second option for commutation after the first option becomes absolute.

Invitation of nominations for National Awards for Senior Citizens (Vayoshreshtha Samman) 2018 to eminent senior citizens and institutions for distinguished service for the cause of elderly persons - reg

Non-acceptance of Nomination Form for Life Time Arrear(LTA)

Non-issue of Pension slip by banks.

Recovery of excess payment made to pensioners.

Modicare to offer 20% lower rates than CGHS rates

Modicare to offer 20% lower rates than CGHS rates

Sushm Dey | TNN | Updated: May 24, 2018, 10:14 IST

TNN

HIGHLIGHTS

The health ministry has finalised the rates for 1,354 packages, which will be covered under NHPS.The packages include 23 specialties such as cardiology, ophthalmology, orthopaedics, urology and oncology, etc, an official said.

NEW DELHI: In a move likely to set new pricing standards for medical procedures in the country, the government-sponsored National Health Protection Scheme (NHPS), popularly known as Modicare, will offer common treatments such as coronary bypass, knee transplant and C-section at a rate which is around 15-20% lower than Central Government Health Scheme(CGHS), which provides comprehensive medical care to government servants, pensioners and their dependants.

The health ministry has finalised the rates for 1,354 packages, which will be covered under NHPS. The packages include 23 specialties such as cardiology, ophthalmology, orthopaedics, urology and oncology, etc, an official said.

For instance, the rate for vertebral angioplasty with single stent has been fixed at Rs 50,000, whereas that with double stent will cost Rs 65,000. Similarly, the price for total knee replacement is fixed at Rs 80,000, whereas a C-section will be charged at Rs 9,000. The list also includes paediatric surgeries, different packages for cancer treatment as well as mental disorders.

For comparison, an angioplasty would cost about Rs 1.5-2 lakh, a C-section around Rs 1.5 lakh and a total
The NHPS rate list is part of a model tender document for the Pradhan Mantri Rashtriya Swasthya Suraksha Mission, reviewed by TOI.

The document, finalised after consultation with Niti Aayog and Indian Council of Medical Research (ICMR), also details the minimum number of days of hospitalisation required to make a claim as well as pre-surgery and post-surgery investigations needed for approval. The document has been shared with state governments for comments. It will also be circulated among the bidding insurers by the states.
Indu Bhushan, chief executive of Ayushman Bharat, said CGHS and Rashtriya Swasthya Bima Yojana (RSBY) rates have been used as reference prices for fixing the rates under the scheme. “However, the rates under the new scheme are on an average 15-20% lower than that of CGHS,” Bhushan said. Lower prices mean beneficiaries of the scheme will be able to opt for more number of procedures under the cover if required or can even enrol more family members for treatment.
Besides, it is expected to reflect in a major drop in health expenditure and set new pricing standards, which, in turn, will create pressure on healthcare providers to bring down their rates for general public, healthcare experts said.
The health insurance scheme aims to cover nearly 50 crore beneficiaries from over 10.74 crore “deprived” families as per socio-economic and caste census (SECC) data with an annual health cover of Rs 5 lakh per family per year. This cover will take care of almost all secondary care and most tertiary care procedures. There is no cap on family size and age in the scheme, ensuring that nobody is left out.

The basic risk cover includes hospitalisation expenses such as registration, nursing and boarding charges in general ward. Besides, consultation fees, surgical equipment and procedure charges and cost of implants, medicines, diagnostic tests and food to patients are also covered. The scheme also covers follow-up care along with pre- and post-hospitalisation expenses.

In case of multiple surgeries, the highest package rate will be waived for the first treatment, and 50% and 25% of the package rate will be provided for the second and third treatment. The rest will be borne by the policy holder.

Prime Minister Narendra Modi is expected to launch the scheme on August 15. Bhushan said the scheme also entails added incentives for private hospitals, especially those providing quality services. “If a hospital is certified by NABH for entry level, it can get 10% more, whereas those certified for advanced level will get 15% more as incentive. Besides, we also want to give advantage to hospitals in lagging areas and such hospitals will get an additional 10%,” he said.

Bhushan said IT infrastructure is the backbone of the scheme and currently the ministry is working to put that in place so that hospitals and providers from across the country can be brought on the platform. The IT platform, to be launched by July, has been modelled on the existing health insurance portal for Telangana.

Relaxation of Rules fr consideration of reimbursement in excess of approved rates pertaining to medical claims

Relaxation of Rules for consideration of reimbursement in excess of the approved rates pertaining to medical claims

Government of India

Ministry of Health and Family Welfare

Department of Health & Family Welfare

EHS Section

No: Z.15025/38/2018/DIR/CGHS/EHS 

Nirman Bhawan, New Delhi

Dated the 22nd May, 2018

OFFICE MEMORANDUM

Subject: - Relaxation of Rules for consideration of reimbursement in excess of the approved rates pertaining to medical claims

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum No. 4-18/2005- C&P [Vo]. l-Pt (1)], dated the 20th February 2009 and to state that it has now been decided to modify the Para 3 (2) of the above referred Office Memorandum as per the details given under the succeeding paragraphs.

a) The requests for full reimbursement which fall under the following defined criteria shall be examined by Directorate General of CGHS and submitted to AS&DG (CGHS) for consideration of approval. After the recommendation of AS&DG (CGHS), the concurrence of Internal Finance Division and approval of Secretary, Ministry of Health & Family Welfare are required for reimbursement in excess of CGHS rates:

1) Treatment was obtained in a private unrecognized hospital under emergency and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged period.

2) Treatment was obtained in a private unrecognized hospital under emergency and was admitted for prolonged period for treatment of Head Injury, Coma , Septicemia, Multi-organ failure , etc.

3) Treatment was obtained in a private unrecognized hospital under emergency for treatment of advanced malignancy

4) Treatment was taken under emergency in higher type of accommodation as rooms as per his/her entitlement are not available during that period.

5) Treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections

6) Treatment was obtained in a private unrecognized hospital under emergency when there is a strike in Govt. hospitals.

7) Treatment was obtained in a private unrecognized hospital under emergency while on official tour to non-CGHS covered area.

b) The requests from CGHS beneficiaries. having a valid CGHS Card at the time of treatment, in respect of the following conditions shall be considered by a High Powered Committee constituted by Ministry of Health & Family Welfare:

(i) Settlement of medical claims in relaxation of rules

(ii) Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he/she is not eligible for air travel treatment facilities are available in city of residence

(iii) Representations from CGHS beneficiaries seeking full reimbursements under special Circumstances, which are not notified.

c) The other terms and conditions mentioned in the OM No. 4-18/2005- C&P[Vol. l-Pt(1)] dated the 20 February 2009 shall remain unchanged. 

Sd/-

(Rajeev Attri)

Under Secretary to Government of India

Source: cghs.gov.in

Non acceptance of nomination Form for Life Time Arrests

CPAO/IT &Tech/Bank Performance/37 [Vol-111)/2018-19/22
Dated: 15.05.2018
OFFICE MEMORANDUM
Subject: Non-acceptance of Nomination Form for Life Time Arrear (LTA)
It has been observed that Pension Payee Scheduled Bank branches are not accepting Nomination Form for “Life Time Arrear” on the pretext that their branch has not received any instructions from their head office.
As per para 23 of the Scheme Booklet on acceptance of Nomination Form for Life Time Arrears provides that where the Nomination for the payment of arrears does not exist then the Authorized Bank will seek instructions of the CPAO, who will in turn, refer the matter to AG/CCA/CA/Dy.CA for obtaining the requisite sanction of Head of the Office. As such, the claimant can also approach the Head of Office where the pensioner served before his/her retirement/ death.
Moreover para 4.5.7 of the Scheme Booklet clearly states that “CPPCs may ensure that the responsibilities assigned to Home Branches are enforced so that the pensioners are not redirected to CPPC for redressal of grievances and information needs. Necessary performance measures and monitoring mechanisms, in co-ordination with the respective administrative structures to achieve the desired level of service delivery in Home Branches as well as CPPCs may be instituted by the Bank.”
This issues with the approval of Chief Controller (Pensions).
sd/-
(Praful Dabral)
Sr. Accounts Officer (IT & Tech)