CGHS-Reimbursement of medical claims

 Reimbursement of medical claims to pensioners under CS(MA) Rules, 1944 as directed by various CATs/Courts

File No.S.14028/30/2022-EHS
S.14028/30/2022-EHS
Government of India
Ministry of Health & Family Welfare
EHS Section

Nirman Bhawan, New Delhi
Dated 12th September, 2022

OFFICE MEMORANDUM

Subject: Reimbursement of medical claims to pensioners under CS(MA) Rules, 1944 as directed by various CATs/Courts-reg.

The undersigned is directed to say that as per Note-2 below Rule-2 of CS(MA) Rules, 1944, Retired Government officials are not covered thereunder. However, as per extent CGHS guidelines, Central Government Pensioners residing in non-CGHS areas have the following options:

1. They can avail Fixed Medal Allowance (FMA) in lieu of OPD facilities under CGHS.
2. They can also avail benefits of CGHS (OPO & IPD) by registering themselves in the nearby CGHS covered city after making the required subscription.
3. They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGHS guidelines.

2. All Ministries/ Departments of Government of India are requested to bring the contents of this OM to the notice of organization(s) under their administrate control for guidance and compliance thereof. Also, retiring Central Government employees may be made aware of the above rule position.

3. Court CATs cases filed by pensioners may be defended by Ministries/ Departments in the light of above rule position. No reference in this regard needs to be made to Ministry of Health & Family Welfare for comments/ clarifications etc, thereon.

4. This issues with the approval of Competent Authority.

Digitally Signed by Guite
Elsy Thang Biak Lun
Date: 12-09-2022 15:52:01
Reason: Approved
(Guite Elsy Thang Blak Lun)
Under Secretary to the Government of India
Tol. No. 011-23061778

To

All the Ministries/Departments, Govt of India.