Reimbursement of Medical Claims to Pensioners residing in Non-CGHS areas

Pensioners residing in Non-CGHS have options to avail medical facilities

Pensioners who are not members of the Central Government Health Scheme (CGHS) have multiple options available to them to receive medical facilities. They can choose to avail either the facilities provided by the government or those offered by private establishments. This decision may depend on the individual’s preferences, financial situation, and proximity to the available healthcare providers. Nonetheless, senior citizens have the opportunity to receive medical attention and care, regardless of their membership in the CGHS.

No:4-35(01)12019-PAT
Government of India
Ministry of Communications
Department of Telecommunications

20, Ashoka Road, 1120, Sanchar Bhawan
New Delhi-110001
Dated: 28/07/2020

OFFICE MEMORANDUM

Subject: Reimbursement of medical claims to pensioners residing in non-CGHS areas

This refers to medical claims being received from pensioners residing in non-CGHS areas. In this respect, Ministry of Health and Family Welfare’s (MoH&FW) OM No. S. 14025/23/2013- MS.EHSS dated 29.09.2016 may be referred (copy enclosed). As per this OM, the pensioners residing in non-CGHS have following options to avail medical facilities:

(a) They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month or as revised from time to time. At present, vide OM 4/34/2017/P&PW(D) dated 19.07.2017, FMA is @ Rs. 1000/- per month.

(b) They can also avail benefits of CGHS (OPD & IPD) by registering themselves in the nearest CGHS city after making the required subscription.

(c) They also have the option to avail FMA for OPD treatment, and CGHS for IPD treatment after making the required subscriptions as per CGHS guidelines.

2. In addition, in accordance to MoH&FW’s OM No. S.11011/11/2016 CGHS (P)/EHS dated 09.01.2017 (copy enclosed), pensioners have option to avail CGHS facilities by making contribution on an annual basis (1 year/ 12 months) or by making contribution for 10 (ten) years (120 months) for getting a pensioner CGHS card with life-time validity.

3. The undersigned is directed to request all the Pr. CCA/CCAS and others concerned offices that the pensioners of this Department residing in non-CGHS areas may be intimated/sensitized (more than once) by an appropriate means about the above options for medical facilities available to them as per MoH&FW OM dated 29.09.2016 and OM No. S.11011/11/2016 CGHS (P)/EHS dated 09.01.2017. They may be advised that for availing reimbursement of their medical bills, they have to mandatorily register themselves with the nearest CGHS facility as per one of the options above. They may also be advised that if they fail to register themselves w.e.f. applicable date with the nearest CGHS facility for availing OPD/IPD treatment, their further medical bills may not be reimbursed by this Department.

4. Compliance report in respect of the above may be furnished to this office for appraisal of Secretary, DoT.

This issues with the approval of competent authority.

sd/-
(S.C. Karol)
Director (Estt.)
Phone. 23036500

Click to view the DoT Order in pdf

Reimbursement of medical claims is a process where pensioners who reside in areas not covered under the Central Government Health Scheme (CGHS) can submit their medical bills to receive reimbursement for the expenses incurred.

Pensioners who reside in areas not covered under CGHS and have valid medical bills can be eligible for reimbursement of their medical claims.

Pensioners can claim reimbursement by submitting their medical bills, along with the necessary documents and forms, to the concerned authority or department responsible for handling medical claims.

The required documents may vary based on the specific policies and guidelines of the authority or department handling the reimbursement process. Generally, pensioners may be required to submit original medical bills, prescriptions, medical reports, discharge summaries, and any other relevant documents.

Pensioners need to fill out the prescribed reimbursement form, attach all necessary documents, and submit them to the appropriate authority or department within the specified time frame. It is essential to follow the instructions provided by the concerned authority or department for a smooth reimbursement process.