Reimbursement of Medical Claims to Pensioners under CS (MA) Rules

How to Claim Medical Reimbursement under CS (MA) Rules

This document provides step-by-step instructions on how to claim medical reimbursement under CS (MA) Rules. These rules apply to pensioners who are entitled to receive reimbursement of medical claims as directed by various CATS/Courts. In accordance with these rules, it is important to follow the proper procedures to ensure that reimbursement is received in a timely and efficient manner. This guide is intended to provide clarity and guidance to those seeking to claim medical reimbursement under CS (MA) Rules, 1944.

No. 5.14025/23/2013-MS.EHSS
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare

Nirman Bhavan, New Delhi
Dated the 29 September, 2016

OFFICE MEMORANDUM

Sub:- Reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various CATS/Courts – Regarding.

The undersigned is directed to state that various references are being received in Ministry of Health and Family Welfare on the above mentioned subject. it is hereby clarified that CS (MA) Rules, 1944 are not applicable to pensioners till date.

2. It is further informed that the following options to avail medical facilities are available to Central Government pensioners:

a) Pensioners residing in CGHS covered areas:
1) They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD facilities.

2). Pensioners residing in CGHS areas cannot optout cf CGHS and avail anyother medical facility {i.e. Fixed Medical Allowance). Such pensioners, if they do not choose to avail CGHS facility by depositing the required contributions, cannot be granted Fixed Medical allowance in lieu of CGHS.

b) Pensioners residing in non -CGHS areas:

1). They can avail Fixed Medical Allowance (FMA) @ Rs.500/- per month

2) They can also avail benefits of CGHS- [OPD and IPD] by registering themselves in the nearest CGHS “city after“ making the required subscription.

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

3. In view, of the above, reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various CATS/Courts, need not be referred to the Ministry of Health and Family Welfare. The respective Administrative Department/Ministry may take their own decision in this regard.

4. Further, all Departments/Ministries are requested to intimate their employees proceeding for retirement regarding the above options for medical facilities available to the Central Government pensioners.

5. This issues with the approval of competent authority.

(SUNIL KUMAR GUPTA)
UNDER SECRETARY TO THE GOVT. OF INDIA