Ministries, Departments have been decentralized and delegated powers to manage all cases of reimbursement. At the earlier time, claims amount more than INR. 2 lakhs required approval by the department of Health & Family Welfare Ministry.
Under CGHS rules, financial control, power has already been shifted to the Additional Directors of the cities or zones. He has the right to approve settlement of medical claims up to INR 5 Lakhs for pensioner beneficiaries, if there is no compulsion of rules is included.
Is CGHS Contribution Compulsory for CGHS Covered Areas Members?
Yes. For both working and retired central Govt employees, CGHS contribution is compulsory. Pensioners, who need to have CGHS facilities, can contribute either on a yearly basis or one time contribution of 10 years for whole lifelong validity. The Contribution can be issued by DD in favor of “P.A.O. CGHS, Delhi” in Delhi state or “Addl. Director by CGHS City name” for other cities. Contributions in respect of Pensioners are calculated on the basis of grade payment they have received during the service period, but for superannuation.
Need to increase Imprest money
Sufficient imprest money is not available in dispensaries so CMOs are not being able to provide minor items of work. For avoidance of delay in minor items of work, the limit of Imprest Money with CMO has been increased to INR. 20,000/- per annum.
Special services: Dental services in 13 dispensaries in Delhi have so far been outsourced to a private service provider.
Case studies: Reimbursement
Query: I retired in Dec 2012 and I had to shift to my native village in Uttaranchal for some reasons. So, I was unable to make a pensioner’s CGHS card. In June 2013, I came back to Delhi and had suffered from Heart attack. Immediately, I was admitted in a private hospital. After discharge from hospital, I had received CGHS Card but I was refused for reimbursement of the expenditure incurred during treatment. Please suggest?…..R.D. Bhardwaj
Answer: After 3 months of retirement, the grace period is over for making a CGHS card. Within this 3 month grace period, the reimbursement of expenses for treatment can be done. In this case of Mr. Bhardwaj, the amount spent on treatment is only after the expiry of the grace period of 3 months from retirement date. That’s why, it will not be reimbursable.
Remember
But if the beneficiary has received a valid card of CGHS or has applied for a CGHS card for pensioner with all satisfactory documents and proper requisite of CGHS before such treatment, then he will be able to receive reimbursement. In order to take advantages of CGHS facility, the retired employees need to apply for a new Pensioner CGHS card within 3 months grace period after retirement and it could save him/her from huge losses.