If a pensioner, residing in a non-CGHS area and awaiting FMA in lieu of OPD facility, intends to get CGHS facility for both OPD and IPD, he/she needs to apply to the concerned branch of the pension disbursing bank in Form-2 for discontinuation of FMA
At present, government pensioners have the option to switch from the fixed medical allowance (FMA) to the OPD facility. The government, in its order dated March 24, 2022, issued guidelines stating the procedure and timeline for the same.
The Department of Pension and Pensioners’ Welfare’s guidelines highlighted the steps for pensioners to wish to switch their options about whether they wish to use the OPD facility under the Central Government Health Scheme (CGHS) or receive FMA.
Prior to this, pensioners or family pensioners, who reside in an area not covered by the CGHS, were eligible to get a fixed medical allowance of Rs 1,000 per month in lieu of the OPD facility. But the latest notice stated that if a pensioner receiving FMA wants to use the OPD facility, they must apply to the pension disbursing bank for FMA cancellation.
FMA recipient wishes to avail OPD facility under CGHS
According to the Ministry of Personnel, Public Grievances & Pensions circular, “If a Pensioner/Family Pensioner residing in non-CGHS area shifts his/her residence to a CGHS covered area, he/she no longer remain eligible for FMA irrespective whether he/she avails the CGHS facility or not. It will, therefore, be the responsibility of the Pensioner/Family Pensioner that on shifting from a non-CGHS area to a CGHS covered area and while requesting for change of address from a non-CGHS area to a CGHS covered area, he/she will apply to the Bank in Form 2 for discontinuation of his/her FMA.”
“The pension disbursing banks will also make a provision in their system so that whenever a Pensioner/Family Pensioner gives an intimation regarding change of residence from a non-CGHS area to a CGHS covered area, the FMA being paid to the Pensioner/Family Pensioner would automatically be stopped, irrespective whether or not the Pensioner/Family Pensioner has requested in Form-2 for stoppage of his/her FMA,” the circular added.
Further, on receipt of an application in Form-2 from the Pensioner/Family Pensioner, who has shifted from a non-CGHS area to a CGHS covered area, the Bank will issue a certificate in Form-3 regarding discontinuation of FMA to the Pensioner/Family Pensioner within 3 working days from the date of receipt of the application.
Thereafter, it will be open to the Pensioner /Family Pensioner to apply to the CGHS authorities for issue of a CGHS card for both OPD and IPD facility.
If a Pensioner/Family Pensioner, residing in a non-CGHS area and awaiting FMA in lieu of OPD facility, intends to avail CGHS facility for both OPD and IPD, he/she may apply to the concerned branch of the pension disbursing bank in Form-2 for discontinuation of FMA, to enable him/her to apply to the CGHS authorities for the CGHS facility.
The person will also have to give an undertaking in Form-2 to the Bank that the option being exercised by him/her to avail medical facility under CGHS or other similar Health Scheme of their respective Ministry/Department, is a one-time option and that he/she has not availed the facility of change of option from CGHS to FMA in the past.
After then, the Pensioner/Family Pensioner may apply to the appropriate CGHS authority for the issuance of a CGHS card for both OPD and IPD services after paying the required CGHS contribution, if not previously paid.
The person concerned will be issued a CGHS Card (with OPD access) in accordance with their procedures, provided he/she otherwise meets the CGHS Card qualifying requirements.
Persons with CGHS/medical facility for both IPD and OPD wish to avail FMA
If a Pensioner/Family Pensioner who is receiving CGHS/medical benefits for both IPD and OPD, wants FMA while residing in a non-CGHS area or upon relocating from a CGHS to a non-CGHS area, they may apply to the CGHS authorities for surrender of OPD benefits under CGHS.
This would be done within 4 working days of receiving the application.
Following this, the Pensioner/Family Pensioner will submit an application to the Head of Office, together with a copy of the surrender certificate, for the issuance of a revised pension payment authorization to cover FMA payment.