Tuesday, June 16, 2009

Govt proposes New Health Insurance Scheme in lieu of CGHS

Posted by Secretary General on 11:46 AM with No comments
With an effort to introduce Central Government Employees & Pensioners Health InsuranceScheme (CGEPHIS) recommended by Sixth Central Pay Commission, Ministry of Health & FamilyWelfare, invites Expressions of Interest from Insurers and Health Insurance consultants for the proposed scheme.

As per the document known as Expression of Interest published the CGHS website in this regard,Government of India proposes to provide inpatient health care services to the following personnel of the Central Government .

Beneficiaries

All personnel of the Central Government including All India Service officers, serving, newly recruited, retired and retiring and others who are covered under the existing CGHS(Central Government Health Services) and under CS (MA) [Central Services (Medical Attendance) Rules] Rules shall be offered Health Insurance Scheme on voluntary or on compulsorily basis . This could be:
CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the health Insurance Scheme.
CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.
CGEPHIS would be available on voluntary basis for the existing Central Government Employees and pensioners serving in CGHS area/ covered by CGHS. In this case such serving Central Government Employees and Central Government existing Pensioners shall have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total premium has to be born by the beneficiary.
CGEPHIS would also be available on voluntary basis for the existing serving employees and pensioners in non-CGHS areas not covered by CGHS. In this case such serving Central Government Employees and existing Pensioners (who have opted for CGHS facility) shall have to opt out of CGHS scheme. They will also have the option of choosing both CGHS and Insurance policy. In such case the total premium has to be born by the beneficiary.
The proposals relating to sum assured/policy limits, family size, age limit, Insurance coverage are as follows

Sums Insured / Policy Limits

The scheme shall provide coverage for meeting all expenses relating to hospitalization of beneficiary members up to Rs. 500,000/- per family per year subject to stated limits on cashless basis through smart cards. The benefit shall be available to each and every member of the family on floater basis i.e. the total reimbursement of Rs. 5 .00 lack can be availed by one individual or all members of the family. The document also says the Government has proposed to restrict the benefit in respect of Domiciliary hospitalization and Maternity to Rs.50,000/- for each admission

Family Size / Age Limit

Serving Employees: Self, spouse, two dependent children and dependent parents (New born shall be considered insured from day one).
Retired Employees: Self, spouse and one dependent child.
Additional dependent family member can be covered under the scheme by paying the fixed percentage of premium per additional dependent family member. The premium shall be borne by the beneficiary.
All beneficiaries shall be insured till survival.
The definition of dependent shall be as per guidelines issued by Central Government.
Insurance Coverage

In addition to the coverage afforded under a standard medical insurance policy, the following shall also be covered under CGEPHIS:

Pre-existing diseases
Maternity benefit
Day-one Coverage for all diseases
New-born babies
Pre and Post hospitalization cover of 30 days and 60 days respectively
Domiciliary Hospitalization

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