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Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS).

As per the recommendations of the sixth CPC, the Misnistry of Health and family Welfare, Government come up with a detailed plan of a health insurance scheme in lieu of the CGHS.

Over View
Central Government Health Scheme (CGHS) is a scheme for providing health care to serving Central Government employees and their dependant family members. Over the years, the scheme has been extended to cover central government pensioners, their dependant family members and certain other categories like members of parliament and ex-members of parliament, freedom fighters etc. Employees of some select autonomous bodies as also PIB accredited journalists have also been extended CGHS facilities on cost-to-cost basis in Delhi.

Central Government Health Scheme is available in 25 cities [Delhi (including Noida, Gurgaon, Faridabad, and Ghaziabad), Ahemdabad, Allahabad, Bangalore, Bhopal, Bhubaneshwar, Chandigarh, Chennai, Dehradun, Guwahati, Hyderabad, Jabalpur, Jaipur, Jammu, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong and Thiruvanthapuram]. Central Government Employees living outside the CGHS areas are entitled to reimbursement for medical attendance and treatment under the Central Services (Medical Attendance) Rules [CS(MA) Rules]. Pensioners of the Central Government are not covered under these rules. At present, Central Government Pensioners living in non-CGHS areas are paid a sum of Rs. 100 p.m. for meeting their medical expenditure. Consequently, there has been a long standing demand from Central Govt. pensioners residing in non CGHS areas for medical services at par with those available to Central Govt. pensioners in CGHS areas. The VIth Pay Commission has recommended the introduction of a health insurance scheme in lieu of the CGHS.

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:
1. CGEPHIS shall be compulsory to new Central Government Employees who would be joining service after the introduction of the health Insurance Scheme.
2. CGEPHIS shall be compulsory to new Central Government retirees who would be retiring from the service after the introduction of the Insurance Scheme.
3. 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.
4. 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.

Family Size / Age Limit

1. Serving Employees: Self, spouse, two dependent children and dependent parents (New born shall be considered insured from day one).
2. Retired Employees: Self, spouse and one dependent child.
3. 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.
4. All beneficiaries shall be insured till survival.
5. 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:
1. Pre-existing diseases
2. Maternity benefit
3. Day-one Coverage for all diseases
4. New-born babies
5. Pre and Post hospitalization cover of 30 days and 60 days respectively
6. Domiciliary Hospitalization

More details here

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