CGEPHIS is Central Government Employees and Pensioners Health Insurance Scheme.
1. Name of the Scheme:
Central Government Employees and Pensioners Health Insurance Scheme.
2. Who Can Join ?
All Central Government Employees and Pensioners.
Compulsory to those who will join after the introduction of CGEPHIS. Existing employees and pensioners who are already CGHS beneficiaries have to opt out of CGHS.
3. Current Target
Approx 17 Lakhs Central government employees and 7 Lakhs pensioners.
4. Insurance Coverage for Treatment
a) In-patient benefits in which insurance scheme will pay all the expenses for the medical treatment in empanelled hospitals.
b) Coverage of Pre-existing diseases.
c) Pre & Post hospitalization benefit.
d) Domiciliary Hospitalization.
e) Day Care Procedures.
f) Maternity and Newborn Benefits.
5. Family Size
Serving/Retired Employees: Self, Spouse, Two dependent children and up to Two Dependent Parents. Any additional dependent member in addition to above can be covered under the Scheme by paying the fixed amount of premium.
6. Age Limit of Dependant Members
a) Son – 25 years or till starts earning.
b) Daughter – Till get married.
c) Sisters – Dependent unmarried /widowed / divorced/ abandoned / separated from their husband.
d) Daughter in law – Widowed irrespective of age limit.
e) Brothers – Up to the age of becoming a major.
f) Dependent Parents – As per condition of eligibility.
7. How to Identify Family ?
Beneficiaries shall be identified by a “Photo Smart Card” issued by the insurer to all beneficiaries which would have all personal details, medical history, policy limits etc. of the CGEPHIS members. .
8. What is the sum Assured for the Insurance Premium ?
Up to 5 Lakhs per family per year in any empanelled hospital.
9. What is the Buffer/ Corporate sum insured ?
Rs 25 Crore shall be provided by the insurer additionally if expense exceed Rs 5 Lakhs for the family.
10. Who are the Health Service Providers ?
Public and Private Health Providers which provide hospitalization and/or a Day Care Services would be eligible for inclusion under the
CGEPHIS.a) General Hospitals having 100 or more beds.
b) Specialty Hospitals.
c) Super Specialty Hospitals having more than 150 beds.
d) Cancer Hospitals.
11. Entitlements for various types of wards
SL NO
PAY DRAWN IN PAY BAND/ BASIC PENSION
ENTITLEMENT
1
Upto Rs. 13,950/-
General Ward
2
Rs. 13,960/- to 19,530/-
Semi-Private
Ward3
Rs. 19,540/- and above
Private Ward
12. Enrolment
The process is taken by the insurance company and shall issue a photo smart card to the CGEPHIS beneficiaries. The enrolment period in the first year shall be for 180 days in the case of retired employees and 60 days in case of serving employee.
13. Call Centre Service
The Insurer shall provide dedicated telephone services for the guidance and benefit of the CGEHIS beneficiaries whereby the Insured Persons shall receive guidance about various issues by dialing a National Toll free number exclusively for this scheme.
14. Nodal Ministry
The Ministry of Health & Family Welfare would be the Nodal Agency
for the implementation of CGEPHIS.
Latest list of Hospitals and Diagnostic centres under Central Government Health Scheme (CGHS) in Kolkata, West Bengal. As on date (23-07-2010) there are 21 empanelled CGHS hospitals / Diagnostic Centres are there in Kolkata. The list is given below.
| Empanelled Hospitals Kolkata | |
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List of Hospitals and Diagnostic centres under central Government Health scheme (CGHS) in Chennai, TamilNadu. Currently there are 24 Hospitals are there under the CGHS in Chennai. The list is shown in the table given below.
| Empanelled Hospitals Chennai | |
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Below is the list of Empanelled Hospitals and Diagnostic centers under Central Government Health Scheme (CGHS) in Trivandrum, Kerala.
| Empanelled Hospitals Thiruvananthapuram | |
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Below is the list of Empanelled Hospitals and Diagnostic centers in Ahmedabad, Gujrath under Central Government Health Scheme (CGHS).
| Empanelled Hospital Ahmedabad | |
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Demand Survey
Governmet of India is contemplating introduction of a helath Insurance Scheme for central government employees and pensioners and their dependant family members all over india. Ministry of Health & Family Welfae intends to assess the demand for the above scheme fromthe prospective beneficiaies through this survey for taking further steps in this direction.
Who can Join
All the personnel of the central government including all India service officers, serving and retired and others who are covered under the existing CGHS (Central government Health Scheme) and under CS (MA) Rules can join the scheme. The scheme is proposed to be implemented on voluntary basis for existing employees and pensioners and compulsarily for future employees and pensioners.
Insurance Coverage
The scheme shall provide coverage for meeting expense of hospitalization and surgical procedures for beneficiary members up to Rs. 5.00 Lakh per family per year subject to limits, in any of the network hospitals. the benefit to the family will be on floater basis. ie. the total reimbursment of Rs. 5 lakh can be availed of individually or collectively by members of the family.
All diseases under the proposed scheme shall be covered from day one.
Insurance premium.
The beneficiary will have to pay an annual premium which will be determined after the formal introduction of the scheme. It will vary according to the grade pay of the officer. The estimated annual premium for a standard family size will be in the range of Rs. 8000 to Rs 120000 pa. It is however proposed to be subsidised by the government to a considerable extent. The amount of premium shall be decided by the transparent process of bidding amongst the insurance companies paticipating in the scheme. In case of srving employees, the premium would be deducted by the Drawing & Disbursing officer, In the case of Pensioners they would be required to authorise the Bank branch from which they are drawing their pension, to deduct the insurance premium.
Family Size
In case of serving employees, self, spouse, two dependent children and dependant parents would be covered. New born will be covered as a part of insured family member during the currency of the policy.
In case of retired employees, self, spouse,two dependent children and dependent parents would be covered.
Additional dependent family member can be covered under the scheme by paying an additional premium per additional dependent family member. The premium shall be borne by the beneficiary and there would be no govt subsidy for the same.
List of cities where CGHS is currently functioning.
Ahemdabad, Allahabad, Bangalore, Bhubaneswar, Bhopal, chandigarh, Chennai, Delhi, Dehradun, Guwahati, Hyderabad, Jaipur, Jabalpur, Jammu, Kanpur, Kolkata, Lucknow, Meeru, Mumbai, Nagpur, Patna, Pune, Ranchi, Shillong, Trivandrum.
Dowload CGEHS demand survey.
More News relating central government employees health Inurance scheme
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
