Launching Central Government Employees and Pensioners Health Insurance Scheme

In a desperate bid to reduce the cost of medical claims applied by the Central Government Employees, the Health Ministry has proposed to end the Central Government Health Scheme (CGHS) and will launch an insurance based scheme called the Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS).

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    Under this new scheme the medical claim bills will be processed and paid by the IRDA registered and approved insurance companies, instead of the government.

    Currently, the medi-claim amount paid by the government to its employees is Rs. 6,000 annually, and the new FMA is still to be calculated. The ministry is working on a presumable bid of around Rs. 14,000 per family. The coverage of each family annually will be approximately Rs. 1000 crores, annually. The medical coverage of a nuclear family will be around Rs. 5 Lakhs per year. An additional sum of Rs. 10 crores will be provided in each of the four zones by the insurance companies as buffer when it comes to such cases.

    The CGHS currently has no annual cap, but each procedure will have a maximum limit set. This will tremendously help the government employees because it will open up new deals and advantages prevailing in the medical insurance sector.

    According to the industry sources, this proposal was supposed to be launched in 2011 when the committee of secretaries gave its principal approval. However, it has been revived after the NDA government took charge. The total number of CGHS beneficiaries today stands at 36,67,765. Serving and retired government employees are included under this scheme. Also inclusion of former vice presidents, former prime ministers MPs and former MPs, sitting and retired judges of the Supreme Court, PIB accredited journalists, Railway Board employees, Delhi Police personnel are all included in this new medical insurance scheme.

    This health scheme will no doubt help bring in a substantial growth to the medical insurance sector. Providing better care and deals to every individual who avails this insurance. In case of transplants the expenses of the donor or the processing amount of cadaver organ can be very huge; this is not generally included in the insurance policies. However it will be covered from now on under the new conditions set by the Rashtriya Swasthya Bima Yojana. The onus of executing this new CGEPHIS policy will lie on the shoulders of Health Ministry and not on the Labor Ministry.

    The scheme is applicable to both retired and serving employees or people who hold a valid relation of working under the government sector. This new insurance plan will bring a great financial relief for many families who otherwise could not get expensive and better medical care due to lack of medical funds. Due to these colossal reasons the CGEPHIS scheme will finally be able to help government employees in the manner it was originally proposed.

     (Source: This article has been adapted from the article "Medical bill rising, ministry plans to shift to health insurance scheme" that appeared on January 29, 2015   in indianexpress.com.)

    Written By: PolicyBazaar - Updated: 29 July 2021

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