CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME- Draft

                                                                   DRAFT

               CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE  SCHEME  (CGEPHIS)

1. NAME OF THE SCHEME:

The name of the proposed scheme is “Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS)”.

2. BENEFICIARIES:

All personnel of the Central Government including All India Service officers, serving, newly recruited, retired / 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 compulsory basis as indicated below:

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 following:
a. Existing Central Government Employees and Pensioners who are already CGHS beneficiaries. In this case they 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 insurance premium has to be borne by the member.

b. Existing Central Government Employees and Pensioners who are not CGHS beneficiaries but are covered under CS (MA) Rules. Pensioners are however not covered under CS(MA)Rules.

3. TARGET GROUP:
              All personnel of the Central Government including All India Service officers, serving and retired, and others who are covered under the existing CGHS and under CS (MA) Rules shall be offered the Health Insurance Scheme. It is estimated that approximately 17 lakh serving employees and 7 lakh pensioners shall be offered this Scheme on compulsory / optional basis.

4. INSURANCE COVERAGE:
         a) In-patient benefits – The Insurance Scheme shall pay all expenses incurred in course of medical treatment availed of by the beneficiaries in an Empanelled Hospitals/ Nursing Homes (24 hours admission clause) within the country, arising out of either illness/disease/injury and or sickness.

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HEALTH INSURANCE SCHEME-DEMAND SURVEY