Govt proposes New Health Insurance Scheme in lieu of CGHS

With an effort to introduce Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS) recommended by Sixth Central Pay Commission, Ministry of Health & Family Welfare, 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 tothe 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 lac 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

 CLICK HERE TO DOWNLOAD THE DOCUMENTATION FOR EXPRESSION OF INTEREST  CALLED FOR BY THE HEALTH MINISTRY


 SOURCE - GCONNECT