OFFICIAL ORGAN OF THE BHARAT PENSIONERS SAMAJ, NEW DELHI - 110 014

(Federation of All India Pensioners Associations)

(MEMBER, INTERNATIONAL FEDERATION ON AGEING, TORONTO, CANADA)
DIRECT SUCCESSOR TO PENSIONER ESTD IN 1955
SPECIAL SUPPLEMENT APRIL 2010
REGD. No. DELBIL/2006/17678
Pensioners Hand Book 2010
Guidelines for
CENTRAL GOVERNMENT
RETIRING OFFICIALS AND PENSIONERS
(Including Rlys)
Compiled & edited by :
S. C. Maheshwari
BHARAT PENSIONERS SAMAJ
PB - 3303, Jangpura, Delhi - 110 014 [Office Ph - 2437 6642]
(Summer Timings : 9.30 am to 1.30 pm only)
Only for Esteemed Members and Dedicated Affiliates in exchange for
their love and devotion for BHARAT PENSIONERS SAMAJ
Restricted
Circulation
Pensioners Hand Book
2010
Guidelines for
CENTRAL GOVERNMENT
RETIRING OFFICIALS AND
PENSIONERS (Including Rlys)
Dedicated to Unsung Heroes
who laid down their lives
while serving the Country
Compiled & edited by :
S. C. Maheshwari
Formerly DEN, C. Rly,
Secretary (Rlys) Bharat Pensioners Samaj
General Secretary RREWA Gurgaon
Published by:
BHARAT PENSIONERS SAMAJ
PB - 3303, Jangpura, Delhi - 110 014
Printed by :
COMPUDATA SERVICES
42, DSIDC Shed, Scheme - I
Okhla - II, New Delhi - 110 020
PREFACE
The 6
th
Central Pay Commission submitted its Report to the Government
of India on 24
th
March, 2008. The Union Cabinet broadly accepted its
recommendations on 14
th
August, 2008. The Government Resolution in this
regard was published in the Gazette of India on the 29
th
August, 2008. Orders
for revision of pension of pre-2006 pensioners / family pensioners were
issued on the 1
st
September, 2008. Several other orders including
clarifications were issued during the last nearly two years.
2. For some time past, the need was being felt for a compact Handbook
for pensioners & family pensioners. Such a Handbook should give, in a
simple language, the broad pension policy governing pre-2006 pensions,
the basic rules, the procedures and regulations in regard to sanctioning and
disbursement of pension and retirement benefits. Apart from the financial
benefits, pensioners are interested to know as to what medical facilities are
available to them. We are glad to say that this need has been fulfilled with
this Hand Book written by our Secretary (Railway Pensioners), S C
Maheshwari. We are sure that our learned Members and Affiliated
Associations would find it both interesting and useful.
3. As our esteemed readers are aware, we published two Special
Supplements of our monthly journal "BHARAT PENSIONER" in 2008. The
first one, was published immediately, in April, 2008, after the 6
th
CPC
submitted its Report. The 2
nd
Supplement, in a book form, was published in
September, 2008, i.e., as soon as the first implementation Order was issued
on 1
st
September, 2008 as mentioned above.
4. The present Hand Book would, therefore, be the 3
rd
Special Supplement
of 'BHARAT PENSIONER' published in the wake of the recommendations
of the 6
th
Central Pay Commission. As in the past, we have decided to supply
a copy, free of cost, to each Member in accordance with the Rules &
Regulations of BHARAT PENSIONERS SAMAJ. Everyone is, of course,
keen t o support our bel oved BHARAT PENSIONERS SAMAJ
FINANCIALLY; hence to begin with, each one of us, I am sure, would
demonstrate it too with a token Special Donation of Rs 100 only forthwith,
by Money Order. An MO form accordingly has been printed and pasted in
the Hand Book itself. What you have to do it to simply fill it up with your
(Sender's) name & postal address and hand it over at a Post Office Counter
with the requisite amount.
Shyam Sunder
Secretary General
Dated 2
nd
April, 2010 BHARAT PENSIONERS SAMAJ
FOREWORD
Pensioners, even highly educated ones, suffer lot of hardship
in getting fair deal at the hands of administration, more out of
ignorance than indifference on the part of the latter. I have come
across a case of a pensioner, retired at the level of Chief Engineer
in a department of Union Government, whose pension was not
fixed properly even at the time of the Fifth Pay Commission and
its effect compounded now after the Sixth Pay Commission.
There are innumerable cases of retirees who suffer untold misery
particularly in the advanced age and poor health, in securing even
small facilities they are rightfully entitled to and have to run from
pillar to post for the same.
Retired Railway Employees Welfare Association (RREWA)
has been rendering yeomans service in creating awareness
amongst pensioners, not only from Railways but also from all the
departments of Government, and interceding on their behalf with
Department of Pension and Pensioners Welfare and other
Ministries of the Union Government. The Association, under the
able stewardship of Shri S C Maheshwari, has succeeded in
securing relief to the pensioners in a number of areas in an effort
to improve their lot.
An attempt has been made in the present venture to bring
together a large number of issues relevant to the retirement and
the retired life. The Hand Book, very rightly, draws attention to the
need for taking action well before the retirement to ensure not only
trouble free transition from life during active service to peaceful
retired existence but also to provide for an unfortunate situation of
death in harness. Overview of the retirement benefits is quite
comprehensive. Detailed coverage of the problems that can be
encountered in the eventuality of the demise of the pensioner and
advance planning for the situation can not be over emphasized.
Coverage on End of Life Issues and a comprehensive note on the
significance of will is very useful.
P C Sharma IRTS (Retd)
[Former Advisor Safety,
Railway Board]
(ii)
INTRODUCTION
The Hand Book for PENSIONERS/Family Pensioners which
is first of the series, give the salient features of the pension policy
governing pre 01.1.2004 employees of the Central Government
and attempts to highlight the basic rules, the procedures and
regulations governing the sanctioning and disbursement of
pension and retirement benefits, in the process all relevant
aspects central to pension policy like qualifying service, record of
service and operational aspects relating to processing of pension
papers, nominations to be made have also been highlighted. This
Pensioners/Family Pensioners guide also contains other relevant
information on health, banking procedures, etc. that are relevant
for pensioners. While the Handbook gives a general Overview on
matters relating to pension, Government Servants and Pensioners/
Family Pensioners are advised to consult the original rules/
orders if necessity arises, for more specific information. Please
visit the websites www.rrewa.org. & http://pensionersportal.gov.in/
The Handbook is being published for wider dissemination of
information to bring about better awareness on pensionary & old
age related matters. By giving a wide coverage, this Handbook&
the referred web sites, it is felt will serve the needs of retiring
officials, pensioners/Family pensioners in understanding the
broad pension policy of the Central Government in case of pre
1.1.2004 entrants.
Before bringing out the Hand book, to facilitate easy access
publishers have made available at website www.rrewa.org all the
relevant circulars and orders issued by the Department of Pension.
Rly Board & other Govt. Agencies. Also the relevant rules and
govt. policies on the subject are posted on to the website
www.rrewa.org It will be our endeavor to keep the dissemination
channel on the Internet online & up-to-date for the benefit of
Associations of Pensioners, Pensioners/Family pensioners and
serving employees of the Government /Sr Citizens.
Suggestions for improvement of the Hand book are welcome.
S.C.Maheshwari
Former DEN, C Rly
Secretary (Rlys), Bharat Pensioners Samaj
General Secretary, RREWA ,Gurgaon
Contents
Part I Basics for Retiring officials 1-9
General; Retirement benefits; Service records;
Qualifying Service, verification of Service; Nominations;
Will; Occupation of Government accommodation, Point
of Retirement; Quantum of Retirement benefits;
Processing &finalizing pension papers; Provisional
pension; Sanction of family Pension
Part II Overview of Retirement benefits 10-22
Entitlement and Quantity, Persons Eligible for Pension;
When is pension given; Classes of Pension; Pension
Constituents; How Pensionary Benefits are worked
out:- Pension; Commutation of Pension; Retirement
Gratuity; Dearness relief: Death Gratuity for family;
Family Pension; Non Pensionary Retirement Benefits:-
Provident Fund Account; Central Government
Employees Group Insurance Scheme; Travelling
allowance etc; Medical facilities for pensioners
Part III Basics for Pensioners 24-38
Pension Disbursement:- Disbursement of pension
by the Banks; Disbursement of Pension to NRI
pensioners, Receipt of two pensions; post retirement
conviction/imprisonment: Know your PPO, Post
retirement changes in the Family; Certificates required
by a Bank from pensioners; Drawal of pension by infirm
Pensioners; Transfer of pension; Restoration of
commuted Portion of Pension; Life time arrears;
Recovery of excess or wrong payment; Issue of
duplicate PPO, Disbursement of Family pension,
Procedure claiming Family Pension; Certificates to be
furnished by the family pensioner to the pension
disbursing agency. Miscellaneous; Grievance redressal.
Annexures
I: Commutation Table 39
II: Forms 40
III : End of life issues 63
IV : Will; Annexure 66
V : Healthy ageing 76
VI : CGHS 82
VII : RELHS - 97 137
Bibliography Back Title
Page
PART - I
BASICS FOR RETIRING OFFICIALS
SECTION 1 - GENERAL
1.1. You are a government employee and regularly interact with your
office colleagues and the members of public in the discharge of your
official duties. You have possibly served in different positions for over
30 years since the day you joined service. Time flies. Occasional
farewell functions of your erstwhile colleagues sometimes do remind
you of your own impending retirement but the thought of retirement
vanishes as quickly as it comes.
1.2. In service, you have had the unique opportunity to serve the
country and the society. The service span spread over three decades
or more looks infinite to begin with. Your office going becomes an
addiction. Time passes, and suddenly you realize that the day of
retrospection and parting has arrived. The service was rewarding but
also taxing. You are now entitled to a well-deserved peaceful and quiet
retirement. To ensure that you are not caught unawares, and you and
your family get all the retirement benefits in time, it is essential that you
acquaint yourself and know in good time the basics of Pensionary
benefits and policy relating thereto. A careful perusal of this handbook
will help you to achieve a smooth transition from the life of an active
civil servant to a contented and informed pensioner.
SECTION 2 - WHAT YOU SHOULD KNOW ABOUT
RETIREMENT
1.3. Retirement benefits for pre 01-01-04 entrants comprises:-
(a) Pension with an option to commute a lump sum amount of upto
40% of the monthly pension;
OR
Service gratuity in case total qualifying service is less than 10
years when no pension is admissible.
(b) Retirement or Death Gratuity if you have rendered a minimum of
5 years qualifying service.
(c) Family Pension for eligible spouse and children in the case of
death of Government servant, while in service or after retirement.
Dependent parents and siblings (i.e. Brother/sister) are also
entitled to family pension when their turn comes
1.4. In addi ti on, there are certai n non-Pensi onary
retirement benefits/payments, which include.
(a) General Provident Fund, accumulations inclusive of interest
thereon.
(b) Encashment of earned leave to the credit of the retiring Government
servant on the date of retirement subject to a maximum of 300
days.
(c) Accumulated amount in the Saving Fund segment together with
the interest under the C.G.E.G.I.S.
(d) Insurance cover benefit under the Central Government Employees
Group Insurance Scheme (CGEGIS) to the family in the event of
death of Government servant while in service.
(e) Travelling Allowance to the pensioner and his family, at the scale
applicable to him while in service, for travel to the home place
within India, as declared by him and entered in his service records,
for post-retirement settlement.{In addition to travelling allowance,
Railway Retirees are also entitled to KIT/Cattle wagon passes /
Transport allowance according to their status &date of appointment
for shifting their belongings to the place of settlement within India }
(f) CGHS /RELHS/ECHS facilities or medical allowance,
1.5 The determination of your entitlement for Service Gratuity,
Pension and DCRG is dependent inter-alia on the length of qualifying
service. This information will be available in the Service Book / Service
Record, being maintained by the administrative authorities for all
employees on their rolls.
1.6. SERVICE RECORD
(a) A service book starts as soon as you enter service and contains
records of all prominent events such as appointment, confirmation,
promotion, grant of increments, grant of leave, awards, punishment
etc., occurring in ones service career. The service book also
contains entries relating to verification of service from time to
time and the total length of service.
(b) Rules require every Head of Office to show the service book to
the respective employee every year. It is the duty of every Head
of Office to initiate action to show the Service Books to the
Government servants under his administrative control every
year and to obtain their signatures therein in token of their having
inspected the Service Books.
(c) It will not take much time for you to have a look at your service
book once a year to ensure that all relevant entries have been
properly recorded. This will save you a lot of bother at the end of
your service. So please do insist on verifying your Service Book
entries once a year and get the deficiencies if any remedied
immediately. A copy of the service book is also available on
payment of a nominal fee. It is advisable that you obtain a
certified copy of your service record at the time of retirement
1.7. QUALIFYING SERVICE
The rules governing computation of qualifying service for the
employees retiring from the service in the civilian departments are
contained in Chapter III of the Central Civil Services (Pension) Rules,
1972 and the corresponding rules applicable to employees of Defence
services and Railways. Service rendered in State Governments/
Central or State autonomous organizations prior to joining the Central
Government is also reckoned for computation of pensionary benefits
under the Central Government in certain specified circumstances. In
case you have any service of the nature mentioned above and the
requisite conditions are satisfied, please ensure that suitable entries
/ mention has been made in your Service Book, well in time, i.e. when
the events are fresh and records are easily available.
1.8. VERIFICATION OF SERVICE
Rule 32 of the Central Civil Service (Pension) Rules, 1972 requires
Heads of Office to verify the service rendered by each Government
servant under his administrative control and determine the qualifying
service on completion of 25 years of service or 5 years before the date
of his retirement, whichever is earlier, and communicate the same to
him in the Form prescribed for this purpose. If you have reached this
milestone and have not been told of your qualifying service please
ask for it.
1.9. NOMINATIONS
(a) One may not like it, but it is essential and never too soon to make
proper provision for ones money and effects in the unforeseen
eventuality of death. This will relieve ones dependents and dear
ones of considerable amount of hardship and trouble.
(b) Nominations are allowed for enabling the nominee(s) to receive
the following in the event of death:
(i) Provident Fund dues
(ii) Death Gratuity
(iii) Benefits under Central Government Employees Insurance
Scheme
(iv) Life time arrears of pension / retirement gratuity and leave
encashment.
(c) In the absence of a nomination, the family members may be
subjected to considerable hardship and hassles in the process
of obtaining a succession certificate to claim dues. This involves
both time and money. Therefore, please file your nomination in
the prescribed formats with your administrative authority. You
are free to change your nominations whenever your priorities
change.
(d) Nominations in the case of lifetime arrears (LTA) of pension are
to be filed before retirement with the Heads of office along with
the application for pension. The pensioner can also file
subsequent modifications to nominations with the respective
pension disbursing authorities.
(e) In the case of pensioners drawing pension from Banks, the
nomination referred to in the preceding paragraph will apply only
to that amount which has not been drawn and credited to their
respective Bank Accounts at the time of death. For the amounts
already credited to the account, the normal banking laws and
procedures govern the pensioners. Incidentally, bank regulations
provide for nomination by the account holder in respect of the
balance amount standing to his credit in the event of death. You
may approach your designated bank and insist on making such a
nomination in addition to the nomination filed with the Head of Office.
Note: Forms required are given in Annexure II
1.10. WILL
You will also have other moneys and effects for which a proper provision
may be necessary. A proper Will is the answer for this purpose. The
Will ensures that intestate provisions do not apply. There are various
ways in which a Will can be made. It is best to consult a lawyer who will
provide you the guidance in this behalf. For details: please refer to
Annexure IV: Will
1.10 (a) What you should know to safeguard your & your familys interest
and what your Spouse & close relatives should know: - Please
refer to Annexure III : End of the life issues
1.10 (a) How should you plan your post retirement? Please refer to
annexure V Healthy ageing. For references see Bibliography at
the END
1.11. OCCUPATION OF GOVT ACCOMMODATION
(a) In case you are in occupation of Government accommodation, you
should know that there is a regular system of issue of No Demand
Certificate annually by the Directorate of Estates/Personnel/
Accounts Branch. Please ensure that this periodical No Demand
certificate is obtained by you.
(b) A reference is required to be made to the concerned Estate
Manager/Personnel/Accounts branch by the Head of Office at least
two years before the anticipated date of your retirement for updating
the rent recovery record. Please ensure that your Head of Office
makes the reference to the Estate Manager/Personnel branch in
this behalf when you reach this milestone.
Note: Govt has the right to withhold gratuity in case non-vacation of govt
accommodation before retirement.
1.12. POINT OF RETIREMENT:
You will retire from service on the last day (afternoon) of the month in
which you attain the age of superannuation, which is presently 60 years.
In the case of those, whose birthday falls on the first of a month, the
date of retirement is the last day (after noon) of the preceding month.
You are however free to select your date of retirement in the following
circumstances: -
(a) Voluntary retirement (VRS) on completion of 20 years or more
of qualifying service
(b) Premature retirement on attaining the age of 50 years in case
or Group A and Group B officers and 55 years in the case of
Group C and Group D officials
Note: (a) The Govt. servant retiring on superannuation should
formally relinquish charge of office on the afternoon of that day itself
even if it happens to be a closed holiday. The cash, stores, etc. may
be made over by the retiring officer on the close of the previous
working day. The actual relinquishment of charge of office shall be
made in the prescribed form on the last day of service for which the
physical presence of the officer in the office need not be insisted.
(F.R. 56 GOI Decision (3).
1.13. QUANTUM OF RETIREMENT BENEFITS
A broad overview of the retirement benefits together with quantum,
admissible to Central government employees is given in Part II of the
Handbook. The write-up indicates normal entitlements under the
Pension Rules. If any clarification or additional information is required
in regard to any specific provision, you may like to consult appropriate
rules and orders issued by the Government. Pensionary entitlements
under special circumstances such as under Extraordinary Pension
Rules have not been included in this Handbook.
SECTION 3 - PROCESSING / FINALISATION
OF PENSION PAPERS
1.14. PROCESSING OF PENSION PAPERS
(a) Your Head of Office processes pension claims. In the event of
death of an employee in harness, the Head of Office is also
responsible for settling the familys entitlements of the terminal
benefits.
(b) The process for sanctioning your pension claims is to be
initiated by the Head of Department twenty-four months in
advance of the retirement date.
(c) Eight months prior to the retirement date, you are to furnish
certain information (e.g. joint photograph with your spouse,
family details with their date of birth, name of the Bank & A/c
Number through which you desire to draw your pension etc.) to
your Head of office in the prescribed form. Make enquiries from
your office in case you do not receive any intimation from the
Head of office in this regard.
{As joint pension account with spouse in Banks is now permitted,
it is advisable to open a joint A/C with your spouse (CPAO/Tech/
Amendments/Sch.Book/2005-06/69 dated 9.6.2005)}
(d) The Head of office is required to send complete pension papers
to the Accounts officer not later than six months before the date
of retirement.
(e) Dues owed by the retiring employees on account of license fee
for Government accommodation, advances, overpayment of
pay and allowances are required to be assessed by the Head of
Office and intimated to the Accounts officer two months in
advance of the date of retirement so that these are recovered
from retirement gratuity before payment. For this purpose the
license fee for those in occupation of Government
accommodation is taken into account upto the end of the
permissible period for which accommodation can be retained
after retirement under the rules on normal rent. The recovery of
the license fee beyond that period is the responsibility of the
Directorate of Estates. If, for any reason final dues cannot be
assessed in time, then 10% of gratuity wil be withheld f temporarily.
(f) The Pay & Accounts Officer (PAO)/FA&CAO {in case of Rlys}
who finally sanctions pension, is required to ensure that your
Pension Payment Order (PPO) is dispatched to the Central
Pension Accounting Office not later than one month in advance
of the retirement date. You will receive intimation thereof from the
PAO.
(g) However, for Rly pensioners FA & CAO sends PPOs directly to
the Accountant General, Director of Accounts (Postal) or Public
Sector Bank, as the case may be, where the payment of pension
is to be arranged through Treasury, the Accounts Officer will
issue the PPO, duly signed and embossed seal affixed on it to
the concerned Treasury Officer.
15. Your cooperation with the Head of Office is vital for you to ensure
timely settlement of your claims. Please ensure that you submit your
papers and furnish all relevant information in good time. This will
enable the administration to complete formalities and issue your
Pension Payment Order before you retire.
1.16 PROVISIONAL PENSION
(a) If any delay is anticipated in the sanction of your Pensionary
benefits, the Head of Office is required to sanction provisional
pension and provisional gratuity and also make arrangements
for payment thereof on due dates.
(b) Rules also provide for grant of provisional pension where
departmental or judicial proceedings are pending at the time of
retirement. However, in such cases, gratuity is not released and
the commutation of pension is also not allowed pending settlement
of departmental / judicial proceedings.
1.17 SANCTION OF FAMILY PENSION
Entitlement of family pension is also sanctioned at the same time as
pension and indicated in the PPO. After the death of the pensioner, the
designated disbursing authority or the branch of the bank that was
disbursing the pension during pensioners lifetime, as recorded, will
disburse family pension, straightaway. In such cases, no separate
sanction for family pension is required.
SECTION 4 - MISCELLANEOUS
1.18. INTEREST ON DELAYED PAYMENT
You are entitled to receive interest on the amount of retirement gratuity
if its payment is delayed for administrative reasons beyond a period
of 3 months; the prescribed rate of interest is at par with the interest
rate admissible on the balances in the General Provident Fund, which,
at present, is 8% per annum. Interest is not payable on pension or
commuted pension even if there is delay.
1.19. MODE OF PENSION DISBURSEMENT
Retiring employees have an option to draw their pension through:
(i) Pay and Accounts Officer attached to the office from which
they retire, or
(ii) Treasury of the place where they permanently settle down
after retirement, or
(iii) A branch of the public sector bank (PSB) entrusted with
disbursement of pension on behalf of the Central Government
at the intended place of their residence after retirement, or
(iv) A few approved private sector banks.
1.20. Drawal of pension through Pay and Accounts Offices or
through the Treasuries involves claiming Pension every month
by presentation of a bill by the pensioner. Drawal of pension
through public sector banks is simpler as the bank automatically
credits the pension to the bank account of the pensioner every
month.
For this purpose pensioners are required to open an account in
their own name or jointly with spouse in the Branch of the public
sector bank through which they wish to draw their pension. Joint
Account with spouse is permitted. It will be in your interest to
operate this account solely for the purpose of pension without
maintaining other transactions in this account. This will enable
you to keep a watch on the amount of pension and dearness
relief credited to your account by the bank from time to time.
This will also help you to verify with the Bank authorities
immediately on receipt of higher or lower pension. This will
facilitate timely reconciliation and avoid the possibility of the
bank effecting any recovery at a later date.
1.21. Retiring employees of the Department of Posts can draw
pension through post offices or through Banks. This facility of drawing
pension through Post Offices is not available to other pensioners
except those belonging to Railways. Those drawing pension from Post
Offices can also avail of the facility of having their monthly pension
credited to their post office saving bank account at places where saving
bank facilities are available in the concerned Post Offices. This will
enable them to draw their pension {without the need for presenting
themselves in person with a bill every month} in the same manner, by
which other pensioners draw their pension through public sector
BB Banks.Existing P.O. Pension A/cs can be transfered.
PART - II
OVERVIEW OF RETIREMENT BENEFITS
SECTION 1 - ENTITLEMENT
AND QUANTITY
2.1. PERSONS ELIGIBLE FOR PENSION
(a) A Central Government civilian employee in pensionable service.
(b) He must be permanent at least in one post, not necessarily in the
last post held.
(c) Quasi -permanent and temporary empl oyees reti ri ng on
superannuation pension/invalid pension after rendering not less
than 10 years service. He is also entitled to seek voluntary
retirement after completion of 20 years service.
Please Note:
(i) An employee who is dismissed or removed from service forfeits
his pension. The competent authority may, however, in cases
deservi ng speci al consi derati on, deci de to sancti on
compassionate allowance, as per the scale laid down in the
rules;
(ii) Resignation from service entails forfeiture of past service.
2.2. WHEN IS PENSION GIVEN
Pension is payable after you attain the age of retirement
(superannuation) and is payable upto &including the day of death
irrespective of time of death
Full Pension is also payable before superannuation age on voluntary
retirement after rendering 20

years or more of qualifying service. Pro-
rata pension in case of less than 20 years of qualifying service (w.e.f
1.1.06) is also payable to permanent Government servants - on
absorption in a PSU/Autonomous Body - provided the Government
servant has rendered not less than 10 years qualifying service under
Government prior to absorption.
Family pension is payable to an eligible family member on the death
of an employee while in service or after retirement. The following
are as present covered in the definition of family in relation to a
Government servant/Pensioner for the purpose of eligibility for family
pension:
(a) Wife in the case of a male Government servant, or husband in the
case of a female Government servant;
(b) A judicially separated wife or husband, such separation not being
granted on the ground of adultery and the person surviving was
not held guilty of committing adultery;
(c) Son/Daughter upto the date of his/her marriage or till the date he/
she starts earning, or till the age of 25 years ( in case of son only),
whichever is the earliest;
(d) Unmarried/widowed/divorced daughter, upto the date of marriage/
remarriage or till the date she starts earning, whichever is earliest;
and
(e) Son or Daughter suffering from any disorder or disability of mind
including mentally retarded or is physically crippled or disabled or
blind so as to render him or her unable to earn a living even after the
age of 25 years ( admissible to unmarried only)
(f) Parents who were wholly dependent upon Government servant
when he/she was alive provided the deceased employee has left
behind neither a widow nor a child.
(g) The dependent disabled siblings (i.e. brothers/sisters) of
Government servants/pensioners have also been included in the
definition of family for the purpose of eligibility for family pension
on their turn.
Further, the dependency criteria for the purpose of family pension
has been revised and fixed as the minimum family pension, along
with the dearness relief thereon, DOP & PW O.M. No. 38/37/08-
P&PW (A) dt. 2, 9.2008,
2.3. CLASSES OF Pension:
Pension granted may be may be:
Superannuation Pension / Retiring Pension
Invalid Pension
Compensation Pension
Compulsory Retirement Pension or Compassionate Allowance.
2.4. PENSION CONSTITUENTS
Pensionary benefits are made up of the following: -
Pension subject to a minimum of Rs.3500 per mensem (w.e.f
1.1.06) and a maximum of upto 50% of the highest pay in
Government.
Lump sum payment resulting from commutation of a portion
(upto 40%) of pension.
Retirement/death gratuity not exceeding Rs.3.5 lakhs .this
limit raised to 10 lac w.e.f 1.1.06
Family Pension in the event of death of employee / pensioner :
Enhanced family pension @ 50% of the last pay drawn immediately
before retirement of the employee / Pensioner upto 7 years after
the death of the government servant/ pensioner or upto the age
of 67 years{of the employee/Pensioner had he been alive} which-
ever is earlier (this is not applicable in the case of parents).{w.e.f
1.1.06 in case of a Govt employee dying in harness enhanced
family pension is payable for 10 years}
2.5. HOW ARE PENSIONARY BENEFITS WORKED OUT
2.5.1. Service Gratuity
You will be entitled to receive service gratuity (and not
pension) if total qualifying service is less than 10 years.
Admissible amount of 1/2 months basic pay last drawn for
each completed six-monthly period of qualifying service.
No minimum or maximum monetary limit on the quantum.
This one time lump sum payment is distinct from and is paid
over and above the retirement gratuity.-
2.5.2 Pension
You will be entitled to receive monthly pension in case you have
completed at least 10 years of qualifying service on superannuation
from service.
Full pension with 20 years of qualifying service is 50% of the
average emoluments of last ten months or 50 % of the last pay
drawn which ever is beneficial to the pensioner. (with effect from
01.01.06 OM38/37/08P&PW(A) dated 10.12.2009)
In case where Govt servant becomes entitles to pension on completion of
ten year of qualifying of service in accordance with rule 49 (2) of CCS
(pension) Rule 1972, pension in those cases shall also be paid at 50% of
emoluments or average emoluments whichever is more beneficial to govt
servants (O.M. 38/37/208-P&PW(A)dated 2.9.2008)
Minimum pension presently is Rs.3500 per mensem.
Maximum limit on pension is 50% of the highest pay in the Govt.
of India per mensem.
D.R. is payable on the same rate as D.A. to existing employees.
Pension is payable upto and including the date of death.
W.e.f 1.1.06 additional pension is admissible to older pensioners at
the following rates
1. On completion of 80 years of age = 20% of basic pension
2. On completion of 85 years of age = 30% of basic pension
3. On completion of 90 years of age = 40% of basic pension
4. On completion of 95 years of age = 50% of basic pension
5. On completion of 100 years of age = 100% of basic
pension
D.R. will also be payable on this additional pension
2.5.3. Commutation of Pension
You have an option to commute a portion of pension, not exceeding
40% of it, into a lump sum payment, with effect from 1.1.96. After
implementation of 6
th
CPC w.e.f 01.1.06, all future commutation
of pension will be as per revised commutation table as per
annexure (I) this table is subject to periodical revision on the basis
of interest and mortality rate. However, this table will not be
applicable to past commutations in respect to post 31.12.05
pensioners who have already commuted their pension prior to
implementation of 6th CPC recommendations.
No medical examination is required if this option is exercised
within one year of retirement.
If you decide to opt for commutation after the expiry of one year,
you will have to undergo medical examination by the specified
competent authority.
Monthly pension will stand reduced by the portion commuted and
the commuted portion will be restored on the expiry of 15 years.
Dearness relief entitlement will continue to be calculated on the
basis of the original pension (i.e. without reduction of commutation
portion)
Commuted portion of pension will be restored on the expiry of 15
years. Revision of Pension - rule 10 of CCS (Commutation)
Rules, 1981. {GOI decisions w.r. to S.C. judgment}
2.5.4. Retirement gratuity:
Minimum of 5 years qualifying service and eligibility to receive
service gratuity / pension is essential to get this one time lump
sum benefit.
Retirement gratuity is calculated at the rate of 1/4th of a months
basic pay plus dearness allowance last drawn before retirement
for each completed six monthly period of qualifying service.
There is no minimum limit for the amount of gratuity.
Maximum retirement gratuity payable is 16
1/2
times the basic
pay, limited to Rs. 3.5 lakhs. This limit is raised to 10 lac w.e.f
1.1.06
Sixth Central Pay Commission in Para 5.1.33 of its Report made the
following recommendation:
"Linkage of full pension with 33 years of qualifying service should be
dispensed with. Once an employee renders the minimum pensionable
service of 20 years, pension should be paid at 50% of the average
emoluments received during the past 10 months or the pay last drawn,
whichever is more beneficial to the retiring employee. Simultaneously,
the extant benefit of adding years of qualifying service for purposes of
computing pension / related benefits should be withdrawn as it would no
longer be relevant".
This recommendation was accepted by Government of India vide
Resolution No.38/37/2008-P&PW (A) dated 29

th August, 2008. It is clear
from the above recommendations / decisions, that the benefit of adding
years of qualifying service is withdrawn for the purpose of computing
pension as well as other related benefits such as gratuity.
2.5.5. Dearness relief
Dearness relief is sanctioned as compensation against price
rise.
Quantum payable will be governed by the orders issued by the
Government. The formulation in this regard is based on 100%
neutralization for Pensioners / Family pensioners as in the case
of serving employees.
All pensioners, irrespective of the amount of their pension, are
eligible for this benefit.
There is no ceiling in regard to the total of pension plus dearness
relief that a pensioner can receive.
D.R. is payable to re-employed pensioners who held posts below
Group A and those ex-servicemen who held posts below the
ranks of Commissioned officers at the time of their retirement, it
is also payable to employed family pensioners. DR on pension in
respect of the above 2 categories became payable with effect
from July 18, 1997.
DR to re-employed pensioners/family pensioners is presently
regulated in accordance with the instructions contained in the
DoP&PWs OM No. 45/73/97-P&PW (G) dated 2.7.1999. Consequent
upon the revision in ignorable amount of pension from Rs. 1500/- to Rs.
4000/- in terms of DOPT OM No. 3/13/2008-Estt(Pay-Z) dated
11.11,2008, the amount of Rs 1500/- appeared in OM dated 2.7.1999
is revised as Rs. 4000/-. The other conditions for grant of DR to re-
employed pensioner / family pensioner remain the same.
2.5.6. DEATH GRATUITY FOR FAMILY
Widow/Widower or, the nominee of a permanent or a quasi-
permanent or a temporary employee, including CPF beneficiaries,
dying while in service is entitled to receive this one time lump sum
benefit.
No stipulation in regard to any minimum length of service rendered
by deceased employee.
Entitlement is regulated as under:
Qualifying Service Rate
Less than 1 year : 2 times of basic pay
1 year or more but 6 times of basic pay
less than 5 years
5 years or more but 12 times of basic pay
less than 20 years
For service of 20 years or more:
1/2 months basic pay for each completed six monthly period of
qualifying service subject to a maximum of 33 times of basic pay.
Maximum amount of death gratuity admissible is Rs.3.5 lacs.
This has been enhanced to 10 lacs w.e.f 1.1.06
2.5.7. FAMILY PENSION
Family pension is payable to the widow/widower or an eligible
family member from the day following the date of death of the
employee while in service or after retirement.
An employee should have had minimum of 1 year of continuous
service before ones death for the family to become eligible for
family pension.
Family pension is also admissible in case of an employee dying
before completion of one year of continuous service, provided the
deceased employee immediately prior to the appointment to the
service was declared fit by the appropriate medical authority.
Family of a retired employee in receipt of monthly pension or
compassionate allowance is eligible for family pension after the
death of the pensioner.
Family pension is also admissible to eligible family member of a
Central Government employee absorbed in a public sector
undertaking provided the employee (i) is / was in receipt of
monthly pension or had received lumpsum payment in its lieu for
the service rendered in the Government; (ii) was in the service of
PSU as on 22.1.90; (iii) had exercised option for being governed
by Family Pension Scheme of the Central Government; and (iv)
requisite exemption from the operation of EPFA & Misc.Prov. Act,
1952 has been granted by the EPF Organization.
It is payable only to one member of the family at a time and is as
per the order prescribed under the Rule.
Amount of Family pension admissible is at the rate of 30% of last
pay at the time of death / retirement, subject to minimum of Rs.
3500 per mensem (w. e .f 1.1.06).
W.e.f 1.1.06 additional pension is admissible to older pensioners
at the same scale & rates as mentioned in Para 2.5.2.
In the case of pensioners who had retired prior to 1.1.96, Family
pension at the rate of 30% is admissible corresponding to the
scale of pay as on 1.1.96.
Maximum amount admissible is 30% of the highest pay in Central
Government.
In the case of an employee having rendered not less than 7 years
continuous service, for a period of 7 years following the date of
death or retirement on superannuation or upto the age of 65 years
(now 67 with the superannuation age being increased to 60
years) whichever is earlier, family pension is admissible at
enhanced rate which is fifty percent of last pay. The entitlement
of enhanced family pension is however restricted to the amount
of pension in the case of an employee dying after retirement but
in no case less than 30% of the last pay.{ W.e.f 1.1.06 in case of
a Govt. Employee dying in harness enhanced family pension is
payable for 10 years. However, parents are not entitled to enhanced
F.P.
Like pension, Family pension is also payable upto and including
the date of death of the recipient irrespective of time of death.
Family pension is payable to spouse if she/he is employed under
Government or otherwise and even international organizations.
Payment of Family pension is discontinued if the spouse remarries;
in that event the entitlement of family pension passes on to the
eligible son or daughter, including an unmarried / widowed or
divorced daughter provided his or her own earning is less than
Rs.3500 plus the amount equal to DR amount in force (w.e.f
1.1.06) per month.
{W.e.f 1.1.06. The Childless widow of deceased employee will
continue to receive family pension even after remarriage subject
to the condition that Family pension shall cease once her
independent income from all sources becomes equal to or higher
than minimum prescribed limit of family pension in the Central
Govt. }
Family pension is payable for life to a son/daughter who is
suffering from any disorder/disability of mind or is physically
impaired/disabled, thus rendering him/her unable to earn a living.
Married sons/daughters, whether suffering from any disorder/
disability of mind/mentally retarded or physically crippled/disabled,
are not eligible for family pension as per the extant instructions
( R l y . B d . N o F
( E )III/2005/PN1/32 dt.15.1.2010)
Family pension is also admissible to the dependent parents of an
employee/pensioner on their turn. The level of dependency (w.e.f
1.1.06) is determined based on the earning of Rs 3500 plus
amount equal to prevalent DR per month as in the case of
children.
Dependency criteria (w.e.f 1.1.06) for all purposes is the minimum
family pension along with dearness relief thereon.
For the purpose of grant of Family Pension the family has been
categorized as given below:
Category I
(a) Widow/Widows or Widower, upto the date of death or re-
marriage, whichever is earlier. A judicially separated wife or
husband, such separation not being granted on the ground of
adultery and the person surviving was not held guilty of committing
adultery is entitled to family pension.
(b) Son/Daughter (including widowed/Divorced daughter) upto
the date of his/her marriage/re-marriage or till the date he/she
starts earning or till the age of 25 years (in case of Son),
whichever is the earliest.
(c) Son/Daughter, suffering from any disorder or disability or is
physically-crippled or disabled so as to render him/her unable
to earn a living is entitled to family pension for life under certain
conditions without any age limit.
Category II
(a) Parents who were wholly dependent on the Government
servant when he/she was alive provided the deceased employee
had left behind neither a widow nor a child. Family pension to
dependent parents/unmarried/divorced/widowed daughter will
continue till the date of death and it shall be payable only after the other
eligible family members in Category I, have ceased to be eligible to
receive family pension and there is no disabled child to receive family
pension.
(b) Dependent disabled siblings (i.e. brothers/sisters)
The family pension to category II members shall be payable only
after all the other eligible family members in Category I, have ceased
to be eligible to receive family pension and there is no disabled child
to receive family pension.
The dependency criteria for the purpose of family pension is the
minimum family pension of Rs. 3500 plus DR admissible
2.5.8. Revision / consolidation of pension / Family pension of pre-
2006 pensioners/family pensioners in accordance with 6th CPC
recommendations
1. The pension / family pension of pre-2006 pensioners/ family
pensioners will be consolidated with effect from 1-1-2006 and the
amount so arrived at will be regarded as basic pension / family
pension with effect from 1-1-2006.
A. The following shall be added together for such consolidation
(i) The existing pension/family pension, i.e. pension inclusive of
commuted amount if any as on 31.12.2005 (D.P. not to be
included)
(ii) Dearness pension at 50% of (i) above
(iii) 12% D R on 50% DP
(iv) Dearness Relief at 24% of basic pension/basic family pension
and
(v) Fitment weightage at 40% of the existing pension/family pension
at (i) above
Thus existing Basic pension inclusive of commuted value if any (but
minus D.P.), multiplied by 2.26 = Revised consolidated pension /
Family pension
Note: Existing pension means basic pension inclusive of commuted
portion if any.
B. The revised pension (consolidated as above) shall not be lower
than fifty percent of the sum of the minimum of the Pay Band and
the Grade Pay corresponding to the pre-revised pay scale from
which the pensioner had retired.
C. The revised family pension shall not be lower than 30% of the sum
of the minimum of the Pay Band and Grade Pay corresponding
to the pre-revised pay scale in which the pensioner / deceased
Government servant had last worked.
In case the pension consolidated as at A above, is higher than the
pension calculated at B above, the same (higher pension) will be treated
as revised Basic Pension w.e.f. 1-1-2006.
In case the family pension consolidated as at A above, is higher than
the family pension calculated as at C above, the same (higher family
pension) will be treated as revised basic family pension w.e.f: 1-1-
2006.
Where the consolidated pension/family pension at A above works out
to an amount less than Rs. 3500, the same shall be stepped up to Rs.
3500 with effect from 1-1-2006.
Dearness relief to family pensioners is paid at the same rate and
on the same conditions as for the pensioners.
The quantum of consolidated pension shall be increased in respect
of old age pensioners as per Para 2.5.2.
INCASE OF PSU ABSORBEES:
(A) The full pension of the PSU absorbees shall be notionally revised
with effect from 1-1-2006 based on full pension as on 31-12-2005
in accordance with the instructions for revision of pension issued
in respect of other Central Govt. pensioners.
(B) The restorable 1/3rd commuted portion of pension shall be the
sum of the following with effect from 1-1-2006:
(i) 1/3rd of full pension as on 31-12-2005;
(ii) Dearness Pension on the full pension as on 31-12-2005 i.e.,
50% of full pension as on 31-12-2005;
(iii) Dearness Relief at 24% of the sum of basic full pension and
Dearness Pension;
(iv) Fitment weightage at 40% of the full pension as on 31-12-2005.
Dearness Relief is admissible on full pension as notified from time to
time subject to the condition that the absorbee was not employed / re-
employed at the time of restoration.
If the pre-revised 1/3rd restored pension plus DP and DR as on
1-9-2008 is more than the revised 1/3rd restorable pension as at (B)
above, plus DR the absorbee shall continue to draw the pre-revised
pension plus DP and DR till such time the restored amount of revised
pension plus DR works out to be more than the pre-revised restored
pension.
The quantum of 1/3rd restorable pension as at (B) above shall be
increased in respect of old pensioners as per Para 2.5.2.
For procedure claiming Family Pension please refer to Part III
Section I Pension disbursement Para 3.10.
SECTION 2 :-NON-PENSIONARY RETIREMENT BENEFITS
2.6. PROVIDENT FUND ACCOUNT
(a) Provident Fund Accounts are now maintained on a decentralized
basis. The Head of office / attached Pay and Accounts Officer of
the office in which you serve maintain your General Provident
Fund Account. Please ensure that you receive your annual
statement of account / get your passbook up-dated, as the case
may be, every year. It may be in your interest to preserve all the
yearly account slips in a separate folder in chronological order. If
you notice any missing credit, please take up the matter with the
Head of office / Pay and Accounts Officer immediately. It is easier
to trace missing credits while they are still current.
(b) In the event of your transfer from one office to another, the balance
lying to your credit in the GP Fund account in the previous office
is also transferred to the new office where a new account number
is allotted to you. This is not applicable when you go on Foreign
Service in which case the Provident Fund Account continues to
be maintained by the previous office.
(c) In case of deputations, you should check that the office you are
deputed to forwards regularly credits of PF to your parent office
and particularly watch updating of your GPF pass books /
statements
(d) Subscriptions to Provident Fund are stopped three months prior
to the date of superannuation. This has been designed to enable
the Pay and Accounts Officer to finalize and settle your account
and arrange payment of the balance by the time of your retirement.
2.7. CENTRAL GOVERNMENT EMPLOYEES GROUP
INSURANCE SCHEME
A portion of your monthly contributions paid while in service is
credited in a Savings Fund, on which interest accrues. You must
apply to your Head of office, who shall issue a sanction for the
payment of your accumulation in Savings Fund and arrange for its
disbursement, soon after your retirement.
2.8 TRAVELLING ALLOWANCE & OTHER FACILITIES TO REACH
THE INTENDED PLACE OF RESIDENCE AFTER RETIREMENT
You are eligible for travelling allowance from the last station of duty to
the intended place of residence anywhere in India. This is allowed on
full scale applicable to journeys on transfer. This benefit has to be
availed within one year from the date of retirement, otherwise it
lapses. In addition to travelling allowance, you get composite transfer
grant, Fare for self & family from the station of retirement to the station
of settlement & also an allowance/Fare (according to status) for
transport of personal effects and for the transport of conveyance
subject to certain conditions. Railway retirees are entitled to Kit pass
/ Transport allowance (according to status) for shifting of personal
effects including conveyance to intended place of residence within
India, a Dog pass, Free Passes ( by Trains) for self & family from
station of retirement to the station of settlement and also composite
transfer grant. Rly retirees are also entitled to post retirement
complimentary passes according to their status
{Ministry of Finance DOE F.No.19030/3/2008-E.IV dtd 23.9.09 & Rly
Bd No E (W )2004 PS 5-9/1 dt 17.06.09}
2.9. MEDICAL FACILITIES FOR PENSIONERS
(a) 2.9.1. CGHS / RELHS / ECHS: Central Govt pensioners / family
pensioners other than Railways & Defence are covered under the
Central Government Health Scheme on prescribed contribution. You
must get your name registered with any of the CGHS Dispensaries
(now called Wellness Centres) in the country. The registration is not
related to the place of last posting or the place of your residence. You
will be required to obtain a new CGHS card. An application to the
specified officer of CGHS at the city chosen by you is necessary. You
may obtain a life card by payment of a fee equivalent to ten times of
your annual contribution. Railway pensioners are covered by RELHS-97
{Retired Railway Employees Liberalized Health Scheme) and the Defence
pensioners & family pensioners are covered by ECHS (Ex servicemen
Contributory Heath Scheme). For Salient features of CGHS & RELHS
please see Annexure 6 & 7 respectively.
(b) Even in the event of not availing CGHS facilities prior to retirement
you are eligible for CGHS facilities on superannuation.
(c) Vide Railway Board letter No 2003/H/28/1/RELHS dated 16.3.2009
& even No dated 08.04.09, joining RELHS-97 has been made mandatory
for all retiring Railway Employees.
2.9.2 FMA Fixed Medical Allowance is payable to those Central Govt.
Pensioners/Family Pensioners who are residing in non-CGHS areas.
Wherever CGHS facilities are available, Fixed Medical Allowance is
not payable. In case of Railway Pensioners & Family pensioners FMA is
payable if the residence of such a pensioner / Family pensioner is beyond
2.5 Kms from Rlys health unit/hospital & that he or she is eligible to join
the scheme, however member ship of the scheme is not a precondition
for entitlement to FMA. Such a pensioner in receipt of FMA if he is a
member of RELHS Scheme will loose entitlement for day to-day OPD
though they will be eligible for Indoor treatment as well as OPD for chronic
diseases provided they are members of RELHS-97.
PART - III
BASICS FOR PENSIONERS
SECTION 1 - PENSION DISBURSEMENT
3.1 Disbursement of Pension - Pension Disbursing Authority
(PDA) by the Bank
(a) Disbursement
(i) All PPOs and any subsequent amendments issued by Pay &
Accounts Officer are routed to the disbursing bank through
Central Pension Accounting Office, Bhikaji Cama Place, New
Delhi (E-Mail: pension@x400.nicgw.nic.in). These are in turn
transmitted by the Link Branch of the designated bank to the
disbursing branch.
(ii) The PAO and the bank authorities are required to ensure that the
pensioner is kept informed about the movement of the PPO at all
stages.
Note: In the case of Rly pensioner, Designated FA&CAO
discharges the function of CPAO / PAO.
(iii) On receipt of documents, the paying branch shall immediately
address the pensioner through a letter advising him to appear at
the branch along with the documents for the purpose of
identification.
(iv) After the completion of necessary formalities in this regard, the
Pensioners portion of PPO will be handed over by the Disbursing
Branch to the Pensioner.
(v) Subsequent drawal of monthly pension and its credit to the
pensioners account shall be automatic without the need for the
pensioner to go to the bank specifically for this purpose.
(b) Disbursement to Non-Resident Indian (NRI) Pensioners
The NRI Pensioners should open an ordinarynon resident bank
account in any scheduled bank in India and execute a power of
attorneyin favour of the bank as required. They should also submit
life certificate and nationality certificate as prescribed to enable the
credit of pension amount due to them in to their accounts.
(c) Receipt of Two Pensions
If you are in receipt of more than one pension, you should furnish full
details to your PDA for revision of both the pensions and regulating
dearness relief thereon.
(d) Post-retirement Conviction/Imprisonment:
If a pensioner is convicted or sentenced to imprisonment by a Court,
his pension will be suspended. In the event of conviction / imprisonment
by a court of law, full facts of the case should be reported to your PDA
/ Head of Office.
3.2 Know Your Pension Payment Order :
(a) Your PPO is a valuable document containing a running account
of your pensionary entitlements. It is given a number. Make a note
of it carefully at some safe place and do refer to it in your
correspondence with the pension sanctioning authority or the
pension disbursing authority. This will enable them to link proper
records and will help them to promptly respond to your letters.
(b) PPO is issued in two halves/copies, namely, pensioners half/
Copy and Disbursers half/Copy. Pensioners half/copy of the
PPO is given to the pensioner by the designated pension
disbursing authority immediately after completion of formalities
for identification of pensioner before the first disbursement of
pension. Please do insist on getting your half/copy of the Pension
Payment Order as this is a vital document to every pensioner.
(c) Also ensure to keep it in safe custody and to familiarize other
members of your family with its contents, so that in the event of
any untoward event, they are not put to any difficulty for lack of
these documents please also keep a photocopy separately.
(d) Post retirement Changes in the family:
Post retirement changes in the details of your family arising out of
your marriage/remarriage after retirement or children born to you
after your retirement should be intimated to your Head of Office with
full details and relevant documents. Also ensure that a notification of
your family pension is done by pursuing the matter with your Head of
Office. Similarly, other post retrial changes / events with respect to
dependents like divorce / widow hood/marriage of daughter, mental
/ physical/visual disability of children/siblings be intimated to your
pension sanctioning authority with supporting documents, obtaining
acknowledgement which should be carefully preserved.
3.3. Certificates Required by a Bank from Pensioner
(a) Life Certificate: The pensioner will present himself before the
competent pension disbursing authority to furnish a life certificate
in the prescribed form, to be obtained from the competent officer
of the RBI or public sector bank authorized for disbursement of
pension in the month of November each year. The pension
including element of dearness relief from November onwards will
not be credited in the pensioners account by the bank in case he
fails to furnish the required certificate by presenting himself
before the competent officer. In case of serious illness/
incapacitation and on production of medical certificate to that
effect, officer-in-charge of paying branch may depute an officer
of the bank to visit the pensioner for recording life certificate.
(b) Employment/Non-employment Certificate: The pensioner will furnish
a certificate of non-employment/employment/re-employment yearly
in the month of November. If this certificate is not submitted, the
dearness relief from November onwards will not be credited by
the bank. Pension will continue to be credited,
( c) In case of NRI pensioners/family pensioners who are unable to
come to India for personal identification may be allowed pension
/ family pension on the basis of a certificate to be issued by an
authorized official of the India Embassy / High Commission of India
or Consul of India consulate in the country where the pensioner is
residing. This certificate is to be issued on verification of Pensioner
/ Family Pension on the basis of photograph pasted in the PPO or
on the basis of photograph pasted on the Passport or any other
such document.
CGAs Authority No. - F.No. 1(7)/CPAO Scheme Book/2005/TA/585
dated 22.09.2006
(d) In the case of physically handicapped pensioner or who is unable
to present himself at the paying branch, the requirement of personal
appearance will not be necessary, as it is in the case of ordinary
pensioner who has to present himself before the bank to complete
the formalities. The pensioner has to submit to the paying branch a
certificate from a registered medical practitioner about his being
physically handicapped / sick, each year, about the requirement of
producing life certificate and his inability to present himself physically,
to the officer-in-charge of bank so that he may nominate an officer to
visit the pensioner's residence for the purpose of verification, recording
of specimen signatures, identification marks and life certificate etc
3.4. Drawal of Pension by infirm Pensioners
In the case of physically handicapped/sick/infirm pensioner who is
unable to present himself/herself at the paying branch, such a
pensioner has to submit a medical certificate to this effect from a
RMP to the Manager of the Paying branch of the Bank with a request
to arrange disbursal of pension at the residence. On receipt of such
request, supported by a medical certificate, Bank Manager is supposed
to nominate an officer of the Bank for disbursal of pension to such a
pensioner at the place of residence.
Note: Now-a-days Banks give ATM cards for pension accounts also.
But it is not advisable for pensioners to have ATM cards as these are
ridden with frauds/wrong payments.
3.5. Transfer of Pension
(i) In the case of transfer from one paying branch to another of the
same PSB at the same station, the link branch will make
necessary entries in the register maintained by them and forward
the disbursers portion of PPO to the paying branch at which the
payment is desired under intimation to the CPAO and the
pensioner.
If the transfer is at a different station, the link branch after keeping
the requisite note will forward the disbursers portion of PPO to
the link branch at the new station for arranging payment through
the new paying branch. CPAO will be informed of this by the old
link branch as well as by the new link branch.
(ii) In the case of transfer from one PSB to another PSB within the
same station or a different station, the old bank (transferor paying
branch) sends a letter duly signed by the Branch Manager to the
Branch Manager of the new paying branch together with a copy
of PPO showing the last payment. The new paying branch will
commence the pension payment immediately on receipt of letter
of the last payment certificate. It is the responsibility of the
concerned bank branches to complete all required formalities
regarding intimation to link branches and CPAO.
In case of Rly Pensioners :-
3.5.1 Transfer of Pensions. Applications for transfer of pensions may
fall under the following three categories:-
(a) Transfer from one paying branch to another within the same station
or at a different station;
(b) Transfer from one PSB to another within the same station (such
transfer to be allowed only once in a financial year); and
(c) Transfer from one PSB to another PSB at a different station or by
a treasury.
3.5.2 Request falling under category (a) above may be entertained by PSB
itself. In case the transfer is at the same station, Link Branch will make
necessary entries in the register maintained by them in the form in Annexure
B and forward the disbursers portion of PPO to the paying branch at
which payment is desired under intimation to the designated FA & CAO, and
the pensioner. In case the transfer is at a different station, Link Branch, after
keeping the requisite note will forward the disbursers portion of the PPO to
the Link Branch at new station for arranging payment through the new
paying branch. Necessary intimation of affecting such transfer will be sent
to the designated FA & CAO by the new as well as old link branches for
keeping a note of change in their records under intimation to the pensioner.
The receiving link branch, on receipt of pension documents, will ensure
forwarding the PPO to the paying branch within three days and intimate the
pensioner simultaneously.
Before forwarding the disbursers portion of PPO to the new paying branch/
link branch, it will be ensured that the month upto which the payment has
been made is invariably indicated in the disbursers portion of PPO.
3.5.3 (i) In cases falling under categories (b) and (c) of Para 3.5.1 when a
pensioner applies for transfer on a single sheet of paper, the old bank
(Transferer paying branch) will send a letter duly signed by its Branch
Manager to the new paying branch wherever located alongwith a photocopy
to the pensioners PPO showing the last payment made. This will be sent by
speed post/courier/Regd Post to the new paying branch at the new location
alongwith a copy each to the pensioner. FA&CAO and for information, to
the Link Branch of the old paying branch. The PPO issuing FA&CAO will
also arrange to intimate the new designated FA&CAO (i.e. pension debit
accepting FA&CAO) in case change of designated FA & CAO is also
involved. Simultaneously the old paying branch will send the banks copy of
PPO through its Link branch, duly completing all entries to the FA&CAO
who issued the PPO for transmission to the new Link branch. However
pensioners copy of PPO will be retained by pensioner and produced at the
new paying branch.
(ii) The new paying branch will commence pension payment immediately
on receipt of letter of the last payment certificate as at (i) above.
Simultaneously it will send intimation to its Link branch with full details of the
commencement of the pension. The old paying branch and its link branch will
ensure that the Banks copy of PPO is transmitted to the new paying branch
through its Link bank.
(iii) Pension will be paid for 3 months on the basis of the photocopy of the
pensioners PPO at transferee (New) Branch, from the date of payment
made at the transferer (Old) & transferee (New) bank branch to ensure that
all documents under the procedure are received by the transferee (New)
branch with in a period of 3 months. However in a case falling under category
(c) of Para 3.5.1 where pensioner wishes to draw his pension from the
Treasury it will be necessary for the FA&CAO to forward the documents
duly countersigned along with a forwarding letter bearing his special seal to
the Accountant General concerned under whose jurisdiction the Treasury
from where the pensioner wishes to draw his pension for onward transmission
to the Treasury concerned.
3.5.4 To avoid the risk of over payment at the time of transfer, the following
certificate may recorded on the PPO by the Paying Branch of the P.S.B.
Certified that payment of pension upto the month of .20... has been
made and that this PPO consists of continuation sheets for
recording disbursement.
3.5.5 Except as provided for above, the transfer of the pension from one
place to another will not ordinarily be permitted.
3.6. Restoration of Commuted Portion of Pension
After the pensioner has completed 15 years from the date of
commutation, he will apply in the prescribed form to the pension
disbursing authority/bank/post office who will restore the commuted
portion of the pension as mentioned in the PPO. If the amount of
commuted pension is received on two or more points of time,
restoration of the commuted amount also takes place at two or more
points of time as the case may be.
The absorbed employees in Central PSUs/Autonomous Bodies who
have become entitled to restoration of 1/3rd commuted portion of
pension, based on the Supreme Court Judgment dt.15.10.95 will
apply to the concerned Ministry/Deptt/Office where they were
employed prior to absorption.
3.7. Life Time Arrears
A pensioner is entitled to file nomination in Form A prescribed under
Arrears of Pension (Nomination) Rules, 1983 to the pension disbursing
authority or head of office, as the case may be, for payment of life time
arrears. This obviates the hardship faced by the nominee survivor of
the deceased in getting the payment of balance amount in the
account of the deceased pensioner.Nomination facility is not available
to Family pensioners. The arrears of Family pension pass on to the
next eligible member of the family. The question of submitting a
succession certificate will arise if no nomination has been made or
there is no eligible member in the family left to receive the family
pension.
3.8. Recovery of Eecess or Wrong Payment
Vide Para 36 of RBI Master Circular Disbursement of Pension dated
01-07-09 all agency banks have been advised that whenever any excess
/ overpayment is detected, the entire amount thereof should be credited
to the Government account in lump sum immediately.
3.9. Issue of Duplicate PPO
If the pensioners portion of PPO is lost, worn out or torn and it is
sought to be renewed, the paying branch will forward the request of
the pensioner along with both halves i.e. pensioners half and
disbursers half of the PPO to the CPAO through the Link branch for
renewal. In order that payment of pension is not delayed in the
absence of disbursers portion of the PPO, all connected documents
may be sent to CPAO immediately after the payment for the month
is made so as to leave sufficient time with CPAO to do the needful and
return the documents by the time payment for the next month
becomes due.
In the case of Rly pensioners :- In cases in which pensioner's
portion of the P.P.O. is lost, worn or torn and it is sought to be
renewed, the paying branch will forward the request of the pensioner,
alongwith both the halves of the P.P.O. to the concerned nominated
F.A.& C.A.O. through the Link branch for renewal. In order that
payment of pension is not unnecessarily delayed in such cases in the
absence of the disbursers portion of the P.P.O., care may be taken
to send the connected documents to nominated F.A. & C.A.O.,
immediately after payment for a month is made so as to leave
sufficient time with the nominated F.A.& C.A.O. to do the needful and
return the documents by the time payment for the next month
becomes due. The nominated F.A.& C.A.O. will also be reminded by
the paying branch in cases where the return of the document is
unduly delayed.
SECTION 2 - DISBURSEMENT OF FAMILY PENSION
3.10. Family Pension Claims
(a) As mentioned in Para 1.17., family pension entitlement is also
sanctioned at the same time as pension. For getting family
pension, the eligible member of the family of the deceased
pensioner should apply in the prescribed Form, together with a
death certificate, to the
(i) Pension disbursing authority, if the amount of family pension
is already indicated in the PPO; or
(ii) Head of Office in all other cases.
(b) The payment of Family pension, at the rate, and to the person
indicated in the PPO shall be communicated by the paying
branch of the bank without waiting for any authority from Pay &
Accounts Officer or CPAO.
(c) In case the claimant is a child, payment shall commence after a
fresh payment authority is received from PAO/FA &CAO of the
concerned Ministry/Deptt through usual channels.
(d) Family pension to eligible family members of the govt employee
missing/kidnapped by insurgent/terrorists may be sanctioned
after a period of six months from the date of registration of FIR.
{DOP & PW F.No. 1/28/04-P&PW(E) dated 31.3.09}
Procedure for Claiming Family pension by the Spouse:
A. Claim to be preferred to Pension disbursing agency. Form 14
along with details of dependent children if any for claiming Family
pension (Form can be had from the Bank) along with relevant
documents and witnesses as follows :
1. Death Certificate of pensioner
2. An affidavit by the Widow that she has not remarried and that if
she does so in future she will immediately report the incidence to
pension disbursing agency.
3. Proof of age of the Widow and the dependent children, if any
4. Claimant will have to open a separate SB/pension account with
the Bank.
5. An undertaking for refunding any excess amount ever credited.
6. Two specimen signatures of the applicant or left hand thumb
impression duly attested (to be furnished in two separate sheets)
if the claimant is illiterate.
7. Two copies of passport size photograph of the applicant and each
of the dependents if any, duly attested.
8. Descriptive Roll of the applicant duly attested in duplicate indicating
height and personal marks, if any, on the hand, face etc.
(Specify at least two conspicuous marks)
9. Certificate of age: two attested copies
NOTE: Attestation should be done by two Gazetted Government
officials or two or more persons of respectability in the town, village
or Pargana in which the applicant resides.
In case of re-marriage of the widow while applying for family pension
on behalf of minor child, the widow should furnish the date of her re-
marriage to the Branch of the Authorized Bank at which payment is
desired and her full address in the application for family pension. It is
not necessary to furnish a fresh application or the documents as
these are already with the Bank along with pension papers on which
family pension was originally admitted to her.
Procedure for Claiming Family pension by post retiral Spouse /
Children :-
Endorsement of Family Pension Entitlement of Post-Retiral
Spouses in the PPO
(i) As and when a pensioner marries or re-marries after retirement,
he shall intimate the event to the Head of Office who processed his
pension papers at the time of his retirement. He shall also furnish
along with his application an attested copy of the certificate of
marriage in respect of his post-retirement marriage.
(ii) The Head of Office on receipt of the application mentioned above
and after due verification, where necessary, forward the papers to the
concerned Pay & Accounts Officer for issue of corrigendum PPO.
While forwarding the papers to the Pay & Account Officer, the
provisions of Clause (b) of sub-rule (7) ofRule 54of the CCS
(Pension) Rules, 1972, shall be kept in mind.
(iii) When the pensioner does not have any child or children from his
previous marriage, if any, the post-retiral spouse shall be eligible for
full family pension. Where the pensioner has any eligible child or
children from another wife who is not alive, the family pension to the
post-retiral spouse and the child/children from the previous marriage
will be authorized in terms of clause (b) of sub-rule (7) ofRule
54ibid.(iii)The corrigendum PPO shall be forwarded by the Pay &
Accounts Officer to the concerned Pension Disbursing Authority
through the Central Pension Accounting Office.
A copy of the corrigendum PPO shall also be endorsed to the
pensioner.(iv)As far as children, including those born after retirement,
are concerned, a fresh PPO will be issued as and when the turn of
each child for receipt of family pension is reached as at present
{For Rly Pensioners/Family pensioners, designated FA &CAO will
discharge the function of CPAO/PAO}
The F.A. & C.A.O. of the Zonal Railway, under whose jurisdiction the
places where the pensioner wishes to settle fall, will be the co-
coordinating officer with the Link Branch of the nominated Public
Sector Banks. (He will be referred to as the designated F.A. & C.A.O.)
Claim by eligible Dependents not mentioned in PPO:
Where the names of eligible children/dependents have not been
mentioned in PPO for various reasons like the pension was sanctioned
prior to 1-1-1990 orthe child is a post-retiral one or post-retiral
manifestation of disability of the child,
Case 1
Both parents expired and the dependent eligible Child is his
turn to get Family Pension :-
Following Documents along with claim application need to be submitted
to the Pension Sanctioning Authority:
Copy of PPO of pensioner/family pensioner, Proof of Parentage,
Proof of dependency, proof of age, Proof of residence, Ration card/
Photo ID card. Family declaration giving details of dependent children
(With acknowledgement of concerned department) of the Pensioner
submitted to the department during his/her life time (if available)
Affidavit before the magistrate declaring (I)That his/her monthly
Income from all sources is less than the minimum of Family pension
plus D.R. i.e. Rs 3500 plus an amount equal to Dearness Relief. In
case of unmarried dependant daughter, Affidavit to also include the
declaration:- (II) That she has never been married.
In case of Mentally Challenged or Blind Claimant :- in addition to
above documents, medical examination report from the Civil
Surgeon/CMO of the District.
In case of divorced Dependent Daughter:- In addition to above
documents. Marriage proof (invitation Card & photograph, marriage
certificate if registered or any other proof) , proof of divorce , a suitable
declaration to this affect in affidavit & details of dependant children if
any.
In case of a widowed Dependant Daughter: - Following additional
documents to be submitted
Proof of marriage, the death certificate of husband, suitable declaration
to this affect and that she has not remarried in affidavit and details of
dependant children, if any.
Case II
Both or one parent surviving drawing Pension/Family pension:-
The pensioner/family pensioner, if he so desires, can furnish a list of
eligible children/siblings to the Pension Sanctioning Authority, inter
alia, indicating whether any child is handicapped or not.
The receipt of this list may be acknowledged by the pension sanctioning
authority, mentioning the details of the eligible children taken on
record.
This acknowledgement may be preserved by the members of the
family of the pensioner for production at the time of submission of
claim for family pension in their own turn to the Pension Sanctioning
Authority.
In case of guardian, the responsibility of producing this
acknowledgement will be of the guardian. However, production of this
acknowledgement, not to be a pre-condition to the processing of
claims for family pension.
3.11. Certificates to be furnished by Family Pensioner to the
pension disbursing agency :
(a) Certificate for mentally / physically handicapped child/
dependent :
A mentally/physically/visually handicapped son or daughter is eligible
to receive family pension for his/her life as referred to in Part II. In
addition to life certificate every year in the month of November a
certificate obtained from a Medical Officer not below the rank of Civil
Surgeon will have to be furnished to the paying branch every Five
years (in the month of November). The certificate must state that the
person continues to suffer from the disorder/disability of mind or
continues to be physically/visually impaired or disabled rendering
him/her unable to earn a living. In case of minors/mentally disabled
Family pensioner, the guardian should submit the required certificates.
(b) In case of other recipients of family pension (such as divorced,
a widow or an unmarried daughter or son below 25 yrs ), the
certificate of remarriage/marriage/dependency is required at yearly
interval, in the month.
Note: In case of widow/divorced/unmarried recipients of family
pension, an undertaking (through an affidavit) will have to be given at
the time of the commencement of family pension that in case she
remarries, she will report the fact to the pension disbursing authority.
(e) Certificate of dependency of Parents: The dependent parents
of a deceased Govt. servant in receipt of family pension are required
to furnish a certificate to the Treasury/Bank and Post office, every
year, in the month of November, that is his or her or their combined
income, as the case may be, is less than three thousand five hundred
plus the amount equal to DR (admissible to family pensioner) per
month from their own pension or any other source.
Note: Necessary Forms required with reference to Para 3.10
and 3.11 are given in Annexure II.
(f ) In the case of physically handicapped /sick/infirm family pensioner
unable to present himself at pension disbursing agency for the
submission of Certificates or for receiving payment of pension :
Same procedure as mentioned in Para3.3 &3.4 is to be adopted.
SECTION 3 - MISCELLANEOUS
3.12. General
All pensions including dearness relief thereon and gratuities are
payable in rupees in India only.
They are expressed in whole rupees, the fraction being rounded
off to the next higher rupee.
Pension/family pension is payable upto and including the day on
which its recipient dies irrespective of time of death.
The widow is required to give this certificate of non-remarriage,
with the undertaking to inform the Bank when she remarries, only
once (in the form of an affidavit) that is, at the First time claiming
family pension. {Although she will have to produce life certificate
in usual format every year.}
Grant of pension and its continuance are subject to future good
conduct of the pensioner.
Pension finally authorized cannot be revised to the disadvantage
of the pensioner except to correct a clerical error.
Pension cannot be attached or seized for any demand against a
pensioner, nor can a pensioner make any assignments in
anticipation of pension. But if a pensioner is convicted of a serious
crime or is found guilty of grave misconduct or negligence,
pension may be withheld or withdrawn fully or partly for a specified
or indefinite period after following the prescribed procedure which
inter-alia requires an opportunity being given to the pensioner to
show cause against the action proposed to be taken.
Acceptance of certain kinds of post-retirement employment (e.g.
commercial employment before expiry of two years from
retirement, employment under foreign governments etc.) by
pensioners who retire from Group A service/post requires prior
permission of the Central Government. Failure to comply with
this requirement may lead to stoppage of pension.
In case any Dicipline & Appeal (DAR)/Vigilance/Court case is
pending at the time of retirement no gratuity is paid, nor is
commutation of pension allowed. However, pension is paid which
is provisional, subject to adjustment after finalization of DAR/
Vigilance/Court case.
Any dues outstanding at the time of retirement can be recovered
from gratuity, leave encashment or commutation amount of pension
3.13. Redressal of Grievances
(a) The normal route: If you have any grievance in pension matters
you may take it up with your Head of Office, the pension sanctioning
authority or the pension disbursing authority, or in the Pension
ADALAT pertaining to the jurisdiction of your pension sanctioning
authority ( PSA) as the case may be.
(b) The nodal route: If considered necessary, you may also approach
the Department of Pension and Pensioners Welfare, Lok Nayak
Bhawan (3rd Floor), Khan Market, Now Delhi-110 003, which is
the nodal Department for looking into the grievances and problems
of pensioners.
(c) The RTI route: The RTI Act, 2005 is the latest but the most potent
tool in the hands of the public for expeditions settlement of their
grivences against the Government and other Public authorities.
In case you do not receive response to your representation within
a reasonable time, you may file an RTI application, under the said
Act, addressed to the "Chief Public Information Officer", office of
(Name of the office, with complete address) with an IPO of Rs 10/
-. Through the RTI application, you can assertain the status of
your case as well as the reasons for inordinate delay on the part
of bureaucracy including the Dealing Hands. In extreme cases,
you may ask for the name(s) of the official(s) with designation(s)
responsible for the inordinate delay and the action taken against
him/them.
Note : For prompt attention, all your correspondence should
contain the following essential details, so that past records can
be easily linked:-
(i) Name
(ii) Full address
(iii) Office from which retired, (abbreviations not to be used) with
full address.
(iv) Post held at the time of retirement, Basic pay (and scale of
pay) & date of retirement.
(v) Qualifying service
(vi) If pension has been sanctioned, quantum may be specified
alongwith :-
(a) particulars of Accounts Officer who issued the PPO
(b) particulars of Pension Disbursing Authority, and
(c) PPO number (with a photocopy of the PPO)
(d) Give particulars of correspondence so far (with evidence)
(vii) Make your representation: (Make it specific, brief and short.)
ANNEXURE - I
COMMUTATION VALUE FOR A PENSION OF Re.
l PER ANNUM
Age next Commutation Age next Commutation Age
Commutation
birth day value birthday value next birth value expressed
expressed as expressed as day
as number of
year's number of year's purchase
purchase purchase
20 9.188 41 9.075 62 8.093
21 0.187 42 9.059 63 7.982
22 9.186 43 9.140 64 7.862
23 9.185 44 9.9I9 65 7.731
24 9.184 45 8.996 M 7.591
25 9.183 46 8.971 67 7.431
26 9.182 47 8.943 68 7.262
27 9.180 4S 8.913 69 7.083
28 9.178 49 8.881 70 6.897
29 9.176 50 8.846 71 6.703
30 9.173 51 8.808 72 6,502
31 9.169 52 8.708 73 6.296
32 9.164 53 8.724 74 6.085
33 9.159 54 8.678 75 5.872
34 9.152 55 8.627 76 5.657
35 9.145 56 8.572 77 5.443
36 9.136 57 8.512 78 5.229
37 9.126 58 8.446 79 5.018
38 9.116 59 8.371 80 4.812
39 9.103 60 8.287 81 4.611
40 9.090 61 8.194
ANNEXURE - II
FORMS
Nomination for Retirement Gratuity/Death Gratuity
When the Government servant has a family and wishes to
nominate one member, or more than one member, thereof.
I,......................., hereby nominate the person/persons mentioned
below who is/are member(s) of my family, and confer on him/them
the right to receive, to the extent specified below, any gratuity the
payment of which may be authorized by the Central Government in
the event of my death while in service and the right to receive on my
death, to the extent specified below, any gratuity which having
become admissible to me on retirement may remain unpaid at my
death -
Original nominee(s) Alternate nominee(s)
Names Relationship Amount Name, address, Amount
and with the or share relationship and age of or share
address Government Age of conferred on the of gratuity
of servant gratuity nominee shall pass in payable
nominee/ payable the event of the nominee to each
nominees each* pre-deceasing the
Government servant or
the nominee dying after
the death of the
Government servant but
before receiving
payment of gratuity
(1) (2) (3) (4) (5) (6)

This nomination supersedes the nomination made by me earlier
on ....................................... which stands cancelled.
NOTE.-(i) The Government servant shall draw lines across the
blank space below the last entry to prevent the insertion
of any name after he has signed.
(ii) Strike out which is not applicable.
Dated this............day of...................2010 at..........................
Witnesses to signature :
1. .......................................
2. ........................................ Signature of Government servant
*This column should be filled in so as to cover the whole amount of
the gratuity.
**The amount/share of the gratuity shown in this column should
cover the whole amount/share payable to the original nominee(s).
(To be filled by the Head of Office)
Nomination by................................ Signature of Head of Office
Designation................................... Date..................................
Office.......................................... Designation........................
Proforma for acknowledging the receipt of the
nomination form by the Head of Office
To
...................................................
...................................................
...................................................
Sir,
In acknowledging the receipt of your nomination, dated the
................/cancellation, dated the ...............................of the nomination
made earlier in respect of gratuity in Form ................................... I am
to state that it has been duly placed on record.
Signature of Head of Office
Place .................................
Dated the ........................... Designation..............................
NOTE. - The Government servant is advised that it would be in the
interest of his nominees if copies of the nominations and the related
notices and acknowledgements are kept in safe custody so that they
may come into the possession of the beneficiaries in the event of his
death.
FORM 2
[See Rule 53(1)]
Nomination for Retirement Gratuity/Death Gratuity
When the Government servant has no family and wishes to
nominate one person or more than one person
I,...................., having no family, hereby nominate the person/
persons mentioned below and confer on him/them the right to
receive, to the extent specified below, any gratuity the payment of
which may be authorised by the Central Government in the event of
my death while in service and the right to receive on my death, to the
extent specified below, any gratuity, which having become admissible
to me on retirement may remain unpaid at my death :
Original nominee(s) Alternate nominee(s)
Names Relationship Age Amount Name, address Amount
and with the or share relationship and age of or share
address Government of conferred on the of gratuity
of servant gratuity nominee shall pass in payable
nominee/ payable the event of the nominee to each
nominees each* pre-deceasing the
Government servant or
the nominee dying after
the death of the
Government servant but
before receiving
payment of gratuity
(1) (2) (3) (4) (5) (6)
This nomination supersedes the nomination made by me earlier on
.......................................which stands cancelled.
NOTE.-(i) The Government servant shall draw lines across the blank space
below the last entry to prevent the insertion of any name after he
has signed.
(ii) Strike out which is not applicable.
Dated this.................day of...............200.... at.........................
Witnesses to signature :
1. ......................................
2. ...................................... Signature of Government servant
(To be filled by the Head of Office)
Nomination by................................ Signature of Head of Office
Designation................................... Date..................................
Office.......................................... Designation........................
* This column should be filled in so as to cover the whole amount
of the gratuity.
** The amount/share of the gratuity shown in this column should
cover the whole amount/share payable to the original nominee(s).
Pro forma for acknowledging the receipt of the
nomination form by the Head of Office
To
...................................................
...................................................
...................................................
Sir,
In acknowledging the receipt of your nomination, dated the
................/cancellation, dated the ...............................of the nomination
made earlier in respect of gratuity in Form ................................... ,I
am to state that it has been duly placed on record.
Signature of Head of Office
Place ...........................................
Dated the ...............................Designation....................................
NOTE. - The Government servant is advised that it would be in the
interest of his nominees if copies of the nominations and the related
notices and acknowledgements are kept in safe custody so that they
may come into the possession of the beneficiaries in the event of his
death.
FORM 3
Details of Family
[See Rule 54(12)]
Name of the Government servant ... ......................................
Designation ... ... ... ......................................
Date of birth ... ... ... ......................................
Date of appointment ... ... ... ......................................
Details of the members of my family
*as on ... ... ... ......................................
Serial Name of the Date of Relationship Initials of Remarks
No members of Birth with the the Head
family* officer of Office
(1) (2) (3) (4) (5) (6)
1.
2.
3.
4.
5.
6.
7.
8.
9.
I hereby undertake to keep the above particulars up-to-date by
notifying to the Head of Office any addition or alteration.
Place...................................... Signature of Government servant
Dated the...............................
*Family for this purpose means family as defined in Clause (b) of
sub-rule (14) of Rule 54 of the CCS (Pension) Rules, 1972.
NOTE. - Wife and husband shall include respectively judicially
separated wife and husband.
FORM 5
[See Rule 59(1)(c) & 61(1)]
Particulars to be obtained by the Head of Office from the
retiring Government servant eight months before the date of
his retirement
1. Name
2. (a) Date of birth
(b) Date of retirement
3.
1
Two specimen signatures (to be furnished in an separate sheet)
duly attested by a Gazetted Government servant
4.
2
Three copies of passport size joint
3
photograph with wife or
husband (To be attested by the Head of Office)
5. Two slips showing the particulars of height and
4
personal
identification marks duly attested by a Gazetted Government
servant
6. Present address
7.
5
Address after retirement
8. Name of the Treasury or the Branch of Public Sector Bank or the
Pay and Accounts Office through which the pension is to be
drawn
9.
6
Details of the family in Form 3
10. Indicate whether family pension is admissible from any other
source - Military or State Government and/or a Public Sector
Undertaking/Autonomous body/Local Fund under the Central or
a State Government
Place................................................ Signature
Dated the......................................... Designation
Ministry/Deptt./Office
Footnotes: 1. Two slips each bearing the left hand thumb and finger
impressions duly attested may be furnished by a person who is not
literate to sign his name.If such a Government servant on account of
physical disability is unable to give left hand thumb and finger
impressions he may give thumb and finger impressions of the right
hand.Where a Government servant has lost both the hands, he may
give his toe impressions. Impressions should be duly attested by a
Gazetted Government servant.
2. Two copies of passport size photograph of self only need be
furnished if the Government servant is governed by Rule 54 of the
Central Civil Services (Pension) Rules, 1972 and is unmarried son/
daughter of a widower or widow.
3. Where it is not possible for a Government servant to submit a
photograph with his wife or her husband, he or she may submit
separate photographs. The photographs shall be attested by the
Head of Office.
4. Specify a few conspicuous marks, not less than two, if possible.
5. Any subsequent change of address should be notified to the Head
of Office.
6. Applicable only where Rule 54 of the Central Civil Services
(Pension) Rules, 1972, applies to the Government servant.
FORM 10
[Rule 77(2)]
Form of letter to the member or members of the family of a
deceased Government servant where valid nomination
for the grant of the death gratuity exists
No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
...............................................
...............................................
...............................................
Subject :- Payment of death gratuity in respect of the late
Shri/ Shrimati........................................
Sir/Madam,
I am directed to state that in terms of the nomination made by the
late Shri/Shrimati....................................(Designation) in the Office/
Department/Ministry of..............................a death gratuity is payable
to his/her nominee(s). A copy of the said nomination is enclosed
herewith.
2. I am to request that a claim for the grant of the gratuity may be
submitted by you in the enclosed Form 12.
3. Should any contingency have happened since the date of making
the nomination, so as to render the nomination invalid, in whole or in
part, precise details of the contingency may kindly be stated.
Yours faithfully,
Head of Office.
FORM 11
[See Rule 77(2)]
Form of letter to the member or members of the family of a
deceased Government servant where valid nomination for
the
grant of the death gratuity does not exist
No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
...............................................
...............................................
...............................................
Subject :- Payment of death gratuity in respect of
late Shri/Shrimati........................................
Sir/Madam,
I am directed to say that in terms of Rule 50 of the Central Civil
Services (Pension) Rules, 1972, a death gratuity is payable to the
fol l owi ng members of the fami l y of l ate Shri /
Shrimati........................................(Designation), in the Office/
Department/ Ministry of ..................................................in equal shares
:-
(i) Wife/husband including judicially separated wife/husband.
(ii) Sons including step children and adopted
children.
(iii) Unmarried daughters including step-children and adopted
children.
2. In the event of there being no surviving member of the family as
indicated above, the gratuity will be payable to the following members
of the family in equal shares :-
(i) widowed daughters including step daughters and adopted
daughters;
(ii) father including adoptive parents in case of individuals
whose personal law permits adoption ;
(iii) Mother including adoptive parents in case of individuals
whose personal law permits adoption ;
(iv) brothers below the age of eighteen years and unmarried and
widowed sisters including step brothers and step sisters;
(v) married daughters ; and
(vi) children of a pre-deceased son.
3. It is requested that a claim for the payment of gratuity may be
submitted in the enclosed Form 12 as soon as possible.
Yours faithfully,
Head of Office.
FORM 12
[See Rule 77(2)]
Form of application for the grant of death gratuity
on the death of a Government servant
(To be filled in separately by each claimant and in case the claimant
is minor, the Form should be filled in by the guardian on his/her behalf.
Where there are more than one minor, the guardian should claim
gratuity in one Form on their behalf)
1. (i) Name of the claimant in case he is not minor ... ...
...
(ii) Date of birth of the claimant ... ... ...
2. (i) Name of the guardian in case the claimants
are minors ... ... ...
(ii) Date of birth of the guardian ... ... ...
3. (i) Name of the deceased Government servant
in respect of whom gratuity is being claimed ... ...
...
(ii) Date of death of Government servant ... ... ...
(iii) Office/Department/Ministry in which
the deceased served last ... ... ...
4. Relationship of the claimant/guardian
with the deceased Government servant ... ... ...
5. Full Postal Address of the claimant/guardian ... ... ...
6. (i) Where gratuity is claimed by the guardian
on behalf of minors, the names of the
minors, their ages, relationship with the
deceased Government servant, etc. - ... ... ...
Serial Name Age Relationship with the Postal Address
No. deceased Government
servant
1.
2.
3.
4.
(ii) Relationship of the guardian with minor ... ... ...
7. Place of payment of Pension and Gratuity
(Treasury, Sub-Treasury, Public Sector Bank
branch, or the Pay and Accounts Office) ... ... ...
Signature/Thumb-
impression of the
claimant/guardian
8. Two specimen signatures
1
or left hand thumb
and finger impressions of the claimant/guardian
duly attested(To be furnished in a separate sheet) ... ...
...
9.
2
Attested by -
Name Full Address Signature
(i) ............................... ...................... ..........................
(ii) ............................... ...................... ..........................
10. Witnesses:
(i) ............................... ...................... ..........................
(ii) ............................... ...................... ..........................
Footnote : 1. To be furnished in case the applicant is not literate
enough to sign his name.
2. Attestation should be done by two Gazetted Government servants
or two or more persons of respectability in the town, village or
Pargana in which the applicant resides.
FORM 13
[See Rule 77(3)]
Form of letter to the widow/widower of a deceased
Government servant for grant of Family Pension, 1964
No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
...............................................
...............................................
...............................................
Subject :- Payment of Family Pension, 1964, in respect of
late Shri/Shrimati........................................
Sir/Madam,
I am directed to state that in terms of Rule 54 of the Central Civil
Services (Pension) Rules, 1972, a family pension, 1964, is payable
to you as wi dow/wi dower of the l ate Shri /Shri mati
.................................... (Designation) in the Office/Department/ Ministry
of ..........................................
2. You are advised that a claim for the grant of Family Pension, 1964,
may be submitted in the enclosed Form 14.
3. The Family Pension, 1964, will be payable till your death or
remarriage, whichever event occurs earlier. In the event of your death
or remarriage, the Family Pension, 1964, shall be granted to the child
or children, if any, through the guardian.
Yours faithfully,

Head of Office.

FORM 14
[See Rule 77(3) and 81(2)]
Form of application for the grant of Family Pension, 1964,
on the death of a Government servant/pensioner
1. Name of the applicant ... ... ...
(i) Widow/Widower ... ... ...
(ii) Guardian if the deceased person
is survived by child or children ... ... ...
2. Name and age of surviving widow
/widower and children of the
deceased Government servant/
pensioner served last ... ... ...
Serial Name Relationship with Date of birthday
No the deceased person by Christian era
1.
2.
3.
4.
5.
6.
3. Name and No. of the PPO of the ... ... ...
deceased pensioner
4. Date of death of the Government ... ... ...
servant/pensioner
5. Office/Department/Ministry in ... ... ...
which the deceased Government
servant/ pensioner served last
6. If the applicant is guardian, his date ... ... ...
of birth and relationship with the
deceased Government servant/pensioner
6. A. If the applicant is a widow/widower
the amount of service pension which
she/he may be in receipt on the date
of death of the husband/wife ... ... ...
7. Full address of the applicant ... ... ...
8. Place of payment of Pension and
Gratuity (Treasury, Sub-treasury or
Public Sector Bank Branch and Pay
and Accounts Office) ... ... ...
9. Enclosures :
(i) Two specimen signatures of the applicant,
duly attested (To be furnished in two separate sheets)
(ii) Two copies of passport size photograph of
the applicant, duly attested
(iii) Two slips each bearing left hand thumb and
finger impressions* of the applicant, duly attested
(iv) Descriptive Roll of the applicant, duly attested,
indicating (a) height and (b) personal marks, if
any, on the hand, face, etc. (Specify a few
conspicuous marks, not less than two, if
possible.)(To be furnished in duplicate)
(v) Certificate(s) of age (in original with two
attested copies) showing the dates of birth
of the children. The certificate should be
from the Municipal Authorities or from the
local panchayat or from the head of a recognised
school if the child is studying in such school
(This information should be furnished in respect
of such child or children, the particulars of whose
date of birth are not available with the Head of Office)
10. Indicate whether family pension is admissible
from any other source - Ministry or State
Government and/or a public sector undertaking
/autonomous body/local fund under the
Central or a State Government ... ... ...
11. Signature or left hand thumb-impression*
of the applicant ... ... ...
12. Attested by :
Name Full Address Signature
(i) ............................... ...................... ..........................
(ii) ............................... ...................... ..........................
13. Witnesses :
Name Full Address Signature
(i) ............................... ...................... ..........................
(ii) ............................... ...................... ..........................
NOTE. - Attestation should be done by two Gazetted Government
servants or two or more persons of respectability in the town, village
or Pargana in which the applicant resides.
*To be furnished in case the applicant is not literate enough to sign his
name.
FORM 22
[ See Rule 81(4)]
Form of application for the grant of Residuary
1
Gratuity
on the death of a pensioner
(To be filled in separately by each applicant)
1. Name of the applicant ... ... ...
2. (i) Name of the guardian in case the
applicant is a minor ... ... ...
(ii) Date of birth of guardian ... ... ...
3. Name of the deceased pensioner ... ...
...
4. Office/Department/Ministry in which the
deceased pensioner served last ... ... ...
5. Date of death of the pensioner ... ... ...
6. Date of retirement of the deceased
pensioner ... ... ...
7. Amount of monthly *pension (including
ad hoc increase, if any) sanctioned to
deceased pensioner ... ...
...
8. Amount of retirement gratuity received by
the deceased pensioner ... ... ...
9. The amount of *pension (including ad hoc
increase, if any) drawn by the deceased
till the date of death ... ...
...
10. If the deceased had commuted a portion
of pension before his death, the commuted
value of the pension ... ...
...
11. Total of items 8,9 and 10 ... ... ...
12. Amount of death gratuity equal to 12 times
of the emoluments ... ...
...
13. The amount of residuary gratuity claimed,
i.e., the difference between the amount
shown against items 12 and 11 ... ... ...
14. Relationship of the applicant with the
deceased pensioner ... ...
...
15. Date of birth of the applicant ... ... ...
16. Name of the Treasury or Sub-Treasury at
which payment is desired ... ... ...
17. Full address of the applicant ... ...
...
18. Signature or thumb-impression of the
applicant (To be furnished in a separate
sheet duly attested.**) ... ... ...
19. Attested by :
Name Full Address Signature
(i) ............................... ...................... ..........................
(ii) ............................... ...................... ..........................
20. Witnesses
Name Full Address Signature
(i) ............................... ...................... ..........................
(ii) ............................... ...................... ..........................
Footnote : 1. If a retired Government servant in receipt of service
gratuity or pension dies within five years from the date of his
retirement from service including compulsory retirement as a penalty
and the sums actually received by him at the time of his death on
account of such gratuity or pension including ad hoc increase, if any,
together with the death-cum-retirement gratuity and the commuted
value of any portion of pension commuted by him are less than the
amount equal to 12 times of his emoluments, a residuary gratuity
equal to the deficiency becomes payable to the family.
* When a Government servant has retired before earning a
pension, the amount of service gratuity should be indicated.
** Attestation should be done by two Gazetted Government
servants or by two or more persons of respectability in the town,
village or pargana in which the applicant resides.
FORM 23
[ See Rule 38(3)]
Form of Medical Certificate
Certified that *I/(We) have carefully examined AB son of CD a
.............................in the..........................His age by his own statement
is..............................years, and by appearance about ..........................
years. I/(We) consider AB to be completely and permanently
incapacitated for further service of any kind in the Department to
which he belongs in consequence of ........................... (here state
disease or cause).
(If the incapacity does not appear to be complete and permanent,
the certificate should be modified accordingly and the following
addition should be made.)
*I am/We are of opinion that AB is fit for further service of a less
laborious character than that which he had been doing/may, after
resting for..............................months, be fit for further service of less
laborious character than that which he had been doing.
Medical Authority
Place
Dated the
FORM 25
Inserted by G.I., Deptt of Personnel & A.R., Notification No. 29/4/
83-Pension Unit, dated the 15th November, 1984)
[ See Rule 10(1) ]
Form of application for permission to Central Services
Officers to accept commercial employment within a period of
two years after retirement
1. Name of the Officer ... ... ...
(in BLOCK letters)
2. Date of retirement ... ... ...
3. Particulars of the Ministry/Deptt/
Office in which the officer served
during the last 5 years preceding
retirement (with duration) :
Name of Ministry/ Post held Duration
Department/Office From To
4. Post held at the time of retirement and
period for which held ... ... ...
5. Pay scale of the post and pay drawn by the
Officer at the time of retirement ... ... ...
6. Pensionary benefits :
Pension expected/sanctioned
(commutation if any, should be mentioned) Gratuity, if any
7. Details regarding commercial employment
proposed to be taken up -
(a) Name of the firm/company/Co-operative
Society, etc. ... ... ...
(b) Products being manufactured by the firm/type
of business carried out by the firm, etc. ... ...
...
(c) Whether the official had during his official
career, any dealings with the firm, etc. ... ...
...
(d) Duration and nature of the official dealings
with the firm ... ... ...
(e) Name of the job/post offered ... ... ...
(f) Whether post was advertised, if not,
how was offer made (attach newspaper
cutting of the advertisement, and a copy
of the offer of appointment, if any) ... ... ...
(g) Description of the duties of the job/post ... ...
...
(h) Remuneration offered for post/job ... ... ...
(i) If proposing to set up a practice, indicate -
(a) Professional qualification/in the ... ... ...
field of practice
(b) Nature of proposed practice ... ...
...
8. Any information which the applicant desires
to furnish in support of his request ... ...
...
9. Declaration :-
I hereby declare that -
(i) the employment which I propose to take up will not bring me
into conflict with Government ;
(ii) my commercial duties will not be such that my previous
official position or knowledge or experience under Government
could be used to give my proposed employer an unfair
advantage ;
(iii) my commercial duties will not involve liaison or contact with
the Government departments.
Dated: Signature of the applicant
Address :
Certificate to be submitted by Pensioner
LIFE CERTIFICATE
Certified that I have seen the Pensioner
(Name of Pensioner)...............Holder of the Pension Payment Order No.
that, he is alive on this date.
For BANK
Signature of a responsible officer or a well-known person
PLACE NAME
Designation
CERTIFICATE OF RE-MARRIAGE/NON-MARRIAGE
I hereby declare that I am not married / 1 have not been married during
the past six months.
OR
I hereby declare that I have not been re-married and I undertake to report
such an event to the Bank.
Pl ace Signature
Dated Name of Family Pensioner
P.P.O. No.
I certify to the best of my knowledge and belief that the above declaration
is correct:
Signature of a responsible officer or a well-known person
Pl ace Name
Designation
FORM OF certificate OF NON-EMPLOYMENT/RE-EMPLOYMENT
I declare that I have not been serviving in any capacity either in a
Government department/office, Company, Corporation, Autonomous
body or Society of Central or State Government or Union Territory or a
Local Fund during the half- year ended May/November, 20. ...........
OR
I declare that I have been employed/re-employed in the office of
__________________________ which is a part of/financed by
_________________________________ Government and was in
receipt of the following monthly rates of emoluments during the half year
ended May/November 20 ............... or during the months of
___________________ falling within the said half year.
(a) Pay (b) Honorarium
Special Pay
Allowance
(including D.A., A.D.A., etc.)
OR
(ii) Further, that the orders of my re-employment do/do not stipulate my
pension being held in abeyance during the re-employment period.
OR
I declare that I have not accepted any commercial employment in
India.
OR
I declare that I have not accepted commercial employment in India
after obtaining previous sanction of the Central Government and none of
the conditions, if any, attached thereto by Government has been violated.
OR
(iii) I declare that I have accepted commercial employment in India
without obtaining the previous sanction of the Central Govt.
Note: This declaration is required to be given for a period of two years
from the date of retirement.
I declare that I have not accepted any employment under a Govt
outside India/an International Organization of which the GoI is not a
member.
OR
I declare that I have accepted employment under a Government
outside India/an International Organization of which the GoI is not a
member after obtaining the previous sanction of the Central Govt. and
none of the conditions attached thereto by the Government has been
deviated from.
OR
I declare that I have not accepted any employment under a Government
outside India / an International Organization of which Govt of India is not
a member, without obtaining the previous sanction of the Central Govt.
Pl ace ______________ Si gnat ur e
Dated Name of the Pensioner
P.PO. No.
Designation of authorized Officer
(Certificate at (ii) and (iii) are to be furnished only by retired Group 'A'
officers.)
Application for Rly Employees Widow for Complimentary Pass
1. Name of the applicant:
2. Name of the deceased Rly Employee:
3. Post Last Held by deceased Rly Employee:
4. Station of Last posting:
5. Date of Death of Rly Employee
6. Details of Widow & dependents
S No Name Relation with Age Date of Birth
Deceased Rly
Employee
7. Class of Pass entitled to
8. Present address
Signatures / LHTI of Widow
Following Documents must be attached:
1 Copy of death certificate
2. Copy of PPO
3 Copy of Service Certificate of the deceased employee
4. Copy of Family I-Card.
5. Affidavit of the widow declaring that she has not remarried and that her
name is not included in the Pass of any relative who happens to be a Rly
employee
6. Two pp size Photographs (Attested) of the claimant &each of the
dependent entitled to be included in pass
ANNEXURE - III
END OF LIFE ISSUES
What the spouse / family should know ?
( Before your ..... departure )
1. Your will: What and Where ?
2. Birth Certificate
3. Pension papers including retirement certificate if superannuated
4. Marriage certificate if any
5. Property papers: House/Flat ownership, Real Estate Property
Tax papers i.e. Municipal Tax papers, Land and Building Tax
papers, Society Tax papers , etc
6. Rent papers with all correspondence in connection with the
same
7. Pending litigation papers, if any
8. Court decisions, if any
9. Names of Legal Advisors and their telephone Nos. and addresses
10. Telephone files - first receipt indicating the security deposit
11. Deposit receipts of Gas connection indicating the security
deposit
12. Deposit receipts of Electric meter and water connection with
amount of security
13. Medical files with last reports
14. Passport, driving license , Identity card, election card
15. Income Tax and Wealth tax files
16. Policy files, LIC, GIC, Health, Medical, Fire Accident etc.
17. Motor car / scooter papers and car/scooter insurance
18. Bank/Post office account with details of each account, Name of
the Banks/Post office etc.
19. Detail and keys of Bank Lockers with details of Bank and Locker
numbers
20. Fixed Deposits should be held jointly to be operated by one of
them. Details of maturity and receipt of interest should be clearly
available
21. Cumulative Time Deposits in Post Office / Bank indicating details
thereof
22. Share certificates / Mutual funds - normally the same should be
in joint name
23. Ensure that joint pension Account along with spouse is opened
24. Any other matter of interest to your family
After your Departure
In case of a Govt. Pensioner what the spouse / claimant of family
pension need to do:
1. Obtain Death certificate.
2. Deposit in police station any Arms & ammunition if the
deceased had an Arms license.
3. Inform Pension Disbursing Authority in writing along with a copy
of death certificate.
4. Open a new S.B. A/c in the pension disbursing bank for receiving
Family pension unless you already have a separate S.B account
in your individual name.
5. Obtain Family pension claim Form from the Bank, complete it and
submit it to pension disbursing Bank along with all enclosures.
Obtain acknowledgment.
6. Get the Pension account Pass book, of the deceased, updated to
ascertain the Balance. If it is a joint account, you can request the
Bank to delete the name of the deceased and continue to operate
it. In case it is not a joint account, you have to apply to Bank for its
closure and payment of the Balance to you or to all the heirs. If
there is no nomination depending on the size of closing Balance,
the Bank may ask you to produce legal heir certificate for which
you will have to file an application in the competent court having
Jurisdiction.
If the deceased was a Rly Pensioner:
Then the spouse is also
entitled to complimentary free Rly pass/passes
(1) Approach the pass issuing authority i.e. the office from where
deceased spouse was taking post retirement pass. (2) Obtain the
form for claiming Widow/widower complimentary passes, fill it up
and submit it with the following documents (attested copies):-
1. Death certificate
2. Service / Retirement certificate
3. Pass entitlement certificate (Form GTB 25), if available
4. PPO
5. Two P.P. size attested photos of the claimant.
6. An affidavit (in original) declaring (i) that the spouse i.e. the widow/
widower has not remarried ( ii ) That her/his name is not included
in the privilege/complimentary Rly pass of any other relative and
(iii) Details of dependants, if any.
7. Two copies of pp size Photos of each of the dependents if any.
8. Copy of Photo ID card issued for the purpose of passes.
9. Copy of Family I. Card.
10. Proof of age
ANNEXURE - IV
REGISTERED WILL
1. WHAT IS WILL
WILL is a legal declaration of the intention of the Testator (Writer of
Will) with respect to his own property (NOT ANCESTRAL) which he
desires to be carried into effect after ones death. It is revocable by
Testator at any time during his lifetime. However, a registered WILL can
be revoked by subsequent registered WILL only. A person writing WILL
does a great service to his family and loved ones. There is no stamp duty
for immovable property transferred through WILL. It is the prerogative of
the person having property to distribute and to disinherit anyone from his
assets in the manner he considers appropriate and just. There is definite
advantage in preparing WILL in comparison with not preparing a WILL.
When head of family is alive, one always says that my children are
very good, obedient etc. and would never fight for property. In
todays materialistic world, all such values have disappeared.
Everyone is for own family and interest and dont underestimate the
power of spouse of your son and daughter who often make brothers
and sisters to fight for paternal property in courts. Hence, decide
now the division of your property by writing and registering the same
before area Sub - Registrar / SDM.
2. I AM TOO YOUNG TO BOTHER FOR WILL.
There is nothing you can guarantee yourself a ripe old age.
Accidents happen and illness, terrorist attack and earth quake have
been known to turn fatal. Age is not the key factor. If you have
spouse and children, you must write a WILL. Dont just bless the
children. Leave them a WILL and save them from harassment at the
hands of the Municipal Corporation/committee/Development
Authority/Banks/Insurance and greedy relatives.
3. REASONS WHY SENIOR CITIZENS SHOULD WRITE
AND REGISTER A WILL
Make a WILL when you are in sound physical and mental condition and
get it registered. It acts as deterrent for miscreants to prove ownership with
false documents or documents signed by the elderly under duress if a
contesting REGISTERED WILL exists.
4. WILL ON PLAIN PAPER ONLY
WILL can be written on plain paper preferably typed double space (no
stamp paper) witnessed by two persons putting ones signature on WILL.
Witnesses need not know contents of WILL. It is advised that the witnesses
should be young and reliable.
In case one is very old it is desirable that a certificate with date
from a doctor be obtained on WILL itself (both the copies of WILL)
about the health and capacity of the person to write his WILL.
5. I DONT HAVE A BIG ESTATE.
Most have little idea of the size of our estate and are not sure how to
calculate our net worth. Even a small flat costs Rs. 50 lacs in cities like
Delhi and satellite towns of metros.
6. I HAVE NOMINEES FOR MY ASSETS, I DONT
NEED A WILL.
Nominees only hold the asset in trust so it can be passed to the legal
heirs. For immovable property, one cannot nominate a Nominee. Hence
you do need WILL for transferring immovable property, business, motor car
etc.
7. CONSULT SPOUSE WHILE MAKING WILL.
IT IS THE RESPONSIBILITY OF THE WIFE TO ENSURE THAT
THE SPOUSE WRITES AND REGISTERS WILL.THE WOMAN
SUFFERS THE MOST IN ITS ABSENCE. THIS IS THE ONLY WAY
FOR SMOOTH TRANSFER OF PROPERTY (MOVABLE/
IMMOVABLE) AND BUSINESS TO WIDOW/RELATIVE.
8. WRITE WILL EARLY IN LIFE AND REVISE
PERIODICALLY.
One should make WILL as early as possible in life say marriage, or
buying property whichever is earlier. Death comes at all ages including
young and without warning. It is never too early/late to write and register
a WILL.
For example, a person has a family of himself, his wife, two major sons
and two major daughters. All are well settled and married. He desires to
give away Rs. 15 lakhs to his wife and rest to his four children, he can do so
by writing his intention in the WILL. However, if he does not make a WILL
and were to die intestate, then his all assets will be divided amongst his wife
and four children in equal proportion. Which of the options is more
desirable?However, if there is a dispute between widow and four children,one
has to obtain a succession certificate from appropriate local court which may
take 3 to 5 years and about 2.5 percent of total cost of property and lawyer
fee which generally depends upon valuation of total wealth including
property and lot of accrimination between the five legal heirs.
9. DONT NEGLECT THE MARRIED DAUGHTERS.
Sons have no birth-right to parental property. Daughters have equal
rights for parental property. Son is a son till he gets married;
daughter is daughter for ever.
10.MENTION NAMES AND AGES OF LEGAL HEIRS.
The WILL writer must mention the legal heirs, i.e. in the case of
male,mother, wife, son and daughter with their name, age and address and
in the case of female, husband, son and daughter. Someone in the family
should know where the registered Will is kept.
11. WHAT CAN BE BEQUEATHED IN WILL
All properties movable & immovable self acquired property,
i.e. generated through independent income, gift (not ancestral) can be
bequeathed by WILL. Ancestral property is the one obtained from paternal
grand-father, paternal great-grand-father etc. However, property inherited
from a person other than his father, paternal grand father or great-grand-
father is considered to be self acquired property and therefore can be willed.
Give full description and share of property, number, street, floor, area, city
and description from whom bought etc. Similarly give description of
business, share in business etc.
Generally all movable and immovable property is first bequeathed
to spouse and one can mention, if necessary, on spouse's demise to
be distributed to son/daughter. One can also mention that spouse
has full right to sell the immovable property.
It helps to have a clearly articulated WILL or succession plan. And it
means a clearly articulated one. Take one case described by Subhash
Lakhotia, a Delhi based Tax Consultant. Before his death, this client had
equally distributed his property between his sons in a written WILL.
The WILL also said my wife will have the right to stay in the house
owned by me. Guess, where his wife ended up: in a small garage that was
part of the house, thus technically meeting the requirements laid down by her
husband.
Wording should have been My wife would be permitted to stay at the
same place occupied by me that includes my bedroom, drawing room,
kitchen, lobby and garden.
12. BUSINESS AND WILL
If you are a business man, you need to decide who will take over your
business after your demise. In a proprietary concern, if you dont leave a
Registered WILL, all the legal heirs become owners of business. Hence
in your life time, include your spouse as partner in business. .
13. REVISION OF WILL
Making WILL is not a one time affair. If circumstances change like
death in family, purchase of house, shop, business and like, new WILL should
be written and registered. Only a subsequent registered WILL can
replace an earlier registered one.
One can revise ones WILL any number of times
14. REGISTRATION OF WILL A MUST FOR PRACTICAL
AND LEGAL REASONS
IF A WILL IS REGISTERED, it may be possible to get the leasehold
property mutated in the name of beneficiary legal heirs in Development
Authority/Municipal committee/ corporation etc . It also removes any
ground for suspicion.Registered Will is certainly superior to
unregistered one. Registration cost in Sub Registrar / SDM Office in
Delhi is nominal Rs. 100/- only and the time taken just less than an hour.For
registration, take two original copies of preferably typed WILL with photo
pasted on right hand side top and your identity card and two young and
reliable witnesses (male or female) with identity cards like passport,
election card, driving licence.As soon as the WILL is signed on every page
by the author of WILL and also signed by two witnesses to WILL, then the
WILL is ready for being presented to Sub-registrar. A small receipt in
duplicate evidencing the registration of WILL is given to the writer of the
WILL. On production of the small receipt, the original registered WILL be
returned to you duly stamped AFTER ONE HOUR...Registered Will is
necessary for mutation purposes and is also useful for getting money from
P.F., Gratuity, LIC policy, Banks, Mutual Funds, Bonds, Shares, Post Office
deposits etc. in case there is no nomination. Even for transfer of motor car,
one needs preferably a registered WILL.
15. REMITTANCE OF MONEY ABROAD FOR SELLING
ANCESTORAL PROPERTY
These days, a large number of parents have all their children
settled abroad and for them it is highly desirable or even essential
to write and register a WILL. The properties of such parents, when
dead, are vulnerable to the greed of dishonest persons trying to grab
the properties by any foul means.
Government has now permitted the proceeds of sale of such properties
to be sent to children settled abroad. The issue of remittance is stipulated
under the Foreign Exchange Management Act (FEMA). As per FEMA,
an amount upto US$ 1 million can be remitted outside India in a calendar year
in case of sale of ancestral property through normal banking channels after
obtaining a certificate from a Chartered Accountant certifying that all taxes
have been paid. Evidence of inheritance of property like Will shall have to
be shown to the bankers for such remittance.
ALL THOSE WHO ARE CHILDLESS AND / OR SINGLE
MUST WRITE AND REGISTER A WILL.
16. REGISTERED WILL & FREEHOLD PROPERTIES
During the last few years, a large number of properties have become
free-hold from lease-hold, meaning thereby that, such properties have no
connection from the authorities from which they were purchased, i.e.
L&DO or DDA (in Delhi). Hence, on demise of the owner there is no need
to go to L&DO/DDA for mutation of the property. In spite of this, one has
to mutate all properties with Development Authority/Municipal Committee/
Corporation etc for Property Tax and other purposes like building plans,
water, sewage etc. Hence, it is highly desirable, in fact essential, that as and
when a property is purchased, a copy of Registered Deed is immediately
submitted to MCD so that information regarding ownership is recorded in
Municipal records. Similarly, in case of death, legal heirs should intimate to
Development Authority/Municipal Committee/ Corporation etc in the proper
forms, with a copy of the death certificate, for mutation of property in their
names.In case one fails to do so, property in Development Authority/
Municipal committee/ Corporation etc continues to be in the name of earlier
owner and Property Tax is also deposited in the name of earlier owner, which
is legally incorrect. If property is on rent to another party, property tax is
deductible from house income for income tax purposes.
17. FREEHOLD Properties AND REVERSE Mortgage
In case a property is freehold, one can have assured income after60
years of age through Reverse Mortgage.
18. PROPERTY IN JOINT NAMES
MOST PEOPLE BELIEVE ERRONEOUSLY THAT
PROPERTY IS AUTOMATICALLY INHERITED BY SPOUSE.
Legally, not so. Property can only be inherited legally either by WILL or, in
the absence of WILL, by the laws of intestate succession as applicable to
the particular religion. If, however, property has been purchased jointly
by paying proportionate cost of property, both owners should write
separately their WILL only for the portion of which they are owner.
19. Development Authority / Municipal Committee / Corporation
etc preferRegistered Will for mutation of property.
Property received through WILL by a person is legally his own in all
respects and should be mutated/transferred Development Authority/
Municipal Committee / Corporation etc L&D Office and also in Water
Supply and Electricity Officesrecords by submitting Registered Will, death
certificate and other required papers/documents at the earliest. Procure
20 original death certificates, because most authorities insist for original
death certificate or notarized death certificate.
Guidelines are available for mutation in Development Authority/Municipal
Committee / CorporationOffice.Guidance for filing of forms in such
bodies can best be obtained from the typists sitting outside these offices.
20. WHAT HAPPENS WHEN THERE IS NO WILL
It is not that property is not transferred if one has unregistered Will. In
that case DDA insists that legal heirs should write revocation deed in favour
of one to whom they wish property to go. This is in case where all legal heirs
agree to give property to agreed person, say, mother.
If there is disagreement between legal heirs, only course is to approach
local Court for succession certificate, which will indicate how property will
be distributed among legal heirs. For this, one has to apply to Court.
Thereafter, Court issues notice to all legal heirs and also gets one legal notice
published in leading local newspaper for filing of objections. After the matter
is decided, Legal Heir Certificate on stamp paper of 2.5% of value of
property is issued. If the total property is worth one crore, stamp duty shall
be 2.5 lakhs. plus advocate fee and delay of five years.
21. MUTATION OF POWER-OF-ATTORNEY PROPERTY
If property (flat) is on leasehold on power-of-attorney, get it mutated in
your name in the DDA by paying stamp duty and registering same. It is
advisable to get property registered in female name because Stamp Duty is
only 4% while in the other case it is 6%. All properties purchased on Power
of Attorney are not properties of POA(Power of Attorney holder) holder in
legal sense though fact of physical possession with other documents are in
his favour.
Many people are reluctant to get the leasehold property converted into
free-hold because they feel that it is not necessary since they are in physical
possession of flat, have power of attorney and registered Will in their favour.
Little do they realise that power of attorney lapses with the death of
the person who issued same. Secondly, registered Will comes into force
on the death of the person and one will never know when and where writer
of Will dies and chances of getting the death certificate are remote. Also,
Development authority insists that in case of registered Will in
favour of someone other than legal heir, no objection affidavit be
brought from legal heirs. In such circumstances, it is doubtful if any legal
heir will give No Objection to POA holder.
The cost of converting the lease hold property to free-hold goes
on increasing with the increase in land prices. Hence the necessity
of converting leasehold into freehold at the earliest.
22. CONTENTS OF WILL SHOULD BE KEPT SECRET
(IF NECESSARY)
Otherwise the beneficiaries might pick up a row and quarrel with the
writer of WILL/beneficiaries as to quantum or proportion of properties
disposed of by him as between the beneficiaries. Everyone including the rich
want free money. Original WILL and registration papers of properties can
be kept in bank locker. Never keep any original document in Office.
23. NOTHING PASSES TO SPOUSE AUTOMATICALLY
Most believe that on their demise, property flat/house/money/shares
shall automatically pass on to their spouse. There is no such provision
in any law. Property passes to legal heirs only and spouse gets a portion
depending upon the number of legal heirs. If husband and wife have same
or different properties both must write separate Wills.
24. WILL AND NOMINATION
Most believe that by making nominations, there is no need for writing
WILL. Nothing could be more fallacious than this.
It is important to understand the distinction between a WILL and
NOMINATION. A Nomination does not lay down a separate Law of
Succession. A nominee does not become owner of the property after the
death of nominator. A nominees name will come on Share Certificate of
Society, Company, Bank FD/Account etc. but nominee does not become
owner. A nominee is only a trustee of the legal heirs. In case of
contradiction between the contents of a Will and those of Nomination, a Will
contents prevail, as Nomination does not give any succession rights.
In case one wishes nominee gets legal title over property, one
should write Will in favour of Nominee. In other words, nominee and
person in whose favour WILL is written are same.
25. POWER OF ATTORNEY / GIFT DEED / REVOCATION
DEED OF PROPERTY TO RELATIVES
Reply is an emphatic No because one may lose the total
property and be left in lurchon road. It actually has happened to
many old persons.
26. ACTION TO BE TAKEN ON DEATH OF WRITER OF WILL
AS PER SECTION 57 READ WITH SECTION 213 OF
SUCCESSION ACT, 1925 AND AS HELD IN RAM CHAND GANESH
DAS VS. SARDARA SINGH (AIR 1962 PUNJAB 382) AND JAGDISH
CHANDER TRIKHA VS. PUNJAB NATIONAL BANK AIR 1998
DELHI PAGE 275-276, IT IS NOT NECESSARY TO GET
REGISTERED WILL PROBATED IN several States. However, in
case someone challenges the WILL, it may become necessary to get the
WILL probated. The stamp fee for getting WILL probated is 2.5 per cent
of the total property value involved in the WILL and lawyer fee. However
it may vary from State to State. Practical considerations demand that when
property owner is no more, the name of deceased is withdrawn and
substituted by legal heirs as soon as death certificate is received to prevent
complications arising from long list of relatives and heirs who tend to surface
from nowhere in any investment instrument. If property is on lease, tenant
be informed of death along with death certificate with the request to draw
new lease deed in favour of legal heirs.
If one is beneficiary of WILL, please read the contents of WILL
and act according to the dictates of WILL.
27. RESIDUARY CLAUSE
By a Will one can bequeath ones property, present as well as future.
A Residuary Clause(s) should make provision about properties not specifically
identified in the Will. Clause can be written as follows:
I GIVE, DEVISE AND BEQUEATH ALL MY MONEY AND
OTHER PROPERTY MOVABLE AND IMMOVABLE
WHATSOEVER AND WHERESOEVER NOT OTHERWISE
DISPOSED OF BY THIS WILL AND ANY SUCH MOVABLE AND
IMMOVABLE PROPERTY PURCHASED IN FUTURE IN THE
MANNER DESCRIBED ABOVE, I.E. FIRST TO AND
ON HIS/HER DEMISE TO MY
28. DRAFTING OF WILL
Get WILL drafted from a person who is well versed with drafting of
WILL. Every WILL is special keeping in view relationship in each family
before and after death. Remember the future peace of your spouse and
family depends on your WILL.
29. EMPOWER SPOUSE WITH FINANCIAL KNOWLEDGE
Most ladies (working as well as housewives) are not interested in
financial matters. They feel that it is a mans domain and consequently
suffer heavily when one becomes a widow. THE ONLY TIME A WIDOW
IS RESPECTED AND LISTENED TO BY CHILDREN IS WHEN SHE
HAS PROPERTY AND MONEY IN HER FAVOUR.
30. PREPARE AN ASSET REGISTER OF SELF AND SPOUSE
giving details of Movable and Immovable property, Pension file, Income-tax
file, Bank accounts, PPF, Senior Citizens Saving account, Bank locker
Number, valuable documents kept in the locker, PLACE WHERE WILL
kept, passport, other documents etc. Otherwise the spouse and other
eligible relatives spend months / years searching and listing assets.
Also mention names of near relatives / friends who will help the
spouse (widow) for getting movable and immovable property in her
name from various authorities.
31. Please do not part with your original / photocopies of WILL and
any property documents in any circumstances because hostile
person can destroy the same. Original documents should be kept in
a locker & Pray and only photocopies with you.
Above are only some of the guidelines. One may act as per his/her
circumstances.
REMEMBER
* YOU CAN WRITE / REWRITE WILL / CHANGE NOMINEE
BUT DONT FORGET
* YOU CANNOT REVOKE GIFT / REVOCATION DEED
DONT GIVE MONEY, PROPERTY
AND POWER OF ATTORNEY
TO ANYONE WHEN ONE IS ALIVE.
DDDDD DD DDD DD DDDDD DD DDD DD DDDDD DD DDD DD DDDDD DD DDD DD DDDDD DD DDD DD
ANNEXURE - V
HEALTHY AGEING
How should you plan your retirement?
Simple practical tips for healthy ageing !
By Dr. V.S. Natarajan -
Pioneer in Geriatric Medicine in India
Plan well ahead:
50 is the old age of youth and
60 are the youth of old age.
Avoid loneliness:
Loneliness is the enemy of old age. Try to avoid this. Cultivate
lot of hobbies in life. Reading books, listening to music, radio,
computer, gardening, and spiritual activity are good at old age.
Be independent:
Do your basic work by yourself. It gives you pride and dare in life.
Life without bondage:
When getting older try to reduce your bondage with your family. Live
like a droplet on lotus leaf.
Meditation:
Centering the scattering thoughts can be done by meditation.
It gives you mental peace and leads to reduce your stress.
It gives you more mental strength to face your life.
Vow of silence:
Vow of silence in a particular day is a wonderful activity for elders.
To start with 15-30 minutes gradually increase it up to two hours.
Try to do twice in a week.
Fasting:
Taking low calorie food regularly will increase your life span.
Try to fast at least once a week. It gives you strength and brisk.
Your part in the family:
Avoid too much of expectations. It gives you disappointment only.
Try to help as much as possible for your family.
Service:
For doing service one need not have a good health and money.
Do concern about others. Do counsel others with the help of your
experience to overcome their problems. Do community prayer for the
needy.
Pranayama:
Learn pranayama from a qualified teacher.
Practice it regularly for a healthy mind and body.
Will:
Write it right now to avoid unnecessary conflicts and
confusions in the family.
Spiritual thoughts:
When getting older it is natural to accept the super power above us.
It gives you confidence and energy which leads to peaceful life.
Periodical medical check up:
Even if there are no complaints, periodic
health check-up is very essential.
Good diet:
Wheat, ragi, pulses, milk, green vegetables,
green leaves and fruits can be taken moderately.
Finance:
Finance is very important now. Make a habit to save
from your young age to lead your old age. Save for yourself.
Work and rest:
Do work to burn calories. At the same time take rest.
Friends:
A friend indeed a friend in need is true especially at old age. Maintain
a good relationship with close friends.
Picnic:
Have some fun going picnic with friends and relatives.
It gives you more energy. It refreshed your mind.
Home:
Decide the home / place you are going to live
at your old age from the middle age itself.
Death:
No medicine to death. It wont come after announcement. Throw
your fear of death and enjoy your life each and every minute.
EXERCISE
What are the health benefits by doing exercise?
The benefits of exercise far exceed its risks, regardless of the
presence of other risk factors. Regular exercise can reduce mortality
rates even for smokers and obese persons. Indirect benefits include
opportunities for social interaction, an enhanced sense of well-being,
and possibly an improved quality of sleep.
Improvement of physical and physiologic factors
Regular exercise can preserve skeletal muscle strength, aerobic
capacity, and bone density, contributing to mobility and independence.
Exercise is one of the few interventions that can restore physiologic
capacity once it has been lost.
Skeletal muscle strength and power (rare of doing work) decline with
age. These changes can be prevented, at least partially, or reversed
by appropriate exercise. Regular exercise also promotes a balance
energy state and reduces risk of obesity.
Improvement of functional ability
Regular exercise reduces the risk of age-related decline in functional
ability, and it appears to improve quality of life by improving physical
functioning and enhancing psychologic well-being.
Prevention and treatment of disease
In the elderly, regular exercise increases insulin sensitivity and
glucose tolerance reduces resting systolic and diastolic blood
pressure, normalizes blood lipid levels including reductions in
circulating triglycerides and an high-density lipoprotein cholesterol,
and reduces visceral fat contest. Thus, regular exercise can help
prevent cardio-vascular disease (e.g. heart attack, hypertension,
diabetes, osteoporosis, obesity) related disorders, colonic cancer,
and psychiatric disorders. It is part of rehabilitation after a heart attack
or after surgery.
Prevention of falls and fall-related injuries
Regular exercise can help prevent falls and fall-related injuries by
improving several risk factors for fall related to poor mobility, including
strength, balance, neuro-muscular coordination, joint function and
endurance. Exercise provides overall benefits, despite a modest
increased risk of falls during the exercise.
Reduction in mortality
Many studies report that regularly active elderly persons have 20 to
50% lower mortality (death) rates, despite a slight (but widely
publicized) temporary increase in the risk of sudden death during
exercise.
Benefits of exercise programs for older persons
Improved aerobic capacity.
Reduced mean arterial blood pressure.
Reduced resting heart rate.
Increased maximum oxygen consumption
Increased muscle mass and strength
Increased bone density
Increased flexibility
Improved gait velocity
Improved lipid profile especially increase
in high-density cholesterol (good Cholesterol)
Improved sense of well-being
Reduces weight
Prevents constipation
Is there any relationship between exercise and cancer
prevention?
In a study conducted in Japan regarding exercise and its relationship
to the incidence of cancer, an assessment was made on a group of
sedentary workers up to their old age. It was observed that for those
engaged in sedentary work for more than 20 years, the incidence of
cancer involving the colon and rectum was increased. In a similar
study conducted in U.S.A. young athletic woman were followed up to
their old age. It was found that the incidence of cancer involving breast
and uterus was considerably low.
Thus these two studies indicate that exercise has a direct impact in
reducing the risk of cancer.
What type of exercise for elderly?
Of all types of exercise, endurance exercises (e.g. walking, cycling,
and swimming) provide the most well documented health benefits for
the elderly. Jogging is generally inappropriate for elderly persons not
already accustomed to it.
Patients do not have to be active for 30 minutes at a time but can
accumulate 30 minutes over 24 hours. As little as 10 minutes of
exercise has health benefits, and three 10-minute bouts of activity
have the same fitness effects as one 30-minute bout.
For the elderly, walking is generally the most readily available form of
aerobic exercise and should be performed for more than 30 minutes
during each session. Elderly people can walk 3 to 5 km daily.
Exercises are best done early in the morning or in the evening. They
should not be done on a full stomach. The elderly can exercise as the
presence of other participants makes the session a social event and
the group leader can prod them and encourage their continued
participation.
Those who are having restricted mobility like arthritis of knees and
poor vision they can sit and do upper body exercise. Instead of doing
exercise continuously for half an hour a patient can do 10 minutes at
a time for three times a day.
The exercise form best suited for any given elderly individual has to
be decided upon after consultation with the doctor. In the presence of
certain diseases, certain exercises may be harmful. For example
diabetic patients whose retina has been affected or those who suffer
from both diabetes and hypertension should not perform exercises
involving standing on the head or bending forward. Those who have
week hearts should avoid strenuous exercises, which can cause
breathlessness. During the month following a heart attack, all forms
of exercise except walking should be eschewed.
Dose of insulin and oral hypoglycemic in diabetics may need to be
adjusted (according to the amount of anticipated exercise) to prevent
hypoglycemia during exercise.
How do we know that excess of exercise has been done?
If you noticed any one of the following events while doing exercise
consult your doctor immediately.
Pulse rate more than 120/minute
Palpitation excessive heart beat
Chest pain
Difficulty in breathing
Pain in the joints
Extreme weakness
Any tips for keep moving?
No age limit to start exercise.
Physical inactivity is the leading cause of premature death.
Before starting exercise first, pre-exercise screening by a doctor
is essential.
Do it in the empty stomach in the morning or evening hours.
Minimum 30 minutes exercise per day for 5 days per week is a
must.
Those who are unable to do outdoor exercise choose indoor
cycling, treadmill, floor exercises
Walking stick (cane), walker or frames may be useful for people
who are not stable on their feet.
Group exercise is preferable
So exercise is the best tonic for the elderly, all the benefits of which
can be enjoyed without any extra expense.
ANNEXURE - VI
CENTRAL GOVERNMENT HEALTH SCHEME
SALIENT FEATURES
The Central Government Health Scheme (CGHS) provides
comprehensive health care facilities for the Central Govt. employees
and pensioners and their dependents residing in CGHS covered
cities.
Started in New Delhi in 1954, Central Govt. Health Scheme is now in
operation in Allahabad, Ahemdabad, Bangalore, Bhubhaneshwar,
Bhopal, Chandigarh, Chennai, Delhi, Dehradun, Guwahati, Hyderabad,
Jaipur, Jabalpur, Kanpur, Kolkatta, Lucknow, Meerut, Mumbai, Nagpur,
Patna, Pune, Ranchi, Shillong, Trivandrum and Jammu.
The Central Govt. Health Scheme provides comprehensive health
care to the CGHS Beneficiaries in India. The medical facilities are
provided through Wellness Centres (previously referred to as CGHS
Dispensaries) /polyclinics under Allopathic, Ayurveda, Yoga, Unani,
Sidha and Homeopathic systems of medicines.
* 78 Ayush dispensary/units, * 248 Allopathic Dispensaries,
* 19 Polyclinics, * 3 Yoga Centres * 65 Laboratories, * 17 Dental Units
CGHS Cards: DEFINITION OF FAMILY
In accordance with the initial instructions, the term of Family for the
purposes of the Scheme shall consist of the Government servants
wife or husband, as the case may be, children and stepchildren and
parents who are mainly dependent on and residing with the
Government servant concerned. Subsequently in pursuance of the
recommendations of the Sixth Central Pay Commission, it has been
decided that for availing the medical facilities under the scheme,
parents, sisters, widowed sisters, widowed daughters, minor brothers
and children will be deemed dependent on the Government employee
if they are residing with him and their income from all sources
including pension and pension equivalent of DCRG benefit is less
than Rs. 3500 + DR per month.
{in case of Divorced/ widowed daughters Residing with condition
has been withdrawn vide OM No. 4.24/96-C & P/CGHS (p)dated
30.05.2007. & 4.24/96-C & P/ CGHS/ (p) dated 25.02.2009}
ENTITLEMENT OF THE SCHEME:
All Central Government pensioners (except Railway Pensioners and
Armed Forces pensioners) who were eligible for availing CGHS
facilities while in service are eligible for availing CGHS facilities after
retirement. The scheme is also applicable to Central Government
employees who retired with Contributory Provident Fund benefits.
Similarly families of Central Government employees in receipt of
family pension are also eligible to avail of these facilities, if the
deceased Government servant was eligible for these facilities while
in service.
It is not that only those Central Government employees who were
actually availing of CGHS facility during service are eligible to enjoy
84
85
DETAILED PROVISIONS FOR ELIGIBILITY OF
PENSIONERS/FAMILY PENSIONERS TO JOIN CGHS
All Central Government Pensioners (except Railway Pensioners
and Armed Forces Pensioners) who were eligible for availing CGHS
facilities while in service are eligible for CGHS facilities after retirement.
The Scheme is also applicable to Central Government employees who
retired with Contributory Provident Fund benefits. Similarly, families of
Central Government employees are eligible for the facilities for which
the deceased Government servant was eligible while in service.
All India Service Pensioners who retire while serving under State
Governments are also eligible to avail CGHS.
Pensioners can join CGHS immediately after retirement or at any
time thereafter.
Pensioners joining CGHS sometime after retirement are not required
to pay the contribution for the intervening period. However, in such
cases, they shall be required to pay admission fee of Rs. 30/-.
Similarly, pensioners who had discontinued their CGHS membership
and want to be readmitted to the scheme shall not be required to pay the
contribution for the intervening period, but pay a readmission fee of
Rs. 30/-
Pensioners have the option to get their names registered with any of
the CGHS dispensaries in CGHS-covered cities.
Pensioners residing in an area not covered by CGHS and who have
opted for availing monthly medical allowance, but also desire to avail
CGHS facilities for indoor hospitalization treatment from the nearest
CGHS covered city can be issued CGHS cards bearing stamp Not valid
for OPD Treatment
(OM. NO. 11055/1/2000-CGHS (P) dated 25.2.2000)
PROCEDURE FOR APPLYING FOR CGHS CARD BY
PENSIONER
A pensioner has to get a separate identity card surrendering the one
being used while in service. Application should be submitted to the Addl.
Director, CGHS, Bikaner House, New Delhi - 110 001 in the prescribed
form with the documents mentioned below:-
1. Photo copy of last pay certificate
2. Photo copy of Pension Payment Order
3. Group photograph with eligible dependents
4. Dependency certificate in the application form, duly certified
5. Certificate about surrender of CGHS card used while in service
6. Certificate from Pension-Drawing Authority indicating non-drawal
of Fixed Medical Allowance
7. Bank Draft from a Nationalized Bank / Postal Order for the required
amount in favour of Addl. Directors CGHS.
Application can be given three months prior to retirement or within
one month of retirement. If there is delay in applying, a readmission fee
of Rs. 30/- (or if contribution for the intervening period is less than
Rs. 30/-, actual contribution) is to be paid . For rates of Contribution to
be made please see p ..... under the sub head:
Revised Rates of Contribution to CGHS & Entitlement of Private Ward
(OM. No. S-12015/2/93-CGHS (P) dated 5.11.93 of MOH&FW)
TEMPORARY VISIT IN COVERED CITY
Central Govt. employees and dependent family members who are
beneficiaries of the CGHS. and who may be visiting other cities where
the scheme is operating and stay in the areas covered by the Scheme are
entitled for free medical attendance / treatment under the said Scheme.
(Necessary authority/ temporary cards for medical treatment in any of
those cities should be issued by the respective departments in case of
serving employees.) Medical facilities should be restricted to a period not
exceeding six months after which fresh authorities may be issued, if
necessary. Similar facilities are also available to pensioners and the
dependent family members if holding. CGHS Cards and permission shall
be granted by CGHS of the city being visited. Pensioners do not need
temporary permit but will be given CGHS facilities in all CGHS covered
Cities (he/she may be visiting) on the basis of their CGHS Token Card/
Plastic card with their Photo affixed thereon.
(Deptt of Health OM. No. S - 11001/6/91-CGHS(P) dt 10.06.1991)
87 86
PRODUCTION OF CGHS TOKEN CARD
The production of CGHS Token Card is obligatory on every visit to
enable correct identification of the patient and to prevent misuse of card.
The misuse of card is a cognizable offence. However, in view of
humanitarian service, essential and immediate treatment should not be
denied to the patient but the beneficiary should be advised to bring the
CGHS Card at the time of subsequent Visits and, if considered necessary,
a note may be made in OPD ticket of the patient. The production of
CGHS Index Card in the dispensary will enroll the card holder as a
member of the said dispensary. The renewal of Pensioners Token
card shall be done in the dispensary itself now called wellness centre.
The Indian Postal Order should be sent to Pensioner Cell, Nirman
Bhavan/DDO Office outside Delhi, regularly on or before 6th day of the
following month. Before accepting the IPO the Chief Medical Officer
In charge must see the date of issue of I.P.O/ DDs which should be
within one month of issue from the Post Office. The Chief Medical
Officer in charge will obtain a certificate from each pensioner for any
rise of pay/pension due to incremental rise after every two years for
calculation of rate of pension or the fact may he verified from his Pension
Payment Order (PPO) before revalidation of card. The Chief Medical
Officer In charge may therefore re-fix the rate of contribution accordingly.
In case of Pensioner, the transfer of card from one Wellness Centre to
another shall be) done by the Chief Medical In charge of the WC.
REGISTRATION OF CGHS CARD IN WELLNESS CENTRE
Card Holder must deposit the Index Card in the dispensary and obtain
receipt from the receiving clerk. The receiving clerk, will initial the Token
Card in confirmation. Until he deposits the Index Card, the beneficiary
is not entitled for treatment in the said WC. On transfer to another WC,
the Card Holder must collect the index card from the WC and deposit the
same along with necessary forms (in duplicate) to the new WC which
has been allotted to him. It is only after the deposition of Index Card in
the WC that the members mentioned in the token card are entitled to
obtain CGHS facilities.
INTRODUCTION OF CGHS PLASTIC CARDS:
Consequent on computerization of CGHS, it has been decided to
introduce CGHS Plastic Cards for CGHS beneficiaries individually,
containing photograph of the beneficiary and details regarding card
number, name of the beneficiary, entitlement of ward facility, date of
issue along with the date of validity and a bar code to identify the
beneficiary.
As there are different categories of beneficiaries, it has been
decided to have four colour codes to identify the category to which the
beneficiary belongs - Blue colour code is for serving employees; Red
colour for Members of Parliament; Green colour for pensioners and
Yellow in case of autonomous bodies . (See also Annexure 6B)
SURRENDER OF CGHS CARD
The CGHS Identity Card held by the beneficiary other than Pensioner,
General Public, Ex-MPs etc. must be surrendered to the issuing authority
in the following events:-
(a) Retirement /Resignation
(b) Death of Government Servant
(c) Transfer of Govt. Servant to another office. The Govt. servant, if
transferred to another office where he/ she is again entitled for
CGHS benefits, must apply and obtain a new Identity Card.
Pensioners, Ex-M.Ps, Member of General Public etc. are also required
to surrender their Identity Cards to the Issuing Authority on its expiry in
case they no longer desire to avail CGHS facilities.
MISUSE OF CGHS CARD
If the Medical Officer detects a case of misuse of CGHS Token Card
by unauthorized person, he will bring to the notice of Chief Medical
Officer In charge and / or the matter reported to the Zonal HQ/ etc. for
further necessary action.
LOSS OF IDENTITY CARD
As a lost card is likely to be misused, the card holder must inform
immediately to the Police and inform the following with a, copy of F.I.R.
(i) Issuing authority
(ii) C.M.O. In charge of the concerned Wellness Centre.
(iii) Headquarters of CGHS in the cities other than Delhi.
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A duplicate card can be issued after realising penalty of Rs 5/- for
1st instance. 2nd. instance Rs 7/-, 3rd and subsequent instance Rs 10/.
In case of individual Plastic Cards in Delhi / elswhere, the procedure is
same but, the penalty is Rs 50/-.
DEPENDENCE CERTIFICATE
Every Card Holder must certify that the parents /Dependents whose
names have been included in the token card, normally reside with him.
Such a certificate must be furnished at the time of issue of Token Card
and renewed every January. Otherwise the parents shall be treated as
non-entitled persons. The certificate must also state that the income from
all sources does not exceed Rs 3500 + DA p.m. {in case of Divorced/
widowed daughters residing with condition has been withdrawn vide
OM No. 4.24/96-C & P/CGHS (P) dated 30.05.2007. & 4.24/96-C &
P/ CGHS/ (P) dated 25.02.2009}
FACILITIES NOT PERMISSIBLE TO THE PENSIONERS:
1. Treatment in Non-recognized Hospitals / Nursing Home
except in EMERGENCY
2. Treatment outside India
3. Administration of routine injections at ones residence
4. Dressing of wound at residence
5. Supply of artificial appliances, e.g., dentures, spectacles,
contact lens, etc. [In respect of dentures, an amount upto Rs
2,000/- is reimbursible.]
6. Orthodontic treatment
7. Treatment for obesity due to inogenous factors.
8. CS (MA) Rules, 1944 are not applicable to pensioners residing
in areas not-covered by CGHS
(GOI OM No. 14025-4/96-MS dt 20.8.2004)
FIXED MEDICAL ALLOWANCE FOR PENSIONERS
1. Pensioners/Family Pensioners residing in an area not covered
by CGHS (or corresponding Health Schemes of other Ministries/
Departments), and who have specifically opted for not availing of
outdoor facilities from the nearest CGHS dispensary, are entitled
for a Fixed Medical Allowance per month for meeting day-to-day
medical expenses that do not require hospitalization.
2. Pensioners who have opted for availing FMA, but also desire
to avail CGHS facilities for indoor Hospitalization treatment from
the nearest CGHS covered city can be issued CGHS cards
bearing stamp NOT VALID FOR OPD TREATMENT.
CGHS HELPLINE: Tel. 011-66667777,
e-mail-helpline-cghs@nic.in
Revised Rates of Contribution to CGHS & Entitlement of
Private Ward
(A) Monthly Contributions for availing CGHS facility:
S. Grade Pay Rs
No.
1 Upto Rs. 1,650/- per month 50/-
2 Rs. 1,800/-; Rs. 1,900/-; Rs. 2,000/-;
Rs. 2,400/-; and Rs. 2,800/- per month 125/-
3 Rs. 4,200/- per month 225/-
4 Rs. 4,600/-; Rs.4,800/-; Rs.5,400/-; and
Rs.6,600/- per month 325/-
5 Rs. 7,600/- and above per month 500/-
(B) Entitlement of wards in private hospitals empanelled under
CGHS:
S. No. WARD Pay in Pay Band + Grade Pay
1 General Ward : Upto Rs. 13,950/-
2 Semi-private ward : Rs. 13,960/- to Rs. 19,530/-
3 Private ward : Rs. 19,540/- and above
(C) Monetary Ceiling for Free Diet:
The monetary ceiling for free diet for CGHS beneficiaries is revised to
pay / pension / family pension of Rs. 7,450/-per month.
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(D) Monetary ceiling for free diet (for beneficiaries suffering from
TB or mental disease):
The monetary ceiling for free diet in case of beneficiary suffering from
TB or Mental disease is revised to pay / pension / family pension of Rs.
11,160/-per month.
(E) Pay slab for determining the entitlement of Nursing Home
facilities in Government/State Government/Municipal Hospitals:
The monetary ceiling for determining the entitlement of Nursing Home
facilities in Central Government / State Government /Municipal Hospitals
is revised to pay / pension / family pension Rs. 13,950/- per month and
above
(F) Monetary Ceiling for direct consultation with Specialists in
Central Government / State Government / Municipal Hospitals:
The monetary ceiling for determining the entitlement for direct consultation
with Specialists in Central Government / State Government / Municipal
Hospitals is revised to pay / pension / family pension of Rs. 33,480/- per
month and above.
(G) Pay slab for determining the entitlement of accommodation in
AIIMS, New Delhi:
The revised entitlement, be revised as per the pay drawn by the officials,
as given below:
S. Pay (in the Pay Band)/Pension/ Ward entitlement
No. Family Pension drawn per month
1 Upto Rs. 19,530/- General Ward
2 From Rs. 19,540/- to Rs. 25110/- Private Ward
3 Rs. 25, 120/- and above Private Ward / Deluxe
Ward
3. It is clarified that the reference to pay in this order relates to the pay
drawn in the pay band.
4. Pensioners have an option to get their CGHS pensioner card made
by either making CGHS contribution on an annual basis (twelve months)
or by making contribution for 10 (ten) years [120 months(one hundred
and twenty months) ] for getting a pensioner CGHS card with life-time
validity. It is clarified that:
(i) Contributions to be made by pensioners & family pensioners
would be the amount that they were subscribing at the time of
their retirement or at the time of death of the Government
servant;
(ii) Pensioner beneficiaries, who have already obtained CGHS card
with life time validity by paying a lump sum amount equivalent
to 10 years contribution, will not be required to pay any
additional amount as a result of the revision in the rates of
contribution for availing CGHS facility;
(iii) Entitlement of pensioners & family pensioners, who have
already deposited their contribution for life time CGHS facility,
will not be changed;
(iv) Pensioners & family pensioners who are contributing to the
CGHS on an annual basis and wish to continue to avail CGHS
benefits will have to contribute at the revised rates upto the time
of contribution needed to cover a period of a total of ten years
from the time pensioner CGHS card was issued for the first time
to them. The revised rate of contribution for the remaining period
would be with reference to the grade pay that he / she would
have drawn in the post held by him / her (at the time of his / her
retirement / death) had he / she continued to be in service now
but for his / her retirement / death; and
(v) Any pensioner / family pensioner who is entitled to avail CGHS
facility has not so far got his / her pensioner CGHS card made,
the rate of contribution in such cases will be with reference to
the grade pay that he / she would have drawn in the post held by
him / her (at the time of his / her retirement / death) had he / she
continued to be in service now but for his / her retirement / death.
(OM. No. S.11011/2/2008-CGHS (P) dated 20.05.09 from
Ministry of H & FW)
REFERRAL PROCEDURE
CGHS/ Govt. Specialist / CMO I/c advises specific treatment
procedure / test. Permission to undergo the same at one of the recognized
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Hospitals / Diagnostic centre isgranted by CMO I/c in case of pensioner
CGHS beneficiaries / ex- Members of Parliament / Freedom Fighters /
ex- Governors, etc., by CMO I/c of concerned Wellness Centre and by
Rajya Sabha Secretariat, as the case may be, in case of Honble
Members of Parliament and by HOD in case of Serving Govt. employees
and by Autonomous bodies in case of serving employees and pensioners
of Autonomous bodies covered under CGHS.
If the beneficiary seeks permission from a CGHS recognized
hospital in another CGHS city, other than the city where he is registered,
permission shall be granted by Addl. Director / Joint Director CGHS of
concerned city. However, no TA/DA shall be permitted if treatment
facilities are available in the city of residence; TA as per entitlement is
permitted if no treatment facilities are available in city of residence.
OPD treatment in private recognized hospitals is not permitted
except in case of Satellite Towns of Delhi , viz., Noida, Gurgaon,
Faridabad and Ghaziabad , wherein the CMO I/c can directly refer the
beneficiaries to recognized hospitals and in post-operative follow-up
cases of Cardiac surgery, Cancer treatment, Kidney transplantation,
Hip/Knee Joint Replacement , Neurosurgery and Accident cases.
OPD medicines are to be collected through concerned Wellness
Centre except in case of emergency, in which case reimbursement shall
be considered by HOD of department / Joint Director/Addl Director of
CGHS in case of pensioners , etc.,
In permitted post-operative cases, for conditions as stated above, the
beneficiaries may purchase from chemist and claim reimbursement.
However, a utilization certificate from the treating doctor is required to
be submitted.
PROCEDURE FOR TAKING TREATMENT IN EMERGENCY
In emergency cases involving accidents, serious nature of disease etc.,
the person / persons on the spot may use their discretion for taking the
patient for treatment in a private hospital/clinic/nursing home in case no
government or recognized hospital is available nearer than the private
hospital. Question has been raised about the need for transferring the
patient to Government/ Recognized Hospital after the emergency is over
for obtaining further treatment. It is clarified that the patient while he is
in a private hospital should act according to the advice of the hospital
authorities. He should get discharged form the hospital only when the
hospital authorities discharge him. After discharge, the beneficiary may
submit his medical reimbursement claim. Powers in this regard have
been delegated to the Head of CGHS organization in various CGHS
covered cities in respect of both serving beneficiaries as well as
pensioners for deciding which cases fall under the emergency category.
Since it is not possible to obtain prior permission in emergency, treatment
taken by CGHS beneficiaries in emergency will be considered on merits
even if the treatment is taken from a non-recognized private hospital. For
granting ex-post-facto approval in emergency cases both for serving/
pensioner beneficiaries, the power is delegated to the Head of the
concerned CGHS covered city where the beneficiary is registered.
REIMBURSEMENT
Unlike cases of treatment in Govt/Private Hospitals with the prior
approval of the competent authority where the claim for reimbursement
is required to be submitted within three months (in the prescribed
application form medical, see annex 6A) & supported by Essentiality
Certificate etc. In case of treatment taken in emergency the claims are
required to be submitted within one month of the date of discharge from
the hospital/clinic etc.
CREDIT FACILITIES IN PRIVTE RECOGNIZED HOSPITALS
FOR EMERGENCY TREATMENT
In accordance with the orders of the Ministry of Health & FW vide their
O.M. No, Rec -24/ 2001/JD (M)/CGHS/Delhi/CGHS (P) dt. 7-9-2001,
in case of emergency, the recognized Private hospital shall not refuse
admission or demand advance from the beneficiary & shall provide
Credit Facility to the concerned patient on the production of valid
CGHS Card. The recognized CGHS Hospital /Diagnostic Centre shall
submit the bill for re-imbursement subject to the ceiling of approved rate
to the respective Department / Addl Director, CGHS, where the
payment is made by CGHS Directorate.
In case of reimbursement when the treatment was obtained in a
private non-empanelled hospital under emergency
Vide OM No; 4-l8/2005-C&PfVol.I-Pt. (I) dated 20.02. 2009 Ministry
of H &FW it has been decided:
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(1) To do away with the procedure for verification of bills and issue of
Essentiality Certificate by the treating doctor, and the Medical
Superintendent of the hospital, Ministries / authorities concerned may
verify and check the authenticity of the claims on the basis of the
prescription slip and the diagnostic report submitted by the Government
servant / pensioner. In the event of any doubt, the concerned Ministry /
Authority can always get verification done from the Hospital concerned.
Modified reimbursement claim form, along with checklist is annexed
(see annexure 6A).
(2) All cases involving requests for relaxation of rules for reimbursement
of full expenditure will henceforth be referred to a Technical Standing
Committee, to be chaired by the DGHS / Addl. DGHS and consist of
Director (CGHS) and subject matter specialists. If the Technical
Standing Committee recommends the relaxation of rules for permitting
full reimbursement of expenditure incurred by the beneficiary, the full
reimbursement may be allowed by the Secretary (Health & Family
Welfare) in consultation with IFD. A check list for consideration of
requests for reimbursements in excess of approved rates may include:
(a) The treatment was obtained in a private non-empanelled hospital
under emergency and the patient was admitted by others when
the beneficiary was unconscious or severely incapacitated and
was hospitalized for a prolonged period;
(b) The treatment was obtained in a private non-empanelled hospital under
emergency and was admitted for prolonged period for treatment of
Head Injury, Coma, Septicemia, Multi-organ failure, etc.;
(c) The treatment was obtained in a private non-empanelled hospital
under emergency for treatment of advanced malignancy;
(d) The treatment was taken under emergency in higher type of
accommodation as rooms as per his / her entitlement are not
available during that period;
(e) The treatment was taken in higher type of accommodation
under specific conditions for isolation of patients to avoid
contacting infections;
(f) The treatment was obtained in a private non-empanelled hospital
under emergency when there is a strike in Government hospitals;
(g) The treatment was obtained in a private non-empanelled hospital
under emergency, while on official tour to non-CGHS covered
area;
(h) Approval for air-fare with or without attendant on the advice of
treating doctor for treatment in another city even though he is not
eligible for air travel / treatment facilities are available in city of
residence and
(i) Any other special circumstances.
REIMBURSEMENT OF COST OF MEDICINES PURCHASED
DIRECTLY FROM AUTHORIZED CHEMIST DURING
EMERGENCY
The medicines prescribed by Specialists and non-formulary
medicines can not be procured by the CGHS beneficiary direct
from any local chemist. The concerned medicines would be
procured by the CGHS dispensary (Wellness Centre) from its
approved chemist and supplied to the beneficiary. However,
powers have been delegated to the Heads of the Ministries / Departments
and the Additional / Joint / Deputy Directors of the CGHS covered cities
to reimburse the expenditure incurred by the CGHS beneficiaries on
purchase of medicines directly from authorized / registered chemist
shops during emergency. What constitutes emergency has been left
to the judgement of the Administrative Ministry/ Departments
and the Additional / Joint / Deputy Director of the CGHS covered
cities who will consider and decide the quantum of reimbursement
for medicines and service provided / procured in such situations,
provided hospitalization is not involved and for which separate
provision exists.
The CGHS beneficiaries and their family members are supplied
medicines prescribed by the Doctors in the CGHS WC free of
cost. In case of the beneficiaries taking treatment in the hospital
(Govt/Referral/Private Recognized) as out-door patient,
medicines prescribed by the specialists of these hospitals in the
OPD are supplied by their respective dispensaries. However,
the expenditure incurred during hospitalization as in-door patient
is re-imbursable. The concerned government servant is required
to submit his claim in the prescribed proforma to his department
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within three months of the date of discharge from the hospital
(within one month from the date of discharge in case of treatment
taken in emergency).
REIMBURSEMENT FROM TWO SOURCES:
Beneficiaries who have subscribed to Medical insurance
policies in addition to availing CGHS facilities/ C S. (MA) Rules
1944 may be allowed to claim reimbursement from both the
sources subject to the condition that the reimbursement from
such sources should not exceed the total expenditure incurred
by the beneficiary on the treatment. The beneficiary will make
first claim to the insurance company, and second claim to CGHS
or Ministry/ department concerned. The insurance company will
issue certificate indicating the amount reimbursed.
(OM No. S. 11011/4/2003-CGHS (P) dated 19-02-2009)
Individual plastic card mandatory: W.e.f 31 03.2010 individual
plastic cards in lieu of existing paper board cards are mandatory
for CGHS beneficiaries in Delhi. New individual plastic cards in
other cities shall also be issued by CGHS bearing unique
beneficiary identification. No (Ben I D No) for each beneficiary
{OM No Misc. 6024/2007 CGHS (HQ) / CGHS (P) dated
30-12-2009}
DOCUMENTS REQUIRED FOR SUBMISSION OF MEDICAL
BILLS
1. Individuals representation
2. Medical Reimbursement Form duly filled
3. Cash vouchers countersigned and stamped by the Medical
Officer
4. Prescription
5. Xerox copy of the CGHS Identity Card
6. Distance from residence to the Private Hospital and to the
nearest Govt. Hospital (in case of treatment taken in
emergency)
7. Medical History Sheet/Discharge summary
ANNEXURE - 6A
Central Government Health Scheme
Modified Check List For Reimbursement Of Medical Claims
of Claims of CGHS Beneficiaries
1. CGHS Token /plastic card No. and place of issue:
(Or Ben I D of Employee/Pensioner)
2. Validity of CGHS Card /Plastic card (For pensioners):
fromtoEntitlement: Pvt / Semi Pvt /General Ward
3. Full name of Card Holder (Block Letters):
4. Status (Govt Servant/Pensioner/Other):
5. The following documents are submitted:
{Please tick () the relevant column}
(a) Medical 2004 Form : Yes/No
(b) Photocopy of CGHS card: Yes/No
(c) No. of Original Bills:
(d) Copy of discharge summary: Yes/No
(e) Copy of referral Specialist/CMO: Yes/No
(f) Whether the hospital has given breakup: Yes/No
For lab investigations
(g) Original papers have been lost;
the following documents are submitted
I. Photocopies of claim papers: Yes/No
II. Affidavit on Stamp Paper: Yes/No
(h) Incase of death of card holder the following documents are
submitted
I. Affidavit on Stamp paper by Claimant: Yes/No
II. No objection from other legal
Heirs on Stamp papers: Yes/No
III. Copy of death certificate: Yes/No
99 98
Dated: Signature of CGHS card holder
Tel. No. (O) (R)
E-mail Address
Name of the Bank . Branch..SB A/C No.
Branch MICR Code ..... Tel. No. of Bank Branch..
Central Government Health Scheme Medical 2004 Form
for Reimburement of Medical Claims of CGHS Beneficiaries
Computer No
(To be filled by the claimant)
1. CGHS Token/Plastic card No. and Place of issue:
(Or Ben I D of Employee/Pensioner)
2. Validity of C GHS Token Card/Plastic card: from.to.
& entitlement: Pvt. / Semi Pvt. /General Ward
3. Full name of the card holder (Block Letters):
4. Full address:
5. Telephone no. (O) (R) ..
6. E-mail address if, any.
7. Name of the Bank . BranchSB A/C
Branch MICR Code .... Tel. No. of Bank Branch...
8. Name of the patient & relationship with the card holder:
9. Status tick () (Govt Servant/Pensioner/Serving employee or pensioner
of Autonomous body/Member of Parliament/Ex-M.P./Ex-
Governor/Former Judge of Supreme Court/Former Judge of High
Court/Freedom Fighter/Legal Heir/others)
10. Basic Pay/Basic Pension
11. Name of the Hospital with Address:
(a) OPD treatment and investigations
(b) Indoor Treatment
12. Date of admission.Date of discharge.(In case of
Indoor Treatment only)
13. Total amount Claimed:
(a) OPD Treatment
(b) Indoor Treatment
14. Details of Referral:
15. Details of Medical advance if, any:
Declaration
I hereby declare that the statements made in the application are true to
the best of my knowledge and belief and the person for whom medical
expenses were incurred is wholly dependant on me. I am a CGHS
beneficiary and the CGHS card was valid at the time of treatment.
I agree for the reimbursement as is admissible under the rules.
Dated: Signature of CGHS card holder
Note: Misuse of CGHS facilities is a criminal offence. Suitable action
including cancellation of CGHS card shall be taken in case of wilful
suppression of facts or submission of false statements. Suitable disciplinary
action shall be taken in case of serving employees.
Information
(a) Kindly write correct postal address in block letters.
(b) Obtain Break-up of Investigations from the Hospital (details and
rates of individual tests and the exact number of Sugar tests, X-ray
films, etc.) as the Reimbursable amount is calculated as per
approved rates only.
(c) Affidavit Draft against column (I) of check list in case of loss of
Original Papers:
Draft for Affidavit for Duplicate
Claim Papers / Bills on Stamp Paper
I, .............son/wife/daughter of ............
and resident of Lost / misplaced / not traceable. I hereby give an
undertaking that I have not received any payment against original bills /
claim papers from any source and that if the original papers are traced
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I shall not stake claim against original bills in future and that in the event
I receive any cheque against original bills in future I shall return the same
to competent authority.
Deponent
Verified by Notary Public
(d) Draft against column (I) of check list-in case of Death of Card holder
Draft for Affidavit on Stamp Paper for claiming medical
reimbursement
I, wife/son/daughter of Late..and
resident of hereby submit the medical claim papers pertaining to
treatment of my father/mother/Late Shri/Smt..who has expired
on(copy of Death Certificate is enclosed).
Late Shri/Smt..has left behind the following other legal heirs none
of whom have any objection if the entire amount reimbursable is paid to
me.
.
.
No Objection Certificate signed by other legal heirs on Stamp paper is
enclosed herewith.
Deponent
Deponent
Attested by Notary Public
Draft for No Objection Certificate on Stamp Paper
We s/o d/o Late Shri ..
s/o d/o Late Shri ...
being the legal heirs of Late Shrihave no objection
if the entire amount reimbursable pertaining to the treatment of our father
is paid to our brother Shri...
Address
Deponents
Verified by Notary Public
APPLICATION FOR ADMISSION TO CGHS (PENSIONERS)
To
The Additional Director,
Central Govt. Health Scheme
Dear Sir,
I along with the members of the family whose particulars are given at Sl.
No. 5 may please be admitted to CGHS on payment of subscription on
the basis of LAST PAY DRAWN / PENSION / FAMILY PENSION*.
My particulars are as under:
1. Name of the Head of family :
2. Residential Address :
3 In case the applicant is a Pensioner,
(a) Date of retirement:
(b) Ministry / Deptt / Office:
(c) Gross pension, if fixed:
(d) PPO No.....................
4. In case the applicant is a family pensioner:
(a) Name of the deceased Govt Servant:
(b) Date of Death of the deceased Govt Servant:
(c) Ministry / Deptt / Office:
(d) Post held at the time of retirement:
(e) Pay last drawn at the time of retirement:
(f) Relation of the applicant with the deceased Govt Servant:
(g) Amount of family pension: at the enhanced rate
(Please also specify the date upto which enhanced family pension is
admissible) :
(h) F.P.P.O No. .....................................
5. Details of family according to the term family
SI. No. Name Age Date of Birth Relationship
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I declare that:
(i) I will abide by the rules and regulations and modifications of the
services which may be issued from time to time.
(ii) I will deposit my contribution on six monthly / yearly instalments.
(iii) I wish to avail of CGHS facilities on the basis of last pay drawn /
Pension.
(iv) I have not applied for CGHS Card previously / I have surrendered
my CGHS identity Card issued to me from my Office while in service
and the payment of contribution has been made upto the date of
surrender of Card.
(v) 1 hereby undertake to surrender the CGHS Card being issued to me
if not required, in the Dispensary (Wellness Centre) concerned. In
case the Card is not surrendered before the expiry of validity period
and Card is retained by me, even if no facility is availed by me, I
undertake to pay the CGHS contribution for the intervening period.
* Strike off whatever is not applicable
Place : Date :
Signature of Applicant
AFFIDAVIT
(To be attested by a Notary Public or Gazetted Officer)
I............................................. solemnly affirm that I am, and my
dependants
Whose names are given below, are residing in...........................(place)
and my address
is.....................................................................................
Sl. Name of the Govt. servant Age Date of Birth Relationship
No. and also dependants
Place :
Date : Signature of Applicant/Deponent
Attested by
Signature with name and Office Seal
ANNEXURE - 6 B
CGHS Plastic card
F.No. M-l/2004-C&P/Pt-XII
Government of India, Ministry of Health & Family Welfare,
Department of Health & Family Welfare CGHS (P) Division
Nirman Bhavvan, Maulana Azad Road,
New Delhi-110011.
Dated 15th May 2009
OFFICE MEMORANDUM
Sub: Clarifications regarding Plastic Cards for Individual CGHS
beneficiaries -
With reference to the above mentioned matter the undersigned is
directed to state that individual Plastic Cards are being issued to all
CGHS beneficiaries in Delhi and NCRT in place of Family Cards. In this
regard this office has been receiving several queries seeking clarifications
and, therefore , this Ministry has decided to issue an Office Memorandum
clarifying the issues,
It is clarified that:
(1) Data of CGHS beneficiaries is available on Data base of Servers
located at NIC Headquarters.
(2) The individual Plastic Cards are only Identity cards bearing a
unique number for each beneficiary. It is only an identity card for
accessing the Data on Computer Data Base. Address of beneficiary,
validity for CGHS facilities, Name of wellness Centre are available
in Data base.
(3) The Plastic Cards arc issued for a maximum period of Five years
or till entitled for CGHS benefits whichever may be earlier. In case
of CGHS pensioners who have paid for Rest of Life facilities a
new plastic Cards shall be issued after Five years without any
additional contribution. Similarly, new Plastic Cards shall be issued
to serving employees after Five Years.
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(4) The Plastic Cards bear a colour strip on the top side of Card. The
Colour of Strip is Blue in case of serving employees, Green in case
of Pensioner beneficiaries. Freedom Fighters etc... Yellow in case
of Autonomous Bodies and others and Red in case of Members
of Parliament.
(5) As of now computerization is under process in cities other than
Delhi. After computerization of all CGHS covered Cities, the
plastic Cards will be valid all over India and there is no need for
obtaining temporary attachment while on a visit to another CGHS
City.
(6) In case of Pensioners applying for CGHS Cards applying for the
first time in Delhi, an acknowledgment slip is issued immediately
on submission of complete Set of Documents and prescribed
subscription fee. The print-out Slip is valid for availing CGHS
facilities till Plastic Cards are issued. Individual Plastic Cards are
issued within *7* Days after receiving the same from agency
appointed for preparation of Plastic Cards. The acknowledgment
slips are valid for availing treatment from empanelled hospitals
with permission / under emergency.
(7) Beneficiaries / Empanelled Hospitals / Diagnostic Centres can
verify the Data at http://cghs.nic.in/welcome.jsp
(8) Permissions for treatment shall be granted on the basis of
Ben ID (Beneficiary Identity Number) printed on Plastic
Cards, While granting permission Data like the name of
Serving employee / Pensioner and the relationship of
individual family member etc. can be verified at http://
cghs.nic.in/welcome.jsp. Similarly, hospitals / Diagnostic
Centres can verify Data at http://cghs.nic.in/welcomc.jsp ,
in case a beneficiary is admitted under emergency.
(9) At the lime of submission of Medical Claim the Ben ID
number of Serving employee or Pensioner shall be entered
on Modified Medical 2004 form as he / she shall be the
claimant. Copy of Plastic Card of Patient shall be enclosed
along with Medical Reimbursement Claim.
(10) In case of loss of Plastic Card, Serving employee / Pensioner
shall apply at CGHS (HQ) for Duplicate Plastic Card along
with IPO for Rs 50 / a copy of FIR lodged with Police, a copy
of old Card. A print-out slip shall be issued immediately
for availing CGHS - facilities and Plastic Card after 7" Days.
In case of serving employees the application shall be
forwarded by his / her department.
(11) In case of change in residential address and shifting from
one dispensary (WC) to another, CMC I/C of dispensary
shall make modifications in Data base and transfer the cards
to new dispensary. CMC I/c of new dispensary shall accept
transfer of Card and Data shall be transferred to new
dispensary.
(12) In case of superannuation / transfer lo another city, serving
employees get the card deleted from Data base at Dispensary
and obtain a certificate from CMC I/C and surrender the
card to his / her department. Department shall issue a
surrender certificate to employee for getting a new Card at
another city (if covered under CGHS) or for obtaining a
pensioner CGHS card in case of superannuation.
(13) It is compulsory to bring original Plastic Cards every time
for availing CGHS benefits.
(14) All beneficiaries entitled for semi-private ward in empanelled
private hospitals are eligible for Nursing Home facilities in
Govt Hospitals and (those entitled for Private-ward are
eligible for Direct Consultation with specialists in Govt
Hospitals. Similarly, beneficiaries entitled for Private ward
in empanelled private hospitals are also eligible for Private
ward facilities at A.1.1.M.S., Now Delhi. No separate
endorsement is required for these criteria.
JAI PRAKASH
UNDER SECRETARY TO GOVERNMENT OF INDIA
(Tel. 2306 1881)
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CGHS Card No while in service
Application For New CGHS Card For Penseners of
Central Government
1. Name of the Applicant
2. Category : Pensioner, Pensioners of autonomous Body, Others
Pl. specify)
3. Name of Department / Service from where retired
4. Last Pay with Grade Pay............................ Basic Pension:
(in case of Pensioners)
5. Residential Address:
6. Telephone (R) (M)
7. e-mail ID
8. Date of Superannuation: Date / Month / Year
9. Details of family
(Please see definition of family before filling up columns)
S. Name of family Relationship with Date of Birth Blood Group
No member CGHS card holder
(Compulsory) (Optional)
(Attach proof of age)
10. Are all the persons, whose names are given above, are dependent
upon you and are residing with you? Yes / No
{Please attach proof of their staying with you, like copy of Ration Card
/ Election ID / Pass Port / Identity Card issued by College / School /
University / Bank Pass Book, etc.}
11. Paste one stamp sized photograph of each member of Family
(including self) whose names are proposed to be included as part of your
family in the space given below.
S.No S.No.. S.No. S.No
Name Name. Name. Name.
S.No S.No.. S.No. S.No
Name Name. Name. Name.
I undertake to intimate to CGHS immediately if there is any change in
dependency criteria of my family members included in this application
form. If I fail to intimate and if the CGHS comes to know of the change,
then the CGHS facility is liable to be withdrawn by the CGHS and / or
appropriate authority will be free to initiate any action against me.
I undertake to surrender the CGHS Card(s) on ceasing to be eligible for
CGHS benefits.
I certify that the information furnished by me in this application has been
verified to be correct and that no information has been concealed or has
been misrepresented and I stand by the same.
Encl. Proof of Residence / Stay of dependents. Proof of age of son /
dependant brother
Attested copy of Disability Certificate issued by competent authority (in
case of dependent Son aged 25yrs and above)
Surrender Certificate of CGHS card while in Service
Attested copies of PPO & Last 8 Pay Certificate
DD bearing No..................................dated
............................drawn on........................ Bank.......................,
Branch.................................................... For Rs........................
No.
Date
Signature & Name of the Applicant
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(To be filled by CGHS)
Verified - {by Authorized Signatory, CGHS (Hqrs)}
valid upto.................../for rest of life
CGHS Wellness Center (a.k.a. Dispensary) Allotted
Entitlement: General ward/ Semi-private ward/Private ward
Signature with Stamp
(TO BE FILLED BY THE SPONSORING AUTHORITY IN
CASE OF PENSIONERS OF AUTONOMOUS BODY)
The information furnished by the applicant has been verified and found
to be correct. It is recommend that a CGHS Card be issued to Shri / Smt
/ Kumari .................,,...............................................Designation
.................................. I am authorized sponsoring authority for the
issue of CGHS Card and approval of the competent authority has been
obtained.
Enclosed DD bearing No..................................dated
............................drawn on ........................ Bank.......................,
Branch
.................................................... For Rs........................
No.
Date
Signature & Name of the Sponsoring Authority
Designation (Stamp) with Tel. Number
To The Additional Director, CGHS (Hqrs), 9, Bikaner House Hutments,
Shahjahan Road, New Delhi
(To be filled by CGHS)
Verified by Authorized Signatory, CGHS (Hqrs) valid upto.................../
for rest of life
CGHS Wellness Center (a.k.a. Dispensary) Allotted
Entitlement: General ward/ Semi-private ward/Private ward
Signature with Stamp
INSTRUCTIONS
Definition of Family:
(1) Husband / Wife* (* First wife only)
(2) Dependent Parents / Step Mother (in case of adoption, only adoptive
& not Real parents)
(3) If adoptive father has more than one wife, the first wife only
(4) A female employee has a choice to include either her dependent
parents or her dependent parents - in - law; option exercise can be
changed only once during service.
(5) Children including legally adopted children, step children and children
taken as wards subject to the following conditions:
(i) Unmarried son Till he starts earning or attains the
age of 25 years whichever is earlier
(ii) Daughter Till she starts earning or gets
married irrespective of the age limit
which ever is earlier
(iii) Son suffering from permanent Irrespective of age limit
disability of any kind (physical
or mental) as defined above
(iv) Dependent divorced / abandoned Irrespective of age limit
or separated from their husband
widowed daughters and dependent
unmarried / divorced / abandoned or
separated from their husband /
widowed sisters
(v) Dependent Minor brothers Upto the age of becoming major
For the purpose of availing CGHS facility for disabled sons above 25
years, please attach a copy of the certificate of disability issued by the
competent authority.
'Disability' will be AS DEFINED IN SECTION 2(1) OF THE PERSONS
WITH DISABILITIES (EQUAL OPPORTUNITIES, PROTECTION
OF RIGHTS AND FULL PARTICIPATION) ACT, 1995 (NO: 1 OF
1996)' WHICH IS REPRODUCED BELOW:
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(1) 'DISABILITY' MEANS
(I) BLINDNESS
(II) LOW VISION
(III) LEPROCY CURED
(IV) HEARING IMPAIRMENT
(V) LOCOMOTOTR DISABILITY
(VI) MENTAL RETARDATION
(VII) MENTAL ILLNESS
DEPENDENCY:
Members of family (other than spouse) whose income is less than
Rs.3500/+DR- per month are treated as dependents and are normally
residing with CGHS beneficiary.
The following Documents are to be enclosed by pensioners applying for
issue of new pensioners CGHS Card:
(I) Proof of Residence / Stay of dependents -{ copy of Ration
Card / Election ID / Pass Port / Identity Card issued by College
/ School / University / Bank Pass Book, etc.}
(II) Proof of age of son and dependant brother
(III) Attested Copy of Disability certificate issued by Competent
Authority (in case of dependent son aged 25 and above)
For Pensioners applying for CGHS card for the first time the following
additional documents are required:
(IV) Surrender Certificate of CGHS Card while in service
(V) Attested copies of PPO /Last Pay Certificate
Contribution by Pensioners should be made by Bank Draft (Scheduled
Banks) payable in Delhi in favour of Pay & Accounts Officer CGHS,
New Delhi.
ANNEXURE - 6C
WHITHER CGHS ?
THE ALTERNATE DRAFT
PROPOSAL FOR CGE&P
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.
Esteemed Members, please do'nt forget
TO FILL UP THE M O & REMIT RS 100
identified procedures. OPD services shall not be part of Day Care
facilities.
1. Eye Surgery
2. Lithotripsy (kidney stone removal)
3. Tonsillectomy
4. D&C
5. Dental surgery following an accident
6. Surgery of Hydrocele
7. Surgery of Prostrate
8. Few Gastrointestinal Surgery
9. Genital Surgery
10. Surgery of Nose/Throat / Ear
11. Surgery of Urinary System
12. Dialysis
13. Chemotherapy
14. Radiotherapy
15. Treatment related to dog bite/snake bite etc.
16. Treatment of fractures/dislocation, Contracture releases and minor
reconstructive procedures of limbs which otherwise require hospitalization
17. Laparoscopic therapeutic surgeries that can be done in daycare
18. Identified surgeries under General Anesthesia or any procedure
mutually agreed upon between insurer and health care provider.
Note: Insurers will provide the exhaustive list of Day care procedures.
f) The expenses incurred for treatment taken in empanelled Hospitals/
Nursing Homes /Day Care Clinics by the beneficiaries suffering from
such disabilities as defined in Section 2 (i) of the person with disabilities
(equal opportunities, protection of rights and full participation) Act, 1995
(No: 1 of 1996) which includes blindness, low vision, leprosycured,
hearing impairment, locomotors disability, mental retardation, mental
illness etc. are also payable irrespective of age and income limit subject
to size limit of the family.
g) Maternity and Newborn Benefits:
A. Maternity benefit
1. This means treatment taken in Empanelled Hospital/Nursing Home
arising from childbirth including Normal Delivery/Caesarean Section
including miscarriage or abortion induced by accident or other medical
emergency.
2. This benefit would be limited to only first two living children in respect
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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.
NOTE: In case of organ transplant, the expenses incurred for the Donor
are also payable under the scheme.
b) Coverage of Pre-existing diseases: All diseases under the Scheme
shall be covered from day one. A person suffering from any disease prior
to the inception of the policy shall also be covered.
c) Pre & Post hospitalization benefit: Benefit up to 30 days Pre
Hospitalization & up to 60 days Post Hospitalization respectively which
would cover all expenses related to treatment of the sickness for which
hospitalization was done.
d) Domiciliary Hospitalization: The Scheme would also cover Domiciliary
Hospitalization where the medical treatment for such illness/disease /
injury requires as in-patient treatment at empanelled Hospitals/Nursing
Homes but actually taken whilst confined at home in India under the
circumstances that ? His/her condition is such that patient cannot be
moved to a hospital or, If no room is available in empanelled Hospitals/
Nursing home within that area.
Note: Pre and Post hospitalization benefit under this section would not
be covered.
e) Day Care Procedures: Given the advances made in the treatment
techniques, many medical treatments, formerly requiring hospitalization,
can now be treated on a day care basis. The scheme would also provide
for day care facilities (less than 24 hours hospitalization) for such
of Dependent Spouse/Female Employee covered from day one under
the policy, without any waiting period.
B. Newborn benefit
1. Newborn child (single/twins) to an insured mother would be covered
from day one up to the expiry of the current policy for the expenses
incurred for treatment taken in empanelled Hospitals/Nursing Homes/
Day Care Clinics as In-patient during the currency of the policy and will
be treated as part of the mother subject to eligibility under maternity
benefit. However, next year the child could be covered as a regular
member of the family subject to size of the family.
2. In first pregnancy, twins are born then the benefit will ceases for
second pregnancy. However, in second pregnancy twins are born then
both will be covered till the expiry of the current policy.
3. Congenital diseases of new born child shall be covered.
5. FAMILY SIZE:
1. Serving/Retired Employees: Self, Spouse, Two dependent children
and up to Two Dependent Parents. New born shall be considered insured
from day one till the expiry of the current policy irrespective of the
number of members covered subject to eligibility under maternity
benefit.
Note:
i. For the policy period, new born would be provided all benefits under
CGEPHIS and will NOT be counted as a separate member. The
child will be treated as part of the mother.
ii. Verification for the new born could be done by any of the existing
family members who are getting the CGEPHIS benefits.
iii. Member is required to enroll new born child at the time of renewal
of the policy prior to expiry of the policy.
2. Any additional dependent member in addition to above [Sr. No. 5 (1)]
can be covered under the Scheme by paying the fixed amount of
premium. This additional full premium shall be borne by the beneficiary.
3. All Members (Serving/Retired Employees) shall be insured till they are
the member of the scheme unless withdrawn from the Scheme.
A. Age limit of dependent for the purposes of CGHS and CS (MA) Rules
1944 includes:-
1. Son - Till he starts earning or attains the age of 25 years, whichever
is earlier;
2. Daughters - Till she starts earning or gets married, irrespective of age
limit whichever is earlier. Further, Dependent divorced/abandoned or
separated from their husband and widowed daughters irrespective of
age limit.
3. Sisters - Dependent unmarried /widowed / divorced/ abandoned /
separated from their husband - irrespective of age limit.
4. Daughter in law - Widowed - irrespective of age limit.
5. Brothers - Up to the age of becoming a major.
6. Dependent Parents - As per condition of eligibility.
B. Income limit for dependency of family members If monthly income
from all sources of income is less than Rs. 3,500/- per month plus
dearness allowance of the family member, then the following would be
entitled to be treated as dependant on the employee:
1. Parents
2. Sisters
3. Widowed Sisters / Widow Daughter - in-law.
4. Widowed / Divorced / Separated Daughters,
5. Brothers
6. Step mother
7. Children.
NOTE: The definition of dependent shall be as per guidelines issued by
Central Government from time to time.
C. Addition & Deletion of Family Members during currency of the policy:
i) Addition to the family is allowed in following contingencies during the
policy:
a) Marriage of the CGEPHIS beneficiary (requiring inclusion of spouses
name), or
b) Parents becoming dependants.
ii) Deletion from Family is allowed in following contingencies:
a) Death of covered beneficiary,
b) Divorce of the spouse,
c) Member becoming ineligible (on condition of dependency)
D. New Employees/Retirees
a) As regards the new incumbents / pensioners the coverage in the
insurance scheme is compulsory. The data of such employees / pensioners
will be collected from the various departments.
b) The Pay and Account Offices of all the Ministries/Departments would
provide the data to the insurer. Each of the New Employee/Pensioners
of the Ministry/Department would be provided with the enrolment form
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which needs to be filled in and submitted to the respective Ministry which
will consolidate all the forms and forward the same to the Nodal Officer/
Ministry on monthly basis.
c) The said employees would have to be covered in the Insurance
Scheme from the date of joining/retirement. Thus for them the inclusion
in the policy will be made by charging the pre defined monthly Prorata
premium rate which would be less than the yearly premium rate.
6. IDENTIFICATION OF 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. This card would be
used across the country to access Health Insurance Benefits. The
photograph embedded in the chip of the Smart Card will be taken as the
proof for determining the eligibility of the beneficiaries.
7. SUM INSURED AND BUFFER / CORPORATE SUM
INSURED A. SUM INSURED:
The Scheme shall provide coverage for meeting all expenses relating to
hospitalization of beneficiary members up to Rs. 5, 00,000/- per family
per year in any of the Empanelled Hospital/Nursing Home/Day Care
Unit 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 lakh can be availed
by one individual or collectively by all members of the family.
B. BUFFER / CORPORATE SUM INSURED:
An additional Sum Insured of Rs.25 Crore shall be provided by the
Insurer as Buffer/Corporate Floater in case hospitalization expenses of
a family (per illness or annual) exceed the original sum insured of Rs 5.00
lakhs. Insurer is required to inform the Nodal Agency with the details on
case to case basis.
8. PAYMENT OF PREMIUM:
As the policy would be renewed every year, there is an element of
uncertainty in the level of premiums depending upon the actual number
of enrolment and claims submitted and the inflow into the fund. To ensure
a certain degree of stability in premiums at least for a period of 3 to 5
years, Insurers will quote the premium for various ranges.
I. These numbers will consist of both serving and retired employees.
II. 1, 00,000 persons shall be taken as assured beneficiaries for the first
year to calculate the estimated premium to be paid to the insurer.
III. If the number of beneficiaries exceeds the first slab, in such case the
premium shall be adjusted retrospectively according to eligible stage in
which beneficiaries number will fall.
IV. Deleted
NOTE: (a) This includes the Management cost, intermediary cost and
burning cost (claims paid and outstanding) etc. If claim ratio is less, the
premium can be taken care by refund clause mentioned at Sr. No.9.
(b) This premium will be paid to the Insurers for the beneficiaries to be
enrolled during the policy period in case of new joinees / retirees and
exiting employees/pensioners. This premium will also take care of the
members inadvertence missed for any reasons.
(c) to (g) Deleted
9. REFUND OF PREMIUM/ADJUSTMENT OF PREMIUM:
If there is a surplus after the pure claims experience on the premium
(excluding Service Tax) at the end of the policy period, after providing
20% of the premium paid towards the Companys administrative cost, in
the balance 80% after providing for claims payment and outstanding
claims, 90% of the left over surplus will be refunded by the insure to the
Central Government/Nodal agency within 30 days after the expiry of the
policy period or shall be adjusted with renewal premium.
10. ELIGIBLE HEALTH SERVICES PROVIDERS:
Both Public and Private Health Providers which provide hospitalization
and / or a Day Care Services would be eligible for inclusion under the
CGEPHIS, subject to such requirements for empanelment as agreed
between the Central Government and Insurers.CGEPHIS aspires to
provide to all its beneficiaries high quality medical care services that are
affordable. With this objective, it has prescribed National Accreditation
Board for Hospitals & Healthcare Providers (NABH).
Accreditation as minimum eligibility criteria for empanelment of both
Public and Private hospitals.The Hospitals/Nursing Homes/Day Care
Clinics interested to join the CGEPHIS should be accredited with NABH
/JCI (Joint Commission International)/ACHS (Australia) or by any other
accreditation body approved by International Society for Quality in
Health Care (ISQua) as minimum eligibility criteria for empanelment of
hospitals. In addition such Hospitals/Nursing Homes/Day Care Clinics
should have the following facilities:
i) General purpose hospital having 100 or more beds with the following
specialties :General Medicine, General Surgery, Obstetrics and
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Gynecology,Paediatrics, Orthopedics (excluding Joint Replacement),
ICU and Critical Care units ,ENT and Ophthalmology, (Dental specialty
-desirable), Imaging facilities , in house laboratory facilities and Blood
Bank.ii) Specialty hospitals (specialties list given below) Hospitals
having less than 100 beds can apply as a specialty hospital -provided they
have at least 25 beds earmarked for each specialty applied for with at
least 15 additional beds Thus under this category a single specialty
hospital would have at least 40 beds. However, under this category a
maximum of three specialties is allowed.
- Cardiology , Cardiovascular and Cardiothoracic surgery
- Urology - including Dialysis and Lithotripsy
- Orthopedic- Surgery - including arthroscopic surgery and Joint
Replacement
- Endoscopic surgery
- Neurosurgery
iii) Super-specialty Hospitals- with 150 or more beds with treatment
facilities in at least three of following Super Specialties in addition to
Cardiology& Cardio-thoracic Surgery and Specialized Orthopaedic
Treatment facilities that include Joint Replacement surgery:
Nephrology & Urology incl. Renal Transplantation
Endocrinology
Neurosurgery
Gastro-enterology & GI Surgery incl. Liver Transplantation
Oncology ( Surgery, Chemotherapy & Radiotherapy)
These hospitals shall provide treatment /services in all disciplines
available in the hospital.
iv) Cancer hospitals having minimum of 50 beds and all treatment
facilities for cancer including radio-therapy (approved by BARC /
AERB).
NOTE - A:
a) Such Hospitals/Nursing Homes/Day Care Clinics that obtained entry
level pre accreditation certificate from NABH would also be eligible for
empanelment under CGEPHIS.
b) The Hospitals/Nursing Homes/Day Care Clinics which are already
empanelled under CGHS, if desire to be get empanelled under CHEPHIS
and are not accredited by NABH/JCI/ACHS/ ISQua are required to
apply for NABH accreditation within two months from the date of
empanelment under the Scheme as per criteria mentioned below at A
(Criteria for Empanelment of Private Hospitals/Nursing Homes/Day
Care Clinics in addition to the NABH /JCI / ACHS / ISQua/ NABL
criteria). A certificate confirming to apply with NABH within the
stipulated period should be given by the hospital while getting empanelled
under CGEPHIS.
c) Any Hospitals/Nursing Homes/Day Care Clinics not applying to
NABH within stipulated period shall be automatically de-paneled from
the Scheme.
d) In addition, the empanelled Hospitals/Nursing Homes/Day Care
Clinics having in-house diagnostic Laboratories or using the linked
diagnostic laboratories shall also apply for National Accreditation Board
for Testing & Calibration Laboratories (NABL) certification of the
Laboratory as per condition.
Note - B:
1) Hospitals/Nursing Homes/Day Care Clinics that have already applied
for / accredited under NABH/JCI/NABL shall inform the office of
Insurer with supportive document.
2) Those applying to NABH/JCI for accreditation to join the CGEPHIS
shall also agree to the CGHS package rates and to the clause 11-A and
11-B mentioned below. A. Criteria for Empanelment of Hospitals/
Nursing Homes / Day Care Clinics in addition to the NABH /JCI / ACHS
/ ISQua / NABL criteria.
i. Fully equipped and engaged in providing Medical and/ or Surgical
facilities. The facility should have an operational pharmacy and diagnostic
services. In case health provider does not have an operational pharmacy
and diagnostic services, they should be able to link with the same in close
vicinity so as to provide cash less service to the patient.
ii. Those Hospitals/Nursing Homes/Day Care Clinics undertaking surgical
operations should have a fully equipped Operating Theatre of their own.
iii. Fully qualified doctors and nursing staff under its employment round
the clock.
iv. Agreeing to the cost of packages for each identified procedures as
approved under the CGHS scheme.
a) These package rates shall mean and include lump sum cost of inpatient
treatment/day care/diagnostic procedures for which CGEPHIS
beneficiary is admitted from the time of admission to discharge including
(but not limited to) Registration charges, Admission charges,
Accommodation charges including Patients diet, Operation Charges,
Injection charges, dressing charges, Doctors/ Consultant visit charges,
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1. Private ward is defined as a hospital room where single patient is
accommodated and which has an attached toilet (lavatory and bath). The
room should have furnishings like wardrobe, dressing table, bed-side
table, sofa set, carpet, etc. as well as a bed for attendant. The room has
to be air-conditioned.
2. Semi Private Ward is defined as a hospital room where two to three
patients are accommodated and which has attached toilet facilities and
necessary furnishings.
3. General ward is defined as a hall that accommodates four to ten
patients.
NOTE:
a) Treatment in higher Category of accommodation than the entitled
category is not permissible.
b) The package would cover the entire cost of treatment of the patient
from date of admission to his/ her discharge from hospital and any
complication while in hospital, making the transaction truly cashless to
the patient as per CGHS package rates.
c) The applicable CGHS rates under the Scheme would be for the policy
period and shall not be amended during the currency of the policy. Rates
for such procedures which are not in the CGHS list, can only be
considered, if, finalized during the policy period.
d) Procedures will be subject to Cashless services and a preauthorization
procedure, as per Clause 11.
e) Districts may be clubbed under respective State/Zones by the Central
Government for the application of CGHS package rates.
v) Maintaining the necessary records as required and the Insurer or his
representative/Central Government/Nodal Agency will have an access
to the records of the insured patient.
vi) Allowing the Insurer or his representative / Central Government /
Nodal Agency to visit, carry out the inspection as and deemed fit.
vii) The Private Empanelled Hospitals/Nursing Homes/Day Care Clinics
be legally responsible for user authentication.
viii) Telephone, Fax, Scanner and have atleast 256 KBPS broadband
internet connectivity. Each empanelled Hospital/Nursing Home/Day
Care Clinics shall posses a Personal Computer with 2 smart card
readers. These empanelled Hospitals/Nursing Homes/Day Care Clinics
must have the capacity to submit all claims / bills in electronic format to
the Bill Clearing Agency and must also have dedicated equipment,
ICU/ICCU charges, Monitoring charges, Transfusion charges, Anesthesia
charges, Preanesthetic checkups, Operation Theater charges, Procedural
Charges/Surgeon charges, Cost of surgical disposables and sundries
used during hospitalization, Cost of Medicines and Drugs, Blood, Oxygen
etc, Related routine and essential diagnostic investigations, Physiotherapy
charges etc, Nursing care and charges for its services. The list is an
illustrative one only.
b) In order to remove the scope of any ambiguity on the point of package
rates, it is reiterated that the package rate for a particular procedure is
inclusive of all sub-procedures and all related procedures to complete the
treatment procedure. The patient shall not be asked to bear the cost of
any such procedure/item.
c) No additional charge on account of extended period of stay shall be
allowed, if, the extension is due to infection on the consequences of
surgical procedure or due to any improper procedure.
d) Cost of implants is payable in addition to package rates as per CGHS
ceiling rates for defined implants or as per actual, in case there is no
CGHS prescribed ceiling rates.
e) Cost of External Equipments required for treatment as listed in CGHS
scheme (Appendix - A) is payable in addition to package rates as per
CGHS ceiling rates for defined External Equipments or as per actual, in
case there is no CGHS prescribed ceiling rates.
f) Expenses incurred for treatment of new born baby are separately
payable in addition to delivery charges to mother.
g) Package rates envisage duration of indoor treatment as follows:
* Upto 12 days: for Specialized (super specialty) Treatment.
* Upto 7 days: for other Major surgeries.
* Upto 3 days: for Laparoscopic surgeries/ Normal delivery.
* 1 day: for Day Care/ Minor surgeries
h) Entitlements for various types of wards: CGHS beneficiaries are
entitled to facilities of private, semi-private or general ward depending
on their pay drawn in pay band/ pension. These entitlements are
amended from time to time and the latest order in this regards needs to
be followed. The entitlement is as follows:-
S.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 Ward
3. Rs. 19,540/- and above Private Ward
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software and connectivity for such electronic submission. NIC
concurrence is required.
B. Additional Benefits to be Provided by Empanelled Hospitals/Nursing
Homes /Day Care Clinics In addition to the benefits mentioned above,
both Empanelled Public and Private Hospitals/Nursing Homes/Day
Care Clinics should be in a position to provide following additional
benefits to the CGEPHIS beneficiaries:
1) Free OPD consultation including pre and post hospitalization
consultation.
2) Has to display its status of being a preferred provider of CGEPHIS
at the reception/admission desks and to keep the displays and other
materials supplied by the Insurer for the ease of beneficiaries, Central
Government and Insurer.
3) Agrees to provide a separate help desk headed by paramedical for
providing the necessary assistance round the clock to the CGEPHIS
beneficiary.
C. Delisting of hospitals: Empanelled Hospitals/Nursing Homes/Day
Care Clinics would be delisted by the Insurer from the CGEPHIS
network, if, it is found that guidelines of the Scheme are not followed by
them and services offered are not satisfactory as per laid down
standards.
11. CASHLESS ACCESS SERVICE:
The Insurer has to ensure that all CGEPHIS members are provided with
adequate facilities so that they do not have to pay any deposits at the
commencement of the treatment or at the end of treatment to the extent
as the Services are covered under the Scheme. The service provided by
the Insurer along with subject to responsibilities of the Insurer as detailed
in this clause is collectively referred to as the Cashless Access
Service. The services have to be provided by the Empanelled Hospitals/
Nursing Homes/Day Care Clinics to the beneficiary based on Photo
Smart Card authentication only without any delay. The beneficiaries
shall be provided treatment free of cost for all such ailments covered
under the Scheme within the limits/sub-limits of defined package rates
and sum insured, i.e., not specifically excluded under the scheme. A.
Pre-Authorization for Cashless Access in case of Emergency/Planned
Hospitalization for Listed /Non Listed packaged procedures: Packaged
procedures would mean the rates for various procedures approved by
the CGHS based on city and the same shall be treated for that State/
Zone. It would be the responsibility of the Insurer to have all empanelled
hospitals/nursing homes/ day care clinics agreed to the same. Once the
identity of the beneficiary and/ or his/her family member is established
by verifying the Photo Smart Card, shall be swiped Photo Smart Card for
on line verification and following procedure shall be followed for
providing the health care facility listed/not listed in packages: Request for
Authorization shall be forwarded by the Empanelled Hospitals/Nursing
Homes/Day Care Clinics after obtaining due details from the treating
doctor in the prescribed format i.e. Request for Authorization Letter
(RAL). The RAL needs to electronically send to the 24-hour Authorization
/Cashless department of the Insurer along with contact details of treating
physician, as it would ease the process. The medical team of Insurer
would get in touch with treating physician, if necessary.
a. The RAL (Request for Authorization Letter) should reach the
Authorization Department of Insurer within 6 hrs of admission in case of
emergency or within 3 days prior to the expected date of admission, in
case of planned admission.
b. In failure of the above clause a, the clarification for the delay needs
to be forwarded along with RAL by the Empanelled Hospitals/Nursing
Homes/Day Care Clinics.
c. Treatment code is required to be selected from the packaged
procedures and mentioned in RAL in case of listed procedure.
d. The RAL form should be dully filled in all cases with clearly mentioned
Yes or No. There should be no nil, or blanks, which will help in providing
the outcome at the earliest. Along with RAL copies of diagnostic test
reports should also be forwarded electronically or the case may be.
e. If, given medical data is not sufficient for the medical team of
Authorization Department to confirm the eligibility, it will be responsibility
of the Empanelled Hospitals/Nursing Homes/Day Care Clinics to
provide the complete details without any further delay, failing which it
would be treated as violation of the norms.
f. In case of non listed procedure, the Empanelled Hospitals/Nursing
Homes/Day Care Clinics and Insurer shall negotiate the cost of package
based on the type of treatment required; the agreed amount shall become
a package rate of that procedure.
g. Insurer guarantees payment only after receipt of RAL and the
necessary medical details. Only after Insurer has ascertained the rates
as per CGHS prescribed rates and or negotiated the packages (if no rates
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are fixed by CGHS), with provider, shall issue the Authorization Letter
(AL). This shall be completed within 12 hours of receiving the RAL and
response shall be sent by the insurer.h. In case the ailment is not covered,
insurer can deny the authorization.
In such case it would be the responsibility of the Empanelled Hospitals/
Nursing Homes/Day Care Clinics to inform the beneficiary accordingly.
i. The Insurer needs to file a report to Nodal Agency explaining reasons
for denial of every such claim on day to day basis.
j. Authorization letter [AL] will mention the authorization number and the
amount guaranteed as a CGHS package rates and negotiated rates for
such procedure for which package has not been fixed earlier. Empanelled
Hospitals/Nursing Homes/Day Care Clinics must see that these rules
are strictly followed.
k. The guarantee of payment is given only for the necessary treatment
cost of the ailment covered and mentioned in the request for Authorization
letter (RAL) for hospitalization.
l. The entry on the Smart Card at the time of admission as well at
discharge would record the authorization number as well as package
amount for listed procedure and agreed package amount by the Empanelled
Hospitals/Nursing Homes/Day Care Clinics and Insurer in case of non
listed procedure. Negotiated package would be entered manually by the
hospital since this would not be available in the package list on the
computer.
m. Having carried out these activities, the insurer shall have to ensure
that all data are uploaded on the insureds server and a read-only access
shall be provided, through a link, to the officials / departments as may be
authorized by the MoHFW.
B. Business Contingency Plan (BCP) (Off Line Procedure) In the event
on-line system becoming inoperative for any reason, the insurer shall
resort to the Business Contingency Plan by default (BCP). On visit to an
Empanelled Hospitals/Nursing Homes/Day Care Clinics, the beneficiarys
details shall be verified. Once the identity of the beneficiary and/ or his/
her family member is established by verifying the Photo Smart Card
manually (Xerox copy of the Smart Card shall be kept by the Empanelled
Hospitals/Nursing Homes/Day Care Clinics for record purpose) following
procedure shall be followed for providing the health care facility listed/
not listed in packages in addition to procedure envisaged at
a. A manual pre-authorization form filled up and faxed to Insurer within
6 hours of admission along with copy of diagnostic reports.
b. The same shall be authorized within a turnaround time of not more than
12 hours.
c. Cashless treatment shall be given accordingly, without charging any
money from the beneficiary.
d. On completion of treatment discharge documents are signed.
e. Having carried out these activities, the insurer shall have to ensure that
all data are uploaded on the insureds server and a read-only access shall
be provided, through a link, to the officials / departments as may be
authorized by the MoHFW.
Note:
In cases where the beneficiary is admitted in a hospital during the current
policy period but is discharged after the end of the policy period, the claim
has to be paid by the insurance company under operating policy in which
beneficiary was admitted
12. RUN-OFF PERIOD
A Run-Off period of one month will be allowed in case of cancellation/
non renewal of the policy. This means that preauthorizations done till the
cancellation/ non renewal of the policy period and treatment/surgeries
for such preauthorizations done up to one month after the expiry of
policy period, all such claims will be honored.
14. REPUDIATION OF CLAIMS
In case of any claim is found untenable, the Insurer shall communicate
reasons to the Health provider and Designated Authority of the Central
/Nodal Agency for this purpose with a copy to the Beneficiary. All such
claims shall be reviewed by the Central Government on monthly /
quarterly basis.
15. ENROLMENT:
The enrolment of the beneficiaries would be undertaken by the Insurance
Company selected by Central Government/Nodal Agency. The Insurer
shall enroll the beneficiaries as per procedure laid down below and shall
issue Photo Smart cards as per Central Government specifications and
handover the same to the CGEPHIS beneficiaries.
(a) 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. However,
in the case of new joinees and new retirees the enrolment will continue
throughout the year.
(b) Insured will have the option to change the details regarding dependent
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beneficiary in the smart card; however the total number of dependents
cannot be more than the number fixed at the time of renewal at
designated district Kiosk setup by the insurer within 60 days prior to the
expiry period of the policy.
(c) The Insurer will arrange for preparation of the Photo Smart Card as
per the Guidelines provided.
(d) At the time of delivering the smart card, the Insurer shall provide a
booklet along with Photo Smart Card to the CGEPHIS beneficiary
indicating the list of the Networked Hospitals, the availability of benefits
and the names and details of the contact person/persons, and toll-free
number of call centre. To prevent damage to the smart card, a plastic
jacket should be provided to keep the smart card.
(e) If the smart card is lost within the policy period then beneficiary can
get a new card issued at the designated District Kiosk, by paying to the
insurer, a pre-defined fee agreed by Central government/ Nodal Agency.
(f) To address the problems of incorrectness, functionality of cards etc
and enrolment could not be done by the beneficiary for any reason; the
same would be done at designated district kiosk by the insurer.
(g) Advance publicity shall be given by the Insurer and Central Government/
Nodal Agency on Pan India basis.
(h) Insurance Company would carry out enrolment at agreed designated
District office of the Insurer in case of Pensioners and scan document
will be given for the purpose on the spot. In case of Serving Employees
the data will be collected from Head of Department level. In both the
cases photo Smart Cards along with the enrollment kit shall be sent by
the insurers directly to the insured persons at their respective mailing
addresses at insurers cost.
(i) Insurance Company will also provide a web-based application, which
would be available to Head of Departments of the Ministries/Departments.
The empanelled Hospitals/Nursing Homes/Day Care Clinics and the
beneficiaries shall have the access to the website to see their relevant
information.
(j) Nodal Agency at the Health Ministry will also monitor data related to
Insurance plan like enrolment etc through this website.
(k) The Scheme as well as the enrolment form would be put up on the
web-site of the various Ministries/Departments on a permanent basis.
(l) Any Employee / Pensioner who opts for the Insurance Scheme shall
remain the member of the scheme with future renewals automatically
awarded unless he/she opts out of the scheme. The beneficiary is
required to submit the declaration to the MOH&FW for discontinuation
from the Scheme 90 days prior to expiry of the policy. In such cases the
benefits shall cease on the expiry of the policy.
ENROLMENT PROCESS
The process of enrolment shall be as under:
A. Serving Employees:
1. Departments and offices will call for options from employees to join
voluntary CGEPHIS with or without existing CGHS/CS (MA) benefits.
2. Head of Department of the Administrative Ministry/Department
would be the contact point for the Insurance Companies.
3. Enrolment forms giving details about self and family and authorization
to the department for recovery of premium on a monthly basis would be
consolidated by the Administrative Ministry/Department. The data of
the beneficiary and dependent members to be covered along with 2
recent passport size photo and copy of enrolment form will be forwarded
to Insurance Company on monthly basis.
4. Insurance Company will issue Smart Cards on the basis of information
received of the beneficiaries for enrolment.
5. Such Smart Cards along with the enrollment kit shall be sent by the
insurers directly to the insured persons at their respective mailing
addresses at insurers cost within 7 days.
B. Retired Employees:
1. In case of Retired Employees, wide publicity of the Scheme should be
given through various media sources like advertisement in local
newspapers, Cable network etc.
2. A notice would be posted in the pension paying branches (approximately
30,000 in numbers) / post offices giving details of proposed Scheme.
3. Information can also be disseminated through pensioners associations
and other related agencies.
4. Enrolment forms would be made available with Pension Paying
Branches/ Post Offices as well as on the website of the Departments/
Ministries.
5. The enrolment process for the pensioners shall continue as per
schedule agreed by the Government/Nodal Agency. Insurer in consultation
with the Central Government/Nodal Agency/shall chalk out the enrolment
programme by identifying enrolment stations at Insurers district offices
during fixed period to complete the task in scheduled time.
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6. Retired employees opting for the scheme would fill up the enrolment
form giving details relating to self and dependent members along with the
proof of self and dependents as per CGEPHIS Guide Line along with 2
recent passport size photos each at Insurers' district offices for enrolment
under the scheme along with his /her first contribution by cheque only.
7. The enrolment form would be accompanied by authorisation form to
the pension paying agency to debit contribution of his/her future premium
for the purpose of continuing as a member of the Insurance Scheme.
8. Insurance companies will issue scanned Photo document to pensioners
on the basis of information received at the time of enrolment of the
beneficiaries. Photo Smart Cards along with the enrollment kit shall be
sent by the insurers directly to the insured persons at their respective
mailing addresses at insurers cost.
9. Copy of enrolment form along with the authorization form would be
sent to Central Pension Accounting Office for preparation of the data.
Central Pension Accounting Office will pass on the authorization form
of the pensioners to the respective pension paying units for deduction of
premium for future renewals.
10. Limited access to the database available with the Central Pension
Accounting Office / MOHFW would be available to the Insurance
Company.
B. For Future Employees and Pensioners:
a. All future employees and future pensioners shall necessarily be
covered under CGEPHIS.
b. At the time of their entry into or retiring from service they are required
to carry out certain documentary formalities at their respective places of
posting and the Ministry. Enrolment into CGEPHIS shall be dovetailed
to such activities and the documentation for the same shall be made an
integral part of the entry / exit exercise.
c. The insurer shall have to provide enrolment forms (printed as well as
soft versions) at all such locations.
d. Employee shall fill up form enrolment form, authorization form for
deducting the contribution and submit 2 recent passport size photographs
of the family each (individual) to DDO/ Nodal Officer.
e. Insurer shall arrange to collect the enrolment form & family photograph
from the respective DDOs/ Nodal Officers under acknowledgement.
f. After required processing, all relevant data shall be uploaded on the
server and smart cards shall be issued by the insurers.
g. Such Smart Cards along with the enrolment kit shall be sent by the
insurers directly to the insured persons at their respective mailing
addresses at insurers cost.
h. The insurance cover shall be effective from the date of joining or
retirement of an employee.
i. All these activities shall have to be uploaded on the insureds server on
a read-only access, a link shall be provided to the officials / departments
as may be authorized by the MoHFW. Note: The Insurer will have to
complete the following activities before the start of the enrolment
process:
* Empanelment of the Hospitals/Nursing Homes/Day Care Clinics
* Setting up of District Kiosk
* Prepare the enrolment kit and get it approved by the Government.
16. SPECIFICATIONS FOR SMART CARDS AND
SOFTWARE:
NIC concurrence is required. The Smart Cards to be used must have the
valid Compliance Certificate from National Informatics Centre, New
Delhi. The specifications of the smart card are listed as below.
* Microprocessor based Integrated Circuit(s) card with Contacts, with
minimum 64 Kbytes available EEPROM.
* Compliant with ISO/IEC 7816-1,2,3 and SCOSTA 1.2b/SCOSTACL
1.2 with all latest errata and addendum (ref. http://scosta.gov.in).
* Must have a valid SCOSTA or SCOSTA-CL Compliance Certificate
from NIC.
* Supply Voltage 3V or 5V nominal.
* Protocol T=0 or T=1.
* Data Retention minimum 10 years.
* Write cycles minimum 300,000 numbers.
* Chip Temperature Range 25 to +70 Degree Celsius.
* Operating Temperature Range 25 to +55 Degree Celsius.
* Composite layered Construction of PETG (middle layer) and PVC
(outer layers). Ratio of PETG and PVC content should be 50% each.
* Surface Glossy with pre printed content as provided by Department.
a. Smart Card shall be the property of the Central Government and shall
be insurer-neutral. The insurer shall have no proprietary rights over it
and, therefore, shall not be entitled to place its name, logo etc. on the
same.
b. The Smart Card Chip Memory File System and Layout shall be
provided by MoH/NIC.
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c. The Smart Card Visual Zone layout shall be designed by the shortlisted
bidder and approved by MoH.
d. Insurer shall provide following Smart Card related software and
services,
i. Smart Card Sourcing as per the specifications given above.
ii. Smart Card Personalization as per the Layout provided by MoH.
iii. Smart Card Key Management System as per MoH/NIC wetted
architecture.
iv. Developing all Smart Card based Transaction applications as per
MoH/NIC wetted architecture.
e. The card shall have universal acceptability, across the country, by all
empanelled hospitals / nursing homes/Day care clinics in the insurers
panel.
f. To address the problems of incorrectness and functionality of cards,
the insurers shall be required to open kiosks in all major cities as may be
advised by the MoHFW.
g. Preparation of transaction systems, mechanism for data transfer, and
establishment of district kiosks and uploading of MIS on the websites
advised by the MoHFW shall be the responsibility of the insurer.
17. EXCLUSIONS
The Insurer shall not be liable to make any payment under this Scheme
in respect of any expenses whatsoever incurred in connection with or in
respect of:
A. Hospitalization Benefits:
1) Conditions that do not require hospitalization:
a) Conditions that do not require hospitalization. Outpatient Diagnostic,
Medical and Surgical procedures or treatments unless necessary for
treatment of a disease covered under Day Care procedures or Inpatient
hospitalization.
b) Expenses incurred at Hospital or Nursing Home primarily for
evaluation / diagnostic purposes only during the hospitalized period.
Expenses on vitamins and tonics etc unless forming part of treatment for
injury or disease as certified by the attending physician. Expenses on
telephone, tonics, cosmetics / toiletries, etc.
2. Any dental treatment or surgery which is corrective, cosmetic or of
aesthetic procedure, including wears and tears etc. unless arising from
disease or injury which requires hospitalization for treatment including
following dental treatment which indicates that the teeth are the real
source of disturbance.
a) Jaw bone disease treatment
b) Wholesale removal of teeth
c) Surgical operations needed for removal of Odontomes and impacted
wisdom tooth
d) Gum boils under oral surgery.
e) Treatment of pyorrhea and Gingivitis may also be
reimbursed as it is covered under the term Gum treatment.
f) Extraction,
g) Scaling and Gum treatment
h) Filling of teeth
i) Root Canal treatment.
3. Congenital external diseases etc: Congenital External Diseases or
Defects or Anomalies, Convalescence, General Debility, Run Down
condition or Rest Cure.
4. Sex change or treatment which results from or is in any way related
to sex change.
5. Vaccination/Cosmetic or of aesthetic treatment: Vaccination,
Inoculation or change of life or cosmetic or of aesthetic treatment of any
description and Plastic Surgery other than as may be necessitated due
to an accident or as a part of any illness. Cost of Spectacles / Contact
Lens.
6. Suicide etc: Intentional self-injury/Suicide/Self manmade injuries.
7. Naturopathy, Homeopathy, Unani, Siddha, Ayurveda:
(a) Homeopathy, Unani, Siddha, Ayurveda treatment unless taken as
inpatient in a network hospital.
(b) Naturopathy, unproven procedure or treatment, experimental or
alternative medicine including acupressure, acupuncture, magnetic and
such other therapies etc. Any treatment received in convalescent
home, convalescent hospital, health hydro, nature care clinic or similar
establishments.
8. External and / or durable Medical/Non-medical equipment of any kind
used for diagnosis and / or treatment except covered under CGHS
scheme.
B. Maternity Benefit Exclusion Clauses:
a. Those insured persons who are already having two or more living
children will not be eligible for this benefit. Claim in respect of only first
two living children will be considered in respect of any one insured person
131 130
covered under the policy or any renewal thereof. In such situation any
such child born during the policy period, the same shall be covered as an
additional member at the time of renewal only.
b. Expenses incurred in connection with voluntary medical termination
of pregnancy during the first twelve weeks from the date of conception
are not covered except induced by accident or other medical emergency
to save the life of mother.
c. Pre-natal and post-natal expenses are not covered unless admitted in
Hospital/nursing home and treatment is taken there.
18. INFRASTRUCTURE OF INSURER
Insurer shall establish an exclusive Project Office at convenient place for
coordination with the Central Government / Nodal agency at the National
level. The project office shall coordinate with Central Government /
Nodal Agency on a daily basis and ensure effective implementation of
CGEPHI Scheme. Accordingly, Insurer will also have the dedicated unit
at Zonal/State and district level. The Project Manager shall be appointed
within 7 days and the project office shall be placed by the Insurer at New
Delhi within 30 days of signing of the contract having sufficient people
with appropriate qualification and experience to perform various functions.
19. MANAGEMENT INFORMATION SYSTEMS (MIS)
SERVICE THROUGH DEDICATED WEBSITE
The Insurer shall provide Management Information System (MIS)
reports regarding the enrolment, admission, pre-authorization, claims
settlement and such other information regarding the Services as required
by the Government / Nodal Agency. The reports will be submitted by the
INSURER to the Government / Nodal Agency on a regular basis as
agreed between the Parties.
a) to (c) Deleted
20. CALL CENTER SERVICES
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. This service provided by the Insurer
as detailed below is collectively referred to as the Call Centre Service.
I. Call Centre Information The Insurer shall operate a Call Centre for the
benefit of all Insured Persons. The Call Centre shall function for 24 hours
a day, 7 days a week and round the year. As a part of the Call Centre
Service the Insurer shall provide the following :
a) Answers to queries related to Coverage and Benefits under the
Policy.
b) Information on Insurers office, procedures and information related to
CGEPHIS.
c) General guidance on the CGEPHIS.
d) Information on cash-less treatment subject to the availability of
medical details required by the medical team of the Insurer.
e) Information on Network Providers and contact numbers.
f) Claim status information.
g) Advising the hospital regarding the deficiencies in the documents for
a full claim.
h) Any other relevant information/related service to the Beneficiaries.
i) Any of the required information available at the Call Centre to the
Government/Nodal Agency.
j) Maintaining the data of receiving the calls and response on the system.
k) Any related service to the Government / Nodal Agency.
II. Language: The Insurer undertakes to provide services to the
Insured Persons in English and local languages.
III. Toll Free Number/Fax Number
a) The Insurer will operate a dedicated National Toll Free number with
a facility of a minimum of 10 lines. The cost of operating of the number
shall be borne solely by the Insurer. The toll free numbers will be
restricted only to the incoming calls of the clients only. Outward facilities
from those numbers will be barred to prevent misuse.
b) The Insurer will operate a dedicated National Toll Free Fax. The cost
of operating of the number shall be borne solely by the Insurer.
IV. Insurer to inform Beneficiaries
The Insurer will intimate the National Toll Free number/Fax number to
all beneficiaries along with addresses and other telephone numbers of the
Insurers City units / Zonal units and Project Office.
21. DISPUTE RESOLUTION AND GRIEVANCE REDRESSAL
If any dispute arises between the parties during the subsistence of the
policy period or thereafter, in connection with the validity, interpretation,
implementation or alleged breach of any provision of the scheme, it will
be settled in the following way:
a. Dispute between Beneficiary and Health Care Provider/Care Provider
and the Insurance Company: Grievance Redressal centre shall be set up
in each District/State level for all possible redressal of grievance of
beneficiaries/Health provider by the Insurer.
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b. Dispute between Insurance Company and the Central Government A
dispute between the Central Government /Nodal Agency and Insurance
Company shall be referred to the respective Chairmen/ CEOs/CMDs
of the Insurer for resolution. In the event that the Chairmen/ CEOs /
CMDs are unable to resolve the dispute within {60 } days of it being
referred to them, then either Party may refer the dispute for resolution
to a sole arbitrator who shall be jointly appointed by both parties, or, in the
event that the parties are unable to agree on the person to act as the sole
arbitrator within {30 } days after any party has claimed for an arbitration
in written form, by three arbitrators, one to be appointed by each party
with power to the two arbitrators so appointed, to appoint a third
arbitrator.
* The law governing the arbitration shall be the Arbitration and Conciliation
Act, 1996 as amended or re-enacted from time to time.
* The proceedings of arbitration shall be conducted in the English
language.
* The arbitration shall be held in New Delhi, India.
22. AGREEMENTS:
a) Service Level Agreements (SLAs)/ MOUs shall be signed with
Insurance Companies and proper mechanism for ensuring compliance
established including penalty clauses.
b) Insurer will also enter into SLAs/MOUs with other intermediaries for
ensuring compliance established including penalty clauses.
23. TERM & TERMINATION OF AGREEMENT BETWEEN
INSURER & CENTRAL GOVERNMENT
The Agreement shall take effect on the date of signature hereof by both
Parties, and shall remain in force till the end of the policy period and the
runoff period subject to a right to the Central Government to terminate
the Agreement, on the basis of review of the performance of the
INSURER before the same period. The Central Government will review
the performance of the INSURER based on factors including but not
limited to:
a) Compliance with the guidelines specified in respect of enrolment &
transaction.
b) The facilities set up and arrangements made by the INSURER toward
servicing the beneficiaries such as quality assurance, handling of
grievances, availability of benefits and hassle-free transactions etc
agreed to between stakeholders.
c) Empanelment of Hospitals/ Nursing Homes/Day Care Clinics.
d) The quality of service provided.
e) The beneficiaries satisfaction reports received.
f) Grievance Redressal.
g) Any withholding of information as sought by the Central Government
at the bidding and implementation stage of the Scheme; and
h) Such other factors as the Central Government deems fit. The
Agreement may be terminated:
a) By the Central Government before the period mentioned above.
b) By both parties by mutual consent provided it gives the other party at
least 60 days prior written notice.
In case of termination as given above:
a. The Insurer will pay back to the Central Government within one week
the unutilized amount of premium left plus service tax after settlement of
claims for which the preauthorization is given till date of termination.
b. If the insurer fails to do as per clause above, the insurer will pay the
Central Government, the total package amount for all the cases for which
preauthorization has been given, but claim not settled.
c. In addition to above the Insurer shall pay interest at the rate of 12%
per annum on the amount refundable as determined by clauses (a) and
(b) above for the period extending from the date of premium paid till the
date of receipt of refund.
d. The Central Government reserves the right to re-allot the policy to any
other insurer as it deems fit for the rest of the period in the event of
termination and the Insurer shall not have any claims to it.
24. PERFORMANCE PARAMETERS AND PENALTY
CLAUSE:
Insurer is required to perform multiple activities in performance of their
obligations arising out of the insurance contract to them. Any activity not
performed by the insurer within the given time line shall hamper
implementation of CGEPHIS from the planned date. Such activities will
be required to be completed within the specified period from the date of
award of the insurance contract to them failing which a penalty as
specified percentage on total premium shall be payable by them to the
Govt. of India for the period of delay.
25. NODAL MINISTRY:
a) The Ministry of Health & Family Welfare would be the Nodal Agency
for the implementation of CGEPHIS.
135 134
b) A Coordination Committee having the representatives from Ministry
of Health & Family Welfare, Ministry of Finance and Department of
Administrative Reforms & Public Grievances for monitoring the
implementation of the Scheme on a regular basis.
c) Nodal Cell at the Health Ministry will monitor data related plan like
enrolment, empanelment of hospitals, authorization status, claims status,
utilization statistics, network hospital status and other MIS through a
website maintained by the Insurer.
26. MEDICAL AUDIT:
The Insurance Company shall also carry out inspection of hospitals, investigations,
on the spot verification of inpatient admissions, periodic medical audits, to ensure
proper care and counselling for the patient at network hospital by coordinating with
hospital authorities, feedback from patients, attend to complaints from beneficiaries,
hospitals etc on regular basis. Proper records of all such activities shall be
maintained electronically by the Insurer.
ANNEXURE - 7
Salient features
Retired Employees Liberalized Health Scheme
(RELHS-1997)
(1) Retired Railway employees covered under RELHS-97 are provided
with full medical facilities as admissible to serving employees in respect
of medical treatment, investigations, diet, and reimbursement of claims
for treatment in Govt or recognized non railway hospitals. They will also
be eligible, inter-alia, for a) ambulance services b) medical passes c)
Home visits d) Medical attendance for first two pregnancies of married
daughters at concessional rates and e) treatment of private servants as
applicable to serving railway employees.
Note: (i) Those who join the RELHS-97 shall hold identity cards with
photographs of all the beneficiaries.
(ii) For the purpose of d) of sub Para (1) above special identification
cards will be issued duly affixing photographs of married daughters with
clear instructions on the card which shall read ONLY FOR
CONFINEMENT AND TREATMENT DURING ANTE-NATAL
AND POST-NATAL PERIODS FOR THE FIRST TWO
PREGNANCIES AT CONCESSIONAL RATES (IRMM 2000 Sub-
Section(11) Retired Employees 612A)
(iii) RELHS Medical I. Card, Though valid through, out Indian
Railways is required to be registered in a Railway hospital / dispensary
nearer to the place of residence of the beneficiary, who should normally
avail medical treatment from his own Railway Hospital / dispensary
unless he is referred to an other Railway Hospital for specific reasons.
(iv) Beneficiary carrying a RELHS Medical I. card can obtain medical
treatment from any Railway hospital / dispensary all over Indian
Railways in case of medical emergency situation.
(v) During temporary stay at some other place, beneficiary should carry
his/her Medical I. Card with him/her and report in writing to the nearest
Railway Hospital / dispensary intimating the concerned Medical officer
regarding the planned duration of his stay, so that proceedings can be
done, after that he can avail medical treatment for that duration in the
place of his temporary stay. (Rly. Bd. No 2006/H.I./13/RTI dt 29.12.2006)
137
136
OUR URGENT MAJOR DEMANDS
1. FMA @ Rs 1,000 wef 01.01.06
2. Full Parity to all past pensioners
3. All 6th CPC recommendations wef 01.01.06
4. Full revised ex-gratia to (ex-gratia) pensioners too
5. Improvement & expansion : CGHS / RELHS / ECHS
6. CS (MA) Rules, 1944 benefits to non - CGHS Areas
7. Scrapping Central Health Insurance Scheme
8. 50% Merger to BSNL pensioners in IDA scales
9. Full pension benefits to 100% commutation PSU absorbees
Shyam Sunder, Secy Genl
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(vi) When one of the family members moves out of station
carrying RELHS Medical I. card with him/her:-
(a) Short duration: - Attested Photocopy of RELHS Medical I. card
will be considered a valid document for availing outdoor medical facilities
at a Railway hospital / health unit. However, in case of a medical
emergency, indoor treatment will be allowed on the basis of attested
photo copy of I. card in railway & private recognized hospital but the
original Medical I. Card will have to be produced within 15 days.
(ii) Long duration: The original card may be deposited with the issuing
authority who may issue split Medical I. cards to the beneficiaries as
requested by them. (Rly Bd No 2004/H/28/1 RELHS/Card dt 22.03.05)
(2) Eligibility: Minimum 20 years of qualifying service in the Railways
will be necessary for joining the Scheme and the following categories of
persons will be eligible to join the same:
(i) All serving Railway employees desirous of joining the scheme will
be eligible to join it in accordance with the procedure laid down herein
under Mode of Joining
(ii) All retired Railway employees who were members of the old
RELHS will automatically be included in the RELHS '97
(iii) Spouse of the Railway employee who dies in harness
(iv) Family pensioners whose spouse had the requisite 20 years of
qualifying service
(v) SRPF optees & their widows
(vi) PSUs absorbees who resigned from Railways on their being
permanently absorbed in PSUs can join RELHS subject to fulfilment
of conditions prescribed in this regard.
These orders are not applicable to those Railway servants who quit
service by resignation on any other account.
(vii)Ex-Minister for Rlys, ex-MOSR & Dy. Minister for Railways
{Rly Bd No 2003/H/28/1 RELHS dated 16.03.2009, 2007/H/28./1/
RELHS/Misc dated 30.11.09 & No. 2009/H/23/2 dt 11.12.2009}
Note: With effect from 16.03.09, RELHS has been made mandatory
for all retiring Rly employees .In case the retiring officer/staff is unwilling
to join the Scheme he/she should clearly submit his/her unwillingness in
writing in the Declaration Proforma along with reasons thereof. This
shall be treated as final and no further chance will be given to join the
Scheme thereafter.{Rly Bd No 2003/H/28/1 RELHS dt 16.03.2009 &
8.04.09}
(3) Family/Dependents:
Definition of family for the purpose of this Scheme will be the same as
in respect of the serving Railway employees. The definition of dependant
will be the same as in the Pass Rules.
However, unmarried sons over 21 years of age without an upper age
limit, even if not a student or invalid, provided they are wholly dependent
on & reside with Railway Employee/Pensioner, will be covered in the
definition of Family. (Rly Bd No. 2008/H-I/2/15 dated 16.02.09) Also the
widowed daughters, irrespective of their age, provided they are wholly
dependent on Railway employee/pensioner and legally divorced sister, if
father is not alive will be covered in the definition of family /dependents.
(Rly Board No.2008/H-I/2/15 dated 16.02.2009 &even No dt 26.10.2009)
(4) Rate of contribution:
(a) For joining RELHS 97, one-time contribution equal to the last
months basic pay will have to be made at the time of retirement by those
who join the scheme. The persons who are already members of the
existing RELHS are not required to make any fresh payment. However,
those who joined the existing RELHS after 1.1.96 had to pay the
difference of one-time contribution on account of introduction of fifth pay
commissions revised pay scales w.e.f. 1.1.96. Similarly those who have
joined the existing RELHS-97 after 1.1.06 have to pay the difference of
one-time contribution on account of introduction of sixth pay commissions
recommendations. It will be the responsibility of the Railway
Administration to realize the amount due from the concerned RELHS
members
(b) In respect of employees who have already retired on the date of
reopening of RELHS and who had not joined RELHS earlier, one time
contribution will be Twice the revised basic pension.
(ii) For family pensioners: A sum equivalent to double the amount
of their revised normal family pension as on the date of joining
139 138
(iii) For SRPF Optees : For those SRPF Optees or their widows for
whom ex-gratia payment has been approved on the basis of the
recommendations of the V CPC, a one-time contribution at
twice the ex-gratia monthly payment may be deposited.
(vi) For Ministers: An amount equivalent to one Months basic
Salary drawn, on the date of enrolment, by an in-position
Minister of equal status.
[Rly Bds Letter No 2000/H/28/1(RELHS) dt 23-06-2000), Rly Bd No
2003/H/28/1/RELHS dated 16.3.09 & No. 2009/H/23/2 dt 11.12.2009]
(5) Mode of Joining:
Joining RELHS-97 has been made mandatory w.e.f 16.03.09. In case
retiring officer/staff is unwilling to join the scheme, he/she should clearly
submit his/ her unwillingness giving reasons thereof. No further chance
will be given to them thereafter.
(b) Such of the post 16-03-09 retirees who have not yet joined the
scheme are given last & final chance to join by 31-03- 2010. The medical
I. card will be issued by the Personnel Department of the concerned
Railway on realization of contribution due..(Rly. BD No 2003/H/28/1/
RELHS dated16.3.09) or the Personnel Department of the Division from
which the retiree is drawing post-retirement passes.
(Rly Board No 2005/H/28/1/RELHS dated 31.08.09.)
For Ministers: - The CPO of the Zonal Railway from where they wish
to avail of Railway Medical facilities, may be contacted. It will be the
responsibility of the concerned Zonal Railway to issue Medical Card on
realization of contribution due from the ex-Ministers/dependants for
joining the scheme.
Providing Medical Treatment of Rly Beneficiaries:
The Railway beneficiaries should be insisted upon to report to their
respective Authorized Medical Attendant only. The Railway Doctor to
whom they have reported, should take all the steps to attend to his/her
medical problems. The only exception is during acute emergency like
Road Accident, Acute Heart Attack, etc., where the situation is such that
the loss of time to report to Railway Doctor can cause serious deterioration
to the patient's condition. Under such circumstances, the railway
beneficiary should himself/herself get admitted to nearest suitable
Hospital and submit reimbursement claim. Within 180 days, he/she
should also inform his/her Authorized Medical Officer at the earliest.
The Railway Doctor to whom the Railway beneficiary has reported for
his/her medical problem will decide the line of action plan. The action plan
could be:-
a) It may be possible to provide the medical treatment within the
facilities as available within the Health Unit/Railway Hospital set up at
a distance which can be travelled by the patient conveniently.
(B) For those cases which cannot be managed as per (a) above,
following alternative methods can be adopted:-
(B.I) To avail services from Government Hospital,
(B.2) To avail services from Recognized Private Hospital for
particular Disease/Diseases,
(B.3) In exceptional cases, it may be essential to avail services from
Unrecognized Private Hospital.
Note: 1.Adequate number of proper quality Private Hospital should be
recognized to facilitate Railway Doctors to provide proper treatment to
Railway patients if in-house facilities are not adequate.
2. Pathological & Radiological and other types of Diagnostic
Investigations for Rly beneficiaries:
To improve the standard of Health Care delivery. Railway Health Units,
located more than 25 Kms away from concerned Rly hospital, may be
provided diagnostic facility through private recognized diagnostic Centres
{ Rly Bd Nos 2005/H/21/FHU dated 16.1.2006, 2005/H/6-4/Policy-II
dt 16 .04. 2007, & 2007/11/21/FH dt 04.O2.O8}
System to be followed to get Medical treatment done from
Unrecognized Private Hospital.
(A) For those cases where there is no emergency: - Proper proposal
with estimate recommended by Standing Medical Board of the Railway
Hospital, recommended by MD/CMS/MS in charge of the Hospital,
CMD of Zonal .Railway and duly concurred by FA&CAO should be
sent to Railway Board to obtain prior approval of Railway Board.
(B) For those cases where there is an emergency:-
141
140
(B.I) A proposal from CMD with some rough estimate to be sent to
DG/RHS by Fax for administrative approval of DG/RHS. Approval will
be sent by fax within hours.
(B.2) After office hours and on holidays, administrative approval from
DG/RHS to be obtained over telephone. In case DG/RHS is not
available, information can be left with EDH/EDH (P). Administrative
approval by Fax to be obtained as per Para (B.I) on next working day.
(Rly Board No. No. 2005/H/6-4/Policy-II dated 16.04.2007)
Treatment in an emergency: 1) Where, in an emergency, a Railway
employee or his dependant has to go for treatment (including confinement)
to a Government hospital or a recognized hospital or a dispensary run by
a philanthropic organization, without prior consultation with the Authorized
Medical Officer, reimbursement of the expenses incurred, to the extent
otherwise admissible, will be permitted.
(Para 648 IRMM 2000 Vol. I)
Emergency shall mean any condition or symptom resulting from any
cause, arising suddenly and if not treated at the early convenience, be
detrimental to the health of the patient or will jeopardize the life of the
patient. Some examples are:- Road accidents, other types of accidents,
acute heart attack etc. Under such conditions, when the Railway
beneficiary feels that there is no scope of reporting to his/her authorized
Railway Medical Officer and avails treatment in the nearest and suitable
private Hospital, in which case Authorized medical officer should be
informed at the earliest ( not later than 24 hrs.), the reimbursement claims
are to be processed for sanction. Genuineness of emergencies is to be
established at the earliest by any means of communication and not later
than 24 hours of the patient being admitted in the Private Recognized
Hospital.
In case the genuineness of emergency is not established, then the
reimbursement to the patient for the amount he paid to the private hospital
will be limited to the CGHS rates only for the bill raised till decision is
taken on emergency by Railway doctor.
(Rly Bd No 2007/H/ 28/I /RELHS/Smart card dated 24.07.08)
For establishing emergency condition ex-post -facto, Authorized Railway
Medical officer shall examine the following parameters, on record:-
(a) Admission details: (i) Date and time of admission (ii)Admitted
through OPD service/ emergency service. (iii) Admitted to an ICU bed
or general bed or cabin bed. (b) Clinical findings at the time of
admission. Following findings should be made available and critically
evaluated:-
(i) Pulse rate (ii) B.P. (iii) Level of consciousness (iv) Any convulsive
feature (v) Urine output (vi) Any other feature of shock. (vii) Body
temperature (viii) Extant of external wound (ix) Extant of active bleeding
(x) Extant of Chest pain or pain in other part/s of the body. c) Types of
medical treatment given immediately after admission. (i) List of
Emergency medicines used immediately after admission. (ii) Type of
surgical procedure done immediately after admission.
(Rly Bd No. 2005/H/6-4/Policy-II dated: 3 1 .01. 2007)
However, For the knowledge and benefit of beneficiaries, the
following opinion of the Directorate of Health of the Rly Board, may also
be noted:
(1) Any heart attack mild, major or acute if not treated well in time will
cause some permanent damage to heart muscles.
(2) In case of following symptoms, the patient should report to nearest
competent doctor for consultation & further advice :(i) In case of pain
anywhere in chest, (ii) In case of pain in abdominal region, (iii) In case
of sudden weakness in one or both upper or lower limb or sudden
weakness in one or both upper or lower limb accompanied with loss of
grip or giddiness (iv) In case of pain in Shoulder extending towards
Elbow with or without pain in Chest (v) In case of perspiration with
breathing problem ( Rly Board No. N0.2006/H-1/13/RTI dated 05-6.07)
Reimbursement:
The beneficiary has to submit his /her claim on the prescribed Forms
within 180 days. Once the emergency is established beyond doubt, and
then the case will be further processed as follows:
1. Procedure:
The procedure to be followed for consideration and rejection of the
reimbursement claim, if the treatment is taken by railway employee in a
non-recognized private hospital without referral by authorized Medical
Officer shall be as under:-
143 142
A. At the Division/ Zonal Hospital / Production Unit Level:
(i) AMO will scrutinize the claim first and will forward it to CMS of the
concerned Division/ Production Unit or MD of the Zonal Hospital.
(ii) CMS/MD will scrutinize the claim and if emergency is established
will recommend the amount to be reimbursed and will send it for
financial concurrence of the Associated Finance.
(iii) The proposal will be sent to CMD of the concerned Zone.
B. At the Zonal Headquarters:
(i) The CMD of the concerned zone scrutinizes the reimbursement
claim and will send the same for FA & CAOs concurrence.
(ii) If the reimbursement amount is within the powers delegated to
General Manager, the claim will be sent for his approval
otherwise the proposal will be sent to Board for consideration.
2. The competent authority to reject the claim shall be the authority
which scrutinizes the claim in cases where emergency is not established.
A. The competent authority to reject the claim in case where
emergency is not established as per guidelines laid down in
Boards letter No.2005/H/6-4/Policy-ll dated 31.1,07 shall be
CMS of the Division/Production Unit or Medical Director of the
Zonal Hospital, as the case may be.
B. In case, the proposal has been duly forwarded to the concerned
CMD and after scrutiny, he comes to the conclusion that
emergency is not established; the competent authority to reject
the claim shall be CMD concerned,
C. In case, the rejection is on any ground other than emergency not
being established, the competent authority to reject the claim
shall be DRM at the Divisional level and General Manager at the
Zonal level/Production Unit level.
D. The reasons for not recommending the proposal for sanction of
competent authority need to be intimated to the employee at the
scrutiny level itself.
Note: For calculating the amount/money to be sanctioned, the following
guidelines need to be followed:-
a) Treatment taken in Govt Hospital - Full admissible amount should be
recommended for sanction.
b)Treatment taken in Recognized Private Hospital for an ailment for
which it is recognized - Rate as approved by Railway should be
processed for sanction.
c) Treatment taken in a Recognized Private Hospital but for an ailment
for which it is not recognized or treatment taken in a non-recognized
Private Hospital:- Reimbursement should be made at the CGHS rates of
that city or nearest city. CGHS (Central Govt Health Scheme) approved
rates are to be recommended/processed as an upper limit for sanction.
Note: 1. In civil appeal no 560 of 2004 decided on 6.8.2004, Suman
Rekheja Vs State of Haryana. (2004)13 SSC 562 the Supreme Court
held that 100 percent medical expenses at AIIMS rates and 75 % of
expenditure in excess thereto is to be reimbursed in case of treatment
taken in an emergency in a non-recognized Private Hospital.
2. Railway hospitals are covered by Consumer Protection Act 1986
and RELHS beneficiaries are Consumers as per the definition of the said
Act [Laxman Thamapa Kotgiri Vs GM, Central Railways & others civil
appeal No 171 of 2004 {2005 (1) SCALE page 600}
In Medical Science, no list can be fully exhaustive. Hence, it is likely
that there will be few occasions when a claim has been submitted which
is not appearing exactly in the CGHS rate list. On these cases, the MD/
CMS/MS in charge of Divisions will apply their mind and will come to a
logical conclusion. Then, they will pass a speaking order to certify the
rate/s being recommended, in consultation with Associated Finance.
(Rly Board No. 2005/H/6-4/Policy-II dated: 3 1 .01. 2007)
As per the time schedule laid down, normally a reimbursement case
should be finalized within 60 days.
{N. Rly HQ office P.S. No 11768/99 dt 31.03.1999}
Fixed Medical Allowance (FMA): As per Boards letter No. PC/V/
98/1/7/1/1 dated 21.4.99, a Fixed Medical Allowance @
Rs. 100/- per month is granted to the Railway Pensioners/Family
Pensioners who are residing beyond 2.5 Kms from Railway Hospital/
Health Unit/Dispensary. This fixed medical allowance is given to meet
the day-to-day medical expenses. They are not entitled to receive
144
145
outdoor treatment from Health Unit/Railway Hospital etc, except in
cases of Chronic Diseases.
The following will be treated as chronic diseases:
(a). Any disease which persists for a period of approximately three
months or more is defined as a chronic disease. Some of the common
illneses which are treated as chronic diseases are:- 1. Arthritis and
related conditions. 2. Cardiovascular disease. 3. Cancer of any part of
body. 4. Diabetes mellitus 5. Epilepsy disorders 6. Obesity/chronic
weight loss. 7. Tuberculosis. 8. AIDS 9. Oral Health Problem 10.
Chronic skin disorders.
(Rly. Bd No2006/H/DC/JCM dated I2 10.2006)
Note: Lockup Dispensaries are not considered as Health Units.
Entitlement for Private / Semi-private Wards/cabins : Same yard
stick as that of CGHS is followed for railway beneficiaries also. For
details, please refer to Annexure 6 Salient features CGHS
(O.M. No.18 (1)/EV/2009 dated 14.04.2009 Ministry of H &FW)
ANNEXURE - 7A
Medical Reimbursement Claim Profoma
1. Name of the employee/ex employee
2. Whether in service or retired
3. Designation
4. Office /

unit of posting
5. Pay & Scale of Pay of the Employee last pay drawn in case of retired
employee
6. Name of the patient
7. Permanent address of the employee/Pensioner
8. Temporary address of the employee/Pensioner
9. Relationship with Railway Employee for Whom reimbursement is
claimed.
10. Age of Patient
11. Medical RELHS card No.
12 Whether referred or none. Referred
13. If referred, by whom
14. Name of the institution where treatment is taken
15. Date of admission
16. Date of discharge
17. Date of submission of claim
18. Reasons for delayed submission of claim if delayed for more than 6
months
19. Total period of Stay as indoor patient
20. Reasons for long Stay (if Stayed for more than 48 hrs)
21. Type of medical emergency
22. Was there no Railway/ Govt. Facility available to deal it
146 147
JUST 1% ONLY JUST 1% ONLY JUST 1% ONLY JUST 1% ONLY JUST 1% ONLY
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BHOOL NA JANA HINDION BPS KI QURBANIAN !
[DONT FORGET SACRIFICES OF BPS]
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For ECS Deposit, SB Account Number
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23 Distance, of the nearest. Govt. hospital & whether facilities available
there.
24. Distance of the nearest Rly hospital and whether facilities available
there. If not, how far is the railway hospital with the facilities?
25. Distance of the private hospital from residence/place of illness,
where facilities availed.
26. When the railway medical Officer was informed about such admission
27. Did the patient take any? Treatment before or after the present
sickness (If this

existed before) and if yes, when
28. Total amount claimed with break up of charges (detailed instructions
at (f) of foot note below)
29. Total No. of enclosures
Countersign of Controlling Signature of employee/pensioner
officer/Unit in-charge
(in case of serving employees)
Declaration to be signed by the person claiming medical
Reimbursement
I hereby declare that the statements in this application are true to the
best of my knowledge and belief and
(i) That the person for whom the medical expenses are incurred, is wholly
dependent upon me.
(ii) That the medical expenses were incurred for self.
Strike out whichever is not applicable from (i) & (ii)
Date Signature of claimant
Place Designation & office to which attached
Foot note: i. item Nos 18, 19, 20, 2 1, 22, 23, 24 and 25 are applicable only
to non-referred cases.
2. Following documents should be attached with this Performa
(a) EMPLOYEE/ RETIRED EMPLOYEES APPLICATION GIVING GIVING THE
CIRCUMSTANCES UNDER WHICH HE/SHE TOOK THE TREATMET.
(b) Photo copy of Medical / RELHS I. Card duly attested by a Gazetted
officer
(c) Essentiality certificate issued by the treating doctor, duly countersigned
by the hospital superintendent of the treating doctor
(d) Discharge certificate in original
(e) Bills/Vouchers (in original) duly countersigned by the treating doctor
along with prescription slip in original
(f) Detailed item-wise breakup of all the bills (this means all the bills/
vouchers submitted as per (e) above may be reproduced in legible
manner, e.g.
Bill No Name of the Chemist Dated
Description of item Qty. Price
i)
ii)
ii)
Total
(h) In case of referred cases, attach original referral slip
CERTIFICATES
(To be completed in the case of patients who are
admitted to hospital for treatment)
Part A
I, Dr....................................................... ...............hereby certify;
(a) That the patient was admitted to hospital on my advice/on the advice
of.................................................................. (name of Medical Officer)
(b) that the patient has been under treatment at ....................................
and that the under-mentioned medicines were prescribed by me. In this
connection these were essential for the recovery/prevention of serious
deterioration in the condition of the patient. The medicines are not
stocked in the (name of the hospital).............................................. for
supply to private patients and do not include proprietary preparations for
149
148
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which cheaper substances of equal therapeutic value neither are
available nor preparations which are primarily foods, toilets or disinfectants.
Name of medicines Price
1
2
3
(c) That the injections administered were not for immunizing or
prophylactic purposes.
(d) That the patient was suffering from ............................ and was
under my treatment from ............... to ..................................
(e) That the X-ray, laboratory tests, etc. for which an expenditure of Rs
....................... was incurred were necessary and were undertaken on
my advice at .............................................. (name of hospital or
laboratory).
(f) That I called in Dr ....................................... for specialist consultation
and that the necessary approval of the
(name of the Principal Medical Officer), as required under the
rules was obtained.
Date.......................... Signature and designation of the
Place......................... Medical Officer in charge of the
case at the hospital
Part B
I certify that the patient has been under treatment at
the............................................ hospital and that the services of the
special nurses, for which an expenditure of Rs. .......... was incurred vide
bills and Receipts attached, were essential for the recovery/prevention
of serious deterioration in the condition of the patient.
Date..................... ....................................................
Place.................. Signature and designation of the
Medical Officer in charge of the hospital.
Countersigned Principal Medical Officer
Part C
I certify that Shri/ Shrimati / Kumari......................................... wife /
son/daughter .................................................. of ...................employed
in the ...........................................has been under treatment
for....................................disease from.................................
to............................. at the....................................................... hospital
and that the facilities provided were the minimum which were essential
for the patients treatment.
Date .......................................................
Place.................. Medical Officer
Department ................................ Hospital
Note: Certificates not applicable should be strucke off. The (Essentiality
Certificate as given in Part A (b) above is compulsory and must
be filled in by (he Medical Officer in all cases.)
Instruction for submission: In both referred & non-referred cases
retiree's application should be submitted to the concerned M.D Zonal
Rly. Central Hospital/CMS i.e. under whose jurisdiction applicants
RELHS I. Card is registered.
For official use only
(i) In all cases being sent to Board
(ii) In cases of GM/AGM sanction for un-referred /non-Govt,
unrecognized cases
1. Verbatim of CMD
2. Verbatim of FA & CAO
151 150
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BHOOL NA JANA HINDION BPS KI QURBANIAN !
Have you already donated 1% of your 32 months' ARREARS
( 2nd instalment ) ? If not, donate today:
For ECS Deposit, SB Account Number
(SBI, Jangpura) is : 01274 - 10825178380
Bibliography
1. G.O.I. Pensioners Portal : http://pensionersportal.gov.in/
2. Ministry of health & family Welfare
http://mohfw.nic.in/cghsnew/index.asp
2. Pension Process Map and Time Frame as follows:
CCS (Pension) Rules : 56(1), (2) & (4), 59(a), (b), (c) & 59(c)
3. Ministry of Railways (Rly Board): Establishment Code Vol II
Chapter 18
4. Ministry of Railways (Rly Board): Railway Service (Pension)
Rules, 1993
5. Ministry of Railways (Rly Board): Accounts Code-Chapter 10
6. The Pensions Act, 1871
7. Ministry of Personnel, PG & Pensions: Central Civil Services
(Pension) Rules,1972
8. C.G. Pensioner PAYMENT OF ARREARS OF PENSION
(NOMINATION) RULES, 1983
9. Ministry of Personnel, PG & Pensions: Liberalized Pension awards
Central Government
10. CGAs : SCHEME FOR PAYMENT OF PENSIONS TO C.G.
CIVIL PENSIONERS THROUGH AUTHORISED BANKS
11. Ministry of Personnel, PG & Pensions: CCS (General Provident
Fund) Rules, 1960
12. Ministry of Personnel, PG & Pensions: CCS (Commutation of
Pension) Rules, 1981
13. Dr. V.S. Natarajan, M D, Chennai: Healthy Ageing
14. N. AHUJA MA.,LLB, Advocate: Will
Postal Regd No DL(S)-01/3274/2009-11
Licence No U(SE)-18/2009-11
to post without pre-payment
BHARAT PENSIONER : Registered with Registrar of
Newspapers for India vide No. R. N. DELBIL/2006/17678
BOOK POST / PRINTED MATTER:
Printer & publisher : Shyam Sunder for Secy Genl,
Bharat Pensioners Samaj e-mail : bps.shyamsunder@gmail.com
Printed at Compudata Services, 42, DSIDC Shed, Scheme-I, Okhla-II, New
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Editor (for the purpose of the Act) : Y C Rai.