New Health Insurance Scheme for Government Employees under Consideration

Ministry of Health and Family Welfare

There is a proposal for introduction of a health insurance scheme for the central government employees and pensioners on pan-India basis, with special focus on pensioners living in non-CGHS areas. The proposal is to make this scheme voluntary cum contributory for serving employees & pensioners. However, it is proposed to be made compulsory for the new entrants in Government service.

The salient features of the proposed Health Insurance Scheme are as under;

· Optional for serving Central Government employees and pensioners including future pensioners,

· Compulsory for new recruits,

· Covers all the members of family as per CGHS norms,

· Sum insured – Rs. 5 lakh per year on a family floater basis,

· Corporate buffer of Rs 25 Crore to take care of cases exceeding Rs. 5 lakh,

· All pre existing diseases covered from the day one,

· Pre and post hospitalisation benefits available,

· Domiciliary Hospitalisation benefit,

· Maternity benefit upto two living children,

· OPD not covered however OPD consultations will be free,

· Payment of FMA for meeting OPD needs,

· Cashless treatment facility,

· Govt. to subsidise significantly the payment of premium,

· Employees / pensioners to contribute 20 to 30 percent of the premium,

· Identification of beneficiaries through a Smart Card.

The proposed scheme will be an alternative to the CGHS and it will provide an option to the serving employees and pensioners to choose a scheme as per his/her convenience.

The Scheme will have special focus on the pensioners living in non-CGHS areas who are getting Fixed Medical Allowance at the rate of Rs.300/- only per month to take care of their medical needs and have been demanding extension of CGHS or CS (MA) Rules to cover their OPD and Inpatient medical needs which is not feasible due to resource constraints. The Health Insurance Scheme seems to be a viable alternative. It will have additional implications, due to coverage of pensioners living in non-CGHS areas and not covered under any Government Scheme.

The proposal for inclusion of the Health Insurance Scheme for the Central Government employees and pensioners in the 12th Plan has been moved by the Ministry for consideration of the Steering Committee on Health in the Planning Commission. On receipt of approval of Planning Commission, the proposal would be placed before the Expenditure Finance Committee and finally before the Cabinet for approval of the scheme. No strict time frame can be given in this regard.


This information was given by the Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad in reply to a Starred question in Lok Sabha today.

Source: PIB