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vnatarajan
30-10-2008, 12:11 PM
Dear Co-Pensioners (Central Govt.)

Many of the Central Govt. Pensioners are members of the Central Govt. Health Scheme (CGHS) and are supposed to benefit from the same!. Unfortunately, there is more dissatisfaction and despair rather than cure and treatment of diseases.

There are several areas of dissatisfaction like : Inability to maintain supply and quality of medicines; Crowding of dispensaries; Inadeqaute support laboratories for scans/ tests; Inadequate strength of Doctors and staff; Lack of Specialist category of Doctors resulting in referral system to Govt. Hospitals and the related issues;Non-recognition of adequate no. of effective Private Hospitals in many cities for inpatient/ specialised surgical & other treatments etc; Not extending uniform facilities at all Urban centres- (eg what is allowed in Mumbai/ Trivandrum for getting in-patient treatment etc is not followed in other cities like Chennai/ Bangalore/other places); and many more!

What is sometimes most-humiliating is the lack of appreciation of the need for attending to SENIOR/AGED PENSIONER-PATIENTS' problems and often not extending the due courtesy and care- when the Ministry of Social Justice has itself urged every other ministry to extend some help and facilities!

Therefore, it is high-time for SR CITIZEN CENTRAL GOVT.PENSIONER MEMBERS (SCPs) to voice their grievance and seek suitable remedies.

Demands can be listed- say for eg:

Apart from CGHS facilities, the SCPs must have facilities like (wherever/ whenever/ whichever ):

1.Freedom to go to Private (CGHS Recognised & Non-recognised) Hospitals/ Clinics for inpatient/ specialised treatments/ diagnosis/ scans/ tests - cashless or even on payment- cum- reimbursible basis.

2.Special Mediclaim Policy at Govt. cost to SCPs(as CGHS members have paid/ pay thier membership fees).

CAN ALL INTERESTED CGHS Members/ co-pensioners give their valuable views/ suggestions/ alternatives/ experiences etc in order to sort out this challenging issue?

Thanks in advance..

vnatarajan
(Chennai)

subba Rao R S
30-10-2008, 03:17 PM
Dear Co-Pensioners (Central Govt.)

Many of the Central Govt. Pensioners are members of the Central Govt. Health Scheme (CGHS) and are supposed to benefit from the same!. Unfortunately, there is more dissatisfaction and despair rather than cure and treatment of diseases.

There are several areas of dissatisfaction like : Inability to maintain supply and quality of medicines; Crowding of dispensaries; Inadeqaute support laboratories for scans/ tests; Inadequate strength of Doctors and staff; Lack of Specialist category of Doctors resulting in referral system to Govt. Hospitals and the related issues;Non-recognition of adequate no. of effective Private Hospitals in many cities for inpatient/ specialised surgical & other treatments etc; Not extending uniform facilities at all Urban centres- (eg what is allowed in Mumbai/ Trivandrum for getting in-patient treatment etc is not followed in other cities like Chennai/ Bangalore/other places); and many more!

What is sometimes most-humiliating is the lack of appreciation of the need for attending to SENIOR/AGED PENSIONER-PATIENTS' problems and often not extending the due courtesy and care- when the Ministry of Social Justice has itself urged every other ministry to extend some help and facilities!

Therefore, it is high-time for SR CITIZEN CENTRAL GOVT.PENSIONER MEMBERS (SCPs) to voice their grievance and seek suitable remedies.

Demands can be listed- say for eg:

Apart from CGHS facilities, the SCPs must have facilities like (wherever/ whenever/ whichever ):

1.Freedom to go to Private (CGHS Recognised & Non-recognised) Hospitals/ Clinics for inpatient/ specialised treatments/ diagnosis/ scans/ tests - cashless or even on payment- cum- reimbursible basis.

2.Special Mediclaim Policy at Govt. cost to SCPs(as CGHS members have paid/ pay thier membership fees).

CAN ALL INTERESTED CGHS Members/ co-pensioners give their valuable viewws/ suggestions/ alternatives/ experiences etc in order to sort out this challenging issue?

Thanks in nadvance.

Shri V Natarajan,

vnatarajan
(Chennai)


AS of now it appears to that to make available the medical facilities as suggested by you is very difficult. Alternatively CGHS can organise periodical medical check-up on rotation to every CGHS member with priority to Sr Pensioners. Suggest preventive measures so as to live in good health till last breath.

R S Subba Rao
bangalore

vnatarajan
30-10-2008, 04:32 PM
Dear Mr Subba Rao

Many thanks for your suggestion.
May be problem is not so intense as in Chennai etc.

Problems get multiplied when specialist attention is needed, particularly at Chennai CGHS clinics- and many aggrieved pensioners have aggressively approached our association to pursue actions. Advisory councils for each dispensary has been formed which included members from pensioners, serving employees besides CGHS functionaries.But meetings are not regular nor the pursuant actions are result-oriented!

Things are not improving as they should, say even in a reasonable time-frame!

However, in comparable situations, CGHS has chosen to provide some extended lee-way in Trivandrum and Mumbai. Their circular, as furnished by one of our members is reproduced here:

-------------------------------------------------------------------------------------
OM No-11011/73!2006-COHS. Desk -II dated
2.7.2008 from Ministry of Health & FW, Depts. of
Health & EW, Nirman Bhavan, New Delhi

Subject : Treatment of CGHS beneficiaries In Mumbai and Thiruvananthapuram due to non-availability of facilities in empanelled private Hospitals under CGHS, Mumbai and Thiruvananthapuram, for treatment and fixation of package rates
Central Government Health Scheme (CGHS) has been empanelling private hospitals and diagnostic centers, in cities where it exists, for providing health facilities to its beneficiaries. As part of the process of fresh empowerment, private hospitals and diagnostic centers were requested to quote for various procedures, tests, etc. Based n the competitive rates, which emerged out of the tendering process, the rates were offered to all private hospitals and diagnostic centers that were found to be fulfilling the eligible conditions for empanelment under CGHS. In order to be empanelled under the CGHS, these hospitals and diagnostic centers were required to sign a Memorandum of Agreement (MOA) with Director, CGHS and were also required to submit appropriate performance bank guarantee to the CGHS. Those hospitals and diagnostic centers which accepted the rates that emerged out of the tender process and were willing to sign the MOA and submit the appropriate performance bank guarantee were empanelled under CGHS in the cities in which they were situated.

2. It has been brought to the notice of the Ministry of Health & Family Welfare that hospitals and diagnostic centers empanelled under CGHS, Mumbai and Thiruvananthapuram have been showing lack of interest in continuing with CGHS due to their perceived grievance of high amount of performance bank guarantee and the rates that were being offered. This has resulted in the ailing CGHS beneficiaries not being able to get treatment in private hospitals and diagnostic centers.

3. The matter has been examined in the Ministry of Health & Family Welfare and as an interim arrangement, it has been decided that CGHS beneficiaries in Mumbai and Thiruvananthapuram may be allowed to get their treatment/tests, rate, in any private hospital / Diagnostic centre in their respective cities and claim reimbursement from their respective Departments / Ministries/CGHS, as the case may be, subject to the condition that the reimbursement would be limited to the CGHS rates that have been fixed for the city. There will be no change in the procedure for claiming of reimbursement of expenses.

4. The hospitals, not being in the list of empanelled hospitals under the CGHS, may not provide treatment under CGHS package rates for the city and may charge their own prevailing rates. The hospitals will also not be extending credit facilities to pensioner CGHS beneficiaries. Hence the beneficiaries may have to spend for their treatment from their own resources and claim reimbursement from their respective Ministries Department CGHS. Before they proceed to get treatment in a hospital the beneficiaries are requested to get the permission from the concerned authorities.

5. This issues with the concurrence of IFO, Department of Health & Family Welfare! Vide their Dy. No. 1150/IFD/2008 dated the 24th June, .2005

-------------------------------------------------------------------------------------

I feel similar facilities can be extended by CGHS at other cities also where pensioners require/ are desirous of availing the same (eventhough it is on 'pay & claim' basis).

vnatarajan

mukuntharajan
02-11-2008, 11:27 PM
hi
i fully agree with mr. v. natarajan that the CGHS needs to be made user-friendly as it existed prior to 2004 when the beneficiaries were given reference memo to private recognised hospitals for specialists opinion. investigation and suggestion of treatment in the first instance and later on another reference memo would be issued by cghs for cashless inpatient treatment if warranted.

another frightening issue is that the cghs compelling us to get specialist opinion from government hospitals which is again nothing but harassment. what if a beneficiary obtains specialist opinion from the clinic of the government specialist. will it change or lose the authenticity if the specialist opinion is obtained from his clinic instead of hospital which is authorised by the government of tamilnadu.

when in hyderabad, kolkatta and some other metros have facility of Pay Clinics which are authorised for obtaining specialists opinion, why Civil Surgeon / Civil Asst. Surgeon's clinics in Chennai should not be treated as Pay Clinic to help beneficiaries .

all our continued and untiring efforts are falling in deaf years of the authorities and therefore the best remedy will be to pool our resources and seek judicial remedy

mukuntharajan



Dear Co-Pensioners (Central Govt.)

Many of the Central Govt. Pensioners are members of the Central Govt. Health Scheme (CGHS) and are supposed to benefit from the same!. Unfortunately, there is more dissatisfaction and despair rather than cure and treatment of diseases.

There are several areas of dissatisfaction like : Inability to maintain supply and quality of medicines; Crowding of dispensaries; Inadeqaute support laboratories for scans/ tests; Inadequate strength of Doctors and staff; Lack of Specialist category of Doctors resulting in referral system to Govt. Hospitals and the related issues;Non-recognition of adequate no. of effective Private Hospitals in many cities for inpatient/ specialised surgical & other treatments etc; Not extending uniform facilities at all Urban centres- (eg what is allowed in Mumbai/ Trivandrum for getting in-patient treatment etc is not followed in other cities like Chennai/ Bangalore/other places); and many more!

What is sometimes most-humiliating is the lack of appreciation of the need for attending to SENIOR/AGED PENSIONER-PATIENTS' problems and often not extending the due courtesy and care- when the Ministry of Social Justice has itself urged every other ministry to extend some help and facilities!

Therefore, it is high-time for SR CITIZEN CENTRAL GOVT.PENSIONER MEMBERS (SCPs) to voice their grievance and seek suitable remedies.

Demands can be listed- say for eg:

Apart from CGHS facilities, the SCPs must have facilities like (wherever/ whenever/ whichever ):

1.Freedom to go to Private (CGHS Recognised & Non-recognised) Hospitals/ Clinics for inpatient/ specialised treatments/ diagnosis/ scans/ tests - cashless or even on payment- cum- reimbursible basis.

2.Special Mediclaim Policy at Govt. cost to SCPs(as CGHS members have paid/ pay thier membership fees).

CAN ALL INTERESTED CGHS Members/ co-pensioners give their valuable views/ suggestions/ alternatives/ experiences etc in order to sort out this challenging issue?

Thanks in advance..

vnatarajan
(Chennai)

vnatarajan
07-11-2008, 08:10 AM
hi CGHS member -pensioners,

How do you react to the referral system wherein you have to get the specialists' opinion from a Govt. Hospital for certain ailments/ diseases for which the local CGHS dispensaries may not have the requiste specialists!

There is no standing/ formal memorandum of understanding or orders which bind or make the concerned Govt. Hospitals to reciprocate this requirement and often the suffering/ referred aged pensioner-member is put to unnecessary harassment like standing in a common janata queue inspite of his CGHS identity or his being a senior citizen etc.

What is most humiliating is, the routine AMO attending to the OP queue does not recognise the CGHS referral and what he decides overrides everything and the pentioner-patient is driven from pillar to post before collapsing! Nor rhe CGHS dispensary heads/ higher officials may be ready to use their discretion in some cases!

Yes, this type of treatment has ended in a calamity at Chennai and it shd not happen again anywhere! Hence my vociferous arguments here for some practical/ betterment of systems and facilities.

Our Govt. has magnanimously enacted a "Senior Citizens' Act 2007'" - only for namesake- and many of the States are yet to recognise the same or give credence to it!

Relevant to the queue system in Govt. Hospitals-the above act has directed:

"All Government hospitals or those funded by the Government must provide beds for Senior Citizens as far as possible. Also, special queues to access medical facilities should be arranged for them"

CAN U CITE ANY GOVT.HOSPITALS ANYWHERE IN THE COUNTRY FOLLOWS THIS DIRECTIVE OF THE ACT?

Let us share the information so that we can pursue some actions as required!

vnatarajan.

G.Ramdas
05-02-2010, 08:26 PM
An article has appeared in the gconnect main page under 6CPC matters on the above topic which is reproduced for ready ref.
"Recommendations of Sixth Pay Commission, provided for implementing an alternative health insurance scheme in the place of existing CGHS. Of course, the existing CGHS requires to be revamped for the very reason that it caters to minority of Government employees.

While Central Government employees community are posted knook and corner of the country, the existing CGHS is limited only to 26 cities. As we all know, the rest of places are covered by Central services (Medical Attendance) Rules, which seldom serve the real purpose.

In this scenario, the present contemplation of the Government in bringing a new Health Insurance Scheme in the place of existing CGHS, and medical treatment under Central services (Medical Attendance) Rules, is positive and welcome one.

We provide here the official documents released by the Government (which is available in Ministry of health and family welfare) for assessing the willingness of the CG employees to join in the proposed health insurance Scheme. This documentation is named as Demand Survey.

We request all the Gconnect readers to go through the document and apply in the given format in case they are willing to join as beneficiary in the proposed health insurance scheme.

Some of our friends pointed out the documentation is slightly vague in the sense that whether the proposed scheme is applicable for non-CGHS centers as the filled up applications were required to be furnished at the CGHS centers available in 26 cities mentioned in the said documentation.

However, we feel that as per the wordings of the demand survey document as well as earlier proposals of the government the scheme has been proposed for non-CGHS centers also and the employees belonging to non-CGHS centers can send the willingness to the Deputy Director, Ministry of Health and Family Welfare directly (address mentioned in the document survey)

Check here to go through the Demand Survey Document released by Ministry of Health


Government of India
Ministry of Health & Family welfare
Department of Health & Family welfare
Nirman Bhavan, New Delhi

DEMAND SURVERY

CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME (CGEPHIS)

OBJECT OF DEMAND SURVEY – Government of India is contemplating introduction of a Health Insurance Scheme for Central Government Employees and Pensioners and their dependent family members all over India. Ministry of Health & Family Welfare intends to assess the demand for the above Scheme from the prospective beneficiaries through this survey for taking further steps in this direction.

WHO CAN JOIN THE SCHEME – All the personnel of the Central Government including All India Service officers, serving and retired, and others who are covered under the existing CGHS (Central Government Health Scheme) and under CS(MA)Rules [Central services (Medical Attendance) Rules] Can join the Scheme. The Scheme is proposed to be implemented on voluntary basis for existing employees and pensioners and compulsorily for future employees and pensioners.

INSURANCE COVERAGE – The scheme shall provide coverage for meeting expenses of hospitalization and surgical procedures for beneficiary members up to Rs.5.00 lakh per family per year subject to limits, in any of the network hospitals. The benefit to the family will be on floater basis i.e. the total reimbursement of Rs.5.00 lakh can be availed of individually or collectively by members of the family.

Coverage of Pre-existing diseases: All diseases under the proposed scheme shall be covered from day one.

INSURANCE PREMIUM – The beneficiary will have to pay an annual premium which will be determined after the formal introduction of the Scheme. It will vary according to the grade pay of the officer. The estimated annual premium for a standard family size will be in the range of Rs.8,000 to Rs.12,000 p.a. It is however proposed to be subsidized by the Government to a considerable extent. The amount of premium shall be decided by the transparent process of bidding amongst the Insurance companies participating in the Scheme. In case of serving employees, the premium would be deducted by the Drawing & Disbursing Officer. In the case of pensioners, they would be required to authorize the Band branch from which they are drawing their pension, to deduct the insurance premium.

FAMILY SIZE
a) In case of serving employees, self, spouse, two dependent children and dependent parents would be covered. New born will be covered as a part of insured family member during the currency of the policy.

b) In case of retired employees, self, spouse, two dependent children and dependent parents would be covered.

NOTE:

1. Additional dependent family member can be covered under the scheme by paying an additional premium per additional family member. The premium shall be borne by the beneficiary and there would be no govt. subsidy for the same.

2. The definition of dependent shall be as per guidelines issued by Central Government from time to time.
Serving Central Government employees and Central Government pensioners, if interested in becoming a member of the proposed insurance scheme may send their details as per the format given below, to the Additional Director / Joint Director in the following cities nearest to his place, where CGHS is presently functioning, not later than 15th Feb. 2010.

Ahmedabad - Guwahati - Mumbai
Allahabad - Hyderabad - Nagpur
Bangalore - Jaipur - Patna
Bhubaneshwar - Jabalpur - Pune
Bhopal - Jammu - Ranchi
Chandigarh - Kanpur - Shillong
Chennai - Kolkata - Trivandraum
Delhi - Lucknow - Jammu
Dehradun - Meerut

Alternatively they can also send their details at the following address:

V.P.Singh
Deputy Secretary
Ministry of Health & Family Welfare
Room No.529-A, Nirman Bhawan
New Delhi-110 108
E mail : vijay.singh62@nic.in

FORMAT OF DEMAND SURVEY FOR THE CENTRAL GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME (CGEPHIS)

1. Name :
2. Designation :
3. Office Address :
4. Mailing Address :
5. e-mail id (if available) :
6. Date of Birth :
7. Age as on 01.01.2010 :
8. Date of Retirement :
(for pensioners)
9. Whether CGHS beneficiary :
(Yes / No)
10. Nearest CGHS location :
11. Family size :
(Details including gender & age)

I am interested in joining the Health Insurance Scheme as and when it becomes operational.

Date:
Place: Signature:"This also appeared as ADVT. in most National dailies on 28.01.09.
Under the same article I have posted my comments as under




An Advertisement in the major newspapers also appeared on 28th Jan calling for staff/pensioners who would be willing to join the new scheme.
The proposal as appeared in the Ad does not clarify the following:

Why the existing pensioners who have given lifetime contribution to CGHS including hospitalisation should again pay for a new scheme unless this has got additional/superior features?
will the contribution to the new scheme be over and above the existing CGHS contribution? While the existing CGHS scheme contribution is based on type of ward allowed, will ther be any such differentiation in the new one.

The proposed premium seems to be much higher than the prevailing mediclaim schemes. Why?

To encourage more and more staff and pensioners to join the scheme better clarity is required in the proposal

As this is an important issue it is requested that pensioners deliberate on the same and give their considerd views to the Govt. while responding to the advt.
G.Ramdas

RSundaram
07-02-2010, 07:14 PM
While the frustration and travails of all pensioners and senior citizens in dealing with sequential steps of processes, some of which are repetitive is understandable, organising satisfactory systems is also complex, particularly so in the government sector. No one in the CRM chain is incentivised to serve the customer. If anything a strange supervisory mechanism is put in place which is geared to prevent frauds by a few while causing disservice or humiliating service to all the rest.

The new Insurance system is outsourcing the system of referral, reimbursement procedures, tests, and stay etc of hospital inpatient treatment. CGHS has not been able to deploy technology to reduce clerical effort or repeatedly entering details in different registers. Presumably , the new system will do away with the need to insure with mediclaim as many of us do for ease of taking hospital treatment. Insurance companies will employ technology to facilitate cashless transactions by the patients. But time alone will tell if the new system will be more service oriented. By this deft stroke government distances itself from potential frauds too.

One must understand insurers will love those who do not fall ill or require hospital treatment. Hospitals with latest equipment will love the doctors who perform the maximum number of procedures in order to get a better ROI. Insurers will run into conflicts with hospitals because of their perception that some hospitals do redundant procedures and in turn hospitals will accuse insuring companies running up arrears in bill clearance.

Interposing an intermediary of insurance company will ultimately and surely result in increased costs which will be passed on to us as premia payments despite having Life Time card.

Ideal thing will be to have hospitals with multiple specaility like AIIMS Delhi to be in each city now served by CGHS and to expand them slowly to other centres. Relatively speaking why is AIIMS more efficent than State Govt Hospitals?

The proposed insurance system is an easy way for the government to escape the commitment already made to the serving and retired.

ramanrao60
08-02-2010, 09:35 AM
sir
a beautifully written piece

in fact in usa it is the insurance co which calls the shots and not the medical guys and its a huge mess now

president Obama is trying to reform this and with what success we have to wait and watch

as far as india is concerned i feel for pensioners govt has to foot the premia bill in toto

for serving employees cghs rates may by rationalized in such a way that premia is born by govt and employee in 80:20 ratio

sa8298
10-02-2010, 05:09 PM
In fact right to life is a fundamental right. There is no right to life without right to medical facilities. Hence, righ to medical facilities is also nothing but right to life.

The Government has the responsibility to provide health facilities free of cost to all its citizens. The Government which has a constitutional commitment to give decent standard of living to its employees and commits itself to be a model emloyer is duty bound to provide medical facilities to its employees free of cost. The CGHS has emerged under this background, with a minimum subscription of Rs.2/- etc., During the past ten years this subscription has been increased manifold.

Similarly the premium part of the Health Insurance Scheme would be increased in a short while from now. The Government should provide the medical facilties to all its employees free of cost. Let it insure the medical cost of its employees with any of the insurance companies, and bear the premium. In fact, the expenditure incurred by any government employee on account of treatment of any illness either on himself or his dependent should be reimbursed. Let the Government issue a cashless card to its employees and recognise all the hospitals for this purpose for hospitalisation and settle the bill to the hospitals. Let the CGHS be still operative for OPD purposes only and a pharmacy units for issuing medicines for OPD. But for hospitalisation the recommendation of CGHS should not be made as mandatory.

G.Ramdas
17-02-2010, 11:01 AM
Dear All,
The vagueness in the new Health Insurance Scheme has somewhat been reduced by the draft CGEPHIS scheme notified by the Health Min. in their web site http://mohfw.nic.in/DRAFT%20CGEPHIS.pdf.
What is surprising is that the overall ceiling for reimbursement for an entire family, in any finacial year is only 5 lacs, as against the existing CGHS provision of unlimited reimbursement.Will anybody like to switch over the new scheme, with this background
G.Ramdas