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rajanch
16-12-2009, 11:56 AM
My parents have mediclaim policy, by the contribution of father and his company SAIL, and he do not have any pension. Now I am in DAE, and I have CHSS, so parents are also eligible because they are dependent on me. Can some body guide me wheteher cancellation of mediclaim policy essential to get CHSS facility for my parents. Thanks in advance for the reply

tvenkatam
17-12-2009, 08:54 AM
My parents have mediclaim policy, by the contribution of father and his company SAIL, and he do not have any pension. Now I am in DAE, and I have CHSS, so parents are also eligible because they are dependent on me. Can some body guide me wheteher cancellation of mediclaim policy essential to get CHSS facility for my parents. Thanks in advance for the reply

Dear Friend,

The benefits of mediclaim policy and the Health scheme of Government can be availed concurrently both in respect of yourself and members of your family.

According to O.M. of 19.02.2009 from Dept. of Health & Family welfare, the beneficiaries who have subscribed to medical insurance policies in addition to availing CGHS facilities would 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.

Therefore, you only stand to gain by possession of Mediclaim policy for your parents who are members of your family and are the beneficiaries of CGHS.

svsankar
17-12-2009, 11:57 PM
I would just like to add to clarification given by senior member that you cannot submit claim for the same medical treatment in both the places. You can have both but decide before a treatment where you are going to make the claim.

tvenkatam
18-12-2009, 09:27 AM
Dear Friends,

The claim under Mediclaim policy will have to be raised first with the Insurance provider. The insurance agency will pay the Hospital (in case of cashless facility) or reimburse the insurer certain percentage of amount subject to limitations of terms of policy on the basis of claim admitted by TPA. The beneficiary will then obtain a copy of the bill along with the details of amount admitted by TPA and that paid by Insurance agency and make a second claim with CGHS (for CGHS beneficiaries) or Head of Office (for non CGHS employees) under CCS (MA) Rules for release of difference of expenditure. The admissibility will be subject to the condition that the reimbursement from both the sources will not exceed the total expenditure of treatment. For availing this facility the hospital of treatment need not be an approved one. Of course, the hospital should be in the net work of Insurance agency concerned.

rajanch
18-12-2009, 09:44 AM
Thank you, for your reply,

svsankar
19-12-2009, 12:32 PM
Thank you, for your reply,

Dear Sir,

The details of what venkatam sir are available in circular dated 19 feb 2009 in mohfw.nic.in under cghs\circulars.