The new plan by the health ministry is to end the current scheme - the Central Government Health Scheme (CGHS) and moving it to an insurance based scheme - the Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS). Under the new scheme the insurance companies with the Insurance Regulatory and Development Authority (IRDA).
At Present under CGHS, the government employees paid Rs. 6000 yearly as a fixed medical allowance. Under the new scheme the Fixed Medical Allowance is yet to be fixed. The actual figures would base on the insurance company; the government has arrived at the presumptive figure of Rs. 14000 per family.
Under this scheme each family is covered for 5 lakh per year. Above that the insurer would get clearance from the nodal agency, pertaining to each case. An additional sum of 10 crores would be given to all 4 zones for such cases. The scheme would cover medical expenses up to Rs 5 lakh per family per year. Beyond that, the insurer would have to get clearance from the nodal agency on a case to case basis.
The existing employees could choose between CGHS and CGEPHIS, but for new employees the CGEPHIS would be compulsory. Sources in the health ministry said the proposal dated back to 2011, when the committee of secretaries gave its approval. The proposal was revived after the NDA government took charge. Former Health Minister Dr Harsh Vardhan, was opposed to the idea as according to Vardhan the change would actually mean a higher burden on the exchequer.
Besides serving the retired government employees, this included former vice-presidents, former prime ministers, MPs and former MPs, sitting and retired judges of the Supreme Court, PIB accredited journalists, railway board employees, Delhi Police personnel in Delhi and employees and pensioners of 60 autonomous/statutory bodies.
The CGHS covers only 25 cities, and the new scheme would be pan-India. This would automatically increase the financial commitment. All diseases, including pre-existing ones, were to be covered, and in case of transplants, the expenses incurred for the donor or processing of cadaver organ would also be covered. Interestingly, the Rashtriya Swasthya Bima Yojana, which was run by the labor ministry so far, would be under the health ministry from April 1, as it moved from an insurance-based scheme to a trust-based scheme.
Source: Abantika Ghosh