Introduction of Central Govt.Emloyees&Pensioners Health Insurance Scheme (CGEPHIS)

Dear Comrades,
On recommendations of the 6th CPC Now the Govt.of India, Ministry of Health decided to implement Central Government Employees&Pensioners Health Insurance Scheme (CGEPHIS) and now the ministry inviting Expression of Interest from Insurers and Health Insurance Consultants for the proposed scheme.

Brief Facts of the Scheme

The Scheme shall provide coverage of Health Insurance to the family of the beneficiary up to Rs.5, 00,000/- .The total reimbursement of Rs.5 lac can be availed by one individual or all members of the family. There is a sub limit of Rs.50, 000/- per admission.
An additional sum of Rs. 15 crore shall be provided as Buffer / corporate floater to take care of hospitalization expenses of a family (per illness or annual) exceed the original sum insured of Rs 5.00 lac. In all such cases an additional amount up to Rs. 5.00 lac per family shall be provided from the Scheme Floater, on the recommendation of the committee set up by the Central government/ Nodal agency.
Family size/Age limit for
1. Serving Employees: Self, spouse, two dependent children and dependent parents (New born shall be considered insured from day one).
2. Retired Employees: Self, spouse and one dependent child.
3. Additional dependent family member can be covered under the scheme by paying the fixed percentage of premium per additional dependent family member. The premium shall be borne by the beneficiary.
4. All beneficiaries shall be insured till survival.
The definition of dependent shall be as per guidelines issued by Central Government
Insurance Coverage
1. Pre-existing diseases
2. Maternity benefit
3. Day-one Coverage for all diseases
4. New-born babies
5. Pre and Post hospitalization cover of 30 days and 60 days respectively
Domiciliary Hospitalization
The services provided under the scheme are cashless basis through smart card. Views are sought on the industry’s ability to organize free OPD consultation in designated hospitals/nursing homes on panel, free of any charge, in certain designated locations. The OPD coverage is of Rs.10, 000/- per family per annum. Coverage of expenses towards treatment of AIDS may also be sought by the Government which generally happens to be an exclusion in a standard medical insurance policy. There will be a general health check up for all beneficiaries at least once a year. For full notificatio of Health Ministry please click the below link

http://www.mohfw.nic.in/AA-CGEPHIS.doc