Issue of Individual Plastic Cards to each CGHS Beneficiary

Issue of Individual Plastic Cards to each CGHS Beneficiary


The last date for submission of completed application forms in the Dispensary is 31st March, 2009...

CGHS vide Circular No. Misc.6024/2007/CGHS(HQ)/CGHS (P) dated 17/12/2007 made it mandatory for each CGHS beneficiary to have Individual Plastic Card in place of Index Card for the family. All existing CGHS Card Holders in Delhi/NCR, who have not applied for Plastic Cards so far, may apply immediately.
CGHS Card holders are requested to apply for individual Plastic Cards in the prescribed application form and the duly filled in application form may be deposited to Chief Medical Officer In-Charge of their respective Dispensaries.
The last date for submission of completed application forms in the Dispensary is 31st March, 2009.


Clarifications regarding Plastic Cards for Individual CGHS beneficiaries


F.No.11-1/2004-C&P/Pt-XII

Government of India

Ministry of Health & Family Welfare
Department of Health & Family Welfare

Department of Health & Family Welfare

CGHS (P) Division

Nirman Bhawan, Maulan Azad Road,
New Delhi - 110011.

Dated the 15th May, 2009

OFFICE MEMORANDUM

Sub: Clarifications regarding Plastic Cards for Individual CGHS beneficiaries-

With reference to the above mentioned matter the undersigned is directed to state that individual Plastic Cards are being issued to all CGHS beneficiaries in Delhi and NCRT in place of Family Cards. In this regard this office has beenreceiving several queries seeking clarifications and therefore, this Ministry has decided to issue an Office MemorandumClarifying the issues.
It is clarified that:
1. Data of CGHS beneficiaries is available on Data base of Servers located at NIC Headquarters.
2.The individual Plastic Cards are only Identity cards bearing a unique number for each beneficiary, validity for CGHS facilities, name of wellness Centre are available in Data base.
3.The Plastic Cards are issued for a maximum period of Five Years or till entitlled for CGHS benefits, whichever may be earlier. In case of CGHS pensioners who have paid for 'Rest of Life' facilities a new Plastic Cards shall be issued after 'Fiver Years' without any additional contribution. Similarly, New Plastic Cards shall be issued to serving employees after 'Five Years'.
4. The Plastic Cards bear a colour strip on the top side of Card. The Colour of Strip is Blue in case of Serving employees, Green in case of Pensionerbeneficiaries, Freedom Fighters etc.,, Yellow in case of Autonomous Bodies and other and Red in case of Members of Parliament.
5. As of now computerization is under process in cities other than Delhi. After computerization of allCGHS coverd Cities the Plastic Cards will be valid all over India and there is no need for obtaining temporaryattachment while on a visit to another CGHS City.
6. In case of Pensioners applying for CGHS Cards applying for the first time in Delhi, an acknowledgment slip is issued immediately on submission of complete Set of Documents and prescribed subscription fee. The print out Slip is valid for availing CGHSfacilities till Plastic Cards are issued. Individual Plastic Cards are issued within '7' Days after receiving the same from agency appointed for preparation of Plastic Cards. The acknowledgment slips are valid for availing treatment from empanelled hospitals with permission / under emergency.
7. Beneficiaries / Empanelled Hospitals / Diagnostic Centres can verify the Data at
8. Permissions for treatment shall be granted on the basis of ben ID (Beneficiary Identity Number) printed on Plastic Cards. While granting permission Data like the name of Serving employee / Pensioner and the relationship of Individual family member etc., can be verified at http:/cghs.nic.in/welcome.jsp , in case a beneficiary is admitted under emergency.
9. At the time of Submission of Medical Claim the Ben ID number of Serving employee or Pensioner shall be entered on Modified Medical 2004 form as he / she shall be the claimant. Copy of Plastic Card of Patient shall be enclosed along withMedical Reimbursement Claim.
10. In case of loss of Plastic Cards, Serving employee / Pensioner shall apply at CGHS (HQ) for Duplicate Plastic Card along with IPO for Rs.50 / a copy of FIR lodged with Police, a copy of lod Card. A 'print out slip' shall be issued immediately for availing CGHSfacilities and Plastic Card after '7' Days. In case of serving employees the application shall be forwarded by the his / her department.
11. In case of change in residential address and shifting from one dispenasry to another, CMO I/C of Dispensary shall make modifications inData base and transfer the cards to new dispensary. CMO i/c of new dispensary shall accept transfer of Card and Data shall be transferred to new dispensary.
12. In case of superannuation / transfer to another city, serving employees get the card deleted from Data base at Dispensary andobtain a certificate from CMO i/c and surrender the card to his / her department. Department shall issue a surrendercertificate to employee for getting a new Card at another city (if covered under CGHS) or for obtaining apensioners CGHS card in case of superannuation.
13. It is compulsory to bring original Plastic Cards every time for availing CGHS benefits.
14. All nenficiaries entitled for semi-private ward in empanelled private hospitals are eligible for Nursing Home facilities in Govt. Hospitals and those entitled for Private ward are eligible for Direct Consultation with specialists in Govt. Hospitals. Similarly,beneficiaries entitled for Private ward in empanelled private hospitals are also eligible for Private ward facilities at A.I.I.M.S., New Delhi. No separate endorsement is required for these criteria.
JAIPRAKASH
UNDER SECRETARY TO GOVERNMENT OF INDIA



APPLICATION FOR CGHS CARD for PENSIONERS OF CENTRAL GOVERNMENT


1. Name of the Applicant: …………………………………………………………………………………………………

2. Category Pensioners Others (Pl.Specify)

…………………………………….


3. Name of Department / Service from where retired


4. Last Pay / Basic Pension: …………………………………………………………………………..
( in case of Pensioners) ( Pre-revised)


5. Residential Address:…………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………

6. Telephone Number: ( R ) ( M )

7. e-mail ID ………………………………………………………………………..

8. Date of Superannuation: _ _ / _ _ / _ _ _ _
Date Month Year
9. Details of Family

{* Please see definition of Family before filling up this column}

S.No. Name of Family member Relation ship to CGHS Card Holder* Date of Birth#
(Compulsory) Blood Group
(optional)
Self

{# Please attach Proof of age of Persons mentioned above}

10. Are all the persons whose names are given above are dependant upon you and are residing with you? Yes / No

{Please attach proof of their staying with you , like copy of Ration Card / Election ID / Pass Port / Identity Card issued by College / School / University / Bank Pass Book , etc., }

11. Paste one ID Card size of Photograph of each member of Family (including self) whose names are proposed to be included as part of your family in the space given below.

I Undertake to intimate to CGHS immediately if there is any change in dependency criteria of my family members included in this application form. If I fail to intimate and if the CGHS comes to know of the change then the CGHS facility is liable to be withdrawn by the CGHS and the CGHS and / or appropriate authority will be free to initiate any action against me.

I Undertake to surrender the CGHS Card(s) on ceasing to be eligible for CGHS benefits.

I certify that the information furnished by me in this application has been verified to be correct and that no information has been concealed or has been misrepresented and I stand by the same.

Encl. Proof of Residence / Stay of dependents
Proof of age of son/ Disability certificate
Surrender Certificate of CGHS Card while in service
Attested copies of PPO & Last Pay Certificate



DD bearing No…………………………….dated ……………………….drawn on Bank ……………………………….Branch ……………………………………………../ Postal Order No. ……………………………….. for Rs……………………



Signature of Applicant.


To
The Additional Director, CGHS(HQ), 9, Bikaner House Hutments, Shahjahan Road, New Delhi.


Verified – by Authorized Signatory, CGHS(HQ) valid upto…………/………/……………… / for Rest of Life


. CGHS Dispensary Allotted ………………………………………………….

* ( to be filled by CGHS )




Signature

INSTRUCTIONS


Definition of Family:

(1 ) Husband / Wife* (* First wife only)
(2 ) Dependant Parents / Step Mother ( in case of adoption , only adoptive & not real parents)
(3 ) If adoptive father has more than one wife , the first wife only.
(4 ) A female employee has a choice to include either her dependent parents or her dependent parents – in law ; option exercise can be changed only once during service .
(5 ) Children including legally adopted children , step children and children taken as wards subject to the following conditions:

(i) Son Till he starts earning or attains the age of 25 years , whichever is earlier.
(ii) Daughter Till she starts earning or gets married, irrespective of the age limit , whichever may be earlier.
(iii) Son Suffering from any permanent disability of any kind (physical or mental ) as defined below Irrespective of age limit.

(iv) Dependent divorced / abandoned or separated from their husband / widowed daughters and dependent unmarried / divorced abandoned or separated from their husband / widowed sisters Irrespective of age limit.

(v) Dependent Minor brother(s ) Upto the age of becoming a major.

For the purpose of availing CGHS facility for a disabled sons above 25 years , please attach a copy of n the certificate of disability issued by the competent authority.

‘Disability’ will be AS DEFINED IN SECTION 2(1) OF ‘THE PERSONS WITH DISABILITIES (EQUAL OPPORTUNITIES, PROTECTION OF RIGHTS AND FULL PARTICIPATION ) ACT ,1995 (NO: 1 OF 1996 )’ WHICH IS REPRODUCED BELOW:
“(1) “DISABILITY’ MEANS
(I) BLINDNESS
(II) LOW VISION
(III) LEPROCY CURED
(IV) HEARING IMPAIRMENT
(V) LOCOMOTOTR DISABILITY
(VI) MENTAL RETARDATION
(VII) MENTAL ILLNESS ”
(VIII)

Dependency:

Members of family (other than spouse) whose income is less than Rs.3500/-+DA per month are treated as dependents and are normally residing with CGHS beneficiary.

The Following Documents are to be enclosed:
(I) Proof of Residence / Stay of dependents –{ copy of Ration Card / Election ID / Pass Port / Identity Card issued by College / School / University / Bank Pass Book , etc.,}
(II) Proof of age of son -
(III) Attested Copy of Disability certificate issued by Competent Authority( in case of dependent son aged 25 and above )
For Pensioners applying for CGHS card for the First time the following Additional Documents are required:

(IV) Surrender Certificate of CGHS Card while in service.
(V) Attested copies of PPO & Last Pay Certificate
Contribution by Pensioners should be made by Bank Draft ( Scheduled Banks ) payable in Delhi in favour of “Pay & Accounts Officer CGHS , New Delhi”.





CGHS Card No while in service : ----------------------------------


APPLICATION FOR CGHS CARD for PENSIONERS of AUTONOMOUS BODIES




1. Name of the Applicant: …………………………………………………………………………………………………


2. Name of Autonomous Body from where retired………………………………………………………………………………..

3. Last Pay / Basic Pension: …………………………………………………………………………..
( in case of Pensioners)


4. Residential Address:…………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………

5. Telephone Number: ( O ) ( R ) ( M )

6. e-mail ID


7. Date of Superannuation: _ _ / _ _ / _ _ _ _
Date Month Year
8. Details of Family
{* Please see definition of Family before filling up this column}
S.No. Name of Family member Relation ship to CGHS Card Holder* Date of Birth#
(Compulsory) Blood Group
(optional)
Self













{# Please attach Proof of age of Persons mentioned above} (P.T.O.)

9. Are all the persons whose names are given above are dependant upon you and are residing with you? Yes / No

{Please attach proof of their staying with you , like copy of Ration Card / Election ID / Pass Port / Identity Card issued by College / School / University / Bank Pass Book , etc., }

10. Paste one ID Card size of Photograph of each member of Family (including self) whose names are proposed to be included as part of your family in the space given below.


I Undertake to intimate to CGHS immediately if there is any change in dependency criteria of my family members included in this application form. If I fail to intimate and if the CGHS comes to know of the change then the CGHS facility is liable to be withdrawn by the CGHS and the CGHS and / or appropriate authority will be free to initiate any action against me.

I Undertake to surrender the CGHS Card(s) on ceasing to be eligible for CGHS benefits.

I certify that the information furnished by me in this application has been verified to be correct and that no information has been concealed or has been misrepresented and I stand by the same.

Encl. Proof of Residence / Stay of dependents
Proof of age of son/ Disability certificate
Surrender Certificate of CGHS Card while in service
Attested copies of PPO & Last Pay Certificate



Signature of Applicant.

(TO BE FILLED BY THE SPONSORING AUTHORITY )
The information furnished by the applicant has been verified and found to be correct. It is recommend that a CGHS Card be issued to Shri /Smt. /Kumari ……………………………………………………….., Designation ………………………………. In this Ministry / Department / Organization. Instructions are issued to the concerned Division to start deducting CGHS Subscriptions every month from the salary of the applicant / CGHS Subscriptions are deducted every month from the salary of the applicant. I am authorized sponsoring authority for the issue of CGHS Card and approval of the Competent authority has been obtained.
** Enclosed DD bearing No…………………………….dated ……………………….drawn on Bank ……………………………….Branch …………………………………………….. for Rs……………………
** in case of Pensioners of Autonomous bodies entitled for CGHS facilities.
No.
Date Signature & Name of the Sponsoring Authority
Designation (Stamp ) with Tel. Number
To
The Additional Director, CGHS(HQ), 9, Bikaner House Hutments,

Verified – by Authorized Signatory, CGHS(HQ) valid upto…………/………/………………

CGHS Dispensary Allotted ………………………………………………….
* ( to be filled by CGHS )
Signature with Stamp ( for CGHS pensioners making card First Time)

INSTRUCTIONS


Definition of Family:

(1 ) Husband / Wife* (* First wife only)
(2 ) Dependant Parents / Step Mother ( in case of adoption , only adoptive & not real parents)
(3 ) If adoptive father has more than one wife , the first wife only.
(4 ) A female employee has a choice to include either her dependent parents or her dependent parents – in law ; option exercise can be changed only once during service .
(5 ) Children including legally adopted children , step children and children taken as wards subject to the following conditions:

(i) Son Till he starts earning or attains the age of 25 years , whichever is earlier.
(ii) Daughter Till she starts earning or gets married, irrespective of the age limit , whichever may be earlier.
(iii) Son Suffering from any permanent disability of any kind (physical or mental ) as defined below Irrespective of age limit.

(iv) Dependent divorced / abandoned or separated from their husband / widowed daughters and dependent unmarried / divorced abandoned or separated from their husband / widowed sisters Irrespective of age limit.

(v) Dependent Minor brother(s ) Upto the age of becoming a major.

For the purpose of availing CGHS facility for a disabled sons above 25 years , please attach a copy of n the certificate of disability issued by the competent authority.

‘Disability’ will be AS DEFINED IN SECTION 2(1) OF ‘THE PERSONS WITH DISABILITIES (EQUAL OPPORTUNITIES, PROTECTION OF RIGHTS AND FULL PARTICIPATION ) ACT ,1995 (NO: 1 OF 1996 )’ WHICH IS REPRODUCED BELOW:
“(1) “DISABILITY’ MEANS
(I) BLINDNESS
(II) LOW VISION
(III) LEPROCY CURED
(IV) HEARING IMPAIRMENT
(V) LOCOMOTOTR DISABILITY
(VI) MENTAL RETARDATION
(VII) MENTAL ILLNESS ”
(VIII)

Dependency:

Members of family (other than spouse) whose income is less than Rs.3500/-+DA per month are treated as dependents and are normally residing with CGHS beneficiary.

The Following Documents are to be enclosed:
(I) Proof of Residence / Stay of dependents –{ copy of Ration Card / Election ID / Pass Port / Identity Card issued by College / School / University / Bank Pass Book , etc.,}
(II) Proof of age of son -
(III) Attested Copy of Disability certificate issued by Competent Authority( in case of dependent son aged 25 and above )
For Pensioners applying for CGHS card for the First time the following Additional Documents are required:

(IV) Surrender Certificate of CGHS Card while in service.
(V) Attested copies of PPO & Last Pay Certificate
Contribution by Pensioners should be made by Bank Draft ( Scheduled Banks ) payable in Delhi in favour of “Pay & Accounts Officer CGHS , New Delhi”.