OFFICIAL ORGAN OF THE BHARAT PENSIONERS SAMAJ, NEW DELHI - 110 014

(Federation of All India Pensioners’ Associations)

(MEMBER, INTERNATIONAL FEDERATION ON AGEING, TORONTO, CANADA)

DIRECT SUCCESSOR TO “PENSIONER” ESTD IN 1955

SPECIAL SUPPLEMENT APRIL 2010REGD. No. DELBIL/2006/17678

Pensioners Hand Book 2010

Guidelines for

CENTRAL GOVERNMENT

RETIRING OFFICIALS AND PENSIONERS

(Including Rlys)

Compiled & edited by :S. C. Maheshwari

BHARAT PENSIONERS SAMAJ

PB - 3303, Jangpura, Delhi - 110 014 [Office Ph - 2437 6642]

(Summer Timings : 9.30 am to 1.30 pm only)

Only for Esteemed Members and Dedicated Affiliates in exchange for

their love and devotion for BHARAT PENSIONERS SAMAJ

Restricted

Circulation

Pensioners Hand Book

2010

Guidelines for

CENTRAL GOVERNMENTRETIRING OFFICIALS AND

PENSIONERS (Including Rlys)

Dedicated to Unsung Heroeswho laid down their liveswhile serving the Country

Compiled & edited by :S. C. Maheshwari

Formerly DEN, C. Rly,Secretary (Rlys) Bharat Pensioners Samaj

General Secretary RREWA Gurgaon

Published by:BHARAT PENSIONERS SAMAJPB - 3303, Jangpura, Delhi - 110 014

Printed by :COMPUDATA SERVICES42, DSIDC Shed, Scheme - IOkhla - II, New Delhi - 110 020

PREFACE

The 6th Central Pay Commission submitted its Report to the Government

of India on 24th March, 2008. The Union Cabinet broadly accepted its

recommendations on 14th August, 2008. The Government Resolution in this

regard was published in the Gazette of India on the 29th August, 2008. Orders

for revision of pension of pre-2006 pensioners / family pensioners were

issued on the 1st September, 2008. Several other orders including

clarifications were issued during the last nearly two years.

2. For some time past, the need was being felt for a compact Handbook

for pensioners & family pensioners. Such a Handbook should give, in a

simple language, the broad pension policy governing pre-2006 pensions,

the basic rules, the procedures and regulations in regard to sanctioning and

disbursement of pension and retirement benefits. Apart from the financial

benefits, pensioners are interested to know as to what medical facilities are

available to them. We are glad to say that this need has been fulfilled with

this Hand Book written by our Secretary (Railway Pensioners), S C

Maheshwari. We are sure that our learned Members and Affiliated

Associations would find it both interesting and useful.

3. As our esteemed readers are aware, we published two Special

Supplements of our monthly journal "BHARAT PENSIONER" in 2008. The

first one, was published immediately, in April, 2008, after the 6th CPC

submitted its Report. The 2nd Supplement, in a book form, was published in

September, 2008, i.e., as soon as the first implementation Order was issued

on 1st September, 2008 as mentioned above.

4. The present Hand Book would, therefore, be the 3rd Special Supplement

of 'BHARAT PENSIONER' published in the wake of the recommendations

of the 6th Central Pay Commission. As in the past, we have decided to supply

a copy, free of cost, to each Member in accordance with the Rules &

Regulations of BHARAT PENSIONERS SAMAJ. Everyone is, of course,

keen to support our beloved BHARAT PENSIONERS SAMAJ

FINANCIALLY; hence to begin with, each one of us, I am sure, would

demonstrate it too with a token Special Donation of Rs 100 only forthwith,

by Money Order. An MO form accordingly has been printed and pasted in

the Hand Book itself. What you have to do it to simply fill it up with your

(Sender's) name & postal address and hand it over at a Post Office Counter

with the requisite amount.

Shyam Sunder

Secretary General

Dated 2nd April, 2010 BHARAT PENSIONERS SAMAJ

FOREWORD

Pensioners, even highly educated ones, suffer lot of hardship

in getting fair deal at the hands of administration, more out of

ignorance than indifference on the part of the latter. I have come

across a case of a pensioner, retired at the level of Chief Engineer

in a department of Union Government, whose pension was not

fixed properly even at the time of the Fifth Pay Commission and

its effect compounded now after the Sixth Pay Commission.

There are innumerable cases of retirees who suffer untold misery

particularly in the advanced age and poor health, in securing even

small facilities they are rightfully entitled to and have to run from

pillar to post for the same.

Retired Railway Employees Welfare Association (RREWA)

has been rendering yeoman’s service in creating awareness

amongst pensioners, not only from Railways but also from all the

departments of Government, and interceding on their behalf with

Department of Pension and Pensioners’ Welfare and other

Ministries of the Union Government. The Association, under the

able stewardship of Shri S C Maheshwari, has succeeded in

securing relief to the pensioners in a number of areas in an effort

to improve their lot.

An attempt has been made in the present venture to bring

together a large number of issues relevant to the retirement and

the retired life. The Hand Book, very rightly, draws attention to the

need for taking action well before the retirement to ensure not only

trouble free transition from life during active service to peaceful

retired existence but also to provide for an unfortunate situation of

death in harness. Overview of the retirement benefits is quite

comprehensive. Detailed coverage of the problems that can be

encountered in the eventuality of the demise of the pensioner and

advance planning for the situation can not be over emphasized.

Coverage on End of Life Issues and a comprehensive note on the

significance of will is very useful.

P C Sharma IRTS (Retd)

[Former Advisor Safety,

Railway Board]

(ii)

INTRODUCTION

The Hand Book for PENSIONERS/Family Pensioners which

is first of the series, give the salient features of the pension policy

governing pre 01.1.2004 employees of the Central Government

and attempts to highlight the basic rules, the procedures and

regulations governing the sanctioning and disbursement of

pension and retirement benefits, in the process all relevant

aspects central to pension policy like qualifying service, record of

service and operational aspects relating to processing of pension

papers, nominations to be made have also been highlighted. This

Pensioners/Family Pensioners guide also contains other relevant

information on health, banking procedures, etc. that are relevant

for pensioners. While the Handbook gives a general Overview on

matters relating to pension, Government Servants and Pensioners/

Family Pensioners are advised to consult the original rules/

orders if necessity arises, for more specific information. Please

visit the websites www.rrewa.org. & http://pensionersportal.gov.in/

The Handbook is being published for wider dissemination of

information to bring about better awareness on pensionary & old

age related matters. By giving a wide coverage, this Handbook&

the referred web sites, it is felt will serve the needs of retiring

officials, pensioners/Family pensioners in understanding the

broad pension policy of the Central Government in case of pre

1.1.2004 entrants.

Before bringing out the Hand book, to facilitate easy access

publishers have made available at website www.rrewa.org all the

relevant circulars and orders issued by the Department of Pension.

Rly Board & other Govt. Agencies. Also the relevant rules and

govt. policies on the subject are posted on to the website

www.rrewa.org It will be our endeavor to keep the dissemination

channel on the Internet online & up-to-date for the benefit of

Associations of Pensioners, Pensioners/Family pensioners and

serving employees of the Government /Sr Citizens.

Suggestions for improvement of the Hand book are welcome.

S.C.Maheshwari

Former DEN, C Rly Secretary (Rlys), Bharat Pensioners Samaj

General Secretary, RREWA ,Gurgaon

Contents

Part I Basics for Retiring officials 1-9

General; Retirement benefits; Service records;

Qualifying Service, verification of Service; Nominations;

Will; Occupation of Government accommodation, Point

of Retirement; Quantum of Retirement benefits;

Processing &finalizing pension papers; Provisional

pension; Sanction of family Pension

Part II Overview of Retirement benefits 10-22

Entitlement and Quantity, Persons Eligible for Pension;

When is pension given; Classes of Pension; Pension

Constituents; How Pensionary Benefits are worked

out:- Pension; Commutation of Pension; Retirement

Gratuity; Dearness relief: Death Gratuity for family;

Family Pension; Non Pensionary Retirement Benefits:-

Provident Fund Account; Central Government

Employees Group Insurance Scheme; Travelling

allowance etc; Medical facilities for pensioners

Part III Basics for Pensioners 24-38

Pension Disbursement:- Disbursement of pension

by the Banks; Disbursement of Pension to NRI

pensioners, Receipt of two pensions; post retirement

conviction/imprisonment: Know your PPO, Post

retirement changes in the Family; Certificates required

by a Bank from pensioners; Drawal of pension by infirm

Pensioners; Transfer of pension; Restoration of

commuted Portion of Pension; Life time arrears;

Recovery of excess or wrong payment; Issue of

duplicate PPO, Disbursement of Family pension,

Procedure claiming Family Pension; Certificates to be

furnished by the family pensioner to the pension

disbursing agency. Miscellaneous; Grievance redressal.

Annexures

I: Commutation Table 39

II: Forms 40

III : End of life issues 63

IV : Will; Annexure 66

V : Healthy ageing 76

VI : CGHS 82

VII : RELHS - 97 137

Bibliography Back TitlePage

PART - I

BASICS FOR RETIRING OFFICIALS

SECTION 1 - GENERAL

1.1. You are a government employee and regularly interact with your

office colleagues and the members of public in the discharge of your

official duties. You have possibly served in different positions for over

30 years since the day you joined service. Time flies. Occasional

farewell functions of your erstwhile colleagues sometimes do remind

you of your own impending retirement but the thought of retirement

vanishes as quickly as it comes.

1.2. In service, you have had the unique opportunity to serve the

country and the society. The service span spread over three decades

or more looks infinite to begin with. Your office going becomes an

addiction. Time passes, and suddenly you realize that the day of

retrospection and parting has arrived. The service was rewarding but

also taxing. You are now entitled to a well-deserved peaceful and quiet

retirement. To ensure that you are not caught unawares, and you and

your family get all the retirement benefits in time, it is essential that you

acquaint yourself and know in good time the basics of Pensionary

benefits and policy relating thereto. A careful perusal of this handbook

will help you to achieve a smooth transition from the life of an active

civil servant to a contented and informed pensioner.

SECTION 2 - WHAT YOU SHOULD KNOW ABOUTRETIREMENT

1.3. Retirement benefits for pre 01-01-04 entrants comprises:-

(a) Pension with an option to commute a lump sum amount of upto

40% of the monthly pension;

OR

Service gratuity in case total qualifying service is less than 10

years when no pension is admissible.

(b) Retirement or Death Gratuity if you have rendered a minimum of

5 years qualifying service.

(c) Family Pension for eligible spouse and children in the case of

death of Government servant, while in service or after retirement.Dependent parents and siblings (i.e. Brother/sister) are alsoentitled to family pension when their turn comes

1.4. In addition, there are certain non-Pensionary

retirement benefits/payments, which include.

(a) General Provident Fund, accumulations inclusive of interest

thereon.

(b) Encashment of earned leave to the credit of the retiring Government

servant on the date of retirement subject to a maximum of 300

days.

(c) Accumulated amount in the Saving Fund segment together with

the interest under the C.G.E.G.I.S.

(d) Insurance cover benefit under the Central Government Employees

Group Insurance Scheme (CGEGIS) to the family in the event of

death of Government servant while in service.

(e) Travelling Allowance to the pensioner and his family, at the scale

applicable to him while in service, for travel to the home place

within India, as declared by him and entered in his service records,

for post-retirement settlement.{In addition to travelling allowance,

Railway Retirees are also entitled to KIT/Cattle wagon passes /

Transport allowance according to their status &date of appointment

for shifting their belongings to the place of settlement within India }

(f) CGHS /RELHS/ECHS facilities or medical allowance,

1.5 The determination of your entitlement for Service Gratuity,

Pension and DCRG is dependent inter-alia on the length of qualifying

service. This information will be available in the Service Book / Service

Record, being maintained by the administrative authorities for all

employees on their rolls.

1.6. SERVICE RECORD

(a) A service book starts as soon as you enter service and contains

records of all prominent events such as appointment, confirmation,

promotion, grant of increments, grant of leave, awards, punishment

etc., occurring in one’s service career. The service book also

contains entries relating to verification of service from time to

time and the total length of service.

(b) Rules require every Head of Office to show the service book to

the respective employee every year. It is the duty of every Head

of Office to initiate action to show the Service Books to the

Government servants under his administrative control every

year and to obtain their signatures therein in token of their having

inspected the Service Books.

(c) It will not take much time for you to have a look at your service

book once a year to ensure that all relevant entries have been

properly recorded. This will save you a lot of bother at the end of

your service. So please do insist on verifying your Service Book

entries once a year and get the deficiencies if any remedied

immediately. A copy of the service book is also available on

payment of a nominal fee. It is advisable that you obtain a

certified copy of your service record at the time of retirement

1.7. QUALIFYING SERVICE

The rules governing computation of qualifying service for the

employees retiring from the service in the civilian departments are

contained in Chapter III of the Central Civil Services (Pension) Rules,

1972 and the corresponding rules applicable to employees of Defence

services and Railways. Service rendered in State Governments/

Central or State autonomous organizations prior to joining the Central

Government is also reckoned for computation of pensionary benefits

under the Central Government in certain specified circumstances. In

case you have any service of the nature mentioned above and the

requisite conditions are satisfied, please ensure that suitable entries

/ mention has been made in your Service Book, well in time, i.e. when

the events are fresh and records are easily available.

1.8. VERIFICATION OF SERVICE

Rule 32 of the Central Civil Service (Pension) Rules, 1972 requires

Heads of Office to verify the service rendered by each Government

servant under his administrative control and determine the qualifying

service on completion of 25 years of service or 5 years before the date

of his retirement, whichever is earlier, and communicate the same to

him in the Form prescribed for this purpose. If you have reached this

milestone and have not been told of your “qualifying service” please

ask for it.

1.9. NOMINATIONS

(a) One may not like it, but it is essential and never too soon to make

proper provision for one’s money and effects in the unforeseen

eventuality of death. This will relieve one’s dependents and dear

ones of considerable amount of hardship and trouble.

(b) Nominations are allowed for enabling the nominee(s) to receive

the following in the event of death:

(i) Provident Fund dues

(ii) Death Gratuity

(iii) Benefits under Central Government Employees Insurance

Scheme

(iv) Life time arrears of pension / retirement gratuity and leave

encashment.

(c) In the absence of a nomination, the family members may be

subjected to considerable hardship and hassles in the process

of obtaining a succession certificate to claim dues. This involves

both time and money. Therefore, please file your nomination in

the prescribed formats with your administrative authority. You

are free to change your nominations whenever your priorities

change.

(d) Nominations in the case of lifetime arrears (LTA) of pension are

to be filed before retirement with the Heads of office along with

the application for pension. The pensioner can also file

subsequent modifications to nominations with the respective

pension disbursing authorities.

(e) In the case of pensioners drawing pension from Banks, the

nomination referred to in the preceding paragraph will apply only

to that amount which has not been drawn and credited to their

respective Bank Accounts at the time of death. For the amounts

already credited to the account, the normal banking laws and

procedures govern the pensioners. Incidentally, bank regulations

provide for nomination by the account holder in respect of the

balance amount standing to his credit in the event of death. You

may approach your designated bank and insist on making such a

nomination in addition to the nomination filed with the Head of Office.

Note: Forms required are given in Annexure II

1.10. WILL

You will also have other moneys and effects for which a proper provision

may be necessary. A proper ‘Will’ is the answer for this purpose. The

‘Will’ ensures that intestate provisions do not apply. There are various

ways in which a ‘Will’ can be made. It is best to consult a lawyer who will

provide you the guidance in this behalf. For details: please refer to

Annexure IV: “Will”

1.10 (a) What you should know to safeguard your & your family’s interest

and what your Spouse & close relatives should know: - Please

refer to Annexure III : “End of the life issues”

1.10 (a) How should you plan your post retirement? Please refer to

annexure V “Healthy ageing. For references see Bibliography at

the END

1.11. OCCUPATION OF GOVT ACCOMMODATION

(a) In case you are in occupation of Government accommodation, you

should know that there is a regular system of issue of ‘No Demand’

Certificate annually by the Directorate of Estates/Personnel/

Accounts Branch. Please ensure that this periodical ‘No Demand’

certificate is obtained by you.

(b) A reference is required to be made to the concerned Estate

Manager/Personnel/Accounts branch by the Head of Office at least

two years before the anticipated date of your retirement for updating

the rent recovery record. Please ensure that your Head of Office

makes the reference to the Estate Manager/Personnel branch in

this behalf when you reach this milestone.

Note: Govt has the right to withhold gratuity in case non-vacation of govt

accommodation before retirement.

1.12. POINT OF RETIREMENT:

You will retire from service on the last day (afternoon) of the month in

which you attain the age of superannuation, which is presently 60 years.

In the case of those, whose birthday falls on the first of a month, the

date of retirement is the last day (after noon) of the preceding month.

You are however free to select your date of retirement in the following

circumstances: -

(a) Voluntary retirement (VRS) on completion of 20 years’ or more

of qualifying service

(b) Premature retirement on attaining the age of 50 years in case

or Group ‘A’ and Group ‘B’ officers and 55 years in the case of

Group ‘C’ and Group ‘D’ officials

Note: (a) The Govt. servant retiring on superannuation should

formally relinquish charge of office on the afternoon of that day itself

even if it happens to be a closed holiday.  The cash, stores, etc. may

be made over by the retiring officer on the close of the previous

working day.  The actual relinquishment of charge of office shall be

made in the prescribed form on the last day of service for which the

physical presence of the officer in the office need not be insisted. –

(F.R. 56 GOI Decision (3).

1.13. QUANTUM OF RETIREMENT BENEFITS

A broad overview of the retirement benefits together with quantum,

admissible to Central government employees is given in Part II of the

Handbook. The write-up indicates normal entitlements under the

Pension Rules. If any clarification or additional information is required

in regard to any specific provision, you may like to consult appropriate

rules and orders issued by the Government. Pensionary entitlements

under special circumstances such as under Extraordinary Pension

Rules have not been included in this Handbook.

SECTION 3 - PROCESSING / FINALISATION

OF PENSION PAPERS

1.14. PROCESSING OF PENSION PAPERS

(a) Your Head of Office processes pension claims. In the event of

death of an employee in harness, the Head of Office is also

responsible for settling the family’s entitlements of the terminal

benefits.

(b) The process for sanctioning your pension claims is to be

initiated by the Head of Department twenty-four months in

advance of the retirement date.

(c) Eight months prior to the retirement date, you are to furnish

certain information (e.g. joint photograph with your spouse,

family details with their date of birth, name of the Bank & A/c

Number through which you desire to draw your pension etc.) to

your Head of office in the prescribed form. Make enquiries from

your office in case you do not receive any intimation from the

Head of office in this regard.

{As joint pension account with spouse in Banks is now permitted,

it is advisable to open a joint A/C with your spouse (CPAO/Tech/

Amendments/Sch.Book/2005-06/69 dated 9.6.2005)}

(d) The Head of office is required to send complete pension papers

to the Accounts officer not later than six months before the date

of retirement.

(e) Dues owed by the retiring employees on account of license feefor Government accommodation, advances, overpayment ofpay and allowances are required to be assessed by the Head ofOffice and intimated to the Accounts officer two months inadvance of the date of retirement so that these are recoveredfrom retirement gratuity before payment. For this purpose thelicense fee for those in occupation of Governmentaccommodation is taken into account upto the end of thepermissible period for which accommodation can be retainedafter retirement under the rules on normal rent. The recovery ofthe license fee beyond that period is the responsibility of theDirectorate of Estates. If, for any reason final dues cannot beassessed in time, then 10% of gratuity wil be withheld f temporarily.

(f) The Pay & Accounts Officer (PAO)/FA&CAO {in case of Rlys}who finally sanctions pension, is required to ensure that yourPension Payment Order (PPO) is dispatched to the CentralPension Accounting Office not later than one month in advanceof the retirement date. You will receive intimation thereof from the

PAO.

(g) However, for Rly pensioners FA & CAO sends PPOs directly tothe Accountant General, Director of Accounts (Postal) or PublicSector Bank, as the case may be, where the payment of pensionis to be arranged through Treasury, the Accounts Officer will

issue the PPO, duly signed and embossed seal affixed on it tothe concerned Treasury Officer.

15. Your cooperation with the Head of Office is vital for you to ensuretimely settlement of your claims. Please ensure that you submit yourpapers and furnish all relevant information in good time. This willenable the administration to complete formalities and issue yourPension Payment Order before you retire.

1.16 PROVISIONAL PENSION

(a) If any delay is anticipated in the sanction of your Pensionarybenefits, the Head of Office is required to sanction provisionalpension and provisional gratuity and also make arrangementsfor payment thereof on due dates.

(b) Rules also provide for grant of provisional pension wheredepartmental or judicial proceedings are pending at the time ofretirement. However, in such cases, gratuity is not released andthe commutation of pension is also not allowed pending settlementof departmental / judicial proceedings.

1.17 SANCTION OF FAMILY PENSION

Entitlement of family pension is also sanctioned at the same time aspension and indicated in the PPO. After the death of the pensioner, thedesignated disbursing authority or the branch of the bank that wasdisbursing the pension during pensioners’ lifetime, as recorded, willdisburse family pension, straightaway. In such cases, no separatesanction for family pension is required.

SECTION 4 - MISCELLANEOUS

1.18. INTEREST ON DELAYED PAYMENT

You are entitled to receive interest on the amount of retirement gratuityif its payment is delayed for administrative reasons beyond a periodof 3 months; the prescribed rate of interest is at par with the interestrate admissible on the balances in the General Provident Fund, which,at present, is 8% per annum. Interest is not payable on pension orcommuted pension even if there is delay.

1.19. MODE OF PENSION DISBURSEMENT

Retiring employees have an option to draw their pension through:

(i) Pay and Accounts Officer attached to the office from which

they retire, or

(ii) Treasury of the place where they permanently settle down

after retirement, or

(iii) A branch of the public sector bank (PSB) entrusted with

disbursement of pension on behalf of the Central Government

at the intended place of their residence after retirement, or

(iv) A few approved private sector banks.

1.20. Drawal of pension through Pay and Accounts Offices or

through the Treasuries involves claiming Pension every month

by presentation of a bill by the pensioner. Drawal of pension

through public sector banks is simpler as the bank automatically

credits the pension to the bank account of the pensioner every

month.

For this purpose pensioners are required to open an account in

their own name or jointly with spouse in the Branch of the public

sector bank through which they wish to draw their pension. Joint

Account with spouse is permitted. It will be in your interest to

operate this account solely for the purpose of pension without

maintaining other transactions in this account. This will enable

you to keep a watch on the amount of pension and dearness

relief credited to your account by the bank from time to time.

This will also help you to verify with the Bank authorities

immediately on receipt of higher or lower pension. This will

facilitate timely reconciliation and avoid the possibility of the

bank effecting any recovery at a later date.

1.21. Retiring employees of the Department of Posts can draw

pension through post offices or through Banks. This facility of drawing

pension through Post Offices is not available to other pensioners

except those belonging to Railways. Those drawing pension from Post

Offices can also avail of the facility of having their monthly pension

credited to their post office saving bank account at places where saving

bank facilities are available in the concerned Post Offices. This will

enable them to draw their pension {without the need for presenting

themselves in person with a bill every month} in the same manner, bywhich other pensioners draw their pension through public sector

BBBanks.Existing P.O. Pension A/cs can be transfered.

PART - II

OVERVIEW OF RETIREMENT BENEFITSSECTION 1 - ENTITLEMENT

AND QUANTITY

2.1. PERSONS ELIGIBLE FOR PENSION

(a) A Central Government civilian employee in pensionable service.

(b) He must be permanent at least in one post, not necessarily in the

last post held.

(c) Quasi-permanent and temporary employees retiring on

superannuation pension/invalid pension after rendering not less

than 10 years service. He is also entitled to seek voluntary

retirement after completion of 20 years service.

Please Note:

(i) An employee who is dismissed or removed from service forfeits

his pension. The competent authority may, however, in cases

deserving special consideration, decide to sanction

compassionate allowance, as per the scale laid down in the

rules;

(ii) Resignation from service entails forfeiture of past service.

2.2. WHEN IS PENSION GIVEN

Pension is payable after you attain the age of retirement

(superannuation) and is payable upto &including the day of death

irrespective of time of death

Full Pension is also payable before superannuation age on voluntary

retirement after rendering 20 years or more of qualifying service. Pro-

rata pension in case of less than 20 years of qualifying service (w.e.f

1.1.06) is also payable to permanent Government servants - on

absorption in a PSU/Autonomous Body - provided the Government

servant has rendered not less than 10 years qualifying service under

Government prior to absorption.

Family pension is payable to an eligible family member on the death

of an employee while in service or after retirement. The following

are as present covered in the definition of ‘family’ in relation to a

Government servant/Pensioner for the purpose of eligibility for family

pension:

(a) Wife in the case of a male Government servant, or husband in the

case of a female Government servant;

(b) A judicially separated wife or husband, such separation not being

granted on the ground of adultery and the person surviving was

not held guilty of committing adultery;

(c) Son/Daughter upto the date of his/her marriage or till the date he/

she starts earning, or till the age of 25 years ( in case of son only),

whichever is the earliest;

(d) Unmarried/widowed/divorced daughter, upto the date of marriage/

remarriage or till the date she starts earning, whichever is earliest;

and

(e) Son or Daughter suffering from any disorder or disability of mind

including mentally retarded or is physically crippled or disabled or

blind so as to render him or her unable to earn a living even after the

age of 25 years ( admissible to unmarried only)

(f) Parents who were wholly dependent upon Government servant

when he/she was alive provided the deceased employee has left

behind neither a widow nor a child.

(g) The dependent disabled siblings (i.e. brothers/sisters) of

Government servants/pensioners have also been included in the

definition of ‘family’ for the purpose of eligibility for family pension

on their turn.

Further, the dependency criteria for the purpose of family pension

has been revised and fixed as the minimum family pension, along

with the dearness relief thereon, DOP & PW O.M. No. 38/37/08-

P&PW (A) dt. 2, 9.2008,

2.3. CLASSES OF Pension:

Pension granted may be may be:

Superannuation Pension / Retiring Pension

Invalid Pension

Compensation Pension

Compulsory Retirement Pension or Compassionate Allowance.

2.4. PENSION CONSTITUENTS

Pensionary benefits are made up of the following: -

– Pension subject to a minimum of Rs.3500 per mensem (w.e.f1.1.06) and a maximum of upto 50% of the highest pay inGovernment.

– Lump sum payment resulting from commutation of a portion(upto 40%) of pension.

– Retirement/death gratuity not exceeding Rs.3.5 lakhs .thislimit raised to 10 lac w.e.f 1.1.06

– Family Pension in the event of death of employee / pensioner :Enhanced family pension @ 50% of the last pay drawn immediatelybefore retirement of the employee / Pensioner upto 7 years after

the death of the government servant/ pensioner or upto the age

of 67 years{of the employee/Pensioner had he been alive} which-

ever is earlier (this is not applicable in the case of parents).{w.e.f

1.1.06 in case of a Govt employee dying in harness enhanced

family pension is payable for 10 years}

2.5. HOW ARE PENSIONARY BENEFITS WORKED OUT

2.5.1. Service Gratuity

– You will be entitled to receive service gratuity (and not

pension) if total qualifying service is less than 10 years.

– Admissible amount of 1/2 month’s basic pay last drawn for

each completed six-monthly period of qualifying service.

– No minimum or maximum monetary limit on the quantum.

– This one time lump sum payment is distinct from and is paid

over and above the retirement gratuity.-

2.5.2 Pension

You will be entitled to receive monthly pension in case you have

completed at least 10 years of qualifying service on superannuation

from service.

– Full pension with 20 years of qualifying service is 50% of the

average emoluments of last ten months or 50 % of the last pay

drawn which ever is beneficial to the pensioner. (with effect from

01.01.06 OM38/37/08P&PW(A) dated 10.12.2009)

– In case where Govt servant becomes entitles to pension on completion of

ten year of qualifying of service in accordance with rule 49 (2) of CCS

(pension) Rule 1972, pension in those cases shall also be paid at 50% of

emoluments or average emoluments whichever is more beneficial to govt

servants (O.M. 38/37/208-P&PW(A)dated 2.9.2008)

– Minimum pension presently is Rs.3500 per mensem.

– Maximum limit on pension is 50% of the highest pay in the Govt.

of India per mensem.

– D.R. is payable on the same rate as D.A. to existing employees.

– Pension is payable upto and including the date of death.

W.e.f 1.1.06 additional pension is admissible to older pensioners at

the following rates

1. On completion of 80 years of age = 20% of basic pension

2. On completion of 85 years of age = 30% of basic pension

3. On completion of 90 years of age = 40% of basic pension

4. On completion of 95 years of age = 50% of basic pension

5. On completion of 100 years of age = 100% of basic

pension

D.R. will also be payable on this additional pension

2.5.3. Commutation of Pension

– You have an option to commute a portion of pension, not exceeding

40% of it, into a lump sum payment, with effect from 1.1.96. After

implementation of 6th CPC w.e.f 01.1.06, all future commutation

of pension will be as per revised commutation table as per

annexure (I) this table is subject to periodical revision on the basisof interest and mortality rate. However, this table will not beapplicable to past commutations in respect to post 31.12.05pensioners who have already commuted their pension prior to

implementation of 6th CPC recommendations.

– No medical examination is required if this option is exercised

within one year of retirement.

– If you decide to opt for commutation after the expiry of one year,you will have to undergo medical examination by the specifiedcompetent authority.

– Monthly pension will stand reduced by the portion commuted andthe commuted portion will be restored on the expiry of 15 years.

– Dearness relief entitlement will continue to be calculated on thebasis of the original pension (i.e. without reduction of commutationportion)

– Commuted portion of pension will be restored on the expiry of 15years. Revision of Pension - rule 10 of CCS (Commutation)Rules, 1981. {GOI decisions w.r. to S.C. judgment}

2.5.4. Retirement gratuity:

– Minimum of 5 years qualifying service and eligibility to receive

service gratuity / pension is essential to get this one time lump

sum benefit.

– Retirement gratuity is calculated at the rate of 1/4th of a month’s

basic pay plus dearness allowance last drawn before retirement

for each completed six monthly period of qualifying service.

– There is no minimum limit for the amount of gratuity.

– Maximum retirement gratuity payable is 161/2 times the basic

pay, limited to Rs. 3.5 lakhs. This limit is raised to 10 lac w.e.f

1.1.06

Sixth Central Pay Commission in Para 5.1.33 of its Report made the

following recommendation:

"Linkage of full pension with 33 years of qualifying service should be

dispensed with. Once an employee renders the minimum pensionable

service of 20 years, pension should be paid at 50% of the average

emoluments received during the past 10 months or the pay last drawn,

whichever is more beneficial to the retiring employee. Simultaneously,

the extant benefit of adding years of qualifying service for purposes of

computing pension / related benefits should be withdrawn as it would no

longer be relevant".

This recommendation was accepted by Government of India vide

Resolution No.38/37/2008-P&PW (A) dated 29 th August, 2008. It is clear

from the above recommendations / decisions, that the benefit of adding

years of qualifying service is withdrawn for the purpose of computing

pension as well as other related benefits such as gratuity.

2.5.5. Dearness relief– Dearness relief is sanctioned as compensation against price

rise.

– Quantum payable will be governed by the orders issued by the

Government. The formulation in this regard is based on 100%

neutralization for Pensioners / Family pensioners as in the case

of serving employees.

– All pensioners, irrespective of the amount of their pension, are

eligible for this benefit.

– There is no ceiling in regard to the total of pension plus dearness

relief that a pensioner can receive.

– D.R. is payable to re-employed pensioners who held posts below

Group ‘A’ and those ex-servicemen who held posts below the

ranks of Commissioned officers at the time of their retirement, it

is also payable to employed family pensioners. DR on pension in

respect of the above 2 categories became payable with effect

from July 18, 1997.

DR to re-employed pensioners/family pensioners is presently

regulated in accordance with the instructions contained in the

DoP&PW’s OM No. 45/73/97-P&PW (G) dated 2.7.1999. Consequent

upon the revision in ignorable amount of pension from Rs. 1500/- to Rs.

4000/- in terms of DOPT OM No. 3/13/2008-Estt(Pay-Z) dated

11.11,2008, the amount of Rs 1500/- appeared in OM dated 2.7.1999

is revised as Rs. 4000/-. The other conditions for grant of DR to re-

employed pensioner / family pensioner remain the same.

2.5.6. DEATH GRATUITY FOR FAMILY

– Widow/Widower or, the nominee of a permanent or a quasi-

permanent or a temporary employee, including CPF beneficiaries,

dying while in service is entitled to receive this one time lump sum

benefit.

– No stipulation in regard to any minimum length of service rendered

by deceased employee.

– Entitlement is regulated as under:

Qualifying Service Rate

Less than 1 year : 2 times of basic pay

1 year or more but 6 times of basic pay

less than 5 years

5 years or more but 12 times of basic pay

less than 20 years

For service of 20 years or more:

1/2 month’s basic pay for each completed six monthly period of

qualifying service subject to a maximum of 33 times of basic pay.

– Maximum amount of death gratuity admissible is Rs.3.5 lacs.

This has been enhanced to 10 lacs w.e.f 1.1.06

2.5.7. FAMILY PENSION

– Family pension is payable to the widow/widower or an eligible

family member from the day following the date of death of the

employee while in service or after retirement.

– An employee should have had minimum of 1 year of continuous

service before one’s death for the family to become eligible for

family pension.

– Family pension is also admissible in case of an employee dying

before completion of one year of continuous service, provided the

deceased employee immediately prior to the appointment to the

service was declared fit by the appropriate medical authority.

– Family of a retired employee in receipt of monthly pension or

compassionate allowance is eligible for family pension after the

death of the pensioner.

– Family pension is also admissible to eligible family member of a

Central Government employee absorbed in a public sector

undertaking provided the employee (i) is / was in receipt of

monthly pension or had received lumpsum payment in its lieu for

the service rendered in the Government; (ii) was in the service of

PSU as on 22.1.90; (iii) had exercised option for being governed

by Family Pension Scheme of the Central Government; and (iv)

requisite exemption from the operation of EPFA & Misc.Prov. Act,

1952 has been granted by the EPF Organization.

– It is payable only to one member of the family at a time and is as

per the order prescribed under the Rule.

– Amount of Family pension admissible is at the rate of 30% of last

pay at the time of death / retirement, subject to minimum of Rs.

3500 per mensem (w. e .f 1.1.06).

– W.e.f 1.1.06 additional pension is admissible to older pensioners

at the same scale & rates as mentioned in Para 2.5.2.

In the case of pensioners who had retired prior to 1.1.96, Family

pension at the rate of 30% is admissible corresponding to the

scale of pay as on 1.1.96.

– Maximum amount admissible is 30% of the highest pay in Central

Government.

– In the case of an employee having rendered not less than 7 years’

continuous service, for a period of 7 years following the date of

death or retirement on superannuation or upto the age of 65 years

(now 67 with the superannuation age being increased to 60

years) whichever is earlier, family pension is admissible at

enhanced rate which is fifty percent of last pay. The entitlement

of enhanced family pension is however restricted to the amount

of pension in the case of an employee dying after retirement but

in no case less than 30% of the last pay.{ W.e.f 1.1.06 in case of

a Govt. Employee dying in harness enhanced family pension is

payable for 10 years. However, parents are not entitled to enhanced

F.P.

– Like pension, Family pension is also payable upto and including

the date of death of the recipient irrespective of time of death.

– Family pension is payable to spouse if she/he is employed under

Government or otherwise and even international organizations.

– Payment of Family pension is discontinued if the spouse remarries;

in that event the entitlement of family pension passes on to the

eligible son or daughter, including an unmarried / widowed or

divorced daughter provided his or her own earning is less than

Rs.3500 plus the amount equal to DR amount in force (w.e.f

1.1.06) per month.

{W.e.f 1.1.06. The Childless widow of deceased employee will

continue to receive family pension even after remarriage subject

to the condition that Family pension shall cease once her

independent income from all sources becomes equal to or higher

than minimum prescribed limit of family pension in the Central

Govt. }

– Family pension is payable for life to a son/daughter who is

suffering from any disorder/disability of mind or is physically

impaired/disabled, thus rendering him/her unable to earn a living.

Married sons/daughters, whether suffering from any disorder/

disability of mind/mentally retarded or physically crippled/disabled,

are not eligible for family pension as per the extant instructions

( R l y . B d . N o F

( E )III/2005/PN1/32 dt.15.1.2010)

– Family pension is also admissible to the dependent parents of an

employee/pensioner on their turn. The level of dependency (w.e.f

1.1.06) is determined based on the earning of Rs 3500 plus

amount equal to prevalent DR per month as in the case of

children.

– Dependency criteria (w.e.f 1.1.06) for all purposes is the minimum

family pension along with dearness relief thereon.

For the purpose of grant of Family Pension the family has beencategorized as given below:

Category I

(a) Widow/Widows or Widower, upto the date of death or re-marriage, whichever is earlier. A judicially separated wife or

husband, such separation not being granted on the ground of

adultery and the person surviving was not held guilty of committing

adultery is entitled to family pension.

(b) Son/Daughter (including widowed/Divorced daughter) uptothe date of his/her marriage/re-marriage or till the date he/she

starts earning or till the age of 25 years (in case of Son),

whichever is the earliest.

(c) Son/Daughter, suffering from any disorder or disability or isphysically-crippled or disabled so as to render him/her unable

to earn a living is entitled to family pension for life under certain

conditions without any age limit.

Category II

(a) Parents who were wholly dependent on the Governmentservant when he/she was alive provided the deceased employee

had left behind neither a widow nor a child. Family pension to

dependent parents/unmarried/divorced/widowed daughter will

continue till the date of death and it shall be payable only after the other

eligible family members in Category I, have ceased to be eligible to

receive family pension and there is no disabled child to receive family

pension.

(b) Dependent disabled siblings (i.e. brothers/sisters)

– The family pension to category II members shall be payable only

after all the other eligible family members in Category I, have ceased

to be eligible to receive family pension and there is no disabled child

to receive family pension.

The dependency criteria for the purpose of family pension is the

minimum family pension of Rs. 3500 plus DR admissible

2.5.8. Revision / consolidation of pension / Family pension of pre-2006 pensioners/family pensioners in accordance with 6th CPCrecommendations

1. The pension / family pension of pre-2006 pensioners/ family

pensioners will be consolidated with effect from 1-1-2006 and the

amount so arrived at will be regarded as basic pension / family

pension with effect from 1-1-2006.

A. The following shall be added together for such consolidation

(i) The existing pension/family pension, i.e. pension inclusive ofcommuted amount if any as on 31.12.2005 (D.P. not to beincluded)

(ii) Dearness pension at 50% of (i) above

(iii) 12% D R on 50% DP

(iv) Dearness Relief at 24% of basic pension/basic family pension

and

(v) Fitment weightage at 40% of the existing pension/family pension

at (i) above

Thus existing Basic pension inclusive of commuted value if any (but

minus D.P.), multiplied by 2.26 = Revised consolidated pension /

Family pension

Note: Existing pension means basic pension inclusive of commuted

portion if any.

B. The revised pension (consolidated as above) shall not be lower

than fifty percent of the sum of the minimum of the Pay Band and

the Grade Pay corresponding to the pre-revised pay scale from

which the pensioner had retired.

C. The revised family pension shall not be lower than 30% of the sum

of the minimum of the Pay Band and Grade Pay corresponding

to the pre-revised pay scale in which the pensioner / deceased

Government servant had last worked.

In case the pension consolidated as at A above, is higher than the

pension calculated at B above, the same (higher pension) will be treated

as revised Basic Pension w.e.f. 1-1-2006.

In case the family pension consolidated as at A above, is higher than

the family pension calculated as at C above, the same (higher family

pension) will be treated as revised basic family pension w.e.f: 1-1-

2006.

Where the consolidated pension/family pension at A above works out

to an amount less than Rs. 3500, the same shall be stepped up to Rs.

3500 with effect from 1-1-2006.

– Dearness relief to family pensioners is paid at the same rate and

on the same conditions as for the pensioners.

The quantum of consolidated pension shall be increased in respect

of old age pensioners as per Para 2.5.2.

INCASE OF PSU ABSORBEES:

(A) The full pension of the PSU absorbees shall be notionally revised

with effect from 1-1-2006 based on full pension as on 31-12-2005

in accordance with the instructions for revision of pension issued

in respect of other Central Govt. pensioners.

(B) The restorable 1/3rd commuted portion of pension shall be the

sum of the following with effect from 1-1-2006:

(i) 1/3rd of full pension as on 31-12-2005;

(ii) Dearness Pension on the full pension as on 31-12-2005 i.e.,

50% of full pension as on 31-12-2005;

(iii) Dearness Relief at 24% of the sum of basic full pension and

Dearness Pension;

(iv) Fitment weightage at 40% of the full pension as on 31-12-2005.

Dearness Relief is admissible on full pension as notified from time to

time subject to the condition that the absorbee was not employed / re-

employed at the time of restoration.

If the pre-revised 1/3rd restored pension plus DP and DR as on

1-9-2008 is more than the revised 1/3rd restorable pension as at (B)

above, plus DR the absorbee shall continue to draw the pre-revised

pension plus DP and DR till such time the restored amount of revised

pension plus DR works out to be more than the pre-revised restored

pension.

The quantum of 1/3rd restorable pension as at (B) above shall be

increased in respect of old pensioners as per Para 2.5.2.

For procedure claiming Family Pension please refer to Part IIISection I Pension disbursement Para 3.10.

SECTION 2 :-NON-PENSIONARY RETIREMENT BENEFITS

2.6. PROVIDENT FUND ACCOUNT

(a) Provident Fund Accounts are now maintained on a decentralized

basis. The Head of office / attached Pay and Accounts Officer of

the office in which you serve maintain your General Provident

Fund Account. Please ensure that you receive your annual

statement of account / get your passbook up-dated, as the case

may be, every year. It may be in your interest to preserve all the

yearly account slips in a separate folder in chronological order. If

you notice any missing credit, please take up the matter with the

Head of office / Pay and Accounts Officer immediately. It is easier

to trace missing credits while they are still current.

(b) In the event of your transfer from one office to another, the balance

lying to your credit in the GP Fund account in the previous office

is also transferred to the new office where a new account number

is allotted to you. This is not applicable when you go on Foreign

Service in which case the Provident Fund Account continues to

be maintained by the previous office.

(c) In case of deputations, you should check that the office you are

deputed to forwards regularly credits of PF to your parent office

and particularly watch updating of your GPF pass books /

statements

(d) Subscriptions to Provident Fund are stopped three months prior

to the date of superannuation. This has been designed to enable

the Pay and Accounts Officer to finalize and settle your account

and arrange payment of the balance by the time of your retirement.

2.7. CENTRAL GOVERNMENT EMPLOYEES GROUPINSURANCE SCHEME

A portion of your monthly contributions paid while in service is

credited in a Savings Fund, on which interest accrues. You must

apply to your Head of office, who shall issue a sanction for the

payment of your accumulation in Savings Fund and arrange for its

disbursement, soon after your retirement.

2.8 TRAVELLING ALLOWANCE & OTHER FACILITIES TO REACHTHE INTENDED PLACE OF RESIDENCE AFTER RETIREMENT

You are eligible for travelling allowance from the last station of duty to

the intended place of residence anywhere in India. This is allowed on

full scale applicable to journeys on transfer. This benefit has to be

availed within one year from the date of retirement, otherwise it

lapses. In addition to travelling allowance, you get composite transfer

grant, Fare for self & family from the station of retirement to the station

of settlement & also an allowance/Fare (according to status) for

transport of personal effects and for the transport of conveyance

subject to certain conditions. Railway retirees are entitled to Kit pass

/ Transport allowance (according to status) for shifting of personal

effects including conveyance to intended place of residence within

India, a Dog pass, Free Passes ( by Trains) for self & family from

station of retirement to the station of settlement and also composite

transfer grant. Rly retirees are also entitled to post retirement

complimentary passes according to their status

{Ministry of Finance DOE F.No.19030/3/2008-E.IV dtd 23.9.09 & Rly

Bd No E (W )2004 PS 5-9/1 dt 17.06.09}

2.9. MEDICAL FACILITIES FOR PENSIONERS

(a) 2.9.1. CGHS / RELHS / ECHS: Central Govt pensioners / family

pensioners other than Railways & Defence are covered under the

Central Government Health Scheme on prescribed contribution. You

must get your name registered with any of the CGHS Dispensaries

(now called Wellness Centres) in the country. The registration is not

related to the place of last posting or the place of your residence. You

will be required to obtain a new CGHS card. An application to the

specified officer of CGHS at the city chosen by you is necessary. You

may obtain a life card by payment of a fee equivalent to ten times of

your annual contribution. Railway pensioners are covered by RELHS-97

{Retired Railway Employees Liberalized Health Scheme) and the Defence

pensioners & family pensioners are covered by ECHS (Ex servicemen

Contributory Heath Scheme). For Salient features of CGHS & RELHS

please see Annexure 6 & 7 respectively.

(b) Even in the event of not availing CGHS facilities prior to retirement

you are eligible for CGHS facilities on superannuation.

(c) Vide Railway Board letter No 2003/H/28/1/RELHS dated 16.3.2009

& even No dated 08.04.09, joining RELHS-97 has been made mandatory

for all retiring Railway Employees.

2.9.2 FMA Fixed Medical Allowance is payable to those Central Govt.

Pensioners/Family Pensioners who are residing in non-CGHS areas.

Wherever CGHS facilities are available, Fixed Medical Allowance is

not payable. In case of Railway Pensioners & Family pensioners FMA is

payable if the residence of such a pensioner / Family pensioner is beyond

2.5 Kms from Rlys health unit/hospital & that he or she is eligible to join

the scheme, however member ship of the scheme is not a precondition

for entitlement to FMA. Such a pensioner in receipt of FMA if he is a

member of RELHS Scheme will loose entitlement for day –to-day OPD

though they will be eligible for Indoor treatment as well as OPD for chronic

diseases provided they are members of RELHS-97.

PART - III

BASICS FOR PENSIONERS

SECTION 1 - PENSION DISBURSEMENT

3.1 Disbursement of Pension - Pension Disbursing Authority(PDA) by the Bank

(a) Disbursement

(i) All PPOs and any subsequent amendments issued by Pay &

Accounts Officer are routed to the disbursing bank through

Central Pension Accounting Office, Bhikaji Cama Place, New

Delhi (E-Mail: pension@x400.nicgw.nic.in). These are in turn

transmitted by the Link Branch of the designated bank to the

disbursing branch.

(ii) The PAO and the bank authorities are required to ensure that the

pensioner is kept informed about the movement of the PPO at all

stages.

Note: In the case of Rly pensioner, Designated FA&CAOdischarges the function of CPAO / PAO.

(iii) On receipt of documents, the paying branch shall immediately

address the pensioner through a letter advising him to appear at

the branch along with the documents for the purpose of

identification.

(iv) After the completion of necessary formalities in this regard, the

Pensioner’s portion of PPO will be handed over by the Disbursing

Branch to the Pensioner.

(v) Subsequent drawal of monthly pension and its credit to the

pensioner’s account shall be automatic without the need for the

pensioner to go to the bank specifically for this purpose.

(b) Disbursement to Non-Resident Indian (NRI) Pensioners 

The NRI Pensioners should open an ordinary non resident bank

account in any scheduled bank in India and execute a power of

attorney in favour of the bank as required.  They should also submit

life certificate and nationality certificate as prescribed to enable the

credit of pension amount due to them in to their accounts.  

(c) Receipt of Two Pensions 

If you are in receipt of more than one pension, you should furnish full

details to your PDA for revision of both the pensions and regulating

dearness relief thereon.    

(d) Post-retirement Conviction/Imprisonment:

If a pensioner is convicted or sentenced to imprisonment by a Court,

his pension will be suspended.  In the event of conviction / imprisonment

by a court of law, full facts of the case should be reported to your PDA

/ Head of Office.

3.2 Know Your Pension Payment Order :

(a) Your PPO is a valuable document containing a running account

of your pensionary entitlements. It is given a number. Make a note

of it carefully at some safe place and do refer to it in your

correspondence with the pension sanctioning authority or the

pension disbursing authority. This will enable them to link proper

records and will help them to promptly respond to your letters.

(b) PPO is issued in two halves/copies, namely, pensioner’s half/

Copy and Disburser’s half/Copy. Pensioner’s half/copy of the

PPO is given to the pensioner by the designated pension

disbursing authority immediately after completion of formalities

for identification of pensioner before the first disbursement of

pension. Please do insist on getting your half/copy of the Pension

Payment Order as this is a vital document to every pensioner.

(c) Also ensure to keep it in safe custody and to familiarize other

members of your family with its contents, so that in the event of

any untoward event, they are not put to any difficulty for lack of

these documents please also keep a photocopy separately.

(d) Post retirement Changes in the family: 

Post retirement changes in the details of your family arising out of

your marriage/remarriage after retirement or children born to you

after your retirement should be intimated to your Head of Office with

full details and relevant documents.  Also ensure that a notification of

your family pension is done by pursuing the matter with your Head of

Office.  Similarly, other post retrial changes / events with respect to

dependents like divorce / widow hood/marriage of daughter, mental

/ physical/visual disability of children/siblings be intimated to your

pension sanctioning authority with supporting documents, obtaining

acknowledgement which should be carefully preserved.

3.3. Certificates Required by a Bank from Pensioner

(a) Life Certificate: The pensioner will present himself before the

competent pension disbursing authority to furnish a life certificate

in the prescribed form, to be obtained from the competent officer

of the RBI or public sector bank authorized for disbursement of

pension in the month of November each year. The pension

including element of dearness relief from November onwards will

not be credited in the pensioner’s account by the bank in case he

fails to furnish the required certificate by presenting himself

before the competent officer. In case of serious illness/

incapacitation and on production of medical certificate to that

effect, officer-in-charge of paying branch may depute an officer

of the bank to visit the pensioner for recording life certificate.

(b) Employment/Non-employment Certificate: The pensioner will furnish

a certificate of non-employment/employment/re-employment yearly

in the month of November. If this certificate is not submitted, the

dearness relief from November onwards will not be credited by

the bank. Pension will continue to be credited,

( c) In case of NRI pensioners/family pensioners who are unable to

come to India for personal identification may be allowed pension

/ family pension on the basis of a certificate to be issued by an

authorized official of the India Embassy / High Commission of India

or Consul of India consulate in the country where the pensioner is

residing. This certificate is to be issued on verification of Pensioner

/ Family Pension on the basis of photograph pasted in the PPO or

on the basis of photograph pasted on the Passport or any other

such document.

CGA’s Authority No. - F.No. 1(7)/CPAO Scheme Book/2005/TA/585dated 22.09.2006

(d) In the case of physically handicapped pensioner or who is unable

to present himself at the paying branch, the requirement of personal

appearance will not be necessary, as it is in the case of ordinary

pensioner who has to present himself before the bank to complete

the formalities. The pensioner has to submit to the paying branch a

certificate from a registered medical practitioner about his being

physically handicapped / sick, each year, about the requirement of

producing life certificate and his inability to present himself physically,

to the officer-in-charge of bank so that he may nominate an officer to

visit the pensioner's residence for the purpose of verification, recording

of specimen signatures, identification marks and life certificate etc

3.4. Drawal of Pension by infirm Pensioners

In the case of physically handicapped/sick/infirm pensioner who is

unable to present himself/herself at the paying branch, such a

pensioner has to submit a medical certificate to this effect from a

RMP to the Manager of the Paying branch of the Bank with a request

to arrange disbursal of pension at the residence. On receipt of such

request, supported by a medical certificate, Bank Manager is supposed

to nominate an officer of the Bank for disbursal of pension to such a

pensioner at the place of residence.

Note: Now-a-days Banks give ATM cards for pension accounts also.

But it is not advisable for pensioners to have ATM cards as these are

ridden with frauds/wrong payments.

3.5. Transfer of Pension

(i) In the case of transfer from one paying branch to another of the

same PSB at the same station, the link branch will make

necessary entries in the register maintained by them and forward

the disburser’s portion of PPO to the paying branch at which the

payment is desired under intimation to the CPAO and the

pensioner.

If the transfer is at a different station, the link branch after keeping

the requisite note will forward the disburser’s portion of PPO to

the link branch at the new station for arranging payment through

the new paying branch. CPAO will be informed of this by the old

link branch as well as by the new link branch.

(ii) In the case of transfer from one PSB to another PSB within the

same station or a different station, the old bank (transferor paying

branch) sends a letter duly signed by the Branch Manager to the

Branch Manager of the new paying branch together with a copy

of PPO showing the last payment. The new paying branch will

commence the pension payment immediately on receipt of letter

of the last payment certificate. It is the responsibility of the

concerned bank branches to complete all required formalities

regarding intimation to link branches and CPAO.

In case of Rly Pensioners :-

3.5.1 Transfer of Pensions. – Applications for transfer of pensions may

fall under the following three categories:-

(a) Transfer from one paying branch to another within the same station

or at a different station;

(b) Transfer from one PSB to another within the same station (such

transfer to be allowed only once in a financial year); and

(c) Transfer from one PSB to another PSB at a different station or by

a treasury.

3.5.2 Request falling under category (a) above may be entertained by PSB

itself. In case the transfer is at the same station, Link Branch will make

necessary entries in the register maintained by them in the form in Annexure

‘B’ and forward the disburser’s portion of PPO to the paying branch at

which payment is desired under intimation to the designated FA & CAO, and

the pensioner. In case the transfer is at a different station, Link Branch, after

keeping the requisite note will forward the disburser’s portion of the PPO to

the Link Branch at new station for arranging payment through the new

paying branch. Necessary intimation of affecting such transfer will be sent

to the designated FA & CAO by the new as well as old link branches for

keeping a note of change in their records under intimation to the pensioner.

The receiving link branch, on receipt of pension documents, will ensure

forwarding the PPO to the paying branch within three days and intimate the

pensioner simultaneously.

Before forwarding the disburser’s portion of PPO to the new paying branch/

link branch, it will be ensured that the month upto which the payment has

been made is invariably indicated in the disburser’s portion of PPO.

3.5.3 (i) In cases falling under categories (b) and (c) of Para 3.5.1 when a

pensioner applies for transfer on a single sheet of paper, the old bank

(Transferer paying branch) will send a letter duly signed by its Branch

Manager to the new paying branch wherever located alongwith a photocopy

to the pensioner’s PPO showing the last payment made. This will be sent by

speed post/courier/Regd Post to the new paying branch at the new location

alongwith a copy each to the pensioner. FA&CAO and for information, to

the Link Branch of the old paying branch. The PPO issuing FA&CAO will

also arrange to intimate the new designated FA&CAO (i.e. pension debit

accepting FA&CAO) in case change of designated FA & CAO is also

involved. Simultaneously the old paying branch will send the bank’s copy of

PPO through its Link branch, duly completing all entries to the FA&CAO

who issued the PPO for transmission to the new Link branch. However

pensioner’s copy of PPO will be retained by pensioner and produced at the

new paying branch.

(ii) The new paying branch will commence pension payment immediately

on receipt of letter of the last payment certificate as at (i) above.

Simultaneously it will send intimation to its Link branch with full details of the

commencement of the pension. The old paying branch and its link branch will

ensure that the Bank’s copy of PPO is transmitted to the new paying branch

through its Link bank.

(iii) Pension will be paid for 3 months on the basis of the photocopy of the

pensioner’s PPO at transferee (New) Branch, from the date of payment

made at the transferer (Old) & transferee (New) bank branch to ensure that

all documents under the procedure are received by the transferee (New)

branch with in a period of 3 months. However in a case falling under category

(c) of Para 3.5.1 where pensioner wishes to draw his pension from the

Treasury it will be necessary for the FA&CAO to forward the documents

duly countersigned along with a forwarding letter bearing his special seal to

the Accountant General concerned under whose jurisdiction the Treasury

from where the pensioner wishes to draw his pension for onward transmission

to the Treasury concerned.

3.5.4 To avoid the risk of over payment at the time of transfer, the following

certificate may recorded on the PPO by the Paying Branch of the P.S.B. –

“Certified that payment of pension upto the month of …….…20... has been

made and that this PPO consists of …………………continuation sheets for

recording disbursement.”

3.5.5 Except as provided for above, the transfer of the pension from one

place to another will not ordinarily be permitted.

3.6. Restoration of Commuted Portion of Pension

After the pensioner has completed 15 years from the date of

commutation, he will apply in the prescribed form to the pension

disbursing authority/bank/post office who will restore the commuted

portion of the pension as mentioned in the PPO. If the amount of

commuted pension is received on two or more points of time,

restoration of the commuted amount also takes place at two or more

points of time as the case may be.

The absorbed employees in Central PSUs/Autonomous Bodies who

have become entitled to restoration of 1/3rd commuted portion of

pension, based on the Supreme Court Judgment dt.15.10.95 will

apply to the concerned Ministry/Deptt/Office where they were

employed prior to absorption.

3.7. Life Time Arrears

A pensioner is entitled to file nomination in Form A prescribed under

Arrears of Pension (Nomination) Rules, 1983 to the pension disbursing

authority or head of office, as the case may be, for payment of life time

arrears. This obviates the hardship faced by the nominee survivor of

the deceased in getting the payment of balance amount in the

account of the deceased pensioner.Nomination facility is not available

to Family pensioners. The arrears of Family pension pass on to the

next eligible member of the family. The question of submitting a

succession certificate will arise if no nomination has been made or

there is no eligible member in the family left to receive the family

pension.

3.8. Recovery of Eecess or Wrong Payment

Vide Para 36 of RBI Master Circular “Disbursement of Pension” dated

01-07-09 all agency banks have been advised that whenever any excess

/ overpayment is detected, the entire amount thereof should be credited

to the Government account in lump sum immediately.

3.9. Issue of Duplicate PPO

If the pensioner’s portion of PPO is lost, worn out or torn and it is

sought to be renewed, the paying branch will forward the request of

the pensioner along with both halves i.e. pensioner’s half and

disburser’s half of the PPO to the CPAO through the Link branch for

renewal. In order that payment of pension is not delayed in the

absence of disburser’s portion of the PPO, all connected documentsmay be sent to CPAO immediately after the payment for the monthis made so as to leave sufficient time with CPAO to do the needful andreturn the documents by the time payment for the next monthbecomes due.

In the case of Rly pensioners :- “In cases in which pensioner's

portion of the P.P.O. is lost, worn or torn and it is sought to be

renewed, the paying branch will forward the request of the pensioner,

alongwith both the halves of the P.P.O. to the concerned nominated

F.A.& C.A.O. through the Link branch for renewal. In order that

payment of pension is not unnecessarily delayed in such cases in the

absence of the disburser’s portion of the P.P.O., care may be taken

to send the connected documents to nominated F.A. & C.A.O.,

immediately after payment for a month is made so as to leave

sufficient time with the nominated F.A.& C.A.O. to do the needful and

return the documents by the time payment for the next month

becomes due. The nominated F.A.& C.A.O. will also be reminded by

the paying branch in cases where the return of the document is

unduly delayed.

SECTION 2 - DISBURSEMENT OF FAMILY PENSION

3.10. Family Pension Claims

(a) As mentioned in Para 1.17., family pension entitlement is also

sanctioned at the same time as pension. For getting family

pension, the eligible member of the family of the deceased

pensioner should apply in the prescribed Form, together with a

death certificate, to the

(i) Pension disbursing authority, if the amount of family pension

is already indicated in the PPO; or

(ii) Head of Office in all other cases.

(b) The payment of Family pension, at the rate, and to the person

indicated in the PPO shall be communicated by the paying

branch of the bank without waiting for any authority from Pay &

Accounts Officer or CPAO.

(c) In case the claimant is a child, payment shall commence after a

fresh payment authority is received from PAO/FA &CAO of the

concerned Ministry/Deptt through usual channels.

(d) Family pension to eligible family members of the govt employee

missing/kidnapped by insurgent/terrorists may be sanctioned

after a period of six months from the date of registration of FIR.

{DOP & PW F.No. 1/28/04-P&PW(E) dated 31.3.09}

Procedure for Claiming Family pension by the Spouse:

A. Claim to be preferred to Pension disbursing agency. Form 14

along with details of dependent children if any for claiming Family

pension (Form can be had from the Bank) along with relevant

documents and witnesses as follows :

1. Death Certificate of pensioner

2. An affidavit by the Widow that she has not remarried and that if

she does so in future she will immediately report the incidence to

pension disbursing agency.

3. Proof of age of the Widow and the dependent children, if any

4. Claimant will have to open a separate SB/pension account with

the Bank.

5. An undertaking for refunding any excess amount ever credited.

6. Two specimen signatures of the applicant or left hand thumb

impression’ duly attested (to be furnished in two separate sheets)

if the claimant is illiterate.

7. Two copies of passport size photograph of the applicant and each

of the dependents if any, duly attested.

8. Descriptive Roll of the applicant duly attested in duplicate indicating

height and personal marks, if any, on the hand, face etc.

(Specify at least two conspicuous marks)

9. Certificate of age: two attested copies

NOTE: Attestation should be done by two Gazetted Government

officials or two or more persons of respectability in the town, village

or Pargana in which the applicant resides.

In case of re-marriage of the widow while applying for family pension

on behalf of minor child, the widow should furnish the date of her re-marriage to the Branch of the Authorized Bank at which payment isdesired and her full address in the application for family pension. It isnot necessary to furnish a fresh application or the documents asthese are already with the Bank along with pension papers on whichfamily pension was originally admitted to her.

Procedure for Claiming Family pension by post retiral Spouse /Children :-

– Endorsement of Family Pension Entitlement of Post-RetiralSpouses in the PPO

(i) As and when a pensioner marries or re-marries after retirement,

he shall intimate the event to the Head of Office who processed his

pension papers at the time of his retirement. He shall also furnish

along with his application an attested copy of the certificate of

marriage in respect of his post-retirement marriage.

(ii) The Head of Office on receipt of the application mentioned above

and after due verification, where necessary, forward the papers to the

concerned Pay & Accounts Officer for issue of corrigendum PPO.

While forwarding the papers to the Pay & Account Officer, the

provisions of Clause (b) of sub-rule (7) of Rule 54 of the CCS

(Pension) Rules, 1972, shall be kept in mind.

(iii) When the pensioner does not have any child or children from his

previous marriage, if any, the post-retiral spouse shall be eligible for

full family pension. Where the pensioner has any eligible child or

children from another wife who is not alive, the family pension to the

post-retiral spouse and the child/children from the previous marriage

will be authorized in terms of clause (b) of sub-rule (7) of Rule

54 ibid.(iii)The corrigendum PPO shall be forwarded by the Pay &

Accounts Officer to the concerned Pension Disbursing Authority

through the Central Pension Accounting Office.

A copy of the corrigendum PPO shall also be endorsed to the

pensioner.(iv)As far as children, including those born after retirement,

are concerned, a fresh PPO will be issued as and when the turn of

each child for receipt of family pension is reached as at present

{For Rly Pensioners/Family pensioners, designated FA &CAO will

discharge the function of CPAO/PAO}

The F.A. & C.A.O. of the Zonal Railway, under whose jurisdiction the

places where the pensioner wishes to settle fall, will be the co-

coordinating officer with the Link Branch of the nominated Public

Sector Banks. (He will be referred to as the designated F.A. & C.A.O.)

Claim by eligible Dependents not mentioned in PPO:

Where the names of eligible children/dependents have not been

mentioned in PPO for various reasons like the pension was sanctioned

prior to 1-1-1990 or the child is a post-retiral one or post-retiral

manifestation of disability of the child,

Case 1

Both parents expired and the dependent eligible Child is histurn to get Family Pension :-

Following Documents along with claim application need to be submitted

to the Pension Sanctioning Authority:

Copy of PPO of pensioner/family pensioner, Proof of Parentage,

Proof of dependency, proof of age, Proof of residence, Ration card/

Photo ID card. Family declaration giving details of dependent children

(With acknowledgement of concerned department) of the Pensioner

submitted to the department during his/her life time (if available)

Affidavit before the magistrate declaring (I)That his/her monthly

Income from all sources is less than the minimum of Family pension

plus D.R. i.e. Rs 3500 plus an amount equal to Dearness Relief. In

case of unmarried dependant daughter, Affidavit to also include the

declaration:- (II) That she has never been married.

In case of Mentally Challenged or Blind Claimant :- in addition to

above documents, medical examination report from the Civil

Surgeon/CMO of the District.

In case of divorced Dependent Daughter:- In addition to above

documents. Marriage proof (invitation Card & photograph, marriage

certificate if registered or any other proof) , proof of divorce , a suitable

declaration to this affect in affidavit & details of dependant children if

any.

In case of a widowed Dependant Daughter: - Following additional

documents to be submitted

Proof of marriage, the death certificate of husband, suitable declaration

to this affect and that she has not remarried in affidavit and details of

dependant children, if any.

Case II

Both or one parent surviving drawing Pension/Family pension:-

The pensioner/family pensioner, if he so desires, can furnish a list of

eligible children/siblings to the Pension Sanctioning Authority, inter

alia, indicating whether any child is handicapped or not.

The receipt of this list may be acknowledged by the pension sanctioning

authority, mentioning the details of the eligible children taken on

record.

This acknowledgement may be preserved by the members of the

family of the pensioner for production at the time of submission of

claim for family pension in their own turn to the Pension Sanctioning

Authority.

In case of guardian, the responsibility of producing this

acknowledgement will be of the guardian. However, production of this

acknowledgement, not to be a pre-condition to the processing of

claims for family pension.

3.11. Certificates to be furnished by Family Pensioner to the pension disbursing agency :

(a) Certificate for mentally / physically handicapped child/dependent :

A mentally/physically/visually handicapped son or daughter is eligible

to receive family pension for his/her life as referred to in Part II. In

addition to life certificate every year in the month of November a

certificate obtained from a Medical Officer not below the rank of Civil

Surgeon will have to be furnished to the paying branch every Five

years (in the month of November). The certificate must state that the

person continues to suffer from the disorder/disability of mind or

continues to be physically/visually impaired or disabled rendering

him/her unable to earn a living. In case of minors/mentally disabled

Family pensioner, the guardian should submit the required certificates.

(b) In case of other recipients of family pension (such as divorced,

a widow or an unmarried daughter or son below 25 yrs ), the

certificate of remarriage/marriage/dependency is required at yearly

interval, in the month.

Note: In case of widow/divorced/unmarried recipients of family

pension, an undertaking (through an affidavit) will have to be given at

the time of the commencement of family pension that in case she

remarries, she will report the fact to the pension disbursing authority.

(e) Certificate of dependency of Parents: The dependent parents

of a deceased Govt. servant in receipt of family pension are required

to furnish a certificate to the Treasury/Bank and Post office, every

year, in the month of November, that is his or her or their combined

income, as the case may be, is less than three thousand five hundred

plus the amount equal to DR (admissible to family pensioner) per

month from their own pension or any other source.

Note: Necessary Forms required with reference to Para 3.10and 3.11 are given in Annexure II.

(f ) In the case of physically handicapped /sick/infirm family pensioner

unable to present himself at pension disbursing agency for the

submission of Certificates or for receiving payment of pension :

Same procedure as mentioned in Para3.3 &3.4 is to be adopted.

SECTION 3 - MISCELLANEOUS

3.12. General

– All pensions including dearness relief thereon and gratuities are

payable in rupees in India only.

– They are expressed in whole rupees, the fraction being rounded

off to the next higher rupee.

– Pension/family pension is payable upto and including the day on

which its recipient dies irrespective of time of death.

– The widow is required to give this certificate of non-remarriage,

with the undertaking to inform the Bank when she remarries, only

once (in the form of an affidavit) that is, at the First time claiming

family pension. {Although she will have to produce life certificatein usual format every year.}

– Grant of pension and its continuance are subject to future good

conduct of the pensioner.

– Pension finally authorized cannot be revised to the disadvantage

of the pensioner except to correct a clerical error.– Pension cannot be attached or seized for any demand against a

pensioner, nor can a pensioner make any assignments inanticipation of pension. But if a pensioner is convicted of a seriouscrime or is found guilty of grave misconduct or negligence,pension may be withheld or withdrawn fully or partly for a specifiedor indefinite period after following the prescribed procedure whichinter-alia requires an opportunity being given to the pensioner toshow cause against the action proposed to be taken.

– Acceptance of certain kinds of post-retirement employment (e.g.commercial employment before expiry of two years fromretirement, employment under foreign governments etc.) bypensioners who retire from Group A service/post requires priorpermission of the Central Government. Failure to comply withthis requirement may lead to stoppage of pension.

– In case any Dicipline & Appeal (DAR)/Vigilance/Court case is

pending at the time of retirement no gratuity is paid, nor is

commutation of pension allowed. However, pension is paid which

is provisional, subject to adjustment after finalization of DAR/

Vigilance/Court case. 

– Any dues outstanding at the time of retirement can be recovered

from gratuity, leave encashment or commutation amount of pension

3.13. Redressal of Grievances

(a) The normal route: If you have any grievance in pension matters

you may take it up with your Head of Office, the pension sanctioningauthority or the pension disbursing authority, or in the PensionADALAT pertaining to the jurisdiction of your pension sanctioningauthority ( PSA) as the case may be.

(b) The nodal route: If considered necessary, you may also approachthe Department of Pension and Pensioners’ Welfare, Lok NayakBhawan (3rd Floor), Khan Market, Now Delhi-110 003, which isthe nodal Department for looking into the grievances and problemsof pensioners.

(c) The RTI route: The RTI Act, 2005 is the latest but the most potenttool in the hands of the public for expeditions settlement of theirgrivences against the Government and other Public authorities.In case you do not receive response to your representation withina reasonable time, you may file an RTI application, under the saidAct, addressed to the "Chief Public Information Officer", office of(Name of the office, with complete address) with an IPO of Rs 10/-. Through the RTI application, you can assertain the status ofyour case as well as the reasons for inordinate delay on the partof bureaucracy including the Dealing Hands. In extreme cases,you may ask for the name(s) of the official(s) with designation(s)responsible for the inordinate delay and the action taken againsthim/them.

Note : For prompt attention, all your correspondence shouldcontain the following essential details, so that past records canbe easily linked:-

(i) Name

(ii) Full address

(iii) Office from which retired, (abbreviations not to be used) with

full address.

(iv) Post held at the time of retirement, Basic pay (and scale of

pay) & date of retirement.

(v) Qualifying service

(vi) If pension has been sanctioned, quantum may be specified

alongwith :-

(a) particulars of Accounts Officer who issued the PPO

(b) particulars of Pension Disbursing Authority, and

(c) PPO number (with a photocopy of the PPO)

(d) Give particulars of correspondence so far (with evidence)

(vii) Make your representation: (Make it specific, brief and short.)

ANNEXURE - I

COMMUTATION VALUE FOR A PENSION OF Re.l PER ANNUM

Age next Commutation Age next Commutation Age

Commutation

birth day value birthday value next birth value expressed

expressed as expressed as day

as number of

year's number of year's purchase

purchase purchase

20 9.188 41 9.075 62 8.093

21 0.187 42 9.059 63 7.982

22 9.186 43 9.140 64 7.862

23 9.185 44 9.9I9 65 7.731

24 9.184 45 8.996 M 7.591

25 9.183 46 8.971 67 7.431

26 9.182 47 8.943 68 7.262

27 9.180 4S 8.913 69 7.083

28 9.178 49 8.881 70 6.897

29 9.176 50 8.846 71 6.703

30 9.173 51 8.808 72 6,502

31 9.169 52 8.708 73 6.296

32 9.164 53 8.724 74 6.085

33 9.159 54 8.678 75 5.872

34 9.152 55 8.627 76 5.657

35 9.145 56 8.572 77 5.443

36 9.136 57 8.512 78 5.229

37 9.126 58 8.446 79 5.018

38 9.116 59 8.371 80 4.812

39 9.103 60 8.287 81 4.611

40 9.090 61 8.194

ANNEXURE - II

FORMS

Nomination for Retirement Gratuity/Death Gratuity

When the Government servant has a family and wishes to

nominate one member, or more than one member, thereof.

I,......................., hereby nominate the person/persons mentioned

below who is/are member(s) of my family, and confer on him/them

the right to receive, to the extent specified below, any gratuity the

payment of which may be authorized by the Central  Government in

the event of my death while in service and the right to receive on my

death, to the extent specified below, any gratuity which having

become admissible to me on retirement may remain unpaid at my

death -

Original nominee(s) Alternate nominee(s)

Names Relationship Amount Name, address, Amount

and with the or share relationship and age of or share

address Government Age of conferred on the of gratuity

of servant gratuity nominee shall pass in payable

nominee/ payable the event of the nominee to each

nominees each* pre-deceasing the

Government servant or

the nominee dying after

the death of the

Government servant but

before receiving

payment of gratuity

(1) (2) (3) (4) (5) (6)

             

This nomination supersedes the nomination made by me earlier

on ....................................... which stands cancelled.

NOTE.-(i) The Government servant shall draw lines across the

blank space below the last entry to prevent the insertion

of any name after he has signed.

(ii) Strike out which is not applicable.

Dated this............day of...................2010 at..........................

Witnesses to signature :

1. .......................................

2. ........................................ Signature of Government servant

*This column should be filled in so as to cover the whole amount of

the gratuity.

**The amount/share of the gratuity shown in this column should

cover the whole amount/share payable to the original nominee(s).

(To be filled by the Head of Office)

Nomination by................................ Signature of Head of Office

Designation................................... Date..................................

Office.......................................... Designation........................

 Proforma for acknowledging the receipt of thenomination form by the Head of Office

To

    ...................................................

    ...................................................

    ...................................................

Sir,

In acknowledging the receipt of your nomination, dated the

................/cancellation, dated the ...............................of the nomination

made earlier in respect of gratuity in Form ................................... I am

to state that it has been duly placed on record.

Signature of Head of Office

Place .................................

Dated the ........................... Designation..............................

NOTE. - The Government servant is advised that it would be in the

interest of his nominees if copies of the nominations and the related

notices and acknowledgements are kept in safe custody so that they

may come into the possession of the beneficiaries in the event of his

death.

FORM 2[See Rule 53(1)]

Nomination for Retirement Gratuity/Death Gratuity

   When the Government servant has no family and wishes to

nominate one person or more than one person

    I,...................., having no family, hereby nominate the person/

persons mentioned below and confer on him/them the right to

receive, to the extent specified below, any gratuity the payment of

which may be authorised by the Central Government in the event of

my death while in service and the right to receive on my death, to the

extent specified below, any gratuity, which having become admissible

to me on retirement may remain unpaid at my death :

Original nominee(s) Alternate nominee(s)

Names Relationship Age Amount Name, address Amount

and with the or share relationship and age of or share

address Government of conferred on the of gratuity

of servant gratuity nominee shall pass in payable

nominee/ payable the event of the nominee to each

nominees each* pre-deceasing the

Government servant or

the nominee dying after

the death of the

Government servant but

before receiving

payment of gratuity

(1) (2) (3) (4) (5) (6)

This nomination supersedes the nomination made by me earlier on

.......................................which stands cancelled.

NOTE.-(i) The Government servant shall draw lines across the blank space

below the last entry to prevent the insertion of any name after he

has signed.

(ii) Strike out which is not applicable.

Dated this.................day of...............200.... at.........................

Witnesses to signature :

1. ......................................

2. ...................................... Signature of Government servant

(To be filled by the Head of Office)

Nomination by................................ Signature of Head of Office

Designation................................... Date..................................

Office.......................................... Designation........................

* This column should be filled in so as to cover the whole amount

of the gratuity.

**  The amount/share of the gratuity shown in this column should

cover the whole amount/share payable to the original nominee(s).

Pro forma for acknowledging the receipt of thenomination form by the Head of Office

To

    ...................................................

    ...................................................

    ...................................................

Sir,

In acknowledging the receipt of your nomination, dated the

................/cancellation, dated the ...............................of the nomination

made earlier in respect of gratuity in Form ................................... ,I

am to state that it has been duly placed on record.

Signature of Head of Office

Place ...........................................

Dated the ...............................Designation....................................

    NOTE. - The Government servant is advised that it would be in the

interest of his nominees if copies of the nominations and the related

notices and acknowledgements are kept in safe custody so that they

may come into the possession of the beneficiaries in the event of his

death.

FORM 3Details of Family[See Rule 54(12)]

Name of the Government servant ... ......................................

Designation ... ... ... ......................................

Date of birth ... ... ... ......................................

Date of appointment ... ... ... ......................................

Details of the members of my family

*as on ... ... ... ......................................

Serial Name of the Date of Relationship Initials of Remarks

No members of Birth with the the Head

family* officer of Office

(1) (2) (3) (4) (5) (6)

1.

2.

3.

4.

5.

6.

7.

8.

9.

I hereby undertake to keep the above particulars up-to-date by

notifying to the Head of Office any addition or alteration.

Place...................................... Signature of Government servant

Dated the...............................  

    *Family for this purpose means family as defined in Clause (b) of

sub-rule (14) of Rule 54 of the CCS (Pension) Rules, 1972.

    NOTE. - Wife and husband shall include respectively judicially

separated wife and husband.

 FORM 5[See Rule 59(1)(c) & 61(1)]

Particulars to be obtained by the Head of Office from theretiring Government servant eight months before the date ofhis retirement

1. Name

2. (a) Date of birth

(b) Date of retirement

3. 1Two specimen signatures (to be furnished in an separate sheet)

duly attested by a Gazetted Government servant

4. 2Three copies of passport size joint 3photograph with wife or

husband (To be attested by the Head of Office)

5. Two slips showing the particulars of height and 4personal

identification marks duly attested by a Gazetted Government

servant

6. Present address

7. 5Address after retirement

8. Name of the Treasury or the Branch of Public Sector Bank or the

Pay and Accounts Office through which the pension is to be

drawn

9. 6Details of the family in Form 3

10. Indicate whether family pension is admissible from any other

source - Military or State Government and/or a Public Sector

Undertaking/Autonomous body/Local Fund under the Central or

a State Government

Place................................................ Signature

Dated the......................................... Designation

  Ministry/Deptt./Office

Footnotes: 1. Two slips each bearing the left hand thumb and finger

impressions duly attested may be furnished by a person who is not

literate to sign his name.If such a Government servant on account of

physical disability is unable to give left hand thumb and finger

impressions he may give thumb and finger impressions of the right

hand.Where a Government servant has lost both the hands, he may

give his toe impressions. Impressions should be duly attested by a

Gazetted Government servant.

2. Two copies of passport size photograph of self only need be

furnished if the Government servant is governed by Rule 54 of the

Central Civil Services (Pension) Rules, 1972 and is unmarried son/

daughter of a widower or widow.

3. Where it is not possible for a Government servant to submit a

photograph with his wife or her husband, he or she may submit

separate photographs. The photographs shall be attested by the

Head of Office.

4. Specify a few conspicuous marks, not less than two, if possible.

5. Any subsequent change of address should be notified to the Head

of Office.

6. Applicable only where Rule 54 of the Central Civil Services

(Pension) Rules, 1972, applies to the Government servant.

 FORM 10[Rule 77(2)]

Form of letter to the member or members of the family of adeceased Government servant where valid nomination

for the grant of the death gratuity exists

No....................................................

Government of India

Ministry of........................................

Department/Office.............................

Dated the..........................................

To

...............................................

...............................................

...............................................

Subject :- Payment of death gratuity in respect of the lateShri/ Shrimati........................................

Sir/Madam,

    I am directed to state that in terms of the nomination made by the

late Shri/Shrimati....................................(Designation) in the Office/

Department/Ministry of..............................a death gratuity is payable

to his/her nominee(s). A copy of the said nomination is enclosed

herewith.

2. I am to request that a claim for the grant of the gratuity may be

submitted by you in the enclosed Form 12.

3. Should any contingency have happened since the date of making

the nomination, so as to render the nomination invalid, in whole or in

part, precise details of the contingency may kindly be stated.

Yours faithfully,              

Head of Office.              

FORM 11[See Rule 77(2)]

Form of letter to the member or members of the family of adeceased Government servant where valid nomination for

thegrant of the death gratuity does not exist

No....................................................

Government of India

Ministry of........................................

Department/Office.............................

Dated the..........................................

To

...............................................

...............................................

...............................................

Subject :- Payment of death gratuity in respect of late Shri/Shrimati........................................

Sir/Madam,

    I am directed to say that in terms of Rule 50 of the Central Civil

Services (Pension) Rules, 1972, a death gratuity is payable to the

following members of the family of late Shri/

Shrimati........................................(Designation), in the Office/

Department/ Ministry of ..................................................in equal shares

:-

(i) Wife/husband including judicially separated wife/husband.

(ii) Sons including step children and adopted

children.

(iii) Unmarried daughters including step-children and adopted

children.

2. In the event of there being no surviving member of the family as

indicated above, the gratuity will be payable to the following members

of the family in equal shares :-   

(i) widowed daughters including step daughters and adopted

daughters;

(ii) father including adoptive parents in case of individuals

whose personal law permits adoption ;

(iii) Mother including adoptive parents in case of individuals

whose personal law permits adoption ;

(iv) brothers below the age of eighteen years and unmarried and

widowed sisters including step brothers and step sisters;

(v) married daughters ; and

(vi) children of a pre-deceased son.

3. It is requested that a claim for the payment of gratuity may be

submitted in the enclosed Form 12 as soon as possible.

Yours faithfully,           

Head of Office.          

FORM 12[See Rule 77(2)]

Form of application for the grant of death gratuityon the death of a Government servant

(To be filled in separately by each claimant and in case the claimant

is minor, the Form should be filled in by the guardian on his/her behalf.

Where there are more than one minor, the guardian should claim

gratuity in one Form on their behalf)

1. (i) Name of the claimant in case he is not minor ... ...

...

(ii) Date of birth of the claimant ... ... ...

2. (i) Name of the guardian in case the claimants

are minors ... ... ...

(ii) Date of birth of the guardian ... ... ...

3. (i) Name of the deceased Government servant

in respect of whom gratuity is being claimed ... ...

...

(ii) Date of death of Government servant ... ... ...

(iii) Office/Department/Ministry in which

the deceased served last ... ... ...

4. Relationship of the claimant/guardian

with the deceased Government servant ... ... ...

5. Full Postal Address of the claimant/guardian ... ... ...

6. (i) Where gratuity is claimed by the guardian

on behalf of minors, the names of the

minors, their ages, relationship with the

deceased Government servant, etc. - ... ... ...

Serial Name Age Relationship with the Postal Address

No. deceased Government

servant

1.

2.

3.

4.        

(ii) Relationship of the guardian with minor ... ... ...

7. Place of payment of Pension and Gratuity

(Treasury, Sub-Treasury, Public Sector Bank

branch, or the Pay and Accounts Office) ... ... ...

Signature/Thumb-

impression of the

claimant/guardian

8. Two specimen signatures 1or left hand thumb

and finger impressions of the claimant/guardian

duly attested(To be furnished in a separate sheet) ... ...

...

9. 2Attested by -

Name Full Address Signature

(i) ............................... ...................... ..........................

(ii) ............................... ...................... ..........................

10. Witnesses:

(i) ............................... ...................... ..........................

(ii) ............................... ...................... ..........................

Footnote : 1. To be furnished in case the applicant is not literate

enough to sign his name.

2. Attestation should be done by two Gazetted Government servants

or two or more persons of respectability in the town, village or

Pargana in which the applicant resides.

FORM 13[See Rule 77(3)]

Form of letter to the widow/widower of a deceasedGovernment servant for grant of Family Pension, 1964

No....................................................

Government of India

Ministry of........................................

Department/Office.............................

Dated the..........................................

To

...............................................

...............................................

...............................................

Subject :- Payment of Family Pension, 1964, in respect of late Shri/Shrimati........................................

Sir/Madam,

    I am directed to state that in terms of Rule 54 of the Central Civil

Services (Pension) Rules, 1972, a family pension, 1964, is payable

to you as widow/widower of the late Shri/Shrimati

.................................... (Designation) in the Office/Department/ Ministry

of ..........................................

2. You are advised that a claim for the grant of Family Pension, 1964,

may be submitted in the enclosed Form 14.

3. The Family Pension, 1964, will be payable till your death or

remarriage, whichever event occurs earlier. In the event of your death

or remarriage, the Family Pension, 1964, shall be granted to the child

or children, if any, through the guardian.

Yours faithfully,       

 

Head of Office.        

 

FORM 14[See Rule 77(3) and 81(2)]

Form of application for the grant of Family Pension, 1964,on the death of a Government servant/pensioner

1. Name of the applicant ... ... ...

(i) Widow/Widower ... ... ...

(ii) Guardian if the deceased person

is survived by child or children ... ... ...

2. Name and age of surviving widow

/widower and children of the

deceased Government servant/

pensioner served last ... ... ...

Serial Name Relationship with Date of birthday

No the deceased person by Christian era

1.

2.

3.

4.

5.

6.      

3. Name and No. of the PPO of the ... ... ...

deceased pensioner

4. Date of death of the Government ... ... ...

servant/pensioner

5. Office/Department/Ministry in ... ... ...

which the deceased Government

servant/ pensioner served last

6. If the applicant is guardian, his date ... ... ...

of birth and relationship with the

deceased Government servant/pensioner

6. A. If the applicant is a widow/widower

the amount of service pension which

she/he may be in receipt on the date

of death of the husband/wife ... ... ...

7. Full address of the applicant ... ... ...

8. Place of payment of Pension and

Gratuity (Treasury, Sub-treasury or

Public Sector Bank Branch and Pay

and Accounts Office) ... ... ...

9. Enclosures :

(i) Two specimen signatures of the applicant,

duly attested (To be furnished in two separate sheets)

(ii) Two copies of passport size photograph of

the applicant, duly attested

(iii) Two slips each bearing left hand thumb and

finger impressions* of the applicant, duly attested

(iv) Descriptive Roll of the applicant, duly attested,

indicating (a) height and (b) personal marks, if

any, on the hand, face, etc. (Specify a few

conspicuous marks, not less than two, if

possible.)(To be furnished in duplicate)

(v) Certificate(s) of age (in original with two

attested copies) showing the dates of birth

of the children. The certificate should be

from the Municipal Authorities or from the

local panchayat or from the head of a recognised

school if the child is studying in such school

(This information should be furnished in respect

of such child or children, the particulars of whose

date of birth are not available with the Head of Office)

10. Indicate whether family pension is admissible

from any other source - Ministry or State

Government and/or a public sector undertaking

/autonomous body/local fund under the

Central or a State Government ... ... ...

11. Signature or left hand thumb-impression*

of the applicant ... ... ...

12. Attested by :

Name Full Address Signature

(i) ............................... ...................... ..........................

(ii) ............................... ...................... ..........................

13. Witnesses :

Name Full Address Signature

(i) ............................... ...................... ..........................

(ii) ............................... ...................... ..........................

NOTE. - Attestation should be done by two Gazetted Government

servants or two or more persons of respectability in the town, village

or Pargana in which the applicant resides.

*To be furnished in case the applicant is not literate enough to sign his

name.

FORM 22[ See Rule 81(4)]

Form of application for the grant of Residuary1 Gratuityon the death of a pensioner

(To be filled in separately by each applicant)

1. Name of the applicant ... ... ...

2. (i) Name of the guardian in case the

applicant is a minor ... ... ...

(ii) Date of birth of guardian ... ... ...

3. Name of the deceased pensioner ... ...

...

4. Office/Department/Ministry in which the

deceased pensioner served last ... ... ...

5. Date of death of the pensioner ... ... ...

6. Date of retirement of the deceased

pensioner ... ... ...

7. Amount of monthly *pension (including

ad hoc increase, if any) sanctioned to

deceased pensioner ... ...

...

8. Amount of retirement gratuity received by

the deceased pensioner ... ... ...

9. The amount of *pension (including ad hoc

increase, if any) drawn by the deceased

till the date of death ... ...

...

10. If the deceased had commuted a portion

of pension before his death, the commuted

value of the pension ... ...

...

11. Total of items 8,9 and 10 ... ... ...

12. Amount of death gratuity equal to 12 times

of the emoluments ... ...

...

13. The amount of residuary gratuity claimed,

i.e., the difference between the amount

shown against items 12 and 11 ... ... ...

14. Relationship of the applicant with the

deceased pensioner ... ...

...

15. Date of birth of the applicant ... ... ...

16. Name of the Treasury or Sub-Treasury at

which payment is desired ... ... ...

17. Full address of the applicant ... ...

...

18. Signature or thumb-impression of the

applicant (To be furnished in a separate

sheet duly attested.**) ... ... ...

19. Attested by :

Name Full Address Signature

(i) ............................... ...................... ..........................

(ii) ............................... ...................... ..........................

20. Witnesses

Name Full Address Signature

(i) ............................... ...................... ..........................

(ii) ............................... ...................... ..........................

Footnote : 1. If a retired Government servant in receipt of service

gratuity or pension dies within five years from the date of his

retirement from service including compulsory retirement as a penalty

and the sums actually received by him at the time of his death on

account of such gratuity or pension including ad hoc increase, if any,

together with the death-cum-retirement gratuity and the commuted

value of any portion of pension commuted by him are less than the

amount equal to 12 times of his emoluments, a residuary gratuity

equal to the deficiency becomes payable to the family.

* When a Government servant has retired before earning a

pension, the amount of service gratuity should be indicated.

** Attestation should be done by two Gazetted Government

servants or by two or more persons of respectability in the town,

village or pargana in which the applicant resides.

FORM 23[ See Rule 38(3)]

Form of Medical Certificate

Certified that *I/(We) have carefully examined AB son of CD a

.............................in the..........................His age by his own statement

is..............................years, and by appearance about ..........................

years. I/(We) consider AB to be completely and permanently

incapacitated for further service of any kind in the Department to

which he belongs in consequence of ........................... (here state

disease or cause).

    (If the incapacity does not appear to be complete and permanent,

the certificate should be modified accordingly and the following

addition should be made.)

    *I am/We are of opinion that AB is fit for further service of a less

laborious character than that which he had been doing/may, after

resting for..............................months, be fit for further service of less

laborious character than that which he had been doing.

Medical Authority

Place

Dated the

 FORM 25

Inserted by G.I., Deptt of Personnel & A.R., Notification No. 29/4/

83-Pension Unit, dated the 15th November, 1984)

[ See Rule 10(1) ]

Form of application for permission to Central ServicesOfficers to accept commercial employment within a period of

two years after retirement

1. Name of the Officer ... ... ...

(in BLOCK letters)

2. Date of retirement ... ... ...

3. Particulars of the Ministry/Deptt/

Office in which the officer served

during the last 5 years preceding

retirement (with duration) :      

Name of Ministry/ Post held Duration

Department/Office From To

4. Post held at the time of retirement and

period for which held ... ... ...

5. Pay scale of the post and pay drawn by the

Officer at the time of retirement ... ... ...

6. Pensionary benefits :      

Pension expected/sanctioned

(commutation if any, should be mentioned) Gratuity, if any

7. Details regarding commercial employment

proposed to be taken up -      

(a) Name of the firm/company/Co-operative

Society, etc. ... ... ...

  (b) Products being manufactured by the firm/type

of business carried out by the firm, etc. ... ...

...

  (c) Whether the official had during his official

career, any dealings with the firm, etc. ... ...

...

  (d) Duration and nature of the official dealings

with the firm ... ... ...

  (e) Name of the job/post offered ... ... ...

  (f) Whether post was advertised, if not,

how was offer made (attach newspaper

cutting of the advertisement, and a copy

of the offer of appointment, if any) ... ... ...

  (g) Description of the duties of the job/post ... ...

...

  (h) Remuneration offered for post/job ... ... ...

  (i) If proposing to set up a practice, indicate -    

    (a) Professional qualification/in the ... ... ...

field of practice

    (b) Nature of proposed practice ... ...

...

8. Any information which the applicant desires

to furnish in support of his request ... ...

...

9. Declaration :-      

  I hereby declare that -      

  (i) the employment which I propose to take up will not bring me

into conflict with Government ;

  (ii) my commercial duties will not be such that my previous

official position or knowledge or experience under Government

could be used to give my proposed employer an unfair

advantage ;

  (iii) my commercial duties will not involve liaison or contact with

the Government departments.

Dated: Signature of the applicant

Address :

Certificate to be submitted by PensionerLIFE CERTIFICATE

Certified that I have seen the Pensioner

(Name of Pensioner)...............Holder of the Pension Payment Order No.

that, he is alive on this date.

For ——————BANK

Signature of a responsible officer or a well-known person

PLACE NAME

Designation

CERTIFICATE OF RE-MARRIAGE/NON-MARRIAGE

I hereby declare that I am not married / 1 have not been married during

the past six months.

OR

I hereby declare that I have not been re-married and I undertake to report

such an event to the Bank.

Place Signature

Dated Name of Family Pensioner

P.P.O. No.

I certify to the best of my knowledge and belief that the above declaration

is correct:

Signature of a responsible officer or a well-known person

Place Name

Designation

FORM OF certificate OF NON-EMPLOYMENT/RE-EMPLOYMENT

I declare that I have not been serviving in any capacity either in a

Government department/office, Company, Corporation, Autonomous

body or Society of Central or State Government or Union Territory or a

Local Fund during the half- year ended May/November, 20. ...........

OR

I declare that I have been employed/re-employed in the office of

__________________________ which is a part of/financed by

_________________________________ Government and was in

receipt of the following monthly rates of emoluments during the half year

ended May/November 20 ............... or during the months of

___________________ falling within the said half year.

(a) Pay (b) Honorarium

Special Pay

Allowance

(including D.A., A.D.A., etc.)

OR

(ii) Further, that the orders of my re-employment do/do not stipulate my

pension being held in abeyance during the re-employment period.

OR

I declare that I have not accepted any commercial employment in

India.

OR

I declare that I have not accepted commercial employment in India

after obtaining previous sanction of the Central Government and none of

the conditions, if any, attached thereto by Government has been violated.

OR

(iii) I declare that I have accepted commercial employment in India

without obtaining the previous sanction of the Central Govt.

Note: This declaration is required to be given for a period of two years

from the date of retirement.

I declare that I have not accepted any employment under a Govt

outside India/an International Organization of which the GoI is not a

member.

OR

I declare that I have accepted employment under a Government

outside India/an International Organization of which the GoI is not a

member after obtaining the previous sanction of the Central Govt. and

none of the conditions attached thereto by the Government has been

deviated from.

OR

I declare that I have not accepted any employment under a Government

outside India / an International Organization of which Govt of India is not

a member, without obtaining the previous sanction of the Central Govt.

Place ______________ Signa tu re

Dated Name of the Pensioner

P.PO. No.

Designation of authorized Officer

(Certificate at (ii) and (iii) are to be furnished only by retired Group 'A'

officers.)

Application for Rly Employee’s Widow for Complimentary Pass

1. Name of the applicant:

2. Name of the deceased Rly Employee:

3. Post Last Held by deceased Rly Employee:

4. Station of Last posting:

5. Date of Death of Rly Employee

6. Details of Widow & dependents

S No Name Relation with Age Date of Birth

Deceased Rly

Employee

7. Class of Pass entitled to

8. Present address

Signatures / LHTI of Widow

Following Documents must be attached:

1 Copy of death certificate

2. Copy of PPO

3 Copy of Service Certificate of the deceased employee

4. Copy of Family I-Card.

5. Affidavit of the widow declaring that she has not remarried and that her

name is not included in the Pass of any relative who happens to be a Rly

employee

6. Two pp size Photographs (Attested) of the claimant &each of the

dependent entitled to be included in pass

ANNEXURE - III

END OF LIFE ISSUES

What the spouse / family should know ?( Before your ..... departure )

1. Your will: What and Where ?

2. Birth Certificate

3. Pension papers including retirement certificate if superannuated

4. Marriage certificate if any

5. Property papers: House/Flat ownership, Real Estate Property

Tax papers i.e. Municipal Tax papers, Land and Building Tax

papers, Society Tax papers , etc

6. Rent papers with all correspondence in connection with the

same

7. Pending litigation papers, if any

8. Court decisions, if any

9. Names of Legal Advisors and their telephone Nos. and addresses

10. Telephone files - first receipt indicating the security deposit

11. Deposit receipts of Gas connection indicating the security

deposit

12. Deposit receipts of Electric meter and water connection with

amount of security

13. Medical files with last reports

14. Passport, driving license , Identity card, election card

15. Income Tax and Wealth tax files

16. Policy files, LIC, GIC, Health, Medical, Fire Accident etc.

17. Motor car / scooter papers and car/scooter insurance

18. Bank/Post office account with details of each account, Name of

the Banks/Post office etc.

19. Detail and keys of Bank Lockers with details of Bank and Locker

numbers

20. Fixed Deposits should be held jointly to be operated by one of

them. Details of maturity and receipt of interest should be clearly

available

21. Cumulative Time Deposits in Post Office / Bank indicating details

thereof

22. Share certificates / Mutual funds - normally the same should be

in joint name

23. Ensure that joint pension Account along with spouse is opened

24. Any other matter of interest to your family

After your Departure

In case of a Govt. Pensioner what the spouse / claimant of family

pension need to do:

1. Obtain Death certificate.

2. Deposit in police station any Arms & ammunition if the

deceased had an Arms license.

3. Inform Pension Disbursing Authority in writing along with a copy

of death certificate.

4. Open a new S.B. A/c in the pension disbursing bank for receiving

Family pension unless you already have a separate S.B account

in your individual name.

5. Obtain Family pension claim Form from the Bank, complete it and

submit it to pension disbursing Bank along with all enclosures.

Obtain acknowledgment.

6. Get the Pension account Pass book, of the deceased, updated to

ascertain the Balance. If it is a joint account, you can request the

Bank to delete the name of the deceased and continue to operate

it. In case it is not a joint account, you have to apply to Bank for its

closure and payment of the Balance to you or to all the heirs. If

there is no nomination depending on the size of closing Balance,

the Bank may ask you to produce legal heir certificate for which

you will have to file an application in the competent court having

Jurisdiction.

If the deceased was a Rly Pensioner:

Then the spouse is also

entitled to complimentary free Rly pass/passes

(1) Approach the pass issuing authority i.e. the office from where

deceased spouse was taking post retirement pass. (2) Obtain the

form for claiming Widow/widower complimentary passes, fill it up

and submit it with the following documents (attested copies):-

1. Death certificate

2. Service / Retirement certificate

3. Pass entitlement certificate (Form GTB 25), if available

4. PPO

5. Two P.P. size attested photos of the claimant.

6. An affidavit (in original) declaring (i) that the spouse i.e. the widow/

widower has not remarried ( ii ) That her/his name is not included

in the privilege/complimentary Rly pass of any other relative and

(iii) Details of dependants, if any.

7. Two copies of pp size Photos of each of the dependents if any.

8. Copy of Photo ID card issued for the purpose of passes.

9. Copy of Family I. Card.

10. Proof of age

ANNEXURE - IV

REGISTERED WILL

1. WHAT IS WILL

WILL is a legal declaration of the intention of the Testator (Writer of

Will) with respect to his own property (NOT ANCESTRAL) which he

desires to be carried   into effect after one’s  death.  It is revocable by

Testator at any time during his lifetime.  However, a registered WILL can

be revoked by subsequent registered WILL only. A person writing WILL

does a great service to his family and loved ones.   There is no stamp duty

for immovable property transferred through WILL. It is the prerogative of

the person having property to distribute and to disinherit anyone from his

assets in the manner he considers appropriate and just. There is definite

advantage in preparing WILL in comparison with not preparing a WILL.

When head of family is alive, one always says that my children are

very good, obedient etc. and would never fight for property. In

today’s materialistic world, all such values have  disappeared.

Everyone is for own family and interest and don’t underestimate the

power of spouse of your son and daughter who often make brothers

and sisters to fight for paternal property in courts. Hence, decide

now the division of your property by writing and registering the same

before area Sub - Registrar / SDM.

2. I AM TOO YOUNG TO BOTHER FOR WILL.  

There is nothing you can guarantee yourself a ripe old age. 

Accidents happen and illness, terrorist attack and earth quake  have

been known to turn fatal.  Age is not the key factor.  If you have

spouse and children, you must write a WILL.  Don’t just bless the

children.  Leave them a WILL and save them from harassment at the

hands of the Municipal Corporation/committee/Development

Authority/Banks/Insurance and greedy relatives.

3. REASONS WHY SENIOR CITIZENS SHOULD WRITE

AND REGISTER  A WILL 

Make a WILL when you are in sound physical and mental condition and

get it registered.  It acts as deterrent for miscreants to prove ownership with

false documents or documents signed by the elderly under duress if a

contesting REGISTERED WILL exists.

4. WILL ON PLAIN PAPER ONLY

WILL can be written on plain paper preferably typed double space (no

stamp paper) witnessed by two persons putting one’s  signature on WILL. 

Witnesses need not know contents of WILL.  It is advised that the witnesses

should be young and reliable. 

In case one is very old it is desirable that a certificate with date

from a doctor be obtained on WILL itself  (both the copies of WILL)

about the health and capacity of the person to write his WILL.

5. I DON’T HAVE A BIG ESTATE.

Most have little idea of the size of our estate and are not sure how to

calculate our net worth.    Even a small flat costs Rs. 50 lacs in cities like

Delhi and satellite towns of metros.

6. I HAVE NOMINEES FOR MY ASSETS, I DON’T

NEED A WILL.

Nominees only hold the asset in trust so it can be passed to the legal

heirs.  For immovable property, one cannot nominate a “Nominee”.   Hence

you do need WILL for transferring immovable property, business, motor car

etc.

7. CONSULT SPOUSE WHILE MAKING WILL.

IT IS THE RESPONSIBILITY OF THE WIFE TO ENSURE THAT

THE SPOUSE WRITES AND REGISTERS WILL. THE WOMAN

SUFFERS THE MOST IN ITS ABSENCE. THIS IS THE ONLY WAY

FOR SMOOTH TRANSFER OF PROPERTY (MOVABLE/

IMMOVABLE) AND BUSINESS TO WIDOW/RELATIVE.

8. WRITE WILL EARLY IN LIFE AND REVISE

PERIODICALLY.

One should make WILL as early as possible in life – say  marriage, or

buying property whichever is earlier.  Death comes at all ages including

young and without warning.   It is never too early/late to write and register

a WILL.

For example, a person has a family of himself, his wife, two major sons

and two major daughters.  All are well settled and married.   He desires to

give away Rs. 15 lakhs to his wife and rest to his four children, he can do so

by writing his intention in the WILL.  However, if he does not make a WILL

and were to die intestate, then his all assets will be divided amongst his wife

and four children in equal proportion.   Which of the options is more

desirable? However, if there is a dispute between widow and four children, one

has to obtain a succession certificate from appropriate local court which may

 take 3 to 5 years and about 2.5 percent of total cost of property and lawyer

fee which generally depends upon  valuation of total wealth including

property and lot of accrimination  between the five legal heirs.  

9. DON’T NEGLECT THE MARRIED DAUGHTERS.

Sons have no birth-right to parental property. Daughters have equal

rights for parental property. Son is a son till he gets married;

daughter is daughter for ever.

10. MENTION NAMES AND AGES OF LEGAL HEIRS.

The WILL writer must mention the legal heirs, i.e. in the case of

male, mother, wife, son and daughter with their name, age and address and

in the case of female, husband, son and daughter. Someone in the family

should know where the registered Will is kept.

11. WHAT CAN BE BEQUEATHED IN WILL

All properties – movable & immovable self acquired property,

i.e. generated through independent income, gift (not ancestral) can be

bequeathed by WILL. Ancestral property is the one obtained from paternal

grand-father, paternal great-grand-father etc.  However, property inherited

from a person other than his father, paternal grand father or great-grand-

father is considered to be self acquired property and therefore can be willed.

Give full description and share of property, number, street, floor, area, city

and description from whom bought etc. Similarly give description of

business, share in business etc.

Generally all movable and immovable property is first bequeathed

to spouse and one can mention, if necessary, on spouse's demise to

be distributed to son/daughter. One can also mention that spouse

has full right to sell the immovable property.

It helps to have a clearly articulated WILL or succession plan.  And it

means a clearly articulated one. Take one case described by Subhash

Lakhotia, a Delhi based Tax Consultant.  Before his death, this client had

equally distributed his property between his sons in a written WILL.   

The WILL also said “my wife will have the right to stay in the house

owned by me”. Guess, where his wife ended up: in a small garage that was

part of the house, thus technically meeting the requirements laid down by her

husband.

Wording should have been “My wife would be permitted to stay at the

same place occupied by me that includes my bedroom, drawing room,

kitchen, lobby and garden”.

12. BUSINESS AND WILL

If you are a business man, you need to decide who will take over your

business after your demise.  In a proprietary concern, if you don’t leave a

Registered WILL, all the legal heirs become owners of business.   Hence

in your life time, include your spouse as partner in business.  .

13. REVISION OF WILL

Making WILL is not a one time affair.  If circumstances change like

death in family, purchase of house, shop, business and like, new WILL should

be written and registered. Only a subsequent registered WILL can

replace an earlier registered one.

              “One can revise one’s WILL any number of times “

14. REGISTRATION OF WILL – A MUST FOR PRACTICAL

AND LEGAL REASONS

IF A WILL IS REGISTERED, it may be possible to get the leasehold

property mutated in the name of beneficiary legal heirs in Development

Authority/Municipal committee/ corporation etc .  It also removes any

ground for suspicion. Registered Will  is certainly superior to

unregistered one. Registration cost in Sub Registrar / SDM Office in

Delhi  is nominal Rs. 100/- only and the time taken just less than an hour. For

registration, take two original copies of preferably typed WILL with photo

pasted on right hand side top and your identity card and  two young and

reliable witnesses (male or female)  with identity cards like passport,

election card, driving licence. As soon as the WILL is signed on every page

by the author of WILL and also signed by two witnesses to WILL, then the

WILL is ready for being presented to Sub-registrar.   A small receipt in

duplicate evidencing the registration of WILL is given to the writer of the

WILL.  On production of the small receipt,  the original registered WILL be

returned to you duly stamped AFTER ONE HOUR...    Registered Will is

necessary for mutation purposes and is also useful for getting money from

P.F., Gratuity, LIC policy, Banks, Mutual Funds, Bonds, Shares, Post Office

deposits etc. in case there is no nomination. Even for transfer of motor car,

one needs preferably a registered WILL.

15. REMITTANCE OF MONEY ABROAD FOR SELLING

ANCESTORAL PROPERTY

These days, a large number of parents have all their children

settled abroad and for them it is highly desirable or even essential

to write and register a WILL. The properties of such parents, when

dead, are vulnerable to the greed of dishonest persons trying to grab

the properties by any foul means.

Government has now permitted the proceeds of sale of such properties

to be sent to children settled abroad. The issue of remittance is stipulated

under the Foreign Exchange Management Act (FEMA).   As per FEMA,

an amount upto US$ 1 million can be remitted outside India in a calendar year

in case of sale of ancestral property through normal banking channels after

obtaining a certificate from a Chartered Accountant certifying that all taxes

have been paid.   Evidence of inheritance of property like Will shall have to

be shown to the bankers for such remittance.

ALL THOSE WHO ARE CHILDLESS AND / OR SINGLE

MUST WRITE AND REGISTER A WILL.

16. REGISTERED WILL & FREEHOLD PROPERTIES

During the last few years, a large number of properties have become

free-hold from lease-hold, meaning thereby that, such properties have no

connection from the authorities from which they were purchased, i.e.

L&DO or DDA (in Delhi). Hence, on demise of the owner there is no need

to go to L&DO/DDA for mutation of the property.  In spite of this, one has

to mutate all properties with Development Authority/Municipal Committee/

Corporation etc for Property Tax and other purposes like building plans,

water, sewage etc. Hence, it is highly desirable, in fact essential, that as and

when a property is purchased, a copy of Registered Deed is immediately

submitted to MCD so that information regarding ownership is recorded in

Municipal records. Similarly, in case of death, legal heirs should intimate to

Development Authority/Municipal Committee/ Corporation etc in the proper

forms, with a copy of the death certificate, for mutation of property in their

names. In case one fails to do so, property in Development Authority/

Municipal committee/ Corporation etc continues to be in the name of earlier

owner and Property Tax is also deposited in the name of earlier owner, which

is legally incorrect.   If property is on rent to another party, property tax is

deductible from house income for income tax purposes.

17. FREEHOLD Properties AND REVERSE Mortgage

In case a property is freehold, one can have assured income after 60

years of age through Reverse Mortgage. 

18. PROPERTY IN JOINT NAMES

MOST PEOPLE BELIEVE ERRONEOUSLY THAT

PROPERTY IS AUTOMATICALLY INHERITED BY  SPOUSE. 

Legally, not so.  Property can only be inherited legally either by WILL or, in

the absence of WILL, by the laws of intestate succession as applicable to

the particular religion. If, however, property has been purchased jointly

by paying proportionate cost of property, both owners  should   write

separately their WILL only for the portion of which they are owner. 

19. Development Authority / Municipal Committee / Corporation

etc prefer Registered Will for mutation of property.

Property received through WILL by a person is legally his own in all

respects and should be mutated/transferred Development Authority/

Municipal Committee / Corporation etc L&D Office and also in Water

Supply and Electricity Offices records by submitting Registered Will, death

certificate and other required papers/documents at the earliest.   Procure

20 original death certificates, because most authorities insist for original

death certificate or notarized death certificate.

Guidelines are available for mutation in Development Authority/Municipal

Committee / Corporation Office. Guidance for filing of forms in such

bodies can best be obtained from the typists sitting outside these offices.

20. WHAT HAPPENS WHEN THERE IS NO WILL

It is not that property is not transferred if one has unregistered Will.  In

that case DDA insists that legal heirs should write revocation deed in favour

of one to whom they wish property to go. This is in case where all legal heirs

agree to give property to agreed person, say, mother. 

If there is disagreement between legal heirs, only course is to approach

local Court for succession certificate, which will indicate how property will

be distributed among legal heirs. For this, one has to apply  to Court. 

Thereafter, Court issues notice to all legal heirs and also gets one legal notice

published in leading local newspaper for filing of objections. After the matter

is decided, Legal Heir Certificate on stamp paper of 2.5% of value of

property is issued.   If the total property is worth one crore, stamp duty shall

be 2.5 lakhs. plus advocate  fee and delay of five years.

21. MUTATION OF POWER-OF-ATTORNEY PROPERTY

If property (flat) is on leasehold on power-of-attorney, get it mutated in

your name in the DDA by paying stamp duty and registering same. It is

advisable to get property registered in female name because Stamp Duty is

only 4% while in the other case it is 6%. All properties purchased on Power

of Attorney are not properties of POA(Power of Attorney holder) holder in

legal sense though fact of physical possession with other documents are in

his favour.

Many people are reluctant to get the leasehold property converted into

free-hold because they feel that it is not necessary since they are in physical

possession of flat, have power of attorney and registered Will in their favour.

Little do they realise that power of attorney lapses with the death of

the person who issued same.  Secondly, registered Will comes into force

on the death of the person and one will never know when and where writer

of Will dies and chances of getting the death certificate are remote. Also,

Development authority insists that in case of registered Will in

favour of someone other than legal heir, no objection affidavit be

brought from legal heirs. In such circumstances, it is doubtful if any legal

heir will give ‘No Objection’ to POA holder.

The cost of converting the lease hold property to free-hold goes

on increasing with the increase in land prices.  Hence the necessity

of converting leasehold into freehold at the earliest.

22. CONTENTS OF WILL SHOULD BE KEPT SECRET

(IF NECESSARY)

Otherwise the beneficiaries might pick up a row and quarrel with the

writer of WILL/beneficiaries as to quantum or proportion of properties

disposed of by him as between the beneficiaries. Everyone including the rich

want free money. Original WILL and registration papers of properties can

be kept in bank locker.  Never keep any original document in Office.

23. NOTHING PASSES TO SPOUSE AUTOMATICALLY

Most believe that on their demise, property – flat/house/money/shares

shall automatically pass on to their spouse.   There is no such provision

in any law.  Property passes to legal heirs only and spouse gets a portion

depending upon the number of legal heirs. If husband and wife have same

or different properties both must write separate Wills.

24. WILL AND NOMINATION

Most believe that by making nominations, there is no need for writing

WILL.  Nothing could be more fallacious than this.

It is important to understand the distinction between a “WILL” and

“NOMINATION”.  A Nomination does not lay down a separate Law of

Succession.   A nominee does not become owner of the property after the

death of nominator.  A nominee’s name will come on Share Certificate of

Society, Company, Bank FD/Account etc. but nominee does not become

owner.   A nominee is only a trustee of the legal heirs. In case of 

contradiction between the contents of a Will and those of Nomination, a Will

contents prevail, as Nomination does not give any succession rights.

In case one wishes nominee gets legal title over property, one

should write Will in favour of Nominee.  In other words, nominee and

person in whose favour WILL is written are same.

25. POWER OF ATTORNEY / GIFT DEED / REVOCATION

DEED  OF PROPERTY TO RELATIVES

Reply is an emphatic ‘No’ because one may lose the total

property and be left in lurch on road.  It actually has happened to

many old persons.

26. ACTION TO BE TAKEN ON DEATH OF WRITER OF WILL

AS PER SECTION 57 READ WITH SECTION 213 OF

SUCCESSION ACT, 1925 AND AS HELD IN RAM CHAND GANESH

DAS VS. SARDARA SINGH (AIR 1962 PUNJAB 382) AND JAGDISH

CHANDER TRIKHA VS. PUNJAB NATIONAL BANK AIR 1998

DELHI PAGE 275-276, IT IS NOT NECESSARY TO GET

REGISTERED WILL PROBATED IN several States. However, in

case someone challenges the WILL, it may become necessary to get the

WILL probated.  The stamp fee for getting WILL probated is 2.5 per cent

of the total property value involved in the WILL and lawyer fee. However

it may vary from State to State. Practical considerations demand that when

property owner is no more, the name of deceased is withdrawn and

substituted by legal heirs as soon as death certificate is received to prevent

complications arising from long list of relatives and heirs who tend to surface

from nowhere in any investment instrument. If property is on lease, tenant

be informed of death along with death certificate with the request to draw

new lease deed in favour of legal heirs.

If one is beneficiary of WILL, please read the contents of WILL

and act according to the dictates of WILL.

27. RESIDUARY CLAUSE

By a Will one can bequeath one’s property, present as well as future. 

A Residuary Clause(s) should make provision about properties not specifically

identified in the Will.   Clause can be written as follows:

”I GIVE, DEVISE AND BEQUEATH ALL MY MONEY AND

OTHER PROPERTY – MOVABLE AND IMMOVABLE

WHATSOEVER AND WHERESOEVER – NOT OTHERWISE

DISPOSED OF BY THIS WILL AND ANY SUCH MOVABLE AND

IMMOVABLE PROPERTY PURCHASED IN FUTURE IN THE

MANNER DESCRIBED ABOVE, I.E. FIRST TO ……………… AND

ON HIS/HER DEMISE TO MY ……………

28. DRAFTING  OF WILL

Get WILL drafted  from a person who is well versed with drafting  of

WILL.  Every WILL is special keeping in view relationship in each family

before and after death. Remember the future peace of your spouse and

family depends on your WILL.

29. EMPOWER SPOUSE WITH FINANCIAL KNOWLEDGE

Most ladies (working as well as housewives)  are not interested in

financial matters.  They feel that it is a man’s domain and consequently

suffer heavily when one becomes a widow. THE ONLY TIME A WIDOW

IS RESPECTED AND LISTENED TO BY CHILDREN IS WHEN SHE

HAS PROPERTY AND MONEY IN HER FAVOUR.

30. PREPARE AN ASSET REGISTER OF SELF AND SPOUSE

giving details of Movable and Immovable property, Pension file, Income-tax

file, Bank accounts, PPF, Senior Citizens Saving account, Bank locker

Number, valuable documents kept in the locker, PLACE WHERE WILL

kept, passport, other documents etc. Otherwise the spouse and other

eligible relatives spend months / years searching and listing assets.

Also mention names of near relatives / friends who will help the

spouse (widow) for getting movable and immovable property in her

name from various authorities.

31. Please do not part with your original / photocopies of WILL and

any property documents  in any circumstances because hostile

person can destroy the same.  Original documents should be kept in

a locker & Pray and only photocopies with you.

Above are only some of the guidelines.  One may act as per his/her

circumstances. 

REMEMBER

* YOU CAN WRITE / REWRITE WILL / CHANGE NOMINEE

BUT DON’T FORGET

* YOU CANNOT REVOKE GIFT  / REVOCATION DEED

DON’T GIVE MONEY, PROPERTY

AND POWER OF ATTORNEY 

TO ANYONE WHEN  ONE IS ALIVE.

LEARN TO SAY ‘NO’LEARN TO SAY ‘NO’LEARN TO SAY ‘NO’LEARN TO SAY ‘NO’LEARN TO SAY ‘NO’

ANNEXURE - V

HEALTHY AGEING

How should you plan your retirement?Simple practical tips for healthy ageing !

By Dr. V.S. Natarajan -

Pioneer in Geriatric Medicine in India

Plan well ahead:

“50 is the old age of youth and

60 are the youth of old age”.

Avoid loneliness:

Loneliness is the enemy of old age. Try to avoid this. Cultivate

lot of hobbies in life. Reading books, listening to music, radio,

computer, gardening, and spiritual activity are good at old age.

Be independent:

Do your basic work by yourself. It gives you pride and dare in life.

Life without bondage:

When getting older try to reduce your bondage with your family. Live

like a droplet on lotus leaf.

Meditation:

Centering the scattering thoughts can be done by meditation.

It gives you mental peace and leads to reduce your stress.

It gives you more mental strength to face your life.

Vow of silence:

Vow of silence in a particular day is a wonderful activity for elders.

To start with 15-30 minutes gradually increase it up to two hours.

Try to do twice in a week.

Fasting:

Taking low calorie food regularly will increase your life span.

Try to fast at least once a week. It gives you strength and brisk.

Your part in the family:

Avoid too much of expectations. It gives you disappointment only.

Try to help as much as possible for your family.

Service:

For doing service one need not have a good health and money.

Do concern about others. Do counsel others with the help of your

experience to overcome their problems. Do community prayer for the

needy.

Pranayama:

Learn pranayama from a qualified teacher.

Practice it regularly for a healthy mind and body.

Will:

Write it right now to avoid unnecessary conflicts and

confusions in the family.

Spiritual thoughts:

When getting older it is natural to accept the super power above us.

It gives you confidence and energy which leads to peaceful life.

Periodical medical check up:

Even if there are no complaints, periodic

health check-up is very essential.

Good diet:

Wheat, ragi, pulses, milk, green vegetables,

green leaves and fruits can be taken moderately.

Finance:

Finance is very important now. Make a habit to save

from your young age to lead your old age. Save for yourself.

Work and rest:

Do work to burn calories. At the same time take rest.

Friends:

“A friend indeed a friend in need” is true especially at old age. Maintain

a good relationship with close friends.

Picnic:

Have some fun going picnic with friends and relatives.

It gives you more energy. It refreshed your mind.

Home:

Decide the home / place you are going to live

at your old age from the middle age itself.

Death:

No medicine to death. It won’t come after announcement. Throw

your fear of death and enjoy your life each and every minute.

EXERCISE

What are the health benefits by doing exercise?

The benefits of exercise far exceed its risks, regardless of the

presence of other risk factors. Regular exercise can reduce mortality

rates even for smokers and obese persons. Indirect benefits include

opportunities for social interaction, an enhanced sense of well-being,

and possibly an improved quality of sleep.

Improvement of physical and physiologic factors

Regular exercise can preserve skeletal muscle strength, aerobic

capacity, and bone density, contributing to mobility and independence.

Exercise is one of the few interventions that can restore physiologic

capacity once it has been lost.

Skeletal muscle strength and power (rare of doing work) decline with

age. These changes can be prevented, at least partially, or reversed

by appropriate exercise. Regular exercise also promotes a balance

energy state and reduces risk of obesity.

Improvement of functional ability

Regular exercise reduces the risk of age-related decline in functional

ability, and it appears to improve quality of life by improving physical

functioning and enhancing psychologic well-being.

Prevention and treatment of disease

In the elderly, regular exercise increases insulin sensitivity and

glucose tolerance reduces resting systolic and diastolic blood

pressure, normalizes blood lipid levels including reductions in

circulating triglycerides and an high-density lipoprotein cholesterol,

and reduces visceral fat contest. Thus, regular exercise can help

prevent cardio-vascular disease (e.g. heart attack, hypertension,

diabetes, osteoporosis, obesity) – related disorders, colonic cancer,

and psychiatric disorders. It is part of rehabilitation after a heart attack

or after surgery.

Prevention of falls and fall-related injuries

Regular exercise can help prevent falls and fall-related injuries by

improving several risk factors for fall related to poor mobility, including

strength, balance, neuro-muscular coordination, joint function and

endurance. Exercise provides overall benefits, despite a modest

increased risk of falls during the exercise.

Reduction in mortality

Many studies report that regularly active elderly persons have 20 to

50% lower mortality (death) rates, despite a slight (but widely

publicized) temporary increase in the risk of sudden death during

exercise.

Benefits of exercise programs for older persons

· Improved aerobic capacity.

· Reduced mean arterial blood pressure.

· Reduced resting heart rate.

· Increased maximum oxygen consumption

· Increased muscle mass and strength

· Increased bone density

· Increased flexibility

· Improved gait velocity

· Improved lipid profile – especially increase

in high-density cholesterol (good Cholesterol)

· Improved sense of well-being

· Reduces weight

· Prevents constipation

Is there any relationship between exercise and cancerprevention?

In a study conducted in Japan regarding exercise and its relationship

to the incidence of cancer, an assessment was made on a group of

sedentary workers up to their old age. It was observed that for those

engaged in sedentary work for more than 20 years, the incidence of

cancer involving the colon and rectum was increased. In a similar

study conducted in U.S.A. young athletic woman were followed up to

their old age. It was found that the incidence of cancer involving breast

and uterus was considerably low.

Thus these two studies indicate that exercise has a direct impact in

reducing the risk of cancer.

What type of exercise for elderly?

Of all types of exercise, endurance exercises (e.g. walking, cycling,

and swimming) provide the most well documented health benefits for

the elderly. Jogging is generally inappropriate for elderly persons not

already accustomed to it.

Patients do not have to be active for 30 minutes at a time but can

accumulate 30 minutes over 24 hours. As little as 10 minutes of

exercise has health benefits, and three 10-minute bouts of activity

have the same fitness effects as one 30-minute bout.

For the elderly, walking is generally the most readily available form of

aerobic exercise and should be performed for more than 30 minutes

during each session. Elderly people can walk 3 to 5 km daily.

Exercises are best done early in the morning or in the evening. They

should not be done on a full stomach. The elderly can exercise as the

presence of other participants makes the session a social event and

the group leader can prod them and encourage their continued

participation.

Those who are having restricted mobility like arthritis of knees and

poor vision they can sit and do upper body exercise. Instead of doing

exercise continuously for half an hour a patient can do 10 minutes at

a time for three times a day.

The exercise form best suited for any given elderly individual has to

be decided upon after consultation with the doctor. In the presence of

certain diseases, certain exercises may be harmful. For example

diabetic patients whose retina has been affected or those who suffer

from both diabetes and hypertension should not perform exercises

involving standing on the head or bending forward. Those who have

week hearts should avoid strenuous exercises, which can cause

breathlessness. During the month following a heart attack, all forms

of exercise except walking should be eschewed.

Dose of insulin and oral hypoglycemic in diabetics may need to be

adjusted (according to the amount of anticipated exercise) to prevent

hypoglycemia during exercise.

How do we know that excess of exercise has been done?

If you noticed any one of the following events while doing exercise

consult your doctor immediately.

· Pulse rate more than 120/minute

· Palpitation – excessive heart beat

· Chest pain

· Difficulty in breathing

· Pain in the joints

· Extreme weakness

Any tips for keep moving?

· No age limit to start exercise.

· Physical inactivity is the leading cause of premature death.

· Before starting exercise first, pre-exercise screening by a doctor

is essential.

· Do it in the empty stomach – in the morning or evening hours.

· Minimum 30 minutes exercise per day for 5 days per week is a

must.

· Those who are unable to do outdoor exercise – choose indoor

cycling, treadmill, floor exercises

· Walking stick (cane), walker or frames may be useful for people

who are not stable on their feet.

· Group exercise is preferable

So exercise is the best tonic for the elderly, all the benefits of which

can be enjoyed without any extra expense.

ANNEXURE - VI

CENTRAL GOVERNMENT HEALTH SCHEME

SALIENT FEATURES

The “Central Government Health Scheme” (CGHS) provides

comprehensive health care facilities for the Central Govt. employees

and pensioners and their dependents residing in CGHS covered

cities.

Started in New Delhi in 1954, Central Govt. Health Scheme is now in

operation in Allahabad, Ahemdabad, Bangalore, Bhubhaneshwar,

Bhopal, Chandigarh, Chennai, Delhi, Dehradun, Guwahati, Hyderabad,

Jaipur, Jabalpur, Kanpur, Kolkatta, Lucknow, Meerut, Mumbai, Nagpur,

Patna, Pune, Ranchi, Shillong, Trivandrum and Jammu.

The Central Govt. Health Scheme provides comprehensive health

care to the CGHS Beneficiaries in India. The medical facilities are

provided through Wellness Centres (previously referred to as CGHS

Dispensaries) /polyclinics under Allopathic, Ayurveda, Yoga, Unani,

Sidha and Homeopathic systems of medicines.

* 78 Ayush dispensary/units, * 248 Allopathic Dispensaries,

* 19 Polyclinics, * 3 Yoga Centres * 65 Laboratories, * 17 Dental Units

CGHS Cards: DEFINITION OF FAMILY

In accordance with the initial instructions, the term of Family for the

purposes of the Scheme shall consist of the Government servant’s

wife or husband, as the case may be, children and stepchildren and

parents who are mainly dependent on and residing with the

Government servant concerned. Subsequently in pursuance of the

recommendations of the Sixth Central Pay Commission, it has been

decided that for availing the medical facilities under the scheme,

parents, sisters, widowed sisters, widowed daughters, minor brothers

and children will be deemed dependent on the Government employee

if they are residing with him and their income from all sources

including pension and pension equivalent of DCRG benefit is less

than Rs. 3500 + DR per month.

{in case of Divorced/ widowed daughters ‘Residing with’ condition

has been withdrawn vide OM No. 4.24/96-C & P/CGHS (p)dated

30.05.2007. & 4.24/96-C & P/ CGHS/ (p) dated 25.02.2009}

ENTITLEMENT OF THE SCHEME:

All Central Government pensioners (except Railway Pensioners and

Armed Forces pensioners) who were eligible for availing CGHS

facilities while in service are eligible for availing CGHS facilities after

retirement. The scheme is also applicable to Central Government

employees who retired with Contributory Provident Fund benefits.

Similarly families of Central Government employees in receipt of

family pension are also eligible to avail of these facilities, if the

deceased Government servant was eligible for these facilities while

in service.

It is not that only those Central Government employees who were

actually availing of CGHS facility during service are eligible to enjoy

84 85

DETAILED PROVISIONS FOR ELIGIBILITY OF

PENSIONERS/FAMILY PENSIONERS TO JOIN CGHS

All Central Government Pensioners (except Railway Pensioners

and Armed Forces Pensioners) who were eligible for availing CGHS

facilities while in service are eligible for CGHS facilities after retirement.

The Scheme is also applicable to Central Government employees who

retired with Contributory Provident Fund benefits. Similarly, families of

Central Government employees are eligible for the facilities for which

the deceased Government servant was eligible while in service.

All India Service Pensioners who retire while serving under State

Governments are also eligible to avail CGHS.

Pensioners can join CGHS immediately after retirement or at any

time thereafter.

Pensioners joining CGHS sometime after retirement are not required

to pay the contribution for the intervening period. However, in such

cases, they shall be required to pay admission fee of Rs. 30/-.

Similarly, pensioners who had discontinued their CGHS membership

and want to be readmitted to the scheme shall not be required to pay the

contribution for the intervening period, but pay a readmission fee of

Rs. 30/-

Pensioners have the option to get their names registered with any of

the CGHS dispensaries in CGHS-covered cities.

Pensioners residing in an area not covered by CGHS and who have

opted for availing monthly medical allowance, but also desire to avail

CGHS facilities for indoor hospitalization treatment from the nearest

CGHS covered city can be issued CGHS cards bearing stamp “Not valid

for OPD Treatment”

(OM. NO. 11055/1/2000-CGHS (P) dated 25.2.2000)

PROCEDURE FOR APPLYING FOR CGHS CARD BY

PENSIONER

A pensioner has to get a separate identity card surrendering the one

being used while in service. Application should be submitted to the Addl.

Director, CGHS, Bikaner House, New Delhi - 110 001 in the prescribed

form with the documents mentioned below:-

1. Photo copy of last pay certificate

2. Photo copy of Pension Payment Order

3. Group photograph with eligible dependents

4. Dependency certificate in the application form, duly certified

5. Certificate about surrender of CGHS card used while in service

6. Certificate from Pension-Drawing Authority indicating non-drawal

of Fixed Medical Allowance

7. Bank Draft from a Nationalized Bank / Postal Order for the required

amount in favour of Addl. Directors CGHS.

Application can be given three months prior to retirement or within

one month of retirement. If there is delay in applying, a readmission fee

of Rs. 30/- (or if contribution for the intervening period is less than

Rs. 30/-, actual contribution) is to be paid . For rates of Contribution to

be made please see p ..... under the sub head:

Revised Rates of Contribution to CGHS & Entitlement of Private Ward

(OM. No. S-12015/2/93-CGHS (P) dated 5.11.93 of MOH&FW)

TEMPORARY VISIT IN COVERED CITY

Central Govt. employees and dependent family members who are

beneficiaries of the CGHS. and who may be visiting other cities where

the scheme is operating and stay in the areas covered by the Scheme are

entitled for free medical attendance / treatment under the said Scheme.

(Necessary authority/ temporary cards for medical treatment in any of

those cities should be issued by the respective departments in case of

serving employees.) Medical facilities should be restricted to a period not

exceeding six months after which fresh authorities may be issued, if

necessary. Similar facilities are also available to pensioners and the

dependent family members if holding. CGHS Cards and permission shall

be granted by CGHS of the city being visited. Pensioners do not need

temporary permit but will be given CGHS facilities in all CGHS covered

Cities (he/she may be visiting) on the basis of their CGHS Token Card/

Plastic card with their Photo affixed thereon.

(Deptt of Health OM. No. S - 11001/6/91-CGHS(P) dt 10.06.1991)

8786

PRODUCTION OF CGHS TOKEN CARD

The production of CGHS Token Card is obligatory on every visit to

enable correct identification of the patient and to prevent misuse of card.

The misuse of card is a cognizable offence. However, in view of

humanitarian service, essential and immediate treatment should not be

denied to the patient but the beneficiary should be advised to bring the

CGHS Card at the time of subsequent Visits and, if considered necessary,

a note may be made in OPD ticket of the patient. The production of

CGHS Index Card in the dispensary will enroll the card holder as a

member of the said dispensary. The renewal of Pensioners’ Token

card shall be done in the dispensary itself now called wellness centre.

The Indian Postal Order should be sent to Pensioner Cell, Nirman

Bhavan/DDO Office outside Delhi, regularly on or before 6th day of the

following month. Before accepting the IPO the Chief Medical Officer

In charge must see the date of issue of I.P.O/ DDs which should be

within one month of issue from the Post Office. The Chief Medical

Officer in charge will obtain a certificate from each pensioner for any

rise of pay/pension due to incremental rise after every two years for

calculation of rate of pension or the fact may he verified from his Pension

Payment Order (PPO) before revalidation of card. The Chief Medical

Officer In charge may therefore re-fix the rate of contribution accordingly.

In case of Pensioner, the transfer of card from one Wellness Centre to

another shall be) done by the Chief Medical In charge of the WC.

REGISTRATION OF CGHS CARD IN WELLNESS CENTRE

Card Holder must deposit the Index Card in the dispensary and obtain

receipt from the receiving clerk. The receiving clerk, will initial the Token

Card in confirmation. Until he deposits the Index Card, the beneficiary

is not entitled for treatment in the said WC. On transfer to another WC,

the Card Holder must collect the index card from the WC and deposit the

same along with necessary forms (in duplicate) to the new WC which

has been allotted to him. It is only after the deposition of Index Card in

the WC that the members mentioned in the token card are entitled to

obtain CGHS facilities.

INTRODUCTION OF CGHS PLASTIC CARDS:

Consequent on computerization of CGHS, it has been decided to

introduce CGHS Plastic Cards for CGHS beneficiaries individually,

containing photograph of the beneficiary and details regarding card

number, name of the beneficiary, entitlement of ward facility, date of

issue along with the date of validity and a bar code to identify the

beneficiary.

As there are different categories of beneficiaries, it has been

decided to have four colour codes to identify the category to which the

beneficiary belongs - Blue colour code is for serving employees; Red

colour for Members of Parliament; Green colour for pensioners and

Yellow in case of autonomous bodies . (See also Annexure 6B)

SURRENDER OF CGHS CARD

The CGHS Identity Card held by the beneficiary other than Pensioner,

General Public, Ex-MPs etc. must be surrendered to the issuing authority

in the following events:-

(a) Retirement /Resignation

(b) Death of Government Servant

(c) Transfer of Govt. Servant to another office. The Govt. servant, if

transferred to another office where he/ she is again entitled for

CGHS benefits, must apply and obtain a new Identity Card.

Pensioners, Ex-M.Ps, Member of General Public etc. are also required

to surrender their Identity Cards to the Issuing Authority on its expiry in

case they no longer desire to avail CGHS facilities.

MISUSE OF CGHS CARD

If the Medical Officer detects a case of misuse of CGHS Token Card

by unauthorized person, he will bring to the notice of Chief Medical

Officer In charge and / or the matter reported to the Zonal HQ/ etc. for

further necessary action.

LOSS OF IDENTITY CARD

As a lost card is likely to be misused, the card holder must inform

immediately to the Police and inform the following with a, copy of F.I.R.

(i) Issuing authority

(ii) C.M.O. In charge of the concerned Wellness Centre.

(iii) Headquarters of CGHS in the cities other than Delhi.

8988

A duplicate card can be issued after realising penalty of Rs 5/- for

1st instance. 2nd. instance Rs 7/-, 3rd and subsequent instance Rs 10/.

In case of individual Plastic Cards in Delhi / elswhere, the procedure is

same but, the penalty is Rs 50/-.

DEPENDENCE CERTIFICATE

Every Card Holder must certify that the parents /Dependents whose

names have been included in the token card, normally reside with him.

Such a certificate must be furnished at the time of issue of Token Card

and renewed every January. Otherwise the parents shall be treated as

non-entitled persons. The certificate must also state that the income from

all sources does not exceed Rs 3500 + DA p.m. {in case of Divorced/

widowed daughters ‘residing with’ condition has been withdrawn vide

OM No. 4.24/96-C & P/CGHS (P) dated 30.05.2007. & 4.24/96-C &

P/ CGHS/ (P) dated 25.02.2009}

FACILITIES NOT PERMISSIBLE TO THE PENSIONERS:

1. Treatment in Non-recognized Hospitals / Nursing Home

except in EMERGENCY

2. Treatment outside India

3. Administration of routine injections at one’s residence

4. Dressing of wound at residence

5. Supply of artificial appliances, e.g., dentures, spectacles,

contact lens, etc. [In respect of dentures, an amount upto Rs

2,000/- is reimbursible.]

6. Orthodontic treatment

7. Treatment for obesity due to inogenous factors.

8. CS (MA) Rules, 1944 are not applicable to pensioners residing

in areas not-covered by CGHS

(GOI OM No. 14025-4/96-MS dt 20.8.2004)

FIXED MEDICAL ALLOWANCE FOR PENSIONERS

1. Pensioners/Family Pensioners residing in an area not covered

by CGHS (or corresponding Health Schemes of other Ministries/

Departments), and who have specifically opted for not availing of

outdoor facilities from the nearest CGHS dispensary, are entitled

for a Fixed Medical Allowance per month for meeting day-to-day

medical expenses that do not require hospitalization.

2. Pensioners who have opted for availing FMA, but also desire

to avail CGHS facilities for indoor Hospitalization treatment from

the nearest CGHS covered city can be issued CGHS cards

bearing stamp “NOT VALID FOR OPD TREATMENT”.

CGHS HELPLINE: Tel. 011-66667777,

e-mail-helpline-cghs@nic.in

Revised Rates of Contribution to CGHS & Entitlement of

Private Ward

(A) Monthly Contributions for availing CGHS facility:

S. Grade Pay Rs

No.

1 Upto Rs. 1,650/- per month 50/-

2 Rs. 1,800/-; Rs. 1,900/-; Rs. 2,000/-;

Rs. 2,400/-; and Rs. 2,800/- per month 125/-

3 Rs. 4,200/- per month 225/-

4 Rs. 4,600/-; Rs.4,800/-; Rs.5,400/-; and

Rs.6,600/- per month 325/-

5 Rs. 7,600/- and above per month 500/-

(B) Entitlement of wards in private hospitals empanelled under

CGHS:

S. No. WARD Pay in Pay Band + Grade Pay

1 General Ward : Upto Rs. 13,950/-

2 Semi-private ward : Rs. 13,960/- to Rs. 19,530/-

3 Private ward : Rs. 19,540/- and above

(C) Monetary Ceiling for Free Diet:

The monetary ceiling for free diet for CGHS beneficiaries is revised to

pay / pension / family pension of Rs. 7,450/-per month.

9190

(D) Monetary ceiling for free diet (for beneficiaries suffering from

TB or mental disease):

The monetary ceiling for free diet in case of beneficiary suffering from

TB or Mental disease is revised to pay / pension / family pension of Rs.

11,160/-per month.

(E) Pay slab for determining the entitlement of Nursing Home

facilities in Government/State Government/Municipal Hospitals:

The monetary ceiling for determining the entitlement of Nursing Home

facilities in Central Government / State Government /Municipal Hospitals

is revised to pay / pension / family pension Rs. 13,950/- per month and

above

(F) Monetary Ceiling for direct consultation with Specialists in

Central Government / State Government / Municipal Hospitals:

The monetary ceiling for determining the entitlement for direct consultation

with Specialists in Central Government / State Government / Municipal

Hospitals is revised to pay / pension / family pension of Rs. 33,480/- per

month and above.

(G) Pay slab for determining the entitlement of accommodation in

AIIMS, New Delhi:

The revised entitlement, be revised as per the pay drawn by the officials,

as given below:

S. Pay (in the Pay Band)/Pension/ Ward entitlement

No. Family Pension drawn per month

1 Upto Rs. 19,530/- General Ward

2 From Rs. 19,540/- to Rs. 25110/- Private Ward

3 Rs. 25, 120/- and above Private Ward / Deluxe

Ward

3. It is clarified that the reference to pay in this order relates to the pay

drawn in the pay band.

4. Pensioners have an option to get their CGHS pensioner card made

by either making CGHS contribution on an annual basis (twelve months)

or by making contribution for 10 (ten) years [120 months(one hundred

and twenty months) ] for getting a pensioner CGHS card with life-time

validity. It is clarified that:

(i) Contributions to be made by pensioners & family pensioners

would be the amount that they were subscribing at the time of

their retirement or at the time of death of the Government

servant;

(ii) Pensioner beneficiaries, who have already obtained CGHS card

with life time validity by paying a lump sum amount equivalent

to 10 years’ contribution, will not be required to pay any

additional amount as a result of the revision in the rates of

contribution for availing CGHS facility;

(iii) Entitlement of pensioners & family pensioners, who have

already deposited their contribution for life time CGHS facility,

will not be changed;

(iv) Pensioners & family pensioners who are contributing to the

CGHS on an annual basis and wish to continue to avail CGHS

benefits will have to contribute at the revised rates upto the time

of contribution needed to cover a period of a total of ten years

from the time pensioner CGHS card was issued for the first time

to them. The revised rate of contribution for the remaining period

would be with reference to the grade pay that he / she would

have drawn in the post held by him / her (at the time of his / her

retirement / death) had he / she continued to be in service now

but for his / her retirement / death; and

(v) Any pensioner / family pensioner who is entitled to avail CGHS

facility has not so far got his / her pensioner CGHS card made,

the rate of contribution in such cases will be with reference to

the grade pay that he / she would have drawn in the post held by

him / her (at the time of his / her retirement / death) had he / she

continued to be in service now but for his / her retirement / death.

(OM. No. S.11011/2/2008-CGHS (P) dated 20.05.09 from

Ministry of H & FW)

REFERRAL PROCEDURE

CGHS/ Govt. Specialist / CMO I/c advises specific treatment

procedure / test. Permission to undergo the same at one of the recognized

9392

Hospitals / Diagnostic centre is granted by CMO I/c in case of pensioner

CGHS beneficiaries / ex- Members of Parliament / Freedom Fighters /

ex- Governors, etc., by CMO I/c of concerned Wellness Centre and by

Rajya Sabha Secretariat, as the case may be, in case of Hon’ble

Members of Parliament and by HOD in case of Serving Govt. employees

and by Autonomous bodies in case of serving employees and pensioners

of Autonomous bodies covered under CGHS.

If the beneficiary seeks permission from a CGHS recognized

hospital in another CGHS city, other than the city where he is registered,

permission shall be granted by Addl. Director / Joint Director CGHS of

concerned city. However, no TA/DA shall be permitted if treatment

facilities are available in the city of residence; TA as per entitlement is

permitted if no treatment facilities are available in city of residence.

OPD treatment in private recognized hospitals is not permitted

except in case of Satellite Towns of Delhi , viz., Noida, Gurgaon,

Faridabad and Ghaziabad , wherein the CMO I/c can directly refer the

beneficiaries to recognized hospitals and in post-operative follow-up

cases of Cardiac surgery, Cancer treatment, Kidney transplantation,

Hip/Knee Joint Replacement , Neurosurgery and Accident cases.

OPD medicines are to be collected through concerned Wellness

Centre except in case of emergency, in which case reimbursement shall

be considered by HOD of department / Joint Director/Addl Director of

CGHS in case of pensioners , etc.,

In permitted post-operative cases, for conditions as stated above, the

beneficiaries may purchase from chemist and claim reimbursement.

However, a utilization certificate from the treating doctor is required to

be submitted.

PROCEDURE FOR TAKING TREATMENT IN EMERGENCY

In emergency cases involving accidents, serious nature of disease etc.,

the person / persons on the spot may use their discretion for taking the

patient for treatment in a private hospital/clinic/nursing home in case no

government or recognized hospital is available nearer than the private

hospital. Question has been raised about the need for transferring the

patient to Government/ Recognized Hospital after the emergency is over

for obtaining further treatment. It is clarified that the patient while he is

in a private hospital should act according to the advice of the hospital

authorities. He should get discharged form the hospital only when the

hospital authorities discharge him. After discharge, the beneficiary may

submit his medical reimbursement claim. Powers in this regard have

been delegated to the Head of CGHS organization in various CGHS

covered cities in respect of both serving beneficiaries as well as

pensioners for deciding which cases fall under the emergency category.

Since it is not possible to obtain prior permission in emergency, treatment

taken by CGHS beneficiaries in emergency will be considered on merits

even if the treatment is taken from a non-recognized private hospital. For

granting ex-post-facto approval in emergency cases both for serving/

pensioner beneficiaries, the power is delegated to the Head of the

concerned CGHS covered city where the beneficiary is registered.

REIMBURSEMENT

Unlike cases of treatment in Govt/Private Hospitals with the prior

approval of the competent authority where the claim for reimbursement

is required to be submitted within three months (in the prescribed

application form medical, see annex 6A) & supported by Essentiality

Certificate etc. In case of treatment taken in emergency the claims are

required to be submitted within one month of the date of discharge from

the hospital/clinic etc.

CREDIT FACILITIES IN PRIVTE RECOGNIZED HOSPITALS

FOR EMERGENCY TREATMENT

In accordance with the orders of the Ministry of Health & FW vide their

O.M. No, Rec -24/ 2001/JD (M)/CGHS/Delhi/CGHS (P) dt. 7-9-2001,

in case of emergency, the recognized Private hospital shall not refuse

admission or demand advance from the beneficiary & shall provide

Credit Facility to the concerned patient on the production of valid

CGHS Card. The recognized CGHS Hospital /Diagnostic Centre shall

submit the bill for re-imbursement subject to the ceiling of approved rate

to the respective Department / Addl Director, CGHS, where the

payment is made by CGHS Directorate.

In case of reimbursement when the treatment was obtained in a

private non-empanelled hospital under emergency

Vide OM No; 4-l8/2005-C&PfVol.I-Pt. (I) dated 20.02. 2009 Ministry

of H &FW it has been decided:

9594

(1) To do away with the procedure for verification of bills and issue of

Essentiality Certificate by the treating doctor, and the Medical

Superintendent of the hospital, Ministries / authorities concerned may

verify and check the authenticity of the claims on the basis of the

prescription slip and the diagnostic report submitted by the Government

servant / pensioner. In the event of any doubt, the concerned Ministry /

Authority can always get verification done from the Hospital concerned.

Modified reimbursement claim form, along with checklist is annexed

(see annexure 6A).

(2) All cases involving requests for relaxation of rules for reimbursement

of full expenditure will henceforth be referred to a Technical Standing

Committee, to be chaired by the DGHS / Addl. DGHS and consist of

Director (CGHS) and subject matter specialists. If the Technical

Standing Committee recommends the relaxation of rules for permitting

full reimbursement of expenditure incurred by the beneficiary, the full

reimbursement may be allowed by the Secretary (Health & Family

Welfare) in consultation with IFD. A check list for consideration of

requests for reimbursements in excess of approved rates may include:

(a) The treatment was obtained in a private non-empanelled hospital

under emergency and the patient was admitted by others when

the beneficiary was unconscious or severely incapacitated and

was hospitalized for a prolonged period;

(b) The treatment was obtained in a private non-empanelled hospital under

emergency and was admitted for prolonged period for treatment of

Head Injury, Coma, Septicemia, Multi-organ failure, etc.;

(c) The treatment was obtained in a private non-empanelled hospital

under emergency for treatment of advanced malignancy;

(d) The treatment was taken under emergency in higher type of

accommodation as rooms as per his / her entitlement are not

available during that period;

(e) The treatment was taken in higher type of accommodation

under specific conditions for isolation of patients to avoid

contacting infections;

(f) The treatment was obtained in a private non-empanelled hospital

under emergency when there is a strike in Government hospitals;

(g) The treatment was obtained in a private non-empanelled hospital

under emergency, while on official tour to non-CGHS covered

area;

(h) Approval for air-fare with or without attendant on the advice of

treating doctor for treatment in another city even though he is not

eligible for air travel / treatment facilities are available in city of

residence and

(i) Any other special circumstances.

REIMBURSEMENT OF COST OF MEDICINES PURCHASED

DIRECTLY FROM AUTHORIZED CHEMIST DURING

EMERGENCY

The medicines prescribed by Specialists and non-formulary

medicines can not be procured by the CGHS beneficiary direct

from any local chemist. The concerned medicines would be

procured by the CGHS dispensary (Wellness Centre) from its

approved chemist and supplied to the beneficiary. However,

powers have been delegated to the Heads of the Ministries / Departments

and the Additional / Joint / Deputy Directors of the CGHS covered cities

to reimburse the expenditure incurred by the CGHS beneficiaries on

purchase of medicines directly from authorized / registered chemist

shops during emergency. What constitutes emergency has been left

to the judgement of the Administrative Ministry/ Departments

and the Additional / Joint / Deputy Director of the CGHS covered

cities who will consider and decide the quantum of reimbursement

for medicines and service provided / procured in such situations,

provided hospitalization is not involved and for which separate

provision exists.

The CGHS beneficiaries and their family members are supplied

medicines prescribed by the Doctors in the CGHS WC free of

cost. In case of the beneficiaries taking treatment in the hospital

(Govt/Referral/Private Recognized) as out-door patient,

medicines prescribed by the specialists of these hospitals in the

OPD are supplied by their respective dispensaries. However,

the expenditure incurred during hospitalization as in-door patient

is re-imbursable. The concerned government servant is required

to submit his claim in the prescribed proforma to his department

9796

within three months of the date of discharge from the hospital

(within one month from the date of discharge in case of treatment

taken in emergency).

REIMBURSEMENT FROM TWO SOURCES:

Beneficiaries who have subscribed to Medical insurance

policies in addition to availing CGHS facilities/ C S. (MA) Rules

1944 may 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. The beneficiary will make

first claim to the insurance company, and second claim to CGHS

or Ministry/ department concerned. The insurance company will

issue certificate indicating the amount reimbursed.

(OM No. S. 11011/4/2003-CGHS (P) dated 19-02-2009)

Individual plastic card mandatory: W.e.f 31 03.2010 individual

plastic cards in lieu of existing paper board cards are mandatory

for CGHS beneficiaries in Delhi. New individual plastic cards in

other cities shall also be issued by CGHS bearing unique

beneficiary identification. No (Ben I D No) for each beneficiary

{OM No Misc. 6024/2007 CGHS (HQ) / CGHS (P) dated

30-12-2009}

DOCUMENTS REQUIRED FOR SUBMISSION OF MEDICAL

BILLS

1. Individual’s representation

2. Medical Reimbursement Form duly filled

3. Cash vouchers countersigned and stamped by the Medical

Officer

4. Prescription

5. Xerox copy of the CGHS Identity Card

6. Distance from residence to the Private Hospital and to the

nearest Govt. Hospital (in case of treatment taken in

emergency)

7. Medical History Sheet/Discharge summary

ANNEXURE - 6A

Central Government Health Scheme

Modified Check List For Reimbursement Of Medical Claims

of Claims of CGHS Beneficiaries

1. CGHS Token /plastic card No. and place of issue:

(Or Ben I D of Employee/Pensioner)

2. Validity of CGHS Card /Plastic card (For pensioners):

from…………to………Entitlement: Pvt / Semi Pvt /General Ward

3. Full name of Card Holder (Block Letters):

4. Status (Govt Servant/Pensioner/Other):

5. The following documents are submitted:

{Please tick () the relevant column}

(a) Medical 2004 Form : Yes/No

(b) Photocopy of CGHS card: Yes/No

(c) No. of Original Bills: …………

(d) Copy of discharge summary: Yes/No

(e) Copy of referral Specialist/CMO: Yes/No

(f) Whether the hospital has given breakup: Yes/No

For lab investigations

(g) Original papers have been lost;

the following documents are submitted—

I. Photocopies of claim papers: Yes/No

II. Affidavit on Stamp Paper: Yes/No

(h) Incase of death of card holder the following documents are

submitted—

I. Affidavit on Stamp paper by Claimant: Yes/No

II. No objection from other legal

Heirs on Stamp papers: Yes/No

III. Copy of death certificate: Yes/No

9998

Dated: Signature of CGHS card holder

Tel. No. (O) (R)

E-mail Address

Name of the Bank ……. ……… Branch………………..SB A/C No.

Branch MICR Code …...…….. Tel. No. of Bank Branch…………..

Central Government Health Scheme Medical 2004 Form

for Reimburement of Medical Claims of CGHS Beneficiaries

Computer No

(To be filled by the claimant)

1. CGHS Token/Plastic card No. and Place of issue:

(Or Ben I D of Employee/Pensioner)

2. Validity of C GHS Token Card/Plastic card: from…….…to….…

& entitlement: Pvt. / Semi Pvt. /General Ward

3. Full name of the card holder (Block Letters):

4. Full address:

5. Telephone no. (O)………………… (R) …………………..

6. E-mail address if, any.

7. Name of the Bank ………. …… Branch………………SB A/C

Branch MICR Code …..…….. Tel. No. of Bank Branch………...…

8. Name of the patient & relationship with the card holder:

9. Status tick () (Govt Servant/Pensioner/Serving employee or pensioner

of Autonomous body/Member of Parliament/Ex-M.P./Ex-

Governor/Former Judge of Supreme Court/Former Judge of High

Court/Freedom Fighter/Legal Heir/others)

10. Basic Pay/Basic Pension

11. Name of the Hospital with Address:

(a) OPD treatment and investigations

(b) Indoor Treatment

12. Date of admission………….Date of discharge…….(In case of

Indoor Treatment only)

13. Total amount Claimed:

(a) OPD Treatment

(b) Indoor Treatment

14. Details of Referral:

15. Details of Medical advance if, any:

Declaration

I hereby declare that the statements made in the application are true to

the best of my knowledge and belief and the person for whom medical

expenses were incurred is wholly dependant on me. I am a CGHS

beneficiary and the CGHS card was valid at the time of treatment.

I agree for the reimbursement as is admissible under the rules.

Dated: Signature of CGHS card holder

Note: Misuse of CGHS facilities is a criminal offence. Suitable action

including cancellation of CGHS card shall be taken in case of wilful

suppression of facts or submission of false statements. Suitable disciplinary

action shall be taken in case of serving employees.

Information

(a) Kindly write correct postal address in block letters.

(b) Obtain Break-up of Investigations from the Hospital (details and

rates of individual tests and the exact number of Sugar tests, X-ray

films, etc.) as the Reimbursable amount is calculated as per

approved rates only.

(c) Affidavit Draft against column (I) of check list – in case of loss of

Original Papers:

Draft for Affidavit for Duplicate

Claim Papers / Bills on Stamp Paper

I, …………….............son/wife/daughter of ……...........………….

and resident of Lost / misplaced / not traceable. I hereby give an

undertaking that I have not received any payment against original bills /

claim papers from any source and that if the original papers are traced

101100

I shall not stake claim against original bills in future and that in the event

I receive any cheque against original bills in future I shall return the same

to competent authority.

Deponent

Verified by Notary Public

(d) Draft against column (I) of check list-in case of Death of Card holder

Draft for Affidavit on Stamp Paper for claiming medical

reimbursement

I, ………………wife/son/daughter of Late……………..and

resident of ………hereby submit the medical claim papers pertaining to

treatment of my father/mother/……Late Shri/Smt……..who has expired

on………(copy of Death Certificate is enclosed).

Late Shri/Smt……..has left behind the following other legal heirs none

of whom have any objection if the entire amount reimbursable is paid to

me.

……………………………………….

……………………………………….

No Objection Certificate signed by other legal heirs on Stamp paper is

enclosed herewith.

Deponent

Deponent

Attested by Notary Public

Draft for No Objection Certificate on Stamp Paper

We………………… s/o d/o Late Shri ……………………..

………………… s/o d/o Late Shri ……………………...

being the legal heirs of Late Shri……………………have no objection

if the entire amount reimbursable pertaining to the treatment of our father

is paid to our brother Shri…….…….…….

Address

Deponents

Verified by Notary Public

APPLICATION FOR ADMISSION TO CGHS (PENSIONERS)

To

The Additional Director,

Central Govt. Health Scheme

Dear Sir,

I along with the members of the family whose particulars are given at Sl.

No. 5 may please be admitted to CGHS on payment of subscription on

the basis of LAST PAY DRAWN / PENSION / FAMILY PENSION*.

My particulars are as under:

1. Name of the Head of family :

2. Residential Address :

3 In case the applicant is a Pensioner,

(a) Date of retirement:

(b) Ministry / Deptt / Office:

(c) Gross pension, if fixed:

(d) PPO No.....................

4. In case the applicant is a family pensioner:

(a) Name of the deceased Govt Servant:

(b) Date of Death of the deceased Govt Servant:

(c) Ministry / Deptt / Office:

(d) Post held at the time of retirement:

(e) Pay last drawn at the time of retirement:

(f) Relation of the applicant with the deceased Govt Servant:

(g) Amount of family pension: at the enhanced rate

(Please also specify the date upto which enhanced family pension isadmissible) :

(h) F.P.P.O No. .....................................

5. Details of family according to the term family

SI. No. Name Age Date of Birth Relationship

103102

I declare that:

(i) I will abide by the rules and regulations and modifications of the

services which may be issued from time to time.

(ii) I will deposit my contribution on six monthly / yearly instalments.

(iii) I wish to avail of CGHS facilities on the basis of last pay drawn /

Pension.

(iv) I have not applied for CGHS Card previously / I have surrendered

my CGHS identity Card issued to me from my Office while in service

and the payment of contribution has been made upto the date of

surrender of Card.

(v) 1 hereby undertake to surrender the CGHS Card being issued to me

if not required, in the Dispensary (Wellness Centre) concerned. In

case the Card is not surrendered before the expiry of validity period

and Card is retained by me, even if no facility is availed by me, I

undertake to pay the CGHS contribution for the intervening period.

* Strike off whatever is not applicable

Place : Date :

Signature of Applicant

AFFIDAVIT

(To be attested by a Notary Public or Gazetted Officer)

I............................................. solemnly affirm that I am, and my

dependants

Whose names are given below, are residing in...........................(place)

and my address

is.....................................................................................

Sl. Name of the Govt. servant Age Date of Birth Relationship

No. and also dependants

Place :

Date : Signature of Applicant/Deponent

Attested by

Signature with name and Office Seal

ANNEXURE - 6 B

CGHS Plastic card

F.No. M-l/2004-C&P/Pt-XII

Government of India, Ministry of Health & Family Welfare,

Department of Health & Family Welfare CGHS (P) Division

Nirman Bhavvan, Maulana Azad Road,

New Delhi-110011.

Dated 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 been receiving several queries seeking clarifications

and, therefore , this Ministry has decided to issue an Office Memorandum

clarifying 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. It is only an identity card for

accessing the Data on Computer Data Base. Address of beneficiary,

validity for CGHS facilities, Name of wellness Centre are available

in Data base.

(3) The Plastic Cards arc issued for a maximum period of Five years

or till entitled 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 ‘Five years’ without any

additional contribution. Similarly, new Plastic Cards shall be issued

to serving employees after ‘Five Years’.

105104

(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 Pensioner beneficiaries. Freedom Fighters etc... Yellow in case

of Autonomous Bodies and others and Red in case of Members

of Parliament.

(5) As of now computerization is under process in cities other than

Delhi. After computerization of all CGHS covered Cities, the

plastic Cards will be valid all over India and there is no need for

obtaining temporary attachment 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 CGHS

facilities 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 http://cghs.nic.in/welcome.jsp

(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. Similarly, hospitals / Diagnostic

Centres can verify Data at http://cghs.nic.in/welcomc.jsp ,

in case a beneficiary is admitted under emergency.

(9) At the lime 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 with Medical Reimbursement Claim.

(10) In case of loss of Plastic Card, 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 old Card. A ‘print-out slip’ shall be issued immediately

for availing CGHS - facilities and Plastic Card after 7" Days.

In case of serving employees the application shall be

forwarded by his / her department.

(11) In case of change in residential address and shifting from

one dispensary (WC) to another, CMC I/C of dispensary

shall make modifications in Data base and transfer the cards

to new dispensary. CMC I/c of new dispensary shall accept

transfer of Card and Data shall be transferred to new

dispensary.

(12) In case of superannuation / transfer lo another city, serving

employees get the card deleted from Data base at Dispensary

and obtain a certificate from CMC I/C and surrender the

card to his / her department. Department shall issue a

surrender certificate to employee for getting a new Card at

another city (if covered under CGHS) or for obtaining a

pensioner CGHS card in case of superannuation.

(13) It is compulsory to bring original Plastic Cards every time

for availing CGHS benefits.

(14) All beneficiaries 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.1.1.M.S., Now Delhi. No separate

endorsement is required for these criteria.

JAI PRAKASH

UNDER SECRETARY TO GOVERNMENT OF INDIA

(Tel. 2306 1881)

107106

CGHS Card No while in service —————

Application For New CGHS Card For Penseners of

Central Government

1. Name of the Applicant

2. Category : Pensioner, Pensioners of autonomous Body, Others

Pl. specify) —————

3. Name of Department / Service from where retired

4. Last Pay with Grade Pay............................ Basic Pension:

(in case of Pensioners)

5. Residential Address:

6. Telephone (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 columns)

S. Name of family Relationship with Date of Birth Blood Group

No member CGHS card holder

(Compulsory) (Optional)

(Attach proof of age)

10. Are all the persons, whose names are given above, are dependent

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 stamp sized 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.

S.No…… S.No……….. S.No……. S.No…

Name…… Name………. Name……. Name….

S.No…… S.No……….. S.No……. S.No…

Name…… Name………. Name……. Name….

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 / 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 /

dependant brother

Attested copy of Disability Certificate issued by competent authority (in

case of dependent Son aged 25yrs and above)

Surrender Certificate of CGHS card while in Service

Attested copies of PPO & Last 8 Pay Certificate

DD bearing No..................................dated

............................drawn on........................ Bank.......................,

Branch.................................................... For Rs........................

No.

Date

Signature & Name of the Applicant

109108

(To be filled by CGHS)

Verified - {by Authorized Signatory, CGHS (Hqrs)}

valid upto.................../for rest of life

CGHS Wellness Center (a.k.a. Dispensary) Allotted —————

Entitlement: General ward/ Semi-private ward/Private ward

Signature with Stamp

(TO BE FILLED BY THE SPONSORING AUTHORITY IN

CASE OF PENSIONERS OF AUTONOMOUS BODY)

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

.................................. 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........................

No.

Date

Signature & Name of the Sponsoring Authority

Designation (Stamp) with Tel. Number

To The Additional Director, CGHS (Hqrs), 9, Bikaner House Hutments,

Shahjahan Road, New Delhi

(To be filled by CGHS)

Verified by Authorized Signatory, CGHS (Hqrs) valid upto.................../

for rest of life

CGHS Wellness Center (a.k.a. Dispensary) Allotted —————

Entitlement: General ward/ Semi-private ward/Private ward

Signature with Stamp

INSTRUCTIONS

Definition of Family:

(1) Husband / Wife* (* First wife only)

(2) Dependent 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) Unmarried 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

which ever is earlier

(iii) Son suffering from permanent Irrespective of age limit

disability of any kind (physical

or mental) as defined above

(iv) Dependent divorced / abandoned Irrespective of age limit

or separated from their husband

widowed daughters and dependent

unmarried / divorced / abandoned or

separated from their husband /

widowed sisters

(v) Dependent Minor brothers Upto the age of becoming major

For the purpose of availing CGHS facility for disabled sons above 25

years, please attach a copy of 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:

111110

“(1) 'DISABILITY' MEANS

(I) BLINDNESS

(II) LOW VISION

(III) LEPROCY CURED

(IV) HEARING IMPAIRMENT

(V) LOCOMOTOTR DISABILITY

(VI) MENTAL RETARDATION

(VII) MENTAL ILLNESS”

DEPENDENCY:

Members of family (other than spouse) whose income is less than

Rs.3500/+DR- per month are treated as dependents and are normally

residing with CGHS beneficiary.

The following Documents are to be enclosed by pensioners applying for

issue of new pensioners CGHS Card:

(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 and dependant brother

(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”.

ANNEXURE - 6C

WHITHER CGHS ?

THE ALTERNATE DRAFT

PROPOSAL FOR CGE&P

DRAFT CENTRAL GOVERNMENT EMPLOYEES AND

PENSIONERS HEALTH INSURANCE SCHEME (CGEPHIS)

1. NAME OF THE SCHEME:

The name of the proposed scheme is “Central Government Employees

& Pensioners Health Insurance Scheme (CGEPHIS)”.

2. BENEFICIARIES:

All personnel of the Central Government including All India Service

officers, serving, newly recruited, retired / retiring and others who are

covered under the existing CGHS (Central Government Health Services)

and under CS

(MA) [Central Services (Medical Attendance) Rules] Rules shall be

offered Health Insurance Scheme on voluntary or on compulsory basis

as indicated below:

1. CGEPHIS shall be compulsory to new Central Government Employees

who would be joining service after the introduction of the Health

Insurance Scheme.

2. CGEPHIS shall be compulsory to new Central Government retirees

who would be retiring from the service after the introduction of the

Insurance Scheme.

3. CGEPHIS would be available on voluntary basis for the following: a.

Existing Central Government Employees and Pensioners who are

already CGHS beneficiaries. In this case they have to opt out of CGHS

scheme. They will also have the option of choosing both CGHS and

Insurance policy. In such case the total insurance premium has to be

borne by the member.

Esteemed Members, please do'nt forget

TO FILL UP THE M O & REMIT RS 100

identified procedures. OPD services shall not be part of Day Care

facilities.

1. Eye Surgery

2. Lithotripsy (kidney stone removal)

3. Tonsillectomy

4. D&C

5. Dental surgery following an accident

6. Surgery of Hydrocele

7. Surgery of Prostrate

8. Few Gastrointestinal Surgery

9. Genital Surgery

10. Surgery of Nose/Throat / Ear

11. Surgery of Urinary System

12. Dialysis

13. Chemotherapy

14. Radiotherapy

15. Treatment related to dog bite/snake bite etc.

16. Treatment of fractures/dislocation, Contracture releases and minor

reconstructive procedures of limbs which otherwise require hospitalization

17. Laparoscopic therapeutic surgeries that can be done in daycare

18. Identified surgeries under General Anesthesia or any procedure

mutually agreed upon between insurer and health care provider.

Note: Insurers will provide the exhaustive list of Day care procedures.

f) The expenses incurred for treatment taken in empanelled Hospitals/

Nursing Homes /Day Care Clinics by the beneficiaries suffering from

such disabilities as defined in “Section 2 (i) of the person with disabilities

(equal opportunities, protection of rights and full participation) Act, 1995

(No: 1 of 1996)” which includes blindness, low vision, leprosy–cured,

hearing impairment, locomotors disability, mental retardation, mental

illness etc. are also payable irrespective of age and income limit subject

to size limit of the family.

g) Maternity and Newborn Benefits:

A. Maternity benefit

1. This means treatment taken in Empanelled Hospital/Nursing Home

arising from childbirth including Normal Delivery/Caesarean Section

including miscarriage or abortion induced by accident or other medical

emergency.

2. This benefit would be limited to only first two living children in respect

113112

b. Existing Central Government Employees and Pensioners who are not

CGHS beneficiaries but are covered under CS (MA) Rules. Pensioners

are however not covered under CS(MA) Rules.

3. TARGET GROUP:

All personnel of the Central Government including All India Service

officers, serving and retired, and others who are covered under the

existing CGHS and under CS (MA) Rules shall be offered the Health

Insurance Scheme. It is estimated that approximately 17 lakh serving

employees and 7 lakh pensioners shall be offered this Scheme on

compulsory / optional basis.

4. INSURANCE COVERAGE:

a) In-patient benefits – The Insurance Scheme shall pay all expenses

incurred in course of medical treatment availed of by the beneficiaries

in an Empanelled Hospitals/ Nursing Homes (24 hours admission clause)

within the country, arising out of either illness/disease/injury and or

sickness.

NOTE: In case of organ transplant, the expenses incurred for the Donor

are also payable under the scheme.

b) Coverage of Pre-existing diseases: All diseases under the Scheme

shall be covered from day one. A person suffering from any disease prior

to the inception of the policy shall also be covered.

c) Pre & Post hospitalization benefit: Benefit up to 30 days Pre

Hospitalization & up to 60 days Post Hospitalization respectively which

would cover all expenses related to treatment of the sickness for which

hospitalization was done.

d) Domiciliary Hospitalization: The Scheme would also cover Domiciliary

Hospitalization where the medical treatment for such illness/disease /

injury requires as in-patient treatment at empanelled Hospitals/Nursing

Homes but actually taken whilst confined at home in India under the

circumstances that ? His/her condition is such that patient cannot be

moved to a hospital or, If no room is available in empanelled Hospitals/

Nursing home within that area.

Note: Pre and Post hospitalization benefit under this section would not

be covered.

e) Day Care Procedures: Given the advances made in the treatment

techniques, many medical treatments, formerly requiring hospitalization,

can now be treated on a day care basis. The scheme would also provide

for day care facilities (less than 24 hours hospitalization) for such

of Dependent Spouse/Female Employee covered from day one under

the policy, without any waiting period.

B. Newborn benefit

1. Newborn child (single/twins) to an insured mother would be covered

from day one up to the expiry of the current policy for the expenses

incurred for treatment taken in empanelled Hospitals/Nursing Homes/

Day Care Clinics as In-patient during the currency of the policy and will

be treated as part of the mother subject to eligibility under maternity

benefit. However, next year the child could be covered as a regular

member of the family subject to size of the family.

2. In first pregnancy, twins are born then the benefit will ceases for

second pregnancy. However, in second pregnancy twins are born then

both will be covered till the expiry of the current policy.

3. Congenital diseases of new born child shall be covered.

5. FAMILY SIZE:

1. Serving/Retired Employees: Self, Spouse, Two dependent children

and up to Two Dependent Parents. New born shall be considered insured

from day one till the expiry of the current policy irrespective of the

number of members covered subject to eligibility under maternity

benefit.

Note:

i. For the policy period, new born would be provided all benefits under

CGEPHIS and will NOT be counted as a separate member. The

child will be treated as part of the mother.

ii. Verification for the new born could be done by any of the existing

family members who are getting the CGEPHIS benefits.

iii. Member is required to enroll new born child at the time of renewal

of the policy prior to expiry of the policy.

2. Any additional dependent member in addition to above [Sr. No. 5 (1)]

can be covered under the Scheme by paying the fixed amount of

premium. This additional full premium shall be borne by the beneficiary.

3. All Members (Serving/Retired Employees) shall be insured till they are

the member of the scheme unless withdrawn from the Scheme.

A. Age limit of dependent for the purposes of CGHS and CS (MA) Rules

1944 includes:-

1. Son - Till he starts earning or attains the age of 25 years, whichever

is earlier;

2. Daughters - Till she starts earning or gets married, irrespective of age

limit whichever is earlier. Further, Dependent divorced/abandoned or

separated from their husband and widowed daughters – irrespective of

age limit.

3. Sisters - Dependent unmarried /widowed / divorced/ abandoned /

separated from their husband - irrespective of age limit.

4. Daughter in law - Widowed - irrespective of age limit.

5. Brothers - Up to the age of becoming a major.

6. Dependent Parents - As per condition of eligibility.

B. Income limit for dependency of family members – If monthly income

from all sources of income is less than Rs. 3,500/- per month plus

dearness allowance of the family member, then the following would be

entitled to be treated as dependant on the employee:

1. Parents

2. Sisters

3. Widowed Sisters / Widow Daughter - in-law.

4. Widowed / Divorced / Separated Daughters,

5. Brothers

6. Step mother

7. Children.

NOTE: The definition of dependent shall be as per guidelines issued by

Central Government from time to time.

C. Addition & Deletion of Family Members during currency of the policy:

i) Addition to the family is allowed in following contingencies during the

policy:

a) Marriage of the CGEPHIS beneficiary (requiring inclusion of spouse’s

name), or

b) Parents becoming dependants.

ii) Deletion from Family is allowed in following contingencies:

a) Death of covered beneficiary,

b) Divorce of the spouse,

c) Member becoming ineligible (on condition of dependency)

D. New Employees/Retirees

a) As regards the new incumbents / pensioners the coverage in the

insurance scheme is compulsory. The data of such employees / pensioners

will be collected from the various departments.

b) The Pay and Account Offices of all the Ministries/Departments would

provide the data to the insurer. Each of the New Employee/Pensioners

of the Ministry/Department would be provided with the enrolment form

115114

which needs to be filled in and submitted to the respective Ministry which

will consolidate all the forms and forward the same to the Nodal Officer/

Ministry on monthly basis.

c) The said employees would have to be covered in the Insurance

Scheme from the date of joining/retirement. Thus for them the inclusion

in the policy will be made by charging the pre defined monthly Prorata

premium rate which would be less than the yearly premium rate.

6. IDENTIFICATION OF FAMILY:

Beneficiaries shall be identified by a “Photo Smart Card” issued by the

insurer to all beneficiaries which would have all personal details, medical

history, policy limits etc. of the CGEPHIS members. This card would be

used across the country to access Health Insurance Benefits. The

photograph embedded in the chip of the Smart Card will be taken as the

proof for determining the eligibility of the beneficiaries.

7. SUM INSURED AND BUFFER / CORPORATE SUM

INSURED A. SUM INSURED:

The Scheme shall provide coverage for meeting all expenses relating to

hospitalization of beneficiary members up to Rs. 5, 00,000/- per family

per year in any of the Empanelled Hospital/Nursing Home/Day Care

Unit subject to stated limits on cashless basis through smart cards. The

benefit shall be available to each and every member of the family on

floater basis i.e. the total reimbursement of Rs. 5.00 lakh can be availed

by one individual or collectively by all members of the family.

B. BUFFER / CORPORATE SUM INSURED:

An additional Sum Insured of Rs.25 Crore shall be provided by the

Insurer as Buffer/Corporate Floater in case hospitalization expenses of

a family (per illness or annual) exceed the original sum insured of Rs 5.00

lakhs. Insurer is required to inform the Nodal Agency with the details on

case to case basis.

8. PAYMENT OF PREMIUM:

As the policy would be renewed every year, there is an element of

uncertainty in the level of premiums depending upon the actual number

of enrolment and claims submitted and the inflow into the fund. To ensure

a certain degree of stability in premiums at least for a period of 3 to 5

years, Insurers will quote the premium for various ranges.

I. These numbers will consist of both serving and retired employees.

II. 1, 00,000 persons shall be taken as assured beneficiaries for the first

year to calculate the estimated premium to be paid to the insurer.

III. If the number of beneficiaries exceeds the first slab, in such case the

premium shall be adjusted retrospectively according to eligible stage in

which beneficiaries number will fall.

IV. Deleted

NOTE: (a) This includes the Management cost, intermediary cost and

burning cost (claims paid and outstanding) etc. If claim ratio is less, the

premium can be taken care by refund clause mentioned at Sr. No.9.

(b) This premium will be paid to the Insurers for the beneficiaries to be

enrolled during the policy period in case of new joinees / retirees and

exiting employees/pensioners. This premium will also take care of the

members inadvertence missed for any reasons.

(c) to (g) Deleted

9. REFUND OF PREMIUM/ADJUSTMENT OF PREMIUM:

If there is a surplus after the pure claims experience on the premium

(excluding Service Tax) at the end of the policy period, after providing

20% of the premium paid towards the Company’s administrative cost, in

the balance 80% after providing for claims payment and outstanding

claims, 90% of the left over surplus will be refunded by the insure to the

Central Government/Nodal agency within 30 days after the expiry of the

policy period or shall be adjusted with renewal premium.

10. ELIGIBLE HEALTH SERVICES PROVIDERS:

Both Public and Private Health Providers which provide hospitalization

and / or a Day Care Services would be eligible for inclusion under the

CGEPHIS, subject to such requirements for empanelment as agreed

between the Central Government and Insurers.CGEPHIS aspires to

provide to all its beneficiaries high quality medical care services that are

affordable. With this objective, it has prescribed National Accreditation

Board for Hospitals & Healthcare Providers (NABH).

Accreditation as minimum eligibility criteria for empanelment of both

Public and Private hospitals.The Hospitals/Nursing Homes/Day Care

Clinics interested to join the CGEPHIS should be accredited with NABH

/JCI (Joint Commission International)/ACHS (Australia) or by any other

accreditation body approved by International Society for Quality in

Health Care (ISQua) as minimum eligibility criteria for empanelment of

hospitals. In addition such Hospitals/Nursing Homes/Day Care Clinics

should have the following facilities:

i) General purpose hospital having 100 or more beds with the following

specialties :General Medicine, General Surgery, Obstetrics and

117116

Gynecology,Paediatrics, Orthopedics (excluding Joint Replacement),

ICU and Critical Care units ,ENT and Ophthalmology, (Dental specialty

-desirable), Imaging facilities , in house laboratory facilities and Blood

Bank.ii) Specialty hospitals (specialties list given below) Hospitals

having less than 100 beds can apply as a specialty hospital -provided they

have at least 25 beds earmarked for each specialty applied for with at

least 15 additional beds – Thus under this category a single specialty

hospital would have at least 40 beds. However, under this category a

maximum of three specialties is allowed.

- Cardiology , Cardiovascular and Cardiothoracic surgery

- Urology - including Dialysis and Lithotripsy

- Orthopedic- Surgery - including arthroscopic surgery and Joint

Replacement

- Endoscopic surgery

- Neurosurgery

iii) Super-specialty Hospitals- with 150 or more beds with treatment

facilities in at least three of following Super Specialties in addition to

Cardiology& Cardio-thoracic Surgery and Specialized Orthopaedic

Treatment facilities that include Joint Replacement surgery:

Nephrology & Urology incl. Renal Transplantation

Endocrinology

Neurosurgery

Gastro-enterology & GI –Surgery incl. Liver Transplantation

Oncology – ( Surgery, Chemotherapy & Radiotherapy)

These hospitals shall provide treatment /services in all disciplines

available in the hospital.

iv) Cancer hospitals having minimum of 50 beds and all treatment

facilities for cancer including radio-therapy (approved by BARC /

AERB).

NOTE - A:

a) Such Hospitals/Nursing Homes/Day Care Clinics that obtained entry

level pre accreditation certificate from NABH would also be eligible for

empanelment under CGEPHIS.

b) The Hospitals/Nursing Homes/Day Care Clinics which are already

empanelled under CGHS, if desire to be get empanelled under CHEPHIS

and are not accredited by NABH/JCI/ACHS/ ISQua are required to

apply for NABH accreditation within two months from the date of

empanelment under the Scheme as per criteria mentioned below at “A”

(Criteria for Empanelment of Private Hospitals/Nursing Homes/Day

Care Clinics in addition to the NABH /JCI / ACHS / ISQua/ NABL

criteria). A certificate confirming to apply with NABH within the

stipulated period should be given by the hospital while getting empanelled

under CGEPHIS.

c) Any Hospitals/Nursing Homes/Day Care Clinics not applying to

NABH within stipulated period shall be automatically de-paneled from

the Scheme.

d) In addition, the empanelled Hospitals/Nursing Homes/Day Care

Clinics having in-house diagnostic Laboratories or using the linked

diagnostic laboratories shall also apply for National Accreditation Board

for Testing & Calibration Laboratories (NABL) certification of the

Laboratory as per condition.

Note - B:

1) Hospitals/Nursing Homes/Day Care Clinics that have already applied

for / accredited under NABH/JCI/NABL shall inform the office of

Insurer with supportive document.

2) Those applying to NABH/JCI for accreditation to join the CGEPHIS

shall also agree to the CGHS package rates and to the clause 11-A and

11-B mentioned below. A. Criteria for Empanelment of Hospitals/

Nursing Homes / Day Care Clinics in addition to the NABH /JCI / ACHS

/ ISQua / NABL criteria.

i. Fully equipped and engaged in providing Medical and/ or Surgical

facilities. The facility should have an operational pharmacy and diagnostic

services. In case health provider does not have an operational pharmacy

and diagnostic services, they should be able to link with the same in close

vicinity so as to provide ‘cash less’ service to the patient.

ii. Those Hospitals/Nursing Homes/Day Care Clinics undertaking surgical

operations should have a fully equipped Operating Theatre of their own.

iii. Fully qualified doctors and nursing staff under its employment round

the clock.

iv. Agreeing to the cost of packages for each identified procedures as

approved under the CGHS scheme.

a) These package rates shall mean and include lump sum cost of inpatient

treatment/day care/diagnostic procedures for which CGEPHIS

beneficiary is admitted from the time of admission to discharge including

(but not limited to) Registration charges, Admission charges,

Accommodation charges including Patients diet, Operation Charges,

Injection charges, dressing charges, Doctors/ Consultant visit charges,

119118

1. Private ward is defined as a hospital room where single patient is

accommodated and which has an attached toilet (lavatory and bath). The

room should have furnishings like wardrobe, dressing table, bed-side

table, sofa set, carpet, etc. as well as a bed for attendant. The room has

to be air-conditioned.

2. Semi Private Ward is defined as a hospital room where two to three

patients are accommodated and which has attached toilet facilities and

necessary furnishings.

3. General ward is defined as a hall that accommodates four to ten

patients.

NOTE:

a) Treatment in higher Category of accommodation than the entitled

category is not permissible.

b) The package would cover the entire cost of treatment of the patient

from date of admission to his/ her discharge from hospital and any

complication while in hospital, making the transaction truly cashless to

the patient as per CGHS package rates.

c) The applicable CGHS rates under the Scheme would be for the policy

period and shall not be amended during the currency of the policy. Rates

for such procedures which are not in the CGHS list, can only be

considered, if, finalized during the policy period.

d) Procedures will be subject to Cashless services and a preauthorization

procedure, as per Clause – 11.

e) Districts may be clubbed under respective State/Zones by the Central

Government for the application of CGHS package rates.

v) Maintaining the necessary records as required and the Insurer or his

representative/Central Government/Nodal Agency will have an access

to the records of the insured patient.

vi) Allowing the Insurer or his representative / Central Government /

Nodal Agency to visit, carry out the inspection as and deemed fit.

vii) The Private Empanelled Hospitals/Nursing Homes/Day Care Clinics

be legally responsible for user authentication.

viii) Telephone, Fax, Scanner and have atleast 256 KBPS broadband

internet connectivity. Each empanelled Hospital/Nursing Home/Day

Care Clinics shall posses a Personal Computer with 2 smart card

readers. These empanelled Hospitals/Nursing Homes/Day Care Clinics

must have the capacity to submit all claims / bills in electronic format to

the Bill Clearing Agency and must also have dedicated equipment,

ICU/ICCU charges, Monitoring charges, Transfusion charges, Anesthesia

charges, Preanesthetic checkups, Operation Theater charges, Procedural

Charges/Surgeon charges, Cost of surgical disposables and sundries

used during hospitalization, Cost of Medicines and Drugs, Blood, Oxygen

etc, Related routine and essential diagnostic investigations, Physiotherapy

charges etc, Nursing care and charges for its services. The list is an

illustrative one only.

b) In order to remove the scope of any ambiguity on the point of package

rates, it is reiterated that the package rate for a particular procedure is

inclusive of all sub-procedures and all related procedures to complete the

treatment procedure. The patient shall not be asked to bear the cost of

any such procedure/item.

c) No additional charge on account of extended period of stay shall be

allowed, if, the extension is due to infection on the consequences of

surgical procedure or due to any improper procedure.

d) Cost of implants is payable in addition to package rates as per CGHS

ceiling rates for defined implants or as per actual, in case there is no

CGHS prescribed ceiling rates.

e) Cost of External Equipments required for treatment as listed in CGHS

scheme (Appendix - A) is payable in addition to package rates as per

CGHS ceiling rates for defined External Equipments or as per actual, in

case there is no CGHS prescribed ceiling rates.

f) Expenses incurred for treatment of new born baby are separately

payable in addition to delivery charges to mother.

g) Package rates envisage duration of indoor treatment as follows:

* Upto 12 days: for Specialized (super specialty) Treatment.

* Upto 7 days: for other Major surgeries.

* Upto 3 days: for Laparoscopic surgeries/ Normal delivery.

* 1 day: for Day Care/ Minor surgeries

h) Entitlements for various types of wards: CGHS beneficiaries are

entitled to facilities of private, semi-private or general ward depending

on their pay drawn in pay band/ pension. These entitlements are

amended from time to time and the latest order in this regards needs to

be followed. The entitlement is as follows:-

S.No. Pay drawn in pay band/Basic Pension Entitlement

1. Upto Rs. 13,950/- General Ward

2. Rs. 13,960/- to 19,530/- Semi-Private Ward

3. Rs. 19,540/- and above Private Ward

121120

software and connectivity for such electronic submission. NIC

concurrence is required.

B. Additional Benefits to be Provided by Empanelled Hospitals/Nursing

Homes /Day Care Clinics In addition to the benefits mentioned above,

both Empanelled Public and Private Hospitals/Nursing Homes/Day

Care Clinics should be in a position to provide following additional

benefits to the CGEPHIS beneficiaries:

1) Free OPD consultation including pre and post hospitalization

consultation.

2) Has to display its status of being a preferred provider of CGEPHIS

at the reception/admission desks and to keep the displays and other

materials supplied by the Insurer for the ease of beneficiaries, Central

Government and Insurer.

3) Agrees to provide a separate help desk headed by paramedical for

providing the necessary assistance round the clock to the CGEPHIS

beneficiary.

C. Delisting of hospitals: Empanelled Hospitals/Nursing Homes/Day

Care Clinics would be delisted by the Insurer from the CGEPHIS

network, if, it is found that guidelines of the Scheme are not followed by

them and services offered are not satisfactory as per laid down

standards.

11. CASHLESS ACCESS SERVICE:

The Insurer has to ensure that all CGEPHIS members are provided with

adequate facilities so that they do not have to pay any deposits at the

commencement of the treatment or at the end of treatment to the extent

as the Services are covered under the Scheme. The service provided by

the Insurer along with subject to responsibilities of the Insurer as detailed

in this clause is collectively referred to as the “Cashless Access

Service.” The services have to be provided by the Empanelled Hospitals/

Nursing Homes/Day Care Clinics to the beneficiary based on Photo

Smart Card authentication only without any delay. The beneficiaries

shall be provided treatment free of cost for all such ailments covered

under the Scheme within the limits/sub-limits of defined package rates

and sum insured, i.e., not specifically excluded under the scheme. A.

Pre-Authorization for Cashless Access in case of Emergency/Planned

Hospitalization for Listed /Non Listed packaged procedures: Packaged

procedures would mean the rates for various procedures approved by

the CGHS based on city and the same shall be treated for that State/

Zone. It would be the responsibility of the Insurer to have all empanelled

hospitals/nursing homes/ day care clinics agreed to the same. Once the

identity of the beneficiary and/ or his/her family member is established

by verifying the Photo Smart Card, shall be swiped Photo Smart Card for

on line verification and following procedure shall be followed for

providing the health care facility listed/not listed in packages: Request for

Authorization shall be forwarded by the Empanelled Hospitals/Nursing

Homes/Day Care Clinics after obtaining due details from the treating

doctor in the prescribed format i.e. “Request for Authorization Letter”

(RAL). The RAL needs to electronically send to the 24-hour Authorization

/Cashless department of the Insurer along with contact details of treating

physician, as it would ease the process. The medical team of Insurer

would get in touch with treating physician, if necessary.

a. The RAL (Request for Authorization Letter) should reach the

Authorization Department of Insurer within 6 hrs of admission in case of

emergency or within 3 days prior to the expected date of admission, in

case of planned admission.

b. In failure of the above “clause a”, the clarification for the delay needs

to be forwarded along with RAL by the Empanelled Hospitals/Nursing

Homes/Day Care Clinics.

c. Treatment code is required to be selected from the packaged

procedures and mentioned in RAL in case of listed procedure.

d. The RAL form should be dully filled in all cases with clearly mentioned

Yes or No. There should be no nil, or blanks, which will help in providing

the outcome at the earliest. Along with RAL copies of diagnostic test

reports should also be forwarded electronically or the case may be.

e. If, given medical data is not sufficient for the medical team of

Authorization Department to confirm the eligibility, it will be responsibility

of the Empanelled Hospitals/Nursing Homes/Day Care Clinics to

provide the complete details without any further delay, failing which it

would be treated as violation of the norms.

f. In case of non listed procedure, the Empanelled Hospitals/Nursing

Homes/Day Care Clinics and Insurer shall negotiate the cost of package

based on the type of treatment required; the agreed amount shall become

a package rate of that procedure.

g. Insurer guarantees payment only after receipt of RAL and the

necessary medical details. Only after Insurer has ascertained the rates

as per CGHS prescribed rates and or negotiated the packages (if no rates

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are fixed by CGHS), with provider, shall issue the Authorization Letter

(AL). This shall be completed within 12 hours of receiving the RAL and

response shall be sent by the insurer.h. In case the ailment is not covered,

insurer can deny the authorization.

In such case it would be the responsibility of the Empanelled Hospitals/

Nursing Homes/Day Care Clinics to inform the beneficiary accordingly.

i. The Insurer needs to file a report to Nodal Agency explaining reasons

for denial of every such claim on day to day basis.

j. Authorization letter [AL] will mention the authorization number and the

amount guaranteed as a CGHS package rates and negotiated rates for

such procedure for which package has not been fixed earlier. Empanelled

Hospitals/Nursing Homes/Day Care Clinics must see that these rules

are strictly followed.

k. The guarantee of payment is given only for the necessary treatment

cost of the ailment covered and mentioned in the request for Authorization

letter (RAL) for hospitalization.

l. The entry on the Smart Card at the time of admission as well at

discharge would record the authorization number as well as package

amount for listed procedure and agreed package amount by the Empanelled

Hospitals/Nursing Homes/Day Care Clinics and Insurer in case of non

listed procedure. Negotiated package would be entered manually by the

hospital since this would not be available in the package list on the

computer.

m. Having carried out these activities, the insurer shall have to ensure

that all data are uploaded on the insured’s server and a read-only access

shall be provided, through a link, to the officials / departments as may be

authorized by the MoHFW.

B. Business Contingency Plan (BCP) (Off Line Procedure) In the event

on-line system becoming inoperative for any reason, the insurer shall

resort to the Business Contingency Plan by default (BCP). On visit to an

Empanelled Hospitals/Nursing Homes/Day Care Clinics, the beneficiary’s

details shall be verified. Once the identity of the beneficiary and/ or his/

her family member is established by verifying the Photo Smart Card

manually (Xerox copy of the Smart Card shall be kept by the Empanelled

Hospitals/Nursing Homes/Day Care Clinics for record purpose) following

procedure shall be followed for providing the health care facility listed/

not listed in packages in addition to procedure envisaged at

a. A manual pre-authorization form filled up and faxed to Insurer within

6 hours of admission along with copy of diagnostic reports.

b. The same shall be authorized within a turnaround time of not more than

12 hours.

c. Cashless treatment shall be given accordingly, without charging any

money from the beneficiary.

d. On completion of treatment discharge documents are signed.

e. Having carried out these activities, the insurer shall have to ensure that

all data are uploaded on the insured’s server and a read-only access shall

be provided, through a link, to the officials / departments as may be

authorized by the MoHFW.

Note:

In cases where the beneficiary is admitted in a hospital during the current

policy period but is discharged after the end of the policy period, the claim

has to be paid by the insurance company under operating policy in which

beneficiary was admitted

12. RUN-OFF PERIOD

A Run-Off period of one month will be allowed in case of cancellation/

non renewal of the policy. This means that preauthorization’s done till the

cancellation/ non renewal of the policy period and treatment/surgeries

for such preauthorization’s done up to one month after the expiry of

policy period, all such claims will be honored.

14. REPUDIATION OF CLAIMS

In case of any claim is found untenable, the Insurer shall communicate

reasons to the Health provider and Designated Authority of the Central

/Nodal Agency for this purpose with a copy to the Beneficiary. All such

claims shall be reviewed by the Central Government on monthly /

quarterly basis.

15. ENROLMENT:

The enrolment of the beneficiaries would be undertaken by the Insurance

Company selected by Central Government/Nodal Agency. The Insurer

shall enroll the beneficiaries as per procedure laid down below and shall

issue Photo Smart cards as per Central Government specifications and

handover the same to the CGEPHIS beneficiaries.

(a) The enrolment period in the first year shall be for 180 days in the case

of retired employees and 60 days in case of serving employee. However,

in the case of new joinees and new retirees the enrolment will continue

throughout the year.

(b) Insured will have the option to change the details regarding dependent

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beneficiary in the smart card; however the total number of dependents

cannot be more than the number fixed at the time of renewal at

designated district Kiosk setup by the insurer within 60 days prior to the

expiry period of the policy.

(c) The Insurer will arrange for preparation of the Photo Smart Card as

per the Guidelines provided.

(d) At the time of delivering the smart card, the Insurer shall provide a

booklet along with Photo Smart Card to the CGEPHIS beneficiary

indicating the list of the Networked Hospitals, the availability of benefits

and the names and details of the contact person/persons, and toll-free

number of call centre. To prevent damage to the smart card, a plastic

jacket should be provided to keep the smart card.

(e) If the smart card is lost within the policy period then beneficiary can

get a new card issued at the designated District Kiosk, by paying to the

insurer, a pre-defined fee agreed by Central government/ Nodal Agency.

(f) To address the problems of incorrectness, functionality of cards etc

and enrolment could not be done by the beneficiary for any reason; the

same would be done at designated district kiosk by the insurer.

(g) Advance publicity shall be given by the Insurer and Central Government/

Nodal Agency on Pan India basis.

(h) Insurance Company would carry out enrolment at agreed designated

District office of the Insurer in case of Pensioners and scan document

will be given for the purpose on the spot. In case of Serving Employees

the data will be collected from Head of Department level. In both the

cases photo Smart Cards along with the enrollment kit shall be sent by

the insurers directly to the insured persons at their respective mailing

addresses at insurer’s cost.

(i) Insurance Company will also provide a web-based application, which

would be available to Head of Departments of the Ministries/Departments.

The empanelled Hospitals/Nursing Homes/Day Care Clinics and the

beneficiaries shall have the access to the website to see their relevant

information.

(j) Nodal Agency at the Health Ministry will also monitor data related to

Insurance plan like enrolment etc through this website.

(k) The Scheme as well as the enrolment form would be put up on the

web-site of the various Ministries/Departments on a permanent basis.

(l) Any Employee / Pensioner who opts for the Insurance Scheme shall

remain the member of the scheme with future renewals automatically

awarded unless he/she opts out of the scheme. The beneficiary is

required to submit the declaration to the MOH&FW for discontinuation

from the Scheme 90 days prior to expiry of the policy. In such cases the

benefits shall cease on the expiry of the policy.

ENROLMENT PROCESS

The process of enrolment shall be as under:

A. Serving Employees:

1. Departments and offices will call for options from employees to join

voluntary CGEPHIS with or without existing CGHS/CS (MA) benefits.

2. Head of Department of the Administrative Ministry/Department

would be the contact point for the Insurance Companies.

3. Enrolment forms giving details about self and family and authorization

to the department for recovery of premium on a monthly basis would be

consolidated by the Administrative Ministry/Department. The data of

the beneficiary and dependent members to be covered along with 2

recent passport size photo and copy of enrolment form will be forwarded

to Insurance Company on monthly basis.

4. Insurance Company will issue Smart Cards on the basis of information

received of the beneficiaries for enrolment.

5. Such Smart Cards along with the enrollment kit shall be sent by the

insurers directly to the insured persons at their respective mailing

addresses at insurer’s cost within 7 days.

B. Retired Employees:

1. In case of Retired Employees, wide publicity of the Scheme should be

given through various media sources like advertisement in local

newspapers, Cable network etc.

2. A notice would be posted in the pension paying branches (approximately

30,000 in numbers) / post offices giving details of proposed Scheme.

3. Information can also be disseminated through pensioners associations

and other related agencies.

4. Enrolment forms would be made available with Pension Paying

Branches/ Post Offices as well as on the website of the Departments/

Ministries.

5. The enrolment process for the pensioners shall continue as per

schedule agreed by the Government/Nodal Agency. Insurer in consultation

with the Central Government/Nodal Agency/shall chalk out the enrolment

programme by identifying enrolment stations at Insurers district offices

during fixed period to complete the task in scheduled time.

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6. Retired employees opting for the scheme would fill up the enrolment

form giving details relating to self and dependent members along with the

proof of self and dependents as per CGEPHIS Guide Line along with 2

recent passport size photos each at Insurers' district offices for enrolment

under the scheme along with his /her first contribution by cheque only.

7. The enrolment form would be accompanied by authorisation form to

the pension paying agency to debit contribution of his/her future premium

for the purpose of continuing as a member of the Insurance Scheme.

8. Insurance companies will issue scanned Photo document to pensioners

on the basis of information received at the time of enrolment of the

beneficiaries. Photo Smart Cards along with the enrollment kit shall be

sent by the insurers directly to the insured persons at their respective

mailing addresses at insurer’s cost.

9. Copy of enrolment form along with the authorization form would be

sent to Central Pension Accounting Office for preparation of the data.

Central Pension Accounting Office will pass on the authorization form

of the pensioners to the respective pension paying units for deduction of

premium for future renewals.

10. Limited access to the database available with the Central Pension

Accounting Office / MOHFW would be available to the Insurance

Company.

B. For Future Employees and Pensioners:

a. All future employees and future pensioners shall necessarily be

covered under CGEPHIS.

b. At the time of their entry into or retiring from service they are required

to carry out certain documentary formalities at their respective places of

posting and the Ministry. Enrolment into CGEPHIS shall be dovetailed

to such activities and the documentation for the same shall be made an

integral part of the entry / exit exercise.

c. The insurer shall have to provide enrolment forms (printed as well as

soft versions) at all such locations.

d. Employee shall fill up form enrolment form, authorization form for

deducting the contribution and submit 2 recent passport size photographs

of the family each (individual) to DDO/ Nodal Officer.

e. Insurer shall arrange to collect the enrolment form & family photograph

from the respective DDOs/ Nodal Officers under acknowledgement.

f. After required processing, all relevant data shall be uploaded on the

server and smart cards shall be issued by the insurers.

g. Such Smart Cards along with the enrolment kit shall be sent by the

insurers directly to the insured persons at their respective mailing

addresses at insurer’s cost.

h. The insurance cover shall be effective from the date of joining or

retirement of an employee.

i. All these activities shall have to be uploaded on the insured’s server on

a read-only access, a link shall be provided to the officials / departments

as may be authorized by the MoHFW. Note: The Insurer will have to

complete the following activities before the start of the enrolment

process:

* Empanelment of the Hospitals/Nursing Homes/Day Care Clinics

* Setting up of District Kiosk

* Prepare the enrolment kit and get it approved by the Government.

16. SPECIFICATIONS FOR SMART CARDS AND

SOFTWARE:

NIC concurrence is required. The Smart Cards to be used must have the

valid Compliance Certificate from National Informatics Centre, New

Delhi. The specifications of the smart card are listed as below.

* Microprocessor based Integrated Circuit(s) card with Contacts, with

minimum 64 Kbytes available EEPROM.

* Compliant with ISO/IEC 7816-1,2,3 and SCOSTA 1.2b/SCOSTACL

1.2 with all latest errata and addendum (ref. http://scosta.gov.in).

* Must have a valid SCOSTA or SCOSTA-CL Compliance Certificate

from NIC.

* Supply Voltage 3V or 5V – nominal.

* Protocol T=0 or T=1.

* Data Retention minimum 10 years.

* Write cycles minimum 300,000 numbers.

* Chip Temperature Range –25 to +70 Degree Celsius.

* Operating Temperature Range –25 to +55 Degree Celsius.

* Composite layered Construction of PETG (middle layer) and PVC

(outer layers). Ratio of PETG and PVC content should be 50% each.

* Surface – Glossy with pre printed content as provided by Department.

a. Smart Card shall be the property of the Central Government and shall

be insurer-neutral. The insurer shall have no proprietary rights over it

and, therefore, shall not be entitled to place its name, logo etc. on the

same.

b. The Smart Card Chip Memory File System and Layout shall be

provided by MoH/NIC.

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c. The Smart Card Visual Zone layout shall be designed by the shortlisted

bidder and approved by MoH.

d. Insurer shall provide following Smart Card related software and

services,

i. Smart Card Sourcing as per the specifications given above.

ii. Smart Card Personalization as per the Layout provided by MoH.

iii. Smart Card Key Management System as per MoH/NIC wetted

architecture.

iv. Developing all Smart Card based Transaction applications as per

MoH/NIC wetted architecture.

e. The card shall have universal acceptability, across the country, by all

empanelled hospitals / nursing homes/Day care clinics in the insurer’s

panel.

f. To address the problems of incorrectness and functionality of cards,

the insurers shall be required to open kiosks in all major cities as may be

advised by the MoHFW.

g. Preparation of transaction systems, mechanism for data transfer, and

establishment of district kiosks and uploading of MIS on the websites

advised by the MoHFW shall be the responsibility of the insurer.

17. EXCLUSIONS

The Insurer shall not be liable to make any payment under this Scheme

in respect of any expenses whatsoever incurred in connection with or in

respect of:

A. Hospitalization Benefits:

1) Conditions that do not require hospitalization:

a) Conditions that do not require hospitalization. Outpatient Diagnostic,

Medical and Surgical procedures or treatments unless necessary for

treatment of a disease covered under Day Care procedures or Inpatient

hospitalization.

b) Expenses incurred at Hospital or Nursing Home primarily for

evaluation / diagnostic purposes only during the hospitalized period.

Expenses on vitamins and tonics etc unless forming part of treatment for

injury or disease as certified by the attending physician. Expenses on

telephone, tonics, cosmetics / toiletries, etc.

2. Any dental treatment or surgery which is corrective, cosmetic or of

aesthetic procedure, including wears and tears etc. unless arising from

disease or injury which requires hospitalization for treatment including

following dental treatment which indicates that the teeth are the real

source of disturbance.

a) Jaw bone disease treatment

b) Wholesale removal of teeth

c) Surgical operations needed for removal of Odontomes and impacted

wisdom tooth

d) Gum boils under oral surgery.

e) Treatment of pyorrhea and Gingivitis may also be

reimbursed as it is covered under the term “Gum treatment”.

f) Extraction,

g) Scaling and Gum treatment

h) Filling of teeth

i) Root Canal treatment.

3. Congenital external diseases etc: Congenital External Diseases or

Defects or Anomalies, Convalescence, General Debility, “Run Down”

condition or Rest Cure.

4. Sex change or treatment which results from or is in any way related

to sex change.

5. Vaccination/Cosmetic or of aesthetic treatment: Vaccination,

Inoculation or change of life or cosmetic or of aesthetic treatment of any

description and Plastic Surgery other than as may be necessitated due

to an accident or as a part of any illness. Cost of Spectacles / Contact

Lens.

6. Suicide etc: Intentional self-injury/Suicide/Self manmade injuries.

7. Naturopathy, Homeopathy, Unani, Siddha, Ayurveda:

(a) Homeopathy, Unani, Siddha, Ayurveda treatment unless taken as

inpatient in a network hospital.

(b) Naturopathy, unproven procedure or treatment, experimental or

alternative medicine including acupressure, acupuncture, magnetic and

such other therapies etc. Any treatment received in convalescent

home, convalescent hospital, health hydro, nature care clinic or similar

establishments.

8. External and / or durable Medical/Non-medical equipment of any kind

used for diagnosis and / or treatment except covered under CGHS

scheme.

B. Maternity Benefit Exclusion Clauses:

a. Those insured persons who are already having two or more living

children will not be eligible for this benefit. Claim in respect of only first

two living children will be considered in respect of any one insured person

131130

covered under the policy or any renewal thereof. In such situation any

such child born during the policy period, the same shall be covered as an

additional member at the time of renewal only.

b. Expenses incurred in connection with voluntary medical termination

of pregnancy during the first twelve weeks from the date of conception

are not covered except induced by accident or other medical emergency

to save the life of mother.

c. Pre-natal and post-natal expenses are not covered unless admitted in

Hospital/nursing home and treatment is taken there.

18. INFRASTRUCTURE OF INSURER

Insurer shall establish an exclusive Project Office at convenient place for

coordination with the Central Government / Nodal agency at the National

level. The project office shall coordinate with Central Government /

Nodal Agency on a daily basis and ensure effective implementation of

CGEPHI Scheme. Accordingly, Insurer will also have the dedicated unit

at Zonal/State and district level. The Project Manager shall be appointed

within 7 days and the project office shall be placed by the Insurer at New

Delhi within 30 days of signing of the contract having sufficient people

with appropriate qualification and experience to perform various functions.

19. MANAGEMENT INFORMATION SYSTEMS (MIS)

SERVICE THROUGH DEDICATED WEBSITE

The Insurer shall provide Management Information System (MIS)

reports regarding the enrolment, admission, pre-authorization, claims

settlement and such other information regarding the Services as required

by the Government / Nodal Agency. The reports will be submitted by the

INSURER to the Government / Nodal Agency on a regular basis as

agreed between the Parties.

a) to (c) Deleted

20. CALL CENTER SERVICES

The Insurer shall provide dedicated telephone services for the guidance

and benefit of the CGEHIS beneficiaries whereby the Insured Persons

shall receive guidance about various issues by dialing a National Toll free

number exclusively for this scheme. This service provided by the Insurer

as detailed below is collectively referred to as the “Call Centre Service”.

I. Call Centre Information The Insurer shall operate a Call Centre for the

benefit of all Insured Persons. The Call Centre shall function for 24 hours

a day, 7 days a week and round the year. As a part of the Call Centre

Service the Insurer shall provide the following :

a) Answers to queries related to Coverage and Benefits under the

Policy.

b) Information on Insurer’s office, procedures and information related to

CGEPHIS.

c) General guidance on the CGEPHIS.

d) Information on cash-less treatment subject to the availability of

medical details required by the medical team of the Insurer.

e) Information on Network Providers and contact numbers.

f) Claim status information.

g) Advising the hospital regarding the deficiencies in the documents for

a full claim.

h) Any other relevant information/related service to the Beneficiaries.

i) Any of the required information available at the Call Centre to the

Government/Nodal Agency.

j) Maintaining the data of receiving the calls and response on the system.

k) Any related service to the Government / Nodal Agency.

II. Language: The Insurer undertakes to provide services to the

Insured Persons in English and local languages.

III. Toll Free Number/Fax Number

a) The Insurer will operate a dedicated National Toll Free number with

a facility of a minimum of 10 lines. The cost of operating of the number

shall be borne solely by the Insurer. The toll free numbers will be

restricted only to the incoming calls of the clients only. Outward facilities

from those numbers will be barred to prevent misuse.

b) The Insurer will operate a dedicated National Toll Free Fax. The cost

of operating of the number shall be borne solely by the Insurer.

IV. Insurer to inform Beneficiaries

The Insurer will intimate the National Toll Free number/Fax number to

all beneficiaries along with addresses and other telephone numbers of the

Insurer’s City units / Zonal units and Project Office.

21. DISPUTE RESOLUTION AND GRIEVANCE REDRESSAL

If any dispute arises between the parties during the subsistence of the

policy period or thereafter, in connection with the validity, interpretation,

implementation or alleged breach of any provision of the scheme, it will

be settled in the following way:

a. Dispute between Beneficiary and Health Care Provider/Care Provider

and the Insurance Company: Grievance Redressal centre shall be set up

in each District/State level for all possible redressal of grievance of

beneficiaries/Health provider by the Insurer.

132 133

b. Dispute between Insurance Company and the Central Government A

dispute between the Central Government /Nodal Agency and Insurance

Company shall be referred to the respective Chairmen/ CEO’s/CMD’s

of the Insurer for resolution. In the event that the Chairmen/ CEO’s /

CMD’s are unable to resolve the dispute within {60 } days of it being

referred to them, then either Party may refer the dispute for resolution

to a sole arbitrator who shall be jointly appointed by both parties, or, in the

event that the parties are unable to agree on the person to act as the sole

arbitrator within {30 } days after any party has claimed for an arbitration

in written form, by three arbitrators, one to be appointed by each party

with power to the two arbitrators so appointed, to appoint a third

arbitrator.

* The law governing the arbitration shall be the Arbitration and Conciliation

Act, 1996 as amended or re-enacted from time to time.

* The proceedings of arbitration shall be conducted in the English

language.

* The arbitration shall be held in New Delhi, India.

22. AGREEMENTS:

a) Service Level Agreements (SLAs)/ MOUs shall be signed with

Insurance Companies and proper mechanism for ensuring compliance

established including penalty clauses.

b) Insurer will also enter into SLAs/MOUs with other intermediaries for

ensuring compliance established including penalty clauses.

23. TERM & TERMINATION OF AGREEMENT BETWEEN

INSURER & CENTRAL GOVERNMENT

The Agreement shall take effect on the date of signature hereof by both

Parties, and shall remain in force till the end of the policy period and the

runoff period subject to a right to the Central Government to terminate

the Agreement, on the basis of review of the performance of the

INSURER before the same period. The Central Government will review

the performance of the INSURER based on factors including but not

limited to:

a) Compliance with the guidelines specified in respect of enrolment &

transaction.

b) The facilities set up and arrangements made by the INSURER toward

servicing the beneficiaries such as quality assurance, handling of

grievances, availability of benefits and hassle-free transactions etc

agreed to between stakeholders.

c) Empanelment of Hospitals/ Nursing Homes/Day Care Clinics.

d) The quality of service provided.

e) The beneficiaries’ satisfaction reports received.

f) Grievance Redressal.

g) Any withholding of information as sought by the Central Government

at the bidding and implementation stage of the Scheme; and

h) Such other factors as the Central Government deems fit. The

Agreement may be terminated:

a) By the Central Government before the period mentioned above.

b) By both parties by mutual consent provided it gives the other party at

least 60 days prior written notice.

In case of termination as given above:

a. The Insurer will pay back to the Central Government within one week

the unutilized amount of premium left plus service tax after settlement of

claims for which the preauthorization is given till date of termination.

b. If the insurer fails to do as per clause above, the insurer will pay the

Central Government, the total package amount for all the cases for which

preauthorization has been given, but claim not settled.

c. In addition to above the Insurer shall pay interest at the rate of 12%

per annum on the amount refundable as determined by clauses (a) and

(b) above for the period extending from the date of premium paid till the

date of receipt of refund.

d. The Central Government reserves the right to re-allot the policy to any

other insurer as it deems fit for the rest of the period in the event of

termination and the Insurer shall not have any claims to it.

24. PERFORMANCE PARAMETERS AND PENALTY

CLAUSE:

Insurer is required to perform multiple activities in performance of their

obligations arising out of the insurance contract to them. Any activity not

performed by the insurer within the given time line shall hamper

implementation of CGEPHIS from the planned date. Such activities will

be required to be completed within the specified period from the date of

award of the insurance contract to them failing which a penalty as

specified percentage on total premium shall be payable by them to the

Govt. of India for the period of delay.

25. NODAL MINISTRY:

a) The Ministry of Health & Family Welfare would be the Nodal Agency

for the implementation of CGEPHIS.

135134

b) A Coordination Committee having the representatives from Ministry

of Health & Family Welfare, Ministry of Finance and Department of

Administrative Reforms & Public Grievances for monitoring the

implementation of the Scheme on a regular basis.

c) Nodal Cell at the Health Ministry will monitor data related plan like

enrolment, empanelment of hospitals, authorization status, claims status,

utilization statistics, network hospital status and other MIS through a

website maintained by the Insurer.

26. MEDICAL AUDIT:

The Insurance Company shall also carry out inspection of hospitals, investigations,

on the spot verification of inpatient admissions, periodic medical audits, to ensure

proper care and counselling for the patient at network hospital by coordinating with

hospital authorities, feedback from patients, attend to complaints from beneficiaries,

hospitals etc on regular basis. Proper records of all such activities shall be

maintained electronically by the Insurer.

ANNEXURE - 7

Salient features

Retired Employees Liberalized Health Scheme

(RELHS-1997)

(1) Retired Railway employees covered under RELHS-97 are provided

with full medical facilities as admissible to serving employees in respect

of medical treatment, investigations, diet, and reimbursement of claims

for treatment in Govt or recognized non railway hospitals. They will also

be eligible, inter-alia, for a) ambulance services b) medical passes c)

Home visits d) Medical attendance for first two pregnancies of married

daughters at concessional rates and e) treatment of private servants as

applicable to serving railway employees.

Note: (i) Those who join the RELHS-97 shall hold identity cards with

photographs of all the beneficiaries.

(ii) For the purpose of d) of sub Para (1) above special identification

cards will be issued duly affixing photographs of married daughters with

clear instructions on the card which shall read “ONLY FOR

CONFINEMENT AND TREATMENT DURING ANTE-NATAL

AND POST-NATAL PERIODS FOR THE FIRST TWO

PREGNANCIES AT CONCESSIONAL RATES” (IRMM 2000 Sub-

Section(11) Retired Employees 612A)

(iii) RELHS Medical I. Card, Though valid through, out Indian

Railways is required to be registered in a Railway hospital / dispensary

nearer to the place of residence of the beneficiary, who should normally

avail medical treatment from his own Railway Hospital / dispensary

unless he is referred to an other Railway Hospital for specific reasons.

(iv) Beneficiary carrying a RELHS Medical I. card can obtain medical

treatment from any Railway hospital / dispensary all over Indian

Railways in case of medical emergency situation.

(v) During temporary stay at some other place, beneficiary should carry

his/her Medical I. Card with him/her and report in writing to the nearest

Railway Hospital / dispensary intimating the concerned Medical officer

regarding the planned duration of his stay, so that proceedings can be

done, after that he can avail medical treatment for that duration in the

place of his temporary stay. (Rly. Bd. No 2006/H.I./13/RTI dt 29.12.2006)

137136

OUR URGENT MAJOR DEMANDS1. FMA @ Rs 1,000 wef 01.01.06

2. Full Parity to all past pensioners

3. All 6th CPC recommendations wef 01.01.06

4. Full revised ex-gratia to (ex-gratia) pensioners too

5. Improvement & expansion : CGHS / RELHS / ECHS

6. CS (MA) Rules, 1944 benefits to non - CGHS Areas

7. Scrapping Central Health Insurance Scheme

8. 50% Merger to BSNL pensioners in IDA scales

9. Full pension benefits to 100% commutation PSU absorbees

Shyam Sunder, Secy Genl

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(vi) When one of the family members moves out of station

carrying RELHS Medical I. card with him/her:-

(a) Short duration: - Attested Photocopy of RELHS Medical I. card

will be considered a valid document for availing outdoor medical facilities

at a Railway hospital / health unit. However, in case of a medical

emergency, indoor treatment will be allowed on the basis of attested

photo copy of I. card in railway & private recognized hospital but the

original Medical I. Card will have to be produced within 15 days.

(ii) Long duration: The original card may be deposited with the issuing

authority who may issue split Medical I. cards to the beneficiaries as

requested by them. (Rly Bd No 2004/H/28/1 RELHS/Card dt 22.03.05)

(2) Eligibility: Minimum 20 years of qualifying service in the Railways

will be necessary for joining the Scheme and the following categories of

persons will be eligible to join the same:

(i) All serving Railway employees desirous of joining the scheme will

be eligible to join it in accordance with the procedure laid down herein

under “Mode of Joining”

(ii) All retired Railway employees who were members of the old

RELHS will automatically be included in the RELHS '97

(iii) Spouse of the Railway employee who dies in harness

(iv) Family pensioners whose spouse had the requisite 20 years of

qualifying service

(v) SRPF optees & their widows

(vi) PSUs absorbees who resigned from Railways on their being

permanently absorbed in PSUs can join RELHS subject to fulfilment

of conditions prescribed in this regard.

These orders are not applicable to those Railway servants who quit

service by resignation on any other account.

(vii)Ex-Minister for Rlys, ex-MOSR & Dy. Minister for Railways

{Rly Bd No 2003/H/28/1 RELHS dated 16.03.2009, 2007/H/28./1/

RELHS/Misc dated 30.11.09 & No. 2009/H/23/2 dt 11.12.2009}

Note: With effect from 16.03.09, RELHS has been made mandatory

for all retiring Rly employees .In case the retiring officer/staff is unwilling

to join the Scheme he/she should clearly submit his/her unwillingness in

writing in the Declaration Proforma along with reasons thereof. This

shall be treated as final and no further chance will be given to join the

Scheme thereafter.{Rly Bd No 2003/H/28/1 RELHS dt 16.03.2009 &

8.04.09}

(3) Family/Dependents:

Definition of ‘family’ for the purpose of this Scheme will be the same as

in respect of the serving Railway employees. The definition of “dependant”

will be the same as in the Pass Rules.

However, unmarried sons over 21 years of age without an upper age

limit, even if not a student or invalid, provided they are wholly dependent

on & reside with Railway Employee/Pensioner, will be covered in the

definition of Family. (Rly Bd No. 2008/H-I/2/15 dated 16.02.09) Also the

widowed daughters, irrespective of their age, provided they are wholly

dependent on Railway employee/pensioner and legally divorced sister, if

father is not alive will be covered in the definition of family /dependents.

(Rly Board No.2008/H-I/2/15 dated 16.02.2009 &even No dt 26.10.2009)

(4) Rate of contribution:

(a) For joining RELHS ’97, one-time contribution equal to the last

month’s basic pay will have to be made at the time of retirement by those

who join the scheme. The persons who are already members of the

existing RELHS are not required to make any fresh payment. However,

those who joined the existing RELHS after 1.1.96 had to pay the

difference of one-time contribution on account of introduction of fifth pay

commission’s revised pay scales w.e.f. 1.1.96. Similarly those who have

joined the existing RELHS-97 after 1.1.06 have to pay the difference of

one-time contribution on account of introduction of sixth pay commission’s

recommendations. It will be the responsibility of the Railway

Administration to realize the amount due from the concerned RELHS

members

(b) In respect of employees who have already retired on the date of

reopening of RELHS and who had not joined RELHS earlier, one time

contribution will be Twice the revised basic pension.

(ii) For family pensioners: A sum equivalent to double the amount

of their revised normal family pension as on the date of joining

139138

(iii) For SRPF Optees : For those SRPF Optees or their widows for

whom ex-gratia payment has been approved on the basis of the

recommendations of the V CPC, a one-time contribution at

twice the ex-gratia monthly payment may be deposited.

(vi) For Ministers: An amount equivalent to one Month’s basic

Salary drawn, on the date of enrolment, by an in-position

Minister of equal status.

[Rly Bd’s Letter No 2000/H/28/1(RELHS) dt 23-06-2000), Rly Bd No

2003/H/28/1/RELHS dated 16.3.09 & No. 2009/H/23/2 dt 11.12.2009]

(5) Mode of Joining:

Joining RELHS-97 has been made mandatory w.e.f 16.03.09. In case

retiring officer/staff is unwilling to join the scheme, he/she should clearly

submit his/ her unwillingness giving reasons thereof. No further chance

will be given to them thereafter.

(b) Such of the post 16-03-09 retirees who have not yet joined the

scheme are given last & final chance to join by 31-03- 2010. The medical

I. card will be issued by the Personnel Department of the concerned

Railway on realization of contribution due..(Rly. BD No 2003/H/28/1/

RELHS dated16.3.09) or the Personnel Department of the Division from

which the retiree is drawing post-retirement passes.

(Rly Board No 2005/H/28/1/RELHS dated 31.08.09.)

For Ministers: - The CPO of the Zonal Railway from where they wish

to avail of Railway Medical facilities, may be contacted. It will be the

responsibility of the concerned Zonal Railway to issue Medical Card on

realization of contribution due from the ex-Ministers/dependants for

joining the scheme.

Providing Medical Treatment of Rly Beneficiaries:

The Railway beneficiaries should be insisted upon to report to their

respective Authorized Medical Attendant only. The Railway Doctor to

whom they have reported, should take all the steps to attend to his/her

medical problems. The only exception is during acute emergency like

Road Accident, Acute Heart Attack, etc., where the situation is such that

the loss of time to report to Railway Doctor can cause serious deterioration

to the patient's condition. Under such circumstances, the railway

beneficiary should himself/herself get admitted to nearest suitable

Hospital and submit reimbursement claim. Within 180 days, he/she

should also inform his/her Authorized Medical Officer at the earliest.

The Railway Doctor to whom the Railway beneficiary has reported for

his/her medical problem will decide the line of action plan. The action plan

could be:-

a) It may be possible to provide the medical treatment within the

facilities as available within the Health Unit/Railway Hospital set up at

a distance which can be travelled by the patient conveniently.

(B) For those cases which cannot be managed as per (a) above,

following alternative methods can be adopted:-

(B.I) To avail services from Government Hospital,

(B.2) To avail services from Recognized Private Hospital for

particular Disease/Diseases,

(B.3) In exceptional cases, it may be essential to avail services from

Unrecognized Private Hospital.

Note: 1.Adequate number of proper quality Private Hospital should be

recognized to facilitate Railway Doctors to provide proper treatment to

Railway patients if in-house facilities are not adequate.

2. Pathological & Radiological and other types of Diagnostic

Investigations for Rly beneficiaries:

To improve the standard of Health Care delivery. Railway Health Units,

located more than 25 Kms away from concerned Rly hospital, may be

provided diagnostic facility through private recognized diagnostic Centres

{ Rly Bd Nos 2005/H/21/FHU dated 16.1.2006, 2005/H/6-4/Policy-II

dt 16 .04. 2007, & 2007/11/21/FH dt 04.O2.O8}

System to be followed to get Medical treatment done from

Unrecognized Private Hospital.

(A) For those cases where there is no emergency: - Proper proposal

with estimate recommended by Standing Medical Board of the Railway

Hospital, recommended by MD/CMS/MS in charge of the Hospital,

CMD of Zonal .Railway and duly concurred by FA&CAO should be

sent to Railway Board to obtain prior approval of Railway Board.

(B) For those cases where there is an emergency:-

141140

(B.I) A proposal from CMD with some rough estimate to be sent to

DG/RHS by Fax for administrative approval of DG/RHS. Approval will

be sent by fax within hours.

(B.2) After office hours and on holidays, administrative approval from

DG/RHS to be obtained over telephone. In case DG/RHS is not

available, information can be left with EDH/EDH (P). Administrative

approval by Fax to be obtained as per Para (B.I) on next working day.

(Rly Board No. No. 2005/H/6-4/Policy-II dated 16.04.2007)

Treatment in an emergency: 1) Where, in an emergency, a Railway

employee or his dependant has to go for treatment (including confinement)

to a Government hospital or a recognized hospital or a dispensary run by

a philanthropic organization, without prior consultation with the Authorized

Medical Officer, reimbursement of the expenses incurred, to the extent

otherwise admissible, will be permitted.

(Para 648 IRMM 2000 Vol. I)

“Emergency” shall mean any condition or symptom resulting from any

cause, arising suddenly and if not treated at the early convenience, be

detrimental to the health of the patient or will jeopardize the life of the

patient. Some examples are:- Road accidents, other types of accidents,

acute heart attack etc. Under such conditions, when the Railway

beneficiary feels that there is no scope of reporting to his/her authorized

Railway Medical Officer and avails treatment in the nearest and suitable

private Hospital, in which case Authorized medical officer should be

informed at the earliest ( not later than 24 hrs.), the reimbursement claims

are to be processed for sanction. Genuineness of emergencies is to be

established at the earliest by any means of communication and not later

than 24 hours of the patient being admitted in the Private Recognized

Hospital.

In case the genuineness of emergency is not established, then the

reimbursement to the patient for the amount he paid to the private hospital

will be limited to the CGHS rates only for the bill raised till decision is

taken on emergency by Railway doctor.

(Rly Bd No 2007/H/ 28/I /RELHS/Smart card dated 24.07.08)

For establishing emergency condition ex-post -facto, Authorized Railway

Medical officer shall examine the following parameters, on record:-

(a) Admission details: (i) Date and time of admission (ii)Admitted

through OPD service/ emergency service. (iii) Admitted to an ICU bed

or general bed or cabin bed. (b) Clinical findings at the time of

admission. Following findings should be made available and critically

evaluated:-

(i) Pulse rate (ii) B.P. (iii) Level of consciousness (iv) Any convulsive

feature (v) Urine output (vi) Any other feature of shock. (vii) Body

temperature (viii) Extant of external wound (ix) Extant of active bleeding

(x) Extant of Chest pain or pain in other part/s of the body. c) Types of

medical treatment given immediately after admission. (i) List of

Emergency medicines used immediately after admission. (ii) Type of

surgical procedure done immediately after admission.

(Rly Bd No. 2005/H/6-4/Policy-II dated: 3 1 .01. 2007)

However, For the knowledge and benefit of beneficiaries, the

following opinion of the Directorate of Health of the Rly Board, may also

be noted:

(1) Any heart attack mild, major or acute if not treated well in time will

cause some permanent damage to heart muscles.

(2) In case of following symptoms, the patient should report to nearest

competent doctor for consultation & further advice :(i) In case of pain

anywhere in chest, (ii) In case of pain in abdominal region, (iii) In case

of sudden weakness in one or both upper or lower limb or sudden

weakness in one or both upper or lower limb accompanied with loss of

grip or giddiness (iv) In case of pain in Shoulder extending towards

Elbow with or without pain in Chest (v) In case of perspiration with

breathing problem ( Rly Board No. N0.2006/H-1/13/RTI dated 05-6.07)

Reimbursement:

The beneficiary has to submit his /her claim on the prescribed Forms

within 180 days. Once the emergency is established beyond doubt, and

then the case will be further processed as follows:

1. Procedure:

The procedure to be followed for consideration and rejection of the

reimbursement claim, if the treatment is taken by railway employee in a

non-recognized private hospital without referral by authorized Medical

Officer shall be as under:-

143142

A. At the Division/ Zonal Hospital / Production Unit Level:

(i) AMO will scrutinize the claim first and will forward it to CMS of the

concerned Division/ Production Unit or MD of the Zonal Hospital.

(ii) CMS/MD will scrutinize the claim and if emergency is established

will recommend the amount to be reimbursed and will send it for

financial concurrence of the Associated Finance.

(iii) The proposal will be sent to CMD of the concerned Zone.

B. At the Zonal Headquarters:

(i) The CMD of the concerned zone scrutinizes the reimbursement

claim and will send the same for FA & CAO’s concurrence.

(ii) If the reimbursement amount is within the powers delegated to

General Manager, the claim will be sent for his approval

otherwise the proposal will be sent to Board for consideration.

2. The competent authority to reject the claim shall be the authority

which scrutinizes the claim in cases where emergency is not established.

A. The competent authority to reject the claim in case where

emergency is not established as per guidelines laid down in

Board’s letter No.2005/H/6-4/Policy-ll dated 31.1,07 shall be

CMS of the Division/Production Unit or Medical Director of the

Zonal Hospital, as the case may be.

B. In case, the proposal has been duly forwarded to the concerned

CMD and after scrutiny, he comes to the conclusion that

emergency is not established; the competent authority to reject

the claim shall be CMD concerned,

C. In case, the rejection is on any ground other than emergency not

being established, the competent authority to reject the claim

shall be DRM at the Divisional level and General Manager at the

Zonal level/Production Unit level.

D. The reasons for not recommending the proposal for sanction of

competent authority need to be intimated to the employee at the

scrutiny level itself.

Note: For calculating the amount/money to be sanctioned, the following

guidelines need to be followed:-

a) Treatment taken in Govt Hospital - Full admissible amount should be

recommended for sanction.

b)Treatment taken in Recognized Private Hospital for an ailment for

which it is recognized - Rate as approved by Railway should be

processed for sanction.

c) Treatment taken in a Recognized Private Hospital but for an ailment

for which it is not recognized or treatment taken in a non-recognized

Private Hospital:- Reimbursement should be made at the CGHS rates of

that city or nearest city. CGHS (Central Govt Health Scheme) approved

rates are to be recommended/processed as an upper limit for sanction.

Note: 1. In civil appeal no 560 of 2004 decided on 6.8.2004, Suman

Rekheja Vs State of Haryana. (2004)13 SSC 562 the Supreme Court

held that 100 percent medical expenses at AIIMS rates and 75 % of

expenditure in excess thereto is to be reimbursed in case of treatment

taken in an emergency in a non-recognized Private Hospital.

2. Railway hospitals are covered by Consumer Protection Act 1986

and RELHS beneficiaries are Consumers as per the definition of the said

Act [Laxman Thamapa Kotgiri Vs GM, Central Railways & others civil

appeal No 171 of 2004 {2005 (1) SCALE page 600}

In Medical Science, no list can be fully exhaustive. Hence, it is likely

that there will be few occasions when a claim has been submitted which

is not appearing exactly in the CGHS rate list. On these cases, the MD/

CMS/MS in charge of Divisions will apply their mind and will come to a

logical conclusion. Then, they will pass a speaking order to certify the

rate/s being recommended, in consultation with Associated Finance.

(Rly Board No. 2005/H/6-4/Policy-II dated: 3 1 .01. 2007)

As per the time schedule laid down, normally a reimbursement case

should be finalized within 60 days.

{N. Rly HQ office P.S. No 11768/99 dt 31.03.1999}

Fixed Medical Allowance (FMA): As per Board’s letter No. PC/V/

98/1/7/1/1 dated 21.4.99, a Fixed Medical Allowance @

Rs. 100/- per month is granted to the Railway Pensioners/Family

Pensioners who are residing beyond 2.5 Kms from Railway Hospital/

Health Unit/Dispensary. This fixed medical allowance is given to meet

the day-to-day medical expenses. They are not entitled to receive

144 145

outdoor treatment from Health Unit/Railway Hospital etc, except in

cases of Chronic Diseases.

The following will be treated as chronic diseases:

(a). Any disease which persists for a period of approximately three

months or more is defined as a chronic disease. Some of the common

illneses which are treated as chronic diseases are:- 1. Arthritis and

related conditions. 2. Cardiovascular disease. 3. Cancer of any part of

body. 4. Diabetes mellitus 5. Epilepsy disorders 6. Obesity/chronic

weight loss. 7. Tuberculosis. 8. AIDS 9. Oral Health Problem 10.

Chronic skin disorders.

(Rly. Bd No2006/H/DC/JCM dated I2 10.2006)

Note: Lockup Dispensaries are not considered as Health Units.

Entitlement for Private / Semi-private Wards/cabins : Same yard

stick as that of CGHS is followed for railway beneficiaries also. For

details, please refer to Annexure 6 “Salient features CGHS”

(O.M. No.18 (1)/EV/2009 dated 14.04.2009 Ministry of H &FW)

ANNEXURE - 7A

Medical Reimbursement Claim Profoma

1. Name of the employee/ex employee

2. Whether in service or retired

3. Designation

4. Office / unit of posting

5. Pay & Scale of Pay of the Employee last pay drawn in case of retired

employee

6. Name of the patient

7. Permanent address of the employee/Pensioner

8. Temporary address of the employee/Pensioner

9. Relationship with Railway Employee for Whom reimbursement is

claimed.

10. Age of Patient

11. Medical RELHS card No.

12 Whether referred or none. Referred

13. If referred, by whom

14. Name of the institution where treatment is taken

15. Date of admission

16. Date of discharge

17. Date of submission of claim

18. Reasons for delayed submission of claim if delayed for more than 6

months

19. Total period of Stay as indoor patient

20. Reasons for long Stay (if Stayed for more than 48 hrs)

21. Type of medical emergency

22. Was there no Railway/ Govt. Facility available to deal it

146 147

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23 Distance, of the nearest. Govt. hospital & whether facilities available

there.

24. Distance of the nearest Rly hospital and whether facilities available

there. If not, how far is the railway hospital with the facilities?

25. Distance of the private hospital from residence/place of illness,

where facilities availed.

26. When the railway medical Officer was informed about such admission

27. Did the patient take any? Treatment before or after the present

sickness (If this existed before) and if yes, when

28. Total amount claimed with break up of charges (detailed instructions

at (f) of foot note below)

29. Total No. of enclosures

Countersign of Controlling Signature of employee/pensioner

officer/Unit in-charge

(in case of serving employees)

Declaration to be signed by the person claiming medical

Reimbursement

I hereby declare that the statements in this application are true to the

best of my knowledge and belief and

(i) That the person for whom the medical expenses are incurred, is wholly

dependent upon me.

(ii) That the medical expenses were incurred for self.

Strike out whichever is not applicable from (i) & (ii)

Date Signature of claimant

Place Designation & office to which attached

Foot note: i. item Nos 18, 19, 20, 2 1, 22, 23, 24 and 25 are applicable only

to non-referred cases.

2. Following documents should be attached with this Performa

(a) EMPLOYEE/ RETIRED EMPLOYEE’S APPLICATION GIVING GIVING THE

CIRCUMSTANCES UNDER WHICH HE/SHE TOOK THE TREATMET.

(b) Photo copy of Medical / RELHS I. Card duly attested by a Gazetted

officer

(c) Essentiality certificate issued by the treating doctor, duly countersigned

by the hospital superintendent of the treating doctor

(d) Discharge certificate in original

(e) Bills/Vouchers (in original) duly countersigned by the treating doctor

along with prescription slip in original

(f) Detailed item-wise breakup of all the bills (this means all the bills/

vouchers submitted as per (e) above may be reproduced in legible

manner, e.g.

Bill No Name of the Chemist Dated

Description of item Qty. Price

i)

ii)

ii)

Total

(h) In case of referred cases, attach original referral slip

CERTIFICATES

(To be completed in the case of patients who are

admitted to hospital for treatment)

Part A

I, Dr....................................................... ...............hereby certify;

(a) That the patient was admitted to hospital on my advice/on the advice

of.................................................................. (name of Medical Officer)

(b) that the patient has been under treatment at ....................................

and that the under-mentioned medicines were prescribed by me. In this

connection these were essential for the recovery/prevention of serious

deterioration in the condition of the patient. The medicines are not

stocked in the (name of the hospital).............................................. for

supply to private patients and do not include proprietary preparations for

149148

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which cheaper substances of equal therapeutic value neither are

available nor preparations which are primarily foods, toilets or disinfectants.

Name of medicines Price

1

2

3

(c) That the injections administered were not for immunizing or

prophylactic purposes.

(d) That the patient was suffering from ............................ and was

under my treatment from ............... to ..................................

(e) That the X-ray, laboratory tests, etc. for which an expenditure of Rs

....................... was incurred were necessary and were undertaken on

my advice at .............................................. (name of hospital or

laboratory).

(f) That I called in Dr ....................................... for specialist consultation

and that the necessary approval of the ————————————

——— (name of the Principal Medical Officer), as required under the

rules was obtained.

Date.......................... Signature and designation of the

Place......................... Medical Officer in charge of the

case at the hospital

Part B

I certify that the patient has been under treatment at

the............................................ hospital and that the services of the

special nurses, for which an expenditure of Rs. .......... was incurred vide

bills and Receipts attached, were essential for the recovery/prevention

of serious deterioration in the condition of the patient.

Date..................... ....................................................

Place.................. Signature and designation of the

Medical Officer in charge of the hospital.

Countersigned Principal Medical Officer

Part C

I certify that Shri/ Shrimati / Kumari......................................... wife /

son/daughter .................................................. of ...................employed

in the ...........................................has been under treatment

for....................................disease from.................................

to............................. at the....................................................... hospital

and that the facilities provided were the minimum which were essential

for the patient’s treatment.

Date .......................................................

Place.................. Medical Officer

Department ................................ Hospital

Note: Certificates not applicable should be strucke off. The (Essentiality

Certificate as given in Part A (b) above is compulsory and must

be filled in by (he Medical Officer in all cases.)

Instruction for submission: In both referred & non-referred cases

retiree's application should be submitted to the concerned M.D Zonal

Rly. Central Hospital/CMS i.e. under whose jurisdiction applicant’s

RELHS I. Card is registered.

For official use only

(i) In all cases being sent to Board

(ii) In cases of GM/AGM sanction for un-referred /non-Govt,

unrecognized cases

1. Verbatim of CMD

2. Verbatim of FA & CAO

151150

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For ECS Deposit, SB Account Number(SBI, Jangpura) is : 01274 - 10825178380

Bibliography

1. G.O.I. Pensioners Portal : http://pensionersportal.gov.in/

2. Ministry of health & family Welfare

http://mohfw.nic.in/cghsnew/index.asp

2. Pension Process Map and Time Frame as follows:

CCS (Pension) Rules : 56(1), (2) & (4), 59(a), (b), (c) & 59(c)

3. Ministry of Railways (Rly Board): Establishment Code Vol II

Chapter 18

4. Ministry of Railways (Rly Board): Railway Service (Pension)

Rules, 1993

5. Ministry of Railways (Rly Board): Accounts Code-Chapter 10

6. The Pensions Act, 1871

7. Ministry of Personnel, PG & Pensions: Central Civil Services

(Pension) Rules,1972

8. C.G. Pensioner PAYMENT OF ARREARS OF PENSION

(NOMINATION) RULES, 1983

9. Ministry of Personnel, PG & Pensions: Liberalized Pension awards

Central Government

10. CGA’s : SCHEME FOR PAYMENT OF PENSIONS TO C.G.

CIVIL PENSIONERS THROUGH AUTHORISED BANKS

11. Ministry of Personnel, PG & Pensions: CCS (General Provident

Fund) Rules, 1960

12. Ministry of Personnel, PG & Pensions: CCS (Commutation of

Pension) Rules, 1981

13. Dr. V.S. Natarajan, M D, Chennai: Healthy Ageing

14. N. AHUJA MA.,LLB, Advocate: Will

Postal Regd No DL(S)-01/3274/2009-11Licence No U(SE)-18/2009-11to post without pre-payment

BHARAT PENSIONER : Registered with Registrar of

Newspapers for India vide No. R. N. DELBIL/2006/17678

BOOK POST / PRINTED MATTER:Printer & publisher : Shyam Sunder for Secy Genl,

Bharat Pensioners Samaj e-mail : bps.shyamsunder@gmail.com

Printed at Compudata Services, 42, DSIDC Shed, Scheme-I, Okhla-II, New

Delhi - 11 00 20 (printers) from

(place of publication) 2/15-B

Hospital Road, Jangpura-A, New Delhi - 110 014

Editor (for the purpose of the Act) : Y C Rai.