CGHS Medical Reimbursement Claims – A complete Streamlining Administrative Procedures

CGHS Medical Reimbursement Claims – A complete Streamlining Administrative Procedures 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. Though, a number of complaints are being received from the pensioner beneficiaries about the slow and tardy pace of disposal of MRC claims (Medical Reimbursement Claims) by CGHS, Complaints have also been received about the unnecessary harassment of pensioner beneficiaries who are also senior citizens, affecting them mentally and financially, and thereby creating a bad image for CGHS. CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. It has therefore been decided to lay down a comprehensive procedure to be followed by all concerned in CGHS to ensure timely and hassle free disposal of the MRC claims by CGHS in order to facilitate prompt reimbursement of medical expenses to the pensioner beneficiaries. The below order is directed to follow the procedure religiously in both letter and spirit to ensure speedy and timely disposal of the Medical Reimbursement Claims (MRCs) filed by the pensioner CGHS beneficiaries. The procedure to be followed by CGHS for dealing with MRC cases shall be as follows… F. No. S.11024/8/2011/CGHS(P) Government of India Ministry of Health and Family Welfare Department of Health and Family Welfare Directorate General of C,G.H.S. Nirman Bhawan, New Delhi Dated the 14th November, 2011 CIRCULAR SUBJECT : Streamlining of Procedure for disposal of Medical Reimbursement Claims (MRCs) in CGHS The pensioner CGHS beneficiaries and their dependent family members are entitled to get cashless medical treatment In CGHS empanelled private hospitals on a referral by a Government medical specialist / CMO in-charge, after obtaining prior permission from the CMO in-charge of the CGHS Wellness Centre/Dispensary they are attached to. They are however, also entitled to obtain the medical services from any un-empanelled hospital in emergency condition and get reimbursement of medical expenses incurred by themselves or any of their dependent family members. They can file Medical Reimbursement Claims (MRCs) with the respective CGHS Wellness Centres they are attached to- The CMO In charge is expected to scrutinize the claim papers with reference to the prescribed Checklist and forward the same to the Office of AD/ JD in charge of the zone/city. The Office of AD/JD processes the claim and arranges reimbursement of the admissible amount to the pensioner beneficiary at the earliest. 2. A number of complaints are being received from the pensioner beneficiaries about the slow and tardy pace of disposal of MRC claims by CGHS, Complaints have also been received about the unnecessary harassment of pensioner beneficiaries who are also senior citizens, affecting them mentally and financially, and thereby creating a bad image for CGHS. CGHS is responsible for taking care of healthcare needs and well being of the central government employees and pensioners. It has therefore been decided to lay down a comprehensive procedure to be followed by all concerned in CGHS to ensure timely and hassle free disposal of the MRC claims by CGHS in order to facilitate prompt reimbursement of medical expenses to the pensioner beneficiaries. 3. The procedure to be followed by CGHS for dealing with MRC cases shall be as follows; i. The beneficiary will submit the MRC in the prescribed format with all relevant supporting vouchers/documents in original, to the CMO-I/C of the relevant CGHS Wellness Centre. The CGHS Wellness Centre shall verify and ensure, before accepting the claim papers, that all relevant documents are enclosed as per the prescribed checklist and issue a dated acknowledgement to the claimant in token of receipt of the MRC by CGHS. ii. The CGHS Wellness Centre shall forward the MRC papers online to the Office of Zonal AD/JD, CGHS for further processing for reimbursement of claims. The physical papers shall be sent to the office of the AD/JD within one / two days of receipt of claim papers. iii. If there are still any deficiencies / gaps found in MRC documents/papers, the Office of AD/JD, shall retain the papers and communicate the list of deficiencies / observations, preferably online, to the CMO-I/C for removing the shortcomings. The MRC may also be returned in original to the CMO- I/C, if it is absolutely necessary for doing the needful to remove the deficiencies in consultation with the beneficiary. iv. The CMO-I/C shall contact the beneficiary concerned and inform him about the shortcomings in the MRC papers and request him to submit the requisite information / documents. The CMO I/C shall not return the MRC in original unless it is rejected in total. v. The MRCs should be scrutinized and processed by the Office of AD/JD as far as possible through computerized software as per the extant policy and instructions issued from time to time about the CGHS rates and admissibility of claims under CGHS. vi. The amount found admissible as per the CGHS guidelines may be passed for payment and forwarded online / manually to the PAO for making payment. The original documents should also be forwarded simultaneously to the PAO for making payment of the admissible amount to the claimant. vii. When a bill is sent to the PAO, the details pertaining to the claimant will be entered through computer and the claimant shall be informed of the same along with bill number, amount admissible and details of disallowances clearly indicating the specific reasons / grounds for deductions. viii. The Office of AD/ID of the zone / city shall submit a weekly report in Form —'MRC-I' and Monthly Return in Form — 'MRC — II' indicating the details of disposal of MRC cases, to the Office of AD(HQ), CGHS for Delhi & NCR and to the Office of Additional DDG (HQ), CGHS for other than Delhi and NCR CGHS cities. ix. A separate analytical statement shall be attached with the Monthly Return in Form-'MRC- II' giving therein, the details of the MRCs pending for 2 months and above, clearly indicating the reasons there for and steps taken to dispose of such cases. x. The Office of AD (HQ), CGHS, New Delhi and Office of Addl. DDG (HQ), CGHS shall compile the Monthly returns received from the respective zones and cities and submit a consolidated Monthly Return on MRC cases (Zone-wise/City wise) to the Director, CGHS for monitoring of MRC cases on a monthly basis. A copy of this Monthly Return shall also be endorsed by AD (HQ), CGHS and Addl. DDG (HQ), CGHS to Additional Secretary and Director General, CGHS for his information. 4. All the CMO — I/C of the CGHS Wellness Centres and the ADs and JDs of the zone /city are herby directed to follow the above procedure religiously in both letter and spirit to ensure speedy and timely disposal of the Medical Reimbursement Claims (MRCs) filed by the pensioner CGHS beneficiaries. End: Forms – MRC-I & II sd/- (L.C.Goyal) AS&DG (CGHS) Source: http://msotransparent.nic.in/cghsnew/index.asp Source: www.cgstaffnews.com Share and Care
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CHQ Editorial - December 2011

Editorial - December 2011 ON THE SADDLE AGAIN No one can dare to dispute the fact today that there is great frustration amongst the Postal employees, due to the protracted delay and lethargic disposal of agreed demands in strike charter of July 2011. When we issued strike notice, the whole mechanism of Postal service had activated and worked. After called off the strike in the wake of definite assurances by the head of the department, again the red tapism and usual lethargy in disposing the genuine agreed demands is revived. Secretary, Department of Posts & Member had agreed during the negotiations to reduce the cash norms to GDS from Rs. 20000/- to Rs. 10000/-. It was agreed for causing orders protecting full wages for GDS in cases of reduction of workload. It was assured that the casual labourers engaged prior to 1993 will be provided with new pay scales within a month and for others it will be considered subsequently. There are many such items, if you go through the agreement, you could see. Whether any of them was brought in to action by issue of orders? The proposal of cadre review was mooted by us during 2008. Time frames have been fixed twice and the latest is before 30.10.2011. Two informal sittings were over. Thereafter, static silence is prevailing. When the Department initiated fifth cadre review for IPS officers now, will it not its duty to finalise the first cadre review for the poor Postal operative cadres. Will not the anger agony and anguish prevailing among the so called system administrators be felt by the powers? It was the agreement that there will be no closure of RMS offices or post offices. This was reiterated more than thrice in all the recent three agreements. But the Chief PMG Maharashtra abolished two sections arbitrarily. The staff went on strike. When our leaders discussed with the Directorate, and in turn the senior officer telephoned the Chief PMG in the presence of them, he was replying that he will not restore and if need be he may be transferred from the circle. The Directorate replied what to do? If they could not control the circle head, what is the need for higher bodies and agreements and all those? Are they really not having teeth or is it an enactment of drama already decided to play to deceive us? When there is an agreement that there will be no closure of Post offices and in case of inevitable circumstances simultaneous opening of post offices will be ensured, willfully, it is being denied by some PMGs for which there is no action or intervention from the Directorate. What prevented them to issue clear cut instructions on this score? The Sub PM once punished with minor penalty is not entitled to work as SPM in whole career. No one shall be posted to one B/C class office as SPM more than once in whole career. All these orders are issued by vigilance section as preventive measures. Alright! Whereas the Chief PMG who involved in corruption and caught red handed by CBI is now reposted as Chief PMG, West Bengal with the same financial powers authorities and all privileges. No such yardsticks as applied to postmasters are smeared to such officers. Even though it was agreed to cancel both the vigilance orders on SPM postings, nothing is moving so far because they are poor postal Assistants and not the bureaucrats. For the first time, based on stiff position of the Hon'ble Minister, the cluster policy for officers was introduced in the Postal service. Now they are seeking opinions among the same officers about the same cluster policy. For what? Just to dilute or withdraw the same in favour of them. We are not objecting? Nor least bothered? But why not the same spirit is not being extended in causing orders in the cases of agreed items in the strike charter? Training centers are institutions which will motivate the trainees and refresh them. What is going on PTC Madurai? A lady officer who is a sadist and not having an inch of humanity and very notorious for her topsy turvy activities is posted and ruining the atmosphere? The Nazi regime of Hitler is revived in the PTC and the authorities to control the atrocities and highhandedness are remaining as silent spectators. While posting in charges for training centers, is it not the prerequisite to select polite, gentle and firm officers who could motivate the staff with kindness and advices. Whether the training centers can be improved by the sadists and egoistic characterized persons? In many divisions, Circles, the departmental orders and instructions are grossly violated. Many new recruited officers never care the Rules and regulations and simply dictate their dictums. There is no check on them. There is no refresher training to them on human management and the criterion to adhere the Government of India orders with consecrated look. Their topsy turvy activities are not being controlled by the Circle heads. Without minding the cost of expenditure and inconvenience to staff, one PMG is opening post offices on Sundays just for booking two or three speed post articles. The counter working hours have been enhanced to 10 to 11 hours of a day. We don't know whether he knows the concept of Night post offices. He never calculates the loss incurred due to opening of POs, staff, wages, electricity etc. This is nothing but to appear in the press daily with some new announcements which are all not worthy and lead loss to the department. There are very many similar to these episodes. As the social Audit Panel and also the Fifth Pay Commission right pointed out that the existence of Director posts are white elephants, it is nothing but creating two power centers in region and the sufferers and victims are the employees at large. This is an introspection of the events and shape of things that are required to be judged in the right perspective. Never – the – less, we are trying our level best not to resort to direct action and settle the issues by talks unless such an action is forced upon us callously by the powers – that – be. The present situation is entirely undesirable and it cannot be allowed. There can be no justification for continued increase in the misery of the workers due to protraction in settlement of their demand! We should not be pushed into wall once again to restart and revive agitational programmes. Will the authorities understand our feelings and act swiftly to avert further action? SOURCE:aipeup3chq.com Share and Care
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Job Highlights 19 NOVEMBER 2011 - 25 NOVEMBER 2011

1. Staff Selection Commission (Western Region) invites applications for various posts. 2. Rajasthan Gramin Bank, Alwar requires Officers Middle Management (Scale-II), Officer Junior Management (Scale-I) and Office Assistants. 3. Rewa Sidhi Gramin Bank invites applications for appointment as Officer MMG Scale-III, Officer MMG Scale-II, Officer JMG Scale-I and Office Assistants. 4. Parliament of India invites applications for various posts. 5. CSIR-Central Mechanical Engineering Research Institute, Durgapur requires Scientists and Senior Scientist. 6. Bharat Heavy Electricals Limited, Jagdishpur requires Junior Workers in Ceramic Trade. 7. Employees' State Insurance Corporation, New Delhi requires Professors and Associate Professors. 8. Employees' State Insurance Corporation PGIMSR and Model Hospital, Bangalore requires Para-Medical Staff. 9. East Coast Railway invites applications for recruitment against Sports Quota. 10. Central University of Bihar invites applications for appointment on non-teaching posts-Group 'A'. 11. Central Salt and Marine Chemicals Research Institute, Bhavnagar requires Scientists. 12.Hindustan Organic Chemicals Limited, Kochi invites applications for various posts. 13. The Indian Navy invites applications from unmarried male candidates to joint the prestigious Indian Naval Academy, Ezhimala, Kerala 10+2 Cadet (B.Tech) Entry Scheme. Source: Employmentnews Share and Care
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Pension Useful Information

Type Of pension Superannuation Family Pension Voluntary Retirement (VR ) Eligibility The qualifying service for evaluation of pension is reduced to 20 years w.e.f. 01.09.2008. Earlier it was 33 years. Pension is evaluated on the basis of the last 10 months average pay or last pay drawn whichever is beneficial to retiring employee Terms related to the PENSION Calculation PENSION DCRG (Death Cum Retirement Gratuity) COMMUTATION RESTORATION of Pension FAMILY PENSION PENSION The pension amount is calculated based on the Basic Pay at the time of retirement, Age, Service years, etc. It is calculated as 50% of average emoluments of last 10 months salary drawn. It is calculated on Basic and Dearness Pay only Formula for Calculation of Pension Amount = 50% of Avg. emoluments (last 10 months*SMP/66 DCRG This is basically known as Gratuity. Gratuity is the amount given to the employee at the time of retirement. It is calculated on Basic, DP and DA. This amount is limited to maximum Rs.3,50,000 / - only. Formula for Calculation of DCRG Last Salary Drawn X SMP _______________________________ 4 OR last Salary Drawn X SMP ---------------------------------------------- 2 (in case of Death) COMMUTATION At the time of retirement of the employee, a portion of pension can be withdrawn by the employee. A maximum of 40% of pension amount can be withdrawn at the time of retirement. However, depending on the amount withdrawn proportionate amount will be deducted from the Pension amount till 15 years and employee will get reduced Pension till 15 years Formula for calculation of Commutation Commutation Percent of Full Pension x Age Factor x 12 Formula for calculation of Reduced Pension Full Pension – Commutation Percent of Full Pension) + DA on Full Pension RESTORATION The commuted portion of pension shall be restored on expiration of 15 years from the date of retirement. After this period the employee is entitled for full pension. FAMILY PENSION In case of death of retired employee, his/her pension is entitled to his/her family or the nominees fixed by the employee. The wife is entitled till her remarriage or death whichever is earlier. In case of Son/Daughter, children are entitled till an age of 25 years or marriage, whichever is earlier Thanks to: http://nfpemavelikaradivision.blogspot.com Share and Care
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Black Money.. and YOU

Anna Hazare says, Bring back the Black Money... Do you know what will happen if 1456 Lac Crores comes back?...  India financially No.1...  Petrol Rs.25, Diesel Rs.15, Milk Rs.8...  No need to pay Electricity Bill...  Indian Borders will become more stronger than China Wall  1500 Oxford like Universities can be opened...  28000 Kms Rubber road (like in Paris) can be made...  2000 Hospitals ( with all facilities and all medicines) can be opened...  95 Crore people will have their own house... Support India by forwarding this message to atleast 10 Indians,... I did my job, now its your turn to FORWARD THIS...  Share and Care
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Revised Results of Postmaster Grade I of Karnataka circle announced today

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AIPEU Circle Secretary to visit Haveri on 08.11.2011

We heartly welcome our AIPEU P3 Karnataka Circle Secretary Shri S S Manjunth to Haveri on 08.11.2011 by, Divisional Secretary/President and all the members of AIPEU Haveri Division, Haveri

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