01 Feb, 2015 5:46p.m.

Move to replace CGHS with insurance-based scheme

The health ministry has moved a proposal for ending the Central Government Health Scheme (CGHS) in its current form and moving to an insurance-based scheme — the Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS) — in an apparent attempt to cut costs.
Instead of the government directly paying the medical bills of CGHS beneficiaries, the new scheme will be implemented through insurance companies registered with the Insurance Regulatory and Development Authority and selected through bidding.

Currently, under CGHS, government employees pay Rs 6,000 annually as fixed medical allowance (FMA). The new FMA for beneficiaries is yet to be calculated. While the government’s actual financial commitment will depend on bids and the new FMA, the ministry is working on a presumptive figure of Rs 14,000 per family, which works out to approximately Rs 1,000 crore annually.

The scheme will cover medical expenses up to Rs 5 lakh per family per year. Beyond that, the insurer will have to get clearance from the nodal agency on a case to case basis. An additional sum insured of Rs 10 crore in each of the four zones will be provided by the insurer as buffer for such cases. The CGHS in its present form does not have any annual cap, but each procedure has a prescribed maximum limit for reimbursement. While a note for the Expenditure Finance Committee (EFC) was circulated last year, a fresh proposal incorporating inputs from various departments including the DoPT, erstwhile Planning Commission and Ministry of Statistics and Programme Implementation has been sent to the finance division of the health ministry.

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