Reimbursement of medical expenses to pensioners where payment of FMA is allowed to staff working in the interior where AMA not available

Reimbursement of medical expenses to pensioners where payment of FMA is allowed to staff working in the interior where AMA not available
No. 4/4/2013 -P&PW-(D)
Government of India
Ministry of Personnel, Public Grievances & Pensions
Department of Pension & Pensioners Welfare

Lok Nayak Bhavan, Khan Market,
New Delhi,
Dated the 6th December, 2013

OFFICE MEMORANDUM

Sub:- Reimbursement of medical expenses pensioners where payment of FMA is allowed to staff working in the interior where AMA not available – request of Shri Mukesh Singh.

The undersigned is directed to forward herewith a representation dated 27.62013 of Shri Mukesh Singh in original received through Deptt. of Expenditure vide letter No.164/EV/2013- Hindi dated 7.10.2013 for considering the grievances raised therein expeditiously in accordance with the extant rules/instructions under intimation to the representationist to whom a copy of this communication is also being endorsed.
Encl: As above.
(Deepa Anand)
Under Secretary to the Govt„ of India

To
Ministry of Health& Family Welfare.
Deptt, of Health & Family Welfare.
(Kind Attn: Shri V.P. Singh),
Deputy Secretary.
Nirman Bhawa.n,
New Delhi
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BHARATIYA PRATIRAKSHA MAZDOOR SANGH

Ref: BPMS / CSMA / 156 (8/1/L)
Dated: 27.06.2013
To,
Smt. Sudha Krishnan,
Joint Secretary (Pers),
Govt of India, Min of Finance,
Department of Expenditure,
Room No. 39-A, North Block,
New Delhi – 110001

Subject: Reimbursement of Medical Expenses where Payment of Fixed Medical Allowance is allowed to staff working in the interior where AMA not available.

Respected Madam,

With due regards, it is submitted that this Federation has raised the subject matter before the Secretary, MOH&FW and Min of Defence on 05.07.2011 and reminded from time to time that Fourth Central Pay Commission (04th CPC) recommended in Para 16.9 as under;

“We recognize that employees covered by Medical Reimbursement Scheme (MRS) under the Central Services (Medical Attendance) Rules, 1944 are experiencing difficulties as regards the treatment and reimbursement of expenses incurred by them. There is also considerable administrative and accounting work involved in the settlement of claims. Various kinds of malpractices in the scheme have also brought to our notice. We, therefore, recommend grant of a Fixed Medical Allowance of Rs.25/- per month for outdoor treatment to all employees covered by MRS. The expenses incurred on special diseases (cancer, diabetes, mental diseases, poliomyelitis, tubercular diseases and leprosy) and hospitalization may continue to be reimbursed to all employees as at present under the scheme”.

Thereupon Govt issued instructions vide G.O.I., M.H., O.M. No. S-14020/1/88-MS, dated 17th July, 1990, 28th Sep, 1991, that quantum of medical allowance of Rs. 25/- per month per employee working in interior may be granted where no Authorized Medical Attendant is available within a radius of 05 km, and if available, he is not willing to be appointed as AMA.

It is worth to mention here that the reimbursement of medical expenses for indoor treatment were allowed by the concerned authorities though the employee was drawing Rs. 25/- per month FMA.
Subsequently, Fifth Central Pay Commission (5thCPC) also recommended in Para 114.24 on the subject matter as under;

“We are in favour of a greater freedom of choice in obtaining medical aid and advice, where Central Government is unable to organize its own facilities for employees. Such a freedom, while aiming at development of employees within their own responsibilities, will reduce much of clerical work involved in medical reimbursement claims for day-to-day need. For serious ailments and hospitalizations, however, we still do not see any justification for removal of restrictions. Accordingly, we recommend that in areas presently covered by Medical reimbursement Scheme for outpatient purposes a medical allowance of Rs. 100/- per month per employee may be granted only for outpatient facilities, not provided by either CGHS or any departmental medical facilities.”

Thereupon Govt issued instructions to enhance the quantum of FMA to Rs. 100/- from Rs. 25/- per month per employee vide G.O.I., M.H., O.M. No. S-14020/1/88-MS, dated 18th Jan, 1999, for employee working in interior where no Authorized Medical Attendant is available within a radius of 05 km, and if available, he is not willing to be appointed as AMA.

But this O.M. does not prohibit for reimbursing the medical expenses in case the Government Employee or his dependant is being treated as ‘indoor patient’ because the employee is being granted the Fixed Medical Allowance for the reimbursement of consultation fees paid to any doctor available in the interior areas. Even the employee has to bear the cost of medicines prescribed by such doctors and in such circumstances he is authorized for reimbursement of cost of medicines, any pathological test etc. as ‘Out Door Patient’.
Simultaneously, on the recommendation of 5th CPC, Govt introduced Fixed Medical Allowance of Rs. 100/- per month from 01.12.1997 to Central Government Pensioners/family Pensioners not covered under CGHS vide DOP&PW, O.M. No. 45/57/97-P&PW, dated 19.12.1997. According to this scheme, a pensioner/family pensioner may opt either CGHS facility or Fixed Medical Allowance of Rs.100/ which has been enhanced to Rs. 300/- vide your O.M. No. 390/2010-MS, Dated 14th July, 2010. Since the issuance of the O.M. dated 19.12.1997 the medical reimbursement of the Govt employee and their family members has been discontinued.

It is to be kept in the mind that the DOP&PW, O.M. No. 45/57/97-P&PW, dated 19.12.1997 is concerned with the payment of Fixed Medical Allowance to the pensioners/family pensioners, where CGHS facility is not available, on the recommendation of 5th CPC, whereas this federation is raising the issue of Fixed Medical Allowance being granted to serving employees residing in the interior area and who are under the purview of CS (MA) Rules, 1944 and have been granted Rs. 25/ per month vide G.O.I., M.H., O.M. No. S-14020/1/88-MS, dated 17th July, 1990, 28th Sep, 1991 and the quantum enhanced to Rs. 100/- per month vide G.O.I., M.H., O.M. No. S-14020/1/88-MS, dated 18th Jan, 1999.

The employee residing in the interior area has no option to avail outpatient medical facility from any source of Central Government/State Government/Local Municipality/Private Medical practitioner appointed as Authorized Medical within a radius 05 km, hence he has been compelled/granted by Central Government to accept Rs. 25/- or 100/- as FMA and whenever such medical facility will be provided to him, this FMA will be discontinued forthwith.

Therefore you are requested to issue necessary directives to the authorities to reimburse the medical claims for indoor treatment where the serving employees are getting FMA Rs. 100/- per month. Further, you are requested to make an arrangement for meeting with the reps of this federation and concerned authorities of MOH&FW according to your own convenient.

Thanking you.
Sincerely yours
(MUKESH SINGH)
Secretary
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BHARATIYA PRATIRAKSHA MAZDOOR SANGH

Ref: BPMS / CSMA / 156 (8/1/L)
Dated: 15.10.2013
To,
Smt. Sudha Krishnan,
Joint Secretary (Pers),
Govt of India, Min of Finance,
Department of Expenditure,
Room No. 39-A, North Block,
New Delhi – 110001

Subject: Reimbursement of Medical Expenses where Payment of Fixed Medical Allowance is allowed to staff working in the interior where AMA not available.

Reference: 1. Your letter No. 164 / E V / 2013, dated 07.10.2013
2. This Federation’s letter of even no. dated 27.06.2013

Respected Madam,

Kindly accept our thanks for initiating the action on the subject matter and communicating the same to this recognized Federation vide letter cited under reference (1).

But, it is worth to mention here that the ‘Department of Pension & Pensioners’ Welfare’ has nothing to do with the matter because the issue is not related to the pensioners.

It is a matter of reimbursement of medical expenses where payment of Fixed Medical Allowance is allowed @ Rs.100/ per month to the staff working in the interior where AMA is not available.

Therefore, you are requested to issue necessary directives to the authorities of ‘Ministry of Health & Family Welfare, Govt of India’ to redress the genuine grievances of serving employees (not pensioners), which is pending since long.

Thanking you.
Sincerely yours
sd/-
(MUKESH SINGH)

Secretary