Procedure and time-line for change of option by the pensioners/family pensioners for availing OPD facility under CGHS or Fixed Medical Allowance

As per the existing instructions, pensioners/family pensioners residing in an area not covered by CGHS have the option to avail Fixed Medical Allowance (FMA) of Rs. 1000/- per month in lieu of OPD facility under CGHS. The pensioners/family pensioners can change the option from FMA to OPD facility under CGHS or vice versa once during their life time. Department of Pension & Pensioners’ Welfare, Ministry of Personnel, Public Grievances and Pensions, GoI, has now issued instructions laying down the procedure and time-line for change of option by the pensioners/family pensioners for availing OPD facility under CGHS or Fixed Medical Allowance.

As per these instructions, if a pensioner/family pensioner in receipt of FMA, intends to avail the OPD facility under CGHS, he/she may apply to the concerned pension disbursing bank for discontinuation of FMA. The pension disbursing bank shall discontinue the payment of FMA and issue a certificate to this effect within three working days from the date of receipt of application. Thereafter, the pensioner can apply to the concerned CGHS authorities for issue of CGHS card after paying requisite CGHS contributions, if not already paid and the CGHS authorities will, issue a provisional CGHS card to the pensioner/family pensioner within four working days from the date of completion of all formalities and deposit of contributions by the pensioner/family pensioner, till issue of a regular CGHS Card.

If a pensioner/family pensioner, who is availing CGHS/medical facility for both IPD and OPD, intends to avail FMA while residing in a non-CGHS area or on shifting of residence from a CGHS area to a non-CGHS area, he can  apply to the CGHS authorities for  surrender of OPD facility under CGHS. The CGHS authorities will make necessary endorsement on the CGHS card and issue a certificate within four working days from the date of receipt of application, that the pensioner/family pensioner is not availing OPD facility. Thereafter, the pensioner/family pensioner can submit an application to the Head of Office along with  a copy of the surrender certificate for issue of a revised pension payment authority for payment of FMA. The revised Pension Payment Authority will be issued within two months from the date of submission of application by the pensioner/family pensioner. The payment of FMA in such cases will be made from the date of issue of the surrender certificate by the CGHS authorities.

Source : PIB