CGEPHIS SCHEME

CGEPHIS

Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS)

Government of India Introduces Health Insurance Scheme for Central Government Employees and Pensioners and their dependant family members

1. Who can Join the Scheme :

- All Central Government Employees

- India Service Officers

- Retired Employees

- who covered existing CGHS and CS (MA) Rules

2. This scheme is compulsory for new employees and pensioners, and voluntary basis for existing employees.

3. CGEPHIS Structure

-          This scheme shall provide coverage for all expenses relating to hospitalization of beneficiary members up to Rs. 500,000/- per family per year – subject to limits on cashless basis through smart cards.

4. Pre-existing diseases covers under the scheme from day one.

5. Insurance Premium :

-   The beneficiary will have to pay an annual premium.

-   The estimated annual premium for a standard family size will be in a range   of Rs. 8000 to Rs. 12000/- per annum.

-    The premium amount will vary according to grade pay of the beneficiary

-    The premium amount shall be decided by the insurance companies.

-    For serving employees, the premium would be detected by the Drawing & Disbursing Officers

-    Pensioners would be required to authorize the Bank Branch from which they are drawing their pension amount, to deduct the Insurance premium.

6. Insurance Coverage



The Following shall be covered insurance policy under this scheme :

1. Pre-existing diseases


2. Day-one Coverage for all diseases


3. Maternity benefit


4. Pre and Post hospitalization cover of 30 days and 60 days respectively


5. New-born babies


6. Domiciliary Hospitalization

7. CGEPHIS Scheme for Family  :

-   Employees :  This Scheme will cover for self, spouse, two dependant children and dependant parents. New born will be covered as a part of insured family member during currency of the policy.

-   Retired Employees : - This Scheme will cover for self, spouse, two dependant children and dependant parents

-   Additional dependant family members can be covered under the scheme by paying an additional premium.