Mar 02, 2017 the matter has been examined in this ministry and it has been decided that employees, who had superannuated on 3112017 may be allowed to apply for cghs pensioner card by paying the subscription at the prevalent rates applicable as on 3112017 vide om no. The plastic cards which are identity cards, would hereinafter be issued with validity till the pensioner beneficiary is entitled for cghs benefits. Revision of rates of cghs subscription for pensioner. Applying for new cghs card in case of new pensioner s card cghs card no. If i fail to intimate and if the cghs comes to know of the change then the cghs facility is. Application form for renewal of plastic card pensioners pensioners can use this application form for renewing their cghs cards. Requisition for pensioners cghs cards shall be accompanied by three copies of recent 3 x 5 cm size individual photographs of all family members of the retiring employee, one set of which shall be pasted on the application form and shall be attested by a gazetted officer in charge of administration other than cghs. Cghs mrc detailed checklist documents submitted by. Revised guidelines shall be followed in respect of such pending medical claims. Contribution for life time cghs card for pensioners central. Cghs application form for pensioner s cghs card file reference number cghs application form for pensioner s cghs card file date pensioner cghs. Pendency of medical claims of cghs pensioner beneficiaries due to deficiency in documentation more documents required. In the application form, the particlulars is available in two languages are hindi and english.
If the pensioner is applying for cghs card after the three months of hisher retirement, a sum of rs. Form for availing medical facilities under cghs or fixed. Application for cghs or fixed medical allowance for central government pensioners. Form of application for endorsement of particulars of spouse from postretiral marriage and children born after retirement in the ppo. Application for new plastic card in fillable pdf about forms compiled in pdf fillable as excel word format these forms retain the original format of the form. Form mrc p for pensioner beneficiaries central government health scheme medical reimbursement claim form to be filled by the principal card holder claimant in block letters 1. If i fail to intimate and if the cgiis comes to know of the change then the cghs is liable to be withdrawn by the cghs and the cghs and or appropriate authority will be free to initiate any action me. Application for renewal of plastic card pensioners. Apr 11, 2015 click the link below to view the file cghs application form for pensioners cghs card file reference number cghs application form for pensioners cghs card. Servant pensioner serving employee or pensioner of. Form of application for switch over of pension payment through authorised bank. Download government pension forms infillable pdf general forms, commutation of pension orms, gpf cpf forms, nomination forms, medical cghs forms, indemnity bonds etc.
Form of application for revision of family pension as on 1. Form of letter to the chief administrative medical authority for medical examination in connection with the commutation of pension form 3. Oct 14, 2019 cghs status of reimbursement medical claim bill of pensioner. Jan 24, 2019 download central government heath scheme cghs form aa medical reimbursement claim form for pensioner beneficiariesfillable pdf. Form mrc p for pensioner beneficiaries central government health scheme. I undertake to surrender the cghs cards on ceasing to be eligible for cghs. However, the retiring government servant should submit the details of family afresh along with form 5. After verification attach the photographs and required documents and submit the application form. Jun 10, 2014 new medical reimbursement claim mrc form for cghs beneficiaries. Medical reimbursement claim form mrc s for serving and mrc p for pensioner available on cghs. Form of application for permission to central services officers to accept commercial employment with in a period of one year after retirement form 25. Application forms available for download for plastic card. But he was said to repay the medical allowance from 1st january 2015 till date.
Requisition for pensioner s cghs cards shall be accompanied by three copies of recent 3 x 5 cm size individual photographs of all family members of the retiring employee, one set of which shall be pasted on the application form and shall be attested by a gazetted officer in charge of administration other than cghs. Application for cghs or fixed medical allowance for central government pensioners file date 31. One is to be used by serving employees and the other by pensioners who. Wife and husband shall include respectively judicially separated wife and husband. Rounding off of pension family pension when payable to more than one personpayable for part of a month minimum and maximum amount of pension enhanced from 111996 minimum pension of rs. Form to be used by the medical board when reporting on injuries diseasedeath.
Cghs application for new plastic card in fillable pdf. In respect of pensioner cghs beneficiaries, who have paid cghs contribution for rest of life cghs. Click the below link to download the application form. One can apply for cghs plastic card by filling form online and submitting it. Adhaar card copy of self and all dependent family members. Application form to enroll central government pensioners for central government health scheme also read admin forms application form for nps tier ii activation mar 9, 2011 admin forms form to register with nsdl for getting a valid pran mar 9, 2011 click the following link to download the form download application form for pens ioners cghs. Application for cghs card applying for new cghs card in case of new pensioners card cghs card no. Separate forms have been developed for serving beneficiaries and pensioner beneficiaries with requirement of minimum information required for processing of the claims. Revision of medical reimbursement claim mrc form for cghs. Medical reimbursement claim form there are 2 types of medical reimbursement claim forms that are available for download on the cghs. Cghs department will bear major treatment expenses in the old age of the pensioner as well as his eligible family members, when his monthly earning is very low i. Downalod medical certificateforms, application for cghs card for pensioners, cghs reimbursement claim forms. Form a application for cghs card for serving employees of central government.
Mar 02, 2012 ministry of health and family welfare has uploaded in its website recently that the application format for cghs card for pensioners of central government. Application form for restoration of commuted pension from to dear sir, subject. Medical formscertificate, cghs card form pensioners portal. Application for cghs card for pensioners of central government cghs card no. The details of spouse, all childrens and parents whether eligible for family pension. For pensioners you have to fill form online then print it and get it verified from the authorized person. Cghs aa medical reimbursement pensioners in fillable pdf. Application form to enroll central government pensioners for central government health scheme also read admin forms application form for nps tier ii activation mar 9, 2011 admin forms form to register with nsdl for getting a valid pran mar 9, 2011 click the following link to download the form download application form for pensioners cghs.
Cghs has many draw backs like should be in city to get cards, not all states have good hospitals. One set of all individual photos stuck in the form. In respect of pensioner cghs beneficiaries, who have paid cghs contribution for rest of life cghs facilities, the plastic cards would, hereinafter, be issued for rest of life. In case of new pensioner s card, the cghs beneficiary id card no. Letter of the chief administrative medical authority form. Form of application for the grant of residuary gratuity on the death of a pensioner form 22. Hi all, i am an it professional and the new proposed scheme looks like the best. I undertake to surrender the cghs cards on ceasing to be eligible for cghs benefits. Sep 08, 2017 the plastic cards which are identity cards, would hereinafter be issued with validity till the pensioner beneficiary is entitled for cghs benefits. If i fail to intimate and if the cghs comes to know of the change then the cghs facility is liable to be withdrawn by the cghs and or appropriate authority will be free to initiate any action agents me.
If i fail to intimate and if the cghs comes to know of. Application for renewal of plastic card pensioners mandate form for individuals. Download central government heath scheme cghs form aa medical reimbursement claim form for pensioner beneficiariesfillable pdf. Central government health scheme cghs list of cghs forms. Form foravailingmedicalfacilitiesunder cghs orfixedmedicalallowanceafterretirement. I undertake to surrender the cghs card s on ceasing to be eligible for. Check list of enclosures for pensioners cghs, allahabad. Certificate of necessity for bipap and bilevel ventilatory support. Form for availing medical facilities under cghs or fixed medical allowance after retirement. Central govt pensioners and their eligible family members getting pension.
Cghs medical reimbursement form for pensioners national book. After retirement from service in 2008, i got a lifetime pensioner card for cghs issued in chennai. If i fail to intimate and if the cghs comes to know of the change then the cghs facility is liable to be withdrawn by the. Age proof of self and all dependent family members. Oct 12, 2019 pendency of medical claims of cghs pensioner beneficiaries due to deficiency in documentation. Restoration of commuted pension 15 years after date of commutation ref. So the cghs card holders should choose the residence located in cghs facilitate cities and well communicated to cghs authorized hospitals. Frequenty asked questions with answers about cghs faqs on cghs are intended to provide general information and guidance needed for the cghs beneficiaries to avail cghs facilities. Pendency of medical claims of cghs pensioner beneficiaries due to deficiency in documentation. Application for cghs card for pensioners of central. Medical reimbursement claim form there are 2 types of medical reimbursement claim forms that are available for download on the cghs site. Application form for renewal of cghs card pensioners.
Application for cghs card applying for new cghs card in case of new pensioner s card cghs card no. To be filled by the principal card holderclaimant in block letters a name of the principal cghs card holder. Application for cghs or fixed medical allowance for. Contribution for life time cghs card for pensioners. But, everything is restricted in non cghs area or nonlisted hospitals for cghs card holders. I undertake to intimate to cghs immediately if there is any change in dependency criteria of my family members included in this application form. Form mrc p for pensioner beneficiaries central government health scheme medical reimbursement claim form 1.
Frequenty asked questions with answers about cghs faqs on cghs are intended to provide general information and guidance needed for the cghs beneficiaries to avail cghs facilities the contents must be read in conjunction with omsoffice orders as issued from time to time. The application form for central government pensioners is called form b. Pendency of medical claims of cghs pensioner beneficiaries. Application for cghs card for pensioners of central government. Application for cghs card for pensioners of central government 1. New medical reimbursement claim mrc form for cghs beneficiaries. Central govt pensioners and their eligible family members getting pension from central civil estimates 3. Dear sirmadam, i along with the members of my family whose particulars are given at sl.
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