Procedure for a Pensioner/Family Pensioner to switch their option from FMA to CGHS (OPD) facility and vice versa

Payment of FMA

No. 4/05/2019-P&PW(D)
भारत सरकार
कार्मिक, लोक श‍िकायत एवं पेंशन मंत्रालय
पेंशन एवं पेंशनभोगी कल्‍याण विभाग

तृतीय तल, लोक नायक भवन
खान मार्केट, नई द‍िल्‍ली-110003
दिनांक: 23 मार्च, 2022

OFFICE MEMORANDUM

Sub: Procedure for implementation of change of option by a Pensioner/ Family Pensioner from FMA to CGHS (OPD) facility and vice-versa-reg

The undersigned is directed to say that the Central Government Civil Pensioners/ Family Pensioners residing in areas not covered under Central Government Health Scheme administered by the Ministry of Health & Family Welfare and corresponding health schemes administered by other Ministries/ Departments for their retired employees for meeting expenditure on their day-to­-day medical expenses that do not require hospitalization, are entitled to receive a monthly Fixed Medical Allowance (FMA). The amount of FMA was revised from time to time and was last revised to Rs.1000/- p.m. w.e.f. 01.07.2017 vide this Department’s OM No. 4/34/2017- P&PW(D) dated 19.07.2017.

2. Only those Pensioners/ Family Pensioners who are residing in an area not covered by CGHS, and specifically opt for not availing of OPD facilities in the nearest CGHS dispensary, are entitled medical allowance. An option is required to be exercised by a retiree at the time of retirement for availing OPD medical facility or FMA. Only one change in option in the life-time of a Pensioner/ Family Pensioner is allowed.

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3. The Department-related Parliamentary Standing Committee on Personnel, Public Grievances, Law and Justice, in its 110th report on “Pensioner’s Grievances-Impact of Pension Adalats and Centralized Pensioners Grievance Redress and Monitoring System (CPENGRAMS)” has made following recommendation :

• (3.22) The Committee takes note of the difficulties faced by pensioners in surrendering their Fixed Medical Allowance (FMA) and getting FMA Surrender Certificate to avail CGHS indoor & outdoor (OPD) facilities, and, accordingly, recommends DoPPW and CGA that the procedural loopholes coming in this way should be plugged and ensure that all such pensioners should get FMA Surrender Certificates in a hassle free manner through online mode under intimation to the bank concerned and a timeline should be fixed in this regard.

4. If a Pensioner/Family Pensioner who is residing in a non-CGHS areas and is in receipt of FMA, intends to avail the OPD facility under CGHS, etc. he has to forego FMA to become eligible for OPD facility under CGHS. However. in the absence of any guidelines for discontinuance of FMA by the Bank and issue of CGHS card for OPD facility, Pensioners/Family Pensioners are often facing difficulty in exercising revised option in this regard. The matter has been examined in consultation with Ministry of Health and Family Welfare and Central Pension Accounting Office and the following procedure is laid down in this regard:-

• (i) If a Pensioner/ Family Pensioner residing in non-CGHS area shifts his/her residence to a CGHS covered area, he/she no longer remains eligible for FMA irrespective whether he/she avails the CGHS facility or not. It will, therefore, be the responsibility of the Pensioner/Family Pensioner that on shifting from a non-CGHS area to a CGHS covered area and while requesting for change of address from a non-CGHS area to a CGHS covered area, he/she will apply to the Bank in Form 2 for discontinuation of his/her FMA. The pension disbursing banks will also make a provision in their system so that whenever a Pensioner/Family Pensioner gives an intimation regarding change of residence from a non-CGHS area to a CGHS covered area, the FMA being paid to the Pensioner/Family Pensioner would automatically be stopped, irrespective whether or not the Pensioner/ Family Pensioner has requested in Form-2 for stoppage of his/her FMA.
• On receipt of an application in Form-2 from the Pensioner/Family Pensioner, who has shifted from a non-CGHS area to a CGHS covered area, the Bank will issue a certificate in Form-3 regarding discontinuation of FMA to the Pensioner/Family Pensioner within three working days from the date of receipt of the application for the said certificate. Thereafter, it will be open to the Pensioner /Family Pensioner to apply to the CGHS authorities for issue of a CGHS card for both OPD and IPD facility, by payment of requisite CGHS contributions.
• In case the Pensioner/Family Pensioner applies for issue of a CGHS card, the same will be issued to him/her by the CGHS authorities as per their laid down procedure, if the Pensioner/Family Pensioner otherwise fulfils the eligibility conditions for issue of CGHS Card. The CGHS authorities will, however, 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 and such provisional Card will remain valid till issue of a final CGHS Card.
• (ii) If a Pensioner/Family Pensioner, residing in a non-CGHS area and availing FMA in lieu of OPD facility, intends to avail CGHS facility for both OPD and IPD, he/she may apply to the concerned branch of the pension disbursing bank in Form-2 for discontinuation of FMA, to enable him/her to apply to the CGHS authorities for the CGHS facility. The Pensioner/Family Pensioner will also give an undertaking in Form-2 to the Bank that the option being exercised by him/her to avail medical facility under CGHS or other similar Health Scheme of their respective Ministry/Department, is a one­ time option and that he/she has not availed the facility of change of option from CGHS to FMA in the past. The pension disbursing bank shall, thereafter, stop the payment of FMA in respect of such Pensioner/Family Pensioner and issue a certificate in Form-3 to him/her regarding discontinuance of FMA, within three working days from the date of receipt of application.
• Thereafter the Pensioner/Family Pensioner may apply to the concerned CGHS authorities for issue of CGHS card for both OPD as well as IPD facility after paying requisite CGHS contribution, if not already paid. The CGHS authorities will, issue the CGHS Card (including OPD facility) to him/her as per their procedure, if the Pensioner/Family Pensioner otherwise fulfils the eligibility conditions for issue of CGHS Card. The CGHS authorities will, however, 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 and such provisional Card will remain valid till issue of a final CGHS Card.
• (iii) After discontinuing the FMA, the bank will make necessary changes in both halves of PPO in regard to discontinuance of FMA. The CPPC of the concerned bank, shall send an intimation to the Central Pension Accounting Office (CPAO) in the proforma at Form-4 for updating the record. CPAO will thereafter forward the intimation to the concerned Pay & Account Office (PAO) after updating the data in the PARAS (i.e. CPAO’s database). On receipt of intimation from CPAO, PAO will inform the change in status to the concerned Head of Office for record.

5. 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/she may apply to the CGHS authorities for surrender of OPD facility under CGHS. On receipt of an application to this effect, 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 and is availing only IPD facility under CGHS. Thereafter, the Pensioner/Family Pensioner will submit an application to the Head of Office along with copy of the surrender certificate for issue of a revised pension payment authority for payment of FMA. The case for issue of the revised pension payment authority will then be processed in the usual manner through PAO and CPAO and sent to the Pension Disbursing Bank for payment of FMA along with monthly pension. The revised Pension Payment Authority will be issued within two months from the date of submission of application by the Pensioner/Family pensioner in this regard. The payment of FMA in such cases will, however, be made from the date of issue of the surrender certificate by the CGHS authorities.

Encl: FMA Forms

(Charanjit Taneja)
Under Secretary to the Government of India

Download DoPPW Order Procedure for implementation of change of option by a Pensioner/ Family Pensioner from FMA to CGHS (OPD) facility and vice-versa