DGEHS SCHEME FREQUENTLY ASKED QUESTIONS

1.        What is this Delhi Government Employees Health Scheme all about?

Delhi Government Employees Health Scheme is a welfare scheme of Delhi Government to provide medical facilities to Delhi Government employees and pensioners on the pattern of Central Government Health Scheme on the basis of contribution by the beneficiaries

2.        Who can become the member and how?

1. The membership of scheme is compulsory for all employees.

2.        The membership of the scheme for pensioners is optional. Employee at the time of retirement can opt for the scheme by depositing the contribution in lump sum or in installments. A lump sum deposition of contribution shall make the pensioner and dependents beneficiary for the life term. The pensioner who opt to pay in installments shall be covered under the scheme for the period the subscription is deposited. Once ten years contribution is paid the pensioner and his dependent shall be covered for rest of their life.

3. Retiring officers of Indian Administrative Service/Indian Forest Service of AGMUT cadre, officers of DANICS/UTCS cadres including their family pensioners can also opt for the scheme.
4. /statutory bodies fully funded by Delhi Govt. may opt for Delhi Government Employee Health Scheme.

5. In case of expiry Autonomous of the pensioner beneficiary who has deposited contribution for lifelong benefits, the family pensioners of such expired pensioners will continue to get benefits of the scheme.

6. The membership of the scheme is prospective in nature i.e. from the date of becoming the member. By contributing the stipulated contribution/subscription one can become the member of the scheme.

7. The pensioners who do not opt for the scheme are eligible to get fixed medical allowance at Rs. 300/- per month.

3. What is the subscription of the scheme ?

Subscription of the scheme is as per OM dated 28.07.2010 as per following list:
The rates of contribution for serving Delhi Government employees : 

Contribution shall be recovered from the monthly salary bills of the employees.

4. I am a pensioner (Family pensioner), whether I can become Life member for the scheme?

A pensioner or a family pensioner can become member of the scheme with prospective effect by paying in the contribution as lump sum or in installments at time of retirement or any time thereafter.

5. I have deposited a lumpsum of 60 months contribution in 1997 before the modified scheme was notified in 2003. Will I be getting the medical benefits?

For those pensioners who have deposited 60 months contribution as per scheme orders in 1997, the medical facilities will be provided to such pensioners under the scheme on life long basis.

6. From where the Medical Facility card will be issued to me?

The medical facility card is issued from the office where the employee is working or from the office where from he retired, in case of pensioners. In case of eligible pensioners who have not retired from Government of NCT of Delhi, the DGEHS cards shall be issued by Directorate of Health Services.

7. What are the hospitals recognized empanelled under the scheme ?

1. All health facilities (hospitals/dispensaries) run by the Govt. of NCT of Delhi and autonomous bodies under Delhi Government, local bodies viz. MCD, NDMC, Delhi Cantonment Board, Central Government and other Government bodies [such as AIIMS, Patel Chest Institute (University of Delhi) etc.] are recognized under the scheme. In addition, some Private Hospitals/Diagnostic centers notified from time to time are also recognized/ empanelled as referral health facilities.

2. Beneficiaries residing in NCR areas outside Delhi are allowed to get treatment even during non-emergent conditions from Government Institutions and CGHS recognized centers after referral from Government institutions in concerned areas or in Delhi as per provisions of the scheme.

3. Private recognized hospitals/diagnostic centers in NCR region outside Delhi for beneficiaries residing in these areas will be same as for CGHS beneficiaries as notified by CGHS from time to time.

8. Do I need a referral to avail treatment facilities in these hospitals?

1. All beneficiaries are supposed to get attachment to one of the Delhi Government Allopathy Dispensary / Hospital, the Medical Officer In-charge / staff physician will be the Authorized Medical Attendant for the respective beneficiaries. In non-emergent / routine cases for getting treatment / diagnostic facility from the recognized private hospitals / diagnostic centers, prior permission of Authorized Medical Attendant (AMA) is required. However, during emergency the patient can directly approach the private recognized hospitals.

2. No permission is needed for getting treatment from health facilities / institutions under Delhi Government, its autonomous bodies and those under local bodies (viz. MCD, NDMC and Delhi Cantonment Board) as per CS(MA) rules

9. Are there any credit facilities for the beneficiary under the scheme?

Currently credit / cashless facilities are available at all recognized Private hospitals / diagnostic centers during emergency treatment for all beneficiaries. In this regard, Agreements with these hospitals have been signed. In such cases, the bill will be sent by the empanelled hospital to concerned offices from where the health card to the beneficiary has been issued. In case of pensioners, the credit / cashless facility is available during non-emergent conditions also in all empanelled private hospitals. For this an authorization / permission from Authorized Medical Attendant is required. Agreements in this regard have been entered with all empanelled private institutions.

10. Where should I deposit my medical reimbursement bills?

The medical reimbursement bills along with filled Performa along with other essential supportive documents are to be deposited to the concerned office from where the Medical Facility card have been issued. Serving employees shall be reimbursed the bills the concerned administrative department. However, bills of pensioners shall be forwarded to DGEHS cell of DHS for payment after due verification of validity of the card and dependent members of the pensioner.

11. My spouse is also in service, whether he/she can also avail the benefits?

If both husband and wife are in service, only one of them will contribute to the scheme and both of them will be getting the benefits under the scheme, the spouse being dependent on the contributing member for medical reimbursement purpose, in accordance to CS(MA) rules & the spouse shall not avail medical reimbursement from his/her office. For this purpose both of them shall have to give a joint undertaking in his/her office.

12. Whether the scheme is applicable to the employee where medical allowance is being given?

 No, this scheme is not applicable to the employees who are getting any medical allowance.

13. Is the scheme benefits available to pensioners residing outside Delhi also?

Vide OM dated 21st Feb 2005, the scheme has been extended to cover the DGEHS beneficiaries residing in National Capital Region (NCR) outside Delhi, though on a limited basis. For this all, governmental health institutions in NCR are recognized for the purpose of medical treatment. All CGHS recognized private hospitals/diagnostic centers in these areas are also recognized as referral institutions for which prior permission of competent authority will be required for undergoing treatment.

14. Who is a competent authority to sanction advance?

Under the scheme, now the financial power to sanction advance for medical treatment to the tune of 90% of expected expenditure of treatment has been decentralized and delegated to head of the departments vide OM dated 21.2.2005.

15. Whether fixed medical allowance is allowed to family pensioners also?

Yes, the fixed medical allowance is admissible to family pensioners.

16. Is there any provision of change of dispensary / hospital to which I am attached?

No change of dispensary / hospital is permissible except on change of residence of the card holder or any valid reason to the satisfaction of issuing authority. When there is any change of residence necessitating change of dispensary / hospital, the beneficiary should submit an application in duplicate to the card issuing authority together with DGEHS Medical Facility Card. The card issuing authority shall make entry in the appropriate column. Then the beneficiary shall submit request to the Officer I/C of the old dispensary / Hospital, who will make entry in his records and then handover the index card to the card holder with the direction to hand over the index card to the Officer I/C of new dispensary / hospital.

17. Where can a pensioner deposit his/her bills for  reimbursement.

A pensioner can deposit individual  bills for reimbursement, completed in all respect, directly in Directorate of  Health Services or to the AMA concerned who in turn will send bills to DHS for  reimbursement. But as per circular dated 17/04/2012 pensioner will submit their medical claim bill in their respective department from their retire w.e.f. 01/05/2012