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Health Insurance for Retired Employees Research Team | Posted On Monday, September 09,2019, 07:50 PM

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Health Insurance for Retired Employees



The health insurance for retired employees refers mainly to the central and the state government schemes designed to support the medical requirements of the retired state and central government employees. These health policies allow retired people to save money on treatment and get treatments at the best medical facilities across India. The main aim is to reduce their financial burden and out-of-pocket expenditures on medical and healthcare facilities.

The retired persons are supported by a limited amount of retirement corpus. To counter the rising cost of medical services, the government has made sure the government employees and pensioners must be supported with medical health plans that provide them with sufficient coverage at the time of medical emergency. Some of the plans are devised in a manner that not only the beneficiary but also the family members can avail the sum assured on a family floater basis. The schemes come with the cashless facility at private and public empanelled hospitals allowing and provides insurance coverage on a large number of ailments as well as on emergency hospitalizations. Discussed below are some of the best government health insurance schemes for state and government pensioners currently available in India.

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Medical Facilities for Pensioners:

The central government has launched a new health insurance policy to cover all state government employees and retired persons and bring them under social security. The scheme is known as the CGEPHIS scheme (Central Government Employees and Pensioners Health Insurance Scheme) aimed to benefit 17 lakh government employees and 70,000 pensioners.

All central government pensioners are eligible to receive treatment under this scheme irrespective of whether or not they were a part of the CGHS scheme during their employment years. Which means, the scheme is also applicable to retired persons not living in CGHS areas, thus helping all pensioners receive the proper medical care post-retirement.

The enrolment for the scheme is optional for the existing employees and the former employees as they will become automatically eligible for the benefits of this scheme. The new joiners will be compulsorily enrolled under the scheme.

See Also: 6 National Health Insurance Scheme in India

The scheme enables the employees to take advantage of the cashless facility by using the smart cards and enable cashless bill payments at empanelled hospitals. The retirees can readily avail the medical facilities as there are no waiting periods or terms for the pre-existing medical conditions. The scheme also incorporates certain features of private health insurance schemes like day care procedures that do not require 24-hour hospitalization.

The scheme is a step towards helping the central government employees to cover their healthcare needs and reduce their out-of-pocket expenditures. As the scheme would cover all CGHS facilities and empanelled hospitals, this would greatly reduce the travel time and avail emergency medical care any time, which usually took more time if they had to visit CGHS facilities.

Pensioners residing in areas not covered under the CGHS are eligible to get a monthly medical allowance of Rs. 100 per month. The pensioners have to get their names registered under any CGHS dispensaries after writing an application in the prescribed format and submitting at the relevant centre for the issue of CGHS cards.

Best Health Insurance for Retired Employees:

To bring the retired persons under medical security and provide them with an avenue to avail health insurance benefits after their retirement, the state and the government organisations have taken certain steps to ensure the retired persons are covered under certain medical schemes. Listed below are some of the prominent health insurance schemes by the government to provide insurance to retired persons.

SBI Pensioner’s Medical Insurance:

The former employees of the SBI, as well as the current employees, are eligible to receive medical benefits under this policy.

See Also: Types of Retirement Plans

Chief Minister’s Comprehensive Health Insurance Scheme:

The Chief Minister’s Comprehensive Health Insurance Scheme was launched by the Tamil Nadu government to help the poor and the vulnerable families living in the state and provide them with medical insurance coverage. The scheme was incorporated by the Chennai based insurance provider named United India Insurance and is backed by the state government. The medical insurance plan offers coverage for emergency hospitalization with various empanelled public and private sector hospitals within the state.

The scheme is available only for the residents of the sate and the plan is provided to people earning less than Rs. 72,000 per year. For enrolling under the scheme, the applicant must produce the family card issued by the state government. The applicant must also provide a valid income proof issued by the Village Administrative Officer. The health coverage can be availed for self, spouse, dependent children and dependent parents. Some of the important features of this scheme are as follows:

  • The sum insured offered under the scheme can be availed on family floater basis
  • The beneficiaries can avail cashless treatment only. The scheme has no reimbursement benefits.
  • The insured person can avail coverage for emergency hospitalizations, general medical expenses and surgical treatments and the coverage amount is a maximum of Rs. 1 lakh per family.
  • The scheme also offers coverage for diagnostic procedures and follow-up procedures.
  • The scheme covers 1027 types of treatments and procedures and insures the beneficiary from 38 diagnostic procedures and 154 follow up procedures.
  • The empanelled private and public hospitals providing service under this cover also offer free medical health check-ups through their health campaigns and drives. The heath camps are conducted once or twice every month in every district.
  • The patients that require medical attention are identified in the health drives. If any ailment is detected then the patients are referred to the empanelled hospitals for treatment.
  • Orphans and Sri Lankan refugees are also eligible for getting enrolled under this scheme and availing treatment without providing income proof.
  • The smart card must be enrolled with the liaison officer at the time of treatment at the hospitals.
  • The beneficiaries can also call the toll free helpline number to get the required information about the scheme.

See Also: Health Insurance for Government Employees

Medical Insurance for State Employees and Pensioners:

The government has introduced a medical insurance scheme for state government employees and pensioners that are aimed to benefit over 15 lakh employees, and it comes with the cashless facility. The cashless facility can not only be used by the beneficiary but also his family members. The cashless facility can be used at some of the best hospitals across India. The beneficiaries need to register themselves by visiting the registration centres and provide their biometric details like the thumb impression to avail the cashless facility. The biometric details will be matched with the Aadhaar database that will help in the identification of the authenticity of the beneficiary.

The enrolment process will take place online on the official government website. At the time of enrolment, the beneficiaries are required to provide their personal details like name, address, employee identity number, etc., on the website post which, the beneficiaries are required to provide the details of their family members. Once the application is filled with all the necessary details, a system-generated link will be sent to the applicant after the completion of the registration process. The link contains a login ID and a password. The applicant will also receive an insurance identity card on their e-mail.

These initiatives are aimed to ensure the state employees and pensioners avail the best medical care, so they retain their peace of mind and focus more on others aspects of their life leaving financial worries behind.

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