R.S. Gupta (Deceased) Through LRs Ms. Sangeeta Gupta vs Union Of India & Anr.

The applicant (since deceased) is challenging the order dated 26.07.2017 (Annexure A-1) by which his claim for reimbursement of treatment of his wife taken at Max Institute, Saket Nagar, New Delhi for the period from 26.10.2008 to 11.11.2008 has been rejected by the respondents. He is seeking direction to the respondents to reimburse the expenses in proportion to the increase of Fixed Medical Allowance from Rs.100/- to Rs.1000/- per month along with interest.

During the pendency of this Original Application, the applicant, R.S. Gupta left for his heavenly abode and he is substituted by Ms. Sangeeta Gupta, daughter of the deceased applicant.

The applicant, in his Original Application, has stated that he is governed by the Civil Service (Medical Attendance) Rules, 1944, upon his retirement from service. The applicant resides in Gwalior and there is no facility of CGHS in Gwalior. He has submitted a bill amounting to Rs.6,04,718.23 on 02.12.2008 in respect of indoor treatment of his wife from 26.10.2008 to 11.11.2008. However, vide the impugned order dated 26.07.2017 (Annexure A-1), the respondents have rejected his claim. The applicant submits that the Office Memorandum dated 05.06.1998 (Annexure A-2) provides for reimbursement of expenses incurred for indoor treatment to the pensioners residing in non CGHS area. Therefore, as per this OM, the applicant is entitled to get the amount reimbursed for indoor treatment of his wife.

In their reply, the respondents have stated that the 5^th Central Pay Commission had recommended for extension of CS (MA) Rules, 1944 to the Central Government pensioners residing in the areas not covered by CGHS. However, the Ministry of Health & Family Welfare, vide the Office Memorandum dated 20.08.2004 (Annexure R-1) had clarified the in view of huge financial implications, it is not feasible to extend CS (MA) Rules, 1944 to the pensioners. Further, according to CS (MA) Rules, 1944, pensioners residing in non CGHS area are having option to (a) for Fixed Medical Allowance @ Rs.500/- per month or (b) avail the benefit of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making required subscriptions and also have the option to avail FMA for OPD treatment and CGHS for IPD treatment after making required subscription as per CGHS guidelines.

Heard learned counsel for the parties and perused the pleadings and the documents available on record. Both the parties were also given time of 15 days’ to submit their written arguments. However, none of the parties have filed their written submissions.

It is not in dispute that at the relevant point of time, the applicant was residing in a non-CGHS covered area. It is also established from the records that after retirement he did not exercise the option for CGHS coverage and did not make the requisite CGHS subscription/registration. The applicant has nevertheless sought reimbursement of the expenditure under the CS (MA) Rules, 1944, on the ground that since he resides in a non-CGHS area, he is entitled to get reimbursement under the CS (MA) Rules.

The Office Memorandum dated 29.09.2016 (Annexure A-3) clearly provides that the CS (MA) Rules, 1944 are not applicable to pensioners. The said O.M. further provides that the medical-facility options are available to Central Government pensioners residing in non-CGHS areas and they may: (i) avail Fixed Medical Allowance (FMA) in lieu of OPD medical facilities; (ii) avail CGHS OPD and IPD facilities by registering themselves in the nearest CGHS-covered city after making the requisite subscription; or (iii) avail FMA for OPD treatment and CGHS facilities for IPD treatment after making the requisite subscription in accordance with CGHS guidelines.

The Office Memorandum dated 05.06.1998 (Annexure A-2) relied upon by the applicant regarding extension of CS (MA) Rules to pensioners residing in non-CGHS areas cannot be treated as an operative statutory extension of the Rules. The subsequent clarification dated 20.08.2004 (Annexure R-1) made it clear that the earlier O.M. was in response to a reference concerning the recommendation of the Fifth Central Pay Commission and that the CS (MA) Rules had not thereby been made applicable to Central Government pensioners. This position has subsequently been reiterated by the Ministry of Health & Family Welfare in the OM dated 29.09.2016.

The distinction between a pensioner who is already a CGHS beneficiary and one who has never subscribed to CGHS is material. Government instructions permit CGHS beneficiaries residing in non-CGHS areas to obtain treatment in specified Government/approved hospitals and claim reimbursement in accordance with CGHS rules. That facility cannot automatically be extended to a pensioner who has never obtained CGHS coverage or paid the prescribed subscription. In the present case, the applicant has admittedly neither registered himself under CGHS nor paid the requisite CGHS subscription. Consequently, there was no subsisting CGHS coverage on the date on which the treatment was undertaken. The applicant cannot invoke the CS (MA) Rules, 1944, since those Rules do not apply to pensioners. The fact that the applicant resides in a non-CGHS area does not alter the legal position. The Government has specifically provided alternative medical facilities to such pensioners, including FMA and the option of obtaining CGHS coverage from the nearest CGHS covered city on Central Administrative Tribunal^{payment of the prescribed subscription. Hence, I am of the considered view} that there is no merit in the claim of the applicant.

Accordingly, this Original Application is dismissed being devoid of any merit. No order as to costs.