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Judgment
Sunil Thomas, Member J
The applicant herein retired as Headmaster of a Junior Basic School on 30.4.2002 from the revised pay scale of Rs. 7,450-11500/- with Grade Pay of Rs. 4,600/- after the VIth CPC (pre-revised pay scale of Rs. 6,500-10,500/-) attached to the substantive post of Primary School Teacher Grade-I held by him. He subscribed for a life time CGHS card with add on to his spouse on 28.1.2014, in accordance with Annexure A3 OM dated 20.5.2009. He was allotted the entitlement of semi-private wards and issued with Annexure A4 CGHS card.
Consequent to fixation of basic pay in VIth CPC, applicant’s Grade Pay was Rs. 4,600/- with effect from 1.1.2006. Accordingly, as per Annexure A2, he contributed a sum of Rs. 325/- per month for 120 months, total contribution being Rs. 39,000/-. The minimum last pay drawn by the applicant as per VIth CPC was fixed for the purpose of revision of pension and family pension as Rs. 18,790/- with Grade Pay of Rs. 4,600/- evidenced by Annexure A5. By Annexure A6, the pension as per VIIth CPC was revised and fixed at Rs. 60,400/-.
According to the applicant, on account of implementation of the recommendations of the VIIth CPC, rates of subscription under the CGHS were revised and entitlement of wards in private hospitals empanelled under CGHS was also consequentially revised. Every Central Government officer whose basic pay was above Rs. 50,000/- was entitled to private ward in the empanelled hospitals. According to the applicant by virtue of Annexure A7, the applicant whose basic pay was revised to Rs. 60,400/- was eligible and entitled for private ward under the CGHS.
Requesting to upgrade his CGHS card in the light of Annexure A7, the applicant submitted Annexure A8 representation dated 4.2.2025. It was rejected by the 3rd respondent by Annexure A1. Another representation dated 17.2.2025 was submitted as Annexure A9 requesting to reconsider his claim explaining more facts. It was rejected by Annexure A2 order. Aggrieved by the above orders, the applicant has approached this Tribunal.
The relief sought is to quash Annexures A1 and A2 and to declare that the applicant is entitled to private wards with a further direction to the respondents to revise and upgrade the CGHS cards of the applicant and his wife to the entitlement of private wards.
Refuting the claim of the applicant, a reply statement was filed by the respondents. It was contended that the contribution to the entitlement of semi-private ward is calculated at Rs. 325/- per month based on the Grade Pay of the applicant at Rs. 4,600/-. The ward entitlement is fixed upon the rate of subscription and hence, the claim of the applicant for upgradation of ward from semi-private to private was not acceptable. Further the applicant had remitted the life time subscription amount at 120 times of the monthly subscription amount and hence the entitlement of the semi-private is static and cannot be changed. For pensioners the ward entitlement is based on the last salary drawn and there is no provision for revision for those who retired before VIIth CPC.
It was stated that for pensioners and family pensioners who have already opted for the life time CGHS card by paying one-time lumpsum subscription will continue to be eligible for the same ward as per their original entitlement at the time of retirement or death. They are not required to pay any additional amount due to the revised rates.
It was stated that the request for upgradation of ward was rejected because at the time of issuing the life time CGHS facility card, the applicant was eligible for semi-private entitlement as per OM dated 20.5.2009 and correct ward entitlement was allotted to the applicant. As per paragraph 3 of the aforementioned OM, it was specifically prescribed that the entitlement of pensioners/family pensioners who have already deposited their contribution for life time CGHS facility, will not be changed. It was stated that the applicant was issued with the CGHS life time card on 28.1.2014 based on the Ministry of Health & Family Welfare OM dated 20.5.2009. The CGHS contribution and ward entitlement of semi-private ward was correctly allotted as per the said OM, which at paragraph 5(iii) prescribed that “entitlement of pensioners/family pensioners who have already deposited their contribution for life time CGHS facility, will not be changed”. Accordingly, it was contended that the OA was without any merits and was liable to be rejected.
A rejoinder was filed by the applicant denying the allegations in the reply statement and contending that according to Annexure A3, ward entitlement depends only on the pay drawn in the pay band by the pensioner and not fixed up on the rate of subscription. The applicant relied on Annexure A10 Office Memorandum dated 22.11.2020. It was stated that Annexures A1 and A2 were in violation of the instructions in Annexure A10. The applicant has been drawing an initial pay of Rs. 18,790/- plus Grade Pay of Rs. 4,600/- to be taken into account as basic pay of Rs. 23,390/- as per Annexure A5 based on Rule 3(8) of CCS (Revised Pay) Rules, 2008. As per Annexure A3, the applicant was grouped in the 4th category of drawing Grade Pay of Rs. 4,600/- to Rs. 6,600/- per month and collected a higher contribution of Rs. 325/- for 120 months to get admitted in CGHS on 28.1.2014. But the entitlement and other benefits including private ward were not extended. Accordingly, it was claimed that the OA ought to be allowed.
Heard both sides and examined the records.
The basic facts are not in dispute. It is an admitted fact that the applicant subscribed the life time CGHS card with addon facility based on his entitlement as evidenced from Annexure A3 OM. He was allotted to the entitlement of semi-private wards. It is also not in dispute that consequent to the fixation of basic pay in VIth CPC, his Grade Pay was Rs. 4,600/- with effect from 1.1.2006. The minimum last pay drawn by the applicant as per VIth CPC fixed for the purpose of revision of pension and family pension was Rs. 18,790/- plus Grade Pay of Rs. 4,600/-. Thus, as per the VIIth CPC, basic pay of the applicant was revised and fixed to Rs. 60,400/-. It is not in dispute that on account of implementation of the recommendations of the VIIth CPC rate of subscription under the CGHS was revised and entitlement of wards in the private hospitals empanelled under the CGHS was also revised. A Central Government officer whose basic pay was above Rs. 50,000/- was entitled to get private ward in empanelled hospitals as evident from Annexure A7. It states that ward entitlement of private is available to officer whose corresponding basic pay drawing in the 7th CPC per month is above Rs. 50,500/-. This is the basis of the claim set up by the applicant.
His claim was declined by Annexures A2 and A1 for the reason that as per Annexure A3 order dated 20.5.2009 at paragraph 5(iii) “entitlement of pensioners/family pensioners, who have already deposited their contribution for life time CGHS facility, will not be changed”. It is on this premise the claim of the applicant was rejected.
Evidently, as per Annexure A5, the applicant was having the last pay drawn as Rs. 18,790/- plus Grade Pay of Rs. 4,600/- which was above Rs. 19,540/- required for private wards as mentioned in Annexure A3. As per Annexure A3, the contribution per month Rs. 325/- is liable to be paid based on the Grade Pay drawn of the officer being Rs. 4,600/-, 4,800/-, 5,400/- and Rs. 6,600/- per month. The entitlement of wards in private hospitals empanelled is provided under paragraph 3(B). Private ward is available to persons whose pay drawn in pay band is Rs. 19,540/- and above.
The learned senior counsel for the applicant has invited our attention to Rule 3(8) of CCS (Revised Pay) Rules, 2008 wherein the basic pay in the revised pay structure is defined to mean the pay drawn in the prescribed pay band plus the applicable Grade Pay. Accordingly, the definition of basic pay mentioned in Annexures A1 and A2 has to be understood so, as rightly contended by the learned senior counsel for the applicant. The applicant is eligible for entitlement of private wards since the last pay drawn was revised to Rs. 60,400/- by Annexure A6. By virtue of Annexure A7, officers whose basic pay is above Rs. 50,500/- is eligible for private ward. Annexure A7 dated 28.10.2022 is the OM relating to revision of rates of subscription under the Central Government Health Scheme due to revision of pay and allowances of the Central Government employees. It states that entitlement of wards in private hospitals empanelled under CGHS as contained in paragraph 3(B) of the OM dated 9.1.2017 stands revised. Ward entitlement of private is available to those officers who draw basic pay of Rs. 50,500/- and above in the VIIth CPC. Evidently, the applicant is entitled for the benefits of private ward and the contention of the respondents that he is not entitled to the benefit by virtue of paragraph 5(iii) of Annexure A3 is not sustainable.
Accordingly, the OA is allowed. In supersession of Annexures A1 and A2, the applicant is held to be entitled to the private wards. The respondents are directed to revise and upgrade the CGHS cards of the applicant and his wife accordingly, as expeditiously as possible at any rate within a period of two months from the date of receipt of a copy of this order and grant him all the benefits accordingly. No costs.