DOPT OM NO 22017/4/98-ESTT(D) DATED 12.10.98.
PARA-3.--- ACCORDING TO LEGAL OPINION , IT WOULD NOT BE IN ORDER IF
ELIGIBLE EMPLOYEES , WHO WERE WITHIN THE ZONE OF CONSIDERATION FOR THE
RELEVANT YEAR BUT ARE NOT ACTUALLY IN SERVICE WHEN THE DPC IS BEING HELD
ARE NOT CONSIDERED WHILE PREPARING YEAR WISE ZONE OF
CONSIDERATION/PANEL AND CONSEQUENTLY , THEIR JUNIORS ARE CONSIDERED IN
THEIR PLACES WHO WOULD NOT HAVE BEEN IN THE ZONE OF CONSIDERATION IF THE
DPC HAD BEEN HELD IN TIME. THIS IS CONSIDERED IMPERATIVE TO IDENTIFY
THE CORRECT ZONE OF CONSIDERATION FOR RELEVANT YEAR.
NAMES OF THE RETIRED OFFICIALS MAY ALSO BE INCLUDED IN THE PANEL. SUCH
RETIRED OFFICIALS WOULD HOWEVER HAVE NO RIGHT FOR ACTUAL PROMOTION. THE
DPC MAY IF NEEDED BE PREPARED EXTENDED PANEL FOLLOWING THE PRINCIPLES
OF DOPT OM DATED 09.04.96.
ALL INDIA ASSOCIATION OF CENTRAL EXCISE
GAZETTED EXECUTIVE OFFICERS
President:
Address for communication: Secretary
General:
Lokanath Mishra 240, Razapur,
Ghaziabad-201001 (U.P.) Ravi
Malik
Vice Presidents: Sampat Rai, Vatan
Kamble (Central); Anurag Chaudhary, Ravi Joshi (North); A. Ravinder Singh,
Rajan G. George (South); A. S. Roy, Shubhrangshu Deb (East); P. D. Nimhan, S.
K. Jha (West)
Joint Secretaries: Anand Kishore,
Laxmi Lal Singhvi (Central); N. N. Lal, R. K. Solanki (North); G. Srinath, S.
Chandrasekar (South); Ashwini Majhi, V. N. Jha (East); G. K. Jhala, M. K. Misra
(West)
Office Secretary: C.S.Sharma (Mob. 09313885411) Treasurer: N.R.Manda (Mob.
09871483585)
(Recognised by G.O.I., Min. of Fin. vide
letter F.No. B. 12017/10/2006-Ad.IV A Dt.21.01.08)
Ref. No. 214/P/13
Dt. 29.07.13
To,
Ms. Praveen Mahajan,
Chairperson, CBEC,
North Block, New Delhi.
Subject: Disposal of
representations against irregularities in the seniority list.
Madam,
It is submitted with due regards
that many of our officers have represented against wrong fixation of their
seniority in the all India seniority list of the Central Excise
Superintendents. Their representations are not being disposed of and the same
are long pending with the CBEC either in Ad. II section or in HRD wing. Even
the names of a few officers are also missing in the list circulated recently by
the CBEC vide its letter F.No.32012/21/2009-Ad.II Dt. 23.07.13 meant for ad hoc
promotions to the post of Asstt. Commissioner.
2. The disposal of the representations is very much
required for the due correction of the seniority list and the promotions of the
officers in accordance of the same. Many of our officers are expected to be
promoted as a result of the ensuing cadre restructuring but they may miss their
chance due to the wrong fixation of the seniority.
3. In view of the above, it is requested that all of the
pending representations as well as future representations of the officers may
kindly be disposed of ‘on priority’.
Thanking you,
Yours faithfully,
(RAVI MALIK),
Secretary
General.
Message of Ravi Malik
Dear friends,
good evening.
All units are requested to kindly send their
comments IMMEDIATELY but latest by 08.08.13.
Love,
Ravi Malik, SG/AIACEGEO
F.No.712/251/HRD/WF-1/1
Directorate General of Human Resource
Development
Customs & Central Excise
Infrastructure & Welfare Wing
C-4, IRCON
Building
District Centre, Saket
New Delhi-110 017
To,
All Staff Welfare
Associations
26th
JULY, 2013
(Recognized under CBEC)
Sub: Proposal of “HEALTH INSURANCE
SCHEME for CBEC Employees” – Reg.
As you are
aware a new scheme for HEALTH INSURANCE SCHEME for CBEC Employees is under
consideration by the DGHRD. All the Associations are requested to actively
participate in drafting of the proposed HEALTH INSURANCE SCHEME such that the
scheme is sustainable and its benefits can percolate to all cadres
effectively. The draft of the proposed scheme is enclosed. You are
requested to through the proposed modalities of the draft Scheme and give
suggestions on the following points:
(a) Should the CBEC employees (proposed
beneficiaries) also contribute a portion of the premium for the proposed Health
Insurance cover?
(b) What should be the estimated contribution? It is
felt that 20% of the premium should be the contribution from the employee and
the rest 80% of the premium would be paid from the Welfare Fund. Approximately
20% of the estimated premium will be Rs. 500/-per annum which can be deducted
yearly from the salary of the Departmental employee. Income tax benefit may
also be available on the premium paid for the proposed Scheme.
(c) At present, the CGHS beneficiaries pays Rs.
600/- to Rs. 6000/- per year for the CGHS Scheme benefits as a
contribution of Rs. 50/- to Rs. 500/- per month, (depending upon the Grade Pay
of a CGHS beneficiary) is deducted from his/her salary. With
a meager payment of Rs. 500/- per annum, additional medical benefits
worth Rs. 2 lakh will be available to the employee and his family under the
proposed Scheme. The CGHS Scheme will continue and contribution of premium
will also be deducted from the salary of the employee.
(d) Each Association may like to estimate as to how
many employees are willing to participate with the above broad parameters? You
may estimate the numbers for the respective cadre the concerned Associations is
representing through an informal survey and commit to enroll a minimum number
from each Cadre .this will enable this office to estimate the size and spread
of the scheme.
Any other suggestions in any of the proposed
components of the Scheme can be given by email/fax to
HEALTH
INSURANCE SCHEME FOR CBEC EMPLOYEES
BACKGROUND:
As
an outcome of the all India
Conference of Chief Commissioners and Directors General, 2012, four Break-Away
Groups were constituted for parallel discussion on different issues. The
Break-Away Group-IV deliberated on Staff Welfare. One of the recommendations
made by this group was to explore corporate style tie-up with good hospitals in
every major city for effective treatment of Departmental employees and their
families. The suggestions are as reproduced below:
‘’TIE-UP WITH GOOD HOSPITALS……
The existing CGHS facilities
particularly in metros have been restrictive/non-existent to fulfill genuine
needs of the employees. It is desirable that department should explore
corporate style tie-up with good hospitals in every major city, for effective
treatment of our officers and their families. The difference between the CGHS
entitlement and negotiated fees of the hospital can be met either by Welfare
Fund or through an insurance agency scheme suitably negotiated for the whole
service to leverage better rates.’’
In pursuance of the
above recommendation, a new Health Insurance Scheme is proposed (in addition to
the existing facilities under CGHS/CSMA Rules) for the government employees
working under CBEC.
A.
NAME OF THE SCHEME: ‘’Health Insurance Scheme of CBEC ’’.
The office of DGHRD will act as the Nodal Agency of the welfare scheme.
B.
COVERAGE OF THE SCHEME:
The Health
Insurance Scheme will provide Cashless access
to Health care facilities to 55,000 working
employees of CBEC and his/her family { “family “as defined under the
CGHS/CS (MA) Rules, 1944 and the guidelines issued by Central Government from
time to time} thereby enabling access to
healthcare facilities for In-Patient department (IPD) i.e. Hospitalization in over 3,000 hospitals /
nursing homes which are empanelled/recognized under CGHS/CSMA Rules across the
country with an Annual Checkup of the Government Employee once in a year. Initially the new
scheme will be for two years as a pilot project, for providing a health
insurance cover to every employee of CBEC and his/her family worth Two Lakh rupees for one year at a time from the date of contract. The insurance
cover will include all pre-existing diseases. However the OPD facility will
continue to be provided through the CGHS scheme, as per the CGHS/CSMA Rules.
C.
SCOPE OF THE
SCHEME:
1.
The working employees of CBEC and his/her family (herein after referred to as the “employee”), can avail the
medical benefits on actual expenses incurred by him/her and without the
restriction of the CGHS price sub-limits (but restricted to up to the cover of
Rs. 2 lakh per annum).
2.
The government employee (including his/her family) can avail the
benefits’ worth the medical insurance cover of Rs. 2.00 lakh in a year.
Thereafter, treatment can be obtained under CGHS/CSMA Rules on the previous
(existing) pattern.
3.
The treatment will be on cashless basis i.e without any
upfront payment to be made by the individual to the hospital.
D.
FINANCING:
It is proposed that the Scheme may be financed
completely from the Welfare Fund and 100% of the premium for the health
insurance cover will be paid by the Central Govt. on behalf of the CBEC
employee.
E.
ANTICIPATED PREMIUM:
The Health insurance Cover will be upto
Rs. 2.00 Lakh p.a. on family floater basis for all Ailments including Critical Illness ** (Without
CGHS Limits /Cap)
Particulars
|
Amt. (Rs.)
|
i)
Net premium payable ( Excl. S.Tax)
|
15.00 crores
|
ii) Insurance Company liability per annum
|
15.30 crores
|
iii) * Service Tax @12.36% on Premium
|
1.85 crores*
|
iv) Net
Premium Payable (incl. S.Tax)
|
16.85 crores
|
*Exemption from Service
Tax has been granted to a few Govt. Sponsored Welfare Schemes vide Notification
no. 25/2012- Service Tax dtd. 20.06.12 issued by Min. of Finance, Department Of
Revenue, Govt. of India. CBEC may like to consider similar exemption for the
proposed HIS Scheme for CBEC employees too.
** “Critical illness” includes following ailments:
Cancer, Coronary artery bypass surgery, neurological surgery, First heart
attack, Kidney failure, Multiple sclerosis, Major organ transplant, Stroke,
Aorta graft surgery, Paralysis & Primary pulmonary arterial hypertension.
F.
Eligibility of beneficiaries:
1.
All employees of CBEC (of all Groups/Cadres) and their family (as
defined under the CGHS rules) shall be insured.
2.
The employees to be insured shall be from those already enrolled under CGHS/CSMA having a
valid CGHS Card or the certificate issued under CSMA Rules. The data of new
employees will be sent to the HRD duly certified by the Head of the Department
periodically.
3.
New entrants on appointment/ marriage/ birth shall also be
eligible.
G.
ADVANTAGES OF THE NEW HEALTH INSURANCE SCHEME :
1.
Cashless Health care treatment for all employees in over 3,000 hospitals /
nursing homes across the country.
2.
The employee can avail the medical benefits on actual expenses
incurred by him/her without the restriction of the CGHS price sub-limits
(but restricted up to the cover of Rs. 2 lakh in a year).
3.
The employee can avail the cashless IPD benefits’ worth Rs.
2.0 lakh per year. Thereafter, he/she can obtain the treatment under
CGHS/CSMA Rules on the previous (existing) pattern.
4.
An annual Medical check-up will be conducted by the insurance
company for all employees of CBEC (of all Groups/Cadres).They will be required
to conduct the tests as prescribed under the CGHS norms. Thus there will be
gross saving on the expenditure incurred from the medical funds at present.
5.
No upfront payment to be made by the Govt. employee and thereby no medical
reimbursement claims will be required to be filed by the employees until the
limit of health cover is exhausted.
6.
Saving on human resources dedicated at present for processing the
claims, since all the claims will be processed by the insurance company and
will be settled directly by them with the empanelled hospitals.
H.
Benefits:
a.
100% Premium shall be paid by CBEC on behalf of all the employees.
b.
The Health Insurance Scheme shall be for a period of 2 years for the
individuals w.e.f. the date of agreement between CBEC and Health Insurance
Service provider.
c.
The insured members can claim Medical benefits worth Rs. 2.0 lakh per annum under the Health
Insurance cover. The health insurance cover will replace the medical benefits
provided from the Welfare Fund by DGHRD under the welfare schemes and the
service provider will bear the cost of treatment up to the cover limit of Rs.
Two lakh. However expenses over and above the Rs. 2.0 lakh cover may be
considered by the Governing Body on a case to case basis.
d.
Employee to utilize the medical cover of up to Rs. 2.0 lakh under the
new health insurance scheme first. Thereafter, (beyond this limit of 2 lakh),
further treatment can be continued from CGHS, on reimbursement basis, under the
existing CGHS/ CSMA Rules.
e.
In case of death of the employee due to accident, the education fees
up to maximum of Rs. 3,000/- per month will be paid by the insurance company
for the Dependent children for the academic year.
f.
Treatment in
higher category of accommodation than the entitled category is not permissible
under this scheme. If it happens, at the
discretion of the card holders then the cardholder is liable to pay the extra
expenses to the Hospital directly.
g.
Cost of implants, if any, over and above the package rates will also be borne by the
insurer.
h.
Pre-existing diseases shall be covered.
i.
In case of death due to accident, expenditure of carriage of dead
body to be borne by the insurance company up to Rs.10,000/-
j.
Free annual Medical check-up for all employees of CBEC as per tests prescribed
under the CGHS norms.
k.
Pre & Post hospitalization benefits can be availed under the
insurance cover for up to 07 days and up to 15 days respectively.
l.
The insurance cover will also include minor surgeries which do not
require hospitalization (such as Cataract etc.) i.e involving only one-day or
less than 24 hours treatment.
m.
All the benefits/procedures will be on the pattern of the CGHS scheme
wherever not mentioned.
I.
EXCLUSIONS
:
1. Any dental treatment or
surgery which is corrective, cosmetic or of aesthetic procedure, including
wears and tears etc.
2. Sex change.
3. Vaccination.
4. Those insured persons who
are already having two or more living children will not be eligible for
Maternity benefit.
5. Pre-natal and post-natal
expenses, unless admitted in the Hospital/Nursing Home and treatment is taken
there.
6. Any type of OPD treatment.
J.
ENROLMENT:
I.
Identification to be as per existing CGHS membership.
II.
The health insurance cover shall be for a period of two years subject to
midterm review at the end of the first year of contract.
III.
The entire 100%
annual insurance premium shall be borne by the Central Government CBEC per annum along with the
Service Tax, as applicable on behalf of all the
employees.
IV.
The insurance companies shall be selected through a transparent
process and shall enter into a contract with the Department, through DGHRD, for
implementation of the scheme.
V.
Each insurance company shall be awarded the contract at the
lowest rate of premium offered by it (being the L1 bidder).
VI.
With this background, technical and financial bids will be
invited from all insurance companies dealing with health insurance and licensed
by Insurance Regulatory and Development Authority (IRDA) for implementation of
the Health Insurance Scheme for working employees of CBEC and their families.
VII.
If the utilization of total accrued premium received from the Central Government (CBEC) does not reach 80% of the actual
pay-out made towards claims settlement then the differential balance amount (i.e.
80% of total premium paid by CBEC minus the actual pay-out in claims settled) shall be rolled over and adjusted
in the premium payable by CBEC for the next year. However, in the second year,
such differential amount, if any, will be refunded to CBEC by the Insurance Company,
within one month of the expiry of the contract period, failing which the
insurance company is liable to refund the said amount with interest @ 10% p.a.
and a penalty of Rs. 50 lakh. Insurance company shall submit claims MIS as per CBEC requirements.
K.
DISPOSAL OF CLAIMS:
a.
All hospitalizations in all locations shall be on cashless basis which means the beneficiary doesn’t have to pay any
cash charges upfront.
b.
The actual expenses incurred on the treatment will be paid in full by
the insurance company uptil the insurance cover limit of Rs. Two lakh per
employee.
c.
Once the insurance cover limit for IPD treatment is exhausted (i.e. the
2.0 lakh cover), the employee can seek further treatment from CGHS directly on
the earlier (existing) pattern as per the CGHS /CSMA Rules/Scheme.
d.
The insurance company is liable to provide the facilities of medical cover
once the enrollee is admitted just before the date of expiry of the
contract/insurance cover period, provided the cover amount is not exhausted.
e.
In case any claim
is found untenable, the Insurer shall communicate reasons to the Nodal Agency
for this purpose with a copy to the beneficiary. Insurer will file a report to the Nodal
Agency explaining reasons for denial of each claim periodically and these
reports shall be reviewed by the D.G.(HRD) on monthly/quarterly basis.
L.
MODALITIES OF IMPLEMENTATION:
1.
Cadre Controlling
Officer’s office would be the contact point for the Insurance Companies. The
data related to employees will be provided by the Head of the Department to the
Insurer ( duly verified from the Service Book) with copy to the Nodal Agency.
2.
The valid CGHS
Card or the filled in Enrolment forms will be given by the Department to the Insurance
Company within 60 days from the date of entering the contract.
3.
The enrollment in
the first year should be completed by the insurer within 60 days and the insurance cover will become effective
for complete one year (excluding the 60 day period) for all those enrolled
uptil that date. However the insurance cover period for those enrolled after 60
days will reduce to that extent. Therefore the onus of providing the verified
data to the service provider within 60 days is on the department. The enrolment
of new entrants will continue throughout the year.
4.
Insurance Company
will issue Smart Cards to the employees along with the list of the Networked
Hospitals, the benefits and the contact details of their persons with toll-free
number of their help centre.
5.
If the card is
lost within the policy period then beneficiary can get a new card issued by
paying to the insurer, a pre-defined fees agreed by the Nodal Agency.
6.
Publicity shall be given by the Insurer and the Nodal Agency
through website, Advisory Committee Members and Circulars and through Workshops and Kiosk/help centers by the Insurance Company in Zonal Head Quarters.
7.
The details of
the Scheme and further amendments, if any, as well as enrolment form would be
put up on the web-site of DG (HRD) and of all Commissionerates.
8.
Insurance Company
will also provide the Application Performa through their website and the Head
of the Department/empanelled Hospitals/Nursing Homes/Day Care Clinics and the
beneficiaries’ can access the website to see the relevant information. All relevant data shall be uploaded on the
insurer’s website on a read-only access and a link shall be provided to the DG
(HRD).
9.
The Insurer shall provide Management Information System (MIS) reports
regarding the enrolment, admission, claim settlement and such other information
regarding the Services to the Nodal Agency monthly. Nodal Agency will also monitor data related to
enrolment etc. available through their website.
M. MID TERM REVIEW:
A mid-term review of the Scheme will be carried out
by a Review Committee, headed by DG (HRD), CBEC, at Delhi, with the following composition, for
making recommendations to the Board for continuation/ extension of the Scheme:
1.
Director General, HRD, CBEC Chairperson
2.
Any Zonal Chief Commissioner (co-opted by DG, HRD) Co-Chairperson
3.
Addl. Director General (I&W), DGHRD Member
4.
Addl. Director General (EMC), DGHRD Member
5.
Addl. Director (I&W), DGHRD Member-Secy.
N.
GRIEVANCE REDRESSAL:
a.
In case of any grievance faced by the beneficiary, a Grievance Redressal Committee (GRC),
headed by a Zonal Chief Commissioner, will be constituted to settle the
grievances and settle the disputes on the claims, if any.
b.
The Grievance Redressal Committee (GRC), will comprise of the following
members:
1.
Zonal Chief Commissioner Chairperson
2.
Executive Commissioner at Zonal Hqr. Member
3.
Additional Commissioner, CC Unit Member-Secretary
4.
Authorized Representative of
Health Insurance Service provider Member
c.
The GRC will meet periodically as decided by the Chairperson of the GRC.
d.
The decision of the Grievance Redressal Committee (GRC) will be final
and binding on all.
