The Ministry of Health & Family Welfare has announced relaxation in age and marital status criteria for dependent sons and brothers suffering from critical/terminal illnesses under CGHS/CS(MA) Rules, 1944. In an Office Memorandum, the Ministry of Health & Family Welfare has said that these modifications shall come into force with immediate effect.
The ministry said that an unmarried dependent son is eligible for CGHS facilities up to the age of 25 years, subject to the prescribed conditions. A permanently disabled unmarried son is eligible for CGHS facilities for life, subject to the applicable conditions. Similarly, a dependent brother is ordinarily eligible up to the age of 18 years, while a disabled dependent brother may be covered without any age limit.
At present, dependent daughters and sisters are already eligible for CGHS facilities, subject to fulfilment of prescribed conditions. Divorced/abandoned/separated from husband/widowed daughters and sisters are also eligible for CGHS facilities under the existing provisions.
“With the approval of the competent authority, it has now been decided that CGHS/medical attendance facilities may be extended for life to those dependent sons and brothers, who are suffering from critical/terminal illnesses, subject to fulfilment of the prescribed dependency conditions and assessment by the competent Medical Board,” said Ministry of Health & Family Welfare.
Accordingly, the following provisions shall be applicable:
(i) Indicative nature of illnesses: The provisions are intended to cover chronic, severe, critical or terminal illnesses resulting in substantial and continuing functional impairment or inability to earn a livelihood/self-sufficiency. These may, inter alia, include advanced or life-threatening malignancies, severe neurological disorders, end-stage organ diseases requiring long-term treatment/support, severe congenital or genetic disorders, and other chronic multi-system or debilitating conditions of comparable severity.
(ii) Eligibility: Eligibility shall be determined on a case-to-case basis, taking into account the chronic/severe/critical or terminal nature of the disease, extent of functional impairment in day-to-day life, ability of the dependent to earn a livelihood or attain self-sufficiency and continuing dependency. In cases involving multi-system diseases or complex medical conditions, the concerned specialist(s) shall assess the clinical condition and functional impairment.
(iii) CGHS beneficiaries: In the case of CGHS beneficiaries, eligibility shall be assessed and recommended by decentralised Medical Boards to be constituted at the level of Additional Directors/CGHS Regional Headquarters, as applicable. An Appellate Medical Board shall be constituted at CGHS Headquarters for consideration of appeals/references against the recommendations of the decentralised Medical Boards.
(iv) CS(MA) beneficiaries: In the case of beneficiaries covered under the CS(MA) Rules, 1944, eligibility shall be assessed and recommended by the Directorate General of Health Services (DGHS).
(v) Marital status: Marriage shall not constitute a ground for cessation of CGHS/medical attendance facilities in respect of a dependent son or brother covered under these provisions, whether on account of critical/terminal illness or permanent disability, provided the prescribed dependency conditions continue to be satisfied and the competent Medical Board/authority recommends continuation of coverage.
(vi) Scope of relaxation: The relaxation of the marital-status condition shall not result in any expansion of the definition of “family” under the applicable rules. The benefit shall remain confined to the eligible dependent son or brother and shall not extend to his spouse or children.
(vii) Review of medical criteria: The medical criteria and disease profile for such cases shall be treated as a living framework and may be periodically reviewed/revised by the designated CGHS Board in consultation with appropriate medical specialists.
