केंद्र सरकार स्वास्थ्य योजना-Kendra Sarkar Svasthya Yojna in Hindi


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प्रस्तावना: Central Government Health Scheme यह योजना स्वास्थ्य एवं परिवार मंत्रालय द्वारा केंद्रीय सरकार के कर्मचारियों, पेंशनरों और सीजीएचएस (CGHS) के अंतर्गत आने वाले शहरों में रह रहे, उनके आश्रितों को व्यापक स्वास्थ्य सुविधाएँ प्रदान करता है। उपयोगकर्ता इस योजना को स्वास्थ्य संबंधी कार्यालयों, कल्याण केंद्रों आदि से इस योजना के बारे में विस्तृत जानकारी प्राप्त कर सकता है। इस योजना के अंतर्गत राष्ट्रीय स्तर पर कई स्वास्थ्य संबंधी कार्यक्रम चलाए जा रहे हैं। जो विभिन्न स्तरों पर विशेष, व्यापक और सबसे अलग स्वास्थ्य सुविधा प्रदान करता है। इस योजना का लाभ 75 प्रतिशत निधिकरण केंद्र सरकार द्वारा एवं 25 प्रतिशत राज्य सरकार द्वारा दिया गया है।

केंद्रीय सरकार स्वास्थ्य योजना की पात्रता: इस योजना के अंतर्गत आवेदनकर्ता सरकारी कार्यालय का कर्मचारी या पेंशनर होना अनिवार्य है:-

आवश्यक ददतावेज: केंद्रीय सरकार स्वास्थ्य योजना के लिए निम्नलिखित दस्तावेज अनिवार्य हैं :-

  • निवास स्थान प्रमाण पत्र (Residence Proof)
  • आवेदक का आयु प्रमाण पत्र / विकलांग प्रमाण पत्र (Date of Birth Proof)
  • कर्मचारी पहचान पत्र
  • सत्यापित वेतन प्रमाण पत्र (Salary certificate)

केंद्रीय सरकार स्वास्थ्य योजना आवेदन फॉर्म

APPLICATION FOR CGHS CARD FOR PENSIONERS OF CENTRAL GOVERNMENT

1. Name of the Applicant:  …………………………………………………………………………

2. Category:                  Pensioners_____    Others (Pl.Specify) __________

3. Name of Department / Service from where retired ……………..

4. Last Pay / Basic Pension: …………………………………………………………………………..
( in case of Pensioners) ( Pre-revised)

5. Residential

Address:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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6. Telephone Number: ( R ) ( M ………………………………………….

7. e-mail ID ………………………………………………………………………..

8. Date of Superannuation: _ _ / _ _ / _ _ _ _
Date Month Year

9. Details of Family
{* Please see definition of Family before filling up this column}

S.No.Name of Family memberRelation ship to CGHS
Card Holder*
Date of Birth#
(Compulsory)
Blood Group(Optional)
Self

{# Please attach Proof of age of Persons mentioned above}

10. Are all the persons whose names are given above are dependant upon you and are residing with you? Yes / No
{Please attach proof of their staying with you , like copy of Ration Card / Election ID / Pass Port / Identity Card issued by College / School / University / Bank Pass Book , etc., }

11. Paste one ID Card size of Photograph of each member of Family (including self) whose names are proposed to be included as part of your family in the space given below.

S.No …     S.No.       S.No…       S.No……
Name       Name      Name         Name

 

S.No …    S.No. …   S.No…        S.No……
Name      Name         Name       Name

 

I Undertake to intimate to CGHS immediately if there is any change in dependency criteria of my family members included in this application form. If I fail to intimate and if the CGHS comes to know of the change then the CGHS facility is liable to be withdrawn by the CGHS and the CGHS and / or appropriate authority will be free to initiate any action against me.

I Undertake to surrender the CGHS Card(s) on ceasing to be eligible for CGHS  benefits.

I certify that the information furnished by me in this application has been verified to be correct and that no information has been concealed or has been misrepresented and I stand by the same.

Encl:  Proof of Residence / Stay of dependents Proof of age of son/ Disability                         certificate  Surrender Certificate of CGHS Card while in service Attested                       copies of PPO & Last Pay Certificate.

DD bearing No…………………………….dated ……………………….drawn on Bank ……………………………….Branch ……………………………………………../ Postal Order No. ……………………………….. for Rs……………………

To The Additional Director, CGHS(HQ), 9, Bikaner House Hutments, Shahjahan Road, New Delhi.

Verified – by Authorized Signatory, CGHS(HQ) valid upto…………/………/……………… / for Rest of Life .

CGHS Dispensary Allotted …………………………………………………. * ( to be filled by CGHS )

 

Signature

INSTRUCTIONS

Definition of Family:

(1 ) Husband / Wife*                                                                          (* First wife only)

(2 ) Dependant Parents / Step Mother ( in case of adoption , only adoptive & not real parents)

(3 ) If adoptive father has more than one wife , the first wife only.

(4 ) A female employee has a choice to include either her dependent parents or her dependent parents – in law ; option exercise can be changed only once during service .

(5 ) Children including legally adopted children , step children and children taken as wards subject to the following conditions:

(i) SonTill he starts earning or attains the age of 25 years ,
whichever is earlier.
(ii)DaughterTill she starts earning or gets married, irrespective of
the age limit , whichever may be earlier.
(iii)Son Suffering from any permanent
disability of any kind (physical or mental )
as defined below
Irrespective of age limit.
(iv)Dependent divorced / abandoned or separated from their husband / widowed daughters and
dependent unmarried / divorced abandoned or
separated from their husband / widowed sisters
Irrespective of age limit.
(v)Dependent Minor brother(s ) Upto the age of becoming a major.

For the purpose of availing CGHS facility for a disabled sons above 25 years , please attach a copy of n the certificate of disability issued by the competent authority.

‘Disability’    will be AS DEFINED IN SECTION 2(1) OF ‘THE PERSONS WITH DISABILITIES (EQUAL OPPORTUNITIES, PROTECTION OF RIGHTS AND FULL PARTICIPATION ) ACT ,1995 (NO: 1 OF 1996 )’ WHICH IS REPRODUCED BELOW:

“(1) “DISABILITY’ MEANS

(I) BLINDNESS

(II) LOW VISION

(III) LEPROCY CURED

(IV) HEARING IMPAIRMENT

(V) LOCOMOTOTR DISABILITY (VI) MENTAL RETARDATION (VII) MENTAL ILLNESS ” (VIII)

Dependency:

Members of family (other than spouse) whose income is less than Rs.3500/-+DA per month are treated as dependents and are normally residing with CGHS beneficiary.

The Following Documents are to be enclosed:

(I) Proof of Residence / Stay of dependents –{ copy of Ration Card / Election ID       / Pass Port / Identity Card issued by College / School / University / Bank Pass          Book , etc.,}

(II) Proof of age of son

(III) Attested Copy of Disability certificate issued by Competent Authority( in case of dependent son aged 25 and above )

For Pensioners applying for CGHS card for the First time the following Additional Documents are required:

(IV) Surrender Certificate of CGHS Card while in service.

(V) Attested copies of PPO & Last Pay Certificate

Contribution by Pensioners should be made by Bank Draft ( Scheduled Banks ) payable in Delhi in favour of “Pay & Accounts Officer CGHS , New Delhi”.

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