The Tribunal ruled that pensioners residing in non-CGHS areas are not entitled to reimbursement for medical expenses under CS(MA) Rules, as the necessary statutory provisions and subscriptions were not fulfilled.

ORDER 

Per: Justice Sunil Thomas, Judicial Member -

The applicant retired from the service of Department of Posts as Sorting Assistant on 31.12.2002. After retirement, he is residing in a non- CGHS area. He opted for Fixed Medical Allowance (FMA for short) in lieu of outpatient CGHS treatment and was drawing Rs. 1,000/- per month. The Government by Annexure A1 OM dated 5.6.1998 has extended the benefits of CS(MA) Rules to pensioners residing in areas not covered by CGHS. It was claimed that a pensioner who is residing in a non-CGHS area is entitled for medical benefits as per the said OM.

2. The wife of the applicant, was treated as an inpatient at Medical Trust Hospital, Ernakulam from 5.11.2019 to 18.11.2019 due to L4 and L5 spondylodiscitis in emergency; as there were no well-equipped hospitals in the nearby places. She underwent decompression biopsy and posterior spine stabilisation under general anaesthesia on 13.11.2019. After discharge, she continued treatment as outpatient. Applicant incurred an expenditure of Rs. 1,72,344/- for the treatment of wife. He submitted a request letter dated 18.11.2019 enclosing Annexure A5 discharge summary and medical bills seeking reimbursement of medical expenses. The said bill was rejected by 3^rd respondent by Annexure A8 dated 14.2.2020 stating that CS(MA) rules are not applicable to retired Government employees.

3. Contending that the said stand of the 3^rd respondent was not justifiable in the light of Annexure A1 OM dated 5.6.1998 and various decisions of Supreme Court and this Tribunal, including Annexures A9 to A11 decisions, the applicant has approached this Tribunal seeking the following reliefs:

“(i) Call for the records leading to Annexures A8 and set aside the same.

(ii) Declare that the applicant is entitled to get the reimbursement of the treatment expenses of his wife for the illness for which she was treated as per the Discharge Summary at Annexure A5 and bills submitted along with Annexure A6 request letter for reimbursement.

(iii) Issue an order or direction to the respondents to reimburse the applicant the expenditure incurred by him as per the bills submitted along with the request letter at Annexure A6 for the treatment of his wife for the illness as explained in the Discharge Summary at Annexure A5, with interest at the rate of 12% from the date of Annexure A6 till the date of payment.”

4. Respondents filed common reply statement denying the various contentions. Respondents contended that by virtue of note 2(iv) below Rule 2 of Central Civil Service (Medical Attendance) Rules, 1944, pensioners are not covered by the Rules. Ministry of Health and Family Welfare has issued OM No. S.14025/23/2013-MS.EHSS dated 29.9.2016 clarifying that CS(MA) Rules are not applicable to pensioners. The said OM was produced as Annexure R1. It was reiterated in Postal Directorate OM No. 9-11/2020-Medical dated 20.10.2020, produced as Annexure R2. From Annexures R1 and R2 it is very clear that pensioners are not covered under CS(MA) Rules, 1944. As such there is no provision under CS(MA) Rules to reimburse the medical bills to the pensioners for the treatment they had availed after their retirement. Pensioners residing in non-CGH