Pensioners in non-CGHS areas opting for fixed medical allowance are ineligible for reimbursement under CS(MA) Rules, as 1998 OM does not extend coverage per clarifications and binding precedent.

This Original Petition is filed by the applicant in O.A.No.180/00672/2022 aggrieved by the order dated 21.02.2025 passed by the Central Administrative Tribunal, Ernakulam, dismissing his original application.

2. The petitioner retired as a Junior Engineer(Civil), from the Andaman Public Works Department and he is now settled in North Paravur, Ernakulam District. According to the petitioner, his place of residence will not fall under the Central Government Health Scheme (hereinafter referred to as CGHS, for short) and the nearest CGHS covered city, was Thiruvananthapuram. He claims that it is Central Services (Medical Attendance) Rules, 1944 (hereinafter referred to as CS (MA) Rules, for short), which is applicable to him and he had opted for Fixed Medical Allowance (hereinafter referred to as FMA, for short), in lieu of CGHS. While so, on 07.05.2022, the 24 year old son of the petitioner, who was studying in Bangalore, sustained severe head injuries in a motor accident. For the treatment, he had to spend Rs.18,07,596/- as per Annexure A-3. Accordingly, the petitioner raised Annexure A-9 claim dated 21.07.2022, before the respondents seeking reimbursement of the medical bills under CGHS. But it was rejected as per Annexure A-10 order on the ground that petitioner is not registered under any CGHS and is drawing FMA. It is challenging Annexure A-10, the petitioner filed the afore OA.

3. The learned Tribunal after considering the materials on record and hearing both sides, dismissed the O.A. as per Ext.P1 order.

4. Heard Adv.Sathyanathan V.K., the learned counsel appearing for the petitioner and Adv.T.V.Vinu, the learned CGC appearing for the respondents.

5. The learned counsel for the petitioner submitted that the decision rendered by the Tribunal is against the legal propositions laid down by the various Division Benches of the Administrative Tribunals, High Courts and even the Hon'ble Apex Court. He contended that O.M.No.S14025/4/96/MS dated 05.06.1998 issued by the Government of India, Ministry of Health and Family Welfare, would show that CS(MA) Rules, 1944 has been extended to pensioners residing in areas not covered by CGHS and that the Central Administrative Tribunal, Chandigarh Bench in the decision in Dharminder Sharma v. Union of India [OA No.060/00737/2015) (Annexure A12), and the Division Bench of the Madras High Court in the decision in Union of India v. R.Rangarajan (CWP No.32770/2004)(Ext.P10) have relied on this OM and has granted benefits to persons similar to the petitioner. He further submitted that the said decisions have been upheld by the High Court and the SLP filed was not entertained. He argued that the discrimination showed towards the entire employees like the petitioner by saying that CS(MA) Rules do not apply to them is clear violation of Articles 14 and 21 of the Constitution of India. He further contended that various Tribunals and High courts are following the afore decisions and is granting reimbursements.

6. Per contra, the learned CGC supported the impugned order and contended that there are no grounds to interfere with it. He argued that the petitioner, who is a retired employee, is not covered by CS(MA) Rules and he has also not subscribed to CGHS. He submitted that on retiring, the petitioner opted for FMA in lieu of CGHS and therefore, he is not entitled to get reimbursement of the medical bills. He contended that O.M.No.S14025/4/96/MS dated 05.06.1998 is only an inter-departmental communication reflecting the opinion of the Ministry of Health and Family Welfare and the said Ministry is not competent to decide on implementation of the Pay Commission recommendations.