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What are the Delhi Government Employees Health Scheme and its eligibility criteria?

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What are the Delhi Government Employees Health Scheme and its eligibility criteria?
The Delhi Government Employees Health Scheme (DGEHS) is a benefit programme designed to give its beneficiaries access to top-notch medical care. The scheme is modelled after the CGHS and typically adheres to its rates and rules. It was introduced in April 1997 with the goal of offering complete medical facilities to Delhi Government employees, pensioners, and their dependents.
The scheme recognizes all healthcare facilities (hospitals/dispensaries) operated by the Government of the National Capital Territory (NCT) of Delhi, autonomous bodies under the Delhi government, local bodies such as MCD, NDMC, Delhi Cantonment Board, central government, and other government bodies such as AIIMS, Patel Chest Institute (University of Delhi), etc. In addition, many private hospitals and diagnostic centershave been impanelled under the scheme.
Employees and their dependent family members are entitled to reimbursement for medical attendance and treatment, including OPD and IPD (Outpatient and Inpatient Department), at Delhi Government Dispensaries run by the Delhi Government and Recognized Private Hospitals impanelled under DHS/DGEHS only in the Delhi and NCR Region in accordance with DHS/DGEHS provisions, approved rates, and as per the employee concern.
These are the objectives of the scheme that the Delhi government has announced:

  • To provide health services to each and every employee across all ministries of the Delhi government.
  • To offer medical care to all retired people, Delhi assembly members, and former employees.
  • Maintaining the health of staff in order to increase departmental output.
  • To ensure that the CGHS is put into practice at the state level.

Who is eligible to join the scheme?

  • All currently employed GNCTD (Government of National Capital Territory of Delhi) personnel including dependent family members and pensioners (including family pensioners) of currently serving employees along with them too.
  • Sitting and former MLAs, former city council members, and their dependent family members.
  • Sitting and retired judges of the Delhi High Court.
  • Officers who have retired from the Indian Administrative Service, Indian Forest Service of AGMUT cadre, DANICS, or UTCS (Union Territory Civil Services) cadres and their family pensioners.
  • Families of IAS AGMUT Cadre/DANICS Officers serving outside of Delhi on deputation/short-term transfers upon annual payment of DGEHS subscription in advance.
  • Upon authorization from the competent authority, autonomous/legislative bodies are completely supported by the Delhi government.

Family Members’ Eligibility
The following family members are eligible to be recognized as dependents in order to receive DGEHS benefits:

  • Husband/wife, including many wives and a wife who has been judicially separated.
  • Parents (apart from stepparents), provided that:if adoption occurs, adoptive parents rather than biological parents;only the first wife if the adoptive father had more than one wife
  • In the case of female employees, her parents or parents-in-law, based on her preference, provided that the requirements for reliance, residency, etc. are met.
  • Children, including stepchildren, legally adopted kids, etc. Son is eligible until he begins working, turns 25 years old, or gets married, whichever comes first. The daughter is eligible until she begins to earn money or until she gets married, whichever comes first (irrespective of age).
  • Sons, regardless of their age, who are suffering froma persistent disability, whether it be physical or mental. Having 40% or more of one or more disabilities qualifies as having a permanent disability.
  • Dependent daughters who have been widowed, divorced or abandoned by their husbands (irrespective of age).
  • Dependent sisters who are not married, divorced, separated from their husbands, or who have been widowed (irrespective of age).
  • Minor brother (up to the age of becoming a major or 18 years of age).
  • A brother, who is permanently disabled, either physically or mentally (irrespective of age).
  • Step-mother
  • Minor children of widowed or divorced daughters who are dependent on the CGHS recipient and ordinarily reside with him are eligible up to the age of 18.

Note:If these family members normally live with the government employee and their combined income, including pensions and family pensions, does not exceed Rs. 9000 plus the amount of inflation relief on the basic pension of Rs. 9000/- as of the date of consideration, they will be deemed to be dependent on the employee. Parents are an exception who may reside in another station with other family members.

Conditions required to be eligible for DGEHS
The following are the multiple eligibility criteria in order to be considered for medical treatment:

  • All government employees, both active and retired (including family pensioners), as well as their dependant family members, are eligible to join the Delhi Government Employees Health Scheme.
  • The scheme has been declared open-ended, meaning that a pensioner may join the scheme at any time.
  • Government employees who receive fixed medical benefits must choose between joining the Delhi Government Employees Health Scheme and giving up their fixed medical benefits or continuing to receive them. In accordance with the Delhi Government Employees Health Scheme, dual benefits are not permitted.
  • If a retired employee is receiving FMA (Fixed Medical Allowance) and wants to choose the plan, he or she must first apply to discontinue receiving FMA before paying the required DGEHS subscription at the current rates. In a lifetime, there can be only one switchover.
  • According to CS (MA)/Central Service Medical Attendance rules, if an employee’s spouse is a government employee as well, only one spouse may benefit from the scheme as long as the other spouse, who is deemed dependent for medical benefits purposes, does not receive any medical benefits or allowances in this regard from the employee’s place of employment. Before issuing the membership/health card, it may be necessary to obtain a joint declaration from them stating that both of them will be receiving the benefits under the scheme.

For the government of NCT of Delhi employees who are currently working, membership is required; for retirees/pensioners, it is not (i.e. optional). The scheme is also open to ministers, MLAs, former MLAs,judges, former judges of the Delhi High Court, and employees of fully financed autonomousgovernment agencies in the NCT of Delhi. Employees of the Delhi government must make a mandatory monthly contribution, which is deducted from their pay in accordance with salary slabs. Pensioners can join the scheme by submitting a lump sum contribution equal to 10 years’ worth of installments or by making six monthly payments from January to June and July to December for 10 years.

Concluding Remarks
DGEHS is one of the largest government-sponsored health insurance schemes for government employees and their dependent family members. It takes care of all its beneficiaries despite numerous challenges. This scheme’s successful implementation is a result of its thorough planning, strict restrictions, streamlined procedures, ongoing monitoring, and use of cutting-edge e-health platforms.To prevent unnecessary admissions, procedures, and overtreatment, safeguards and regulations must be reformed. DGEHS will succeed if there is a strong political will, administrative dynamism, and a missionary desire to achieve its objectives. Failures in implementation can increase the expenses of such plans exponentially and place a burden on upcoming allocations for the healthcare industry.

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