On Sept 7, the health ministry extended coverage of Central Govt Health Scheme (CGHS) to adopted sisters of scheme beneficiaries. On Sept 1, the eligibility criteria for CGHS was expanded to include married sons and brothers of scheme card holders who are critically or terminally ill. Over the years, the criteria for beneficiaries have been steadily expanded. Yet the contribution by the cardholder remains the same, unlike in health insurance where the addition of a beneficiary, especially an elderly or ill beneficiary, could entail a steep increase in the premium paid.According to the Sept 7 office memorandum, the ministry received references “regarding the eligibility of adopted sisters (i.e. sisters adopted by parents of a CGHS beneficiary) for inclusion as dependent family members under CGHS”. The ‘sisters’ have to be legally adopted by the parents of CGHS beneficiary and have to satisfy the existing criteria of dependency (staying in the same house as the cardholder), income ceiling (not be earning more than Rs 9,000 per month plus the applicable dearness allowance) and marital status (i.e. be unmarried, divorced, abandoned or separated), as applicable to biological sisters.
The coverage of sons and brothers of beneficiaries was earlier available only to unmarried dependents. There were also age limits of 25 for sons and 18 for brothers, except for those permanently disabled, who were covered for life. The office memorandum issued by the health ministry on Sept 1 spelt out that “marriage shall not constitute a ground for cessation of CHS/medical attendance facilities in respect of dependent son or brother covered under these provisions whether on account of critical/terminal illness or permanent disability...”Also, the lifetime coverage would now also apply for “chronic, severe, critical or terminal illnesses resulting in substantial and continuing functional impairment or inability to earn a livelihood/self-sufficiency”.The addition of critically terminally ill beneficiaries could have a major financial implication for the exchequer as there is no ceiling on the amount spent on CGHS beneficiaries. Since no health insurance would normally cover a critically or terminally ill person, this expansion is fortuitous for an ill person, but only if s/he has a parent or sibling who is a CGHS cardholder.
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For dependent daughters and sisters there has never been any age limit but the coverage stops once they get married or get a job with salary above the stipulated limit. Similarly, unmarried/divorced/abandoned/separated daughters and sisters have been eligible for coverage for life, provided they fulfilled the condition of dependency and income. Children and siblings are required to “normally reside” with the primary cardholder to qualify for benefits.
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