LRS MISS SANGEETA GUPTA vs M/o Finance

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Reserved

CENTRAL ADMINISTRATIVE TRIBUNAL, JABALPUR BENCH
JABALPUR
(Hybrid Mode)

Original Application No.202/803/2017

rd

Jabalpur, this Thursday, the 03 day of September, 2026




HON’BLE MRS. MALLIKA ARYA, ADMINISTRATIVE MEMBER

R.S. Gupta (deceased) through LRs Ms. Sangeeta Gupta, D/o Late Shri R.S.
Gupta, R/o 46, Vikas Nagar, Gwalior (M.P.) – 474002.

-Applicant through LR

(By Advocate – Shri Rajendra Bhargava through VC)
V e r s u s

1. Union of India through Commissioner, Customs, Central Excise &
Service Tax, Manik Bagh Palace, Indore – 452001.
2. Union of India through Secretary, Ministry of Health and Family
Welfare, Nirman Bhawan, New Delhi – 110001.
- Respondents
(By Advocate – Shri Rajendra Singh Dhakar)

(Date of reserving order :12.08.2026)


O R D E R

The applicant (since deceased) is challenging the order dated
26.07.2017 (Annexure A-1) by which his claim for reimbursement of
treatment of his wife taken at Max Institute, Saket Nagar, New Delhi for the
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period from 26.10.2008 to 11.11.2008 has been rejected by the respondents.
He is seeking direction to the respondents to reimburse the expenses in
proportion to the increase of Fixed Medical Allowance from Rs.100/- to
Rs.1000/- per month along with interest.
2. During the pendency of this Original Application, the applicant, R.S.
Gupta left for his heavenly abode and he is substituted by Ms. Sangeeta
Gupta, daughter of the deceased applicant.
3. The applicant, in his Original Application, has stated that he is
governed by the Civil Service (Medical Attendance) Rules, 1944, upon his
retirement from service. The applicant resides in Gwalior and there is no
facility of CGHS in Gwalior. He has submitted a bill amounting to
Rs.6,04,718.23 on 02.12.2008 in respect of indoor treatment of his wife
from 26.10.2008 to 11.11.2008. However, vide the impugned order dated
26.07.2017 (Annexure A-1), the respondents have rejected his claim. The
applicant submits that the Office Memorandum dated 05.06.1998
(Annexure A-2) provides for reimbursement of expenses incurred for indoor
treatment to the pensioners residing in non CGHS area. Therefore, as per
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this OM, the applicant is entitled to get the amount reimbursed for indoor
treatment of his wife.
th
In their reply, the respondents have stated that the 5 Central Pay
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Commission had recommended for extension of CS (MA) Rules, 1944 to
the Central Government pensioners residing in the areas not covered by
CGHS. However, the Ministry of Health & Family Welfare, vide the Office
Memorandum dated 20.08.2004 (Annexure R-1) had clarified the in view of
huge financial implications, it is not feasible to extend CS (MA) Rules,
1944 to the pensioners. Further, according to CS (MA) Rules, 1944,
pensioners residing in non CGHS area are having option to (a) for Fixed
Medical Allowance @ Rs.500/- per month or (b) avail the benefit of CGHS
(OPD and IPD) by registering themselves in the nearest CGHS city after
making required subscriptions and also have the option to avail FMA for
OPD treatment and CGHS for IPD treatment after making required
subscription as per CGHS guidelines.
5. Heard learned counsel for the parties and perused the pleadings and the
documents available on record. Both the parties were also given time of 15
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days’ to submit their written arguments. However, none of the parties have
filed their written submissions.
It is not in dispute that at the relevant point of time, the applicant was
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residing in a non-CGHS covered area. It is also established from the records
that after retirement he did not exercise the option for CGHS coverage and
did not make the requisite CGHS subscription/registration. The applicant
has nevertheless sought reimbursement of the expenditure under the CS
(MA) Rules, 1944, on the ground that since he resides in a non-CGHS area,
he is entitled to get reimbursement under the CS (MA) Rules.
7. The Office Memorandum dated 29.09.2016 (Annexure A-3) clearly
provides that the CS (MA) Rules, 1944 are not applicable to pensioners.
The said O.M. further provides that the medical-facility options are
available to Central Government pensioners residing in non-CGHS areas
and they may: (i) avail Fixed Medical Allowance (FMA) in lieu of OPD
medical facilities; (ii) avail CGHS OPD and IPD facilities by registering
themselves in the nearest CGHS-covered city after making the requisite
subscription; or (iii) avail FMA for OPD treatment and CGHS facilities for
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IPD treatment after making the requisite subscription in accordance with
CGHS guidelines.
The Office Memorandum dated 05.06.1998 (Annexure A-2) relied
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upon by the applicant regarding extension of CS (MA) Rules to pensioners
residing in non-CGHS areas cannot be treated as an operative statutory
extension of the Rules. The subsequent clarification dated 20.08.2004
(Annexure R-1) made it clear that the earlier O.M. was in response to a
reference concerning the recommendation of the Fifth Central Pay
Commission and that the CS (MA) Rules had not thereby been made
applicable to Central Government pensioners. This position has
subsequently been reiterated by the Ministry of Health & Family Welfare in
the OM dated 29.09.2016.
9. The distinction between a pensioner who is already a CGHS
beneficiary and one who has never subscribed to CGHS is material.
Government instructions permit CGHS beneficiaries residing in non-CGHS
areas to obtain treatment in specified Government/approved hospitals and
claim reimbursement in accordance with CGHS rules. That facility cannot
automatically be extended to a pensioner who has never obtained CGHS
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coverage or paid the prescribed subscription. In the present case, the
applicant has admittedly neither registered himself under CGHS nor paid
the requisite CGHS subscription. Consequently, there was no subsisting
CGHS coverage on the date on which the treatment was undertaken. The
applicant cannot invoke the CS (MA) Rules, 1944, since those Rules do not
apply to pensioners. The fact that the applicant resides in a non-CGHS area
does not alter the legal position. The Government has specifically provided
alternative medical facilities to such pensioners, including FMA and the
option of obtaining CGHS coverage from the nearest CGHS covered city on
payment of the prescribed subscription. Hence, I am of the considered view
that there is no merit in the claim of the applicant.
10. Accordingly, this Original Application is dismissed being devoid of
any merit. No order as to costs.

(Mallika Arya)
Administrative Member


am/-
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