1. Fixed Medical Allowance was first granted to Pensioners and Family Pensioners based on 5th CPC recommendations from 1.12.1997. This Allowance was granted to Pensioners / Family Pensioners residing in non-CGHS areas vide OM 45/55/97-P&PW (C) Dated 19.12.1997.
2. This quantum was enhanced to 300/- per month (from 1.9.2008); and then 500/- per month (from 19.11.2014) ; and now 1000/- per month (from 1.7.2017) is being drawn as FMA by the Central Government. But the condition that non-CGHS pensioners / family pensioners are only entitled to that monthly medical allowance continues.
3. The main condition for payment of FMA is that the Pensioner / Family Pensioner shall reside in Non-CGHS area only. Those Pensioners and Family Pensioners residing in CGHS Areas or living in such areas that are presently brought under CGHS coverage are not eligible for FMA from the date of their moving into CGHS areas. This means those Pensioners / Family Pensioners initially drawn FMA also will be stopped with drawal of FMA from the prospective date.
4. The option to join CGHS for non-CGHS Pensioners / Family Pensioners of P&T Department was blocked by the Health Ministry for many years. But recently after 7th CPC and out of pressure from Court Case, the Government has ordered that any P&T Pensioner residing in non-CGHS areas also can join CGHS on payment of required subscription. But for those Non-CGHS Pensioners / Family Pensioners, a further option to totally come under CGHS for both OPT and IPT (Out-patient and In-patient treatment) or come to CGHS only for IPT but remain under FMA in lieu of Out-Patient treatment also exists.
5. At the time of retirement an option either to remain under CGHS or opting for FMA shall be given by retiring officials. This option given at the time of his or her retirement is described as one time option at the time of retirement. However, the above Pensioner is allowed “only one change in option in the life time. This means irrespective of the option exercised by the Pensioner at the time of his or her retirement, he or she is allowed one life time option to change the option. Many DPA offices will naturally entertain unnecessary doubt about the difference of “one time option at the time of retirement” and “one time change of option in the life time of the pensioner”.
6. Earlier CGHS was not made compulsory for Pensioners. They can join or not join the CGHS, but even then they are not eligible for FMA if they reside in areas covered under CGHS.
7. If a Pensioner is drawing his or her pension from a place covered by CGHS while residing in a non-CGHS area is eligible for FMA provided he or she submits a declaration in the Proforma.
8. If a Pensioner is drawing two pensions viz., one from Military and one from Civilan source, he or she is eligible for FMA provided he or she is not availing any medical facility provided by one of these sources. If the pensioner is availing medical facilities provided from one of the two organizations, he or she is not eligible for FMA.
9. There is no Rule directly barring a Pensioner from drawing FMA if his or her spouse is eligible for Medical Treatment from a source available from the place of his or her work. There is no Rule directly asking the Pensioner to submit any certificate from that source that he or she is not availing any medical benefit from that source. Normally based on a written undertaking from the Pensioner of non-CGHS area that he or she is not availing any medical facility from the source of his or her spouse, the FMA is sanctioned.
