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"Dependent Family Members under CGHS"
The Central Government Health Scheme (CGHS) is not limited to the principal cardholder alone. It also extends to dependent family members, subject to certain conditions. Understanding these criteria is crucial for availing benefits under the scheme.
Who Can Be Considered a Dependent?
To be eligible as a dependent under CGHS, the following three key conditions must be met (except in the case of spouse and disabled son):
- Relationship with the principal CGHS
cardholder
- Residence – they must be normally
residing with the cardholder
- Income – their income from all sources, including pension and the pension equivalent of DCRG, must be less than ₹9,000 + DA per month.
List of Eligible Dependents
The following family members are considered dependent if they meet the above conditions:
- Spouse – automatically eligible
regardless of income
- Son – up to the age of 25
years or till he starts earning or gets married, whichever is earlier
- Disabled
son –
considered dependent irrespective of age or income, provided the
disability occurred before 25 years of age
- Daughter – eligible until she
gets married or starts earning
- Divorced,
separated, or widowed daughter – also eligible; her dependent children may also
be included
- Unmarried / widowed sisters
- Minor brothers
- Step-mother (but not step-father)
- Parents – included, but
step-parents are not
- Legally
adopted children – considered at par with biological children
- In case of adopted child: only the first wife of adoptive father is eligible (if more than one)
Important Notes
- A disabled dependent son of any age is eligible provided disability occurred before the age of 25
- More
than one wife and a judicially separated wife can be
included
- Real
parents are not eligible in case of legal adoption
Definition of Disability
As per the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, a person with disability means:
“A person suffering from not less than 40% of any of the specified disabilities, certified by a recognized medical authority.”
Recognized Disabilities Include:
- Blindness
- Low vision
- Leprosy-cured
- Hearing impairment
- Locomotor disability
- Mental retardation
- Mental illness
To continue CGHS benefits for a disabled dependent son above 25 years, a disability certificate issued by a Government Medical Board must be submitted along with the CGHS card application.
Reference:
For more details, refer to OM No. 4-24/96-C&P/CGHS (P)/EHS, dated 7th May 2018 on the official CGHS Website.
Quick Reference
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CBWAI (Central Government Health Scheme Beneficiaries Welfare Association of India) is a registered, all-India welfare association. All are requested to join by clicking on link https://tinyurl.com/bde9r8vb
I kindly request all members and readers to go through this post and share your valuable views, suggestions, or questions in the comments section below. Your feedback will help improve the content and make it more useful for everyone.
Regards,
Chandra Kant Bapat
National Coordinator, CBWAI
Excellent topic viz , presentation on family definition, various criteria adopted to become dependents of pensioners. Here, I am having a doubt Sir. The Author has mentioned that "adopted children of first wife of adopted father are considered as dependent". I think CGHS might have considered the children of adopted father under the category of brothers of pensioner. Thank you Sir for taking so much pain in writing this article view it is helpful for all the pensioners.
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