On September 7, the Ministry of Health increased the coverage of the Central Government Health Scheme (CGHS) by including the nursing mothers of beneficiaries under this scheme. Previously, on September 1, the eligibility criteria for CGHS were expanded to include married sons and brothers of cardholders who are in critical or terminal health conditions.
Over many years, the conditions for receiving benefits have gradually improved. However, the contribution paid by the cardholder remains unchanged, unlike medical insurance, where adding a beneficiary, especially an elderly or sick one, can lead to a significant increase in the insurance premium.
According to a memo dated September 7, the ministry received requests regarding the right of nursing mothers (i.e., sisters adopted by the parents of a CGHS beneficiary) to be included as dependent family members under CGHS. These sisters must be officially adopted by the parents of the CGHS beneficiary and meet existing dependency criteria (living in the same household as the cardholder), income ceiling (income must not exceed 9000 rupees per month plus applicable living allowance), and marital status (must be unmarried, divorced, abandoned, or separated), similar to biological sisters.
Previously, coverage for sons and brothers of beneficiaries was only available for unmarried dependents. There were age restrictions: 25 years for sons and 18 years for brothers, except for those with permanent disabilities, who were covered for life. The Ministry of Health's memo from September 1 specified that 'marriage is not a ground for termination of medical care for a dependent son or brother covered by these provisions, regardless of whether it is related to a critical/terminal illness or permanent disability...'
Furthermore, lifelong coverage now also extends to 'chronic, severe, critical, or terminal illnesses leading to substantial and prolonged impairment of function or inability to earn a living/support oneself.' Adding critically ill beneficiaries can have serious financial implications for the treasury, as there is no upper limit on expenses for CGHS beneficiaries. Since regular medical insurance typically does not cover critically or terminally ill people, this expansion is beneficial for the sick person, but only if they have a parent or brother who is a CGHS cardholder.
No age limits were ever set for dependent daughters and sisters; however, coverage ceases after their marriage or obtaining employment with a salary above the established limit. Similarly, unmarried, divorced, abandoned, or separated daughters and sisters were entitled to lifelong coverage provided they met the dependency and income conditions. Children and brothers must 'ordinarily reside' with the primary cardholder to claim benefits.