Health scheme benefits can’t be denied for delayed lump-sum contribution: U’khand HC

Dehradun: Uttarakhand high court (HC) has directed the state govt to reimburse over Rs 13 lakh spent by a retired principal on lung cancer treatment, holding that "benefits under the state's Golden Card health scheme cannot be denied merely because the contribution was deposited late as a lump sum by the beneficiary."Vinay Anand Baurai, retired principal of govt-aided Shri Guru Ram Rai (PG) College, Dehradun, had deposited a lump sum contribution of Rs 20,000 under the scheme, covering the estimated monthly contributions from Aug 2022, a month prior to the commencement of his treatment in Sept 2022, which continued until May 2024. However, the health department rejected his claim on three grounds: the college's alleged delay in adopting the scheme, Baurai's failure to exercise the option within the prescribed time, and the payment of monthly contributions in a lump sum rather than through regular installments.
Challenging the decision before the HC, Baurai argued that once the requisite contribution was accepted by the authorities, he was entitled to the scheme's benefits. Agreeing with him, the division bench of Chief Justice Manoj Kumar Gupta and Justice Subhash Upadhyay observed that "once the state received the contribution, whether paid belatedly or in a lump sum, it could not subsequently deny benefits on that ground."Chief standing counsel CS Rawat submitted that reimbursement of medical expenses for employees of govt-aided colleges may be subject to certain restrictions. Under the scheme, institutions are required to deduct monthly contributions from the salary or pension of employees or pensioners and deposit the amount online with the state health agency. The state contended that contributions must be deducted in advance upon opting for the scheme, whereas in the petitioner's case, a lump sum of Rs 20,000 was deducted in April 2024.The petitioner's counsel submitted that Baurai retired on Aug 31, 2022, and it was beyond his control if the college delayed adopting the scheme. Even if there was such a delay, his claim could not be rejected on that ground. The state govt health scheme was notified on Nov 25, 2021, to provide employees protection against unforeseen medical expenses through monthly contributions.The court noted that the bills had been forwarded by the director of higher education, Nainital, with approval for necessary govt sanction. In an approval dated June 11, 2025, the director acknowledged that the entire amount of Rs 20,000 towards the scheme had been deducted from the petitioner's pension."It has not been explained how there was any delay on the part of the college in selecting or adopting the scheme. In any case, such delay would not cause any harm to the employee. We find no valid reason to deny the petitioner's claim for reimbursement," the court said on Monday, directing the state to process and pay Baurai's claim within four weeks in accordance with the scheme, which provides beneficiaries with up to Rs 5 lakh in annual health cover for cashless secondary and tertiary hospitalisation.