"RBI Medical Scheme 2026: MAF/MAFS, Eligibility & OPD Claim"

For Reserve Bank of India families, the RBI Medical Scheme — better known as the Medical Assistance Fund Scheme (MAF / MAFS) — is the backbone of healthcare after retirement. Because RBI runs its own medical system rather than CGHS, its rules, limits and claim process are unique, and every year the coverage is revised. This in-depth guide explains the RBI Medical Scheme in plain language: what MAFS is, who is eligible, what it covers, and how retired employees claim OPD and hospitalisation benefits.

What is the RBI Medical Assistance Fund Scheme (MAFS)?

The Medical Assistance Fund Scheme (MAFS) was introduced in the Reserve Bank of India with effect from 1 January 1987. Its original purpose was to provide financial assistance towards a part of the hospitalisation expenses incurred by serving employees and their eligible family members, and by retired employees and their spouses, for treatment within India.

A key change came on 1 April 2009, when the MAF Scheme was converted into a scheme available to members only after their retirement. In other words, MAFS today is essentially a post-retirement medical benefit — serving employees are looked after through the Bank's separate in-service medical arrangements, while MAFS steps in once an employee retires. Over the years it has been operated through a Group Mediclaim Policy with an insurer (renewed annually), so a retired RBI employee's medical cover is a combination of the MAF corpus and an insurance-backed mediclaim policy.

RBI medical scheme eligibility

Eligibility under the RBI Medical Scheme is centred on retired staff:

• Retired RBI employees and their spouses are the core beneficiaries of MAFS.
• Under the OPD policy, cover has been extended to include dependent children with disabilities of eligible members.
• Serving employees are covered separately by the Bank's own in-service medical facilities and reimbursement, not by MAFS (after the 2009 restructuring).

Because RBI is a statutory body with its own service conditions, its staff are outside CGHS (the Central Government Health Scheme used by central civil employees). That is why RBI has its own medical scheme rather than relying on CGHS — a point worth understanding if you are comparing schemes across government and public-sector employers. Our canteen and hospital by department guide maps how different employers' medical systems compare.

MAFS and the Group Mediclaim Policy (GMP)

For hospitalisation, retired members are covered through a Group Mediclaim Policy (GMP) renewed each year with an insurer (for example, with a public-sector insurer for the 2025-26 and 2026-27 policy years). This provides cashless treatment through network hospitals, backed by the MAF. In practice, MAFS and the GMP work hand in hand: the mediclaim policy provides the insurance cover, while the fund supports the overall scheme.

Enhanced coverage & limits

The scheme's limits are revised and generally enhanced each policy year. Recent enhancements include:

• Cataract surgery — up to ₹90,000 per eye, covering laser treatment, multifocal lenses and spectacles.
• Intra-vitreous injections — up to ₹1,25,000 per eye (e.g. Avastin, Lucentis, Macugen, Ozurdex).
• Autoimmune-disorder injections — up to ₹25,000 per injection.
• AYUSH treatment — covering up to 50% of the sum insured for curative naturopathy at accredited facilities.

These figures illustrate how comprehensive the RBI retired employees' medical benefits have become, but because they change every year, always confirm the current year's limits from the official policy document before treatment.

OPD cover — the Group Mediclaim OPD policy

Alongside hospitalisation, RBI provides out-patient (OPD) cover for pensioners through a Group Mediclaim OPD policy, with limits enhanced for the 2025-26 and 2026-27 policy years and cashless access via network providers for eligible pensioners (typically aged 60 and above). The OPD cover is wide-ranging and includes:

• Preventive care — vaccinations, physiotherapy, yoga therapy (up to ₹6,000 without prescription) and de-addiction programmes.
• Consultations — general physicians and specialists.
• Diagnostics — laboratory tests, radiology and periodic health check-ups.
• Dental care — fillings, implants, dentures and braces (excluding purely cosmetic procedures).
• Vision & hearing — spectacles, contact lenses, and hearing aids with repairs up to ₹10,000.

This OPD policy is what many pensioners are referring to when they search for RBI medical reimbursement for everyday, non-hospitalisation expenses.

RBI medical reimbursement & the OPD claim form

Claiming under the RBI Medical Scheme follows clear timelines, though the exact forms are updated each policy year:

• Hospitalisation (GMP): intimation to the insurer/TPA is generally required within 30 days of admission, with documents submitted within 45 days of discharge; complete claims are typically processed within about 15 days. Cashless treatment is available at network hospitals.
• OPD reimbursement: claims are generally submitted within 90 days of treatment, using the current OPD claim form, along with original bills, the doctor's prescription (with registration number) and investigation reports (photocopies of reports are usually accepted).

Keep every bill and prescription, note the claim window, and use the latest year's MAFS / OPD claim form — an outdated form or a missed deadline is the most common reason claims are held up.

RBI health insurance for serving employees

While MAFS is post-retirement, serving RBI employees are not left uncovered. The Bank provides medical facilities and reimbursement for in-service staff and their families through its own arrangements — dispensary facilities, hospitalisation support and reimbursement of medical expenses as per the Bank's rules. So across a full RBI career, medical cover is continuous: the Bank's in-service scheme while working, and MAFS plus the Group Mediclaim Policy after retirement.

The salary and pay angle

A common related search is around the RBI medical scheme and salary. Two things are worth clarifying. First, RBI has its own pay scales (for example, its officers in Grade A/B/C and clerical/support cadres are paid on RBI's independent scales, not the Central Government's 7th CPC matrix). Second, MAFS is not a monthly salary deduction like the CGHS subscription central employees pay — it is a fund-and-insurance-based scheme, so the medical benefit is part of RBI's overall service conditions rather than a line item cut from your monthly pay. In short, the RBI medical scheme is a service benefit, funded through the scheme and the Bank's mediclaim policy.

Finding the official RBI MAFS / medical benefits PDF

Because limits and forms change annually, the authoritative source is RBI's own circulars and the yearly Group Mediclaim / MAFS policy documents. Retired-employee associations and RBI pensioner forums also publish each year's MAFS and OPD policy PDFs, which many pensioners use as a handy reference. Whichever you read, cross-check the policy year and confirm the current claim form and limits from official RBI communications before relying on any figure.

How the RBI medical scheme differs from CGHS

Because RBI staff are often compared with central government employees, it helps to see how the RBI Medical Scheme differs from CGHS:

• Who runs it: CGHS is run by the Ministry of Health for central civil employees; the RBI scheme is run by the Reserve Bank for its own staff.
• Funding: CGHS beneficiaries pay a monthly subscription based on pay level; MAFS is fund-and-insurance-based, not a monthly salary cut.
• Structure: CGHS works through wellness centres and empanelled hospitals with referrals; the RBI scheme works through a Group Mediclaim Policy (cashless network hospitals) plus a separate OPD policy for pensioners.
• Who's covered: CGHS covers serving and retired central civil employees; MAFS is post-retirement (serving RBI staff use the Bank's in-service arrangements).

So a retired RBI employee should look to MAFS and the RBI Group Mediclaim/OPD policy, not CGHS. For how every employer's medical and canteen facilities compare, see our canteen and hospital by department guide.

Practical tips

• Confirm the current year's limits — the scheme is enhanced almost every policy year.
• Use cashless network hospitals for planned hospitalisation to avoid out-of-pocket outlay.
• Track your deadlines — 30 days to intimate and 45 days to submit for hospitalisation; ~90 days for OPD.
• Keep originals — bills and prescriptions with the doctor's registration number.
• Use the latest claim form for the running policy year.

Conclusion

The RBI Medical Scheme — the Medical Assistance Fund Scheme (MAFS) working together with the Group Mediclaim Policy — gives retired Reserve Bank employees and their spouses substantial, steadily improving healthcare cover, from ₹90,000-per-eye cataract surgery to a broad OPD package. Understand your eligibility, note the claim timelines, use the current OPD claim form, and confirm each year's limits from the official policy, and this uniquely RBI scheme will do exactly what it was set up for in 1987 — protect the health of RBI families after a lifetime of service.

This guide is for general information on the RBI Medical Assistance Fund Scheme and related Group Mediclaim policies. Coverage, limits, forms and timelines are set by the Reserve Bank of India and its insurers and are revised each policy year — always confirm the current position from official RBI documents and your pensioner association.