Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108
No: S.11011/7/99-CGHS (P)
Dated, the 27th April, 2011
O F F I C E M E M O R A N D U M
Subject: Medical Facilities for inpatient treatment and post-operative follow-up treatment to CGHS Beneficiaries in Non-CGHS areas.
The undersigned is directed to invite attention to the Office Memorandum of even number dated 30th September, 1999, issued by the Ministry of Health & Family Welfare on the above subject and to state that keeping in view the difficulties being faced by the pensioner CGHS beneficiaries residing in non-CGHS covered areas, it has now been decided to liberalise the CGHS Rules with regard to pensioner CGHS beneficiaries and serving employees, as below, to
enable them to avail medical facilities for in-patient treatment and post-operative follow-up treatment:
a) (i) CGHS pensioner beneficiaries (and their dependant and eligible family members), who are holding a valid CGHS Card and are residing in a non-CGHS areas shall be eligible to obtain treatment from Government hospitals (Central Government / State Government / Local self Government / hospitals recognised under Central Services (Medical Attendance) Rules, 1944 / hospitals and clinics empanelled under Ex-Servicemen Contributory Health Scheme (ECHS) and submit the medical reimbursement claim to the Additional Director / Joint Director of CGHS of the CMO in charge of CGHS Wellness Centre, where the CGHS is registered.
(ii) In case of non-emergency treatment from hospitals approved under Central Services (Medical Attendance) Rules, 1944 and Ex-Servicemen Contributory Health Scheme (ECHS), it is necessary to obtain prior approval from CMO in charge of concerned Wellness Centre where the CGHS card is registered.
(iii) In case of medical emergency, treatment may be obtained from any hospital and medical claim shall be submitted to Additional Director / Joint Director, CGHS of the
concerned city through CMO in charge of the Wellness Centre, where the CGHS card is registered.
(iv) Reimbursement shall be limited to the CGHS rates of the city where the card is
registered and as per the ceiling rates and ward entitlements or as per actuals, whichever is lower.
(v) CGHS pensioner beneficiaries / serving Central Government employees (and their dependant and eligible family members) and holding a valid CGHS Card and on a visit to non CGHS covered area may obtain treatment under emergency from Government hospitals (Central Government / State Government / Local self Government / hospitals recognised under Central Services (Medical Attendance) Rules, 1944 / hospitals and clinics empanelled under Ex-servicemen Contributory Health Scheme (ECHS) and the medical claim shall be submitted to Additional Director / Joint Director, CGHS of the concerned city through CMO in charge of the Wellness Centre, where the CGHS card is registered, in case of pensioners , etc., and to the concerned Ministry / Department / office in case of serving employees.
(vi) Reimbursement shall be limited to the CGHS rates of the city nearest to the place, where treatment is obtained and as per the ceiling rates and ward entitlements or as per actuals, whichever may be less.
b) (i) CGHS pensioner beneficiaries (and their dependant and eligible family members) , who are holding a valid CGHS Card and residing in a non-CGHS areas shall be eligible to obtain post operative follow-up treatment from Government hospitals (Central Government / State Government / Local self Government / hospitals approved under Central Services (Medical Attendance) Rules, 1944 / hospitals and clinics empanelled under Ex-servicemen Contributory Health Scheme (ECHS) in follow up cases of Renal Transplant surgery, Knee and Hip Joint Replacement, Cancer treatment , Neuro-surgery and cardiac surgery. However, prior permission is to be obtained from the CMO in charge of the concerned Wellness Centre, where the CGHS card is registered.
(ii) Permission shall be issued for 3 to 6 months at a time and may be extended based on medical requirement. Reimbursement for consultation, procedures and investigations shall be limited to CGHS rates of the city, where the card is registered and as per the ceiling rates and ward entitlements or as per actuals, whichever may be lower. OPD medicines shall be obtained from the concerned Wellness centre for a maximum period of 3 months at a time.
c) Wherever treatment is obtained from a hospitals approved under Central Services (Medical Attendance) Rules, 1944 / ECHS approved hospital, the beneficiaries (as in (a), (b) & (c) above) shall submit a certificate from the hospital that they have not charged more than the approved applicable hospitals approved under Central Services (Medical Attendance) Rules, 1944 / ECHS rates.
d) This Office Memorandum supersedes the earlier OM of even number dated 30th September 1999.
e) This arrangement is provisional and would be in place till such time the proposed Health Insurance Scheme for Central Government employees & pensioners is brought into effect.
f) These orders will come into effect from the date of issue.
[R.Ravi]
Director
http://mohfw.nic.in/writereaddata/cghsdata/mainlinkfile/File383.pdf
Mannu Lal says
Sir,
I got superannuated in July2013-(had grade pay 7600).Self and Wife hold CGHS Card.We reside in Thane(Maharashtra).Thane has no empaneled CGHS hospital.We suffer from BP and Sugar decease respectively.On visit to nearest CGHS WC Mulund(falls under Mumbai) i.e.20 km from my residence ,medicines not available or some times fall short.This in fact makes so uncomfortable that BP and SUGAR rises in us.Not only this,Doctor(s) found so struggling in computer searching alternate medicines that they least bother to check our status of health condition-they have no time rather than managing the day’s show some how -frankly, authorities may have snap checks.
I am an Ex serviceman(released in 1986 after 15 years 0f active service) and entitled for ECHS but not opted so far.I feel,Service doctors at least check patients and armed with required medicines.
Looking above, kindly visualize our conditions.
Now. please suggest that- can I have both health schemes( after paying for ECHS Card)
If not ,can I get refund of Rs. 60000/-paid for CGHS Card of my Grade Pay.
Don’t authorities realise putting so many conditions on CGHS/ECHS beneficiaries? It looks that pensioners are more likely to earn from their health condition specially in their old age?
CHAYA DEVI says
Pl inform me the CGHS cost for undergoing vaginal Hysterectomy. Also inform if it includes bed charges, Room, Medicines also at the earliest. I spent Rs 34,000/- and my Dept is paying me only 12,150/-. The hospital is a recognised CGHS Hospital at MYSORE
Regards
Chaya
rajiv rattan bhardwaj says
Respected Sir,
I am working in bank and required revision of THR left due to failure of earlier implant fixed in Sep 1996. Presently I am under the treatment at AIIMS.As per specification/quotation of implant suggested by the doctor costs Rs 302700.00.
Sir, please inform me the latest cost of implant under the CGHS/AIIMS scheme because is paying Rs 92000/- toward cost of implant and surgery exclusive of medicines ,boardin charges etc.
Sir,18.06.2011 is the proposed date of admission.
sir, You are requested to please do the need full at the earliest.