Treatment of CGHS beneficiaries at Government Hospitals – Clarification reg

Treatment of CGHS beneficiaries at Government Hospitals – Clarification reg

Treatment of CGHS beneficiaries at Government Hospitals – Clarification reg

Z15025/18/2020/DIR/CGHS
Government of India
Min. of Health & Family Welfare
Department of Health
Directorate General of CGHS

545-A Nirman Bhawan, New Delhi.
Dated the 9th October, 2020

OFFICE MEMORANDUM

Subject: Clarification regarding treatment of CGHS beneficiaries at government hospitals – regarding

With reference to the above subject the undersigned is directed to state that this Ministry is in receipt of several representations seeking clarifications about treatment at government hospitals. In this regard attention is drawn to Office memorandum No. S-11012/1/91-CGHS(P) (Vol.I) dt 18.03.1992 vide which guidelines regarding settlement of Claims were issued and to convey the approval of competent authority for issue of the following clarifications regarding treatment at government hospitals:

i. CGHS beneficiaries have the option to avail Consultation from Specialists/ Investigations / treatment procedures from any Government Hospital Central /State)

ii. The definition of “Government hospital” would include any hospital of Central Government /State Government/Government Departments such as Railways, Atomic Energy Commission, etc., as also hospitals of Public Sector Undertakings (such as those of the Steel Authority of India Limited/Coal India Limited, hospitals under Municipalities etc.

iii. Normally, many services at government hospitals are free. However, in case any government hospital charges for certain treatments, the same can be availed by way of reimbursement from the authorities concerned as per CGHS approved rates.

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iv. CGHS beneficiaries shall be eligible for reimbursement as per the ward entitlement he/she is entitled as per the criteria prescribed in case of AIIMS. In other government hospitals, where only General ward and Nursing home facility are available. CGHS beneficiaries, who are eligible eligible for semi-private ward and higher are eligible for treatment in Nursing Home wards.

v. Reimbursement for Implants shall be limited to CGHS prescribed ceiling rates. The other treatment charges are applicable item wise as per eligible ward entitlement.

vi. In case of treatment at ILBS , New Delhi , NIMS Hyderabad the reimbursement shall be as per CGHS rates.

vii. Medical claims are to be submitted through concerned CGHS Wellness Centre in case of Pensioners, ex-MPs, etc., and to the concerned Ministry /department /Office in case of serving employees and to the Rajya Sabha Secretariat / Lok Sabha Secretariat in case of Members of Parliament and to the concerned Autonomous body in case of CGHS beneficiaries of Autonomous Bodies for reimbursement.

(Sanjay Jain)
Director, CGHS

To

  1. All Ministries / Departments, Government of India
  2. Director, CGHS, Nirman Bhawan, New Delhi
  3. Estt.I/ Estt.II/ Estt.III/ Estt.IV Sections, Ministry of Health & Family Welfare
  4. Admn.I/Admn.II Sections of Dte.GHS
  5. Addl. Director, CGHS(HQ) / Addl.DDG(HQ)/Addl. Directors Directors of CGHS Cities
  6. Rajya Sabha / Lok Sabha Secretariat
  7. Registrar, Supreme Court of India /Punjab & Haryana High Court, Chandigarh
  8. Under Secretary, U.P.S.C.
  9. Under Secretary Finance Division
  10. Deputy Secretary (Civil Service News), Department of Personnel & Training, 5th Floor Saradar Patel Bhawan, Sansad Marg , New Delhi
  11. PPS to AS&MD, NRHM/AS (H) /DGHS
  12. Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi
  13. Office of the Comptroller & Auditor General of India, 10 Bahadur Shah Zafar Marg, New Delhi
  14. All Offices / Sections / Desks in the Ministry
  15. UTI Infrastructure Technology And Services Limited, UTI-ITSL Tower, Plot No3 Sector – 11, CBD Belapur, Navi Mumbai-400614
  16. Nodal Officer, MCTC, CGHS with a request to upload a copy of OM on CGHS Web-site
  17. All Hospitals empanelled under CGHS through Addi. Director, CGHS of concerned city.
  18. Office Order folder
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Copy to

PPS to Secretary, HFW
PPS to AS&DG, CGHS, MoHFW
PPS to JS(AS), MoHFW
PS to Director, CGHS
US, EHS , MoHFW

Copy for information to

PPS to Hon’ble HFM
PPS to Hon’ble MOS

treatment-of-cghs-beneficiaries-at-government-hospitals-clarification

Source: CGHS

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