Central Government employee is considered a CGHS beneficiary once CGHS contribution is regularly deducted from their monthly salary. However, merely having the contribution deducted does not automatically ensure the issuance of a CGHS card. The employee is required to submit the prescribed application form to their respective Administration/ Establishment branch to initiate the issuance process of the CGHS card.

• Monthly CGHS deduction from salary signifies eligibility.
• The employee must submit an application in the prescribed format to the Administration Branch.
• The CGHS card is issued only after proper application and processing.
• Failure to apply may result in non-issuance, despite ongoing contribution.

Regular deductions without application do not suffice for availing CGHS benefits; formal application is mandatory.

F. No.11/03/2024-EC. VII/134 (H)
Government of India
Directorate General
Central Public Works Department
Nirman Bhawan, New Delhi

दिनांक: 07.04.2025

OFFICE MEMORANDUM

Subject: Issuance of CGHS serving card to serving Central Govt. employee upon deduction of monthly CGHS contribution – regarding.

The undersigned is directed to refer to MoOH&FW OM No. S-6252/2003-2004-R&H/CGHS/CGHS(P) dated 15.0.2004 (copy enclosed) on subject cited above.

2. All SDGs/ADGs are requested to ensure that all the employees of CPWD who are contributing towards the CGHS are issued with CGHS card. In case where the Govt. Servant in spite of written intimation/Memorandum do not apply for a CGHS card, such cases may be immediately reported to Senior Officers for taking suitable action.

3. This issues with the approval of the Competent Authority.

Enclose: As above

(नीलांजन कर्मकार)
उप निदेशक (प्रशासन-VI)

Dated the 15th June, 2004

The undersigned is directed to state that various Ministries/ Departments of the Govt. of India are raising the question of accrual of CGHS benefits to the ‘Central Govt. Servants.

2. In this connection, it is stated that as per CGHS rules, th benefits Of CGHS accrue from the date on which the Central Govt. Servant applies for a CGHS card. Further, the CGHS is a compulsory scheme for all Central Govt. employees having their place of residence as recorded in the service book in an area covered by a CGHS dispensary. Therefore, as soon as the Govt. employee joins a particular Office and intimates his/her residential address that falls in a CGHS covered areas, the Administration Branch officially intimates the Cash Branch to start deducting the monthly CGHS contribution from the salary of the Govt. Servant. This is not linked/made conditional to the Govt. Servant filling up the necessary forms and applying to his Administration Branch for getting a CGHS card.

4. In some cases, the administrative Ministry/ Department have referred medical reimbursement cases to the Department of Health wherein the Govt. servant has been regularly contributing towards the CGHS by way of deductions from the monthly salary but he/she has not applied to his Administration Branch for obtaining a CGHS Card by filling up the necessary forms.

3. The Matter has been considered in the Department of Health and it is of the view that if the CGHS contribution were being compulsorily deducted from the monthly salary of the Govt. employee, it would be unfair to deny the Govt. servant the benefit of CGHS facilities merely on the ground that he/she had not applied to the Administration Branch for getting a CGHS card. As a Matter of fact, if the concerned Office/ Department is regularly deducting the CGHS contribution from the monthly salary of the Govt. servant, it is the. responsibility of the said Office/Department to ensure that a CGHS card is issued to such Govt. servants.

4. In view of the above, the Administration/ Estt. Branch of all the Ministries/ Departments of the Govt. of India are requested to ensure that all such Govt. servants who are contributing towards the CGHS are issued with CCHS cards.  In cases where the Govt. servant in spite of written intimation/ Memorandum do not apply for a CGHS card, such cases may be immediately reported to the Senior Officers for taking suitable action.

(ANUP PANDEY)
DIRECTOR

The post Issuance of CGHS serving card to serving Central Govt employee upon deduction of monthly CGHS contribution appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS: Important Office Order dated 12.11.2024

F. No. Z215025/19/2024/DIR/CGHS

/I/3721886/2024
(Comp No.8281 286 )
भारत सरकार
स्‍वास्‍थ्‍य एवं परिवार कल्‍याण मंत्रालय
केंद्रीय सरकार स्‍वास्‍थ्‍य योजना

रामकृष्‍ण पुरम, दिल्‍ली
दिनांक 12-11-2024

OFFICE ORDER

Subject: Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS

In order to streamline the process of issuing restricted medicines to beneficiaries (all beneficiaries eligible for OPD services in CGHS) under the Central Government Health Scheme (CGHS), the following guidelines are issued for strict compliance by all Medical Officers:

Definition of Restricted Medicines:

1. Anti-cancer medicines (Chemotherapeutic, immunotherapeutic medicines)
2. Drugs used for the treatment of other terminal illnesses like CKD, Enzyme deficiencies, Hemophilia, rare diseases, etc.
3. Limited/Specialized use drugs with prohibitive cost eg: Intra-ocular, intra-articular injections, etc.
4. Cost of restricted medicine More than Rs. 10,000/ unit of administration or more; or Rs. 50,000/ month or more.

Standard Operating Procedure for Issue of Restricted Medicine.

• CGHS shall maintain only two lists of Restricted medicines, i.e. Online Restricted Medicines and ‘STC’ Restricted Medicines which shall be displayed on the CGHS Website for information of beneficiaries.
• Immunotherapy of Medicine shall remain in the STC Restricted Medicine list.
• CGHS shall issue guidelines for the use of STC Restricted Medicines as per established CDSCO approval/ guidelines. O/o Additional Director MSD/City shall be authorized to issue the medicine without the scrutiny of the Standing Technical Committee in case the disease is covered under the issued guideline.
• In case there are no guidelines available, or the medicine has been prescribed for an indication not covered under the guidelines, the same shall be subject to the recommendation of the Standing Technical Committee.
• In case, an STC Restricted Medicine, has been advised and approved for more than 20 cases in 6 months, the same shall be included in the Online list except for Immunotherapy Medicines.
• The application for Restricted Medicines is to be submitted by the beneficiary to the Medical Officer along with the following documents:
  1. Duly filled Restricted Medicine Form (Annexure 1) by the main cardholder.
  2. Photocopy of Prescription of treating Specialist.
  3. Authorization Letter in case the beneficiary is unable to collect the medicine in person.
  4. CGHS Issued Prescription (Print out) of Restricted Medicine.

7. The Medical Officer shall only use the Online module of the CGHS application for prescribing the Restricted Medicine. In the case of STC Restricted Medicine, the Authorised Medical Officer (CMO Drugs/ Additional Director) at the Central Store/ Medical Store shall prescribe the medicines using the online module.
8. It is reiterated that the beneficiary may submit the request for Restricted medicine to any Wellness Centre across the country, however, the beneficiary must be informed that the medicine shall be available at the concerned (based on place of indent) Medical Store/Central Store/ designated Wellness Centre.
9. The Online request shall be processed by the Medical Stores/ Central Store of the city on the same day for medicine available in the Online Restricted List.
10. In the case of STC/Offline Restricted Medicines, the use of ‘Offline Indent Vouchers’ shall be discontinued, and the applications shall only be submitted on the prescribed form along with all relevant reports chronically arranged, with copies of imaging reports if any. A separate record shall be maintained at the level of the Wellness Centre for the same.
11. The Supplier of the medicine shall supply the medicine at the Medical Store/ Central Store of the city/wellness centres as per arrangement made by the Additional Director of the City/MSD.
12. The Medicine shall be distributed by the Pharmacist using the Online module of CGHS application; at the place of supply of medicine.
13. The beneficiary shall collect the medicine from the designated place within 15 days from the date of Supply (i.e. date of receipt of the medicines in MSD/WC).

signed by
Dr Satheesh Y H
Date: 12-11-2024 16:42:51
(Dr. Satheesh Y. H.)
Director (CGHS)

The post Issuance of Restricted Medicines to Beneficiaries under CGHS appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

Revision of CGHS package rates for General Surgery 2024 – CGHS Order dated 01.02.2024

F No Z15025/ 8/2023/ DIR/CGHS
Govt. of India
Min. of Health & Family Welfare
Department of Health & Family Welfare
Directorate of CGHS

CGHS Bhawan,
RK Puram -Sector-13, New Delhi.
Dated the February 1st, 2024

OFFICE MEMORANDUM

Subject: Revision of CGHS package rates for General Surgery – regarding

I am directed to convey the approval of the Competent Authority for the revision of CGHS package rates for General Surgery as per the details given below:

(all figures are in Rupees)

2.These package rates are applicable in all CGHS Cities.

3.These rates are in supersession of the hitherto existing CGHS package rates for the above items. The other terms and conditions of empanelment shall remain unchanged.

4.The revised package rates shall be applicable from the date of issue and shall be valid till further orders.

5.This issues with the approval of the Competent Authority and concurrence of the Integrated Finance Division, Ministry of H&FW vide CD No. 3186 dated 01.02.2024

(Dr. Manoj Jain)
Director, CGHS

Latest CGHS Package Rates 2024 for General Surgery PDF Download

The post Latest CGHS package rates for General Surgery 2024 – CGHS Order dated 01.02.2024 appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE

RAJYA SABHA
UNSTARRED QUESTION NO. 268

TO BE ANSWERED ON 05 TH DECEMBER, 2023

CASHLESS TREATMENT FACILITIES TO CGHS BENEFICIARIES

268. SHRI RAVICHANDRA VADDIRAJU:
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) Whether Government is planning to expand cashless treatment facilities for the Central Government Health Scheme (CGHS) beneficiaries as is being done in AIIMS Delhi, PGIMER Chandigarh and JIPMER Puducherry bringing under the ambit of CGHS and proposes to include all AIIMS across the country; and

(b) If so, the details thereof and present status of its implementation of the scheme?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) & (b) As per the decision taken by the Government, Memorandums of Agreement (MoAs) have been signed by CGHS with AIIMS, New Delhi; PGIMER, Chandigarh; JIPMER, Puducherry and AIIMS located at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, Rishikesh, Bilaspur, Rajkot, Kalyani, Bhatinda, Bibinagar, Guwahati, Deoghar and Mangalagiri; to facilitate cashless treatment/ investigation facilities to Pensioner beneficiaries and other eligible categories of CGHS beneficiaries at these premier institutions. The guidelines related to treatment of CGHS pensioner beneficiaries and other entitled class of beneficiaries at these Institutes are given at Annexure.

Annexure

The guidelines related to treatment of CGHS Pensioner beneficiaries and other entitled class of beneficiaries are as under:

• CGHS Pensioners and other beneficiaries entitled for cashless treatment like ex-MPs, ex- Governors, former Judges of Supreme Court of India , former Judges of High Courts, Freedom Fighters, etc., holding a Valid CGHS Card are eligible for cashless treatment at AIIMS.
• The validity of the CGHS card and the ward entitlement are printed on CGHS Card.
• AIIMS shall create a Special desk for CGHS beneficiaries.
• Entitled CGHS beneficiaries shall present their CGHS Card for verification at CGHS Desk.
• CGHS shall facilitate verification of card details on line from CGHS Data base in consultation with NIC.
• Entitled CGHS beneficiaries shall submit a self attested copy of CGHS Card of self. In case of treatment of a dependant family member copy of the CGHS card of self and family member shall be submitted.
• CGHS Desk at AIIMS refers the beneficiaries to OPD / Investigations / Indoor treatment as the case may be.
• Bills in physical form along with copy of CGHS card shall be submitted by AIIMS in the last week of month to the office of Addl. Director, CGHS of concerned City.
• AIIMS shall send bill to CGHS as per AIIMS rates, except in case of Room rent for Indoor treatment. Bills for room rent shall be sent to CGHS as per prescribed rates for empanelled Hospitals. The beneficiaries are eligible for indoor treatment as per their ward entitlement, as indicated on their CGHS Card.
• AIIMS shall create a separate Bank Account for CGHS beneficiaries to reimburse the bills by CGHS.
• Additional Director, CGHS of concerned City shall process the bills expeditiously and payment shall be credited into the Bank Account created by AIIMS for CGHS.
• CGHS pensioners and others eligible for cashless treatment can avail treatment without any mandatory referral from CGHS.

The post CGHS cashless treatment facilities for the beneficiaries appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

मि.सं.1-20/2023 /सीजीएचएस /सं.नि.आयुश)

1/3620026/ 2023

F. No.S-11011/ 90/ 2016- CGHS/ (HEC)/ AYUSH/Pt-II.
Ministry of Health & Family Welfare
Directorate General of CGHS
Office of the Director, CGHS

CGHS Bhawan, R.K Puram
Sec-13, New Delhi-66
Dated: /09/2023

OFFICE MEMORANDUM

Subject: Clarification on the referral for CGHS beneficiaries aged 75 years & above and consultation through Video Conferencing for AYUSH system-reg.

With reference to the above mentioned subject the undersigned is directed to draw the attention to Office Memorandum vide F.No. Z.15025/ 35/ 2019/ DIR/ CGHS/ CGHS(P) dated 29.05.2019 & 27.06.2019 and clarified that the referral for 75 years and above and consultation through Video Conferencing for AYUSH system is not appropriate since as per Ayurvedic literature, many procedures are contra-indicated after 75 years of age and in certain disease conditions also.

Moreover, to examine the physical condition of the patient whether he is eligible for the therapy is to be assessed by the treating Ayurvedic physician for which consultation is necessary, which is not possible through Video Conferencing and therefore, referral by the treating Ayurvedic physician, for once, is required for taking the treatment from the AYUSH Day Care Centre for a period of approximately 7 days / 15 days.

This issues in consultation with the experts in the field.

Signed by Manoj Jain
Date: 05-10-2023 17:11:45
(Manoj Jain)
Director, CGHS

The post CGHS beneficiaries aged 75 years & above and consultation through Video Conferencing for AYUSH system appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

BHARAT PENSIONERS’ SAMAJ

All India Federation of Pensioners’ Associations)
(Registered No, 2023 of 1962-62)
Member International Federation on Ageing. Montreal (Canada)
2/13-A – LGF Backside, Jangpura – ‘A’, New Delhi – 110 014

No.BPS/ BDPA (I)/Fixed-Med/ Enhancement/ 2023

Dated 5th October 2023

To:

Hon’ble Smt. Nirmala Sitaraman,
Finance Minister, Govt. of India,
15, Safdarjung Road,
New Delhi

Sub: A request to expedite decision for enhancing Fixed Medical Allowance from Rs. 1000/- Per Month to Rs. 3000/- PM.

Respected Madam,

1. In continuation of our letter of even No. Dated 26.04.2023, we write to remind you that the Parliamentary committee on Pensioner’s Grievance has submitted its 110th report on 10.12.2021; wherein it has been recommended the enhancement vide para3.14, sub Para (i) “Fixed Medical Allowance may be enhanced from Rs 1000 to Rs 3000 per month since most pensioners are suffering from different diseases at old age and are unable to manage with meager pension as CGHS hospital is not available in every town”.

2. As were given to understand, the same was forwarded to you ministry vide F. No. 4/34/2017-P&PW(D dated 31-01-2018 for final decision.

3. We were also informed that the same has been sent to your office vide No. सं.12(3)2/ई-V/2023 –dated 05.05.2023.

4. Madam Sir, since the issue was under examination in your ministry and we have come to know that you have given nod to the proposal.

We therefore look forward to your august office for its clearance for issuance of orders on the subject by the ministry.

With Regards,

Yours Sincerely,

(D.D. MISTRY)
Secretary BSNL/PSU

The post BPS – Request to expedite decision for enhancing Fixed Medical Allowance from Rs. 1000/- Per Month to Rs. 3000/- PM appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

GOVERNMENT OF INDIA
MINISTRY OF RAILWAYS
(RAILWAY BOARD)

No. 2023/H/28/1/ RELHS/ Empanelled(CGHS)

New Delhi, Dated: 19.09.2023

General Managers,
All Indian Railways
Including PUs, RDSO and NAIR.

Sub:- Provision of OPD consultation & related investigation for RELHS beneficiaries aged 75 years & above from specialists of Private Hospitals empanelled by Railway – As a PILOT PROJECT FOR ONE YEAR FROM 01.11.2023 TO 31.10.2024.

The matter of provison of direct Outpatient Department (OPD) consultation and related investigation from specialists of private hospitals empanelled by Railway for RELHS beneficiaries aged 75 years and above has been drawing attention of Ministry of Railway for some time. After consideration of the issue, Railway Board has decided as under:-

(i) RELHS beneficiaries aged 75 years and above may be permitted to seek direct OPD consultation from specialists of.Private Hospitals empanelled by Railway, without referral from Railway Hospital/ Health Unit under which beneficiary 1s registered.

(ii) If any CGHS listed investigation/ procedures is advised and is required to be undertaken In emergency, no other authorization will be required, and the same may be undertaken from empanelled hospital at CGHS rates for that city/or as per MoU with Railways in cashless procedure. Bills along with copy of UMID card, copy of prescription/ Reports and declaration form (copy enclosed) signed by the beneficiary and duly endorsed by the competent authority of the empanelled hospital will be sent to Railway under which the hospital 1s empanelled for payment.

(iii) In non-emergency cases, approval of competent authority from Railways will be required for undertaking (a) CGHS non-listed investigations/ planned procedures; and (b) those CGHS listed investigations, which cost above Rs. 10000/-, whenever advised by specialist of empanelled hospitals.

(iv) Medicines prescribed by a specialist doctor of private railway empanelled hospitals will be issued by concerned Railway hospitals/Health Units on authorization of available railway doctor.

(v) Private Hospitals empanelled under Railways shall provide above facilities on cashless basis at CGHS rates to Railway beneficiaries aged more than 75 years. The hospitals shall submit the bills along with valid UMID card and declaration form signed by the beneficiary who has availed the facilities, duly endorsed by the competent authority of the empanelled hospital.

(vi) This facility will be available for only those aged 75 years & above RELHS beneficiaries who are eligible for OPD consultation at Railway Hospitals/ Health Units. This facility is not available to beneficiaries having UMID card with FMA.

(vii) These guidelines will not supercede the instruction issued vide Board’s letter No. 2018/ TransCell/ Health/ CGHS (eOffice No.327783) dated 16.06.2021 which will remain inforce for emergency cases/IPD cases as specified therein.

(viii) This is a Pilot Project only for one year i.e. 01.11.2023 to 31.10.2024. Railways will ensure the period of Pilot Project without fail.

(ix) To ensure that UMID cards are not misused, proper accountal of expenditure incurred on the present scheme may be maintained by Railway/ PU.

(x) Empanelled hospitals need to be provided access to HMIS portal so that data-is captured efficiently and can be retrieved whenever required.

(Dr. A. K. Malhotra)
Principal Executive Director/ Health
Railway Board.

DECLARATION BY RAILWAY BENEFICIARY AGED 75 YEARS AND ABOVE REGARDING FACILITIES AVAILED AT RAILWAY EMPANELLED HOSPITAL

The post Provision of OPD consultation related investigation for RELHS beneficiaries aged 75 years & above from specialists of Private Hospitals empanelled by Railway appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

F.No Z15025/27/ 2023/ DIR/CGHS
Min. of Health & Family Welfare
Directorate of CGHS

CGHS Bhawan,
RK Puram Sector-13 New Delhi
Dated 12th September, 2023

OFFICE MEMORANDUM

Subject: Guidelines regarding Purchase of Medicines by Post-Organ Transplant Surgery Patients under CGHS – reg.

With reference to the above-mentioned subject the undersigned is directed to convey the approval of Competent Authority to issue guidelines for the purchase of Medicines in the cases of Post-Organ transplant CGHS beneficiaries as per the details given under:

1. CGHS beneficiaries, who are recovering from Organ transplant surgery shall be permitted to purchase OPD medicines, based on the advice of the treating Specialist for up to a period of six months if, they are not in a position to visit CGHS Wellness Centre or to send an authorized representative.

2. The reimbursement of such medicines would be considered as per the following details:

• The reimbursement on restricted medicines having CGHS rate contract, shall be limited to the CGHS rates.
• The reimbursement in respect of other medicines for which there is no rate contract under CGHS, shall be limited to 85% of MRP or actual expenditure incurred, whichever is lower (since 15% discount is the minimum discount prescribed under CGHS for Local Chemists).
• However, products manufactured/ marketed as food supplement, cosmetics and ayurvedic preparations advised by allopathic doctors are not reimbursable, as per extant CGHS guidelines.

Serving employees would claim reimbursement from their respective department.

(V.K. Sharma)
Addl.-DDG(HQ) CGHS

The post Purchase of Medicines by Post-Organ Transplant Surgery Patients under CGHS appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

CGHS Bhawan, New Delhi-66
Dated: 4th August, 2023

OFFICE MEMORANDUM

Subject: Empanelment of private hospitals under CGHS Delhi & NCR.

With regard to this Directorate’s Office Memorandum dated 13.09.2022 regarding empanelment under continuous empanelment scheme 2022, the undersigned is to convey that in addition to the list of the hospitals (including dental clinics, eye centres and diagnostic laboratories already empanelled. the hospitals as per the list attached (Six HCOs – Annexure-A) have also been empanelled under CGHS in Delhi & NCR with issuance of this order. The newly empanelled hospitals may be treated as included in the existing list of empaneltled health care organization under CGHS on same terms and conditions as have been indicated in the Office Memorandum dated 26.12.2017. The empanelment shall be till 30.09.2024 as with other empanelled HCOs or till finalization of new empanelment whichever is earlier. HCOs would claim NABH/NABL rates only for those investigations which are NABH/NABL accredited.

Encl: As above

[Dr. Manoj Jain]
Additional Director (HQ)

The post Empanelment of CGHS Private Hospitals Name of the Hospitals / Address/ Details of Nodal Officer appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

Guidelines for Medical Claim reimbursement claim and Permission cases – Controller of Defence Accounts Circular dated 01.09.2023

Office of the Controller of Defence Accounts
Rajendra Path, Patna- 800019

Circular

No -AN/Pay/Med/ Patna/Vol-III

Date: 01/09/2023

To
The Officer-In-Charge
All section of M.O CDA Patna
All sub offices

Subject: Guidelines for Medical Claim reimbursement claim and Permission cases.

Of late, it is observed/ noticed during course of audit of medical reimbursement claims, received in this Office that some of officials/ officers are not adhering to CGHS/ CS(MA) Rules resulting in return/rejection of bills at audit level. Some of the officials/officers are not even taking a little bit pain to go through audit Observation /advice given by this office and resubmitting the claim without or partial complying the requirements resulting in multiple return/ rejection of the claims. Accordingly, list of the documents are numerated below for information and strict compliance so that reimbursement of claim to the individual may be process within the stipulated timelines.

• Submission of Medical Claims with enclosing following documents:-
  • MED-97 form in respect of CSMA beneficiaries or, MRC(S) /MED-2004 form in respect of CGHS beneficiary are to be duly filled and signed with date by the beneficiary.
  • Referral Memo of the CGHS for CGHS beneficiary and CGHS Doctor may clearly mention on the prescription for what type of treatment/OPD consultation is to be taken at empanelled hospital (Auth: MH & F.W. OM No.Z.15025/117/2017/DIR/CGHS/EHS, dated- 15.01.2018)
  • Certificate ‘A’ is required in case of OPD treatment taken at AMA. (Auth: M.H & F.W. OM No. H.11022/01/2014-MS, dated-15.07.2014)
  • In OPD case, Prescription slip of treating doctor clearly indicating Medicines description and Pathology test is to be enclosed with the claim. (Auth: M.H & F.W. OM No. Z.15025/ 117/ 2017/DIR/ CGHS /EHS, dated- 15.01.2018)
  • Details/ Bifurcation of all medicines, lab tests, investigations, no. of consultation etc is to be included in IPD/OPD bills and submitted separately. (Auth: M.H & F.W. OM No. S.11011/9 /2012-CGHS(P), dated-05.06.2014)
  • Photocopy of CGHS card for CGHS beneficiary. (Auth: M.H & F.W. OM No. S.11011/9/2012-CGHS(P), dated-05.06.2014)
  • In IPD Case, Bed History Sheet/Bed Head Ticket ie prescription sheet during admission is to be enclosed with the claim.
  • Legal heir certificate in case of death of the Govt. servant. (Auth: M.H & F.W. OM No. S.11011/9/2012-CGHS(P), dated-05.06.2014)
  • Discharge Summary of the hospital in case of inpatient treatment. (Auth: M.H & F.W. OM No. S.11011 /9/2012-CGHS(P), dated-05.06.2014)
  • In case of treatment taken as per CSMA rule, all Medicine bills should be verified by the treating doctor with his stamp. (Auth: M.H OM No. F. 1-17/52-LSG(M), dated-18.12.1952)

• Incase of Emergency treatment obtained:
  • In addition to the above documents, the following documents should also be submitted:
• • Emergency certificate (Original) from the treating doctor.(Auth: M.H & F.W. OM No. S.11011/9/2012-CGHS(P), dated-05.06.2014)
  • Self-application of the beneficiary highlighting the emergency circumstances. (Auth: M.H & F.W. OM No. S.11012/1/91-CGHS(P) (Vol. I), dated-18.03.1992)

2. Submission of request for Permission from the Head of the Department involving TA with enclosing following documents:

• Referral letter from the CGHS dispensary/Govt. Hospital may clearly indicate about said treatment is not available at the same station or, referral letter from Govt. Hospital/CGHS dispensary for availing the said treatment in different city with the name of the hospital. (Auth: MH & F.W. OM No. S.14025/7/2000-MS, dated-28.03.2000)

3. The claims for advance should have the following documents:

• Reference letter from CGHS/AMA for taking treatment.
• Estimate of Medical Expenditure with break-up details from the hospital authorities of inpatient treatment. (Auth MH & F.W. OM No. Z.15025/8/ 2021/DIR/CGHS, dated- 22.09.2021)
• Incase of emergency, emergency certificate from the hospital.
• A copy of CGHS card/list of dependent family members.
• Application from the beneficiary/ dependent family members for requisition of advance.

4. Implants: Tax Invoices in Original along with outer pouch and stickers is required for reimbursement of the claims. This is mandatory requirements and cannot be substituted in any way. (Auth: MH & F.W. OM No. S.11011/9/2012-CGHS(P), dated-05.06.2014)

5. Time period of Submission: 6 month in case of non advance case and within 1 month in case of advance cases. {Auth: M.H & F.W. OM No. S-12015/3/93-CGHS(P), dated- 30.12.1993 (for Medical advance) & M.H & F.W. OM No. 1-60/2017-CGHS/C&P/EHS, dated- 01.06.2020 (for non advance case)}

6. All Medical Re-imbursement claims may be sent in duplicate and all enclosed documents may be self-attested.

7. Important: OPD medicines prescribed by empanelled hospital have to be taken from CGHS wellness center. (Auth: MH & F.W. OM No. Z.15025/117/2017/ DIR/CGHS/EHS, dated- 15.01.2018)

8. It is also noticed that some of the officers/staff are transferred to Non-CGHS covered area has not surrender his/her CGHS cards. Those officers/staff who is posted and residing in Non-CGHS covered area, CGHS cards of the self and his/her family members will be forwarded to this office for surrender. (Auth: M.H & F.W. OM No.4-36/99-C&P/CGHS/CGHS(P) , dated-01.07.2005)

CDA has seen.

Ranjan Kumar
Senior Accounts Officer

The post Guidelines for Medical Claim reimbursement claim and Permission cases – CGHS appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.