Subject: Relaxation of procedures to be followed in considering requests for medical reimbursement.
The undersigned is directed to slate that under the extant instructions, a CGHS card holder. who wishes to apply for reimbursement of the expenditure incurred by him / her on medical treatment of either self or his I her dependent family members. the present reimbursement procedure needs verification of bills and issue of essentiality certificate by the treating doctor, and the Medical Superintendent of the hospital. The process of verification of bills and issue of essentiality certificates are time consuming with the doctor at times being busy or being away from office for whatever reason. This necessitates repeated visits to the hospital for getting the verification done and essentiality certificate obtained. Representations have been received in the Ministry of Health 8. Family Welfare requesting for doing away with the two requirements and for the Ministries i authorities concerned to verify and check the authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the Government servant / pensioner. in the event of any doubt, the concerned Ministry / Authority can always get verification done from the hospital concerned.
(a) The treatment was obtained in a private non-empanelled hospital under emergency and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalised for a prolonged period;(b) The treatment was obtained in a private non-empanelled hospital under emergency and was admitted for prolonged period for treatment of Head injury, Coma. Septicemia, Multi-organ failure, etc.;(c) The treatment was obtained in a private non-empanelled hospital under emergency for treatment of advanced malignancy;(d) The treatment was taken under emergency in higher type of accommodation as rooms as per his I her entitlement are not available during that period;(e) The treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections;(f) The treatment was obtained in a private non-empanelled hospital under emergency when there is a strike in Government hospitals:(g) The treatment was obtained in a private non-empanelled hospital under emergency, while on official tour to non-CGHS covered area;(h) Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he is not eligible for air travel I treatment facilities are available in city of residence and(i) Any other special circumstances.
Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File21.pdf
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