F. No. S.11011/11/2016-CGHS(P)/EHS
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
(EHS Section)

Dated, the 28th October, 2022
Nirman Bhawan, New Delhi

OFFICE MEMORANDUM

Subject: Revision of rates of subscription under Central Government Health Scheme due to revision of pay and allowances of Central Government employees and revision of pension/ family pension on account of implementation of recommendations of the Seventh Central Pay Commission.

In partial modification to this Ministry’s O.M. of even number dated 9th January, 2017, the undersigned is directed to say that entitlement of wards in private hospitals empanelled under CGHS as contained in Para 3(B) of the O.M. ibid stands revised as under with effect from the date of issue of this O.M. :

CGHS Updated Rate Card PDF Download

2. This issues with the concurrence of the Department of Expenditure vide their I.D. Note No. 18(1)/EV/2016 dated 11th May, 2022 read with I.D. Note dated 6th October, 2022.

3. Hindi Version follows.

(Guite Elsy Gat Biak Lun)
Under Secretary to Govt. of India

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No.S.11011/29/ 2019-EHS
Government of India
Ministry Of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi – 110 108
Dated: the 13th September,2019

OFFICE MEMORANDUM

Subject: Emergency treatment in CGHS empanelled Hospitals

The extant instructions under CGHS provide that under emergency conditions, a CGHS beneficiary can get admission in any CGHS empanelled Hospital without any prior permission. It has, however, been brought to the notice that the Hospitals deny admission or insist on referral memo from CGHS Wellness Centre even in emergency conditions.

2. In accordance with the Memorandum of Agreement between the CGHS empanelled Hospital and the Government of India, refusal to provide treatment to bonafied CGHS beneficiaries in emergency cases and other eligible categories of beneficiaries on credit basis, without valid ground, would attract disqualification for continuation of empanelment.

Also check:  CGHS medical facilities reimbursement to Central Government pensioners

3. It is, therefore reiterated that in emergency the empanelled hospitals will not refuse admission or demand an advance payment from the CGHS beneficiary or his family member and will provide credit facilities to the patient.

(Rajeev Attri)
Under Secretary to the Govt. of India
(Tel.011 – 2306 1883)

Source – CGHS

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CGHS

S-1101110912019/ Addg.HQ/ CGHS
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

Nirman Bhawan, New Delhi
Dated the 14th January,2020

OFFICE MEMORANDUM

Subject: Notification of CGHS Rates for 15 Investigations under CGHS

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office memorandum No S.11045/ 36/2012-CGHS (HEC) dated 01.10.2014 vide which CGHS package rates for various treatment procedures and investigations were notified by the Government for Health Care Organizations (HCOs) empanelled under CGHS and to state that representations from various stake holders regarding non-availability of CGHS rates for some of the investigations have been received in this Ministry. The matter was reviewed and it is now decided to notify CGHS package rates for the following investigations and their inclusion in CGHS rate list as under:

The rates for investigations from S.No.1 to S.No.13 are for Non-NABL/ Non-NABH accredited HCOs. The rates for NABL/ NABH accredited HCOs shall be 15% more. The rates from S.No.14 &15 shall be common for both NABH-accredited /Non-NABH accredited HCOs.

Also check: CGHS medical facilities reimbursement to Central Government pensioners

These rates shall come in to force from the date of issue of the letter.

This issues with concurrence of Integrated Finance Division of Ministry of Health & Family Welfare vide CD No 3495 dated:13.01.2020.

Sd/-(Dr. Manoj Jain)
Addl. DDG (HQ), CGHS

Read this: CGHS – Medical benefits to dependent parents of Central Government Employees

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Medical benefits to dependent parents of Central Government Employees

13 DEC 2019

For availing of medical facilities under Central Government Health Scheme (CGHS), parents are deemed to be dependent on the Central Government employee if they are normally residing with the employee and their monthly income from all sources including pension/ family pension does not exceed Rs. 9,000 plus the amount of Dearness Relief thereon. This condition of dependency is applicable to Pensioners of State Government(s) as well.

Also check: CGHS medical facilities reimbursement to Central Government pensioners

Regarding any scheme for providing medical facility to the dependent parents of employees of private sector, The Employees’ State Insurance (ESI) Act, 1948 read with ESI (Central) Rule, 1950 provides for medical benefits to the dependent parents of the Insured person i.e. an employee who works in a factory/ establishment having 10 or more workers & registered under the said Act and drawing salary less than Rs. 21,000 per month (Rs. 25,000 in case of persons with disability). Income limit for dependency of parents from all sources is Rs. 9,000 per month. The ESI Act is not applicable to Central Government employees and their dependents.

The Minister of State (Health and Family Welfare), Sh Ashwini Kumar Choubey stated this in a written reply in the Lok Sabha here today.

PIB

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Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

No S. 11012/15/2015-CGHS-l/I

Nirman Bhawan, New Delhi 110011
Dated the 19th February, 2019

OFFICE ORDER

Subject: Opening of CGHS Wellness Centre (Allopathic) at Varanasi

This is for information of all eligible Central Govt. employees/ Central Govt. Pensioners, ex-MPs and other eligible stakeholders that a Central Government Health Scheme (CGHS) Wellness Centre has started functioning at Type -III Govt. Quarters 98-100 at Kendriya Colony , Bada Lapur, Sindhoura Road , Chandmari , Varanasi from 19th February, 2019 to provide comprehensive medical facilities.

The CGHS Wellness Centre (1) at Varanasi shall cover all eligible Central Govt. Employees residing within 5 km radius of the Wellness Centre and eligible pensioners and ex-MPs , etc., living in and around Varanasi as per CGHS guidelines.

The CGHS beneficiaries shall be able to avail the CGHS facilities through the Wellness Centre from 0730 a.m. to 02.00 p.m. on all days, except Sundays and Gazzetted holidays.

The CGHS wellness Centre shall be under the administrative control of Addl Director, CGHS, Allahabad (Tel No 0532-256 0578).

(Dr. Atul Prakash)
Director, CGHS

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GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY WELFARE
OFFICE OF THE ADDITIONAL DIRECTOR
CENTRAL GOVERNMENT HEALTH SCHEME
54 SOUTH CHHAJUBAGH PATNA-800 001.

No.5-2/2018-19/Covered Area/CGHS(PAT.)/ 3355

Dated the 17th April 2018.

OFFICE MEMORANDUM

Subject :- Demarcation of CGHS Patna covered area under CGHS Wellness Centre – reg.
With reference to the above noted subject the undersigned is to state that the demarcation of CGHS Patna covered area has been reviewed and now it has been decided that under mention areas will be covered by the CGHS Patna:-

West :- Danapur Cantt. Area to Danapur Railway Station, Khagaul along Danapur-Khagaul Road and adjoining areas upto 500 Metre.

North :- Upto the Bank of Ganga River

East :- Upto the Sabalpur along Patna Bypass Road and adjoining area upto the Beur, Patna area.

South :- Anishabad-Janipur Road including Phulwarishariff and along AIIMS-Khagaul Road upto the Khagaul and adjoining area.

The serving Central Government Employees residing outside the CGHS covered areas shall be covered under CS(MA) Rules. However, the serving Central Government Employees residing within the Municipal limits of the city, shall be given a onetime choice to opt for CGHS (instead of CS(MA) Rules) from the nearest CGHS Wellness Centre.

Sd/-
(Dr. Shib Shankar Shah)
Additional Director, CGHS
demarcation-of-cghs-patna-covered-area

Source: CGHS

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No: S.11011/03/2018-CGHS (HEC)
Government of India
Directorate General of Central Government Health Scheme
Department of Health & Family Welfare

Nirman Bhawan, New Delhi.
Dated the 11th April, 2018

OFFICE ORDER

Subject: Empanelment of private hospital (including dental clinics and eye centres) and diagnostic centres under CGHS Delhi & NCR.

In continuation of this Directorate’s Office Memorandum of even no. dated 26.12.2017 regarding empanelment under continuous empanelment scheme, 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 (including dental & eye centres) and diagnostic laboratories as per the list attached (22 HCOs) have also been empanelled under CGHS in Delhi & NCR with issuance of this order. The newly empanelled hospitals (including dental clinics & eye centres) and diagnostic laboratories may be treated as included in the existing list of empanelled health care organization under CGHS on same terms and conditions as have been indicated in the Office Memorandum dated 26.12.2017.

Encl: As above

[Dr. D.C. Joshi]

Director (CGHS)

Source: CGHS

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CGHS empanels eligible private hospitals as and when they apply and sign Memorandum of Agreement as per terms and conditions of empanelment under tender process/continuous empanelment scheme.

Some private hospitals have opted out of CGHS. The details are at Annexure.

The above statement said in a written reply to a question in Parliament on 20.3.2018 by the Minister of State for Health and Family Welfare Shri Ashwini Kumar Choubey.

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UNSTARRED QUESTION NO: 4758
ANSWERED ON: 23.03.2018

Delay in Payment to Empanelled Hospitals

RAJIV PRATAP RUDY

Will the Minister of

HEALTH AND FAMILY WELFARE be pleased to state:-

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether there is a delay in the payment to empanelled hospitals under Government sponsored health programmes such as Central Government Health Scheme (CGHS) and Rashtriya Swasthya Bima Yojana (RSBY);

(b) if so, the details thereof and the reasons therefor;

(c) whether CGHS and RSBY has been effective in reducing the burden of out of pocket spending of poor households, if so, the details thereof; and

(d) the total number of beneficiaries and total funds allocated under CGHS and RSBY over the last four years, State/UT wise including Bihar?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)

(a) & (b): Under CGHS there is some delay in payment to empanelled hospitals. Following are the reasons for delay in settlement of hospital bills under CGHS:-
i. Resource constraints particularly in the last quarter of Financial Year.
ii. Need for consultation with Specialists in some cases.
iii. Time taken in scrutinizing of Hospital bills.

Under RSBY, Insurance Companies make payment, as due and admissible, to the empanelled hospitals as per their claim. Details are not maintained at Central level.

(c): Under CGHS, the beneficiaries, who are primarily Central Government Employees and Pensioners, are provided health facilities including OPD, medicines, reimbursement of expenditure incurred on hospitalization etc. and they do not have to incur out of pocket expenditure. They have to bear additional expenditure only if they opt for specific brand of implants costing more than CGHS rates.

Under RSBY, claims amounting to Rs. 5012.17 Crore have been settled since 2011-12 to 2016-17, which may be construed as a reduction in out of pocket expenditure for the beneficiaries under RSBY, who have availed the hospitalization benefits.

(d): There are 32,53,219 number of CGHS beneficiaries as on 13.03.2018.

The total funds allocated under CGHS over the last four years is as under:-

Year Funds Allocated (Rupees in Crores)

2013-14 1772.75
2014-15 1734.02
2015-16 1872.29
2016-17 2026.91

Under RSBY no funds are allocated to States. Funds as central share of premium are released on receipt of proposals from State Governments. The State-wise list of beneficiaries under RSBY over the last four years including Bihar is at Annexure.

Source : LokSabha

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Ministry of Defence
Department of Defence
D(Civ-II)

MoD ID No.12(10)/2017/D(Civ-II)

Dated: 13.02.2018

Subject: Grant of Fixed Medical Allowance to Central Government Civil Pensioners residing in areas not covered under Central Government Health Scheme-reg.

A copy of Deptt of Pension & Pensioners Welfare O.M.No.4.34.2017-P&PW(D) dated 31.01.2018 on the above mentioned subject is forwarded for information and necessary action.

Encl.As above

(Pawan Kumar)
Under Secretary to the Govt of India

Source: www.mod.gov.in

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