Medical Card Archives - CENTRAL GOVERNMENT EMPLOYEES NEWS

Prescribed maximum per day package rates for Covid related treatment in private hospitals in NCT of Delhi

admin — Mon, 23 Nov 2020 05:01:31 +0000

Prescribed maximum per day package rates for Covid related treatment in private hospitals in NCT of Delhi

package rates for Covid related treatment

Tele 25683476
Mil 36833

Central Organisation ECHS
Adjutant General’s Branch
Integrated Headquarters
Ministry of Defence (Army)
Thimayya Marg, Near Gopinath
Circle. Delhi Cantt-110010

B/49770/AG/ECHS/ Treatment

11 Nov 2020

IHQ of MoD (Navy)/Dir ECHS (N)
DAV Subroto Park
All HQ Command (Med)
All HQ Command (ECHS)
AMA ECHS Embassy of India. Nepal
All Regional Centres

RATES FOR TREATMENT AT PRIVATE HEALTH CARE ORGANIZATIONS (HCOs) EMPANELLED UNDER ECHS-IN VIEW OF THE COVID-19 PANDEMIC

1. Refer to this HO letter No B/49773/AG/ECHS/Rates/Policy dated 29 Jul 2020.

2. It was promulgated vide above letter that rates for treatment for Coved-19 in private empanelled hospital in respect of ECHS beneficiaries in a city shall be as per the package rates prescribed by the concerned state government. In case no such rates have been prescribed by the state government in any ECHS city, the rates prescribed by government of NCT Delhi shall be applicable till rates are notified by the concerned state government.

3.The rates for NCT Delhi have been promulgated vide Govt of NCT Delhi order No 52/DGHS/ PH-IV/COVID-19/ 2020/prsecyhfw/ 14450-14649 dt 20 Jun 2020. The prescribed maximum per day package rates for covid related treatment in private hospitals in NCT of Delhi are as below

Hospital rates for per day of admission (in RS.)

Category of Hospitals	Moderate Sickness	Sever Sickness	Very Severe Sickness
	ISOLATION BEDS Including supportive care and oxygen	ICU without need for ventilator care	ICU with ventilator care (invasive/non invasive
NABH accredited Hospitals (including entry level)	10,000/- (including cost of PPE Rs.1200/-)	15,000/- (including cost of PPE Rs.2000/-)	18,000/- (including cost of PPE Rs.2000/-)
Non-NABH accredited Hospitals	8,000/- (including cost of PPE Rs.1200/-)	13,000/- (including cost of PPE Rs.2000/-	15,000/- (including cost of PPE Rs.2000/-)

Covid-19 Testing

(State Rate or ICMR Rates)

4 .As laid down the above rates are inclusive of PPE rates indicated. The rates of PPE will be applicable in all caws/ states where PPE cost are not specified by respective State Govts.

5.ECHS empanelled Health Care Organizations (HCOs) shall perform the treatment/ test on cashless basis in respect of ECHS beneficiaries and submit the bills to ECHS through UTIITLS. The reimbursement for the cost of expenditure on the test at approved rates shall be reimbursed.

6.These order comes into effect from 29 Jul 2020. the date of issue of this letter at para No 1 above

(Panchal Kalpeshkumar S)
Lt Col Jt Dir (Med) for Dir (Med)

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Procedure to process of medical reimbursement claim – CHECK LIST FOR PROCESSING MEDICAL CLAIM

admin — Mon, 23 Nov 2020 03:18:34 +0000

Medical Reimbursement Claim – Central Government Employees

By SPEED POST

F.No.D-12015/06/ 2020-Ad.IX
Government of India
Ministry of Finance
Department of Revenue
Central Board of Direct Taxes

Room No.10, 5th Floor,
Jeevan Vihar Building,
Parliament Street, New Delhi – 110001

Dated : 28.10.2020

All Principal Chief Commissioner of Income Tax
All Director General of Income Tax (Inv.)

Sub : Streamlining of procedure to process of medical reimbursement claim.

Sir/Madam,

It has been observed that the medical reimbursement claims are being received in the Board, are incomplete and not subjected to any initial check. As a result a lot of time is spent on further communications resulting in delay in settlement of the claim.

2. It has therefore been decided that in future all medical claim are to be submitted to the Board on the basis of the attached Check List with proper referencing of the documents with page number and Annexure.

3. Offices of the Pr. CCIT and DGIT (lnv.) are requested for wide circulation of this advisory amongst the all subordinate offices under their control.

Yours Faithfully

Biswajit Guha
Under Secretary to the Govt. of India
Telefax: 011-23741823

Copy to : IFU/DT for information

Reimbursement of medical claims to pensioners residing in non-CGHS areas – DoT

CHECK LIST FOR PROCESSING MEDICAL CLAIM

Name & Designation of the Claimant: —————-

Office where working: —————-

Name of Patient & relationship with claimant: —————-

*S.No.*	*Detail about the claim*	*Remark*	*Page No.I Annexure*
1	Whether the patient is a CGHS beneficiary availing benefits under the Scheme. If, so whether a copy of the CGHS Card is enclosed.	Yes/No
2	In case of non-CGHS beneficiary, whether an AMA was appointed, and if so, whether the Appointment Order of AMA is enclosed.	Yes/No
3	Whether Medical Claim Form (duly filled in) has been submitted	Yes/No
4	Whether the claim was submitted within the stipulated period of three months from the date of discharge from the hospital.	Yes/No
5	If delayed, whether reasons for delay beyond 3 months was intimated.
6	Name of Hospital from where the treatment was taken/is being taken.
7	Whether the treatment was obtained from a Government Hospital or CGHS empanelled Private Hospital.	Government Hospital/ CGHS Empanelled Hospital/Non- empanelled hospital
8	In case of CGHS empanelled hospital, whether a copy of the Order/OM is enclosed.	Yes/No
9	Whether the case was referred by CGHS Doctor/AMA. If so, whether a copy of the ‘Referral slip’ is enclosed.	Yes/No
10	In case of treatment was obtained from a Private hospital under emergency, whether Emergency Certificate is enclosed in original.	Yes/No
11	Whether the permission was taken from the concerned office. If so, whether a copy of ‘Permission letter’ is enclosed.	Prior permission or Ex-facto permission
12	Disease(s) being treated
13	Whether the claim for reimbursement has been approved by the H.O.D.	Yes/No

14	Details of payments made by the employee.
15	Whether the treatment was obtained on credit basis. If so, whether a copy of the permission given by his/her office.	Yes/No
16	Whether ‘prescription slips’ of ‘day-to-day report’ of the treating doctor/hospital are enclosed.	Yes/No
17	Whether the Medical Bills of the Hospital are enclosed in original and certified.	Yes/No
18	Total amount of bills given by the Hospital
19	Whether the Discharged Summary has been enclosed in original.	Yes/No
20	Whether a table indicating each item of expenditure charged by the hospital vis-a-vis actual admissible amount as per CGHS rate/CS(MA) Rules, duly authenticated by the HoD concerned has been forwarded with the claim.	Yes/No
21	Amount admissible for reimbursement as per CGHS/CS(MA) Rates.	Rs.
22	A copy of CGHS rate list highlighting the treatment procedures done in the hospital.	Yes/No
23	Outer Pouch of the Stents used for the patients in the hospital is/are enclosed in original.	Yes/No/N.A.
24	A copy of Death Certificate was furnished (in case of death).	Yes/No/N.A.
25	Affidavit on Stamp paper was submitted by the Claimant (in case of death)	Yes/No/N.A.
26	Whether any medical advance was sanction. If so, the amount sanctioned and a copy of the Sanction Order to be enclosed.	Yes/No
27	Net amount to be sanctioned (after adjustment of Medical Advance, if sanctioned)	Rs.
28	Whether a self explanatory letter from the beneficiary if treatment taken in emergency has been enclosed.	Yes/No

medical reimbursement claim

CHECK LIST FOR PROCESSING MEDICAL ADVANCE

Name & Designation of the Claimant:

Office where working:

Name of Patient & relationship with claimant:

*S.No.*	*Detail about the claim*	*Remark*	*Page No.*
1	Whether the patient is a CGHS beneficiary availing benefits under the Scheme. If, so whether a copy of the CGHS Card is enclosed .	Yes/No
2	In case of non-CGHS beneficiary, whether an AMA was appointed, and if so, whether the Appointment Order of AMA is enclosed.	Yes/No
3	Name of Hospital from where the treatment is being taken/proposed to be taken.
4	Whether it is a Govt. Hospital or CGHS empanelled private hospital or Non-CGHS empanelled hospital
5	In case of CGHS empanelled hospital, whether a copy of the OM of its empanelment is enclosed .	Yes/No
6	Whether the case was referred by CGHS Doctor/AMA. If so, whether a copy of the ‘Referral Slip’ is enclosed.	Yes/No
7	Whether credit facility is extended to the patient.	Yes/No
8	Whether approval of H.O.D. was obtained.	Yes/No
9	Estimated cost for the treatment given by the hospital.	Rs.
10	Whether the admissible amount has been restricted as per CGHS rates I CS(MA) Rules I Govt. hospital rates.	Yes/No
11	Amount of Advance admissible for sanction	Rs.

Proforma for item-wise expenditure charged by the hospital vis-a-vis actual admissible amount as per CGHS rate/ CS(MA) Rules, duly authenticated by the HoD concerned

Name & Designation of the Claimant:

Office where working:

Name of Patient & relationship with claimant:

Name of the Hospital and address;

Duration of the Treatment:

SI. No.	Items	Amount Charged	Amount admissible as per CGHS rate/ CS(MA) Rules	Remarks
1)	Bed Charges			Annexure – 1
2)	ICU Charges			Annexure -2
3)	Doctors’ Visit			Annexure -3
4)	Medicines			Annexure -4
5)	Lab/ Test Charges			Annexure -5
6)
7)
8)
9)
10)

medical reimbursement claim

Checked and verified by:

Signature with stamp

Certified and authenticated by HoD

Signature with stamp

Annexure

Proforma for Item-wise details

Name of item : Medicines

SI. No.	Date	Name of medicines	CGHS Code	Amount Charged	Amount admissible as per CGHS rate / CS(MA) Rules	Remarks
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

medical reimbursement claim central government employees

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CGHS serving employees and pensioners CHECKLIST FOR ISSUE OF PERMISSION FOR HEARING AID DEVICE

admin — Sat, 21 Nov 2020 06:06:08 +0000

CGHS serving employees pensioners issue for Hearing Aid Device

CHECKLIST FOR ISSUE OF PERMISSION FOR HEARING AID DEVICE

(The following format is for CGHS serving employees and pensioners based on OM No. S.14025/10/2002/MS, MOHFW dated 26/5/2015. Similar format for checklist may be used by Departments/ Ministries/ Autonomous bodies for their employees)

S No	Documents to be enclosed duly indexed and numbered
1	Request letter of CGHS serving / pensioner beneficiary duly forwarded by CMO l/C with despatch number of WC.
2	Copy of plastic card of CGHS serving /pensioner beneficiary(ies) (card holder and dependent who need the machine)-duly verified by CMO l/C with stamp
3	Computerized referral slip from PARENT WC duly signed by the CGHS doctor.
4	Prescription from Govt. ENT Specialist carrying: (a) Pure Tone Audiometry (PTA) report along with diagnosis based on the report (b)Audiometry number (c)Type of Hearing Aid advised as treatment (d)Sign and stamp of Govt. Specialist with name
5	PTA report in original carrying (a) PTA report along with diagnosis (b) Audiometry number (c) Countersign and stamp of Govt. Specialist with name
6	Undertaking from the main card holder that no reimbursement of Hearing Aid device from CGHS, has been done in the last five years, in respect of himself/ his dependent in need of the Hearing Aid.
7	Undertaking by CMO l/C that as per records of the Wellness Centre, no permission for Hearing Aid has been issued to the beneficiary in need of the Hearing Aid, in the last five years.
8	In those cases where permission for a new hearing aid device is being sought and cost of old device has been reimbursed by CGHS more than 5 years back, a condemnation certificate from a technical expert duly countersigned by Govt. ENT specialist, needs to be enclosed, regarding the irreparable condition of the old device.
9	If representative of pensioner beneficiary is being sent to the Office of Additional Director to collect the permission letter then, the following are needed:1. authority letter from pensioner beneficiary in favour of the representative2. Photocopy and original ID card of representative.3. Original plastic card to be sent with representative

CGHS card is valid till ————— (dd/mm/yy) as per CGHS database.

The beneficiary has retired from Department ———— and whether Autonomous body or no (Yes/No).

Contact number of beneficiary is ———— email ID is ———— Forwarded to Additional Director CGHS ————- (city/zone) for necessary action.

Name of CMO l/C / officiating CMO l/C ——————-

Wellness Centre ————————-

Signature and stamp of CMO l/C ——————————-

*Please note-All information as required in the above checklists needs to be filled mandatorily.

CGHS employees pensioners issue for Hearing Aid Device

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