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File No.
No. Z.15025/79/2/DIR/CGHS
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Issued From · Date
Nirman Bhawan, New Delhi · 5th October, 2016
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| Government of India · Ministry of Health & Family Welfare · Department of Health & Family Welfare | |
With reference to the above subject the undersigned is directed to state that the matter has been reviewed by the Ministry in view of the difficulties faced by the CGHS pensioner beneficiaries. Therefore, with a view to streamline and to simplify the procedures, it has now been decided to further delegate powers to the Addl. Directors of CGHS Cities / Zones in respect of CGHS pensioner beneficiaries, etc., as under:
Requests for permission / ex-post facto approval for elective treatment / investigations in non-empanelled hospitals / diagnostic centres in respect of Pensioners / ex-MPs / freedom Fighters, etc., shall be considered by Addl. Director of concerned CGHS city / Zone, subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less.
Requests for approval of elective treatment / investigations in empanelled hospitals / diagnostic centres without recommendation of Govt. Specialist or CMO and without prior permission in respect of Pensioners / ex-MPs / freedom Fighters, etc., shall be considered by Addl. Director of concerned CGHS city / Zone, subject to the reimbursement being restricted to CGHS rates or actual expenditure, whichever is less.
| Sl. | Authority | Revised Delegated Powers |
|---|---|---|
| a) | Additional Director, CGHS of City / Zone | Rs. 7,00,000/- |
| b) | Director, CGHS | Rs. 15,00,000/- |
| c) | Addl. Secretary & DG, CGHS | Rs. 25,00,000/- |
| Sl. | Authority | Revised Delegated Powers |
|---|---|---|
| a) | Additional Director, CGHS of City / Zone | Rs. 7,00,000/- |
| b) | Director, CGHS | Rs. 15,00,000/- |
| c) | Addl. Secretary & DG, CGHS | Rs. 25,00,000/- |
Delegation of Powers for Permission / ex-post facto Approval / Settlement of Medical Reimbursement Claims of Individual Beneficiaries / Hospital Bills in respect of Unlisted procedures / Implants (no CGHS rates):
| Sl. | Authority | Original 2016 Powers |
|---|---|---|
| a) | Additional Director, CGHS of City / Zone | Rs. 1,00,000/- (still operative) |
| b) | Director, CGHS | Rs. 1,50,000/- Revised to Rs. 3,00,000/- by OM dated 27.12.2023 |
| c) | Addl. Secretary & DG, CGHS | Rs. 1,50,000/- Revised to Rs. 5,00,000/- by OM dated 27.12.2023 |
| Para | Provision |
|---|---|
| 2. | Revised delegations will not include any case involving relaxation of rules, irrespective of amount. Cases exceeding monetary limits go to Ministry of Health & Family Welfare for obtaining concurrence of Integrated Finance Division. |
| 3. | These delegations are in supersession of all earlier instructions on this matter in respect of the delegations now being conveyed. |
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(Dr. D.C. Joshi)
Director, CGHS
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| Date | Subject & File No. | Link |
|---|---|---|
| 07.04.1999 | No. S-12020/4/97-CGHS(P) Earlier delegation OM on referral / permission / ex-post-facto — superseded by this OM |
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| 05.10.2016 | No. Z.15025/79/2/DIR/CGHS THIS OM Original delegation for pensioner CGHS beneficiaries. Paras (i)–(iv) still operative; Para (v) partially modified (2023). |
| Date | Subject & File No. | Link |
|---|---|---|
| 27.12.2023 |
No. Z.15025/14/2023/DIR/CGHS PARTIAL MODIFICATION Partially modifies Para (v) of this OM. Director, CGHS raised to Rs. 3,00,000/-; AS&DG raised to Rs. 5,00,000/-. Supersedes all earlier delegation OMs. |
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| 28.06.2024 |
No. Z15025/19/2024/DIR/CGHS/EHS LATER OM Revised Referral Guidelines — references the 2023 OM (which modifies this OM) for delegated powers on unlisted procedures (Section B.iv). |
| ► | Para (i): Addl. Director can approve elective treatment / investigations in non-empanelled facilities (limited to CGHS rates or actual, whichever is less) |
| ► | Para (ii): Addl. Director can approve treatment / investigations in empanelled facilities taken without prior permission or CMO recommendation (procedural lapse cases) |
| ► | Para (iii) — Medical Reimbursement: Addl. Director Rs. 7L | Director Rs. 15L | AS&DG Rs. 25L |
| ► | Para (iv) — Hospital Bills: Addl. Director Rs. 7L | Director Rs. 15L | AS&DG Rs. 25L |
| ► | Para (v) — Unlisted Procedures / Implants (original, partially modified 2023): Addl. Director Rs. 1L (unchanged) | Director Rs. 1.5L → Rs. 3L by 2023 OM | AS&DG Rs. 1.5L → Rs. 5L by 2023 OM |
| ► | No case involving relaxation of rules is covered regardless of amount. Cases above limits go to Ministry of HFW with IFD concurrence. |
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