05.10.2016 Ex-post-facto-approval-in-respect-of-Pensioner-CGHS-beneficiaries-etc. (1).pdf
No: Z.15025/79/2/DIR/CGHS
44-408
Government of India
Ministry of Health and Family Welfare Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108
Dated the 5th October, 2016
OFFICE MEMORANDUM
Subject:- Delegation of powers for settlement of reimbursement claims/Permissions /ex-post
facto approval in respect of Pensioner CGHS beneficiaries, etc.,
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With reference to the above subject the undersigned is directed to state that 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:
i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs /
Imaging Centre:
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
ii) Permission/ ex-post facto approval in cases involving procedural lapse:
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.
iii) Delegation of Powers for Settlement of Medical Reimbursement Claims (at approved rates) of
Individual Pensioner Beneficiary, etc.,
| 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/- |
iv) Delegation of Powers for settlement of Hospital Bills (at approved rates) for the Treatment
given to Pensioner Beneficiaries, etc.,
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/-
v) 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)
If there is no CGHS package rate for treatment / CGHS Ceiling rate for implant approval shall be granted as per AIIMS package rate (if only procedural charge, it shall not be considered as package rates)/ AIIMS rate for implant and if there is no CGHS/AIIMS rate approval shall be granted as per actual rate.
| Revised Delegated Powers | ||
|---|---|---|
| a) | Additional Director, CGHS of City /Zone | Rs 1,00,000/- |
| b) | Director, CGHS | Rs. 1,50,000/- |
| c) | Addl Secretary & DG,CGHS | Rs. 1,50,000/- |
2.
The revised delegations mentioned above will be subject to the conditions that it will not
include any case involving relaxation of rules, irrespective of the amount involved. Further, cases
where the amounts exceed the monetary limits prescribed above will have to be referred to the
Ministry of Health & Family Welfare for obtaining the concurrence of Integrated Finance Division in the
Ministry of Health & Family Welfare.
3.
The above delegations are in supersession of all the earlier instructions in the matter in
respect of the delegations now being conveyed.
This issues with the concurrence of Integrated Finance Division, Ministry of Health &
Family Welfare, vide Dy. No C-3373 dt. 20.09.2016
Linest.
5-10-2016
(Dr.D.C. Joshi)
Director, CGHS
To
1. C.C.A, MOHFW, Nirman Bhawan, New Delhi
2. Addl. DDG(HQ), CGHS, MOHFW, Nirman Bhawan, New Delhi
3
4.
6.
7.
9.
AD(HQ), CGHS, R.K.Puram, Sector-12. New Delhi
All Addi. Directors of CGHS cities outside Delhi
Additional Director (SZ)/(CZ)/(EZ)/(NZ)/(MSD), MCTC CGHS, New Delhi JD(HQ), JD (Grievance)/JD (R&H), CGHS, Delhi
Director(Policy), MoHFW, Nirman Bhawan, New Delhi
Hospital Empanelment Cell, CGHS, MoHFW, Nirman Bhawan, New Delhi CGHS-1///IV, Dte. Gen of CGHS, MOHFW, Nirman Bhawan, New Delhi
10. Integrated Finance Division, MoHFW, Nirman Bhawan, New Delhi
11. All Pay & Accounts Offices, Min. of Health & Family Welfare
12. Deputy Secretary (Civil Service News), Department of Personnel & Training, 5th Floor,
Sardar Patel Bhawan, New Delhi
13. Shri Umraomal Purohit, Secretary, Staff Side, 13-C. Ferozshah Road, New Delhi
14. All Staff Side Members of National Council (JCM)
15. ED(H)/Planning, Railway Board, Ministry of Railways, Rail Bhawan, Rafi Marg, New Delhi-
110001
16. Central Organization, ECHS Department of Ex-Servicemen Welfare, Ministry of Defence,
New Delhi
17. Chairman, Employees State Insurance Corporation. Ministry of Labour & Employment,
Panchdeep Bhawan, C.I.G. Marg, New Delhi-110002
18. UTI-ITSL, 153/1, First Floor, Old Madras Road, Ulsoor, Bengaluru-560008
19. UTI Infrastructure Technology And Services Limited, Plot No 3, Sector 11, CBD Belapur
Navi Mumbai, PIN - 400614
20. Hindi Section, MoHFW, Nirman Bhawan, New Delhi for providing Hindi version of this OM. 21. Guard file
Copy for information to:
Secretary MoHFW, Nirman Bhawan, New Delhi
2 Addl. Secretary &DG.CGHS, MoHFW, Nirman Bhawan, New Delhi
3
Under Secretary, Directorate of Public Grievances, 2nd Floor, Sardar Patel Bhawan, Sansad Marg, New Delhi-110001.