09.10.2020 Referral.pdf

Medical

15 Mar 2026

Z15025/18/2020/DIR/CGHS

Government of India

Min of Hoalt C

amny weitar Department of Health

Directorate General of CGHS

545-A Nirman Bhawan, New Delhi.

Dated the 9 October, 2020

OFFICE MEMORANDUM

Subject: Clarification regarding treatment of CGHS beneficiaries at government hospitals - regarding

With reference to the above subject the undersigned is directed to state that this Minigto is in receipt of several representations seeking clarifications about treatment at government hospitals. In this regard attention is drawn to Office memorandum No S 11013/781 CGHS)( (Vol.l) dt 18.03.1992 vide which guidelines regarding settlement of Claims were issued and to convey the approval of competent authority for issue of tthe folloing clorifinntin

treatment at government hospitals:

1. CGHS beneficiaries have the option to auail Coneultotioe fam / treatment procedures from any Government Hospital Central /State)

Investigations

The definition of "Government hospital" would include any hospital of Central Government /State Government/Government Departments such as Railways Atomin Energy Commission, etc., as also hospitals of Public Sector Undertakings (such as those of the Steel Authority of India Limited/Coal India Limited hocnitoin Municipalities etc.

Normally, many services at government hospitals are free. However, in case any government hospital charges for certain treatments, the same can be availed by way of reimbursement from the authorities concerned as per CGHS approved rates. iv CGHS beneficiariee pboll

boicncianes sal be ellgible for reimbursement as per the ward entitlement he/ she

is entitled as per the criteria prescribed in case of AllIMS. In other government hosnitale who

ully General ward and Nursing home facility are available, CGHS beneficiaries, who are eligible eligible for semi-private ward and higher are eligible for treatmonti

ing Home wards.

v. Reimbursement for Implants shall he limited to CGHS

bed celing rates. The other treatment charges are applicable item wise as per eligible ward entitlement.

vi. In case of treatment at ILBS, New Delhi, NIMS Hyderabad the reimbursement shall be as per CGHS rates

vii. Medical claims are to be submitted through concerned CGHS Wellness Centre in cagA of Pensioners, ex-MPS, etc., and to the concerned Ministry /department /Office in case

of serving employees and to the Raiya Sabha Secretariat /Lok Sabha Secretarint in

case of Members of Parliament and to the concerned Autonomous body in case of CGHS beneficiaries of Autonomous Bodies for reimbursement

(Sanjay Jain)

To Director, CGHS

1. All Ministries / Departments, Government of India

2. Director, CGHS, Nirman Bhawan, New Delhi

3. Estt.l/ Estt.II/ Estt.III/ Estt.IV Sections, Ministry of Health & Family Welfare 4. Admn.I/Admn.Il Sections of Dte.GHS

C

Adur. Direeor, CGHS(HU)7 Addl.DDG(HQ)/Addl. Directors Directors of CGHS Cities Rajya Sabha /Lok Sabha Secretariat 6.

7. Registrar, Supreme Court of India /Puniah & Ha High C 8. Under Secretary, U.P.S.C.

9. Under Secretary Finance Division

Chandigarn

10. Deputy Secretary (Civil Service News), Department of Personnel & Training, 5th Floor Saradar Patel Bhawan, Sansad Marg, New Delhi 11.PPS to AS&MD, NRHM/AS (H) /DGHS

12. Secretary, Staff Side, 13-C, Ferozshah Road. New Delhi

13.

Delhi Office of the Comptroller & Auditor General of India, 10 Bahadur Shah Zafar Marg, New

14 AlLOfficaSontinn

ces/3eltions/ Desks in the Ministry

15.UTI Infrastructure Technology And Services Limited, UTI-ITSL Tower, Plot No3 Sector- 11, CBD Belapur, Navi Mumbai-400614

16. Nodal Officer, MCTC, CGHS with a request to upload a copy of OM on CGHS Web-site

17.All Hospitals empanelled under CGHS through Addl. Director, CGHS of concerned city

18.

1o.ice raer folder

Copy to

PPS to Secretary, HFW

PPS to AS&DG, CGHS, MoHFW

חחח

PPS to JS(AS), MHFW

PS to Director, CGHS

US, EHS. MOHFW

Copy for information to

PPS to Hon'ble HFM

PPS to Hon'ble MOS