28.06.2024 CGHS revised guidelines.pdf
File No.: Z15025/19/2024/DIR/CGHS/EHS(Comp No. 8281286) W3687286/2024
Government of India
Ministry of Health & Family Welfare
(EHS Section)
Nirman Bhawan, New Delhi
OFFICE MEMORANDUM
Dated the 28-06-2024
Subject: Revised guidelines for Referral Process in CGHS-reg. In partial modification of MoHFW OM No. Z.15025/117/DIR/CGHS/EHSS dated 15.01.2018 and 10.12.2018, the undersigned is directed to convey approval of the Competent Authority for issue of revised guidelines for referral procedures for Consultation. Investigations and Treatment in Government and Private hospitals (empanelled with CGHS), as per details given below:
A. In continuation of OM No Z.15025/18/2020 dated the 09.10.2020 the term "Government hospital", shall also include all AIIMSS, Institutions of National Importance (INIs), North East Institutions, Tata Memorial Hospital and all other medical institutions
under
central
government. No
referral'permission/endorsement shall be required
for undergoing
consultation investigation/ investigations/procedures.
treatment
procedure
including unlisted
B. Treatment at Private empanelled hospital(s):
i. Single referral for Specialist Consultation: A referral issued by any Medical Oficer of a CGHS Wellness Centre will be valid for three months. During this period. the beneficiary may consult two more specialists i.e. up to total of three specialists, if recommended by the primary specialist. A maximum 6 consultations shall be allowed during this validity period of 3 months.
. Investigation and treatment Procedures advised by specialist of empanelled private hospital after referral by CGHS: No further endorsement from CGHS shall be required for undergoing routine listed investigations and minor procedures, not requiring admission in the hospital, as advised by the specialist, within the validity period of 3
months from the date of issue of the initial referral. However, Referral/endorsement from CGHS shall be required for special investigations like CT Scan, MRI Scan, PET Scan and any other investigation costing over Rs. 3.000/- and the reterral will be valid for 3
months.
ii. Correspondingly, relerral endorsement would be required from Medical Officer of CGHS for any procedure requiring admission in the hospital, which would be valid for 3 month.
iv. Unlisted investigation(s) and treatment procedures advised by the Specialist of CGHS empaneled hospital: Permission for undergoing
such investigations and treatment procedures shall be considered as per the delegated powers vide OM Z.15025/14/2023/ DIR/CGHS dated 27.12.2023 in case of pensioners and OM No. S 12020/4/97-CGHS(P) dated 07.04.1999 in case of serving employees. i.e.
a. CGHS (Additional Director/ Director) in case of Pensioner beneficiaries.
b. Head of the Department/ Ofice (HOD/HO0) in case of serving employee(s)
v. In partial modification of O.M. No. Z15025/35/2019/ DIR/CGHS/CGHS(P) dated 29.05.2019, the special provision for CGHS beneficiaries to avail Consultation/investigations/treatment procedures shall hereinafter apply to CGHS beneficiaries aged 70 years and above. as against 75 years prescribed in OM as mentioned above dated 29.05.2019. The other conditions shall remain unchanged. The beneficiaries can also avail of the services through tele-consultation
facility available through e-Sanjeevani (https://esanjeevani.mohfw.gov.in/).
2.0
vi. In case of treatment under emergency and post-operative follow-up treatment, the instructions shall remain as per extant rules. Reference Instructions:
a. O.M. No. S.I101V29/2019-EHS dated 13.09.2019.
b. O.M. No. Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019 (regarding post-operative follow-up treatment).
Signed by
Hemlata Singh
bdedeig6OM4:28:11
Under Secretary to the Government of India
Tel 011-23061778.
To
1. All Ministries and Departments of the Government of India through the CGHS website
2. Addl. Director, CGHS(HQ)/ Addl. DDG(CGHS)/ Addl. Directors, CGHS of
Cities / Zone.
3. All CGHS Wellness Centres through concerned AD, CGHS
4. MCTC, CGHS with the directions to upload the document on CGHS Website (www.cghs.gov.in).
5. All HCOs empanelled under CGHS through CGHS website.
6. Director, AllMS as per list; JIPMER, Puducherry; PGIMER, Chandigarh; 7. DDG NIC Health with the request to modify the CGHS application. 8. Sh. Jitendra Singh, CDAC, Noida
9. CEO & MD NHA with the request to kindly inform the Claim Processing Doctors regarding the referral process.
10. LACs/ ZACs through Addl. Directors, CGHS.
11. Sanctioning Authorities in CGHS.
12. CMO Hospital Cell, CGHS HQ.
13. All CGHS empanelled private hospitals through Additional Director of concerned city
Copy of Information to:
1. PPS to Secretary (H&FW). MoHFW
2. PPS to Secretary (Personnel), DoPT, MoPPG&P
3. PPS to Secretary(DARPG &DoPPW), MoPPG&P
5. PPS to JS (MoHFW), CGHS Hemlalí rgh
4. PPS to AS & DG CGHS
28|06|24
(Hemlata Singh) Under Secretary to the Government of India
Tel 011-23061778
Fi le N o.Z1 50251 1 17 12017/Dl R/CGHS
ffi tr#
z 15025 / t t7 /20 t7 tDtR/cGHS/ EHS
Goyernment of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
EIIS Section
**Jr*
Nirman Bhawan, Nerv Delhi
Dated the 15'h January,2018
OFFICE VIEMORANDUM
Sub: Simplilication of referral system uncler CGI{S
,rr**
With reference to the above mentionecl subject the undersigned is directed to state that this Ministry has b."n ."."i-iing representations for simplification of procedure for CGHS beneficiaries to Lrndertake treatment at private hospitals empanellecl under CGHS. The guidelines issued earlier on referral/ permission under office Memorancla No S I l0lll6/g6-cGHS (p) clt. I116197 and 02/09199, s-1202014197 -CGHS (P) ctt. 07t04n999, s. nln/t/200-ccHs (p) dr. 1010412001 and RA/cons/H ydl09-10/CGHS-Iv, datecl I t/o6t2at0 and z'15025110512017lDlR/cGHS clt. ogllll2olT has been revierved and it has now been decided to revise the guidelines fbr consultation and treatment at CGHS empanelled private hospitals as per the details given under:
i) All CGHS beneficiaries (in all CGHS Cities) shall be permitted for seeking opD consultation from Specialists at Private hospitals empanellid under CGHS afte;being ref'erred by any Medical officer/cMo or bcus wellness Centre. The referral may be mentione.d on the computer -generated Prescription slip. After consultation at empanelled hospitals beneficiary shall report back to concerned wellness centre, rvhere Mo/CMo would endorse listed investigation and issue medicines"u. p.. guidelines mentioned below. For unlisted inveltigation/treatment proceclure CMo Incharge shall submit the prescription to competent iLrthority for consideration in case of pensioner beneflciaries. Serving emplol,ees shall seek permission for unlisted . inYestigation/treatment procedure lrom their'department as per prevailing guidelines. ii) The medicines prescribed by specialists shall be supplied by CGHS as per the available -generic name at the cGHS weilness centre.
File No.Z1 50251 1 17 12017lDl R/CGHS
In case the medicine prescribed by the Specialist is available by an alternative brand name having the same composition. it shall be supplied by the brand name available at CGHS Wellness Centre.
If, the medicine prescribecl by the Specialist is not available at CGHS Wellness Centre either by generic name or alternate brand name, it shall be indented by the same brand name through Authorized Local Chemist.
iii) With reference to OM 2.15025110512017/DIR/CCHS dated 09llll20l7, it is clarified that the validity of the advice of Central Government /State Government Specialist / CGHS Medical otficer fbr listed treatment procedures shall be treated as valid fbr three months unless mentioned otherwise and no other referral (permission) letter is required to under-{o. the treatment procedure at any of the empanelled Hospitals. It is also clarified that once a specific treatment procedure (listed) has been advised by a Specialist of Central Government /State Government or a CGHS Medical officer, it is the option of CCHS beneficiary to undergo at any of the CGHS empanelled hospitals of his/her choice and it is not compulsory that Specialist /CGHS Medical officer shall ref-er the beneficiary for treatment to any CGHS recognizecl hospitals.
iv) In case of Haemo-Dialysis, the advice for treatment can be macle upto six months and in such cases thg advice shall be valid for upto six months.
v) In case of Radio-therapy lChemotherapy advised by a Government Specialist the advice shall be valid for all the cycles of Radio+herapy/Chemotherapy. The specialist has to specify the specific Radio-therapl'procedure. Self-attested (by beneficiary) photo-copies of the permission letter is required to be submitted.
vi) In case of post-operative fbllor,v up treatment in six conditions as specified in OM dated 10.04.2001, permission fbr follou.up treatment shall be required from competent authoritl,.
vii) In case of non-listed investigations / treatment procedures permission from competent authority is required to be obtained.
2. This issues with the approval of competent guidelines.
authority in supersession of earlier Lder Singh.l
Under Secretary to Government of India
Tel- 011-23062666
To:
All Ministries / Departments, Government of India
I
Directo'r, CGHS. Nirman Bharvan, Neu,Delhi
2
Addl. DDG (HQ)/A|lAdditional Directors iJoint Directors of CGHS cities outside Delhi J
-)
T
Fite No.Z1 SOZST 1 1t t2O 17lD!R/CGHS
: Allpay &.Accounts Officers under CCHS j.,n,. Additionar Director rHq.ri)aooi,ionur orrecror (SZ)/ (cz)/ (EZ)/ (N4, cGHS, Ner,v 9 JD (Gr.)/JD(R&H), CGHS Delhi 7 cGHs oesk-rD"Jl-ir/ccnTvccHs-r. Dre.GHS, Nirman Bhawan. New Derhi. ,;^ i*Y i;iil:1 5,JlfflJy,.i',:'l*iil,;,:l;ITi,*,,n * e,,irv'w.ra* 19 Rajya Sabha / Lok Sabha'S"l."ta.iat.
i) X:i!:3,''rr:1i:,ffi;g*:fff,;unjab & Harvana High court, chandigarh I3 Finance Division.
o,
iff','J":::.f# J:,:l'iiffi:: N:;'3"ff:arrmenr or personner & rrain ing, 15 PPS to Se
'
conrror), ri*;:ii"l-H:,H'i?H;,T'i".,fiLySH)/ Secretary (HR)/ Secretary (ArDs 16 pps to ocus zsia,vo,inilira 17 Swamv 1as 1n;7aia oc (cGHS). Publishers (P)iii.,';'il. ^t z'q6s, R.i. ilirr, chennai 600028. I 8 shri Umraomat purotriii...*."ry, starr sicre, ii_c,-e"-rshah Road. Nerv Derhi. l9 A' Staf,f Side Menrb.r;;Nrti"nar councir rrc,rl 1u, p., rist attached). : $:i:l-Jilhe comptrorr.. a a,.rito.cene.ri"i'r)-,.ri", ro-bli"iu.*6r,u,, zarar Marg, 2l All Offices / Sections / Desks-in 22' the Minisrry. url-lrsc' rs:zr,^rrr, n"ffiia.Madras n'oua, Ursoor. Bengaruru-56000g. iil Nodar or]'icer, Mcrc. ccrb *i,r,;;il;;;;ffi a copy oroM on GGHS web_ 24 Offlce Order Folder.
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12:27:07 Date:
IST
3
21so2ffiff2o2o/DrR/ccHS
Government of lndia
Min. of Health & Family Welfare
Department of Health
Directorate General of GGHS
545-A Nirman Bhawan, New Delhi.
Dated the 9th October ,2OZO
oFFtcE MEMORANpUM
subject: clarification regarding treatment of cGHS beneficiaries at government hospitats - regarding
With reference to the above subject the undersigned is directed to state that this Ministry is in receipt of several representations seeking clarifications about treatment at government hospitals. ln this regard attention is drawn to office memorandum No. s-11012/1/g1-cGHS(p) (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 following clarifications regarding treatment at government hospitals:
i' CGHS beneficiaries have the option to avail Consultation from Specialists/ lnvestigations / treatment procedures from any Government Hospitar centrar/state)
ii' The definition of "Government hospital" would include any hospital of central Government /state GovernmenuGovernment Departments such as Railways. Atomic Energy commission, etc., as also hospitals of Public sector Undertakings (such as those of the Steel Authority of lndia Limited/coal lndia Limited, hospitals under Municipalities etc. iii' Normally, many services at government hospitars 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' oGHS beneficiaries shall be eligible for reimbursement as per the ward entilement he/ she is entitled as per the criteria prescribed in case of AllMS. ln other government hospitals' where only General ward and Nursing home facility are available, CGHS beneficiaries, who are eligible eligible for semi-private ward and higher are eligible for treatment in Nursing Home wards. v' Reimbursement for lmplants shall be limited to CGHS prescribed ceiling rates. The other treatment charges are applicable item wise as per eligible ward entiflement.
ln case of treatment at ILBS , New Delhi , NIMS Hyderabad the reimbursement shall be as per CGHS rates.
Medical claims are to be submitted through concerned CGHS wellness Centre in case
vil.
of Pensioners, ex-MPs , etc., and to the concerned Ministry /department /office in case of serving employees and to the Rajya Sabha Secretariat / Lok Sabha Secretariat in case of Members of Parliament and to the concerned Autonomous body in case of cGHS beneficiaries of Autonomous Bodies for reimbursement
\..v
(Sanjay Jain)
Director, CGHS To 1. All Ministries / Departments, Government of tndia 2. Director, CGHS, Nirman Bhawan, New Delhi 3' Estt.l/ Estt.ll/ Estt.lll/ Estt.lV Sections, Ministry of Health & Family Welfare 4. Admn.l / Admn.ll Sections of Dte.GHS 5' Addl. Director, CGHS(HQ) / Addl.DDG(HQ)/Addl. Directors Directors of CGHS Cities 6. Rajya Sabha / Lok Sabha Secretariat 7 ' Registrar, Supreme Court of lndia /Punjab & Haryana High Court, Chandigarh B. Under Secretary, U.p.S.C. 9. Under Secretary Finance Division
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
" 35fi: of the comptroller & Auditor General of tndia, 10 Bahadur Shah zafarMarg, New 14.All Offices / Sections / Desks in the Ministry
15'UTl lnfrastructure Technology And services Limited, UT|-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 SGHS web-site L7 'All Hospitals empanelled under CGHS inrougrr Addl. Director, CGHS of concerned city. lB.Office Order folder
Copy to
PPS to Secretary, HFW
PPS to AS&DG, CGHS, MoHFW
PPS to JS(AS), MoHFW
PS to Director,CGHS
US, EHS , MoHFW
Copy for information to
PPS to Hon'ble HFM
PPS to Hon'ble MOS
No.' 2.1 5025t 1 412023/ Dl R/CG HS
Government of lndia
Ministry of Health and Family Welfare
Directorate of CGHS
CGHS Bhawan,
RK Puram Secfo r'73,New Delhi
Dated the 27th December, 2023'
OFFICE MEMORANDUM
beneficiaries. etc..
with reference to the above subject the undersigned is directed to draw attention to the OM No Z 15025119/2/DIR/CGHS dated Sth October 2016 vide which powers had been delegated for setflement of reimbursement claims/ Permissions/ex-post facto approvals in respect of Pensioner CGHS beneficiaries. lt has now been decided by the competent Authority to further delegate financial powers to the Addl. secretary & DG, CGHS and Director, CGHS in respect of approvals related to unlisted treatment procedures/ investigations/ implants, in partial modification of para (v) of the above referred oM as per the details given under:
a) Revised Delegation of Financial Powers for Permission / ex-post facto Approval / settlement of Medical Reimbursement claims of Individual Beneficiaries / Hospital Bi||sinrespectofUn|istedtreatmentprocedures/investigations/|mplantsareas per the details given below:
Revised Delegated Powers
ns. t "00,000/- (No change) a) nOOitional Director , CGHS of Ctty tLone
b)
Upto Rs. 3,00,000/-
Upto Rs. 5,00,000/- c) Addl. Secretary & DG,GGHS
lf there is no 6GHS package rate for treatment procedures / investigations/ lmplants
b)
approvar shail be granted as per AilMs rate (if any) and if there is no cGHs/AllMS rate approval shall be granted as per actual rate.
c) In respect of unlisted treatment procedures / investigations / lmplants, which cost more than Rs. 1,50,000/- the cases shall continue to be placed before Standard Technical Committee (STC) for justification, before considering the approval.
2 The revised financial delegations mentioned above will be subject to the conditions that they 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 be considered by the Ministry of Health & Family Welfare with the concurrence of lntegrated Finance Division.
3. The above mentioned delegations of financial powers are in supersession of all the earlier OM in this regard.
4. The other terms and conditions mentioned in the Office Memorandum No. Z15O25l79l2lDlRICGHS dated 5'n October 2016 shall remain unchanged. 5. This issues with the concurrence of Integrated Finance Division, Ministry of Health and Family Welfare.
To
1. Addl. DDG(HO), CGHS/ AD(HQ), CGHS/ All Addl. Directors of CGHS 2. Addl. cEo, NHA
3. PPS to Secretary, Ministry of Health & Family Welfare
4. PPS to AS&DG (CGHS), Ministry of Health & Family Welfare
5. PPS to JS, Ministry of Health & Family Welfare, looking after CGHS 6. N.O., CGHS(MCTC) with the requestto upoad this OM on the CGHS website. 7. Guard file
'.:~.
Subject:-
NO.S-12020/4/97-CGHS(P)
Governinent of India
Ministry of Health ~ Family ~elfare
(Department of Health)
Nirman Bhavan; New Delhi
Dated the 7th April, 1999.
i'i
OFFI~E MEMORANDUM . . . ..
. f
Delegation of 'Powers uI1der CGHS relating to referral. system, perndssion cases and E!x-post-~acJ:'9 ~ap~~pva;t:
. t
-'.Regard1ng., .' I;c<;'>;~,,~?': .,' :t;\
'. ,." .~.'.
~ --. I ." . ':., ;.'", ","',;. . . . . I' ..
. .The undersigned is dLrec;ted ~b say'thatthe matter regarding
I
delpg'a~i6n of'powers under CGHS has been under'c.onsideratiop..of !iIt
the Gov'ernment for some t~me past so as 'tc?reduce the <:lelay in obtaining facilities under CGHSincludingex-post-facto app~oval
!
of medical claims preferred byCGHS beneficiaries:and ~t has now been decided todeleg~te' .the powers -rot"referral system, permiss.i;;on cases, J~t)ci ,ex;'post.:;,,;'fact'o approvalas.indic:ated below:-
. . :,. : ~.;'~F~1UtAL. SYST~' .' . " . .
1. Propedures/inyestigations
for which there is .no
prescr-ihed CGH$ rate .for
CGHS."r.ecognised private.
hO'spitals/diagnostic
cel1t,i'~. .
I.
2. .
.I;n case of medical
emergency beneficiary may
.
go directly to private
'!,.,
recognised! ,Government
. referral hospit.~\l.,..' .a.nd . tmbmi l: an .MRC ...r ~fter
. discharge from.' t'he
hospital.;:."
3 ~n p~egna?cy cases
permissiO~1 for.t'es t s I procedures, the. estimates of which are' not. more' than Rs.20,OOO/-, may':pegranted by HOD (for serving employees) and by Head of CGHS covered ci~ies
(for 'Pensioners) . provided the tests/ procedures ha~e been
recommended . by Govt'. Specialist.
Reimbursement may i:>edlimit.:eq
.to AIIMS rate in the caBe~()t Delhi and outside Delhi. In case rates have not been fixed by AIIMS'for any.particular
'procedure/investigation/test, reimbursement may be made- a-s per actuals. .
I I
P~wers are delegated to lhe Heads of the CGHS Organisations in various CGHS covered cities in respect of both pensioners and>' .serving empl()y~es. for
deciding which. case~'. :Jii11 under- the "eroergency" category. . . ~
Once .' the pregnancy is diagnosed/confirmed by' the
j Government !CGHS' doctors .' including the Medi'cal Officer
~orking at. the dispenRary
level, the HOD of ,'concer.ned Department! . Ministry..
.' ., .Contd..../-
I.
I
. 4.
-:2:- ;. .
.,
In case. of beneficiary,
,.
may permit admission for
confinement purpose in the
private. hospitals recognised under CGHS. ."f" ". The powers for grant of, such.'
I!
I
1-
'!jI' .1,. r~
~nspite!ofifacility being availab1e: in the city' still" chooses to' get
treatment in CGHS recognised. hospi tal ill another city
'.
s. In case, of pensioners if permission is granted for treatmen~ in another city for such procedures/tests
that:.are' advised by thf:!. Govt'.I. CGHSC... special'ists
and are not available in the same. city
".
I :,,>
..b.. In case of emergency in . re,;;pect of' pe'nsioner~/. ._s.~rving ~mployees','
,
I
permission are delegated to the Heads of CGHS organisations in; various CGHS covered cities both ~n 'r~spect.of pensioners and. serving employees' but .without grant of TA/DA..
I
Permis~ion mct¥ be'..granted to pensioner beneficiaries bY'Head of the CGHS 'Organisation.inthe various CGHS covered cities .on the' basis"'of. specific advice from treating .Gpvt. specialist.
. TA may be limited to' the Referral' Hospitalsavailablein the nearest city by the shortest route. In case of deviation, prior. permission of.
,Director,.CGH$, 'may be' ..obtained..
Since it is not always possible to obtain prior permission in emergency, treatment taken by CGHS beneficiaries in emergency will be considered on merits
I:;:
even if the treatment is taken
",
,froma non-recognised private
hospital. For granting ex-post
"
facto approval 'in emergency
.. cases,' both for s!i!rving/'
pensioner beneficiaries, the
power is deiegated to the Head
of the concerned CGHS covered
city.
7. Treatment in pri vate recognised hospital
'". '-
Referral may be made 'on the reconunendation of the tt;:'eatment procedure by the Govt.
specialist for indoor treatment in private hospitals recognised under CGHS.
The permission 'both for pensioners and" aerv.ing employees fora period of six months for follow-up treatment
may be given by the Head of CGHS covered city from the qate o'f discharge of the 'benef iciar}' from the hospital.
Cont1.../-
.-
-:3:-
,
PERMIsstON CASES
:1
'"
,i
II
.!j
'jI
"
.
1, Cases where permission is , to- be given for items with ceil~ng rates
2. Permission for items for whi6h S'tanding Committ,ees exist and the Standing Comrni t tee has recommertded 'the case
3. Supply of .Oxygen cylinder, Leucocyte filter, Infusion pump etc.
4. ,Air travel . .'
5. permission for highly expensive procedures like B .M'. T. , 'Card"iac defibrillator, carotid stents, etc. as per Govt. ceiling rates as the cost involved are very high or where there is no policy decision
..
'When treatment is taken with prior permission and where the ceiling rates have been fixed for purchase of implants such as pacemakers,. Rotablatar total joint replacement etc. the procedure of calling 3 quotations i,snot required and the Head ....9f the CGHS .
organisation'of;the cqncerned CGHS ,covered c,ity may grant permission in such c~ses.
Permission may be g~ven by the Ministry' of Health and Family Welfare' for it'ems which have been notified by the CQHS.
permission maybe given by the Ministry of Health and Family Welfare on the x:eaommendations of the Standing Commi~tee for items which have:been notified
by the CGHS,
Permission may be given by the Ministry of Health 'and Family' Welfare ,on the basis of the
recommendation .of Director, CGHS.
For highly expensive procedures like BMT, Cardiac Defibrillato~, Carotid Stenting etc.M/o HFW not f fie, s t h' e equipments/instruments/ implants for domiciliary use withspecif ic ceiling 'rates. Hence, pe;mission for any instrument/equipment/implant outside the notified list will be dealt by the M/o HFW on a case t~ case basis, in consultation with DGHS/Finance Division. I
Contd. . / -
-:4 -
Ex-paST-FACTO APPROVAL
1.
.,
'Treatment taken without recommendation of CGHS/ Govt. specialist, but \'1ith permission of CMO in-charge of CGHS dispensary in a
recognised priv~te ,hospital within approved , ceiling rates
pow~rs are delegated to the Heads of CGHS organisations in the CGHS covered cities both in respect of pensioners and serving employees to. decide such type of c'ases.
2. Treatment taken in private hospitals
'!
recognised under CGHS
."
without prior permission
Powers are delegated t,o the 'Heads of CGHS organisations in the CGHS covered cities both in respect of pensioners and serving employees to decide
such type of cases. I
\
I
-~
3 . Emergency cases within approved ceiling rates in respect of treatment taken in private 'hospitals recoghised under CGHS.
4 . Emergency cases wit;hin ceiling approved rate in respect, of treatment taken i~ ~rivate
unrecogllised hospit~l. '
5. Cases where prior peD~ission for treatment in CGHS recognised Government ,referral hospital was granted for a' particular' procedure and at the time of actual 'operation, some device/artificial
'appliance/ additional treatment/ procedurel diagnostic procedure. has
been used/undertaken for which no prior permission
was taken.
6. Ex-post-facto permission for treatment in Govt. ,referral, ho.spitals, like
'AIIMS, 'PGI Chandigarh, etc. .' ,
Powers are delegated. to the Heads of CGHS organisations in the CGHS covered cities both in respect' of peI~sioners and serving employees to decide such type of cases.
Powers: are delegated to the Heads of,CGHS organisations in the CGHS coveredcities both in r~spect of pensioners and serving employees., to decide such type of cases.
Powers .are delegated to the Heads of CGHS organisations in the CGHS covered cities both in respect of pensioners and serving employees to decide such type of cases.
For servinq employees:
HOD of the concerned Ministryl Department/Office may decide such type of cases.
For pensioners:
Head of the CGHS organisation of the concerned CGHS covered city may 'decide such type of cases.Contd.../-
,
/
~.,!
7. T~eatment under emergency in private hospitals recognised under CGHS and
. approval to be given as per' approved rates for approv~d procedures/ Appliances/devices.
8. Treatment. taken tinder emergency but approval to be .given above the approvedrates .
9. ,Relaxation of CGHS Rules
10. Air travel permission/Ex post:-facto approval for air."travel undertaken for medical treatment
11. Reimbursement of :treatment/test for which . there is no prescribed rates under CGHS
:....
- :5:-
Powers are delegated to the
Heads of CGHS organisations in
the CGHS covered cities both
in respect of pensioners and
serving employees ~o decide
such type of cases. :
Ministry of Hea~th and Family
Welfare may decide 'such type
of cases in' special
circumstances,'-'depending upon
the merits of each case."
Ministry of Health and Family
Welfare will decide such type
pf cases.
Ministry of Health and Family
Welfare will decide such type
of cases.
Powers are delegated to the
Heads of CGHS organisations in
the CGHS covered cities both
in respect of pensioners and
serving employees. and
reimbursement may be made as
per AIIMS rate/actual,
.whichever may be less, or as
per actual in case there is no, AIIMS rate, both in the case
pertaining to CGHS, Delhi and
'CGHS,outside Delhi.
, ,
12.
Monetary limit to issue sanction for settlement of individual fy1edical Reimbursement Claims/ to accord permission/ grant of medical advance
Subject to the approval of Head of the CGHS organisation . of the concerned CGHS covered city/Ministry of Health and Family Welfare, where prescribed in the preceding paras, the monetary limit for issuing sanction has been raised as under:-
a) RS.2 lakbs
(in case
of serving
employees
beneficiaries)
b) Rs.2 lakhs
(in case
of pensioner
. CGHS.
beneficiaries) I
.,
By the
HOD
By the
Head of the
concerned CGHS covered city. .
C~mtd. . / -
"
-:6:-"",
c) Rs.2 to 5 lakbs: Director,
CGHS
do) Above Rs.5r . lakhs: Ministry
,of Health
and :;
Family
Welfare,.
These orders will come into effect from the date of issue.
,3. The above orders are .issued with the approval of, S'ecretary(Health) and co.ncurrence of JS&FA vide Dy. No.1766/99-
JS&FA dated~ '23.3.99. . ~(BRAHAM DEV) UNDER SECRETARY TO 'THE GOVERNMENT OF INDIA
All Minlstries/Departments' of Government of India.
Director General. 'of Heal th Services.
Director, CGHS. '. All Additional/Deputy Directors of OGHS.
All. Officers/Sections/Desks in the Ministry of Health & Family Welfare.
C & A.G. of India, 10, Bahadur Shah Zafar Marg,
New Delhi-2, with the request that ,these 'orders may be made applicable to the persons serving under him.,,:
"
7. Copy for folder.
I-.'
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