Postal Rulings: GA_28-06-2024

Medical

15 Mar 2026

File No.: Z15025/19/2024/DIR/CGHS/EHS(Comp No. 8281286)

1/3687286/2024

Government of India

Ministry of Health & Family Welfare

(EHS Section)

Nirman Bhawan, New Delhi Dated the 28-06-2024

OFFICE MEMORANDUM

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 AllMSs, Institutions of National Importance (INIS), North East Institutions, Tata Memorial Hospital and all other referral permission endorsement shall be consultation investigation/

medical

institutions

treatment

under

central

required

procedure

government. No. for undergoing including unlisted

investigations/procedures.

B. Treatment at Private empanelled hospital(s):

i. Single referral for Specialist Consultation: A referral issued by any Medical Officer 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 referral will be valid for 3 months.

ii. Correspondingly, referral/ 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. ie.

a. CGHS (Additional Director/ Director) in case of Pensioner

beneficiaries.

b. Head of the Department/ Office (HOD/HOO) 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.11011/29/2019-EHS dated 13.09.2019.

b. O.M. No. 215025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019

(regarding post-operative follow-up treatment).

Signed by Hemlata Singh

Darende 0620214:28:11

Under Secretary to the Government of India

Tel 011-23061778.

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. Noidal

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 4. PPS to AS & DG CGHS

5. PPS to JS (MoHFW), CGHS

Hemlata Singh 28/06/24

(Hemlata Singh)

Under Secretary to the Government of India

Tel 011-23061778

File No.215025/1 2017/DIR/CGHS

Z 15025/117/2017/DIY EHS

Government of India

Ministry of Health & Family Welfare Department of Health & Family Welfare EHS Section

OFFICE MEMORANDUM

Sub: Simplification of referral system under CGHS

Nirman Bhawan, New Delhi Dated the 15th January, 2018

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for CGHS beneficiaries to undertake treatment at private hospitals empanelled under CGHS. The guidelines. issued earlier on referral/ permission under Office Memoranda No S 11011/6/96 -CGHS (P) dt. 11/6/97 and 02/09/99, S-12020/4/97-CGHS (P) dt. 07/04/1999, S.1 101 1/1/200-CGHS (P) dt. 10/04/2001 and

dated 11/06/2010 and 2.15025/105/2017/DIR/CGHS dt. 09/11/2017 has been reviewed and it has now been decided to revise the guidelines for consultation and treatment at CGHS empanelled private hospitals as per the details given under.

RA/Cons/Hyd/09-10/CGHS-IV.

All CGHS beneficiaries (in all CGHS Cities) shall be permitted for seeking OPD consultation from Specialists at Private hospitals empanelled under CGHS after being referred by any Medical Officer/CMO of CGHS Wellness Centre. The referral may be mentioned on the computer generated Prescription slip. After consultation at empanelled hospitals beneficiary shall report back to concemed wellness centre, where MO/CMO would endorse listed investigation and issue medicines as per guidelines mentioned below. For unlisted investigation/treatment procedure CMO Incharge shall submit the prescription to competent authority for consideration in case of pensioner beneficiaries. Serving employees shall seek permission for unlisted investigation/treatment procedure from their department as per prevailing guidelines.

The medicines prescribed by specialists shall be supplied by CGHS as per the available generic name at the CGHS Wellness Centre.

File No.Z15025/117/2017/DIR/CGHS

lii)

iv)

vi)

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 prescribed 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

With reference to OM Z.15025/105/2017/DIR/CGHS dated 09/11/2017, it is clarified that the validity of the advice of Central Government /State Government Specialist/ CGHS Medical officer for listed treatment procedures shall be treated as valid for three months unless mentioned otherwise and no other referral (permission) letter is required to undergo. 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 CGHS 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 refer the beneficiary for treatment to any CGHS recognized hospitals

In case of Haemo-Dialysis, the advice for treatment can be made upto six months and in such cases the advice shall be valid for upto six months.

In case of Radio-therapy / Chemotherapy advised by a Government Specialist the advice shall be valid for all the cycles of Radio-therapy/Chemotherapy. The specialist has to specify the specific Radio-therapy procedure. Self-attested (by beneficiary) photo-copies of the permission letter is required to be submitted.

In case of post-operative follow up treatment in six conditions as specified in OM dated 10.04.2001, permission for follow-up treatment shall be required from competent authority

In case of non-listed investigations / treatment procedures permission from competent authority is required to be obtained.

This issues with the approval of competent authority in supersession of earlier guidelines.

[Dharminder Singh]

Under Secretary to Government of India Tel- 011-23062666

To:

All Ministries/Departments, Government of India

Director, CGHS, Nirman Bhawan, New Delhi

Addl. DDG (HQ)/All Additional Directors /Joint Directors of CGHS cities outside Delhi

File No.Z15025/117/2017/DIR/CGHS

Delhi.

10.

19.

a adada

All Pay & Accounts Officers under CGHS

Additional Director (Hqrs)/ Additional Director (SZ) (CZ) (EZ) (NZ), CGHS, New

JD (Gr./JD(R&H), CGHS Delhi

CGHS Desk-l/Desk-II/CGHS-I/CGHS-II, Dte.GHS, Nirman Bhawan. New Estt./Estt./Estt.III/Estt. IV Sections, Ministry of Health & Family Welfare. Admn.1/Admn. Sections of Die.GHS.

Rajya Sabha / Lok Sabha Secretariat.

Registrar, Supreme Court of India Punjab & Haryana High Court, Chandigarh, U.P.S.C. Dholpur House, New Delhi

Finance Division.

Deputy Secretary (Civil Service News), Department of Personnel & Training,

5th Floor, Sardar Patel Bhawan, New Delhi.

Delhi

PPS to Secretary (H&FW) Secretary (AYUSH) Secretary (HR) Secretary (AIDS Control), Ministry of Health & Family Welfare.

PPS to DGHS/SS&MD, NRHM/AS (H)/AS & DG (CGHS).

Swamy Publishers (P) Ltd., P. B. No. 2468, R. A. Puram, Chennai 600028.

Shri Umraomal Purohit. Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi.

All Staff Side Members of National Council (JCM) (as per list attached).

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

All Offices/ Sections / Desks in the Ministry.

UTI-ITSC. 153/1. First floor, Old Madras Road, Ulsoor, Bengaluru-560008.

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

24 Office Order Folder.

Signature valid

Digitally signed by DHARMINDER SINGH

Date: 2018 816 12:27:07

IST

Reason: Approved

मेय

Z 15025/117/2017/DIR/CGHS/ EHS Government of India

Ministry of Health & Family Welfare Department of Health & Family Welfare

EHS Section

****

OFFICE MEMORANDUM

Nirman Bhawan, New Delhi Dated the 10th December, 2018

Sub: Revision of guidelines regarding simplification of referral system under CGHS

***

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for undergoing treatment/investigations at private hospitals empanelled under CGHS. In this regard attention is drawn to the guidelines issued under Office Memoranda No. Z.15025/117/2017/DIR/CGHS/EHS, dated 15.01.2018 and S.11045/40/2012/CGHS/HEC/CGHS (P), dated 22.02.2013 and to state that the matter has been reviewed by this Ministry and it has now been decided to revise the guidelines for consultation and treatment at CGHS empanelled private hospitals as per the details given under:-

ii)

iii)

iv)

vi)

Referral from CGHS Medical Officer/CGHS Specialist for consultation with Specialists at Private Hospitals empanelled under CGHS shall be valid for 30 days in the same hospital.

Referral shall be valid for consultations upto 3 times in the same hospital within 30

days.

Similarly referral shall be valid for consultation with a maximum of 3 different Specialists, if required during a single visit.

Advice of the CGHS Medical Officer/CGIS Specialist for listed investigations shall be valid for a period of 30 days.

Advice of the CGHS Medical Officer/CGHS Specialist for listed treatment procedure shall be valid for a period of 3 months.

If any listed investigation advised by Specialist of empanelled hospital is required urgently as a medical emergency and certified as such, may be undertaken at the same

hospital.

vii)

viii)

Hospitals are empanelled under CGHS for the Specialists available and not by the name of Specialists.

The Referral of CGHS Medical Officer/Specialists may be issued through Computers or even manually with proper stamp of referring doctor.

The other terms and conditions as prescribed on the above referred OMS shall remain unchanged.

To:

Under Secretary to Government of India

Rajeev Attri 124 2018

110/12/2018

Tel- 011-2306 1883

All Ministries / Departments, Government of India Director, CGHS, Nirman Bhawan, New Delhi

Delhi.

Addl. DDG (HQ)/All Additional Directors /Joint Directors of CGHS cities outside Delhi All Pay & Accounts Officers under CGHS

Additional Director (Hqrs) / Additional Director (SZ)/ (CZ)/ (EZ)/ (NZ), CGHS, New

JD (Gr.)/JD(R&H), CGHS Delhi

CGHS Desk-1/Desk-II/CGHS-I/CGHS-II, Dte.GHS, Nirman Bhawan. New Estt.I/Estt.II/Estt.III/Estt.IV Sections, Ministry of Health & Family Welfare. Admn.I/Admn.II Sections of Dte.GHS.

Rajya Sabha / Lok Sabha Secretariat.

Registrar, Supreme Court of India /Punjab & Haryana High Court, Chandigarh. U.P.S.C, Dholpur House, New Delhi

Finance Division.

Deputy Secretary (Civil Service News). Department of Personnel & Training,

5th Floor, Sardar Patel Bhawan, New Delhi.

Delhi.

PPS to Secretary (H&FW)/ Secretary (AYUSH)/ Secretary (HR)/ Secretary (AIDS Control), Ministry of Health & Family Welfare.

PPS to DGHS/SS&MD, NRHM/AS (H)/AS & DG (CGHS).

22.

site.

Office Order Folder.

Swamy Publishers (P) Ltd., P. B. No. 2468, R. A. Puram, Chennai 600028.

Shri Umraomal Purohit, Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi.

All Staff Side Members of National Council (JCM) (as per list attached).

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

All Offices/Sections / Desks in the Ministry.

UTI-ITSC, 153/1, First floor, Old Madras Road, Ulsoor, Bengaluru-560008.

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

Z15025/18/2020/DIR/CGHS

Government of India

Min. of Health & Family Welfare

Department of Health

Directorate General of CGHS

545-A Nirman Bhawan, New Delhi. Dated the 9th 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 Ministry is in receipt of several representations seeking clarifications about treatment at government hospitals. In this regard attention is drawn to Office memorandum No. S-11012/1/91-CGHS(P) (Vol.1) dt 18.03.1992 vide which guidelines regarding settlement of Claims were issued and to convey the approval of competent authority for issue of the following clarifications regarding treatment at government hospitals:

iii.

iv.

CGHS beneficiaries have the option to avail Consultation from Specialists/ Investigations / treatment procedures from any Government Hospital Central/State)

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

CGHS beneficiaries shall be eligible for reimbursement as per the ward entitlement he/ she is entitled as per the criteria prescribed in case of AIIMS In 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.

Reimbursement for Implants shall be limited to CGHS prescribed ceiling rates. The other treatment charges are applicable item wise as per eligible ward entitlement.

vi.

vil.

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

through

Medical claims are to be submined CGHS Wellness Centre in case

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

(Sanjay Jain) Director, CGHS

1. All Ministries / Departments, Government of India

2. Director, CGHS, Nirman Bhawan, New Delhi

3. Estt./Estt.II/Estt.II/Estt. IV Sections, Ministry of Health & Family Welfare

4. Admn.l/Admn II 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 India /Punjab & Haryana High Court, Chandigarh

8. 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

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

Delhi

14.All Offices / Sections/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.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. Z.16025/14/2023) DIRICGHS

Government of india

Minis by of Health and Family Weiform Directorate of CGHS

CGHS Bhawan,

RK Puram Sector-13, New Derhi Dated the 2 December, 2023.

OFFICE MEMORANDUM

Subject: Delegation of Financial powers for settlement of reimbursement claims/Permissions lex-post facto approval in respect of Pensioner CGHS beneficiaries, etc.

With reference to the above subject the undersigned is directed to draw attention to the OM No Z 15025/79/2/IR/CGHS dateo 5 Outober 2016 vide which powers had been delegated for settlement of reimbursement claims Permissions/ex-post facto approvals in respect of Pensioner CGHS benelicanes. it has now been decided by the Competent Authority to further delegate financial powers to the Adai Secretary & DG, 2GHS and Director, CGHS in respect of approvals related to unlisted treatment procedures/ vestigations/ plants in partial modification of para (v) of the above refereu Ok as per

the details given under

a) Revised Delegation of Financial Powers for Permission Blepost facio Approval

Settlement of Medical Reimbursement Claims of individual Beneficianes / Hosprai Bulls in respect of Unlisted treatment procedures/investigations / Implants are as

per the details given below.

Revised Delegated Powars

Adotional Die CGHS of City Zone

Rs. 1,00,000/- (No change)

Director, CGHS

Upic Rs. 3,00,000/-

Addi. Secretary & DG,CGAS

Upto Rs. 5.00.000/-

b) if there is no CGHS package rate for treatment procedures/invesüyations/ Implants approval shall be granted as per AllMS rate (if any) and f there is no CGHS/AIIMS rate approval shall be granted as per actual rate.

c) in respect of unlisted treatment procedures investigations / Implants, which cost more

than Rs. 1,50,000/- the cases shall sununue 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 integrated

Finance Division.

3. The above mentioned delegations of financial powers are in supersession of all he earner

OM in mis regard

4 The omer terms and conditions

in the Office Memorandum No.

Z15025/79/2/DIR/CGHS dated 5th October 2016 shall remain unchanged.

5. This issues with the concurrence of integrated Finance Division. Ministry of Health and

Family Wellare

(Dr. Manoj Jain) Director, CGHS

та

1. Addl. DDG(HQ), CGHS/AD(HQ), CGHS/ All Addl. Directors of CGHS

2. Addi, CEO, NHA

3. PPS to Secretary, Ministry of Health & Family Welfare

4. PPS to AS&DG (CGHS), Ministry of Health & Family Welfare

5. PPS 10 JS. Ministry of Health & Family Welfare, looking after CGHS

B. N.O.. CGHS(MCTC) with the request to upoad this O on the CGHS website

7. Guard le

Governinent of India Ministry of Health & Family Welfare (Department of Health)

Nirman Bhavan, New Delhi Dated the 7th April, 1999.

OFFICE MEMORANDUM

Subject: Delegation of Powers under CGHS relating to referral, system, permission cases and ex-post-facto approval

Regarding

The undersigned is directed to say that the matter regarding delegation of powers under CGHS has been under consideration of the Government for some time past so as to reduce the delay in obtaining facilities under CGHS including ex-post-facto approval of medical claims preferred by CGHS beneficiaries and it has now been decided to delegate

delegate the powers Tor referral system, permission cases and ex-post-facto approval as indicated below:-

REFERRAL SYSTEM

1. Procedures/investigations Permission

for which there is no prescribed CGHS rate for CGHS recognised private hospitals/diagnostic

centre.

case

of medical emergency beneficiary may go directly to private recognised/ Government referral hospital and submit an MRC after discharge

hospital.

from

the

for

tests/ procedures, the estimates of which are: not more than Rs. 20,000/-, may be granted by HOD (for serving employees) and by Head of CGHS covered cities (for 'Pensioners) provided the tests/ procedures have been

Govt.

recommended Specialist.

Reimbursement may be limited to AIIMS rate in the case of Delhi and outside Delhi. case rates have not been fixed

by AIIMS for any particular procedure/investigation/test, reimbursement may be made per actuals.

ав

Powers are delegated to the Heads of the CGHS Organisations in various CGHS covered cities in respect of both pensioners and serving employees for deciding which cases fall under the "emergency" category.

In pregnancy cases

Once

the

pregnancy

diagnosed/confirmed by the Government/CGHS

doctorS

including the Medical Officer working at the dispensary level, the HOD of concerned Department/ Ministry

Contd.../-

1. Procedures/investigations for which there is no prescribed CGHS rate for CGHS recognised private hospitals/diagnostic centre.	Permission for tests/ procedures, the estimates of which are not more than Rs.20,000/-, may be granted by HOD (for serving employees) and by Head of CGHS covered cities (for Pensioners) provided the tests/ procedures have been recommended by Govt. Specialist. Reimbursement may be limited to AIIMS rate in the case of Delhi and outside Delhi. In case rates have not been fixed by AIIMS for any particular procedure/investigation/test, reimbursement may be made as per actuals.
2. In case of medical emergency beneficiary may go directly to private recognised/ Government referral hospital and submit an MRC after discharge from the hospital.	Powers are delegated to the Heads of the CGHS Organisations in various CGHS covered cities in respect of both pensioners and serving employees for deciding which cases fall under the "emergency" category.
3 In pregnancy cases	Once the pregnancy is diagnosed/confirmed by the Government/CGHS doctors including the Medical Officer working at the dispensary level, the HOD of concerned Department/ Ministry may permit admission for confinement purpose in the private hospitals recognised under CGHS.
4. In case of beneficiary, inspite of facility being available in the city still chooses to get treatment in CGHS recognised hospital in another city	The powers for grant of such permission are delegated to the Heads of CGHS organisations in various CGHS covered cities both in respect of pensioners and serving employees but without grant of TA/DA.
5. In case of pensioners if permission is granted for treatment in another city for such procedures/tests that are advised by the Govt./ CGHS specialists and are not available in the same city	Permission may be granted to pensioner beneficiaries by Head of the CGHS Organisation in the various CGHS covered cities on the basis of specific advice from treating Govt. specialist. TA may be limited to the Referral Hospitals available in the nearest city by the shortest route. In case of deviation, prior permission of Director, CGHS, may be obtained.
6. In case of emergency in respect of pensioners/ serving employees	Since it is not always possible to obtain prior permission in emergency, treatment taken by CGHS beneficiaries in emergency will be considered on merits even if the treatment is taken from a non-recognised private hospital. For granting ex-post-facto approval in emergency cases, both for serving/ pensioner beneficiaries, the power is delegated to the Head of the concerned CGHS covered city.
7. Treatment in private recognised hospital	Referral may be made on the recommendation of the treatment procedure by the Govt. specialist for indoor treatment in private hospitals recognised under CGHS. The permission both for pensioners and serving employees for a period of six months for follow-up treatment may be given by the Head of CGHS covered city from the date of discharge of the beneficiary from the hospital.

Contd.../-

1. Cases where permission is to be given for items with ceiling rates	When treatment is taken with prior permission and where the ceiling rates have been fixed for purchase of implants such as pacemakers, Rotablator total joint replacement etc. the procedure of calling 3 quotations is not required and the Head of the CGHS organisation of the concerned CGHS covered city may grant permission in such cases.
2. Permission for items for which Standing Committees exist and the Standing Committee has recommended the case	Permission may be given by the Ministry of Health and Family Welfare for items which have been notified by the CGHS.
3. Supply of Oxygen cylinder, Leucocyte filter, Infusion pump etc.	Permission may be given by the Ministry of Health and Family Welfare on the recommendations of the Standing Committee for items which have been notified by the CGHS.
4. Air travel	Permission may be given by the Ministry of Health and Family Welfare on the basis of the recommendation of Director, CGHS.
5. Permission for highly expensive procedures like B.M.T., Cardiac defibrillator, carotid stents, etc. as per Govt. ceiling rates as the cost involved are very high or where there is no policy decision	For highly expensive procedures like BMT, Cardiac Defibrillator, Carotid Stenting etc. M/o HFW notifies the equipments/instruments/implants for domiciliary use with specific ceiling rates. Hence, permission for any instrument/equipment/implant outside the notified list will be dealt by the M/o HFW on a case to case basis in consultation with DGHS/Finance Division.

Contd../-

EX-POST-FACTO APPROVAL

Treatment taken without recommendation of CGHS/ Govt. specialist, but with permission of CNO in-charge Of CGHS dispensary in recognised private hospital within approved ceiling rates

Treatment

private

in 111

taken hospitals

recognised under CGHS without prior permission

Emergency Cases within approved ceiling rates in respect of treatment taken in private hospitals recognised under CGHS.

Emergency cases within ceiling approved rate in respect of treatment taken in private unrecognised hospital.

Савея where prior permission for treatment CGHS recognised referral

Government hospital was granted for a particular procedure and at the time of actual operation.

Gome

device/artificial

appliance/ additional treatment/ procedure/ diagnostic procedure has been used/undertaken for which no prior permission

was taken.

Ex-post-facto permission for treatment in Govt. referral hospitals like AIIMS, PGI Chandigarh, etc.

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.

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.

Powers are delegated to the Heads of CGHS organisations in the CGHS covered cities both in in respect 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 serving employees:

HOD of the concerned Ministry/ 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.../-

Treatment under emergency in private hospitals recognised under CGHS and approval to be given as per approved rates

rates for approved procedures/

Appliances/devices.

Treatment taken under emergency but approval to be given above the approved rates

Relaxation of CGHS Rules

10. Air travel permission/Ex

post-facto approval for air travel undertaken for medical treatment

11.

12.

Reimbursement treatment/test for which there 15 no prescribed rates under CGHS

Monetary limit to issue sanction for settlement of individual Medical Reimbursement Claims/ to accord permission/ grant of medical advance

-15:-

bowers 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.

Ministry of Health and Family Welfare may decide such type of

in special circumstances, depending upon the merits of each case.

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.

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 lakhs

(in case

of serving

employees beneficiaries)

b) Rs.2 lakhs

(in case

of pensioner CGHS

beneficiaries)

By the

HOD

By the Head of the

concerned

CGHS-

covered city.

Contd../

-:6:-

c) Rs.2 to 5 lakhs: Director,

CGHS

d) Above Rs.5 lakhs: Ministry

of Health and Family Welfare.

2. These orders will come into effect from the date of issue.

3. The above orders are issued with the approval of Secretary (Health) and concurrence of JS&FA vide Dy. No. 1766/99- JSLFA dated 23.3.99.

Beokame

(BRAHAM DEV)

UNDER SECRETARY TO THE GOVERNMENT OF INDIA

All Ministries/Departments of Government of India.

Director General of Health Services.

Director, CGHS.

All Additional/Deputy Directors of CGHS.

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.

Copy for folder.

Z 15025/35/2019/DIR/CGHS/ CGHS(P)

Government of India

Ministry of Health & Family Welfare Department of Health & Family Welfare

Nirman Bhawan, New Delhi Dated the 29th May, 2019.

OFFICE MEMORANDUM

Sub: Consultation from Specialists at CGHS empanelled hospitals in respect of CGHS

beneficiaries aged 75 years and above -regarding

With reference to the above mentioned subject the undersigned is directed to state that the matter related to relaxation of consultation norms in respect of elderly CGHS beneficiaries was under consideration of this Ministry and it has now been decided that hereinafter, CGHS beneficiaries aged 75 years and above shall be permitted to seek direct OPD Consultation from Specialists of private hospitals empanelled under CGHS without referral from CGHS Wellness Centre.

2. If any investigations procedures are advised and are required in emergency, no other authorization is required and the same may be undertaken. However, in non-emergency conditions approval of competent authority is required if any non-listed investigations / procedures are advised. Medicines prescribed are to be procured from CGHS Wellness Centre. 3. Private hospitals empanelled under CGHS shall provide such facilities on cashless basis at CGHS rates to pensioners, ex-MPs, Members of Parliament and such other Categories of CGHS beneficiaries, who are eligible for treatment /investigations on credit basis. More than 75 year old dependents of serving CGHS beneficiaries, who are otherwise not eligible for Cashless treatment shall claim the reimbursement from concerned Ministry /Department Beneficiaries of Autonomous Bodies /Statutory Bodies covered under CGHS shall claim reimbursement from the respective organization,

These orders are in supersession of the earlier guidelines on the subject.

To:

(Dr. Manoj Jain)

15119

Addl. DDG(HQ), CGHS

All Ministries / Departments, Government of India

2 Director, CGHS, Nirman Bhawan, New Delhi

3 CGHS Desk-l/Desk-II/CGHS-I/CGHS-II, Dte.GHS, Nirman Bhawan. New Delhi

4 Estt. / Estt.II/Estt.II/Estt.IV Sections, Ministry of Health & Family Welfare

5 Admnl/Admn.Il Sections of Dte GHS

Addl. Director, CGHS(HQ)/Addl. Directors/Joint Directors of CGHS Cities

7 Rajya Sabha / Lok Sabha Secretariat

8 Registrar, Supreme Court of India /Punjab & Haryana High Court, Chandigarh 9 Under Secretary, U.P.S.C.

10 Under Secretary Finance Division

11 Deputy Secretary (Civil Service News), Department of Personnel & Training,

5th Floor, Sardar Patel Bhawan, New Delhi.

12 PPS to Secretary (H&FW) Secretary (AYUSH) Secretary(HR)/ Secretary(AIDS

Control), Ministry of Health & Family Welfare

13 PPS to AS&MD, NRHM / AS (H)

/DGHS

14 Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi

15 All Staff Side Members of National Council (JCM) (as per list attached)

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

Delhi

17 All Offices / Sections / Desks in the Ministry

18 UTI Infrastructure Technology And Services Limited, UTI-ITSL Tower, Plot No3 Sector-

11, CBD Belapur, Navi Mumbai-400614

19 Nodal Officer, MCTC, CGHS with a request to upload a copy of OM on CGHS Web-site 20 All Hospitals empanelled under CGHS through Addl. Director, CGHS of concerned city.

21 Office Order folder

Copy for information to

Joint Secretary, Cabinet Secretariat, Rashtrapati Bhawan, New Delhi

Z 15025/35/2019/DIR/CGHS/ CGHS(P)

Government of India

Ministry of Health & Family Welfare Department of Health & Family Welfare

OFFICE MEMORANDUM

Nirman Bhawan, New Delhi Dated the 29" May, 2019.

Sub: Post-operative Follow-up treatment from Hospitals empanelled under CGHS in

respect of critically ill CGHS beneficiaries-regarding

With reference to the above mentioned subject the undersigned is directed to state that in view of the difficulties being faced by critically ill CGHS beneficiaries in getting post-operative follow-up treatment at CGHS empanelled hospitals, the matter was reviewed and it has now been decided that critically ill CGHS beneficiaries shall be permitted for follow up treatment in CGHS empanelled hospitals as per the details given under.

II.

iv.

Permission for post-operative follow-up treatment in respect of the following post operative conditions requiring frequent Consultations from Specialists at private hospitals empanelled under CGHS, need not be re validated from time to time and follow-up treatment may be under taken at CGHS rates without time limit.

The consultation /investigations are permitted under these follow-up cases. The conditions covered are:

a. Post Cardiac Surgery Cases including Coronary Angioplasty

b. Post Organ Transplant Cases (Liver, Kidney, Heart, etc.)

c. Post Neuro Surgery Cases/Post Brain Stroke cases requiring regular follow-up

treatment

d. End Stage Renal Disease/follow up cases of Liver Failure

e. Cancer treatment

f Auto-immune disorders like Rheumatoid Arthritis requiring regular follow-up

Neurological disorders like Dementia, Alzheimer's disease, Parkinsonism, etc.,

Medicines prescribed are to be procured from CGHS Wellness Centre,

The beneficiaries shall have to submit a self-attested photo copy of the permission letter to the hospital to enable the hospitals to provide credit facility in respect of pensioners and other categories of CGHS beneficiaries entitled for credit facility. Serving employees (and their dependents) who may not be entitled for cashless facilities shall enclose a self-attested photo copy of permission letter to claim reimbursement from the concerned Ministry /Department.

Permission in respect of Pensioner CGHS beneficiaries, Ex-MPs (and other categories of CGHS beneficiaries, whose medical expenditure is borne by CGHS) etc., shall be granted by CGHS. Permission in respect of Hon'ble Members of Parliament shall be

granted by Rajya Sabha Secretariat/Lok Sabha Secretariat as the case may and by concerned Ministry /Department in respect of serving beneficiaries and by concerned Autonomous Body/ Statutory Body in respect of serving /pensioner beneficiaries.

However, if any non-listed investigations / procedures are advised permission from competent Authority shall be required, except in emergency.

These orders are in supersession of the earlier guidelines on the subject

915119

(Dr. Manoj Jain)

Addl. DDG(HQ), CGHS

1 All Ministries / Departments, Government of India

2 Director, CGHS, Nirman Bhawan, New Delhi

3 CGHS Desk-I/Desk-II/CGHS-I/CGHS-II, Dte.GHS, Nirman Bhawan. New Delhi

4 Estt./Estt.II/Estt.II/Estt IV Sections, Ministry of Health & Family Welfare

Admn.l/Admn.Il Sections of Dte. GHS

6 Addl. Director, CGHS(HQ)/Addl. Directors/Joint Directors

Rajya Sabha / Lok Sabha Secretariat

of CGHS Cities

8 Registrar, Supreme Court of India /Punjab & Haryana High Court, Chandigarh 9 Under Secretary, U.P.S.C.

10 Under Secretary Finance Division

11 Deputy Secretary (Civil Service News), Department of Personnel & Training.

5th Floor, Sardar Patel Bhawan, New Delhi..

12 PPS to Secretary (H&FW) Secretary (AYUSH) Secretary(HR)/ Secretary(AIDS

Control), Ministry of Health & Family Welfare

13 PPS to AS&MD, NRHM/AS (H) /DGHS

14 Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi

15 All Staff Side Members of National Council (JCM) (as per list attached)

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

Delhi

17 All Offices / Sections / Desks in the Ministry

18 UTI Infrastructure Technology And Services Limited, UTI-ITSL Tower, Plot No3 Sector-

11, CBD Belapur, Navi Mumbai-400614

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

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

21 Office Order folder

Copy for information to

Joint Secretary, Cabinet Secretariat, Rashtrapati Bhawan, New Delhi

Revised Delegation of Financial Powers

		Revised Delegated Powers
a)	Additional Director, CGHS of City Zone	Rs. 1,00,000/- (No change)
b)	Director, CGHS	Upto Rs. 3,00,000/-
c)	Addl Secretary & DG,CGHS	Upto Rs. 5,00,000/-

EX-POST-FACTO APPROVAL

1. Treatment taken without recommendation of CGHS/ Govt. specialist, but with permission of CMO in-charge of CGHS dispensary in a recognised private hospital within approved ceiling rates	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.
2. Treatment taken in private hospitals recognised under CGHS without prior permission	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.
3. Emergency cases within approved ceiling rates in respect of treatment taken in private hospitals recognised under CGHS.	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.
4. Emergency cases within ceiling approved rate in respect of treatment taken in private unrecognised hospital.	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.
5. Cases where prior permission 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/ procedure/ diagnostic procedure has been used/undertaken for which no prior permission was taken.	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.
6. Ex-post-facto permission for treatment in Govt. referral hospitals like AIIMS, PGI Chandigarh, etc.	For serving employees: HOD of the concerned Ministry/ 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.
7. Treatment under emergency in private hospitals recognised under CGHS and approval to be given as per approved rates for approved procedures/ Appliances/devices.	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.
8. Treatment taken under emergency but approval to be given above the approved rates	Ministry of Health and Family Welfare may decide such type of cases in special circumstances, depending upon the merits of each case.
9. Relaxation of CGHS Rules	Ministry of Health and Family Welfare will decide such type of cases.
10. Air travel permission/Ex-post-facto approval for air travel undertaken for medical treatment	Ministry of Health and Family Welfare will decide such type of cases.
11. Reimbursement of treatment/test for which there is no prescribed rates under CGHS	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 Medical 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 lakhs (in case of serving employees beneficiaries) : By the HOD b) Rs. 2 lakhs (in case of pensioner CGHS beneficiaries) : By the Head of the concerned CGHS covered city. c) Rs. 2 to 5 lakhs: Director, CGHS d) Above Rs. 5 lakhs: Ministry of Health and Family Welfare.

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