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Extension of WBHS,2008 to retired members of AIS

October 1, 2011 Leave a comment
Government of West Bengal
Finance Department
Audit Branch
Medical Cell
No. 9021-F (MED)   Dated the 16th Sept, 2011.

Notification

    From some time past, the Government has been considering extension of  benefits of the West Bengal Health Scheme, 2008 to the retired members of All India Services who rendered services in the affairs of the State and not enrolled under the  Central Government Health Scheme (CGHS).  Now, the Governor is pleased to extend the benefits of the West Bengal Health  Scheme, 2008 to such retired members of All India Services on payment of one-time  contribution of Rs. 40,000/- (Rupees Forty Thousand) only.  The respective Pension Sanctioning Authority will enroll the names of such  pensioners following the provisions of the West Bengal Health Scheme, 2008 for the  pensioners. The said Authority will also settle the claims for reimbursement. Except  one-time contribution, all other terms and conditions of the Scheme will remain the  same.

By order of the Governor,
Sd/-
(C.M. Bachhawat)
Principal Secretary to the
Government of West Bengal,
Finance Department.


Click here to view more orders on CGHS

Click here to view the order.

Categories: CGHS, PENSIONERS

Fresh empanelment of private hospitals and revision of package rates applicable under CGHs. Jabalpur and Delhi.

September 13, 2011 Leave a comment
G.I., Deptt. of H & FW., O.M.No:S.11011/23/2009-CGHS D.II/Hospital Cell (Part IX) dated 08.09.2011 
Fresh empanelment of private hospitals and revision of package rates applicable under CGHS. Jabalpur and Delhi.

1.   The undersigned is directed to invite reference to this Ministry’s Office Memorandum of even number dated the 8th December 2010 and 21st February 2011 vide which hospitals were empanelled under CGHS, Jabalpur & NCR -Delhi at revised package rates payable to private hospitals for treating CGHS beneficiaries.


2.    The undersigned is also directed to invite reference to the continuous empanelment scheme in Jabalpur and NCR of Delhi initiated through notification of Office Memorandum No. S.11011/23/2009-CGHS D.II/Hospital Cell (Part IX) dated 8th December 2010 and 21st February 2011 and enclose a further list of hospitals, which have qualified under the continuous empanelment scheme under the categories mentioned and have conveyed their acceptance of the CGHS rates and have signed the Memorandum of Agreement with CGHS and have also furnished the appropriate  performance bank guarantee. These hospitals are also taken as included in the list of approved hospitals for empanelment under CGHS, Jabalpur and NCR of Delhi and will be eligible to treat CGHS beneficiaries at revised rates with effect from the date of issue of this Office Memorandum;

3.  This Office Memorandum and the CGHS rates for Jabalpur and Delhi can be downloaded from the website of CGHS. http://msotransparent.nic.in/cghsnew/index.asp


4.  The empanelment shall be valid for two years from the date of issue of the notification or till next date empanelment, whichever is earlier.

Click here to see the Fresh list of hospitals under CGHS in Jabalpur

Categories: CGHS, jabalpur

Fresh empanelment of private hospitals and revision of package rates applicable under CGHS, Mumbai – Clarification regarding.

September 8, 2011 Leave a comment
Government of India 
Ministry of Health and Family Welfare 
Department of Health & Family Welfare 
Nirman Bhawan, New Delhi 110 108

No:S.110011/23/2009-CGHS D.II/Hospital Cell (Part I)

Dated 28/08/2011
OFFICE MEMORANDUM


Subject: Fresh empanelment of private hospitals and revision of package rates applicable under CGHS, Mumbai – Clarification regarding.


1. The undersigned is directed to invite reference to the Office Memorandum of even number dated 1st September, 2011 on the above subject, vide which inter alia revised package rates applicable under CGHS, Mumbai were notified and to state that that in response to serveral representations received by this Ministry with requests for correction of typographical and other anomalies in the notified rates, the rates earlier notified for empanelment for empanelled hospitals under CGHS, Mumbai have now been reviewed.

2. Accordingly, a corrected list of package rates applicable for empanelled hospitals under CGHS, Mumbai is enclosed.

3.The hospitals, which are already empanelled / being empanelled under continuous empanelment scheme under CGHS, Mumbai are hereby requested to take note of the corrected rates (The bills already cleared will not be reopened.)

4.  The other hospitals shortlisted for consideration of empanelment are also requested to accept the corrected rates and come forward to sign MOAs with Addl. Director, CGHS, Mumbai.

5.  This issues with the concurrence of Finance Division vide Dy. No.561 dated 8th June 2011 of the Office of SS & FA, Min. of Health & Family Welfare. A copy of this Office Memorandum along with the corrected rate list and a copy of MOA are placed on the internet at http://msotransparent.nic.in/cghsnew/index.asp
sd/- 
(Jai Prakash) 
Under Secretary to Government of India


Categories: CGHS, hospital list

Fresh empanelment of private under CGHS, BENGALURU, CHANDIGARH, CHENNAI, HYDERABAD. JABALPUR, KANPUR, KOLKATA AND MUMBAI

August 11, 2011 Leave a comment



Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108


No:S.110011/23/2009-CGHS D.II/Hospital Cell (Part IX)

Dated, the 27th JuIy, 2011

OFFICE MEMORANDUM

Subject:- Fresh empanelment of private under CGHS, BENGALURU,
CHANDIGARH, CHENNAI, HYDERABAD. JABALPUR, KANPUR, KOLKATA AND MUMBAI

    1.  The undersigned is directed to state that CGHS had initiated action for
empanelment of private hospitals under CGHS, under Continuous Empanelment
Scheme, which was notified vide Office Memorandum of even number dated 8th
December, 2010.


   2. The undersigned is directed to enclose a further list of hospitals,
under the categories mentioned in the document, that have conveyed their
acceptance of the CGHS rates in various cities announced and placed on CGHS
website and have signed the Memorandum of Agreement with CGHS and have also
furnished the appropriate performance bank guarantee. These hospitals are
also taken as included in the list of approved hospitals for empanelment
under CGHS, Bengaluru, Chandigarh, Chennai, Hyderabad, Jabalpur, Kanpur,
Kolkata and Mumbai.


   3. It has now been decided that in the list of hospitals enclosed, which
have been now approved under the fresh empanelment procedure, and have now
signed the fresh Memorandum of Agreement and submitted the appropriate
performance guarantee will be eligible to treat CGHS beneficiaries at
revised rates with effect from the date of issue of letter.


   A copy of this Office Memorandum and CGHS rates for different cities are
available at web site http://msotransparent. nic. in/cghsnew/index.asp


 

[Jai Prakash]
Under Secretary to Government of India

Click here to view the list

Categories: CGHS, hospital list, PENSIONERS

Fresh empanelment of private hospitals under CGHS, Bangalore, Chandigarh, Hyderabad, Kolkatta, Ahmedabad and Pune.

July 25, 2011 Leave a comment

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108
No:S.110011/23/2009-CGHS D.II/Hospital Cell (Part IX)

Dated, the 5th July. 2011

OFFICE MEMORANDUM

Subject:- Fresh empanelment of private hospitals under CGHS, Bangalore, Chandigarh, Hyderabad, Kolkatta, Ahmedabad and Pune.

   1.   The undersigned is directed to state that CGHS had initiated action for empanelment of private hospitals under CGHS, under Continuous Empanelment Scheme, which was notified vide Office Memorandum of even
number dated 8th December, 2010.

   2.    The undersigned is directed to enclose a further list of hospitals, under the categories mentioned in the document that have conveyed their acceptance of the CGHS rates in various cities announced and placed on CGHS website and have signed the Memorandum of Agreement with CGHS and have also furnished the appropriate performance bank guarantee. These hospitals are also taken as included in the list of approved hospitals for empanelment under CGHS, BENGALURU, CHANDIGARH, HYDERABAD, KOLKATA, AHMEDABAD AND PUNE.

   3.    It has now been decided that in the list of hospitals enclosed, which have been now approved under the fresh empanelment procedure, and have now signed the fresh Memorandum of Agreement and submitted the appropriate performance guarantee will be eligible to treat CGHS beneficiaries at revised rates with effect from the date of issue of letter.

       A copy of this Office Memorandum and CGHS rates for different cities are available at web site http://msotransparent. nic. in/cqhsnew/index.asp

 
sd/-
[R. Ravi]
Director
Click here to view the list of hospitals

Categories: CGHS, hospital list, PENSIONERS

Eligibility of permanently disabled son of a Central Government Health Service (CGHS) beneficiary to avail CGHS facility- reg.

July 13, 2011 Leave a comment


CGHS facility for disability clarified

Eligibility of permanently disabled son of a Central Government Health Service (CGHS) beneficiary to avail CGHS facility has been clarified with respect to schizophrenia as a disability. It is clarified that schizophrenia is a case of mental disorder and falls within the definition of disability as defined in Section 2 (i) of The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (No.1 of 1996) and is covered by the terms `mental retardation’ and `mental illness’.

It has, therefore, been decided that sons of CGHS beneficiaries suffering from 40 per cent or more of schizophrenia will be entitled to avail CGHS facility even after attaining the age of 25 years, provided they are financially dependent on and residing with the CGHS beneficiary.

For this purpose, the CGHS beneficiary will furnish to the CGHS the disability certificate issued by the appropriate authority to the effect that the disabled person is still suffering from a disability which is more than 40 per cent, after every five years.

Details are available in the Department of Health and Family Welfare

OM No. 4 – 24/96- C&P/CGHS (P) dated May 26, 2011.

Categories: CGHS

Minutes of the meeting held on 14/7/2010 regarding proposed Central Government Employees and Pensioners Health Insurance Scheme

June 21, 2011 Leave a comment
F.No.B.12012/03/2010-CGHS (P)
Government of India,
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 6th June, 2011.

Subject: – Minutes of the meeting held on 14/7/2010 regarding proposed Central Government Employees and Pensioners Health Insurance Scheme – regarding.

   The undersigned is directed to enclose a copy of the Minutes of the meeting of Staff Side Members of National Council (JCM) with Joint Secretary (Regulation), Ministry of Health & Family Welfare held on 14/07/2010 regarding proposed Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS) for information and further necessary action, if any.

 
sd/-
(JAI PRAKASH)
Under Secretary to the Govt. of India.

Minutes of the meeting of Staff Side Members of National Council (JCM) with Joint Secretary (Regulation) held on 14/07/2010 at 11: 00 AM in the Committee Room of Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi on the proposed Health Insurance Scheme for Central Government employees and pensioners.

   Shri Vineet Chawdhry, Joint Secretary (Regulation) M/o Health and Family Welfare held a meeting with staff side members of National Council (JCM) on 14th July. 2010. List of the participants in the meeting is at Annexure.

   At the outset, Chairman welcomed the Staff Side members of National Council (JCM) to the meeting to discuss the proposed Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS), to be rolled out in compliance of the recommendation of Sixth Central Pay Commission and to directions of Committee of Secretaries (COS). He informed the members about the salient features of the Scheme which had already been circulated, and said that:

   • The proposed scheme shall be compulsory for new appointees and new retirees and would be voluntary for existing pensioners and employees.

   • Government may bear upto 75% of the insurance premium share as a subsidy depending upon the eligible categories of the employee. The remaining portion of the premium will be borne by the members as is being done for CGHS.

   • Scheme will have no age limit, therefore member of any age can join the scheme.

   • All pre existing diseases will be covered from day one.

   • He further stated that OPD benefit is not available under the Insurance scheme due to various constraints, however, free OPD consultation will be provided by the networked hospitals and also they will charge the discounted CGHS rates for diagnostics procedures if prescribed during OPD consultation. However, cost of medicines will not be covered in such cases.

   • The scheme will operate on cashless basis on the lines of existing CGHS packages for the treatment taken in the networked hospitals by pensioners beneficiaries and no money is to be paid by the members to the hospitals.

   • The ‘family’ under CGEPHIS has been defined as self, spouse two dependent children and two dependent parents. Dependency criteria will remain same as applicable under CGHS. For including any additional member as a beneficiary under the scheme, the beneficiary would have to bear the entire premium on the additional member without it being subsidized by the Government.

   • The Insurance cover for the family will be Rs. 5 lakh and it will operate on family floater basis. In addition to this, a provision has also been made to create a corporate buffer of Rs. 25 Crore to take care of eventualities in cases where the above limited is exhausted fully and the member/ beneficiary is still undergoing treatment. In other words, although a monetary limit of Rs 5 Iakh has been kept as insurance cover for the family but it is only to decide the insurance premium with the Insurer. In fact, the members will enjoy an unlimited cover for their medical treatment under this Health Insurance Scheme too. Anything over and above Rs. 5 lakh will be borne by the Government.

   • Pre and post hospitalization benefits would also be available to the members.

   • Insurance premium to be paid would be deducted from the salary of the serving employees and pensioners would authorize their banks to deduct the applicable premium.

   • There will be a provision in the scheme for the beneficiaries to opt out of the scheme after three years.

   Shri V. P. Singh, Deputy Secretary (Medical services) informed the members that the Ministry conducted a ‘Demand Survey’ and gave wide publicity through newspaper advertisements all over India and invited response from the target population i.e., employees and pensioners who are willing to join the Scheme when it becomes operational. It was hosted on the website of the Ministry and CGHS website and willingness was invited through email too. The response have been quite encouraging and around 16,000 responses have been received which are being compiled for analysis. Majority of the response were from Non CGHS area and people have shown their willingness to join the scheme. The staff side requested that the outcome of the ‘Demand Survey’ may also be shared with them on its completion, which was agreed to.

   He also informed that as per the information made available by IRDA, 97% of the claims settled by the Insurance companies involved amount of less than Rs 3 lakh annually. Only 0.35 % of the claims were for amount exceeding Rs. 5 lakh annually, the balance falling between the Rs 3 to 5 lakh. Hence the proposed insurance cover of Rs 5 lakh would be adequate for the beneficiaries.

   DR. S. P. Goswamy, National Consultant (Health Insurance), Ministry of Health and Family Welfare informed the members that most of the benefits available under CGHS have been made a part of the CGEPHIS. The CGEPHIS is almost a replica of CGHS. Most of the defined day-care procedures which are covered in CGHS under OPD have been made part of the scheme. Further, in such cases where patients require hospitalization, but the condition of the patient is such that he cannot be shifted to hospital or bed is not available, CGEPHIS shall provide for such medical treatment under domiciliary hospitalization. These cases are part of OPD in CGHS

   Chairman further informed the Staff Side that all possible efforts have been made to make the Scheme suitable for the employees and pensioners retaining in it all the important features of CGHS and CS(MA)Rules, 1944, so that it attracts the target group and provide a freedom of choice in the hands of employees and pensioners, to select the best suitable scheme for them. He sought the views of the Staff Side members of JCM on the Scheme.

   Opening the discussion from the Staff Side, Shri S.K.Vyas Member(Staff side) JCM informed the meeting of their collective view on the scheme and stated that they have been opposing the Health Insurance Scheme all along and they still hold the view that CS(MA) Rules, 1944 is more suitable and it may be extended to all non CGHS areas and should provide cover to the pensioners who have been deprived of this medical facility since long. He further opined that the proposed scheme will also deprive the existing benefits available to the employees and pensioners viz. OPD facilities, coverage to all dependent family members etc. Extension of CS(MA) Rules, 1944, to all pensioners living in Non CGHS areas is their long pending demand. The Staff side unanimously stated that if the Government has already made up its mind to introduce Insurance Scheme, it should be implemented with the following points given due consideration before introduction of the scheme, so that it attracts the prospective members to join the scheme:

   • The Scheme should not be made compulsory for the future employees and pensioners. A voluntary option for joining the scheme must be given to all future employees and pensioners. The choice must be left to them. Especially the future retirees should not be deprived of the CGHS benefits that they have been availing during their service period as per the present scheme.

   • All eligible dependent members of the family may be allowed to join the scheme without any additional financial burden on members. This is being done in the existing CGHS and no financial burden is being imposed on members. Whatever the liability of premium for additional members is worked out; the same may be borne by the Government.

   • As the OPD consultation will be free in networked hospital, the cost of medicines on the prevailing guidelines of the CGHS may be reimbursed to the members. Else, an amount to Rs. 1000 +DA per month as Fixed Medical Allowance (FMA) be paid to them on the analogy of the Transport Allowance. The revised amount of Rs. 300/- per month as FMA is inadequate, considering the ever increasing cost of the medical treatment under the present inflationary conditions.

   • The annual contribution to be made by the employee as his share of the Insurance premium for the Health Insurance policy should not in any case be more than the CGHS contribution applicable for him.

   • Life time contribution in respect of insurance premium may be taken from the pensioners as per the present CGHS provisions (for ten years for life time benefit) and rest may be borne by the government.

   Staff side raised the point about the implementation process of the scheme and enquired about the number of Insurance companies that may be involved in this scheme, as insurers to cover the entire country. Chairman informed the members that it will depend upon the future scenario as it emerges in due course.

   Shri S.K. Vyas reiterated his opinion that the extension of CS(MA) Rules, 1944, to the pensioners living in non CGHS areas would be more economical and cost effective way of addressing their health related issues in comparison to the proposed Health Insurance Scheme (CGEPHIS).

   Shri C. Srikumar raised the issue of revision of Fixed Medical Allowance (FMA) to those employees who are posted in remote areas where AMA is not available. Since the Government has already issued order for revising the FMA for pensioners, necessary order for serving employees may also be issued.

   Chairman assured the Staff Side members of the National Council(JCM) that the Ministry will look into the points raised by them seriously and the concerns expressed by them and suggestions made by them will be given due consideration while finalising the Scheme.

   The meeting ended with a vote of thanks to the chair.
 

Courtesy:AIRF

Categories: CGHS, PENSIONERS

Issue of pensioner CGHS Cards to Central Government servants before retirement.

February 27, 2011 Leave a comment


Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108


No: 37-1/2009-C & P/CGHS (P)
Date: February 23, 2011


OFFICE MEMORANDUM




Subject:       Issue of pensioner CGHS Cards to Central Government servants before retirement.




      Central Government servants on their retirement from service are entitled to CGHS facility, if they retire from office Ministries I Departments I Offices covered by CGHS. For availing CGHS facility, if eligible, after retirement from service, pensioners are required to fill up the requisite form and deposit the appropriate amount [lump sum amount equivalent to one year’s contribution for availing CGHS facility for one year (which can be extended on an annual basis on payment of the appropriate contribution as applicable at the time of renewal) or pay in lump sum equivalent to ten years’ contribution for availing CGHS facility with life-time validity). The process of issuing of pensioner CGHS cards starts only after the Government servant retires from service and only after the Pension Pay Order (PPO) and Last Pay Certificate (LPC) are issued by the Ministry / Department I Office. The completion of the formalities takes two to three months, which puts pensioners in a problematic condition for getting treatment from the date on which they retire from service and the time when a pensioner CGHS card is issued to them. 

2. The Ministry of Health & Family Welfare has received representations from retired Central Government servants and from officials due for retirement within the next few months with the request that the policy regarding issue of pensioner CGHS cards be simplified so that they are in a position to get the pensioner CGHS card a day after their retirement from service. 

3. The matter has been examined by the Ministry of Health & Family Welfare in consultation with CGHS and it has been decided that the following course of action will be taken in respect of officials who are entitled to avail CGHS facility after his I her retirement from Government service: 

  (i)     All Ministries I Departments will, alongwith pension papers, give the application for issue of pensioner CGHS cards to the official three months before the due date for retirement of the official; 

  (ii)     The official, if he / she is interested in availing CGHS facility after his I her retirement, will: 

    a.       Fill up the form for issue of pensioner’s card; 

    b.       affix stamp sized photographs of the family members entitled to avail CGHS facility in the proforma for issue of pensioner’s card; 

    c.       enclose Demand Draft I Pay Order for the appropriate amount with reference to his I her decision to get CGHS card with life-time validity (the amount will be equal to ten years’ contribution) or with validity for one year (the amount will be equal to one year’s contribution). For obtaining the card in Delhi, the Demand Draft I Pay Order will have to be made payable to “Pay & Accounts Officer (CGHS), payable at Delhi” and for obtaining card in a CGHS city outside Delhi, the Demand Draft I Pay Order will have to be made payable to “Additional Director or Joint Director (as the case may be) of the CGHS city, payable in that city”; 

(iii) The Ministry I Department will add a certificate of pay, grade pay, etc., drawn by the applicant to the application form and also mention the entitlement of ward (Private ward I Semi-Private Ward / General Ward) at the time of retirement of the official; 

(iv) The Ministry I Department will forward the application complete in all respects to the Additional Director in the concerned CGHS city after verifying the particulars furnished by the applicant six weeks before the date of retirement of the official; 

(v) CGHS pensioner cell in the concerned CGHS city will initiate action to get the pensioner card prepared; 

(vi) The validity of the pensioner card will start from a date after the last day of service of the official; 

(vii) If the beneficiary, while in service, has been issued plastic card, then the beneficiary identification number (Ben ID No.) will not be changed at the time of preparation of pensioner card and the same Ben ID number will be carried forward in the pensioner card; 

(viii) The pensioner card will be handed over to the retired official only after the date of superannuation I retirement from service; and 

(ix) Before the pensioner CGHS card is issued to the beneficiary, the plastic CGHS cards issued to all the members of the family will be surrendered 

4. AIr Ministries / Departments are requested to give wide publicity to the contents of these instructions.




Director
[R Ravi]





Application Form & Instructions… Click here… 

Categories: CGHS, PENSIONERS

80% CGHS drugs bought locally

February 27, 2011 2 comments


   NEW DELHI: Almost 80% of the drugs purchased for Central Government Health Scheme (CGHS) dispensaries in Delhi between 2002 and 2007 were bought from local chemist while only 20% were procured through the centralized route. 

    In absolute numbers, the value of medicines purchased through local chemists stood at Rs 366.33 crore of the total expenditure of Rs 459.21 crore. 

   Similar was the story with CGHS dispensaries (which provide health care facilities for central government employees and pensioners and their dependents residing in CGHS covered cities) in Hyderabad, Bangalore, Allahabad, Patna, Kolkata, Mumbai, Pune and Guwahati. 

   Almost 74%-91% of the drug purchases between 2002 and 2007 in these dispensaries were from local  chemists, according to the Public Accounts Committee’s latest report. Also, most of the medicines in the formulary (centralized drug list) did not have a rate contract. 

   The report said the committee was given to understand that the purchase system of approaching local chemists was introduced to enable the CGHS dispensaries to supply to the beneficiaries those medicines which were not in stock. 
“Audit had pointed out that there was procurement of smaller number of medicines from the formulary list. According to the audit, CGHS dispensaries made extensive purchases of medicines from local chemists ignoring the quality and cost effectiveness of these purchases,” the PAC report said. 

   The major suppliers of these drugs purchased in bulk were generally the well-established larger pharma companies who were providing discounts upto 40% on MRP, the report said. 

   But over the period of time the system degenerated. The committee’s examination of the subject has revealed that such degeneration crept in as there was no database regarding procurement, distribution and inventory management of the drugs for which no effective monitoring could be put in place to ascertain the reasons of largescale procurement through local purchases. 

   However, the committee headed by Murli Manohar Joshi added that the health ministry lately has swung into action and taken a number of measures to cut down on local purchases as well as to bring in efficiency in the procurement system. 

   PAC said that the measures included computerization of all the dispensaries in Delhi, culling out a list of about 262 medicines that were not in the formulary of Medical Stores Organization (MSO) but frequently prescribed by doctors and procured locally, and entering into a rate contract for all these drugs.

Source –  TOI

Categories: CGHS, MEDICAL

Conditions for reimbursement of medical fee in Private Hospitals

February 27, 2011 Leave a comment

General Concepts of Medical Rules

Employees and their family members are entitled to reimbursement for medical attendance and treatment.
3 Categories of Hospital facilities are admissible for employees.
  • CGHS Hospitals.
  • Recognized Private Hospitals.
  • Private Hospitals (Other than Recognized).

What are the Medical facilities available for reimbursement ?


In India

  • Operation for sterilization.
  • Treatment of sterility
  • Venereal diseases and Delirium Tremens
  • Avitaminosis and Hypovitaminosis.
  • Correction of eye.
  • Treatment for immunizing and prophylactic purposes.
  • Diseases causing General debility and secondary anemia.
  • Confinement including at residence if attended by Child Welfare and Maternity Centres staff; Pre-natal and Post-natal Treatment.
  • Testing of eyesight for glasses for employees only.
  • Blood and blood transfusion charges.
  • Dental Treatment
  • Anti-rabic treatment
  • cost of hepatitis Vaccine B, C & D.

Outside India

  • Cardio Vascular Surgery
  • Kidney transplant
  • Other organ transplant
  • Joint replacement and surgery
  • Bone-marrow transplant
  • Certain types of medical and ontological disorder, such as leukemia and neoplastic conditions.
  • Micro vascular surgery and neuro surgery.
  • Treatment with Laser which obviates the need of open surgery.
  • Treatment with laser which obviates the need of open surgery.
  • Extra corporeal stone disintegration by ultrasonic shock waves.

What are the recognized Hospitals for Medical Treatment ?

  • All State Government Hospitals including District Hospitals and Municipal Hospitals
  • All Hospitals recognized by primary health centres and dispensaries recognized by state government for treatment of their employees and or members of their family.
  • All maternity and child welfare centres with facilities for indoor treatment and recognized by state government.
  • Cantonment hospitals in cantonment areas where there are no government hospitals.
  • All railway hospitals
  • All Government hospitals recognized by state government / CGHS rules / CS(MA) Rules
  • Hospitals funded by Central / State government.
  • Pay clinics in Bihar, Punjab , Haryana, UP ,MP, Rajasthan and Chandigarh.

How to Get medical Reimbursement when treated in a Private Hospital ?

An employee has to go to nearest CGHS or Government hospital for treatment. But in some emergency cases they may be forced  to go to nearby Private hospital which may not be a recognized hospital.
In such cases the employee has to obtain an emergency certificatefrom the doctor of this private hospital. In this emergency certificate,  the reason for choosing the private hospital should be specified and it should be duly signed by the doctor.

How much  amount can be reimbursed for medical treatment for employees ?

There is no limit for the reimbursable amount. Full amount for the medicines will be reimbursed and for other expenses including lab tests, scanning, operation, doctors fee etc specific rates approved according to CS(MA) rules will be given.

 

 

Who are eligible for medical reimbursement ?

  • Central Government employees.
  • Dependant family members of employees.

Who are the Dependant Family Members eligible for Medical Reimbursement ?

  • Husband / Wife
  • Parents / Stepmother
  • For female employee, either her parents or parents-in-law.
  • Children including adopted children.
  • For unmarried son, Till he starts earning or attains the age of 25.
  • For Daughter, Till she starts earning or gets married.
  • No age limit for  son suffering from permanent disability.
  • Widowed daughters and dependent divorced / separated daughter.
  • Sisters including unmarried / divorced / abandoned or separated from husband / widowed sister irrespective of age limit.
  • Minor brothers.

Forms required for Medical Reimbursement 

What are the things to remember when claiming for Medical Reimbursement ?

  • Forms selected are correct or not.
  • All the certificates are duly signed by the Doctor.
  • Seal of the hospital is included in all the bills and the certificates.
  • In case of Private hospital, emergency certificate is also present.
  • If insurance policy is also claimed, then total reimbursement should not exceed the total expenditure.

(SOURCE)

Categories: CGHS, MEDICAL