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Conditions for supply of OPD Medicines for major diseases prescribed by the Specialists of Private Hospitals recognized under CGHS, through CGHS Dispensarie

June 23, 2010 Leave a comment
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   The manner of providing OPD medicines prescribed by Specialists of private hospitals recognized under CGHS through CGHS dispensaries, for treatment of diseases like Cancer, Heart, Neuro-Surgery,  Organ Transplant and Knee/Hip replacement has been under consideration of the Government for quite some time past. It has now been decided that, OPD medicines for the purposes stated above would be provided through CGHS dispensaries, on the basis  of the prescription of the Specialist of the Private hospitals  recognized under CGHS, subject to the following conditions:-
  1. As drugs are costly, a Utilization Certificate from the  treating Specialist should be obtained by the patient from time  to time for accountability.

     

  2. In respect of follow up treatment in private hospitals  recognized under CGHS, the procedures as given in this Ministry’s  O.M. No. S-11017/1/95-CGHS(P), dated 20.9.1995, would continue to be
    applicable.
2 This issues with the concurrence of JS&FA vide Dy.No.4073/98, dated 8.9.1999
Categories: CGHS

Conditions for supply of OPD Medicines for major diseases prescribed by the Specialists of Private Hospitals recognized under CGHS, through CGHS Dispensarie

June 23, 2010 Leave a comment
Categories: CGHS

Govt. Servant responsible for Deletion of the name of an ineligible Dependent—-cghs

June 23, 2010 Leave a comment
Categories: CGHS

Govt. Servant responsible for Deletion of the name of an ineligible Dependent—-cghs

June 23, 2010 Leave a comment
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   The undersigned is directed to state that in accordance with the definition of ‘family’ mentioned in Ministry of Health Memo. No. F.6(1) 1-54-H, dated the Ist May, 1954 the family of a beneficiary for the purpose of CGHS scheme includes husband/wife of the CGHS card-holder, as the case may be, wholly dependent children or step-children and parents, who are mainly dependent on and residing with the Government Servant. While it is incumbent upon the card issuing. Authorities, i.e. various departments and offices participating in the scheme, to ensure that the names of only genuine and eligible persons are included in the CGHS token cards, it is the responsibility of the employees concerned to apply for a deletion of the name of the dependent from the CGHS card, when the ward is no more entitled to the benefit eligible  under the scheme. The failure on the part of a cardholder  to get the name of a child deleted from the CGHS token-card when  he is no more dependent on him is a good and sufficient reason  for initiating disciplinary proceedings against him in terms of the CCS (CCA) Rules, 1965. All Ministers/Departments of the Government of India are requested kindly to ensure that the above said provisions are complied with fully. These instructions may also be brought to the notice of all employees concerned.



Opting out of the C.G.H. SchemeSpouse  employed outside Central Government and availing Medical Facilities provided  by his/her Employer

   Central Government Servants covered under Central Govt. Health Scheme and whose spouse is employed in Defence or Railway Services, State Government or Corporations or Bodies financed partly or wholly by the Central or State Government, Local Bodies and private organizations which provide medical facilities to the employees and their family members, can opt out of the CGH Scheme and avail medical facilities so provided by the above mentioned organizations.


   It is to be ensured that neither of the two nor their family members avail medical facilities from both the sources at the same time and for this purpose, the concerned Central Government employee shall give an undertaking to the authority issuing the CGHS Card.

Re-admission under CGHS after ‘opting out’

   Such Government Servants, who have opted out of CGHS, may apply for readmission and avail the benefit of CGHS in case their spouse dies or resigns or is dismissed from the office/organization, which provided medical facilities.

Availability of ‘Opting Out’ Facility

   The facility of opting out of CGHS can only be availed twice during the whole service career of the employee. Administrative Ministry/Department shall record the same by making an entry in the employee’s Service Book.
Categories: CGHS

PERSONS ELIGIBLE UNDER CGH SCHEME

June 23, 2010 Leave a comment
Categories: CGHS

PERSONS ELIGIBLE UNDER CGH SCHEME

June 23, 2010 Leave a comment

Eligibility Criterion

 

‘Residence’ alone (and not the Headquarters) is to be considered as criterion for determining the eligibility of a Central Government servant for availing medical facilities under Central Government Health Scheme. Thus, Central Government employees and their family members etc. residing in any of the 27 notified cities (list given in previous chapter) shall be covered under the Scheme. The scheme has recently been extended to the cities of Chandigarh, Bhopal and Shillong.

Persons Eligible under the C.G.H. Scheme

Following persons are eligible to avail medical facilities under the
Central Government Health Scheme:
  1. All Central Government employees paid from civil estimates (except
    Railways and Delhi Administration) including their families.

     

  2. Pensioners of Central Government (except pensioners belonging to
    Railways and Armed Forces) and their families.

     

  3. Pensioners retiring with Contributory Provident Fund benefits and
    their families.

     

  4. Widows of Central Government Pensioners, getting family pension.

     

  5. Delhi Police Personnel and their families.

     

  6. Civilian employees of Defence paid from Defence Service Estimates
    (except at Mumbai when the scheme is in operation).

     

  7. Child drawing pension on death of a Central Government employee
    including minor brothers and sisters of such child.

     

  8. Ex-Governors and their families.

     

  9. Ex-Vice President and their families.

     

  10. Central Government employees on leave preparatory to retirement.

     

  11. Central Government servants who are deputed to semi-Government and
    autonomous bodies receiving substantial grant from or financed by the
    Central Government and their family members.

     

  12. Military Officers while on deputation to civil departments and
    getting their emoluments from Civil Estimates.

     

  13. Families of ‘CGHS covered government servants’ who are on temporary
    transfer outside Delhi/CGHS centers for a short period up to six months
    provided they deposit six months contribution in advance.

     

  14. Pensioners visiting CGHS covered cities and staying at a place
    falling in CGHS covered cities.

     

  15. Employees of CGHS not residing in the CGHS covered cities.

     

  16. Ministers/Deputy Ministers of the Central Government/State
    Government and their families.

     

  17. Parliamentary Secretaries of the Central Government and their
    families.

     

  18. Members of Parliament and their families.

     

  19. Ex-Members of Parliament including those who are not in receipt of
    any pension.

     

  20. Retired judges of the Supreme Court and High Court residing in CGHS
    covered areas besides Delhi/New Delhi.

     

  21. Work charged and Industrial Staff working in establishments run by
    various Ministers/Departments of Central Government, immediately from
    the date of their joining the service.

     

  22. Employees of Kendriya Vidyalaya Sangathan stationed at Calcutta,
    Madras and Bombay.

     

  23. Employees of Ordnance Factory Board Headquarters, Calcutta and
    Ordnance Equipment Factories Headquarters, Kanpur.

     

  24. Ad-hoc employees of CGHS organization outside Delhi.

     

  25. All India Service Pensioners who retire while serving under the
    State at their option.

     

  26. Freedom Fighters and members of their family receiving central
    pension under the Swatantra Sainik Samman Pension Scheme.

     

  27. Family member of the deceased Ex-Members of Parliament.

     

  28. Pensioners of the Ordnance Factories.

     

  29. Members of staff side of the National Council of the Joint
    Consultative Machinery even though not serving as Central Government
    employees.

     

  30. Persons employed in semi-government and autonomous bodies who are
    permitted to join the CGH Scheme.

     

  31. Accredited Journalists who produce a certificate from the Press
    Council of India stating that he is the member of the Press Association,
    New Delhi.

     

  32. Retired employees of Indian Council of Agricultural Research.

     

  33. Employees of statutory canteens in CGHS covered cities if not
    covered under any other medical scheme.

     

  34. Employees of Central Council of Indian Medicine.

     

  35. Retired Divisional Accountants of the Indian Audit and Accounts
    Department.



Persons Not Eligible under CGH Scheme.

The following categories of persons are not entitled to avail CGHS facilities-
  1. Family members who are not longer dependent upon the government
    servant though staying with him/her.

     

  2. Independent brothers or sisters, even if minor.

     

  3. Married (but not separated) daughter staying with her parents.

     

  4. Government servants and their family members staying in an area not
    covered under CGHS.

     

  5. Government servant transferred to State Government or an ineligible
    department or are deputed to a foreign service. However, their families
    may be issued temporary permits for availing CGHS facilities on
    pre-payment of prescribed charged.



Dependent family members


Meaning of Family

The term ‘family means and includes:-
  1. Husband/wife including more than one wife and a judicially separated
    wife,

     

  2. Parents (excluding step parents,) subject to the following:

     

  3. In case of adoption, adoptive parents and not real parents,

     

  4. If adoptive father has more than one wife, only the first wife; and

     

  5. In case of female employees, parents or parents-in-law, at her
    option, subject to the conditions of dependency and residence etc. being
    satisfied.
Note: Option to include either her parents or parents-in-law is
not available to a female family pensioner.
  1. Children including step children, legally adopted children, children
    taken as wards by the Government servant under the Guardians and Ward
    Act, 1980, provided such a ward lives with him, treated as a family
    member and is given the status of a natural-born child through a special
    will executed by that Government Servant.

    Notes:- (i) Son is eligible till he starts earning
    (irrespective of age)
    (ii) Daughter is eligible till she starts earning or gets
    married, which ever is earlier (irrespective of age)
  2. Sons suffering from permanent disability either physically or
    mentally, without any age-limit.

     

  3. Windowed daughters (irrespective of age)

     

  4. Unmarried/widowed sisters (irrespective of age).

     

  5. Dependent Brothers (irrespective of age).

     

  6. Divorced/Separated daughters.

     

  7. Step-mother.
Categories: CGHS

Cost of Medicines purchases by CGHS Beneficiaries for OPD Treatment are not reimbursable

June 23, 2010 Leave a comment
Categories: CGHS

Cost of Medicines purchases by CGHS Beneficiaries for OPD Treatment are not reimbursable

June 23, 2010 Leave a comment
    A reference is invited to Ministry of Health and Family Welfare’s O.M. No. S-11012/1/91- CGHS(P), Vol.I, dated  18.3.1992, wherein it has been mentioned that OPD treatment is not  reimbursable underCGHS.

   Despite the instructions, this Ministry has been receiving  number of requests for reimbursement of cost of medicines purchases by CGHS  beneficiaries for OPD treatment. In order to avoid unnecessary reference to  this Ministry it has been decided to reiterate that OPD medicines  purchases by CGHS beneficiaries are not reimbursable and they should be got  issued by the beneficiaries from the concerned  CGHS dispensary.
This may be brought to the notice of all Govt. Servants.
 

The above orders are also applicable to pensioner beneficiaries.

A reference is invited to Ministry of Health and Family Welfare’s O.M. No. S-11012/1/91- CGHS(P), Vol.I, dated 18.3.1992, wherein it has been mentioned that OPD treatment is not reimbursable under CGHS.

   Despite the instructions, this Ministry has been receiving number of requests for reimbursement of cost of medicines purchases by CGHS beneficiaries for OPD treatment. In order to avoid unnecessary reference to this Ministry it has been decided to reiterate that OPD medicines  purchases by CGHS beneficiaries are not reimbursable and they should be got  issued by the beneficiaries from the concerned CGHS dispensary.

This may be brought to the notice of all Govt. Servants.

The above orders are also applicable to pensioner beneficiaries.

Categories: CGHS

Instructions regarding issue of Medicines to the CGHS Beneficiaries for Chronic Illness, Reiterated

June 23, 2010 Leave a comment
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            The Central Government servants/pensioners who are  availing of medical facilities under the Central Government Health Scheme  and are suffering from chronic illnesses like diabetes, tuberculosis,  heart ailment, hypertension, I.H.D., epilepsy, etc., can be issued medicines  for a period of three months at a time by the Officer-in-charge of the  CGHS dispensary, provided the specialist has prescribed the medicine for a  long period.  This Ministry has been receiving complaints from the patients  suffering fro long term diseases and the Pensioners Organizations, etc.,  that the patients are not being issued medicines for a period of three  months at a time and they have go to the dispensary every month for issue of  the requisite medicines.

 2. In order to alleviate the hardships being faced by such  CGHS beneficiaries, CMO-in-charge of the CGHS dispensaries all over  the country are requested to issue them medicines for a period of 3  months at a time against the individual valid prescription containing  the advice of the Government specialist.  They may, however, satisfy  themselves of the circumstances for the period for which the medicines
are issued.  
3. The CMO-in-charge may also maintain the records  indicating all such cases where medicines are issued to CGHS  beneficiaries for a long period along with the name of the beneficiary,  diagnosis and justification for issue of medicines.
4. The above-mentioned orders are also being circulated to  all the Ministries/Departments of the Government of India for general  information of all the CGHS beneficiaries.
Categories: CGHS, MEDICAL

Instructions regarding issue of Medicines to the CGHS Beneficiaries for Chronic Illness, Reiterated

June 23, 2010 Leave a comment
Categories: CGHS, MEDICAL