Department of Health and
Family Welfare, Ministry of Health and Family Welfare has observed that issues
relating to CGHS Matters are referred by various Ministries and Departments to
Department of Health in a routine manner which could have been settled at the
CGHS beneficiary’s own Ministry or Department.
Hence, it is informed by Department of Health and Family Welfare that
cases related to CGHS matters are to be examined thoroughly as per the CGHS
guidelines and instructions and clarification on CGHS policy matter or
relaxation of rules is required, the administrative Ministry/Department may
refer the case to Department of Health and family welfare with specific
recommendation of Joint Secretary/Head of Department with justification along
with all supporting documents.
The Office
Memorandum dated 27.06.2012 issued in this regard is as follows.
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108
No.S.11011/1/2012-CGHS (P)
Dated the 27th June, 2012
OFFICE MEMORANDUM
Sub: Guidelines to be
followed by Ministries/Departments while referring cases to Ministry of Health & Family Welfare on CGHS matters
— reg.
Central Government Health Scheme (CGHS) was introduced in 1954
to provide comprehensive medical care for serving/retired Central Government
employees and their family members. Instructions have been issued from time to
time to regulate this medical facility to ensure that Ministries and
Departments of Government of India including the CGHS beneficiaries have a
clear idea on different aspects of CGHS.
2. Various instructions on eligibility, dependency, CGHS
contributions, issue of CGHS cards, medical advance, settlement of medical
claims and medical facilities provided under CGHS have been issued. These
instructions are by no means exhaustive but an effort has been made to ensure
that most cases are settled at the beneficiary’s own Ministry / Department.
3. Despite issuing a number of guidelines on settlement of
reimbursement claims and delegation of powers for referral and approval cases,
it has been observed that cases are being referred to this Ministry in a
routine manner without adequate examination. Instances of cases have come to
notice where despite the lack of documentary evidence, cases have been
recommended and referred to this Ministry for examination, with or without the
approval of the concerned Joint Secretary/Head of Department.
4. In such cases, it becomes difficult to examine the legitimacy
of the claims and much time and effort is spent in collating and verifying the
facts of the case. Accordingly, it is
impressed upon all the Ministries/Departments of the Government of India to
ensure that cases are examined thoroughly as per the CGHS guidelines and
instructions. If any clarification on CGHS policy matter/relaxation of rules is
required, the Administrative Ministry / Department may, if they are satisfied
with the justification/merit of the case, refer it to this Ministry with the
specific recommendation of the concerned Joint Secretary /Head of Department
along with all supporting documents.
5. This issues with the approval of Additional Secretary &
Director General (CGHS).
sd/-
(V.P.Singh)
Deputy Secretary to the
Government of India
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