Dear
Comrades,
You might have known that the problems
relating to Postal Dispensary, Bhubaneswar are being taken by this Divisional
union time and again. Observing unnecessary delay in bringing a solution to the
problems faced by the beneficiaries, we have brought the same to the notice of both
the Hon’ble Minister of State for Communication and Information Technology,
Govt. of India and Minister of Health & Family Welfare, Govt. of India
through Sj. Mohan Jena, Honourable ( M P ) Lok Sabha who wrote on 13.07.2010.
Replying to the above letter vide his letter No. D O No. 24 – 9 / 2010 –
Medical, dated 11.08.2010 ( already published in this blog), Sj. Sachin Pilot, the
then Hon’ble Minister of State for
Communication and Information Technology, Govt. of India stated “The Department
has sent a proposal to the Ministry of Health and Family Welfare for merger of
19 such departmental dispensary with CGHS dispensaries which include merger of
Bhubaneswar Postal Dispensary with CGHS Dispensary. The Proposal is pending
with the Ministry of Health and Family Welfare for a decision”. Similarly,
acknowledging the letter of Sj. Jena, Sri Gulam Nabi Azad, the then Minister,
Health and Family Welfare, Govt. of India replied on 25.10.2010, “I am having
the matter examined and will take the necessary action accordingly”.
And my Dear Comrades,
now the result is before you. For the success, we have definitely played a role.
The Department of Health & Family
Welfare
Facts to know on CGHS
1. The Scheme :
Central Govt. Health Scheme ( CGHS )
is a compulsory scheme for all Central Govt. Employees residing within the areas covered by CGHS
dispensaries. As soon as a person joins Central Govt. service and intimates his
residential address which is within a CGHS covered area, CGHS contribution at
the appropriate rate should be recovered
whether the CGHS card is issued or not. But in such cases, the offices
concerned should ensure that the employee applies for a card and if he is not
applying despite intimation, suitable
action should be taken.
The benefit of CGHS accrue from the
date on which the Government servant applies for a CGHS card.
2. Conditions for availing the Scheme :
i.
The
Govt. Servant should reside in the area covered by the scheme.
ii.
An
employee covered by the scheme whose spouse is employed and getting medical
facilities can opt out of the Scheme and avail the medical facilities provided
by the employer of the spouse. If both husband and spouse contribute to the
CGHS, eligible parents of both may avail the benefits.
iii.
If
both the husband and wife are the Govt. employees, the contribution will
normally be paid by on who gets higher pay.
iv.
If
an employee or a member of his family
covered under CGHS falls ill at a place not covered under CGHS, treatment shall
be admissible under CS(MA) Rules.
v.
An
employee transferred to another CGHS station
or goes to abroad leaving his
family at the old station , may continue to pay the contribution, in which
case his family can continue to receive the benefits at the old station for that duration. However, if the transfer
is to a non-CGHS station , this facility is admissible only for six months.
vi.
CGHS
contribution will be recovered every month from the pay bill during the period of duty, suspension and
leave ( other than EOL) not exceeding four months as follows :
Grade pay of the beneficiary
|
Rate of monthly contribution
|
Up to Rs.1650/-
|
50
|
Rs.1800/-, 1900/-, 2000/-, 24000/- and Rs.2800/-
|
125
|
Rs.4200/-
|
225
|
Rs.1600/-, 4800/-, 5400/- and 6600/-
|
325
|
Rs.7600/- and above
|
500
|
vii.
In
case of leave exceed four months, one may not opt to contribute and in such
cases, the CGHS facilities will not be available.
viii.
Pensioners
residing anywhere may get registered in any dispensary.
ix.
A
retired employee who does not join the CGHS immediately after retirement has to
pay a registration fee of Rs.30/- if he subsequently desires to get himself registered with the CGHS and applies
for the CGHS Card.
x.
Pensioners
/ Family Pensioners have to contribute the amount they were subscribing at the
time of retirement /death of the Govt. servant.
xi.
Pensioners
/ Family Pensioners should pay their contribution for one year in advance
either from January to December or from July to June.
xii.
Pensioners
can avail life time facility by paying 10 years contribution on one lump sum at
the time of retirement.
3. Definition of Family : Same as C S ( MA )
Rules :
Family means employee’s
i.
Husband
/ Wife including more than one wife and judicially separated wife.
ii.
Parents
and Step Mothers – Incase of adoption, only the adoptive and not the real
parents. If the adoptive father has more than one wife, the first wife only. A
female employee has the choice to include
either her parents or parents-in-law. Option exercised can be changed only once
during the service.
iii.
Children including legally adopted children, step
children and children taken as wards subject to the following condition:-
Unmarried Son – Till he starts earning
or attains the age of 25 years whichever is earlier
Daughter – Till she starts earning or
gets married whichever is earlier irrespective of age limit.
Son suffering from permanent
disability of any kind ( physical or mental ) – No age limit
iv.
Widowed
daughters and dependent / divorced / separated daughters – Irrespective of age
limit.
v.
Sisters
including unmarried / divorced / abandoned
or separated from husband / widowed sisters – Irrespective of age limit.
vi.
Minor
brothers
4. Entitlement of Accommodation/Nursing Home
& Free Diet:
i.
Accommodation
:
Pay in
the pay band / Pension / Family Pension
|
Ward
entitlement in private hospitals empanelled under CGHS
|
Up to
Rs.13950
|
General
Ward
|
Rs.13960
to Rs.19530
|
Semi-Private
Ward
|
Rs.19540
and above
|
Private
Ward
|
ii.
Nursing
Home facilities in Govt./State. Govt./ Municipal Hospitals available for those drawing Pay / Pension / Family Pension Rs.13950 per month and above
iii.
Monetary
Ceiling for free diet :
a. For CGHS beneficiaries –
Pay/Pension/Family Pension of Rs.7450/- per month.
b. For beneficiaries suffering from TB /
mental decease - Pay/Pension/Family Pension of Rs.11160 /-per month.
iv.
Monetary
ceiling for direct consultation with specialists in Central Govt./State
Govt./Municipal Hospitals - Pay/Pension/Family Pension of Rs.33480/- per month.
FAQs on CGHS
1. Who are entitled for CGHS facilities?
a. All Central Govt. employees and their
dependant family members residing in CGHS covered areas.
b. Central Govt Pensioners and their
eligible family members getting pension from Central Civil Estimates
c. Sitting and Ex-Members of Parliament
d. Ex-Governors & Lt. Governors
e. Freedom Fighters
f. Ex-Vice Presidents
g. Sitting and Ex-Judges of Supreme Court
& High Courts
h. Employees and pensioners of certain
autonomous organizations in Delhi
i. Journalists (in Delhi
j. ( for OPD & at RML Hospital
k. Delhi
Police Personnel in Delhi
l. Railway Board employees
2. In how many cities CGHS is presently
operative?
CGHS facilities are available in 25 cities in
India
1. Ahmedabad 2 Allahabad
3 Bengaluru 4 Bhopal Chandigarh Hyderabad Jabalpur Jammu Kanpur Lucknow Meerut Nagpur
21 Patna Ranchi
3. For
CGHS cards , as dependant , what is the meaning of the word “ family “
The term ‘family’ means and includes:-
a. “Husband or wife as the case may be
and other dependant family members.
b. Dependant Family Members:
parents, sisters,
widowed sisters, widowed daughters, minor brothers and minor sister, children
and step-children wholly dependent upon the Government Servant and are normally
residing with the Government Servant”. Also now included , dependent divorced /
separated daughters (including their dependant minor children) and step-mother.
c. The term dependency means that income
from all sources including pensions and pension equivalent of DCRG benefit is
less than Rs.3500/- plus amount of DA on Basic pension of Rs3500/- per month.
d. However, there is no such clause as
dependency in respect of spouse.
4. What is the procedure to register with the
CGHS?
a. Pensioners:
b. One can get a CGHS card made from the
office of AD / JD of the City.
c. Forms can be downloaded from CGHS
Website or can be taken from office of AD / JD of city.
d. Documents required
i. Application in prescribed format
ii. Proof of Residence
iii. Proof of Stay of dependents
iv. Proof of age of son
v. Disability certificate, if any in case
of sons aged 25 & above, who would otherwise cease to be a beneficiary.
vi. Photos of eligible family members
vii. Surrender Certificate of CGHS Card while
in service ( only in those cases where CGHS Card was issued while in service)
viii. Attested copies of PPO & Last Pay
Certificate
ix. Draft for required amount towards CGHS
contribution – in the name of ‘P.A.O., CGHS New Delhi’ in Delhi
x. In case PPO is not ready for any reason
there is option to get a provisional card on the basis of Last Pay Certificate.
xi. The data is entered through computers and
entered in data base and a print out is issued same day for immediate use.
Plastic cards are subsequently sent to the residence of the card holder by post.
e. Serving
employees:-
Serving employees
submit the forms in prescribed format enclosing
photos of eligible family members and submit to the Ministry / Department/Office
, where he / she is employed. The application form shall be forwarded by the
Ministry / Office /Department to the office of Addl. Director CGHS of city for
preparation of card. Print out is issued for immediate use.
5.
Are CGHS facilities free of cost?
For serving employees
residing in CGHS covered area obtaining CGHS card is compulsory Deduction from
salary is made by the department, every month, depending upon their pay w.e.f
1st June 2009 .
Grade pay
|
contribution
|
Up to Rs.1650/-
|
50
|
Rs.1800/-, 1900/-, 2000/-, 24000/- and Rs.2800/-
|
125
|
Rs.4200/-
|
225
|
Rs.1600/-, 4800/-, 5400/- and 6600/-
|
325
|
Rs.7600/- and above
|
500
|
Pensioners who want
to avail CGHS facilities can make contribution either on yearly basis or one
time ( ten yrs ) contribution for whole life validity. Payment can be made by
Demand Draft in favour of “ P.A.O. CGHS Delhi”
if in Delhi or “ Additional Director of the CGHS City “Contribution in respect
of Pensioners are calculated on the basis of grade pay they are entitled had they been in
service , but for superannuation.
6. What
is the system for the services of specialists in Dispensaries?
Prior registration is
required appointment with the CGHS Wellness Centre, where specialist services
are available. However, In case of emergency contact CMO i/c of dispensary of
Wellness Centre for consulting specialist without prior appointment.
7. Is there any interactive mechanism at dispensary level?
At the Wellness
Centre ‘Local Advisory Committees’ are formed. CMO i/c holds a meeting with
Local Advisory Committee members to discuss local dispensary related issues.
8. How
long does it take to get the CGHS Cards?
computerized printout of index card is issued
on the same day. Plastic cards are sent to the residence in ‘3’ weeks time.
9. Whom
Should I approach in case the CGHS Card is not issued to me in the prescribed
time?
Contact Joint
Director (HQ), CGHS, Bikaner House, New Delhi in case of Delhi and Addl.
Director of City in case of other cities.
10. What
should I do if I lose my CGHS Cards ?
Application is to be
submitted to AD/JD along with two photographs and a IPO for Rs. 50/- for issue
of duplicate card. Indian Postal Order payable to “ P.A.O. CGHS Delhi” if in
Delhi or “ Additional Director of the CGHS City “ in respect of other cities .
11. What
should I do if the details on the Card viz. name, date of birth, entitlement,
etc. are wrong?
Kindly bring the
anomalies to the notice of Joint Director, CGHS (HQ), and Bikaner House in
Delhi and to the Addl. Director, Joint Director of concerned CGHS City in other
cities.
12. Is
there a colour scheme for plastic cards? What are the details?
CGHS Plastic cards
have the following colour at the top:
i. Serving Government employees - Blue
ii. Pensioners, ex-MPs , Freedom Fighters,
etc., - Green
iii. Member of Parliament - Red
iv. Beneficiaries of Autonomous Bodies /
Journalist – Yellow
13. I
retired in 1998 from Central Govt. but, I never made a CGHS card. Can I get a
card now?
Pensioners can apply
for CGHS card with relevant documents. However, the subscriptions as applicable
at current rates shall have to be paid.
14. My
husband/wife is also employed under Central Government and is eligible for a
separate CGHS Card. Is it necessary that separate cards are to be obtained?
No. Spouse drawing
higher pay shall make the card and other spouse is eligible to avail CGHS
benefits as member.
15. My
husband / wife retired in 2002. He / she was paying CGHS subscription every
year. After his death can I get Card on my name. Do have I to pay extra. Shall
I get Life Time Valid card ?
Yes, the ownership of
card can be transferred in the name of spouse on submission of required
documents. Addl. Director of concerned city shall transfer the ownership of
Card in the computer Data base and same CGHS plastic cards with same
Beneficiary ID can be used
a. No extra payment to be made, in case of
life time cards.
b. However in other cases one has to pay 10
years subscription for life time card.For example, if the spouse had
contributed for seven years before he expired , balance payment for the
remaining three years is to be paid for a life time card.
c. Documents required :
Application in
prescribed format
Proof of Family
Pension with its break up from Bank
Prescribed
contribution if, card is not for life time
16. How
to transfer CGHS card from one WC to other in the same city?
If there is any
change in residential address , CMO i/c may be approached with proof of
residence for transferring the data from one Wellness Centre to another in the
same city. CMO i/c of the new Wellness Centre will accept the data of
transferred card. In respect of serving
employees the request is to be forwarded by his/her office / department.
17. I
am CGHS beneficiary at Kanpur. Visiting Mumbai for 6 months. Can I get CGHS
facilities at Mumbai .Can same card of Kanpur continue or a separate card to be
made. From where to get permission for the same?
Subsequent to
computerization no separate permission is required and CGHS card is valid for
availing facilities from any CGHS Wellness Centre in India. For any assistance
, Addl. Director of the city may be contacted.
18. Who
is competent to delete name of sons who have crossed age of 25 years?
CMO i/c of Wellness
Centre is competent to delete the name of son aged 25 yrs and above. Computer system does
not allow sons aged 25 and above to avail medical facilities.
19. After
retirement in 2007 I got a Life time Pensioner CGHS card made in Delhi. Now I
am shifting to Dehradoon. Can I use the same card. Do I pay again?
Pensioners shifting
from one CGHS covered city to another, will have to apply to the Addl. Director
of concerned city for transfer of card. The card shall be transferred online
and a receipt will be issued to the beneficiary , on the basis of which , Addl.
Director of new city ( say Dehradun) shall receive the data. Same Plastic cards
and same Ben ID will be valid. No contribution is required to be paid in
respect of pensioner benfciries holding life time cards.
20. I
live in Gurgaon but my office is in Saket. Can I avail facilities from both the
places because it is convenient for me.
Yes. Subsequent to
computerization CGHS facilities can be availed from any Wellness Centre in India
21. Is
there any age limit for sons / daughters as dependant in CGHS Card ?
a. Son is eligible till he starts earning
or attains the age of 25 years or gets married whichever is earlier.
b. However, in case the son is suffering
from any permanent disability of any kind (physical or mental) he is eligible
for CGHS benefits even after 25yrs .
Disability means
blindness, low vision, leprosy-cured, hearing impairment, loco motor
disability, mental retardation, mental illness. A disability certificate from
Medical Board is required.
c. Daughter is eligible till she starts
earning, or gets married, whichever is earlier (irrespective of age)
22. Are
step-children allowed CGHS facilities?
Yes. If they are
dependent on card holder: other conditions as in case of dependant sons and
daughters.
23. Can
dependent in-laws be included under family members for CGHS facilities?
A
lady Government servant will be given a choice to include either her parents or
parents –in-law for the purpose of availing the benefits under CGHS subject to
the condition of dependence and residence, etc., being satisfied. Such option
is not available for male Government servants .
24. Me
and my wife are both central Govt. employees and have dependant brothers /
sisters and parents. Can we make separate cards and include family members?
Yes. Both Government
employees have the option to make CGHS Contribution and obtain Two separate
CGHS cards and the names of the eligible dependant family members can be
included on their respective cards. Your wife can include the names of her
parents/ brothers / sisters and such other eligible dependants in her card,
subject to the condition of dependence and residence, etc., being satisfied.
25. Can
the CMO or the pharmacist give a different brand than the one prescribed by the
specialist?
Medicines are issued
at CGHS Wellness Centres by the same brand, if available or by generic name or
by any available brand name of equal therapeutic value.
26. What
is the procedure for getting life saving drugs ?
In Delhi- through
CGHS Medical Store Depot, Gole Market The documents required are:-
i. Prescription of specialist. of Govt. Hospital
ii. Photocopy of his/ her token card/
plastic card.
iii. Copy of permission if his prescription
is from CGHS approved private Hospital.
iv. Utilization certificate in original
during subsequent visit.
v. Indent is also placed online through
CGHS Wellness centre.
vi. In other cities request is to be
submitted to the Addl. Director of City.
27. What should I do if the Wellness Centre/Dispensary does not give
all the medicines?
Contact CMO i/c of
the concerned Wellness Centre or Addl. Director, CGHS of concerned city or
Director, CGHS.
28. How
long does it take to get the medicines ?
Medicines available
in the dispensary are issued immediately. If any medicine is not available and
is to be indented through Authorized Local Chemist the same are issued on the
next day.
29. Are the prescription of specialists of empanelled hospitals
binding on the dispensary ?
Medicines are issued
on the basis of prescriptions of government doctors. However, in permitted
cases medicines are issued on the basis of prescriptions of empanelled
hospitals and medicines will be issued as per the available brand / generic
names.
30. What
is the maximum period for which medicines can be given in one go ?
i. For treatment of Chronic illnesses
medicines upto ‘3’ months are issued in one go , provided there is a valid
prescription.
ii. In case of a beneficiary visiting a
foreign country , medicines upto ‘6’ months are issued in respect of cronic
illnesses , based on valid prescription and documentary support of visit to a
foreign country. Beneficiary is required to submit an application for obtaining
permission from AD/JD along with the following documents:-
Copy of
valid CGHS card/ token card.
Valid prescription
for six months counter signed by HOD of Specialty of Govt. Hospital .
Proof of
station leaving like ticket, Visa etc.
31. If
some medicines like antibiotics are urgently required and are not available at
CGHS Wellness Centre what can be done?
In case some medicines are not
available and are urgently required for treatment, there is provision for issue
of authority form by CMO i/c for collection of medicines, for a few days like
3-5 days, directly from authorized local chemists .
32. How
to get a drug if same is not available in WC & also not supplied by
Chemist(ALC)?
Beneficiary, after
authorization by CMO i/c can purchase such drugs from open market & claim
reimbursement from ALC.
33. What
should beneficiary do, if he/ she notice some deterioration in the quality of
drugs?
He /she should return
the medicine to WC & get replacement. Samples can be sent for testing
through CMOI/C.
34. My
father is a cancer patient and after operation is bed ridden. Doctors have
advised Protein powder. Can I get from CGHS?
Dietary supplements
are not permissible under CGHS.
35. Is
Penfill Injection provided under CGHS ?
Insulin pen is not
supplied under CGHS. But, Insulin pen cartridges are supplied under CGHS
36. What
do I do if I am unwell at odd hours, say late in night?
CGHS beneficiaries
have the option to go to any of the 24 hr functional dispensaries in Delhi, a
nearby govt. hospital / empanelled private hospital or even any private
hospital , in case of emergency.
37. Whom
should I contact if the doctors are not present in the Wellness Centre /
Dispensary?
Contact CMO i/c of
the concerned Wellness Centre or Addl. Director, CGHS of concerned city or
Director, CGHS.
38. In
emergency who are all entitled to get treatment at Pvt Empanelled Hospital ?
Any beneficiary
holding a Valid CGHS card.
39. What
should I do in case of emergency?
CGHS beneficiaries
have the option to go to any of the 24 hr functional dispensaries in Delhi, a
nearby govt. hospital / empanelled private hospital or even any private
hospital
40. What
are the papers to be submitted for any investigation by an empanelled
diagnostic centre?
i. Original or self attested copy of
prescription of CGHS Doctor / Government specialist
ii. Copy of CGHS Card of the patient and
main card holder (head of family).
41. What
are the criteria for Entitlement of Treatment endorsed on CGHS Card like
General ward / Semi-Pvt ward or Pvt. Ward in CGHS Empanelled Hospitals?
Endorsement of
entitlement for general/semi- private/private ward facility is done according
to their basic pay / basic pension as under :
Pay in the pay band / Pension /
Family Pension
|
Ward entitlement in private
hospitals empanelled under CGHS
|
Up to
Rs.13950
|
General
Ward
|
Rs.13960
to Rs.19530
|
Semi-Private
Ward
|
Rs.19540
and above
|
Private
Ward
|
42. Which
are the categories eligible for cashless treatment?
Hospitals shall
provide credit facility to the following categories of CGHS beneficiaries
(including dependant family members, whose names are entered on CGHS Card):
·
Members
of Parliament;
·
Pensioners
of Central Government drawing pension from central estimates;
·
Vice-presidents,
Former Governors and former Prime Ministers;
·
Ex-Members
of Parliament;
·
Freedom
Fighters;
·
Serving
employees of Ministry of Health & Family Welfare (including attached /
subordinate offices under the Ministry of Health & Family Welfare)
43. What
should I do if the empanelled hospital refuses to entertain or give a
step-motherly treatment?
Contact CMO i/c of
the concerned Wellness Centre or Addl. Director, CGHS of concerned city or the
nodal officer for grievances.
44. I
am a serving employee of an autonomous body, holding CGHS card. Who will give
me permission for treatment on the recommendation of Govt. specialist?
Permission
for specific treatment procedure as advised by a Govt. Specialist at private
empanelled hospitals shall be granted by the Head of Autonomous body in respect
of serving employees as well as pensioners of Autonomous bodies covered under
CGHS.
45. What is the time within which my medical claim is to be
reimbursed?
If all documentation is complete
medical claims of pensioners are cleared in 45 days.
46. What can I do if my claim is unnecessarily delayed?
Pensioner beneficiaries can contact
the Additional Directors of concerned city / zone on any Wednesday between 11
A.M. and 1 P.M.
47. I am a CGHS Pensioner. My wife was admitted in pvt hospital in
emergency state. How to get reimbursement of money spent on her treatment?
Apply to CMO I/c of
WC with :
·
MRC
forms duly filled in as per Check list
·
Copy
of Discharge summary
·
Hospital
bills with break-up
·
Receipts
in original
·
Copy
of the valid CGHS Card
·
Copies
of other documents issued by hospital
MRC forms are
available with CMO I/c and can also be downloaded from CGHS Website
http://msotransparent.nic.in/cghsnew/index.asp
Serving employee in
similar cases shall submit the medical claim to his department.
48. My
original papers having bills, Receipts of hospital treatment are lost. Can I
claim on duplicate papers?
Yes. With affidavits
on Stamp paper. Details of Draft for Affidavit may be seen in the instructions
sheet appended to Medical Claim Form available at
http://msotransparent.nic.in/cghsnew/index.asp and CMO i/c.
49. My
husband/wife was a CGHS card holder. He/She was sick and died while in
hospital. How do I get MRC?
Apply to CMO I/c of
WC with :
i.
MRC
forms duly filled in as per Check list
ii. Copy of Death summary
iii.
Hospital bills with break-up
iv.
Vouchers in original
v.
Copy of the valid CGHS Card
vi.
Death Certificate
vii. Affidavit on Stamp paper of yourself
being Legal Heir and NOC from other legal heirs in favour of claimant
viii. Copies of other documents issued by
hospital
Draft for affidavit
may be seen in the instructions sheet appended to the Medical Claim Form
available at CGHS Web site at http://msotransparent.nic.in/cghsnew/index.asp
50. I
retired in Dec 2011. Due to certain reasons I had to go to my native place in
Uttranchal and could not make pensioner’s CGHS card. In May 2012 I came to
Delhi and had Heart attack. In emergency I was treated in pvt hospital .I got
CGHS Card made after discharge but I have been refused reimbursement of the
expenditure incurred.
After retirement
three months grace period is given to get CGHS card made. The treatment taken
and expenditure incurred thereon within the grace period of three months from
the date of retirement will be allowed and expenditure reimbursable subject to
the condition that the beneficiary has either obtained or applied for CGHS
pensioner card with all documents and requisite CGHS subscription within one
month of expiry of the grace period of three months. The expenditure on
treatment taken after the grace period of three months from date of retirement
will not be reimbursable unless the beneficiary has obtained a valid CGHS card
or has applied for CGHS pensioner card with all documents and requisite CGHS
subscription prior to taking such treatment.
51. I
went to Hyderabad to visit my son and had fracture of leg bone. I received
treatment from a pvt hospital. Shall I get full reimbursement?
Reimbursement for
treatment taken in a private hospital under medical emergency shall be
considered as per CGHS rates only.
52. Is
treatment for IVF reimbursable?
IVF treatment is
approved under CGHS. The details may be seen as per Office Memorandum
Z.15025/5/2011/CGHS III/CGHS(P) dated 22.11.2011 , which can be downloaded from
CGHS Website at http://msotransparent.nic.in/cghsnew/index.asp
53.
Are ambulance charges reimbursable?
Yes. Ambulance
charges are reimbursable within the city , if there is a certificate from
treating doctor that conveyance by any other mode would definitely endanger
patient’s life or would grossly aggravate his/her condition.
54. I
have a Mediclaim Insurance Policy. Due to emergency received treatment in a pvt
hospital. Some amount was paid by Insurance Co. Can I get balance from CGHS
Yes.
First Bills are submitted to Insurance Company. Duplicate bills with
certificate from Insurance Company may be claimed from CGHS by Pensioner CGHS
beneficiaries. CGHS shall consider reimbursement at CGHS rates or actual
whichever may be less. However, the total reimbursement from both sources
should not exceed actual expenditure. Serving employees shall submit claim to
department for reimbursement.
55. I submitted MRC for Rs. 1 Lac 20 thousand but I was reimbursed
only Rs. 45,800/-. Why total amount was not reimbursed?
Government has no
agreement with private hospitals, which are not empanelled under CGHS for
charging CGHS rates. However, if treatment is undertaken at private non-
empanelled hospitals under emergency , reimbursement will be limited to CGHS
rates or actual, whichever may be lower. Since, non empanelled private
hospitals often charge at rates different from the CGHS rates there will be
difference in the amount reimbursed if the private hospital charges are higher
than CGHS rates.
56. I
want to get my Cataract Surgery done at Pvt empanelled hospital ? How can I get
it done?
Beneficiaries are
required to obtain advice from a Govt. Specialist / CMO i/c for Cataract
surgery. Pensioners can apply to CMO I/c of WC for permission to obtain the
treatment at one of the empanelled hospitals of his /her choice. Serving
employees to apply to his / her Department / office.
57. Is
it necessary that the Govt specialist should write ‘referred to CGHS empanelled
Hospital’ for obtaining permission?
Advice of Government
specialist is required only for the specific treatment procedure /
investigation to be undertaken. There is no need to specifically refer to any
empanelled hospital/ diagnostic lab. It is the choice of beneficiary to under
treatment / investigations at any of the empanelled hospitals / diagnostic
laboratories after obtaining permission from competent authority.
58. CMO
In-charge does not refer me to Pvt. Hospitals on my request?
As per CGHS
guidelines there is no provision for OPD referrals to private empanelled
hospitals except in satellite towns of NCR
59. I am an accredited journalist
with CGHS Card Can I seek treatment in Pvt. empanelled Hospitals in emergency
and get credit facility?
No. Journalists are
entitled only for OPD treatment from dispensaries and treatment from Dr.RML Hospital
60. What
are the facilities available to me if I am a pensioner in a non-CGHS area ?
i.
Pensioner residing in non- CGHS covered areas
have the option to become CGHS beneficiary and avail CGHS facilities from the
nearest CGHS covered city.
ii.
Pensioners
residing in non-CGHS areas have also the option to avail Fixed Medical
Allowance of Rs.300/- per month and opt not to avail CGHS facility.
iii.
Pensioners residing in non-CGHS areas have
also the option to avail Fixed Medical Allowance of Rs300/- per month for OPD
treatment and obtain CGHS card from nearest CGHS covered city for inpatient
facilities under CGHS. No OPD medicines shall be issued in such cases.
iv.
CGHS pensioner beneficiaries (and their
dependant and eligible family members) who are holding a valid CGHS Card and
residing in a non-CGHS area shall be eligible to obtain inpatient medical
treatment and also follow up treatment from Govt. Hospitals / CS(MA) /ECHS
approved hospitals on proper referral from CGHS dispensary and submit the
medical reimbursement claim to the Addl. Director/ Joint Director of CGHS of
city where the CGHS card is registered.
1. In case of medical emergency , treatment
may be obtained from any hospital and medical claim shall be submitted to AD/JD
, CGHS of the concerned city.
2. Reimbursement shall be limited to the
CGHS rates of the city where the card is registered and as per the ceiling
rates and ward entitlements or as per actuals, whichever may be less.
61. I
am a serving employee residing in a place close to a city covered under CGHS.
Can I get CGHS card issued from the nearest CGHS city?
There is no provision
to avail CGHS facilities in respect of serving government employees residing in
non-CGHS covered areas. They are covered under CS(MA) Rules 1944.
62. I
have retired from Delhi. Now I want to settle in a city where no CGHS facility
is available. How to cover my family for medical care?
Pensioners are
eligible for CGHS facilities and can obtain CGHS card from the nearest CGHS
covered city.
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