Clarification regarding treatment of CGHS beneficiaries at government hospitals: CGHS OM dated 09.10.2020

 

Z15025/18/2020/01 R/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

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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.I) dt 18.03.1992 vide which guidelines regarding settlement of Claims were issued and to convey the approval of competent authority for issue of tthe following clarifications regarding treatment at government hospitals: 

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

ii. 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.

iii. 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.

iv. 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 .

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

vii. Medical claims are to be submitted through concerned 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 I 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



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