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Member of Parliament |
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FAQ's (FAQs on CGHS are
intended to provide general information and guidance needed for the CGHS
beneficiaries to avail CGHS facilities. The contents must be read in
conjunction with OMs/Office orders as issued from time to time. The contents
are not intended to be applicable to specific/exceptional cases and no such
claims may be made under it. Whenever any difference in interpretation of
meaning and/or content of the facts stated here vis-à-vis the original
OM/office order arises, the latter will be treated as final and binding). Question Answer Who are eligible for CGHS facilities? Persons Eligible under the C.G.H. Scheme 1.
All Central Government employees paid from the Central Civil
Estimates (except Railways and Delhi Administration), including their
families. 2.
Pensioners of Central Government (except pensioners belonging to
Railways and the Armed Forces) and their families. 3.
Central Government Pensioners retiring with Contributory
Provident Fund benefits and their families. 4.
Widows of Central Government pensioners, in receipt of family
pension. 5.
Delhi Police personnel and their families, in Delhi only. 6.
Railway Board employees. 7.
Civilian employees of Defense paid from Defense Service
Estimates. (except at Mumbai where the scheme is in operation). 8.
Child drawing pension on death of a Central Government employee
including minor brothers and sisters of such child. 9.
Ex-Governors and Lt. Governors and their families. 10.
Ex-Vice Presidents and their families. 11.
Central Government servants who are deputed to semi-government
and autonomous bodies receiving substantial grant from, or financed by the
Central Government. 12.
Central Govt. employees on deputation to statutory/autonomous
during the period of deputation. 13.
Military Officers while on deputation to civil departments and getting
their emoluments from Central Civil Estimates. 14.
Families of Governments servants transferred to a non-CGHS area,
for a maximum period of six months on deposit of CGHS contribution (for the
period of 6 months) in advance. 15.
Families of IAS Officers on North-Eastern Cadre, who continue to
stay back in Delhi even after repatriation of the IAS Officer to the
North-Eastern Cadre, provided that they continue to occupy Government
accommodation in Delhi/New Delhi, on deposit of CGHS contribution in advance (one
to three years). The same also applies to families of IAS Officers of J&K
Cadre. 16.
Parliamentary Secretaries
of the Central
Government and their families. 17.
Members of Parliament and their families. 18.
Ex-Members of Parliament. 19.
Sitting Judges of Supreme Court and High Court of Delhi and
former Judges of Supreme Court and High Courts. 20.
Work Charged and Industrial Staff working in establishments run
by various Ministries/Departments of Central Government, immediately from the
date of their joining the service. 21.
Employees of Kendriya Vidyalays Sangathan stationed at Delhi
& NCR, Kolkata, Chennai, Hyderabad, Mumbai and Bengaluru. 22.
Employees of Ordnance Factory Board Headquarters, Kolkata and
Ordnance Equipment Factories Headquarters, Kanpur. 23.
All India Service pensioners who retire while serving under the
State at their option. 24.
Freedom Fighters and members of their family receiving Central
Pension under the Swatantrata Sainik Samman Pension Scheme. 25.
Family members of the Deceased Ex-Members of Parliament. 26.
Pensioners of Ordnance factories. 27.
Members of Staff Side of the National Council of the Joint
Consultative Machinery, even though not serving as Central Government
employees. 28.
Persons employed in semi-government and autonomous bodies who
are permitted to join the CGH Scheme. 29.
An Accredited Journalist who produces a certificate from the
Press Council of India stating that he is a member of the Press Association,
New Delhi (for OPD and at RML Hospital). 30.
Retired Divisional Accountants of the Indian Audit and Accounts
Department and those whose pay and pension are entirely borne by the State
governments. 31.
PSU absorbees who had commuted 100% of their pension and have
been restored 1/3rd portion of their pension after 15 years. 32.
Absorbees of Statutory Bodies/Autonomous Bodies of Central Govt.
(including those who proceeded on deputation initially or were on deemed
deputation and then absorbed), who are in receipt of Central Civil Pension. 33.
Serving and retired Railway Audit Staff. 34.
Serving and
retired Divisional
Accounts Officers and Divisional
Accountants posted in the Office of Accountant Generals in States. 35.
CISF personnel (and their families) and CAPF (Central Armed
Police Forces) personnel posted in CGHS cities. 36.
Employees of Supreme Court Legal Services Committee. 37.
Employees of India Pharmacopoeia Commission, and their families. 38.
Family and dependent members of a Central Govt. employee (a CGHS
beneficiary) who stay back in CGHS covered area after posting of the employee
to N.E. region (including Sikkim), Andaman & Nicobar Lakshadweep or
Ladakh region and CAPF personnel posted in Left Wing Extremist areas, on
payment of annual CGHS contribution in advance. 39.
Defence Industrial Employees of Naval Dockyard Central Ordnance
Depot and AFMSD, in Mumbai. Eligibility Criterion Residence ‟
alone (and not the
Headquarters) is the
criterion for determining eligibility of a Central Government
servant for availing medical facilities under the Central Government Health
Scheme. Thus, Central Government employees and their family members etc.
residing in any of the notified cities (list given in previous chapter) are
covered under the Scheme. What are the
facilities available under CGHS? 1.
OPD Treatment at WCs including issue of medicines. 2.
Specialist Consultation at Polyclinic/Govt. Hospitals and at
CGHS empanelled hospitals after referral by CGHS. 3.
OPD/Indoor Treatment at Government and Empanelled Hospitals. 4.
Investigations at Government and Empanelled Diagnostic centers. 5.
Cashless facility available for treatment in empanelled
hospitals and diagnostic centersfor Pensioners and other identified
beneficiaries. 6.
Reimbursement of expenses for treatment availed in Govt.
/Private Hospitals under emergency and specific treatment advised by Govt.
Specialist or Specialist of Pvt. HCOs duly endorsed by CMO/MO of WCs. 7.
Reimbursement of expenses incurred for purchase of hearing aids,
artificial limbs, appliances etc., after obtaining permission. 8.
Family Welfare, Maternity and Child Health Services. 9.
Medical consultation and
dispensing of medicines
in Ayurveda, Homeopathy, Unani and Siddha system of
medicines (AYUSH) What are the timings of Wellness Centres/Polyclinics? Wellness Centers are
open from 7:30 AM to 2:00 PM on all working days except emergency services
wherever applicable. Timings of WCs with
emergency services are as follows The Wellness Centres
remain closed on all Central Govt. holidays. However in case of three
consecutive holidays occurring together, Wellness Centres will not be closed
for more than 2 consecutive days. There are also nine
First Aid Posts ( FAP) at following locations in Delhi
The timings of these
FAPs is from 9:00 AM to 5:00 PM In how many cities CGHS is presently operational? Following Cities have CGHS facilities at present 1.
AGARTALA 2.
AGRA 3.
AHMEDABAD 4.
AIZWAL 5.
AJMER 6.
ALIGARH 7.
ALLAHABAD (PRAYAGARA) 8.
AMABALA 9.
AMRITSAR 10.
BAGHPAT 11.
BANGALURU 12.
BAREILLY 13.
BERHAMPUR 14.
BHOPAL 15.
BHUBANESWAR 16.
CHANDIGARH 17.
CHENNAI 18.
CHHAPRA 19.
CUTTACK 20.
DARBHANGA 21.
DHANBAD 22.
DEHRADUN 23.
DELHI & NCR DELHI, FARIDABAD, GHAZIABAD, GREATER NOIDA,
GURGAON ,INDIARAPURAM, SAHIBABAD 24.
DIBRUGARH 25.
GANDHINAGAR 26.
GANGTOK 27.
GAYA 28.
GORAKHPUR 29.
GUWAHATI 30.
GUNTUR 31.
GWALIOR 32.
HYDERABAD 33.
IMPHAL 34.
INDORE 35.
JABALPUR 36.
JAIPUR 37.
JALANDHAR 38.
JALPAIGURI 39.
JAMMU 40.
JODHPUR 41.
KANPUR 42.
KOHIMA 43.
KOLKATA 44.
KOTA 45.
LUCKNOW 46.
MEERUT 47.
MORADABAD 48.
MUMBAI 49.
MUZZAFARUPUR 50.
NAGPUR 51.
NELLORE 52.
PANAJI 53.
PATNA 54.
PUDUCHERRY 55.
PUNE 56.
RAIPUR 57.
RANCHI 58.
RAJAHMUNDRY 59.
SAHARANPUR 60.
SHILLONG 61.
SHIMLA 62.
SILCHAR 63.
SONEPAT 64.
SRIAGAR 65.
VARANASI 66.
VIJAYAWADA 67.
TIRUCHIRAPALLI 68.
TIRUNELVELI 69.
TIRUPATI 70.
THIRUVANANTHAPURAM 71.
VISAKHAPATNAM *Soon to be started 1.
KOCHI 2.
KANNUR 3.
KOZIKODA 4.
OM Is there any age limit for sons /daughters as dependant in
CGHSCard? on is eligible till he
starts earning or attains the age of 25 years or gets married whichever is
earlier. However, in case the
son is suffering from any permanent disability of provided the
disability occurred before the age of 25 years. Who is responsible for deletion of the names of ineligible
dependents? It is the
responsibility of various departments/offices forwarding the application for
CGHS card to ensure that the names of only genuine and eligible persons are
included in the CGHS token cards. What is the role of a beneficiary in providing information
regarding any change in data regarding his card? It is the
responsibility of the beneficiary to provide information to CGHS authorities
regarding any changes required in the beneficiary database especially related
to death, marriage, earning status (see dependency criteria) of any card
holder in the family. Are the family members of Central Government Servant not
residing with him eligible for CGHS facilities? Family members who are
wholly dependent upon the Central Government employee are normally expected
to reside with the primary card holder. However, during a visit to another
CGHS covered city they are eligible for CGHS facilities on the basis of
individual Plastic Card issued to the dependent family member. What is the grace period for getting CGHS card for availing
treatment facility/ reimbursement for indoor treatment by pensioners
immediately after retirement? Pensioners are
permitted a period of three months from the date of superannuation to obtain
a CGHS pensioner Card for consideration of reimbursement for the treatment
taken during grace period, subject to the condition that Application complete
with all documents and requisite CGHS subscription is submitted to the office
of Additional Director during the fourth month after retirement for issue of
CGHS pensioner card. In case, CGHS
pensioner card is not made in the 4th month after retirement, no
reimbursement for the expenditure incurred for treatment during the period
prior to making CGHS card, including grace period. Who is defined as a 'Person with disability'? A 'person with
disability' as defined in 'The Persons with Disabilities (Equal
Opportunities, Protection of Rights and Full Participation) Act, 1995' as, a
person suffering from not less than forty percent (40%) of any disability (as
given below), certified by a medical authority. "Medical authority"
means any hospital or institution specified for the purposes of this Act by
notification by the appropriate Government. A disability certificate from
Medical Board of a Government Hospital is required to be submitted in CGHS
with application form to continue availing facilities for disabled dependant
and unmarried son beyond 25 years of age. Disability means
blindness, low vision, leprosy-cured, hearing impairment, locomotor
disability, mental retardation, mental illness. Details may be seen at the
following link - Are step-children allowed CGHS facilities? Yes, if they are
dependent on card holder and other conditions being fulfilled as in case of
dependant sons and daughters. Can dependent in-laws be included under family members for CGHS
facilities A lady Government
servant has the option 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. My wife and I are both central Government employees and have
dependant brothers / sisters and parents. Can we make separate cards and
include family members? Yes. If both husband
and wife are in central Govt. service, spouse has the choice to make his/ her
parents and brothers/sisters as dependents in his/her separate CGHS card. However, if wife is in
service then she has the choice to make either her parents or her parents -
in-law as dependents in her card. What is the procedure to register with the CGHS? Pensioners: One can get a CGHS
card made from the office of Additional Director of the City. Forms can be
downloaded from CGHS Website. They are also available in the office of
Additional Director of city. 1.
Upload the data through the ONLINE www.cghs.nic.in ,
T-Number will be generate and take the printout along with documents. 2.
Proof of residence 3.
Proof of stay of dependents 4.
Proof of age of son 5.
Disability certificate, if any in case of sons aged 25 &
above, who would otherwise cease to be a beneficiary. 6.
Individual passport size photos of eligible family members 7.
Surrender Certificate of CGHS Card while in service ( only in
those cases where CGHS Card was issued while in service) 8.
Attested copies of PPO & Last Pay Certificate 9.
Draft for required amount towards CGHS contribution – in the
name of PAY &ACCOUNT OFFICER., MOHFW, MUMBAI. In case PPO is not
ready for any reason, there is option to get a provisional card on the basis
of Last Pay Certificate. The data uploaded in the data base and a print out
is issued on the same day for immediate use. Plastic cards are sent to the
Wellness Centres and the beneficiaries collect the cards from there. The
plastic card numbers are displayed on the notice board of the Wellness Centre
for the information of the beneficiaries. SMS is sent to the mobile number of
the beneficiaries reminding them to collect their plastic cards. 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 Additional Director CGHS of city for preparation
of card. The plastic cards are distributed through the Wellness Centres as in
case of pensioners. SMS is sent in case of serving employees also. Can I print
my own CGHS card? Yes, the facility to
print your own card is available for CGHS beneficiaries by visiting CGHS
portal cghs.nic.in. A colored print out on the card may be taken and
laminated for use as a plastic card. The services can also be availed by
showing the printout of index card is issued on the day the application is
submitted. However, computerized
printout of index card is issued on the same day. Usually, it takes 3 to 4
weeks for the plastic card to be made after which it is delivered to the
Wellness Centre, for collection by beneficiaries. OM No.
Z.15025/1/2016/DIR/CGHS, dated 31st March, 2016 Whom should I approach in case the CGHS Card is not issued to me
in the prescribed time? You may contact
Additional Director CGHS Mumbai. What should I do if I lose my CGHS Card? Application is to be
submitted to Additional Director of the city along with two photographs and
an IPO for Rs. 50/- for issue of duplicate card. Copy of FIR for the lost
cards is also to be submitted with the application. Indian Postal Order
payable to “Pay and Account Officer,. MOHFW, Mumbai. Option of “Print you own
card” is also available on CGHS website. OM No. Z.15025/1/2016/DIR/CGHS,
dated 31st March, 2016 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 Additional Director, CGHS, Mumbai, along with the
necessary documents to rectify the error. Is there a colour scheme for plastic cards? What are they? CGHS Plastic cards
have any one of the following colour strips at the top indicating the
category:
Beneficiaries of Autonomous
Bodies/Journalists |
Yellow |
Are CGHS facilities free of cost?
No, they are not. For
serving Central Government employees residing in CGHS covered area, obtaining a
CGHS card is compulsory.
The following deductions
from salary of the employees are made by the department, every month, depending
upon their pay in the pay
matrix of 7th Pay commission (wef 1/1/2017)
Corresponding levels in
Pay Matrix as per 7th CPC Contribution per month
|
Level 1-5 |
Rs. 250 |
|
Level 6 |
Rs. 450 |
|
Level 7-11 |
Rs. 650 |
|
Level 12 and above |
Rs. 1000 |
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 on
line by bharat khosh app in favour of “
PAY AND ACCOUNT OFFICER, MOHFW,
Contribution to be made
by the Pensioners/Family Pensioners would be the amount that they were
subscribing at the time of their retirement or at the time of the death of
government servant. Contribution amount as applicable on the date of applying
for Card is to be paid.
What are the criteria for Entitlement of ward endorsed on CGHS
Card in CGHS Empanelled Hospitals?
Entitlement of wards in
private hospitals empanelled under CGHS is as under
|
Ward Entitlement |
Corresponding Basic pay drawn by
the officer in 7th CPC per month |
|
General Ward |
Upto Rs. 47,600/- |
|
Semi Private Ward |
Rs. 47,601 to 63100/- |
|
Private Ward |
Rs. 63101 and above |
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.
How can the family members of Central Armed Police Forces
personnel who are transferred out from CGHS covered areas to J&K State and
Left Wing Extremism affected areas, avail CGHS services if they stay back?
1.
CGHS facilities are
extended to the eligible dependent family members of such CAPFs personnel.
2.
CGHS contributions shall
be paid in advance on annual basis, by the CGHS beneficiary through bank DD,
drawn in favour of the AD/JD of the concerned CGHS city where his family is
residing/place where the CGHS beneficiary was last posted.
3.
The annual CGHS
subscription will have to be paid within two months from the date of posting of
the CAPF personnel.
4.
A certificate from the
Ministry of Home Affairs confirming the residence of the family and dependent
members in CGHS covered city/area will be required, along with the posting
order.
What are the different options for availing CGHS services to
pensioners?
- Pensioners Residing in CGHS covered areas:
- They can get themselves registered in CGHS dispensary
after making requisite contribution and can avail both OPD and IPD
facilities.
- Such Pensioners are not eligible for Fixed Medical
Allowance in lieu of CGHS.
- Pensioners residing in non-CGHS areas have the
following option -
- They can opt for availing Fixed Medical Allowance
(FMA) @ Rs. 1000/- per month.
- They can also avail benefits of CGHS (OPD and IPD) by
registering themselves in the nearest CGHS city after making the required
subscription. In such cases no Fixed Medical Allowance is given
- They also have the option to availing FMA for OPD
treatment and CGHS only for IPD treatments after making the required
subscriptions as per CGHS guidelines.
I have retired from Delhi. Now I want to settle at city where no
CGHS facility is available. How do I cover my family for medical care?
Pensioners are eligible
for CGHS facilities and can obtain CGHS card from the nearest CGHS covered
city.
I retired in 1998 from Central Government service but, I never
made a CGHS card. Can I get a CGHS card now?
Pensioners can apply for
CGHS card with relevant documents. However, the subscriptions as applicable at
current rates shall have to be paid.
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.
My husband / wife retired in 2009. He /she was paying CGHS
subscription every year. After his death can I get the card transferred in 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.
Additional Director of concerned city shall transfer the ownership of Card in
the computer database and same CGHS plastic cards with same Beneficiary ID can
be used.
No extra payment is to
be made, in case of life time cards. However in other cases one has to pay
total 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.
Documents required:
1.
Application in
prescribed format
2.
Proof of Family Pension
with its break up from the bank having his/her pension account.
How to transfer CGHS card from one Wellness Centre 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 on-line from one Wellness Centre to another in the same
city. CMO I/c of the new Wellness Centre will accept on-line, the data of
transferred card.
In respect of serving
employees the request is to be forwarded by his/her office / department.
Whether serving employees on transfer to another CGHS covered city
can get the same CGHS Cards transferred online?
Yes. There is provision
for online transfer of same CGHS cards of serving employees of Central Government
on transfer from one CGHS city to another CGHS city is as per the details given
under:
1.
Serving employees on
transfer from one CGHS city to another CGHS City shall submit an application to
the Additional Director of CGHS City (forwarded by the Ministry /Department
from where he /she is being transferred) along with copy of the transfer /
relieving order for transfer of CGHS Cards to another CGHS City with an
undertaking that he shall avail CGHS facilities from the nearest CGHS Wellness
Center in the new CGHS City.
2.
Addl. Director, CGHS of
city transfers the card online and issues an acknowledgement slip to the
serving employee. CGHS Plastic cards shall be retained by the serving employee.
3.
Serving employee in the
new CGHS City submits an application duly forwarded by his /her Ministry
/Department, certifying that CGHS contribution is being deducted, to the
Additional Director of new CGHS City for acceptance of the transit CGHS Cards
to the data base of new City and allocation of a CGHS Wellness Centre in new
CGHS City.
I am CGHS beneficiary at Kanpur and I am visiting Mumbai for 6
months. Can I get CGHS facilities at Mumbai? Can the same card of Kanpur
continue or is a separate card to be made? From where do I 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,
Additional Director of the city (Additional Director CGHS HQ in case of Delhi)
may be contacted.
After retirement in 2007 I got a Life time Pensioner CGHS card
issued in Delhi. Now I am shifting to Dehradun. 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 Additional 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,
Additional Director of new city ( say Dehradun) shall receive the data. The
same Plastic cards and same Ben ID will be valid in the new city. No
contribution is required to be paid in respect of pensioner beneficiaries
holding life time cards.
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.
What are the rules on domiciliary visit?
The Medical Officer will
pay domiciliary visit wherever considered necessary owing to the inability of
the patient to attend the dispensary.
Domiciliary visits
except in case of emergency will normally be made before or after the
dispensary working hours.
What are the
Special provisions for CGHS beneficiaries aged 80 years and above?
The special provisions
under CGHS to the beneficiaries aged 80 years and above are as given under:
- Consultation of Doctor at CGHS Wellness Centre without
standing in Queue
- CGHS Doctors shall enquire by phone, at least once in a
month to enquire about their wellbeing / make a home visit if residing
within 5 K.M.s of CGHS WC
- Settlement of medical claims on priority out of turn.
- Follow up treatment from same specialist in
non-empanelled hospital from where he/she was earlier taking treatment- as
a special case in view of advanced age and difficulty to change physician
subject to the reimbursement limited to CGHS rates and collection of
medicines as per CGHS guidelines.
Can a non CGHS beneficiary get First Aid at the Wellness Center?
During working hours
First Aid treatment is given to all emergent cases irrespective of the fact
that the patient is a CGHS beneficiary or not.
What are the guidelines on issue of medicines from CGHS?
Guidelines regarding
issue of medicines vide OM, dated 16.02.2016 is linked below-
What types of medicines/items are not supplied under CGHS?
OM is linked below -
https://cghs.gov.in/showfile.php?lid=3792
What are the guidelines for vaccines under CGHS?
The vaccines covered
under Universal Immunization Programme (UIP) are administered as per schedule.
Rest of the vaccines admissible as per the advice of Govt. Specialist.
What is the procedure for getting life saving drugs?
Based on a valid
prescription of Govt. / Empanelled Hospital Specialist for life saving and
other restricted drugs, these are procured by the Additional Director of city.
https://cghs.gov.in/index1.php?lang=1&level=2&sublinkid=6046&lid=3667
Is there any provision for issue of medicines by empanelled
hospitals at the time of discharge?
The private hospitals
empanelled under CGHS are required to provide medicines for a period of upto
(cost not exceeding Rs 2000/-) at the time of discharge from hospital.
1.
Only essential medicines
in generic name shall be provided.
2.
No non-drug items shall
be provided
3.
No nutritional
supplements, tonics, cough syrups, Vitamins, Injections shall be supplied.
The hospital shall raise
the bill separately for the medicines and submit bills to CGHS in case of
pensioner CGHS beneficiaries.
In case of serving CGHS
beneficiaries taking treatment on payment basis the hospital may supply the
medicines on payment basis to the beneficiary and he/she can claim
reimbursement from his/her Ministry / Department. However, it is the choice as
per convenience of the serving beneficiary either to buy such medicines from
the hospital at the time of discharge or to obtain from CGHS Wellness Centre.
The relevant OM is linked below - https://cghs.gov.in/showfile.php?lid=4133
Is the prescription of specialists of empanelled hospitals valid
in the Wellness Centre?
Yes, Beneficiaries in
all CGHS Cities can seek OPD consultation from Specialists in any of the CGHS
empanelled hospitals after being referred by the Doctors of the Wellness
Centre. The relevant OM is linked below -
https://cghs.gov.in/showfile.php?lid=4921
What are the guidelines for Specialist Consultation from CGHS
empanelled Hospitals?
1.
There is a provision to
avail consultation from Specialists of private hospitals empanelled under CGHS
after a CGHS beneficiary is referred by CGHS Doctors / Specialist of CGHS to
any empanelled hospital.
2.
The referral by CGHS is
valid for a period of one month for consultation from any one private
empanelled hospital and CGHS beneficiary can visit the same empanelled hospital
three times during the one month. During each visit, beneficiary can consult
upto three different specialists in the same hospital.
3.
There is also provision
for post-operative follow up treatment, which includes specialist consultation
in the same hospital where , the initial treatment was taken with prior
permission in respect six conditions, viz., Cancer treatment, Cardiac surgery,
Hip/Knee Implant surgery, Neuro-surgery, Renal transplantation and post Trauma
cases. There is a provision for taking permission for post-operative follow up
treatment for upto three to six months at a time. Permission for post-
operative follow up treatment is granted by CGHS in respect of pensioners,
etc., and by concerned Ministry /Department in respect of serving CGHS
beneficiaries.
https://cghs.gov.in/showfile.php?lid=4921
https://cghs.gov.in/showfile.php?lid=5266
How many times
CGHS beneficiaries can Consult Specialists at private empanelled hospital on
referral by CGHS?
The referral by CGHS is
valid for a period of one month for consultation from any one private
empanelled hospital and CGHS beneficiary can visit the same empanelled hospital
three times during the one month. During each visit, beneficiary can consult
upto three different specialists in the same hospital. The relevant OM is
linked below –https://cghs.gov.in/showfile.php?lid=5266
What is the procedure for undergoing treatment / investigations
recommended by Specialist at private empanelled hospital, after referral by
CGHS?
The investigations /
treatment advised by Specialists of Private empanelled hospitals (after referral
by CGHS) may be undertaken in the same hospital, if they are needed in
emergency.
If there is no emergency, the investigations advised by Specialists of Private
empanelled hospitals are required to be endorsed by the Medical Officer of CGHS
as part of checks and balances in the system. The relevant OM is linked below –
https://cghs.gov.in/showfile.php?lid=4921
What is the maximum period for which medicines can be given in one
go?
For treatment of Chronic
illnesses medicines upto „3‟ months are issued in one go, provided there is a
valid prescription.
In case
of a beneficiary visiting a foreign
country , medicines upto „6‟ months are issued in
respect of chronic illnesses , based on valid prescription and documentary
support of visit to a foreign country. The relevant OM is linked below -
https://cghs.gov.in/showfile.php?lid=3786
Is re-registration required if a beneficiary visits WC to just
collect indented medicines?
No.
Is it mandatory for the Diagnostic Labs to stamp the date and the
number of tests performed on original prescription slip?
Yes.
Is treatment taken in an emergency at non empanelled private
hospital reimbursable? If yes what is the procedure?
CGHS considers for
reimbursement at CGHS rates in case the treatment taken in an emergency from
private non empanelled hospitals. The reimbursement shall be restricted to CGHS
package rate or actual expenditure whichever is less.
OM- Z.15025/79/DIR/CGHS,
dated 5th October, 2016.
What are the guidelines for consideration of reimbursement over
and above the approved CGHS rates?
The requests for
reimbursement which fall under the following defined criteria shall be examined
by Directorate General of CGHS
https://cghs.gov.in/showfile.php?lid=4995
Is there a provision for collection of medicines from the WC by an
authorized person?
Yes, the CGHS
beneficiaries can authorize a representative to collect medicines from CGHS
Wellness Centre on the basis of valid prescription.
What are the guidelines for settlement of MRC?
Normally the medical
reimbursement claim is to be submitted within three months of discharge from
Hospital/availing treatment. Relevant OM is linked below -
https://cghs.gov.in/showfile.php?lid=5037
What should I do in case of overcharging by the empanelled pvt.
HCOs.
If the empanelled Pvt.
HCOs has charged over and above the CGHS approved/package rates, the
beneficiary can complain to Additional. Director, CGHS of concerned city/zone,
in case of pensioner‟s beneficiary and serving employees forward their
grievances through the Deptt. with all relevant documents for grievance redresal.
Where should I complain for the medical negligence at empanelled
HCO‟s?
The beneficiary can
approach State Medical Council/Medical Council of India with all proof of
medical negligence against empanelled HCO‟s.
What is the system for availing the services of specialists in
Wellness Centres?
Prior registration is
required for appointment with specialists in CGHS Wellness Centre, where
specialist services are available.
Facility of online appointment with CGHS Specialist can be availed by visiting
www.cghs.nic.in
However, in case of emergency contact CMO I/C of the Wellness Centre for
consulting specialist without prior appointment.
What is the procedure for online appointment?
Online appoint with
Medical Officer of the wellness centre or with Specialist who visits a
particular Wellness center can be booked by visiting CGHS portal cghs.nic.in
through the link Book Appointment.
https://cghs.nic.in/ors
What is the mechanism for grievance redressal in CGHS?
Complaint/Grievance
Redressal
The complaints/
grievances can be sent
1.
At Wellness center level
– to the CMO I/C.
2.
At city/zone level –to
the Additional Director of the city/zone.
3.
Higher administrative
level – For Delhi- Addl. Director (HQ).
For Outside Delhi – ADDG
(HQ).
The addresses and contact numbers may be found in the contact list.
CGHS Directorate contact
details – https://cghs.gov.in/showfile.php?lid=3689
Delhi/NCR
Outside Delhi
CGHS HQ Delhi (AD (HQ) & Zonal ADs) -
https://cghs.gov.in/showfile.php?lid=3996
Contact details of ADs –
https://cghs.gov.in/showfile.php?lid=3951
Contact Details of WCs
of Delhi/NCR –
https://cghs.gov.in/showfile.php?lid=3997
Contact details of WCs outside Delhi –
https://cghs.gov.in/showfile.php?lid=3695
List of Empanelled Pvt.
HCOs –
https://cghs.gov.in/showfile.php?lid=5103
List of Empanelled Pvt. HCOs- City-wise list available at www.cghs.gov.in
Beneficiaries are advised to approach the authorities normally in the order
they are mentioned above, personally, or
through phone calls, letters or emails at the contact details
on the CGHS website or available on the above link.
Written Complains/
suggestions may also be dropped in the complaint
/suggestion box displayed in the Wellness centers.
The grievances at
Wellness Centre level can be sorted out in the "Advisory Committee"
meetings held normally on every 2nd Saturday of the month.
On all Wednesdays, from
11.00AM to 1.00PM complainants can meet the Additional Directors for grievance
redressal.
Beneficiaries may also
lodge their complaints/grievances in the “Public Grievance Redressal and
Monitoring System (CPGRAMS)” in the Government portal- pgportal.gov.in or through email.
https://cghs.gov.in/index1.php?lang=1&level=1&sublinkid=6022&lid=3947
What is the procedure for reimbursement of medical claim in CGHS?
Apply within 90 days of
discharge / completion of treatment procedure, to CMO I/c of the Wellness
Centre, where your CGHS card is registered, along with the following documents:
1.
Medical Reimbursement
Claim (MRC) forms duly filled in
2.
Check list
3.
Copy of Discharge
summary
4.
Original Hospital bills
with break-up
5.
Receipts in original
6.
Copy of the valid CGHS
Card
7.
Copy of cancelled cheque
showing bank details for ECS payment or mandate form if name of beneficiary is
not printed on cheque.
8.
Copies of other
documents issued by hospital.
Serving employee in
similar cases shall submit the medical claim to his department.
Relevant OM is linked
below - https://cghs.gov.in/showfile.php?lid=5037
My spouse was a CGHS main card holder. He/she was sick and died
while in hospital. How do I get the medical claim reimbursed?
Apply to CMO I/c of
Wellness Centre with the same documents as above. In addition, the following
need to be enclosed:
1.
Copy of Death summary.
2.
Death Certificate
3.
Affidavit on non
judicial Stamp paper of yourself being Legal Heir and NOC from other legal
heirs in favour of claimant.
It is also to be noted
that the CMO I/C is to be informed regarding the death of the card holder but
till such time that the claim is settled, the main card holder's name is not to
be deleted from the database as it would then not be possible to submit the MRC
on- line.
My original claim papers having bills, receipts of hospital
treatment are lost. Can I claim on duplicate papers?
Yes, it can be claimed
with affidavit on non-judicial stamp paper. Details of Draft for Affidavit may
be seen in the instructions sheet appended to Medical Reimbursement Claim (MRC)
Form available on the CGHS website and with CMO I/c.
I went to Hyderabad on personal visit and sustained fracture of
leg bone. I received treatment f r o m a private non empanelled hospital. Will
I get reimbursement?
Reimbursement for
treatment taken in a non empanelled private hospital under medical emergency
shall be considered as per CGHS rates.
What are the guidelines for IVF?
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, link given below -
OM- http://cghsnagpur.gov.in/fckimagefile/circular_3.pdf
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.
OM No. S.4924/2010/CGHS (R&H)/CGHS(P), dated 17th January, 2011.
I have a Mediclaim Insurance Policy. Due to emergency, I received
treatment in a private hospital. Some amount was paid by Insurance Co. Can I
get balance from CGHS?
Yes, first the bills are
to be submitted to Insurance Company. Duplicate bills and vouchers duly
verified with the stamp of Insurance Company along with a certificate from
Insurance Company indicating the amount for which the beneficiary has received
credit from them, needs to be submitted along with the usual MRC forms and
checklist. These may be submitted to CGHS by Pensioner
CGHS beneficiaries and
to the department by serving
beneficiaries.
Reimbursement would be
done at CGHS rates or actual whichever is less. However, the total
reimbursement from both sources should not exceed actual expenditure.
OM-No.
S.11011/4/2003-CGHS (P), dated 19th February, 2009.
Is it necessary that the Govt. specialist should specify the name
of the empanelled Hospital for the purpose of referral?
No.
What are the ceiling rates for reimbursement of Expenses on
purchase of Hearing Aids?
The revised ceiling
rates fixed for various types of hearing aids (for one ear) are as under
|
Body worn / Pocket type |
Rs. 3000/- |
|
Analogue BTE |
Rs. 7000/- |
|
Digital BTE |
Rs. 15000/- |
|
Digital ITC/CIC |
Rs. 20000/- |
The cost of hearing aids
shall include all taxes in including VAT and shall carry 3 year warranty. The
cost of Analogue BTE /Digital BTE/ITC/CIC type hearing aid shall also include
the cost of hearing mould.
I am an accredited journalist with CGHS Card. Can I seek treatment
in Private Empanelled Hospitals in emergency and get credit facility?
Journalists are entitled
for OPD treatment from Wellness Centres and OPD treatment and Nursing Home
facility at Dr. RML Hospital. However, they are eligible to avail CGHS rates at
empaneled HCOs on payment basis. There is no provision for reimbursement under
CGHS.
Who can avail Preventive Health Check up (PHC) and where are the
facilities available?
In view of the
importance of Diagnosis of Chronic Non-communicable Health Problems at the
preventive level, facility of Preventive Health Check up (PHC ) is available
for
- Beneficiaries who are 40 years old or above
- Who are already not suffering from any chronic ailments
like Daibetes Hypertension Heart disease etc.
- This check up done once in a year only.
- Serving beneficiaries will not require any permission
from their respective offices.
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