List of Emergency Conditions in CGHS Treatment

The medical emergency conditions included under the purview of CGHS Act are enlisted below:

a) Acute Coronary Syndromes viz. (Coronary Artery By-pass Graft or Percutaneous Trans-Luminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra- Ventricular Tachycardia, Cardiac Tamponade, Acute Left-Ventricular Failure, Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stokes-Adams Attack, Acute Aortic dissection. 

b) Acute Limb Ischemia, Rupture of Aneurism, Medical and surgical shock and peripheral circulatory failure. 

c) Cerebro-Vascular Attack, Strokes, sudden Unconsciousness, Head Injury, Respiratory failure, De-compensated Lung Disease, Cerebro-Meningeal Infection, Convulsions, Acute Paralysis, Acute Visual Loss. 

d) Acute Abdomen 

e) RTA (Road Traffic Accident) with injuries including fall 

f) Acute Poisoning

g) Acute Renal Failure 

h) Acute Abdomen in females including Acute Obstetrical and Gynecological Emergencies.

i) Heat Stroke

O.P.D. (Outdoor Patient Department) treatment and subsequent follow-up after hospitalization is not permitted in Private Hospitals and Diagnostic Centres recognized under CGHS. Exceptions for follow-up treatment are permissible in following conditions for a period of 3 to 6 months after conducting the surgical procedure, are as follows: 

a. Neuro-surgery 

b. Cardiac Surgery including Angioplasty 

c. Cancer Surgery, Radiotherapy and Chemotherapy 

d. Organ transplant viz. Kidney 

e. Knee replacement. 

f. RTA (Road Traffic Accident)

Credit to CGHS Beneficiaries in Empanelled Private Hospitals to Continue

Press Information Bureau

Government of India

Ministry of Health and Family Welfare

Press Note 

Credit to CGHS Beneficiaries in Empanelled Private Hospitals to Continue 

There have been reports in the Media that private hospitals on the panel of CGHS are denying credit facilities to the eligible CGHS beneficiaries for delay in settlement of hospitals bills. Lower package rates and inadmissible deductions etc. have also been reported to be the other reasons for withdrawal of agreed cashless /credit facilities. 

24 out of 407 Private hospitals empanelled under CGHS decided unilaterally to discontinue credit facility to the eligible categories of CGHS beneficiaries. Show Cause Notices stand issued to these Hospitals and the empanelment of five Hospitals has been suspended for a period of six months or till further orders, whichever is earlier. 

In this regard, the CGHS beneficiaries are advised not to be guided by misleading information as most of the private hospitals are continuing to extend the cashless facilities to the CGHS beneficiaries. The Ministry of Health and Family Welfare will ensure that the CGHS empanelled private hospitals continue to extend cashless /credit facilities to the eligible CGHS beneficiaries in compliance with the terms and conditions as laid down in the Memorandum of Agreement signed by them with CGHS. Ministry of Health and Family Welfare has already taken special steps for clearance of pending hospital bills on a priority basis and the pendency of bills is almost cleared. 

CGHS has already invited bids for revision of package rates through a transparent tender process, where the last date for submission of bids was 16th March, 2014. Steps are underway to conclude the tender process early. 

Renewal of CGHS plastic cards in Delhi NCR – regarding.

S 11011/11/2014-CGHS (P)

Government of India

Ministry of Health and Family Welfare

CGHS (P)

Nirman Bhavan, New Delhi

Dated: the 12th March, 2014

OFFICE MEMORANDUM 

Sub: Renewal of CGHS plastic cards in Delhi NCR – regarding.

The undersigned is directed to refer to this Ministry’s O.M No. S 11011/1/2014- CGHS (P) dated 10.02.2014 vide which fresh instructions were issued supplementing the existing guidelines on the issue of CGHS Plastic cards . In this regard attention is also drawn to this Ministry’s O.M. No. Misc. 6024/2007/CGHS (HQ)/ CGHS(P) dated 27.12.2010 in respect of pensioner CGHS beneficiaries vide which it was clarified that :-

“The Plastic Cards (which are identity cards), would hereinafter be issued with validity till the pensioner beneficiary is entitled for CGHS benefits. In respect of pensioner CGHS beneficiaries, who have paid CGHS contribution for ‘Rest of Life’ CGHS facilities, the Plastic Cards would, hereinafter, be issued for ‘Rest of Life’.

The plastic cards already issued with a printed validity of five years to pensioner beneficiaries, who had paid CGHS contributions for ‘Rest of Life’ CGHS facilities, would be taken as valid for use for ‘Rest of Life’. However, such CGHS pensioner beneficiaries have the option to obtain new plastic cards after five years, if they choose to do so.”

2. Accordingly, the CGHS pensioner beneficiaries have the option to apply for new CGHS plastic card which are now being issued with validity for ‘whole life’ printed on the plastic card itself. However, the serving employees are issued CGHS plastic cards with validity of five years and they are due for renewal every five years on expiry of validity period indicated on their CGHS plastic card. Fresh cards are being issued in place of old cards on regular basis. Since the applications are being received for renewal of old cards in a very large number, it has created bottleneck and it is taking some time to issue fresh cards.

3. In light of the above, with a view to avoid inconvenience to the CGHS beneficiaries and to facilitate them in availing CGHS services, it has been decided to allow them to access CGHS facilities with the old cards for a further period of six months from the date of expiry of CGHS cards as indicated on their CGHS Plastic cards. However, they have to apply for renewal of CGHS plastic card in the prescribed Form as provided in this Ministry’s OM dated 10.02.2014 as referred to above.

4. In this connection, it is clarified that the beneficiaries who have already submitted applications for renewal of CGHS cards on expiry of their validity period and have so far not received fresh CGHS cards, they will not be denied CGHS facilities, provided the beneficiary is entitled to CGHS benefits as per CGHS guidelines.

5. A CGHS beneficiary is required to apply for new CGHS plastic cards three months in advance or within six months of expiry of validity of the plastic cards and it is recommended to keep a copy of the same as a proof of submission of application for renewal of card which can be produced on demand before the CGHS authorities, if required, for availing the CGHS benefits on the basis of old card.

6. CGHS Wellness Centres will provide the medical facilities to CGHS beneficiaries on the basis of old CGHS plastic card upto a maximum period of six months from the date of validity as indicated on the CGHS plastic card after due verification of the entitlement and validity of CGHS card as per CGHS data base.

7. The CGHS empanelled private hospitals / diagnostic centres are requested to provide the medical facilities on the basis of old card upto a maximum period of six months from the date of validity as indicated on the CGHS plastic card, subject to the condition that the CGHS beneficiary has submitted the application for renewal of CGHS plastic card, complete in all respect, to the CGHS card issuing authority.

8. This OM shall come into effect from the date of issue and will remain in force for one year or till further order, whichever is earlier.

Sd/-

[V. P. Singh]

Deputy Secretary to the Government of India

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File669.pdf

Private hospitals to stop CGHS cashless scheme from March 7

In a blow to government employees, including those who have retired, the Central Government Health Service has announced withdrawal of cashless medical service in private hospitals empanelled with the CGHS scheme from March 7. Patients will henceforth have to cough up hospital charges and later claim the amount from the government, according to the new rule.

The move will affect 50 lakh serving employees and over 30 lakh pensioners, as well as their family members. At a conservative estimate, the total number of persons affected could well be over two crore.

The move was necessary, said the Association of Healthcare Providers India (or AHPI, the nodal body of private empanelled hospitals) for a number of reasons, the main ones being CGHS owes these hospitals around Rs 200 crore in unpaid services as well as “unreasonably low” CGHS tariffs that haven’t been revised for the last four years. A doctor’s consultation fee, for example, remains Rs 58.

Also, AHPI says CGHS makes “illegal” deductions of 10% on all payments leading to losses for member hospitals. AHPI claims the amount runs up to Rs 180 crore.

In Karnataka, 20 hospitals, all in Bangalore, are empanelled with AHPI. HCG, Apollo hospitals, MS Ramaiah Memorial Hospital and Bangalore Baptist Hospital, among others, will not provide the cashless health scheme from March 7.

“When we were empanelled with the government, it was agreed upon that we will get 10% rebate on treatment charges if the government pays within seven days. But now, this deduction has been made applicable even when the amount is unpaid for years. That’s illegal. This has led to huge losses for member hospitals amounting to over Rs 180 crore over the past three years,” says Dr Alexander Thomas, CEO, Bangalore Baptist hospital, who represents AHPI in Bangalore.

Some hospitals have put up a public notice to this effect, reading, “CGHS tariffs are unreasonably low and not been revised for the last four years, threatening the very existence of the medical service providers.”

Dr Naresh Shetty of AHPI said, “The empanelled hospitals have been providing services under most difficult circumstances. They had to deal with steep hikes in electricity and water tariff, consumables, wages, taxes. We’ve been requesting a revision since June 2013 but there’s been no response.”

Official speak

The dues are just one issue. The bigger issue is that a doctor’s consultation charge of Rs 58 is appalling. The fees for several procedures are abysmally low. We don’t want to let down our beneficiaries but we have no choice. We ask the CGHS to consider the rates of the National Accreditation Board for Hospitals & Healthcare Providers. We’ve suggested that if at all CGHS were to take tender route, let CGHS decide the rates based on lowest bid received from NABH – accredited hospitals. Adopting rates like this would be logical and rational. Treating a patient can’t be made similar to selling onions and potatoes.

Source:http://timesofindia.indiatimes.com/india/Private-hospitals-to-stop-CGHS-cashless-scheme-from-March-7/articleshow/31438842.cms

Renewal of CGHS Plastic Cards – reg.

S 11011/1/2014-CGHS (P) 

Government of India 

Ministry of Health and Family Welfare 

Department of Health and Family Welfare 

CGHS (Policy) Division

Nirman Bhavan, New Delhi 

Dated: the 10th February, 2014

OFFICE MEMORANDUM

Sub: Renewal of CGHS Plastic Cards – reg.

The undersigned is directed to refer to this Ministry’s O.M No.S.11012/3/2011-CGHS (P) dated 29.12.2011 laying down the guidelines for issue of individual plastic cards to CGHS beneficiaries. CGHS Plastic Cards were introduced in September, 2008 in Delhi NCR and the cards were initially issued with a validity period of 5 years. The CGHS Plastic Cards completing their validity period are due for renewal and accordingly fresh cards with renewed validity period are being issued by the Office of Additional Director, CGHS of the city concerned. With a view to further streamline the process of renewal of CGHS Plastic Cards, it has been decided to issue the following guidelines supplementing the existing instructions on issue of CGHS Plastic Cards:

Serving beneficiary

a) Application for renewal of CGHS Plastic Cards in the prescribed proforma (Form AA) alongwith requisite documents (current photographs, copy of pay slip and address proof of residence, if changed), should be submitted through their Administrative Office to the Office of Additional Director, CGHS of the respective CGHS city following the same procedure as prescribed for issue of fresh CGHS card.

b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with a validity period of 5 years.

c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry.

Pensioner beneficiary

a) Application for renewal of Pensioners’ CGHS Plastic Cards in the prescribed proforma (Form BB) alongwith requisite documents (current photographs, PPO or LPC, address proof, if changed) should be submitted to the parent CGHS Wefiness Centre where his /her card is registered. He / she can also submit the application to the Office of Additional Director, CGHS of the respective CGHS city for renewal of CGHS cards.

b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with validity for lifetime or up to the date for which the contribution has been made by the beneficiary.

c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry. This issues with the approval of Additional Secretary and Director General, CGHS.

End: Specimen Form AA and Form BB.

Sd/- 

(V.P.Singh) 

Deputy Secretary to the Government of India

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File666.pdf

Treatment from CGHS Empanelled Hospitals

Government empanels private hospitals under CGHS for indoor treatment and treatment can be undertaken with prior permission or under emergency. OPD medicines are issued by CGHS Wellness Centres on the prescription by CGHS Medical officers / Government specialists only.

In case of cardiac surgery, cancer treatment, neuro-surgery, renal transplantation and hip/knee joint replacement surgery, there is provision for issue of permission for post-operative follow up treatment from the same empanelled hospitals, where the initial treatment was taken with prior permission. In such cases OPD medicines as per the available brand name / generic name are issued by CGHS Wellness Centres.

In respect of other post-operative cases, where permission was granted, there is provision for issue of OPD medicines on the prescriptions of empanelled hospital for up to one month.

This was stated by Shri GhulamNabi Azad, Union Minister for Health and Family Welfare in a written reply to the Lok Sabha today.

Source: PIB

Cashless Facility TO CGHS Beneficiaries

Central Government Health Scheme (CGHS) empanels private hospitals for providing inpatient medical treatment to its beneficiaries. They may avail the requisite treatment with prior permission for procedures advised by CGHS and other government specialists / CMO–in-charge. CGHS pensioner beneficiaries are entitled for cashless medical treatment in the CGHS empanelled private hospitals. The empanelled private hospitals under CGHS provide treatment to the pensioners on credit /cashless basis for the procedures for which they are empanelled.

However, in case of emergency conditions empanelled hospitals are expected to provide treatment to pensioners on credit basis, even for conditions for which they are not empanelled and they are expected to shift the patient to another empanelled hospital after stabilization as per the Memorandum of Agreement (MoA) signed with government.

In case of violation of the terms of the Memorandum of Agreement, suitable action, including depanelment can be initiated against errant hospitals.

This was stated by Shri Ghulam Nabi Azad, Union Minister for Health and Family Welfare in a written reply to the Lok Sabha today.

Source: PIB

Reimbursement of Medical Claims-Regarding

No. 21/26/2013-EC-X 

GOVERNMENT OF INDIA 

DIRECTORTE GENERAL OF WORKS 

CENTRAL PUBLIC WORKS DEPARTMENT

Nirman Bhawan, New Delhi 

Dated the 24th January, 2014

To 

1. All the CEs/SEs/SEs(Coord.)/EEs/DDG (Hort.)/DDOH.

Subject: Reimbursement of Medical Claims-Regarding

Sir, 

After repeated requests and making available of the required formalities for processing of reimbursement of medical claims, it has been observed that the medical reimbursement claims are still being received in this Directorate are forwarded/processed in a very casual manner resulting in delay in final settlement of claims of individuals and settling medical claims of different C.G.H.S. approved Hospitals.

To minimize the delay and to streamline the process of scrutinizing and submission of reimbursement of medical claims the stage wise steps required are appended below for action on the part of field units of this Directorate:-

1. The duly filled up Modified Check list for Reimbursement of Medical Claims and Medical Claims Form as per prescribed Performa.

2. The Copy of new CGHS card.

3. The Copy of Permission Letter from concerned office.

4. The Original Bills along with discharge/ Death summary from the Hospital.

5. Emergency Certificate in original from Hospital.

6. In case of death of CGHS Card Holder following documents as prescribed in modified checklist: 

i. Affidavit on stamp paper by claimant. 

ii. No objection from other Legal Heirs on stamp paper. 

iii. Copy of Death Certificate.

7. Whether any advance was granted in the medical Reimbursement Claim? If so, provide the details of the same and under which rules the facility was allowed to applicant.

8. Whether credit facility was granted for the treatment? If so provide the details of the same. Under which rule the credit facility was allowed to serving Govt. official?

9. Medical Reimbursement Claim has to be submitted in duplicate.

10. It has to be mentioned by the forwarding /concern office (Chief Engineer) as to whether the amount claimed for reimbursement is as per the CGHS prescribed rate or not and it has also need to be certified that there is no need of any relaxation of rules in the instant case.

11. Original pouch of Stent packets along with requisite documents prescribed by MOHFW from time to time needs to be enclosed in the MRC file in order.

12. The amount mentioned for stents and other consumables may please be checked as per ceiling rates fixed by MOHFW and the same may be indicated in the forwarding letter.

13. As per the observations of IFD and Works Division in the precedent cases the case requires to be submitted in line with the guidelines of precedent cases providing the details of amount charged by the hospital indicating the S.I. No. of the CGHS items with relevant instructions and thus arriving at the amount admissible.

The case may be submitted with the details of amount charged by the hospital indicating the S.I. No. of the CGHS items with relevant instructions and thus arriving at the amount admissible as per the below format:- 

(i) Name of the Hospital ……………………………… Period of treatment from ………..   to ………… 

(extracts of hospital recognition be placed in the file or instructions relating of treatment from non-empanelled hospital be placed in the file and it may be averred all stipulations have been complied with

S.No.

Particulars/Name Item/(SI. No. of the CGHS items list with extracts.

Amount Claimed

(Quantity X CGHS Rates)

Extracts of Relevant Instruction s of CGHS Placed at F/….

Amount Admissible as per CGHS rates

(ii) All relevant OMs pertaining to the case (item wise-reimbursement) may be placed in the file alongwith the Mb o Health & Family Welfare OM No. S-11011/23/2009/CGHS D-11 dated 17th August, 2010 and subsequent clarificatory OMs issued thereafter.

(iii) It may be indicated whether 10% discount has been availed and case may be put up as per prescribed format as mentioned above.

14. Clarification regarding admissible and non-admissible items under CGHS provided in Mb o Health & Family Welfare’s O.M. No.F.No.2-1/2012/CGHSNC/CGHS(P) dated 01st August, 2013 has to be complied with.

15. As per Ministry of Health and Family Welfare's Draft MOA F.No. D.12034/22/09/CGHS-Desk-I following has to be checked.

(i) DISCOUNT : Hospital shall also allow a discount of 10% on every cash payment.

(ii) CREDIT: On production of a valid permission by the CGHS beneficiary- the hospital shall provide credit facilities to the Members of Parliament, Pensioners, Ex-Members of Parliament, Freedom Fighters, Serving CGHS employees, serving employees of Ministry of Health & Family Welfare, serving employees of Directorate General of Health Services and such other categories of CGHS cardholders as notified by the Government. In case of emergency the hospital shall provide credit to all CGHS beneficiaries.

(iii) TREATMENT IN EMERGENCY: 

In emergency the hospital shall not refuse admission or demand an advance payment from the beneficiary or his family member and shall provide credit facilities to the patient whether the patient is a serving employee or a pensioner availing CGHS facilities, on production of a valid CGHS card and the hospital shall submit the bill for reimbursement to the concerned Deptt./Ministry/CGHS. The refusal to provide the treatment to bonafide CGHS beneficiaries in emergency cases without valid ground, would attract disqualification for continuation of empanelment.

The list of ailments which may be treated as emergency has been mentioned in the MOA for the Hospitals, which is illustrative only and not exhaustive, depending on the condition of the patient.

(iv) For serving employees (other than CGHS/ DGHS /Ministry of H&FW), the payment shall be made by the patient and he shall claim reimbursement from his office subject to the approved ceiling rates. The Private Hospital shall allow a discount of 10% on all payments made in cash.

(v) The treatment procedure shall be performed on the basis of the authorization letter issued by the Chief Medical Officer of the concerned CGHS dispensary in case of pensioners and by the administrative department / ministry in case of serving employees.

(vi) The Hospital agrees that during the In-patient treatment of the CGHS beneficiary, the Hospital shall not ask the beneficiary or his attendant to purchase separately the medicines / sundries / equipment or accessories from outside and shall provide the treatment within the package deal rate, fixed by the CGHS which includes the cost of all the items. Appropriate action, including removing from CGHS empanelment and / or termination of this Agreement, may be initiated on the basis of a complaint, medical audit or inspections carried out by CGHS teams / appointed TPA.

(vii) The hospital shall not refer the patient to other specialist / other hospital without prior permission of CGHS authorities. Prior intimation shall be given to CGHS whenever patient needs further referral.

(viii) Entitlement for various types of wards to CGHS beneficiaries has also been provided in the aforesaid MOA.

This issues with the approval of DDG (HQ)

Sd/- 

(Rahul Ranbir Singh) 

Deputy Director (Administration)

Source:http://cpwd.gov.in/WriteReadData/other_cir/9291.pdf

Extension of CGHS facility to State Govt Employees..?

While answering to a question in Parliament, Minister Shri.Ghulam Nabi Azad said that the Central Government Health Scheme is primarily meant for the Central Government employees and pensioners receiving salary / pension from Central Civil Estimates of Government of India. 

The State Government employees and other members of public are not eligible to join CGHS. However, no requests from State Governments including Kerala have been received for improvement in CGHS. 

CGHS is basically providing the dispensary services through its Wellness Centres manned by the General Duty Medical Officers. However, CGHS also provides the services of medical specialists through the Polyclinics and Central Government hospitals. In addition, the CGHS medical specialists also visit designated dispensaries on stipulated days in each week to provide medical consultation to the beneficiaries. Due to shortage of specialists in CGHS it is practically not feasible and financially viable to provide Specialist facilities in each CGHS Wellness Centre. Moreover, CGHS is also engaging contractual specialists against the vacant posts of specialists to provide the medical consultation services to its beneficiaries. 

CGHS has a dedicated wing of specialists at the Safdarjung Hospital, New Delhi for its beneficiaries. The CGHS beneficiaries are also allowed to consult specialists at Dr. RML Hospital and other Government hospitals in NCR in respective specialties. In addition, CGHS has empanelled a large number of private hospitals to provide inpatient medical care to its beneficiaries on the advice of Government specialists. 

As per the Terms & Conditions for empanelment under CGHS, all empanelled private hospitals are required to provide credit facilities to the CGHS beneficiaries in case of emergency. Pensioners and other specified category of beneficiaries are entitled for credit facilities under normal circumstances also. Non-compliance of the said provision attracts penalty as per the Memorandum of Agreement signed by them. 

List of Super Speciality Hospitals in Coimbatore, Chennai and other Tamilnadu regions...

For super speciality treatment such as open heart surgery, neuro surgery, bone marrow transplant, kidney transplant or specialised investigations like CAT scan, MRI angiography etc. referral arrangements are available with the reputed hospitals of the country. The total cost of such treatment, diagnostic facilities or surgical intervention is borne by the ESI Scheme.

Medical Benefit Super specialty treatment 

List of hospitals in Coimbatore, Chennai and other Tamilnadu regions where ESI Beneficiaries can avail Super speciality treatment

Hospitals in Coimbatore

1. Lalitha Hospital, Cross Cut Road, Coimbatore
2. The Eye Foundation, RS Puram,Coimbatore
3. Sheela Clinic, East Power House Road, Coimbatore
4. Kongunadu Hospital Private Ltd, Tatabad, Coimbatore
5. KG Hospital, Coimbatore
6. PSG Hospital, Coimbatore
7. Kovai Medical Centre and Hospital, Avinashi Road, Coimbatore
8. Sri Ramakrishna Hospital, Coimbatore
9.  KTVR Group hospitals, Coimbatore

Other Hospitals in Tamilnadu Region

1. Appollo Hospital, Greams Road, Chennai
2. Mahatma Eye Hospital, Thiruchirapalli
3. Miot Hospital, Manapakkam, Chennai
4. Prem's Eye Clinic, Bazaar Road,Saidapet, Chennai-15
5. Sugam Hospital, T.H.Road, Chennai-19
6. AG Eye Hospital, Puthur, Trichy
7. Harvey Health Care Limited, TTK Road, Chennai
8. Bejan Singh Eye Hospital, Nagercoil
9. The Institute of Orthopaedic Research and Accident Surgery, Madurai
10. Dr. J. Mathias Hospital, Nagercoil
11. Sooriya Hospital, Chennai.
12. Dr. Agarwals Eye Hospitals Ltd., Cathedral Road, Chennai-86
13. Vizhiagam Eye Hospital, Sivaganga
14. Shanmuga Hospitals and Salem Cancer Institute, Salem
15. Sri Kavery Medical Centre(TRichy) Pvt Ltd. Trichy
16. Joseph Eye Hospital, Trichy
17. Meenakshi Mission Hospital and Research Centre, Madurai
18. Madras Medical Mission, Chennai
19. Kidney Care Centre, Madurai Road, Tirunelveli
20. Quality Care Hospital, Ellis Road, Madurai
21. Sri Ramachandra Hospital, Porur, Chennai
22. Maruti Hospital, Tennur, Trichi-17
23. Appollo Hospital, KK Nagar, Madurai
24. Mani Hospital (P) Ltd. Theni

Source:http://www.esicoimbatore.org/benefits/super_speciality_hospitals.htm

Grant of fixed medical allowance to Defence civilians who residing in area not covered under CGHS.

OFFICE OF THE PR. CONTROLLER OF DEFENCE ACCOUNTS (PENSIONS)

DRAUPADI GHAT, ALLAHABAD- 211014

Circular No. 117

Dated: 16 /01/2014

Subject: Grant of fixed medical allowance to Defence civilians who residing in area not covered under CGHS.

Reference: This office circular No. 03 dated 30-03-1999.

Please refer to this office circular No. 03 dated 30.03.1999 under which Min. of PPG & P, Deptt of P & PW OM No. 45/57/97-P & PW (C) letters dated 24.08.1998 and 30.12.1998 were circulated for implementation of Govt. decision. As per P & PW OM dated 30.12.1998, pensioners who adopted Fixed Medical Allowance or medical facilities under CGHS or corresponding health scheme in accordance to P & PW OM No. 45/57/97-P & PW (C) dated 19.12.1997 circulated under this office circular no. G1/C/195/Vol-I/Tech dated 25.02.1998, can change their option once in the life time. As per existing procedure for change in option, pensioners submit their option to their PDA and PDAs take action accordingly.

In this context, it has been decided that pensioners who had originally opted for medical facilities under CGHS or corresponding health scheme may desire to change their option to draw Fixed Medical Allowance, in such cases Fixed Medical Allowance will be authorized by this office from the date of option, through Corr. PPO.

For issue of Corr. PPO, pensioners are required to submit their application with revised option (Specimen enclosed as annexure-A) to this office, duly supported with a certificate from PDA to the effect that above named pensioner has not opted for Fixed Medical Allowance (specimen of the certificate enclosed as Annexure-B).

In cases where pensioners have originally opted for Fixed Medical Allowance and now want to avail medical facilities, they will submit their revised option to their PDA and after receipt of revised option PDA will stop the payment of Fixed Medical Allowance from the following month of the receipt of the revised option and issue a certificate for stoppage of Fixed Medical Allowance.

Sd/-

 (S B Mathdevaru)

DyCDA (P)

Source:http://pcdapension.nic.in/6cpc/Circular-117.pdf

Deduction of CGHS contribution from Government Servant on change of Grade Pay by virtue of promotion/MACP — clarification reg.

Central Public Works Department

No. DG/ESTT/33

ISSUED BY THE AUTHORITY OF DIRECTOR GENERAL, CPWD  

Nirman Bhawan, New Delhi 

Dated the 16th January, 2014

OFFICE MEMORANDUM 

Sub : Deduction of CGHS contribution from Government Servant on change of Grade Pay by virtue of promotion/MACP — clarification reg.

It has been brought to our attention that the CGHS/DGHS guidelines regarding the monthly subscription/contribution are not being followed properly. It has been observed that in cases where pay of a Government employee is revised from a retrospective date consequent upon grant of MACP etc., CGHS contribution are also being recovered from the retrospective effect.

In this connection, attention is drawn to the clarification given by Ministry Ministry of Health & Family Welfare vide letter No.S11030/55/2011-CGHS(P) dated 26/10/2012 wherein it has been made clear that in cases where pay of a Govt. employee is revised from a retrospective date, resulting in change of amount of CGHS contribution payable, contribution at the higher slab rate may be recovered only from the date of issue of the order and not the date from which the pay is being effected. A copy of the said clarification is enclosed.

All offices of CPWID/PWD are requested to comply the aforesaid instructions strictly.

Encl : As above

( Raj Kumar )

Deputy Director (Admn)III

Source:http://cpwd.gov.in/

CGHS Hospitals will stop cashless treatment from 1st Febraury

The 800 hospitals in the country empanelled under the Central Government Health Scheme will stop cashless transactions from February 1, 2014, because, they claim, the government has not cleared arrears of Rs 600 crore.

The aggrieved hospitals have come together under the umbrella of the Association of Healthcare Providers India and had served notice to the CGHS office in New Delhi on December 13, 2013.

A meeting with the Union health secretary K.N. Desiraju on January 9 yielded no results.

A senior officer of AHPI said, “The amount has been budgeted in the health budget and it must be released. But it is not being done. Hence, the question is, where is it going?”

Since 2010, the hospitals have been complaining of 40 per cent unauthorised deductions in the payments. Now they have come together to put across their point to the government.

AHPI general secretary for AP Govind Hari says, “The problem started in 2002 when they started inviting tenders. In doing so, they reduced the cost of surgeries drastically. Also, orthopaedic treatment costs Rs 3,200 in Karnataka and Rs 10,000 in AP. These errors in terms of determining the cost put the hospitals in a spot.”

A senior member of the APHI said, “We want to quit as it has become more of a burden than a service as the clearance promise of 180 days is hardly followed.”

Additional director, CGHS, Dr Prasad, says, “We have not received any communication from the hospitals.” But senior officers in the Begumpet office of the department say there has been an assessment of the pending amount, and deliberations have started to sort out that matter.

Source : Deccan Chronicle

Govt to revise rates for CGHS empanelled hospitals

In a good news for lakhs of beneficiaries under the Central Government Health Scheme (CGHS), the Government is in the process of revising the rates of medical procedures offered by empanelled hospitals and diagnostic centres and giving them early payment assurance to encourage more medical institutions join the scheme.

The Ministry of Health and Family Welfare has floated e-tenders for empanelment of hospitals and decided that the rates of various medical procedures would be fixed by an average of rates quoted in e-tenders instead of the old system where the lowest quotation became the rate.

Rates of all medical procedure centres under CGHS would be revised by April next year.

Eye tests in CGHS empanelled hospitals labs

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
RAJYA SABHA

UNSTARRED QUESTION NO-1334
ANSWERED ON-17.12.2013

Eye tests in CGHS empanelled hospitals labs

1334 . SHRI BASHISTHA NARAIN SINGH

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether the Eye Specialists visiting the CGHS dispensaries are referring eye tests to CGHS empanelled hospitals Diagnostic labs and imagaing centres in Delhi;

Reimbursement of medical expenses to pensioners where payment of FMA is allowed to staff working in the interior where AMA not available

No. 4/4/2013 -P&PW-(D)
Government of India
Ministry of Personnel, Public Grievances & Pensions
Department of Pension & Pensioners Welfare

Lok Nayak Bhavan, Khan Market,
New Delhi,
Dated the 6th December, 2013

OFFICE MEMORANDUM

Sub:- Reimbursement of medical expenses pensioners where payment of FMA is allowed to staff working in the interior where AMA not available – request of Shri Mukesh Singh.

   The undersigned is directed to forward herewith a representation dated 27.62013 of Shri Mukesh Singh in original received through Dept. of Expenditure vide letter No.164/EV/2013- Hindi dated 7.10.2013 for considering the grievances raised therein expeditiously in accordance with the extant rules/instructions under intimation to the representationist to whom a copy of this communication is also being endorsed.

Details of Dental Clinics in New Delhi under Central Government Health Scheme

Press Information Bureau 
Government of India 
Ministry of Health and Family Welfare

17-December-2013 18:46 IST 
Details of Dental Clinics in CGHS Dispensaries 
Central Zone : New Delhi

S.No.	Wellness Centers	Address
1	Dr. Z.H. Road (D44)	CGHS Building, Dr. Z.H. Road, New Delhi.
2	Chitra Gupta Road (D51)	CGHS Building, Near Aram Bagh, New Delhi.
3	Aliganj, Lodi Road .I (D9)	CGHS Building, Near LodhiRoad, New Delhi.
4	Kali Bari (D 76)	CGHS Building, Kali Bari Marg, DIZ Area, New Delhi.
5	CGHS DispensaryChanakyapuri	CGHS Dispensary Chanakyapuri, New Delhi.

   The dental services in CGHS Delhi have been outsourced in 13 Wellness Centres (5 under Central Zone and 8 under South Zone) for 22 dental procedures. The location wise details are as follows: 

Dialysis Facilities in Government Hospitals

Press Information Bureau
Government of India

Dialysis Facilities in Government Hospitals

   Although, health is a State subject and is primarily the responsibility of State Governments to provide health care including dialysis facilities for the patients, the Central Government through the hospitals under it, supplements the efforts of the State Government.

   Dialysis facility is available at the Central Government hospitals like All India Institute of Medical Sciences (AIIMS), Delhi, Dr. Ram Manohar Lohia Hospital, Delhi, Safdarjung Hospital, Delhi, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry and Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. Under Pradhan Mantri Swasthya Surakha Yojana (PMSSY), six new AIIMS have been set up and upgradation of identified medical colleges has been undertaken which will also improve health care facilities.

Irregularities in Medical Treatment

Press Information Bureau
Government of India

Irregularities in Medical Treatment

   In a special audit drive undertaken by all the Principal Controllers of Defence Accounts (PCsDA) to examine the bill processing procedures of Ex-servicemen Contributory Health Scheme (ECHS), PCDA, Western Command had raised observations relating to excess payment to ECHS empanelled hospitals amounting to Rs.15 crores. All the observations raised by the PCDA, Western Command were thoroughly analysed by Regional Centre, Chandigarh and it was noticed that most of the observations raised were due to incorrect interpretation of the policies. Wherever observations of the Controller of Defence Accounts were conceded to, the overpayments have been duly deducted from the concerned hospitals and suitable warnings issued to them.

Suspension of empanelment of ‘Saket City Hospital, New Delhi’ from the list of Hospitals/Centres empanelled under CGHS - reg.

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
CGHS Division

No. S 11030/4/2013-CGHS (P)

Dated the 13th September, 2013

OFFICE MEMORANDUM

Sub: Suspension of empanelment of ‘Saket City Hospital, New Delhi’ from the list of Hospitals/Centres empanelled under CGHS - reg.

   The undersigned is directed to state that CGHS has empanelled private hospitals in various CGHS covered cities to provide inpatient healthcare facilities to its beneficiaries. Empanelment of the private hospitals is done under a contractual agreement between the Government of India and the private hospital on mutually agreed terms and conditions.