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)

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.

Criteria for Setting up of CGHS Dispensary

Press Information Bureau
Government of India

Criteria for Setting up of CGHS Dispensary

   The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area are as under:
 
   (i) In an existing CGHS city: For opening of a new Allopathic CGHS dispensary in an existing CGHS city, there has to be a minimum of 2,000 Card holders (serving employees of Central Government and Central Civil pensioners).
 
   (ii) Extension of CGHS to a new City: For extension of CGHS to a new city there has to be a minimum of 6,000 Card holders.

REIMBURSEMENT OF MED CLAIM FOR EMERGENCY TREATMENT IN NON EMPANELLED HOSPITAL.

Central Organisation ECHS
Adjutant General’s Branch
Integrated Headquarters
Maude Line
Delhi Cantt - 110 010

B/49773/AG/ECHS/Rates policy

15th oct 2013

Reginal Centre ECHS
MUMBAI

REIMBURSEMENT OF MED CLAIM FOR EMERGENCY TREATMENT IN NON EMPANELLED HOSPITAL

   1. A Clarification was sought from the Chief Medical Officer (SAG), CGHS Mumbai on the rates at which the claims are settled of CGHS beneficiaries. The CGHS authorities have clarified vide their letter No 3(xiv)3/13 Genl/1958/13 dt 30 Aug 13 that reimbursement at 25% higher rate that the 2002 CGHS rates is applicable to those who have taken treatment in private non empanelled hospital through CGHS in Mumbai.

Private Hospitals threaten to stop CGHS treatment

   Cashless treatment may be stopped for central government employees
 
   Corporate hospitals across the country have threatened to stop cashless treatment to lakhs of Central Government employees from January 1. This will impact about 45 lakh employees of the Central Government and public sector agencies who are benefiting from the insurance scheme.

   Protesting against “unviable” rates being given to them under the Central Government Health Scheme (CGHS), the Association of Healthcare Providers (India) (AHPI) has said that it will give three months’ time to the Government to revise the rates.

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.

Funds for Unani under CGHS.

   Like other systems of medicine practiced under CGHS, Unani division has also a set and transparent system of procurement of medicines. Procurement of Unani medicines is done from three Sources:-

   1. IMPCL: for bulk purchase of 94 Unani Medicines. IMPCL is a Public Sector Undertaking (PSU) which supplies medicines at the rates fixed by the Office of Chief Advisor Cost, Department of Expenditure, and Ministry of Finance. There is no requirement of tendering to procure medicines from M/s IMPCL.
 
   2. From Private Manufacturers: through open tendering-both for Generic & branded items.
 
   3. Authorized Local Chemist (ALC):  medicines which are not available in the dispensary or store are procured through Authorized Local Chemist. Local Purchase system is a stop gap method for daily need. Authorized Local Chemist is appointed after following the due codal provisions.

Treatment from CGHS Empanelled Hospitals.

   As per the existing guidelines, a CGHS beneficiary is required to obtain permission from his administrative Department / Office or CMO in charge (in case of pensioner beneficiary) to avail medical treatment in a CGHS empanelled private hospital. However, in case of emergency he can go to any hospital whether empanelled or not, to avail medical treatment. This provision is necessary to ensure proper medical treatment of a CGHS beneficiary in consultation with the Government specialists. This is also a measure of ‘checks and balances’ to ensure financial propriety and optimum utilization of public money.

   This Ministry has been receiving representations from the individuals; Pensioners Associations etc. to allow the CGHS beneficiaries to take treatment from the CGHS empanelled private hospitals without obtaining the requisite permission. However, their requests have not been acceded to as the present referral system is considered necessary in the interest of the beneficiaries and it is also necessary as a check and balance measure to ensure financial propriety.