HomeCGHSSimplification of procedure for treatment at private hospitals empanelled under CGHS

Simplification of procedure for treatment at private hospitals empanelled under CGHS

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Simplification of procedure for treatment at private hospitals empanelled under CGHS

File No.Z15025/105/2017/DIR/CGHS
Z 15025/105/2017/DIR/CGHS/EHS
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
EHS Section
***

Nirman Bhawan, New Delhi
Dated the 9th November, 2017

OFFICE MEMORANDUM

Sub: Simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rules, 1944

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for undergoing treatment at private hospitals empanelled under CGHS. The matter has been examined and it has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under CGHS of specific treatment procedures listed under CGHS rate list are advised by a Specialist in a Central Government / State Govt. Specialist hospital or a CGHS Medical Officer without any requirement of any other referral (permission) letter.

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2. Private empanelled hospitals shall perform the treatment on cashless basis in respect of pensioners, ex-MPs, Freedom Fighters, Regular employees {both CGHS and CS (MA) beneficiaries} of this Ministry & other categories of CGHS beneficiaries, who are presently eligible for credit facility and shall enclose the prescription issued by Government Specialist or a CGHS Medical Officer, in original (or a self-attested photocopy) along with the hospital bill submitted to the competent authorities.

3. Serving government employees shall enclose the prescription issued by a Government Specialist or a CGHS Medical Officer in original (or a self-attested photocopy), while submitting the medical claim to the concerned Ministry /department/office for reimbursement.

4. CGHS Medical Officer / Government Specialist shall not refer the beneficiaries to any particular empanelled hospital by name but, shall specify the treatment procedure and mention ‘referred to any CGHS empanelled centre’.

5. These orders are applicable only in respect of treatment procedures for which CGHS rates are available.

6. This issue with the concurrence of IFD vide FTS No. 3130849, dated 09.11.2017.

[Sunil Kumar Gupta]
Under Secretary to Government of India

Signed Copy

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3 COMMENTS

  1. The above OM of Min. of Health & Family Welfare Dated .9th Nov.2017 regarding simplified referral by CDMO etc. Kindly clarify the following :

    (1) whether this OM is applicable for referral for Laboratory Test also.

    (2) Whether this OM is applicable for Serving employee of Central Govt. Departments who are residing out side CGHS coverage areas

    kindly clarify in this regards,

  2. The above-mentioned circular is badly worded especially in the first para. Meaning should be brought out clearly. Can IGE corner please advise the ministry to carry out necessary corrections?

  3. The above letter of Min. of Health & Family Welfare DTD.9th Nov.2017 may be gone through regarding simplified referral by CDMO etc. The CGHS beneficiaries are already entitled for cash less treatment from any referral Hospital. But now the above letter speaks to submit the bill to the concerned authority for re-imbursement. Please clarify the above position whether the CGHS beneficiary should pay cash for his treatment from referral Hospital and then submit the bill to concerned authority?If so what about credit facility extended to CGHS beneficiary?

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