The
Department of Health & Family Welfare under Ministry of Health
& Family Welfare has issued an important clarification order
regarding that the title of ‘Guidelines to be followed by
Ministries/Departments while referring cases to Ministry of Health &
Family Welfare on CGHS matters’.
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108
No.S.11011/1/2012-CGHS (P)
Dated the 27th June, 2012
OFFICE MEMORANDUM
Sub: Guidelines
to be followed by Ministries/Departments while referring cases to
Ministry of Health & Family Welfare on CGHS matters — reg.
Central
Government Health Scheme (CGHS) was introduced in 1954 to provide
comprehensive medical care for serving/retired Central Government
employees and their family members. Instructions have been issued from
time to time to regulate this medical facility to ensure that Ministries
and Departments of Government of India including the CGHS beneficiaries
have a clear idea on different aspects of CGHS.
2.
Various instructions on eligibility, dependency, CGHS contributions,
issue of CGHS cards, medical advance, settlement of medical claims and
medical facilities provided under CGHS have been issued. These
instructions are by no means exhaustive but an effort has been made to
ensure that most cases are settled at the beneficiary’s own Ministry /
Department.
3.
Despite issuing a number of guidelines on settlement of reimbursement
claims and delegation of powers for referral and approval cases, it has
been observed that cases are being referred to this Ministry in a
routine manner without adequate examination. Instances of cases have
come to notice where despite the lack of documentary evidence, cases
have been recommended and referred to this Ministry for examination,
with or without the approval of the concerned Joint Secretary/Head of
Department.
4.
In such cases, it becomes difficult to examine the legitimacy of the
claims and much time and effort is spent in collating and verifying the
facts of the case. Accordingly, it is impressed upon all the
Ministries/Departments of the Government of India to ensure that cases
are examined thoroughly as per the CGHS guidelines and instructions. If
any clarification on CGHS policy matter/relaxation of rules is required,
the Administrative Ministry / Department may, if they are satisfied
with the justification/merit of the case, refer it to this Ministry with
the specific recommendation of the concerned Joint Secretary /Head of
Department along with all supporting documents.
5. This issues with the approval of Additional Secretary & Director General (CGHS).
sd/-
(V.P.Singh)
Deputy Secretary to the Government of India
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