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Clarification regarding admissible / non-admissible items under CGHS
F.No.2-1/2012/CGHS/VC/CGHS (P)
Government of India
Ministry of Health and Family
Welfare
Department of Health and Family
Welfare
Nirman Bhawan, New Delhi
Dated the 1st October, 2012.
OFFICE MEMORANDUM
Subject: Clarification regarding admissible
/ non-admissible items under CGHS.
The undersigned is directed to refer to the
directions given by Hon’ble High Court of Delhi in the case of Sh. Kanhiya Singh
Vs UOI and others [W.P.(C)9044/2011], regarding admissibility and
non-admissibility of certain items under CGHS, the following clarifications are
issued:-
2. “CGHS Package Rate” means and includes lump
sum cost of inpatient treatment / day care / diagnostic procedures for which a
CGHS beneficiary has been permitted by the competent authority or for treatment
under emergency from the time of admission to the time of discharge including
(but not limited to ) – (i) registration charges, (ii) Admission charges, (iii)
Accommodation charges including patients diet, (iv) Operation charges, (v)
Injection charges, (vi) Dressing charges, (vii) Doctor / consultant visit
charges, (viii) ICU /ICCU Charges, (ix) Monitoring charges, (x) Transfusion
charges, (xi) Anesthesia charges, (xii) Operation theatre charges, (xiii)
Procedural charges / surgeon’s fee, (xiv) Cost of surgical disposables and all
sundries used during hospitalization, (xv) Cost of surgical disposables and all
sundries used during hospitalization, (xv) Cost of medicines, (xvi) Related
routine and essential investigations, (xvii) Physiotherapy charges etc. (xviii)
Nursing care and charges for its services.
3. Cost of Implants / Stents / Grants is
reimbursable in addition to package rates as per CGHS ceiling rates for Implants
/ Stents / Grafts or as per actual, in case there is no CGHS prescribed ceiling
rate.
4. During In-patient treatment of the CGHS
beneficiary, the hospital will not ask the beneficiary or his / her attendant to
purchase separately the medicines / sundries / equipments or accessories from
outside and will provide the treatment within the package rate, fixed by the
CGHS, which includes the cost of all the items.
5. In cases of conservative treatment, where
there is no CGHS package rate, the above mentioned items are admissible – items
wise at CGHS rates or as per AIIMS rates (if there is no CGHS rate) or as per
actual (if there is no CGHS / AIIMS rate) for any item.
6. Package rates envisage up to a maximum
duration of indoor treatment as follows:
12 days for Specialized (Super Specialties)
treatment:
7 days for other Major Surgeries;
3 days for Laparoscopic surgeries / normal
deliveries; and
1day for day care / Minor (OPD)
surgeries.
7. However, if the beneficiary is required to
stay in the hospital for his / her recovery for a period more than the period
covered in the prescribed package rate, in exceptional cases, supported by
relevant medical records and certified as such by the hospital, the additional
reimbursement shall be limited to accommodation charges s per entitlement,
investigations charges at approved rates, and doctors visit charges (not more
than 2 visits per day per visit by specialists / consultants) and cost of
medicines for additional stay). No additional charge on account of extended
period of stay shall be allowed if that extension is due to infection on the
consequences of surgical procedure or due to any improper proceed.
8. The above list is however not exhaustive.
Some patients may require additional facilities/ procedures, which are
admissible depending upon the medical requirements as advised by the treating
doctors/specialists, with proper justification. Therefore, it is not possible to
indicate a comprehensive list of items, which are not admissible. However, the
following items are not admissible for the purpose of reimbursement under
CGHS:
Telephone charges
Toiletries
Sanitary napkins
Talcum powder
Mouth fresheners
[V.P.Singh]
Deputy Secretary to the Government of India
Source:
http://msotransparent.nic.in/cghsnew/index.asp
Employee is not entitled to regular pension till the departmental and judicial proceedings against him are concluded-CAT
New Delhi, October 01, 2012(PTI): The Central Administrative Tribunal (CAT) has dismissed a former Indian Telecommunication Services (ITS) officer’s plea for a hike in his pension, saying he is not entitled to it till the departmental and judicial proceedings against him are concluded.
A bench of CAT Chairman Syed Rafat Alam and member Ramesh Chandra Panda gave the order on a plea by ITS officer R P S Panwar against whom six disciplinary proceedings and one criminal case is pending.
Panwar had contented his current pension of Rs 23,913 should be hiked to Rs 38,772 as per the Sixth Central Pay Commission’s recommendations as the disciplinary proceedings and criminal case pending against him have been stayed by the concerned judicial authorities.
The CAT, however, dismissed his plea saying “We are of the considered view that the applicant is not entitled to get his provisional pension revised as per the sixth CPC until the departmental and judicial proceedings pending against him are finally decided,”
Panwar, in his application, had told the Tribunal that he was placed under temporary suspension from September 2003 and was allowed to retire on reaching the age of retirement in April 2006.
He had contented that he is entitled to a higher pension as he had retired after the recommendations of the sixth pay commission had come into effect from January 1, 2006.
The counsel for the Department of Telecommunications had argued that Panwar should not be given any relief as he is facing “serious” charges of amassing disproportionate assets.
Agreeing with the DoT’s argument, the Tribunal ruled that he was not
entitled to arrears of leave encashment and other dues till the matters
pending against him are resolved.
E-Brochure on Reservation for SC, ST and OBC released by DOPT
Department of Personnel and Public Grievances and Pensions has issued an E-Brochure on Reservation for SC, ST and Other Backward Classes in Central Services.
The circulars related to Brochure on Reservation have also been published by DOPT in its official Website.
The following is the foreward of this brochure.
Click the links below for E-brochure on Reservation for SC, ST and OBC released by DOPTA Brochure on Reservation for the Scheduled Castes and Scheduled Tribes in Services was last brought out in the year 1993. An important event, namely, introduction of reservation for Other Backward Classes in services under the Union Government took place in that year. The 1993 edition of the Brochure only contained Office Memoranda on reservation for OBCs but did not form an integral part thereof. It is for the first time that a Brochure on Reservation for the Scheduled Castes, Scheduled Tribes and Other Backward Classes is being brought out.2. A major development in the matter of reservation was the replacement of `vacancy based reservation’ by the ‘post based reservation’ in the year 1997. This brought in drastic changes in the way the reservation system was implemented. Problems raised by various stake-holders in connection with the new system of implementation of reservation were attempted to be solved by explaining the issues to the concerned organizations individually, but doubts still continue to be raised. The Reservation Division of this Department led by Shri Rajeev Kapoor, Joint Secretary, and Shri K.G. Verma, then Director have prepared a comprehensive Brochure, covering various aspects of the subject.The difficulties faced by the people in understanding the provisions of reservation have been kept in view while preparing the Brochure. The subject has been presented in a simple language and is easy to comprehend.3. Efforts have been made to make this document error free. Nevertheless, if any error is noticed, it may be brought to the knowledge of the Joint Secretary of Reservation Division of the Department of Personnel and Training.
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Introduction | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - De-Reservation | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Determination of Reservaion Quota | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Miscellaneous | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Monitoring and Institutional Safeguard | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Verification of Claim of SC, SCT and OBC | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Scope for Reservation | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Relaxation and Concessions | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Reservation Registers and Roaster Registers | SC, ST & OBC Reservation | Released in 2011 |
| Click here to download this OM/Order | File No. | Date |
|---|---|---|
| E-Brochure - Filling up of Reserved Vacancies | SC, ST & OBC Reservation | Released in 2011 |
CGHS allows for referral letters in respect of specialised treatment with validity of six months in the cases of Diabetes, Hypertension & other Cardiac Diseases, Dialysis and Cancer.
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
S-11045/40/2012/CGHS/HEC/CGHS (P)
Ministry of Health & Family Welfare
Department of Health & Family Welfare
S-11045/40/2012/CGHS/HEC/CGHS (P)
Nirman Bhawan, New Delhi
Dated the 1st October, 2012
OFFICE MEMORANDUM
Sub: Permission for treatment / investigations in respect of CGHS beneficiaries availing treatment for Diabetes, Hypertension & other Cardiac Diseases, Dialysis and Cancer.
The undersigned is directed to refer to the subject mentioned above and to state that at present the CGHS beneficiaries undergoing treatment for Diabetes, Hypertension & other Cardiac Diseases. Dialysis and Cancer require repeated investigations / treatment procedures
over a period of time and as per the existing guidelines they are
required to procure permission every time to get the prescribed
treatment / investigations done at CGHS empanelled hospitals /diagnostic
centres.
2. With a view to alleviate the inconvenience to CGHS beneficiaries in obtaining the requisite permission(s) every time, this Ministry has decided to permit issue of permission (referral) letters by competent authorities with a validity of six months from the date of issue of the original prescription for undergoing the prescribed treatment /investigation procedures to be conducted at the prescribed intervals over a period of six months as advised by a Government Specialist. The same permission (referral) letter shall be valid for undergoing the prescribed treatment procedures / investigations on multiple times during the six months, at intervals as advised by the Government Specialist.
sd/-
Deputy Secretary to Government of IndiaCentral Government Health Scheme – Procedure for issuing CGHS Cards
Central Government Health Scheme (CGHS) is a welfare scheme to take care of health of Central Government Employees and Pensioners residing at selected cities in India. Central Government Employees and Pensioners residing in 24 cities are benefited by this scheme.
Click here To know more about CGHS
As one of the procedures, a card is issued to persons entitled for CGHS treatment which is known as CGHS card. Production of the CGHS Card is obligatory at every visit to enable correct identification of the patient and to prevent misuse of card.
The following is the frequently asked questions on issue of CGHS cards.
| S.N. | QUESTION | ANSWER |
|---|---|---|
| 1 | I am a pensioner, How do I avail CGHS facilities |
One get a CGHS card made from the office of AD / JD of the City |
| 2 | How do I get the forms for CGHS card |
Forms can be downloaded from CGHS Website or can be taken from office of AD / JD of city between 1000 am to 1230 pm |
| 3 | What are the documents required for getting Pensioners CGHSCard |
Application in prescribed format Proof of Residence Proof of Stay of dependents Proof of age of son Disability certificate, if any in case of sons aged 25 & above , who would otherwise cease to be a beneficiary. Photos of eligible family members Surrender Certificate of CGHS Card while in service ( only in those cases where CGHS Card was issued while in service) Attested copies of PPO & Last Pay Certificate Draft for required amount towards CGHS contribution – in the name of `P.A.O., CGHS New Delhi’ in Delhi-and in the name of ‘AD, CGHS of the city’. In case PPO is not ready for any reason there is option to get a provisional card on the basis of Last Pay Certificate. |
| 4 | Are CGHS facilities free of cost | There is a contribution to be paid to become a member of CGHS |
| 5 | What are the rates of contribution for CGHS ? How to pay the contribution ? |
For serving employees residing in CGHS covered area obtaining CGHS card is compulsory Deduction from salary is made by the department, every month, depending upon their pay Pensioners who want to avail CGHS facilities can make contribution either on yearly basis or one time ( ten yrs ) contribution for whole life validity. |
| The rate of contribution is given in separate table – New CGHS Contribution Payment can be made by Demand Draft in favour of” P.A.O. CGHS Delhi” if in Delhi or” Additional Director of the CGHS City” |
||
| 6 | What are the timings to submit the Application forms for CGHS Cards |
1000 am to 1230 pm |
| 7 | What are the criteria for Entitlement of Treatment endorsed on CGHS Card like General ward / Semi-Pvt ward or Pvt. Ward in CGHS Empanelled Hospitals |
Endorsement of entitlement for general/semi- private/private ward facility is done according to their basic pay/pension plus dearness pay/pension as per OM 11011/2/2008/CGHS(P) dated 20th May 2009. General Ward upto Rs.13950/- in revised scales(6 CPC) Semi -Private Rs.13960 to Rs.19530/- Private ward Rs.19540 and above |
| 8 | I have lost my CGHS Pensioner Token card. What should I do to get a Duplicate Card |
Application is to be submitted to AD/JD along with with a copy of FIR, and two photographs and a IPO for Rs. 5/- In case of Plastic Card IPO for Rs.50 shall be submitted. Indian Postal Order payable to” P.A.O. CGHS Delhi” if in Delhi or” Additional Director of the CGHS City” |
| 9 | 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? |
No |
| 10 | I am a pensioner and I stay in an area not covered under CGHS. I get Rs.100 as medical allowance with pension. Can I get CGHS facilities? What is the procedure? Do I have to get the medical allowance discontinued ? |
You can obtain CGHS facilities from nearest CGHS covered city. If you avail Rs.100/- for OPD medicines - CGHS card shall be issued only for indoor treatment. If you opt to forego medical allowance of Rs. 100 a certificate from concerned authorities (like Bank) that medical allowance has been discontinued shall be submitted before you can obtain CGHS cards from nearest CG HS covered city for both OPD medicines & indoor treatment. |
| 11 | If I am a CGHS city card holder and my family members go to other CGHS covered city what is the procedure of treatment for my family members |
Temporary authority is issued by the respective Department for the family members for their treatment in another CGHS covered city. |
| 12 | I am a pensioner and reside in Pitampura in North Delhi in Delhi. Can I get my CGHS Card registered at Vivek Vihar in eastern part of NCR |
No. Card is to be registered in the CGHS WC nearest to your residence |
| 13 | I am a pensioner and had my card registered at RK Puram Sector 8 dispensary in 1999. Now I have shifted to Dwarka. Can I be forced to shift my dispensary |
CGHS card is registered at the CGHS WC nearest to the residence of pensioner beneficiary. However , if a card is already registered at a particular dispensary there is no compulsion to shift to another dispensary in case of change of residence. |
| 14 | 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 |
| 15 | I retired from service/took VRS. However, I have not yet received my PPO. How can I get a CGHS Card made as I need medicines regularly for treatment of my hypertension? |
In case PPO is not ready for any reason there is provision to get provisional card for six months only , on the basis of Last Pay Certificate. |
| 16 | I have retired from Delhi. Now I want to settle at city where no CGHS facility is available . How to cover my family for medical care? |
Pensioners eligible for CGHS facilities can get the CGHS card from the nearest CGHS covered city |
| 17 | I retired in 1998 from Central Govt. but, I never made a CGHS card. Can I get a card now? |
Yes, |
| 18 | Can a beneficiary avail CGHS facility if he resides in an area not covered by WC |
For pensioners ,Yes Serving employees shall be covered under CS(MA) Rules |
| 19 | I am CGHS beneficiary at Kanpur. Visiting Mumbai for 6 months Can I get CGHS facilities at Mum bai Can same card of Kanpur continue or a separate card to be made From where to get permission for the same |
Yes No, pensioners shall approach AD of visiting city with copy of his card for obtaining temporary permit to avail CGHS facilities. In case of serving employees such temporary permit is issued by his parent department. |
| 20 | What is the procedure for getting dispensary changed for Serving/Pensioners card holders? |
CM0 I/c shall do the needful. In computerized dispensaries the Data of beneficiaries is transferred to another dispensary. The dispensary where the card is transferred accepts the Data transfer. |
| In non-Computerized dispensary, CM0 i/c issues a transfer letter along with Index. Serving employees - Apply through the department, concerned Pensioners – Apply directly to CM0 I/c of WC |
||
| 21 | My husband retired in 2002. He was paying CGHS subscription every year. After his death can I get Card on my name. Do have I to pay extra Shall I get Life Time Valid card |
Yes, card can be made in the name of spouse on submission of required documents. No extra payment to be made, in case of life time cards. However in other cases one has to pay 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 i) Application in prescribed format ii) Proof of Family Pension with its break up components from Bank. iii) Prescribed contribution, if the card is not for whole life validity. Photos of eligible members. |
| 22 | My husband retired from Central Government but, no CGHS card was made as a pensioner. I am drawing family pension. Can I get pensioners’ CGHS Card now ? |
Yes |
| 23 | My father / hiusband was a CGHS pensioner Card holder. He died last month. Can I still avail CGHS facilities ? |
Yes CGHS pensioner card is issued in the name of dependent getting the family pension, by AD / JD of the city Documents required iv) Application in prescribed format v) Proof of Family Pension with its break up components from Bank. vi) Prescribed contribution, if the card is not for whole life validity. vii) Photos of eligible members. |
| 24 | Who is competent to delete name of sons who have crossed age of 25 years |
CM0 I/c of Wellness centre In computerized dispensaries , the system automatically blocks registration. |
| 25 | Who is competent to transfer | CM0 I/c of Wellness centre |
| pensioner card from one WC to other |
||
| 26 | I am an IAS officer and my husband an IPS officer. We are both belong to AP Cadre and now posted in Delhi on deputation. In whose name card to be made ? Will both pay CGHS subscription ? |
One spouse with higher salary can make card and other spouse can have CGHS facilities on same card as member Only the spouse in whose name the card is issued shall pay CGHS subscription |
| 27 | I am an IPS officer and my wife, an IAS officer. Both of us belong to AP Cadre and now posted in Delhi on deputation. I am in Central Govt. but my wife is with Delhi Govt. Can I have our children names in my CGHS Card while my wife can have facilities from Delhi Govt. |
Yes |
| 28 | After retirement in 2007 I got a Life time Pensioner CGHS card made in Delhi. Now I am shifting to Dehradoon. Can I use the same card. Do I pay again |
No, CGHS Card is to be surrendered in the office of AD-HQ Delhi, a surrender certificate and NOC are to be obtained and a fresh card shall have to be obtained from the office of JD- Dehradoon No extra fee to be paid, if the card is for life time |
| 29 | I have a CGHS Pensioner card. My daughter has got married. Whom should I report to get her name deleted from card |
CM0 I/c of the Wellness Centre |
| 30 | I got a Lifetime pensioner CGHS Card made in 2007. Now in 2009 I wish to surrender CGHS card. Shall I get balance amount of subscription refunded |
No |
| 31 | I live in Gurgaon but my office is in Saket. Can I avail facilities from both the places because it is convenient for me |
No Department issues CGHS Card at dispensary as per the residential address. |
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