CGHS Orders : Follow-up Treatment of CGHS Beneficiaries in Recognized Hospitals (No. S-11011/1/2000-CGHS dt: 10/4/2001)
Text of MH &FW, O.M. F.No.
S-11011/1/2000-CGHS (P) dated 10/4/2001 Follow-up Treatment of CGHS
Beneficiaries in Recognized Hospitals
The undersigned is directed to refer to
Office Memorandum No.S.11017/1/95-CGHS (P), dated September 20, 1995 and
to say that it has been decided to modify the order in view of
difficulties being faced by Central Government Health Scheme
beneficiaries.
It has now been decided that the CGHS
beneficiaries will be eligible for follow-up treatment relating to Neuro
Surgery, Cardiac Surgery (including Coronary Angioplasty &
implants), Cancer Surgery/Chemotherapy/Radiotherapy, Kidney
transplantation, Hip/Knee replacement Surgery and Accident cases in the
same Institutions/Hospitals where the treatment was earlier carried out
with prior permission of competent authority. The follow-up treatment
will however, be subject to the following conditions :
1. The reimbursement of expenditure for
Consultation/Treatment including hospitalization if
required/Investigations will be limited to rates as fixed under Central
Government Health Scheme.
2. The beneficiary should collect all
the OPD medicines prescribed in connection with the treatment from the
dispensary concerned in normal timing. In emergency these could be
procured from market.
3. In case there is no approved CGHS
rates for any procedure, or test, reimbursement will be made as per All
India Institute of Medical Sciences rates, if any, or actual whichever
is less or as per actual in
case there is no AIIMS rates also.
4. Reimbursement in respect of Central
Government Employees and other working employees and pensioners of
autonomous bodies which were covered under CGHS will be made by
respective departments from Service Head; from Rajya Sabha/Lok Sabha
Secretariat as the case may be in case of Member of Parliament and
EX-Member of Parliament. In respect of Central Government Pensioners,
Freedom fighters etc. covered under Central Government Health Scheme,
the reimbursement will be made by respective Additional/Joint/Deputy
Director of CGHS of concerned City from CGHS head.
5. Permission for follow-up treatment
may be granted by the Head of the Department in case of Central
Government Employees, working employees and pensioners of Autonomous
Bodies admitted under the scheme and by Rajya Sabha Secretariat/Lok
Sabha Secretariat as the case may be in case of Members of Parliament
and Ex-MPs and by CMO Incharge of concerned CGHS Dispensary in case of
Pensioners, Freedom Fighters etc. for 3-6 months at a time, which may be
extended if required on the bases of medical record.
6. In case of other conditions 9other
than those mentioned earlier) where prior permission for treatment in a
private hospital recognized under CGHS is granted, regular follow-up
treatment is to be obtained from CGHS Dispensary/CGHS/Govt. specialist
only. However the OPD medicines prescribed on discharge summary may be
issued by concerned CGHS dispensary up to a maximum period of one month.
7. Permission for follow-up treatment in
case of accidents, where patients were admitted under emergency without
prior permission in recognized hospitals under CGHS may be considered
by Head of CGHS Organization of city concerned subject to Ex-post facto
sanction for initial treatment based on discharge summary and possession
of a valid CGHS card. In such cases Medical reimbursement claim may be
accompanied by a copy of the Permission letter.
8. In exceptional cases where permission
for treatment of the above mentioned conditions in a private
un-recognized hospital was granted by Ministry of Health and Family
Welfare, permission for follow-up treatment may be considered by Head of
CGHS organization of concerned city on a case to case basis and HOD in
respective cities.
9. This issues with the concurrence of Finance Division vide Dy. No. 2266/JS (FA) dated 4/4/2001.
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