CGHS Orders : Reimbursement of the
cost of OPD medicines for treatment in post operative conditions (No.
Misc. 10001/2000/JD/R&H/CGHS/CGHS(P) dt: 30/4/2001)
Text of MH & FW, O.M. F. No. Misc. 10001/2000/JD/R&H/CGHS/CGHS(P),dated 30/4/2001
Reimbursement of the cost of OPD
medicines for treatment in post operative conditions like Cardiac
Surgery, Organ transplantation, Knee/hip replacement, Neuro
surgical/neurological cases and cancer.
The issue of reimbursement of the cost
of OPD medicines in certain conditions has been under consideration in
the Ministry of Health and Family Welfare for some time. As per existing
procedure the cost of OPD medicines are not reimbursable except in
cases of maintenance Haemodialysis. However, keeping in view the
difficulties and financial hardship faced by the CGHS beneficiaries, it
has now been decided that reimbursement of the cost of OPD medicines may
be considered for the following cases:
a. Post operative cases of major Cardiac Surgery/Cardiology.
b. Oncology cases.
c. Post Operative Organ transplant cases.
d. Post operative Joint replacement cases.
e. Post operative Major Neurosurgical/Neurology cases
2. As drugs are costly, a utilization
certificate from the treating specialist should be obtained by the
beneficiary while preferring claims.
3. The reimbursement will be permissible
only if the initial treatment has been taken with prior permission of
competent authority in a Government Private recognized hospital.
4. The reimbursement will be allowed for
an initial period of six months from the date of discharge from the
hospital and in case further extension is required, fresh recommendation
from a Government Specialist will have to be obtained for further
continuation of the treatment.
5. This issues with the concurrence of Finance Division vide their Dy. No.2780/2001-JS (FA), dated 26/4/2001.
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