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Procedural Impediments of CGHS Beneficiaries – Lok Sabha

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA
UNSTARRED QUESTION NO: 780
ANSWERED ON: 14.12.2018
Procedural Impediments of CGHS Beneficiaries
JANARDAN SINGH SIGRIWAL
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-
(a) whether the Government has made it mandatory for the CGHS beneficiaries who have been referred to CGHS empanelled hospitals, to report back to the concerned wellness centre to endorse investigations advised by the specialists at empanelled hospitals and if so, the details thereof;
(b) whether the Government has taken note of inconvenience and harassment being faced by CGHS beneficiaries who have to visit dispensaries time and again for endorsement of such investigations and if so, the reaction of the Government thereto;
(c) whether the Government has received representations in this regard and if so, the details thereof; and
(d) the corrective measures taken/ proposed to be taken by the Government to simplify/change the procedure in this regard in the interest of sick people, pensioners and serving employees?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a) & (b): Yes; The Government vide its Office Memorandum No. Z.15025/117/2017/DIR/CGHS/EHS, dated the 15th January, 2018 permitted all CGHS beneficiaries to seek OPD consultation from Specialists at Private Hospitals empanelled under CGHS after being referred by any Medical Officer/CMO of CGHS Wellness Centre. After consultation at empanelled hospitals beneficiary shall report back to concerned Wellness Centre, where Medical Officer/CMO would endorse listed investigation and issue medicines.
The Government has reviewed the matter and issued revised guidelines.
(c): Yes; some representations were received for permitting investigations on the advice of Specialist of Private Hospitals empanelled under CGHS.
(d): The guidelines for referral issued vide Office Memorandum No. Z.15025/117/2017/DIR/CGHS/EHS, dated the 15th January, 2018 have been modified vide Office Memorandum No. Z.15025/117/2017/DIR/CGHS/EHS, dated the 10th December, 2018 and the following modifications have been made in the interest of sick people, pensioners and serving employees:-
  • The referral shall be valid for consultations upto 3 times in the same hospital within 30 days.
  • CGHS beneficiaries have been permitted to consult upto 3 Specialists, if required during a single visit.
  • Investigations advised by Specialist of Private Empanelled Hospitals may be undertaken if they are required in emergency as certified by Specialist without endorsement by CGHS.

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