MEDICAL FACILITIES FOR GOVERNMENT EMPLOYEES

GOVERNMENT OF INDIA

MINISTRY OF HEALTH AND FAMILY WELFARE

DEPARTMENT OF HEALTH AND FAMILY WELFARE

RAJYA SABHA

UNSTARRED QUESTION NO. 2566

TO BE ANSWERED ON 9TH AUGUST, 2016

MEDICAL FACILITIES FOR GOVERNMENT EMPLOYEES 2566. SHRI RAM KUMAR KASHYAP:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state the details of medical facilities being provided to Central Government employees?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND

FAMILY WELFARE

(SHRI FAGGAN SINGH KULASTE)

(i) Central Govt. employees drawing their salary from Central Civil Estimates of Government of India are covered under Central Govt. Health Scheme (CGHS) in the cities where CGHS is in operation.

Facilities available to Central Government employees under CGHS are as under :

1. OPD treatment and medicines from CGHS Wellness Centres

2. Specialist Consultation at Govt. Hospitals

3. Hospitalization at Govt. and CGHS empanelled hospitals

4. Investigations at Govt. and empanelled Diagnostic centres.

5. Medical consultation and dispensing of medicines in Ayurveda, Homeopathy, Unani and Siddha systems of medicine (AYUSH).

6. In case of emergency, CGHS beneficiaries can go to any hospital, empanelled or non-empanelled and avail medical treatment.

7. Reimbursement of expenses for treatment in Private unrecognized hospitals in case of emergency.

8. The beneficiary can go to any CGHS Wellness Centre in the country.

9. Reimbursement of expenses incurred for purchase of medical equipments such as hearing aid, hip/knee joint implants, artificial limbs, pace makers, ICD/Combo device, Neuro implants etc., as per the CGHS ceiling rates and guidelines.

(ii) Central Government employees who are not covered under CGHS are provided medical facilities under Central Service (Medical Attendance) Rules, 1944. They can avail treatment from Central Government / State Govt. Hospitals and hospitals recognised by the State Govt./CGHS/CS (MA) as well as the hospitals fully funded by either Central Govt. or the State Govt. with the approval of the Head of the Department on the basis of medical prescription issued by the concerned Authorized Medical Attendant.

http://rajyasabha.nic.in

Read More »

NO CGHS Funds for next 2 Months

Health Ministry – Started in 1954, the CGHS — with approximately 30 lakh beneficiaries — covers retired and serving central government employees, MPs and their immediate families across 25 Indian cities.

The health ministry has no money left in the Central Government Health Scheme (CGHS) account for the next two months till funds according to the revised estimate are released. Having exhausted the Rs 1,600 crore that was initially allocated, the ministry has now asked for Rs 450 crore more.

The crisis in CGHS, one of the oldest health schemes run by the government, was precipitated by successive budget cuts, said sources.

Started in 1954, the CGHS — with approximately 30 lakh beneficiaries — covers retired and serving central government employees, MPs and their immediate families across 25 Indian cities. A total of 945 private hospitals and 165 diagnostic centres are empanelled with CGHS, which means that treatment in these hospitals for specified conditions are reimbursed by the government. Expenses at government hospitals are automatically covered for CGHS card holders.

“Funding for CGHS has been steadily going down, in 2013-14 it was Rs 1,832 crore, in 2014-15 it was Rs 1,798 crore and this year it was Rs 1,600 crore which we have exhausted. More funds will come only in January which is when the demands submitted under revised estimates are released. So the next two months will be difficult. We have asked for another Rs 450 crore for the rest of the year,” a source said. The matter was discussed at a presentation given to Health Minister J P Nadda on Tuesday, along with a host of measures to increase the beneficiary base and make transactions easier through the use of technology.

While instructions were issued to start clearing bills at one go instead of the earlier practice of 10 per cent payment in first instalment and the rest later, the ministry realises that the Rs 80-90 crore corpus that was handed out to UTIITSL for payment purposes is hardly sufficient.

“We need at least a couple of hundred crores corpus for the payments to continue without any hitch. We are looking at how to raise that money from other sources if possible,” said an official. The fund crunch hit at a time when the ministry was in the process of clearing private hospital bills to the tune of several hundred crores, pending for years. The pendency had led to a mass exodus of hospitals a couple of years ago, drastically reducing the number of private institutions empanelled with CGHS.

However, unfazed by the fund shortage, officials said this was only a “temporary phase”.

Source: The Indian Express

Read More »

Treatment by CGHS empanelled hospitals in emergency cases: Rajya Sabha Q&A

GOVERNMENT OF INDIA

MINISTRY OF  HEALTH AND FAMILY WELFARE

RAJYA SABHA

QUESTION NO  295

ANSWERED ON  25.11.2014

Treatment by CGHS empanelled hospitals in emergency cases

295. SHRI A.U. SINGH DEO:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether Government is aware that empanelled hospitals provide cashless services to pensioners only for the diseases for which they are empanelled, even during the emergencies;

Read More »

List of Emergency Conditions in CGHS Treatment

List of Emergency Conditions in CGHS Treatment

The medical emergency conditions included under the purview of CGHS Act are enlisted below:

a) Acute Coronary Syndromes viz. (Coronary Artery By-pass Graft or Percutaneous Trans-Luminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra- Ventricular Tachycardia, Cardiac Tamponade, Acute Left-Ventricular Failure, Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stokes-Adams Attack, Acute Aortic dissection. 

b) Acute Limb Ischemia, Rupture of Aneurism, Medical and surgical shock and peripheral circulatory failure. 

c) Cerebro-Vascular Attack, Strokes, sudden Unconsciousness, Head Injury, Respiratory failure, De-compensated Lung Disease, Cerebro-Meningeal Infection, Convulsions, Acute Paralysis, Acute Visual Loss. 

d) Acute Abdomen 

e) RTA (Road Traffic Accident) with injuries including fall 

f) Acute Poisoning

g) Acute Renal Failure 

h) Acute Abdomen in females including Acute Obstetrical and Gynecological Emergencies.

i) Heat Stroke

O.P.D. (Outdoor Patient Department) treatment and subsequent follow-up after hospitalization is not permitted in Private Hospitals and Diagnostic Centres recognized under CGHS. Exceptions for follow-up treatment are permissible in following conditions for a period of 3 to 6 months after conducting the surgical procedure, are as follows: 

a. Neuro-surgery 

b. Cardiac Surgery including Angioplasty 

c. Cancer Surgery, Radiotherapy and Chemotherapy 

d. Organ transplant viz. Kidney 

e. Knee replacement. 

f. RTA (Road Traffic Accident)

Read More »

Credit to CGHS Beneficiaries in Empanelled Private Hospitals to Continue

Press Information Bureau

Government of India

Ministry of Health and Family Welfare

Press Note 

Credit to CGHS Beneficiaries in Empanelled Private Hospitals to Continue 

There have been reports in the Media that private hospitals on the panel of CGHS are denying credit facilities to the eligible CGHS beneficiaries for delay in settlement of hospitals bills. Lower package rates and inadmissible deductions etc. have also been reported to be the other reasons for withdrawal of agreed cashless /credit facilities. 

24 out of 407 Private hospitals empanelled under CGHS decided unilaterally to discontinue credit facility to the eligible categories of CGHS beneficiaries. Show Cause Notices stand issued to these Hospitals and the empanelment of five Hospitals has been suspended for a period of six months or till further orders, whichever is earlier. 

In this regard, the CGHS beneficiaries are advised not to be guided by misleading information as most of the private hospitals are continuing to extend the cashless facilities to the CGHS beneficiaries. The Ministry of Health and Family Welfare will ensure that the CGHS empanelled private hospitals continue to extend cashless /credit facilities to the eligible CGHS beneficiaries in compliance with the terms and conditions as laid down in the Memorandum of Agreement signed by them with CGHS. Ministry of Health and Family Welfare has already taken special steps for clearance of pending hospital bills on a priority basis and the pendency of bills is almost cleared. 

CGHS has already invited bids for revision of package rates through a transparent tender process, where the last date for submission of bids was 16th March, 2014. Steps are underway to conclude the tender process early. 

Read More »

Suspension of empanelment of ‘Saket City Hospital, New Delhi’ from the list of Hospitals/Centres empanelled under CGHS - reg.

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
CGHS Division

No. S 11030/4/2013-CGHS (P)

Dated the 13th September, 2013

OFFICE MEMORANDUM

Sub: Suspension of empanelment of ‘Saket City Hospital, New Delhi’ from the list of Hospitals/Centres empanelled under CGHS - reg.

   The undersigned is directed to state that CGHS has empanelled private hospitals in various CGHS covered cities to provide inpatient healthcare facilities to its beneficiaries. Empanelment of the private hospitals is done under a contractual agreement between the Government of India and the private hospital on mutually agreed terms and conditions.

Read More »

CGHS Facilities

Press Information Bureau
Government of India

   CGHS Facilities

   CGHS is basically providing the dispensary services through its Wellness Centres manned by the General Duty Medical Officers. However, CGHS also provides the services of medical specialists through the Polyclinics and Central Government hospitals. In addition, the CGHS medical specialists also visit designated dispensaries on stipulated days in each week to provide medical consultation to the beneficiaries. Due to shortage of specialists in CGHS it is practically not feasible and financially viable to provide Specialist facilities in each CGHS Wellness Centre. Moreover, CGHS is also engaging contractual specialists against the vacant posts of specialists to provide the medical consultation services to its beneficiaries. CGHS has a dedicated wing of specialists at the Safdarjung Hospital, New Delhi for its beneficiaries. The CGHS beneficiaries are also allowed to consult specialists at Dr. RML Hospital and other Government hospitals in NCR in respective specialties. In addition, CGHS has empanelled a large number of private hospitals to provide inpatient medical care to its beneficiaries on the advice of Government specialists.

Read More »

Criteria for Setting up of CGHS Dispensary

Press Information Bureau
Government of India

Criteria for Setting up of CGHS Dispensary

   The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area are as under:
 
   (i) In an existing CGHS city: For opening of a new Allopathic CGHS dispensary in an existing CGHS city, there has to be a minimum of 2,000 Card holders (serving employees of Central Government and Central Civil pensioners).
 
   (ii) Extension of CGHS to a new City: For extension of CGHS to a new city there has to be a minimum of 6,000 Card holders.

Read More »

Administrative Functioning of CGHS Unani

        Central Government Health Scheme provides the healthcare facilities to its beneficiaries predominantly in the Allopathic system of medicine as per their demand. AYUSH system of medicine is a very small component under CGHS. The Unani system is an even smaller component of AYUSH. There are 10 small units of Unani system consisting of one or two Unani doctors and pharmacists attached to main CGHS Wellness Centres in Delhi, Kolkata, Lucknow, Hyderabad and Bangalore.

Read More »

INDEMNITY BOND FOR SETTLEMENT OF DUPLICATE HOSPITAL BILLS

   We, hereby give an undertaking that the original bills of hospital / diagnostic lab / imaging centre, the ID Nos. of which are appended are said to have been destroyed in a fire accident that took place on 11.08.2013 at UTI-ITSL New Delhi office and that we are now submitting the print outs of scanned copies of the above referred original documents/bills for consideration of payment.

   We also hereby give an undertaking that no claim shall be made against original documents / bills, of which printouts of the scanned copies are submitted herewith and we agree to indemnify against any loss that may be caused to CGHS due to final settlement of these claims on the basis of printouts of scanned documents/bills and this indemnity bond. We further give an undertaking that if original bill(s) is /are found, no claim shall be made against the same and that in the event of any inadvertent payment received against original bills in future, we agree to indemnify against any loss that may have been caused to CGHS due to final settlement of these claims.

Read More »

REIMBURSEMENT OF MED CLAIM FOR EMERGENCY TREATMENT IN NON EMPANELLED HOSPITAL.

Central Organisation ECHS
Adjutant General’s Branch
Integrated Headquarters
Maude Line
Delhi Cantt - 110 010

B/49773/AG/ECHS/Rates policy

15th oct 2013

Reginal Centre ECHS
MUMBAI

REIMBURSEMENT OF MED CLAIM FOR EMERGENCY TREATMENT IN NON EMPANELLED HOSPITAL

   1. A Clarification was sought from the Chief Medical Officer (SAG), CGHS Mumbai on the rates at which the claims are settled of CGHS beneficiaries. The CGHS authorities have clarified vide their letter No 3(xiv)3/13 Genl/1958/13 dt 30 Aug 13 that reimbursement at 25% higher rate that the 2002 CGHS rates is applicable to those who have taken treatment in private non empanelled hospital through CGHS in Mumbai.

Read More »

Private Hospitals threaten to stop CGHS treatment

   Cashless treatment may be stopped for central government employees
 
   Corporate hospitals across the country have threatened to stop cashless treatment to lakhs of Central Government employees from January 1. This will impact about 45 lakh employees of the Central Government and public sector agencies who are benefiting from the insurance scheme.

   Protesting against “unviable” rates being given to them under the Central Government Health Scheme (CGHS), the Association of Healthcare Providers (India) (AHPI) has said that it will give three months’ time to the Government to revise the rates.

Read More »

Empanelment of private hospitals (including dental clinics and eve care centres) & Imaging Centre under CGHS Jabalpur.

GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY WELFARE
OFFICE OF THE ADDITIONAL DIRECTOR
CENTRAL GOVT. HEALTH SCHEME
1544/A NAPIER TOWN
JABALPUR

No.6-8/13-Estt/CGHS/JBP/ 2101-13

Dated:-24.07.2013

OFFICE MEMORANDUM

Subject: Empanelment of private hospitals (including dental clinics and eve care centres) & Imaging Centre under CGHS Jabalpur.

   In reference to (I) the Ministry of Health & F.W. O.M. No. S.11011/23/2009-CGHS D.II/ Hospital Cell(Part IX) dated 14.02.2013 vide which the 'Continuous Empanelment Scheme' for private hospitals and diagnostic centres under CGHS was revived and (ii) Dte. General of CGHS Office Order No. S.11045/23/2013/CG HS D-ll(HEC)/CGHS(P)/(Pt.) dated 15.07.2013, vide which powers for empanelment & issuance of notifications have been delegated to all the ADs/JDs in respect of their respective CGHS cities, a list of additional private hospitals (including dental clinics and eye centres) and Imaging Centre has been finalized for a period of one year from the date of issue of this O.M. or till the next new empanelment, whichever is earlier. This list has been finalized after following the due process and terms & conditions as laid down in the O.M. dated 14.02.13 as well as signing of MOA and execution of Performance Bank Guarantee by them signifying acceptance of the terms and conditions of empanelment and rates notified under CGHS in 2010/2011 and subsequent orders.

Read More »

Suspension of empanelment of 'Saket City Hospital, New Delhi' from the list of Hospitals / Centres empanelled under CGHS - reg.

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
CGHS Division

No. S-11030/4/2013-CGHS (P)
Dated the 13th September, 2013

OFFICE MEMORANDUM

Sub: Suspension of empanelment of 'Saket City Hospital, New Delhi' from the list of Hospitals / Centres empanelled under CGHS - reg.

   The undersigned is directed to state that CGHS has empanelled private hospitals in various CGHS covered cities to provide inpatient healthcare facilities to its beneficiaries. Empanelment of the private hospitals is done under a contractual agreement between the Government of India and the private hospital on mutually agreed terms and conditions.

Read More »