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This page was exported from HARMONY eMagazine [ http://harmonysrinivas.com ] Export date: Sat May 6 14:34:48 2017 / +0000 GMT MEDICAL FACILITIES TO CENTRAL GOVT. EMPLOYEES-2016 This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Ch. Srinivasa Rao Founder-Editor, “HARMONY” Formerly COA, CSIR-NGRI Hyderabad A. PRIMARY ASPECTS Applicability The Central Services (Medical Attendance) Rules, 1944 are applicable to all Govt. servants, and their families, civilians paid from the Defence Services Estimates; industrial and work-charged staff who are not covered by Employees State Insurance Scheme and employees of the Ordnance and Ordnance Equipment Factories who are put up beyond a distance of 8 Km. radius from the factory premises through an option. All those Govt. employees who are on deemed deputation of Autonomous/ Statutory Bodies of the Central Govt. and retiring while on such deemed deputation will also be eligible for CGHS facility, provided they are receiving Central Civil Pension and are not availing the medical facility provided by such Bodies after their retirement. The contributions to be made will be decided by the Grade Pay they would have now drawn in the Govt. in the post held by them but for their absorption. The families of a Central Govt. servant are eligible for medical facilities even when the Govt. servants are under voluntary training/embodiment in the Territorial Army/Military service during emergency, proceeding Ex-India on deputation or leave including study leave and deputation-cum-special leave under the various schemes. Govt. Hospitals Central Govt. employees and the members of their families are permitted to avail of medical facilities in any of the Central/State Govt. Hospitals and the Hospitals recognized by the State Govt./CGHS Rules/CS (MA) Rules, 1944, Hospitals fully funded by Central/State Govts. Maternity & Child Welfare Centres with In-patient arrangements, Cantonment Hospitals, Railway Hospitals, Pay Clinics recognized by State Govts., Hospitals maintained by Local Bodies, PSUs, Port Trust, including their Medical Officers are also recognized for treatment of Govt. employees and their families. Govt. employees and members of his family may avail medical facilities from any of the Central/State Govt. Hospitals and the Hospitals recognized by the State Govt./CGHS/CS (MA) Rules, 1944 as well as the Hospitals fully funded by either Central/ State Govt. Authorized Medical Attendant A Medical Officer. appointed by the Department of Health & Family Welfare, Govt. of India or any other Department of the GoI; a Medical Officer whether or not under the employ of the Central Govt. or the Chairman of the Central Govt. Employees' Welfare Co-ordination Committee in relation to the Central Govt. employees at that station is considered to be an Authorized Medical Attendant (AMA) under these rules. The AMA of a Govt. servant is determined with reference to the place at which he alls ill as Officers of appropriate rank may or may not be available at all the places. In case of emergency, a Govt. servant is allowed to take treatment from any other empanelled AMA even if such an AMA is not nominated by his own Department. Honorary Medical Officers outside Hospital precincts and any AMA who is on leave cannot be treated as AMAs. Appointment of private AMA In terms of Supplementary Rule 2 (10), even a private Registered Medical Practitioner (RMP) can be appointed as AMA in respect of a class or classes of Central Govt. employees where adequate number of Doctors in the employ of the Central/State Govt. is not available, or because of remoteness of the area in which the patient lives. Such an AMA is required to follow CS (MA) Rules strictly. Treatment at Consulting Room should be limited to the administration of injections only. An RMP who is owning a Nursing Home should not be appointed as AMA. No private Dentist is permitted to be appointed as AMA. Pathological and other tests for the purpose of diagnosis should be carried out on the advice of the AMA only at the Govt. Hospital. Indian Systems of Medicine The policy of the Govt. was that Allopathic scientific medicine should continue to be the basis for the development of the National Health Services in the country. This policy has recently been modified to admit Indian and Homoeopathic Systems of Medicines (ISM). Simultaneous treatment in more than one system of medicine such as Allopathic, Ayurveda, Homoeopathic, Unani, etc., provided that it is done with the knowledge of the doctor of the other system. The beneficiaries under CS (MA) Rules, 1944 may purchase only licensed Ayurvedic/Unani/Sidha/Homoeopathic medicines/drugs prescribed by their AMAs from the nearest source available. The concerned Department/Ministry/Office should ensure the authenticity of the medical claims submitted. In case of any clarifications, Ministry of AYUSH may be approached by the concerned Office. B. INSTITUTIONAL ASPECTS CGHS subscription Pensioners have an option to get their CGHS Card made by either making CGHS contribution on an annual basis (12 months) or by making contribution for 10 years (120 months) for getting a pensioner CGHS Card with life-time validity. Similarly, pensioners under “National Pension Scheme” (NPS) drawing additional relief on death/disability of Govt. servant in terms of DOPW O.M.No.3841/06/P&)PW(A) dated 5-5-2009 and staying in areas not covered by CGHS/corresponding Health Scheme of other Ministries can get a pensioners' Medical Card by paying appropriate amount in the nearest CGHS/corresponding health scheme of other Ministries covered city to their residence to enable them to obtain indoor treatment. It is clarified that contributions to be made by pensioners/family pensioners would be the amount that they were subscribing at the time of their retirement or at the time of death of the Govt. servant. The rate of subscription is detailed in the pages that follow. Pension beneficiaries who have already obtained CGHS Card with Life-time validity will not be required to pay any additional amount even on revision of pay scales. Entitlement of pensioners/family pensioners who have already deposited their contribution for Life-time CGHS facility will not be changed. In case of pensioner/family pensioner who is entitled to avail CGHS facilities has not so far got CGHS Card made, the rate of contribution in such cases will be w.r.t. the Grade Pay that would have drawn in the post held by him/her at the time of retirement/ death had he/she continued to be in service now but for his retirement/ death. Pensioners/family pensioners who are contributing to the CGHS on an annual basis and wish to continue to avail CGHS benefits will have to contribute at the revised rates up to the time of contribution needed to cover a period of a total of ten years from the time pensioner CGHS Card was issued for the first time to them. The revised rate of contribution for the remaining period would be with reference to the Grade Pay, he/she would have drawn in the post held by him/her at the time of retirement/death and continued to be in service now but for his retirement/death. On revision of rates: (i) Life-time CGHS Card holders need not pay any additional amount; (ii) Original entitlement will not change; (iii) those who are paying on annual basis and wish to continue to avail CGHS benefits will have to contribute at the revised rates up to the time of contribution needed to cover a period of total of 10 years from the time CGHS Card was issued with reference to the Grade Pay that he/she would have drawn in the post held by him/her at the time of retirement/death had he/she continued to be in service. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » CGHS subscription rates S.No. 1. 2. 3. 4. 5. Grade pay Up to Rs.1,650 Rs.1,800, Rs.1,900, Rs.2,000, Rs.2,400 and Rs.2,600 Rs.4,200/Rs.4,600, Rs.4,800, Rs.5,400 and Rs.6,600 Rs.7,600 and above Contribution p.m. Rs. 50/Rs.125/Rs.225/Rs.325/Rs.500/- Life-time CGHS Cards It is compulsory for all the Pensioners to enroll themselves for availing medical facility by making lump sum one-time contribution. Pensioners on having deposited the lump sum one-time subscription equivalent to 10 years for availing medical facility have to be issued a permanent Medical Identity Card. CSIR pensioners who enroll themselves with the Dispensaries at the various Labs./Instts. shall now be eligible for medical treatment and reimbursement as applicable to the Govt. pensioners covered under CGHS Scheme. If Pensioners or their dependent family members are referred to Govt./recognised Hospital for consultation/ Specialist treatment from Out-Patient Department, the medicines so prescribed have to be procured by the Dispensary. The Reimbursable and Non-Reimbursable Diagnostic and Other Procedures have been listed under AnnexureI. Supply of medicines Specialists of the Hospital are normally advised to prescribe formulatary drugs of Medical Store Depot to the beneficiaries of CGHS as far as applicable so that immediate availability of drugs can be ensured. Further, medicines prescribed by the Specialist having identical Pharmaceutical formulations and therapeutic values, if available in the Depot/Dispensary, the same may be issued, except otherwise marked as essential. No reimbursement shall be admissible to the pensioners for OPD treatment at the Govt./Recognised Hospitals and the medicines prescribed by the Specialists of such Hospitals are to be procured and supplied by the Dispensaries. Medical reimbursement with regard to indoor treatment shall be admissible provided the patient is referred for Specialist treatment by the Medical Officer-in-Charge of the Dispensaries. In respect of CSIR pensioners and their families who reside at places where CSIR Lab./Instt. Dispensary facilities are not available shall be eligible for the medical facilities provided by a Govt./recognised Hospital or in lieu of OPD treatment, they are eligible to draw Rs.500/- p.m. Analogue Insulin: The following types of Insulin (analogue) penfil/vial/cartridges are permitted to be issued to the CGHS beneficiaries on valid prescription by a Specialist: (i) Inj. Novomix 30; (ii) Inj. Levemir; (iii) Inj. Novorapid; and (iv) Inj. Lantus vial/Solostar Supply of Inj. Human Insulin (30/70) in cartridge form on valid prescription is provided without recovering any cost from the CGHS beneficiaries, including other brands of Penfil Insulin (analogue). The beneficiaries will bear the cost of the pen from their own sources for utilizing the Injection after obtaining permission from the Addl. Director (MSD) on valid prescription of Specialist on case-to-case basis, as an interim arrangement. Generic drugs In continuation of orders emphasizing the need of prescribing generic drugs, it is reiterated that all Specialists/Doctors working in CGHS are to ensure that generic drugs are prescribed to the maximum extent possible with a view to make medical treatment cost-effective and affordable. Opting out of CGHS If the spouse of a Govt. servant is employed in a private organization which provides medical facilities, the Govt. servant can opt out of CGHS and avail the facilities provided by such an organization Annual medical examination It has been decided that Group A Officers of Central Civil Services/Posts above the age of 40 years will be covered by the Annual Medical Check-up Scheme. The following package rates for the above purpose have been approved: (i) Annual Medical Examination of Men Officers: Rs.2,000/- (ii) Annual Medical Examination of Women Officers: Rs.2,200/A list of empanelled Hospitals for undergoing Annual Medical Examination in the various cities/towns under each State has been provided. The Officers outside Delhi/NCR where CGHS/CS(MA) Rules recognized Hospitals are available would follow. The medical reports may be filed in ACRs of respective staff members while providing a copy to the individuals. C. ELIGIBILITY CRITERIA Income limits for dependency A member of the family is treated as dependant only if his/her income from all sources such as recurring monthly income from houses, land-holdings, etc. is less than Rs.3,500/- plus Dearness Relief thereon per month as discussed hereunder. However, lump sum non-recurring income such as CPF benefits, Govt. of India Prize Bonds, Gratuity, Commuted Gratuity, Insurance benefits, etc. should not be regarded as income for this purpose. Further, the income limit for the purpose of providing CGHS coverage to the family members of the CGHS covered Central Govt. employees to Rs.3,500/- plus amount of Dearness Relief on the basic pension of Rs.3,500/- as on the date of consideration. The amount of DR as indicated in the income limit stands for the amount of DR drawn by a pensioner/family pensioner on the date of consideration and not the amount of DR due on the date of consideration. If wife and husband are Central Govt. servants, they may be allowed to avail the medical concessions along with eligible dependents according to his/her status by furnishing their respective administrative authorities, a joint declaration (in duplicate) as to who will prefer the claim for reimbursement of medical expenses. A copy of each shall be recorded in their personal files in their respective Offices. Such declaration shall remain in force till it is revised by them. The methods of determining dependency of family members on the Govt./CSIR Employees have been given in Annexure-II. Entitlement of Wards duration and charges payable are given in Annexure-III. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Accommodation Allotment of accommodation in a Hospital depends upon the pay, i.e., pay in the Pay Band/Pension/Family Pension, being drawn by the Govt. servant at the time of falling ill by himself or by his family members. If suitable accommodation as per the status of the Govt. servant is not available, accommodation of a higher class may be allotted, provided that it is certified by the Medical Superintendent of the Hospital that accommodation of the appropriate class was not available at the time of admission and that the admission of the patient into the Hospital could not be delayed. However, before seeking higher class of accommodation, efforts should be put in to seek admission in any other similar Hospital, if available, at the same station. Fixed Medical Allowance At present, Fixed Medical Allowance (FMA) at a revised rate of Rs.500/- is granted w.e.f. 19-11-2014 to the Central Govt. pensioners/family pensioners residing in areas not covered under CGHS administered by the MOH&FW and corresponding Health Schemes administered by other Ministries/Departments for their retired employees for meeting expenditure on their day-to-day medical expenses that do not require Hospitalization. With regard to the date of eligibility for grant of FMA to Family Pensioners, it is clarified that in cases where the existing pensioner/family pensioner was in receipt of FMA, the family pensioner next-in-line may be allowed FMA from the same date from which he/she becomes eligible for family pension, if he/she otherwise fulfills the conditions for grant of FMA. FMA under NPS: Pensioners under “National Pension Scheme” (NPS) drawing additional relief on death/disability of Govt. servant in terms of DOPW O.M. No.3841/ 06/P&)PW(A) dated 5-5-2009 and staying in areas not covered by CGHS/corresponding Health Scheme of other Ministries can get a pensioners' Medical Card by paying appropriate amount in the nearest CGHS/corresponding health scheme of other Ministries covered city to their residence to enable them to obtain indoor treatment. They are also entitled to draw FMA as fixed by the Govt. As and when the Health Insurance Scheme is introduced, the NPS Pensioners would be shifted to such Scheme. D. TREATMENT PROCEDURES Medical attendance Medical attendance is distinct from medical treatment. Medical attendance does not require repeated consultations/prescriptions. It includes attendance at the Hospital/Dispensary or at the residence of the Govt. servant or at the consulting room of the AMA whether maintained at the Hospital or at the residence of AMA. Reimbursement of consultation fees at the prescribed rates should be restricted to the first four consultations/visits at the rate of one consultation in a calendar day which should be completed within a period of 10 days from the date of commencement of treatment. A Govt. servant shall be entitled to medical attendance by the AMA free of charge. Any amount paid on account of such medical attendance shall be reimbursed to him on production of a Certificate in writing by the AMA. Status of a Govt. servant will be determined on the basis of the actual pay being drawn at the time of falling ill. In the case of re-employed pensioners, the pension should be taken into consideration along with pay for the purpose of determining the grade. Cost of admissible medicines prescribed during these consultations is reimbursable on production of original prescriptions/cash memos. There should be a reasonable gap between the closing of the first spell of illness from the disease and recurrence of the same disease for a second time to justify a fresh claim. Prolonged treatment should be received only at the OPDs of a Govt./recognized Hospital. The Controlling Officer may reject any claim, if he is not satisfied with its genuineness. He may communicate the reasons for rejection and afford an opportunity to the claimant of being heard within 45 days of the date of receipt of the order. Delegation of Powers It has been decided to further decentralize the powers for settlement of medical claims to individual Ministries/Departments/Lok Sabha and Rajya Sabha Secretariat and to the Secretary-General of Supreme Court (as the case may be) as under: A. Permission/Ex post facto approval for elective treatment/investigation taken in non-empanelled Hospitals/Diagnostic Centres subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less: a) Pensioners/Ex-MPs/Freedom Fighters, etc. - Request to be considered by AS & DG (CGHS) in terms of MOH&FW O.M. No.S.11016/16/2010-CGHS(P) dated 24-1-2011 b) Serving beneficiaries/sitting MPs/Judges of Supreme Court - Request to be considered by HOD or HOO of individual Ministries/ Departments/LS & RS Secretariat/Secretary-General of Supreme Court. B. Ex-post facto approval of elective treatment/investigation in empanelled Hospitals/Diagnostic Centres without recommendation of Govt.Specialist or CMO-in-Charge, subject to reimbursement being restricted to CGHS rate or actual expenditure, whichever less: a) Pensioners/Ex-MPs/Freedom Fighters, etc. - Request to be considered by A&DG (CGHS) as before in terms of O.M. No.S.11016/16/2010-CGHS(P) dated 24-1-2011 b) Serving beneficiaries/sitting MPs/Judges of Supreme Court - Request to be considered by HOD or HOO of individual Ministries/ Department/LS & RS Secretariat/Secretary-General of Supreme Court C. Ex post facto approval of elective treatment at empanelled Hospitals with recommendation of Govt. Specialist/CMO-in-Charge but without obtaining the permission of competent authority, subject to reimbursement being restricted to CGHS rates or actual expenditure, whichever is less. Instructions issued vide MOH&FW O.M. No.S.12020/4/97-CGHS(P) dated 7-4-1999 will be applicable. D. Permission/Ex post facto approval for Cancer treatment taken in non-empanelled Hospital, subject to reimbursement being restricted to CGHS rates or actual expenditure, whichever is less: a) Pensioners/Ex-MPs/Freedom Fighters, etc. - Additional Director of concerned Zones b) Serving beneficiaries/sitting MPs/Judges of Supreme Court - HOD or HOO of individual Ministries or Departments/LS&RS Secretariat/ Secretary-General of Supreme Court. E. Condonation of delay in submission of medical claims by pensioners, etc.: a) Less than one year … AD of concerned city/AD(HQs), Delhi b) Between one and two years … Director, CGHS c) More than two years … AS & DG (CGHS) This is w.e.f. date of discharge/completion of treatment. F. Permission for treatment/investigations at non-empanelled Hospital/Diagnostic Lab. When facility for the same are not available in any empanelled Hospital/Lab. Or any Govt. Hospital: Permission to be granted by AS&DG (CGHS) in consultation with Experts, if required. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Package rate In compliance of the directions of Hon'ble High Court of Delhi in the case of Shri Kanhiya Singh Vs. UOI and others [WP(C) 9044/2011 clarifying admissibility/ inadmissibility of items of expenditure for claiming reimbursement under CGHS, the requisite clarifications regarding admissible and non-admissible items under CGHS are provided hereunder: a) “CGHS Package Rate” shall mean and include lump sum cost of inpatient treatment/day care/Diagnostic procedure 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 patient's 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, (xii) Anesthesia charges, (xiv) Cost of surgical disposables and all sundries used during hospitalization, (xv) Cost of medicines, (xvi) Related routine and essential investigations, (xvii) Physiotherapy charges, (xviii) Nursing care and charges for its services, etc. In addition to the above mentioned items, some patients may require additional facilities/procedures which are admissible with proper justification in deserving cases. Therefore, it is not possible to give a comprehensive list of items, which are not admissible. However, Telephone charges, Toiletries, Sanitary napkins, Talcum powder, Mouth fresheners, etc. are not admissible. b) Cost of Implants/Stents/Grafts is reimbursable in addition to package rates as per CGHS ceiling rates for Implants/Stents/Grafts or as per actual, whichever is lower in case there is no ceiling rate prescribed under CGHS. c) 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/ equipment 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. d) In cases of conservative treatment/where there is no CGHS package rate, the above mentioned items are admissible -- itemwise 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) available for any item. e) Package rates envisage up to a maximum duration of indoor treatment as follows: Specialized/Super Specialties) treatment … 12 Days Other Major Surgeries … … 7 Days Laparoscopic surgeries/normal deliveries; and … 3 Days Day-care/Minor (OPD) surgeries … … 1 Day However, if the beneficiary has to stay in the Hospital for his/her recovery for a period more than the period covered in package rate, in exceptional cases, supported by relevant medical records and certified as such by Hospital, the additional reimbursement shall be limited to accommodation charges as per entitlement, investigation charges at approved rates, and doctors' visit charges (not more than 2 visits per day per visit by Specialists/Consultants) and cost of medicines during 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. In the absence of prescribed rates The claims for reimbursement of charges of treatment/examination, etc. for which no corresponding rates are not available in the nearest Govt. Hospitals for regulating such claims may be reimbursed by (a) restricting such claims to the rate of Govt. Hospitals in the concerned State, and (b) where such rates/facilities are not available in the concerned State, full reimbursement of such charges may be made on the certification of the Director of Health Services of the concerned State. Permission for procedures The recommendation of a specific treatment/investigation procedure by Govt./ CGHS/CMO-in-Charge is in itself adequate for issuing permission and an endorsement “referred to CGHS recognized/approved Centre” is neither necessary nor to be insisted upon for grant of permission. Tests/investigations at empanelled Diagnostic Labs. In case of CS (MA) Beneficiaries availing tests/investigations at private Hospitals/ Diagnostic Labs./imaging Centres empanelled, and after obtaining permission from their respective Departments/Ministries, the medical prescription issued by an AMA (Govt. Specialist) prescribing Diagnostic tests/investigations shall be treated as valid for a single use within a period of two weeks from the date of prescription. However, the medical prescription shall remain valid beyond two weeks for undertaking Diagnostic tests/ investigations, if specifically prescribed by the AMA/Govt. Specialist, about the date or period by which the prescribed tests are to be conducted for a routine check up or follow up treatment. The medical prescription would require revalidation or issue of a fresh prescription from the prescribing AMA/Govt. Secialist for getting the prescribed tests done after expiry of the validity period of two weeks or as prescribed by the AMA/Govt. Specialist, as the case may be. Relaxation of procedures It has been decided to do away with the procedure for verification of bills and issue of Essentiality Certificate by the treating doctor, and the Medical Superintendent of the Hospital. Authorities concerned may verify and check the authenticity of the claims on the basis of the prescription slip and Diagnostic report submitted by the Govt. servant/pensioner. In the event of any doubt, they can always refer for verification. All cases involving requests for relaxation of rules for reimbursement of full expenditure will henceforth be referred to a Technical Standing Committee (TSC) to be chaired by the DGHS/Addl. DGHS and consist of Director (CGHS) and subject matter Specialists. If the TSC recommends the relaxation of rules for permitting full reimbursement of expenditure incurred by the beneficiary, it may be allowed by the Secretary (H&FW) in consultation with Internal Finance Division. A check list for consideration of requests for reimbursements in excess of approved rates may include: a) the treatment was obtained in a private non-empanelled Hospital under emergency and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was Hospitalized for a prolonged period; b) the treatment was obtained in a private non-empanelled Hospital under emergency and was admitted for prolonged period for treatment of Head injury, coma, septicemia, multi-organ failure, etc. c) the treatment was obtained in a private non-empanelled Hospital under emergency for treatment of advanced malignancy; (i) when there is a strike in Govt. Hospitals (or) (ii) while the individual was on Official tour to Non-CGHS covered area. d) the treatment was taken under emergency in higher type of accommodation as rooms as per his/her entitlement are not available during that period; e) the treatment was taken in a higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections. f) approval for airfare with or without an Attendant on the advice of treating doctor for treatment in another city even though he is not eligible for air travel/ treatment facilities are available in city of residence; and g) any other special circumstances. Empowerment of HODs Powers have been delegated to the Heads of Departments of Ministries/ Departments to accord post facto approval/permission in cases where an employee or his dependent family members go to an empanelled Institution after due prescription by a Govt. Specialist but without obtaining prior permission from Ministry/ Department, subject to the Head of Department being satisfied with the genuineness of the reason which made the beneficiary go directly to an empanelled Institution even before obtaining the approval. The reimbursement to be made in such cases will be the financial ceiling and the procedure to be followed. Cancer treatment: Powers are also hereby delegated to the above authorities for grant of permission to Cancer patients for post-operative follow up treatment from the same Centre where permission has been granted earlier for treatment. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Consultation with Specialist If the AMA is of the opinion that the case of a patient is of such a serious or special nature as to require medical attendance by some person other than himself, he may refer the patient to a Specialist or Officer or if the patient is too ill to travel, summon such Specialist/Medical Officer to attend upon the patient. In case of emergency In case of emergency, the recognized private Hospital cannot refuse admission or even demand advance from the beneficiary. They shall provide credit facilities to the concerned patient on production of valid CGHS Card. Reimbursement in respect of serving CGHS beneficiaries will be made by the respective Departments. On the advice of Specialist of CGHS/Govt. Hospital/CMO-in-Charge of CGHS Dispensary, the beneficiary is free to avail specialized treatment/Diagnostic tests at any CGHS recognised Hospitals/Centres as per prescribed rates. For non-emergency cases, CGHS beneficiaries are entitled to medical reimbursement for treatment in recognised Hospitals, subject to written permission from the competent authority. On production of permission, the recognized Hospitals/ Diagnostic Centres shall provide credit facilities to CGHS beneficiaries including pensioners, family pensioners and their dependents. CSIR Pensioners who are holding permanent/valid Medical Identity Card or CGHS Card with a photograph of self with dependent family members can avail OPD treatment in any of the CSIR Lab./Instt. Dispensaries, subject to the condition that any expenditure incurred on Inpatient treatment during such visit by that Lab./Instt. will be recouped by the concerned Lab./Instt./CSIR HQs., as the case may be, where the Pensioner is registered for medical facility. Expenses incurred in Emergency Reimbursement of medical expenses incurred in emergency would be allowed as per the prevailing nonNABH CGHS rates as applicable to a CGHS covered city; and non-NABH rates applicable to the nearest CGHS covered city in case of Non-CGHS city, as the case may be, or the actuals, whichever is less. When package rates are prescribed under CGHS, the non-NABH rates of the CGHS covered city and nonNABH rates of the nearest CGHS city (in case of Non-CGHS covered city) or the actuals, whichever is less, will be applicable. Special diseases A Central Govt. servant or a member of his family may receive treatment for special diseases such as Cancer, Diabetes, Mental diseases, Poliomyelitis, Cerebral Palsy and Spastics, Tubercular diseases. Leprosy, Thalassemia Major, at a Hospital where specialized treatment for a particular disease is available on the recommendation of Medical Superintendent of the recognized Hospital to whom the patient is referred for treatment. In cases where a patient who has undergone treatment in a recognized Hospital for a particular disease is advised by the Medical Superintendent of the Hospital to continue certain treatment or check-ups after discharge from the Hospital, such patient may be allowed to consult and receive medical treatment directly from a Govt./ recognized Hospital without consulting the AMA. Super-imposition of another disease Where a patient consults the same Doctor in regard to another disease during the course of treatment of one disease, such consultation should be regarded as “fresh consultation” and paid at full rate. If one or more minor treatment procedure form part of a major treatment procedure, package charges would be made against the major procedures. Only half of actual charges quoted for the minor procedures would be added to the package charges of the first major procedure. Liver-related issues The CGHS/CS (MA) beneficiaries will have to submit their request for permission for Liver Transplantation to the Standing Committee through their respective Departments in case of serving employees and the Addl. Director, CGHS of the concerned city in case of pensioner. As Liver Transplant Surgery is a planned surgery, prior permission has to be obtained before the surgery is undertaken. However, if for some reason it is done in emergency to save the life of the patient, the Standing Committee shall consider the cases referred to it for recommending grant of ex post facto permission on case to case basis. Ceiling rate: Effective from 16-1-2013, an amount of Rs.11,50 lakhs plus pre-transplant evaluation of donor and recipient Rs.2,50,000/- is payable. The package rate for Liver Transplant Surgery involving a deceased donor shall be Rs.11,00 lakhs which includes, the cost of consumables during the organ retrieval and the cost of preservative solution, etc. The package charges include: 30 days stay of the recipient and 15 days for the donor starting one day prior to the transplant surgery. Charges for Medical and Surgical consumables, surgical and procedure charges, operation theatre charges, Anaesthesia charges, pharmacy, investigations and in-house doctor consultation for both donor and recipient during the above period which includes all post-operative investigations and procedures during the above mentioned period; and exclude: Charges for drugs like Basiliximab/Daclizumab, HBIG and peg Interferon Cross Matching charges for blood and blood products. The extra stay, if any, may be reimbursed after justification by the treating Specialists as per CGHS Guidelines only The drugs mentioned above would be reimbursed as per CGHS rates or actual whichever is lower. Cancer-related issues As the list “CGHS, Delhi” did not have any empanelled Hospitals for treatment of Cancer patients, as an ad hoc measure, it has been decided to permit treatment at any of the 25 Regional Cancer Centres recognized by the MOH&FW under National Cancer Control Programmes, subject to the condition that the reimbursement will be as per the rates fixed in such Centres or actuals, whichever is less. Coronary diseases The rates of Coronary Bypass Surgery in respect of all recognized private Hospitals have been regulated on package deal basis. No limit has been prescribed on number of bypass surgeries. Package rate means a lump sum cost of In-patient treatment or Diagnostic procedure which includes all charges, admission, accommodation, ICU/ICCU, monitoring, operation theatre, anesthesia, cost of disposables, surgical charges, surgeon's fee, related routine investigations, physiotherapy charges and medicines used during Hospitalization, etc. Package rate for CABG and Coronary Angiography includes room rent from the date of admission to the date of discharge, service charges, nursing/medical care, surgeon's and anesthetist's fee, operation theatre charge, etc. The Hospital/Centre cannot charge more than the package rate from the beneficiary. Package rate does not include diet, cosmetics, TV charges, telephone charges, toiletry, tonics and medicines advertised in mass media, etc. Expenses over and above the prescribed rates, if any, have to be borne by the beneficiaries. If the beneficiary is required to stay in the Hospital for recovery for more than the above period, the additional reimbursement shall be limited to room rent as per entitlement, cost of the prescribed medicines and investigations, doctors' visits (2 times a day) during additional stay. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » IVF treatment The following Guidelines are laid down for considering cases for reimbursement of expenses incurred on In Vitro Fertilization (IVF) treatment by CGHS beneficiaries and beneficiaries under CS (MA) Rules, 1944, w.e.f. 22-11-2013: i) Requests for IVF treatment will be considered only on the basis of advice tendered by the HOD of Gynaecology & Obstetrics (HOD of G&O) of a Govt. Medical Institution (GMI); ii) Permission for IVF treatment to be undertaken may be given by the HOD in the Ministries/Departments on the recommendations of the HOD of G&O of a GMI; iii) IVF procedure will be allowed in a GMI on the recommendations of the HOD G&O of a GMI; iv) IVF procedure may be allowed, on case to case basis, in a private medical institution registered with the State/Central Govt. and has the necessary facilities including equipment and trained manpower for carrying out the procedure. It is mandatory to obtain the recommendations of the HOD G&O of a GMI for permitting the procedure to be undertaken in a private institution; v) There should be clear evidence of failure of conventional treatment before permitting IVF treatment procedure; vi) The age of women undergoing IVF treatment procedure should be between 21 and 39 years; vii) The woman has to be married and living with her husband viii) The IVF treatment procedure will be allowed only in cases of infertility where the couple has no living issue; ix) Reimbursement of expenditure incurred on IVF procedure will be allowed up to a maximum of 3 fresh cycles; x) An amount not exceeding Rs.65,000/- only per cycle or the actual cost whichever is lower will be allowed for reimbursement. This amount will be inclusive of the cost of drugs, disposables and monitoring cost during IVF procedures; xi) As IVF treatment is planned procedure, reimbursement cases can be considered only if prior approval was obtained by the beneficiary; xii) There will be a one-time permission for availing IVF treatment consisting of three cycles. The concerned Department shall obtain an Undertaking from the applicant that he/she has not claimed the reimbursement from the GOI in the past and will not claim in the future. Hearing-Aids The revised ceiling rates fixed for various types of Hearing-Aids (for one ear) are as given hereunder: Body-worn/Pocket type … Rs. 3000/Analogue BTE Digital … Rs. 7000/BTE Digital … Rs. 15000/ITC/CIC … Rs. 20000/Dental treatment Dental treatment is not covered under these rules. However, if the diagnosis of the physiological or other disability from which a Govt. servant is suffering indicates that teeth are the actual source of problem, dental treatment of a major kind such as treatment of jaw bone disease, removal of all the teeth, removal of odontomes and impacted wisdom tooth, gum boils, etc. is reimbursable. Expenses incurred by Central Govt. employees in connection with the following types of dental treatment, if obtained at Govt. recognized Hospitals are reimbursable: (a) extraction (b) scaling and gum treatment (including Pyorrhea and Gingivitis) (c) filling of teeth (d) root canal treatment. Reimbursement of expenditure for complete Denture with a ceiling of Rs.2000/- (Denture of one Jaw would be Rs.1000/-) is admissible on one-time basis. It was decided that the existing facilities for reimbursement of expenditure incurred on dental treatment in Govt. Hospitals by Central Govt. employees and their families be extended to similar treatment availed of in private recognized Hospitals on the advice of AMA, if such treatment is not available in the nearest Govt. Hospital. In-patient treatment in Non-CGHS areas It has been decided to liberalize the CGHS Rules with regard to pensioner CGHS beneficiaries and serving employees as below to enable them to avail medical facilities for In-patient treatment and post-operative follow up: (a)(i) CGHS pensioner beneficiaries and their dependent and eligible family members who are holding a valid CGHS Card and are residing in a Non-CGHS areas shall be eligible to obtain treatment from Govt. Hospitals (Central/State Govt./Local Self-Govt./Hospitals recognized under CS (MA) Rules, 1944/Hospitals and Clinics empanelled under Ex-Servicemen Contributory Health Scheme (ECHS) and submit the medical reimbursement claim to the Addl. Director/Jt. Director of CGHS of the CMO in charge of CGHS Wellness Centre where the CGHS Card is registered. (ii) In case of non-emergency treatment from Hospitals approved under CS (MA) Rules, 1944 and ECHS, it is necessary to obtain prior approval from CMO in charge of the concerned Wellness Centre where the CGHS Card is registered. (iii) In case of medical emergency, treatment may be obtained from any Hospital and medical claim shall be submitted to Addl. Director/Jt. Director, CGHS of the concerned city through CMO-in-Charge of the Wellness Centre, where the CGHS Card is registered. (iv) Reimbursement shall be limited to the CGHS rates of the city where the Card is registered and as per the ceiling rates and ward entitlements or as per actuals, whichever is lower. (v) CGHS pensioner beneficiaries and others, on a visit to Non-CGHS covered area and obtain treatment under emergency from the above recognized Hospitals under ECHS and the medical claim shall be submitted to Addl./Director/Jt. Secretary, CGHS of the concerned city through CMO-in-charge of the Wellness Centre where the Card is registered and to the concerned Ministry/ Department/Office in case of serving employees. (vi) Reimbursement shall be limited to the CGHS rates of the city nearest to the place, where treatment is obtained and as per the ceiling rates and ward entitlements or as per actuals, whichever may be less. (b)(i) Similarly they shall be eligible for follow up cases of renal transplant surgery, knee and hip-joint replacement, Cancer treatment, neurosurgery and Cardiac surgery. However, prior permission is to be obtained from the CMO-in-Charge of the concerned Wellness Centre, where the CGHS Card is registered. (ii) Permission shall be issued for 3 to 6 months at a time and may be extended based on medical requirement. Reimbursement for consultation, procedures and investigations shall be limited to CGHS rates of the city where the Card is registered and as per the ceiling rates and ward entitlements or as per actual whichever is lower. OPD medicines shall be obtained from the concerned Wellness Centre for a maximum period of 3 months at a time. (c) Wherever treatment is obtained from a Hospital approved under CS (MA) Rules/ ECHS, the beneficiaries (as in (a) & (b) above) shall submit a Certificate from the Hospital that they have not charged more than the approved applicable Hospitals approved under CS (MA) Rules/ECHS rates. (d) This arrangement is provisional and would be in place till such time the proposed Health Insurance Scheme for Central Govt. employees and pensioners is brought into effect. (e) This O.M. supersedes the earlier O.M. dated 30-9-1999. In-patient treatment A Govt. servant can receive treatment in a Hospital where he is ordinarily entitled to receive treatment under the rules as an In-patient for himself and members of his family without consulting his AMA. While claiming reimbursement, a Certificate should be produced from the Medical Superintendent of the Hospital that the facilities provided were the minimum and were essential for the patient's treatment. If a Central Govt. servant or family member suffering from an infectious disease receive In-patient treatment in a Govt. Infectious Diseases Hospital situated at a place where the Govt. servant is entitled to receive medical attendance and treatment. Cases of medical treatment requiring Hospitalization will normally be referred to a Govt./recognized Hospital by the AMA for admission. If Hospitalization is not considered necessary but treatment is expected to be prolonged, a patient should be referred to the OPD of a Govt./recognized Hospital and the charges levied, if any, are reimbursable. Prolonged treatment is defined as “a case of single and continuous spell of illness which requires either more than 4 consultations/visits within a period of 10 days from the date of commencement of treatment or more than a course of 15 injections.” The average stay in a Hospital as an In-patient should be reckoned as two weeks. Any Hospital stay beyond three weeks is treated as prolonged stay. Even in emergency, Hospitalization in Nursing Home/Clinic of AMA is not admissible. However, treatment at the Consulting room of AMA is permissible. A Govt. servant and his/her family members are entitled to treatment in such Govt. Hospital at or near the place where the patient fell ill. If there is no such Hospital other than Govt. Hospital at or near the place which provides treatment free of charge. Permission can be granted to such employees to obtain medical services from any of the private Hospitals recognized under CGHS. Heads of Department are empowered to use their discretion in reimbursement of medical claims in relaxation of rules in respect of treatment taken in private Hospitals/medical institutions without any distinction between private Clinics/Nursing Homes. Reimbursement can be allowed up to the extent admissible without any overall ceiling; but this is subject only to individual itemwise prescribed ceiling. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Treatment at residence If the AMA is of the opinion that owing to the absence or remoteness of a suitable Hospital or to the severity of the illness, a Govt. servant may receive treatment at his residence. He shall be entitled to receive the cost of treatment as per rules. Claims for reimbursement have to be preferred within three months. Heads of Departments are delegated with powers to condone the delay, if any, in submission of claims. Condonation of delay Henceforth, only the cases in which the bills are submitted after 6 months from the date of completion of medical treatment/discharge of the patient from the Hospital are required to be taken up for condonation. The power of condonation of such delays and other terms and conditions would be same as enumerated in the O.M. No.S.l4025/8/99/-MS dated 25-5-1999. Engagement of Ambulance The doctor treating the patient certifies in writing that conveyance of patient by any other mode would definitely endanger the patient's life or would grossly aggravate his/her condition; and that the journey is undertaken within the same city. Ambulance service can be availed. Constant Attendant Allowance Payment of Constant Attendant Allowance shall be governed by the following provisions: i) Constant Attendant Allowance (CAA) will be applicable to cases where the disability for which CAA is payable is attributable to or aggravated by service. ii) CAA may be granted to a Govt. servant who is awarded a Disability Pension for 100% disablement, and if in the opinion of the Medical Board, the services of a Constant Attendant for at least a period of three months is needed, and the necessity arises solely from the condition of the accepted disability or disabilities. iii) CAA shall not be payable for any period during which the Pensioner is an inmate or an In-patient of a Govt. Institution or Hospital iv) Payment of CAA shall be made along with Disability Pension on the basis of ddeclaration in a prescribed pro forma which shall be submitted to Pension Disbursing Authority during the months of May and November each year. Special nursing Special Nursing as certified to be essential for the recovery or for the prevention of serious deterioration in the condition of the patient by the Medical Officer concerned and the Medical Superintendent of the Hospital in prescribed pro forma, limited to the amount which is in excess of 25% of the pay of the Govt. servant concerned is reimbursable. Special Nurse/Ayah/Attendant charges Reimbursement for Attendant charges are admissible only in cases where it is certified by the Hospital authorities that it forms part of treatment and that the Attendant was not engaged in lieu of "Special Nursing". The daily rate payable per shift of 12 hours are: Special Nurse: Rs.150/- and Ayah/Attendant: Rs. 75/-. The Head of Office has been delegated with the power to reimburse Ayah/ Attendant charges of up to the ceiling limit of Rs.2000/- for the period of stay as Indoor patient in the Hospitals recognized under the State Govt./CGHS Rules/CS (MA) Rules, 1944 on submission of a Certificate from the Medical Superintendent of the Hospital. Domiciliary Rehabilitation Medicine Domiciliary (home-based) care is medically justified in the practice of rehabilitation medicine which involves the care of the patient with chronic diseases or temporary or permanent disability or functional limitation due to lack of health. It is justified as such persons find ambulation practically impossible or are significantly dependent on care-giver or the cost of visiting the Hospitals become higher than the cost of treatment given. The following allied health services need to be considered for domiciliary care: (i) Physiotherapy; (ii) Occupational Therapy; and (iii) Speech Therapy (for patients of stroke/head injury). The decision for the above care should be based on thorough evaluation and specific prescription including the exact intervention and frequency by a Physical, Medicine and Rehabilitation (PMR Specialist). In case of nonavailability, the treating Govt. Specialist having allopathic Post-graduate qualification in Ortho/Neurology/ Neurosurgery/ENT may allow such benefits following the specific prescription criteria for the following conditions: Orthopaedic disorders: Post-joint replacement surgery in acute phase; Physiotherapy up to two weeks, postdischarge. Neurological disorders (for up to six weeks): Post-stroke: Occupational Therapy (OT), Physiotherapy (PT) and Speech Therapy (ST); Traumatic brain injury: OT and PT Gullian-Barre Syndrome: OT and PT; Spinal cord injury with significant disability/deformity: OT and PT; Motor neuron disease: OT, PT and ST. Locomotor disabilities, with a disability of over 80% or those who are totally dependent on care-giver based on the opinion of two Govt. Specialists by certified care-giver. Care-giver means Rehabilitation Council of India certified personnel + Physiotherapist and Occupational therapist (duly qualified diploma/degree holder. The prescription for home-based rehabilitation programme should include the following descriptive specifies: The therapy to be used -Electrotherapy; Active Exercise Therapy; ADL Training; Speech Therapy; Gait Training, and Passive Exercises The technical person required to institute the therapy; The frequency of the therapy required by the patient; and Duration of the therapy programme. The following rates may be reimbursed: Physiotherapist .. Max. of Rs.300/Occupational Therapist .. Max. of Rs.300/Speech Therapist .. Max. of Rs.300/Certified Care-Giver .. Max. of Rs.150/- or Rs.3,000/- per month for long term requirement, whichever is less No reimbursement to be allowed for the purchase/hiring of therapy equipment/ devices. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Treatment outside the District/State Central Govt. servants and members of their families may receive treatment for all diseases (other than TB, Cancer, Polio and Mental diseases) for which treatment is provided in a Govt./recognized Hospital. Even if necessary facilities for treatment are available in a Govt./recognized Hospital where the person fell ill, treatment outside the District/State can be availed. The choice of the recognized Hospital where the Govt. servant would like to avail of the treatment is left to the beneficiary himself, subject to the condition that no travel expenses are reimbursable. The restrictions with regard to availability in a Govt./recognized Hospital in the respective District/State and also endorsement of CMO of the State have been removed. Treatment at AIIMS The CGHS beneficiaries possessing a valid Card can avail medical treatment facilities in the All India Institute of Medical Sciences, Delhi without any prior permission. Drugs prescribed, if any, during the treatment at OPD should be obtained from concerned CGHS Dispensary on the basis of prescription. The reimbursement will be as per the entitlement and the prescribed rates of AIIMS. Accommodation charges in AIIMS Pay in the Pay Band/Pension/ S.No. 1. 2. 3. Ward entitlement Family Pension p.m. Up to Rs.19,530/From Rs.19,540/- to Rs.25,110/Rs.25,120/- and above General Ward Private Ward Private Ward/Deluxe Ward Treatment abroad A Govt. servant desirous of availing of medical treatment outside India for himself or for a member of his family for treatment as specified in the rules may make an application in prescribed form through the Department/Ministry to which the Govt. servant is attached. The Standing Committee may recommend one Attendant to accompany the Govt. servant or a member of his family and the expenditure shall be reimbursable. The scale of expenditure and the eligibility for treatment shall be identical to the scale of expenditure and the eligibility of an Official of the Indian Foreign Service of the corresponding grade in the Ministry of External Affairs under any Assisted Medical Attendance Scheme. A Govt. servant shall be eligible to claim reimbursement of the cost of any medical treatment obtained inside or outside India as follows: Complex/high risk Cardio Vascular Surgery cases for treatment at Centres with Extensive experience Bone-marrow transplantation Complex Medical and Oncological disorders such as Leukemia and Neo-plastic conditions Complex high risk cases in Micro-vascular and Neurosurgery for treatment at Centres with extensive Experience Treatment of extremely complex ailments other than those mentioned above which in the opinion of Standing Committee can only be treated abroad on falling in the high risk category Appliances High-end prosthetics/appliances will be reimbursed only to the following category of Govt. servants and their dependent family members, subject to fulfilling of other criteria: a) Participating at the State level sport activities duly certified by the competent Sports Authority. b) Upper age limit for the sophisticated prosthetic appliances will be 45 years c) Military or para-military personnel duly certified by their respective Medical Boards that the person has sustained injury while on field duty or undergone amputation because of injury sustained while performing such duty. d) Reimbursement will be made within the ceiling limit fixed for such appliances beyond which the beneficiary will bear the cost. Reimbursement of the cost of various appliances including the cost of Heart Pace- Maker and replacement of the pulse generator, cost of replacement of diseased heart valves, artificial electronic larynx, Hearing-Aid is admissible. In such cases, the administrative authority shall make payment direct to the supplying agency. The Cost-ceiling for Coronary Stents and other Appliances has been given in Annexure-IV Approval for implants Vide CGHS O.M.No.12011/2005/CGHS(R&H)/CGHS(P) dated 4-12-2008 by which the guidelines for permission/approval for reimbursement of cost of Neuro-implants, viz., Deep Brain Stimulation implants, Intra-thecal Bacfofen Pump, Intra-thecal Morphine Pump and Spinal Cord Stimulators for CGHS/CS (MA) beneficieries were notified and to convey the approval of the competent authority to allow reimbursement of cost of the above implants as per the ceiling rates were made valid till 8-12-2016. E. REIMBURSEMENT Claims for Reimbursement Tests at private institutions: Reimbursement of the charges paid to private practitioners/institutions for undertaking skiagrams, electric therapy, bacteriological, pathological examinations, etc. on the advice of the AMA owing to non-availability of the facility at a Govt. Hospital is permissible with the prior consent of the Director of Health Services/Chief Administrative Medical Officer. Blood and transfusion charges: Cost of Blood and transfusion charges paid to a Govt. institution or any other local organization recognized by the State Govt. are refundable, provided that it is certified by the treating Doctor (AMA) that the blood was not available in the Hospital, and that the price paid was reasonable. Testing of eye-sight: Govt. servants may get their eyesight tested for glasses at a Govt./recognized Hospital once in three years on the recommendation of the AMA. Fee paid to the Specialist for such services will be reimbursed according to the scheduled rates prescribed in the concerned State. Expenses towards correction of squint (eye) are reimbursable. There is no provision for reimbursement of cost of spectacles. The members of families are not entitled to the facility for testing of eye sight for glasses. Other medical facilities: Charges which were not included in medical attendance/treatment under these rules shall be determined by the AMA and paid by the patient. Keeping in view the inconvenience faced by the beneficiaries in submission of prescription in original while claiming reimbursement, it has been decided to relax the above condition and to allow a self-attested photocopy of the medical prescription to claim reimbursement without a permission letter issued from the Department concerned. Reimbursement on certain eventualities Reimbursement of medical expenses incurred during various situations such as: Dies non, suspension, study leave, foreign service/deputation abroad (to be sought from the foreign employer), special leave abroad (depending upon the purpose for which the leave is granted), voluntary/ training/embodiment in the Territorial Army/Military service during emergency, while abroad leaving behind family in India, etc. is admissible. Reimbursement by Insurance Companies The beneficiaries under CGHS and CS (MA) Rules, 1944 who have subscribed to “Mediclaim” or similar other policies from an Insurance Agency are permitted to claim reimbursement of the medical expenditure from both the sources, viz., the Insurance Agency and CGHS and Ministries/Departments, subject to the condition that the reimbursement from the two sources would not to exceed the package rates prescribed under the CGHS for the particular treatment. The beneficiary will make the first claim to the Insurance company and the second claim to the CGHS or the Ministry/Department concerned. The medical claim against original vouchers/bills would be raised by the beneficiary first on the Insurance company which would issue a Certificate indicating the amount reimbursed to the Director, CGHS or Head of Department concerned. The Insurance company concerned will retain the original vouchers in such cases. The beneficiary would then prefer his/her medical claim along with photocopies of vouchers/bills duly certified, in ink, along with stamp of the company on the reverse of the vouchers to the concerned organization. Reimbursement from CGHS, etc. will be restricted only to the admissible amount as per approved package rates, subject to the condition that the total amount reimbursed by the two organizations does not exceed the total expenditure incurred by the beneficiary. Special dispensation under CSIR In CSIR system, the DG has been empowered to settle the cases of reimbursement of medical expenses in respect of expensive procedures like BMT, Cardiac defibrillator, Carotid stents, or involving usage of costly equipment/instrument/ implants, etc. while undergoing treatment at a Govt./private recognized Hospital outside the notified list under CS (MA) Rules, 1944/CGHS for which no rates are available either under CS (MA) Rules/CGHS or AIIMS. This is subject to the condition that the treatment is obtained with the prior permission of the Medical Officer-in-Charge of CSIR Dispensary and/or the Director of the Lab./Instt. except in the case of emergency, as the case may be. Reimbursement of cost of OPD medicines: CSIR has approved reimbursement of the cost of OPD medicines for treatment in post-operative conditions in serious diseases in accordance with MH&FW O.M. F.No.10001/2000/JD/R&H/ CGHS/CGHS(P) dated 30-4-2001 to the CSIR pensioners who are not getting OPD facilities from CGHS/CSIR Dispensaries in the following cases: Post-operative Major Neurosurgical/Neurology cases Post-operative cases of major Cardiac surgery/Cardiology/Oncology cases Post-operative Organ transplant cases Post-operative Joint replacement cases Cashless medical facility for CSIR pensioners: Cashless medical facilities for indoor treatment to CSIR pensioners, serving employees and their dependant family members, provided: The CSIR Lab./Instt. may enter into a Memorandum of Understanding with the CGHS recognized Hospitals to provide this facility as per terms mentioned at (b) above. The recognized Hospitals should be willing to provide cashless medical treatment on CGHS approved rates. In case of any difference in rates, the rates specified by the Hospital over and above the CGHS prescribed rates should be charged to the pensioners/employees by the Hospital. Relief from CSIR Welfare Fund: The Scheme for providing financial assistance to the CSIR employees for meeting medical expenses incurred for undergoing treatment for major illness in the private recognized Hospitals over and above the amount admissible under CS (MA) Rules, 1944/CGHS Rules from CSIR Welfare Fund has been extended up to 13-12-2016. As per rules, the medical expenses in respect of the treatment taken in the private recognised Hospitals for major illness like kidney transplant, coronary bye-pass surgery, heart transplant, chemotherapy, brain surgery, etc. are restricted to the ceilings fixed by the GoI. As the cost of treatment actually charged by the Hospitals is very high in comparison with the ceilings fixed under the rules, the additional expenditure will be met from Welfare Fund of CSIR, on case to case basis. The rates of financial assistance from CSIR Welfare Fund for reimbursement of medical expenses incurred by them for undergoing treatment for major illness in private recognized Hospitals over and above the amount admissible under CS (MA) Rules, 1944/CGHS to the extent of 75% of expenses incurred over and above the admissible amount, subject to maximum of Rs.2.00 lakhs in case of treatment of self; and 50%, subject to a maximum of Rs.1.00 lakh in respect of dependent family members This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » F. MISCELLANEOUS ASPECTS Income tax rebates Individuals claiming expenditure for Income Tax purposes for certain ailments from a Specialist working in a Govt. Hospital need not produce a Certificate to that effect. As per amended Rule 11DD, the prescription can be issued by any Specialist mentioned in the amended Rule henceforth, it will not be mandatory to obtain a Certificate from a Specialist working in a Govt. Hospital. Further, in case no payment has been made towards medical insurance, very senior citizens can claim deduction up to maximum of Rs. 30,000/- per year towards actual medical expenses incurred by them. Additional deduction has been granted in respect of expenses incurred on medical treatment of specified ailments and supported by medical prescription from a Specialist. Such deduction can be claimed up to Rs.60,000/- for expenses incurred for senior citizens. From Financial Year 2015-16, higher deduction of up to Rs. 80,000/- is allowable for expenses incurred on medical treatment of the specified ailments for very senior citizens. As per income tax provisions, electronic filing of return is mandatory for persons with total income of Rs.5.00 lakh and above. However, very senior citizens are exempted from electronic filing of return even if their income exceeds Rs. 5.00 lakh provided the returns are furnished in ITR 1 or ITR 2. A deduction to the extent of Rs.40,000/- or the amount actually paid, whichever is less is available for expenditure actually inurred by resident assessee on himself or dependent relative for medical treatment of specified disease or ailment. The diseses have been specified in Rule 11 DD. A Certificate in Form 10-I is to be furnished by the assessee from any Registered Doctor. In view of the rising cost of medical care and special needs of a differently abled person, Finance Bill, 2015 proposes to amend section 80 DD of the Income-tax Act so as to raise the limit of deduction in respect of a person with disability from Rs.50,000/- to Rs.75,000/- and in respect of a person with severe disability, from Rs.1.00 lakh to Rs.1.25 lakh. Certification of disability Rule 54 (6) of the CCS (Pension) Rules, 1972 had been amended vide DOP&PW Notification No.1/18/01P&PW(E)(VoI.II) dated 25-4-2008 to change the competent authority to issue a Disability Certificate from "a Medical Officer not below the rank of a Civil Surgeon" to "a Medical Board comprising of a Medical Superintendent or a Principal or a Director or Head of the Institution or his nominee as Chairman and two other members, out of which at least one shall be a Specialist in the particular area of mental or physical disability including mental retardation". Grant of advance If an advance is requested by the Govt. servant or on his/her behalf of spouse/legal heir, it will be paid direct to the Hospital concerned on receipt of an estimate from the treating Physician/Medical Superintendent of the Hospital. Settlement of advance will be through subsequent claim for reimbursement as admissible under CS (MA) Rules, and balance, if any, recovered from the pay/leave salary of the Govt. servant in not more than four equal monthly installments. In case of prolonged treatment, reimbursement of medical expenses may continue to be allowed to Govt. servants to the extent admissible, and the advance in such cases need not be adjusted within one month as in the above case, if it is certified by the Medical Officer-in-charge. Application for advance should be supported by a Certificate that the patient is being treated indicating the duration of such treatment and the anticipated cost. An advance limited to Rs.10,000/-, or such other amount as the Medical Officer-in-Charge of the patient may recommend whichever is less would be admissible when a Govt. servant or a member of his family is being treated (a) as an In-patient in a Hospital (b) as an out-patient in the case of TB/Cancer. A second advance can also be granted at the discretion of the Head of Office not exceed Rs.10,000/- including the first advance. Advance can also be granted for purchase/replacement of artificial appliances. The limits prescribed for grant of advance for medical treatment are given hereunder which are yet be revised: Limitations S.No. 1. 2. 3. Nature of treatment For indoor treatment in a Hospital and out-patient treatment for diseases like Cancer, etc. where the duration of treatment is 3 months or less In case of TB where the duration of treatment is more than 3 months Major illness of Bypass surgery/ Kidney/Cancer including Acute Myeloid Leukemia, Chronic Active Hepatitis, Subset of Hepatitis-B Rs.10,000/- or the amount recommended by the Physician whichever is less. Limited to 80% of the estimated cost or Rs.36,000/- whichever is less Limited to 90% of the package deal wherever exists or according to the estimate submitted by the Govt./ recognized private Hospital. Heads of Office are empowered to grant advances to Central Govt. servants to enable them to initially meet the expenditure on medical attendance and treatment for themselves and their family members. Advances are admissible to all Govt. servants irrespective of their pay, subject to fulfilment of certain conditions. Temporary Govt. servants can be granted medical advance on providing necessary surety from a permanent Govt. employee. Travelling Allowance When the place at which a patient falls ill is more than 5 miles (8 Km.) by the shortest route from the consulting room of the AMA, the patient shall be entitled to TA for the journey to and from such consulting room. If the patient is too ill to travel, the AMA, Specialist AMA, shall be entitled to TA for the journey to and from the place the patient. However, Compounders/Lab. Assistants are not eligible for TA. Claims for TA shall be accompanied by a Certificate by the AMA. The CGHS beneficiaries are not entitled for grant of conveyance charges when they are referred to Specialists/Hospitals within the city. Since Dispensaries situated at various CSIR Labs./Instts.are equated with CGHS, no conveyance charges shall be payable to for treatment as an Out-patient in recognized Hospitals in the same city, even if the distance involved is more than 8 km. T.A. for Attendant: The facility of TA for the Attendant would only be admissible to those Govt. servants with Disabilities wherein it is certified by the competent Medical Authority that such a person compulsorily requires assistance of another person for travel. Under this clause, necessary Certificate is to be obtained from the HOD of a Govt. Civil Hospital designated for the type/form of disability of the Govt. servant. Based on the Certificate, HoDs would have to further satisfy the need for an Attendant during travel of the Govt. servant before allowing the journey for the Attendant. Casual Workers (TS) Medical facilities as available in the CSIR Dispensaries can be availed by the Casual/Dailywage workers who are conferred with Temporary Status, subject to the condition that no reimbursement of medical expenses would be admissible to them. However, their family members are not entitled to such facility. References 1. GOI MOH&FW O.M. No.4-24/96-C&P/CGHS/CGHS(P) on 17-9-1999 2. GOI MH&FW O.M. F.No.10001/2000/JD/R&H/CGHS/CGHS(P) dated 30-4-2001 3. GOI MOH&FW O.M. No.4-24/96-C&P/CGHS(P) dated 31-5-2007 4. GOI MOPPG&P DOP&PW Notification No.1/18/01-P&PW(E)(VoI.II) dated 25-4-2008 5. CGHS O.M.No.12011/2005/CGHS(R&H)/CGHS(P) dated 4-12-2008 6. GOI MOH&FW O.M. No.S.11012/1/98-CGHS(P) dated 10-12-2008; Swamysnews, Feb. 2009, 49-50 7. GOI MOH O.M. No. 4-18/2005-C&P(Vol.I-Pt.(I) dated 20-2-2009; Swamysnews, April 2009, 61-62 8. GOI MOH O.M. No.4-24/96-C&P/CGHS/CGHS(P) dated 25-2-2009; Swamysnews, April 2009, 68-69 9. GOI MOPPG&P DOP&PW O.M.No.45/6/2008-P&PW(F) dated 16-4-2009 10. CSIR Lr. No. 34-1(11)/CSIR/Pen/2008-09 dated 12-5-2009; GOI MOPPG&P 11. GOI MOPPG&P DOPT O.M. No.4/25/2008-P&PW(D) dated 26-5-2010 12. GOI MOH O.M.No.4-24/96-C&P/CGHS(P) dated 4-11-2010; Swamysnews, Dec. 2010, 48-49 13. Swamy's Pension Compilation (Edn. 2011) 14. GOI MOH O.M.No.S.14025/8/2010-MS dated 18-1-2011; Swamysnews, Feb. 2011, 62 15. GOI MOH O.M. No. S.11011/7/99-CGHS(P) dated 27-4-2011; Swamysnews, July 2011, 21-23 16. GOI MOH O.M. No.S.11011/24/2011-CGHS(P) dated 1-6-2011 17. GOI MOH O.M. No. Z.15025/5/2011-CGHS-III/CGHS(P) dated 22-11-2011; Swamysnews, Jan. 2012, 32-33 18. GOI MOH O.M. No.S.11011/32/2011/CGHS(P) dated 19-1-2012; Swamysnews, March 2012, 28-29 19. GOI DOPT O.M. No.21011/1/2009-Estt.(A)-Part dated 1-2-2012; Swamysnews, March 2012, 33-39 20. GOI MOH O.M. No. F.No.S.14025/3/2010-MS/CGHS(P) dated 16-1-2013; Swamysnews, Mar. 2013, 913 21. Swamysnews, Feb. 2013, 79 22. CSIR Lr. No.5-1(72)/2009-PD dated 7-2-2013 23. GOI MOF DOE O.M. No.19030/3/2013-E.IV dated 17-2-2013 24. GOI MOH O.M. No. F.No. S.11045/13/2013/HEC/CGHS(P) dated 4-3-2013; 25. GOI DOPT O.M.No.21011/1/2009-estt.(A)-Part dated 20-3-2013; Swamysnews, May 2013, 8-13 26. Swamysnews, May 2013, 7-8 27. Swamysnews, June 2013, 84-85 28. GOI MOH O.M.No.F.No.S.14025/14/2012-MS dated 11-6-2013; Swamysnews, July 2013, 22-23 29. GOI MOH&FW DOH&FW O.M. No.F.No.2-1/2012/CGHS/VC/CGHS(O) dated 1-8-2013; Swamysnews, Sept. 2013, 44-46 30. GOI MOPPG&P DOP&W O.M. No. A/25/2008-P&PW(D) dated 2-5-2014 31. GOI MOR (RB) O.M. No.PC-V/2011/A/Med/1 dated 7-7-2014 32. GOI MOH&FW DOH&FW O.M. No.S-11011/25/2014-CGHS-(P) dated 8-7-2014 33. GOI MOPPG&P DOP&PW O.M. No.1/18/01-P&PW(E)(VoI.II) dated 30-9-2014 34. GOI MOF DOE O.M. No.7(1)E.Coord./2014 dated 29-10-2014 35. GOI MOPPG&P DOPT O.M. No. 4/25/2008-P&PW(D) dated 19-11-2014 36. GOI MOH O.M. No.S.3849/09-CGHS(R&H)-CGHS(P) dated 8-12-2014 37. GOI MOH O.M. No.1967/2013/DEL/CGHS/SZ/D52/CGHS(P) dated 30-12-2014 38. GOI MOH&FW DOH&FW O.M. No.1-1/13/Hospital Cell/R&H/CGHS(Pt.I)/CGHS (P) dated 23-2-2015 39. GOI MOH&FW DOH&FW Circular No. S-11011/16/2012-CGHS(P) dated 8-4-2015 40. GOI MOF PIB Notification dated 24-4-2015; www.gconnect.in 41. GOI MOH&FW DOH&FW O.M. No.S.14025/10/2002/MS dated 26-5-2015 42. GOI MOHFW DOHFW O.M. No. S.14025/19/2015-MS dated 27-5-2015 43. GOI MOH&FW O.M. F.No.S.14025/41/ 2015-MS dated 16-12-2015 44. GOI MOH&FW O.M.No.S.14025/22/2015-MS dated 15-1-2016 45. www.gconnect.in 46. www.govtempdiary.com This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Annexure-I Reimbursable and Non-Reimbursable Diagnostic and other Procedures I. Reimbursable: Remarks Diagnostic test Treated as one of the major diseases for treating as an In-patient/Out-patient For rehabilitation/posttreatment/check-up. Patient can consult directly a Govt./ recognised Hospital without consulting AMA/State Medical Officer. Thalassaemia Major Skiagrams; Electric therapy; Reimbursable Bacteriological/pathological tests Blood Transfusion charges Hearing-Aids: Body-worn/Pocket type: Rs. 2,500/Analogue BTE: Rs. 7,000/- Digital BTE: Rs.20,000/- ITC/CIC: Cochlear-implants: Rs.25,000/- Rs.5,35,000/- Admissible, if non-availability of blood in the Hospital is certified by the treating Doctor Reimbursable, if done at other than at Govt. Hospital On the recommendation by a Govt. ENT Specialist on the basis of audiometric and audiological assessment. Type of Hearing-Aid most suited for the beneficiary to be specified. Replacement after 5 years on condemnation by a Technical Expert and on approval of a Govt. ENT Surgeon. Cost of Analogue BTE/Digital BTE/ITC/ CIC type Hearing-Aid includes the cost of ear mould. Cost shall include all taxes including VAT and shall carry “3 years warranty” With 12 channels/24 electrodes with behind the ear speech processor (Unilateral implantation only). Prior permission is needed. Treatment at residence Anti-rabic treatment Specialized treatments: Heart, coronary diseases, kidney, Cancer, post-operative care, etc. Oxygen Concentrators, CT Scan, postoperative care of kidney donor If the condition is serious Reimbursable Testing of eyesight for glasses Intra-Ocular Lenses: Only to GS; once in 3 years As per package deal. - On the recommendation of the In-charge of the Respiratory or ICU of the Govt. Hospitals in prescribed pro forma Hydrophobic foldable IOL: Rs.5,000/Silicon foldable IOL: Rs.3,600/- Admissible Hydrophilic Acrylic Lens: Rs.5,800/PMMA IOL: Rs. 490/Conventional cataract operation Heart Pace Maker, pulse generator, heart valves, electronic larynx, Hearing-Aid. CAPD Fluids, Y-Set, Transfer set, MiniCap and related items Treatment taken outside the District/State for TB, Cancer, Poliomyelitis, Mental diseases Consultation and medicine charge Cost of spectacles -- up to Rs.200/Payment will be made direct to the Hospital/supplier On the advice of Specialist/Govt./ recognized Hospital. With prior permission of HOD, the GS may purchase for one month at a time and claim reimbursement. Utilization Certificate should be submitted. Admissible For treatment of communicable diseases for Immunizing and Prophylactic On the recommendation of a Specialist and on Vaccination for Hepatitis B, Influenza and countersigning by HOD of concerned Speciality of Leprovac for high risk individual Govt. Hospital Dental treatment such as jaw bone disease, removal of all the teeth, removal of If the physiological or other disability indicates that odontomes, impacted wisdom tooth, gum the teeth are real source of problem. boils, etc. Extraction, scaling & gum, filling of Reimbursable teeth, root-canal treatments Complete denture One Jaw (denture) Cost of boot (shoe) Pathological tests General debility or secondary anaemia Venereal diseases Delirium tremens Sterility Sterilization Medical termination of pregnancy Diet charges: - For free diet, the pay of GS should not exceed Rs.7,450/- In case of TB/Mental diseases, Cancer, HIV/AIDS, Renal Dialysis and Thalassemia, the pay limit is Rs.11,160/- Treatment at the Consulting room of AMA. Supply of vitamins, minerals and antioxidants Prolonged treatment Administering Injections Specialist consultation Physiotherapeutic/Occupational therapeutic treatment Non-entitled accommodation in a Hospital Electrical lighting, fan charges Injections at AMA's Consulting room Up to Rs.2000/- -- one time Up to Rs.1000/- -- one time Cost of boot (shoe) in case of patients is reimbursable only after three years for a maximum limit of 3 times. Repairs and adjustments where necessitated under the advice of the Medical Specialist should be got done at the recognized Centres. It has to be ensured that the cost of repairs/adjustment of appliances is less than the cost of replacement. If not available at Govt. Hospital Reimbursable Reimbursable Reimbursable Reimbursable Reimbursable Reimbursable - Where the Hospital charges a flat rate which includes diet, accommodation, ordinary nursing, medical and surgical services, and also in respect of Military or recognized factory Hospitals: 20% of the flat charges will be reckoned as diet charges; - Where it includes diet, accommodation and ordinary nursing only: 50% of the charge will be reckoned as diet charges. Permissible Restricted to prevalent CGHS formulary only Only at OPD of a Govt./recognized Hospital Up to 15 at Consulting room; beyond 15 at OPD of a Hospital On the recommendation of AMA If not available at Govt. Hospital On certification of Medical Superintendent If they form part of accommodation charges Injection charges admissible To AMA/patient, if the place of illness is more than 8 Km (but not within the city) But it is not admissible to Compounders/ Lab. Assistants On special medicines Travelling expenditure Sales tax This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » II. Non-Reimbursable: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Hospitalization and treatment at AMA's Nursing Home even in emergency Cottage booking fee, admission fee, Dhobi charges Air-conditioning/heater charges Dental treatment as such Foods, diet charges, tonics, Toilet preparations, disinfectants, napkins, talcum powder, mouth fresheners Treatment by private Dentist Treatment by Oculist Telephone charges Product manufactured/marketed as food supplement cosmetics and Ayurvedic preparation prescribed by Allopathic doctors will be inadmissible. Vaccines in general Packing & Postage charges on medicines Annexure-II Remarks S.No. Nature of relationship Wife/Husband 1. Condition of dependency is not applicable in case of husband or the wife. In case of spouse employed in an organization where medical facilities are provided or Fixed Medical Allowance is given, he/she can prefer claim from only a single organization, according to their status or preference. - Judicial separation does not dissolve marriage and even a judicially separated wife continues in Law to be a wife. Judicially separated wife Parents 2. Irrespective of the fact whether receiving maintenance allowance or not. In case of judicially separated wife and dependent children, medical expenses in respect of these children allowed husband/wife whoever prefers the claim till the question of Guardianship is decided by the Court of Law. In case adoptive parents are included, real Parents are not eligible (excluding step-parents), step-mother, Adoptive parents 3. Parents-in-Law 4. Sons 5. 6. 7. 8. 9. A female Govt. servant can choose between her parents and Parents-in-Law at the time of marriage and the option exercised can be changed only once during service. Till start earning or attains 25 years of age whichever is earlier Ineligible even if he is below 25 years of age. [Married sons and daughters who are suffering from any Married son disorder or disability of mind including mentally retarded or physically crippled or disabled are not eligible even for family pension vide GID (30) under Rule 54 in CCS (Pension) Rules, 1972. Ed.] Defined disabilities: Blindness; Low-vision; Leprosycured; Hearing impairment; Locomotor disability; Mental Permanently disabled son retardation; and Mental illness; and also includes 80% [revised as 40%] or more of one or more disabilities such as autism, cerebral palsy, mental retardation or a combination of any two or more of such conditions, provided that he is financially dependent on the CGHS beneficiary. Suffering from 40% or more of Schizophrenia, provided they Son suffering with are financially dependent and is residing with the CGHS Schizophrenia beneficiary. This is subject to his continuing to suffer from the disabilities. Disability Certificate to be submitted once in 5 years. Till start earning or get married whichever is earlier Daughters widowed/ divorced/abandoned or separated from their husband Legally adopted children/Step-children/ On giving same status as that of a natural-born child through a special 'Will' Wards (under "Guardians & Wards Act, 1890) 10. Widowed sisters 11. Minor Brothers Minor children of dependent widowed/ separated daughters 12. Dependency and residential conditions with the CGHS beneficiary will continue to apply Up to the age of becoming major (18 years) Effective from 19-1-2012, up to the age of becoming major (18 years) This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Annexure-III Entitlement of Wards duration and Charges Payable Pay (in the Pay Band)/Pension/ S.No. Family Pension p.m. 1. 2. 3. 4. Up to Rs.13,950/From Rs.13,960 to Rs.19,530/Rs.19,540/- and above Day care (6-8 hours admission) Duration of stay in a Hospital 1. Specialized procedure 2. Other procedures 3. Laparoscopic surgery 4. Day care/minor procedure (OPD) Charges payable Ward entitlement per day (max.) General Ward Rs. 500/Private Ward Rs.1000/Private Ward/Deluxe Ward Rs.1500/--Rs. 500/- 12 days 7-8 days 3 days 1 day Monetary ceiling/Pay slab for various issues 1. 2. 3. 4. Monetary ceiling for direct consultation with Specialists in Central/State Govt./Municipal Hospitals Pay slab for determining the entitlement of Nursing Home facilities in Govt./State Govt./Municipal Hospitals The monetary ceiling for free diet for CGHS beneficiaries is revised to pay/pension/family pension For beneficiaries suffering from TB, Leprosy, Mental Illness, Cancer and HIV/AIDS, Renal Dialysis therapy and Thalassemia or mental disease is revised to pay/pension/ family pension Rs.33,480/- p.m. and above Rs.13,950/- p.m. and above Rs.7,450/- p.m. Rs.11,160/- p.m. Where the Hospital charges a flat rate which includes diet, accommodation, ordinary nursing, medical and surgical services, and also in respect of Military or recognized factory Hospitals, 20% of the flat charges will be reckoned as diet charges; where it includes diet, accommodation and ordinary nursing only, 50% of the charge will be reckoned as diet charges. This is a Multipage Post. Visit Next Pages 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, Next Page » Annexure-IV Cost-Ceiling for Coronary Stents and other Appliances Cost-ceiling Remarks S.No. Name of appliance (or actual whichever is less) Coronary/Vascular Stents -Drug Eluting Coronary Stents: i) All DCGI and FDA approved Drug Eluting Stents Rs.65,000/- ii) All DCGI and CE approved Drug Eluting Stents 1. iii) All DCGI approved Drug Eluting Stents Rs.50,000/- Bare Metal Coronary Stents: i) Stainless steel stents Rs.40,000/- A maximum of three Coronary Stents (of which not more than two are drug eluting stents) shall be permitted on the advice of Govt. Specialist of which not more than two shall be of Drug Eluting Stents (DES). However, DES shall be permitted only for patients where restenosis will involve high risk to patient's life, i.e., (a) Osteal/ Proximal LAD lesions; (b) Stenosis of a Coronary artery which is given collaterals to another blocked artery, thus supplying a large area of myocardium; and (c) Stenting of re-stenotic lesions after previous angioplasty. Quote the Batch number and enclose the outer pouch of the Stent packet along with the sticker on it on which details of the stent are printed for reimbursement. ii) Cobalt stents: a) All DCGI and FDA approved CGHS package rate includes the cost of CD and medical record. b) All DCGI and CE approved Rs.12,000/Rs.20,000/- c) All DCGI approved Rs.18,000/iii) Coated/other stents Bare Metal Vascular (Non-Coronary) stents: Rs.15,000/- i) Stainless steel stents ii) Cobalt stents Rs.25,000/- iii) Nitinol/other stents Rs.20,000/- Rs.20,000/Rs.22,000/- 2. Rotablator Pacemaker – single 3. chamber (without Rs.25,000/Rs.50,000/- Or the actual cost whichever is less Rs.37,500/- -do- Rs.65,000/- -do- Rs.1,15,000 -do- rate response) Pacemaker – single 4. chamber (with rate response) Pacemaker 5. (dual chamber) 6. Knee implant 7. Hip implant Rs.60,000/+ Rs.5,000/towards cost of bone cement Rs.35,000/-+ Rs.5,000/- -do- -do- 8. 9. Hearing-Aid - One sided Hearing-Aid - Bilateral towards cost of bone cement Rs.10,000/Rs.20,000/- Digital Hearing-Aid 10. 11. 12. Rs.30,000/- Nebulizer Rs.3,000/- Pulse generator Not provided by CGHS -do-do(a) Moderate to severe sensory neural hearing loss with aided speech discrimination score which cannot be improved to 70% by use of analog Hearing-Aid; and (b) sharply sloping audiogram seen on Pure tone Audiometry, inverted V audiogram or U-shaped audiogram involving 200 Hz. Factors like age, educational/work requirement and bilateral congenital losses to be taken into consideration. Condemning authority: Service Engineer of the authorized Hearing Air Centre/Dealer to be countersigned by the ENT Surgeon of a Govt. Hospital. Or the actual cost whichever is less. The average life is expected to be 5 years. Replacement on condemnation by the treating Physician/Specialist --- Diseased heart 13. -do- --- -do- --- valves Artificial electronic 14. Larynx 15. Cost of boot (shoe) Repairs and adjustments which should be less than cost of replacement should be got done at recognized Centres to be undertaken under the advice of the Medical Specialist. Request may be considered on the following conditions: i) individual request for permission/ ex post facto approval should be considered by a Screening Committee consisting of DDG (M), Directorate of GHS and two Medical Specialists in the concerned field; CPAP machine Rs.50,000/- ii) request should be accompanied by copies of Sleep Lab. Report and all basic investigation reports; 16. BIPAP machine Rs.1,00,000/- iii) beneficiary concerned will have to submit an affidavit for return of the machine to the Department concerned after its utility is over; and The machine shall be provided once in a lifetime to a particular beneficiary. The responsibility for maintenance shall lie with the beneficiary. Neuro-Implants: Rs.3,46,153 + VAT Rs.13,847 DBS Implant (including MER) 17. (Rs.3,60,000) Cost of battery: Life of battery: 3-5 years Prescribing Authority: Neurologist of a Govt. Hospital Rs.2,40,385 + VAT Rs.9,615 18. Intra-thecal Beclofen Pump, Intra-thecal Morphine Pump (Rs.2,50,000) Rs.2,51,923 + VAT Rs.10,077 Life of battery: up to 7 years (Rs.2,62,000) Recurring expenditure on Beclofen and Morphine as per rules applicable to OPD medicines Intra-thecal Infusion pump: Prescribing Authority: Rs.2,16,346 + VAT Rs.8,654 Any two Govt. Specialist of concerned Specialty/Head of Department of (Rs.2,25,000) Neurology/Neuro-Surgery/ Anaesthesiology Rs.2,51,923 + VAT Rs.10,077 Spinal Cord 19. stimulators (Rs.2,62,000) Cost of battery: Life of battery: 3-5 years Rs.1,92,308 + VAT Rs.7,692 (Rs.2,00,000) Replacement of battery before 4 years may be permitted in exceptional cases on the basis of justification provided by the treating Specialist on case to case basis by the DH&FW. Warranty for two years from the date of implantation with free replacement, if battery failure or malfunction of device is reported. Approving authority: CGHS: Addl. Director of the concerned city Under CS (MA) Rules: DDG (M) or equivalent level Officer of DGHS Post date: 2016-05-03 19:15:28 Post date GMT: 2016-05-03 13:45:28 Post modified date: 2017-04-18 09:41:52 Post modified date GMT: 2017-04-18 04:11:52 Powered by [ Universal Post Manager ] plugin. MS Word saving format developed by gVectors Team www.gVectors.com