PERMISSIONS FOR TREATMENT IN PRIVATE CGHS EMPANELLED HOSPITALS CENTRES

 

1.	From where can I get the Specialist consultation as I am suffering from Diabetes and heart disease	Either the Visiting Specialist in WC ( by Appointment ) Or In CGHS Wings of Safdarjang Hospital and Dr. RML Hospital in Delhi Or Specialists of any Govt. Organizations in Delhi and other cities Or Specialists of Pvt Empanelled Hospitals of satellite towns in NCR region upon referrals by CMO I/c of WC
2.	I am entitled for Direct Consultation and Nursing Home facility at Govt Hospitals, Can I go directly for consultation at Govt. hospitals	Yes with prior appointment
3.	I am entitled for Direct Consultation and Nursing Home facility at Govt Hospitals, Can I go directly for consultation at pvt empanelled Hospitals	No. Except the Specialists of Pvt Empanelled Hospitals of satellite towns in NCR region upon referrals by CMO I/c of WC
4.	In emergency who are all entited to get treatment at Pvt Empanelled Hospital	Any beneficiary holding a Valid CGHS card.
5.	Do I get treatment on credit in emergency at Pvt empanelled Hospital?	Yes, on production of Valid CGHS card
6.	I want to get my Cataract Surgery done at Pvt empanelled hospital ? How can I get it done	Get a Govt. Specialist advice Pensioners to Apply to CMO I/c of WC for permission Serving employees to apply to Head of Deptt. of office
7.	Can I get permission for any Pvt Hospital of my choice?	Yes, provided the Hospital is empanelled for that particular procedure.
8.	How to know which Hospital is empanelled for what purposes / facilities?	Information is available on CGHS Website and on Notice boards of all CGHS WCs
9	Is there any updated Govt. publication on CGHS facilities available for sale?	Not at present
10	Is it necessary that the Govt specialist should write ”referred to CGHS empanelled Hospital “for obtaining permission	No
11	I am a serving CGHS beneficiary. Can I get treatment on credit at Pvt. empanelled Hospital in emergency?	Yes

 

12.	Incharge does not refer me to Pvt Hospitals on my request?	As per CGHS guidelines OPD referrals are not permissible except in satellite towns of NCR
13.	I am a serving beneficiary. Can I get treatment on credit in non-emergency on producing permission from my office?	No. You will have to make payment and claim reimbursement.
14.	Is cost of implants reimbursed?	Yes.As per ceiling fixed by the Govt.
15.	Can I opt for better implant by meeting extra cost over and above the ceiling? If yes,how?	Yes,you can.you will have to give an undertaking to the Hospital to that effect.
16.	As a serving beneficiary making payment for my treatment at Pvt.empanelled Hospital.Do I get any rebate while paying the bill?	Yes. The hospital will allow 5°h rebate on the bill.
17.	Can I get advance from my office for treatment in Pvt Hospital as I have obtained permission on the recommendation of a Govt specialist?	Yes. You can apply for 90% of the package rates as advance.
18.	I am a CGHS Pensioner beneficiary receiving treatment in AIIMS It is a Govt. institute, Still I have been asked for payment in advance Will CGHS give me advance	Yes 90 % advance is given Apply through CMO i/c with an estimate from Treating Doctor and all relevant documents
19.	I am entitled for Private ward facilities. The hospital has charged l5% extra for investigations even though the investigations are performed on OPD basis. Is this correct?	No. Charges for investigations are same for all categories whether investigated as In patients or Out patients.
20.	The Pvt empanelled Hospital ask me to make payment even in an emergency. what to do?	Do not pay Make a complaint to AD I JD of the city
21.	I suffered a fall .1 suspect a fracture.Can I go to a diagnostic center in an emergency for x- ray?	In emergency you are expected to seek treatment in a hospital which also has diagnostic facilities.
22.	I am an acredited journalist with CGHS Card Can I seek treatment in Pvt empanelled Hospitals in emergency and get credit facility?	No. Journalists are entitled only for OPD treatment from dispensaries and treatment from Dr.RML Hospital. Journalists are not entitled for reimbursement and are not entitled for treatment from empanelled hospitals.
23.	The specialist recommends me to go a particular Pvt hospital but it is too far from my residence. Can I go to a nearby empanelled Hospital?.	Yes. Specialists are expected only to advice a specific line of treatment and are not authorized to refer to any identified centre. The choice of the Hospital is of the beneficiary.

 

24.	I am a serving employee of an autonomous body ,holding CGHS card. who will give me permission for treatment on the recommendation of Govt specialist?	Office of the serving employee.
25.	I am a pensioner beneficiary of an autonomous organization, having valid CGHS card. Can I obtain permission for treatment at Pvt Hospital from CMO I/c of wellness center?	No. Pensioners of autonomous organizations will be granted permission by their respective offices.
26	I am a pensioner beneficiary of Kolkata. In case of emergency, can I get treatment on credit at any empanelled Pvt Hospitals in other CGHS cities when I am on a visit to such city	Yes.
27.	I want to take treatment in a non-empanelled Hospital of my choice for my planned surgery, recommended by Govt specialist Can I get reimbursement at CGHS rates.?	Permission is granted only for empanelled hospitals. No reimbursement is allowed for taking planned surgery in a non-empanelled hospital.
28.	In case there is no CGHS prescribed ceiling for an implant, what is the cost reimbursable in such a case?	As per actual.
29.	There is no facility for the treatment advised by Govt specialist in Pvt ernpanelled Hospital in the CGHS city I am residing. Can I get T A for travelling to and fro for my treatment at nearby CGHS city?	Yes. TA is admissible to the nearest CGHS city only when treatment facilities are not available in city of residence.
30.	I am denied treatment at CGHS rates and on credit in emergency in a Pvt empanelled Hospital as I did not carry my card. Is this correct?	Yes, Facilities under CGHS at Pvt empanelled Hospitals are available to the beneficiaries on production of a valid CGHS card.
31.	I have been advised Dentures by Govt Hospital Dental Surgeon Will CGHS provide me	Apply to AD / JD of city through CMO I/c of WC Submit Photocopies of Valid CGHS Card & Specialist Advice Permission shall be granted for dentures @ Rs. 2000 / max. and submit the medical claim for reimbursement
32.	I was advised Cataract surgery by Govt. specialist. I took permission for pvt. Empanelled	Reimbursement shall be made as per CGHS rates Rates are available on CGHS Website.

http://mohfw.nic.in/writereaddata/cghsdata/mainlinkfile/File119.pdf

Central Civil Services (Classification, Control and Appeal) Rules, 1965 —Advice of the Union Public Service Commission (UPSC) to be communicated to the delinquent Government servant along with the final order of penalty.

No. 11012/10/2007-Estt. (A)
Government of India
Ministry of Personnel, Public Grievances and Pensions
(Department of Personnel and Training)

North Block,
New Delhi — 110001.
Dated the 7th January, 2008.

OFFICE MEMORANDUM

Subject : Central Civil Services (Classification, Control and Appeal) Rules, 1965 —Advice of the Union Public Service Commission (UPSC) to be communicated to the delinquent Government servant along with the final order of penalty.

The undersigned is directed to refer to the provisions of rule 32 of the Central Civil Services (Classification, Control and Appeal) Rules, 1965 and to say that the nature of consultation with the Union Public Service Commission (UPSC) and the manner of communication of the advice of the UPSC to the delinquent Government servant have been subject matter of litigation in some cases in CAT/High Courts etc. The questions raised from time to time are whether consultation with the UPSC under Article 320 (3) (c) of the Constitution is mandatory and binding on the appropriate authority; and whether a copy of the UPSC’s advice should be furnished to the Charged Officer before the order imposing a penalty is issued. The Hon’ble Supreme Court of India has finally decided the matter in its judgment dated the 19th April, 2007 in Civil Appeal No. 2067 of 2007 (Union of India and Another vs. T.V. Patel).
2. In the above judgment, the Hon’ble Supreme Court referred to the cases of State of U.P. vs. Mandbodhan LaI Srivastava (Constitution Bench of the Hon’ble Supreme Court) [1958 SCR 533] and Ram Gopal Chaturvedi vs. State of Madhya Pradesh (three Judge Bench) [1969 (2) 5CC 240] and did not agree with the contentions on behalf of the respondent that non-supply of a copy of the advice tendered by the UPSC before the final order was passed deprived the delinquent officer of making an effective representation and that it, therefore, vitiates the order The Hon’ble Supreme Court held as follows :-

“In view of the law settled by the Constitution Bench of this Court in the case of Srivastava (supra) we hold that the provisions of Article 320(3)(c) of the Constitution of India are not mandatory and they do. not confer any rights on the public servant so that the absence of consultation or any irregularity in consultation process or furnishing a copy of the advice tendered by the UPSC, if any, does not afford the delinquent government servant a cause of action in a court of law.”

3. The judgement of the Hon’ble Supreme court in the case of S.N. Narula vs. Union of India and others [SLP(c)12188/2003], on the facts and circumstances of that case apparently did not lay down any law. Whereas in the later judgement in T.V. Patel’s case delivered on 19.4.2007, the Appex Court has laid down law relying on two earlier decisions of the Apex Court, one of the Constitution Bench and another of a three Judge Bench. In view of the judgment dated 19.04.2007 of the Hon’ble Supreme Court it is clear that the Disciplinary Authority is not required to furnish a copy of the advice tendered by the Union Public Service Commission to the Charged Officer before the final order of penalty is passed.

4. All Ministries/Departments/Offices etc. are, therefore, requested to comply with the existing provisions of CCS(CCA) Rules, 1965 and bring the contents of this O.M. to the notice of all concerned for adopting a uniform stand and to make serious efforts to get the litigation cases on this subject disposed of by the various courts on the basis of the law laid down by the Hon’ble Supreme Court in the judgements referred to in the preceding paragraphs.

(P. Prabhakaran)
Deputy Secretary to the Government of India

Original pdf

Issue of Individual Plastic Cards to each CGHS Beneficiary- guidelines to pensioner beneficiaries

Misc.6024/2007/CGHS(HQ)/CGHS( P)
Ministry of Health & Family \Velfare
Department of Health

Nirman Bhawan. New Delhi
Dated December 27, 2010

OFFICE MEMORANDUM

Sub: Issue of Individual Plastic Cards to each CGHS Beneficiary- guidelines to pensioner beneficiaries

* * *

The undersigned is directed to draw attention to the office memorandum of even number dated 30th December 2009 and to clarify that in response to representations received from pensioner CGHS beneficiaries, it has now been decided to partially modify para E (2 ) of the said memorandum.

Para E (2) of the Office Memorandum of even number dated 30° December 2009. which reads
as‘

The Plastic Cards ( which are identity cards ) are issued for a maximum period of Five years or till entitled for CGHS benefits. whichever may he earlier. The actual validity of CGHS Card for availing services shall he as per records available in CGIIS Data base. In case of CGFIS pensioners who have paid for ‘Rest of Life’ facilities a new plastic Cards shall be issued after ‘Five years’ without any additional contribution. However the beneficiaries would not be denied CGHS facilities, if there is any inadvertent delay in procurement of new plastic cards after five years, provided the beneficiary is entitled for CGHS benefits.

- is replaced by the modified paragraph which reads as follows:

Para E (2) The Plastic Cards ( which are identity cards ) , would, hereinafter, be issued with validity till the pensioner beneficiary is entitled for CGHS benefits. In respect of pensioner CGHS beneficiaries, who have paid CGHS contribution for ‘Rest of Life’ CGI IS facilities . the Plastic cards would ,hercinaficr ,be issued for ‘Rest of’ Life’.

The Plastic cards already issued with a printed validity of five years to pensioner beneficiaries, who had paid CGHS contribution for ‘Rest of Life’ CGHS, would be taken as valid for use for “Rest of Life’. However, such CGHS pensioner beneficiaries have the option to obtain new plastic cards after five years. if they choose to do so..

The other contents of the Office Memorandum of even number dated 30^th December 2009 remain unchanged.

(.JAI PRAKASH)
Under Secretary to Government of India.
Tel. No. 011-2306 1881.

Original pdf