Guidelines for special provisions to CGHS beneficiaries aged 80 years and above as well as for 78 years & above

 Guidelines for special provisions to CGHS beneficiaries aged 80 years and above as well as for 78 years & above

 Guidelines for special provisions to CGHS beneficiaries aged 80 years and above

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

Nirman Bhawan, New Delhi 110 011

No Z-16025/98/2017-CGHS-III

Dated the 11th July, 2017

OFFICE MEMORANDUM

Subject: – Guidelines for special provisions to CGHS beneficiaries aged 80 years and above

With reference to the above mentioned subject the undersigned is directed to convey the approval of competent authority for special provisions under CGHS to the beneficiaries aged 80 years and above, in continuation of earlier guidelines in this regard , as per the details given below:

a) Consultation of Doctor at CGHS Wellness Centre without standing in Queue

b) CGHS Doctors shall enquire by phone, at least once in a month to enquire about their wellbeing / make a home visit if residing within 5 K.M.s of CGHS WC

c) Settlement of medical claims on priority out of turn.

d) Follow up treatment from same specialist in non-empanelled hospital from where he/she was earlier taking treatment- as a special case in view of advanced age and difficulty to change physician subject to the reimbursement limited to CGHS rates and collection of medicines as per CGHS guidelines.

Dr.D.C.Joshi)
Director, CGHS

Beneficiaries who are aged above 75 years can directly avail the OPD facilities at the empanelled CGHS hospitals without any referral from the Medical Officer of CGHS but only by showing CGHS card. If any investigations or procedures are advised and required in an emergency, no additional permission or endorsement is required from the Medical Officer of CGHS

New CGHS referral rule: Annual health check-up in private hospitals for beneficiaries above 75

CGHS empanelled hospitals: The CGHS centres are set up to provide basic medical services and if required, they can refer the medical case to government hospitals or even private hospitals

As per the new CGHS rules, the CGHS pensioners who are aged 75 years and above have been permitted to undergo annual health check-up at CGHS empanelled hospitals.

CGHS referral new rules 2019: The Central Government Health Scheme (CGHS) beneficiaries who are above 75 years of age have been given some relief when it comes to availing health services such as CGHS OPD consultations, annual health check-up and CGHS treatments in empanelled hospitals. Across the country, the CGHS centres are set up to provide basic medical services and if required depending on the treatment, they can refer the medical case to government hospitals or even private hospitals.

If it is an emergency situation, the beneficiary need not wait for any permission or endorsement from the CGHS centre, however, for a non-emergency situation, an endorsement from the CGHS centre is required.

CGHS 75 year age rule

As per the new CGHS rules, the CGHS pensioners who are aged 75 years and above have been permitted to undergo annual health check-up at CGHS empanelled hospitals. The CGHS circular for 75-year-old states that the permission to the primary cardholder who is aged 75 years and above will be granted by CMO in charge of the CGHS wellness centre.

The beneficiary can undergo the check-up from a private hospital empanelled under CGHS as per CGHS rate list and will also get the cashless facility for the treatments.

The government had also allowed elderly CGHS beneficiaries who are 75 years and above to seek consultations from Specialists without any endorsement from the CGHS centres. The beneficiary is also permitted to consult up to 3 Specialists if required in a single visit to the hospital.

Also, investigations advised by Specialist of the private empanelled hospitals may be under taken if they are required in an emergency as certified by Specialist without endorsement by CGHS. They can, therefore, now undergo treatment or investigations without any prior CGHS referral letter.

However, permission will be required only for any unlisted treatment procedure or tests in non-emergency conditions.

Beneficiaries who are aged above 75 years can directly avail the OPD facilities at the empanelled CGHS hospitals without any referral from the Medical Officer of CGHS but only by showing CGHS card. If any investigations or procedures are advised and required in an emergency, no additional permission or endorsement is required from the Medical Officer of CGHS..