Revised Guidelines for CGHS Beneficiaries

 Revised Guidelines for CGHS Beneficiaries 

The Ministry of Health and Family Welfare, Government of India, issued OM No. Z.15025/117/2017/DIR/CGHS, outlining comprehensive emergency guidelines for Central Government Health Scheme (CGHS) beneficiaries.

Objective:

The primary objective of these guidelines is to ensure timely and effective medical assistance to CGHS beneficiaries in emergency situations.

Key Provisions:

1. Emergency Services: CGHS beneficiaries can avail emergency services from any hospital, including non-empanelled hospitals, without prior permission.

2. Cashless Treatment: CGHS beneficiaries are entitled to cashless treatment for emergency services at empanelled hospitals.

3. Reimbursement: In cases where beneficiaries receive emergency treatment at non-empanelled hospitals, they can claim reimbursement as per CGHS rates.

4. Emergency Assistance: CGHS beneficiaries can contact the CGHS helpline or approach the nearest CGHS wellness center for emergency assistance.

Related Circulars:

Several related circulars have been issued to clarify and update the emergency guidelines for CGHS beneficiaries. These circulars provide additional guidance on:

• Procedures for availing emergency services
• Documentation requirements for reimbursement claims
• Roles and responsibilities of CGHS authorities and empanelled hospitals

CGHS beneficiaries are advised to familiarize themselves with the emergency guidelines and related circulars to ensure they receive timely and effective medical assistance in emergency situations.

Z 15025/117/2017/DIR/CGHS/EHS Government of India

Ministry of Health & Family Welfare Department of Health & Family Welfare EHS Section

OFFICE MEMORANDUM

Nirman Bhawan, New Delhi Dated the 10th December, 2018

Sub: Revision of guidelines regarding simplification of referral system under CGHS

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for undergoing treatment/investigations at private hospitals empanelled under CGHS. In this regard attention is drawn to the guidelines issued under Office Memoranda No. Z.15025/117/2017/DIR/CGHS/EHS, dated 15.01.2018 and S.11045/40/2012/CGHS/HEC/CGHS (P), dated 22.02.2013 and to state that the matter has been reviewed by this Ministry and it has now been decided to revise the guidelines for consultation and treatment at CGHS empanelled private hospitals as per the details given under:-

1. Referral from CGHS Medical Officer/CGHS Specialist for consultation with Specialists at Private Hospitals empanelled under CGHS shall be valid for 30 days in the same hospital.
2. Referral shall be valid for consultations upto 3 times in the same hospital within 30 days.
3. Similarly referral shall be valid for consultation with a maximum of 3 different Specialists, if required during a single visit.
4. Advice of the CGHS Medical Officer/CGHS Specialist for listed investigations shall be valid for a period of 30 days.
5. Advice of the CGHS Medical Officer/CGHS Specialist for listed treatment procedure shall be valid for a period of 3 months.
6. If any listed investigation advised by Specialist of empanelled hospital is required urgently as a medical emergency and certified as such, may be undertaken at the same hospital.
7. Hospitals are empanelled under CGHS for the Specialists available and not by the name of Specialists.The Referral of CGHS Medical Officer/Specialists may be issued through Computers or even manually with proper stamp of referring doctor.
8. The other terms and conditions as prescribed on the above referred OMS shall remain unchanged.

[Rajeev Attri] 

Under Secretary to Government of India Tel- 011-2306 1883