Health Ministry Simplifies Treatment Process at private hospitals under CGHS
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New Delhi: Bringing relief to lakhs of beneficiaries under the Central Government Health Scheme (CGHS) scheme across the country, the Ministry of Health and Family Welfare has announced Simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rules, 1944.
With the move, the government has also extended cashless facilities to CGHS pensioners, ex-employees and many others, who were earlier eligible for treatment only on credit basis. Moreover, the government has directed that the government dispensaries not refer a patient to a particular centre , rather shall specify the treatment procedure and mention ‘referred to any CGHS empanelled centre’.
A office memorandum issued in this regard states that the Ministry had received representations for simplification of procedure for undergoing treatment at private hospitals empanelled under CGHS. The matter had been examined and it has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under CGHS of specific treatment procedures listed under CGHS rate list are advised by a Specialist in a Central Government / State Govt. Specialist hospital or a CGHS Medical Officer without any requirement of any other referral (permission) letter.
Private empanelled hospitals shall perform the treatment on cashless basis in respect of pensioners, ex-MPs, Freedom Fighters, Regular employees {both CGHS and CS (MA) beneficiaries} of this Ministry & other categories of CGHS beneficiaries, who are presently eligible for credit facility and shall enclose the prescription issued by Government Specialist or a CGHS Medical Officer, in original (or a self-attested photocopy) along with the hospital bill submitted to the competent authorities.
Serving government employees shall enclose the prescription issued by a Government Specialist or a CGHS Medical Officer in original (or a self-attested photocopy), while submitting the medical claim to the concerned Ministry /department/office for reimbursement.
CGHS Medical Officer / Government Specialist shall not refer the beneficiaries to any particular empanelled hospital by name but, shall specify the treatment procedure and mention ‘referred to any CGHS empanelled centre’.
These orders are applicable only in respect of treatment procedures for which CGHS rates are available, the directive specifies.
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