Issue of OPD Medicines for 6 Months to CGHS Beneficiaries Going Abroad

No.1-40/2019-CGHS/C&P/DIR/CGHS
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

Nirman Bhawan, New Delhi 110 011
Dated the 19th August , 2019

OFFICE ORDER

Subject:– Issue of OPD Medicines for CGHS beneficiaries going abroad

With reference to the above subject the undersigned is directed to draw attention to Circular No 4-20/2003-C&P Section dated the 28th April, 2005 vide which guidelines were issued for supply of OPD Medicines for upto ‘6’ months to CGHS beneficiaries, who are going to stay abroad and to state that the matter has been reviewed by this Ministry and it is now decided in modification of the earlier guidelines that hereinafter, Chief Medical Officer I/C of concerned CGHS Wellness Centre is empowered for issue of OPD medicines for upto six months to the CGHS beneficiaries visiting abroad, subject to submission of the following documents:

(a) Copy of valid CGHS Card.

(b )Valid prescription for six months.

(c) Documentary Proof of going abroad like ticket, visa etc.

sd/-
(Dr. Atul Prakash)
Director, CGHS

Source: ConfederationSimilar Posts:

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Post-operative Follow-up treatment from Hospitals empanelled under CGHS in respect of critically ill CGHS beneficiaries

Z.15025/35/2019/DIR/CGHS/ CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 29th May, 2019.

OFFICE MEMORANDUM

Sub: Post-operative Follow-up treatment from Hospitals empanelled under CGHS in respect of critically ill CGHS beneficiaries-regarding

With reference to the above mentioned subject the undersigned is directed to state that in view of the difficulties being faced by critically ill CGHS beneficiaries in getting post-operative follow-up treatment at CGHS empanelled hospitals, the matter was reviewed and it has now been decided that critically ill CGHS beneficiaries shall be permitted for follow up treatment in CGHS empanelled hospitals as per the details given under:

i.Permission for post-operative follow-up treatment in respect of the following post – operative conditions requiring frequent Consultations from Specialists at private hospitals empanelled under CGHS, need not be re validated from time to time and follow-up treatment may be under taken at CGHS rates without time limit.

ii. The consultation /investigations are permitted under these follow-up cases. The conditions covered are:
a. Post Cardiac Surgery Cases including Coronary Angioplasty
b. Post Organ Transplant Cases (Liver, Kidney, Heart, etc.,)
c.Post Neuro Surgery Cases/Post Brain Stroke cases requiring regular follow-up treatment
d. End Stage Renal Disease/follow up cases of Liver Failure
e. Cancer treatment
f. Auto-immune disorders like Rheumatoid Arthritis requiring regular follow-up
g. Neurological disorders like Dementia, Alzheimer’s disease, Parkinsonism, etc.,
Medicines prescribed are to be procured from CGHS Wellness Centre.

iii. The beneficiaries shall have to submit a self-attested photo copy of the permission letter to the hospital to enable the hospitals to provide credit facility in respect of pensioners and other categories of CGHS beneficiaries entitled for credit facility. Serving employees (and their dependents) who may not be entitled for cashless facilities shall enclose a self-attested photo copy of permission letter to claim reimbursement from the concerned Ministry /Department. Permission in respect of Pensioner CGHS beneficiaries, Ex-MPs (and other categories of CGHS beneficiaries, whose medical expenditure is borne by CGHS) etc., shall be granted by CGHS. Permission in respect of Hon’ble Members of Parliament shall be granted by Rajya Sabha Secretariat/Lok Sabha Secretariat as the case may and by concerned Ministry /Department in respect of serving beneficiaries and by concerned Autonomous Body / Statutory Body in respect of serving /pensioner beneficiaries

iv. However, if any non-listed investigations / procedures are advised permission from competent Authority shall be required, except in emergency.

These orders are in supersession of the earlier guidelines on the subject.

sd/-
(Dr. Manai Jain)
Addl. DDG(HQ), CGHS

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Waiting Time in CGHS Dispensaries and Treatment of Skin disorders under CGHS

Medicines are normally available at CGHS Wellness Centres and in case any medicine is not readily available, the same are procured through Authorized Local Chemist (ALC) and are supplied to the CGHS beneficiary.

In case any medicine is required urgently, there is a provision for issue of Authority Slip to CGHS beneficiaries to collect medicines directly from ALC without payment.

Medicines for chronic illness are issued upto 3 months for the convenience of CGHS beneficiaries.

Further, following steps have been taken by the Government to augment the availability of medicines at CGHS Wellness Centres:-

Indents have been placed through HLL Life Care Ltd. to procure rate contract generic medicines as an interim measure.

Additional Director of concerned CGHS City has been authorized to procure day to day required generic medicines from nearby Affordable Medicines and Reliable Implants for Treatment (AMRIT) stores till 31st March, 2019.

Treatment of Skin disorders under CGHS

CGHS empanels private General Hospitals, Eye Care Centres, exclusive Cancer Hospitals and Dental Clinics. The private General hospitals are empanelled for all facilities available in the hospital and CGHS does not empanel Speciality wise like Dermatology.

CGHS beneficiary can consult Dermatologist in empanelled hospitals having Dermatology Speciality after referral from CGHS Wellness Centre.

There is no such list of non-listed treatment procedure/investigations; which are not available in CGHS empanelled hospitals/diagnostic centres, under CGHS.

The listed treatment procedure/investigations alogwith its rates are available on CGHS website and any treatment procedure/investigation not included in such lists are considered unlisted for treatment/investigations in CGHS empanelled hospitals/diagnostic centres. Approval of Competent Authority i.e. from the Ministry/Department in case of serving employees and through Additional Director, CGHS in case of pensioner CGHS beneficiaries is required.

Following are the admissible items included under ‘CGHS package rate’ for empanelled hospitals:-
i) Registration Charges, ii) Admission Charges, iii) Accomodation charges including patient 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, xi) Anesthesia charges, xii) Operation theatre charges, xiii) Procedural charges/surgeon’s fee, xiv) cost of surgical disposables and all sundries used during hospitalization, xv) cost of medicines, xvi) Related routine and essential investigations, xvii) Physiotherapy charges etc., xviii) Nursing care and charges for its services.

In addition to the above mentioned items, some patients may require additional facilities/provisions, 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, the following items are not admissible for reimbursement:-

• • Toiletries

• • Sanitary napkins

• • Talcum powder

• Mouth fresheners

CGHS Dispensaries

The number of Central Government Health Scheme (CGHS) Dispensaries/Wellness Centres functioning and proposed to be set up in the country are at Annexure-I and Annexure-II respectively.

The norms for establishment of new Wellness Centre under CGHS are as under:-

(i) In an existing CGHS City:- For opening of a new CGHS Wellness Centre in an existing CGHS City, there has to be a minimum of 2000 Card holders (serving employees of Central Government and Central Civil Pensioners).

(ii) Extension of CGHS to a new City: – For extension of CGHS to a new City, there has to be a minimum of 6000 Card holders.

This information was given by Shri Ashwini Kumar Choubey Minister of State for Health and Family Welfare in written reply to a question in Lok Sabha on 4.1.2019.

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Dated: 24 109/2018

OFFICE MEMORANDUM

Sub: Directions to Private HCOs empanelled under CGHS regarding simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rule, 1944.

With reference to the above mentioned’ subject the undersigned is directed to state that this Ministry has been receiving various complaints regarding difficulties being faced by CGHS beneficiaries in getting the OPD/IPD treatment at Pvt. HCOs after valid referral from the CMO/MO/Govt. Specialist. It has been viewed very seriously by the Competent Authority.

It is observed that the CGHS beneficiaries are facing a lot of resistance from the staff/OPD manager/Doctors of the private NCOs empanelled under CGHS_ CPD timing are clubbed with General OPD or OPD for EWS, which is causing inconvenience to the CGHS beneficiaries. OPD Slot for CGHS beneficiaries is also reduced to half an hour, The CGHS beneficiaries are not allowed to seek the consultation from the Senior Doctor or their OPD, so called premium OPD.

It is reiterated that HCOs empanelled under CGHS shall adhere to the term and conditions while providing treatment/investigation facilities to the CGHS beneficiaries. The private HCOs empanelled under CGHS shall provide quality service to CGHS beneficiaries and care may be taken to avoid inconvenience, especially for the Senior Citizen, Cancer Patients and terminally ill patients. Pvt. HCOs shall avoid any discrimination to CGHS beneficiaries.

As per MOA clause No. 18 (9) discrimination against CGHS beneficiaries’ vis-å-vis general patients — “The amount of Performance Bank Guarantee will be forfeited and the CGHS shall have the right to de-recognize the Health Care Organization as the case may be. Such action could be initiated on the basis of a complaint, medical audit or inspections carried Out by the CGHS teams at random. The decision Of the CGHS will be final.

All the empanelled HCOs under CGHS Delhi/NCR are hereby warned/directed to follow the specified guidelines laid down in MOA and OMs issued by the Ministry Of Health & Family Welfare, Govt. of India from time to time, failing which the Show Cause Notice will be served and action as deemed fit shall be taken.

This issues with the approval of Competent Authority.

sd/-
Dr. Sanjay Jain
Addl. Director, CGHS (HQ)

Source: https://cghs.gov.in

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F.No.C.11322/27/2018/HEC
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

545-A, Nirman Bhavan, New Delhi
Dated the 11th September, 2018

Office Memorandum

Sub: Clarification regarding ‘fall clause’ for the services provided by CGHS empanelled Health Care Organizations under ‘Pradhan Mantri Jan Arogya Yojana’

With reference to the above mentioned subject the undersigned is directed to clarify that if CGHS empanelled Health Care Organizations provide health care facilities under ‘Pardhan Manri Jan Arogya Yojana‘ at rates lower than the CGHS package rates ‘the fall clause’ as mentioned under Memorandum of Agreement with CGHS shall not apply.

Issued with the approval of Competent Authority.

sd/-
(Dr.Atul Prakash)
Director, CGHS

Authrority: https://cghs.gov.in

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