Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110108

No: Z.15025/79/2/DIR/CGHS

Dated the 5th October, 2016

OFFICE MEMORANDUM

Subject- Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner CGHS beneficiaries, etc.

With reference to the above subject the undersigned is directed to state that that the matter has been reviewed by the Ministry in view of the difficulties faced by the CGHS pensioner beneficiaries Therefore, with a view to streamline and to simplify the procedures. it has now been decided to further delegate powers to the Addl. Directors of CGHS Cities / Zones in respect of CGHS pensioner beneficiaries. etc. as under:

i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs /Imaging Centre:

Requests for permission ex-post facto approval for elective treatment / investigations in non-empanelled hospitals / diagnostic centres in respect of Pensioners/ex-MF’s/freedom Fighters, etc. shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less

ii) Permission / ex-post facto approval in cases involving procedural lapse:

Requests for approval of elective treatment l investigations in empanelled hospitals / diagnostic centres without recommendation of Govt. Specialist or CMO and without prior permission in respect of Pensioners/ex-MPs/freedom Fighters, etc, shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS rates or actual expenditure whichever is less.

iii) Delegation of Powers for Settlement of Medical Reimbursement Claims (at approved rates) of Individual Pensioner Beneficiary. etc,

iv) Delegation of Powers for settlement of Hospital Bills (at approved rates) for the Treatment given to Pensioner Beneficiaries, etc,

v) Delegation of Powers for Permission / ex-post facto Approval / Settlement of Medical Reimbursement Claims of Individual Beneficiaries / Hospital Bills in respect of Unlisted procedures / Implants (no CGHS rates)

If there is no CGHS package rate for treatment I CGHS Ceiling rate for implant approval shall be granted as per AIIMS package rate (if only procedural charge. it shall not be considered as package rates)/ AIIMS rate for implant and if there is no CGHS/AIIMS rate approval shall be granted as per actual rate.

2. The revised delegations mentioned above will be subject to the conditions that it will not include any case involving relaxation of rules, irrespective of the amount involved. Further, cases where the amounts exceed the monetary limits prescribed above will have to be referred to the Ministry of Health & Family Welfare for obtaining the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare.

3. The above delegations are in supersession of all the earlier instructions in the matter in respect of the delegations now being conveyed.

This issues with the concurrence of Integrated Finance Division, Ministry of Health & Family Welfare, vide Dy. No C- 3373 dt. 20.09.2016

sd/-
(Dr.D.C.Joshi)
Director, CGHS

Authority: CGHS

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F. No. 44/37/2015/MCTC/CGHS /1114
Monitoring Computerization and Training Cell
Directorate General of CGHS
Min of Health & Family Welfare

New Delhi 5th January, 2016

OFFICE MEMORANDUM

Subject: Guidelines for Computerization of CGHS non-computerized units/future new units

All CGHS units like Allopathic Wellness Centers, Ayush Wellness Centers, Polyclinics, First Aid Posts(FAPs), VVIP units etc. need to be computerized for maintaining transparency and accountability of services provided to the beneficiaries. The following guidelines should be followed for computerization of hitherto non-computerized units or future new units:

1. Procurement of computers and peripherals-For cities other than Delhi, the CMOs In-charge of the unit may put up the demand for computers and peripherals with respective ADs for procurement. In Delhi the procurement of computers and peripherals would be done by AD (MSD) after receiving request from the Zones.

2. Extension of existing leased line

(a) In cases where units to be computerized are co-located with an existing center (like Ayush Wellness Centers, which are located in the same building as Allopathic Wellness Centers), the existing leased line may be extended for the units to be computerized.
(b) For standalone units new Leased Lines have to be installed. Broadband connections of tariff plan up to Rs 2000/- per month may be installed as alternate internet connectivity.

3. Local Area Network (LAN) wiring-The office of respective Additional Directors would get the work done.

4. Procedure for shifting of leased line/ new leased line connection

(a) In cities other than Delhi, the request for shifting of Leased Line in case of relocation of a unit or installation of new leased line for new centers may be put up to MCTC by Additional Directors. MCTC would coordinate with BSNL for demand estimate. Approval of competent authority would be taken by MCTC once demand estimates are received from BSNL and conveyed to respective ADs.

(b) In Delhi, the CM0 1/C would coordinate with local MTNL for demand estimates for new MTNL leased line connection/shifting of MTNL connection. The approval of demand estimate would be taken from competent authority by the Additional Director.

5. Procedure for Broadband Connection and telephone connection – The CMOs In-Charge and respective ADs would coordinate with BSNL/MTNL for the same.

6. Creation of Wellness Center/Unit code, NIC email ID and Password

(a) For creation of email ID, CMOs IN-charge may fill up mail subscription form available on website of NIC. The duly signed and filled form may then be scanned and emailed to NIC with copy to MCTC.

(b) CMO I/C and Additional Director would coordinate with NIC and MCTC through email for the Wellness Center/unit code.

7. Initial Handholding training of staff to use the CGHS computer module if required Local NIC may be contacted through respective Additional Directors for the same.

This issues with the approval of competent authority.

sd/-
Dr. V.K. DHIMAN
Nodal Officer

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S.11011/15/2013-CGHS (P)
Ministry of Health and Family Welfare
CGHS (P) Section

Nirman Bhavan, New Delhi
Dated the 2nd Dec, 2015

OFFICE MEMORANDUM

Sub: Extension of CGHS facilities to the retired employees of Indian Council for Cultural Relations (ICCR)-reg.

The undersigned is directed to refer to this Ministry’s O.M No. S 11011/16/2013-CGHS(P) dated 10th June, 2014 vide which it was decided to extend the CGHS facilities to the retired employees of those autonomous/statutory organizations whose sewing employees were already covered under CGHS in Delhi/NCR only.

2. This Ministry had received a request from Indian Council for Cultural Relations (ICCR) for the Arts to extend the CGHS facility to its retired employees. The proposal was examined in this Ministry and it has now been decided to extend the CGHS facilities to the retired employees of Indian Council for Cultural Relations (ICCR) subject to the following guidelines:-

a) CGHS facilities shall be extended to the retired employees of Indian Council for Cultural Relations (ICCR) only in Delhi/NCR. They will be entitled to OPD facilities and medicines from CGHS dispensaries in Delhi/NCR only on the same lines as is being done in case of serving employees of Indian Council for Cultural Relations (ICCR).

b) They may avail treatment from CGHS empanelled hospitals at CGHS approved rates. The medical expenses for [PD/hospitalization treatment will be borne by Indian Council for Cultural Relations (ICCR) and they will not be eligible for cashless medical facilities.

c) The pensioner’s card will be issued to those pensioners who have been recommended by Indian Council for Cultural Relations (ICCR) and on payment of service charges on cost to cost basis in advance on yearly basis at the rates determined by Department of Health and Family Welfare in consultation with O/o the Chief Advisor (Cost), Department of Expenditure, Ministry of Finance.

d) The CGHS membership card will have to be renewed annually by Indian Council for Cultural Relations (ICCR) in advance for both serving as well as retired employees (wherever applicable). Failure to renew the CGHS membership within the specified time period will lead to de-activation of the CGHS card.

e) There is no provision for issue of life-time CGHS cards to the pensioner beneficiaries of Indian Council for Cultural Relations (ICCR).

3. The office of the Additional Director (HQ), CGHS,New Delhi shall be the nodal office for issue of CGHS cards to the pensioners of Indian Council for Cultural Relations (ICCR). Accordingly, Indian Council for Cultural Relations (ICCR) may co-ordinate with O/o the AD (HQ), CGHS in this regard.

4. This issues with the approval of Additional Secretary & Director Geheral, CGHS and shall be effective from the date of its issue.

sd/-
(Sunil Kumar Gupta)
Under Secretary to the Govt.of India

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Health Insurance Scheme : In this backdrop, the Commission opines that health insurance for the government employees and pensioners remains the most optimal route for ensuring complete coverage for all employees, pensioners and their dependants in the long run. The IV CPC had suggested that feasibility and modalities of an Insurance Scheme for government employees in lieu of medical reimbursement may be considered by the government.

The VI CPC had recommended introduction of a health insurance scheme for Central Government employees and pensioners. It had recommended that for existing employees and pensioners, the scheme should be available on a voluntary basis, subject to their paying the prescribed contribution. It had also been recommended that the health insurance scheme should be compulsory for new government employees who would be joining service after the introduction of the Scheme.

Similarly, it had recommended that those retiring after the introduction of the insurance scheme would be covered under the Scheme.

The Commission observes that in view of the recommendations of the earlier Pay Commissions and various high power committees, the government has been contemplating the introduction of a health insurance scheme on Pan-India basis. The Commission notes that although the Committee of Secretaries had given its ‘in principle’ approval way back in 2011, and an amount of ₹ 2,061 crore had been earmarked under the XII Five Year Plan, the Scheme has still not been implemented.

The Commission notes that given the tardiness in the introduction of the long awaited Insurance Scheme, as already mentioned earlier in this chapter, the pensioners residing outside CGHS area will continue to be at a disadvantage, in terms of medical facilities, compared to their counterparts residing in CGHS areas. As stated earlier in this chapter, according to existing provisions, pensioner residing outside CGHS area but subscribing to CGHS for OPD/IPD can avail medical facility from any hospital–private or public or empanelled under CS (MA)/ECHS–in his/her own city. However, in such cases, the pensioners have to make upfront payment to the hospital and claim reimbursement later. The Commission feels that this could be a limiting factor for many pensioners who may not have the resources to pay hospital expenses upfront. The Commission notes that under CS (MA) Rules/ECHS, there are empanelled hospitals in every part of the country, at least in all major locations. In this backdrop, after identification of some major centres/cities based on minimum population threshold of pensioners, these hospitals could be empanelled by CGHS as well, for extending
medical facilities on a cashless basis.

Considering all the issues, the Commission makes the following recommendations:

i. The Commission strongly recommends the introduction of health insurance scheme for Central Government employees and pensioners. In the interregnum, for the benefit of pensioners residing outside the CGHS areas, the Commission recommends that CGHS should empanel those hospitals which are already empanelled under CS (MA)/ECHS for catering to the medical requirement of these pensioners on a cashless basis. This would involve strengthening of administrative capacity of nearest CGHS centres. However, this step will go a long way in ameliorating the pending grievances of these pensioners.

ii. The Commission recommends that the remaining 33 postal dispensaries should be merged with CGHS. The Commission further recommends that all postal pensioners, irrespective of their participation in CGHS while in service, should be covered under CGHS after making requisite subscription.

iii. Currently, there are various health care schemes in the Central Government catering to specific sets of employees. For example, apart from CGHS, there are Ex-Servicemen Contributory Health Scheme (ECHS) and Railways Employees Liberalized Health Scheme (RELHS) which cover ex servicemen and Railway employees/pensioners, respectively. Although the patterns in these schemes vary, a combined entity of CGHS ECHS-RELHS
would result in a very strong network of health facilities for the Central Government employees across the length and breadth of the country. The Commission recommends that possibility of such a combined network of various medical schemes should be explored through proper examination.

Based on the recommendations of the VI CPC, the Government has been contemplating introduction of a Health Insurance Scheme. The Commission observes that there are many global health care insurance companies today who provide comprehensive health care coverage. Through suitable tie ups with these companies, the government may examine the possibility of enhancing the remit of the proposed Health Insurance Scheme to include all the officers/staff and their dependents posted in Embassies/Missions abroad. Needless to state, this should be preceded by a thorough examination of the annual costs involved under the AMA Scheme vis-à-vis likely annual cost under the insurance route.

Authority: 7th CPC Report

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CGHS Delhi: Additional List of empanelled hospital including dental clinics and eye centres – Order dated 12-05-2015

No: S.1104513612012-CGHS (HEC)
Government of India
Directorate General of Central Government Health Scheme
Department of Health & Family Welfare

Nirman Bhawan, New Delhi.
Dated the 12th May, 2015

OFFICE ORDER

Subject: Empanelment of private hospitals (including dental clinics and eye centres) and diagnostic centres under CGHS Delhi & NCR.

In continuation of this Directorate’s Office Memorandum of even no. dated 01.10.2014 on the above mentioned subject and further empanelment under continuous empanelment scheme vide order dated 10.02.2015 and 24.02.2015, the undersigned is to convey that in addition to the list of the hospitals (including dental clinics & eye centres) and diagnostic laboratories already empanelled, the hospitals (including dental clinics & eye centres) and diagnostic laboratories as per the list attached have also been empanelled under CGHS in Delhi & NCR with issuance of this order. The newly empanelled hospitals (including dental clinics & eye centres) and diagnostic laboratories may be treated as included in the existing list of empanelled health care organization under CGHS with same terms and conditions as have been indicated in the Office Memorandum dated 01.10.2014.

Encl: As above

[Dr. D.C. Joshi]
Director (CGHS)

ADDITIONAL LIST OF EMPANELLED HOSPITALS, DIAGNOSTIC

LABORATORIES, EXCLUSIVE EYE CENTRES AND DENTAL CLINICS

UNDER CGHS. DELHI &NCR w.e.f. 12.05.2015.

HOSPITALS: – DELHI

EXCLUSIVE EYE CENTRES: – DELHI

DIAGNOSTIC CENTRES:- DELHI

EXCLUSIVE DENTAL CLINICS: – DELHI

EXCLUSIVE EYE CENTRES: – GHAZIABAD

HOSPITALS: – NOIDA

EXCLUSIVE DENTAL CLINICS: – GURGAON

EXCLUSIVE EYE CENTRES: – GURGAON

Source: CGHS Portal

• Latest list of CGHS Hospitals in Ghaziabad
• Latest list of CGHS Eye Centres in Noida
• Latest list of CGHS Hospitals in Faridabad
• Latest list of CGHS Hospitals in Gurgaon
• List of CGHS Hospitals in Delhi & NCR