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Delegation of powers
for settlement of reimbursement claims/Permissions ex-post-facto approval in
respect of Pensioner CGHS beneficiaries, etc: CGHS OM No:
Z.15025/79/2/DIR/CGHS dated 05.10.2016
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,
Revised Delegated Powers
|
||
a)
|
Additional Director, CGHS of City/Zone
|
Rs. 7,00,000/-
|
b)
|
Director, CGHS
|
Rs. 15,00,000/-
|
c)
|
Addl. Secretary & DG, CGHS
|
Rs. 25,00,000/-
|
iv) Delegation of Powers for settlement of Hospital Bills (at approved
rates) for the Treatment given to Pensioner Beneficiaries, etc,
Revised Delegated Powers
|
||
a)
|
Additional Director, CGHS of City/Zone
|
Rs. 7,00,000/-
|
b)
|
Director, CGHS
|
Rs. 15,00,000/-
|
c)
|
Addl. Secretary & DG, CGHS
|
Rs. 25,00,000/-
|
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.
Revised Delegated Powers
|
||
a)
|
Additional Director, CGHS of City/Zone
|
Rs. 7,00,000/-
|
b)
|
Director, CGHS
|
Rs. 15,00,000/-
|
c)
|
Addl. Secretary & DG, CGHS
|
Rs. 25,00,000/-
|
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
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