Consultation from Specialists at CGHS empanelled Hospital for beneficiaries aged 75 years and above

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: Consultation from Specialists at CGHS empanelled hospitals in respect of CGHS beneficiaries aged 75 years and above -regarding
With reference to the above mentioned subject the undersigned is directed to state that the matter related to relaxation of consultation norms in respect of elderly CGHS beneficiaries was under consideration of this Ministry and it has now been decided that hereinafter, CGHS beneficiaries aged 75 years and above shall be permitted to seek direct OPD Consultation from Specialists of private hospitals empanelled under CGHS without referral from CGHS Wellness Centre.
2.If any investigations / procedures are advised and are required in emergency, no other authorization is required and the same may be undertaken. However, in non-emergency conditions approval of competent authority is required if any non-listed investigations | procedures are advised. Medicines prescribed are to be procured from CGHS Wellness Centre.
3.Private hospitals empanelled under CGHS shall provide such facilities on cashless basis at CGHS rates to pensioners, ex-MPs , Members of Parliament and such other Categories of CGHS beneficiaries , who are eligible for treatment /investigations on credit basis. More than 75 year old dependents of serving CGHS beneficiaries, who are otherwise not eligible for Cashless treatment shall claim the reimbursement from concerned Ministry /Department. Beneficiaries of Autonomous Bodies /Statutory Bodies covered under CGHS shall claim reimbursement from the respective organization.
4.These orders are in supersession of the earlier guidelines on the subject.

Dr.Manoj Jain
Addl.DDG(HQ)CGHS

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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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