Entitlement of wards in private hospitals empanelled under CGHS - Clarification on issues raised |

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Entitlement of wards in private hospitals empanelled under CGHS – Clarification on issues raised: Department of Health & Family Welfare O.M. dated 22.11.2022

File No: S.11011/11/2016-CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
(EHS Section)

Nirman Bhawan, New Delhi
Dated the 22nd November, 2022

OFFICE MEMORANDUM

Subject: Revision of rates of subscription under Central Government Health Scheme due to revision of pay and allowances of Central Government employees and revision of pension/ family pension on account of implementation of recommendations of the Seventh Central Pay Commission-reg.

In continuation of this Ministry’s OM of even number dated 28.10.2022 (copy enclosed) on the subject cited above, the undersigned is directed to issue clarifications, with regard to several clarification requests received in this Ministry. The clarifications on such issues raised may be seen as under:

View: Entitlement of wards in private hospitals empanelled under CGHS w.e.f. 28.10.2022 – Genuineness of the Order

Sl.No.Issues raisedClarification
i.Is this OM applicable to pensioners of autonomous bodies under CGHS too?Autonomous Bodies/ Statutory Bodies are provided only OPD facilities, under CGHS, on cost to cost basis. IPD treatment costs are borne by the concerned ABs/SBs through their own resources. Therefore, it is for the concerned ABs/SBs to whom CGHS facilities have been extended, to take a decision in the matter.
ii.Is this OM applicable to pensioners who have retired prior to October 2022? Out of retirees, some have given life time contribution while others contribute on a yearly basis.The OM dated 28.10.2022 has been issued with the approval of D/o Expenditure, M/o Finance, to rectify certain anomalies in the ward entitlement of beneficiaries post 7th CPC, as fixed vide OM dated 09.01.2017.There is no change in the subscription rate as already fixed vide OM dated 09.01.2017. There is no linkage between CGHS subscription and ward entitlement. Therefore, all CGHS beneficiaries (Serving & Pensioners) who are eligible for upgradation of the ward entitlement, according to the revised basic pay slabs, as mentioned in OM dated 28.10.2022, may apply for fresh CGHS card. However, Medical claim cases for treatment taken by beneficiaries prior to 28.10.2022, will not be re-opened for the purpose of reimbursement with regard to revised ward entitlement(s).
iii.Many pensioners who have retired on 31/10/2022 had applied for pensioners’ card with contribution before 28/10/2022. What would be the status of their ward entitlement?
2. This issues with approval of Competent Authority.

(Hemlata Singh)
Under Secretary to the Government of India
Tel No. 011-23061778

Encl. As above.

Encl:-Entitlement of wards in private hospitals empanelled under CGHS as per 7th CPC Basic Pay- Revision by MoHFW w.e.f. 28.10.2022

To

  1. All the Ministries/ Departments, Government of India.
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