CGHS :Referral to empanelled hospitals for consultation/endorscment & Consultation from Specialists at CGHS empanelled hospitals in respect of CGHS beneficiaries aged 75 years and above -regarding

Misc. 01/2023 / DIR/CGHS/

Govt. of India

Min. of Health & Family Welfare

Department of Health Directorate of CGHS dated the

3 1  March 2023.

OFFICE ORDER

Subject: Referral to empanelled hospitals for consultation/endorscment — regarding

With reference to the above-mentioned subiect the undersigned is directed to state that this Ministry is in receipt of representations regarding difficulties being faced by CGHS beneficiaries in obtaining referral to empanelled hospitals by CGHS .when they are not in a position to visit CGHS Wellness Centers physically. In view of the representations. as referred to, this matter has been reviewed by this Ministry and it is now decided to issue the following guidelines in this regard:

i) Whenever there is a request for a referral for consultations/endorsement submitted through a representative by a CGHS beneficiary, where the beneficiary is not in a position to attend CGHS Wellness Centre physically, CGHS Medical officer , based on the documents submitted. considers that the request is justified, may issue referral to CGHS empanelled hospital for consultation/endorsement, as the case may be. without insisting on the physical presence of the concerned CGHS beneficiary.

ii) If CGHS Medical Officer is not satisfied with the papers submitted through therepresentative, he/she may avail the option of contacting the CGHS beneficiary by video call or making a domiciliary visit to satisfy the requirement of referral/endorsement and shall not insist on the physical presence of such CGHS beneficiary.

2. Addl. Directors, CGHS of Cities/Zones shall circulate a copy of this Office Order to CMOs In Charge and other CGHS Staff to take necessary action and to monitor the implementation of the guidelines.

Sd/

(Dr.Manoj jain)

Director, CGHS

....................................................................................................................................................................

 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 nonemergency 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 years 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.

 Sd/- 

Dr.Manoj Jain 

Addl. DDG (HQ) CGHS