Reiteration of the guidelines issued by the Ministry of Health and Family Welfare, CGHS, and Dte. General Of Health Services
No.19-3/2024/ADMN.(129)
Office of the Additional Director
Central Government Health Scheme
3rd Floor, E Wing, Kendriya Sadan,
Koramangala, Bengaluru-34
Bengaluru
Dated: 17/10/2024
NOTIFICATION
Sub: Reiteration of the guidelines issued by the
Ministry of Health and Family Welfare, CGHS, and Dte. General Of Health
Services.
With reference to the
above-mentioned subject, the undersigned is directed to draw attention to the
terms and conditions of empanelment under CGHS and to reiterate that the Hospitals,
Diagnostics/Imaging, Eye, and Dental centers empaneled under CGHS shall
provide better services to the CGHS beneficiaries. The following instructions
are to be followed strictly by all HCOs empaneled under CGHS Bengaluru, failing
which necessary action will be initiated in accordance with the MoA.
1. Cashless CGHS facility is obligatory for Pensioners, Ex-members
of Parliament, Sitting Members of Parliament, Freedom Fighters,
and Serving CGHS/DGHS/Ministry of H&FW employees. No advance shall
be collected at the time of admission.
2. Central Government beneficiaries covered under
CSMA, including beneficiaries from central
autonomous bodies and public sector undertakings, are also eligible
for treatment at CGHS rates on a payment basis.
3. CGHS cards are valid all over India. Hence, CGHS beneficiaries and their
dependents, including those from other cities, are eligible to avail treatment
at empaneled HCOs at CGHS rates. Those eligible for credit shall be
given credit.
4. Retired Air India employees with valid CGHS cards are eligible for cashless
treatment at all CGHS empaneled Health Care Organizations (HCOs). Their
bills are to be processed through the UTITSL Portal.
5. Beneficiaries are not to be charged
separately for surgical sundries like cotton gauze, catheters, masks,
gloves, etc. These are essential items and part of the package in the case
of surgical procedures. However, these may be billed to CGHS in medical
management cases. Do not charge the beneficiaries separately for infection
control, medical record, or investigation reports, including image films or
CDs.
6. Do not demand a photocopy of the CGHS card from the beneficiaries. The CGHS card can be
verified from the CGHS app or DigiLocker.
7. When a patient is admitted in an emergency,
there is no need for any endorsement or referral from CGHS.
8. The stamp is not mandatory for the referral
memo.
9. Prescriptions from specialists at empaneled HCO
shall be in generic and must be given in printed form always. Dietary
supplement/Cosmetic items should not be included in the prescription.
10. Establish a dedicated CGHS Kiosk (Help desk).
11. Ensure that the names of nodal officers with
contact numbers are prominently displayed. Any changes to the nodal officer
must be immediately communicated to this office.
12. CGHS beneficiaries aged 70 years and above shall
be permitted to seek direct OPD consultation from specialists of Hospitals
empaneled under CGHS without referral form CGHS Wellness Centre. The terms and
conditions remain the same, mentioned in OM dated 29.05.2019 and 28.06.2024.
13. If any LISTED test or LISTED minor procedure
(not requiring admission) is advised by the treating specialist at empaneled
HCO after INITIAL referral from CGHS, no endorsement or referral from CGHS is
required, provided the test or treatment is carried out in the same hospital
within 3 months and the cost of such tests and procedures is less than Rs 3000.
However, referral from CGHS is required for procedures requiring admission, CT
scan, MRI, PET CT, and other investigations costing more than Rs 3000/-.
14. Bills are to be verified and signed by
Pensioners beneficiaries at the time of discharge. The same shall be uploaded
on the NHA portal.
15. During emergency admissions, the beneficiary
should be given a reasonable time (24 hours) to produce the CGHS Card.
16. In case of any complaint regarding excess
billing/advance payment/harassment of CGHS beneficiaries is received in this
office, necessary action will be initiated as per MoA.
CGHS Bengaluru
To:
All HCOs empaneled under CGHS Bengaluru
Copy to: PS to Director, CGHS, CGHS Bhawan, Sector-13, R.
K. Puram, New Delhi. ADDG (HQ), CGHS, CGHS Bhawan, Sector-13, R. K.
Puram, New Delhi.
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