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Tuesday, August 29, 2017

GUIDELINES FOR CGHS BENEFICIARIES


Treatment package for all wards, includes following charges
Admission charges,
Accommodation charges,
ICU / ICCU charges,
Monitoring charges,
Operation charges,
Anesthetic charges,
Theatre charges,
Cost of drugs and disposable surgical expenses,
Physiotherapy charges in hospital,
If one or more lower level treatment procedure become part of a major treatment procedure, then the package expenses would be charged against the major procedures. The half amount of actual charges billed for the minor treatment procedure would be included in the package amount of the first major treatment procedure.
In order to dispel some doubts prevalent amongst beneficiaries of the scheme an effort has been made to provide some guidelines for the benefit of the members.
ELIGIBILITY
Central Govt. pensioners their spouses, dependent sons. below 25 years of age, daughters till the date of marriage or the date from which they start earning and dependent parents are eligible. Disabled Sons with 40% or more disability are also eligible even beyond the age of 25 years.RATES FOR MEDICAL PROCEDURES
Rates for medical procedures, tests/investigations carried Out by NABL, Non-NABL hospitals and diagnostic laboratories are prescribed by Govt. from time to time.
ISSUE OF CGHS CARDS
Persons retiring from offices/establishments, located in CGHS covered areas, will be issued CGHS cards on the day of retirement, if they opt for CGHS coverage after retirement. Pensioner residing in Non-CGHS covered areas can also enroll themselves and eligible family members in the Weliness Centers nearest to their place of residence or any Wellness Centre by submitting application along with necessary documents to Addl/Jt. Director of the area. CGHS cards can also be issued to pensioners for indoor treatment only while they can continue to draw F.M.A.
VALIDITY
Plastic Card and CGHS token cards are valid for obtaining treatment at Wellness Centers throughout India.
INDOOR TREATMENT
Indoor treatment is provided to the beneficiaries in any of the empanelled hospitals on the recommendation of CMO Incharge. Depending upon the nature of treatment required the patient is referred to the hospital registered for the specific treatment viz. cardio, ortho, eye, general purpose etc.
EMERGENCY TREATMENT
In case of medical emergency beneficiaries and eligible members may obtain indoor treatment from any Govt./Recognized, Private Hospital approved under CSMA rules besides empanelled hospitals without recommendation of the CMO Incharge. Reimbursement for treatment in Private/Govt. Hospitals will be subject to CGHS approved rates.
DIAGNOSTIC TEST
Patients referred to Govt. Hospitals/Institutes for OPD Treatment can undertake diagnostic tests/investigations at the empanelled laboratories/centers, if recommended by the hospital, directly without reverting to Wellness centre for permission. It may be ensured in such cases that the hospital prescription slip is signed by the assistant professor / specialist of the hospital.
NOTE :- Please do carry your token card / plastic card while attending Wellness Centre, Collecting indented medicines, attending empanelled hospitals / labs / diagnostic centers.
After 7th CPC new CGHS Room Entitlement as per the basic payment/ pension amount.
Corresponding Basic Pay drawn by the officer in 7th CPC per month and Ward entitlement
1 Up to Rs. 63,100/- General
2 Rs. 63,101/- to Rs. 80,900/- Private
3 Rs. 80,901/- and above Deluxe/Private
Monthly contributions for availing CGHS facility :- 
1) Level 1 to 5 - Rs. 250/-
2) Level 6 - Rs. 450/-
3) Level 7 to 11 - Rs. 650/-
4) Level 12 and above - Rs. 1000/-

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