Central Government Pensioners CGHS Medical Reimbursement
Reimbursement of Medical Claims under Central Services (Medical Attendance) Rules 1944
The Department of Controller General of Defence Accounts (CGDA) issued an important order regarding medical claims under CS (MA) Rules for Pensioners residing in CGHS covered and non CGHS areas.
As per the order, the Health Ministry has clarified that CS (MA) Rules 1944 are not applicable to pensioners till date. The Ministry has issued the following guidelines for medical facilities to Central Government pensioners :-
Pensioners residing in CGHS covered areas
- They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD facilities.
- Pensioners residing in CGHS areas cannot opt out of CGHS and avail any other medical facility (i.e. Fixed Medical Allowance). Such pensioners, if they do not choose to avail CGHS facility by depositing the required contributions, cannot be granted Fixed Medical allowance in lieu of CGHS.
Pensioners residing in non-CGHS areas
- They can avail Fixed Medical Allowance (FMA) @ Rs. 500/- per month revised to Rs. 1000 from 1.7.2017.
- They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.
- They also have the option to avail FMA, for OPD treatment and CGHS for IPD treatments after making the required subscriptions as per CGHS guidelines.
24×7 National CGHS Helpline
A 24×7 National CGHS Helpline service is available on a toll free number 18002088900. It is a bilingual (Hindi and English) service which is universally accessible ( through landline or mobile of any service provider).
The beneficiaries can seek all CGHS service related information through this Helpline.
The Helpline provides information on queries in the following areas
General information on CGHS: Names and addresses of the Wellness Centers and their timings, addresses of 24×7 Wellness Centers, contact details of the CMOs In charge of these Centers, Contact Details of other officials etc.
Facilities: What all facilities a CGHS beneficiary and his dependents are entitled to if living in a CGHS covered area and a non CGHS area.
CGHS eligibility: Who all are eligible for the CGHS services including the eligibility conditions of dependent family members?
CGHS entitlement: What contribution a beneficiary (serving and pensioner) has to pay according to the pay scale/pension, what is the Ward entitlement of the beneficiary?
Related to Plastic card: What is the procedure for getting a plastic card made for serving and pensioner beneficiary, addition and deletion of names in the card, validity of the card and transfer of the card, loss of the card etc.
Issue of medicines including Life Saving medicines: Procedure of issuing of medicines from the Wellness Center, Authorized Local Chemist, Medical store Depot. Documents required for issuing of life saving medicines, issuing of medicines in emergency, admissible and non admissible items, issuing of medicines for longer durations, procedure for indenting and
issuing the medicines not available in the Wellness Center etc.
Permissions for investigations/procedures: Whether the permissions are required or not required, who is the authority for granting the permission, what is the procedure for getting permission, the documents required for permission etc.
Hospitalization: Hospitalization in emergency, CGHS rates for investigations and procedures, entitlement for cashless facility, procedure for referral, permissions for hospitalization etc.
Medical Reimbursement Claims: Documents required to be submitted with the MRCs, procedure for submission of MRC,
filling of the MRC, information on procedure to t rack status of a claim, clarifications on non reimbursement of a particular item/claim etc.
Health Care Organization (HCO) empanelment: Names of Health Care organizations on the panel of CGHS, facilities for which empanelled, contact details of the Hospital authorities, the Accreditation status of the HCO etc.
Guidance on grievance redressal mechanism and RTI issues and Any other CGHS related information
The book has been compiled keeping in mind the difficulties faced by the members of CGHS specially the pensioners in getting information about CGHS. Many members do not know about facilities available at CGHS and its functioning. The difficulties are specially faced in matters of getting medicines, referral procedure, investigation and treatment procedures, treatment in case of emergency, list of empanelled hospital and most important reimbursement of medical claims. How to present their grievances and to whom is also a problem.
All the information about CGHS is available on site https://cghs.gov.in/index.php and https://cghs.nic.in/ and other related links. However many senior citizen are not aware of use of computers and specially online work like login , OTP, password etc. Though most of them now know use of Smartphone but find it difficult to operate due to small fonts and vision problem and use is limited to WHATSAPP Group or Facebook .
- Central Government Pensioners CGHS Medical Reimbursement
- CGHS revise the time limit for submission of final claims for reimbursement of medical expenses to 6 months
- Simplification of Referral Procedure under CGHS
- CGHS Guidelines for Credit Facilities to Serving Employees
- Payment of CGHS Contribution through Bharatkosh portal
- For Railway Employees Improve the Health Care System and to align with CGHS system
- CGHS Rate List 2023
New CGHS Rates for 36 Radiological / Imaging Investigations as on June 2023
Govt. of India, Department of Health & Family Welfare has issued order on 19th June 2023, CGHS rates for 36 Radiology/ Imaging investigations have been revised for all CGHS Empaneled (NABH / NABL and Non-NABH / NABL Accredited) hospitals in India. [Click to Read More..]
Union Ministry of Health and Family Welfare has decided to revised the CGHS package rates for all CGHS beneficiaries. The Union Govt has also simplified the referral process under CGHS for the benefit of its employees. Initially revise the CGHS package rates of consultation fees, ICU charges and room rent. The referral process under CGHS has also been simplified. [Click here to read more details]