Follow-up Treatment of CGHS Beneficiaries in Recognized Hospitals

The undersigned is directed to refer office memodum No. S.11017/1/95-CGHS (P), dated September 20, 1995 and to say that it has been decided to modify the order in view of difficulties being faced by Central Government Health Scheme beneficiaries.



It has now been decided that the CGHS beneficiaries will be  eligible for follow-up treatment relating to Neuro Surgery, Cardiac  Surgery (including Coronary Angioplasty & implants), Cancer  Surgery/Chemotherapy/Radiotherapy, Kidney transplantation, Hip/Knee
replacement Surgery and Accident cases in the same  Institutions/Hospitals where the treatment was earlier carried out with prior permission of competent authority. The follow-up treatment will however, be subject to the following conditions :

1. The reimbursement of expenditure for Consultation/Treatment
   including hospitalization if required/Investigations will be
   limited to rates as fixed under Central Government Health Scheme.
   
    
2. The beneficiary should collect all the OPD medicines
   prescribed in connection with the treatment from the dispensary
   concerned in normal timing. In emergency these could be procured
   from market.
3. In case there is no approved CGHS rates for any procedure, or test,
   reimbursement will be made as per All India Institute of Medical
   Sciences rates, if any, or actual whichever is less or as per actual in
   case there is no AIIMS rates also.
4. Reimbursement in respect of Central Government Employees and other
   working employees and pensioners of autonomous bodies which were covered
   under CGHS will be made by respective departments from Service Head;
   from Rajya Sabha/Lok Sabha Secretariat as the case may be in case of
   Member of Parliament and EX-Member of Parliament. In respect of Central
   Government Pensioners, Freedom fighters etc. covered under Central
   Government Health Scheme, the reimbursement will be made by respective
   Additional/Joint/Deputy Director of CGHS of concerned City from CGHS
   head.
5. Permission for follow-up treatment may be granted by the Head of the
   Department in case of Central Government Employees, working employees
   and pensioners of Autonomous Bodies admitted under the scheme and by
   Rajya Sabha Secretariat/Lok Sabha Secretariat as the case may be in case
   of Members of Parliament and Ex-MPs and by CMO Incharge of concerned
   CGHS Dispensary in case of Pensioners, Freedom Fighters etc. for 3-6
   months at a time, which may be extended if required on the bases of
   medical record.
6. In case of other conditions 9other than those mentioned earlier)
   where prior permission for treatment in a private hospital recognized
   under CGHS is granted, regular follow-up treatment is to be obtained
   from CGHS Dispensary/CGHS/Govt. specialist only. However the OPD
   medicines prescribed on discharge summary may be issued by concerned
   CGHS dispensary up to a maximum period of one month.
7. Permission for follow-up treatment in case of accidents, where
   patients were admitted under emergency without prior permission in
   recognized hospitals under CGHS may be considered by Head of CGHS
   Organization of city concerned subject to Ex-post facto sanction for
   initial treatment based on discharge summary and possession of a valid
   CGHS card. In such cases Medical reimbursement claim may be accompanied
   by a copy of the Permission letter.
8. In exceptional cases where permission for treatment of the above
   mentioned conditions in a private un-recognized hospital was granted by
   Ministry of Health and Family Welfare, permission for follow-up
   treatment may be considered by Head of CGHS organization of concerned
   city on a case to case basis and HOD in respective cities.
9. This issues with the concurrence of Finance Division vide Dy. No.
   2266/JS (FA) dated 4/4/2001.