Relaxation of procedures to be followed in considering requests for medical reimbursement

Doing Away With Need For Verification Of Medical Reimbursement Claims In CGHS and Guidelines for full reimbursement

No: 4-18/2005-C&P [Vol. l- Pt. (i)]

Ministry of Health & Family Welfare

Department of Health 8. Family Welfare

CGHS (P) Division

******

Nirman Bhawan, Maulana Azad Road

New Delhi, Dated the 20th February, 2009

OFFICE MEMORANDUM

Subject: Relaxation of procedures to be followed in considering requests for medical reimbursement.

The undersigned is directed to slate that under the extant instructions, a CGHS card holder. who wishes to apply for reimbursement of the expenditure incurred by him / her on medical treatment of either self or his I her dependent family members. the present reimbursement procedure needs verification of bills and issue of essentiality certificate by the treating doctor, and the Medical Superintendent of the hospital. The process of verification of bills and issue of essentiality certificates are time consuming with the doctor at times being busy or being away from office for whatever reason. This necessitates repeated visits to the hospital for getting the verification done and essentiality certificate obtained. Representations have been received in the Ministry of Health 8. Family Welfare requesting for doing away with the two requirements and for the Ministries i authorities concerned to verify and check the authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the Government servant / pensioner. in the event of any doubt, the concerned Ministry / Authority can always get verification done from the hospital concerned.

2. The undersigned is also directed to state that CGHS guidelines currently provide for relaxation of guidelines to cover full reimbursement in individual cases depending upon merits of each case. In the case of Hon’ble Members of Parliament, the powers to relax the guidelines have been delegated to the Lok Sabha Secretariat and Rajya Sabha Secretariat respectively and in the case of Hon’ble Chief Justice of Supreme Court and Judges of the Supreme Court to the Secretary General of the Supreme Court.

3. In order to reduce the burden on the Specialists in individual cases of medical reimbursement claim, it has been decided with the approval of heads of the hospitals to revise the guidelines for reimbursement by the competent authority. as follows:

(1) It has now been decided to do away with the procedure for verification of bills and issue of essentiality certificate by the treating doctor. and the Medical Superintendent of the hospital. Ministries i authorities concerned may verify and check the authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the Government servant / pensioner. In the event of any doubt, the concerned Ministry / Authority can always get verification done from the hospital concerned. Modified reimbursement claim form. alongwith checklist is annexed.

(2) All cases involving requests for relaxation of rules for reimbursement of full expenditure will henceforth be referred to a Technical Standing Committee. to be chaired by the DGHS /AddIDGHS and consist of Director (CGHS) and subject matter specialists. if the Technical Standing Committee recommends the relaxation of rules for permitting full reimbursement of expenditure incurred by the beneficiary, the full reimbursement may be allowed by the Secretary (Health 8. Family Welfare) in consultation with IFD. A check list for consideration of requests for reimbursements in excess of approved rates may include:

(a) The treatment was obtained in a private non-empanelled hospital under emergency and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalised for a prolonged period;

(b) The treatment was obtained in a private non-empanelled hospital under emergency and was admitted for prolonged period for treatment of Head injury, Coma. Septicemia, Multi-organ failure, etc.;

(c) The treatment was obtained in a private non-empanelled hospital under emergency for treatment of advanced malignancy;

(d) The treatment was taken under emergency in higher type of accommodation as rooms as per his I her entitlement are not available during that period;

(e) The treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections;

(f) The treatment was obtained in a private non-empanelled hospital under emergency when there is a strike in Government hospitals:

(g) The treatment was obtained in a private non-empanelled hospital under emergency, while on official tour to non-CGHS covered area;

(h) Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he is not eligible for air travel I treatment facilities are available in city of residence and

(i) Any other special circumstances.

4. The Office Memorandum is issued with the concurrence of IFD vide D . No: 908/AS FA12009 dated the 2oth February. 2009.

(R Ravi)

Deputy Secretary to the Government of India

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File21.pdf

Wrong Information by Central Government Pensioners to be Treated as Criminal Offence

Wrong Information by Central Government Pensioners to be Treated as Criminal Offence

If central government pensioners provide wrong information to the government, they shall face criminal cases.
Most high-ranking Central Government employees, after retirement, usually find employment in private sectors, and non-governmental organizations. If a former Central Government employee gets employed with a non-governmental organization, he/she is required to provide information about it to the Government.

While providing the information, the person has to ensure that the organization that he/she belongs to is not involved in activities that are contrary to the government’s foreign policies, national security, and goodwill in the society, or is involved in activities or campaigns that could disrupt them.

The person has to also ensure that the agency is not involved in activities that could earn commercial gains. Criminal action will be taken against the pensioner if he/she hides such information and gives false details to the government.

In addition to these, retired officials of the Central Government will also have to provide all the details of the organization that they are employed with, the reason for accepting the employment, their PAN card number, and information on the kind of activities that the organization is involved in.

The information was provided by sources at the Central Government Employees Welfare Department.

OROP News: Government to issue notification on One Rank One Pension after Bihar polls – Manohar Parrikar

OROP News: Government to issue notification on One Rank One Pension after Bihar polls – Manohar Parrikar

New Delhi: The notification on One Rank One Pension scheme will be issued “within days” of the Bihar poll process coming to an end as the model code of conduct is currently in place, Defence Minister Manohar Parrikar said today.

Asked if it would be a Diwali gift to the protesting veterans, he said, “I am trying to have it before Diwali (November 11).”

The counting of votes in Bihar will take place on November 8 but the model code of conduct will remain in place till November 12.

“It (notification) will be issued within days after the Bihar poll process ends,” Parrikar told reporters here.
He said the government did not come out with the notification as the model code of conduct has been in place.

The protesting ex-servicemen had yesterday in a letter signed in blood to Prime Minister Narendra Modi demanded early implementation of OROP scheme.

On the 133rd day of their relay hunger strike at Jantar Mantar here, the veterans said that the announcement made by Parrikar on September 5 regarding the implementation of OROP had “seven serious shortcomings”.

If implemented without the removal of the shortcomings, it will kill the definition of OROP, the letter claimed.
The letter further accused Parrikar of “changing the goalpost” every now and then.

The protesting veterans asked the Prime Minister to issue notification to implement OROP scheme at the earliest.

Indian Ex-Servicemen Movement spokesperson Col (retd) Anil Kaul said the letter was signed in blood by around 200 general officers and others.

PTI

Comprehensive transfer policy for Railway officers – Denial of inter-railway transfer requests of Group ‘C’ staff-reg

Comprehensive transfer policy for Railway officers – Denial of inter-railway transfer requests of Group ‘C’ staff-reg.

NFIR
National Federation of Indian Railwaymen
3, CHELMSFORD ROAD, NEW DELHI – 110055

Affiliated to :
Indian National Trade Union Congress (INTUC)
International Transport Workers’ Federation (ITF)

No. II/14/Part VI

Dated: 21/10/2015

The Secretary (E),
Railway Board.
New Delhi

Dear Sir,
Sub: Comprehensive transfer policy for Railway officers – Denial of inter-railway transfer requests of Group’C’ staff-reg.
Ref: (i) Railway Board’s letter No. E(O)III/2014/PL/05 dated 31/08/2015.
(ii) NFIR’s letter No. II/14/Part VI dated 28/09/2015.

*****

In continuation of Federation’s letter of even number dated 28/0912015, it is to convey to the Board that protest representations from staff are being received by NFIR against the restrictions clamped by the Board relating to inter-railway transfer requests of Group ‘C’ staff vide tettef No. E(O)III/2014/PL/05 dated 31/08/2015, NFIR strongly feels that the instructions contained under item no. (xi) in Board’s letter dated 3l/08/20l5 need to be deleted.

Complaints have also been received that the mutual transfer requests wherever approved by the competent authorities are not being implemented, lt is further brought to the notice of the Federation that the mutual transfer applications of staff are not being entertained on the plea that 5 years minimum service condition not fulfilled. There are also representations from a few staff that inter railway request transfer applications on’spouse grounds’are not being considered citing “non-fulfilment of 5 years service condition'”.

NFIR, therefore, once again urges upon the Railway Board to review the matter and issue suitable revised instructions for mitigating the staff hardships in the above situations. A copy of the instructions issued may be endorsed to the Federation.

Yours faithfully,
(Dr. M.Raghavaiah)
General Secretary

Source: NFIR

Alowing benefit of Continuous Empanelment Scheme to NABH/NABL accredited Health Care Organisation/Diagnostic Centres

Allowing benefit of Continuous Empanelment Scheme to NABH/NABL accredited Health Care Organisation/Diagnostic Centres

G.I., Ministry of Health & Family Welfare, O.M.F.No.S-11045/36/2012-CGHS(HEC), dated 16.10.2015

Subject : Allowing benefit of Continuous Empanelment Scheme to NABH/NABL accredited Health Care Organisation/Diagnostic Centres

This is with reference to the above subject.

2. The matter has been considered in view of the requests that more Health Care Organisations (HCOs) offering good quality healthcare should be empanelled under the CGHS. After careful consideration, it has now been decided that all HCOs (Hospitals/Diagnostic Centres etc.) that have finally been accredited by NABH/NABL should be allowed the benefit of the Continuous Empanelment Scheme i.e. they may be empanelled under the CGHS even if they did not apply for such empanelment in response to the tender finalised in 2014 Al other conditions for empanelment will remain the same.

3. These instructions may be brought to the notice of all NABH/NABL accredited HCOs in your jurisdiction.

sd/-
(Dr. Manoj Jain)
Sr. CMO (HEC)

Authority: http://msotransparent.nic.in/

LIST OF HEALTH CARE ORGANIZATIONS (HCOs) EMPANELLED UNDER CGHS, DELHI & NCR W.E.F. 01.10.2014 AS PER OFFICE MEMORANDUM No. S.11045/36/2012-CGHS (HEC) DATED THE 1st OCTOBER 2014 AND FURTHER ADDED ON 12.11.2014 & 10.02.2015 & 24.02.2015, 12.05.2015 & 24.06.2015 : Click to view the latest list of hospitals
Click to view the CGHS Medical Reimbursement Medical Claim Form