Clarification regarding issue of medicines under CGHS

Clarification regarding issue of medicines under CGHS

No. 2-2/2014/CGHS(HQ)/PPTY / CGHS(P)

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108

Dated: the 23rd December, 2014

OFFICE MEMORANDUM

Subject: Clarification regarding issue of medicines under CGHS

With reference to the above mentioned subject the undersigned is directed to state that the situation arising out of issue of Office Memorandum No 2/2014/CGHS(HQ)/PPTY / CGHS(P) dated the 25th August ,2014 has been engaging the attention of Government for quite some time. Various representations about the difficulties being encountered have been received from different stakeholders i.e., beneficiaries and doctors, necessitating a review of the matter. It was accordingly considered by a Committee under the Chairmanship of AS&DG,CGHS. After careful review and keeping the recommendations of the Committee in mind, the following guidelines are issued to streamline the functioning of the Wellness Centres:

i. The medicines are to be issued as per the CGHS Formulary and guidelines issued by this Ministry in this behalf.

ii. In case the prescribed medicines are not available in CGHS formulary, but are essential for the treatment of the patient, they can be issued / indented by the doctors of the CGHS Wellness Centre on the basis of a valid prescription of the authorized specialist subject to the condition that such medicines are neither dietary supplements/ food items nor banned drugs. Instructions on this issue i.e., non-admissibility of food items etc. issued vide O.M .No. 39-3/2003-04/CGHS/MSD/RS dated 23rd July 2009 and 3rd August 2009 must be followed.

iii. In case of anti-cancer drugs and other life-saving drugs that are not approved by the DCG1 for use in India, each case should be considered by the Expert Committee under the Chairmanship of Special DG(DGHS).

iv. The technical Standing Committee constituted vide 2-2/2014/CGHS(HQ)/PPTY / CGHS(P) dated 27.08.2014 of this Ministry will review addition or deletion of drugs in the CGHS Formulary/ list of Treatment procedures / investigations / listed implants. The Technical Committee will meet once in three months or as per need, whichever is earlier. In the meantime reimbursement for unlisted procedures / implants will be made at the rates approved by AIIMS/GB Pant Hospital / actuals, whichever is less.

2. The O.M. of even number dated 25.08.2014 is superseded to the above extent while O.M. of even number dated 1.10.2014 is withdrawn.

Sd/-

(Bindu Tiwari)
Director, CGHS(P)
(Tel 2306 1831)

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File866.pdf

The continuous empanelment scheme would be in force initially upto 28th February, 2015 for all CGHS cities except Mumbai.

The continuous empanelment scheme would be in force initially upto 28th February, 2015 for all CGHS cities except Mumbai.

S. No. 11045/36/2012/CGHS/HEC
GOVERNMENT OF INDIA
Central Government Health Scheme
Nirman Bhawan, New Delhi

GUIDELINES FOR CONTINUOUS EMPANELMENT SCHEME FOR EMPANELMENT OF PRIVATE HOSPITALS, DIAGNOSTIC LABORATORIES, EXCLUSIVE EYE CENTRES AND DENTAL CLINICS WITH CGHS.

Background

With a view to ensuring comprehensive health care to CGHS beneficiaries, CGHS has been, apart from the Government Hospitals, empanelling private hospitals, diagnostic laboratories, exclusive eye centres and dental clinics by floating tenders periodically. The last tender process in this context commenced in the January 2014 and through this process package rates for different treatment procedures and investigations have been notified in 2014. As a part of this process, certain hospitals and diagnostic laboratories exclusive eye centres and dental clinics which participated in e-tender process and accepted these rates and also signed MOAs with CGHS have been notified in all CGHS cities except Mumbai.

However, it has been noticed that the number of hospitals, diagnostic laboratories,exclusive eye centres and dental clinics notified in certain cities through the current tender process is not adequate to provide a satisfactory level of Healthcare to CGHS beneficiaries. Also, there has been little or no response in certain other cities, with the result a situation has arisen where CGHS is not in a position to provide to its beneficiaries the requisite healthcare due to lack of adequate number of hospitals, diagnostic laboratories and exclusive eye centres and dental clinics .

Accordingly, it has become necessary to introduce continuous empanelment scheme, under which more hospitals, diagnostic laboratories and imaging centres could be empanelled to take care of inadequacy. In this background, it is proposed to invite willing hospitals, diagnostic laboratories exclusive eye centres and dental clinics to apply for empanelment under CGHS if they fulfill the same eligibility conditions and accept the rates notified by CGHS in 2014.

Empanelment shall be for a period of 2 years or as applicable to other HCOs empanelled earlier through e-tender in 2014 whichever is earlier.

The continuous empanelment scheme would be in force initially upto 28th February, 2015 for all CGHS cities except Mumbai.

Source-http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File859.pdf

Regarding extension of validity of empanelment of All Health Care Organizations emganelled under CGHS

Regarding extension of validity of empanelment of All Health Care Organizations emganelled under CGHS

No: S.11045/36/2012/CGHS (HEC) (Pt.)
Government of India
Directorate General Of Central Govt. Health Scheme

Maulana Azad Road, Nirman Bhawan
New Delhi 110108, dated the 31st July, 2014

O F F I C E   O R D E R

Subiect: Regarding extension of validity of empanelment of All Health Care Organizations emganelled under CGHS.

Attention is drawn to the Office Memorandum issued earlier extending validity of empanelment of all health care organizations under CGHS till 31st July, 2014.

2. It has now been decided to extend the validity of empanelment of all health care organizations already empanelled under CGHS, for a further period of, one month i.e. till 31st August, 2014 or till finalization of next empanelment process, whichever is earlier on’ same terms and conditions as defined in OM on which they were empanelled earlier.

sd/-
[Dr. (Mrs.) Sharda Verma]
Director (CGHS)

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File716.pdf

New Medical Reimbursement Claim (MRC) Form for CGHS beneficiaries

New Medical Reimbursement Claim (MRC) Form for CGHS beneficiaries. The Medical Reimbursement Claim Form has been reviewed and further simplified. Separate forms have been developed for serving beneficiaries and pensioner beneficiaries with requirement of minimum information required for processing of the claims. CGHS Order:-

No.S. 11011/9/2012-CGHS (P)

Government of India

Ministry of Health & Family Welfare

CGHS (Policy)

Nirman Bhawan, New Delhi

Dated the 5th June, 2014

OFFICE MEMORANDUM

Sub:- Revision of Medical Reimbursement Claim (MRC) Form for CGHS beneficiaries - reg.

The undersigned is directed to state that it has been the constant endeavour of the Ministry of Health & Family Welfare to improve the facilities under CGHS and simplify / liberalize the procedures to make the Scheme user friendly.

2. In furtherance of the above objective, the Medical Reimbursement Claim Form has been reviewed and further simplified. Separate forms have been developed for serving beneficiaries and pensioner beneficiaries with requirement of minimum information required for processing of the claims. The CGHS beneficiaries are required to submit their medical reimbursement claims in the prescribed forms with requisite documentary evidences to their Department / office or CGHS, as the case may be for further processing and settlement as per approved CGHS rates and guidelines.

 

3. The following forms have been prescribed:

Form MRC(S) - For Serving CGHS beneficiaries,
Form MRC(P) - For Pensioner CGHS beneficiaries.

Specimen Forms are enclosed
Encl: As Above

sd/-

[V.P. Singh]

Director

Click on following images to save or view:-

Medical Reimbursement Claim Form for Serving Employees Page 1

Medical Reimbursement Claim Form for Serving Employees Page 2

Medical Reimbursement Claim Form for Pensioner Page 1

Medical Reimbursement Claim Form for Pensioner Page 2

Medical Reimbursement Claim Form Annexure-I

Medical Reimbursement Claim Form Annexure-II

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File692.pdf

Renewal of CGHS plastic cards In Delhi NCR – regarding

Renewal of CGHS plastic cards In Delhi NCR – regarding.

S 11011/11/2014-CGHS (P)
Government of India
Ministry of Health and Family Welfare
CGHS (P)

Nirman Bhavan, New Delhi
Dated: the 12th March 2014

OFFICE MEMORANDUM

Sub: Renewal of CGHS plastic cards In Delhi NCR – regarding.

The undersigned is directed to refer to this Ministry’s O.M No. S 11011/1/2014-CGHS (P) dated 10.02.2014 vide which fresh instructions were Issued supplementing the existing guidelines on the issue of CGHS Plastic cards. In this regard attention is also drawn to this Ministry’s O.M. No. Misc. 6024/2007/CGHS(HQ)/CGHS(p) dated 27.12.2010 in respect of pensioner CGHS beneficiaries vide which it was clarified that :-

“The Plastic Cards (which are identity cards), would hereinafter be issued with validity till the pensioner beneficiary is entitled for CGHS benefits. In respect of pensioner CGHS beneficiaries, who have paid CGHS contribution for ‘Rest of Life’ CGHS facilities, the Plastic Cards would, hereinafter, be issued for ‘Rest of Life’.

The plastic cards already issued with a printed vahdity of five years to pensioner beneficiaries, who had paid CGHS contributions for ‘Rest of Life’ CGHS facilities, would be taken as valid for use for ‘Rest at Life’. However, such CGHS pensioner beneficiaries have the option to obtain new plastic cards after five
years, if they choose to do so.”

2. Accordingly, the CGHS pensioner beneficiaries have the option to apply for new CGHS plastic card which are now being issued with validity for ‘whole life’ printed on the plastic card Itself. However, the serving employees are issued CGHS plastic cards with validity of five years and they are due for renewal every five years on expiry of validity period indicated on their CGHS plastic card. Fresh cards are being issued in place of old cards on regular basis. Since the applications are being received for renewal of old cards in a very large number, It has created bottleneck and it is taking some time to issue fresh cards.

3. In light of the above, with a view to avoid inconvenience to the CGHS beneficiaries and to facilitate them in availing CGHS services, it has been decided to allow them to access CGHS facilities with the old cards for a further period of six months from the date of expiry of CGHS cards as indicated on their CGHS Plastic cards. However, they have to apply for renewal of CGHS plastic card in the prescribed Form as provided in this Ministry’s OM dated 10.02.2014 as referred to above.

4 In this connection, it is clarified that the beneficiaries  who have already submitted applications for renewal of CGHS cards on expiry of their validity period and have so far not received fresh CGHS cards, they will not be denied CGHS facilities, provided the beneficiary is entitled to CGHS benefits as per CGHS guidelines.

5. A CGHS beneficiary Is required to apply for new CGHS plastic cards three months In advance or within six months of expwy of validity of the plastic cards and it Is recommended to keep a copy of the same as a proof of submission of application for renewal of card which can be produced on demand before the CGHS authorities, if required, for availing the CGHS benefits on the basis of old card.

6. CGHS Weilness Centres will provide the medic facilities to CGHS beneficiaries on the basis of old CGHS plastic card upto a maximum period of six months from the date of validity as indicated on the CGHS plastic card after due verification of the entitlement and validity of CGHS card as per CGHS data base.

7. The CGHS empanelled private hospitals / diagnostic centres are requested to provide the medical facilities on the basis of old card upto a maximum period of six months from the date of validity as indicated on the CGHS plastic card, subject to the condition that the CGHS beneficiary has submitted the application for renewal of CGHS plastic card, complete in all respect, to the CGHS card issuing authority.

8. This OM shall come into effect from the date of issue and will remain in force for one year or till further order, whlchever is earlier.

sd/-

[V. P. Singh]
Deputy Secretary to the Government of India

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File669.pdf

Renewal of CGHS Plastic Cards – reg.

Renewal of CGHS Plastic Cards - CGHS Orders

The Department of Health and Family Welfare issued orders about the renewal of CGHS plastic cards.

S 11011/1/2014-CGHS (P)
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare
CGHS (Policy) Division

Nirman Bhavan, New Delhi
Dated: the 10th February, 2014

OFFICE MEMORANDUM

Sub: Renewal of CGHS Plastic Cards – reg.

The undersigned is directed to refer to this Ministry’s O.M No.S.11012/3/2011-CGHS (P) dated 29.12.2011 laying down the guidelines for issue of individual plastic cards to CGHS beneficiaries. CGHS Plastic Cards were introduced in September, 2008 in Delhi NCR and the cards were initially issued with a validity period of 5 years. The CGHS Plastic Cards completing their validity period are due for renewal and accordingly fresh cards with renewed validity period are being issued by the Office of Additional Director, CGHS of the city concerned. With a view to further streamline the process of renewal of CGHS Plastic Cards, it has been decided to issue the following guidelines supplementing the existing instructions on issue of CGHS Plastic Cards:

Serving beneficiary

a) Application for renewal of CGHS Plastic Cards in the prescribed proforma (Form AA) alongwith requisite documents (current photographs, copy of pay slip and address proof of residence, if changed), should be submitted through their Administrative Office to the Office of Additional Director, CGHS of the respective CGHS city following the same procedure as prescribed for issue of fresh CGHS card.

b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with a validity period of 5 years.

c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry.

Pensioner beneficiary

a) Application for renewal of Pensioners’ CGHS Plastic Cards in the prescribed proforma (Form BB) alongwith requisite documents (current photographs, PPO or LPC, address proof, if changed) should be submitted to the parent CGHS Wefiness Centre where his /her card is registered. He / she can also submit the application to the Office of Additional Director, CGHS of the respective CGHS city for renewal of CGHS cards.

b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with validity for lifetime or up to the date for which the contribution has been made by the beneficiary.

c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry. This issues with the approval of Additional Secretary and Director General, CGHS.

End: Specimen Form AA and Form BB.

sd/-
(V.P.Singh)
Deputy Secretary to the Government of India

Source: http://msotransparent.nic.in/cghsnew/index.asp

CGHS Orders - Withdrawal of Super-Specialty status of Paras hospital Gurgaon under CGHS with immediate effect.

CGHS Orders - Withdrawal of Super-Specialty status of Paras hospital Gurgaon under CGHS with immediate effect.

No: S.11045/23/2013-CGHS.D.II/HE
Government of India
Directorate General of Central Government Health Scheme
Department of Health and Family Welfare

Nirman Bhawan, New Delhi,
Dated the 11th December, 2013

To,
The Medical Superintendent,
Paras Hospital,
Shushant Lok,
Gurgaon.

Subject : Withdrawal of Super-Specialty status of Paras hospital Gurgaon under CGHS with immediate effect.

With reference to the empanelment of hospitals under CGHS vide Ministry of Health and family Welfare Office Memorandum No: S.1011/23/2009-CGHS D.II/Hospital Cell (Part IX) dated 14.02.2013 and subsequent CGHS Directorates Office Order of even no. dated 27.08.2013 vide which Paras hospital was categorized as Super-Specialty hospital under CGHS, the undersigned is directed to convey that It has been decided to withdraw Super specialty status of Paras Hospital Gurgaon under CGHS with immediate effect till further orders.

You are required to treat COilS beneficiaries and raise the bills as per CGHS approved rates of NABH accredited hospitals. Overcharging if any would be recovered from the pending bills of the hospital.

This issues with approval of competent authority.

sd/-
Sr. CMO(HEC)
Room No. 524-A Wing
Nirman Bhawan. New Delhi

Source: http://msotransparent.nic.in/cghsnew/index.asp