CGHS medical facilities reimbursement to Central Government pensioners

CGHS

CGHS medical facilities reimbursement to Central Government pensioners

CGDA, Ulan Batar Road, Palam, Delhi Cantt.-110010
(Ph.011-25665714,25665560/ Fax-011-25674806/ Email: admin14.cgda@nic.in)

IMPORTANT CIRCULAR

No.AN/XIV/19015/ Govt. Orders/TA /DA/LTC/ Medical

To,
All PCsDA/ CsDA/ PCA (Fys.)
(Through website)

Dated: 29/11/2019

Subject: Reimbursement of medical claims to Pensioners under CS(MA) Rules 1944 - guidelines issued by Ministry of Health & Family

Ministry of Health and Family Welfare vide its OM No. S.14025/23/2013-MS.EHSS dated 29th September 2016 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:-

Also check: CGHS - Central Government Health Scheme

a) Pensioners residing in CGHS covered areas:

1. They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD facilities.
2. 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.

b) Pensioners residing in non-CGHS areas:

1. They can avail Fixed Medical Allowance (FMA) © Rs. 500/- per month revised to Rs. 10001- from 01.07.2017.
2. They can also avail benefits of CGHS (OPD and IPD) by registering themselves in the nearest CGHS city after making the required subscription.
3. 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.

2. All retired/ retiring Officers/ Staff of the Defence Accounts Department may please be advised to adhere to the above provisions and subscribe to CGHS facility by depositing the required contributions for availing medical facilities after retirement.

This issues with the approval of Sr. Jt. CGDA (AN).

(Rajeev Ranjan Kumar) Dy. CGDA (AN)

Clarification regarding demarcation of CGHS covered areas under CGHS Wellness Centre

Clarification regarding demarcation of CGHS covered areas under CGHS Wellness Centre

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS
Nirman Bhawan, Maulana Azad Road
New Delhi 110 011

No. C 14012/02/2018/CGHS-III/DIR
Dated: 6th April, 2018

OFFICE MEMORANDUM

Subject:- Clarification regarding demarcation of CGHS covered areas under CGHS Wellness Centre

With reference to the above subject the undersigned is directed to state that in some of the CGHS Cities the areas covered under CGHS were not specified resulting in inconvenience to the beneficiaries. The matter has been reviewed and it is now decided that hereinafter the coverage of CGHS shall be limited to the areas within 5 km (approx.) radius of the CGHS Wellness Centres , in all CGHS covered Cities , where such demarcations were not specified. The Additional Director, CGHS concerned City shall notify such areas covered under CGHS Wellness Centres.

The serving Central government employees residing outside the CGHS covered areas shall be covered under CS(MA) Rules. However, in all CGHS covered cities the serving Central government employees residing within the Municipal limits of the city, shall be given a onetime choice to opt for CGHS (instead of CS(MA) Rules) from the nearest CGHS Wellness Centre.

S/d,
(Dr.D.C.Joshi)
Director, CGHS

Signed copy

MoD seeks clarification on the dependency of family members in CGHS & CS(MA) Rules

Revision of Income limit for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered employees subsequent to implementation of recommendations of the VI CPC-Clarification regarding

No. 9(6)/2014/D(Civ-II)

Government of India

Ministry of Defence

Sena Bhavan, New Delhi

Dated, 30th December, 2014

 

OFFICE MEMORANDUM

Subject: Revision of Income limit for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered employees subsequent to implementation of recommendations of the VI CPC-Clarification regarding.

The undersigned is directed to refer to the above mentioned subject and to state as follow:

As per MoH&FW ()M No. S-11012/1/98-(‘GHS‘(P) dated 10.12.2008 issued with the commence of Deptt of Expenditure vide ID No. 566/EV/2008 dated 4.11.2008- “It has been decided, in consultation with the Department of Expenditure, to revise the income limit for the purpose of providing CGHS coverage to the family members of the CGHS covered Central  Government employees to “Rs. 3500/- glus the amount of dearness relief on basic pension of Rs. 3500/- as on the date of consideration.

 

The income limit for dependency of Rs. 3500/- plus amount of the deamess relief on the basic pension of Rs. 3500/- as on the date of consideration Shall also be applicable for the cases covered under CS(MA) Rules, 1944 for the purpose of examining divisibility of family members of the Central Government emplqvee for medical facilities under the Rules.

 

2. However, the Note 1 below sub-section 1(1) of Section 4 of Swamy’s Compilation of the Medical Attendance Rules as amended vide Deptt of Expenditure ID No. 566/E.V/2008 dated 4.11.2008 states that “A member of the family is treated as dependent only if his/her incomes from all sources including pension/family pension is less than Rs. 3500/- (excluding dearness relief on the basis pension of Rs. 3500/)".

 

3. Since, the Note 1 below sub-section 1(1) of Section 4 of Swamy’s Compilation of the MA Rules is contradictory to the MoH&FW’ OM dated 10.12.2008, it is requested that the necessary clarification on the dependency of family members may be furnished to this Ministry immediately.

 

(Gurdgep Singh)

Under Secretary to e Govt. of India

 

To

Ministry of Health & Family Welfare,

[CGHS(P) Section],

Nirman Bhavan New Delhi.

 

Ministry of Health & Family Welfare,

(MS Section),Nirman Bhavan,
New Delhi.

Copy to: Shri Mukesh Singh, Secretary, Bharatiya Pratiraksha Mazdoor Sangh (BPMS), 2-A Naveen Market, Kanpur -20001

List of Private Hospitals under CS(MA) Rules

List of Private Hospitals under CS(MA) Rules

List of Private Hospitals in India (Recognised under CS(MA) Rules, 1944) Central Government Employees and Pensioners belonging to Non-CGHS places are covered by Central Services Medical Attendance Rules 1944 as far as reimbursement of medical expenses Out-Patient and In-Patient treatment are concerned.

Ministry of Health and Family Welfare has approved following private hospitals under CS(MA) Rules, for reimbursing package rates when Central Government Employees and Pensioners taking medical treatment in these hospitals...

No	Name of the State	Name of recognised Hospital and Address
1	Andhra Pradesh	1. CITI, Cardiac Centre, Vijay Wada.
		2. Swatantra Hospital, Rajahmundary, A.P.
		3. Nizam’s Institute of Medical Sciences, Hyderabad.
2	Arunchal Pradesh	1. Ramkrishan Mission Hospital, New Itanagar.
3	Assam	1. Welsh Mission Hospital, Shillong
		2. K&J Hills Presbyterian Hospital and Nazareth Hospital Shillong
4	Bihar	1.  Sen Institute of Pathology, Patna (for LabTests.).
		2.  Tata Main Hosptial, Jamshedpur.
		3.  Kurji Holy Family Hospital, Patna.
		4.  Sindiri Fertilizer & Chemical Ltd. Hospital, Sindri.
		5.  St. Luke’s Hospital, Hiranpur, Bihar, Sindri.
		6.  Heavy Engneering Corporations Limited Hospital, Ranchi.
		7.  Asarfi Hospital Private Limited, Dhanbad (Jharkhand)
5	Chandigarh (UT)	1. P.G.I. Chandigarh.2. Pay Clinics.
		2. Pay Clinics.
		3. Heart Care Centre, Manimajra,
		4. New Delhi diagnostic Centre, Chandigarh.
		5. Chandigarh Stone Clinic, Chandigarh.
		6. Chandigarh Clinical Laboratories Pvt. Ltd., Chandigarh.
6	Delhi (UT)	1. Batra Hospital & Medical Research Centre, 1,Tuqhlakabad Industrial Area, M.B.Road, New Delhi.
		2. Escorts Hospital & Research Centre, Faridabad (Haryana).
		3.     Dr. Anand’s Ultrasound and C.T.Scan, F-24, Preet Vihar, Vikas Marg, Delhi-92
		4.     Anand Hospital, 21, Community Centre, Preet Vihar, Delhi-92
		5.     Orthonove; 22-23, Local Shopping Complex, Madan Gir, New Delhi-62
		6.     Moolchand Khairati Ram Hospital, LajpatNagar-III.
		7.     Sarvodaya Medical Research Centre, GD-28, Pitam Pura, Delhi –34.
		8.     North Point Hospital Pvt. Ltd, 1-A, Jang Pura, New Delhi.
		9.     R.G.Store Urological Research Institute, F-7, East of Kailash, New Delhi-65.
		10. Kailash Hospital and Research Centre, H.33, Sector-27, Noida-201301 (UP).
		11. GMR, Institute of Imaging, Research Centre, 9508, Pusa Road, New Delhi.
		12. Medical Laboratory Services, E-67, Saket, New Delhi-17.
		13. South Delhi Ultrasound & X-ray Clinic, A-4, Hauz Khas, New Delhi-16.
		14. G.M.Modi Hospital & Research Centre, Mandir Marg, Saket, New Delhi.17
		15. Jaipur Golden Hospital, 2, Institutional Area, Rohini, New Delhi.85.
		16. Indraprastha Apollo Hospital, Sarita Vishar, Delhi – Mathura Raod, New Delhi-44.
		17. Delhi C.T.and M.R.I.Centre, Anshlok Hospital, 25-A, Block A-B, Community Centre, Safdarjung Enclave (behind Kamal Cinema,) New Delhi-29.
		18. Dharmashila Cancer Hospital and Research Centre, Vasundhara Enclave, Delhi-96.
		19. Dr. Handa X-ray & Diagnostic Centre, B-87, Defence Colony (Near Andrewa ganj Crossing), New Delhi –49.
		20. St. Stephens Hospital, Tis Hazari, Delhi. 54.
		21. Escorts Heart Institute & Research Centre, Okhla, new Delhi.
		22. National Heart Institute & Research Centre, Sapna Commercial Complex, New Delhi-65
7	Goa	1. Dr. P.Saudi’a Pvt. Laboratory, Panaji
8	Gujarat	1. Kasturba Hospital, Bulsar2. The Jublee Hospital, Bhuj, Kandla Port.
		2. The Jublee Hospital, Bhuj, Kandla Port.
		3. Tata Chemical Hospital, Nithpur.
		4. Bankers Heart Institute, Vadodara
		5. Baroda Heart Institute & Research Centre, Vadodara.
9	Haryana	1.      Badshah Khan Hospital, Faridabad.2.      Gujarmal Co-operative Health Bureau, Tumuna Nagar, Haryana.
10	Himachal Pradesh	NIL
11	Jammu & Kashmir	1. Srinagar Nursing Home, Srinagar.
12	Karnataka	1. Kasturba Hospital, Manipal2. Bharat Gold Mines (P) Ltd. Hospital, Oorgaum.
13	Kerala	1. Samritan Hospital, Alwaye (for CardiacSurgery)
		2. Indira Gandhi Co-operative Hospital, Cochin.
		3. Sri Ramakrishan Ashram Charitable Hospital, Thiruananthapuram,
		4. Aryavaidya Sala, Kottakal (Ayurveda)
		5. August Nursing Home &Homeopathic Research Centre, Cochin (Homoeo).
		6. Gautham Hospital,  Panayapally, Kochi.
		7. Vaidyaratnam Nursing Home, Ollur Thaikkattussery, Thrissur, Kerala.
		8. Lakshmi Hospital, Ernakulam, Cochin.
		9. Cochin Hospital, Cochin
		10.Baby Memorial Hospital, Calicut.
		11.P.V.S. Hospital, Calicut.
		12.Westfort Hi-Tech Hospital Limited, Thrissur
14	Madhya Pradesh	1. Birla Institute of Medical Research Centre,Gwalior.
		2. Kalyan Memorial & KDJ Hospital, Baradari Crossing, Morar, Gwalior.
		3. Cancer Hospital and Research Instt., Gwalior.
		4. Podhar Hospital, Podhar Betul (MP)
		5. Jabalpur Hospital and Research Centre, Jabalpur.
		6. Seth Mannulal Jagannath Das Trust Hospital, Jabalpur.
		7.  Bhandari Hospital and Research Centre, Indore (M.P)
		8.  Ayushman Hospital, Bhopal.
		9.  Chirayu Health and Medicare (P) Ltd. Hospital, Bhopal – MP.
		10. Hajela Hospital, Bhopal, MP.
		11. Chandak Hospital and Research Institute, Gwalior (MP).
		12. Charak Hospital Pvt. Ltd, Indore (MP).
		13. New Pandey Hospital, Shanichara, Hoshangabad
15	Meghalaya	1. Welsh Mission Hospital, Shillong.
		2. Ganesh Das Hospital for Women and Children, Shillong.
		3. K.J.Hills Presbyterian Hospital, Shillong.
16	Mizoram	1.     Presbyterian Chruch Synod Hospital, AizwalDistt.
		2.     Sirkawan Christian Hospital, Longel Distt.
17	Maharashtra	1. Salvation Army Evangeline Booth Hospital, Ahmednagar.
		2.  Barshi Maternity & General Co-operative Hospital, Barshi.
		3. S.K.Patil Argya Dham. Malad.
		4. Ji Jamata Hospital, Vashi, New Mumbai.
		5. Wanless Hospital, Miraj Medical Centre, Miraj.
		6. Mure Memorial Hospital, Nagpur.
		7. Pune Medical Foundation, Pune.
		8. N.M.Wadia Hospital, Pune.
		9. Sancheti Hospital, Pune.
		10. Talegaon General Hos. & Convalescent Home and T.B.Hospital Sanatorium Telegaon.
		11. Sanjeevani Hospital, Utamnagar, Pune.
		12. Harikdar Hospital, Pune
		13. Kasturba General Hospital, Pune
		14. Poona Hospital & Research Centre, Pune.
		15. Century Rayan Hospital, Sholapur
		16. N.M.Wadia Hospital, Sholapur.
		17. Kavde Nursing Home, Pune
		18. Deendayal Memorial Hospital, Pune
		19. N.M.wadia Instt. of Cardilogy, Pune.
		20. Jaslok Hospital, Mumbai
		21. Bombay Hospital, Mumbai
		22. Madhukar General Hospital, Pune.
		23. Krishna General Hospital and Stree Clinic, Pune.
		24. Surya Hospital Pvt. Ltd., Pune
		25. Swami Sarvanand Hospital, Ulhas Nagar (Maharastra)
		26. Rajebahadur Heart Foundation Private Ltd.,Nashik.
		27. Dr. Bapaye Hospital, Nashik
		28. Pawana Hospital, Pune.
		29. Padma Dental Care Unit, Chandrapur
		30. Athare Patil Memorial Hospitals & Research Centre Pvt. Ltd. Savedi Road, Ahmednagar
		31. Ashwini Sahakari Rugnalaya and Research Centre, Solapur
		32. Giriraj Hospital, Padmashree Dr. Appasaheb Pawar Heart Care Centre, Pune
		33. Anandrishiji Hospital & Medical Research Centre, Ahmednagar
		34. Sayali Nursing Home, Pune
18	Orissa	1. Panch Karma Centre of Govt. Ayurvedic Hospital, Bhubneswar
19	Punjab	1. B.B.C.Heart Care Pruthi Hopital, Jalandhar (under CS (MA) Rules, 1944.
		2. Sacred Heart Hospital, G.T. Road, Maqsudan, Jalandhar
		3.Tagore Hospital & Heart Care Centre (P) Ltd. Jalandhar
20	Rajasthan	1. Global Hospital and Research Centre MountAbu-Rajasthan.
		2. Rungta Children and General Hospital, Malviya Nagar, Jaipur.(General Purpose treatment diagnostic procedures and specialized treatment for paediatrics.
		3. Soni Hospital, J.L.N.Marg, Jaipur.(General purpouse treatment and diagnostic procedure ande specialized services for CT Scan.)
		4. Heart and General Hospital Yudhistermarg,   Jaipur (Specialized treatment for Cardiology.)
		5. Lakshmi Imaging and Medical Research Hospital, J.L.N.Marg, Soni Hospital Campus, Jaipur.(Specialized services for MRI and CT Scan.).
		6. Rajdhani Clinic and Nursing Home, Jaiput.(Specialized services for General Surgery.
		7. K.C. Memorial Hospital, Jaipur(Specialized treatment for Ophthalmology.)
		8. Urology and Medical care Centre ,Jaipur.(Specialised treatment for Urology.)
		9. Sharda Nursing Home, Hospital Road, Jaipur.(Ophthalmology.)
		10.Shri Amar Jain Medical Relieve Society, Choura Rasta, Jaipur.(General purpose treatment and diagnostic procedure)
		11.Jain Eye Hospitaal, Fathe Teba, Adarash Nagar, Jaipur (Specialized treatment of Ophthalmology.)
		12.Gheesi Bai Memorial Mittal Hospital & Research Centre, Pushkar Road, Ajmer
		13.Goyal Hospital & Research Centre (P) Ltd. Jodhpur
21	Tamil Nadu	1. Sir Ivan Stedford Hospital, Ambattur.
		2.  Apollo Hospital, Chennai
		3.  Catterin Booth Hospital, Nagercoil.
		4. Sacred Heart Hospital, Tuticorin.
		5. C.M.C. Hospital, Vellore.
		6.  Trinity Acute Care Hospital, Madras.
		7.  K.J.Hospital, Chennai
		8.  Sankara Netralaya, Chennai
		9. Meenakshi Mission Hospital and Research Centre, Madurai.
		10. A.V.M. Hospital, Tuticorin, Tamilnadu.
		11. K.G.Hospital, Coimbatore, T.N.
		12. Kovai Medical Research Centre and Hospital Limted, Coimbatore.
		13. Ashwin Poly Clinic Pvt. Ltd., Coimbatore.
		14. Apollo Speciality Hospital, Madurai
		15. Sundaram Arulrhaj Hospitals, Tuticorin
22	West Bengal	1.   Ramkrishna Mission Seva Pratisthan, Kolkata.
		2.  Charteris Hospital, Kalimpong, Darjeeling
23	Uttar Pradesh	1. Muslim University Jawaharlal Nehru Medical College Hospital, Aligarh.
		2. Narinder Mohan Hospital, Ghaziabad.
		3. Ramakrishna Mission Viveka Nanda Polyclinic.
		4. Sitapur Eye Hospital, Sitapur.
		5. Regency Hospital Pvt. Ltd., A-2, Sarvodaya Nagar, Kanpur – U.P.
		6. Noida Medical Centre Ltd. 16-C, Sector –30, Noida, U.P.
		7. Heritage Hospital, Lanka, Varanasi
		8. Peoples Heritage Hospital Ltd, Agra 282002.
		9. Apollo Pankaj Hospital, Agra-282007.
		10. Pushpanjali     Hospital     &     Research     Centre, Pushpanjali Palace, Agra.
		11. Shanti Mangalick Hospital, Agra 282001.
		12.Upadhyay Hospital, Shaheed Nagar Crossing, Agra
24	Uttranchal	1. Himalayan Institute Hospital Trust Jolly Grant, Dehradun.

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File433.pdf

Weight-loss surgery free for Central Govt Employees

Weight-loss surgery free for Central Govt Employees

NEW DELHI: The growing demand for weight-loss surgeries from sarkari babus has forced the Centre to include the procedure, long considered a lifestyle choice, in the central government health scheme (CGHS) list. It will now be available free of cost to those covered under the government scheme at select hospitals.

According to the Union health ministry, guidelines of the US National Institute of Health will be used for select candidates for the procedure. The government has fixed a package rate of Rs 2.25 lakh per person for such a surgery. In India, an estimated 200 million people suffer from weight-related issues. According to Dr Praveen Bhatia, executive member of Obesity Surgery Society of India, close to 2,000 persons undergo weight loss surgery every year. Bariatric surgery involves stapling of a portion of the stomach to reduce a person's appetite.

"The decision has been taken in view of the increasing number of requests for bariatric surgery, commonly known as weight-loss surgery," said a senior health ministry official. He said that till date there no guidelines for consideration of weight-loss surgery under the CGHS scheme and the requests were considered on merits of each case.

The new guidelines provide for reimbursement of surgery charges to patients who have BMI more than or equal to 40 kg/m2. If the person has obesity related co-morbidities, for example hypertension, cardio-vascular disease and diabetes, then surgery can be considered even if the BMI is more than or equal to 35 kg/m2.

The BMI of a healthy individual is anywhere between 18-23 kg/m2, said Dr Deep Goel, director, department of minimal access, bariatric surgery at B L Kapoor Hospital. "The government seems to have finally realised that weight-loss surgery is not a mere cosmetic procedure. It is a life-saver for very obese patients," said Dr Pradeep Chowbey, director, Max Institute of minimal access, metabolic and bariatric surgery.

"The decision will help those unable to afford the procedure on their own. Also, it will force private insurance companies to re-think their policy against reimbursement for weight loss surgery," Dr Bhatia, who chairs the bariatric surgery unit at Sir Ganga Ram hospital, added.

Experts, however, warn that people should not rush to undergo the surgery just because it will be reimbursed or they want to look better. "We get many patients who seek to undergo the procedure to look better or youngsters seeking to get married. One needs to think over the consequences of surgery and diet restrictions before deciding to undergo the same. Also, a wrong surgery conducted by an inexperienced doctor can put the patient at risk for leak and death," said another senior doctor.

Source: http://timesofindia.indiatimes.com
Click here to view Guidelines and Ceiling Rates for Permission/Reimbursement for Bariatric Surgery Procedures under CGHS/CS(MA) Rules