KVS Orders 2013 : Government employees take treatment from any hospital recognized by the State Government / CGHS / CS(MA) Rules

KVS Orders 2013 : Government employees take treatment from any hospital recognized by the State Government / CGHS / CS(MA) Rules

Kendriya Vidyalaya Sangathan
18, Institutional Area, Shaheed Jeet Singh Marg, New Delhi-16.

F.No.110239/51/Cir./2013/KVS(Budget)

Dated 03.04.2013

The Deputy Commissioner
Kendriya Vidyalaya Sangathan
All Regional Offices.

Subject : Govt. employees and the members of their family take treatment from any hospital recognized by the State Government / CGHS / CS (MA) Rules - regarding.

Sir,
I am to refer to the subject cited above and to state that references have been received by this office as to whether Govt./KVS employees covered under CS(MA)Rules can avail treatment from Hospitals recognized under CGHS Scheme. In this connection, it is informed that the orders issued by the Govt. of India Ministry of Health and family welfare vide OM No. S.14025/7/2000-MS, dt 28th March, 2000 and No.S.14021/06/2005-MS dt. 4th January, 2007 were already circulated to all the Units of the Sangathan for reference and further action vide KVS letter No.161-3/99-2000/KVS/Budget dt.26.7.2000 and Letter No.125-21/2006-07/KVS (Budget) dt. 22.5.2007 (copy enclosed). However the said orders are once again circulated to all the Units of the Sangathan for reference and further action.

Yours faithfully,
sd/-
(S.Muthusivam)
Asstt. Commissioner (Fin.)

CGHS Orders 2013 : Regarding tests/investigations at private hospitals / diagnostic laboratories / imaging centres empanelled under CGHS.

CGHS Orders 2013 : Regarding tests/investigations at private hospitals / diagnostic laboratories / imaging centres empanelled under CGHS. ( Office Memorandum of even no. dated 1st January, 2013)

S-11045/40 /2012/CGHS/HEC/CGHS (P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 15th January, 2013

OFFICE MEMORANDUM

Subject: Regarding tests/investigations at private hospitals / diagnostic laboratories / imaging centres empanelled under CGHS.

The undersigned is directed to refer to the Office Memorandum of even no. dated 1st January, 2013 on the above subject and to further lay down the procedure for getting the diagnostic tests / investigations carried out at the CGHS empanelled private hospitals / diagnostic laboratories / imaging centres on a valid prescription issued by a CGHS Medical Officer / Government Specialist, without a referral / permission letter from the Department concerned or CMO-in-charge of CGHS Weliness Centre, as the case may be.

2. The CGHS empanelled private hospitals / diagnostic laboratories / imaging centres shall perform the investigations /diagnostic tests as prescribed by the CGHS Medical Officer /Government Specialist on cashless basis to the CGHS pensioner beneficiaries, ex-MPs, freedom fighters and other eligible categories of CGHS beneficiaries, who are presently eligible for credit facility, at CGHS approved rates, only in respect of the tests / investigations for which CGHS rates are available.

3. The Serving beneficiaries will not require any permission from their Department for getting the diagnostic tests / investigations carried out in a CGHS empanelled private hospital /diagnostic laboratory / imaging centre in respect of investigations for which CGHS rates are available. They will get the prescribed tests done on payment basis and claim reimbursement from their Office.

4. For providing cashless facilities to the eligible CGHS beneficiaries, the empanelled private hospital / diagnostic laboratory / imaging centre shall obtain the prescription either in original or self-attested copy of the prescription and self attested photocopies of the CGHS card of the patient and the CGHS card of the main CGHS card holder beneficiary and enclose the same with their bills for claiming payment from CGHS or the Department concerned, as the case may be. The hospital / diagnostic laboratory / imaging centre shall
however, verify the self attested copies from the original prescription / CGHS cards, before allowing the credit facility to the eligible CGHS beneficiary.

5. The medical prescription issued by a CGHS Medical Officer / Government Specialist prescribing diagnostic tests / investigations shall be treated as valid for a single use within a period of two weeks from the date of prescription unless specifically provided otherwise by the Government Specialist in the prescription, about the date or period after which the prescribed tests are to be conducted for a follow up treatment. The medical prescription would require revalidation or issue of a fresh prescription from the prescribing CGHS doctor/Government Specialist for getting the prescribed tests done after expiry of the validity period of two weeks, as indicated above.

6. The CGHS empanelled private hospitals / diagnostic laboratories / imaging centres shall provide cashless facilities to the serving CGHS beneficiaries entitled for credit facilities in terms of this Ministry’s OM No Rec.1-2008/ Gr./CGHS/Delhi/CGHS (P) dated 10.06.2008, on submission of a self attested photocopy of his / her identity card issued by the Department / Ministry, alongwith self attested photocopies of the CGHS card of the patient and the main cardholder. The hospital / diagnostic laboratory / imaging centre shall enclose the above documents with their bills to the Department concerned for claiming payment.

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

Source: www.msotransparent.nic.in
[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File561.pdf]

Emergency Treatment in CGHS Hospitals – List of Emergency conditions

Emergency Treatment in CGHS Hospitals

CGHS Hospitals – Getting treatment in emergency conditions

 

Under emergency conditions, the empanelled hospitals are expected to provide treatment of CGHS beneficiaries in all available specialities.

 

Private hospitals have been empanelled under CGHS only for such specialities for which they are eligible as per the terms and conditions of empanelment. However under emergency conditions, the empanelled hospitals are expected to provide treatment of CGHS beneficiaries in all available specialities.

 

“Emergency” shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the earliest opportunity would  be detrimental to the health of the patient or shall jeopardize the life of the patient”.

 

CGHS beneficiary attending hospital in emergency: In such a situation the Hospital shall intimate  to BCA within 2 hours of admission and BCA shall respond in 4 hours (however treatment shall not be denied to any CGHS member and this is only an initiation of the e-workflow). Post discharge hospital would upload bills and  download documents as per requirements of CGHS within 72 hours.

 

TREATMENT IN EMERGENCY 

In emergency the hospital shall not refuse admission or demand an advance payment from the beneficiary or his family member and shall provide credit facilities to the patient whether the patient is a serving employee or a pensioner availing CGHS facilities, on production of a valid  CGHS card and the hospital shall submit the bill for reimbursement to the concerned Deptt. / Ministry / CGHS.  The refusal to provide the treatment to bonafide CGHS beneficiaries in emergency cases without valid ground, would attract disqualification for continuation of empanelment.

 

The following ailments may be treated as emergency which is  illustrative only and not exhaustive, depending on the condition of the patient :

 

Acute Coronary Syndromes (Coronary Artery Bye-pass Graft / Percutaneous, Transluminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra Ventricular Tachycardia, Cardiac Temponade, Acute Left Ventricular Failure / Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stoke Adam attack, Acute Aortic Dissection.

 

Acute Limb Ischemia, Rupture of Aneurysm, Medical  and Surgical shock and peripheral circulatory failure. Cerebro-Vascular attack-Stokes, Sudden unconsciousness, Head injury, Respiratory failure, decompensated lung disease, Cerebro-Meningeal Infections, Convulsions, Acute Paralysis, Acute Visual loss.

Acute Abdomen pain.

Road Traffic Accidents / with injuries including fall. Severe

Hemorrhage due to any cause.

Acute poisoning.

Acute Renal Failure.

Acute abdomen pain in female including acute Obstetrical and Gynecological emergencies.

Electric shock. 

Any other life threatening condition.

 

Source: CGEN.in