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CGHS - Follow-Up Treatment Of CGHS Beneficiaries In Recognized Hospitals

with 0 Comment
CGHS Orders : Follow-up Treatment of CGHS Beneficiaries in Recognized Hospitals (No. S-11011/1/2000-CGHS dt: 10/4/2001)

Text of MH &FW, O.M. F.No. S-11011/1/2000-CGHS (P) dated 10/4/2001 Follow-up Treatment of CGHS Beneficiaries in Recognized Hospitals

The undersigned is directed to refer to Office Memorandum 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. 

CGHS - Reimbursement Of The Cost Of OPD Medicines For Treatment In Post Operative Conditions

with 0 Comment
CGHS Orders : Reimbursement of the cost of OPD medicines for treatment in post operative conditions (No. Misc. 10001/2000/JD/R&H/CGHS/CGHS(P) dt: 30/4/2001)

Text of MH & FW, O.M. F. No. Misc. 10001/2000/JD/R&H/CGHS/CGHS(P),dated 30/4/2001

Reimbursement of the cost of OPD medicines for treatment in post operative conditions like Cardiac Surgery, Organ transplantation, Knee/hip replacement, Neuro surgical/neurological cases and cancer.

The issue of reimbursement of the cost of OPD medicines in certain conditions has been under consideration in the Ministry of Health and Family Welfare for some time. As per existing procedure the cost of OPD medicines are not reimbursable except in cases of maintenance Haemodialysis. However, keeping in view the difficulties and financial hardship faced by the CGHS beneficiaries, it has now been decided that reimbursement of the cost of OPD medicines may be considered for the following cases:

a. Post operative cases of major Cardiac Surgery/Cardiology.
b. Oncology cases.
c. Post Operative Organ transplant cases.
d. Post operative Joint replacement cases.
e. Post operative Major Neurosurgical/Neurology cases
2. As drugs are costly, a utilization certificate from the treating specialist should be obtained by the beneficiary while preferring claims.

3. The reimbursement will be permissible only if the initial treatment has been taken with prior permission of competent authority in a Government Private recognized hospital.

4. The reimbursement will be allowed for an initial period of six months from the date of discharge from the hospital and in case further extension is required, fresh recommendation from a Government Specialist will have to be obtained for further continuation of the treatment.

5. This issues with the concurrence of Finance Division vide their Dy. No.2780/2001-JS (FA), dated 26/4/2001. 

Authority: http://cghsmumbai.gov.in

CGHS - Fixation Of Ceiling Limit For Nebulizer To Be Reimbursed

with 0 Comment
CGHS Orders: Fixation of Ceiling Limit for nebulizer to be reimbursed No.11006/2000-JD(R & H)/CGHS(P), dt: 11.6.2001

Text of MH & FW, O.M. No. Misc. 11006/2000-JD(R & H)/CGHS(P), dated 11/6/2001

Fixation of Ceiling Limit for nebulizer to be reimbursed under CGHS and CS(MA) Rules

The undersigned is directed to say that the matter regarding fixation of ceiling limit for reimbursement of the cost of Nebulizer has been under consideration of the Government for some time past. It has now been decided to fix the ceiling with regard to he purchase of Nebulizer at Rs. 3,000/- or the actual cost whichever is less.

2. Permission for use of Nebulizer/ex-post-facto approval may be given only on the advice of Senior Physician or above or Medical Specialist of equivalent rank of a Government Hospital.

3. Keeping in view the average life of a Nebulizer as 5 years, replacement may be permitted on the basis of a certificate of condemnation obtained from the treating physician/specialist as indicated above. The cost of maintenance will be borne by the beneficiary concerned. No request for provision of another Nebulizer may be entertained within 5 years from the date of initial purchase.

4. Reimbursement will be done from Service Head in case of serving Government employees, serving employees and pensioners of autonomous bodies in case of autonomous bodies, and by Lok Sabha / Rajya Sabha Secretariat, as the case may be, in case of MPs and from CGHS Head in case of pensioners, Ex-MPs and Freedom Fighters.

5. These orders will be applicable from the date of issue.

6. These orders will be applicable for beneficiaries covered under CS(MA) Rules, 1944 also.

7. This issues with the concurrence of Finance Division vide their Dy. No.3674/2001-JS(FA) dated 7.6.2001.

Rates of Contribution
CGHS contribution rates effective from 1/5/1998 are as under:



Issue of Identity Card to Serving Employees:

  • i. The Central Government Health Scheme Directorate shall supply the blank Index as well as Identity Cards bearing identical serial numbers to the Central Government offices as per their requisition.
  • ii. The issuing authority shall get the Index and Identity cards filled up by the employee concerned in duplicate mentioning the name of the Card holder and details of family members eligible for CGHS facilities, their date of birth, relationship with the employee etc.
  • iii. The Index Card/Identity Card so filled by the employees has three parts. The first part shall be retained by the issuing authority, second part shall be forwarded to the Deputy Director/Chief Medical Officer of CGHS of the respective cities, and the third part handed over to the employee concerned.
  • iv. An attested photograph of the family members of the beneficiary shall be affixed on the Identity Card duly signed by the officer issuing the card.
  • v. The employee shall deposit the Index Card with the Medical Officer Incharge of the allotted dispensary and retain the Identity Card with himself. The fact of submitting the Index Card should be
  • acknowledged or endorsed on the Identity Card.
  • vi. For availing medical facilities, the beneficiary must show his Identity Card on every visit to the Medical Officer posted at the dispensary.


Issue of Two Separate Identity Cards

  • i. Where the family members wholly dependent on the Government Servant, are residing permanently in some other city covered under the Scheme, the Issuing Authority, after  ensuring the above fact, may issue two separate CGHS Cards (bearing the same serial number) – one for the employee and the other for his/her family members.
  • ii. The card shall be signed by an officer not below the rank of an Under Secretary
  • iii. The card shall be issued for a period not exceeding one year at a time and shall be renewed every year, if the employee furnishes a certificate that his family members are residing in the same city/area. 


Issue of Temporary Family Permit

  • i. Temporary family permits can be issued to families of those employees who are already availing CGHS facilities and are transferred to a city covered under CGHS.
  • ii. If the employee is transferred to a station where CGHS is not in operation, temporary family permits cannot be issued, even if the family continues to stay in an area covered under the scheme. In such cases, the employee and his/her family will be governed by CS (MA) Rules, 1944.
  • iii. In case of a Government servant who is a CGHS beneficiary and who goes on deputation on foreign assignment/deputation outside India, his family members if left behind in a CGHS covered area, will continue to avail of medical facilities under CGHS.
  • iv. Temporary family permits will be issued to the family members of Government employees posted in North Eastern Region, Andaman and Nicobar Islands or Lakshadweep, if the family members continue to stay in an area covered under CGHS. 

Surrender/Cancellation of Identity Card

  • i. The CGHS Identity Card should be surrendered to the concerned department at the time of retirement/resignation/on being relieved from the Department/Office.
  • ii. A certificate for surrender of Identity Card and the contribution recovered up to date, shall be issued to the retiring employee, so as to enable him/her apply for CGHS Pensioner Card.


Issue of Identity Cards to Pensioners
  • i. Pensioners are required to apply in the prescribed form, for issue of CGHS Identity Cards, alongwith photograph of the dependent family members and a copy of Pension Payment Order (PPO).
  • ii. Contribution (based on last pay drawn or basic pension at the option of pensioner), shall be payable alongwith the application, by way of bank draft drawn on a nationalized bank or postal order. Subsequent  contributions shall be payable in advance for six months. For rates of contribution and other details relating thereto, refer Chapter ‘Contribution’.
  • iii. A permanent CGHS Card for whole life can also be issued on payment of ten-years contribution in lump sum. In case contribution for some years has already been paid and a permanent Identity Card is desired on a later date, the amount of contribution payable shall be proportionately reduced.
  • iv. Pensioners are allowed a grace period of three months for depositing the contribution and getting their Identity Cards issued/renewed. If the card is issued/renewed after expiry of grace period, the pensioner shall not be entitled to reimbursement for any treatment taken during the period after expiry of grace period and the actual date of issue/renewal of the card.
  • v. Identity Cards to pensioners are issued by Additional Director/Joint Director of the concerned city.
  • vi. Pensioners can avail CGHS facilities on the basis of their Identity Cards with photograph, in all cities having CGHS facilities, which they (including dependent family members) may be visiting.


Loss of Identity Card :

In case the Identity Card is lost, the beneficiary should lodge a complaint with the police and also report the matter to the C.M.O. Incharge of Dispensary concerned and to the Additional /Deputy Director, CGHS in the city.

A duplicate identity Card shall be issued if the original card is lost, by the authority who had issued the original card, on receipt of an application this respect alongwith following documents:'
  • i. Copy of FIR from Police Station;
  • ii. Copy of complaint lodge with the Police about the loss of original card;
  • iii. Charges for issue of a duplicate card by way of a Postal Order favouring PAO, CGHS of the respective region, for a sum of Rs. 5/- (for the first loss), or Rs.7/- (for the second loss) or Rs.10/- (for third and subsequent loss).'


Replacement of Mutilated Identity Card:

  • i. If an Identity Card gets mutilated, the cardholder shall apply to the Issuing Authority, for issue of a duplicate card alongwith the mutilated card. 
  • ii. The issuing Authority shall forward the application to the Additional Director/Deputy Director CGHS who, in turn, shall send a blank duplicate CGHS Card to the Issuing Authority.
  • iii. The Issuing Authority shall issue the duplicate card under his seal, bearing number of the original card.
  • iv. No. charges shall be payable by the cardholder if the original (mutilated) card was issued more than five years back.
  • v. If the request for issue of duplicate card is made within five years if issue of original (mutilated) card, then the card holder shall be liable to pay Rs. 5/- (for first time) or Rs.7/- (for second time) or Rs. 10/- (for third and subsequent time), by way of a Postal Order. 


Change of Dispensary:

  • i. Change of dispensary is permissible only if the beneficiary changes his residence to place, which is served by another dispensary.
  • ii. When there is a change of residence involving change of dispensary, the employee concerned shall apply in prescribed from (in duplicate) to the card Issuing Authority together with CGHS Identity Card. The Issuing Authority shall make entry in the Identity Card and Index Card and attest the same in the appropriate column.
  • iii. The employee shall then submit two forms to the Medical Officer Incharge of the old dispensary who shall make entry in his records and hand over the Index Card to the employee with the direction that the same may be submitted to the Medical Officer Incharge of new dispensary. 


CGHS - Family Members Of Central Government Servant No Residing With Him/Her

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CGHS Orders: Family Members of Central Government Servant no residing with him/her - No. S-12015/1/85-CGHS (P) dt. 8/7/1985

Text of MH & FW. O.M No. S-12015/1/85-CGHS (P) dt. 8/7/1985

CGHS Facilities to the Family Members of Central Government Servant no residing with him/her.

The undersigned is directed to say that in accordance with the instructions contained in this ministry’s O.M. No. 6(1)-1/54-H dated 1/5/1954 only those family members of a Central Government employee who are wholly dependent and are residing, with him/her can avail CGHS facilities. 

It has come to notice that difficulties are being faced by such family members, who are wholly dependent on government servants but are residing permanently in some other city in an area covered by the Scheme, as they are not allowed to avail CGHS facilities. 

In order to mitigate the hardship it has been decided that family members who are wholly dependent upon the Central Government employee but who are residing in another city in an area covered under the Scheme will also be eligible for availing of CGHS facilities. 

In such cases, the issuing authority after confirming that the family members of the Central Government employee residing in some other city are actually residing in an area covered under the scheme, will issue two separate CGHS cards-one for the Central Government employee and the other for his/her family members.

2. The CGHS cards for the family members will be issued by the concerned Ministries/Departments for a period not exceeding one year at a time and renewable thereafter for similar periods after obtaining a certificate from the Government servant that his family is residing in the same city/area. The card should be signed by an officer not below the rank and status of an Under Secretary to the Government of India.

3. A quarterly statement showing brief particulars of the cards issued should be sent to the Director, CGHS in the proforma enclosed for the quarters ending March, June, September and December each year. Nil statements need not be furnished.

4. These instructions will not be applicable to any other category of person(s) who are not Central Government employees but who have been allowed to avail CGHS facilities. Statement showing the particulars of the Family Member(s) of Government servants who are not residing with the Government servant and in respect of whom separate CGHS card has been issued.

Particulars of the Family Member
Name
Designation of the Government servant
Name Date of Birth
Relationship with the Government Servant 

Authority: http://cghsmumbai.gov.in

CGHS - Temporary Family Permits On Transfer Of Employees

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CGHS Orders: Temporary Family Permits on Transfer of Employees - No.S-12018/6/79-CGHS(P) dt.5/1/1985

Text of MH & FW. O.M No. S-12018/6/79-CGHS (P) dt. 5/1/1985

Issue of Temporary Family Permits on Transfer of  Employees.

The undersigned is directed to refer to this Ministry O.M. No. 4(1)-17/62-H.II dated 17/9/1962 on the subject cited and to clarify that temporary family permits can be issued to families of Central Government employees (including eligible parents) in those cases only which a Central Government employees already availing the CGHS facilities is transferred to Station where CGHS is in operation.

In case of transfer of Central Government employees to a station where CGHS is not in operation, temporary family permits can not be issued to the family of Central Government employee even if the family continue to stay in an area covered under the Scheme and he/she and his/her family in such cases will be governed by CS (MA) Rules, 1944.

Authority: http://cghstvm.nic.in

CGHS - Treatment Immediately After Retirement Without Getting A CGHS Token Card

with 0 Comment
CGHS Orders: Treatment immediately after retirement without  getting a CGHS Token Card - No. S-12015/2/93-CGHS (P) dt. 5/11/1993

Text of MH & FW. O.M No. S-12015/2/93-CGHS (P) dt. 5/11/1993

Reimbursement when Pensioners take Treatment

Immediately after Retirement before getting CGHS card.

The undersigned is directed to say that there have been instances when pensioners have taken treatment immediately after retirement without getting a CGHS Token Card issued. In such cases, when the pensioners submit their reimbursement claims, these could not be entertained as on the date of treatment they had not got their CGHS pensioners card issued, due to some reason or other, which deprived them of reimbursement of medical expenditure incurred during that period.

2. It has, therefore, been decided to allow grace period of one month to the pensioners from the date of their retirement for purposes of admitting their medical claims for reimbursement for the treatment taken immediately after retirement. In other works, if the CGHS Token Card is not got issued within the grace period of one month, the pensioners will not be entitled for any medical reimbursement expenses and CGHS facilities after the grace period of one month.

3. This issues with the approval of Finance Division vide their Dy. No. 622/JS (FA), dated 22/10/1992. 

Authority: http://cghstvm.nic.in

Central Government employees losing interest in Expected Dearness Allowance Jan-2018 ?

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Expected DA Jan 2018: CG Employees losing interest in Expected DA?

Central Government employees losing interest in Dearness Allowance?

It is becoming very obvious these days that the Central Government employees and pensioners are fast losing interest in Dearness Allowance. 

Dearness Allowance is given to the Central Government employees once every six months, in order to help them maintain their lifestyle against the rising prices. Fluctuations in the prices of 392 essential items are recorded regularly at 78 various locations and their data is tabulated once every month to calculate the All India Consumer Price Index Number(AICPIN), which is then released by the Centre. Dearness Allowance is thus calculated. 

For eight years now, we have been calculating the Dearness Allowance in advance and releasing the numbers. This is why we are able to sense an acute loss of interest among the Central Government employees in recent times to know their next and expected Dearness Allowance. 

Dearness Allowance is calculated with the employee’s basic salary. For example, a 5 percent Dearness Allowance for an employee who draws a basic salary of Rs. 7000 per month, will translate into Rs. 350. An employee drawing basic salary of Rs. 20,000 will get an additional Rs. 200 if 1 percent Dearness Allowance is sanctioned. 

All the Central Government employees, defence personnel and pensioners are now being paid as per the recommendations of the Seventh Pay Commission, from January 2016 onwards. The Seventh Pay Commission had recommended that no changes shall be made in the Dearness Allowance calculations and the method adopted by the Sixth Pay Commission continues to be followed. The centre too had accepted the recommendations. 

Under the Sixth Pay Commission method, the Dearness Allowance had increased by 125 percent in the past ten years, from January 2006 to December 2015. It is worth mentioning that at least thrice, a Dearness Allowance of 10 percent was paid to the employees. The table below shows the Dearness Allowance that was paid once every six months. 

The loss of interest among the employees probably has something to do with the fact that the increase in Dearness Allowance has only been marginal ever since the Seventh Pay Commission was implemented. 

There was no Dearness Allowance for the first six months, January to June 2016. Dearness Allowance of only two percent was given for July to December 2016. It looked as if something was wrong with the calculations, right from the start, but the employees thought that things will improve with time. The Dearness Allowance for January to June 2017 was a mere one percent, which came as a rude shock to all. 

The centre claimed that it was because they have the prices under control. 

So, what is the Dearness Allowance for the second term of 2017, July to December 2017, likely to be?
This time too, it is not expected to exceed two percent. 

We expect the Dearness Allowance to be 7% with effect from January 2018.

DA Table from 1.1.2016 as per 7th CPC

Month/Year
CPI(IW) BY2001=100
Total of 12 Months
12 Months Average
DA with Decimal
DA %
Jan-16
269
3152
262.67
0.48
Feb-16
267
3166
263.83
0.92
Mar-16
268
3180
265
1.37
Apr-16
271
3195
266.25
1.85
May-16
275
3212
267.67
2.39
Jun-16
277
3228
269
2.9
2%
Jul-16
280
3245
270.42
3.44
Aug-16
278
3259
271.58
3.89
Sep-16
277
3270
272.05
4.24
Oct-16
278
3279
273.25
4.53
Nov-16
277
3286
273.83
4.75
Dec-16
275
3292
274.33
4.94
4%
Jan-17
274
3297
274.75
5.1
Feb-17
274
3304
275.33
5.32
Mar-17
275
3311
275.92
5.55
Apr-17
277
3317
276.42
5.74
May-17
278
3320
276.67
5.83
Jun-17
280
3323
276.91
5.93
5%
Jul-17
285
3328
277.33
6.09
Aug-17
285
3335
277.92
6.31
Sep-17
285
3343
278.58
6.56
Oct-17
287
3352
279.33
6.85
Nov-17
Dec-17

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