DOPT Orders On Medical Reimbursement

Employees of the central government would be relieved by the Supreme Court’s decision. A two-judge panel of the Supreme Court explicitly states in its ruling that a central government employee cannot have their medical expenses disallowed because they choose to receive emergency care at a private hospital.

If an employee does not seek treatment from a hospital that is on the government panel or list of the CGHS (Central Government Health Scheme) empanelled hospitals, reimbursement cannot be withheld either during employment or after retirement, the SC said.

Because the hospital’s name is not mentioned in the government decree, the right to receive medical treatment cannot be denied. So, let’s now learn more about the latest DOPT orders on medical reimbursement.

CGHS Circulars 2023

CGHS Wellness Centres deliver complete medical care to the pensioners and employees of the Central Government enrolled under the CGHS scheme.

The Legislature, the Judiciary, the Executive, and the Press—the four pillars of India’s democratic system—are all covered by the CGHS in terms of meeting the healthcare requirements of eligible beneficiaries.

Due to the enormous number of beneficiaries and its open-ended, liberal approach to providing healthcare, CGHS Contribution is the premier healthcare facility for Central Government pensioners and employees under empanelled Health Care Organizations of CGHS.

In 71 CGHS-covered cities across India, the CGHS facilities currently cover about 35 lakh beneficiaries, and efforts are being made to expand this number to include further cities to increase service accessibility.

From empanelled hospitals, Central Govt Pensioners, and employees can get facilities like Annual health check-ups.

CGHS Provides Health Care Through The Following Systems Of Medicine

Homeopathic

Allopathic

Ayurveda

Indian system of medicine

Unani

Siddha &

Yoga

New CGHS Referral Rule

Beneficiaries of the CGHS (Central Government Health Scheme) who are older than 75 years old are now more able to access health services like CGHS OPD consultations, yearly physicals, and CGHS treatments in hospitals with empanelled status.

The CGHS facilities are put up throughout the nation to offer basic medical services, and based on the course of treatment, they may refer the health care case to either government-run hospitals or private hospitals if necessary.

The beneficiary does not need to wait for approval or approval from the CGHS centre if it is an emergency, but approval from the CGHS centre is necessary in non-emergency situations.

CGHS Referral Rules – For OPD Consultations

According to the CGHS OPD rules, beneficiaries do not need to have a referral to receive an OPD consultation from a specialist at any Government Hospital.

Beneficiaries in all CGHS Cities who are under the age of 75 must receive a reference from the Medical Officer or CMO in charge of the Wellness Center to have an OPD consultation from a specialist in any of the empanelled hospitals under CGHS. Within 30 days, the referral is good for up to three consultations at the same institution.

Beneficiaries over the age of 75 can use the OPD services at CGHS-accredited hospitals without a referral from a doctor as long as they can prove they have a valid CGHS card. The Medical Officer of CGHS does not need to grant further approval or support any procedures or investigations that are recommended and necessary in an emergency.

CGHS 75-year age rule

According to the new CGHS regulations, CGHS pensioners 75 years of age and older are now able to receive annual health exams in facilities that are CGHS-approved.

According to the CGHS directive for people over 75, the CMO responsible for the operation of the CGHS health centre will provide approval to the main cardholder who is 75 years old or older.

The beneficiary will receive the facility without paying for the treatments in addition to being able to have a checkup at a private hospital that has been accredited by the CGHS.

The govt has even made it possible for CGHS beneficiaries 75 years of age and above to consult with specialists without needing permission from the CGHS centres. The CGHS recipient is also allowed to see up to 3 experts in one hospital visit if necessary.

Additionally, if necessary in an emergency and recommended by specialists from private hospitals with empanelled status, investigations may be carried out without CGHS approval. Therefore, they are now able to have treatment or have tests done without a prior referral letter from the CGHS.

However, permission will be required only for any unlisted treatment procedures or tests in non-emergency conditions.

7th Pay Commission CGHS New Subscription Rates Per Month

Details for all pay matrix levels of CGHS subscription rates list for both serving CG employees and pensioners:

Pay Level 1: Rs. 250 PM

Pay Level 2: Rs. 250 PM

Pay Level 3: Rs. 250 PM

Pay Level 4: Rs. 250 PM

Pay Level 5: Rs. 250 PM

Pay Level 6: Rs. 450 PM

Pay Level 7: Rs. 650 PM

Pay Level 8: Rs. 650 PM

Pay Level 9: Rs. 650 PM

Pay Level 10: Rs. 650 PM

Pay Level 11: Rs. 650 PM

Pay Level 12 and above Rs. 1,000 PM

Instructions to All CGHS Wellness Centres And Units to Follow CGHS Guidelines Issued From Time To Time- Sated 15-December-2022

Here are the salient features of all CGHS wellness centres and units to follow CGHS guidelines issued from time to time dated 15-December 2022.

Salient Features:

1 Doctor will have to mark attendance through biometrics.

2. Can’t deny medicine for up to three months for chronic diseases. Even if six months of the prescription expires, they are under obligation to issue medicines beyond six months for chronic ailments.

3. Will have to check BP, throat, temperature, etc. if needed. Also will dispense injections if the nursing staff is not there.

4. To maintain proper inventory of the medicines etc.

5. Will provide medication beyond 2 pm in cases where it is needed.

6. Self-printed CGHS card to be honoured.

Unmissable Instructions or DOPT Orders On Medical Reimbursement

UPDATED TELEPHONE DIRECTORY/CONTACT DETAILS OF CGHS

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