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
Indian system of medicine
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.
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
- CGHS O.M. dated 05.07.2023 – Revision of room rent for CGHS empanelled AYUSH HCOs & Empanelment of IPD AYUSH Hospitals – reg.
- CGHS O.M. dated 30.06.2023 – Treatment of CGHS pensioner beneficiaries & others at All India Institute of Medical Sciences (AIIMS), New Delhi – regarding
- CGHS O.M. dated 30.06.2023 – Treatment of CGHS pensioner beneficiaries & others at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh – reg.
- CGHS O.M. dated 30.06.2023 – Treatment of CGHS pensioner beneficiaries & others at Jawaharlal Institute of Medical Education and Research (JIPMER), Pondicherry – reg.
- CGHS O.M. dated 28.06.2023 – Empanelment of 8 Private Day Care Centres for Ayurveda, Yoga & Naturopathy under CGHS Delhi & NCR
- CGHS O.M. dated 19.06.2023 – Revision of CGHS rates for 36 Radiological/Imaging investigations-regarding
- CGHS O.M. dated 31.05.2023 – Treatment of CGHS pensioner beneficiaries & others at AIIMS, Bhopal, Bhubaneswar, Raipur, Patna, Rishikesh and Jodhpur
- CGHS O.M. dated 08.05.2023 – Submission of Medical Reimbursement Claims (MRCs) by CGHS Pensioner beneficiaries in the city, wherein the treatment was taken – regarding
- CGHS O.M. dated 01.05.2023 – Validity of CGHS Card in all CGHS Centres
- CGHS O.M. dated 28.04.2023 – Extension of the validity period of already empanelled HCOs under CGHS for six months w.e.f. 1st May 2023 to 31st October 2023
- CGHS O.O. dated 20.04.2023 – Constitution of ‘SQUAD’at Zonal levels under CGHS, Delhi, for random inspection of CGHS WCs and ‘Inspection Team’ for random inspection of empanelled HCOs
- CGHS O.M. dated 12.04.2023 – Revision of Consultation Fee, Room Rent and ICU charges for all Health Care Organisations (HCOs) empanelled under CGHS
- CGHS O.O. dated 05.04.2023 – Revised work schedule of Doctors providing Tele Consultation services through e-Sanjeevani
- CGHS Order dated 31.03.2023 – Referral to empanelled hospitals for consultation/endorsement – regarding
- CGHS O.M. dated 17.03.2023 – Setting up of Grievance/Advisory Committee at Dispensary Level – Modification reg.
- CGHS O.M. dated 15.03.2023 – Scheme for providing medical facilities to the eligible permanent retired, retiring employees of Air India Ltd. – post disinvestment regarding
- List of Empanelled Healthcare Organisations under CGHS Hyderabad as of 31.01.2023 (As on CGHS website-15.02.23)
- Special arrangements for CGHS patients in RML Hospital (20 Jan 2023) (As on the CGHS website)
- MoHFW O.M. dated Jan 2023 – Linking of CGHS Beneficiary ID with the ABHA (Ayushman Bharat Health Account) ID (As on MoHFW website (16.01.2023)
- CGHS O.M. dated 10/16.11.2022 – Clarification regarding the billing of CGHS empanelled Hospitals
- List of Empanelled Health Care Organisations (HCOs) in CGHS Chennai as on November 2022 (as on CGHS website-11.11.2022) (Including Tiruchirappalli, Tirunelveli, and Puducherry)
- MoHFW O.M. dated 28.10.2022 – Revision of rates of subscription under CGHS due to revision of pay & allowances and pension on implementation of recommendations of 7th CPC (Revised entitlement of wards in private hospitals empanelled under CGHS)
- List of AYUSH Health Care Organizations (HCOs) empanelled under CGHS till 31st July 2023 as per O.M. dated 13.05.2022, Corri. dated 15.06.2022 and O.M. dated 10.08.2022 (As on CGHS website-07.09.22)
- CGHS – Frequently Asked Questions (FAQs) – 23.08.2022
- CGHS O.M. dated 13.05.2022 – Extension of empanelment of AYUSH Hospitals/Centres under CGHS and CS(MA) Rules till 31st July 2023
- NOTICE regarding CGHS’ own Diagnostic Labs and Collection Centres at the specified Wellness Centres and Polyclinics under CGHS Delhi (As on CGHS website-11.05.2022)
- CGHS O.O. dated 02.05.2022 – Removal of 64 HCOs empanelled under CGHS, Delhi, from list of empanelled Organisations wef 02.05.2022
- CGHS O.M. dated 29.03.2022 – Prescription by Brand Name by Specialists of Government Hospitals – regarding
- DPPW O.M. dated 23.03.2022 – Procedure for implementation of change of option by a Pensioner/Family Pensioner from FMA to CGHS (OPD) facility & vice-versa
- CGHS O.O. dated 15.03.2022 – Advisory to HCOs empanelled under CGHS to follow terms & conditions of empanelment and to charge only CGHS Rate
- CGHS O.M. dated Feb 2022 – Launch of new CGHS Mobile Application for Android-based devices (As on CGHS website-24.02.22)
- CGHS O.M. dated 27.01.2022 – Storage of CGHS Card on DigiLocker platform for its access and use for CGHS services
- CGHS O.M. dated 20.01.2022 – Extension of timings of eSanjeevni Teleconsultation
- List of Health Care Organizations (HCOs) empanelled under CGHS, Delhi & NCR as per OM dated 01.10.2014 and further added/updated till 19.01.2022 (As on CGHS website-19.01.2022)
UPDATED TELEPHONE DIRECTORY/CONTACT DETAILS OF CGHS
- Contact Details of CGHS Directorate in Delhi.
- Contact Details or List of Additional Directors in Delhi.
- Contact Details or List of Wellness Centres in Delhi.
- Contact Details Or List of Additional Directors & Wellness Centres NOT SITUATED IN DELHI.