Department of Health and family welfare has issued Consolidated list of empaneled hospitals , diagnostic labs & imaging centers under CGHS (Central Government Health Scheme) as on 23rd February 2012.

To access the list of empaneled hospitals , diagnostic labs & imaging centers under CGHS,   CLICK ON THE CITY BELOW:



Fresh Empanelment of CGHS Hospital – Bangalore, Mumbai, Delhi and other places

Department of Health and Family Welfare has issued Office Memorandum dated 16.11.2011 for empaneling certain private hospitals and diagnostic centers and revision of package rates at Bangalore, Bhopal, Kanpur, Jabalpur, Mumbai, Hyderabad, Delhi and Pune.

To download the OM click here

Empanelment of private hospitals and Diagnostic Laboratories and Imaging Centres under CGHS- Clarification — regarding rates

No: S.1011/23/2009-CGHS D.II/Hospital Cell (Part IX)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the September 30, 2011

Subject : Empanelment of private hospitals and Diagnostic Laboratories and Imaging Centres under CGHS- Clarification — regarding rates
With reference to the above mentioned subject the undersigned is directed to draw attention to the CGHS rates notified in 2010 / 2011 applicable to empanelled hospitals and Diagnostic Laboratories and Imaging Centres in Various CGHS cities and to state that in response to the several representations received by this Ministry seeking clarifications regarding CGHS rates applicable, it has now been decided to clarify as under:
1. If CGHS rate is not available for any procedure / investigation / category (say super-specialty) in any CGHS covered city, the CGHS rate notified for such procedure / investigation / category for the nearest CGHS city or the rate notified under CGHS, Delhi, whichever is lower shall be applicable as CGHS rate for such procedure / investigation / category for that city.
2. Since NABL Accreditation for in-house laboratories of hospitals has been made optional, rates prescribed for NABL Accredited laboratories shall be applicable for the in-house laboratories of hospitals, for the investigations under taken for in-patients.

3. It has also been clarified that for any day care procedure requiring short admission — a few hours to one day — accommodation charge for one day as per entitlement shall be applicable, provided the patient has been admitted in a room as per his/her entitlement.
The other terms and conditions shall remain unchanged.
Issues with the concurrence of Finance Division , Min of Health & Family Welfare vide Dy No G1500 dated 27 09.2011.

(Jai Prakash)
Under Secretary to Government of India

CGHS-New Empanelment of hospitals

CGHS had initiated action for empanelment of private hospitals under CGHS, under Continuous Empanelment Scheme,  under Continuous Empanelment Scheme,which was notified vide Office Memoranda of even number dated 8th December, 2010 and 19th January 2011.

Further list of hospitals. under the categories mentioned in the document, that have conveyed their acceptance of the CGHS rates in various cities announced and placed on CGHS website and those hospitals have signed the Memorandum of Agreement with CGHS and have also furnished the appropriate performance bank guarantee. These hospitals are also taken as included in the list of approved hospitals for empanelment under CGHS.

The cities in which those hospitals situated are Bengaluru, Chandigarh, Chennai, Hyderabad, Jabalpur, Kanpur, Kolkata, Mumbai, Delhi&NCR and Hyderabad..

The hospitals which have been now approved under the fresh empanelment procedure,  will be eligible to treat CGHS beneficiaries at revised rates with effect from the date of issue of letter.

Download the CGHS Office Memorandum No:S.110011/23/2009-CGHS D.ll/Hospital Cell (Part IX) dated 27.07.2011 for list of hospitals

Downdload CGHS Office Memorandum No:S.110011/23/2009-CGHS D.II/Hospital Cell (Par IX) dated 05.08.2011 for additional list of hospitals


Reimbursement of Medical Expenses-Frequently asked Questions

Dependency condition not applicable to spouse for reimbursement of medical expenses under CGHS

Q I am a Government employee and beneficiary of CGHS. In my Service Book, I have shown my husband as not employed, as he was not employed at that time. Later on, he started a small business. When my husband suffered heart attack CGHS doctor referred my husband to a CGHS approved hospital where he was conducted angiography and by-pass surgery of heart. I submitted the bills for the same for reimbursement. However my Officer-in-Charge informed that no claim for medical reimbursement for my husband will be accepted since he is an income tax assessee and not my dependent. Kindly clarify.

A As per the definition of family for CGHS, the condition of dependency does not apply to husband/wife. Hence, you are entitled to reimbursement of medical expenses incurred in respect of your husband vide G.I.,M.H.,O.M. No. S-11012/1/98-CGHS(P), dated 14-3-2001 (Sl.No.133 of Swamy’s Annual, 2001).

When both husband and wife are Govt. Servants both can claim reimbursement of medical expenses for their respective parents

Q Both the husband and wife are employees of a Central Government Organization and claiming the medical benefits under CS(MA)Rules, 1944. They have furnished joint declaration according to which husband has preferred to claim the concession for himself, wife, children and his parents and wife has preferred to claim for her parents. Since both the employees belong to same organization and staying at the same station, a doubt has arisen whether the female employee can claim medical reimbursement for her parents and her other dependent family members. Kindly clarify.

A When both husband and wife are Govt. employees, both of them can claim medical reimbursement for their respective parents subject to the condition that the income from all sources of such parents should be less than Rs 1,500 and they should reside with the concerned Govt. servant or with the rest of the family members.

Dependent married son is entitled to medical facilities

Q As per Circular No.4-24/96-C&P/CGHS (P), dated 17- 9-1999 of dept. of Health, a dependent son irrespective of his age is entitled to CGHS medical facilities. There is no mention of his marital status. However, a CGHS authorities in a particular region are refusing to include the name of a married dependent son in the CGHS card of a pensioner on the plea that the son is married. Kindly clarify.

A While defining dependency for son/daughter vide G.I., Ministry of Health and Family Welfare O.M.,dated 31- 12-1992 – Order (a) below Note-2 of the Definition of Family under Chapter 4 of “Swamy’s Compilation of Medical Attendance Rules”, the clause `married’ has been included to the conditions only in the respect of daughter and NOT in respect of son. Hence, the CGHS establishment is not correct.

A Govt. Servant cannot claim medical reimbursement for his father who is in receipt of fixed medical allowance

Q pensioner is residing outside CGHS area and therefore granted Rs 300 per month towards medical allowance. He is residing with his son who is a Govt. employee. The son is claiming medicalreimbursement for OPD treatment of his father on the plea that hisfather’s income is less and therefore dependent upon him. Will you please clarify whether his son can claim medicalreimbursement?

A When the father, who is a pensioner is drawing fixed medical allowance of Rs 300 per month, his son is not entitled to claim medicalreimbursement for the OPD treatment of his father.

Restriction of two children is not applicable for claiming medical reimbursement

Q As per existing rules, reimbursement of Children Education Allowance, LTC, etc., are admissible for two dependent children only. Whether an employee is entitled to reimbursement of the medical expenditure incurred for his wife during the pregnancy of third child and also admissibility of Paternity Leave in such cases.

A There is no ban under the CS(MA) Rules, 1944 or CGHS Rules for reimbursement of medical expenses incurred during the pregnancy of third child. However, Paternity Leave is not admissible if the employee has more than two surviving children vide OM, dated 16-7-1999 (now Rule 38-A of CCS (Leave) Rules, 1972).

Admissibility of medical facilities to the parent residing with family members away from headquarters

Q I am working in a city and family members reside in another city for various reasons. My parents are also residing with my family. In such situation, whether my parents will be eligible for medical treatment under CS(MA) Rules.

A Medical facilities are available to the parents of a Govt. servant even when they reside with the rest of his family members at a place other than his dutystation for whatever reason. In such cases, the conditions regarding residence of the parents with the Govt. servant is waived.

Air travel for medical treatment, admissible to all irrespective of pay scales.

Q If a Government Employee officer is not entitled to travel by air on tour, LTC etc., whether he is entitled for air travel for medical treatment or not.

A TA by air for medical treatment is totally different from TA entitlement on tour/transfer. TA by air for medical attendance is admissible to all the Govt. servants irrespective of their pay, etc., if condition that as air travel was absolutely essential otherwise the life of the patient would have been in danger is fully satisfied. This condition is also applicable employees who entitled for Air Travel during their regular tours and LTC.

Official under suspension is eligible for all medical facilities.

Q Whether a Government Employee who is under suspension is entitled for reimbursement all the Medical expenditures involved at par with working employees.

A The official under suspension is covered by CS(MA) Rules and he is eligible for all the facilities as if he had not been suspended.

Medical facilities if spouse employed in other organization at the same/different station.

Q Please clarify whether the spouse employed in a Bank can avail the medical facility for himself /herself alone from the Bank while the spouse employed in Government department can avail facilities under CS(MA)Rules for self and other family members.

A In such cases medical facilities can be availed either under CS(MA) Rules or from the organization where the other spouse is employed, for all the family members. In the case, cited the spouse employed in the Bank cannot avail the facility for himself/herself alone while the other members avail facilities under CS(MA) Rules. The entire family can avail the facilities from only one source as a unit and for this purpose a joint declaration should be given by the couple to their respective departments. However, if the spouse employed in other organization is stationed at differentstation he/she can avail the facilities from the organization for self only, while the spouse and the family members living with him/her can avail facilities under CS(MA) Rules.

Members of family residing away from the place of posting of the Govt. Servant are entitled to avail medical facilities under CS(MA)Rules

Q A Govt. servant was transferred from one station to another on his own request. His wholly dependent family members are residing in his own house at the old station. He could not shift his family to the new place of posting. His family members are taking treatment at old station. Kindly clarify whether he can avail the facility of medical reimbursement in respect of his family members.

A The concerned Govt. servant can avail the facility in respect of the family members who are residing away from the place of duty. However, the dependent parents should reside either with the Govt. servant or with the other members of family to avail the facility. Please refer to Para 2 (c) under Section 4 of “Swamy’s Compilation of Medical Attendance Rules” (C-7).

Spouse can claim the medical expenses incurred prior to the death of the deceased employee.

Q The wife of a deceased Central Govt. employee has submitted the claims in Form CS(MA) Rules in respect of the said employee and his dependents for the period before his death. There is no clear rule in Medical Attendance Rules on the above issue. Please Clarify.

A Pay and allowances of all kinds claimed on behalf of a deceased Govt. servant may be paid without the production of usual legal authority under the order of Head of Office in which the Govt. servant was employed at the time of his death, provided the Head of Office is otherwise satisfied about the right of the claimant. On receipt of the claim for payment of arrears of pay and allowances of all kinds (including traveling allowances claims) on behalf of a deceased Govt. servant from his heir(s), the Head of Office in which the Govt. servant was last employed should draw the amount in the appropriate bill. On the same lines medical claim also may be paid to the legal heir(s) of the deceased Govt. servant. [ Rule 95 of CGA Receipts and Payment Rules]

Minutes of the meeting held on 14/7/2010 regarding proposed Central Government Employees and Pensioners Health Insurance Scheme

F.No.B.12012/03/2010-CGHS (P)
Government of India,
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated the 6th June, 2011.

Subject: – Minutes of the meeting held on 14/7/2010 regarding proposed Central Government Employees and Pensioners Health Insurance Scheme – regarding.

The undersigned is directed to enclose a copy of the Minutes of the meeting of Staff Side Members of National Council (JCM) with Joint Secretary (Regulation), Ministry of Health & Family Welfare held on 14/07/2010 regarding proposed Central Government Employees and Pensioners Health Insurance Scheme (CGEPHIS) for information and further necessary action, if any.

Under Secretary to the Govt. of India.

Minutes of the meeting of Staff Side Members of National Council (JCM) with Joint Secretary (Regulation) held on 14/07/2010 at 11: 00 AM in the Committee Room of Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi on the proposed Health Insurance Scheme for Central Government employees and pensioners.

   Shri Vineet Chawdhry, Joint Secretary (Regulation) M/o Health and Family Welfare held a meeting with staff side members of National Council (JCM) on 14th July. 2010. List of the participants in the meeting is at Annexure.

   At the outset, Chairman welcomed the Staff Side members of National Council (JCM) to the meeting to discuss the proposed Central Government Employees & Pensioners Health Insurance Scheme (CGEPHIS), to be rolled out in compliance of the recommendation of Sixth Central Pay Commission and to directions of Committee of Secretaries (COS). He informed the members about the salient features of the Scheme which had already been circulated, and said that:

   • The proposed scheme shall be compulsory for new appointees and new retirees and would be voluntary for existing pensioners and employees.

   • Government may bear upto 75% of the insurance premium share as a subsidy depending upon the eligible categories of the employee. The remaining portion of the premium will be borne by the members as is being done for CGHS.

   • Scheme will have no age limit, therefore member of any age can join the scheme.

   • All pre existing diseases will be covered from day one.

   • He further stated that OPD benefit is not available under the Insurance scheme due to various constraints, however, free OPD consultation will be provided by the networked hospitals and also they will charge the discounted CGHS rates for diagnostics procedures if prescribed during OPD consultation. However, cost of medicines will not be covered in such cases.

   • The scheme will operate on cashless basis on the lines of existing CGHS packages for the treatment taken in the networked hospitals by pensioners beneficiaries and no money is to be paid by the members to the hospitals.

   • The ‘family’ under CGEPHIS has been defined as self, spouse two dependent children and two dependent parents. Dependency criteria will remain same as applicable under CGHS. For including any additional member as a beneficiary under the scheme, the beneficiary would have to bear the entire premium on the additional member without it being subsidized by the Government.

   • The Insurance cover for the family will be Rs. 5 lakh and it will operate on family floater basis. In addition to this, a provision has also been made to create a corporate buffer of Rs. 25 Crore to take care of eventualities in cases where the above limited is exhausted fully and the member/ beneficiary is still undergoing treatment. In other words, although a monetary limit of Rs 5 Iakh has been kept as insurance cover for the family but it is only to decide the insurance premium with the Insurer. In fact, the members will enjoy an unlimited cover for their medical treatment under this Health Insurance Scheme too. Anything over and above Rs. 5 lakh will be borne by the Government.

   • Pre and post hospitalization benefits would also be available to the members.

   • Insurance premium to be paid would be deducted from the salary of the serving employees and pensioners would authorize their banks to deduct the applicable premium.

   • There will be a provision in the scheme for the beneficiaries to opt out of the scheme after three years.

   Shri V. P. Singh, Deputy Secretary (Medical services) informed the members that the Ministry conducted a ‘Demand Survey’ and gave wide publicity through newspaper advertisements all over India and invited response from the target population i.e., employees and pensioners who are willing to join the Scheme when it becomes operational. It was hosted on the website of the Ministry and CGHS website and willingness was invited through email too. The response have been quite encouraging and around 16,000 responses have been received which are being compiled for analysis. Majority of the response were from Non CGHS area and people have shown their willingness to join the scheme. The staff side requested that the outcome of the ‘Demand Survey’ may also be shared with them on its completion, which was agreed to.

   He also informed that as per the information made available by IRDA, 97% of the claims settled by the Insurance companies involved amount of less than Rs 3 lakh annually. Only 0.35 % of the claims were for amount exceeding Rs. 5 lakh annually, the balance falling between the Rs 3 to 5 lakh. Hence the proposed insurance cover of Rs 5 lakh would be adequate for the beneficiaries.

   DR. S. P. Goswamy, National Consultant (Health Insurance), Ministry of Health and Family Welfare informed the members that most of the benefits available under CGHS have been made a part of the CGEPHIS. The CGEPHIS is almost a replica of CGHS. Most of the defined day-care procedures which are covered in CGHS under OPD have been made part of the scheme. Further, in such cases where patients require hospitalization, but the condition of the patient is such that he cannot be shifted to hospital or bed is not available, CGEPHIS shall provide for such medical treatment under domiciliary hospitalization. These cases are part of OPD in CGHS

   Chairman further informed the Staff Side that all possible efforts have been made to make the Scheme suitable for the employees and pensioners retaining in it all the important features of CGHS and CS(MA)Rules, 1944, so that it attracts the target group and provide a freedom of choice in the hands of employees and pensioners, to select the best suitable scheme for them. He sought the views of the Staff Side members of JCM on the Scheme.

   Opening the discussion from the Staff Side, Shri S.K.Vyas Member(Staff side) JCM informed the meeting of their collective view on the scheme and stated that they have been opposing the Health Insurance Scheme all along and they still hold the view that CS(MA) Rules, 1944 is more suitable and it may be extended to all non CGHS areas and should provide cover to the pensioners who have been deprived of this medical facility since long. He further opined that the proposed scheme will also deprive the existing benefits available to the employees and pensioners viz. OPD facilities, coverage to all dependent family members etc. Extension of CS(MA) Rules, 1944, to all pensioners living in Non CGHS areas is their long pending demand. The Staff side unanimously stated that if the Government has already made up its mind to introduce Insurance Scheme, it should be implemented with the following points given due consideration before introduction of the scheme, so that it attracts the prospective members to join the scheme:

   • The Scheme should not be made compulsory for the future employees and pensioners. A voluntary option for joining the scheme must be given to all future employees and pensioners. The choice must be left to them. Especially the future retirees should not be deprived of the CGHS benefits that they have been availing during their service period as per the present scheme.

   • All eligible dependent members of the family may be allowed to join the scheme without any additional financial burden on members. This is being done in the existing CGHS and no financial burden is being imposed on members. Whatever the liability of premium for additional members is worked out; the same may be borne by the Government.

   • As the OPD consultation will be free in networked hospital, the cost of medicines on the prevailing guidelines of the CGHS may be reimbursed to the members. Else, an amount to Rs. 1000 +DA per month as Fixed Medical Allowance (FMA) be paid to them on the analogy of the Transport Allowance. The revised amount of Rs. 300/- per month as FMA is inadequate, considering the ever increasing cost of the medical treatment under the present inflationary conditions.

   • The annual contribution to be made by the employee as his share of the Insurance premium for the Health Insurance policy should not in any case be more than the CGHS contribution applicable for him.

   • Life time contribution in respect of insurance premium may be taken from the pensioners as per the present CGHS provisions (for ten years for life time benefit) and rest may be borne by the government.

   Staff side raised the point about the implementation process of the scheme and enquired about the number of Insurance companies that may be involved in this scheme, as insurers to cover the entire country. Chairman informed the members that it will depend upon the future scenario as it emerges in due course.

   Shri S.K. Vyas reiterated his opinion that the extension of CS(MA) Rules, 1944, to the pensioners living in non CGHS areas would be more economical and cost effective way of addressing their health related issues in comparison to the proposed Health Insurance Scheme (CGEPHIS).

   Shri C. Srikumar raised the issue of revision of Fixed Medical Allowance (FMA) to those employees who are posted in remote areas where AMA is not available. Since the Government has already issued order for revising the FMA for pensioners, necessary order for serving employees may also be issued.

   Chairman assured the Staff Side members of the National Council(JCM) that the Ministry will look into the points raised by them seriously and the concerns expressed by them and suggestions made by them will be given due consideration while finalising the Scheme.

  The meeting ended with a vote of thanks to the chair.

 Courtesy :AIRF

Fresh Bid for proposed Cental Govt Health Insurance Scheme

Yet another bid formality is likely happen for ambitious Central Government Employees and Pension Health Insurance Scheme mooted out by Government Last year.

Last year almost all leading insurance companies in India were in fray and ICICI Lombard General Insurance was reported to be the winner of last year’s bid for managing the health insurance of all Central Government Employees.

However, the deal did not materialize as Government was moving to change certain conditions of the scheme after bid is over for which the successful bidder did not accede to. So, last year this health insurance scheme could not be launched.

The other bidders such as Oriental Insurance, New India Assurance, United India Insurance, National Insurance, Cholamandalam Ms General Insurance and Star Health and Allied Insurance will be competing with the last year’s lowest bidder.

This Health Insurance Scheme is meant for employees eligible for medical treatment under the Central Government Health Scheme (CGHS). As per the proposed scheme employees reside in non-CGHS area will also be covered.

As per media reports, the decision to cancel last year’s tender result was due to changes made in the list of beneficiaries, for whom the proposed health insurance scheme would be mandatory in the initial stages. The initial plan was to make health insurance mandatory for new recruits who join after the commencement of the scheme.

It was also decided future pensioners, who retire after the scheme comes into force, should also be asked to be part of it. Later, after finalisation of the tender, the ministry decided to keep this option voluntary for future pensioners and make it mandatory for recruits.

The change, as per media reports, will result in a difference in the number of estimated beneficiaries and hence, the contract could not be successfully finalised.

The CGHS covers over 800,000 families, of which 500,000 are employees and 300,000 are pensioners, through its network of hospitals and clinics in 25 cities and towns across India. Since it has no presence in 10 states, it does not cover all the 3.2 million eligible families.

With the government deciding to put a cap on its annual spend of Rs 1,600 crore, there is no alternative funding mechanism to turn health coverage inclusive. The new health insurance scheme is considered as an attempt to make this possible.

The new proposal, for which expression of interests will be invited from insurance companies in three months, is expected to cover seven lakh pensioners in five years.

According to sources, ICICI had agreed to provide a Rs 5-lakh insurance coverage for each policy holder for an annual premium of Rs 1,500.

The officials said the initial contract would be for three years and the insurance company that administered the programme would have the flexibility to seek a change in the premium amount every year.

Source: The Business Standard