Clarification regarding reimbursement of Ambulance charges to CGHS beneficiaries

No: S.4924/2010/CGHS(R&H)/CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
***********
Maulana Azad, Nirman Bhawan.
New Delhi 110 108 dated the 17th2011
OFFICE MEMORANDUM
Subject:    Clarification regarding reimbursement of Ambulance charges to CGHS beneficiaries-

      The undersigned is directed to refer to the subject mentioned above and to state that this Ministry has been receiving several representations seeking clarifications regarding Ambulance charges to CGHS beneficiaries.

2.       It is accordingly clarified that expenditure incurred on engagement of Ambulance by CGHS beneficiaries, comprising both serving Govt. employees and pensioners is reimbursable provided that:

      (i)       The doctor treating the patient certifies in writing that conveyance of patient by any other mode would definitely endanger the patient’s life or would grossly aggravate his / her condition and

      (ii)       That the journey is undertaken within the same city.

3.       This issues with the concurrence of IED vide Dy. No. 4888/Dt.11.O1.2011 of the office of the AS&FA, Min., of Health &Family Welfare.

s/d
[Jai Prakash]
Under Secretary to Government of India

Click here to view the CGHS order

Fresh empanelment of private hospitals and revision of Room Rent applicable under CGHS

No: S.11011/23/2009-CGHS D.II/Hospital Cell (Part I)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
*************

Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the 16th November , 2010
O F F I C E M E M O R A N D U M

Subject:     Fresh empanelment of private hospitals and revision of Room Rent applicable under CGHS.

        The undersigned is directed to state that CGHS had initiated action for fresh empanelment of private hospitals under CGHS and also for the revision of package rates (which were fixed in 2006-07), to be paid to hospitals, by floating tender for the same. On the basis of the responses received package rates for various procedures / treatments have been arrived at and have been uploaded in the website of CGHS:www.mohfw.nic.in\cghsnew\index.asp and can be down loaded.

2.        “Package Rate” shall mean and include lump sum cost of inpatient treatment / day care / diagnostic procedure for which a CGHS beneficiary has been permitted by the competent authority or for treatment under emergency from the time of admission to the time of discharge including (but not limited to) –
(i) Registration charges,
(ii) Admission charges,
(iii) Accommodation charges including patients diet,
(iv) Operation charges,
(v) Injection charges,
(vi) Dressing charges,
(vii) Doctor / consultant visit charges,
(viii) ICU / ICCU charges,
(ix) Monitoring charges,
(x) Transfusion charges,
(xi) Anesthesia charges,
(xii) Operation theatre charges,
(xiii) Procedural charges / surgeon’s fee,
(xiv) Cost of surgical disposable and all sundries used during hospitalization,
(xv) Cost of medicines,
(xvi) Related routine and essential investigations,
(xvii) Physiotherapy charges etc.
(xviii) Nursing care and charges for its services.

(b)         Cost of Implants / stents / grafts is reimburseable in addition to package rates as per CGHS ceiling rates for Implants / stents / grafts or as per actual, in case there is no CGHS prescribed ceiling rates.

(c)         Treatment charges for new-born baby are separately reimburseable in addition to delivery charges for mother.

d)         The hospitals empanel led under CGHS shall not charge more than the package rates / rates.

2.2         Package rates envisage up to a maximum duration of indoor treatment as follows:

                12 days for Specialised (Super Specialties) treatment;
                7 days for other Major Surgeries;
                3 days for Lapar oscopic surgeries / normal deliveries; and
                1 day for day car e / Minor (OPD) surgeries.

2.3         However, there are certain procedures where there is no prescribed package rate under CGHS. Similarly, there are medical emergencies where the treatment is mainly conservative. The admissible amount in such cases is calculated item wise, room rent, procedures, investigation , etc., .

        Therefore , it has now been decided to revise the rates applicable for room rent (Accommodation Charges) for different categor ies of wards as given below:
                General ward -Rs.1000/- per day
                Semi-private ward -Rs. 2000/ – per day
                Private ward -Rs.3000/- per day

3.         CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-

S. No. Basic Pay (without the inclusion of grade pay) Entitlement
1. Upto Rs. 13,950/- General Ward
2. Between Rs.13,951/ – and Rs.19,530/- Semi-Private Ward
3. Rs. 19,540/- and above Private Ward

4.2         This issues with the concurrence of Internal Finance Division in the Ministry of Health & Family Welfare, vide Dy. No: AS & FA / 3932 /2010 dated the 8th November , 2010.

        The revised rates will come into effect from the date of issue of this Office Memorandum.

[R Ravi ]
Director
[Tel: 2306 3483

State-owned insurance companies to restore cashless treatment facilities (case to case basis) in big private Hospitals

State-owned insurance companies on Tuesday agreed to restore cashless treatment facilities in big private hospitals on a case-to-case basis, a development likely to benefit mediclaim policy holders. “Insurance companies have decided to restore cashless facilities on a case-to-case basis. We discussed ways of making people part of the facility and how reimbursements can be revived,” said Sanjay Datta, head, health insurance, ICICI Lombard, after a Confederation of Indian Industry (CII)-initiated meeting between insurers and the healthcare industry.

State-owned insurance companies — Oriental Insurance, New India Assurance, National Insurance and United Insurance — have also agreed to expand the network of hospitals providing cashless treatment facility (PPN or preferred provider network) for the benefit of mediclaim policy holders.

The CII called a meeting of insurers and healthcare industry representatives to resolve the impasse following withdrawal of cashless treatment facility at 150 hospitals by the four PSU insurance firms from July 1 on allegations of over-billing.

“In order to keep health insurance premiums affordable and viable, all stakeholders, including consumers have to respect and maintain the integrity of the system,” said M. Ramadoss, CMD, New India Assurance.

The meeting was attended by representatives of Fortis, Max Healthcare, Apollo Hospitals.

CGHS website launched

A website meant to cater to the beneficiaries of the Central Government Health Scheme (CGHS) in Bangalore was inaugurated here on Wednesday.

A workshop ‘Reaching out to the beneficiaries,’ an innovative initiative from CGHS Bangalore, held under the aegis of the Chairman, Central Government Employees Welfare Committee (CGEWCC), Ministry of Personnel, Public Grievances and Pensions, Government of India, was held to coincide with the launch of the website.

CGHS beneficiaries including pensioners and CGHS service providers can now access information pertaining to the list of medical officers including phone numbers and e-mail IDs, the list of CGHS empanelled hospitals and other relevant information of CGHS rules and procedures on the newly launched website at: http://www.cghsbng.kar.nic.in

source: Deccanherald

‘RETIRED EMPLOYEES CAN SUE GOVT FOR NEGLIGENCE UNDER CGHS’

RETIRED EMPLOYEES CAN SUE GOVT FOR NEGLIGENCE UNDER CGHS’

The verdict, read with a ruling of the SC in 1995 that in-service Central Government employees are consumers under the Central Government Health Service Scheme, now categorises the entire working and retired work force as consumers, as far as health care is concerned under the scheme

Lakhs of retired central government employees can rejoice as the apex consumer forum has held them to be the consumers under the CGHS scheme, thus conferring a right on them to sue the Centre for damage in case of deficiency in health care provided to them and their dependents.

This was unanimous decision of a full Bench of the National Consumer Disputes Redressal Commission (NCDRC) comprising its president  Justice M.B.Shah, members Rajyalakshi Rao, B.K. Taimni, Justice K.S.Gupta, Justice S.N. Kapoor and P.D.Shenoy. This verdict, read with a ruling of the Supreme Court in 1995 that in-service central government employees are consumers under the Central Government Health Scheme (CGHS). now categorises the entire working and retired work force of the Central Government as consumers, as far as health are is concerned under the scheme.

The question before the NCDRC was “whether a pensioner and beneficiary of the CGHS would be a consumer under the provisions of Consumer Protection Act, 1986, for alleged deficiency in service by the CGHS Medical Officer”.

Answering in the affirmative, NCDRC said medical treatment facilities extended to a retired under CGHS could not be termed as ‘free service’ as it was in consideration of service rendered by him to the government till the age of superannuation, which conferred a right on him to get pension as well as other benefits, including medical treatment prescribed by various rules or the schemes framed by the Centre.

“Such employee would be a consumer as defined in Section 2(1)(d)(ii) of the Consumer Protection Act,” said Justice Shah , writing for the Bench. Explaining the reason behind the conclusion that would make the retired employees feel less neglected, the NCDRC said service rendered by the government employees before retirement would be “consideration” for providing medical facilities to him or his family members.

“Hence, it cannot be said that the hospital which is subsidised by the government is rendering service free of charge,” it said.

The NCDRC verdict came on a petition filed by retired employee Jagdish Kumar Bajpai, through advocate Nikhil Nayar, claiming that he was refused medicines for his wife by the CGHS dispensary in Kanpur. He also claimed damages to the tune of Rs. 4 lakh alleging that his wife died due to the negligence of the medical officer.

(The above news item appeared in Ahmedabad Edition  of  Times ofIndia dated November 7, 2005 – Thanks to Central Government Employees News )