The undersigned is directed to refer office memodum 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 :
- The reimbursement of expenditure for Consultation/Treatment including hospitalization if required/Investigations will be limited to rates as fixed under Central Government Health Scheme.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- This issues with the concurrence of Finance Division vide Dy. No. 2266/JS (FA) dated 4/4/2001.