CGHS – CS(MA) Rules – Medical Reimbursement – Clarification

Clarification on Medical Reimbursement of Central Government Health Scheme (CGHS).

The Department of Health and Family Welfare has published various orders regarding the empanelled hospitals and the revision of package rates on its website regularly. Still there is lot of problems with some of the empanelled hospitals while getting treatment. They did not bother about the package rates and they used some other medical words in discharge summary of the particular treatments.

Hence the amount of reimbursement is reduced or the total claim is ignored. The reimbursement will be made on the basis of the medical bills and reports as in the discharge summary. The pertinent package rates has been searched by the competent authority to sanction his claim of medical treatment according to given reports by the employee.

Department of Health and Family Welfare issued a detailed clarification on 30.09.2011, “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”.

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