Instructions on eligibility, dependency, CGHS contributions, issue of CGHS cards, medical advance, settlement of medical claims and medical facilities provided under CGHS

The Department of Health & Family Welfare under Ministry of Health & Family Welfare has issued an important clarification order regarding that the title of ‘Guidelines to be followed by Ministries/Departments while referring cases to Ministry of Health & Family Welfare on CGHS matters’.

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

Nirman Bhawan, Maulana Azad Road

NewDeihi 110 108

No.S.11011/1/2012-CGHS (P)

Dated the 27th June, 2012

OFFICE MEMORANDUM

Sub: Guidelines to be followed by Ministries/Departments while referring cases to Ministry of Health & Family Welfare on CGHS matters — reg.

Central Government Health Scheme (CGHS) was introduced in 1954 to provide comprehensive medical care for serving/retired Central Government employees and their family members. Instructions have been issued from time to time to regulate this medical facility to ensure that Ministries and Departments of Government of India including the CGHS beneficiaries have a clear idea on different aspects of CGHS.

2. Various instructions on eligibility, dependency, CGHS contributions, issue of CGHS cards, medical advance, settlement of medical claims and medical facilities provided under CGHS have been issued. These instructions are by no means exhaustive but an effort has been made to ensure that most cases are settled at the beneficiary’s own Ministry / Department.

3. Despite issuing a number of guidelines on settlement of reimbursement claims and delegation of powers for referral and approval cases, it has been observed that cases are being referred to this Ministry in a routine manner without adequate examination. Instances of cases have come to notice where despite the lack of documentary evidence, cases have been recommended and referred to this Ministry for examination, with or without the approval of the concerned Joint Secretary/Head of Department.

4. In such cases, it becomes difficult to examine the legitimacy of the claims and much time and effort is spent in collating and verifying the facts of the case.  Accordingly, it is impressed upon all the Ministries/Departments of the Government of India to ensure that cases are examined thoroughly as per the CGHS guidelines and instructions. If any clarification on CGHS policy matter/relaxation of rules is required, the Administrative Ministry / Department may, if they are satisfied with the justification/merit of the case, refer it to this Ministry with the specific recommendation of the concerned Joint Secretary /Head of Department along with all supporting documents.

5. This issues with the approval of Additional Secretary & Director General (CGHS).

sd/-

(V.P.Singh)

Deputy Secretary to the Government of India

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