CGHS Orders : Procedure for Referral to Recognized hospitals – No. S-11011/6/96-CGHS (P) dated 11/7/1997

Text of MH & FW O.M. No. S-11011/6/96-CGHS (P) dated 11/7/1997.

Procedure for Referral to Recognized hospitals Simplified.

In supersession of this Ministry’s Office Memorandum of even number, dated 21/6/1996 on the above subject and keeping in view the inconvenience being faced by the CGHS beneficiaries, it has been decided that :-

1. The beneficiaries will have to option of availing specialized treatment at CGHS recognized hospital of his/her choice after a specialist of CGHS/Government hospital recommends for the same. A certificate regarding non-availibility of beds in Government hospital would not be required. The terms “Government hospital” would include any hospital of a State Government/Government Departments such as Railway, Atomic Energy Commission etc., as also hospitals of Public Sector Undertakings (such as those of the Steel Authority of India Limited/Coal India Limited, etc.)

2. In non-emergency cases, once the recommendation (regarding line of treatment) of a CGHS specialist or a specialist of a hospital of Central/State Government/a Public Sector Undertaking has been obtained, the procedure for obtaining Administrative approval would be as follows:-

In case of serving Government servants, after the Specialist advises a procedure in writing, the permission letter for taking such treatment in a CGHS recognized private hospital/referral hospital of choice in the same city, would be given by the parent Department/Office of the employee.

In case of Pensioners, (including Ex-MPs, Former Governors, etc.), after the initial advice of a specialist has been obtained, the permission letter for such treatment would be given by the CMO Incharge of the concerned CGHS dispensary, but the bill would be raised in the name of Additional Director, CGHS concerned, as in the case of pensioners, the payment is to be made by CGHS directorate.

In case of a medical emergency, the details of which shall be recorded in writing by the CMO Incharge of the CGHS dispensary, the CMO concerned by directly (i.e., even before specialist’s advice has been obtained) refer the CGHS beneficiary to a private recognized hospital for further management / treatment.

The expenditure to be reimbursed by the parent department/office/CGHS Directorate, as the case may be, would be restricted to the package deal rates/rates approved by the Government from time to time. The expenditure in excess of the approved rates/package deal would have to be borne by the beneficiary himself/herself.

In case the beneficiary, in spite of the facility being available in the city still chooses to get treatment in CGHS recognized institutions in another city, permission may be given, but in such cases T.A/D.A would have to be borne by the beneficiary himself/herself.

For availing treatment outside the city of residence of a beneficiary, the permission of Director/Additional Director/Joint Director of the city have to be obtained.

2. These orders will be applicable from the date of issue.

3. This issues with the approval of Joint Secretary & FA vide his Dy. No. 3110 dated 10/6/1997.

Authority: http://www.cghs.gov.in/