9.

MEDICAL

I. MEDICAL ATTENDANCE RULES - GISTS OF IMPORTANT ORDERS

1. C.S (MA) Rules, 1944.

1. Treatment is limited to 10 days (Prolonged treatment is also admissible provided doctor certify it). (20 days for Indian system
of Medicine and Homeopathy) with a maximum of four consultations and ten injections. The number of injections may be raised to
15 depending on the condition or ailment of the patient.
2. There should be a reasonable gap between the closing of first spell and recurrence of the second spell of treatment of the
same disease.
3. Dependency: - Income should not exceed to the extent of Rs.3500 + DA per month at the time of treatment. But it does not
apply in case of spouse.
4. Cost of blood and blood transfusion is reimbursable.
5. Reimbursement of fees paid to specialist of a Govt./recognized hospital for testing eyesight for glasses is admissible once in
three years for Govt. Servant alone and not for his family.
6. Dental treatment including extraction, scaling and gum treatment, root canal treatment and filling of teeth (excluding cost of
denture) is admissible.
7. Expenses incurred for the correction of squint eye is reimbursable.
8. In case of serious illness/accidents where the official is unable to apply, the advance may be sanctioned on an application
made by his wife or other legal heir.
9. In case of consultation of a Specialist/other medical officer is required in the opinion of and only on reference of AMA, the limit
of 4 consultations within 10 days will count from the date on which the specialist/other medical officer is consulted.
10. If consultation is taken on the 10th day and further medicines are prescribed, the consultation fee for that day shall not be
reimbursable. In such cases the patient should go to OPD of Govt. recognized hospital.
11. Cost of medicines, prescribed during these consultation only (i.e. upto 10 days) is reimbursable.
12. Charges for a maximum of 10 injections (it may go up to 15 in special cases) can also be reimbursed.
13. Consultation and injection can be had together and prescribed fee for each can be claimed.
14. A separate claim for each spell of each disease should be preferred.
15. Between two spells of same disease there should be a reasonable gap.
16. If during a spell of treatment of a disease another disease occurs, then consultation made for it will be fresh first consultation
and a separate new spell.
17. Medical claim should be preferred within six months of completion of the treatment. However, the Departments may condone
delay beyond 6 months. The three months has been raised under OM No. S 14025/19/2015-MS dated 27.05.2015
18. Family means for availing medical treatment
(i) Husband/wife
(ii) Parents &Step mother
Note: In case of adoption, only the adoptive and not the real parents. If the adoptive father has more than one wife, his first wife
only. A female employee can choose to include either her parents or her parents in law. Option exercised can be changed only once
during one's service. Resident condition is not applicable for parents.
(iii) Children
Unmarried Son- Till he starts earning or attaining the age of 25, whichever is earlier.
Daughter - Till she starts earning or gets married whichever is earlier, (irrespective of age limit).
Son suffering from permanent disability or mentally - no age limit.
(iv) Widowed daughter and dependent divorced/separated daughters, irrespective of age limit.
(v) Sisters including widowed divorced/separated sisters irrespective of age limit.
(vi) Minor brothers and dependent brothers’ upto the age of becoming major.
(vii) Minor children of widowed/separated daughters.
(viii) Permanently disabled dependent brother. (No age limit) provided he is unmarried, not having his own family, wholly
dependent on and residing with the principal CGHS card holder or beneficiary.
19. Advance may be paid irrespective of pay limit for inpatient hospital treatment. The advance may be paid in one or more
installments for the same illness or injury. There is no limit for the number of advances payable to an official with reference to
himself and to each member of the family and in each case of illness.
20. When advance is paid direct to the hospital, the official should submit the bills for final settlement within one month from the
date of discharge from hospital. The Head of office will correspond directly with the hospital for a refund of the unutilized balance, if
any.
21. For Major illness of Bypass surgery, kidney transplant etc, 90% of the package deal wherever it exists, or the amount
demanded by the hospital concerned in other cases.
22. In case of serious illness/accidents, the wife or other legal heir may apply for advance on behalf of the Government servant.
23. Reimbursement of ambulance charges:
i) The ambulance should be used within the same city and also belong to Govt./Local Fund or Social service organization.
ii) It should be certified that the conveyance of the patient by any other means would definitely endanger his life or aggravate his
health condition.
iii) It should be used between one hospitals to another for certain medical examinations.

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24. Expenses incurred on the surgery and post-operative care of the donor of the Kidney to the employees or to a member of their
family for transplantation will be reimbursed. TA is also admissible.
25. In case of emergency treatment, reimbursement shall be allowed at non - NABH rates under CGHS for the city or nearest CGHS
City.
26. Requests for relaxation of procedures in considering the claims shell be referred along with specified documents (OM No.
S.11024/1/2015 CGHS (P) dated 01.01.2016)

2. Consultation/Visiting/Injection fee. CS (MA) Rules 1944

Medial Post Medical Licentiate &

Graduate specialists Medical Graduates
(Rs.) (MBBS or equivalent)
Consultation Fees
First Consultation 100 70
Subsequent Consultation 60 40
Injection Fees
Intramuscular/Subcutaneous 20 20
Intravenous 40 40
(MOH &FW No. S-14025/10/2010-MS dated 17.03.2011)

3. Reimbursement of following is admissible subject to the prescribed conditions.

(i) Artificial orthopedic appliances.
(ii) Digital hearing aid.
(iii) Cost of Heart Pacemaker & Replacement of Pulse Generator.
(iv) Cost of knee and hip implants.
(v) Cost of Nebulizer.
(vi) Cost of oxygen concentrator.
(vii) Cost of CPAP Machine & BIPAP Machine for domiciliary use.
(viii) Cost of Neuro – implants.
(ix) Cost of cochelear implants.

II. GIST OF IMPORTANT ON CGHS

4. C.G.H.S.
(i) CGHS contributions will be recovered every month from pay bill
(ii) If the husband and wife are Government employees, the contribution will normally be paid by one who gets higher pay.
(iii) In case of leave exceeding 4 months, one may opt not to contribute and in such cases, the CGHS facilities will not be admissible.
(iv) Pensioners/Family pensioners have to contribute the amount they were subscribing at the time of retirement/death of
Government servant.
(v) Pensioners/Family Pensioners should pay their contribution for one year in advance either from January to December or July to
June.
(vi) Pensioners can avail life time facility by paying 10 years contribution in one lump sum at the time of retirement.
(vii) Medical Allowance is not payable if the pensioners are residing in areas where CGHS facility exists.
(Vii) P &T Pensioners who were not CGHS beneficiaries while in service, but residing in CGHS area where there is no P&T dispensary
are entitled to Fixed Medical Allowance.
(ii) Conditions for availing the Scheme:
(i) The employee should reside in the area of operation of the Scheme.
(ii) Pensioners residing anywhere may get registered in any dispensary.
(iii) A family photograph of size 6.5 cm x 5 cm should be affixed to the CGHS token card and got attested by the Department.
In case of CGHS beneficiary falling sick outside CGHS area, treatment is allowed under CS (MA) Rules in Government
Hospitals/Referral Hospitals/Recognised Hospitals
(iv) If both husband and wife are employees and contribute for CGHS, parents of both can be included for the benefits.
(v) Family of the employee can avail the facility if the employee is transferred to another CGHS area or goes to serve abroad and
leaves the family at the old CGHS station.
(vi) Family of the employee who continues to stay back at the old station in a CGHS covered area can avail CGHS facilities even
after the transfer of the employee to a non-CGHS area, for a maximum period of six months on payment of CGHS contribution in
advance for that period.
(vii) Irrespective of age, the dependent permanently disabled/mentally retorted children residing Government servant are eligible
to avail CGHS.
(viii) From 19.01.2012, minor children of widowed/separated daughters can avail up to the age of 18 hours.
(ix) Dependent condition: Less then Rs. 9000/- PM plus the amount of D.A.
(x) May avail medical facilities for in-patient treatment and Post-operative following treatment, while residing in or on visit to a
non CGHS area subject to conditions.
(xi) Can undertake medical treatment from any hospital recognised under CGHS subject to the condition that the reimbursement
shall be allowed as per CGHS/CS (MA) Rules or the actual expenses incurred whichever is less.

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(xii) If the treatment of a particular disease is available in the same city, he may be permitted to avail of the treatment in any other
city of his choice.
(xiii) If the treatment is not available at the same station, he is eligible for the grant of TA/DA.

(iii) (A) Monthly Contributions for availing CGHS facility:

Sl. No. Corresponding levels in the Pay Matrix as Contribution (Rs. Per month)
per 7th CPC
1 Level: 1 to 5 250
2 Level: 6 450
3 Level: 7 to 11 650
4 Level: 12 & above 1000

(B) Entitlement of wards in private hospitals empanelled under CGHS:

Sl. No. Corresponding Basic Pay drawn by the officer in 7th Ward entitlement
CPC per month
1 Up to Rs. 47,600/- General
2 Rs. 47,601/- to Rs. 63,100/- Semi-Private
3 Rs. 63,101/- and above Private

(e) Monetary Ceiling for Free Diet:

The monetary ceiling for free diet for CGHS beneficiaries is revised to pay/ pension / family pension of Rs. 44,900/- per month.
(D) Monetary ceiling for free diet for beneficiaries suffering from TB or mental disease):
The monetary ceiling for free diet in case of beneficiary suffering from TB or Mental disease is revised to pay / pension / family
pension of Rs. 69,700/- per month.
(E) Pay slab for determining the entitlement of Nursing Home facilities in Government / State Government / Municipal Hospitals:
The monetary ceiling for determining the entitlement of nursing home facilities in Central Government / State Government /
Municipals Hospitals is revised to pay / pension / family pension Rs. 47,600/- per month and above.
(F) Monetary Ceiling for direct consultation with Specialists in Central Government /State Government /Municipal Hospitals:
The monetary ceiling for determining the entitlement for direct consultation with Specialists in Central Government / State
Government / Municipal Hospitals will continue at the existing rates until revision of the same after consultation with Ministry of
Finance.
(G) Pay slab for determining the entitlement of accommodation in AIIMS, New Delhi.
The revised entitlement, as per the pay drawn by the officials, is as follows:

Sl . No. Corresponding Basic Pay drawn by the officer in 7th CPC Ward entitlement
per month
1 Up to Rs. 63,100/- General
2 Rs. 63,101/- to Rs. 80,900/- Private
3 Rs. 80,901/- and above Deluxe/Private
4. It is clarified that the reference to pay in this order relates to the pay drawn in the level of pay.
5. Pensioners have an option to get their CGHS pensioner card made by either making CGHS contribution on an annual basis (twelve
months) or by making contribution for 10 (ten) years {120 (one hundred and twenty) months} for getting a pensioner CGHS card with
life-time validity. It is clarified that:
(i) Contribution to be made by pensioners / family pensioners would be the amount that they were subscribing at the time of their
retirement or at the time of death of the Government servant;
(ii) Pensioner beneficiaries, who have already obtained CGHS card with life time validity by paying a lump sum amount equivalent to
10 years’ contribution, will not be required to pay any additional amount as a result of the revision in the rates of contribution for
availing CGHS facility;
(iii) Entitlement of pensioners / family pensioners, who have already deposited their contribution for life time CGHS facility, will not
be changed.
(iv) Pensioners / family pensioners who are contributing to the CGHS on an annual basis and wish to continue to avail CGHS benefits
will have to contribute at the revised rates up to the time of contribution needed to cover a period of a total of ten years from the
time pensioner CGHS card was issued for the first time to them. The revised rate of contribution for the remaining period would be
with reference to the level of pay that he / she would have drawn in the post held by him / her (at the time of his / her retirement /
death) had he / she continued to be in service now but for his / her retirement/ death; and
(v) Any pensioner / family pensioner who is entitled to avail CGHS facility has not so far got his / her pensioner CGHS card made, the
rate of contribution in such cases will be with reference to the level of pay that he / she would have drawn in the post held by him /
her (at the time of his / her retirement / death) had he / she continued to be in service now but for his/ her retirement / death.
6. This issues with the concurrence of the Department of Expenditure vide their I.D. Note No. 18(1)/EV/2016, dated 24/11/2016.
(MOH & FW OM No. S.11011/11/2016 CGHS (P)/EHS dated 09.01.2017)
In partial modification of OM dated 09.01.2017, the revised rates will be effective from 1st February 2017 instead of 1st January 2017.
MOH & FW OM No.S.11011/11/2016-CGHS (P)/EHS dated 13.01.2017)

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5. Revision of rates of subscription under Central Government Health Scheme due to revision of pay and allowances of Central
Government employees and revision of-pension/ family pension on account of implementation of recommendations of the
Seventh Central Pay Commission.
The undersigned is directed to refer to this Ministry’s OM No. S.11011/2/2008-CGHS(P) dated 20th May, 2009 vide which orders
were issued revising the rates of monthly subscription for availing CGHS facility, as also the entitlement for free diet, entitlement of
accommodation in private empanelled hospitals under CGHS, etc.
2. Consequent upon revision of pay on the basis of the implementation of the recommendations of the 7th Central Pay Commission,
it has been decided to revise the rates of subscriptions, to be made by employees / pensioners, for availing benefits under the CGHS,
with effect from 1st January, 2017. It has also been decided to revise the monetary ceiling limits for various entitlements of the
beneficiaries for availing CGHS facilities.

6. Fixed Medical Allowance

The provision of FMA to the employees working in the interior/remote localities where no AMA is available within a radius of 5
kms was withdrawn w.e.f. 3.6.2015.

III. CS (MA) RULES - GIST OF SELECTIVE ORDERS

7. CS (MA) Rules - Gist of Selective orders

(i) Reimbursement for treatment in private hospital in emergent cases
All such cases of medical treatment in a private hospital in emergencies should be decided with the personal approval of the
Head of the Circle (Chief PMG). Permission can be granted to obtain medical services from any of the private hospitals recognized
under CGHS in the 18 CGHS cover cities. If the treatment for a particular disease/procedure is available in the same city, he may be
permitted to avail of the medical services in any city of his choice but in such case, he will not be eligible for sanction to TA/DA. In
case the treatment for a particular disease/procedure is not available at the same station, the beneficiary will be eligible for sanction
of TA of his entitled class for taking treatment in a different city.
(MOH OM No. S-14025/72000-MS dated 28.03.2000)
(ii) Private nursing home/clinic - clarification
"in order to eliminate the confusion regarding distinction between the private hospital and a private nursing home/clinic, the
delegated powers referred to above are applicable to all private medical institutions without making any distinction between a
private hospital and a private nursing home/clinic.
(MOH OM No. S-14025/46/92-MS - dated 4.2.1993)
Note: - For settling permission cases and post facto approval for reimbursement in relaxation of rules in emergent cases under
CGHS/CS (MA) Rules, the powers has been now delegated to Head of office instead of Head of Department.
(MOH OM No. S-14025/2/2011-MS dated 11.1.2011)

(iii) CS (MA) beneficiary can take treatment in CGHS approved hospitals

(i) As per provisions contained in the Department of Health OM No. S 14025/7/2000-MS dt. 28.03.2000, a CS (MA) beneficiary can
avail treatment (OPD/IPD) in any CGHS recognized hospital with the permission of the Department concerned and on a reference
from AMA concerned.
(ii) A CS (MA) beneficiary who obtained treatment at CGHS recognized private hospital with the permission of the Department, he
is entitled to CGHS rates. However in case of emergency, CGHS rate can also be reimbursed without prior permission of the
department.

(iv) FMA to pensioners: -

It has been revised as Rs.500/- per month.
(v) Reimbursement of medical claim for treatment taking in private hospitals in emergent case
In emergent cases involving accidents/serious major deceases etc. the person/persons on the spot may use their discretion for
taking the patient for treatment in a private hospital in case no government/or recognized hospital is nearer than the private
hospital.
(DG (P) No. 31-24/93-PAP dated 25.01.1994)
(vi) (a) The residential condition for members of the family having been waived. Family members may have medical attendance and
treatment even if they do not stay with the employee.
(b) Parents residing with either the Government employee or other family members in a station other than the employee's
headquarters are eligible for reimbursement.
(MOF & FW OM No. S.11011/7/86-CGHS (P) dated 4.2.1987)
(vii) When spouse is in receipt of fixed medical allowance - The employee concerned can claim medical re-reimbursement in respect
of himself/herself, as the case may be and for other family members (except spouse).
(MOH OM No. Z 28013/8/98-MS, dated 26.5.2000)

(viii) Private Medical Practitioners are appointed as AMAs where adequate number of Government doctors in various systems of
medicines are not available or when their services are not available within a radius of five kilometers or because of the remoteness
of the area.
(MOH OM No. S.14023/1/74-MS dated 9.10.1974 & OM No. S 14025/65/78-MS dated 16.8.1979)

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(ix) Where no AMA has been appointed in a suburban area, treatment may be had from AMA employed in a Government hospital
in the adjoining city.
(MOH OM No. S. 14012/1/74-MC, dated 25.2.1976)
(x) Reimbursement of expenses for purchase cost of various artificial appliances - If prescribed by specialist of Government and
recognized hospitals are admissible in the following cases: -

(xi) Replacement of hearing aid shall be allowed after the average life of five years on the basis of condemnation certification from a
technical expert and on approval of ENT specialist.
(MOH OM NO. S 14025/10/2002-MS dated 28.10.2002/15.11.2002.)

(xii) In case of a child below 12 years of age, a hearing aid may be replaced, if damaged after three years of its purchase on the basis
of condemnation certificate from a technical expert and on advice of an ENT specialist of a Government hospital.
(MOH OM No. S.14025/5/2004-MS dated 3.6.2004 & 7.7.2004)

(xiii) Cost of purchase of Nebulizer to be reimbursed under CGHS and CS (MA) Rules -
(1) Rs. 3000/- or the actual cost, whichever is less.
Notes: Permission for use of Nebulizer/ex post facto approval may be given only on the advice of Senior Physician or above or
medical specialist of equivalent rank of a Government Hospital.
(2) The cost of maintenance will be borne by the beneficiary concerned.
(3) Keeping in view the average life view of Nebulizer as 5 years, replacement may be permitted on the basis of a certificate of
condemnation obtained from the treating physician/specialist as indicated above.
(MOH OM. No. 11006/2000-JD (R&H)/CGHS (P) dated 11.06.2001)

(xiv) Reimbursement for Dental Treatment

(a) Expenses incurred on the following types of dental treatment of a major kind obtained at the Government hospital recognized
under C.S. (MA) Rules, or private recognized hospitals on the advice of AMA, if such treatment is not available in the nearest
Government hospitals: -
(a) Extraction;
(b) Treatment of gum boils;
(c) Root canal treatment;
(d) Scaling and gum treatment including pyorrhea and gingivitis;
(e) Filling of teeth;
(f) Treatment of jaw bone disease, wholesale removal of teeth etc.
(g) Surgical operations needed for removal of Odentonmes and impacted wisdom-tooth;
(MOH OM No. S. 14025/63/79-MS dated 1.1.1981 &MOH OM No. S-14020/2/87-MS dated 23.01.1989)

(b) Reimbursement of the cost of-

(i) Complete Denture of one jaw Rs. 1000 (one-time
(ii) Complete Denture Rs. 2000 basis only)
Note: - Reimbursement of the cost of the Denture up to the ceiling limit as above, may be considered only if the procedure is
advised as essential by the Specialist (Dental Surgeon) of a Government hospital Dental Surgeon of a recognized hospital, provided
the patient has been referred by the AMA to that hospital.
(MOH OM No. S.14025/19/2002-MS dated 13.08.2002)

(xv) Guidelines regarding referral letters and settlement of bills

The Hospital shall not undertake treatment of referred cases in specialties for which it is not empanelled. But it shall provide
necessary treatment to stabilize the patient and transport the patient safely to nearest recognized hospital under intimation to CGHS
authorities. However in such cases the Hospital shall charge as per the CGHS rates only for the treatment provided.
CGHS cards/Plastic cards are valid in all CGHS cities, irrespective of the city where the CGHS card is registered. In case any
verification regarding the photocopies of Plastic cards/CGHS card is required the details of the individual may be ascertained by
accessing the data online at http://cghs.nic.in/welcom.jsp by entering relevant details. A print out of the same be enclosed. The
beneficiary will not be asked to submit a colour photocopy of CGHS/Plastic Card.
In case of serving employees admitted under emergency, the hospitals shall ensure that the details pertaining to the office
where the patient is employed are entered in the records.
In case of pensioner CGHS beneficiaries on a visit to another city and treatments taken under medical emergency with prior
permissions, hospitals/diagnostic centers will send hospital bill through UT-ITSL to CGHS of City, where the hospital/diagnostic
center is located irrespective of the city, where the card is registered.
(MOH No. S.110011/23/2009-CGHSD.II/Hospital Cell (Part IX) dated 20.12.2011)

(xvi) Treatment in Private Hospitals in relaxation of Rules in emergent Cases

In emergency case of serious accidents or severe illness, an employee or a member of his family may be admitted for emergent
treatment in the nearest private hospital (including private nursing home/private clinic) in the absence of a Government or
recognized hospital nearer than the private hospital.
Reimbursement of expenditure may be allowed in such cases by the Heads of Departments, subject to the following
guidelines:

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(1) Whether it was a case of real emergency necessitating admission in a private institution, will be decided on merits by the
Controlling Authority.
(2) Medical expenses incurred in a private hospital are reimbursable without any distinction between private hospitals and private
clinics/nursing homes; but treatment in private clinics/nursing homes of AMAs is not permissible.
(3) There is no limit on the amount that can be reimbursed, but individual ceilings prescribed for various items of treatment under
different systems of medicine have to be applied.
(4) If the expenditure is beyond the paying capacity of the employee, the Department may authorize the Controlling Authority to
meet directly the expenditure incurred on admissible items of treatment subject to the prescribed limit. The controlling officer may
make advance payments or advance deposits to the hospital, if demanded.
(Appendix- VIII of Medical Attendance Rules)

(xvii) Revision of rates for reimbursement of medical expenses incurred in emergency conditions under CS (MA) Rules, 1944
1. The reimbursement of medical expenses incurred by a Central Government employee covered under CS(MA) Rules, 1944 on
availing medical treatment for himself and his dependent family members in emergency conditions, would be allowed as per the
prevailing non -NABH CGHS rates as applicable to a CGHS covered city and non-NABH rates applicable to the nearest CGHS covered
city in case of non-CGHS city, as the case may be, or the actuals, whichever is less.
2. For the medical treatment in such cases where package rates are prescribed under CGHS, the non-NABH rates of the CGHS
covered city and non-NABH rates of the nearest CGHS city (in case of non-CGHS covered city) or the actuals, whichever is less, will be
applicable.
3. This OM supersedes all earlier orders issued from time to time under CS (MA) Rules, 1944 on this subject for allowing
reimbursement of medical expenses in emergency conditions when treatment is taken in a non-empanelled private hospital. This
OM will come into effect from the date of issue.
(MOH OM No. S. 14025/14/2012-MS, dated 11.06.2013)

(xviii) Simultaneous treatment in two or more systems of medicine- Treatment for same ailment not
to be taken simultaneously in more than one system of medicine. If treatment for different ailment is taken in different systems of
medicine, the fact to be intimated to the attending doctors of other systems concerned.
(MOH OM No. S.14025/74/9-MS dated 28.05.1980)

(xix) Other conditions for grant of Advance

(1) The advance can be paid in one or more installments for the same illness/injury subject to the limit prescribed.
(2) The advance will be paid direct to the hospital concerned on receipt of an estimate from the treating physician/medical officer.
(3) There is no limit with reference to the number of advances payable.
(4) When an employee is too ill to apply for advance - The advance may be sanctioned on an application in writing made on his
behalf by his wife/legal heir.
(MOH OM No. S. 14025/9/72-MA dated 16.05.1973)
(xx) Medical advance surety to temporary employees
(1) In case of temporary employees, surety from a permanent employee is required.
(2) In the case of artificial appliances, the payment will be made by Ministries/Departments direct to supplying agencies.
(MOH OM No. 14025/67-84-MS dated 24.10.1986)
(xxi) Reimbursement of medical claim for treatment taking in private hospitals in emergent cases- clarification
The Chief PMsG are the head of the Department for all intent purposes and as such it is clarified that in future all such cases of
medical treatment in a Private hospital in an emergency should be decided with the personal approval of the Heads of the Circles.
(i.e. Chief Postmaster General).
(DG (P) No. 31-24/93-PAP, dated 25.01.1994)
(xxii) Claim for treatment outside the headquarters from R.M.P.S appointed as AMAS not reimbursable
A Govt. official and/or entitled members of the family going outside their normal duty station for any reason and require
medical treatment, they should obtain the treatment from the nearest Govt. & other Hospitals recognised under CS (MA) Rules that
is the Govt. officials and/or their entitled family members are not entitled for taking treatment from the private medical
practitioners appointed as A.M.As outside their normal duty station.
(C & AG of India No. 445-Audit I/17/87/III-90(86) dated 10.08.1990)
(xxiii) Treatment of Central Government officials covered under CS (MA) Rules, 1944 in CGHS recognized private hospitals
All the CGHS empanelled private hospitals/Diagnostic Centers are required to treat all CS(MA) beneficiaries on production of
valid ID Card only in case of emergency treatment and in the case of the planned treatment, the same may be allowed after being
referred by AMA and on production of valid ID card and permission letter of his/her concerned Ministry/Department.
(ADG CGHS No. Misc.209/CGHS/Hospital Cell dated 22.04.2008)
(xxiv) Reimbursement of Medical treatment expenses is allowed in the following cases.
1. Dental treatment of a major kind like treatment of jaw bone disease, Removal of teeth, surgical operations, Treatment of gum
boils, scaling, Filling & root canal of teeth etc.
This should be taken only in Government hospital, Dental treatment in Private recognised hospitals is reimbursable only if such
treatment is not available in the nearest Government hospitals.
2. Cost of complete denture (upto Rs. 2000) or Cost of denture for one jaw (upto Rs.1000).
3. Digital hearing aid may be reimbursed up to Rs. 30000 on the recommendations of two ENT surgeons.
4. Cost of Heart pace Maker coronary stent, Rotoblator and replacement of pulse Generator. Replacement of diseased Heart
valves etc.

6
5. Cost of implantation of Intra-ocular lens and treatment there to up to Rs. 6500/- is permissible.
6. Angioplasty and bypass surgery – Reimbursement shall be either at the CGHS rates or actual amount charged by the hospital
whichever is less.
7. Blood and blood transfusion charges.
8. For employees only, testing of eye sight for glasses is permissible once in three years.

IV. CGHS - GIST OF SELECTIVE ORDERS

8. CGHS - Gist of selective orders

(i) CGHS card to pensioners
(i) Pensioners have an option to get their CGHS card either making contributions on an annual basis or 10 year subscription with
lifetime validity.
(ii) Policy with regard to issue of CGHS pensioner card has been simplified. This can be issued immediately on retirement and need
not to wait.
(MOH OM No. 37-1/2009-C & P/CGHS (P) dated 23.2.2011)

(ii) Extension of CGHS facilities to the family members of Central Govt. Servants who are transferred to non - CGHS areas
CGHS facilities can be extended to the families of the Central Govt. Servants who continue to stay back at the old station in a
CGHS - covered area even after the transfer of the Govt. Servant to a non-CGHS area.
For a maximum period of six months from the date of transfer of the Government servant to the non- CGHS area and that the
Government servant should make advance payment of the monthly CGHS contribution to his old office for a maximum period of six
months
(MOH No. 4-36/99-C&P/CGHS/CGHS (P) dated 01.07.2005)
(iii) Clarification on residing and admissibility
(a) The condition of "residing with" shall not apply to the members of the family of the employees covered by CGHS and falling ill
at a place other than where CGHS is functioning.
(b) In such cases, treatment shall be admissible under the relevant provisions of Medical Attendance Rules.
(C) The reimbursement shall be restricted to the amount which would have been incurred had the treatment been taken in a
Government/State Hospital in that City.
(MOH OM. No. S-11011/4/95-CGHS (P) dated 02.06.1995)
(iv) Clarification on disabled certificate
The CGHS beneficiary shall furnish after every five years the disability certificate issued by the appropriate authority to the effect
that the disabled person is still suffering from disability which is 40% or more.
(MOH OM No. 4-24/96-CP/CGHS(P) dated 26.05.2011)
(v) Medicines purchased on emergency
Medicines directly purchased from authorized/registered chemist shops during an emergency can be reimbursed by the Heads
of the Ministries/Department and Additional/Joint/Deputy Directors of the CGHS covered cities
(MOH OM No. 3426/99, JD (M) CGHS/CGHS (P) dated 18.2.2000)
(vi) Issue of medicines for chronic diseases
Normally, medicines are issued only for a limited period of 3 to 4 days, depending upon the nature of illness. However,
medicines can be issued for a period upto three months at a time from the dispensary level itself to the patients who are suffering
from chronic illness like diabetes, tuberculosis, heart ailment, hypertension, IHD, epilepsy etc., provided that the patients have the
valid prescription of the specialists for the requirement of taking the medicine continuously for a long period.
(MOH OM No. S. 11011/8/99-CGHS (P) dated 13.10.1999)
(vii) Purchase of medicine for emergency
In case of emergency, the beneficiaries can purchase the medicines directly from the authorized/registered chemist shops and
claim reimbursement through their respective Head of the Department/Ministry in the case of serving employees and for all other
beneficiaries through their Addl./Joint/Deputy Director of CGHS concerned.
(MOH OM No. 342/99, HD (M) CGHS/CGHS (P) dated 18.2.2000)
(viii) Reimbursement of Ambulance Charges
Expenditure incurred on the engagement of Ambulance by CGHS beneficiaries comprising both serving Government
employees and pensioners is reimbursable provided that -
(i) The doctor treating the patient certified in writing that conveyance of the patient by any other mode would definitely endanger
the patient's life or would grossly aggravate his/her condition; and
(ii) That the journeys is undertaken within the city.
(MOH OM No. S 4924/2010/CGHS (R&H)/CGHS (P) dated 17.1.2011)
(ix) Engagement of ayah is not permissible
CGHS beneficiaries are not eligible for reimbursement of expenses incurred on the engagement of special nurse/ayah at the
residence of the patients even though recommended by treating specialist.
(MOH OM No. S-11018/4/94-CGHS (P) dated 14.6.1995)
(x) Pensioner opted for medical allowance can avail indoor hospital treatment
If a pensioner (including NPS pensioners drawing additional relief on death/disability of Government employee in terms of
Deptt. of Pen. PW OM dated 5.5.2009, opts for medical allowance, but also desires to avail CGHS facilities for indoor hospitalisation
treatment from the nearest CGHS covered city, CGHS card can be issued for only indoor hospitalisation treatment bearing stamp
'NOT VALID FOR OPD TREATMENT"
7
 (MOH OM No. 11015/1/2000-CGHS dated 25.2.2000)
(xi) P & T dispensary beneficiary can avail only FMA
Pensioners of P&T Department, who were not CGHS beneficiaries while in the service but residing in CGHS covered area where
there is no P&T dispensary are entitled to fixed medical allowance.
(MOH OM No. 4-3/98-Pen (Pt. IV) dated 6.10.1999)
(xii) Medical Facilities for inpatient treatment and post-operative follow-up treatment to CGHS beneficiaries in non-CGHS areas
(effective from 27.4.2011)
(i) CGHS pensioners and their eligible dependent family members holding a valid CGHS card and residing in non-CGHS area are
eligible to avail medical facilities (both emergency and non-emergency) for in-patient treatment and post-operative follow up
treatment subject to fulfilling of certain condition.
(ii) Similarly, CGHS beneficiaries and their eligible dependent family members (both pensioners and serving employees) on visit to
non-CGHS are eligible to obtain treatment under emergency subject to conditions.
(MOH OM No. S.11011/7/99-CGHS (P) dated 27.4.2011)
(xiii) Prior permission necessary for treatment in super specialty hospitals for pensioners
CGHS beneficiaries have, so far, been given the option to get themselves treated in any hospital of their choice. However, in
view of the increased outrage on getting treatment in super-specialty hospitals, it has now been decided that CGHS beneficiaries
desirous of getting treated in super-specialty hospital, in non-emergency conditions, prior approval of the concerned Chief Medical
Officer in-charge of the CGHS Wellness center would have to be obtained.
Note: Permission letter for treatment of diabetes, hypertension, cardiac diseases, dialysis and cancer is valid for 6 months and
treatment may be obtained multiple times.
(xiv) Insurance claims CGHS reimbursement both can be claimed
CGHS beneficiaries who have subscribed to the Medical Insurance Policies can claim reimbursement both from the Insurance
Company and CGHS/Departments subject to the conditions that the reimbursement should not exceed the total expenditure on
treatment.
(MOH OM No. S 11011/4/2003-CGHS (P) dated 19.2.2009)
(xv) Clarifications regarding validity of individual Plastic Cards at all CGHS Wellness Centers in the Country.
"Now that computerization of all CGHS covered cities has been completed the plastic Cards are valid in all CGHS cities in India
and there is no need for obtaining temporary attachment while on a visit to another CGHS City. Since, the data is available online
CGHS beneficiaries are permitted to obtain medicines (including indented medicines) from any Wellness Centre located in the same
city, where the card is registered or from any Wellness Centre located in any other CGHS city while on a visit (Official as well as
personal)."
(MOH No.Misc.6024/2007/CGHS (Hq)/CGHS (P) dated 16.03.2011)
(xvi) Enhancement of Ceiling rate from Rs.2 Lakhs to Rs. Lakhs to HOD.
It has been decided to enhance the existing limit of Rs. 2 lakhs to Rs.5 lakhs to settle all cases where there is no relaxation of rules
and the entitlement was worked out with reference to the rate list prescribed.
(MOH & FW No. s 11011/20/2014-CGHS (P) EHSS dated 23.11.2016)

V. SELECTIVE ORDERS ON CS (MA) RULES 1944

9. Revision of consultation / visiting / injection fee of Authorized Medical Attendants (AMAs) under CS (MA) Rules, 1944.
The undersigned is directed to refer to this Ministry's O.M. No.S.14025/10/2001-MS, dated 31-12-2002 on the subject mentioned
above and to say that the issue of further revision of consultation / visiting / injection fees of different categories of Medical Officers
(Authorized Medical Attendants) appointed for the treatment of Central Government employees and their dependent family
members covered under CS (MA) Rules, 1944 of various Ministry / Departments / States / Union Territories has been under
consideration of this Ministry for some time. It has now been decided to revise the same as indicated below:-
Medical Postgraduate / In Rs.

Specialists
Consultation Fees
First Consultation 100
Subsequent Consultation 60
Injection Fees
Intramuscular / Subcutaneous 20
Intravenous 40
Medical Licentiates and

Medical Graduates (MBBS or

equivalent)
Consultation Fees
First Consultation 70
Subsequent Consultation 40
Injection Fees
Intramuscular / Subcutaneous 20
Intravenous 40

8
 2. These orders will supersede the earlier orders issued on the subject from the date of issue.
3. It is also clarified that now there are no separate charges for day and night consultation, as these were prevailing earlier.
4. This order will be effective from the date of issue.
5. This issues with the concurrence of IFD vide Dy. No. C-2699, dated 3-3-2011.
(MOH & FW No.B.12012/03/2010-CGHS (P) dated 06.06.2011)

10. Delegation of powers to condone delay in submission of medical claims

i) Heads of Circles are delegated to condone the delay in respect of claims beyond a period of 3 months and the amount should
not exceed Rs. 500/-
ii) Only the bills delayed for more than six months should be referred.
iii) Free to reject medical claims when not convinced of the reasons for the delay in the submission of the claim after giving a
reasonable opportunity to the employees.
iv) Cases not covered by the aforesaid guidelines and cases presenting special features will be referred to the P&T Directorate
with recommendations of Head of Circle Office order contained in DG P&T Memo No. 32/1/70-PAP/Cell (V) dated 5-5-70 will
continue to remain in force.
(DG P&T No. 30/2/81/PAP(Pt.) dated 25.03.1982)

11. Grant of Fixed Medical Allowance (FMA) to the Central Government Pensioners residing in areas not covered under CGHS.
The undersigned is directed to say that in pursuance of Government's decision on the recommendations of Fifth Central
pay Commission, the Government had issued instructions vide this Department's O.M. No. 45/57/97-P&PW (C) dated 19.12.97 for
grant of Fixed Medical Allowance @ Rs.100/- per month to the Central Government pensioners/family pensioners residing in areas
not covered under Central Government Health Scheme administered by the Ministry of Health & Family Welfare and corresponding
health schemes administered by other Ministries/Departments for their retired employees for meeting expenditure on their day-to-
day medical expenses that do not required hospitalization. Further clarification were issued vide this Department's O.M. Nos.
45/57/97-P& PW (C) dated 24.08.98, 31.12.98 and 18.08.99.
2. The demand for enhancement of FMA has been under consideration of the Government for some time past. Sanction of the
President is hereby conveyed for enhancement of the amount of FMA from Rs.100/- to Rs.300/- per month. The other conditions for
grant of FMA shall continue to be in force.
3. These orders will take effect from 01.09.2008.
4. These orders are issued with the concurrence of the Ministry of Finance (Deptt. of Expenditure) vide their I.D. Note No
347/E.V/2010 dated 14.05.2010 and in consultation with the Comptroller and Auditor General of India vide their UO No. 36-Audit
(Rules) /28-2-9 dated 26.05.2010.
(DOP & PW No. 4/25/2008-P&PW (D) dated 26.05.2010).

12. Fixed Medical Allowance to Beneficiaries of New Pension Scheme drawing additional relief on Death/Disability of Government
Servant
The Fixed Medical Allowance (FMA) is granted to Central Govt. Pensioners/Family pensioners who at the time of
retirement/death are governed by CCS (pension) Rule 1972 or other corresponding rules in operation prior to commencement of
these rules and are eligible for medical facilities after retirement as per instructions contained in this Department's OM No.
45/57/97-P&PW(C) dated 19.12.97 as clarified from time to time
Grant of FMA to the beneficiaries of New Pension Scheme drawing additional relief on death/disability of Government
servant in terms of Department of Pension and Pensioner's Welfare OM No. 38/41/06/P&PW(A) dated 5th May, 2009 has been
examined in consultation with the Ministry of Health & Family Welfare and Deptt. of Expenditure. Since the serving employees who
are covered by NPS and residing in areas covered under CGHS are availing CGHS benefits and similarly the serving employees,
covered under NPS, who are residing in non-CGHS areas are covered under CS (MA) Rules, hence, the NPS pensioners drawing
additional relief on death/disability of Government servant in terms of Department of Pension and Pensioners Welfare OM No.
38/41/06/P&PW(A) dated 5th May, 2009 and staying in areas not covered by GCHS/corresponding health scheme of other Ministries
can get a PMedical card by paying appropriate amount in the nearest CGHS/corresponding health scheme of other Ministries
covered city to their residence to enable them to obtain indoor treatment. They are also entitled to draw Fixed Medical allowance as
fixed by the Government. As and when the Health Insurance Scheme is introduced, the New Pension Scheme pensioners would be
shifted to the Health insurance Scheme.
These order are issued with the concurrence of the Ministry of Health and Family Welfare vide their ID No.
S.11015/3/2010-CGHS(P) dated 18.11.2010 and Ministry of Finance (Deptt. of Expenditure) vide their UO No. 78/EV/2011 dt.
22.03.2011 and in consultation with the comptroller and Auditor General of India vide their UO No.4-Audit (Rules)/17-2009 dated
4.4.2011.
(DOP & PW No.4/27/2009-P&PW (D) dated 24.05.2011)

13. Grant of Fixed Medical Allowance (FMA) to the Central Government Pensioners residing in areas not covered under CGHS.
The undersigned is directed to say that at present Fixed Medical Allowance is granted to the Central Government
pensioners/family pensioners residing in areas not covered under Central Government Health Scheme administered by the Ministry
of Health & Family Welfare and corresponding health schemes administered by other Ministries/Departments for their retired
employees for meeting expenditure on their day-to-day medical expenses that do not require hospitalization. Orders were issued
vide this Department's O.M. of even no. dated 26-05-2010 for enhancement of the amount of Fixed Medical Allowance from Rs.
100/- to Rs. 300/- p.m. w.e.f. 01-09-2008.
9
2. The demand for further enhancement of FMA has been under consideration of the Government for some time past.
Sanction of the President is hereby conveyed for enhancement of the amount of Fixed Medical Allowance from Rs.300 to Rs. 500 per
month. The other conditions for grant of Fixed Medical Allowance shall continue to be as contained in this Departments OMs No.
45/57/97-P&PW(C) dated 19-12-97, 24-08-98, 30-12-98 and 18-8-99.
3. These orders will take effect from date of issue of this O.M.
4. These orders are issued with the concurrence of the Ministry of Finance (Deptt. Of Expenditure) vide their I.D. Note No.
588/E.V/2014 dated 22-10-2014 and in consultation with the Comptroller and Auditor General of India vide their UO No. 174 Staff
(Rules)/02/2011 dated 12-11-2014.
(DOP &PW No. 4/25/2008-P&PW (D) dated 19.11.2014)

14. Reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various CATS/Courts - Regarding.
The undersigned is directed to state that various references are being received in Ministry of Health and Family Welfare on the
above mentioned subject. it is hereby clarified that CS (MA) Rules, 1944 are not applicable to pensioners till date.
2. It is further informed that the following options to avail medical facilities are available to Central Government pensioners:
a) Pensioners residing in CGHS covered areas:
1) They can get themselves registered in CGHS dispensary after making requisite contribution and can avail both OPD and IPD
facilities.
2). Pensioners residing in CGHS areas cannot opt out of CGHS and avail any other medical facility {i.e. Fixed Medical Allowance). Such
pensioners, if they do not choose to avail CGHS facility by depositing the required contributions, cannot be granted Fixed Medical
allowance in lieu of CGHS.
b) Pensioners residing in non -CGHS areas:
1). They can avail Fixed Medical Allowance (FMA) @ Rs.500/- per month
2) They can also avail benefits of CGHS- [OPD and IPD] by registering themselves in the nearest CGHS “city after“ making the
required subscription.
3) They also have the option to avail FMA, for OPD treatment and CG HS for IPD treatments after making the required subscriptions
as per CGHS guidelines.
3. In view. of the above, reimbursement of medical claims to pensioners under CS (MA) Rules, 1944 as directed by various
CATS/Courts, need not be referred to the Ministry of Health and Family Welfare. The respective Administrative Department/Ministry
may take their own decision in this regard.
4. further, all Departments/Ministries are requested to intimate their employees proceeding for retirement regarding the above
options for medical facilities available to the Central Government pensioners.
(DOH & FW No. 5.14025/23/2013-MS.EHSS dated 29.09.2016)

15. Stoppage of Fixed Medical Allowance (FMA) being paid to the Central Government employees working in the interior/remote
areas and their governance under CS (MA) Rules, 1944.
Reference is invited to OM No.S-14020/1/88-MS dated 17.07.1990 in which fixed medical allowance to the tune of Rs. 25/-
per month was granted to employee working in the interior/remote areas where no Authorized Medical Attendant was available
within a radius of 5 Kms, which was subsequently revised to the tune of Rs.100/- per month vide OM F.No.14025/33/98-MS dated
18.01.1999.
2. On receiving a proposal from Ministry of Defence on the issue of medical reimbursement to employees who are in receipt
of fixed Medical Allowance, the matter was examined in the Ministry in consultation with Department of Expenditure and
Department of Personnel & Training.
3. It has now been decided to stop the above mentioned Fixed Medical Allowance. Henceforth, the Central Government
employees residing in interior/remote areas will be governed by the extant rules as laid down under CS (MA) Rules, 1944.
4. This O.M. will be effective from the date of issue. After issuance of this OM, the above mentioned O.Ms i.e. O.M. No.S-
14020/1/88-MS dated 17.07.1990 and O.M. F.No.14025/33/98-MS dated 18.01.1999, stand withdrawn.
5. This issues with the concurrence of the Department of Personnel & Training and Department of Expenditure.
(MOH & FW No.S.14025/09/2013-MS, dated 03.06.2015)

16. Delegation of powers to condone delay in submission of medical claims

i) Heads of Circles are delegated to condone the delay in respect of claims beyond a period of 3 months and the amount should
not exceed Rs. 500/-
ii) Only the bills delayed for more than six months should be referred.
iii) Free to reject medical claims when not convinced of the reasons for delay in the submission of the claim after giving
reasonable opportunity to the employees.
iv) Cases not covered by the aforesaid guidelines and cases presenting special features will be referred to P&T Directorate with
recommendations of Head of Circle Office order contained in DG P&T Memo No. 32/1/70-PAP/Cell (V) dated 5-5-70 will
continue to remain in force.
(DG P&T No. 30/2/81/PAP (Pt.) dated 25.3.1982)

17. Relaxation of procedures to be followed in considering requests for medical reimbursement

The undersigned is directed to state that under the extant instructions, a CGHS card holder, who wishes to apply for
reimbursement of the expenditure incurred by him/her on medical treatment of either self or his/her dependent family members,
the present reimbursement procedure needs verification of bills and issue of essentiality certificate by the treating doctor, and the
Medical Superintendent of the hospital. The process of verification of bills and issue of essentiality certificates are time consuming
10
with the doctor at times being busy or being away from office for whatever reason. This necessitates repeated visits to the hospital
for getting the verification done and essentiality certificate obtained. Representations have been received in the Ministry of Health &
Family Welfare requesting for doing away with the two requirements and for the Ministries/authorities concerned to verify and
check the authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the Government
Servant/Pensioner. In the event of any doubt, the concerned Ministry/Authority can always get verification done from the hospital
concerned.
2. The undersigned is also directed to state that CGHS guidelines currently provide for relaxation of guidelines to cover full
reimbursement in individual cases depending upon merits of each case. In the case of Hon'ble Members of Parliament, the powers
to relax the guidelines have been delegated to the LokSabha Secretariat and Rajya Sabha Secretariat respectively and in the case of
Hon'ble Chief Justice of Supreme Court and Judges of the Supreme Court to the Secretary General of the Supreme Court.
3. In order to reduce the burden on the specialists in individual cases of medical reimbursement claim, it has been decided
with the approval of heads of the hospitals to revise the guidelines for reimbursement by the competent authority, as follows:
(1) It has now been decided to do away with the procedure for verification of bills and issue of essentiality certificate by the
treating doctor, and the Medical Superintendent of the hospital. Ministries/authorities concerned may verify and check the
authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the Government
Servant/Pensioner. In the event of any doubt, the concerned Ministry/Authority can always get verification done from the hospital
concerned. Modified reimbursement claim form along with a checklist is annexed.
(2) All cases involving requests for relaxation of rules for reimbursement of full expenditure will henceforth be referred to a
Technical Standing Committee, to be chaired by the DGHS/Addl. DGHS and consist of Director (CGHS) and subject matter specialists.
If the Technical Standing Committee recommends the relaxation of rules for permitting full reimbursement of expenditure incurred
by the beneficiary, the full reimbursement may be allowed by the Secretary (Health & Family Welfare) in consultation with IFD. A
check list for consideration of requests for reimbursements in excess of approved rates may include:
(a) The treatment was obtained in a private non-empanelled hospital under emergency and the patient was admitted by
others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged period;
(b) The treatment was obtained in a private non-empanelled hospital under emergency and was admitted for prolonged
period for treatment of Head Injury, coma, Septicemia, Multi organ failure, etc.;
(c) The treatment was obtained in a private non-empanelled hospital under emergency for treatment of advanced
malignancy;
(d) The treatment was taken under emergency in higher type of accommodation as rooms as per his/her entitlement are not
available during that period;
(e) The treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid
contacting infections;
(f) The treatment was obtained in a private non-empanelled hospital under emergency when there is a strike in Government
hospitals;
(g) The treatment was obtained in a private non-empanelled hospital under emergency, while on official tour to non-CGHS
covered area;
(h) Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though
he is not eligible for air travel/treatment facilities are available in city of residence and
(i) Any other special circumstance.

4. The Office Memorandum is issued with the concurrence of IFD vide Dy. No. 908/AS&FA/2009 dated the 20th February
2009.
[MoH & FWO.M.No. 4-18/2005-C&P {Vol.I-Pt.(I) dated 20.02.2009]

18. Relaxation of procedures to be followed in considering requests for medical reimbursement claims in respect of CS(MS)
beneficiaries.
Ministry of Health & Family Welfare received several representations from CGHS beneficiaries for issue of guidelines to be
followed in considering requests for relaxation of procedures in considering requests for medical reimbursement over and above the
approved rates. The matter was examined by the Ministry and Office Memorandum No4-18/2005-C&P(Vol-I Pt.(1) dated the 20th
February 2009 was issued prescribing the procedures and guidelines to be followed for consideration of requests received from
CGHS beneficiaries seeking reimbursement of expenditure incurred on medical treatment over and above the approved rates. The
requirement of essentiality certificate in respect of CGHS beneficiaries was also done away with.
However, no such guidelines were issued under CS (MA) Rules. In this regard Department - related Parliamentary Standing
Committee on Health and Family Welfare in the seventy first report impressed upon the Department to immediately address this
issue and extend same facilities to those covered under CS(MA) Rules and to issue a fresh circular clarifying the procedures in this
regard and dispelling misgivings if any. Ministry was also in receipt of representation from several quarters in this regard.
(2) The matter has been examined in consultation with Dte. CGHS and it has been decided to revise the guidelines for
reimbursement by the competent authority to issue guidelines under CS(MA) on similar pattern as under CGHS as per the following
(1) It has now been decided to do away with the procedure for verification of bills and issue of essentiality certificate by the
treating doctor and the Medical Superintendent of the hospital. Ministries/Authorities concerned may verify and check the
authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the Government
servant.In the event of any doubt, the concerned Ministry/ Authority can always get verification done from the hospital
concerned.
(2) It is clarified that essentiality certificate /counter signature of treating doctor in a hospital would not, henceforth, be necessary.
However, essentiality certificate would be required when the treatment is taken from an AMA on OPD basis.

11
(3) All cases involving requests for relaxation of rules for reimbursement of full expenditure will henceforth be referred to the
Technical Standing Committee, to be chaired by the DGHS/Spl. DGHS and Specialists of concerned subject as Members. Addl.
DDG(MG-Section) Dte. GHS shall be Member Secretary for organizing the meeting of Technical Standing Committee. If Technical
Standing Committee recommends the relaxation of rules for permitting full reimbursement of expenditure incurred by the
beneficiary the full reimbursement may be allowed by the Secretary (Health and Family Welfare) in consultation with IFD. A
check list for consideration of requests for reimbursement in excess of the approved rate may include.
a. The treatment was obtained in a private hospital not empaneled under CS(MA)/ CGHS under emergency and the patient was
admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged
period:
b. The treatment was obtained in a private hospital not empaneled under CS(MA) /CGHS under emergency and was admitted for
prolonged period for treatment of Head injury ,Coma, Septicemia, Multi –Organ failure etc:
c. Treatment was obtained in a private hospital not empaneled under CS(MA) /CGHS under emergency for treatment of advanced
malignancy:
d. Treatment was taken in a private hospital not empanelled under CS(MA)/ CGHS under emergency in higher type of
accommodation as rooms as per his/her entitlement was not available during that period:
e. Treatment was taken in higher type of accommodation under specific condition for isolation of patients to avoid contacting
infections.
f. Treatment was obtained in private hospital not empanelled under CS(MA) /CGHS under emergency while on official tour to
another city :
g. Treatment was obtained in a private hospital not empanelled under CS(MA) /CGHS under emergency when there is a strike in
Govt. hospitals.
h. Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he is
not eligible for air travel /treatment facilities are available in city of residence and
i. Any other special circumstances.
(4) The office memorandum is issued with the concurrence of IFD vide Dy. No C -695 dated 07/07/2014.
(MOH & FW OM No. H.11022/01/2014-MS dated 15.07.2014)

19. Relaxation of procedures to be followed in considering for medical reimbursement

The undersigned is directed to state that under the extant instructions, a CGHS card-holder, who wishes to apply for
reimbursement of the expenditure incurred by him/her on medical treatment of either self or his/her dependent family members,
the present reimbursement procedure needed verification of bills and issue of essentiality certificate by the treating doctor, and the
Medical Superintendent of the hospital. The process of verification of bills and issue of essentiality certificates are time-consuming
with the doctor at times being busy or being away from office for whatever reason. This necessitated repeated visits to the hospital
for getting the verification done and essentiality certificate obtained. Instructions were issued vide this Ministry's Office
Memorandum of even number, dated the 20th February, 2009 to do away with the procedure for verification of bills and issue of
essentiality certificate by the treating doctor, and the Medical Superintendent of the hospital. Ministries/ authorities concerned may
verify and check the authenticity of the claims on the basis of the prescription slip and the diagnostic report submitted by the
Government servant/pensioner. In the event of any doubt the concerned Ministry/Authority can always get verification done from
the hospital concerned.
2. Powers have been delegated to the Ministries/Departments to consider and approve requests for reimbursement of
medical expenses on post facto basis. Ministries/Departments do not, however, have powers to grant post facto approval in cases
where the beneficiary, on the basis of the recommendations of a Government specialist goes directly to an empanelled institution
without obtaining prior approval from his/her Ministry/ Department. The Ministry of Health & Family Welfare has received requests
for delegating powers to the Ministries/Departments concerned to accord ex post facto permission in cases where an employee
goes to an empanelled institution after due prescription by a Government specialist but without obtaining prior permission from
his/her Ministry/Department.
3. The matter has been examined in the Ministry of Health & Family Welfare and it has been decided with the approval of the
competent authority to delegate powers to the Heads of Departments of Ministries/ Departments to accord post facto approval/
Permission in cases where an employee or his dependent family members go to an empanelled institution after due prescription by
a Government specialist but without obtaining prior permission from his/her Ministry/Department subject to the Head of
Department being satisfied with the genuineness of the reason which made the beneficiary go directly to an empanelled institute
even before obtaining the approval of his/her Ministry/Department. The reimbursement to be made in such case will be the
financial ceiling and the procedure to be followed will be as outlined in this Ministry's Office Memorandum No. S 12020/4/97-CGHS
(P), dated the 27th December, 2006.
4. The Office Memorandum is issued with the concurrence of IFD vide Dy. No. C. 299/2009, dated the 18th May, 2009.
(M.H., O.M. No. 4-18/2005 -C&P [Vol.I-Pt. (I)] dated 20.05.2009)

20.Reimbursement of medical claim for treatment taking in private hospital in emergent cases clarifications regarding
I am directed to invite a reference to the Ministry of Health and Family Welfare's OM Nos. S-14012/9/75-MC dated
23.2.77, 7.5.79 and 18.6.1982 and S-14025/46/92-MS dated 4.2.1993 regarding reimbursement of medical expenses incurred by the
Government servants for treatment in Private Hospitals in emergent cases. The aforesaid order stipulates that in emergent cases
involving accidents/ serious major diseases etc., the person/ persons on the spot may use their discretion for taking the patient for
treatment in a private hospital in case no Government/ or recognized hospital is nearer than the private hospital. The controlling
authority/department will decide on the merits of the case whether it was a case of real emergency necessitating admission in a
private institution.

12
 Medical claims to the extent admissible and subject to the limits and ceilings prescribed can be authorized by those to
whom powers have been delegated in respect of treatment in private hospitals not recognized under CS (MA) Rules. These powers
can be exercised by Ministries/Departments of the Government of India and also by the Heads of the Departments as defined in GFR
and these declared as such under clause (J) of Sub Rule 1 of Rule III of Delegation of Financial Power Rules, 1978. It would not be
exercised by the authorities lower than the Heads of the Departments.
The Chief PMsG are Heads of Departments for all intent purposes and as such it is clarified that in future all such cases of
medical reimbursement for treatment in a private hospital in emergencies should be decided with the personal approval of the
Heads of the Circles (i.e. the Chief Postmasters General).
All individual cases including pending cases may be decided by the Heads of the Circles in accordance with these
instructions. Past cases already decided may not be re-opened. Only in cases involving general policy or case of doubt the reference
shall be made to the Directorate.
The above issues with the concurrence of Finance Advice Branch vide their ID No. 5274-FA/93 dated 24-12-1993
(DG (P) No. 31-24/93-PAP dated 25.01.1994)

21. Revision of rates for reimbursement of medical expenses incurred in emergency conditions under CS (MA) Rules, 1944.
The undersigned is directed to state that the issue of revision of rates for reimbursement of medical expenses incurred on
availing medical treatment in emergency conditions under CS (MA) Rules, 1944, when treatment is taken in a non- empanelled
private hospital, has been under consideration of the Government for some time.
2. It has now been decided that, reimbursement of medical expenses incurred by a Central Government employee covered under
CS (MA) Rules, 1944 on availing medical treatment for himself and its dependent family members in emergency conditions, would be
allowed as per the prevailing non-NABH CGHS rates as applicable to a CGHS covered city and non-NABH rates applicable to the
nearest CGHS covered city in case of non-CGHS city, as the case may be, or the actuals, whichever is less.
3. For the medical treatment in such cases where package rates are prescribed under CGHS, the non-NABH rates of the CGHS
covered city and non-NABH rates of the nearest CGHS city (in case of non-CGHS covered city) or the actuals, whichever is less, will be
applicable.
4. This OM supersedes all earlier orders issued from time to time under CS(MA) Rules. 1944 on this subject for allowing
reimbursement of medical expenses in emergency conditions when treatment is taken in a non-empanelled private hospital.
5. This OM will come into effect from the date of issue.
6. This issues with the concurrence of the Integrated Finance Division vide their Dy. No.C-282 dated 22-05-2013.
(MOH & FW No. S. 14025/14/2012-MS dated 11.06.2013)

22. Information under RTI Act 2005 regarding CS (MA) Rules

I am directed to refer to your application dated 29.8.2007 regarding subject mentioned above and to furnish the
clarification in respect of your queries as under.
1. As per provisions contained in Department of Health OM No. S. 14025/7/2000-MS dated 28.3.2000, a CS(MA) beneficiary
can avail treatment (OPD/IPD) in any CGHS recognized hospital with the permission of Department concerned and on a reference
from AMA concerned.
2. Same as in (1) above
3. A CS (MA) beneficiary who obtains treatment at CGHS recognized private hospital with the permission of Department,
concerned; the beneficiary is entitled for reimbursement at CGHS rates. However, in case of emergency CGHS rate can also be
reimbursed without prior permission of the Department.
4. The information pertaining to this question/query is not being maintained in the Ministry of Health & Family Welfare and
can be obtained from the concerned Department/Ministries.
(MOH&FW No.S.14025/31/2007-MS dated 06.09.2007)

23.Claim for treatment outside the headquarters from R.M.P.S appointed as AMAS not reimbursable
A Govt. official and/or entitled members of the family going outside their normal duty station for any reason and require
medical treatment, they should obtain the treatment from the nearest Govt. & other Hospitals recognised under CS (MA) Rules that
is the Govt. officials and/or their entitled family members are not entitled for taking treatment from the private medical
practitioners appointed as A.M.As outside their normal duty station.
(C & AG of India No. 445-Audit I/17/87/III-90(86) dated 10.08.1990)

24. Treatment of Central Government officials covered under CS (MA) Rules, 1944 in CGHS recognized private hospitals
I am directed to convey that as per Ministry of H&F. W. O.M. No. S.14025/7/2000-MS dated 28.03.2000, Central
Government employees and their dependent family members may be permitted to avail medical facilities in any of the Central
Government/State Government Hospitals and Hospitals recognized by the State Government/CGHS/CS (MA) Rules, 1944 subject to
the condition that reimbursement is to be limited at the rates fixed by the respective authorities, or the actual expenditure incurred
whichever is less.
Hence all the CGHS empanelled private hospitals/Diagnostic Centers are required to treat all CS(MA) beneficiaries on
production of valid ID Card only in case of emergency treatment and in case of planned treatment, the same may be allowed after
being referred by AMA and on production of valid ID card and permission letter of his/her concerned Ministry/Department.
(ADG CGHS letter No. Misc.209/CGHS/Hospital Cell dated - 22.04.2008)

13
25. Ceiling for reimbursement of special Nursing and Ayah/Attendant charges to the employees covered under CS(MA) Rules,
1944.
The undersigned is directed to invite reference to this Ministry's OM No.S.14025/74/86-MS dated 30.10.1991, wherein an
arrangement for reimbursement for special nursing has been made which stipulates that the amount of such reimbursement is
limited to the amount which is in excess of 25% of the pay of the Government servant. Keeping in view the increase in pay and
allowances and wages of nurses and ayah/attendants and in order to simplify the existing procedure, it has been decided to fix
ceiling rates of special nurse and ayah/attendant for reimbursement to CS(MA) beneficiaries.
2. The ceiling rates for such reimbursement to CS(MA) beneficiary would be as follows:
Special Nurse -Rs. 150/- per shift of 12 hours.
Ayah/Attendant -Rs. 75/- per shift of 12 hours.
3. The reimbursement of special charges for nurse and ayah/attendant at above rates is subject to the condition that for such
purpose a certificate from the medical officer in-charge of the case in the hospital and countersigned by the Medical Superintendent
of the hospital should be produced in the prescribed form as enclosed at annexure.
4. This order will be effective from the date of issue.
5. This issues with the concurrence of IFD vide DY. No. C-2200 dated 05.01.2011
(MOH&FW OM No.S.14025/8/2010-MS dated-18.01.2011)

26. Hospital recognized by the State Govts./CGHS/CS (MA) Rules, 1944- Grant of permission for treatment in any of the
hospitals-regarding.
The undersigned is directed to say that the issue for grant of permission for treatment of Central Govt. employees and the
members of their family in any of the hospitals recognized by the State Govt./CGHS Rules/CS(MA) Rules, 1944,had been under
consideration of the Govt. for some time past. It has now been decided that the Central Govt. employees and the members of their
families may be permitted to avail of medical facilities in any of the Central Govt./State Govts./CS(MA) Rules,1944, as well as the
hospitals fully funded by either Central Govt. or the State Govt, subject to the condition that they will be reimbursed the medical
expenditure at the rates fixed by the Govt. under the CGHS Rules/CS(MA) Rules, 1944 or the actual expenditure incurred, whichever
is less. In other words, the permission can be granted by the Head of the Ministry /Department/Office to the Central Govt.
employees /members of their families to obtain medical services from any of the private hospital recognized under CGHS in the 18
CGHS covered cities also.
2. If the treatment for a particular diseases/procedure is available in the same city where the Govt. servant is employed, he may
be permitted to avail of the medical services in any other city of his choice but in such cases, he will not be eligible for sanction of
TA/DA. In case the treatment for a particular diseases/ procedure is not available at the same station, the beneficiary will be eligible
for sanction of TA of his entitled class for taking treatment in a different city.
3. These orders will be effective from the date of the issue.
4. This issues with the concurrence of Finance Division vide their Dy. No.757/2000-JS FA(H) dated 16.2.2000.
(F.N.S-14025/72000-MS dated 28.03.2000) &
(DG (P) No.6-1/2006-Medical dated 14.09.2010)

27. Attachment of private hospitals for medical treatment under CGHS.

As per the revised guidelines for recognition of private hospitals under CS (MA) Rules for Central Government employees
and their family members, the proposal should be recommended/ forwarded by the local Central Govt. employees Welfare Co-
ordination committee. The proposal should also be recommended/ forwarded by the health department of the respective State
Government. The proposal complete in all respects may be directly forwarded to Ministry of Health and Family Welfare for
consideration for recognition of the hospitals. A copy of Ministry of Health and Family Welfare letter No. F.S14021/5/2008-MS is
being enclosed for your reference.
(DG(P) No. 6-1/2006-Medical (pt.) dated02.02.2010)

28. Revised guidelines for recognition of private hospitals under CS (MA) rules for Central Government employees and their family
members.
1. The proposal for recognition of a private hospital under CS (MA) Rules should be Recommended/forwarded by the local
Central Government Employees Welfare Co-operation Committee.
2. The proposal should also be recommended/forwarded by the Health Department of the respective State Government.
3. A minimum number of 500 Central Government employees should be residing in the city and be benefited by the
recognition of the hospital under CS (MA) Rules.
4. An adequate number of beds should be available in the hospital preferably:
(a) 100 for class 'A' cities.
(b) 50 for class 'B' cities.
(c) 30 for class 'C' cities.
However, the above criteria can be relaxed according to requirement.
5. A hospital providing generalized treatment and diagnostic facilities should have the following departments:-

UPTO 100 BEDDED HOSPITAL MEDICAL AND ALLIED DISCIPLINES

1. Anesthesiology
2. Emergency Services
3. General Medicine
4. General Surgery
14
5. Obst. & Gynecology
6. Paediatrics
7. Pathology
8. Radio Diagnosis

100 AND ABOVE BEDDED HOSPITAL

1. Anesthesiology
2. Blood/Transfusion
3. Emergency Medical & Trauma Services
4. Dentistry
5. Dermatology & Venerology
6. General Medicine
7. General Surgery
8. Obst. & Gynecology
9. Ophthalmology
10. Orthopedics
11. Oto Rhino Laryngology
12. Pediatrics
13. Physical Medicine
14. Psychiatry
15. Radio Diagnosis including Imaging.
The hospital should meet the following fundamental aspects of hospital planning.
A. FUNCTIONAL REQUIREMENT
The hospital should provide the following facilities to the patients:-
(a) O.P.D. treatment
(b) Indoor patient treatments
(c) Supportive and Basic Diagnostic facilities.
(d) Operation Theatre and Labour Room facilities.
B. BUILDING AND SPACE REQUIREMENT
(a) The building must comply with the local municipal bye-laws.
(b) The floor space available for patients should be at least 100 sq. ft. per bed. There should be one lavatory/bathroom for 1-5
beds.
(c) Isolation arrangements should be immediately available for septic and infection cases.
(d) A nurse’s duty room should be available with facilities for the nurses to carry on their duties efficiently.
(e) A separate labour room and a separate operation theatre shall be provided with minimum floor space of 180 sq. ft. each.
(f) There should be provisions for a standby generator for meeting emergency requirement in case of a power failure.
C. MANPOWER REQUIREMENT
(a) The hospital should have adequate manpower both medical and paramedical including specialists (Full Time/visiting) for
each speciality/department available, commensurate with the bed strength of the hospital for providing reasonable quality
Medicare.
(b) The hospital should have adequate number of qualified Resident Medical Officers for providing round the clock emergency
treatment.
D. INSTRUMENT/EQUIPMENT
The hospital should have the major equipment for providing reasonable diagnostics (pathological and radiological)
resuscitative, therapeutic and operative facilities commensurate with the bed strength, departments and specialties
available in the hospital.
(Minimum standards as per B.I.S. will be considered for recommending the case).
6. The hospital should provide round the clock emergency and trauma services.
7. The hospital should have a minimum of one major O.T. one minor O.T. and a labour room in the hospital.
8. Wherever required, a visit to inspect the facilities available in the hospital may be carried out by a team of experts
constituted with the approval of D.G.H.S. or the agency nominated by the Ministry of Health & Family, for which inspection
fee, as applicable will have to be deposited by the hospitals with the inspection agency.
9. The recognition may be granted for a fixed period i.e. 4 years at a time. After that period, the hospital will be requested to
re-apply for recognition giving the relevant details. The hospital should apply at least three months prior to expiry of its
recognition to Department of Health & Family Welfare for re-recognition.
10. The rates charged by the hospital for various diagnostic and therapeutic procedures should be at par or less than the rates
being charged by nearby private recognized hospitals of similar nature under CS (MA) Rules. If no such recognized hospitals
are available in the nearby areas, rates may be compared with rates of C.G.H.S. approved hospitals in a similar class of city
(as per classifications made by the Government in respect of City Compensatory Allowance).
11. For hospitals providing specialized/super specialized treatment/diagnostic facilities, additional technical information as
required will be obtained before recommending the same for recognition under CS (MA) Rules.
12. The hospital should submit an undertaking that the requirements of the statutory provisions relating to 'Disposal of Bio-
Medical Waste' are being complied with.

15
13. The hospitals applying for recognition under CS (MA) Rules, 1944, should furnish details regarding any adverse rulings from
Consumer Courts of any other Court of Law on a case filed by a patient of his/her relative/friend against improper medical
care or wrong medical care, and whether any appeal his pending in any higher Court of Laws during the last five years.
14. A certificate to be furnished by the applicant certifying the veracity of the particulars given in the application for
recognition; and
15. Furnishing of information in the application as to whether the hospital is (i) ISO certified (ii) accredited to QCI or (iii)
adhering to Bureau of Indian Standards.
(MOH&FWOM No.F.S14021/5/2008 MS dated …………..)

29. Age Limit for dependent children of Government servants and pensioners for availing medical facilities under CGHS and
Central Services (Medical Attendance) Rules, 1944 – Regarding.
The undersigned is directed to refer to this Ministry’s O.M. of even number dated 31.5.2007 on the subject noted above
and to say that the issue of inclusion of name of married son, aged below 25 years, in the CGHS Card of a CGHS beneficiaries and
beneficiaries covered under CS (MA), 1944 come up for consideration of this Ministry. The matter has been examined in consultation
with the Department of Personnel & Training and it is clarified that the definition of “family” for the purpose of extending medical
facilities to a beneficiaries under CGHS/CS(MA) Rules is primarily based on the definition of “family” as indicated in the CCS(Pension)
Rules, 1972, CCS(LTC) Rules etc,; which does not include a married son even when below 25 years of age in the definition of “family”
of the Central Government employee/ pensioner.

It is therefore, clarified that, son of the Central Government employee who is a (beneficiary under either CGHS or CS (MA)
Rules, 1944)/ pensioner CGHS beneficiaries who is married, cannot be included in the definition of “family” for the purpose of
extending medical facilities under CGHS/CS (MA) Rules, even when he is below 25 years of age and dependent upon the Central
Government employee/ pensioner.
(MOH & FW No. 4-24/96-C&P/CGHS/CGHS (P) dated 25.02.2009)

30. Extension of medical facilities to permanently disabled dependent brother of a CS (MA) beneficiary.
The undersigned is directed to state that dependent brother of a Central Government employee is presently entitled for
medical facilities under CS (MA) Rules, 1944, upto the age of becoming a major. Ministry of Health and Family Welfare has been
receiving requests from CS (MA) beneficiaries for removal of the upper age-limit in the case of disabled dependent brother so as to
provide them the medical facilities without any age limit as has been provided to disabled son of a CS (MA) beneficiary.
2. Accordingly, with a view to assuage the hardship, it has been decided to extend the medical facilities under CS(MA) Rules, 1944
to permanently disable dependent brother of a CS (MA) beneficiary, without any age limit.
3. For availing medical facilities under this provision, the permanently disabled dependent brother of a CS (MA) beneficiary must
be suffering from any one or more of the disabilities as defined in Section 2(i) of 'The persons with Disabilities (Equal opportunities,
protection of Rights and Full Participation) Act, 1995 (No. 1 of 1996) which includes:
(i) Blindness (ii) Low-vision
(iii) Leprosy-cured (iv) Hearing impairment
(v) Loco motor disability (vi) Mental retardation
(vii) Mental illness
and as per Clause (i) of Section 2 of National Trust for Welfare of Persons with Autism, cerebral Palsy, Mental Retardation and
Multiple Disabilities Act, 1999 (No. 44 of 1999), which presently covers a person suffering from any of the condition relating to
autism, cerebral palsy, mental retardation or a combination of any two or more of such conditions and includes a person suffering
from severe multiple disability. It is clarified that 'permanent disability' means a person with 40% or more of one or more
disabilities.
4. The eligibility criteria for a presently disabled dependent brother to avail medical facilities under CS (MA) Rules, 1944, will be as
under:-
a. He must be wholly dependent on the CS(MA) beneficiary.
b. He should be unmarried and should not have his own family.
c. The income limit for deciding dependency shall be as prescribed by the Ministry of Health and Family Welfare from time to
time and as applicable under CS(MA) Rules, 1944.
d. He must be ordinarily residing with the CS(MA) beneficiary.
e. All the above conditions are required to be fulfilled for availing medical facilities.
5. This Office Memorandum will be effective from the date of issue.
(MOH & FW No.S.14025/02/2014-MS dated 19.06.2014)

31. Revision of time limit for submission of final claims for reimbursement of medical expenses under CA (MA) Rules, 1944 –
regarding.
The undersigned is directed to refer to OM No. F.29-40/68-MA dated 15.10.1968 in which it was laid down that submission
of final claims for reimbursement of medical expenses of Central Government servants in respect of a particular spell of illness
should ordinarily be preferred within 3 months from the date of completion of treatment.
2. A representation was received from National Council (Staff Side) to extend the time limit for submission of such medical
bills from 3 months to 6 months. The matter was examined in the Ministry and it has been decided that the period of 3 months for
submission of medical claims be revised to 6 months. Henceforth, only the cases in which the bills are submitted after 6 months
from the date of completion of medical treatment/discharge of the patient from the hospital are required to be taken up for
16
condonation. The power of condonation of such delays and other terms and conditions would be same as enumerated in the OM
No. S 14025/8/99/-MS dated 25.05.1999.
3. This issue with the approval of the competent authority.
(MOH &FW No. S. 14025/19/2015-MS dated 27.05.2015)

32. Delegation of powers to heads of Department in various Ministries/Departments for settling permission cases and for
approval relating to medical reimbursement under CS(MA) Rules, 1944.
(1) The undersigned is directed to state that this Ministry has been receiving references from different Ministries/Department in
respect of medical claims for clarification and concurrence even when the admissible amount calculated are as per the approved
rate list. This generates extra burden in this Ministry when the matter can be settled in the referring Ministry itself.
(2) The matter has been examined and it has been decided now to delegate powers as follows:
(i) A serving Central Government employee covered under CS(MA) Rules, 1944 who is taking treatment in Government hospital
and desires to obtain treatment in a private hospital recognized under CGHS/CS(MA) Rules, the Head of Department may grant
him permission for indoor treatment on the basis of medical prescription issued by the concerned Authorized Medical
Attendant.
(ii) The Heads of Departments may decide the cases on reimbursement of medical claims in respect of treatment obtained in
emergency at private hospital /private nursing home /private clinic, subject to item-wise ceiling as per rates prescribed under
CGHS/CS(MA) Rules.

(3) It has been decided with the approval of the competent authority to delegate powers to Departments/Ministries to settle all
cases where there is no relaxation of rules and the entitlement has been worked out with reference to the rate list prescribed.
The delegation would, however, be subject to the condition that the Heads of the Departments/ Ministries may settle cases up
to the limit of Rs 2,00,000/-(Rupees two lakhs only )(worked out with reference to the prescribed rate list).
(4) In respect of payment exceeding Rs. 2,00,000/- (Rupees two lakhs only) but as per the prescribed rate list, the
Departments/Ministries concerned may settle such cases in consultation with their respective Internal Finance Division. Only in
those cases where the settled rules are required to be relaxed, should the case be referred to the Ministry of Health and Family
Welfare.
(5) This issues with concurrence of Integrated Finance Division vide CD No.335 dated 28.05.2014

(MOH &FW No. S.14025/01/2014-MS dated 05.06.2014)

33. Revision of rate and guideline for reimbursement of expenses on purchase of Hearing AIDS under CS(MA) Rules, 1944 and
CGHS – Regarding
With reference to the above mentioned subject the undersigned is directed to refer to the Office Memorandum of even no
dated 21.03.2012 , 17.11.2006 and 28.10.2002 and OM No S.14025/36/93/MS dated 26.03.94 and 17.08.99 and to state that
on the basis of recommendation of an Expert Committee, it has been decided to revise the rates and guidelines for hearing aids
to be reimbursed under CS(MA) Rules, 1944 and CGHS.

2. The revised ceiling rates fixed for various types of hearing-aids (for one ear) are as under:-
Body worn/Pocket type Rs. 3000/-
Analogue BTE Digital Rs. 7000/-
BTE Digital Rs. 15000/-
ITC/CIC Rs. 20000/-

The cost of hearing aids shall include all taxes in including VAT and shall carry 3 year warranty. The cost of analogue BTE/Digital
BTE/ITC/CIC type hearing aid shall also include the cost of hearing mould.

3. Beneficiaries covered under CS (MA) Rules /CGHS shall be eligible to obtain hearing aid as per the following guidelines:
(i). Patients/Beneficiaries should be properly referred to CGHS/Government hospital ENT specialist from the
parent CGHS wellness centre (A computerized referral printout should be made wherever computerization has been done).
(ii). It would be mandatory to carry CGHS Beneficiary’s ID card (in original) whenever the CGHS beneficiaries visit
the CGHS/Government ENT specialist for consultation and Audiometric test.
(iii). The ENT specialist of CGHS /Government hospital shall then recommend
a. hearing aid on basis of Audio metric and Audio logical assessment, specifying the type of hearing aid most suited for the
Beneficiary. The‘ Audiogram report’ shall be authenticated by the ENT specialist/Consultant of the CGHS/Government hospital.

4. The permission to procure hearing aid shall be granted by the Additional Director (Zonal) of CGHSIS-Zonal Office
in case of CGHS pensioner beneficiaries, and by the Head of Department/ Office in case of serving employees and CGHS beneficiaries
of Autonomous bodies on the basis of recommendation of a
CGHS/Government ENTspecialist,and an ‘undertaking’ thatthebeneficiaryhasnotbeenreimbursedthecostofhearing – aid in the
preceding five years.

5. Reimbursement claim shall be submitted to CGHS Zonal Office through the CMO – Incharge of the concerned
dispensary by CGHS Pensioner beneficiaries in the prescribed medical reimbursement claim for-along with the
following documents:-

17
a) Referral letter from parent CGHS Wellness Centre (computerized slip where computerization is done already).
b) Copy of ‘prescription’ of ENT consultant (CGIIS/Govt. Hospital) with the ‘Audiogram’ reportduly authenticated by the treating ENT
consultant (CGHS/ Govt).
c) Copy of CGHS Card.
d) Bill/Receipt (in original) carrying details of the hearing – aid seller i.e. NAME, QUALIFICATION AND RCI/MCI REGISTRATION
NUMBER of the hearing – aid seller.
e) The ‘permission letter’ to purchase hearing – aid (in original).
f) Empty Box/boxes or the Carton(s) with the label showing details of the hearing aid supplied.

Incase of the other beneficiaries, the medical claim shall be submitted to the concerned
Ministry/Department/Office. Reimbursement shall be limited to the ceiling rate or actual cost of the hearing – aid, whichever is less.
6.Records of permissions granted for procurement of hearing-aids shall be maintained by CGHS in respect of pensioner
CGHS beneficiaries and by the concerned Ministry/Department/Office in respect of other beneficiaries.
7. Replacement of hearing-aid may be permitted after 5 years on the basis of condemnation certificate issued by a
technical expert and on approval of CGHS/Government ENT Surgeon. Maintenance and repair will be the responsibility of the
beneficiary.
8. These orders shall super cede all the earlier orders issued on the subject.
9. The revised rates and guidelines shall come into force from the date of issue and shall be valid for a period of two year or
till further revision, whichever is earlier.
l0. This issues with the approval of Integrated Finance Division of Ministry of Health & Family Welfare

VI. CGHS – SELECTIVE ORDERS

34. CGHS -- entitlement of transferees

Family members, residing in the CGHS areas of Government servants transferred out of CGHS areas entitled to CGHS
facilities up to six months from the date of transfer on payment of CGHS contribution in advance for that period.
(MH & FW OM No. 4-36/99-C&P/CGHS (P) dated 1.7.2005)

35. Delegation of powers of Head of Department to Head of Office for settling permission cases and post facto approval to
reimbursement in relaxation of rules in emergent cases under CGHS/CS(MA) Rules, 1944.
The undersigned is directed to invite reference to para (ii) of this Ministry's Office Memorandum No.S.14012/9/75-MC (MS) dated
18.06.1982, as mentioned at point 4 under Appendix-VIII of CS(MA) Rules, 1944 relating to reimbursement in relaxation of rules in
emergent cases, which stipulates that powers for settling permission cases and post facto approval should not be exercised by
authorities lower than Heads of Departments.
2. The Ministry of Health and Family Welfare has examined the question of further delegation of powers to Head of Offices/officers
at Under Secretary level, in such offices, which are not headed by officers equivalent to a Deputy Secretary, in the matter and it has
been decided with the approval of the competent authority to delegate such powers in the following manner:-
"In case of medical reimbursement, delegation of power can be given to Under Secretaries in the Departments of Central
Government declared as Heads of Offices subject to the condition that upto Rs. two thousand for taking treatment in OPD and
uptoRs. Five thousand for taking treatment in IPD under CGHS/CS(MA) Rules, 1944. This delegation of powers can be exercised as
per the prescribed rate list of nearest CGHS covered city or actual whichever is lower for CS(MA} beneficiaries and as per package
rate for CGHS beneficiaries in CGHS cities."
3. This order is applicable to both CGHS and CS(MA) beneficiaries.
4. This Office Memorandum issues with the approval of Ministry of Finance vide 10 No 14(1)/E.IIA/2010 dated 06.07.2010.
(MOH & FW No.S.14025/2/2011-MS dated 11.01.2011)

36. Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner
CGHS beneficiaries, etc.
With reference to the above subject the undersigned is directed to state that that the matter has been reviewed by the
Ministry in view of the difficulties faced by the CGHS pensioner beneficiaries Therefore, with a view to streamline and to simplify the
procedures. It has now been decided to further delegate powers to the Addl. Directors of CGHS Cities / Zones in respect of CGHS
pensioner beneficiaries. etc. as under:
i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs /Imaging Centre:
Requests for permission ex-post facto approval for elective treatment / investigations in non-empanelled hospitals /
diagnostic centers in respect of Pensioners/ex-MP's/freedom Fighters, etc. shall be considered by Addl. Director of concerned CGHS
city / Zone subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less
ii) Permission / ex-post facto approval in cases involving procedural lapse:
Requests for approval of elective treatment / investigations in empanelled hospitals / diagnostic centers without recommendation of
Govt. Specialist or CMO and without prior permission in respect of Pensioners/ex-MPs/freedom Fighters, etc, shall be considered by
Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS rates or actual expenditure
whichever is less.
iii) Delegation of Powers for Settlement of Medical Reimbursement Claims (at approved rates) of Individual Pensioner
Beneficiary. etc,

Revised Delegated Powers

18
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

iv) Delegation of Powers for settlement of Hospital Bills (at approved rates) for the Treatment given to Pensioner
Beneficiaries, etc,

Revised Delegated Powers

a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

v) Delegation of Powers for Permission / ex-post facto Approval / Settlement of Medical Reimbursement Claims of
Individual Beneficiaries / Hospital Bills in respect of unlisted procedures / Implants (no CGHS rates)
If there is no CGHS package rate for treatment / CGHS Ceiling rate for implant approval shall be granted as per AIIMS
package rate (if only procedural charge. it shall not be considered as package rates)/ AIIMS rate for implant and if there is no
CGHS/AIIMS rate approval shall be granted as per actual rate.

Revised Delegated Powers

a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 15,00,000/-

2. The revised delegations mentioned above will be subject to the conditions that it will not include any case involving relaxation of
rules, irrespective of the amount involved. Further, cases where the amounts exceed the monetary limits prescribed above will have
to be referred to the Ministry of Health & Family Welfare for obtaining the concurrence of Integrated Finance Division in the Ministry
of Health & Family Welfare.
3. The above delegations are in supersession of all the earlier instructions in the matter in respect of the delegations now
being conveyed.
This issues with the concurrence of Integrated Finance Division, Ministry of Health & Family Welfare, vide Dy. No C- 3373
dt. 20.09.2016
(MOH & FW OM No: Z.15025/79/2/DIR/CGHS dated 05.10.2016)

37.Delegation of power to Heads of Departments in various Ministries/Departments for settling permission cases and post facto
approval relating to referral system and medical reimbursement under CGHS - Enhancement of ceiling rate from Rs. 2 Lakhs to Rs.
5 Lakhs without consultation of IFD of concerned Ministry - Reg.
The undersigned is directed to refer to this Ministry's OM No. S. 12020/4/97-CGHS (P), dated 27.12.2006 and its
clarification issued vide this Ministry's OM No. S. 11011/20/2014-CGHS (P), dated 20.06.2014, where in financial powers were
delegated to the Heads of Departments/Ministries to settle all such cases where there is no relaxation of rules involved and
admissibility of claim was worked out with reference to the CGHS approved rate list and guidelines.
2. This Ministry has been receiving requests from different Ministries/Departments for enhancement of delegation of
financial powers to Head of Departments to settle medical claims/medical advance cases involving financial implications up to Rs. 5
Lakhs without referring the case to Internal Finance Division (IFD).
3. The matter regarding enhancement of delegation of financial powers to the Heads of Departments/Ministries has been
examined in this Ministry and it has been decided with the approval of the competent authority to enhance the existing limit of Rs. 2
Lakhs to Rs. 5 Lakhs to settle all cases where there is no relaxation of rules and the entitlement was worked out with reference to
the rate list prescribed.
In respect of cases involving payment exceeding Rs. 5,00,000/- (Rupees 5 Lakhs only) but as per the prescribed rate list,
the concerned Departments/ Ministries may settle such cases in consultation with their respective Internal Finance Division. Only in
those cases where the settled scheme/rules are required to be relaxed, should the case be referred to the Ministry of Health and
Family Welfare.
4. This issue with concurrence of Internal Finance Division vide FTS No. 91725, dated 01.11.2016.
(MOH& FW No.S.11011/20/2014-CGHS (P)/EHSS dated 23.11.2016)

38. Delegation of powers to heads of Departments in various Ministries/Departments for settling permission cases and post facto
approval relating to referral system in CGHS
The undersigned is directed to refer to this Ministry's Office Memoranda of even number dated the 7th April, 1999 and 7th
March, 2000 on the above subject vide which powers were delegated by the CGHS. Delegation No. 12 of O.M. of 7th April, 1999,
under post facto approval in respect of CGHS for settlement of individual medical reimbursement claims/to accord permission/grant
of medical advance reads as follows :-
Subject to the approval of Head of the CGHS organization of the concerned CGHS covered City/Ministry of Health and
Family Welfare, where prescribed in the preceding paras, the monetary limits for issuing sanction were raised as under:-

19
A Rs. 2 lakhs (in case of By the HoD
serving employee beneficiaries)

B Rs. 2 lakhs (in case of By the Head of the

pensioner CGHS beneficiaries) concerned CGHS covered city

C Rs. 2 to 5 lakhs Director, CGHS

D AboveRs. 5 lakhs Ministry of Health &

Family Welfare

2. Power were further delegated vide Office Memorandum No. S-12020/4/97-CGHS (P), dated the 7th March, 2000, as
follows:-
(i) A serving Central Government servant covered under CGHS who is taking treatment in some CGHS
Dispensary/Government hospital and desires to obtain treatment in a private hospital recognized under CGHS, the Heads of
Departments may grant him permission for indoor treatment on the basis of medical prescription issued to the CGHS beneficiary.
(ii) The Heads of Departments (HoDs) may decide the cases of reimbursement of medical claims in respect of treatment
obtained in emergency at private hospital/private nursing home/private clinic, subject to item-wise ceiling as per rates prescribed for
CGHS beneficiaries without financial limit on the total amount to be reimbursed.
3. The Ministry of Health and Family Welfare has been receiving files from different Ministries/Department in respect of
medical claims/request for advance when the admissible amounts exceeded Rs. 2.00 lakhs even though in most of the cases the
admissible amount calculated were as per the approved rate list. This has created avoidable work in the Ministry without any scope
for value addition in the process of examination.
4. The Ministry of Health and Family Welfare has been examining the question of further delegation of powers to the Heads
of Departments/Ministries in the matter and it has been decided with the approval of the Competent Authority to delegate powers
to Departments/Ministries to settle all cases where there is no relaxation of rules and the entitlement was worked out with
reference to the rate list prescribed without any monetary ceiling. The delegation would, however, be subject to the condition that
the Heads of the Departments/Ministries may settle cases up to the limit of Rs. 2,00,000 (Rupees Two lakhs only) (worked out with
reference to the prescribed rate list). In respect of cases involving payment exceeding Rs. 2,00,000 (Rupees two lakhs only) but as
per the prescribed rate list, the concerned Departments/Ministries may settle such cases in consultation with their respective
Internal Finance Division. Only in those cases where the settled scheme/rules are required to be relaxed, should the case be referred
to the Ministry of Health and Family Welfare.
5. This issues with concurrence of Internal Finance Division vide CD No. C-2572-IFD/2006, dated the 27th November, 2006.
(MOH & FW O.M. No. S. 12020/4/97-CGHS (P), dated 27.12.2006)

39. 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 IFD vide Dy. No. 4888/Dt. 11.01.2011 of the office of the AS&FA, Min., of Health &
Family Welfare.
(MOH&FW OM No.S.3924/2010/CGHS(R&H)/CGHS(P) dated 17.01.2011)

40. Guidelines / Criteria for reimbursement of expenses for In-Vitro Fertilization (IVF) treatment to CGHS beneficiaries and
beneficiaries under Central Services (Medical Attendance) Rules. 1944.
The undersigned is directed to say that the Ministry of Health & Family Welfare has been receiving requests for providing
clarifications as to whether the expenditure incurred on In-Vitro Fertilization ((IVF) treatment is admissible under CGHS, and if so.
whether any guidelines have been laid down for reimbursement of the expenses incurred on IVF treatment.
(2) The matter has been examined by a Technical Committee of the Heads of Department of Gynecology & Obstetrics of
Government Medical institutions, and based on the recommendations of the Committee, the following guidelines are laid down for
considering cases for reimbursement of expenses incurred on IVF treatment by CGHS beneficiaries and beneficiaries under Central
Services (Medical Attendance) Rules, 1944:-
(i) Requests for IVF treatment will be considered only on the basis of advice tendered by the Head of Department of Gynecology &
Obstetrics of a Government Medical institution;
(ii) Permission for IVF treatment to be undertaken may be given by the Head of Department in the Ministries / Departments on the
recommendations of the Head of Department of Gynecology & Obstetrics of a Government Medical institution;
(iii) IVF procedure will be allowed in a Government Medical Institution on the recommendations of the Head of Department of
Gynecology & Obstetrics of a Government Medical institution;
(iv) IVF procedure may be allowed, on a case to case basis, in a private medical institution if the Institution is registered with the
State / Central Government and has the necessary facilities including equipment and trained man power for carrying out the

20
procedure. It is, however, mandatory to obtain the recommendations of the Head of Department of Gynecology & Obstetrics of a
Government Medical institution for permitting the procedure to be undertaken in a private institution;
(v) There should be clear evidence of failure of conventional treatment before permitting IVF treatment procedure;
(vi) The age of women undergoing IVF treatment procedure should be between 21 and 39 years
(vii) The woman has to be married and living with her husband;
(viii) The IVF treatment procedure will be allowed only in cases of infertility where the couple has no living issue;
(ix) Reimbursement of expenditure incurred on IVF procedure will be allowed upto a maximum of 3 (three) fresh cycles;
(x) An amount not exceeding Rs.65,000/- (Rupees sixty five thousand only) per cycle or the actual cost, whichever is lower, will be
allowed for reimbursement. This amount will be inclusive of the cost of drugs and disposables and monitoring cost during IVF
procedures;
(xi) As IVF treatment is a planned procedure, reimbursement cases can be considered by the Ministries / Departments only if prior
approval was obtained by the beneficiary for undergoing the IVF treatment.
(xii) There will be a onetime permission for availing IVF treatment consisting of three cycles in total, which would be admissible to
the beneficiary. The concerned Ministry / Department shall obtain an undertaking from the applicant that he / she has not claimed
the reimbursement earlier from the Government of India in the past and will not claim it in the future.
These guidelines come into force from the date of issue of the Office Memorandum and reimbursement cases of IVF
treatment undertaken after the issue of the Office Memorandum only can be considered by the Ministries / Departments.
4. This issues with the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare, vide Dy. No.C.1747/IFD
(Health)/2011 dated the 21stNovember, 2011
(MOH & FW No: Z.15025/5/201 1-CGHS III/CGHS (P) dated 02.11.2011)

41. Ceiling Rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft to
beneficiaries of CGHS/CS(MA) Rules.
With reference to the above mentioned subject the undersigned is directed to draw attention to the office Memoranda
No. S-11011/7/95-CGHS(P) dated 12/6/1996 and 26-164/98-R&H/CGHS/CGHS(P) dated 22/11/1999 vide which ceiling rates and
guidelines were prescribed for various types of Pacemakers, Rotablator and AICD and to state that while the ceiling rates for
coronary stents have been revised from time to time separately the rates and guidelines for pacemakers, Rotablator and AICD were
not revised. The matter has been examined by the Ministry and it has been decided to revise the ceiling rates (incl. of all taxes) for
these devices as per the details given below:

1. Single Chamber Cardiac Pacemaker without rate Rs. 34,840/-

response-
2. Single Chamber Cardiac Pacemaker with rate Rs. 44,928/-
response
3. Dual Chamber Cardiac Pacemaker Rs. 83,200/-
4. Bi-Ventricular Pacemaker (CRT-P) Rs. 1,95,000/-
5. Implantable Cardioverter Defibrillator (Single Camber) Rs. 1,75,786
(ICD/AICD-Single Chamber)
6. Implantable Cardioverter Defibrillator (Dual Camber) Rs. 3,75,000/-
(ICD/AICD-Dual Chamber)
7. Combo Device (CRT-D) Rs. 4,90,000/-
8. Aortic Stent Graft (expandable, bifurcated and Rs. 4,40,960/-
including delivery system)
9. Rotablator with advance Rs. 49,920/-
10. Rotablator Burr Rs. 23,920

2. Permission for the above mentioned implants shall be granted on the basis of advice of Govt. cardiologist by CMO in-
charge/ Additional Director/ Joint Director, CGHS in case of pensioners, former Governors, former Vice-Presidents, ex-MPs,
Freedom Fighters, etc, by RajyaSabha/ LokSabha Secretariat as the case may be in case of sitting Members of Parliament
and by the concerned Ministry/ Department/ Organization in case of serving Government employees, serving employees
and pensioners of autonomous bodies covered under CGHS. The reimbursement shall be limited to the ceiling rate or
actual rate, whichever may be less.
3. The Warranty terms and conditions as specified by the manufacturer shall be applicable in case of replacement of a device.
4. In case of requests for replacement of a device, a copy of the details of the earlier device as well as a copy of terms and
conditions of Warranty shall be enclosed along with the advice of Govt. specialist.
5. A copy of the device ‘ID No Sticker’ and a copy of terms of warranty shall be enclosed along with the bill of device for
reimbursement.
6. In case of implantation of any of the devices in emergency, reimbursement shall be subject to ex-post facto approval by
Addl. Director/Joint Director, CGHS of city, in consultation with experts, if necessary.
7. These orders are in supersession of earlier guidelines and ceiling rates issued in this regard.
8. The rates shall be valid for a period of two years or till further revision whichever may be earlier.
9. This issues with the concurrence of integrated Finance Division vide CD No C756 dated 14/07/2014.
(MOH & FW No. 12034/02/2014/Misc/-CGHS D.III dated 22.07.2014)

42. Revision of rates for various treatment procedures under CGHS.

21
 With reference to the above mentioned subject the undersigned is directed to draw attention to OM No.
S.11045/36/2012-CGHS (HEC) dated 1.10.2014 whereby CGHS package rates for various treatment procedures were notified by the
Government for empanelled hospitals under CGHS Delhi and NCR. This Directorate has been receiving representations from different
stake holders regarding discrepancies in these notified rates. The matter was examined in this Directorate and now it has been
decided with the approval of competent authority to revise the rates of following treatment procedures under CGHS.

Sr. No. TREATMENT PROCEDURE Revised rates Revised rates

Non-NABH NABH
Gynae&Obst
1 RVF Repair 18975 21821
2 USG for Obstetrics – 770 886
Anomalies scan
Nephrology & Urology
1 Epididymectomy 15938 18750
2 Lithotripsy Extra corporeal 19550 22483
shock wave.
3 Ureteric Catheterization 8278 10950
4 Kidney Transplant (Related) 200000 230000
5 Kidney Transplant 300000 345000
(Unrelated) including
immunosuppressant therapy
General Surgery
1 Secondary suture of wounds 3400 4000
2 Haemorrhoidectomy 20720 24375
3 StapplerHaemorrhoidectomy 38000 43700
4 Varicose vein surgery; 10000 11500
Tendelenburg operation with
suturing or ligation.
5 Catheterization 425 500
6 Fissure in Ano - Fissurectomy 13800 15870
7 LaproscopicParaumblical 17500 20125
Hernia Repair
Ophthalmology
1 Pterygium surgery 5500 6325
2 Conjunctival wound repair or 3300 3795
exploration following blunt
trauma
Imaging Investigations
1 CT-orbit and brain 1600 1840
2 Foramen magnum 93750 107813
decompression for Chari
Malformation
Cardiology
1 DVR 155422 178735

Reimbursement to beneficiaries/empanelled hospitals shall be limited to ceiling rate or as per actuals, whichever is lower.
The other terms and conditions as regards to CGHS package rates remain unchanged.

2. The revised rates shall come into force from the date of issue and shall be in force till further orders and are applicable in
all CGHS cities.

3. This issues with concurrence of Integrated Finance Division of Ministry of Health and Family Welfare vide diary no. C-2289
dated 13/02/2015.
(MOH & FW No.S-11011/48/2014-CGHS (HEC) dated 18.02.2015)

43. Streamlining of procedure for disposal of Medical Reimbursement Claims (MRCs) in CGHS
The Pensioner CGHS beneficiaries and their dependent family members are entitled to get cashless medical treatment In
CGHS empanelled private hospitals on a referral by a Government Medical Specialist / CMO in-charge, after obtaining prior
permission from the CMO in-charge of the CGHS Wellness Centre/Dispensary they are attached to. They are however, also entitled
to obtain the medical services from any un-empanelled hospital in emergency condition and get reimbursement of medical expenses
incurred by themselves or any of their dependent family members. They can file Medical Reimbursement Claims (MRCs) with the
respective CGHS Wellness Centers they are attached to. The CMO In charge is expected to scrutinize the claim papers with reference
to the prescribed Checklist and forward the same to the Office of AD/ JD in charge of the zone/city. The Office of AD/JD processes
the claim and arranges reimbursement of the admissible amount to the pensioner beneficiary at the earliest.
2. A number of complaints are being received from the pensioner beneficiaries about the slow and tardy pace of disposal of
MRC claims by CGHS, complaints have also been received about the unnecessary harassment of pensioner beneficiaries who are also
senior citizens, affecting them mentally and financially, and thereby creating a bad image for CGHS. CGHS is responsible for taking
care of healthcare needs and wellbeing of the Central Government employees and pensioners. It has therefore been decided to lay
down a comprehensive procedure to be followed by all concerned in CGHS to ensure timely and hassle free disposal of the MRC
claims by CGHS in order to facilitate prompt reimbursement of medical expenses to the pensioner beneficiaries.

22
3. The procedure to be followed by CGHS for dealing with MRC cases shall be as follows;
i. The beneficiary will submit the MRC in the prescribed format with all relevant supporting vouchers/documents in original, to
the CMO-I/C of the relevant CGHS Wellness Centre. The CGHS Wellness Centre shall verify and ensure, before accepting the claim
papers, that all relevant documents are enclosed as per the prescribed checklist and issue a dated acknowledgement to the claimant
in token of receipt of the MRC by CGHS.
ii. The CGHS Wellness Centre shall forward the MRC papers online to the Office of Zonal AD/JD, CGHS for further processing for
reimbursement of claims. The physical papers shall be sent to the office of the AD/JD within one / two days of receipt of claim
papers.
iii. If there are still any deficiencies / gaps found in MRC documents/papers, the Office of AD/JD, shall retain the papers and
communicate the list of deficiencies / observations, preferably online, to the CMO-I/C for removing the shortcomings. The MRC may
also be returned in original to the CMO- I/C, if it is absolutely necessary for doing the needful to remove the deficiencies in
consultation with the beneficiary.
iv. The CMO-I/C shall contact the beneficiary concerned and inform him about the shortcomings in the MRC papers and request
him to submit the requisite information / documents. The CMO I/C shall not return the MRC in original unless it is rejected in total.
v. The MRCs should be scrutinized and processed by the Office of AD/JD as far as possible through computerized software as per
the extant policy and instructions issued from time to time about the CGHS rates and admissibility of claims under CGHS.
vi. The amount found admissible as per the CGHS guidelines may be passed for payment and forwarded online / manually to the
PAO for making payment. The original documents should also be forwarded simultaneously to the PAO for making payment of the
admissible amount to the claimant.
vii. When a bill is sent to the PAO, the details pertaining to the claimant will be entered through computer and the claimant shall
be informed of the same along with bill number, amount admissible and details of disallowances clearly indicating the specific
reasons / grounds for deductions.
viii. The Office of AD/JD of the zone / city shall submit a weekly report in Form -'MRC-I' and Monthly Return in Form - 'MRC - II'
indicating the details of disposal of MRC cases, to the Office of AD(HQ), CGHS for Delhi & NCR and to the Office of Additional DDG
(HQ), CGHS for other than Delhi and NCR CGHS cities.
ix. A separate analytical statement shall be attached with the Monthly Return in Form-'MRC- II' giving therein, the details of the
MRCs pending for 2 months and above, clearly indicating the reasons there for and steps taken to dispose of such cases.
x. The Office of AD (HQ), CGHS, New Delhi and Office of Addl. DDG (HQ), CGHS shall compile the Monthly returns received from
the respective zones and cities and submit a consolidated Monthly Return on MRC cases (Zone-wise/City wise) to the Director, CGHS
for monitoring of MRC cases on a monthly basis. A copy of this Monthly Return shall also be endorsed by AD (HQ), CGHS and Addl.
DDG (HQ), CGHS to Additional Secretary and Director General, CGHS for his information.
4. All the CMO - I/C of the CGHS Wellness centers and the ADs and JDs of the zone /city are hereby directed to follow the above
procedure religiously in both letter and spirit to ensure speedy and timely disposal of the Medical Reimbursement Claims (MRCs)
filed by the pensioner CGHS beneficiaries.
(MOH & FW. No. S.11024/8/2011/CGHS(P) dated 14.11.2011)

44. Medical Facilities for inpatient treatment and post-operative follow-up treatment to CGHS Beneficiaries in Non-CGHS areas.
The undersigned is directed to invite attention to the Office Memorandum of even number dated 30th September, 1999, issued
by the Ministry of Health & Family Welfare on the above subject and to state that keeping in view the difficulties being faced by the
pensioner CGHS beneficiaries residing in non-CGHS covered areas, it has now been decided to liberalise the CGHS Rules with regard
to pensioner CGHS beneficiaries and serving employees, as below, to enable them to avail medical facilities for in-patient treatment
and post-operative follow-up treatment:
a) (i) CGHS pensioner beneficiaries (and their dependent and eligible family members), who are holding a valid CGHS Card and are
residing in a non-CGHS areas shall be eligible to obtain treatment from Government hospitals (Central Government / State
Government / Local Self Government / hospitals recognised under Central Services (Medical Attendance) Rules, 1944 / hospitals and
clinics empanelled under Ex-Servicemen Contributory Health Scheme (ECHS) and submit the medical reimbursement claim to the
Additional Director / Joint Director of CGHS of the CMO in charge of CGHS Wellness Centre, where the CGHS is registered.
(ii) In case of non-emergency treatment from hospitals approved under Central Services (Medical Attendance) Rules, 1944 and Ex-
Servicemen Contributory Health Scheme (ECHS), it is necessary to obtain prior approval from CMO in charge of concerned Wellness
Centre where the CGHS card is registered.
(iii) In case of medical emergency, treatment may be obtained from any hospital and medical claim shall be submitted to Additional
Director / Joint Director, CGHS of the concerned city through CMO in charge of the Wellness Centre, where the CGHS card is
registered.
(iv) Reimbursement shall be limited to the CGHS rates of the city where the card is registered and as per the ceiling rates and ward
entitlements or as per actuals, whichever is lower.
(v) CGHS pensioner beneficiaries / serving Central Government employees (and their dependent and eligible family members) and
holding a valid CGHS Card and on a visit to non CGHS covered area may obtain treatment under emergency from Government
hospitals (Central Government / State Government / Local self Government / hospitals recognised under Central Services (Medical
Attendance) Rules, 1944 / hospitals and clinics empanelled under Ex-servicemen Contributory Health Scheme (ECHS) and the
medical claim shall be submitted to Additional Director / Joint Director, CGHS of the concerned city through CMO in charge of the
Wellness Centre, where the CGHS card is registered, in case of pensioners , etc., and to the concerned Ministry / Department / Office
in case of serving employees.
(vi) Reimbursement shall be limited to the CGHS rates of the city nearest to the place, where treatment is obtained and as per the
ceiling rates and ward entitlements or as per actuals, whichever may be less.

23
b) (i) CGHS pensioner beneficiaries (and their dependent and eligible family members) , who are holding a valid CGHS Card and
residing in a non-CGHS areas shall be eligible to obtain post-operative follow-up treatment from Government hospitals (Central
Government / State Government / Local self Government / hospitals approved under Central Services (Medical Attendance) Rules,
1944 / hospitals and clinics empanelled under Ex-servicemen Contributory Health Scheme (ECHS) in follow up cases of Renal
Transplant surgery, Knee and Hip Joint Replacement, Cancer treatment , Neuro-surgery and cardiac surgery. However, prior
permission is to be obtained from the CMO in charge of the concerned Wellness Centre, where the CGHS card is registered.
(ii) Permission shall be issued for 3 to 6 months at a time and may be extended based on medical requirement. Reimbursement for
consultation, procedures and investigations shall be limited to CGHS rates of the city, where the card is registered and as per the
ceiling rates and ward entitlements or as per actuals, whichever may be lower. OPD medicines shall be obtained from the concerned
Wellness Center for a maximum period of 3 months at a time.
c) Wherever treatment is obtained from a hospitals approved under Central Services (Medical Attendance) Rules, 1944 / ECHS
approved hospital, the beneficiaries (as in (a), (b) & (c) above) shall submit a certificate from the hospital that they have not charged
more than the approved applicable hospitals approved under Central Services (Medical Attendance) Rules, 1944 ECHS rates.
d) This Office Memorandum supersedes the earlier OM of even number dated 30th September 1999.
e) This arrangement is provisional and would be in place till such time the proposed Health Insurance Scheme for Central
Government employees & pensioners is brought into effect.
f) These orders will come into effect from the date of issue.
(MOH & FW OM No: S.11011/7/99-CGHS (P) dated 27.04.2011)

45. Permission for undergoing laboratory/pathological tests/specific investigations in case of non-emergencies

The undersigned is directed to refer to O.M. No. No.s.11011/23/2009 CGHS D.II/Hospital Cell/CGHS (P) dated 10-11-2010
of Ministry of Health and Family Welfare and to state that in accordance with the advice of CGHS/other Government Specialist/CMO
in-charge permission for undergoing laboratory/pathological tests/specific investigations in case of non-emergencies should be
obtained from the Competent Authority.
However, the CGHS beneficiary shall have the option of awaiting specific investigation from any of the empanelled
Diagnostic laboratories/Imaging Centre of his/her choice (provided the Diagnostic laboratory/Imaging Centre is empanelled for that
treatment procedure/test).
2. In view of the said OM, the employees of Department of Posts desired of having specific investigation should obtain prior
permission from the Department for getting their medical reimbursement.
3. Claims for reimbursement in the absence of prior permission should not be entertained from the date of issue of this
Office Memorandum (O.M.).
(MOH No. 300/201011/C&APB dated 22.11.2010)

46. Permission for treatment / investigations in respect of CGHS beneficiaries availing treatment for Diabetes, Hypertension &
other Cardiac Diseases, Dialysis and Cancer.
The undersigned is directed to refer to the subject mentioned above and to state that at present the CGHS beneficiaries
undergoing treatment for Diabetes, Hypertension & other Cardiac Diseases, Dialysis and Cancer require repeated investigations /
treatment procedures over a period of time and as per the existing guidelines they are required to procure permission every time to
get the prescribed treatment / investigations done at CGHS empanelled hospitals /diagnostic centres.
2. With a view to alleviate the inconvenience to CGHS beneficiaries in obtaining the requisite permission(s) every time, this
Ministry has decided to permit issue of permission (referral) letters by competent authorities with a validity of six months from the
date of issue of the original prescription for undergoing the prescribed treatment /investigation procedures to be conducted at the
prescribed intervals over a period of six months as advised by a Government Specialist. The same permission (referral) letter shall be
valid for undergoing the prescribed treatment procedures / investigations on multiple times during the six months, at intervals as
advised by the Government Specialist.
(DOH & FW No.S-11045140 /2012/CGHS/HEC/CGHS (P) dated 01.10.2012)

47. Referral of CGHS beneficiaries to empanelled Super-Specialty Hospitals

With reference to the subject mentioned above, the undersigned is directed to state that several representations have been
received from CGHS beneficiaries regarding problems faced by them in obtaining permission to undergo treatment at Super-
Specialty hospitals. The matter has been reviewed and it has now been decided to simplify the procedure for obtaining treatment
from CGHS empanelled super-specialty hospitals .Attention is drawn to Para 6.2 of office memorandum of even number dated 17th
August 2010 wherein it was stated that
"CGHS beneficiaries have, so far, been the option to get themselves treated in any hospital of their choice. However, in view
of the increased outgo on getting treatment in super-specialty hospitals, it has now been decided that CGHS beneficiaries desirous of
getting treated in super-specialty hospitals, in non-emergency conditions, prior approval of the concerned Additional Director, CGHS
would have to be obtained".
The above mentioned procedure is modified to read as follows:
"CGHS beneficiaries have, so far, been the option to get themselves treated in any hospital of their choice. However, in view
of the increased outgo on getting treatment in super-specialty hospitals, it has now been decided that CGHS beneficiaries desirous of
getting treated in super-specialty hospitals, in non-emergency conditions, prior approval of the concerned Chief Medical Officer-in-
Charge, of the CGHS Wellness Centre would have to be obtained."
(MOH&FW OM No.S.11011/23/2009-CGHS D.II/Hospital Cell (Part I)dated 07.02.2011)

48. Streamlining of functioning of CGHS dispensaries.

24
 The question of streamlining the functioning of CGHS dispensaries has been engaging the attention of the Ministry of
Health & Family Welfare for some time now. After considering the suggestions received from various quarters and after discussing
the matter with officials of CGHS, it has been decided, as an initial measure, to streamline the functioning of CGHS dispensaries as
below :-
(i) There is a need for officers and staff in CGHS dispensaries to further improve the delivery of service to CGHS beneficiaries. There
should be a constant and conscious effort to redress most of the grievances andproblems of these beneficiaries at the dispensary
level so that there is no inconvenience caused to them forcing them to approach higher authorities for redressal of their grievances.
The entire staff at the dispensary level have to ensure a polite, positive and responsible attitude to make the service delivery better.
The CMO In-charge must make every effort to ensure this user friendly environment. Complaints of rude/impolite behavior need to
be checked and stern action taken by CMOs (Incharge).
(ii) It is well established that CGHS beneficiaries need to be provided better service. Senior citizens/pensioners among the CGHS
beneficiaries deserve special attention and response. It is re-iterated that senior citizens/pensioners need to be given out of queue
treatment and service at each activity level. Despite repeated instructions in this regard, this system is generally not being enforced
at the dispensary level. CMOs incharge must ensure compliance of these instructions.
(iii) CMOs In-charge of the dispensaries shall personally make rounds of the dispensary particularly during peak hours to ensure that
there is proper environment and beneficiaries particularly pensioners/Senior Citizens arebeing treated promptly;
(iv) The Zonal Additional Directors/Joint Directors shall convene the meetings of Pensioners Associations once in two months
along with CMOs (Incharge) without fail.
(v) A complaint/suggestion/feedback Box with details like number of complaints received and disposed etc. under a seal and lock will
be kept at each dispensary and will be opened by the CMO In-charge in the presence of at least two members of the Advisory
Committee when the Advisory Committee meeting is being held and necessary action taken by the Advisory Committee with regard
to complaints/ suggestions/feedback thus received and, wherever required, the matter will be referred to higher authorities for
necessary action.
(vi) All Zonal Additional Directors and Joint Directors shall conduct at least five surprise inspections of the dispensaries in Delhi and at
least two in other cities in a month and report the outcome of the inspection indicating the areas such as punctuality, availability and
behavior of officers/staff, special care for pensioners/Senior Citizens, deficit areas/complaints and also the good work done in each
of the dispensaries inspected, by way of a confidential monthly D.O. letter to reach AS & DG (CGHS) without fail on or before 10th of
the succeeding month;
(vii) It is seen that a large number of beneficiaries go to the dispensaries for taking repeat medicines. Authorization of repeat
medicines will hereinafter be done by any of the CMOs, apart from the CMO In-charge, available in the dispensary;
(viii) The Zonal Additional Directors/Joint Directors will personally monitor and ensure that the empanelled hospitals etc. do adhere
to the terms & conditions of MOAs. They will also supervise the services, if any, being provided by the private parties in their zones
such as dialysis, dental services etc.
2. Director, CGHS and all Additional Directors/Joint Directors and CMOs In-charge are hereby directed to fully comply with the
instructions contained in this Office Memorandum in both letter and spirit. Noncompliance shall be viewed seriously.
(MOH&FW OM No. S-11030/51/2010-CGHS (P) dated 22.11.2010)

49. 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 disposables 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 reimbursable 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 reimbursable in addition to delivery charges for mother.
(d) The hospitals empanelled under CGHS shall not charge more than the package rates / rates.
2.2 Package rates envisage upto a maximum duration of indoor treatment as follow:
12 days for Specialized (Super Specialties) treatment;
7 days for other Major Surgeries;
3 days for Laparoscopic surgeries/normal deliveries; and
1 days for day care/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
categories of wards as given below:
General ward -Rs. 1000/- per day
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 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. Basic Pay (without the Entitlement

No inclusion of grade pay)
.
1. Upto Rs. 13,950/- General Ward
2. Between Rs. 13,951/- and Semi-Private Ward
Rs. 19,530/-
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 8th November, 2010.
The revised rates will come into effect from the date of issue of this Office Memorandum.
(MOH&FW O.M. No.S.11011/23/2009-CGHS D.II/Hospital Cell (Part I) dated 16.11.2010)

50. Issue of pensioner CGHS Cards to Central Government servants before retirement
Central Government servants on their retirement from service are entitled to CGHS facility, if they retire from office
Ministries/Departments/Offices covered by CGHS. For availing CGHS facility, if eligible, after retirement from service, pensioners are
required to fill up the requisite form and deposit the appropriate amount lump sum amount equivalent to one year's contribution
for availing CGHS facility for one year (which can be extended on an annual basis on payment of the appropriate contribution as
applicable at the time of renewal) or pay in lump sum equivalent to ten years contribution for availing CGHS facility with life-time
validity). The process of issuing of pensioner CGHS cards starts only after the Government servant retires from service and only after
the Pension Pay Order (PPO) and Last pay Certificate (LPC) are issued by the Ministry/Department/Office. The completion of the
formalities takes two to three months, which puts pensioners in a problematic condition for getting treatment from the date on
which they retire from service and the time when a pensioner CGHS card is issued to them.
2. The Ministry of Health & Family Welfare has received representations from retired Central Government servants and from officials
due for retirement within the next few months with the request that the policy regarding issue of pensioner CGHS cards be
simplified so that they are in a position to get the pensioner CGHS card a day after their retirement from service.
3. The matter has been examined by the Ministry of Health & Family Welfare in consultation with CGHS and it has been decided that
the following course of action will be taken in respect of officials who are entitled to avail CGHS facility after his/her retirement from
Government service:
(i) All Ministries/Departments will, along with pension papers, give the application for issue of pensioner CGHS cards to the official
three months before the due date for retirement of the official;
(ii) The official, if he/she is interested in availing CGHS facility after his/her retirement, will;
a. Fill up the form for issue of pensioner's card;
b. Affix stamp sized photographs of the family members entitled to avail CGHS facility in the proforma for issue of pensioner's card;
c. Enclose Demand Draft/Pay Orders for the appropriate amount with reference to his/her decision to get CGHS card with life-time
validity (the amount will be equal to ten years contribution) or with validity for one year (the amount will be equal to one year's
contribution). For obtaining the card in Delhi, the Demand Draft/Pay Order will have to be made payable to "Pay & Accounts Officer
(CGHS), payable at Delhi" and for obtaining card in a CGHS city outside Delhi, the Demand Draft/Pay Order will have to be made
payable to "Additional Directorate or Joint Director (as the case may be) of the CGHS city, payable in that city"
(iii) The Ministry/Department will add a certificate of pay, grade pay, etc drawn by the applicant to the application form and also
mention the entitlement of ward (Private ward/Semi-Private Ward/General Ward) at the time of retirement of the official;
(iv) The Ministry/Department will forward the application complete in all respects to the Additional Director in the concerned CGHS
city after verifying the particulars furnished by the applicant six weeks before the date of retirement of the official;
(v) CGHS pensioner cell in the concerned CGHS city will initiate action to get the pensioner card prepared;
(vi) The validity of the pensioner card will start from a date after the last day of service of the officials;
(vii) If the beneficiary, while in service, has been issued plastic card, then the beneficiary identification number (Ben ID No.) will not
be changed at the time of preparation of pensioner card and the same Ben ID number will be carried forward in the pensioner card;
(viii) The pensioner card will be handed over to the retired official only after the date of superannuation/retirement from service;
and
(ix) Before the Pensioner CGHS card is issued to the beneficiary, the plastic CGHS cards issued to all the members of the family will
be surrendered.
4. All Ministries/Departments are requested to give wide publicity to the contents of these instructions.
(MOH & FW No. 37-1/2009-C & P/CGHS (P) dated 23.02.2011)

51. Clarifications regarding validity of individual Plastic Cards at all CGHS Wellness Centers in the Country.
The undersigned is directed to draw attention to the para E (6) of Office Memorandum of even number dated 30th December,
2009, wherein it was mentioned that after computerization of all CGHS covered cities the plastic Cards will be valid in all CGHS cities
in India and there will be no need for obtaining temporary attachment while on a visit to another CGHS City.

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2. In response to representations received from CGHS beneficiaries seeking clarifications, it has now been decided to further
clarify that:
"Now that computerization of all CGHS covered cities has been completed the plastic Cards are valid in all CGHS cities in India
and there is no need for obtaining temporary attachment while on a visit to another CGHS City. Since, the data is available online
CGHS beneficiaries are permitted to obtain medicines (including indented medicines) from any Wellness Centre located in the same
city, where the card is registered or from any Wellness Centre located in any other CGHS city while on a visit (Official as well as
Personal)."
3. The other contents of the Office Memorandum of even number dated 30thDecember 2009 remains unchanged.
(MOH & FW No.Misc.6024/2007/CGHS (Hq)/CGHS(P) dated16.03.2011)

52. Renewal of CGHS Plastic Cards-reg.

The undersigned is directed to refer to this Ministry's O.M. No. S.11012/3/2011-CGHS (P) dated 29-12-2011 laying down
the guidelines for issue of individual plastic cards to CGHS beneficiaries. CGHS Plastic Cards were introduced in September, 2008 in
Delhi NCR and the cards were initially issued with a validity period of 5 years. The CGHS Plastic Cards completing their validity period
are due for renewal and accordingly fresh cards with renewed validity period are being issued by the Office of Additional Director,
CGHS of the city concerned. With a view to further streamline the process of renewal of CGHS Plastic Cards, it has been decided to
issue the following guidelines supplementing the existing instructions on issue of CGHS Plastic Cards :-
Serving beneficiary
a) Application for renewal of CGHS Plastic Cards in the prescribed proforma (Form AA) alongwith requisite documents
(current photographs, copy of pay slip and address proof of residence, if changed), should be submitted through their Administrative
Office to the Office of Additional Director, CGHS of the respective CGHS city following the same procedure as prescribed for issue of
fresh CGHS card.
b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with a validity period of 5 years.
c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry.
Pensioner beneficiary
A) Application for renewal of Pensioners' CGHS Plastic Cards in the prescribed proforma (Form BB) alongwith requisite
documents (current photographs, PPO or LPC, address proof, if changed) should be submitted to the parent CGHS Wellness Centre
where his/her card is registered. He/She can also submit the application to the Office of Additional Director, CGHS of the respective
CGHS city for renewal of CGHS cards.
B) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with validity for lifetime or up to the date for which
the contribution has been made by the beneficiary.
C) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry.
This issues with the approval of Additional Secretary and Director General, CGHS.

53. Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner
CGHS beneficiaries
i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs /Imaging Centre:
Requests for permission ex-post facto approval for elective treatment / investigations in non-empanelled hospitals / diagnostic
centres in respect of Pensioners/ex-MF’s/freedom Fighters, etc. shall be considered by Addl. Director of concerned CGHS city / Zone
subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less

ii) Permission / ex-post facto approval in cases involving procedural lapse:

Requests for approval of elective treatment l investigations in empanelled hospitals / diagnostic centres without recommendation of
Govt. Specialist or CMO and without prior permission in respect of Pensioners/ex-MPs/freedom Fighters, etc, shall be considered by
Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS rates or actual expenditure
whichever is less.
iii) Delegation of Powers for Settlement of Medical Reimbursement Claims (at approved rates) of Individual Pensioner Beneficiary.
etc,
Revised Delegated Powers
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

iv) Delegation of Powers for settlement of Hospital Bills (at approved rates) for the Treatment given to Pensioner Beneficiaries, etc,
Revised Delegated Powers
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

v) Delegation of Powers for Permission / ex-post facto Approval / Settlement of Medical Reimbursement Claims of Individual
Beneficiaries / Hospital Bills in respect of Unlisted procedures / Implants (no CGHS rates)
If there is no CGHS package rate for treatment I CGHS Ceiling rate for implant approval shall be granted as per AIIMS package rate (if
only procedural charge. it shall not be considered as package rates)/ AIIMS rate for implant and if there is no CGHS/AIIMS rate
approval shall be granted as per actual rate.
Revised Delegated Powers
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-

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b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-
2. The revised delegations mentioned above will be subject to the conditions that it will not include any case involving relaxation of
rules, irrespective of the amount involved. Further, cases where the amounts exceed the monetary limits prescribed above will have
to be referred to the Ministry of Health & Family Welfare for obtaining the concurrence of Integrated Finance Division in the Ministry
of Health & Family Welfare.
(MOH & FW No. Z.15025/79/2/DIR/CGHS dated 05.10.2016)

54. Self-printing of CGHS Card

This is with reference to the above subject.
2. CGHS is pleased to announce a new initiative by which its beneficiaries can now print their own cards at their convenience.
This facility for self-printing is applicable for those beneficiaries whose CGHS Membership has already been approved by the
concerned Additional Director.
3. The step involved in printing of card are given below:
J Visit CGHS portal cghs.nic.in
J Click 'Beneficiary Login'
J Enter Ben ID and Password, and sign in.
In case the beneficiary does not have a password or has forgotten it, then click on 'Generate Password' and follow the instructions.
J Click 'Print Card' for the beneficiary whose card needs to be printed.
J Enter the one Time Password (OTP) sent on registered mobile.
J Click 'Print CGHS Card'
J A message will appear on the screen requesting to take a coloured printout and get the card laminated. Click 'OK'
J Download or open the CGHS card in PDG format.
J Print the CGHS card using Print command.
4. The introduction of this facility may kindly be given due publicity.
(MOH & FW No.Z.15025/1/2016/DIR/CGHS dated 31.03.2016)

55.Self-printing of CGHS Card

Kindly refer to the above subject.
2. This is to intimate that a facility for self-printing of CGHS cards from CGHS website (cghs.nic.in) has been launched by the
Hon'ble Union Health Minister on 29th March, 2016. This facility, which is available only to those beneficiaries who are already a
part of the CGHS, will prove to be useful in various situations.
3. The basic purpose of this reference is to highlight that a card self-printed by the beneficiary stands on the same footing as
one printed and issued by the CGHS itself. Software has been designed to ensure that the self-printed card will be of the same colour
as the card issued by the CGHS. Therefore, all the staff working in your Hospital / Clinic/ Diagnostic Center may be sensitized to
ensure that there is no harassment to a beneficiary carrying a self-printed card. In case of any doubts, the particulars on the self-
printed card may be compared with the CGHS database already available on CGHS website. Such instances should however be rare.
(MOH & FW No. Z.15025/1/2016/DIR/CGHS dated 31.03.2016)

56. Revision of rates and guidelines for reimbursement of expenses on purchase of Hearing Aids under CS(MA) Rules, 1944 and
CGHS-reg.
With reference to the above mentioned subject the undersigned is directed to refer to the Office Memorandum of even
No. dated 17.11.2006 and 28.10.2002 and OM Nos. S.14025/36/93/MS dated 26.03.94 and 17.08.1999 and to state that on the basis
of recommendations of an Expert Committee, it has been decided to revise the rates and guidelines for hearing aids to be
reimbursed under CS (MA) Rules, 1944 and CGHS.
2. The revised ceiling rates fixed for various types of Hearing Aids (for one year) are as under :
Body worn/Pocket type Rs. 2,500/-
Analogue BTE Rs. 7,000/-
Digital BTE Rs. 20,000/-
ITC/CIC Rs. 25,000/-
The cost of hearing aid shall include all Taxes including VAT and shall carry '3' year Warranty.
The cost of Analogue BTE /Digital BTE/ITC/CIC type hearing and shall also include the cost of ear mould.
3. Beneficiaries covered under CS(MA) Rules, 1944/CGHS shall be eligible to obtain hearing aid after the same has been
recommended by a Government E.N.T. Specialist on the basis of audiometric and audiological assessment. ENT Specialist shall
specify the type of hearing and most suited for the beneficiary.
4. The permission to procure hearing aid shall be granted by Chief Medical Officer in-charge of CGHS Wellness Centre in case
of CGHS pensioner beneficiaries and by the Head of Department/Office in case of serving employees and CGHS beneficiaries of
Autonomous Bodies on the basis of recommendation of a Government Specialist and an undertaking that the beneficiary has not
been reimbursed the cost of hearing aid in the preceding five year.
5. Reimbursement claim shall be submitted to CGHS through CMO i/c of concerned dispensary by CGHS Pensioner
beneficiary in the prescribed medical reimbursement claim form along with a photo copy of CGHS card, original bill of the Hearing
aid and original copy of the permission letter. In case of other beneficiaries, the medical claim shall be submitted to the concerned
Ministry/Department/Office. Reimbursement shall be limited to the ceiling rate or actual cost of the hearing aid, whichever is less.
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6. Record of permissions granted for procurement of hearing aids shall be maintained by CGHS in respect of pensioner CGHS
beneficiaries and by concerned Ministry/Department/Office in respect of other beneficiaries.
7. Replacement of hearing aid may be permitted after 5 years on the basis of condemnation certificate issued by a technical
expert and on approval of Government ENT Surgeon. Maintenance and repair will be the responsibility of the beneficiary.
8. These orders shall supersede all the earlier orders issued on the subject.
9. The revised rates and guidelines shall come into force from the date of issue and shall be valid for a period of two years or
till further revision, whichever is earlier.
10. This issues with the concurrence of Integrated Financial Division vide Dy. No. 5894 dated 19.03.2012 of the office of
AS&FA, Min. of Health & Family Welfare
(MOH & FW No. S.14025/10/2012-MS dated 21.03.2012)

57. Clarification regarding admissible non-admissible items under CGHS

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum
of even number dated 1st October 2012 issued by this Department in compliance of the directions of Hon'ble High Court of Delhi in
the case of Shri Kanhiya Singh Vs UOI and others [W.P. (C) 9044/2011] clarifying admissibility / inadmissibility of items of expenditure
for claiming reimbursement under CGHS. The same are being reproduced for a wider circulation and information in compliance of
Hon'ble High Court's latest direction issued on 16-05-2013 in this case. The requisite clarifications regarding admissible and non-
admissible items under CGHS are provided herewith as under :-
a) "CGHS 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 disposables 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 reimbursable in addition to package rates as per CGHS ceiling rates for Implants / stents
/ grafts or as per actual, whichever is lower, in case there is no ceiling rate prescribed under CGHS.
c) During In-patient treatment of the CGHS beneficiary, the hospital will not ask the beneficiary or his /her attendant to
purchase separately the medicines / sundries / equipment or accessories from outside and will provide the treatment within the
package rate, fixed by the CGHS which includes the cost of all the items.
d) In cases of conservative treatment / where there is no CGHS package rate, the above mentioned items are admissible-
items wise at CGHS rates or as per AllMS rates (if there is no CGHS rate) or as per actual (if there is no CGHS / AIIMS rate) available
for any item.
e) Package rates envisage up to a maximum duration of indoor treatment as follows:
12 days for Specialized (Super Specialties) treatment;
7 days for other Major Surgeries;
3 days for Laparoscopic Surgeries / normal deliveries; and
1 day for day care / Minor (OPD) surgeries.
However, if the beneficiary has to stay in the hospital for his / her recovery for a period more than the period covered in
package rate, in exceptional cases, supported by relevant medical records and certified as such by hospital, the additional
reimbursement shall be limited to accommodation charges as per entitlement, investigations charges at approved rates, and doctors
visit charges (not more than 2 visits per day per visit by specialists / consultants) and cost of medicines for additional stay,
No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the
consequences of surgical procedure or due to any improper proceed.
f) In addition to the above mentioned items, some patients may require additional facilities / procedures, which are
admissible with proper justification in deserving cases. Therefore, it is not possible to give a comprehensive list of items, which are
not admissible.
However, the following items are not admissible:
Telephone charges
Toiletries
Sanitary napkins
Talcum powder
Mouth fresheners
2. It has also been decided to clarify that expenses incurred on medicines, consumables, sundry equipment’s and accessories
etc., which are purchased from outside, based on specific authorization of treating doctor / staff of the concerned hospital will be
reimbursable if they are not falling under the list of non-admissible items. In case the empanelled hospital has asked a CGHS
beneficiary for purchase of the said items over and above the package rates, reimbursement shall be made to the beneficiary and
the amount shall be recovered from the pending bills of hospital.
3. This Office Memorandum is Issued in compliance of the directions of Hon'ble High Court of Delhi in W.P. (C) 9044/2011
(Sh. Kanhiya Singh Vs UOI and others)
(Dept. of H & FW F.No. 2-1/2012/CGHS/VC/CGHS(P) dated01.08.2013)

58. Extension of CGHS facilities to permanently disabled dependent brother of a CGHS beneficiary - reg.

29
 The undersigned is directed to state that dependent brother of a Central Government employee is presently entitled for
CGHS coverage upto the age of becoming a major. Ministry of Health and Family Welfare has been receiving requests from CGHS
beneficiaries for removal of the upper age-limit in the case of disabled dependent brother so as to provide them the CGHS facilities
without any age limit as has been provided to disabled son of a CGHS beneficiary.
2. Accordingly, with a view to assuage the hardship, it has been decided to extend the CGHS facilities to permanently disabled
dependent brother of a CGHS beneficiary, without any age-limit.
3. For availing CGHS facilities under this provision, the permanently disabled dependent brother of a CGHS beneficiary must
be suffering from any one or more of the disabilities as defined in Section 2(i) of the persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Act, 1995 (No. 1 of 1996) which includes:-
(i) Blindness (ii) Low-Vision
(iii) Leprosy-cured (iv) Hearing impairment
(v) Loco motor disability (vi) Mental retardation
(vii) Mental illness
and as-per Clause (j) of Section 2 of National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation
and Multiple Disabilities Act, 1999 (No. 44 of 1999), which presently covers a person suffering from any of the condition relating to
autism, cerebral palsy, mental retardation or a combination of any severe multiple disability. It is clarified that permanent disability
means a person with 40% or more of one or more disabilities.
4. The eligibility criteria for a permanently disabled dependent brother to avail medical facilities under CGHS will be as under;
a. He must be wholly dependent on the principal CGHS card holder beneficiary.
b. He should be unmarried and should not have his own family.
c. The income limit for deciding dependency shall be as prescribed by the Ministry of Health and Family Welfare from time to
time and as applicable in CGHS for the time being in force.
d. He must be ordinarily residing with the primary CGHS cardholder beneficiary.
e. All the above conditions are required to be fulfilled for availing CGHS facilities. The CGHS facilities will cease to exist with
immediate effect if any one of the above conditions is violated.
5. This office memorandum will be effective from the date of issue.
(MOH & FW No. S 11011/13/2012-CGHS (P) dated 25.07.2013)

59. Nomination facility under CGHS for claiming medical reimbursement in the event of death of the principal CGHS cardholder -
reg.
The undersigned is directed to state that the Ministry has been receiving representations from CGHS beneficiaries to introduce
nomination facility whereby a person duly nominated by the principal CGHS cardholder can claim the reimbursement of expenses
incurred on the medical treatment of the beneficiary in the event of unfortunate death of the principal card holder.
2. The matter has been examined in this Ministry in the context of difficulties being faced by the family members of a deceased
CGHS cardholder in completing the prescribed formalities for claiming reimbursement of Medical expenses. Accordingly, it has been
decided with the approval of the competent authority to simplify the procedure and provide an option to the principal CGHS
cardholder beneficiary to nominate a person to claim reimbursement of medical expenses in the event of his/ her unfortunate
death.
3. The nomination facility shall be subject to the following conditions:-
a) The nomination facility shall be available only to the CGHS pensioner card holders.
b) Beneficiaries who wish to exercise this option shall submit their declaration of nomination in the prescribed "Nomination From"
duly filled up complete in all respect to the CMO In-charge of the CGHS Wellness Centre where the beneficiary is enrolled. (Proforma
of Nomination Form enclosed)
c) CMO In-charge shall maintain a separate register - "Nomination Register' to record the particulars of the nomination submitted
by the CGHS beneficiary in exercise of this option. Once the nomination details are recorded, the CMO In-charge shall forward the
"Nomination Form" to the card issuing authority, i.e., Addl. Director (HQ), CGHS in the case of Delhi and respective Additional/Joint
Director, CGHS in the case of other CGHS database after due scrutiny and approval of Additional Director, CGHS concerned.
d) The nomination shall be treated as valid only if the same has been entered in the CGHS database.
e) Only one person shall be allowed to be nominated as the original nominee or first nominee. In addition, another person can
also be nominated as alternate nominee or second nominee who can claim reimbursement in case of unfortunate death of the first
Nominee.
f) The principal CGHS cardholder beneficiary can nominate any natural or juristic person as his/her nominee for this purpose,
whether related of unrelated to him/her.
g) This option can be exercised at any time during the lifetime of the beneficiary. However, this option can be exercised only twice
in the lifetime of the pensioner card holder.
h) In case, no option has been exercised during the life time of the CGHS Pensioner beneficiary, the existing CGHS provision for
claiming reimbursement of Medical expenses, requiring submission of Affidavit by the claimant and NOCs from other legal heirs shall
continue to apply.
4. This Office Memorandum will be effective from the date of its issue.
(MOH & FW OM No. S11011/12/2013 – CGHS(P) dated 25.09.2013)

60. Issue of medicines to CGHS beneficiaries at the time of discharge from empanelled private hospitals - regarding;
With reference to the above mentioned subject, the undersigned is directed to state that this Ministry has been receiving
representations regarding difficulties being faced by CGHS beneficiaries in getting medicines immediately after discharge from
empanelled private hospitals.

30
2. The matter has been examined in the Ministry and with a view to alleviate the inconvenience to CGHS beneficiaries in getting
medicine immediately after discharge from empanelled private hospitals, it has been decided that CGHS beneficiaries who had taken
inpatient medical treatment from a CGHS empanelled private hospital will be issued medicines from the treating private hospital at
the time of discharge, for a period upto seven (7) days. The hospital will raise bill for the medicines separately and submit it along
with the hospital bill for inpatient treatment, to CGHS for reimbursement in case of pensioner beneficiaries who are entitled to avail
cashless medical treatment at the hospital.
3. In case of serving CGHS beneficiaries, if the treatment is provided by the hospital on credit basis (in deserving cases), they may
raise bills for medicines supplied to the patient for post hospitalization period (upto 7 days after discharge), and claim
reimbursement from the department/ office concerned alongwith the hospital bill for inpatient treatment. In other cases, where the
inpatient treatment is provided to serving CGHS beneficiaries on payment basis, the empanelled private hospital will supply
medicines for upto 7 days period on payment basis, for which employee can claim reimbursement from his/her office. However, it
will be upto the serving CGHS beneficiary to purchase the prescribed medicines from the hospital at the time of discharge (for upto7
days) or get it from a CGHS dispensary, as may be convenient to him.
4. The above facility will however, be subject to the following conditions:
(i) Only essential medicines in generic form for continuity of treatment will be issued by the hospital.
(ii) No Nutritional supplements, tonic, cough syrup, vitamins, injections will be issued by the hospital. These are not allowed.
(iii) No non-drug items/ equipment / appliances will be issued.
(iv) Total cost of such medicines issued by the hospital must not exceed Rs. 2000/- in any case.
5. This Office Memorandum shall come into force from the date of issue.
6. This issues with the concurrence of IFD vide FTS no. 88285 dt. 13-06-2014.
(MOHFW No. S11011/09/2014-CGHS (HEC) / CGHS (P) dated 20.06.2014)

61. Issue of medicines / reimbursement of expenditure on investigations / treatment procedures / implants and other medical
devices under CGHS- regarding
With reference to the above mentioned subject the undersigned is directed to state that this Ministry has examined the matter in
detail and with a view to streamlines the procedures regarding issue of medicines, reimbursement of expenditure on investigations,
treatment procedures, implants and medical devices and with a view to plug the loopholes in the system, it has now been decided
that:
a) CGHS shall supply / indent only those medicines, which are included in the CGHS formulary, except for para (b) below. However,
for medicines prescribed outside formulary, medicines with identical formulations and /or similar therapeutic effect may be supplied
from CGHS formulary against such medicines. CGHS formulary containing 1447 generic and 622 branded medicines is available on
CGHS Website at http://msotransparentnic.in/cghsnew/index.asp
b) Anti Cancer and other similar medicines are however supplied on a case to case basis. Only the medicines approved by DCGI for
use in India shall be supplied. In case an Indian version is available, which is cheaper than the imported medicine, only the Indian
medicine shall be supplied even if, an imported medicine has been prescribed.
c) Medicines shall be supplied for a maximum period of one month.
d)In case of CGHS beneficiaries going abroad, issue of medicines shall be restricted for a maximum period of three months.
e) CGHS shall hereinafter allow only the listed investigations / treatment procedures for which there are prescribed CGHS rates, to
be under taken in CGHS empanelled diagnostic centres and hospitals.
f) Similarly, only listed implants / medical devices with a CGHS prescribed ceiling rate shall be permitted for treatment /
reimbursement under CGHS.
g) In those cases where any unlisted investigation / treatment procedure is undertaken the reimbursement shall be limited to the
rate of nearest similar investigation / treatment procedure under CGHS. Addl. Director of the city /zone shall take a decision based
on justification in such cases, in consultation with experts in the field, if necessary.
h) In those cases where any unlisted implant / device is installed reimbursement shall be limited to the CGHS rate of nearest similar
implant / device. Addl. Director of the city / zone shall take a decision based on justification in such cases in consultation with
experts in the field, if necessary.
i) Registration of Mobile number with CGHS has been made compulsory as a guard against misuse of CGHS Card.
j) In order to provide a mechanism to update the investigations / treatment procedures / implants, etc., as an ongoing process , a
Technical Committee is being constituted to consider inclusion / exclusion of investigations /treatment procedures / implants , etc.,
under CGHS.
(DOH & FW OM No. 2-2/2014/CGHIS HQ/PPT/CGHS(P) dated 25.08.2014)

62. Payment / reimbursement of medical expenses to beneficiaries under CGHS and Central Services ( Medical Attendance)
Rules,1944 from two sources- From insurance agencies and from the CGHS or from the Ministry /Department.
The undersigned is directed to invite reference to the Office Memoranda, of even number dated the 8th January, 2004 and 27th
February.2004 vide which beneficiaries under CGHS and Central Services (Medical Attendance) Rules 1944 (who have subscribed to
mediclaim policy from an insurance agency) were permitted to claim medical reimbursement of medical expenditure from both the
sources viz. the insurance agency and CGHS and Ministries/ Departments (as the case may be). This benefit was subject to the
condition that the beneficiary will first claim reimbursement from the insurance agency and then from the CGHS or Ministry
/Department concerned. The reimbursement from the two sources was however, not to exceed the package rates prescribed under
the CGHS for the particular treatment.
2. This Ministry had received representations from beneficiaries requesting for the removal of the monetary ‘cap’ mentioned above.
The main argument advanced in the representation was that this offered the beneficiary no incentive to subscribe to the medicalim
policy for reimbursement only upto the package rate as it did not provide them with any additional benefit because they would in

31
any case get the same amount from the CGHS without subscribing to mediclaim policy. Chairman, Insurance Regulatory &
Development Authority (IRDA) also wrote to Secretary (H&FW) requesting appropriate revisions in CGHS rules so that any
expenditure incurred by policy holders which was inadmissible as per the CGHS rules but admissible mediclaim insurance policies
could be suitably claimed from the insurer.
3.The above have been carefully considered in this Ministry and it has been decided with the approval of the Competent Authority
that beneficiaries who have subscribed to Medical Insurance Policies in addition to availing CGHS facilities/ Central Services (Medical
Attendance )Rules, 1944 may be allowed to claim reimbursement from both the sources subject to the condition that the
reimbursement from such sources should not exceed the total expenditure incurred by the beneficiary on the treatment.The
beneficiary will make the first claim to the insurance company and the second claim to the CGHS or the Ministry /Department
concerned. The medical claim against the original vouchers/ bills would be raised by the beneficiary first on the insurance company
which would issue a certificate indicating the amount reimbursed to the Director, CGHS or Head of Department of the Ministry
/Department concerned.

The Insurance Company concerned will retain the original vouchers /bills in such cases. The beneficiary would then prefer his/her
medical claim along with photocopies of vouchers/bills duly certified in ink along with stamp of the insurance company on the
reverse of the vouchers/bills to the concerned organization. Reimbursement from CGHS or other departmental source will be
restricted only to the admissible amount as per approved package rates subject to the condition that the total amount reimbursed
by the two organizations does not exceed the total expenditure incurred by the beneficiary.
(4) These instructions take effect from the date of issue and past cases are not to be re-opened and supercede earlier instructions on
the subject (cited above).
(5 ) This issue with the concurrence of IFD, Ministry of Health & Family Welfare vide their I.D Note no:- 542/as & FA/2009 dated the
4th February,2009.
(MOH &FW OM No :S.11011/4/2003CGHS(P) dated 19.02.2009)

63. Issue of medicines/ reimbursement of expenditure on investigations/ treatment procedures/ implants and other medical
devices under CGHS regarding
With reference to the above mentioned subject the undersigned is directed to draw attention to paragraph (c) and (d) of
the Office Memorandum of even No dated the 25th August 2014 and to state that in response to the representations received from
CGHS beneficiaries in this regard, it has now been decided by the competent authority to withdraw the provisions under para (c) and
para (d) of the Office Memorandum No 2-2/2014/CGHS HQ/PPT/CGHS(P) dated the 25th August, 2014 and to restore the status
existing prior to the issue of above stated OM dated the 25th August, 2014.
In other words medicines under CGHS can be issued for up to 3 months at a time in chronic diseases on the basis of a valid
prescription and for up to 6 months for those beneficiaries who are going abroad, as was the case prior to issue of OM dated
25.8.2014.
(MOH & FW No 2-2/2-14/CGHS HQ/PPT/CGHS(P) dated 21.10.2014)

64. Regarding investigations at private hospitals /diagnostic laboratories /imaging center sempaneled under CGHS
1. With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving
representations for simplification of procedure for undergoing investigations at private hospitals /diagnostic laboratories/
imaging centers empanelled under CGHS. The matter has been examined and with a view to alleviate the inconvenience to
CGHS beneficiaries in obtaining requisite permission for undergoing investigations at CGHS empanelled private
hospitals/diagnostic laboratories, imaging centers, it has now been decided that CGHS beneficiaries shall herein after be
allowed to undergo investigations at private hospitals /diagnostic laboratories /imaging centre empanelled under CGHS after
specific investigations have been advised by a CGHS Medical Officer or a Government Specialist without requirement of any
other referral (permission ) letter.
2. Private empanelled hospitals /diagnostic laboratories/imaging centers shall perform the investigations /diagnostic tests on
cashless basis in respect of pensioners, ex-MPs, freedom fighters and other eligible categories of CGHS beneficiaries who are
presently eligible for credit facility and shall enclose the prescription issued by a CGHS Medical Officer or a Government
Specialist in original along with the hospital bill submitted to competent authorities.
3. Serving Government employees shall enclose the prescription issued by a CGHS Medical Officer or a Government Specialist in
original, while submitting the medical claim to the concerned Ministry/Department/office for reimbursement.
4. CGHS Medical Officer/ Government Specialist shall not refer the beneficiaries to any particular diagnostic laboratory or imaging
centre by name but, shall specify the investigation and mention “referred to CGHS empanelled centre”.
5. These orders are applicable only in respect of investigations for which CGHS rates are available. It shall come into force with
immediate effect.
6. This issue with the concurrence of integrated finance division vide FTS no. 31560/2012

(MOH &FW No.S-11045/40/2012/CGHS/HEC/CCGHS(P) dated 01.01.2013)

65. Permission for Haemodialysis from non CGHS empanelled hospital/centre in respect of CGHS beneficiaries – reg.
The undersigned is directed to state that in order to alleviate the difficulties of the CGHS beneficiaries, it has been decided
that permission for Haemodialysis from a non CGHS empanelled hospital/centre will hence forth be accorded by Additional
Directors/Joint Directors of City/Zones in respect of CGHS beneficiaries with the conditions that reimbursement will be made as per
the CGHS approved rates. Expenditure over and above the CGHS rates will have to be borne by the beneficiary and medicines

32
prescribed by Government Specialist shall be procured from the CGHS Wellness centre. No request for full reimbursement of
expenses incurred will be entertained.
The applicant should enclose a copy of the CGHS card, prescription of Government Specialist advising haemodialysis along
with frequency and duration for which the procedure is needed and the request letter of the applicant giving the name of the
hospital from where haemodialysis is proposed to be done.
This issues with the approval of the competent authority.
(MoH&F OM No. AS 11030/32/2013-CGHS (P) dated 31.10.2013)

66. Revision of Income limit for dependency for the purpose of providing Central Government Health Scheme (CGHS) coverage to
family members of the CGHS covered employees subsequent to implementation of recommendation of the Seventh Central Pay
Commission-regarding
The undersigned is directed to say that subsequent to the implementation of the recommendations of the 6th CPC, the
income limit for dependency for the purpose of extending CGHS coverage to "family" members of the CGHS covered Central
Government employees was enhanced to Rs. 3500/-per month plus the amount of dearness relief on the basic pension of Rs. 3500/-
as on the date of consideration.
2. With the implementation of the recommendations of the 7th Central Pay Commission, the issue of revision of income limit
for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered Central Government
employees and pensioner CGHS beneficiaries was under consideration keeping in view the amount of minimum pension/family
pension fixed by the 7th Central Pay Commission.
3. On the basis of the recommendations of the 7th CPC, the Department of Pension and Pensioners' Welfare under Para 5.2
of their OM No. 38/37/2016-P&PW (A)(i) dated 4/8/2016, has fixed the amount of minimum pension as Rs. 9,000/- per month and
under para 7.1 of this OM the amount of family pension has been fixed as 30% of the basic pay in revised pay structure and shall be
subject to a minimum of Rs. 9,000/- per month and maximum of 30% of the highest pay in the Government. Vide Para 7.3 of the
aforesaid O.M, it has been mentioned that there will be no other change in the provisions regulating family pension.
4. It has been decided, in consultation with the Department of Expenditure, to revise the income limit for the purpose of providing
CGHS coverage to the family members of the CGHS covered Central Government employees to Rs. 9,000/- plus the amount of
dearness relief on basic pension of Rs. 9,000/- as on the date of consideration".
5. As such, all the orders related to the CGHS Rules stand amended to the extent that the income limit for Rs. 35000/- per month
from all sources including pension/and family pension stands amended to and income of Rs. 9000/- plus amount of the dearness
relief on the basic pension of Rs. 9000/- as on the date of consideration. The amount of dearness relief, as indicated in the income
limit stands for the amount of dearness relief drawn by a pensioner/family pensioner on the date of consideration and not the
amount of dearness relief due on the date of consideration.
6. The Income limit for dependency of "Rs. 9000/- plus amount of the dearness relief on the basic pension of Rs. 9000/- as on the
date of consideration", shall also be applicable for the cases covered under CS(MA) Rules, 1944 for the purpose of examining
eligibility of family members of the Central Government employee for medical facilities under the Rules.
7. The orders hall be effective from the date of issue of instructions of this O.M.
8. This issues with the concurrence of Department of Expenditure vide their I.D. No. 204/E-V/2016 dated 19/10/2016.
(MOH & FW OM No.S-11012/2/2016-CGHS-P) dated 8.11.2016)

67.Revision of Income limit for dependency for the purpose of providing Central Government Health Scheme (CGHS) coverage to
family members of the CGHS covered employees subsequent to implementation of recommendation of the seventh Central pay
commission-regarding
The undersigned is directed to say that subsequent to the implementation of the recommendations of the 6th CPC, the
income limit for dependency for the purpose of extending CGHS coverage to "family" members of the CGHS covered Central
Government employees was enhanced to Rs. 3500/-per month plus the amount of dearness relief on the basic pension of Rs. 3500/-
as on the date of consideration.
2. With the implementation of the recommendations of the 7th Central pay commission, the issue of revision of income limit
for dependency for the purpose of providing CGHS coverage to family members of the CGHS covered Central Government
employees and pensioner CGHS beneficiaries was under consideration keeping in view the amount of minimum pension/family
pension fixed by the 7th central pay commission.
3. On the basis of the recommendations of the 7th CPC, the Department of Pension and Pensioners' Welfare under Para 5.2
of their OM No. 38/37/2016-P&PW (A)(i) dated 4/8/2016, has fixed the amount of minimum pension as Rs. 9,000/- per month and
under para 7.1 of this OM the amount of family pension has been fixed as 30% of the basic pay in revised pay structure and shall be
subject to a minimum of Rs. 9,000/- per month and maximum of 30% of the highest pay in the Government. Vide Para 7.3 of the
aforesaid O.M, it has been mentioned that there will be no other change in the provisions regulating family pension.
4. It has been decided, in consultation with the Department of Expenditure, to revise the income limit for the purpose of providing
CGHS coverage to the family members of the CGHS covered Central Government employees to RS. 9,000/- plus the amount of
dearness relief on basic pension of Rs. 9,000/- as on the date of consideration".
5. As such, all the orders related to the CGHS Rules stand amended to the extent that the income limit for Rs. 35000/- per month
from all sources including pension/and family pension stands amended to and income of Rs. 9000/- plus amount of the dearness
relief on the basic pension of Rs. 9000/- as on the date of consideration. The amount of dearness relief, as indicated in the income
limit stands for the amount of dearness relief drawn by a pensioner/family pensioner on the date of consideration and not the
amount of dearness relief due on the date of consideration.

33
6. The Income limit for dependency of "Rs. 9000/- plus amount of the dearness relief on the basic pension of Rs. 9000/- as on the
date of consideration", shall also be applicable for the cases covered under CS (MA) Rules, 1944 for the purpose of examining
eligibility of family members of the Central Government employee for medical facilities under the Rules.
7. The orders hall be effective from the date of issue of instructions of this O.M.
8. This issues with the concurrence of Department of expenditure vide their I.D. No. 204/E-V/2016 dated 19/10/2016.
(MOH & FW OM No. S-11012/2/2016-CGHS-P dated 08.11.2016)

68. Revision of rates of subscription under Central Government Health Scheme due to revision of pay and allowances of Central
Government employees and revision of pension/ family pension on account of implementation of recommendations of the
Seventh Central Pay Commission- clarification reg.
Attention is drawn to this Ministry’s OM of even No. dated 9th January, 2017 and a subsequent OM of even no. dated
13/8/2017, on the subject mentioned above.
2. This Ministry has been receiving several representations w.r.t applicability of CGHS rates to pensioners superannuating on
31.1.2017. The matter has been examined in this Ministry and it is clarified that ’those employees superannuating on or before
31.1.2017 and had submitted their application on or before 31.1.2017 may be allowed the subscription at the prevalent rates
applicable as on 31.1.2017 vide OM.No.S.11011/2/2008-CGHS(P) dated 20.5.2009. Pensioners applying for CGHS pensioner card on
annual/lifetime basis after 31/1/2O17 will have to pay as per the revised rates effective from 1.2.2017 vide OM of even No. dated
13.1.2017′.
3. This issues with the approval of the Competent Authority.
(MOH & FW No.S.11011/11/2016-CGHS (P)/EHS dated 09.02.2017)

VII. FAQ ON CGHS

69. FREQUENTY ASKED QUESTIONS WITH ANSWERS ABOUT CGHS

1. Who are entitled for CGHS facilities?

All Central Govt. employees and their dependant family members residing in CGHS covered areas.
Central Govt Pensioners and their eligible family members getting pension from Central Civil Estimates
Sitting and Ex-Members of Parliament
Ex-Governors & Lt. Governors
Freedom Fighters
Ex-Vice Presidents
Sitting and Ex-Judges of Supreme Court & High Courts
Employees and pensioners of certain autonomous organizations in Delhi
Journalists (in Delhi) Accredited with PIB (for OPD & at RML Hospital)
Delhi Police Personnel in Delhi only
Railway Board employees

2. In how many cities CGHS is presently operative?

CGHS facilities are available in 25 cities in India
1. Ahmedabad 2 Allahabad 3 Bengaluru 4 Bhopal 5 Bhubaneshwar 6. Kolkata 7.Chandigarh 8 Chennai 9.Dehradun 10.Delhi & NCR
11.Guwahati 12. Hyderabad 13. Jabalpur, 14.Jaipur 15 Jammu 16. Kanpur 17. Lucknow 18. Meerut 19. Mumbai 20.Nagpur 21 Patna
22.Pune 23. Ranchi 24. Shillong 25. Thiruvananthapuram

3. For CGHS cards, as dependant, what is the meaning of the word “family “
The term ‘family’ means and includes:-
“Husband or wife as the case may be and other dependant family members.
Dependant Family Members: parents, sisters, widowed sisters, widowed daughters, minor brothers and minor sister, children and
step-children wholly dependent upon the Government Servant and are normally residing with the Government Servant”.
Also now include, dependent divorced / separated daughters (including their dependant minor children) and step-mother.
The term dependency means that income from all sources including pensions and pension equivalent of DCRG benefit is less than
Rs.3500/- plus amount of DA on Basic pension of Rs3500/- per month. However, there is no such clause as dependency in respect of
spouse.

4. What is the procedure to register with the CGHS?

Pensioners:
One can get a CGHS card made from the office of AD / JD of the City. Forms can be downloaded from CGHS Website or can be taken
from office of AD / JD of city between 1000 am to 1230 pm.
Documents required
Application in prescribed format
Proof of Residence
Proof of Stay of dependents
Proof of age of son
Disability certificate, if any in case of sons aged 25 & above, who would otherwise cease to be a beneficiary.

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Photos of eligible family members
Surrender Certificate of CGHS Card while in service (only in those cases where CGHS Card was issued while in service)
Attested copies of PPO & Last Pay Certificate
Draft for required amount towards CGHS contribution – in the name of ‘P.A.O., CGHS New Delhi’ in Delhi-and in the name of ‘AD,
CGHS of the city’.
In case PPO is not ready for any reason there is option to get a provisional card on the basis of Last Pay Certificate.
The data is entered through computers and entered in data base and a printout is issued same day for immediate use. Plastic cards
are subsequently sent to the residence of the card holder by post.

Serving employees:-
Serving employees submit the forms in prescribed format enclosing photos of eligible family members and submit to the Ministry /
Department/Office, where he / she is employed. The application form shall be forwarded by the Ministry / Office /Department to
the office of Addl. Director CGHS of city for preparation of card. Print out is issued for immediate use and

5. How long does it take to get the CGHS Cards?

Normally computerized printout of index card is issued on the same day. Plastic cards are sent to the residence in ‘3’ weeks’ time.

6. Whom Should I approach in case the CGHS Card is not issued to me in the prescribed time?
Contact Joint Director (HQ), CGHS, Bikaner House, New Delhi in case of Delhi and Addl. Director of City in case of other cities.

7. What should I do if I lose my CGHS Cards?

Application is to be submitted to AD/JD along with two photographs and a IPO for Rs. 50/- for issue of duplicate card. Indian Postal
Order payable to “ P.A.O. CGHS Delhi” if in Delhi or “ Additional Director of the CGHS City “ in respect of other cities

8. What should I do if the details on the Card viz. name, date of birth, entitlement, etc. are wrong?
Kindly bring the anomalies to the notice of Joint Director, CGHS (HQ), and Bikaner House in Delhi and to the Addl. Director, Joint
Director of concerned CGHS City in other cities.

9. Is there a colour scheme for plastic cards? What are the details?
CGHS Plastic cards have the following colour at the top:
Serving Government employees - Blue
Pensioners, ex-MPs, Freedom Fighters, etc., - Green
Member of Parliament - Red
Beneficiaries of Autonomous Bodies / Journalist - Yellow

10. Whom should I contact if the doctors are not present in the Wellness Centre / Dispensary?
Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or Director, CGHS.

11. Can the CMO or the pharmacist give a different brand than the one prescribed by the specialist?
Medicines are issued at CGHS Wellness Centres by the same brand, if available or by generic name or by any available brand name of
equal therapeutic value.

12. What is the procedure for getting lifesaving drugs?

In Delhi- through CGHS Medical Store Depot, Gole Market
The documents required are:-
a. Prescription of spl. of Govt.Hospital or CGHS approved private Hospital.
b. Photocopy of his/ her token card/ plastic card.
c. Copy of permission if his prescription is from CGHS approved private Hospital.
d. Utilization certificate in original during subsequent visit.
e. Indent is also placed online through CGHS Wellness centre.
In other cities request is to be submitted to the Addl. Director of City.

13. What do I do if I am unwell at odd hours, say late in night?

CGHS beneficiaries have the option to go to any of the 24 hr functional dispensaries in Delhi, a nearby govt. hospital / empanelled
private hospital or even any private hospital, in case of emergency.

14. What should I do in case of emergency?

CGHS beneficiaries have the option to go to any of the 24 hr functional dispensaries in Delhi, a nearby govt. hospital / empanelled
private hospital or even any private hospital

15. What is the time within which my medical claim is to be reimbursed?

If all documentation is complete medical claims of pensioners are cleared in 45 days.

16. What can I do if my claim is unnecessarily delayed?

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Pensioner beneficiaries can contact the Additional Directors of concerned city / zone on any Wednesday between 11 A.M. and 1
P.M.

17. What should I do if the empanelled hospital refuses to entertain or give a step-motherly treatment?
Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or the nodal officer for grievances.

18. What should I do if the Wellness Centre/Dispensary does not give all the medicines?
Contact CMO i/c of the concerned Wellness Centre or Addl. Director, CGHS of concerned city or Director, CGHS.

19. How long does it take to get the medicines?

Medicines available in the dispensary are issued immediately. If any medicine is not available and is to be indented through
Authorized Local Chemist the same are issued on the next day.

20. What are the facilities available to me if I am a pensioner in a non CGHS area?
a) Pensioner residing in non- CGHS covered areas have the option to become CGHS beneficiary and avail CGHS facilities from the
nearest CGHS covered city.
b) Pensioners residing in non-CGHS areas have also the option to avail Fixed Medical Allowance of Rs300/- per month and opt not to
avail CGHS facility.
c) Pensioners residing in non-CGHS areas have also the option to avail Fixed Medical Allowance of Rs300/- per month for OPD
treatment and obtain CGHS card from nearest CGHS covered city for inpatient facilities under CGHS. No OPD medicines shall be
issued in such cases.
d) CGHS pensioner beneficiaries (and their dependant and eligible family members) who are holding a valid CGHS Card and residing
in a non-CGHS area shall be eligible to obtain inpatient medical treatment and also follow up treatment from Govt. Hospitals / CS
(MA) /ECHS approved hospitals on proper referral from CGHS dispensary and submit the medical reimbursement claim to the Addl.
Director/ Joint Director of CGHS of city where the CGHS card is registered.
In case of medical emergency, treatment may be obtained from any hospital and medical claim shall be submitted to AD/JD, CGHS of
the concerned city.
Reimbursement shall be limited to the CGHS rates of the city where the card is registered and as per the ceiling rates and ward
entitlements or as per actuals, whichever may be less.

21. What is the system for the services of specialists in Dispensaries?

Prior registration is required appointment with the CGHS Wellness Centre, where specialist services are available. However, In case
of emergency contact CMO i/c of dispensary of Wellness Centre for consulting specialist without prior appointment.

22. Are the prescription of specialists of empanelled hospitals binding on the dispensary?
Medicines are issued on the basis of prescriptions of Government doctors. However, in permitted cases medicines are issued on the
basis of prescriptions of empanelled hospitals and medicines will be issued as per the available brand / generic names.

23. What is the maximum period for which medicines can be given in one go?
For treatment of chronic illnesses medicines up to ‘3’ months are issued in one go, provided there is a valid prescription.
In case of a beneficiary visiting a foreign country , medicines up to ‘6’ months are issued in respect of chronic illnesses , based on
valid prescription and documentary support of visit to a foreign country. Beneficiary is required to submit an application for
obtaining permission from AD/JD along with the following documents:-
1. Copy of valid CGHS card/ token card.
2. Valid prescription for six months counter signed by HOD of Specialty of Govt. Hospital.
3. Proof of station leaving like ticket, Visa etc.

24. What are the papers to be submitted for any investigation by an empanelled diagnostic centre?
Original or self-attested copy of prescription of CGHS Doctor / Government specialist
Copy of CGHS Card of the patient and main card holder (head of family).

25. Which are the categories eligible for cashless treatment?

Hospitals shall provide credit facility to the following categories of CGHS beneficiaries (including dependant family members, whose
names are entered on CGHS Card):
• Members of Parliament;
• Pensioners of Central Government drawing pension from central estimates;
• former Vice-presidents, Former Governors and former Prime Ministers;
• Ex-Members of Parliament;
• Freedom Fighters;
• serving CGHS employees;
• serving employees of Ministry of Health & Family Welfare
(including attached / subordinate offices under the Ministry of Health & Family Welfare); and

26. Is there any interactive mechanism at dispensary level?

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At the Wellness Centre ‘Local Advisory Committees’ are formed. CMO i/c holds a meeting with Local Advisory committee members
to discuss local dispensary related issues.

27. Are CGHS facilities free of cost?

For serving employees residing in CGHS covered area obtaining CGHS card is compulsory
Deduction from salary is made by the department, every month, depending upon their pay w.e.f 1st June 2009
Grad Pay w.e.f 1st June 2009 Contribution
Upto Rs.1650 /- Rs. 50/-
Rs.1800/-, Rs1900/-, Rs.2000/- , Rs.2400/- and Rs.2800/- Rs.125/-
Rs.4200/- Rs.225/-
Rs.4600/-,Rs.4800/-, Rs.5400/- Rs.6600/- Rs.325/- and Rs. 7600/- and above Rs. 500/-
Pensioners who want to avail CGHS facilities can make contribution either on yearly basis or one time (ten yrs ) contribution for
whole life validity.
Payment can be made by Demand Draft in favour of “P.A.O. CGHS Delhi” if in Delhi or “Additional Director of the CGHS City “
Contribution in respect of Pensioners are calculated on the basis of grade pay they are entitled had they been in service, but for
superannuation.

28. What are the criteria for Entitlement of Treatment endorsed on CGHS Card like General ward / Semi-Pvt ward or Pvt. Ward in
CGHS Empanelled Hospitals?
Endorsement of entitlement for general/semi- private/private ward facility is done according to their basic pay / basic pension as
under:
o Upto Rs. 13,950/- per month - Entitlement : General Ward
o Rs. 13,960/- to 9,530/- per month -Entitlement: Semi-private Ward
o Rs. 19,540/- and above - per month - Entitlement : Private Ward

29. I am a serving employee residing in a place close to a city covered under CGHS. Can I get CGHS card issued from the nearest
CGHS city?
There is no provision to avail CGHS facilities in respect of serving government employees residing in non-CGHS covered areas. They
are covered under CS (MA) Rules 1944.

30. I retired in 1998 from Central Govt. but, I never made a CGHS card. Can I get a card now?
Pensioners can apply for CGHS card with relevant documents. However, the subscriptions as applicable at current rates shall have to
be paid.

31. My husband/wife is also employed under Central Government and is eligible for a separate CGHS Card. Is it necessary that
separate cards are to be obtained?
No. Spouse drawing higher pay shall make the card and other spouse is eligible to avail CGHS benefits as member.

32. I have retired from Delhi. Now I want to settle at city where no CGHS facility is available. How to cover my family for medical
care?
Pensioners are eligible for CGHS facilities and can obtain CGHS card from the nearest CGHS covered city.

33. My husband / wife retired in 2002. He /she was paying CGHS subscription every year. After his death can I get Card on my
name? Do have I to pay extra. Shall I get Life Time Valid card?
Yes, the ownership of card can be transferred in the name of spouse on submission of required documents. Addl. Director of
concerned city shall transfer the ownership of Card in the computer Data base and same CGHS plastic cards with same Beneficiary ID
can be used.
No extra payment to be made, in case of life time cards.
However in other cases one has to pay 10 years subscription for life time card
For example, if the spouse had contributed for seven years before he expired, balance payment for the remaining three years is to
be paid for a life time card.
Documents required:
i) Application in prescribed format
ii) Proof of Family Pension with its break up from Bank
iii) Prescribed contribution if, card is not for life time

34. How to transfer CGHS card from one WC to other in the same city?
If there is any change in residential address, CMO i/c may be approached with proof of residence for transferring the data from one
Wellness Centre to another in the same city.

CMO i/c of the new Wellness Centre will accept the data of transferred card.

In respect of serving employees the request is to be forwarded by his/her office / department.

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35. I am CGHS beneficiary at Kanpur. Visiting Mumbai for 6 months. Can I get CGHS facilities at Mumbai .Can same card of Kanpur
continue or a separate card to be made? From where to get permission for the same?
Subsequent to computerization no separate permission is required and CGHS card is valid for availing facilities from any CGHS
Wellness Centre in India. For any assistance, Addl. Director of the city may be contacted.

36. Who is competent to delete name of sons who have crossed age of 25 years?
CMO i/c of Wellness Centre is competent to delete the name of son aged 25 yrs and above. Computer system does not allow sons
aged 25 and above to avail medical facilities.

37. After retirement in 2007 I got a Life time Pensioner CGHS card made in Delhi. Now I am shifting to Dehradun. Can I use the
same card? Do I pay again?
Pensioners shifting from one CGHS covered city to another, will have to apply to the Addl. Director of concerned city for transfer of
card. The card shall be transferred online and a receipt will be issued to the beneficiary, on the basis of which, Addl. Director of new
city (say Dehradun) shall receive the data. Same Plastic cards and same Ben ID will be valid. No contribution is required to be paid in
respect of pensioner beneficiaries holding life time cards.

38. I live in Gurgaon but my office is in Saket. Can I avail facilities from both the places because it is convenient for me?
Yes. Subsequent to computerization CGHS facilities can be availed from any Wellness Centre in India.

39. Is there any age limit for sons / daughters as dependant in CGHS Card?
Son is eligible till he starts earning or attains the age of 25 years or gets married whichever is earlier.
However, in case the son is suffering from any permanent disability of any kind (physical or mental) he is eligible for CGHS benefits
even after 25yrs.
Disability means blindness, low vision, leprosy-cured, hearing impairment, locomotor disability, mental retardation, mental illness. A
disability certificate from Medical Board is required.
Daughter is eligible till she starts earning, or gets married, whichever is earlier (irrespective of age)

40. Are step-children allowed CGHS facilities?

Yes. If they are dependent on card holder: other conditions as in case of dependant sons and daughters.

41. Can dependent in-laws be included under family members for CGHS facilities?
A lady Government servant will be given a choice to include either her parents or parents –in-law for the purpose of availing the
benefits under CGHS subject to the condition of dependence and residence, etc., being satisfied.

42. Me and my wife are both central Govt. employees and have dependant brothers / sisters and parents. Can we make separate
cards and include family members?
Yes. Your wife can have her parents as dependant in her card.

43. Can drugs like antibiotics, if not available in WC, be made available urgently from local Chemist?
Yes, beneficiary can collect drugs from the chemist counter on the chemist on the basis of authority form issued by WC

44. How to get a drug if same is not available in WC & also not supplied by Chemist (ALC)?
Beneficiary, after authorization by CMO i/c can purchase such drugs from open market & claim reimbursement from ALC.

45. What should beneficiary do, if he/ she notice some deterioration in the quality of drugs?
He /she should return the medicine to WC & get replacement. Samples can be sent for testing through CMOI/C.

46. My father is a cancer patient and after operation is bed ridden. Doctors have advised Protein powder. Can I get from CGHS?
Dietary supplements are not permissible under CGHS.

47. I am a CGHS Pensioner. My wife was admitted in pvt hospital in emergency state. How to get reimbursement of money spent
on her treatment?
Apply to CMO I/c of WC with:
MRC forms duly filled in as per Check list
Copy of Discharge summary
Hospital bills with break-up
Receipts in original
Copy of the valid CGHS Card
Copies of other documents issued by hospital
MRC forms are available with CMO I/c and can also be downloaded from CGHS Website
http://msotransparent.nic.in/cghsnew/index.asp
Serving employee in similar cases shall submit the medical claim to his department.

48. My original papers having bills, Receipts of hospital treatment are lost. Can I claim on duplicate papers?

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Yes. With affidavits on Stamp paper. Details of Draft for Affidavit may be seen in the instructions sheet appended to Medical Claim
Form available at http://msotransparent.nic.in/cghsnew/index.asp and CMO i/c.

49. My husband/wife was a CGHS card holder. He/She was sick and died while in hospital. How do I get MRC?
Apply to CMO I/c of WC with:
MRC forms duly filled in as per Check list
Copy of Death summary
Hospital bills with break-up
Vouchers in original
Copy of the valid CGHS Card
Death Certificate
Affidavit on Stamp paper of yourself being Legal Heir and NOC from other legal heirs in favour of claimant
Copies of other documents issued by hospital
Draft for affidavit may be seen in the instructions sheet appended to the Medical Claim Form available at CGHS Web site at
http://msotransparent.nic.in/cghsnew/index.asp

50. I retired in Dec 2011. Due to certain reasons I had to go to my native place in Uttranchal and could not make pensioner’s CGHS
card. In May 2012 I came to Delhi and had Heart attack. In emergency I was treated in pvt hospital .I got CGHS Card made after
discharge but I have been refused reimbursement of the expenditure incurred?
After retirement three months grace period is given to get CGHS card made.

(i) The treatment taken and expenditure incurred thereon within the grace period of three months from the date of retirement will
be allowed and expenditure reimbursable subject to the condition that the beneficiary has either obtained or applied for CGHS
pensioner card with all documents and requisite CGHS subscription within one month of expiry of the grace period of three months.

(ii) The expenditure on treatment taken after the grace period of three months from date of retirement will not be reimbursable
unless the beneficiary has obtained a valid CGHS card or has applied for CGHS pensioner card with all documents and requisite CGHS
subscription prior to taking such treatment.

51. I went to Hyderabad to visit my son and had fracture of leg bone. I received treatment from a pvt hospital. Shall I get full
reimbursement?
Reimbursement for treatment taken in a private hospital under medical emergency shall be considered as per CGHS rates only.

52. Is treatment for IVF reimbursable?

IVF treatment is approved under CGHS. The details may be seen as per Office Memorandum Z.15025/5/2011/CGHS III/CGHS (P)
dated 22.11.2011, which can be downloaded from CGHS Website at http://msotransparent.nic.in/cghsnew/index.asp

53. Are ambulance charges reimbursable?

Yes. Ambulance charges are reimbursable within the city , if there is a certificate from treating doctor that conveyance by any other
mode would definitely endanger patient’s life or would grossly aggravate his/her condition.

54. I have a Mediclaim Insurance Policy. Due to emergency received treatment in a pvt hospital. Some amount was paid by
Insurance Co. can I get balance from CGHS?
Yes. First Bills are submitted to Insurance Company. Duplicate bills with certificate from Insurance Company may be claimed from
CGHS by Pensioner CGHS beneficiaries. CGHS shall consider reimbursement at CGHS rates or actual whichever may be less. However,
the total reimbursement from both sources should not exceed actual expenditure.
Serving employees shall submit claim to department for reimbursement.

55. I submitted MRC for Rs. 1 Lac 20 thousand but I was reimbursed only Rs. 45,800/-. Why total amount was not reimbursed?
Expenditure for treatment in private hospitals is considered only if the treatment was taken under emergency at CGHS approved
rates.
In emergency who are all entitled to get treatment at Pvt Empanelled Hospital Any beneficiary holding a Valid CGHS card.

56. I want to get my Cataract Surgery done at Pvt empanelled hospital?

How can I get it done?
Beneficiaries are required to obtain advice from a Govt. Specialist / CMO i/c for Cataract surgery. Pensioners can apply to CMO I/c of
WC for permission to obtain the treatment at one of the empanelled hospitals of his /her choice.
Serving employees to apply to his / her Department / office.

57. Is it necessary that the Govt specialist should write ‘referred to CGHS empanelled Hospital’ for obtaining permission?
Advice of Government specialist is required only for the specific treatment procedure / investigation to be undertaken. There is no
need to specifically refer to any empanelled hospital/ diagnostic lab. It is the choice of beneficiary to under treatment /
investigations at any of the empanelled hospitals / diagnostic laboratories after obtaining permission from competent authority.

58. CMO Incharge does not refer me to Pvt. Hospitals on my request?

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As per CGHS guidelines there is no provision for OPD referrals to private empanelled hospitals except in satellite towns of NCR

59. I am an accredited journalist with CGHS Card Can I seek treatment in Pvt. empanelled Hospitals in emergency and get credit
facility?
No. Journalists are entitled only for OPD treatment from dispensaries and treatment from Dr.RML Hospital. Journalists are not
entitled for reimbursement for treatment from empanelled hospitals.

60. I am a serving employee of an autonomous body, holding CGHS card. Who will give me permission for treatment on the
recommendation of Govt. specialist?
Permission for treatment at empanelled hospitals / diagnostic labs shall be granted by the office of the organization where the
employee is serving.

61. Is Pen fill Injection provided under CGHS?

Insulin pen is not supplied under CGHS. But, Insulin Pen Cartridges are supplied under CGHS.
(Source: http://msotransparent.nic.in/cghsnew/index.asp)

VIII .MEDICAL ADVANCE

70. Medical Advance - Revised instructions

It has been decided to delegate the powers to Heads of Offices for sanction of Medical Advance subject to the following
conditions:
i) The amount of advance is limited to the ceiling provided in this Ministry's OM No. S-11016/1/92-CGHS (P) dated 29-10-92.
(i.e.) 80% of the estimate submitted by the Govt. /Private recognised hospital.
ii) Medical advance is admissible to all Central Govt. employees irrespective of any pay limit subject to other conditions.
iii) Advance is allowed only in cases of estimate submitted from the Govt. hospital or from a Private hospital recognised for
such treatment. The amount of advance in cases where estimate is submitted from a private recognised hospital should be
calculated on the basis of the rates approved for such treatments/diagnosis/examination.
iv) The advance is paid directly to the hospital concerned on receipt of an estimate from the treating physician/Medical
Superintendent of the hospital.
v) For settlement of advance, the employees may be required to submit the adjustment bills within a period of one month
from the date of his discharge from the hospital. In case the entire advance has not been utilized for the treatment of the patient,
the Head of Office concerned will correspond with the hospital for a refund of the unutilised balance of Medical advance.
The orders will come into force with immediate effect.
(DG (P) No. 30-1/94-PAP dated 24.01.1994)

71. Delegation of powers to heads of offices for sanctioning medical advance to Central Govt. employees-regarding
The undersigned is directed to invite a reference to this Ministry's O.M. No.S.11016/1/92-CGHS (P) dated 29-10-1992,
wherein the heads of the Departments/Ministries have been empowered to sanction medical advance to Central Government
employees. Keeping in view the difficulties being experienced by the employees of the offices particularly those who are located far
away from their Ministry/Department Headquarters, it has been decided to delegate the powers to Heads of offices for sanction of
medical advance to the Central Government employees in connection with the treatment with the treatment of their own and the
dependent members of their families in Government/recognised hospitals subject to the following conditions:-

(i) The amount of advance is limited to the ceiling provided in this Ministry's O.M. No.S. 11016/1/92-CGHS (P) dated 29-10-92 i.e.
80% of the estimate submitted by the Government/ private recognised hospital.
(ii) Medical advance is admissible to all Central Government employees irrespective of any pay limit subject to other
conditions.
(iii) Advance is allowed only in cases of estimate submitted from the Government hospital or from a private hospital
recognised for such treatment. The amount of advance in cases where estimate is submitted from a private recognised hospital
should be calculated on the basis of the rates approved for such treatments/diagnosis/examination.
(iv) The advance is paid directly to the hospital concerned on receipt of an estimate from the treating physician/medical
superintendent of the hospital.
(v) For settlement of advance, the employee may be required to submit the adjustment bills within a period of one month
from the date of his discharge from the hospital. In case the entire advance has not been utilised for the treatment of the patient,
the Head of office concerned will correspond with the hospital for refund of the unutilized balance of medical advance.
2. The orders will come into force with immediate effect.
3. These orders are issued with the concurrence of Finance Division vide their diary No. 3241/93-F.II dated 15-10-93.
4. In so far as persons serving in Indian Audit and Accounts Department are concerned, these orders have been issued in
consultation with the C&AG of India Vide their U.O. No. 578-Audit-I/72-90 dated 27-12-93.
(MOH&FW memo No. S. 12015/3/93-CGHS (P) dated 30.12.1993)

72. Grant of 90% medical advance for all treatments (IPD and OPD) under CGHS and CS(MA) Rules, 1944.
1. The undersigned is directed to refer to O.M.No.S14025/7/94-MS dated 15.05.1996, and OM No.S.12025/1/96-CGHS(P) dated
13.05.1997 provisioning, inter-alia, grant of advance upto 90% in case of major illness like by-pass surgery, Kidney transplant, major
cancer treatment, etc.
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2. During the meeting held on 25.03.2015, National Council (Staff Side) requested this Ministry to make provisions for grant of 90%
advance of the estimated cost for all treatments for serving Central Government employees, irrespective of major or minor diseases.
3. The matter was examined in the Ministry. Considering that the basic purpose of grant of advance for treatment of any disease is
to provide relief to a Government Employee from facing hardship, it has been decided with the approval of the competent authority
that serving CS(MA) and CGHS beneficiaries may be granted 90% medical advance of the approved CGHS package rates for all indoor
treatments, irrespective of major or minor diseases, on receipt of a certificate from the treating physician of a
Government/recognized hospital as per the guidelines given in the OM No.S.14025/7/94-MS dated 15.05.1996 and OM No.S-
11016/1/92-CGHS(P) dated 29.10.1992 for CS(MA) and CGHS beneficiaries respectively.
4. For out-door treatment, it has also been decided that advance may be limited to 90% of the total estimated expenditure of the
treatment, subject to the condition that the advance for OPD treatment may only be granted when the total estimate of expenditure
for OPD treatment including tests/investigations is more than Rs.10,000/-.
5. The advance should be released within 10 days on receipt of the request for advance by the administrative
Department/Ministry/Office in order to avoid inconvenience to the employees.
6. The OM No.S.12025/1/96-CGHS(P) dated 13.05.1997 stands withdrawn from the date of issue of this O.M.
(DOH & FW No.S.14025/18/2015-MS/EHSS dated 17.10.2016)

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