Compendium of Orders under Central Government Health Scheme (CGHS) 2017

Since the publication of the 3rd Edition of Nabhi's Central Govt. HealthScheme, a number of significant changes have been made under the scheme.The New Rates for Reimbursement at CGHS, Kolkata have beenannounced. New form Medical 2004, Checklist and Essentiality Certificatehave been prescribed for settlement of medical claims. New procedure forsettlement of medical claims of pensioners w.e.f. 1.4.2004 has been laiddown. Accordingly, powers relating to ex-post facto approval in case ofpensioners, for treatment taken under emergency conditions in privatehospitals has also been delegated to the HODs in the concerned Ministry/Department. Procedure for settlement of medical claims of Ex-Governors hasbeen prescribed. Cost of TAXUS Stent shall be reimbursible in case of highrisk patients. Incorporating the aforesaid and other changes, we are nowpresenting the fourth revised edition of Nabhi's CENTRAL GOVERNMENTHEALTH SCHEME, 2004.The Central Government Health Scheme is the most comprehensivemedical scheme being administered by the Central Government. The Schemewhich covers 27 major cities of India, provides extensive medical facilities toCentral Government employees, pensioners and their dependent family
members, through CGHS dispensaries, Govt. hospitals and even certainprivate hospitals/clinics recognised under the Scheme. However, theGovernment has not framed consolidated rules for regulating the Scheme. Anumber of orders have been issued from time to time, dealing with variousaspects of the Scheme. These orders are generally not accessible and even ifthey are, it is difficult to comprehend them with regard to their applicability ason a particular date.After giving a brief ‘Introduction’ about CGHS, the book proceeds withthe ‘Eligibility’ under the Scheme. Besides Govt. employees and pensioners,the Scheme also covers their ‘Dependent Family Members’. In certaineventualities, the scheme provides for ‘Opting out of the Scheme’ allowingthe employee to avail better medical facilities being provided by the employerof his/her spouse.The next two chapters of the book deal with ‘Medical Facilities underCGHS’ and ‘Reimbursement for Specialised Tests and Treatments’. Ratesof reimbursement for treatments/diagnostic investigations in recognisedhospitals in various cities are compiled and given in Appendices I and II at theend of the book. A separate schedule of Charges for new Procedures atKolkata has been given in Appendix IIA. Rates of reimbursement for various
treatments/tests at AIIMS, Delhi have been incorporated in Appendix III.Chapters on ‘Contribution’ and ‘Identity Cards/Temporary Permits’deal with all aspects related thereto. A separate chapter has been devoted to‘Pensioners/Family Pensioners’, since they are at a stage when they needmedical services the most. Special provisions/benefits provided to pensionershave been discussed with minutest details.‘Travelling Allowance’ is also admissible in case medical treatmententails compulsory journey to another station. This has been discussed in thenext chapter.(ii) ContentsCGHS beneficiaries can also obtain ‘Medical Advance’ for their treatment/diagnostic investigations. They are required to follow the prescribed procedurefor ‘Settlement of Medical Claims’.The last chapter deals with ‘Delegation of Powers and Referral System’under the scheme.The speciality of this book is that it has been written in a simple languageand the relevant orders have been referred at all appropriate places. Text of therelevant orders have been annexed to the relevant chapters, for easy reference.Yet another speciality of the book is its indices, Index of Office
Memoranda, Letters, etc. referred in the book and a comprehensive SubjectIndex have been provided to enhance the practical utility of the book.The Board of Editors is thankful to S/Sh. V.V. Jain, Narender Kumar Jainand Dr. Karunesh Singhal for their valuable suggestions and help in preparationof this book. Though every care has been taken to provide authenticinformation, yet the editors/publishers are not legally or morally responsible forany loss or damage that may arise to any person from any error or omission inthe book. They, however, always welcome suggestions and criticism fromesteemed readers for further improvement of this book, which should be sent inwriting only