केन्द्रीय स्वास्थ्य एवं परिवार कल्याण मंत्रालय ने अपने कार्यालय ज्ञापन
संख्या 4-18/2005- C&P [Vo]. l-Pt (1)]दिनांक 20 फरवरी 2009 के पैरा 3 (2)
में संशोधन करते हुए सी.जी.एच.एस लाभार्थियों द्वारा इमरजेन्सी में निजि
अस्पताल में किए गए ईलाज के पश्चात् सीजीएचएस दर से अधिक के दावों के
प्रतिपूर्ति के सम्बन्ध में कुछ शर्तों के साथ आवश्यक छूट प्रदान किया।
Subject: – Relaxation of Rules for consideration of reimbursement in excess
of the approved rates pertaining to medical claims
With reference to the above mentioned subject the undersigned is directed
to drawattention to the Office Memorandum No. 4-18/2005- C&P [Vo]. l-Pt (1)],
dated the 20th February 2009 and to state that it has now been decided to modify the Para
3 (2) of the above referred Office Memorandum as per the details given under the succeeding
defined criteria shall be examined by Directorate General of CGHS and submitted to AS&DG
(CGHS) for consideration of approval. After the recommendation of AS&DG (CGHS),
the concurrence of Internal Finance Division and approval of Secretary, Ministry of Health
& Family Welfare are required for reimbursement in excess of CGHS rates:
emergency and the patient was admitted by others when the beneficiary was unconscious or
severely incapacitated and was hospitalized for a prolonged period.
emergency and was admitted for prolonged period for treatment of Head Injury, Coma ,
Septicemia, Multi-organ failure , etc.
emergency for treatment of advanced malignancy
rooms as per his/her entitlement are not available during that period.
conditions for isolation of patients to avoid contacting infections
emergency when there is a strike in Govt. hospitals.
emergency while on official tour to non-CGHS covered area.
time of treatment, in respect of the following conditions shall be considered by a
High Powered Committee constituted by Ministry of Health & Family Welfare:
(ii) Approval for air-fare with or without attendant on the advice of
treating doctor for treatment in another city even though he/she is not eligible for air travel treatment facilities are available in city of residence
(iii) Representations from CGHS beneficiaries seeking full reimbursements
under special Circumstances, which are not notified.
c) The other terms and conditions mentioned in the OM No. 4-18/2005-
C&P[Vol. l- Pt(1)] dated the 20 February 2009 shall remain unchanged.