Life time CGHS facilities, Ward Entitlement, Organ Transplant, Emergency Treatment, Grant of Medical Advance – Minutes of the meeting with Staff Side, National Council.

Life time CGHS facilities, Ward Entitlement, Organ Transplant, Emergency Treatment, Grant of Medical Advance – Minutes of the meeting with Staff Side, National Council.

File No.- B-12014/03/2019-JCM
Government of India
Ministry of Health & Family Welfare
W&PG Section
Nirman Bhawan, New Delhi
Dated 3rd June, 2019
Subject: Minutes of the Meeting with Staff Side, National Council.
The undersigned is directed to forward herewith the Minutes of the Meeting with Staff Side of National Council (JCM) on the submitted Agenda Items, held on 16.05.2019 under the Chairpersonship of Secretary (HFW), in Committee Room No. 155-A, Nirman Bhawan, New Delhi.
EHS/CGHS Division is requested to take appropriate action and to furnish an Action Taken Report in this regard.
Encl. As above
Under Secretary to the Govt. of India
Tel. No. 011-2306 1203
1. JS(AS/EHS)/ JS(Dte.GHS)/ JS(Hospital)/ Dir(CGHS)/ Dir(Dte.GHS)/ Dir(Immunisation)/ Dir(VBD)/ DS(EHS)
2 . Secretary, Staff Side, National Council (JCM) 13-C, Ferozeshah Road, N.D
Copy to: Sr. PPS to Secretary (HFW)/ Sr. PPS to AS(H)/ Sr. PPS to DGHS/ Sr. PPS to EA(NS)/ PA to DS(WPG)
Copy for information to:
Depa1iment of Personnel & Training
{(Sh. Raju Saraswat, Under Secretary(JCA)}
North Block, New Delhi-110001

A Meeting was convened under the Chairperson ship of Secretary (HFW) with Staff Side, National Council, on 16.05.2019 at 12:00 Noon , in Committee Room No. 155-A, 1st Floor, Nirman Bhawan, New Delhi, on the Agenda Items pertaining to Ministry of Health & Family Welfare pursuant to DoPT OM No. 3/2/2019-JCA dated 29.03.2019 requesting this Ministry to convene a meeting with Staff Side members of National Council (NC).
List of participants is enclosed at Annexure- ‘A ‘.
2. The Chairman welcomed all the participants. After a short round of introduction, Sh. Shiv Gopal Mishra, Secretary, National Council expressed his gratitude towards Secretary (HFW) for holding this Meeting on a short Notice. Thereafter, Joint Secretary (CGHS) briefed about the Agenda Items raised by Staff Side and these items were taken up one by one for discussion. The gist of discussion s held is summarized below:
i. Issue: Opening of CGHS dispensaries in Agra, Barrackpore (Kolkata) and Kochi.
Staff Side Members of National Council were apprised that P&T Dispensaries at Agra has been taken on strength by CGHS and are functional with effect from 01.04.2019. An extension counter of Kolkata Wellness Centre at Ba1Tackpore has already begun functioning from 28.02.2019.
In Kochi, dispensary will start functioning as soon as BSNL building (Type-V quarters) is handed over to CGHS. On a specific reference from Staff Side, Advisor [CGHS] also informed that the authorities of Dte. General of CGHS are in touch with Prasar Bharti for getting space for dispensary in Coonoor. In Kozhikode, the space for dispensary is in ready stage and will be completed soon.

Status: The issues of opening of CGHS dispensaries in Agra, Barrackpore (Kolkata) and Kochi stand resolved.

ii. Issue: Central Government Health Scheme. Empanelling of hospitals streamlining the procedure to provide in patients treatment to the beneficiaries .
On this issue, Secretary (HFW) explained that last year all the bills could not be settled. However, now priority is being given to bills of smaller hospitals
i.e. less than 100 bedded Hospitals. MoHFW is now clearing bills in a phased manner wherein priority is accorded to smaller hospitals. AS(H) informed that MoHFW is also in the process of developing an online bill clearing system, wherein medical bills I claims of amounts upto Rs.
10 lakhs will be processed first and payment will be released directly through online mechanism.
As regards empanelment of Hospitals in Mumbai, JS(CGHS) apprised that it is a voluntary scheme for hospitals and Govt. cannot force any Hospital to compulsorily get itself empanelled under CGHS. MoHFW may empanel a hospital only if it applies for empanelment under CGHS scheme.
Staff Side informed that Railways have been able to get a number of Hospitals empanelled in Mumbai. Secretary (H) indicated that MoHFW would be willing to adopt innovative ways & means for empanelment of more and more hospitals under CGHS. Secretary (H) requested Staff Side to find-out from DG (Railways) as to how they have been able to get more hospitals empanelled under RMA. Staff Side was also requested to provide their suggestions in this regard. Secretary (HFW) desired that CGHS may also explore possibility for empanelling smaller hospitals and Nursing Homes in Mumbai. Staff Side submitted that CGHS rates may be one of major reason for non-empanelment of Hospitals in Mumbai. On this, Advisor (CGHS) apprised that they are also considering revision of rates under CGHS and have initiated process for fresh empanelment of Hospitals.
iii. Issue: Disproportionate revision of subscription under CGHS due to revision of pay and allowances of Central Govt. Employees on account of implementation of Seventh Pay Commission.
On this issue, it was explained that the matter does not come under their purview. Staff Side may take up the matter with the Department of Expenditure.
iv. Issue: Direct consultation with Specialists Government/State Government Hospitals/Polyclinics.
Continuation of the facility to those CGHS beneficiaries who were
eligible for direct consultation before revision of the Monetary Ceiling.

v. Issue: Revision of monetary ceiling of direct consultation with Specialist in CGHS/Central Government/ State Government Hospitals/Polyclinics in respect of Pensioners and Family Pensioners.
These issues stand resolved with the removal of monetary ceiling vide this Ministry’s OMs dated 05. 12.2017. On the directions of Secretary (HFW), a copy of all OMs issued during the last 2 years was handed-over to Staff Side.
vi. Issue: The process of Plastic Card is still not complete.
Advisor (CGHS) apprised that there is no pendency in issuance of CGHS plastic cards.
This issue also stands resolved.
vii. Issue: Indication of Ward entitlement in Plastic Cards of Pre-01.06.2009 beneficiaries.
Staff Side were asked to report such cases of anomalies in indication of ward entitlement below their actual ward entitlement on CGHS cards issued to pre 01.06.2009 Pensioners to the concerned CGHS authority.
viii. Issue: Grant of One-time option to CGHS beneficiaries to opt for ward entitlement as per their revised Pay in Pay band.
The provision for paying additional amount as a result of revision in the rates of contributions for availing CGHS facility is uniformly applicable to all pensioners who had opted to pay CGHS contribution either on the basis of their last pay or their pension, vide O.M. No. S. 11011/18/99-Desk-I/CGHS(P) dated
03.07.2000. Hence, both categories of pensioners who opted to pay CGHS subscription on the basis of their last pay drawn and those who opted to pay CGHS subscription on the basis of their pension are on equal footing. Hence, the proposal to allow one-time option to pre-01.06.2009 pensioner to opt for re­-determination of their ward entitlement based on their notional pay in pay band is not required. Staff Side agreed with the suggestion.
The issue stands resolved.
ix. Issue: Provision of CGHS facility for life time to dependent disabled/mentally retarded children of Central Government Employees/pensioners.
On this issue, JS(CGHS) informed the Staff side that the matter is under consideration of the Govt, in consultation with the Department of Expenditure
/ Department of Personnel and Training.
x. Issue: Extension of CGHS facilities to retired BSNL employees-follow up action by the Ministry of Health & Family Welfare & fixation of rates of contribution & ward entitlement.
CGHS representative informed that this Ministry vide its correspondence dated 26.04.2017 has already communicated to DoT that the issue has been resolved in a meeting with DoT and BSNL. BSNL authorities agreed to mention Head of Account, Equivalent CDA GP and Pay Scale, Range of Pay in CDA) on PPOs issued to such retirees to enable CGHS decide rate of contribution and entitlement of ward.
The issue stands resolved.
xi. Issue: Non grant of 90°/o Medical Advance for all type of treatments by the Audit Authorities in the Ministry of Defence in violation of Ministry of Health and Family Welfare Letter No. S.14025/ 18/2015-MS/EHSS dated 17.10.2016.
Secretary (HFW) clarified that the policy is clear and there is no anomaly in the instructions. Concerned associations may take u p the matter with the concerned Audit Authority of the Mio Defence. In case any clarification is required, the Audit Authority may make a reference to M/oHFW clearly
bringing out the point of reference.
xii. Issue: Review of ward entitlement for Central Government Employees.
JS(CGHS) informed that the issue has been looked into and guidelines concerning ward entitlement need rationalization to align the same with pay­matrix and subscription of the employees. Staff Side requested that the proposal may be shared with them before finalization. Secretary(HFW) agreed to the suggestion that NC, Staff Side may be consulted before sending the proposal to Department of Expenditure.
xiii. Issue: Withdrawal of the condition imposed in Ministry of Health OM No. S.14011/1/73-M.C., dated 23rd August, 1973 with regard to diabetic treatment.
Staff Side was apprised that the matter will be looked into mandating requirement of medical certificate from any Govt. Medical Officer
/ Specialist for continued treatment in case of diabetes. Staff Side expressed their satisfaction on this arrangement. Govt will soon review in consultation with DGHS.
xiv. Issue: Review of package rate for Organ Transplantation
Staff Side indicated that the package rates for organ transplantation are very less and the CGHS beneficiary employees of the Ministry of Defence are required to cough-up large amount of money for such treatment. JS(CGHS) informed that empanelled hospitals are doing organ transplantation procedures within package rates and no such case of unreasonably lower rates has been raised by any empanelled hospital. He, however, asked the Staff Side members to submit the details of such kind of cases of M/o Defence to Additional Director of respective CGHS City for appropriate consideration.
xv. Issue: Inpatient treatment in Hospitals without going through the AMA.
It was decided that the relevant instructions/orders will be reiterated.
xvi. Issue: Reimbursement of preventive Vaccination charges
The Staff Side members were apprised that the vaccinations which are covered under Universal Immunization Program (UIP) are reimbursed. At present, vaccination of diseases like Swine flu, Dengue and Malaria are not covered under UIP and the same are provided free-of-cost by the concerned State Govt to high-risk people.
xvii. Issue: Emergency Treatments in CGHS recognized Hospitals.
Advisor (CGHS) informed that no referral memo from concerned CGHS
wellness Centre is required in Emergency Treatments. The relevant Orders will be reiterated.
xviii. Issue: Reimbursement of Medical expenses not covered under the CGHS Package Rates.
As per extant instructions, in case of conservative treatment, re­imbursements are made as per package rates. However, where no CGHS package rates are available, reimbursements are made as per AIIMS rates or as per actual, whichever is less.
xix. Issue: Issue of Medicines to CS (MA) beneficiaries availing inpatient treatment in CGHS recognized Hospitals.
JS(CGHS) on this stated that CS(MA) is different from CGHS Scheme. CGHS is a contributory scheme,
whereas under CS(MA), reimbursements are made as per the prescription of AMA. Therefore, this cannot be accepted.
xx. Issue: Permission/Ex-post facto approval for elective treatment/ investigation taken in non-empanelled Hospitals/ Diagnostic Centers for CS (MA) beneficiaries at par with CGHS beneficiaries.
The matter was discussed. After detailed deliberations, Secretary(H) assured that the matter will be examined in consultation with some select major Ministries/Departments of GoI.
xxi. Issue: Treatment of dependents of the deceased Employees/Employees who have taken voluntary retirement/premature retirement/ medical invalidation/compulsory retirement etc.
Staff side were apprised that there is provision for issuing CGHS Provisional Yearly Card on the basis of Last Pay Certificate (LPC) after making required CGHS subscription, as per extant instructions under CGHS Scheme.
xxii. Issue: Medical treatment facilities to Central Government Employees and Pensioners, Implementation of directions given by Hon’ble Supreme Court of India vide its Judgment dated 13.04.2018 in WP (C) No. 694 of 2015.
Hon’ble Supreme Court of India vide its Judgement dated 13th April, 2018 in the WP (Civil) No. 694 of 2015 filed by Shri Shiva Kant Jha Vs UoI directed GoI to frame guidelines for settlement of medical claims of pensioners within 1 month and for constitution of a High Powered Committee for settlement of grievances of medical claims of pensioners. Accordingly, Office Memoranda No. Z.15025/38/2018/DIR/CGHS dated 14.05.2018 and No.
Z.15025/38/2018/DIR/CGHS/EHS dated 22.05.2018 have been issued fixing timelines for settlement of medical claims of pensioners and constitution of High Powered Committee, respectively.
The issue stands resolved .
xxiii. Issue: Grant of Medical Advance for all treatments (IPD and OPD)
under CGHS and CS(MA) Rules, 1944
The Staff Side underlined the difficulties being faced by Central Government employees in availing treatment with limited personal resources. After detailed deliberations it was considered that the matter regarding grant of medical advance upto 90% of the estimated cost,
for which CGHS package rates are not available, needs a detailed examination in consultation with Dte. GHS and Dte. of CGHS.
3. The Chairperson requested Staff Side Members, National Council that the
10 additional Agenda Items may be discussed in a subsequent meeting initially
at the level of JS/AS. Staff Side agreed with the suggestion. Staff Side also thanked Secretary (H) for convening this meeting and expressed satisfaction on the action taken by MoHFW on various agenda items.
The meeting concluded with a vote of thanks to the Chair and the Participants.
List of Participants
Office Side:
1. Ms. Preeti Sudan, Secretary (HFW)-
in Chair.
2. Dr. S. Venkatesh, DGHS
3. Sh. Sanjeeva Kumar, Additional Secretary.
4. Sh. Alok Saxena, Joint Secretary (CGHS).
5. Ms. Gayatri Mishra, Joint Secretary
6. Dr. D. C. Joshi, Advisor (CGHS)
7. Ms. Bindu Sharma, Director
8. Sh. N. K. Bhagat, Director (Hospital ).
9. Dr. Anil Manaktala, DDG(P), Dte.GHS.
10. Dr. Pradeep Saxena, Addtl. DDG, Dte.GHS
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11. Sh. Ziley Singh Vical, Deputy Secretary.
12. Sh. D. D. Maheshwari, Deputy Secretary.
13. Dr. Aruna Jain, Addtl. Director
14. Ms. Soma Sanyal, Under Secretary
15. Sh. Rajeev Attri, Under Secretary
16. Sh. Sandeep Kumar, Section Officer, EHS Section.
Staff Side:
1. Sh. Shiv Gopal Mishra, Secretary, National Council.
2. Sh. Guman Singh, Member, National Council.
3. Sh. K. K. N. Kutty, Member, National Council.
4. Sh. C. Srikumar, Member, National Council.
5. Sh. R. N. Parashar, Member, National Council.
6. Sh. M. S. Raja, Member, National Council.

Source: Confederationhq