CGHS has empanelled 750 Health Care Organizations all over the country

CGHS has empanelled 750 Health Care Organizations all over the country

While answering to a unstarred question No.695 in Lok Sabha on 27th Feb 2015, Minister of Health and Family Welfare Shri.Jagat Prakash Nadda said there is no CGHS rates for implant then that implant is reimbursed as per AIIMS/GB Pant Hospital rates. However, if a benefi- ciary opts for a specific brand of implant, he/she shall have to give a written under- taking to bear the difference between the cost of that specific brand and the pres- cribed ceiling rate.

The detailed reply is reproduced and given below for your ready reference…

“The total number of CGHS beneficiaries in the country as on date are 36,67,795.

The CGHS has empanelled 750 Health Care Organizations all over the country. 

As per reports received from the field, Grants Medical Foundation Pune has restricted the cashless facilities to serious/emergency cases only. Another hospitals in Ranchi ‘Shree Jagannath Hospital and Research Centre’, which was empanelled recently on 17/11/2014 has stopped this facility.

The reason for pendency of payment of hospital bills is insufficient balance of funds available with UTI-ITSL (Bill Clearing Agency) CGHS recoups funds to UTI-ITSL. There was delay in recoupment due to technical reasons. However, efforts are being made to recoup the funds to UTI-ITSL to avoid pendency.

In addition, through internal adjustment, additional funds are being allocated to Pune & Ranchi to clear the pending bills.

CGHS fixes rates for various treatment procedures and investigations through tender process and rates were last notified on 01.11.2014 for Delhi/NCR and on 17.11.2014 for CGHS cities outside Delhi/NCR. AS per the Memorandum of Agreement signed by empanelled hospital with CGHS at the time of their empanelment they are expected to charge as per CGHS package rates only.

CGHS has fixed up ceiling rates for certain implants without specifying any brand name. If there is no CGHS rates for implant then that implant is reimbursed as per AIIMS/GB Pant Hospital rates. However, if a benefi- ciary opts for a specific brand of implant, he/she shall have to give a written under- taking to bear the difference between the cost of that specific brand and the prescribed ceiling rate”.

Read More

Clarification regarding list of hospitals/laboratories for conducting special medical examinations consequent on enhancement of sum assured limit in r/o PLI

Government of India
Ministry of Communications & IT
Department of Posts
Directorate of Postal Life Insurance
25-3/2003-LI (Vol II)                                                                         

Dated  25 February 2015

 Office Memorandum

Subject: Clarification regarding list of hospitals/laboratories for conducting special medical examinations consequent on enhancement of sum assured limit in r/o PLI

            This has reference to para 4 & 14 of this Directorate letter of even number dated 12.01.2015 regarding ‘Enhancement of sum assured to 50 lakhs in r/o PLI.

2.         The Circles are raising doubts regarding process of conducting special medical examination of proponent opting for higher sum assured policies i.e. more than Rs. 20 lacs and authorised medical doctors, hospitals and dispensaries for special medical examination of these proponents. In this regard, it is clarified that special medical examinations may be conducted at any hospital/laboratory approved by CGHS, Central/State Government or at any specialized hospital at CGHS rate.

3.         Status of Medical Officer conducting medical examination of proposer(s) based on special medical reports should be as under:-

i) Civil Surgeon, Medical Officers in the employment of Government enjoying the status not lower than that of a Civil Surgeon or Chief Medical Officer, nearest to the place of duty of the proponent. CMO Grade I/Specialist Grade II shall also be considered as equivalent to the rank of Civil Surgeon.

ii) Medical Officer (Allopathic) equivalent to Civil Surgeon employed in Central and State Government, Public Sector undertaking both State and Centre with at least 10 years experience, nearest to the place of duty of the proponent.

iii) Retired Civil Surgeon, CMO Grade I and Specialist Grade

II.

4.         Revised LI-24 (Proposal Form) for PLI proposals exceeding sum assured limit of Rs. 20 lac is being revised and will follow.

5.         This has approval of CGM (PLI).

Sd/-
                                                                                          (Shipra Sharma)

Addl. General Manager (B&I)

To,
1.    All Chief Postmasters General/Addl. D.G. APS
2.    All Regional Postmasters General
3.    All PTCs/CEPT Mysore
4.    PPS to Secretary(P) / Member(PLI) / Member(P)/Member(Tech) / Member (HRD) / Member (Plg)
5.   PS to JS&FA/All DDGs in Dak Bhawan
6.  DPLI Kolkata/Sr.Tech. Director NIC, DoP
7.   Officers in PLI Directorate
8.   Guard File.

Read More