Revision of time limit for submission of final claims reimbursement of medical expenses under CS(MA) rules, 1944 – regarding.

Revision of time limit for submission of final claims reimbursement of medical expenses under CS(MA) rules, 1944 – regarding.

No. S. 14025/19/2015-MS
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare

Nirman Bhagavan, New Delhi
Dated : 27th May, 2015.

OFFICE MEMORANDUM

Subject: Revision of time limit for submission of final claims reimbursement of medical expenses under CS(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 month s 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 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. The issue with the approval of the competent authority.

(Sunil Kumar Gupta)

Under Secretary to the Govt. of India

Source : mohfw.nic.in

Read More

CGHS Latest Hospital List in Delhi & NCR – May 2015

CGHS Latest Hospital List in Delhi & NCR – May 2015

CGHS Delhi: Additional List of empanelled hospital including dental clinics and eye centres – Order dated 12-05-2015

No: S.1104513612012-CGHS (HEC)
Government of India
Directorate General of Central Government Health Scheme
Department of Health & Family Welfare

Nirman Bhawan, New Delhi.
Dated the 12th May, 2015

OFFICE ORDER

Subject: Empanelment of private hospitals (including dental clinics and eye centres) and diagnostic centres under CGHS Delhi & NCR.

In continuation of this Directorate’s Office Memorandum of even no. dated 01.10.2014 on the above mentioned subject and further empanelment under continuous empanelment scheme vide order dated 10.02.2015 and 24.02.2015, the undersigned is to convey that in addition to the list of the hospitals (including dental clinics & eye centres) and diagnostic laboratories already empanelled, the hospitals (including dental clinics & eye centres) and diagnostic laboratories as per the list attached have also been empanelled under CGHS in Delhi & NCR with issuance of this order. The newly empanelled hospitals (including dental clinics & eye centres) and diagnostic laboratories may be treated as included in the existing list of empanelled health care organization under CGHS with same terms and conditions as have been indicated in the Office Memorandum dated 01.10.2014.

Encl: As above

[Dr. D.C. Joshi]
Director (CGHS)

ADDITIONAL LIST OF EMPANELLED HOSPITALS, DIAGNOSTIC LABORATORIES, EXCLUSIVE EYE CENTRES AND DENTAL CLINICS UNDER CGHS. DELHI &NCR w.e.f. 12.05.2015.

HOSPITALS: – DELHI

Sr. No	Name of the Hospitals	Address & Tel. No.	NABH Accredited / Non-NABH	Facilities Empanelled for
1.	Irene Hospital Empanelled w.e.f. 12.05.2015.	DD-23, Kalkaji Extension, Near Post Office, New Delhi – 110019.	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic with Joint Replacement, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, nephrology, Dental and Diagnostics.
2.	Mangalam Medical and Surgical Centre Empanelled w.e.f. 12.05.2015.	154/81, Main Bawana Road, Pooth Khurd, Near Sector-35, Delhi- 110039. Tel. No. 011- 27762135.	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, nephrology, Dental and Diagnostics.
3.	Jeewan Hospital & Nursing Home Pvt. Ltd. Empanelled w.e.f. 12.05.2015.	Gate No.1, 150, Jeewan Nagar, Opp. Maharani Bagh, New Delhi. Tel. No. 011- 26340303.	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, nephrology, Dental and Diagnostics.
4.	Sanjeevan Medical Research (P) Ltd. Empanelled w.e.f. 12.05.2015.	24, Ansari Road, Darya Ganj, New Delhi- 110002.	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, nephrology, Dental and Diagnostics.

EXCLUSIVE EYE CENTRES: – DELHI

Sr. No	Name of the Exclusive Eye Centres	Address & Tel. No.	NABH / Non-NABH	Empanelled As
1.	Rotary Eye Care Centre Empanelled w.e.f. 12.05.2015	56-57, Tughlakabad Institutional Area, M.B. Road, New Delhi-110062. Tel. No. 011-29968562-63	Non-NABH	Exclusive Eye Care Centre
2.	Indian Institute of Ophthalmology Empanelled w.e.f. 12.05.2015.	C-2, Greater Kailash Enclave-II, New Delhi – 48. Tel. No. 011- 29220859.	Non-NABH	Exclusive Eye Care Centre
3.	Complete Eye Care Centre Empanelled w.e.f. 12.05.2015.	F7, F6, First Floor, Manish Chamber, Local Shopping Complex, Mayur Vihar, Phase-2, Delhi- 110091. Tel. No. 9873077056.	Non-NABH	Exclusive Eye Care Centre
4.	R.V.S. Eye Centre Empanelled w.e.f. 12.05.2015	BFH-09, Opp. Mount Abu Public School, Som Bazar Road, West Shalimar Bagh, Delhi-110088. Tel. No. 011-27478745, 9811671606	Non-NABH	Exclusive Eye Care Centre
5.	DRS Northex Eye Institute Pvt. Ltd. Empanelled w.e.f. 12.05.2015.	C-9/34, First Floor, Sector-7, Rohini, Delhi – 110085. Tel. No. 011-27054949	Non-NABH	Exclusive Eye Care Centre
6.	Jain Eye Hospital and Laser Centre Empanelled w.e.f. 12.05.2015.	AG-152, Shalimar Bagh, New Delhi- 110088. Tel. No. 011- 27479272.	Non-NABH	Exclusive Eye Care Centre
7.	Vision Care Centre Empanelled w.e.f. 12.05.2015.	E-16, 389 & 392, Sector-8, Rohini, New Delhi – 85. Tel. No. 011-27944744.	Non-NABH	Exclusive Eye Care Centre
8.	Rana Eye Centre Empanelled w.e.f. 12.05.2015.	C-8/28, Sector-7, First Floor, Sai Baba Chowk, Rohini, Opp. Metro Pilar, 394, Delhi – 110085. Tel. No. 011-45100652.	Non-NABH	Exclusive Eye Care Centre

DIAGNOSTIC CENTRES:- DELHI

Sr. No	Name of the Diagnostic Centre	Address & Tel. No.	NABL / Non-NABL	Facilities Empanelled for
1.	Dr. Ananad Imaging & Neurological Research Centre, Lab facilities added w.e.f. 12.05.2015.	G14, Preet Vihar, Vikas Marg, Karkarimor, Delhi- 110092.	Non-NABL	Laboratory Investigations

EXCLUSIVE DENTAL CLINICS: – DELHI

Sr. No	Name of the Exclusive Dental Clinics	Address & Tel. No.	NABH / Non-NABH	Empanelled for
1.	Kumar Dental Clinic Empanelled w.e.f. 12.05.2015.	209, Hakikat Nagar, Gali No.7, Near GTB Metro Station, Delhi – 110009. Tel. No. 9810531209.	Non-NABH	All Available Dental Care Facilities
2.	J.A. Aneja Multispeciality Dental Centre Empanelled w.e.f. 12.05.2015	283/23B, 28, Vishnu Garden Extn, New Delhi – 110018. Tel. No. 011-6999009.	Non-NABH	All Available Dental Care Facilities

EXCLUSIVE EYE CENTRES: – GHAZIABAD

Sr. No	Name of the Exclusive Eye Centre	Address & Tel. No.	NABH / Non-NABH	Facilities Empanelled for
1.	Punarjyoti Eye & Mother Care Center Empanelled w.e.f. 12.05.2015.	Duplex No.1, Sector- 15, Vasundhara, Ghaziabad-201012. Tel. No. 0120- 2882400.	Non-NABH	Exclusive Eye Care Centre

HOSPITALS: – NOIDA

Sr. No	Name of the Hospitals	Address & Tel. No.	NABH / Non-NABH	Facilities Empanelled for
1.	Max Multi Speciality Hospital, Empanelled w.e.f. 12.05.2015.	Plot No. 4a, Sector Institutional Green, Opp. NTPC, Near Crown Plaza, Greater Noida – 201306. Tel. No. 0120- 7161234	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic with Joint Replacement, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, nephrology, Dental and Diagnostics.
2.	Navin Hospital, Empanelled w.e.f. 12.05.2015.	NH-3, Sector-Alpha-II, Pocket-F, Greater Noida. Tel. No. 0120- 2321040/150	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, nephrology, Dental and Diagnostics.
3.	Shivalik Hospital Empanelled w.e.f. 12.05.2015.	Sector-51, Main Road, Hoshyarpur, Sector-51, Noida. (U.P.)	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, Nephrology, Dental and Diagnostics.
4.	Prayag Hospital & Research Centre Pvt. Empanelled w.e.f. 12.05.2015.	J-206/A-I, Sector-41, Noida-201302.	Non-NABH	General Medicine, General Surgery, Gynecology and Obst, Orthopedic, Eye, ENT, Endoscopic/Laparoscopic Surgery, Gastroenterology, Neurology, Urology, Nephrology, Dental and Diagnostics.

EXCLUSIVE DENTAL CLINICS: – GURGAON

Sr. No	Name of the Exclusive Dental Clinics	Address & Tel. No.	NABH / Non-NABH	Empanelled for
1.	Dr. Futela’s Dental Centre Empanelled w.e.f. 12.05.2015.	C-11, Nirvana Courtyard, Nirvana Country, South City-2, Sohna Road, Gurgaon. Tel. No. 0124-4011189	Non-NABH	All Available Dental Care Facilities
2.	Lal Super Speciality Dental & Implant Clinic Empanelled w.e.f. 12.05.2015.	Shop. No.C-1, Shiv Palace, Gurudwara Road, Near Canara Bank, Opp. Purani Sabzi Mandi, Gurgaon. Tel. No. 0124-4292180	Non-NABH	All Available Dental Care Facilities

EXCLUSIVE EYE CENTRES: – GURGAON

Sr. No	Name of the Exclusive Eye Centre	Address & Tel. No.	NABH / Non-NABH	Empanelled for
1.	Viaan Eye & Retina Centre Empanelled w.e.f. 12.05.2015.	UG-4, Bestech Central Square Mall, Sushant Lok-II, Sector-57, Gurgaon. Tel. No. 0124-4065151.	Non-NABH	Exclusive Eye Care Centre

Source: CGHS Portal

Read More

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

Removal of medicines from CGHS list – Life saving medicines – Reg.

Removal of medicines from CGHS list – Life saving medicines – Reg.

Member of Parliament Shri.Sardar Sukhdev Singh Dhindsa asked some important questions in respect of CGHS beneficiaries regarding the life saving medicines and concerned minister has given reply on this issue as follows…

With a view to streamline the issue of medicines, an Office Memorandum was issued on 25.08.2014. Under the revised guidelines:

I. CGHS provides/ indents Medicines as per the CGHS formulary, which contains 622 branded medicines and 1447 generic medicines.

II. However, anti-Cancer and other related medicines also called Life-saving medicines, approved by Drug Controller General of India for use in India shall continue to be provided on a case to case basis.

(d) : The following measures have since been taken to overcome the inconvenience caused to the beneficiaries:

i) Since, many beneficiaries were undergoing treatment and were provided certain Insulin’s and Gliptins for anti-diabetic care, it has been decided to permit issue of such medicines to ensure continuity in treatment even though they are not included in the formulary (as an interim measure till the formulary is revised).

ii) The medicines included in the formularies of ESIC(Employees State Insurance Corporation)( 398 generic medicines) and ECHS( Ex-Servicemen Contributory Health Scheme) (517 Generic medicines) are also permitted under CGHS as an interim measure.

iii) Orders were also issued on 1.10.2014 delegating powers to CMOs i/c for providing essential medicines to CGHS beneficiaries. CMOs i/c can issue / indent medicines costing upto Rs1500 per week even though they are not included in any of the above formularies. However, in case the duration of treatment is for more than one week and the cost of medicines is more than Rs.1500/- approval of Additional Director of the concerned CGHS city must be obtained.

iv) Medicines are issued for upto three months at a time in case of chronic diseases and upto six months in case of a CGHS beneficiary going abroad. The revised Orders were issued in this regard on 21.10.2014.

Read More

MACP Scheme – CGHS Facility – CPF to GPF to KVS Employees

MACP Scheme – CGHS Facility – CPF to GPF to KVS Employees

A detailed report has been submitted as written reply to a question in Parliament about the employees working under Kendriya Vidyalaya Sangathan by the Minister of Human Resource Development as follows…

MACP Scheme: The Modified Assured Career Progression Scheme for the Central Government civilian employees has been introduced vide Department of Personnel & Training O.M. No.35034/3/ 2008-Estt.(D) dated 19th May, 2009 as amended from time to time. The extension of Modified Assured Career Progression (MACP) to the employees is subject to the conditions that:-

i) The earlier ACP Scheme was also implemented/adopted by the said Autonomous/Statutory Body.
ii) The proposal to adopt MACP Scheme has been approved by the Governing Body/Board of Directors.
iii) The Administrative Ministry/Financial Adviser of the Ministry has concurred with the proposal.
iv) The financial implications of adoption of MACP Scheme has been taken into account by the Organisation / Body and the additional financial implication can be met by it within the existing Budget Grants.

As the teaching staff of KVS, including Principals had not accepted the earlier ACP Scheme introduced in the year 1999, they would not be entitled for the benefits of MACP scheme.

CGHS Facility : Directorate General of Health Services (DGHS) has extended the CGHS facility to the employees of KVS(HQ) and non-teaching staff of KVS Regional Office, Delhi. Besides this, CGHS facilities have also been extended by the DGHS to the teaching staff as well as non-teaching staff of Regional Offices and Kendriya Vidyalayas, Mumbai, Hyderabad, Kolkata, Chennai and Bangalore.

The matter was taken up with Ministry of Health & Family Welfare in October, 2012 to extend the CGHS facility to the employees serving in Kendriya Vidyalayas/KVS in all other stations across the country and to its pensioners wherever CGHS facilities are available. However, DGHS in December, 2012 had conveyed that CGHS is already facing acute shortage of human resources and it would not be possible to extend CGHS coverage to new cities as well as new establishments.

Switch over from CPF to GPF-cum-Pension Scheme: After the implementation of the Fourth Pay Commission Report, the Govt. of India vide O.M. dated 01.05.1987 provided an opportunity to the government employees to switch over from CPF to GPF-cum-Pension Scheme. For the KVS employees this option was available till 31.01.1989.

Read More

Criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary

Criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary

 

The below information is tabled to a question in Lok Sabha on 11th July 2014 by the Minister of Helath and Family Welfare Shri Harsh Vardhan as follows…

 

The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area are as under:-

(i) In an existing CGHS city:- For opening of a new Allopathic CGHS dispensary in an existing CGHS city, there has to be a minimum of 2000 Card holders (serving employees of Central Government and Central Civil pensioners).

(ii) Extension of CGHS to a new City:- For extension of CGHS to a new city, there has to be a minimum of 6,000 Card holders. However, due to financial and other resource constraints it is not always possible to adhere to the above criteria.

(b): The details about number of CGHS allopathic/AYUSH dispensaries and Hospitals in the country, State/UT-wise are at Annexure.

 

Keeping in view the financial and other resource constraints, a decision has been taken not to expand CGHS to cover new cities/ areas. There are some States and UTs which do not have the presence of CGHS as yet. Accordingly, the Ministry has mooted a proposal to open at least one CGHS dispensary in the capital city of such States/UT’s namely, Himachal Pradesh, Chhattisgarh, Goa, Arunachal Pradesh, Tripura, Manipur, Mizoram, Sikkim, Nagaland, Gujarat and Pudduchery.

 

In addition, there is also a proposal to open one CGHS dispensary in Indore in compliance of the High Court’s directions.

 

ANNEXURE

STATEMENT SHOWING DETAILS OF CGHS HOSPITALS/WELLNESS CENTRES

S.No.	City	ALLOPATHY	POLYCLINIC	AYUSH	CGHS HOSPITALS
1	AHMEDABAD	8	1	2	0
2	ALLAHABAD	7	1	2	0
3	BANGALORE	10	1	4	0
4	BHOPAL	2	0	0	0
5	BHUNESHWAR	3	0	1	0
6	CHANAI	14	2	4	0
7	CHANDIGARH	1	0	0	0
8	DEHRADOON	2	0	0	0
9	GUWAHATI	5	0	1	0
10	HYDERABAD	13	2	6	0
11	JAMMU	2	0	0	0
12	JAIPUR	7	1	2	0
13	JABALPUR	4	0	0	0
14	KANPUR	9	0	3	0
15	KOLKATA	18	1	4	0
16	LUCKNOW	9	1	3	0
17	MEERUT	6	0	2	0
18	MUMBAI	26	2	5	0
19	NAGPUR	11	1	3	0
20	PATNA	5	1	3	0
21	PUNE	9	1	3	0
22	RANCHI	3	0	0	0
23	SHILLONG	2	0	0	0
24	TRIVENDRUM	3	0	2	0
25	DELHI	94	4	36	4
	TOTAL	273	19	85	4

Read More