F.No.5-36/CGHS (HQ)/HEC/2024 Office of the Additional Director Central Government Health Scheme, Headquarter Ministry of Health and Family Welfare, Govt. of India CGHS Bhawan, Sector — 13, R. K. Puram, New Dethi 110066 (Hospital Empanelment Cell) R. K. Puram, New Delhi Dated: 5 August, 2024 NOTIFICATION
With reference to the above mentioned subject the undersigned is directed to draw attention to the terms and conditions of empanelment under CGHS and to reiterate that the Hospitals, Diagnostic/Imaging, Eye and Dental centres empanelled under CGHS shall provide better services to the CGHS beneficiaries, the following instructions are to be followed strictly by all HCOs empanelled under CGHS Delhi/NCR, failing which necessary action will be initiated in accordance with the MoA.
1. Cashless CGHS facility is obligatory for Pensioners, Ex-Members of Parliament, Sitting Members of Parliament, Freedom Fighters, Serving CGHS/DGHS / Ministry of H&FW employees and there is no any provision to take advance Deposit / Payment at the time of admission.
2. Do not charge the beneficiaries separately for infection control. It is essential for the HCOs to maintain infection control.
3. Do not demand a photocopy of the CGHS card from the CGHS beneficiaries. The CGHS card can be verified from CGHS app or Digilocker.
4. Hospitalized beneficiaries and emergencies do not require any separate permission letter.
5. The stamp is not mandatory on the referral memo.
6. Prescriptions must be given in a printed form always.
7. Prescriptions should strictly adhere to the government's policy by being in a generic format.
8. Dietary supplements/Cosmetic items should not be included in the prescription.
9. Establish a dedicated CGHS Kiosk (Help desk).
10. Ensure that the name of the nodal officer and contact number are prominently displayed. Any changes to the nodal officer must be immediately communicated to this office.
11. CGHS beneficiaries aged 70 years and above shall be permitted to seek direct OPD Consultation from Specialists of hospitals empanelled under CGHS without referral from CGHS Wellness Centre. The term and condition remain same, mentioned in OM dated 29.05.2019 and 28.06.2024.
12. The HCO shall retain a scanned copy of the print out of the referral and retum the original print out to the beneficiary.
13. Retired Air India employees with valid CGHS cards are eligible for cashless treatment at all CGHS empanelled Health Care Organizations (HCOs) and their bills are to be processed through UTI ITSL Portal.
14. CS (MA) beneficiaries and their dependent family members can get treatment at CGHS rates from any of the HCOs recognized under CGHS.
15. Bills to be verified and signed by the Pensioners beneficiaries at the time of discharge. The same shall be uploaded on NHA portal.
16. The guidelines issued by OM dated 28.06.2024 stated at point B (ii) applicable to Hospitals, Dental and Eye Care Centre only. In case CGHS beneficiary wants to get the test done in any other empanelled Diagnostics / Imaging Centers, then the test prescribed/ advised by the Specialist of Pvt. Empanelled HCOs must be endorsed by the CGHS Wellness Centre.
In case of any complaint regarding excess billing / advance payment / harassment of CGHS beneficiaries is received in this office, necessary action will be initiated as per MoA.
