Also, they cannot charge above the rate card given by the government. The Union Ministry of Health and Family Welfare has issued new guidelines to resolve complaints of overcharging and refusal to provide service to the beneficiaries of Central Government Health Scheme (CGHS). The purpose of these instructions is to provide correct, affordable and transparent health service to CGHS beneficiaries.

Government changed the rules for CGHS beneficiaries

1. Compulsory treatment

CGHS-empanelled hospitals cannot deny treatment to any eligible beneficiary. The Health Ministry clarified that all services will be provided without any discrimination.

2. Transparency in cost and service

Hospitals will be required to provide information related to treatment at prominent places. This will include the rates mentioned by CGHS. Status of beds available in wards and ICU. It will be necessary to provide information about the ward category fixed for the beneficiaries. Hospitals will not be able to provide the following categories. Doing so will be prohibited for hospitals. It will be necessary to provide information about the empanelment city of the hospital, credit eligibility and contact of the nodal officer.

3. Mandatory reporting

Hospitals must report emergency cases, non-referral cases and direct visits and admissions of beneficiaries above 70 years of age within 24 hours to the concerned Additional Director of CGHS via email. Unreported cases will not be accepted.

4. Accountability in serious cases

In case of death or coma of the patient, it will be mandatory for the hospital to provide the signature and contact details of the attendants of the beneficiary on the final bill.

5. Prescription rules

Prescriptions must use only generic names and be written in capital letters. Hospitals cannot force you to buy a particular brand.

6. Permission will have to be taken first for expensive treatment

Hospitals will have to take permission in advance for expensive treatments. So that unnecessary or excessive charges can be avoided.

7. Penalty will be imposed for not following the rules

Hospitals that do not follow the guidelines may face penalties, including removal from the CGHS network. These new guidelines will help protect the rights of CGHS beneficiaries and provide them with affordable and transparent treatment services.

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CGHS New Rules : There is big news for the CGHS cardholders of the Central Government. The government has made the emergency service of the hospital easier than before for the CGHS cardholders. So that, treatment can start immediately without any hassle. The Ministry of Health has issued new guidelines for the cardholders of the Central Government Health Scheme (CGHS).

The purpose of these guidelines is to make health services even easier. So that people can get better service for consultation, investigation and treatment in government and listed private hospitals. In the Office Memorandum (OM) issued on 24 September 2024, the Ministry of Health has changed the old rules related to referral and has issued a Standard Operating Procedure (SOP) regarding the new rules.

New CGHS rules for emergency cases

If there is an emergency, now Healthcare Organizations (HCOs) will not need to take referral or endorsement from CGHS. They can directly provide cashless treatment. Provided that the patient gets an emergency certificate from the expert of the treating hospital. With this certificate, the hospital will upload the treatment claim on the BCA portal.

Even if any test or treatment is not in the CGHS list for emergency treatment, referral will not be required. The hospital can get permission for this through the NHA portal, and there will be no need to take any permission from the local CGHS office for this.

Changes in referral rules

Now the consultation memo received through CGHS will be valid for three months. If a CGHS medical officer refers you to an expert, then you can take consultation from that expert a maximum of six times within three months. If the primary consultation gives advice, then you can also take advice from two additional experts. These rules apply only to referrals given by CGHS medical officers. These rules will not apply to referrals from government hospitals.

Exemption for beneficiaries above 70 years of age

Beneficiaries who are 70 years or older will no longer need a referral to get consultation from any specialist. These beneficiaries will be allowed to directly seek treatment for any registered test or procedure in listed hospitals. However, if any test or procedure is not in the list of CGHS, then permission will have to be taken from CGHS officials for the same.

Follow-up rules for special cases

Beneficiaries suffering from certain specific ailments will be allowed consultation and testing without any time limit on the basis of primary referral. These ailments include:

Post-cardiac surgery cases

Post-organ transplant cases

Post-neurosurgery cases

End-stage renal disease

Cancer Treatment

Autoimmune disorders

Neurological disorders

People suffering from these diseases will not need to take repeated referrals for treatment or investigation.

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: Good news for central government employees. The Ministry of Health and Family Welfare said that the requirement to link the Central Government Health Service (CGHS) beneficiary ID with the Ayushman Bharat Health Account (ABHA) ID has been put on hold till further orders. The ministry said that it had reviewed its earlier order to compulsorily link the two IDs CGHS and ABHA to arrive at this decision. The Health Ministry had earlier made it mandatory for all CGHS beneficiaries to link their beneficiary ID and ABHA ID. The order was to come into effect from April 1, 2024. It was later extended till June 30, 2024.

In an office memorandum dated June 25, 2024, the Ministry of Health and Family Welfare said that reference is invited to Office Memorandum No. Z 15025/23/2023/DIR/CGHS dated 28.03.2024, wherein linkage of CGHS beneficiary ID with Ayushman Bharat Health Account ID (ABHA) has been made mandatory and to inform that the matter has been reviewed in the ministry and the same is put on hold till further orders.

What is Aura ID?

ABHA number is a 14-digit unique number to access, link and share your health records across multiple systems digitally. Like a bank account number, it is a unique number to identify you and authenticate you when needed.

How do you benefit from ABHA number?

Whether a government or private hospital, it gives a unique ID to the patients to maintain health records. This will often eliminate the need for patients to carry a physical copy of their medical history when seeking treatment elsewhere. The complete record will be available with this unique ID.

How linking CGHS beneficiary ID with ABHA numbers will help central government employees

Linking CGHS beneficiary ID with ABHA numbers will enable central government employees to access their health history on their mobile phones. A CGHS beneficiary can view any of his/her preferred Personal Health Records (PHR) downloaded on his/her mobile device, the ministry had earlier said. A CGHS beneficiary will be able to take an OPD appointment with a doctor by scanning a QR code through his/her mobile device while present in front of the doctor’s room or registration desk at the wellness centre.

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Who can take advantage of CGHS?

According to the official website of CGHS, there are several rules to determine the eligibility of a Central Government employee to avail medical facilities under the Central Government Health Scheme. Central government employees and their family members etc. living in any notified city can take advantage of this scheme.

In which cities you can avail CGHS service?

CGHS service is available in 80 cities. CGHS beneficiaries living in these cities can avail the benefits of this scheme. The complete list is given below.

1) Agra

2) Agartala

3) Ahmedabad

4) Aizawl

5) Ajmer

6) Aligarh

7) Allahabad (Prayagraj)

8) Ambala

9) Amritsar

10) Baghpat

11) Bengaluru

12) Bareilly,

13) Berhampur

14) Bhopal

15) Bhubaneswar

16) Chandrapur

17)Chandigarh

18) Chhatrapati Sambhaji Nagar

19) Chennai

20) Chhapra

21) Coimbatore

22) Cuttack

23)Darbhanga

24) Dhanbad

25) Dehradun

26) Delhi & NCR: Delhi, Faridabad, Ghaziabad, Greater Noida, Noida, Gurgaon, Indirapuram, Sahibabad,

27) Dibrugarh

28) Gandhinagar

29) Gangtok

30) went

31) Gorakhpur

32) Guwahati

33) Guntur

34)Gwalior

35) Hyderabad

36) Imphal

37) Indore

38) Jabalpur

39) Jaipur

40) Jalandhar

41)Jammu

42) Jodhpur

43) Kannur

44)Kanpur

45) Kohima

46) Kolkata

47) Kochi

48) Kota

49) Kozhikode

50) Lucknow

51) Meerut

52) Moradabad

53) Mumbai

54) Muzaffarpur

55) Mysuru

56)Nagpur

57) Nashik

58) Nellore

59) Panaji

60) Patna

61) Panchkula

62) Puducherry

63) Pune

64)Raipur

65)Ranchi

66) Rajahmundry

67) Saharanpur

68) Shillong

69) Shimla

70) Silchar

71) Siliguri

72)Sonepat

73)Srinagar

74) Thiruvananthapuram

75) Tiruchirappalli (Trichy)

76) Tirunelveli

77) Vadodara

78) Varanasi (Banaras)

79) Vijayawada

80) Visakhapatnam

CGHS cardholders can get free treatment in any AIIMS

1) CGHS pensioners and other beneficiaries entitled for cashless treatment like former MPs, former Governors, former Judges of the Supreme Court of India, former Judges of High Courts, freedom fighters etc., who have a valid CGHS card, can avail cashless treatment at AIIMS. Are eligible.

2) Validity of CGHS card and ward eligibility is given on the CGHS card.

3) AIIMS will create a special desk for CGHS beneficiaries. The eligible CGHS beneficiary can produce his/her CGHS card for verification at the CGHS desk.

4) Eligible CGHS beneficiaries can self-verify their CGHS card. In case of treatment of a dependent family member, a copy of the CGHS card of self and the family member will have to be submitted. CGHS will verify the card information from CGHS data base in consultation with NIC.

5) Physical bill along with copy of CGHS card has to be submitted in the office of Additional Director, CGHS of the concerned city in the last week of AIIMS month.

6) AIIMS will create a separate bank account for CGHS beneficiaries for payment of CGHS bills. Payment of the bills will have to be deposited in the bank account created by AIIMS for CGHS.

7) Apart from CGHS pensioners, other people eligible for cashless treatment can avail the benefit of cashless treatment.

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Also, the cost of one day for ICU has been kept at Rs 5,400. The government has released new CGHS rates and packages. The government has also made the rules of referral easier than before.

Charges for CGHS beneficiaries

1. CGHS cardholders will need Rs 350 for OPD consultation.

2. The rate for CGHS beneficiaries for IPD consultation has been fixed at Rs 350.

ICU Charge Fee for CGHS Beneficiaries

Rates for ICU have been fixed at Rs 5,400. This cost for private ward is Rs 862 + Rs 4,500 = Rs 5,362 – total Rs 5,400. ICU charges include Rs 750 for non-NABH hospitals and Rs 862 for NABH hospitals. This includes monitoring, RMO charge fee, nursing care and room rent. The room rent will be as per the eligibility of the ward of the CGHS beneficiary – General Ward, Semi Private Ward or Private Ward.

Room Rent for CGHS Beneficiaries

oom rent for general ward for CGHS cardholders has been revised to Rs 1,500. Room rent for semi-private ward will be Rs 3,000. The room rent for private ward has been kept at Rs 4500.

Referral process made easier for CGHS cardholders

The Union Ministry of Health and Family Welfare (MoHFW) has also simplified the referral process for CGHS Wellness Centre. Earlier the CGHS beneficiary had to personally visit the CGHS Wellness Center and take a referral to the hospital. But now if the CGHS beneficiary is unable to go, he can send someone on his behalf to the wellness center with his documents. The medical officer may ask the beneficiary to go to the hospital after examining the documents. Now CGHS beneficiary can do this work through video call.

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On December 5, 2023, Dr. Bharti Praveen Pawar, Minister of State, Ministry of Health and Family Welfare, in a reply in the Lok Sabha, said that the government has signed a Memorandum of Agreement (MOA) between CGHS and AIIMS. CGHS has provided pensioners and CGHS at AIIMS, New Delhi, PGIMER, Chandigarh, JIPMER, Puducherry Puducherry and AIIMS located at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, Rishikesh, Bilaspur, Rajkot, Kalyani, Bathinda, Bibinagar, Guwahati, Deoghar and Mangalagiri. Cashless treatment facility has been provided to the beneficiaries.

Who will be eligible for cashless treatment at AIIMS, PGIMER, Chandigarh and JIPMER, Puducherry? CGHS beneficiaries should know the rules to avail cashless treatment services in these leading institutions.

Instructions for cashless treatment in AIIMS

1) CGHS pensioners and other beneficiaries entitled for cashless treatment like former MPs, former Governors, former Judges of the Supreme Court of India, former Judges of High Courts, freedom fighters etc., having a valid CGHS card, can avail cashless treatment at AIIMS. Are eligible.

2) Validity of CGHS card and ward eligibility is given on the CGHS card.

3) AIIMS will create a special desk for CGHS beneficiaries. The eligible CGHS beneficiary can produce his/her CGHS card for verification at the CGHS desk.

4) Eligible CGHS beneficiaries can self-verify their CGHS card. In case of treatment of a dependent family member, a copy of the CGHS card of self and the family member will have to be submitted. CGHS will verify the card information from CGHS data base in consultation with NIC.

5) Physical bill along with copy of CGHS card has to be submitted in the office of Additional Director, CGHS of the concerned city in the last week of AIIMS month.

6) AIIMS will create a separate bank account for CGHS beneficiaries for payment of CGHS bills. Payment of the bills will have to be deposited in the bank account created by AIIMS for CGHS.

7) Apart from CGHS pensioners, other people eligible for cashless treatment can avail the benefit of cashless treatment.

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