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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