Now, treatment for CGHS beneficiaries without referral letter

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Aiming to simplify the treatment procedure under the Central Government Health Scheme (CGHS), beneficiaries have been permitted to undergo treatment at any empanelled private hospital without the requirement of a referral (permission) letter.

"It has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under CGHS of specific treatment procedures listed under CGHS rate list, are advised by a specialist in a central government/state government specialist hospitals or a CGHS Medical Officer, without any requirement of any other referral (permission) letter," said a new order issued by the Health Ministry.

The letter, dated November 9, 2017, has been issued to all the ministries and departments of the central government.

According to the new order, which is with IANS, private empanelled hospitals shall perform the treatment on cashless basis in respect of pensioners, ex-MPs, freedom fighters, regular employees (both CGHS and CS[MA] benefeciaries) of the ministry and other categories of CGHS beneficiaries who are presently eligible for credit facility.

"They shall enclose the prescription issued by government specialist or a CGHS medical officer, in original along with the hospital bill submitted to the competent authorities," said the order, which according to the ministry was issued after receiving a lot of representations for simplification of procedures for undergoing treatment at empanelled private hospitals.

Earlier, central government employees/pensioner or his/her dependents could undergo investigation and medical treatment at CGHS approved hospitals once such specialised treatment was required as per the prescription of CGHS medical officers.

As part of the process, earlier, one had to consult at a local dispensary, from where the patient had to be referred to a bigger government hospital where, with the permission of a specialist, the paperwork had to be done to avail the treatment at a CGHS empanelled private hospital.

As per the statistics of the Health Ministry, there are 949 general hospitals, dental and eyecare hospital in India under the CGHS while Delhi alone has 118 hospitals, 104 eye and 52 dental care hospitals. The national capital also has 61 diagnostic centres under the CGHS category.

The new order also states that serving government employees shall enclose the prescription issued by a government specialist or a CGHS medical officer in the original while submitting the medical claim to the concerned ministry/department/office for reimbursement.

"CGHS medical officer/government specialist shall not refer the beneficiaries to any particular empanelled hospital by name but shall specify the treatment procedure and mention referred to any CGHS empanelled centre," according to the new order.

Among the facilities available under the CGHS are OPD treatment including issue of medicines, specialist consultation at polyclinics/government hospitals, indoor treatment at government and empanelled private hospitals, and investigations at government and empanelled diagnostic centres.

"Cashless facility is available for treatment in empanelled hospitals and diagnostic centres for pensioners and other identified beneficiaries; reimbursement of expenses (is available) for treatment availed in private hospitals under emergency; reimbursement of expenses incurred for purchase of hearing aids, artificial limbs, appliances etc. as specified (is available)," according to Health Ministry.

(Rupesh Dutta can be contacted at Rupesh.d@ians.in)

--IANS

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