Govt staff can get reimbursement for emergency help at non-CGHS hospitals

Delhi High Court clarifies rules after petitioner says she could not locate a hospital empanelled under the CGHS scheme for emergency surgery

The Delhi High Court has ruled that government employees are entitled to medical reimbursement in an emergency, even if the treatment is at a hospital not empanelled under the Central Government Health Scheme (CGHS).

 

Justice Jyoti Singh ruled that petitioner Seema Mehta (an employee of an aided school) could not locate a hospital empanelled under the CGHS scheme. Given the life-threatening circumstances, the court held that she could not be denied reimbursement under the scheme.  

What was the case

 

Mehta sought Rs 585,523 as reimbursement for medical expenses incurred due to emergency brain surgery needed after a road accident. Mehta was initially treated at Guru Teg Bahadur Hospital in New Delhi, and was later transferred to Sir Ganga Ram Hospital where she underwent surgery and multiple admissions. Despite submitting a claim for reimbursement to the Directorate of Education (DoE) and the school, she was denied reimbursement on the grounds that the hospital was not empanelled under the Central Government Health Scheme (CGHS). The High Court observed that preservation of human life is of paramount importance and that the State is under an obligation to ensure timely medical treatment to a person in need thereof.

 

“Going by the rulings given in various judgments on the subject, it is now reasonably established that so long as the existence of an emergency is certified through a genuine medical certificate, the covered employees’ choice for treatment between an empaneled and non-empaneled hospital, would not have bearing on their eligibility to receive reimbursement under CGHS," said Akshay Jain, Partner at Saraf and Partners, a law firm.

 

"This decision reiterates the State’s obligation to provide essential medical care to Government employees and reinforces the employees’ right to health as enshrined under Article 21 of the Constitution,” he said.

 

How will this case benefit other employees?

 

“In terms of the present judgment, the employees can claim medical reimbursement in cases of emergency, even if the hospital is not empanelled under the CGHS, thereby making the medical treatment easily accessible. Further by way of the present Judgment, it will be ensured that the employees are not subject to any undue hardship or distress during medical emergencies,” said Manmeet Kaur, Partner at Karanjawala & Co.

 

How to find CGHS empaneled hospital

 

At cghs.nic.in where you can find a comprehensive list of empaneled hospitals and diagnostic centers. 

On the website, there is an option to search for hospitals by city. You can select your city from a dropdown list to view the hospitals available in that area.

 

The site provides detailed information about each empaneled hospital, including their addresses, contact numbers, and the services they offer. This can help you determine which hospital meets your medical needs.

 

Once you identify potential hospitals, it is advisable to contact them directly to confirm their empanelment status and inquire about specific services covered under CGHS