CENTRAL GOVERNMENT HEALTH SCHEME-CGHS-A REVIEW

The Central Govt. Health Scheme in India is comprehensive health care to the CGHS
Beneficiaries. The Central Govt. Health Scheme is applicable to the following categories of people residing in CGHS covered cities:

v      All Central Govt. Servants paid from Civil Estimates (other than those employed in
v      Railway Services and those employed under Delhi Administration except members
v      of Delhi Police Force).
v      Pensioners drawing pension from Civil Estimates and their family members –
(Pensioner residing in non- CGHS areas also may obtain CGHS Card from nearest CGHS covered City)
v      Hon'ble Members of Parliament
v      Hon'ble Judges of Supreme Court of India
v      Ex- Members of Parliament
v      Employees & Pensioners of Autonomous Bodies covered under CGHS (Delhi)
v      Ex- Governors and Ex-Vice Presidents
v      Former Prime Ministers
v      Former Judges of Hon'ble Supreme Court of India and Hon'ble High Courts
v      Freedom Fighters
v      It provides service through following categories of systems:-
§         Allopathic
§         Homeopathic
§         Indian System of Medicines e.g.
§         Ayurveda
§         Unani
§         Yoga
§         Sidha System
The main components of the Scheme are:
v      The dispensary services including domiciliary care.
v      F. W. & M.C.H. Services
v      Specialists consultation facilities both at dispensary, polyclinic and hospital
v      level including X-Ray, ECG and Laboratory Examinations.
v      Hospitalization.
v      Organization for the purchase, storage, distribution and supply of medicines
v      and other requirements.
v      Health Education to beneficiaries.

The dispensary is the backbone of the Scheme. Instructions on these various matters have been issued from. time to time for the guidance of the specialists and medical Officers. With the rapid and continuous expansion of the Scheme, however, not only situation has changed and problems arisen but also. the rapidly expanding staff have not approved practices, procedures and instructions in regard to their various duties and responsibilities. In the following paragraphs is set out the gist of provisions of the Scheme, various instructions and order issued from time to time to serve as a Compendium for the guidance of the CGHS staff.

CGHS Covered Cities:

The CGHS covered cities are DELHI, AHMEDABAD, ALLAHABAD, BENGALURU, BHOPAL, BHUBANESHWAR, CHANDIGARH, CHENNAI, DEHRADUN, GUWAHATI, HYDERABAD, JAIPUR, JABALPUR, KANPUR, KOLKATA, LUCKNOW, MEERUT, MUMBAI, NAGPUR, PATNA, PUNE, RANCHI, SHILLONG, and THIRUVANANTHAPURAM.

Procedure for Reference

CGHS/ Govt. Specialist / CMO i/c advises specific treatment procedure / test. Permission to undergo same at one of the recognized Hospitals / Diagnostic centre is granted by CMO i/c in case of pensioner CGHS beneficiaries / ex- Members of Parliament / Freedom Fighters / ex- Governors , etc., by CMO i/c of Concerned dispensary and by Rajya Sabha Secretariat as the case may be in case of Hon'ble Members of Parliament and by HOD in case of Serving Govt. employees and by Autonomous bodies in case of serving employees and pensioners of Autonomous bodies covered under CGHS.

If the beneficiary seeks permission from a CGHS recognized hospital in another CGHS city , other than the city where he is registered , permission shall be granted by Addl. Director / Joint Director CGHS of concerned city. However , no TA/DA shall be permitted if treatment facilities are available in the city of residence; TA as per entitlement is permitted if no treatment facilities are available in city of residence.

OPD treatment in private recognized hospitals is not permitted except in case of Satellite cities of Delhi , viz., Noida, Gurgaon, Faridabad and Ghaziabad , wherein the
CMO i/c can directly refer the beneficiaries to recognized hospitals and in post operative follow up cases of Cardiac surgery, Cancer treatment, Kidney transplantation, Hip/Knee Joint Replacement , Neurosurgery and Accident cases.

OPD medicines are to be collected through concerned dispensary except in case of emergency , in which case reimbursement shall be considered by HOD of department / Joint Director/Addl. Director of CGHS in case of pensioners , etc.,

In permitted post operative cases , for conditions as stated above, the beneficiaries may purchase from chemist and claim reimbursement. However, an utilization certificate from the treating doctor is required to be submitted.

Source:CGHS