Central Government Health Scheme (CGHS)

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Procedure for Referrals and Admission in Hospitals

Procedures for deriving Specialist Services Referrals

Under CGHS Act, the beneficiary, whenever requiring or needing consultation services with a specialist medical/healthcare professional for expert opinion, will be referred to CGHS Polyclinics or hospitals based on the consultant’s availability for that particular speciality for eg. Pediatrician, Gynaecologist, Dermatologist, Cardiologist, Neurologist etc Due to certain reason if a consultant for the concerned speciality is not available in CGHS, the beneficiary of CGHS will be referred to the concerned OPD (Out-Patient Department) of a Government Hospital or Municipal General Hospital.

Government employees drawing a Basic Pay exceeding Rs. 12,000/- per month, can benefit from direct consultation with CGHS Medical Specialists and Consultants in Government or Municipal Hospital, but are not eligible for consultations in private recognized hospitals under CGHS Act.

Procedure for Admission in Recognized Hospitals

The procedures for admission in hospitals recognized under CGHS are enlisted below:

1. Permission letter will be invariably issued prior to the admission of the patient in the hospital. 

2. Pre-requisite permission will be strictly given for a surgical procedure and not for general medical management or general consultations.

3. Beneficiary will be required to furnish the following documents for getting an admission memo: 

a.  Photocopy of valid CGHS card

b.  Request letter from CGHS beneficiary regarding the choice of hospital/diagnostic centre. 

c. Photocopy of the specialist’s professional advice or opinion in the concerned field from a Govt./Municipal/CGHS hospital or clinic.

4. In case of medical emergency, the private hospital recognized under CGHS, shall not deny or refuse admission or demand advance deposit from the concerned beneficiary. However, the private hospital recognized under CGHS, shall provide credit facilities to the concerned patient on production of a valid CGHS card. The private hospital recognized under CGHS, shall submit the medical bills for reimbursement based on CGHS approval rates to the concerned HOD (Head of Department) of the beneficiary (i.e. serving government employee) or to the Joint Director, CGHS, in case pensioners entitled for benefits under this scheme. It shall be the responsibility of the beneficiary to submit a xerox copy of CGHS card and to take admission in entitled class as per the provisions of the Act. It is the sole responsibility of the hospitals to intimate CGHS office or its concerned branch-office, within 24 hours in case of emergency admission of the beneficiaries who are entitled under CGHS.

5. Based on the merits of the case study on an individual basis, the CMO (Chief Medical Officer) In-charge of the concerned dispensary, to which the CGHS beneficiary is attached, will issue Permission Letter regarding admission to recognized hospital. This decision can be on the basis of the CMO’s own judgment or it could be based upon the recommendations made by the medical specialists from CGHS or Government Hospitals or Municipal Hospitals.

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I am advised to obtain an essentially certificate for the drugs Jalra 50 mg twice a day and Lamosyn 100 mg twice a day which have to be used along with other drugs used to control diabetes. When the drugs are so important to control the diseases why cannot they be provided by CGHS and why essentiality certificate from NIMS or Gandhi Hospital at Hyderabad are insisted. Is there any form to obtain the essentially certificate?
srideviravi Thursday, March 27, 2014
CGHS Card has been issued in my favor under Kolkata Jurisdiction and availing such facility.Now Issuing of the Plastic CGHS Card is under process but the PIN No. of my residential address is modified recently by State GOVT.[KOLKATA-700157 in place of 700059],KOLKATA-700157 is not covered under CGHS Jurisdiction. How I can be able to get the Plastic Card as well as avail such facility.
adityasinha Tuesday, February 04, 2014
I am central government employee. I am planning to preserve cord blood of my baby. Can i reimburse the cord blood banking charges under central government health scheme ??
sppatel777 Monday, December 09, 2013
I am a CGHS Card holder pensioner retired from CDA[Pension, Kolkata. Can the CGHS clinic refer me to a Damdam Municipal Hospital(which is not shown in the website in empanelled List] Non-Empanelled Hospital for treatment ie.
lilyalld1 Thursday, November 28, 2013
I have to purchase BP apparatus on doctor's prescription kindly guide me the procedure
amarjeetsinghsodhi Thursday, November 14, 2013
is there any further progress on the intended CGEPHIS scheme for which RFP was published in 2010
alagh Saturday, November 02, 2013
CGHS / ESI are the benefits given the govt. I sincerely feel all these facilities are not really giving help to the patients, the long hours of waiting fro the doctors, to collect reports is very hectic. Its not like the work is completed within 1-2 hrs, its a day long process. The way the staff treat as if the patients are beggers. How can a patient alone can go from room to room, floor to floor in search of the doctor, its so indefinite that the doctors will be coming and no information is given. People working in private sector will not get leave if they have to wait for days together its difficult. The plight of the patients is very sad and pathetic. Anyway nothing will happen as long as these corrupted politicians are there but still I wanted to share my views. MY HUMBLE REQUEST IS PLEASE GIVE MERCY KILLING FOR THE PEOPLE WHO ARE SUFFERING at they will die peacefully.
Guest- Thursday, October 10, 2013
I m a defence ministry pensioner[civilian].i m not under CGHS can i get covered under the cghs now i retired in 1993.
B.H.AnanthaMurthy Sunday, September 01, 2013
Respected Sir,
Sir, I retired from PSU[PDIL, Sindri-Noida] and i am pension holder. My age is 65 yrs. Can I get the CGHS benifit? If so kindly help me by citing the process of getting CGHS card and the treatment in which type of hospitals? I am residing in Dhanbad in the state of Jharkhand.

Thanking you,
Sona Ram Rajak

Sona47 Tuesday, August 27, 2013
I am retd GOI officer.Card No. P1882 issued from Lucknow.I was in Mumbai with my son when I fell down on 04nov 12 and brocken FEMUR bone in two parts. Got treatment from Breach Candy Hospital which is nearest to me. Submitted the claim on cghs Lucknow on 4 dec 2012 via regd AD post.Thereafter sent many reminders by email/by post but claim has not been till date.I am not provided with details of my Claim number and date inspite of my repeated requests.Please send address/email of appealate authority.
sharad1940 Monday, July 01, 2013
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