Central Government Health Scheme (CGHS)

Rating : 12345
Rate This Article : 1 2 3 4 5
RSS Email Print This Page Comment
Font : A-A+

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.

Post a Comment

Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.
* Your comment can be maximum of 2500 characters
Notify me when reply is posted
I agree to the terms and conditions
CGEPHIS Tuesday, February 28, 2017

Hi All, I am an IT professional and the new proposed scheme looks like the best. CGHS has many draw backs like should be in city to get cards, not all states have good hospitals. Big headache with reimbursement. Modi is doing good job tweet him to support new insurance scheme instead of CGHS which might speed up the process and all employees and retired employees will get insurance cards which never expires in there life time and cashless benifits

docsonia01 Friday, January 20, 2017

can u please clarify about availing the CGHS card facility while on EOL, without pay?

deshmukhbk Friday, January 6, 2017

Can anyone please tell me CGHS package for "Bone Marrow Transplantaion". Please tell me the package number and details of the same. Thanks a lot.

shashibhushantripathi Tuesday, November 3, 2015

Whether Central Ministers/MPs are provided CGHS card or their Identity card is enough.

MAPadmanabhaRao Monday, September 28, 2015

CAN ANYONE PLEASE HELP IN MINISTRY OF HEALTH AT NEW DELHI? MEDICAL BILL SUBMITTED THREE MONTHS AGO. NO REIMBURSEMENT YET. On 1st June 2015 I persanally handed over the file along with a duplicate copy to Dr.BHATIA a lady Medical Officer at CGHS Vikas Puri, New Delhi 110018 for reimbursement of the money spent [nearly Rs 5 lakhs] for total knee replacements to my wife Mrs LEELA RAO (CGHS No 878426) on 1st May 2015 at Saroj Hospital Rohini New Delhi In front of me she kept th file in her office Almirah and was in a hurry to go to R.K.Puram. She did not care to give me any receipt. I did not hear any progress of the fill till date. I am afraid she might have misplaced the file.

View all Comments

Related Links

Show More Related Topics

Health Topics A - Z


Medindia Health Topics Search

Health Insurance

Medindia Newsletters

Subscribe to our Free Newsletters!

Terms & Conditions and Privacy Policy.

Doctor Search

Stay Connected

  • Available on the Android Market
  • Available on the App Store