PROCEDURE FOR REFERRAL

 

CGHS beneficiaries have an option to avail of specialised treatment at CGHS empanelled hospitals of his/her choice, on the recommendation of a specialist of CGHS/ Government hospital.

a)      When there is no emergency(elective) involved and a recommendation (regarding line of treatment) has been made in writing by CGHS specialist or a specialist of the hospital of Central /State Government, the procedure for obtaining administrative approval will be as follows:

                                i.†††††† In case of serving Government servants:
The permission letter, for taking such treatment in a CGHS empanelled private /referral hospital of choice in the same city, will be issued by department /office of the employee.

                               ii.            In case of pensioners (including ex MPs, former governors)
‎The permission letter for treatment will be issued by the CMO Incharge of the concerned CGHS Wellness Centre. The bill however should be raised in the name of Additional director, CGHS concerned.

b)      In case of a medical emergency, the CMO concerned may directly (i.e. even without specialistís advice) refer the CGHS beneficiary to a private empanelled hospital for further management/ treatment. The details are required to be recorded by the CMO in such a case.

c)      Reimbursement will be restricted to the package deal /rates approved by the Government from time to time. The expenditure in excess of the package deal/ approved rates will be borne by the beneficiary himself /herself.

d)      Reimbursement will be by the parent department/ office in case of serving employees and by CGHS directorate for pensioners.

e)      Permission may be given in cases, where the beneficiary, in spite of the facility being available in the city, still chooses to get treatment in CGHS empanelled institutions in another city. No TA /DA will be admissible. In such a case, prior permission of director/ additional directors/ Joint director of the city concerned will be required.



CGHS beneficiaries may undergo investigations at empanelled private hospitals /diagnostic Laboratories/ imaging centres on the basis of advice letter issued by CGHS/Government specialist without requiring any other referral (permission) letter.
Pensioners, ex MPs, Freedom Fighters and other beneficiaries entitled for credit facility may avail tests/ investigations at empanelled hospitals/ centres ,on cashless basis on production of the following documents:

       Prescription of CGHS Medical Officer/ Government specialist in original or self-attested copy,

       Self-attested photocopies of the CGHS card of the patient,

       CGHS card of the main CGHS cardholder beneficiary.

 

Following categories are eligible for credit facility at empanelled HCOs:

       Members of Parliament;

       Pensioners of Central Government drawing pension from central estimates;

       Former Vice-presidents,

       Former Governors and former Prime Ministers;

       Ex-Members of Parliament; Freedom Fighters;

       Serving employees of Ministry of Health & Family Welfare (including attached / subordinate offices under the Ministry of Health & Family Welfare)

       All serving employees of Central Government departments in emergencies.

 

Only those tests /investigations for which rates are available shall be carried out.

Serving beneficiaries may get the tests/investigations (for which rates are available) done on payment basis and claim reimbursement from their office.

The CGHS medical officer Government specialist shall not refer to any particular laboratory/ Centre, but shall specify the test /investigation and mention 'referred to CGHS empanelled centre'. The prescription shall be valid for single use within a period of 2 weeks, unless specifically prescribed otherwise.