Is treatment taken at non empanelled private hospital reimbursable? If yes what is the procedure? & other FAQ&A

Is treatment taken at non empanelled private hospital reimbursable? If yes what is the procedure?

CGHC considers for reimbursement at CGHS rates in case the treatment
taken in an emergency from a private unrecognized hospitals.

The claims are to be submitted at concerned CGHS Wellness Centre in
case of Pensioner CGHS beneficiaries for consideration by CGHS.
In case of serving employees the medical claim shall be submitted to
concerned Ministry /Department for consideration.
The Claims are to be preferred within 6 months period from the date of
discharge from the hospitals. If the claim becomes times barred, then
condonation of period is to be done by the Department concerned.
The claim should have the following documents completed.
a. Prescribed Medical Reimbursement Claim Form
b. All original bills.
c. Photocopy of CGHS Token card.
d. Discharge Slip of the hospital.
e. A detailed list of all medicines, laboratory tests, investigations
number of doctors visits etc. should be submitted for reimbursement
with dates.
g. Self explanatory letter from the beneficiary explaining the emergency
circumstances.
h. Legal heir certificate in case of death of the cardholder.

What should I do in case of emergency or if I am unwell, say late at night?

CGHS beneficiaries have the option to go to any of the four 24 hr functional Wellness Centres in Delhi, a nearby government hospital, empanelled private hospital or even any private hospital.

The four Wellness Centres which are functional 24*7 are located in Dr Zakir Hussain Road, North Avenue, South Avenue, and Kingsway Camp.

Their contact details are given under ‘contact us’ list on the CGHSwebsite.
In case the beneficiary chooses to go to a private empanelled hospital,

following type of beneficiaries will not be asked to make a deposit for
treatment in empanelled hospitals at the time of emergency

Pensioner beneficiaries
CGHS Employees
DGHS Employees and Employeees of Min. of Health and Family Welfare. (including attached / subordinate offices under the Ministry of Health
& Family Welfare).

Is it mandatory for the Diagnostic Labs stamp the date and the number of tests performed on original prescription slip?

The empanelled Diagnostic Labs / Imaging Centers/Hospitals shall stamp the date and the number of tests performed with name of the centre on the body of the original prescription document as part of checks and balance measures in the process.

Is registration required if a beneficiary visits WC to just collect indented medicines ?

No. The indented medicines have to be collected within 15 days of indent

What is the maximum period for which medicines can be given in one go ?

For treatment of Chronic illnesses medicines upto ‘3’ months are issued in one go, provided there is a valid prescription.
In case of a beneficiary visiting a foreign country , medicines upto ‘6’ months are issued in respect of chronic illnesses , based on valid prescription and documentary support of visit to a foreign country.
Beneficiary is required to submit an application for obtaining permission from Additional Director of city/zone along with the following documents:-
1. Copy of valid CGHS card/ token card.
2. Valid prescription for six months counter signed by Specialist of Govt. Hospital.
3. Proof of going abroad leaving like ticket, Visa etc.

Is the prescription of specialists of empanelled hospitals valid in the Wellness Centre?

Yes
Beneficiaries in all CGHS Cities can seek OPD consultation from Specialists
in any of the CGHS empanelled hospitals after being referred by the Medical Officer or CMO In-charge of the Wellness Centre. The beneficiary is required to report back to the concerned Wellness Center and the Medical Officer/CMO In-charge will endorse the investigations and issue medicines.

My father is a cancer patient and after operation is bed ridden. Doctors have advised Protein powder. Can I get it from CGHS?

Dietary supplements are not permissible under CGHS.

What should a beneficiary do, if he/ she notices some deterioration in the quality of drugs?

He /she should return the medicine to Wellness Centre & get replacement. Samples can be sent for testing through CMOI/C.

How to get a drug if same is not available in Wellness Centre & also not supplied by Chemist (ALC) ?

The beneficiary, after authorization by CMO I/c can purchase such drugs from open market & claim reimbursement from the ALC.

How the medicines urgently required at the time of discharge from empanelled private hospitals can be obtained?

Private hospital issues medicines at the time of discharge for a period
upto seven (7) days.
Total cost of such medicines issued by the hospital must not exceed
Rs. 2000/- in any case