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JAGS009
01-12-2010, 05:04 PM
I am working in Customs at Mumbai and CGHS card holder. My parents are living in my home town Uttarakhand and dependent upon me. Can I add the names of my parents in the CGHS card at Mumbai and avail the CGHS facility at Uttarakhand. How can I reimburse the medical expenditure occurred at hometown towards my parents. What is the procedure.

Thanks :)

tvenkatam
01-12-2010, 10:50 PM
I am working in Customs at Mumbai and CGHS card holder. My parents are living in my home town Uttarakhand and dependent upon me. Can I add the names of my parents in the CGHS card at Mumbai and avail the CGHS facility at Uttarakhand. How can I reimburse the medical expenditure occurred at hometown towards my parents. What is the procedure.

Thanks :)

The members of family of CGHS beneficiary should normally be residing with CGHS beneficiary for availing the CGHS facility.
If a CGHS beneficiary or a member of his family covered under CGHS falls ill at a place not covered under CGHS, the treatment will be admissible under CS (MA) Rules, 1944. The reimbursement will be at the rates of State Government hospital in that City.

Ramnath
02-12-2010, 06:52 PM
Dear sir,

Pl. enlighten as to the manner of deciding reimbursement - whether it should be under CGHS or CS (MA) on what condition. Is there any separate rate for CS (MA)?

Is CGHS rate specifically restricted to CGHS card holders? Can we not reimburse an employee not covered under CGHS scheme under CGHS rate (even if without permission from Department in the normal course)?

Eagerly awaiting your clarification.
Yours sincerely,
Ramnath

tvenkatam
03-12-2010, 12:01 AM
Dear sir,

Pl. enlighten as to the manner of deciding reimbursement - whether it should be under CGHS or CS (MA) on what condition. Is there any separate rate for CS (MA)?

Is CGHS rate specifically restricted to CGHS card holders? Can we not reimburse an employee not covered under CGHS scheme under CGHS rate (even if without permission from Department in the normal course)?

Eagerly awaiting your clarification.
Yours sincerely,
Ramnath

Dear friend,

In the case of CGHS, the beneficiary is provided treatment (including specialist treatment) at the designated dispensary. Specialised treatment or test can also be undertaken at any of the CGHS recognized hospitals/diagnostic centre with specific permission/reference of CGHS dispensary. Medicines, in both the cases of OPD treatment, are provided by the concerned dispensary. In the case of hospitalization at approved private hospitals, the medicines are provided by the respective hospitals. These hospitals provide cashless treatment to the beneficiaries and prefer the claims for treatment directly from CGHS at the rates approved by CGHS for each treatment/service. In case of emergency/non-availability of medicine with dispensary, one can purchase the medicines from available sources and claim reimbursement from CGHS. The beneficiaries are required to contribute every month a prescribed amount towards the facility.

The CGHS is not just meant for Central Government employees/pensioners. Serving employees and pensioners of Autonomous bodies, Present and former Supreme Court Judges, Members of Parliament, Freedom fighters, etc., are also covered by CGHS.
All those who are not covered by CGHS are governed by CS (MA) Rules, 1944 for their medical needs. CS (MA) Rules prescribe specific treatment procedure for both OPD and in-house treatment. AMAs and the Hospitals are approved for the purpose. The employees availing the treatment at approved hospitals are required to settle the bills of treatment first and then have them reimbursed from their respective offices. Specific rates for each treatment/test are approved by Government from time to time. In case of emergency when an employee is compelled to avail medical treatment from a private hospital whose rates are not approved under CS (MA) Rules, then the reimbursement is limited to certain ceilings (for each treatment) as prescribed under CS (MA) Rules or the rates approved for the nearest Government hospital by State Government whichever is the least.

The Directorate of CGHS approves eligible hospitals of their region (covered by CGHS dispensaries) for specific treatments/procedures at specified rates not normally published for public reference. On the contrary, the hospitals/services/rates approved by Government in respect of private hospitals under CS (MA) Rules are periodically notified by the Ministry of Health & Family Welfare which form part of CS (MA) Rules.

Reverting back to your queries, it may be stated that there is practically no reimbursement under CGHS to the employee. The claims are made by the referral hospitals directly with the Directorate of CGHS. Reimbursements are made only under CS (MA) Rules by the Heads of Office (in the case of emergency with the approval of Head of Department). The rates for treatment by CGHS referral hospitals are approved by the Directorate of CGHS and are not covered under CS (MA) Rules and, therefore, can not be made applicable to reimbursements under CS (MA) Rules. There may be hospitals whose rates are approved both by CGHS and DGHS/Min. of H&FW which may be eligible for treatment of both CGHS Card holders and under CS (MA) Rules.

kolwadkar
03-12-2010, 08:42 PM
dear JAGSOO9,
I don't agree with tvenkatam's reply. there is no compulsion of your parents residing with you. infacts there are many supreme court judgement on the same and even CGHS doesn't insit on it. adding your parents in the cghs card will not cost you extra. only issue is you will not be able to claim for their OPD bills. second if they needs hospitalisation and it is not an imergency then one has to go to nearest CGHS dispensary for the referral. in case of emergency this is not required they can get hospitaised in any hospital(even private). you need to inform to cghs in given format and then latter you can submit the bills to your dispensary in mumbai for the claim. CGHS will reimburse as per approved cghs rates.i feel it is always beneficial to register them in CGHS card whether they reside with us or not

tvenkatam
03-12-2010, 10:15 PM
Dear Friend,

The link below is the Form of application for issue of CGHS card.

http://mohfw.nic.in/writereaddata/cghsdata/mainlinkfile/File87.pdf

Para 16 of the Form is reproduced hereunder:

“16. Are all the persons whose names are given above are dependent upon you and are residing with you?
{Please attach proof of their staying with you, like copy of Ration Card / Election ID / Pass Port / Identity
Card issued by College / School / University / Bank Pass Book , etc.,}”

The Form also defines the dependency as under:

"Dependency:
Members of family (other than spouse) whose income is less than Rs.3500*/+DA- per
month are treated as dependents and are normally residing with CGHS beneficiary.

The Following Documents are to be enclosed:
(I) Proof of Residence / Stay of dependents –{ copy of Ration Card / Election ID / Pass
Port / Identity Card issued by College / School / University / Bank Pass Book , etc.,}"