View Full Version : Ama beneficies

15-07-2009, 04:39 PM
One of my office colleages for the post of Technical Assistant which GP is Rs. 42000/- availing under AMA facilities. His wife was pregnant and delivery their baby by cesarean in local nursing home in emergency case which is not CGHS recognised hospital. Now he claim for Rs. 20000/- towards medical reimbursement.

As he is under availing AMA facility, our office do not understand is he claim towards medical reimbursement for that purpose. If so in what rules he would get his reimbursement. Is he get reimbursement his medical bill in CGHS rate, in Kolkata.

Abhijit Das

15-07-2009, 08:58 PM
Dear friend
Under emergency, Head of the Department is empowered to sanction reimbursement to the tune of Rs.200000/- only. In your case reimbursement can easily be made which will be restricted to CGHS rates subject to fulfilment of other conditions. CGHS and CS(MA) Rules are similar in this regard. An emergency certificate from hospital and justification for taking treatment at that Nursing Home may be required for satisfaction of the competent authority though not necessary. All the relevant orders are available in NABHI's compilation of Govt orders on medical facilities. In case of any doubt, you may again write for that.

16-07-2009, 09:39 AM
Dear ar ji,

I would like to emphasise certain points already indicated by jitendraacrji.

1. It is absolutely essential to produce (procure and produce) the emergency admission to the office with the covering letter stating clearly the admission to the nearest hospital/nursing home was under emergency condition. As some of the private hospitals/nursing homes do not have standard format for emergency admission, a certificate from the doctor who attended the patient in the nursing home's letter head will do but with the same date as the date of admission. The patient is suppose to collect it while getting admission in the un-recongnised hospital/nursing home.

2. Regarding the cost/actual re-imbursement, CGHS has no role for these cases and even in cases of CGHS beneficiaries getting admitted to private hospitals/nursing homes under emergency condition. Head of Office will forward the bill for approval to head of the dept who is competant to deal with such cases. While processing such cases, actual expediture is re-imbursed and not the CGHS rates but within the ceiling indicated by Jitendraacrji.

(a) The point normally taken into consideration by the HOD is (i) distance between the NUrsing home to residence (place where patient fell sick, (ii) weather any recognised hospital exists within the distance indicated above.
(b) The official having incurred excessive expenditure is well advised to add a para giving the distance to the authorised /recognised hospital which is giving round the clock (emergecy) service vis a vis the actual distance of the private hospital the patient was taken.

More clarifications, if required please.

sr.scientist and Area Welfare Officer (incl: CGHS Dispensaries)

24-07-2009, 09:26 PM
Sorry friend
For CGHS/CS(MA) Rules this facility is not given. This is however applicable for LTC purpose. The right way is to get their name included in your card where you are serving and whenever some big treatment is required, take permission from your office (actually your parents will not move)for temporary shifting of your parents to your Home District and get a temporary Card issued for them. In that case, you can take treatment of your parents there. Try this if necessary.