GUIDELINES FOR CGHS BENEFICIARIES - DAPWA
Central Govt. Health Scheme is a boon for Central Govt. pensioners in
the twilight year of their lives since the cost of Medical care has
reached the seventh haven and affording treatment for diseases and other
ailments has gone out of reach of the pensioners.
In order to dispel some doubts prevalent amongst beneficiaries of the
scheme an effort has been made to provide some guidelines for the
benefit of the members.
EUGIBILITY
Central Govt. pensioners their spouses, dependent sons. below 25 years
of age, daughters till the date of marriage or the date from which they
start earning and dependent parents are eligible. Disabled Sons with 40%
or more disability are also eligible even beyond the age of 25 years.
RATES OF CONTRIBUTION AND ENTITLEMENT FOR WARD/PRIVATE ROOM
Rate of contribution to the scheme is based on the grade pay appropriate to the scale of
pay prescribed by 6th CPC whereas the entitlement for hospital accommodation for Indoor
treatment is determined with reference to Basic Pay/Pension.
Contribution
|
Entitlement as Indoor Patient
| |||||
| Grade Pay | Per Month | Annual | Whole Life | Basic Pay/Pension | Ward/Room | CHARGES PER DAY |
| Upto-1650 | 50 | 600 | 6,000 | Upto-13,950 | General Ward | 1,000 |
| 1800-2800 | 125 | 1,500 | 1,5000 | Upto-19,530 | Semi Pvt. Ward | 2,000 |
| 4200 | 225 | 2,700 | 27,000 | 19540-above | Pvt.Ward | 3,000 |
| 4600-6600 | 325 | 3,900 | 39,000 | |||
| 7600-above | 500 | 6,000 | 60,000 | |||
RATES FOR MEDICAL PROCEDURES
Rates for medical procedures, tests/investigations carried Out by NABL,
Non-NABL hospitals and diagnostic laboratories are prescribed by Govt.
from time to time.
ISSUE OF CGHS CARDS
Persons retiring from offices/establishments, located in CGHS covered
areas, will be issued CGHS cards on the day of retirement, if they opt
for CGHS coverage after retirement. Pensioner residing in Non-CGHS
covered areas can also enroll themselves and eligible family members in
the Weliness Centers nearest to their place of residence or any Wellness
Centre by submitting application along with necessary documents to
Addl/Jt. Director of the area. CGHS cards can also be issued to
pensioners for indoor treatment only while they can continue to draw
F.M.A.
VALIDITY
Plastic Card and CGHS token cards are valid for obtaining treatment at Wellness Centers throughout India.
INDOOR TREATMENT
Indoor treatment is provided to the beneficiaries in any of the
empanelled hospitals on the recommendation of CMO Incharge. Depending
upon the nature of treatment required the patient is referred to the
hospital registered for the specific treatment viz. cardio, ortho, eye,
general purpose etc.
EMERGENCY TREATMENT
In case of medical emergency beneficiaries and eligible members may
obtain indoor treatment from any Govt./Recognized, Private Hospital
approved under CSMA rules besides empanelled hospitals without
recommendation of the CMO Incharge. Reimbursement for treatment in
Private/Govt. Hospitals will be subject to CGHS approved rates.
DIAGNOSTIC TEST
Patients referred to Govt. Hospitals/Institutes for OPD Treatment can
undertake diagnostic tests/investigations at the empanelled
laboratories/centers, if recommended by the hospital, directly without
reverting to Wellness centre for permission. It may be ensured in such
cases that the hospital prescription slip is signed by the assistant
professor / specialist of the hospital.
NOTE :- Please do carry your token card / plastic card while attending
Wellness Centre, Collecting indented medicines, attending empanelled
hospitals / labs / diagnostic centers.
R.P. Sharma
Legal Secretary
DAPWA(Regd.)